HomeMy WebLinkAboutHeating Permit 95-0144 � � :� 1. Pink - File
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F PR/ ��=� `-= '- - 2. Green - Ciry
�.�° CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contr�tor
� � j� ��AKOTA STREET S.E. permit No. �l'�'� y y Single Family �_ Two-Family Mufti-Family
PRIOR L�I#�, MN 55372
HE ITA NFa ArrLl(�4TION / PERMIT �mmercial industrial Public Other
Date '��^ S� PID # — I�(L� D JOB VALUATION FEE
Site Address �� O�6' 3 J�d ;.- 7� ��� e r / �,� �/ � $0 -$1,000 2% of job value, min. $20.00
Lot �� Block Addition $1,001 -$10,000 $20.00 for the first $1,000 pius $1.25 for each additional
$100.00 or fraction thereof to and inciuding $10,000.
Owner's Name L C� �L., f� tf �•�G -�� $�0,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �� ,�, ,� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor �'� /�
Address $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # s
� The price of your heating permit includes one rough-in and one final inspection.
Fumace Make & Mbdel Pa ��, �����PE OF SYSTEM Additional inspections will be billed at $25.00 each.
arm Air Plants
Model Size �_ a � ��, Gravity "-��� -"- -" �''" ' �st be submitted with buildin�c�ermit number before build-
Conn. Load Mechanical be issued.
Air Conditioning CLOSED DUE TO
Fuel Flue Size Vent. System
INACTIVITY 8/30/O1 �'� W�h number of supply and return openings listed
�g. New structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLAN vn. 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.
OtFjsc Devices @,,� �- �� ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. c 447-4230.
TYPE OF WORK ��'"� �S I hereby apply for 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 form
Repair Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
�- � in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ O� � Building Permit # al of lan
aPP P
HEATING PERMIT FEE $ � O � � � � � � �. � 7 ,_ 9 �
STATE SURCHARGE $ .50 plicant's S' nature Date
TOTAL PERMIT FEES $ � - ;�-� Receipt # oZ,�o��d � _ ? � ��
Buildi Official's Signature Date