HomeMy WebLinkAboutHeating Permit 95-0115 , __ _ �
,.,, _ — - - 1. Pink • File
2. Green - City
� p ����'` � �""� � TYPE OF STRUCTURE 3. Yellow - Conuacror
.� ,, c� �t�'1� PRIOR LAKE
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� , m .. � D� �!'TA STREET S.E. permit No. ��� Single Family �_ Two-Family Mufti-Family
�10� , MN 55372
Commerciaf {ndustrial Public Other
ICATION / PERMIT
Date PID #` ^ QS-• '"� -.(� JOB VALUATION FEE
Sfte Address ��� �-' e, � ����� n $0 -$1,000 2% of job value, min. $20.00
Lot � Block �_ Addition � a � f $1,001 -$10,000 $20.00 for the first $1,000 plus $125 for each additional
` $100.00 or fraction thereof to and including $10,000.
Owner's Name�� 1� � �� Z�� t
' �� �' �� v ���� $10,001 - $50,000 $132.50 for the first $10,000 plus $1.00 for each addg
Address tional $100.00 or iraction thereof, to and includin
Q� �` ` �, � $50,000.
Heating Contractor
Address 1�� �. �,'�'(� v 1,``Q,� � r� `'}�0,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Telephone #
m� r•3,3� tional $1,000 or fraction thereof.
The price of your heating permit includes one rough-in and one fina! i�spectian.
Furnace Make & Model TYPE OF SYSTEM AddRional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building„Qermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditionin '� 1
Fuel Flue Size Vent. System � �� HEAT CALCULATIONS REQUIRED 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 ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATlONS 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
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations X Replacement New Construction above is complete and accurate; that the work will be in conformance wfth the ordi-
/� nances and codes of the cfty and with the state building/mechanical codes; that this form
Repair Est. Comp. Date 1..0 —�—�� does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
t� in acxordance with the approved plan in the case of all work which requires review and
Est. Cost $ ��s ��`JD Building Permit # � a roval of plans.
HEATING PERMIT FEE $ �-� 'S � �C� � � � � �-��_
STATE SURCHARGE $ .50 pplicant's ignature � Date
` �- 7-��
TOTAL PERMIT FEES $ Z 3.� O Receipt # aZ.Ip I3(D
Bui ng Official's Signature Date
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