HomeMy WebLinkAboutHeating Permit 95-0303 1. Pink - File
� PRiI �`� ,"�� �� _�'--- -- ,� 2. Green - City
., ?-- '�ITY OF PRIOR LAKE ; ��' � TYPE OF STRUCTURE 3. Yellow - Contractor
�
� � � m��� '��'� E�le Creek Av. S.E, p�, ' N �i� 3 Single Family W Two-Family Mufti-Family
1: ior Lake, MN 55372
' - . / PERMIT �mmercial Industrial Publ� Other
r � JOB VALUATION FEE
Date ��c' PID # .s�"� �~' �'��� �
� $0 -$1,000 2% of job value, min. $20.00
s�e nadre� b ,_ c�0 �
Lot �_ Bbck � Addition „j��� ` $1�00� -$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 ����\�' ���,� l�� 1.� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 'S�� L�t�'��DO� ���'ti-- tionai $100.00 or fraction thereof, to and including
Heating Contractor ����,�� �` ` $50,000.
Address �G- $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 ptice of your heating permit includes one rough-in and one final inspection.
Furnace Make & Modei �'� �4����`" '�1rPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with buiiding �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditionin
Fuel � Flue Size Vent. System HEAT CALCULATIONS 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 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 Output Special Devices C��.s _�—
City Hall business hou�s are 8 a.m. - 4:30 p.m,
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-tN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and 1 acknowledge that the information
ARerations �_ Replacemerrt New nstruction above is complete and ac:curate; that the work wiil be in conformance with the ordi-
nances and oodes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date �e� � does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
in accordance with the appr ved plan in the case of all wodc which requires review and
Est. Cost /.��� Building Permit # `'--� approval plans. �,
HEATING PERMIT FEE $ �-+�- � � ���y��_
STATE SURCHARGE $ .50 /" A icant's S' re Date
TOTAL PERMIT FEES $ �' 7 `� Receipt # o� 7`7� � 7 � �� 7
� Building ' ial's Signature ate