HomeMy WebLinkAboutHeating Permit 95-0306 1. Pink - File
� l 3. Yellow - Contracror
�.��� pR'Oq CITY OF PRIOR LAKE �PE OF STRUCTURE
� m 16200 Eagle Creek Av. S.E. permit �1 . RS- Single Family �� Two-Famiy MuRi-Family
Prior Lake, MN 55372 ;
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT
Date
�0���3 �9J� PID # o��` �I 7� �� 7"�/ JOB VALUATION FEE
L � $p -$1,000 2% of job value, min. $20.00
Site Address
� f _ j B � � ? $1,�1 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
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$100.00 or fraction thereof to and including $10,000.
Owner's Name 1 1 \�`S � A \ �� (� (� �
- $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address \L� 1�.1 g 1�. s� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor
Address � $50,001 and over �532.50 fot tha first $50,004 plw �7.50 for each addi-
tiortal s1,000 or fraictbn �.
Telephone # '�F�� - c '�� ��� „ ._ .� . _ . . . . � ,. _ , .,�. _..:. _ .- . _ ._ ---
The price of your he pection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections �
Job Address
GrnpS}.�R, Warm Air Plants !{ouse Neatin Test R I � 8 � � �• re build-
Model Size Gravity g Heating Contractor
Conn. Load Mechanical ing certificate of occu Name of Tester
Air Conditioning
Fuel T� Flue Size �� t Vent. System ✓ Date ' a_ 1�^ 9s listed
HEATING OR POWER PLANT per room with CFM's — �! with sup-
Supply Openings Steam ply and return loca NT AND
APPLICATIONS MA Percent OZ q akota St.
Return Openings Hot Water S.E. Prior Lake, MN.i �' �!
Radiation Percent CO c�
Input Output � Special Devices City Hall business h� Stack Tem ? � . ,`O
P ' o
Edr. i
Other Devices ALL WORK MUST � y,, ALL
Cfm. � ��'�" �''nT � • �-�b+- /p
TYPE OF WORK I hereby apply for i information
ARerations Replacemerrt _� New Construction above is completei h the ordi-
�., nances and codes � at this form
Repair Est. Comp. Date — does not beoome a pe�m7[ �mnr s�,�,,-___ _ work will be
in a�cordance with the epprowd plan in ttw case of � virotk wt►ich �eqrnre review and
Est. Cost $ �d. 0� Building Perm' # a roval of plan .
�
HEATING PERMIT FEE $ � O. �b Lj
STATE SURCHARGE $ .50 �' plicant's S'gnature Date
TOTAL PERMIT FEES $ . , �i� Receipt # Z7�1 �� / � "��
Buildi icial's Signature Date