HomeMy WebLinkAboutHeating Permit 94-0071 a n/] ��� 1. Pink - File
LJ ; 2. Green - City
° � Y OF PRIOR LAKE l � TYPE OF STRUCTURE 3. ye��� . ��,�e�m►
29 DAKOTA STREET S.E permit No. �� � t� Single Family Two-Family Multi-Family
PRIOR LAKE, MN 55372 �
Commercial Industrial Public Other
- - I G APPLICATION / PERMIT
Date
J°' - PID # � S 1 U� Z^DO `�� JOB VALUATION FEE
Site Address �� � � � t� ,� c� SS y C(Z `� (L j pQ �� �e $0 -$1,000 2% of job value, min. $20.00
Lot Block 1 Addition �A��F � j l� $���� -�10,000 $20.00 for the first $1,000 plus $1.25 for each additional
� -J— $100.00 or fraction thereof to and including $10,000.
Owner's Name �C�'Yh � 5 /� P.,/�t +t�'C 2.
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �� 9( �--' ��c�SS b C 2, tional $100.00 or fraction thereof, to and including
1 \ � �_I � � � $50,000.
Neating Contractor C"\ T 8
Address � �d 'I�t.d .- �°+�ry � � � 1� R ►v S u ; � ( �, $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
G tional $1,000 or fraction thereof.
Telephone # � � Z- � D �1 � - Q � ��
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections wil! be bi!!ed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building �ermit number before build-
Conn. Load Mechanical ing certif
Air Conditioning CLOSED DUE TO
Fuel Flue Size Vent. System �L� apply and return openings listed
HEATING OR POWER PLANT Per room INACTIVITY 8/30/O l iditions send floor plan with sup-
Supply Openings ply and CULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLIC�. ___ __ ____ __ _..- -•- ._. PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special�evices C�
�� �� � 0 .�� Ciry 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.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations � Replacement �Vew 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 �' �, Z`'� �-�v does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
��� in �rdance wiih ihe approved plan in the case of all work which requires review and
Est. Cost $� Building Permit # IY fi� a proval of plans.
HEATING PERMIT FEE $ •� a • U () " (� � ^C���wv'� � "' ( S ` `�
STATE SURCHARGE $ .50 fiesa's Signature Date �
TOTAL PERMIT FEES $ .J � vj� Receipt # ���Z � �^ � � �
uil i Official's ature Date
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