HomeMy WebLinkAboutHeating Permit 95-0131 r -. ✓ "'-, " ' I' _ _"_ _ V ' '
\ `k ' ` _ ' ' ' � ' 1. Pink - File
2. Green - City
°F PRr,� -- � TY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Convactor
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�'� �� Z� D�1iCOTA STREET S.E. permit No `15- � 3 l Single Family � Two-Family Mufti-Famity
PFi� KE, MN 55372
Commercial Industrial Public Other
HEATING A LICATION / PERMIT
Date l� - � � - �� � } PID #�(� � �fo - US��—U �OB VALUATION FEE
�- $0 -$1,000 2% of job value, min. $20.00
Site Address ��.� ��S ��� ���, k�� L_� i �• E.
Lot B lock Addition $1,001 -$10,000 $20.00 for the first $1,000 ptus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Ow�er's Name _��ti� � s u� ��2 �� c.�-� T (� r� �,�1 �. $10,001 -$50,000 $132.50 for the first $10,Q00 plus $1.00 for each addi-
Address ��� ` �.��`'� V �� ����"� S�,� .� � tional $100.00 or fraction thereof, to and including
Heating Contractor � � � �u '� � Y''' $50,000.
Address � `o �� � � < ` �_c;� ' i� v�. - �r , .J,,� ��,�(� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
5 tional $1,000 or fraction thereof.
Telephone # L- � u 1 � - �� � ��' 1
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
Modet Size ���r� �_� 1� Gravity �rd must be submitted with building r�ermit number before build-
Conn. Load U1 ��o h' � Me�na���� CLpsED DUE To �cy will be issued.
„ AirConditioning g/30�01
Fuel ��-��>>� ��ue Size `1 Vent. System �ACTIVITY REQUIRED with number of supply and retum openings �isted
HEATING OR POWER opening. New structures or additions send floor plan with sup-
Supply Openings piy and return locations shown. HEAT LOSS CAL.CULATIONS, 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 ��J Output � � ��`� Special Devices
Ciry Hall business hours are S a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. � \ �,
447-4230.
�"J� �'''"'�. �•• f��'+�CnCe.,
��- �r��� ���9,, rv°�� (,�=�t, PE P WORK
z•��,�, �� =� ���fz ���� �s ��S �,',.� ,�; or � I hereby apply fo� mechanical systems permit and I acknowledge that the information
Afterations ReplacemeM 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 iorm
Repair / Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
�, // in accordance with fhe approved p(an in the case of ail work which requires review and
Est. Cost $ ��j C� ��" Building Permit # •(� �� d approval of plans.
HEATING PERMIT FEE $ a `4� � � � �
� �-1����
STATE SURCHARGE $ .50 licant's S' ture Date
9/ Q �/ �/g ^
TOTAL PERMIT FEES $ � � � �_� Receipt # ,�C.,(c. I7 d � ` (
uildi icial's Signature Date
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