HomeMy WebLinkAboutHeating Permit 95-0153 - -- --- -- 1. Pink - Fil��
F PRI ~ �1 i �, r �� I/ 2. Green - City
° -� CIT-�-�hF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
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� � �� � 2 ��Eag,le Creek Av. S.E. permit No. �'- l 5� Sin gle Famit y Two l y Mufti
r I..i�ke, MN 55372
� � Commercial Industrial Pubtic Other
' � � N�aTfa� aar#►�,p�ON / PERMIT
Date
�' ���-"�`t�� '-' PID # �� ,T,P�G — O �� — D JOB VALUATION FEE
Site Address 4543 �rr $� '$1,00� 2% of job value, min. $20.00
' $1,�1 - $10,000 $20.00 for the first $1,000 plus $1.25 for each additionai
Lot �_ 81ock � Addition
$100.00 or fraction thereof to and i�luding $10,000.
Owne�'s Name ��W► �- �+ �.�1 2 $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ���'`�- ��-J �� �9-� tional $100.00 or fraction thereof, to and including
$50,000.
HeatingContractor ��T��Villg he�ti�g � A/C. in�.
Address 12481 Rhode Island Ave. S�. �0 ,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
a � — tional $1,000 or fraction thereof.
Telephone # 894-0005
CLO5ED DUE TO ig permit includes one rough-in and one final inspection.
Furnace Make 8� Model TYPE OF SYSTEM �ACTIVITY 8/3 0/01 be billed at $25.00 each.
Warm Air Plants
Model Size Gravity �d must be submitted with buildi g c�ermit number before build-
Conn. Load Mechanical .,. ..�� uwcaao v� vwu�.ia� �V will be issued.
Air Conditioninq � 1 �
Fuel Ftue Size Vent. System HEAT CALCULATlONS RE�UlRED 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 sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CIIY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
tnput 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 mechanical systems permit and 1 acknowledge that the information
Afterations 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 buildinglmechanical 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
E�. co� $ l, �,° • Building Permit # ��" �S roval lans.
aPP
HEATING PERMIT FEE $ � �� c�� �'�`���
STATE SURCHARGE $ .5� A lican S�nat e Date
�-�a'`�
TOTAL PERMIT FEES $ C� I ��� R�B�� # a2,L 3 7G
ilding ia's Signature Date