HomeMy WebLinkAboutHeating Permit 95-0149 j����� 1. Pink - File
2. Green - City
.,°� P ��, � v-_� �� CITY�F PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Conuacta
,� � . ��
� ��� m�� ��� - �629 DAKOTA STREET S.E. permit No. -�� Single Family _`-- Two-Famiy Multi-Famity
� 2 7 ,,,, p, H10R LAKE, MN 55372
i i. y y� Commercial Industrial Public Other
� ', � HEATING ApPLICATION / PERMIT
Dale � �`' `�� ,' Plp #�LS�- D U T Of D' O JOB VALUATION FEE
Site Address � � �, C�Z_ $� "�� ��� 2% of job value, min. $20.00
Lot aZ Block 3 Addition`�'� ,Z $�.� -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Ouvvner's Name �r ��• ��1 ��,,'��
1 _ $10,001 -$50,000 $f 32.50 for the first $10,000 plus $1.00 for each addi-
Address �`4�'�" v�. � S 1�{-� tional $100.00 or fraction thereof, to and includiag
$50,000.
Heating Cont��r�.,;�� ��ua��+����r Inc.
Address 12481 Rhode Island Ave ��• $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi
avage tional $1,000 or fraction thereof.
Tele hone 94-0005
The price of your heating permit includes one rough-in and one final inspection. -1
Furnace ake & Model ,-�'i �°L'�� � � �PE OF SYSTEM Additional inspections will be billed at $25.00 each,
� ��,�\ Warm Air Plants
Model Size �� v Grav'rty House Heating Test Record must be submitted with building r�ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air ConditioninA 2
Fuel � Flue Size Vent. System HFAT CALCULATIONS REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT Per room with CFM's per opening. New st►��ctures or additions send floor plan with sup-
Supply Openings ply and return locations ��� �SS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATI(��'° ' � O �ITY OF PRIOR LAKE, 4629 Dakota St.
6'�6(� Radiation c ^ � � `O1
Input Output Special Devices ���� v $�3�
�t- �L �
Edr. 1� ��
Other Devices q� ri� ._., (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afteratians ReplacemeM __�� New Construction above is camplete and accurate; that the work will be in conformance with the ordi-
nances and codes of the city and with the state buitding/mechanicat codes; that this form
Repair Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
n � in accordance wiih the approved plan in the case of all work which requires review and
Est. Cost $ �E'Ll�'-''� Building Permit # approv lans.
HEATING PERMIT FEE $ ��` �� /` C�/ �,,5-`'� �-
STATE SURCHARGE $ .50 , ppli nYs nature Date ��
TOTAL PERMIT FEES $ �'" o Receipt #�.� 3 1(D �� '�
Bui l ' g O f ficia l's S i g n a t u r e D a t e