HomeMy WebLinkAboutHeating Permit 95-0167 k � r , ` -� � � ; �, ���� 1. Pink : File
� � y�, _�, . 2. Green Ciry
� �.�- ��ITY OF PRIOR LAKE 3. Yellow - Conflractor
�� TYPE OF STRUCTURE
�" 16200 Ea le Creek Av. S.E.
� � Q� 9 Permit No. �5' �OZ Single Family Two-Family MuRi-Family
Rrlqr Lake, MN 55372
;; '� Commercial Industrial Public Other
AdPLICATION / PERMiT
Dat P!D # d�' oZ�.� D�O `!� ��B VALUATION FEE
� � n � n ^ � $0 - $1,000 2% of job value, min. $20.00
Site Address I\JI, Ul,l 1
Lot 1� Blodc � Additio $1,001 -$10,000 $20.00 for the first $1,000 pius $1.25 for each additionai
$100.00 or fraction thereof to and including $10,000.
Owner's Name 1 ��i � � $10,001 -$50,000 $132.50 for the first $10,000 plus $i.00 for each addi-
Address ,_'�,�V�, �� ��Q tional $100.00 or fraction thereof, to and including
1 , d `� $so,000.
Heating Contractor � 1� �h (�
Address � c'J��� l�,'( \�.Q, �� .� $50,001 and over $532.50 for the first $50,0�0 plus $7.50 for each addi-
s ��� , � c � y � G � tional $1,000 or fraction thereof.
Telephone # e3't�" tit�lJ�J
The price of your heating permit inctudes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additionai inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building �ermit number before build-
Conn. Load Mechanical _ 1 be issued.
Air ConditioningC ; Ul `'� cL�sED DUE ' I ' �
Fuel Fiue Size Vent. System ,�j$EQ with number of supply and return openings listed
HEATING OR POWER PLAI INA�TIVITy g�3 0�� 1 ing. New structures or additions send iloor plan with sup-
Supply Openings �wn. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water .ILED 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 WOHK I hereby apply for mechanical systems permit and 1 acknowledge that the information
Afterat�ons �_ Replacemerrt 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 oi all work which requires review and
Est. Cost $,� �� Building Permit # �� approva lans.
HEATING PERMIT FEE $ • V � ��C�'��
STATE SURCHARGE $ .50 Appl' t's 'gnature Date
(� �//' 7
TOTAL PERMIT FEES $ � V Receipt # o�-fo 7'� �
Buil ' g Officiat's Signature Date