HomeMy WebLinkAboutHeating Permit 95-0228 - - � � �} �� 1. Pink _ File
r - �,_` �. � �� ,� ,-, "; � 4 2. Green City
�; a- . 9`� �r ��'l'�F PRIOR LAKE z2a TYPE OF STRUCTURE 3. Yellow - Contractor
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� m 16200 Eegle Creek Av. S.E. permit No. `�$.� Single Family �_ Two-Family MuRi-Family
2 � � Priot,Lake, MN 55372
; ; , Commercia! lndustrial Public Other
HEATINCi' iA(�'PLICATION / PERMIT
` `�° � JOB VALUATION FEE
Date � ,�,,, ; PID# ���'bZ2"L�27
� n� M n , n'^ r �� n`^ $0 -$1,000 2% of job value, min. $20.00
Site Address ��'1 ' t 1�w�x r'J1�IVC �
Lot � n Bbck � Addition �� � Ai( l X.�i(.r��wr $1,001 -$10,000 $20.00 for the first $1,000 plus $125 for each additional
_.. $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 tional $100.00 or fraction thereof, to and including
Heating Contractor � � $50,000.
Address $50,001 and over $532.50 for the first $50,000 plus $7.5Q for each addi-
� tiona! $1,000 or fraction thereof.
Telepho e #
n The price of your heating permit includes one rough-in and one final inspection.
Furnace e& ode JI'���� nPE OF SYSTEM Additional irtspections will be biUed at $25.00 each.
Warm Air Plants
Model Size Q�� Gravity �e submitted with uilding �ermit number before build-
Conn. Load
Mechanical CLOSED DUE TO ,SSUed.
Air Co�ditioning INACTIVITY 8/3 0/01
Fuel ___� Flue Size Vent. System ;Q with number of supply and return openings listed
New structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT 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 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 CIT1f HALL
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations Replacemertt � 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/mechanicaf 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 # a roval of plans.
HEATING PERMIT FEE $ i � �,� �, `)
STATE SURCHARGE $ .50 Appli Ys ' re � Date
TOTAL PERMIT FEES $ , Receipt # � � 0 �T �� 2 _ � �
Build' Official's Signature Date