HomeMy WebLinkAboutHeating Permit 95-0168 : _ -- - 1 �Q�'Jr�� t. Pink - File
PRI(� U� 2. Green - City
°� '� --` CiTY 4F PRIOR LAKE TYPE OF STRUCTUFFE 3. Yellow - ConVactor
�� � �
� ��, �, Eagl� Creek Av. S.E. permit No. 5=�6�i Single Family Two-Famiy Mufti-Famity
� JU� 2 ��or Lake, MN 55372
� Commerciai Industrial Public Other
� --� � ATION / PERMIT
Date c PID # o�.'�`II �� D�Z--U �OB VALUATION FEE
Site Address ��Q fi B� ,�' ��, j r�e, $0 -$1,000 2°/a of job vatue, min. $20.00
Lot �/ Bbdc � Addition � $1,00� -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$t 00.00 or fraction thereof to and including $10,000.
Owner's Name � � $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address !i(.J �I t'� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor s � � � •
Address �l �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
S �� ��� *���i �� nno or fraction thereof.
7elephone # p CLOSED DUE TO
The rice o i and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additiona! im
Warm Air Plants INACTIVITY 8/30/O l
Model Size Gravity House Heati i aermit number before build-
Conn. Load Mechanical ing certificatb .,. ____�__. ,
AirCondition •�i��l� ��f
Fuel Flue Size Vent. System 2 � HFA7 GALGULATIONS RE�UIRED with number of supply and return openings listed
HE�►TING OR POWER PLANT Per room with CFM's per opening. New structures o� additions send floor plan with sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLIGATIONS 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 CI7Y HALL
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations � ReplacemeM New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and codes of the cfty and with the state building/mechanical codes; that this form
Repair Est. Comp. Date does not become a permit until signed by the BUILDlNG OFFICIAL; that the work will be
�,.. in acco ance with the approv d plan in the case of aU work which requires review and
Est. Cost $�, . Building Permit # appro al plans.
HEATING PERMIT FEE $ G�/ e W �/�'!�" �
STATE SURCHARGE $ .50 li nYs S' ature Date
TOTAL PERMIT FEES $ � Receipt # �� ��3Z— �_
Buildi Official's Signature Date