HomeMy WebLinkAboutHeating Permit 95-0237 = � " ` °". �° _. - ; - `"-�' 1. Pink - File
2. Green - City
�.�°� p ���'� � CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
� ,-. m 462�9 DAKOTA STREET S.E permit No. �S� �
i fi � P�IOR LAKE, MN 55372 —� Single Family Two-Family Mufti-Family
'=' i �-- - HEA� �1PPLICATION / PERMIT oC.�-/7L-' � u-a �Ommercial Industrial Public Other
l�ate �(2=�� � PID # c# 7-�D � ZD '$(� JOB VALUATION FEE
Site Address 3 �, � � $� '$� ��0 2% of job value, min. $20.00
Lot � Block .3 Addition �,�� ��lJ�-U`�� $1,00� '$�0,000 $20.00 for the first $1,000 plus $1.25 for each additionai
$100.00 or fraction thereof to and including $10,000.
Owner's Name �O w1 � S tR � a C�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 3�� l � fp� ��C��} S� (n )� tionat $100.00 or fraction thereof, to and including
Heffiing Contractor � ` � �; t e �.d�c � � C �S $50,000.
Address � � ` $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # � C ( � - � 1 � �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model ��IM��. � qu,�T1(PE OF SYSTEM Additional inspections wilt be billed at $25.00 each.
a Warm Air Plants
Model Size ��� Gravity House Heating Test Record must be submitted with building nermit number before build-
Mechanical ing certii -- M� w��� be issued.
Conn. Load Air Co�dituoning
Fuel ," � Flue Size 7=� Vent. System �A.L� CL �SED DUr �O upply and retum openings listed
HEATING OR POWER PLANT P�r roo �ACTj� TI L �dditions send floor plan wfth sup-
SupplyOpenings p� a� � Ty g�3�� LCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLI�. ._ F PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 553i�.
Input �_ Output o�4, oa Special Devices
Ciry Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
t/ � Other Devices �� � ecl'�' tI �. ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. � (o �� C � 447-4230.
TYPE OF WORK 1 hereby apply for mechanical systems permit and I acknowledge that the information
ARerations _� Replacement New Construction above is complete and accurate; that the work will be in conformance with the ordi-
/ � nances and codes o# the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date 1 a/ /,r � g�j does not become a permft until signed by the BUILDING OFFICIAL; that the work will be
�U in accordance with the approved plan in the case of all work which requires review and
Est. Cost $`��� Bui{ding Permit # "'—� approval of plans.
HEATING PERMIT FEE $ � o , m Q � ��-.-- �� ,-�/_ �s-
STATE SURCHARGE $ .50 A IicanYs Signature Date
TOTAL PERMIT FEES $ Zo , b� Receipt # � � q / � ��- � � - 95
Buitdi Official's Signature Date