HomeMy WebLinkAboutHeating Permit 94-0144 1. Pink - File
� pR 2. Green - City
�,° �,� CITY OF PRIOR LAKE nPE OF STRUCTURE 3. Yellaw - Conuacror
� 4629 DAKOTA STREET S,E
u m Permit No.� � ��� Single Family Two-Family Muiti-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT �OB VALUATION FEE
Date�O / � PID#� `�6^a�-�
Site Address
�S `7 D� � i5�1 bd rrs f�� $� �$1'�� 2% of job value, min. $20.00
$1,001 -$10,000 $20.00 for the firsi $1,000 plus $1.25 for each additional
Lot � Biock 2 Addition ��-.�� ��S $100.00 or fraction thereof to and including $10,000.
Owner's Name � i� � /� �+ f'�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address f��t �� �" ,�?�"J�r� 7'� �� /)�o�� � tional $100.00 or fraction thereof, to and including
r 1 . S%3�3 7•Z._ $50,000.
Heating Contractor � /���h cP ����t°_7 � E 7!�r �
��� ��.�� � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address ..
,/ tional $1,000 or fraction thereof.
Telephone # ��l � "" �l'� �7 �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE 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 buildina nermit number before build-
Conn. Load Mechanical _ ing certif'�cate of occupancy will be �������+
Air Condition ?o yt
Fuel Flue Size Vent. System �mber of supply and return openings listed
CLOSED DUE T� °tures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT JSS CALCULATIONS, PAYMENT AND
Steam �ACTIVITY 8/30/0
Return Openings Hot Water CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation - - � -•
Input Output Special Devices
Ciry Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devic s ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. ��ri►� A� 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations �_ ReplacemeM � New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and oodes of the city and with the state building/mechanica! codes; that this form
Repair Est. Camp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
T �� .________ in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ ���� � Building Permit # ��— appro al of pla
HEATING PERMIT FEE $ ^Z 7 S� ^ (,� /Y"
STATE SURCHARGE $ .50 IicanYs Signature � Date
TOTAL PERMIT FEES $ aZ �. D� Receipt # QCV ��g r
Building Official's Signature Date