HomeMy WebLinkAboutHeating Permit 95-0001 1. Pink - File
pR� � 2. Green - Ciry
�.�"� '� � CITY OF PRIOR LAKE ���� TYPE OF STRUCTURE 3. Yellow - Conuactw
� m 4629 DAKOTA STREET S.E. Permit No. �S 0 � Singie Fam'ily � Two-Family Multi-Family
PRIOR LAKE, MN 553T2
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT
Date '� / PID # _ _ p JOB VALUATION FEE
Site Address C `� 3 � � (NQ �� ("--� ` /�-- - $0 - $1,000 2°,6 of job value, min. $20.00
Lot Bfock Add' ' n $1,001 -$10,000 $20.00 for the first $1,000 pius $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owner's Name /l �r/1�
� � �� � ���� � $10,001 - $50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
Heating Contractor $50,000.
Address � L �� f� � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # _ l/ CLOSED DUE TO �rmit includes one rough-in and one final inspection.
Furnace Make & Model Ct�✓/�� ��7m OTYPE OF SYSTEM �ACTIVITY 8/30/Ol Iled at $25.00 each.
/' � � p Warm Air Plants
Model Size LP � Gravity ist be submitted with building c�ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fue! �,_..� r- '� . ° 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 CALCULATIOIVS, PAYMEIVT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Input (L?� � � Output L�D� Radiation S.E. Prior Lake, MN. 55372.
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 FINALj - CALL CtTY HALL
Cfm.
447-4230.
TYPE OF WORJ� I hereby apply for mechanical systems permit and I acknowledge that the information
�� above is complste and accurate; ihat the work will be in conformance with the ordi-
Afterations Replacement New Constructio
nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date �� ' � does not become a permft until signed by the BUILDING OFFICIAL; that the work will be
� !,�„� in accordance with the approv d plan in the case of alt work which requires review and
Est. Cost $ �� •� S Building Permit # approval of ans.
HEATtNG PERMIT FEE $ v�' � /' � �y�' �
—t-�--
STATE SURCHARGE $ .50 Ap nYs ' nature Date
TOTAL PERMI7 FEES $ � Receipt # ��� X ` � � �
Buil ing Official's Signature Date