HomeMy WebLinkAboutHeating Permit 94-0107 � (� (7 � � "���� 1. Pink - File
� L5 U 2. Green - City
��� p CIT IOR LAKE � � Tv PE OF STRUCTURE 3. Yellow - Conuacmr
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� m�}'c i 2 D STREE7 S.E. Permit No. Single Family v Two-Family Multi-Family
PRIO E, MN 55372
Commercial Industrial Public Other
HEATi L CATtON / PERMtT
Date PID # �-�. - aol " - � Z 3' o �OB VALUATION FEE
Site Address �a � � s $0 -$1,000 2% of job value, min. $20.00
� � �_,�_ $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 � � c �Pi'� �
$10,001 -$50,000 $132.50 for the fi�st $10,000 plus $1.00 for each addi-
Address �L'� QS tional $100.00 or fraction thereof, to and including
. $50,000.
Heating Contractor Burnsville Heatin
Address I Q Rhode Isla��d Ave ^ $0. $50,001 and over $532.50 for the first $50,000 plus $7,50 for each addi-
S�V�a� �—���- tional $1,000 or fraction thereof.
Telephone # 894-�AA�
The orice of vour heating permit includes one rough•in and one final inspection.
Furnace Make & Model D TYPE OF SYSTEM / �t $25.00 each.
Warm Air Plants L�� CLOSED DUE TO
Model Size �J �"�'� Gravity a submitted with building r�ermit number before build-
Conn. Load
Mechanical INACTIVITY 8/30/O1 ;sued.
Air Conditioning
Fuel � lue Size Vent. System Q with number of supply and return openings listed
HEATING 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 CALCULATIONS, 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 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 ReplacemeM v FVew 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 permit until signed by the BUILDING OFFICIAL; that the work will be
/� in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ 31 �(�. � Building Permit # l approval of plans.
HEATlNG PERMIT FEE $ �� �.� "7' � �/9
STATE SURCHARGE $ --� :50" nYs Signature Date �
/ ����
TOTAL PERMIT FEES $ � eceiPt #�J�(D `� - uilding Official's Signature Date