HomeMy WebLinkAboutHeating Permit 95-0290 (Voided) _ - - �'�� �� t. Pink - File
`' �.,°� pR '- CITY OF PRIOR LAKE 7/�f � 2. ���, - ���,
TYPE OF STRUCTURE 3. Yellow - Contractor
- �. o_� r s
u ' im 4629 DAKOTA STREET S.E rmit No. �15-2 ' le Family Two-Family Multi-Family
i
��� �' :� �OR L,AKE, MN 55372 �
� Commerci Industrial Public Other
� :�_..___.�iF.A�ING AR�:iCAT10N / PERMIT
JOB VALUATIO FEE
Date _ � �- �� - - ---- -- - PID # �J�lQ� -• d j� d
����� T"�. .'�/��, ,•, /1� ��� / $0-$1,000 2%of jobvalue, min. $20.00
Site Address y'T.e-� �-�'! �/"1�
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block Addition �� $100.00 or fraction thereof to and including $10,000.
Owner's Name
� �
i' , � � 0,001 -$50,000 $132.50 for the first $10,000 plus $1.�0 for each addi-
Address �J� Wo /��,/ !G7 ��/ Q� J"�j�� tional $100.00 or fraction thereof, to and including
Heating Contractor
_ � p � $50,000.
Address � '� ° $50,001 an ver $532.50 for the first $50,000 pius $7.50 for each addi-
/
tiona) $1,000 or fraction thereof.
Telephone # — � �`
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model ��'j/',b � TYPE OF STEM ��`� Additional inspections will be billed at $25.00 each.
. j� -- Warm Air PI ts �
Model Size ravity use H in e e rd�ust s bmitted with building r�ermit number before build-
Conn. Load
�'� � � chanical ing rtifi of o�cy ill d.
L Air nditioning rlli(�
Fuel 7� �FIue Size ��� Vent. System HEAT CALCULATIONS REQUIRED wfth number of supply and return openings listed
Q � HEATI G OR POW PLANT per room wfth CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings O 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.
�� �F3�diation S.E. Prior Lake, MN. 55372.
Input � b db Output /W � Spe ' Devic s
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm.
447-4230.
IYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the infarmation
Afterations Replacement FVew Construction /� above is complete and accurate; that the work will be in conformance with the ordi-
�//} �ances and oodes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date cJ/ "!� does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
/��q�� in acc�rdance with the approved plan in the case of all work which requires review and
Est. Cost $ _LJCC/C�CJ �� Building Permit # '�"'"'.'"'"'i"�� approv I plans.
HEATING PERMIT FEE $ ���5� �� � �"�
.
STATE SURCHARGE $ .50 Applicant's 'gnatu Date
T07'AL PERMIT FEES $ �J � Receipt # oC 7Z� � ' � Z r �� ^ ��
Buildi Official's Signature Date