HomeMy WebLinkAboutHeating Permit 94-0177 4 � - �" - - � ����( „ 1. Pink - File
�� OF PRIOR LAKE ��-� 2• Green - City
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TYPE OF STRUCTURE 3. Yellow - ConVactor
� DAKOTA STREET S.E. permit No. a 4 ' ( 77 Single Family Two-Family Multi-Family
IOR LAKE, MN 55372
Commercia! - Indusirial Public Other
APPLICATION / PERMIT
a e PID # ZS- �—Oo3�—D �OB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Site Address ` _ � .
4 � $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot �_ Bloc 1 Addftion �'S�a� � iew �"
$100.00 or fraction thereof to and including $10,000.
Owner's Name �Y�, � �.,
,��� � ! � � � � - $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each add9
Address ti�i ��T� t� tional $100.00 or fraction thereof, to and includin
Heating Contractor � 1 �., ' Y- �.�� $50,000.
$5�1 and over $532.50 for the first $50,000 plus $7.50 for each addi-
Address � ��
�� — � J ��� tiona! $1,000 or fraction thereof.
Telephone #
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM �---���ns will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity � C LOSED DUE �-, �ted with building nermit number before build-
Conn. Load Mechanical _ INACTIVjTY
Air Conditioning �q,��7 g�30/O1 number of supply and return openings listed
Fusl Flue Size Vent. System
HEATING OR POWER PLANT per roor�� ...... ;tructures or additions send floor plan with sup-
Supply Openings ply and return locations shown. ,._. �T 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 � ReplacemeM � 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
Rspair 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 $ 1�,�JlJ • Building PermR # �q-1`� roval of plans.
HEATING PERMIT FEE $ �
STATE SURCHARGE $ .50 Ap + Ys �gnature Date
TOTAL PERMIT FEES $ � Receipt # 23� q 2 —
'r—S—�i4
Iding Official's Signature Date
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