HomeMy WebLinkAboutHeating Permit 95-0133 ,ijl' � I` � ,; - - --- , t. Pink - File
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�.��� pR' � F RIOR LAKE TYPE OF STRUCTURE 3. Yeilow - Ca
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� 4629 DAKC� TREET S.E permit No. 'f S' � Single Famity " Two-Family Multi-Family
, MN 55372
Commercial industriai Public Other
TION / PERMIT
Date �I �3 P!D #� 1-��— D��—� JOB VALUATION FEE
Site Address 5/� $0 -$1,000 2% of job value in. $20.00
Lot �� Block � Addition l $1,001 -$10,000 $20.00 for the firs , 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 the first $10,000 plus $1.00 for each addi-
Address ���o�. E. �� .t1U �5337 tional $100.00 or fraction thereof, to and including
Heating Contractor (_-{- $50,000.
Address $5U,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # ��� 3 � 7 �f
The price of your heating permit includes one rough-in and one final inspection.
Furnac� Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity CLpSED ust be submitted with building permit number before build-
Conn. Load Mechanical Tl�r��� DUE TO II be issued.
AirConditioning 11V IVIT
Fuel Flue Size Vent. System j g� ��� 1 lUIRED with number of supply and return openings listed
�ning. New structures or additions send floor plan with sup-
Supply Openings �j HEATING OR POWER PLANT P � y and return ��..�..._. �own. 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 INSPECIED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and t 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 permit until signed by the BUILDING OFFICIAL; that the work will be
in �rdance with the approved plan in the case of all work which requires review and
Est. Cost $ ��O � 40 Building Permit ���'"��'v `= approval of plans.
HEATING PERMIT FEE $ aZO� O(� � (Q �3 q S
STATE SURCHARGE $ pli nt's Sig ure ate
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TOTAL PERMIT FEES $ �� 5� eceipt # �.t r �/ y�✓ Building icial's Signature Date
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