HomeMy WebLinkAboutHeating Permit 95-0289 s �^ - �,"� �" "- 1. Pink - File
D T . �, t �. 2. Green - City
.��� pR ' J��� ��ITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
� 8 le Creek Av . S.E. r
� �+ ; ��V ��� 9 Permit No. 5�� Single Family �_ Two-Famiy MuRi-Family
�' � Prior Lake, MN 55372
I;r Commercial industrial Public Other
� - �NG APPLICA�TION / PERMIT
_._-----� - JOB VALUATION FEE
Date �� (� ° 9 S � PID #�� Q.3�-' d �3 �
$0 -$1,000 2% of job value, min. $20.00
sice nddress y a� �R� ��e L� N� �'
J ` $1,001 -$10,000 � $20.00 for the first $1,000 plus $1.25 for each additional
Lot J� Block Addftion�tG�n �e,�,�,/�j� Q� $100.00 or fraction thereof to and including $10,000.
Owner"s Name �e ��•n1
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �.O�m-� tional $100.00 or fraction thereof, to and including
Heating Contractor ���}-� /�f�E���ilC�� . ,Gyc� $50,000.
Address �✓ .�� C7 �n� �1. � r--� .�v�e ./�?�LS. S�f�� �0,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # 7� �- �� �i(
,�o� h� The price of your heating permit includes one rough-in and one final inspection.
FuFaase Make & Model S A�' �� T1fPE OF SYSTEM Additional inspections will 6e h�iio�+ �' "'^� "'
Warm Air Plants
Model Size .s ' n!� Gravity "ouse � CL pSED DUE TO Idin�nermit number before build-
�' Mechanical _ ing certil
Conn. Load 'Sy� d l � S y 8/30/0
�� � Air Conditioning �ACTIVIT
Fuel Flue Size S Vent. System bEBI� ipp�y and return openings listed
HEATING OR POWER PLANT per room __.....,...�o� �r additions send floor plan with sup-
Supply Openings � Steam ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Return Openings I Hot Water o�• r APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input �D� Output �.� O� Special Devices
Ciry Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices pLL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
ARerations 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; ihat the work will be
Q .o _ in accordance with the proved plan in the case oi all work which requires review and
Est. Cost $ �i ?00, r Building Permit # approval of plans.
HEATING PERMR FEE $ �• �S l� 3Q-g �
STATE SURCHARGE $ .50 Appli nt's Sig ture Date
TOTAL PERMIT FEES $ S� � Receipt # ,� 7 I � `( ��— ' � � �
Buildi Official's Signature Date