HomeMy WebLinkAboutHeating Permit 95-0254 � — � _; _ � ._ - . .. � 1. Pink - File
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.,p.. CITY 4F PRlOR LAKE �'�
�` ' 62 Ea le Creek Av. S.E. �b-Z6`�
�,,' 2 5� Q� 9 Perm' No. Single Family Two-Family MuRi-Family
Pr�clr Lake, MN 55372 �
� HEATI Ai�PLICATION / PERMIT �mmercial �_ Industrial Public Other
.....� JOB VALUATION FEE
Date '� — PID # oZ-�'-� � � � Q C �- �
$0 - $1,000 2% of job value, min. $20.00
Site Address T � .
Lot � Bbck � Addition .� $�.�� -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and ir�luding $10,000.
Owner�s Name
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �1'N� tional $100.00 or fraction thereof, to and including
Heating Contractor \ ✓C-'� $50,000.
r � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address tional $1,�0 or fraction thereof.
Telephone # T � '� The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model C�- -- � 6 TYPE OF SYSTEM � Additional inspections will be billed at $25.on each.
�,,/ Warm Air Plants
Model Size �� �'�� Gravity Housa u^-'° " � Zo I with building �ermit number before build-
Conn. Load �� �,'� ���_ Mechanical L�SED DtJ 1
Air Conditioning C Q��
Fuel ����Flue Size Vent S � ACTIVITY 813 �er of supply and retum openings listed
4� es or additions send floor plan with sup-
Supply Openings � HEATING OR POWER PLANT � __„� HEAT LOSS CALCULATIONS, PAYMENT AND
�{ Steam
Return Openings -L� Hot Water A, .��..N � IONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
� Radiation S.E. Prior Lake, MN. 55372.
Input�1�?T(� Output 0 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. l �� � 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations ReplacemeM �_ 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. C�np. Date does not me a permft until signed by the BUILDING OFFICIAL; that the work will be
6 in accor nce with the o ed plan in the case of all work which requires review and
Est. Cost $ -C Building Permit # ""�-- approv lan
HEATING PERMIT FEE $ :.L D ° � � '�- �
STATE SURCHARGE $ .50 Applican S' nature Date
TOTAL PERMIT FEES $ �-I• �-� Receipt # �Z �d � � /G-30 — 9S�
Buildin Official's Signature Date