HomeMy WebLinkAboutHeating Permit 95-0137 , I� r� r' t7 r1 fT r=� �- '' 1. Pink - FfIe.�F�.LJV �
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,�� i,�� ., ��� �,� ��TY OF PRIOR LAKE / TYPE OF STRUCTURE _ 3. Yellow - Convacmr
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= ^� 62� Ea le Creek Av S E. `7� 5--13'� �_
� � 9 Permit No. Single Family Two-Family MuRi Family
Prior Lake, MN 55372
�� U` �- i Commercial Industrial Pubtic Other
� ING APPLICATION / PERMIT
Date l.lU" 1�-k' "f L�" PID #�S"oZ ��I ' O3 7�� JO8 VALUATION FEE
��,� /� � ��� M � ` �` ` ` � y $0 - $1,000 2% of job value, min. $20.00
Site Address ���_ �1' uJ tt' IV�-.
/ � ` ,/ /� $1,001 - $10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � 61odc �_ Addition �1��� ���.✓ 7�� U�.�;,✓
$100.00 or fraction thereof to and including $10,000.
Owner's Name �\ ��� ��C/Y $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 tor each addi-
Address Q. ����-P tional $100.00 or fraction thereof, to and inciuding
Heating Contractor Burnsviile Heatin & A/C Inc. �o,000.
Rhode Island Ave SO. $50,OOi and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address �va�;,�n � ,r�.r� ��_� ��� - " - - - � fraction thereof.
Telephone# 894-0005 CLOSED DUE TO one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM INACTIVITY 813 0101 �
Warm Air Plants
Model Size Graviry I with buildin�permit number before build-
Conn. Load Mechanical ing cernncate oT occupanc,y wm un wauvv.
Air Conditioning f -
Fuel Flue Size Vent. System �J(� � HEAT CALCULATIONS REQUIRED with number of supply and return openings listed
HEAT{NG OR POWER PLANT Per room with CFM's per opening. New structures or additions send floor plan with sup-
Suppty 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
Ciry Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-{N AND F{NAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Akerations �,_ 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 form
Repair Est. Comp. Date does not became a permit until signed by the BUILDING OFFICIAL; that the work will be
` n � in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ 1�' VW •� Building Permit # approval lans.
HEATING PERMIT FEE $ _ � � � '"�''�` < -�
STATE SURCHARGE $ .50 pli Ys Si� �nature Date
TOTAL PERMIT FEES $ , Receipt # ��n� I� � 23 �
Buildin icial's Signature Date