HomeMy WebLinkAboutHeating Permit 95-0229 �. i , ' , - " � _ . - i � �� 1. Pink - FGe
F PRIp�, 2. Green - City
�,,° r.� : CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. YeUo�w - Contractor
� '; m; Sf P 2{i�agle Cteek Av. S.E. pe�it No. �15-"�q Single Family �_ Two-Family Mufti-Family
�� Prior La� �NN 55372
HEATING A lC/�1TION / PERMlT �mmercial Industrial Public Other
Date
,� �,�1 �� PID #� 2 S� — q O� Dt5 �" V �OB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Site Address � � ��'2�..�-
Me} ts �-�—� $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot Blodc Addition $100.00 or fraction thereof to and includirtg $10,000.
Owner's Name �(�'(\\2. ��M�� '� �( �o �\1Y VC.� �'�� $10,001 - $50,000 $132.50 for the first $10,000 plus $1.00 ior each addi-
Address ���►\�1L� ��5.� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor � ' � � ` "�- � �.
Address �c��� ��C�Q, ���QC� (��,'� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fractron thereof.
Telephone# ��� >ermit inciudes one rough-in and one final inspection.
���� TYPE OF SYSTEM CLO SED DUE TO billed at $25.00 each.
Furnace aM ke f &� del C'_ �\.\ o
Warm Air Plants INACTIVITY 8/30/O 1
Model Size �►�� Gravity nust be submitted with buildinapermit number before build-
Conn. Load Mechanical ill be issusd.
/� Air Conditioning
Fuel __� 1� FIue Size °`��' Vent. System HEAT GALCULATIONS REQl11RED with number of supply artd 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 CALCULATIONS, PAYMENT AND
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
In ut �y�� Radiation S.E. Prior Lake, MN. 55372.
p 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
Afterations ReplacemeM �_ New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and oodes 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 $ �� � Build+ng Permit # approval of plans.
HEATING PERMtT FEE $ • � �'' �� ` `" W�
STATE SURCHARGE $ .50 I 's �gnat re Date
TOTAL PERMIT FEES $ O`�� .� Receipt #� d 1�7 � �� ��
Bui ding Offi al's Signature Date