HomeMy WebLinkAboutHeating Permit 95-0125 ��� � � � � r� �- . 1. Pink - File
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�1TY�F PRIOR LAKE TYPE OF STRUCTURE
� ��6��OTA STREET S.E permit No. .��� . Single Family � Two-Family Multi-Family
PRIOR LAK , M 55372
" ' Commercial lndustria! Public Other
A ON / PERMIT
Date �� �-.J —�7�� ^ PID # 33 � 01-�3 — d l.� � D JOB VALUATION FEE
Site Address [D� ��,� �P�t� /j� $� �$�'�� 2% of job value, min. $20.00
Lot � Block � Addition ��h� �,a.c�,� $1,001 -$10,000 $20.00 for ihe first $1,000 plus $1.25 for each additional
� , $100.00 or fraction thereof to and including $10,000.
Owner's Name /� � � $10,001 -$50,000 $132.50 for ihe first $10,000 plus $1.00 for each addi-
Address i, tional $100.00 or fraction thereof, to and including
Heating Contractor __ � � � � ���^ � $50,000.
Address HEATING & AIR CONQITIQNING C0. $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # MINNEAPOLIS, MN 55420-2853
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 ��ous� Heating Test Record must be submftted with building �ermit number before build-
C�nn. Load Mechani I .d ���`�'a�dertificatQ of occupancy will be issued.
Air Con�wning ��/ �mber of supply and return openings listed
Fuel Flue Size Vent. System � CLOSED DUE TO ctures or additions send floor plan with sup-
Supply Openings H ER INACTIVITY 8/30/01 �OSS CALCULATIONS, PAYMENT AND
Steam : CITY OF PRIOR LAKE, 4629 Dakota St.
Return Openings Hot Water
Radiation °•�• � ���� �-•--� ---
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 HALZ
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permft and I acknowiedge 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 cfty and wfth 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
,______,� in acxordance with the approved plan in the case of all wo�lc which requires review and
Est. Cost $���, �..� Building Permit # approval of plans.
NEATING PERMIT FEE $ �J,olAS � �-cS�
STATE SURCHARGE $ .50 plicanYs Sig re _ Date
TOTAL PERMIT FEES $ � l, `�a�l Receipt # �1� � 0 � `� ��
Buildi icial's Signature Date
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