HomeMy WebLinkAboutHeating Permit 95-0243 -- -- - -- ;
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`} . ` '. 1. Pink _ File
F PRI ,'; i . �.:._. �.'- - 2. Green City
��o , i�� J� T�F ,pRIOR LAKE � TYPE OF STRUCTURE 3. Yellow - Contractor
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� 4 s a k Av. S.E. permit No. � Single Family Two-Family Mufti-Family
� Prior N 55372
u Commercial Industrial Public Other
TION / PERMIT
Dat� �d '�� PID # 'I7L"" OZ�—� �OB VALUATION FEE
� � $0 -$1,000 2% of job value, min. $20.00
Site Address 3� � t �
/� �/� � $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot L Blxk � Addition 1.���dL
$100.00 or fraction thereof to and including $10,000.
Owner's Name �,/ t� r�'L ✓'�'C 5'C � $10,001 -$50,000 $132.50 for the first $10,000 plus $i.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
Heating Contractor G'' ✓ ° ` � �v+^ S ,/�� `w� $50,000.
� 1 �` , $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address ��-�� /vs1 !K`���// `� �� .�� ���� tional $1,000 orfraction thereof.
Telephone # � �� ���
;ludes one rough-in and one final inspection.
Furnace Make & Model ��!`'� TYPE OF SYSTEM CLOSED DUE TO ?5.00 each.
Warm Air Plants �JACTIVITY 8/3 0/O l 9
Model Size Gravity ibmitted with buildin �ermit number before build-
Conn. Load .3 O/ �-� Mechanical 3d.
° Air Conditioning
Fuel Flue Size Vent. System HEAT CALCULATIONS REQUIRED wfth 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 p�y 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.
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 CITY HALL
Cfm.
447-4230.
'TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations � Replacement New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and codes of the city and w8h 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 accordan� with the approved plan in the case of atl work which requires review and
Est. Cost� � Building Permit # approval
HEATING PERMIT FEE $ � • � � ��-��� � �i�
STATE SURCHARGE $ .50 Applican' Signature Date
TOTAL PERMIT FEES $ �• � v Receipt # �Z� q�L ld
ding Official's Signature Date
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