HomeMy WebLinkAboutHeating Permit 95-0253 .. � , , p , . ._
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�r , -� ' � � 1 . i ` 1. Pink - File
PRIp
' ` , ' 2. Green • Ciry
�.�°� ,�� CITY OF PRIOR LAKE ��-� TYPE OF STRUCTURE 3. Yellaw - ConVactor
u � m Qc� 2 0� DAKOTA STREET S.E. permi o. �-� ` Single Family � Two-Family Mutti-Family
� PRIO� �pJ4E, MN 55372
1 Commercial Industrial Public Other
, ' HEATING APPL�,CATION / PER �'�µ �
Date O- Y^��— �„- �t ��� �� � � 6 6' JOB VALUATION FEE
i7 � 5 r�. � �
Site Address � � ����� � $� -$1,000 2% of job value, min. $20.00
r $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot3 Block Addition � �✓
$100.00 or fraction thereof to and including $10,000.
Owner's Name � !� n1 � iAc�e,.�C'
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address /�7 �'IO 1) YvN �,,�e �•� � tional $100.00 or fraction thereof, to and including
�— $50,000.
Heating Contractor (�o �c c �csk l
Address t �-`1 � ��i (�� Q � , � � � �� ,�,�,5,, i �, p ,� , $5Q001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # �� R - 1,1�.�
, The price of your heating permit includes one rough-in and one final inspection.
�urnac� Make 8� Model � v��sl� ���vw r TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
' � � .��, � � Warm Air Plants
Model Size o Gravity House Heating Test Record must be submitted with building Qermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuel Flue Size 7 4 Vent. System HEAT CALCULATIONS REQUIRED with 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 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 � Special Devices
Edr. City Hall business hours are 8 a.m. - 4:30 p.m.
Other Devices �: cu� V�n,�L ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
, Cfm. I� � _ 'F r r� c��v� t� c 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 with the state building/mechanical codes; that this form
Repair Est. Comp. Date /o `'3 ��`1 S 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 $ ��-� � Buildi�g Permit # approval 1
HEATING PERMIT FEE $ � - o � � � �(, � �y , � �_
�
. STATE SURCHARGE $ .5� pplicanYs S' nature Date
� TOTAL PERMIT FEES $ oLU •� Recei #��1 U 7 ����' �
� —� Buildin Official's Signature Date