HomeMy WebLinkAboutHeating Permit 94-0092 - --- — t. Pink - File
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°�°�'� CiTY OF PRIOR LAKE � 6 � ��� -��N OF S7RUCTURE
`�' 9 �. D � - `'� �
� m 4629 DAKOTA STREET S.E Fami Two-Family Muhi-Family
PRIOR LAKE, MN 55372 P � t�'� �
HEATING APPLICATION / PERMI � y�-'" erciai Industrial Public Other
a � JOB ALUATION FEE
Date PID # aJ` � -�
// ry $0 -$1,000 2% of job value, min. $20.00
Site Address `�(� I D � w�
Lot �� Block .�-5' ��''^-� � �` � � $1,001 -$10,d00 $20.00 for the first $1,000 plus $1.25 for each additional
� Addition $100.00 or fraction thereof to and including $10,000.
Owner's Name !�
� �� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tO l� � • tional $100.00 or fraction thereof, to and including
' $50,000.
Heating Contractor
Address $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone #
/ The price of your heating permit includes one rough-in and one fina! inspection.
Furnace Make & Model D,.�i,�/�u�E OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size `�^ Gravity House Heating Test Record must be submitted with building oermit number before build-
Conn. load Mechanical ing certificaie of occupancy will be issued.
� � Air Conditioning
Fuel Flue Size �_ Vent. System HEAT CALCULATIONS REQUIRED with number of supply and return openings listed
HEAT1NG OR POWER PLANT per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCULATlONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices
City Hall business hours a�e 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 mechanica! systems permit and I acknowledge that the information
Afterations Replacement 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 does not become a permft until signed b e BUILDtNG OFFICIAL; that the work will be
O✓� in acco n with the a prov d plan ' the case o alt work which requires review and
Est. Cost $ 0 Building Permit #�sv� app al p ns.
� S'O�w�22 .5'Q
HEATING PE M1T FEE
STATE SURCHARGE $ .50 Applicant' ignature Date
TOTAL PERMtT FEES $ �� •�� Receipt # ��0 � ' � S 4 � g �4�
8uild' g Official's Signature Date