HomeMy WebLinkAboutHeating Permit 94-0226 1. Pink - File
.��� pR'O ����� LAKE 3. Yellow - C nVactor
TYPE OF STRUCTURE
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u m D 2 9 D A K O T A 3 T S. E. permit No. Z^� Z � Single Fami{y Two-Family Multi-Family
� R�iI�F�CE, � 5372
Commercial Industrial Public Other
EATING APPLIC / PERMIT
JOB VALUATION FEE
Date � .._�;�,��. � �:�. � ) — (� 1 T —D
Site Address �F � dar �r- $0 -$1,000 2% of job value, min. $20.00
Lot Block Addition $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owrier's Name �QU�. �22.CCY1S�Y1 � �'q�p " a� ��
��ioc� �ec�a►-�`�o�d �, $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address _ � , P���p 1G,kQ tional $100.00 or fraction thereof, to and including
Heating Contractor �[�Cl `g rn0 �� � �C , $50,000.
Address �� o� �•��tC.�yQQlZ. J' 1�f r1 �)� i ��.6;.� ;' �� 0� $50,001 and over $532.50 for the first $50,000 plus $7.50 for eacfi addi-
tional $1,000 or fraction thereof.
Telephone # � ��$ S CLO� - �f your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM j�T� �D D rTT ��•��� be billed at $25.00 each.
Warm Air Plants yl � T jV � TO
' Model Size Gravity I�' ! must be submitted with building Rermit number before build-
Conn. Load Mechanical �`'^- Y 8 �3 p�� � will be issued.
Air Conditioning
Fuel Flue Size Vent. System �o'Z � REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT per room with Crn,� _, r 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 Replacemerrt {Vew 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 $ /'7'u'�' �� Building Permit # "°—'� approval of plans. .
HEATING PERMIT FEE $ � 5L� � �Q��
STATE SURCHARGE $ .50 plica Ys S' nature Date
TOTAL PERMIT FEES $ a� J�� � Receipt # __oC.� j 0 I
Buildin Official's Signature Date
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