HomeMy WebLinkAboutHeating Permit 95-0151 �����C�+ 1. Pink - File
2. Green - C1ry
�.��� pRIOR 9 CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Convactor
� m 4629 DAKOTA STREET S.E. permit No. y '1 �J' � Single Family � Two-Family Multi-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT
Date [.( D� �i�3'�� PID #�, �� a" D37 D �OB VALUATION FEE
Site Address �(( � L'/g� ► o�! ��� L,: a i $0 -$1,000 2% of job value, min. $20.00
�� � .� � ��� � ,,,��� � $1,001 - $10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot Block Addition _�, $100.00 or fraction thereof to and including $10,000.
Owne�'s Name l�l, � �F--
� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ���i Ut_ �iL. �) tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor � CLOSED DUE TO
Urn $532.50 for the first $50,000 plus $7.50 for each addi-
Address � 2482 Rhode Island Ave.^ �ACTIVITY 8/30/O l
-- tional $1,000 or fraction thereof.
Telephone # _ $aVage, �.Q005 +
g permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additionai inspe�u���� ..�., be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Reoord must be submitted with building nermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditionin� ✓�/�.�� ,7�
Fuel Flue Size Vent. System d,EAT CALCULATIONS RE�l11RED with number of supply and return openings listed
HEATING OR POWER PLANT per room with CFM's per opening. New structures or additions send floor plan with sap-
Supply Opsnings 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
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST SE 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
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 becc�me a permit until signed by ihe 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 $ �� Building Permit # approv plan .
HEATING PERMIT FEE $ �G�� . �Q � �. ��1. (�' (.,�� ~�'`! S
STATE SURCHARGE $ .50 ApplicanYs Sign ture - � l � at��
TOTAL PERMIT FEES $ Receipt # �„�.37�j �
uilding ficiat's Signature Date