HomeMy WebLinkAboutHeating Permit 95-0105 1. Pink - File
2. Green - City
� PR/p _ � � - - �PE OF STRUCTURE 3. Yeilow - Contractor
� �1TY O�' PR1�R LAKE
� 16200 Ea le Creek Av. S.E.
� m � 9 Permit No. �S /0 Single Family �_ Two-Family Multi-Family
;, � 2 �.akb, MN 55372
' Commercia! lndustrial Public Other
� `, HEATING APPL��►"I'ION / PERMIT
----� � JOB VALUATION FEE
Date ..�-'� , '� �_ � . ..__._...-�RfO # � �J "�-��o— Q3 � `d
- "" � $p . $1,000 2% of job value, min. $20.00
Site Address _ �o.c �' � a.v. �. a. rv �
,.��/ $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot �� Block � Addition �p/ i� �- c(.�Cd :�✓ $100.00 or fraction thereof to and including $10,000.
Owner's Name ��°I 't" �.�c i s S l�1 L.° i nJ
$f0,001 -$50,000 $132.50 for the firsi $10,000 plus $1.00 for each addi-
Address tional $100.00 or fraction thereof, to and incl�ding
� $50,000.
HeatingContractor t ta< �Q, �? � /�
Address /. ,�.Q Z r . � $50,001 and over $532.50 for the first $50,000 pius $7.50 for each addi-
tiona! $1,000 or fraction thereof.
Telaphone # �( � 7'� � � d
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model � rn ei ��ar�. ST�f' NPE OF SYSTEM Additional inspections wil( be bilted at $25.00 each.
Warm Air Plants
Model Size�'7 �i L�d .�L �f�l?� Gravity House Heating Test Record must be submitted with buildi nermit number before build-
Mechanical in� "--�•��^^� W�II be issued. `
Conn. Load Air Conditioning C'e..,�.� L
� CLOSED DUE TO ar of suppiy and return openings listed
Fuel Fiue Size Vent. System P��TACTr as or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT p 1 V VITY 8/30/01 S CALCULATIONS, PAYMENT AND
Steam
Retum Openings Hot Water � TY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55;�ic.
Input Output Special Devices
City Hall business bours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations Replacemertt New Construction above is compiete and accurate; that ihs work wit! be in conformance with the ordi-
nances and c�des of the cfty and with the state building/mechanica! codes; that this form
Repair Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
0o ,/` in acco ce with the approved plan in the case of all work which requires review and
Est. Cost $/ --° Building Permit #���' 4�7`'t� app al oi plans.
HEATING PERMIT FEE $ � . 7, ,� — � � -- g � '
STATE SURCHARGE $ .50 ApplicanYs nalure Date
TOTAL PERMIT FEES $� .� Receipt # ol�ln �L � ��� r l `�
Bu' ing Official's Signature Date
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