HomeMy WebLinkAboutHeating Permit 95-0273 � c�1 1. Pink - File
\ 2. Green - City
��°� p �� OR 9 CtTY OF PRIOR LAKE TYPE QF STRUCTURE 3. Yellow - ConVactcr
� � � 16200 Eegle Creek Av. S.E. permit No. �S-2�3 Single Family Two-Family Multi-Family
Prior Lake, MN 55372
Commercial _� Industrial Public Other
" ` �.�� W � � HE1lTING APPLICATION / PERMIT
���C/I3I�'� � PID # 2 S"D � I�'I O �,� �OB VALUAT�N FEE
Date
� J} �� n� ^ a Q $0 -$1,000 2% of job value, min. $20.00
Site Address (D�i �� \ YS.L3.
g�C� -✓ �� —( 3 $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.
Owner's Name ��� � ��'�Q. $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address � �(`L`,f�l L.J�� tional $100.00 or fraction thereof, to and including
Heating Contractor ���� L1 � $50,000.
Address �9a� ���_�W ��b� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # � ��� `��� �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model �C1JI�IOX TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
�'i'C�.�° - I � Warm Air Plants
Model Size Gravity House Heating Test Rec cLOSED DUE TO � before build-
Conn. Load Mechanical ing certificate of occupar .
Air Condftioning
Fuel .���s Flue Size ��� Vent. System HEAT CALCULATIONS INACTIVITY S�3O�O1 � openings listed
HEATING OR POWER PLANT Per room with CFM's pe �or plan with sup-
Supply Openings ply and return location� ����..,,. .._. .. _ PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input _�,��,Q 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 HAIL
Ctm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations ReplacemeM �� New Construction above is complete and accurate; that the work will be in conformance wiih the ordi-
nances and codes of the city and with the state buildinglmechanical codes; that this form
Repair Est. Comp. Date ���/�7 �QS 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 wo�lc which requires review and
Est. Cost $ g'� . � � Building Permit # "-- approval of plans
HEATING PERMIT FEE $ �� j a� �
STATE SURCHARGE $ .50 ficanYs Sign ure Y __._,_ ate
- /l�/ -�.�
TOTAL PERMIT FEES $ � r 7� eceipt # Buildin icial's Signature Date