HomeMy WebLinkAboutHeating Permit 95-0106 1. Pink - File
2. Green - City
°� pR � O '�� F��' '� �Q R LAKE TYPE OF STRUCTURE 3. Yellow - Contr�tor
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� �, `: �� t620II Ea9l ek Av S.E. permit No. ��o� Single Family �_ Two-Family Mufti-Family
� 2 3t�� Lald� , N 55372
, , �d�� � � Commercial industrial Public Other
HEATING APPL�p�TION / PERMIT
-� �� __� v JOB VALUATION FEE
Date , �? - �.-,� - -- PID #�'�.3 "Q� d ' ��- �
Site Address `� � � F r $� "$� ��� 2% of job value, min. $20.00
Lot Blodc !�Add�'�twn $1 �001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owner's Name � C� r�2 ��? ���po� 0. $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tionai $100.00 or fraction thereof, to and including
Heating Contractor Qc � o�' `^�1� E �`� i- �'1i �� $50,000.
Address �� �.,�� � li���!' �.� �C� �c i,., � j,` $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # '7 — __,
�� Ttie �,;,,� �� ,,,,,,, ,,,,,,.:__ __ •� one rough-in and one final inspection.
Furnace Make & o�e� �t�.S'r�l�[�cI1tJ,�" NPE OF SYSTEM 25.00 each.
Warm Air Plants CLOSED DUE TO
Model Size 1��,�D� c� k{'Du�t' Gravity �ACTIVITY 8/30/O 1 �bmitted with building �ermit number before build-
Conn. Load Mechanical 3d.
� � Air Conditioning
Fuel I� �'� Flue Size G Vent. System _iith 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 ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openi�s Hot Water R e.� e� APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output 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 Replacement �_ New Construction above is complete and accurate; that the work will be in conformance wfth 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
c e� in accordance with the approved plan in the case of all work wh�h requires review and
Est. Cost $��S�C� � Building Permit # approval pla s.
HEATING PERMIT FEE $ � � ► �� .S"'—,�3_9S'"
STATE SURCHARGE $ .50 ApplicanYs nature - Date
TOTAL PERMIT FEES $ / i ` Re���� # �.6 /za �� ��
Buil ' g Official's Signature Date
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