HomeMy WebLinkAboutHeating Permit 95-0120 �—
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"` ., � � "�iTY, OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Conuaciar
�� �,�46�� `�1KOTA STREET S.E. Permit No. r� "� ZD Single Family Two-Family Multi-Family
LAKE, MN 55372
Commercial lndustrial Public Other
A PLICATION / PERMIj
, �� ��, ,, � JOB VALUATION FEE
Date 5� �'7 S PID # /� -
� � . $0 - $1,000 2% of job value, min. $20.00
Site Address � a77 M
, y� � ,� � J� -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block �-' Addition� ' � ��
$100.00 or fraction thereof to and including $10,000.
Owner's Name �.�ti �����.�,�a.r�� �
$10,001 -$50,000 $132.50 for the first $i0,000 plus $1.00 for each addi-
Address 1'1,�71 �"C c�►�iv,r T� ,/L •�Z- • tional $100.00 or fraction thereof, to and including
Heating Contractor F �'��n,v��!�i� �-}-�, �-" A'� c� $50,000.
Address W I� W ✓�-�` � 1ti1,� �� � S SY �' � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
� tional $1,000 or fraction thereof.
Telephone # �}nZ`i
The price of your heating permit includes one rough-in and one final inspection.
� Make 8� Model �,� _ TYPE OF SYSTEM AddRional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size SLa I Gravity House Heatina Tp�* o°-- ' ist be submitted with building permit number before build-
Conn. Load Mechanical T , O be issued.
Air Condftioning C LpSED DUE
Fuel � Flue Size Vent. System g/30/01 B� W�h number of supply and return openings listed
HEATING OR POWER PLAN INACTIVITY g. New structures or additions send floor plan with sup-
Supply Openings n. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water _ -- ••���•� MAY 8E MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MPI. 55372.
Input 3 Q � �� � Output 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 FINAL) - CALL CITY HALL
Cfm. t G c Q 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations ReplacemeM New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est, Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
in accordance with th proved plan in the case of all work which requires review and
Est. Cost $ +.2�0('�. �C'� Bu+lding Permit # approval of plans.
HEATING PERMIT FEE $ .� � ,� d� �� •15 � � I 1 �'`r S�
STATE SURCHARGE $ .50 App canYs ignature Date
2�( -2.5� `.� G -�-���
TOTAL PERMIT FEES $ �- Recei't #
Buildi Official's Signature Date
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