HomeMy WebLinkAboutHeating Permit 95-0224 ---..�,.___ • 1. Pink - File
2. Green - City
�.��� pRIOR 9 Y � � =f-- �ITY OF PRIOF� LAKE TYPE OF STRUCTURE 3. Yeqow - Contracror
u rn`" 4629 DAKOTA STREET S.E. permit No. ��-2-� Single Family __ �� Two-Family Mufti-Family
S� ���KE, MN 55372
'i' '�J � ATING APPLI , �q�� fJN / PERMIT Commercial Industriai Public Other
Date �-�- =, �p�p� ��`"-� �(�� ..� JOB VALUATION FEE
�
Site Address 3a�7 e � $0 -$1,000 2% of job value, min. $20.00
Lot .3 Block �� Addition �r�/1 ��e /Q���,� f� $��� '$�0,000 $20.00 for the first $1,000 plus $1.25 for each additional
—r--� $100.00 or fraction thereof to and including $10,000.
Owner's Name �LU� /7U ��'�
Address 3vC / � ��� � � P� �� $�0,001 - $50,000 $132.50 for the first $10,000 plus $1.00 for each add9
tional $100.00 or fraction thereof, to and includin
Heating Contractor �f.� � 7- $50,000.
Address /Zr�(Q('j /� /,.C�S�►.'1�j 7,(}-� 2� ��? ��� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone# �F'�a`'��U' 377� The price of your haaf��^ -ermit includes one rough-in and one final inspection.
Furnace Make & Model L. en� �� TYPE OF SYSTEM lled at $25.00 each.
Warm Air Plants
Model Size � a�'Q o � 7,� Gravity CLpsED DUE T 1 �st be submitted with building permit number before build-
Conn. Load Mechanica� �ACTIVITy 8/30/0 be issued.
Air Conditioning
Fuel �Z� Flue Size ��� Vent. System _�RED with number of supp�y and retum openings listed
HEATING OR POWER PLAN1 �r 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 7�� 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 CtTY HALL
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and 1 acknowledge that the information
Afterations Replacement � New Construction above is complete and accurate; that the work wi!! be in conformance with the ordi-
J nances and codes of the ciry and with the state building/mechanical codes; that this form
Repair Est. Comp. Date _ ���� / 7J" does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ l, 9�10 �� Building Permit # •�— app val of p(ans. �
HEATING PERMIT FEE $ .�� . �� � 9��a �gS
STATE SURCHARGE $ .50 ApplicanY Signature Date
TOTAL PERMIT FEES $ � � Receipt # eC.kO b� �
B' ding Official's Signature Date
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