DEEPHAVEN HEATING PERMIT APPLICATION

DEEPHAVEN HEATING PERMIT APPLICATION
CITY OF EXCELSIOR
MECHANICAL PERMIT APPLICATION
339 Third Street
Excelsior MN 55331
(952) 474-5233
Date______________
Site Address _______________________________________________
Permit # ______________
Receipt # ______________
Residential
Commercial
Owners Name________________________________________________________________________
Telephone___________________________________
Heating Contractor__________________________________________________________________________
Address___________________________________________________________________________________
City_______________________________________State_______Zip_________Telephone________________
List job cost individually on appropriate line:
Heating Cost $___________________ A/C Cost $ _________________ Total Cost $ ______________
CHECK BELOW:
_______ 1. Furnace, Boiler or AC Replacement
_______ 2. Addition of A/C
_______ 3. Central System [New Construction]
_______ 4. Additions
_______ 5. Gas Piping ______Number of Units
Check Type Of System :
Fireplace
1.25% of Job Cost
2% of Job Cost
2% of Job Cost
2% of Job Cost
1st 3 Units $7.50/ea.
[Each additional Unit $4.50/ea.]
Heating Hot Water
Air Conditioning
Refrigeration
Gas Piping
$________________
$________________
$________________
$________________
$ ________________
$ ________________
Venting Exhaust
Boiler
Alter/Repair
Misc.
Make
Model
Conn. Load
Fuel
Flue Diameter
Input [BTU/EDR]
CFM
Tons
H.P.
The undersigned agrees to do all work in conformance with
City Ordinances and rulings of the Inspection Division and
herewith declares that all facts and representations on this
application are true and correct, and agrees to notify
Metro West Inspections at (763) 479-1720 when
ready for inspection.
Permit Fee ______________________
[$40.00 Min. Fee]
Plan Review ____________________
State Surcharge__________________
[.0005 x Value – Min. $.50; Flat Permit
Fee $1.00]
________________________________________________
Signature of Applicant
Total Fee_____________________
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