HomeMy WebLinkAboutHeating Permit 95-0110 1. Pink - File
PR/ � 'a' ; � -,, ... — - ` 2. Green - City
.�°� `� `�'—` PRIOR LAKE
TYPE OF STRUCTURE 3. Yellow - Conuactor
� ' AKQ�TA STREET S.E. permit No. ��l �U Single Family � Two-Family Mufti-Family
i � � ��R ' I�F, MN 55372
' Commercial Industriai Public Other
,;. ,,� ` TION / PERMIT
Date 5�-- � � 'PID # ,� - / ��I � (� O Z- "Q JOB VALUATION FEE
/ . $0 -$1,000 2% of job value, min. $20.00
Site Address � � ap� Sh � Y� �-
g /a� � $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block � Addition �L�C/L�� l �✓
$100.00 or fraction thereof to and including $10,000.
Owner's Name 1 Y' k�• �SGr G� V�S �
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address � `'4 °� � O� �'�' tional $100.00 or fraction thereof, to and including
Heating Contractor �— � U � 1'(� $50,000.
Address � �--� � � �(' �(1 �� `� � � � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
�� �`� I' � tional $1,000 or fraction thereof.
Telephone # - t �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building permit number before build-
Mechanical ' - --• �^���v will be issued.
Conn. Load Air Conditioning � cLOSED DU
Fuel Flue Size Vent. System L T� C�IIRED with number of supply and return openings listed
�TACTIVITy g�3 �pening. New structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER I O�Q 1 shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water -- : MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 5o,s72.
Input Output Special Devices
Ciry Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices AS �� n'�. � r' ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. O�� f ec�C • �--Free S-�w�nd�� 447-4230.
�� t'� 1� 'hs allea�
TYPE OF WORK � �� p-}hp�r5 I ereby 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 with the ordi-
nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date S� 3 �'� 5 does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
� t � , �o in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ Building Permit # q��d �1 approval of plans.
HEATING PERMIT FEE $ � I • � 5 ��CJ�C�� �' r g-��
STATE SURCHARGE $ .50 ApplicanYs Signature � ate
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TOTAL PERMIT FEES $ �- I • � � Receipt # �� IL `f'
Bui g Official's Signature Date
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