HomeMy WebLinkAboutHeating Permit 95-0141 – ^ ���� 1. Pink - File
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_ PR��R ;�`` �' =-CI'f1f� �F I�RIOR LAKE TYPE OF STRUCTURE 3. Yellow - ConOracror
� � c � gle Creek Av S.E. permit No. ���y � Single Family �_ Two-Family Mufti-Family
' 'i, � � ��ice� MN 55372
; � � ��� � � � Commercial Industrial Public Other
,� ��:--�##EATING / PERMIT
� i JOB VALUATION FEE
Date ''- PID # J S" D�I O
Site Address (N � -� �, � - $� ' $ ��� 2% of job value, min. $20.00
Lot �� Bbck � Addition ` � � $1,001 -$10,000 $20.00 for the iirst $1,000 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 �-�13 \�, �S ��) tional $100.00 or fraction thereof, to and including
Heating Contractor ° � C� ��,�y $50,000.
Address ,�� � �C�,�(`Y� . �t ti1� � Q.., �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
-' °" ^^^ �r fraction thereof.
Telephone # ���t �r� CLOSED DUE TO one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM INACTIVITY 8/3 0/O 1 s � h '
Warm Air Plants
Model Size Gravity �d wfth buildina r�ermit number before build-
Conn. Load Mechanical ing certificate oT occu����r ..,., ,,.. .___ __
Air Condftioning �„r - Zk �n NFAT GALCULATIONS REQUIRED with number of supply and return openings listed
Fuel Flue Size Vent. System - —
HEA7ING OR POWER PLANT per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLlCATIONS MAY BE MAILED 70 THE CIIY 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
�m. 447-4230.
TYPE OF WORK I hereby apply for mechan�al systems permit and I acknowledge that the information
Afterations � Replacemer�t 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 beoome 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 $ � �� , Building Permit # appro I of plans.
HEATING PERMIT FEE $ ZZ ��a �•���
STATE SURCHARGE $ .50 I' nYs Signat r Date
TOTAL PERMIT FEES $ ��- �� Receipt # �J Z/ `� �� �
u ding ial's Signature Date
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