HomeMy WebLinkAboutHeating Permit 95-0195 � � � �� 1. Pink - File
2. Green - Ciry
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°� p ' �'=��� �RIOR LAKE TYPE OF STRUCTURE 3. ,r��� - o�,��
� m� q� Ct'eek Av. S.E. permit No. � Single Family Two-Famiy Mufti-Family
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L """P'i�ior , MN 55372
� � Commercial Industrial Public � Other
CATION / PERMIT
Date PID # �� r — 936 — tJO l"� JOB VALUATION FEE
Site Address / 5'��a� /^iS�f"�' ��� �—� �� �$�'�� 2% of job value, min. $20.00
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot Block Additron $100.00 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 .��b ���TOd� -�'L-- � tional $100.00 or fraction thereof, to and including
/� $50,000.
Heating Contractor N art.'?+� � f� �—t��
Address � � ��^�"A'�'�'���� /'� v� �� T�-�t-- ,/» ������ over $532.50 for the first $50,000 plus $7.50 for each addi-
T� tional $1,000 or fraction thereof.
Telephone # L�� — ��'��
�� The price of your heating permit includes one rough-in and one final inspection.
Furna�ce 16fake & Mode�� TYPE OF SYSTEM CT O ''--�� �nspections will be billed at $25.00 each.
���� � �1� — �-- —f Warm Air Plants L�
Model Size _/��, t'�38 rr� �l�F Graviry � SED DUE Tp �rd must be submitted with building �ermit number before build-
Conn. Load Mechanical ACTIVITy 8 � 3 �� �ncy will be issued.
Air Conditioning _ 01
Fuel � Flue Size Vent. System S REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT N°' �- �er 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 Output Sp cial Devices
�' � City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE 1NSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
�m. 447-4230.
TYPE OF WO�K I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations Replacemern V 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 �t' �/��g� 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 # approval of plans
HEATING PERMIT FEE $ � � � . � ��� � J �c ��
STATE SURCHARGE $ .50 Applica Signature Date
TOTAL PERMIT FEES $���. # aZ.fo T7� �^ S ���
B ding Official's Signature Date
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