HomeMy WebLinkAboutHeating Permit 95-0104 1. Pink - File
2. Green - Chy
�.�°� r � �: �������', ,; RIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractw
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� �� 16200 E I� Creek Av. S.E. pe�� No. �S lb� Singie Family �_ Two-Family MuRi-Family
� 2 3 �ior��e, MN 55372
Commercial Industrial Public Other
HEATING_ AR�`.XICATION / PERMIT
Date ��,,3^.9�� � PID # 33 q3a � ���'� JOB VALUATION FEE
� $0 -$1,000 2% of job value, min. $20.00
Site Address
� $1,001 -$10,000 $20.00 for the first $1,000 pius $1.25 for each additional
Lot bck Addition $100.00 or fraction thereof to and including $10,000.
Ou��er's Name �a�r� c►. �C � S� c $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
t � �� C $50,000.
Heating Contractor � a � L ��,�e /�"��±.
Address /� 7�4 �/,,�.r/�C �q�€ �'t 1� �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tronal $1,000 or fraction thereof.
Te4ephone # �� 7 —�1/ �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model �i w��t �co�n� 5' � nPE OF SYSTEM Additional inspections will be bilied at $25.00 each.
N Warm Air Plants
Model Size �u �1�� �� ��17 Gravity House Heating Test Record must be submitted with building �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Condftioning
Fuel ��� Flue Size Vent. System HEAT CALCULATIONS REQIlIRED with number of supply and return openings listed
HEATING OR POWER PLANT per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings Steam ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input DC �L'� Output ����' 0 Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations ReplacemeM ,�_ New Construction above is complete and acxurate; that the work will be in conformance with the ordi-
nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
E � �� ��` e o in axo with the approved plan in the case of all work which requires review and
3Q O-� Building Permit # appro I of p s.
HEATING PERMIT FEE $ 3 � 7S ��^� 3— f�'"�
STATE SURCHARGE $ .50 ppli nYs Signature Date
_� /
TOTAL PERMIT FEES $ � �1. � � Receipt # �.,� �LU ` —
u ding icial's nature Date
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