HomeMy WebLinkAboutHeating Permit 95-0122 �� (—. R � 7 t. Pink - File
� E� r' {� � �; ��"i * 2. Green - Ciry
�� p ���"�--t``�- `� ` TYPE OF STRUCTURE 3. Yellow - Contractor
�.� � .� ------ �t�(, PRIOR LAKE
�; � 8�29 OTA STREET S.E. permit No. �-�Z Single Family � Two-Family Multi-Family
P � LAKE, MN 55372
� LICATION / PERMIT �mmercial lndustrial Public Other
Date PID # �,�- QD Z— O 7�' d �OB VALUATION FEE
Site Address � � s�i $� "$>>�� 2% of job value, min. $20.00
, $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot Block Addition � $100.00 or fraction thereof to and including $10,000.
Owner's Name �- /V /tl �/'�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address . S� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor �-Q v
Address $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Teleph ne # '" �
The price of your heating permit includes one rough-in and one final inspection.
Furna odel Q v 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 r�ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
� Air Conditioning
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 Openin9s ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATfONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
�/ Radiation S.E. Prior Lake, MN. 55372.
Input �v Output J 7�' �� 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 Replacement �_ FVew 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 � does not become a permft until signed by the BUILDING OFFICIAL; that the work will be
Q� �___,�_^.� in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ Building Permit # approval of lans.
HEATING PERMlT FEE $ � '
� � �_
STATE SURCHARGE $ .50 nt Sign ure � Date
TOTAL PERMIT FEES $ � Receipt # Z.-�O �� (o � ' rG _ � �
uildin icial's Sigrtature Date