HomeMy WebLinkAboutHeating Permit 94-0150 �,
1. Pink - File \
F pR� R 2. Green - City
�.�� � y -CI LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
� m ��� 1� T � a T S.E. permit No. 44 ' Single Family Two-Family Mufti-Family
� "'PRf�ICE, II��1 � �6372
� Commercial Industrial Public Other
El�'�N(� �CA � / PERMIT
Date S° �-- � �� JOB VALUATION FEE
SRe Address � $0 -$1,000 2% of job value, min. $20.00
Lot Block Addition l��z-�;� �<-,��-,.�� $���� '$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 � �i �D_
� - $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address __ �bqa- �.�a,,,� �/,1, F, tional $100.00 or fraction thereof, to and including
s�1[t�S�t�J7�[�,—� $50,000.
Heating Contractor d f�- c.._
� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address 0 �i/. � S Ya tional $1,000 or fraction thereof.
Telephone# ,�?a7Y �(n57v
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-n0 each.
Warm Air Plants
Model Size Gravity D � TO ed with building permit number before build-
Conn. Load Mechanical CLOSED
AirCon�itioning S�I a't� �ACTIVITY g� mber of supply and return openings listed
Fuel Flue Size Vent. S stem tures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT ., ,,,,, 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 � Replacement 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 accordan with the approved plan in the case of all work which requires review and
Est. Cost $ //G s� �(? Building Pe it # T�' ' —' approval s.
HEATING PERMIT FEE $ ��� 'S�'
S7ATE SURCHARGE $ .50 ApplicanYs Signat re Date
/ �o !(o- 9'4
TOTAL PERMIT FEES $ o73��a Receipt # o� ��b uilding Official's Si ature Date