HomeMy WebLinkAboutHeating Permit 95-0174 , ��Q��_�. �?06 �ttt��-�v�+z �
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.�.�°� � CITY R ',QRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
�' 2� �9 �TA STREET S.E. permit No. qs
� � Single Family _�_ Two-Family Mufti-Family
PRI KE, MN 55372
Commercial Industrial Public Other
HEATING APP ICATION / PERMIT
Date o? n .S'� PID # t�� -� - D 63 0 JOB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Site Address aaZ/ / Lc100D �
Lot�_ Block Addition a� $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 _ �/�� 1 E ��.„�.S �rj jL7'"�-}- ,
�/ $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 7�° l C�►4�Nu�aa,� C� 2Cr� j1� .� , tional $100.00 or fraction thereof, to and including
Heating Contractor �I��, �} � �� �J� • $50,000.
Address `�Yu Z- �,(��}�j�E,� �� �/ • $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # 9 y 1- � v��
, 7he price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
� a �� ) � Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building permit number before buifd•
Conn. Load ��, 3(� v Mechanical ing certificate of occupancy will be issued.
Air Conditioning X
Fuel Flue Size Vent. System HEAT CALCULATIONS 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 - ��T 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 ReplacemeM FVew Construction above is complete and accurate; that the work will be in conformance with the ordi-
� P �/�� /9 nances and codes of the city and with the state building/mechanical codes; that this form
Re ir Est. Com . Date � 5� does not become a permit until signed by the BUILDING OFFICIAL; that the�work will be
in accordance with the approved pian in the case of all work which requires review and
Est. Cost $ 1 q 7b � Building Permit # ._ pprov plans. _ �
HEATING PERMIT FEE $ 3� � 5 � �aD�l� ��'
STATE SURCHARGE $ .50 � pticanYs Si ature Date
TOTAL PERMIT FEES $ 33 . DQ Receipt #� 7 s� 7����75—
- Buildi ficial's Signature Date
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