HomeMy WebLinkAboutHeating Permit 95-0267 �,Q� •-----------�----._ , -----_--- - , 1. Pink : File
� � " (r�" '�-` " r, � ' � � 2. Green City
1,.�°� j° '� 9 ` CiTY OF PRiOR LAKE rJ TYPE OF STRUCTURE 3. Yellow ca,�
�� �' 1620p Ea le Creek Av. S.E. ���
u �,_ 7� 9 Permit IJo. �6 '� � Single Family Two Mufti
Pi�ioi � Lake, MN 55372
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�� / PERMIT �mmercial Industrial Public Other
I JOB VALUATION FEE
Da�"' � PID # �.� - �.� 7 �- D�I ' D
� S � ` $0 -$1,000 2% of job value, min. $20.00
Site Address ✓�ri 1 � � !• � ,/�
' c $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additiona)
Lot �_ Bbck �.. Addition � � �✓ $100.00 or fraction thereof to and including $10,000.
Owne�'s Name C� h Q ✓' �' �"'�� �- $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tionat $100.00 or fraction thereof, to and including
Heating Contractor L � � ,, ; � �� D � 1 �,�+� � .`� $50,000.
Address �� � � .� /(�� �,���0 � �, �+� .�� ,/►.� /,,,� � b a � �50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
�y, �a�'f tional $1,000 or fraction thereof.
Telephone # �S`S` -� ����'
�� �� The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model �S ��' ��✓�< TYPE OF SYSTEM Additional inspections will be biiled at $25.00 each.
, Warm Air Plants
Model Size � Gravity House Heating Test Reoord must be submitted with building flermit number before build-
Conn. Load _�U/�� Mechanical -. ... 01 �� �ssued.
�, Air Conditioning CLOSED
Fuel Flue Size � Vent. System DU � T� th number of supply and return openings listed
INACTIVITy g j3 ��O 1 r structures or additions send floor plan with sup-
Supply Openings � HEATING OR POWER PLANT ;AT LOSS CALCULATIONS, PAYMENT AND
Steam ) THE CITY OF PRIOR LAKE, 4629 Dakota St.
Retum Openings Hot Water ^' ' -�-
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices �
� City Fiall 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
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afteratwns � 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 does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
/ � — in �cordance with th proved plan ' the case of all work which requires review and
Est. Cost $ �..�[ -CJ Building Permft # approval of pla
�-°�''
HEATING PERMIT FEE $ �� �"� /�� 7 9,�
�
STATE SURCHARGE $ .50 p 's Signature Date
TOTAL PERMIT FEES $ 2a `S� Receipt # Z. � ��'� �( /� ��
Buil ing Off�i Signature Date