HomeMy WebLinkAboutHeating Permit 95-0065 ^ '� t. Pink - File
� ' � C�s � �� RiOR LAKE �: Ye'`"' _ �° �a`m'
TYPE OF STRUCTURE
9 �
� rn ��9 D A STREET S.E. Permit IVo. Single Family Two-Family Mufti-Family
��,: ; 2 3 "��t 10 E, MN 55372
Commercial Industrial Public Other
CATION / PERMIT
Date PID # �' — aZ 9� -' ��4 —O JOB VALUATION FEE
Site Address I� ` ` �' � $0 -$1,000 2% of job value, min. $20.00
—� r ,, $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block � Addition � �r, ��� ��� _ �c
$100.00 or fraction thereof to and including $10,000.
Owner's Name I. ,wn �.�.c.� � p
— $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �"j ���'i c^a�t„� i�/L �' _ tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor ���n p�,�rur,awe�acoNe�ws�,
Address ������� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
I �i1���---�..�
tional $1,000 or fraction thereof.
Telephone #
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections wili be biNed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building oermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning �/ � c;
Fuel Flue Size Vent. System ALCULATIONS REQllIRED with number of supply and return openings listed
pp y P g HEATING OR POWER PLAN CLOSED DUE °� 9• New structures or additions send floor plan with sup-
Su I O enin s Sieam � TQ �n. HEAT LOSS CALCULATIONS, PAYMENT AND
RetumOpenings HotWater 11V ACT ' IVj'rY 8�30/01 .ED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Input Output Radiation
Special Devices
Ciry nd�� ..,......_ �.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AMD FINAL) - CALL CITY HALL
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations Replacemer�t � New Construction above is complete and accurate; that the work will be in conformance wfth the ordi-
nances and codes of the city and with the state building/mechanica! codes; that this form
Repair Est. Comp. Date �3° �� �1 5� does not becom perm ntil signed by the BUILDING OFFICtAL; that the work will be
in ac�rda ith the approved plan in the case of all work which requires review and
Est. Cost $ t R��,�� Building Permit # ��' d��3 approval s
HEATING PERMIT FEE $ .�ii�,�''` 1
STATE SURCHARGE $ .50 . pplicanYs Sig ature Date
TOTAL PERMIT FEES $ 3 /�7.'� Receipt # 0���3oL•► � � _� � °�
Building ' ial's Signature Date
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