HomeMy WebLinkAboutHeating Permit 95-0166 _ --- -- —____ � �� �G'
� '� ' t � � �`` c' � Ti , 1. Pink ile
F PR1d,Q � - �-.' ``� `� '�`' . - 2. Green - City
�° �.� �� � CITY OF ,PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Convacror
� �`ti, m� 2 3'�jDAK4TA STREET S.E. permit No. �� r� Singie Family �_ Two-Family Multi-Family
`, ` PRIOR �►��, MN 55372
u '.I' Commercial Industrial Pubtic Other
� HEATING d�LI�AT(ON / PERMIT
Date �� I�- �J PID #�S- D�„y — 031 0 JOB VALUATION FEE
Site Address 1�t-�� 1,�1���.� 1..�.Y"�� , $� -$� �� 2°,6 of job value, min. $20.00
�J�� � / � $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block 3 Addition �FCx�o' �''� iL �� �✓ $100.00 or fraction thereof to and inciuding $10,000.
Owner'sName��`�, ��(\(�G.,�1
�^��� ` $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address Q �b (�1��,�.., tional $100.00 or fraction thereof, to and including
Heating Contractor "�''� (1� l, �� ��' � � $50,000.
Address ��/��� �� ����W r✓� ��,(.Q,,`��_ $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
I �� °y -�- tionat $1,000 or fraction thereof.
Telephone # Uc� �.L.> •�
�,(�' �}, The price of your heating permit includes one rough-in and one final inspection.
Furnace`M'ake �odel ����1`.i �1.�NPE OF SYSTEM Additional inspections will be billed at $25.00 each.
�� ��}11 Warm Air Plants
Model Size s �`�� Gravity "-'•-- "^°+�°^ TA� Record must be submitted with buildin��ermit number before build-
Conn. Load Mechanical UE TQ �ill be issued.
Air Conditioning CLOSED D
�UlRED with number of supply and return openings listed
Fuel Flue Size Vent. System INACTIVITY 8/3 0/O 1 :ning. New structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PL hown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLIGA � iun� m., � �� .�AAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
� l." Out ut Radiation S.E. Prior Lake, MN. 55372.
Inpu p Special pevices
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 thai the information
ARerations Replacemerrt FVew 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 all work which requires review and
Est. Cost $ � Building Permit # �� a roval of lans.
HEATING PERMIT FEE $_ �Z� �� �� _ � � � �
STATE SURCHARGE $ .SO licant's Sign ture _ Date
TOTAL PERMIT FEES $ � �� Receipt # _,,C,/o 7�.3 � �^ 2/ �
uitding ial's Signature Date
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