HomeMy WebLinkAboutHeating Permit 95-0295 1. Pink - File
� pR 2. Green - Ciry
.,° �, CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
�' 16200 Ea le Creek Av S.E. c 1�'�2TS
� m 9 Permft No. Single Family Two-Family Multi-Family
Prior Lake, MN 55372
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT
Date �� - 7- 9 S PID #�- /L.3 -(} O�� p �OB VALUATION FEE
�, D � $p - $1,000 2% of job value, min. $20.00
Site Address
Lot Block Additio (J $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owner's Name ,�J �
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �� o� d' /SO f�, 5� tional $100.00 or fraction thereof, to and including
HeatingContractor Pr�� o c- ti.c 1C� �'�� tl- /�� G $50,000.
Address ��o �a � /�`,� � �, Q � c `i'� � P� � $50,001 and over $532.50 for the first $50,000 pius $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # �y 7 - � � 1 � _
� R i ��� .� The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model /`� 9y TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
�arm Air Plants �
Model Size �U �� L5 C�'y.� Gravity House Heating Test Record must be submitted with buildinq �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System HEAT GALCULATIONS REQUIREQ 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 Openir�s Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input �i�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 HALL
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permft and I acknowledge that the information
Alterations 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; that the work will be
��U ,,,,�. in accordance with the approved plan in the case of all wo�lc which requires review and
Est. Cost $/Svb Building Permit� ,�`°�"""''"""'�'�'� �.�,�: .44,. approval pans.
HEATING PERMIT FEE $�,� � . o� S �� - � � ��
STATE SURCHARGE $ .50 A pli nYs Signatur Date
TOTAL PERMIT FEES $�„ .7s Receipt #,� 7,Z.� �
/� -/ 3-�'�
Buil ing Offi I's Signature Date