HomeMy WebLinkAboutHeating Permit 96-0249 PRIp i. Pink - File
�,°� R � CITY OF PRIOR LAKE �V � R ____ 3. Yel�lw - Contractor
� � 16200 Eagle Creek Av. S.E. p �o, � TYPE OF STRUCTURE
Prior Lake, MN 55572
HEATING APPUCATION / PERMIT �s��_ � I Single Family �_ Two-Family Mutti-Fami�y
//�� j� / p Commercial Industrial Public Other
Qate �TT (D P1D #� ol S � o� v a � '�.�.�, f _ �_ � �
Site Address � 1 � �Q �.I..,C J�.J�.� U � G�JI� l��l M c..� � -__. .� , _ _ --- ------�e�. $chedule
Lot �`�. Block � Addition !� o�� ����� I`.�5�: �`S� Ac� n industrial, Commercial & Multi-Family 1% of job cost ($39.50 minimum)
Owner's Nam 't � � (U ��.�..L �� � {�. Residential, Heating & AC $99.50
—� �,,���{ Residential, Heating Onty $64.50
Address 1 7�D� �,I�C�C� U �� W �� �L Residential, Gas Freplace �
��� ����' � ����� �� � � f ,� D � Residential, Additions & Alterations $39.50
Residential, AC Only $39.50
Address Q 7 7�� l0'V�. IC� �� �'V l�Q �.S � IU S S ,3 c�
Telephone # �i �� ���(�' Remember to add the State Surcharge on the bottom of this application.
Furnace Make & Model TYPE OF SYSTEM The price of your heating permit includes one rough-in and one final inspection.
�� Warm Air Plants
Model Size 33 Gravity Additional inspections will be billed at $35.00 each.
Conn. Load Mechanical House Heating Test Record must t� submitted with il 'n r i number before build-
Air Canditioning ing certificate of occupa�^•� ued.
Fuel Flue Size Vent. System
HEATING OR POWER PLANT � r� �� th number of supply and return openings listed per
Supply Openings ���i 1 �ctures or additions send floor plan with supply
Steam � O S�D T $ I3oIO 1 5 CALCULATIONS, PAYMENT AND
Return Openings Hot Water L � � � IE CITY OF PRIOR LAKE, 16200 EAGLE
Radiation A � ^ C� 1 . .,�372.
Input Output Special Devices 1� �'
_.,�urs are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ..�� WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
� C r+s �okup `� Coas �P. aa7-42so
��gys TYPE OF WORK I hereby appiy for a mechanical systems permit and I acknowledge that the
Afterations Replacement New Construction _� �nformation above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
Repair Est. Comp. Date �'3'�(o codes; that this form does not become a permit until signed by the BUtLDING
OFFICIAL; that the work will be in accordance with the approved plan in the
Est. Cost $ 0�,�60 d''• O O Building Permlt #' ��� -�!/, case of all work which requires review and approval of plans.
HEATfNG PERMIT FEE $ ��' S� � p M� �° gG
�
STATE SURCHARGE $ .50 licant's 5ign ure ___ Date
� � � " -"" 7�8 — ��—
TOTAL PERMIT FEES $ ���� Recei't # � � euilding ical's Signature Dnte