HomeMy WebLinkAboutHeating Permit 95-0279 ^�� � �(`; � ` ,_3' �7 �� j��1
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�F PRtp 4 � TYPE OF STRUCTURE 3. Yelfow - Corrtracmr
�.� � �,�V 2 �� O� PRtOR LAKE
� m 16200 E' �, Creek Av. S.E. permit No. �S- �?� Single Family Two-Family Mufti-Family
' �,. _____._�_.--_..-p�tak�, MN 55372
_____..-_...------� � Commercial Industrial Public Other
- � �� ��'EATING APPLICATION / PERMIT
Date
��"� U .� P{D #� 67-I "O O � JOB VALUATION FEE
/ � � � �� S � � $0 - $1,000 2°1a of job value, min. $20.00
Site Address �P
Lot � Block __�__ Addition �b�I�SU i �.�-�. !T! (rZ.S /j �`�-� ��'�� '$�0,000 $20.00 for the first $1,000 plus $1.25 for each additional
7 $100.00 or fract�n thereof to and including $10,000.
Owner's Name i'���^- �� � l� "�U �U� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 1C� �J '�f ��'�"G� �� 1�� �� tional $100.00 or fraction thereof, to and including
, � ^l $50,000.
Heating Contractor � ,Zf �-!�l �- �- �1�� �/!�� �-R--
Address �n f.s � / v vt � N tq-V-e-- � r'� �/� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,�0 or fraction thereof.
� elephone # T �Q � ��° a CJ
�� �� ^ The price of your heating permit includes one rough-in and one final inspection.
ake & Model-�-�S� FCu,� r-�--TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
1� i�.�,.at' ��glarm Air Plants
Nbdei Size Gravity House Heating 7est Record must be submitted with building crermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuel Ftue Size Vent. System I with number of supply and return openings listed
u structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT C DUE TO :AT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water INACTIVITY 8/30/O l ' THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation
Input Output Special Devices
- -, . ._.. ___...--- .._..... .,... ., ....,,. �.�0 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. �a S � p 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations Replacemerrt 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
1 in ance with the approved plan in the case of all work which requires review and
Est. Cost $ D Bui4ding Permit # a va of plans. �
HEATING PERMIT FEE $ �� ��� � "�-� - �S
STATE SURCHARGE $ .50 I' ignatur Date
TOTAL PERMIT FEES $ 3 �� S� /Receipt #_ �I �S
/�- 2 Z - t!�""
� Building Offi ' I's Signature Date
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