HomeMy WebLinkAboutHeating Permit 95-0156 oC . , - --- ,
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�.�°� 9� �1TY OF PRIOR LAKE / TYPE OF STRUCTURE 3. Yellow - ConVactw
v �' r� 29 DAKOTA STREET S.E. QJ
7 p�ar Permit No. Single Family Two-Family Mufti-Family
• PRI �' ' ' KE, MN 55372
Commercial Industrial Public Other
ICATION / PERMIT
JOB VALUATION FEE
Date PID# o �s-03� — a03--�
Ske Address � . $0 -$1,000 2% of job value, min. $20.00
Lot � Block Addition $1,001 -$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.
Owner's Name
\��2� $10�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
C+ � D � 1 i $50,000.
Heating Contractor _ ��
Address HEkTiNG & AIR CQNQlTIOtdING C0. $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
. . tional $1,000 or fraction thereof.
Telephone # MINNEAPOLIS, MN 5542Q-2853
�./� The �►��e ^� �•-��- ' zting permit includes one rough-in and one final inspection.
f�a�e Make & Model -��/ TYPE OF SYSTEM O rill be billed at $25.00 each.
� � �� Warm Air Plants CLOSED T
Model Size Gravi DUE �rd must be submitted with building Qermit number before build-
tY
Conn. Load Mechanical INACTI�TITY 8/30/O 1 �cy will be issued.
Air Conditioning �
F�el Flue Size Vent. System __..., REQUIRED 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 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 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 aomplete 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 7—oZ 7—C,� does not become a permit until signed by the BUIIDING OFFICIAL; that the work will be
in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ ��bU'� Building Permit # approval of plans. ,
HEATING PERMIT FEE $ 7� � � �?..l.�s
STATE SURCHARGE $ .50 Applicant's Signatur /y�^j,L�C. Date
TOTAL PERMIT FEES $ '�f. 0[�3 Receipt # ��J 77
Building Official's Signature Date
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