HomeMy WebLinkAboutHeating Permit 94-0208 t. Pink - F7e
F pR� j � , � , �� (Q 2. Green - Ciry
.�� � ��!l�ei UYI�LlLS R LAKE TYPE OF STRUCTURE 3. Yellaw - Contractor
� 4629 DAKO REET S.E. �[� — Z D�
v Permit No. Singie Family Two-Family Mufti-Family
� � � N 55372
Commercial Industrial Public Other
HEATING APP ION / PERMIT
Date � " � p # � ,�8'[� _ � & !� ,� D JOB VALUATION FEE
. .,��.a
Site Address � � $0 -$1,000 2% of job value, min. $20.00
Loi � Block � Addition � `� � �J � $ ' $�0,000 $20.00 for the firsi $1,000 plus $1.25 for each additional
� $100.00 or fraction thereof to and includirtg $10,000.
Owner's Na e
$70,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address (� � tional $100.00 or fraction thereof, !o and including
Heating Contract � $50,000.
Address . $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
�� r / tional $1,000 or fraction thereof.
Telephone # � � "�` �7J � (•�
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections wil! be billed at $25.00 each.
Warm Air Plants
Mode! Size Gravity House Heating Test Record must be submitted with building r�ermit number before build-
Conn. Load Mechanical .^� ��-':`:_�.- _` ---� •------ ._ :�� � - - - -�
Air Conditioning � number of su I and return o enin s listed
F�e� F��e s�Ze Vent. System CLOSED DUE TO PP Y P 9
Supply Openings HEATING OR POWER PLANT INACTIVITY 8/30/O 1 tructures or additions send floor plan with sup-
Steam T LOSS CALCULATIONS, PAYMENT AND
Return Openings Hot Water 'HE 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 acknowiedge that the information
Alterations Replacement New Construction 9� " dZT 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 buitding/mechanical codes; that this form
Repair Est. Comp. Date does not b come a permit until signed by the BUILDING OFFICIAL; that the work will be
i rdance 'th the approved a in the case of all work which requires review and
Est. Cost $� Building Permit # ' approval of plan
HEATING PERMIT FEE $ � � � �
STATE SURCNARGE $ .50 plicant's Si nature Date
TOTAL PERMIT FEES $ s Receipt # a� � a� ' �` � t �
Buil ' g Official's Signature Date
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