HomeMy WebLinkAboutHeating Permit 94-0180 C�C�Gfl��IC� '.
1. Pink - File
2. Green - City
.��� � Y RIOR LAKE Zl(PE OF STRUCTURE 3. Yellow - ConVactor
� 9
� �' Z 7 9 TA STREET S.E. Permit No. q4'�$O Single Family Two-Family Mufti-Family
PRI KE, MN 55372
Commercial Industrial Public Other
ICATION / PERMIT
Date � 3 PID # �-5 — I� 3'15(0 6— b JOB VALUATtON FEE
Site Address r � �� � �� $� �$�'�� 2% of job value, min. $20.00
Lot .� Block c� Addition T`��a ��''� $���� '$�0,000 $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 �
� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �� �.� tional $100.00 or fraction thereof, to and including
Heating Contractor � �� � . -r'z, .,�, $50,000. .
Address 1�� ti1.3 � .��,�'' �50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
i1,000 or fraction thereof.
Telephone# ��'� � J
CLOSED DUE TO cludes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM �JACTIVITY 8/30/O 1 >25.00 each.
f�� , L r r Warm Air Plants
Model Size �� "C l Gravity , ubmitted with building nermit number before build-
Conn. Load Mechanical ���y �.a�wwcuo u� u�:wNan�:y w�u [�e �ssU@Ca.
Air Conditioning
Fuel Flue Size Vent. System HFAT CALCULATIONS REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT Per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings � ply and return locations 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 Outpui Special Devices
City Hall business hours are S a.m. - 4:30 p.m.
Edr,
��� � er D ices ALL WORK MUS7 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 Replacemerrt 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 ths BUILDING OFFICIAL; that the work wil! be
� in accordance with the approved plan in ihe case of all work which requires review and
Est. Cost $��� Building Permit # ��' ��8 al of `(�
HEATING PERMIT FEE $ � � ro � • Z � �j ��,,� �� �f
STATE SURCHARGE $ �.50 Appli t's Sign re Date
TOTAL PERMIT FEES $ � Receipt # 02. T
G'� ��� ? -q4
B I g Official's Signature Date
C�1•�S
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