HomeMy WebLinkAboutHeating Permit 95-0309 � , -, �,- t. Pink - FNe
P / 3. �Yellow - C ntractor
°� -� CITY OF PRIOR LAKE TYPE OF STRUCTURE
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� 9 ��.� ����00 Eegle Creek Av. S.E. permit No. ���' Single Family Two-Famiy Multi-Family
Prior L�ke, MN 55372
------- - ____��.-�' � Commercial Industrial Public Other
HEATING APPLICATION / PERMIT
Date � y' �2-^a ���� PID # �(-S`" O I� - QL�-v JOB VALUATION FEE
3 �� � � ��� S � �. $0 - $1,0p0 2% of job value, min. $20A0
Site Address .
LoN � Bbck Addition $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.
Owne�'s Name �► �` M� �' �N
$10,001 -$50,000 $132.50 for the first $10,000 p{us $i.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
NTIAL N�AI"ING � ��ur• $so,000.
Heating Cont�_ c.,...__ ., ��
�fW'
Address �� fz�7�� • MN �Y $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Teiephone #
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model � U� 3� TYPE OF SYSTEM Additional inspections will be bitled at $25.00 each.
� Warm Air Plants
Model Size L�� ��.�- Gravity House Heating Test Record must be submitted with building permit number before build-
Conn. Load .`7 ��-� ��� Mechanical ing certif'�cate of occupancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System HEAT CALCULATIONS REQUIRED with number of supply and return openings listed
F --- ••-�*ti �FM�s �er opening. New structures or additions send floor plan wfth sup-
Supply Openings HEATING OR POWER PLANT '�S CALCULATIONS, PAYMENT AND
Steam F CLOSED DUE TO �N OF PRIOR LAKE, 4629 Dakota St.
Return Openings Hot Water � INACTIVITy g/30/O1
Radiation
input Output S Special Devices
Edr. �� fit/�
Other Devices ALL WORK MUST BE INSPECTEV �rsv�.��.-IN AND FINAL) - CALL CITY HALL
Cfm. Nok ��w..� fi��1 goe,�.o,.� 447-4230.
TYPE OF WORK ! hereby apply for mechanical systems permit and I acknowledge that the information
Afterations Replacement J� New Construclion 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
in acco dance with the appro d plan in the case of all work which requires review and
Est. Cost $/. 5�f� Building Permit # �`""-"'"_""�""�'� approv of plans.
HEATING PERMIT FEE $ 2 '� . SC� �, �Z ^ �Z �q,�
STATE SURCHARGE $ .50 IicanYs Signature Date
TO'TAL PERMIT FEES $ 7i�� � � Receipt # ��'f�Z- � 2�2�-�l�
Buildin icial's na ure Date
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