HomeMy WebLinkAboutHeating Permit 95-0192 ��q2q c 1. P�k - File
2. Green - City
� PRI�R` CITY OF PRIOR LAKE ' rrPE oF s�ucn,� 3. Yellow - Contracoor
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� '�', 16200 Eagle Creek Av. S.E. permR No. �'J� ^�`�' 2 Single Family �_ Two-Family Mufti-Family
Prior Lake, MN 55372
Commercial Induslrial Public Other
HEATING APPLICATION / PERMIT
O � , �_�� P'D ���_ �� ���`) JOB VALUATION FEE
Date
�� T. $p _$1,000 2% of job value, min. $20.00
SiteAddress r(Y�h('.�C' �"Cr'G.� � � .
Lot � Block � Addition � $1 �001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
+� tc� $100.00 or fraction thereof to and including $10,000.
Owner's Name � `'� U $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ��Q.� `� � tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor �fl• � ��. ��l d � ��
Address �, � �1� �, � - �0,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
ional $1,000 or fraction thereof.
Telephone # c>��- � CLOSED DUE TO rmit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM INACTIVITY c��3 O�O 1 ed at $25.00 each.
Warm Air Plants
Model Size Gravity st be submitted with buildingyermit number before build-
Conn. Load Mechanical ing certificate of occupancy ww be issued.
Air Conditioning�LV1�1P11 ;��-Yi�� od�� '��''
Fuel Flue Size Vent. System ��AT CALGULATIONS 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 Steam ply and return locations shown. HEAT LOSS CALCULATlONS, PAYMENT AIVD
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
lnput Ouiput Special Devices
Ciry Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINALj • CALL CITY HALL
�m. 447
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations _� Replacement New Construction above is complete and accurate; that the work wiU be in canformance 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 # app al of plans.
HEATING PERMIT FEE $ �O �� �-,���
STATE SURCHARGE $ .50 Appli nt Signature Date
� ,..�� �c��
TOTAL PERMIT FEES $ � Receipt # 7L� �
Building icial's Signature Date