HomeMy WebLinkAboutHeating Permit 94-0140 �.- � , .
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.��� PR'OR R LAKE ) TYPE OF STRUCTURE 3. Yeilow - Conuactor
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� 462 O EET S.E. permit No. Single Family �_ Two-Family Muki-Family
� � P� , 55372
Commercial Industrial Public Other
ION / PERMIT
a�� �� � =' � - JOB VALUATION FEE
Date S # .�5�' � y /� — 03 � —� $o $� �0 2% of job value, min. $20.00
Site Address 3 � �� /J„�,,,�., �,�,
Lot I 2 Biock �- Addition �, l.� ��1�� $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$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 _j3 L/ � l.� ,�6 � tional $100.00 or fraction thereof, to and including
Heating Contractor ��-�t�Gf� Q�t ,c �j� 1� .i�.--�, $50,000.
Address ����� ��Q''��l,ct.n,/,�� U,�y-� • $50,001 and over $532.50 for t�e first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # ���� � ��� a�7.S- _
ur heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM O `ons will be billed at $25.00 each.
Warm Air Plants
Model Size ��c"�d�n a� Gravity ���� $ � 3 p �Ol ` Record must be submitted with building �ermit number before build-
Conn. Load Mechanical _ C �Q�� �I�� ,..�pancy will be issued.
Air Conditioningli, �C��
Fuel Flue Size Veni. System _� .. � GALGULATIONS RE�UIRED with number of supply and return openings listed
HEATING OR POW 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 INSPECT'ED (ROUGH-IN AND FINAL) - CALL CITY HALL
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permft 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 �-. .3 '" / 7' does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
f�' �� in aa;ordance with the approvec! plan in the case of all work which requires review and
Est. Cost $/,S3 Q" Building Permit # approval of plans.
HEATING PERMIT FEE $ � � � ��� /° 9�
STATE SURCHARGE $ .SO nYs Signatu Date
TOTAL PERMIT FEES $ �� � � Receipt # �� Q �� � �
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