HomeMy WebLinkAboutHeating Permit 95-0028 �,
R c 4 (�" r' " 1. Pink - File
' '`�' �� �-� - ,- 2. Green - City
� pR' i � � �� � TYPE OF STRUCTURE 3. Yellow - ConVacror
., � � CITY OF PRIOR LAKE �!
� �. � 4�29 [�TA, TREET S.E. Permit No. _ r� Z � Single Family V Two-Family Multi-Family
, � PRIOR LAK � , 55372
Commercial Industrial Public Other
HEATING APPLICATI�N / PERMIT
Date �lu� PID# -.Z. �'
D 3�_ � JOB VALUATION FEE
Site Address 3 j �^ � � $0 -$1,000 2% of job value, min. $20.00
Lot � Block � Addition WCJ�rI ��'e �.��ar(°S a/t�i'�� $�'�� �$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.
0
Owner's Name r' L
$10,00� -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 173� ,lf�r� ��Tra; s� tional $100.00 or fraction thereof, to and including
Heating Contractor �� { � $50,000.
Address $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone #
�7- }. O The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model 6�'� �'Cr�� TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm
Model Size Gravit "^���A Heating Test Record must be submitted with buildinq �ermit number befora build-
Conn. Load Me�n cLOSED D� TO fi���e of o����� W��� be �SSUed
1 � Air ca INACTIVITY 8/30/O 1
Fuel �r Flue Size Vent �ALCULATIOMS REQUIRED with number of supply and return openings listed
rm wiih CFM's per opening. New structures or additions send floor plan with sup-
SupplyOpenings H �""'� - ,d return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water Arr�ICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices
Edr. City Hall business hours are 8 a.m. - 4:30 p.m.
Other Devices ALL 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
Atterat;on ✓ Replacemertt FVew Construction above is complete and accurate; that the work will be in conformance with the ordi-
F� h�S�j �� � nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date /'�C ��� does not beoome a permit until signed by the BUILDING OFFICIAI; that the work will be
[- .�-' � p� in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ ��7 � Building Permft #�" ��� b val of plans.
HEATtNG PERMIT FEE $ � 1� • 7J � . 2,�_� a
STATE SURCHARGE $ .50 IicartY Signatu Date
TOTAL PERMIT FEES $_ �, 9• � Receipt # II 2� Z'�� �
i ing Signature Date