HomeMy WebLinkAboutHeating Permit 95-0244 �.._.___-._- -__- ._- — 1. Pink - File
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F PR/p�, �_ 2. Green - City
.�° C CITI( OF PRIOR LAKE TYPE OF STRUCTU6f 3. Yen� - c�,��
� 6 Ea le Creek Av S.E. 2�(�
� • m; ��� �� `�� 9 Permit No. f`� Single Famify 'fwo MuRi
r Lake, MN 55372
; � `` ��� Commercial Industrial Public Other
i�1fA�IN6 °L.1CiAT10N / PERMIT
Date��������'��'� �(��-- � —t� JOBVALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Site Address �` Y s� d; v- � v� d J' �S
a' �� $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block Addition ` $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, te and including
Heating Contractor J� v°� �5 U j'' � ��,�,� ;►'�y $50,000.
Address � S r� �-� �' �t �� ��. 001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
s� �.. � �a�,� �
� �� f / `l � � �� tionaf $1,000 or fraction thereof.
Telephone # t� �"
The price of your heating permit includes one rough-in and one final inspection.
Fumace Make & Model C�/"� TYPE OF SYSTEM Additionat inspection� w��� �° ��"��' -• °"" "" .
��� � } � Warm Air Plants
Model Size Gravity House Heating Test CLOSED DUE TO ,11t�ID�1 before buitd-
Conn. Load ���� Mechanical iny certi�icate ot occ� �AC g�3 ��� 1
Air Condftioning
Fue1 Flue Size Vent. System HEAT CALCULATK 3turn openings listed
per room with CFM's „___._ __. __._..... ... a...,�.�.,��� 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 Specia{ 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
Alterations � 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 with the state buildinglmechanical codes; that this form
Repair Est. Comp. Date does not beoome a permft until signed by the BUILDING OFFICIAL; that the work will be
in ac�ordance ' e pproved plan i the case of all work which requires review and
Est. Cost $���� Building Permit # °""'�"--' approv
HEATING PERMR FEE $ �. � D �� f 9�
STATE SURCHARGE $ .50 plicant's ; gnature Date
TOTAL PERM17 FEES $ �Z,� , � Receipt # �d 7 I� �� � � �
uildi Official's �gnature Qate