HomeMy WebLinkAboutHeating Permit 95-0308 1. Ptnk - File
� p � ` 2. Green - Ciry
� QF PRIOR LAKE � NPE OF STRUCTURE 3. Yellow - Contractor
� �' L � 200i ��gle Creek Av S.E. Permit No. �' S
_�. Single Family 7wo-Family Mufti-Family
�� Pri �ke, MN 55372
�°°` " Commercial industrial Public Other
M __ . T�N.,�,�G _A�PF}LICATION / PEF�i�T
Date
lZ Z b ! S PID # '-�1 �� U� � �OB VALUATION FEE
Site Address b�0 — / Zj T� � 7' $o -$�,000 2% of job value, min $20.00
Lot 7 Block / Addition /� ��,� ^`� $� ��� "$� 0,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owne�'s Name � �� 1...1-. t� S
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address J�� 5 O �'� `v�'']' tional $100.00 or fraction thereof, to and including
Heating Contractor/�..1� ( �/�ZA3/b � $50,000.
Address ?Z� ��'' T/91 /2v� � 65��� H�f �/ �,s%/ 3 �0,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
' y tronal $1,000 or fraction thereof.
Telephone #� 3 3 S6 f
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Modei �'71�..�4`�lil. T1fPE OF SYSTEM Additional inspections will be bil{ed at $25.00 each.
arm Air Plants
Model Size ��( �`�' � fll/L�st+71� avity House Heating Test Record must be submitted with buildin��ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuet ��Fiue Siz 3 a t ^ Vent. System HEAT CALGULATtO1VS RE�UIRED with number of supply and teturn openings listed
1 HEATING OR POWER PLANT Per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings ( 5team ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiatian S.E. Priar Lake, MN. 55372.
Input Output Special De vices �i 12.�SC..�( cs �1 �
� �_ � City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices "� I�.��..A 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
Alterations l` Replacemern 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 � A� does not beoome a permit until signed by the BUILDtNG OFFICIAL; that the work wiN be
, in �cordance with the pproved plan i the c se of all work which requires review and
Est. Cost $ Z� � 0 � Building Perm' - val of lans.
HEATING PERMIT FEE $ � � . � � �
lZ
S7ATE SURCHARGE $ .50 pplicant's Signature Date
TOTAL PERMIT FEES $_ � � G � Receipt # � � �—
Bui g Official's Signature Date