HomeMy WebLinkAboutHeating Permit 95-0150 � g (� �� 1. Pink - File
2. Green - City
OF P �, ;i-- - TYPE OF STRUCTUFiE 3. Yellow - Contracror
., � � - - T` �ITY OF PRIOR LAKE
� �8200 Ea le Creek Av S.E. ��
� '; m � 9 Permit No. Single Family � Two Multi
� 2 7� rior Lake, MN 55372
Commercial Industrial Public Other
" HEATING APPLICATION / PERMIT
Date
t�/J ` lit7'"'� � PID # o��'�-I� I� D �OB VALUATION FEE
Site Address -� � $� '$ ��� 2% of job value, min. $20,00
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Blodc Z. Addition
$100.00 or fraction thereof to and including $10,000.
Owner's Name C -�[� �. �
-� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ���---�-- � S� � tional $100.00 or fraction thereof, to and including
Heating Contractor Burnsviile f;e�ting & A/C, inc. $so,000.
O@ S 811 VB. . $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address Savage� MN 55378-1122
Telephone #
894 tional $1,000 or fraction thereof.
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building c�ermit number before build-
Conn. Load Mechanical ing certif'�cate of occupancy will be issued.
Air Conditioning �`�..I�,� .._ _ _ _
Fuel Flue Size Vent. System Z with number of supply and return openings listed
HEATING OR POWER PLANT CLOSED DUE TO Vew structures or addftions send floor plan with sup-
Supply Openings HEAT LOSS CALCULATIONS, PAYMENT AND
Steam INACTIVITY 8/30/O1
Return Openings Hot Water TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation
Input Output Special Devices
City Hall business hours are S a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations � Replacement 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
��^y�� / �/ in axordance with the approved plan in the case of all work which requires review and
Est. Cost $ � j/�W' Building Permit # Q� D��d' approval of lans.
HEATING PERMIT FEE $ . Q � �� / �
STATE SURCHARGE $ .50 'canYs Signatu Date
n > T��O �
TOTAL PERMIT FEES $ O" �� Receipt #�� 7(� Building ' ial's Signature Date