HomeMy WebLinkAboutHeating Permit 95-0245 � (� � 1. Pink - File
F PRIp�, U 3. Yellow - ConVacror
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° �, ; CITY �F PRIOR LAKE
� m� , 1 2� le , k Av. S.E. permit No. •�Z`'�� Single Family � Two-Fami6� MuRi-Family
� ��' � � Pfi�ke� 55372
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,; i y�� � Commercial Industrial Public Other
` N / PERMIT
Date �O''���L1�� �� ,��-�1�� ��� --� dOBVALUATION FEE
`�� �� � �,�������, $0 - $1,000 2/0 of pb value, min. $20.00
Site Address _ ► � ��
Lot � Block Addition �"� "$���� -$�0,000 $20.00 for the first $1,000 pius $1.25 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 ���'-'c `�`� �(11.E^3.0 A � ���1��J tional $100.00 or fraction thereof, to and including
d �so,000.
Heating Contractor �� �
Address \� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
�^ - tional $1,000 or fraction thereof.
Telephon # �� �
The price of your h�eating permit includes one rough-in and one final inspection.
Furnace e& Mode ��Ilnv 1Q�(� NPE OF SYSTEM Additional inspections witl be billed at �'� ""
Warm Air Plants
Model Size ,�►�7 Gravity HousE ED DU E Tp uilding �ermit number before build-
Conn. Load Mechanical ing cei CLpS IT $I3 0'01
Air Conditioning 1
Fuel �,'� Flue Size Vent. System � IN ACTIV supply and return openings listed
HEATING OR POWER PLANT Per rooi __...,.�ds or additions send ffoor plan with sup-
Supply Openings ply and ._..a��ons 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 ,�I� 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
ARerations Replacemer�t%� 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/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 ptan in the case of all work which requires review and
Est. Cost $„� �� �� Building Permit # a al of plans.
HEATING PERMIT FEE $ � � '� �,
�
STATE SURCHARGE $ .50 pli nY Sig ture Date
TOTAL PERMIT FEES $ Receipt # �-l� ��� /�� /8 — c � '
Building Official's Signature Date