HomeMy WebLinkAboutHeating Permit 94-0161 ,`--�-�-, _ �� 79 �
1. Pink - File
P ' 2. Gree� - Cily
� �..� � � IOR LAKE TYPE OF S7RUCTURE 3. Yellow - Convacror
� �� D STREET S.E. permii No. 4-�lvl Single Family \ Two-Family Mufti-Family
� �O E, MN 55372
� Commercial Industrial Public Other
� ATION / PERMIT
� Date PID # ��'OO �-� (J.ZS O �OB VALUATION FEE
A c , $0 -$1,000 2% of job value, min. $20.00
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Lot � Block Z. Addition 1� 1�� �'OST���� �h , $���� "$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 'v`�.�( � � f 1C.�c,�(�(1
$10,001 -$50,000 $132.50 for the first $i0,000 plus $1.00 for each addi-
Address _�� �5�: �� �_�r"��, 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 final inspection.
Furnace Make & Model 1'YPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity ��- -- ��--•�-- T_� �_�.a ......., �.� submitted with building �ermit number before build-
Conn. Load Mechanical CLOSED DITE TO sued.
Air Conditioning �t��c�-Q. Z with number of supply and return openings listed
Fue1 Flue Size vent. System INACTIVITY 8/30/O 1
�lew structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILtu 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
Alterations �_ Replacement �Vew Construction above is complete and accurate; that the work will be in conformance wfth 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
I�/� in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ I,�,.,[�l.J � Building Permit # _ approval of plans.
HEATING PERMIT FEE $ � ,� � -LQ - �'°4,
STATE SURCHARGE $ .50 Appli Y S' nature Date
TOTAL PERMIT FEES $ Receipt # �— ?-! "'Q4
�� `�� ding Official's Signature Date
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