HomeMy WebLinkAboutHeating Permit 95-0256 (�..."_"_: �; — �------ - 1. Pink - File
OF ; � rQ �''� � �-�' � TYPE OF STRUCTURE 3. Yellow - C ntracror (
�� , , 9 CITY OF PRIOR LAKE �
� ��' C� ��� 9 DqKOTA STREET S.E. permit o. QS' 2 � Single Family Two-Family Mufti-Family
' ^"'pRIQ, �.�4KE, MN 55372
o �' �..�.. mmercial Industrial Public Other
` �ICATION / PERMtT
Date D PID #�— ���� Q/,� - V �OB VALUATION FEE
Site Address 15438 FORSYTHE RD SE $0 -$1,000 2%of jobvalue, min. $20.00
Lot �i�-�p Block � Addition ,� � ;.� $���� '$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owner's Name GEORG & CARO BROOKS
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 15438 FORSYTHE RD SE tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor RON' S MECHANICAL , INC .
Address 12011 OLD BRICK YD RD SHAKOPEE $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # 4 4 5- 8 5 8 5
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model �L/�?�57� NPE OF SYSTEM Additionat inspections will be billed at $25.00 each.
�/ Warm Air Plants
Model Size /vlJG /I'I ,��_ Gravity House Heating Test Record must be submitted wfth buildi g nermit number before build-
,• Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning -L 77?��
Fuel �� Flue Size Vent. System HEAT CALCULATIONS REQU�Rc^ '- �ly and return openings listed
�' HEATING OR POWER PLANT per room wi'` "� D 7 TE TQ ons send floor plan with sup-
Supply Openings ply and reti CL,psEI� � Olol .ATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIC CTI VITY g� �R LAKE, 4629 Dakota St.
Radiation S.E. Prior La! ��
Input � Output Special Devices
City Hall busir, _._ � d.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 WOljK I hereby apply for mechanical systems permit and I acknowledge that the information
� above is complete and accurate; that the work will be in conformance with the ordi-
ARerations Replacement �� New Construction
� nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date �dT j q' 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 $.�.' �� �� Building Permit # approval of plans.
�EATING PERMIT FEE $ � �J' �� 7� J� / j
v��� nYs Si ature Date
� STATE SURCHARGE $ .50 � p
: /
TOTAL PERMIT FEES $ � Receipt # � 7 �� G "` ` _ �� - ��
� 9 Z S- Buildin icial's Signature Date
�o"�'�' �