HomeMy WebLinkAboutHeating Permit 95-0286 ------�---------- -_ -- ----- -,-- � 1. Pink - File
.-._. . . - � -, , ' ' ..
2. Green - Ciry
�.�°� F � j ;�,� �� C1TY OF PRIOR LAKE nrPE oF s�ucn�� 3. Yellow - Contractor
� ! rn �� 2$�'�0 Eagle Creek Av. S.E. Permit No. ��j�� Single Family � Two-Family MuRi-Family
' ''`�frior L�ke, MN 55372
` � � Commercial Industrial Public Other
� � - �ik�,,LICATION ! PERMIT
� JOB VALUATION FEE
Date '�� ��� PID # � ���'� �/�-�
r / � ��� �� � $0 - $1,000 2% of job value, min. $20.00
site Address i/_ i� Gf/�� � Ci��
Lot T Bbdc � Addition V�� �� $���� '$10,000 $20.00 for the first $1,000 pius $1.25 for each additionai
$100.00 or fraction thereof to and including $10,000.
Owners Name � L �i�l �'� 6G7 $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �� �"II � �I� L��F�� �-�- tional $100.00 or fraction thereof, to and including
Heating Contractor ���-``✓z �( 7_'3r1� �7' ��'2�'�S $50,000.
Address '� C� �c��1 \�, �, $50,001 and over _ $532.50 tor the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
c� Z� �
Telephone # � L � �-�
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted wkh building �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued. _.
Air Conditioning
Fuel Flue Size Vent. System HEAT GALCULATIONS REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT Per room with CFM's 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 APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output S e�evic s �
l_� Ciry 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
�m. 447-4230.
TYPE OF WORK I heseby app{y 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 with the ordi-
� nances and codes of the city and with the state building/mechanical cades; that this form
Repair Est. Comp. Date ��— �� �� � does not become a permit until signed by the BUI�DING OFFICIAL; that the work wi!! be
U � in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ / S G' Build(ng Permit �. approval of plans " ,�
HEATING PERMIT FEE $ ^�'"� c3 � � '� ���
STATE SURCHARGE $ .50 IicanYs ' ture Date
TOTAL PERMIT FEES $•�� T � Receipt #��/�� � l- � ""
Bui ng cial's Signature Date