HomeMy WebLinkAboutHeating Permit 94-0174 ` 1, Pink - File
(1 � ; ,�R� M � � �6 � 2. Green _ City
U �.� . `� TY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow �a���t�
� �' 4629 DAKOTA STREET S.E. pe/mit No. G4- t�4 Single Family �_ Two-Family Multi-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
ING APPLICATtON / PERMIT
JOB VALUATION FEE
ate PID # 'ZS'-23q —025—b �
�O � � n ^ � n ^ ( �� � � ,� ` $0 - $1,000 2% oi job value, min. $20,00
Site Address � 6 t�C1►►.Nt
Lot J� Block �- Addition �-� PO ' �� 4�d�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 � c�\ �S
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �� � � ���.�( �Q(�� �• (� , tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor �X� ► E� �-
Address �, � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
� tional $1,000 or fraction thereof.
Tefephone # ��� - �J�.J��
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
Modei Size Gravity House Heating Test Record must be subm�+�d wRh building Qermit number before build-
Conn. Load Mechanical ing certifica}� ^' --
Air Conditioninq ?C C�,('1'l� tr-� DUE TO iber of supply and return openings listed
Fuel Flue Size Vent. System CLpsED
HEATING OR POWER PLANT I �A VITy 8/30/01 �res or additions send floor plan with sup-
Supply Openings CTI �S CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water � .-- � �� �ITY OF PRIOR LAKE, 4629 Dakota St.
Radiation �._. ,,�..� �aKe, 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 CtTY HALL
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
ARerations C�_ 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 wfth 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 $ ���• Building Permit #_ 8�"�(� a of plans.
HEATING PERMIT FEE $ � �� �-
STATE SURCHARGE $ .50 ApplicanYs ' at e Date r
TOTAL PERMIT �EES $��J� � Receipt # z'���a � — q�
Buil ' g Official's Signature Date
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