HomeMy WebLinkAboutHeating Permit 94-0216 1. Pink - File
�.� PR'O KE 3. Yellow - C
9 TYPE OF STRUCTURE
u m D • Permit No. y� � Single Family •\ Two-Family Multi-Family
� O� LpKE MN ��
# Commercial Industrial Public Other
TtNG APPL I ERMIT
Date �'o _ _� h2- ��� 0 JOB VALUATION FEE
�
� �' � `'� `� � � $0 - $1,000 2% of job value, min. $20.00
Site Address "��� � �pr��� �� � � � 4�
Lot � Block �� Addition SW^ ��' 'l� i([S $>>�� - $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 � �t� �"�.�r�\�.J $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 3J ��PC'��rL 1 r�� �- , C�� �..� tional $100.00 or fraction thereof, to and including
r- $50,000.
Heating Contractor _ �� c+-`.���, L',�
Address �"'l l l� �� 1 \ cp �-� `'� ��_�:���,�� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
�� tional $1,000 or fraction thereof.
Telephone # gs� � W "'3 0 �
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
Model Size Gravity House Heating Test Record must be submitted with buildin��ermit number before build-
Conn. Load �� ing r��+�+���e of occupancy will be issued.
Air Conditioning sq � orJ 2Tat� � of supply and return openings listed
Fuel Flue Size ent. ystem CLOSED
HEATING OR POWER PLANT Per DUE TO or additions send floor plan wRh sup-
SupplyOpenings P , y INACTIVITy g/30/O1 CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water AP I( OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. rrior �a�b, �.,,.. ____ _
Input Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALt WORK MUST BE INSPECTED (ROUGH-!N 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 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 $ l�'00 . c�o Building Permit # approvat of plans. �
HEATING PERMIT FEE $ "�, � � � S _ � � ja $ � q�
STATE SURCHARGE $ .50 pplicanYs Signature Date
TOTAL PERMtT FEES $'��r + � Receipt # d Y � �
uildin ficial's Signature Date
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