HomeMy WebLinkAboutHeating Permit 95-0269 ��� �i� �J L�, �! �r� ��i �-\'
� � ; , i � � 1. Pink - File
'/ QF � � � ��, TYPE OF STRUCTURE 3. Yenow - Ontractor
OV '��`iY � .� PRIOR LAKE
�� � 16200' le Creek Av. S.E.
� m .���! Permit No. 45 Single Family Two MuRi
ke, MN 55372
� Commercial Industrial Public Other
ICATION ! PERMIT
Date
f/ 7��-� PID # ZS ' D Z c�l° D/� O JOB VALUATION FEE
��53 ,,-�_ �¢ Gw �r /✓�G $0 - $1,000 2% of job value, min. $20.00
Site Address �,3! . ,
Lot � Block / Addition C�r�raN;�� �C N LH $���� '$�0,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owners Name .�L� Yt� �C 1�C—Gn�'�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address SI�M�' tional $100.00 or fraction thereof, to and including
Heating Contractor //l� L,E y�13E,� $50,000.
Address $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # S�S . ,� .�,3 8' 7
The price of your heating permit includes one rough-in and one final inspection.
Furnaoe Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm A+r Plants
Modei Size Gravity House Heating Test Record must be submitted with guilding nermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System � �er of supply and return openings listed
HEATING OR POWER PLANT F CLOSED DUE TO es or additions send floor plan w'rth sup-
SupplyOpenings p�ACTIVIT� 8/30/O1 S CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water A TY OF PRIOR LAKE, 4629 Dakota St.
Radiation �
Input Output Special Devices
City Hafl business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices n�<,�•4 ALl WORK MUST BE INSPECTED (ROUGH-IN ANQ FINAL) - CALL GTY HALL
Cfm. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
ARerations ReplacemeM _� New Construction above is complete and accurate; that the work will ba 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 accordance with the approved plan in the case of all work which requires review and
Est. Cost $ d�� Building Permit # approval plans.
HEATING PERMI7 FEE $ �-S• � 0 � � / �' �.S
STATE SURCHARGE $ .50 plicant's S' t Date
`� - Il �S� 9�
TOTAL PERMIT FEES $ 7Fs •`�� Recaipt #�� �� 2 -
uildin icial's Signature Date