HomeMy WebLinkAboutHeating Permit 95-0257 ^,,...,�.. ,
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�F PRI '� ;"`W= -== -'� -= -�� TYPE OF STRUCTUF�E 3. Yellow - Conuactor
�.� � CITY OF PR14R LAKE
� �, Q�T ,� {��a ��Creek Av. S.E. permit No. �S��S7 Single Family � Two-Family Mufti-Family
, ' � Prior �� y ' �IAN 55372
� L ` V Commercial Industrial Public Other
HEATING APPLIC�►TION / PERMlT
Date� � b�/ PID # �.�-�� —(j� �'� �OB VALUATION FEE
Site Address S' ��a '�� ,,..� $0 -$1,000 2% of job value, min. $20.00
. $1,�1 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additionai
Lot �� '`� Block Addition ,c.t��`� `°'�� ,,-� $100.00 or fraction thereof to and including $10,000.
Owners Name �r �/ � G +�.�..i-�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
Heating Contractor C.� � v`L '� d'�S dr�� y� $50,000.
Address / � �a S ,/v�y �J�-e wl�t, /�e �� ,�1 _ 1�J �� \ �,��0,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
� f tional $1,000 or fraction thereof.
Telephone # '� S`S `� 6 Y6 �
The price of your heating perm�t �^�'�- ' �ne rough-in and one final inspection.
Furnace Make & Model ��^" d � 3 � 7'1(PE OF SYSTEM Additio��� �--- � �ch.
Warm Air Plants
Model Size ' Gravity � CL 4SED DVE T O � �►ith ¢�,,iilding �ermit number before build-
Conn. Load 3 D� L�b Mechanical � ACTI VITy g130
- Air Conditioning IN
Fuel Flue Size Vent. System
b .....���uer of supply and return openings listed
HEATfNG OR POWER PLANT P� -• ��� � 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 APPLlCAT10NS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input 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
Alterations � Replacement New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and codes of the cfty and with the state building/mechanical codes; that this form
Repair Est. Comp. Date l� �� }�� does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
�� � in accordance with t a oved plan ' he case of all work which requires review and
Est. Cost $ Building Permit # approval
HEATtNG PERMIT FEE $ �.(� , dO � �� �.� � J T �
STATE SURCHARGE $ .50 nt's Sign ture Date
TOTAL PERMIT FEES $�->�O Receipt # �� a 3 q � � Sr��
Building �ial's Signature Date
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