HomeMy WebLinkAboutHeating Permit 95-0126 `� j i, ��,� ����� 1. Pi�k - File
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2. Green - City
�.�°� � .� / OF PRIOR LAKE TYPE OF STRUCTURE 3. Yeilow - Conuacror
� ��� D A STREET S.E. permit No. ��2 � Single Family k Two-Family Mufti-Family
PRIO E, MN 55372
Commercia{ Industriai Public Other
HEATiNG APP CATION / PERMIT
Date a�0 .,S' PID # o�J � D�D 'I� JOB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Sfte Address � l /J JI 1°.u� . N�� ,
Lot �- Biock a Addition „�,u,�..� $1,001 -$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.
Owner's Name ��tt� L.�'N G1
C $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ( 4 � (o'f � t D��/►� �/ �� �IQ _N �G _ tional $100.00 or fraction thereof, to and including
Heating Contractor 11� 1/� 1 i $50,000.
Address QT/ /� � �� �1 �$50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
G,/ tional $1,000 or fraction thereof.
Telephone # 7 7/ ����� � ---- �e.mit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM CLOSED DUE Tp 625.00 each.
Warm Air Plants
Model Size Gravity jNACTIVITy g�3 p�� 1 submitted wfth building �ermit number before build-
Conn. Load Mechanical ued.
AirCondition LLNi✓G,r I S
Fuel Flue Size Vent. System HEAT CA�c:u�„ �,.,.._ _ 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 CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input 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. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations Replacemertt FVew 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
i' �_ in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ ��i a7.� Building Permit # prov of plans. 4 �
HEATING PERMlT FEE $ .��9�"'3 v ,,� � 7� - � G ,f �
STATE SURCHARGE $ .50 pplicanYs Si ture _ Date
TOTAL PERMIT FEES $ Receipt # � b I�� —�=---���-
Buildi Official's Signature Date
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