HomeMy WebLinkAboutHeating Permit 94-0199 1. Pink - File
�� PRIOR LAKE - 2. G��� - ���,
TYPE OF STRUCTURE 3. Yellaw - Contracta
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� ,,,,� OTA STREET S.E. permit No. `� ^(9 Single Family '� Two-Family Multi-Family
�P LAKE, MN 55372
Commercial Industrial Public Other
PLICATION / PERMIT
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Date — -' PID #�L S-� p(00 - 00I - n �OB VALUATION FEE
Site Address S�� � 02 � %c�? Pd /� T [�//� eG E $� � '�� 2% of job value, min. $20.00
Lot �� Block Addition R�-S � Z`� $>>�� -$�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� Name W P� `1 �/� Q_ o �- S c�.�J
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �Sf1 /`Zc.� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor �c �- �
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 # �{ y � � oZ �� �
CLOSED DUE TO permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM billed at $25.00 each.
Warm Air Plants INACTIVITY 8/30/O l
Model Size Graviry nust be submitted with building r�ermit number before build-
Conn. Load Mechanical �ill be issued.
Air Conditioning 2. o-�ro n
Fuel Flue Size Vent. System HEAT 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 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 � New Construction above is c�mplete 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 8-(- 9`� does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
eo in accordance with the approved plan in the case of all work which requires review and
Est. Cost $/�C�� — Building Permit # approval plans.
HEATING PERMIT FEE $ �v- D� � �— C- 9Y
STATE SURCHARGE $ .50 pplicanYs Signature Date
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TOTAL PERMIT FEES $ Receipt # a7 �O � d
Building icial's Signature Date
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