HomeMy WebLinkAboutHeating Permit 95-0117 - --- -••.....�. .�.. _ . .. � . �
1. Pink - File
--- 2. Green - City
,r-� -, -� ,- -; -�.
�p (.�; , S 3. Yellow - ConVactor
�
--_� CITY O PRIOR LAKE TYPE OF STRUCTURE
� m� 4629 DAKOTA STREET S.E. permit No. �-� '��7 Singie Family Two-Family Mufti-Family
— 5(99�J PRIOR; KE, MN 55372
a Commercial Industrial Public Other
, HEA_ TINGI� LICATION / PERMIT
Dat PID # ��OO �— Q�d —d �OB VALUATION FEE
Site Address 5102 MEMORIAL TRAIL SE $0 -$1,000 2%of jobvalue, min. $20.00
Lot Block Addition _����a.� ca.wv` '✓ $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 GEROLD & KAREN MELOSKY
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 5102 MEMORIAL TRAIL SE tional $100.00 or fraction thereof, to and including
Heating Contractor RON' S MECHANICAL,
INC . $50,000.
Address 1812 EAST SHAKOPEE AVE SHAKOPEE $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone# 445-8585
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model ��Q'f PS,� nPE OF SYSTEM Addftional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size �Cs�.��5 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 Conditioning r� Tll�3
. Fuel /Ui �'• 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 APPLICATIONS MAY BE MAILED TO THE CIIY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input S C� 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 NALL
Cfm. 447-4230.
TYPE OF WORK 1 hereby apply for mechanical systems permit and 1 acknowledge that the information
Afterations ReplacemeM � {Vew Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and oodes of the city and with the state building/mechanical cades; that this form
Repair Est. Comp. Date does not become a permft until signed by the BUILDING OFFICIAL; that the work will be
Est. Cost $ a�8� �Q in accordance with the approved plan in the case of all work which requires review and
Building Pe�mit # '—'—'— approval of plans.
HEATING PERMIT FEE $ � d .��a�/g,s°
� STATE SURCHARGE $ .50 IicanYs Signa � Date
� �'�"C�
� TOTAL PERMIT FEES $ ���� Receipt # �� �3 � uilding cial's Signature Date