HomeMy WebLinkAboutHeating Permit 95-0130 �—� 1. Pink - File
� � j"� �/-' I� ,` ' ,.-°!�'.---- 2. Grcen - City
� TYPE OF STRUCTURE 3. Yellav - Convacror
�� .�� �' `��TY OF PRIOR LAKE �
� � ;�C29 DAKOTA STREET S.E. Permi No. � Single Family Two-Family Mufti-Family
� � ' IOR LAKE, MN 55372
Commercial Industrial Public Other
APPLlCATION / PERMIT
PID # ��J —O�IJ 4Z-� - a
JOB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Sfte Address
13 SL f � �/ ��� /)��� $1,001 -$10,000 $20.00 for the first $1,000 plus $1,25 for each additional
Lot lock Addition n _ � (1
- $100.00 or fraction thereof to and including $10,000.
Owner's Name /i �LL �( fl�7Jd�S $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �.3�� �610,�/�OO ,S� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor �6n1 ��GBFA��t1:��.�
Address ��do� � S�',�D,O�� �(/� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereoi.
Telephone # �����5�
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYS7EM Additional inspections will be billed at $25.00 each.
Warm Air Plants
. Model Size 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 ��� .�
" 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 o� additions send floor plan wfth sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS 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 ! hereby 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 �/ �D j�f� does not beoome a permit until signed by the BUILDING OFFICIAL; that the work will be
1 in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ `✓ �Q�d'J Building Permit # "�-� approval of plans.
HEATING PERMIT FEE $ �' J k�'�9'�f �
STATE SURCHARGE $ .50 plicanYs Si ture � Date
a �f� � S �,lolQq ���
TOTAt. PERMIT FEES $ Receipt #
Buildin icial's Signature Date