HomeMy WebLinkAboutHeating Permit 95-0152 1. Pink - Fit� ,�i�(�
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°� �� CITY� �F' PRIOR LAKE TYPE OF STRUC7URf 3� Y�� -�TM�
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� - - 1fr�OD � te Creek Av. S.E. q r � l5 2 - Single Family 7wo-Family Mufti-Family
� m ,�, � Permit No
Prior I.�ke, MN 55372
Z 7� Commercial Industrial Public Other
� ' '� '� HEATING ARi�LICATION / PERMIT
' ' ' �`-�--�� �-�(�... ✓ �' JOB VALUATION FEE
Date � UlU' ' ���^1 �.J �"�" v � PID # � � U� � � d � 7 —�
` -- ��j �„r��6y - �� �� $0 - $1,000 2% of job value, min. $20.00
Site Address l�" 7o((J
Lot O 8bck Addition ,LYt_��� %�c�aG ���� $1 �001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
.-3-- -- $f 00.00 or fraction thereof to and including $10,000.
Owner's Name c��iuV' � l.(,� ,� � $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ���- �� 5��-- tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor 8urncviilA fj,pat�•���� /�. ;�, �
Address 12'481 Rhode ISi�.t'��7' f;�v�, S�. $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
� twnat $1,000 or fraction thereof.
Telephone # 894
The price of your heating permit inciudes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 e�h.
Warm Air Plants
Model Size Gravity _ :ing Test Record must be submitted with building oermit number before build-
Conn. Load Mechanic cLOSED DUE TO ;e of occupancy will be issued.
Air Condit
Fuel Flue Size ve�t. s �ACTIVITY 8/30/O1 �LATIOIVS REQUlRED with number of supply and return openings listed
HEATING th CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings ,,, a„� recurn locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR U1KE, 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 Ml1ST BE INSPECTED (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
Alterations Replacement 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 ali work which requires review and
Est. Cost $ �• / Building Permit # "i' approv plans.
HEATING PERMIT FEE $ �� �p '"���
STATE SURCHARGE $ .50 's Signature Date
TO7AL PERMtT FEES $ C Receipt #�� � 76 � f � ��
ilding Off' 's Signature Date