HomeMy WebLinkAboutHeating Permit 95-0135 �-- :-
� _ t. Pink • Fite
F � t J f � '�-- -- 3. Yellow - Contractor
.�° �--�-��F OF PRIOR LAKE TYPE OF STRUCTUF4E
� m �� �� Eagle Creek Av S.E. permit No. ��S Single Famity ✓ Two-Family MuRi-Family
'�"'*rior Lake, MN 55372
�' Commeroial Industrial Public Other
- AI�`LICATION / PERMIT
,f JOB VALUATION FEE
Date - `�'° ' P ID � �S- � G �� Q D � - U
� $p -$1,00p 2% of job value, min. $20.00
Site Address t`�. "�, "�� �_ 1��.� Q�, s,2�
� / ��� � ./-� � �� / �� $1,001 - $10,000 $20.00 for the first $1,000 ptus $1.25 for each additional
Lot � Blodc ' Addition (o i J.l _ � $100.00 or fraction thereof to and including $10,000.
Owner's Name �}w�, -Da-►�,�Sc-.� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 1�i 33� �.,�.�.� !n C'l.�ti tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor STANDARD HEATING AND AIR CONDITIONIN6 C0.
410 $�LAKESTREET $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address MINNEAPOLIS, MN 55408-2998 tiona) $1,000 or fraction thereof.
Telephone #
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 � st Record must be submitted with buildin �ermit number before build-
Gravi CLOSED DUE TO g '
Conn. Load Mechanical _ xupancy will be issued.
A�rc�nd��o��� INACTIVITY 8/30/Ol
Fuel Flue Size Vent. System _ �IONS REQUIRED with number of supply and return openings listed
�I's per opening. New structures or addftions send floor plan with sup-
Su�ly Openings HEA7ING OR P....�.. .�..... ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Retum Openir�s 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
C'�ty 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
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations +� Replacemertt 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 Co '�,3 - Q S does not become a permit until signed by the BUILDING OFFIClAL; that the work will be
— in accordan ith the approved plan in the case of all work which requires review and
Est. Cost $ l d qC} � b� Building Permit # approva lan .
HEATING PERMIT F�E $ a 1� 2 S j, -I y-g �
STATE SURCHARGE $ .50 ' nYs Signat Date
./ G -�q--�
TOTAL PERMIT FEES $ ► Receipt #� I��`'
Bu ding Off' al's Signature Date
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