HomeMy WebLinkAboutHeating Permit 94-0235 1. Pink - File
2. Green - City
� PR��R � CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - ConVacror
� m 4629 DAKOTA STREET S.E permit No. ��— Z Single Family � Two-Family Mufti-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
H ATING APPLICATION / PERMIT
� � �' � PID # ,�� (�.,3� — �,Z,�—D �OB VALUATION FEE
Date . ,
Site Address � �] � J $� '$>>�� 2% of job value, min. $20.00
"' "a �n:.v 13 �:c.c+�... �/'t'v� /�/ �
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot Block Addition $100.00 or fraction thereof to and including $10,000.
Owner's Name �'_. s �,✓.l,:,-r
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address r � t �� �� �.. . /L�� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor — L�s � �.ti
Address � e e.. �r �`�.� � �, �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # T �_�/ E/S'"�+ ��Gz �� The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model �.nl�: �r?—at�?�r/v� NPE Of SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size / D o ��� Gravity � _ House Heating Test Record must be submitted with building �ermit number before build-
Conn. Load i�� Mechanical ' of occupancy will be issued.
Air Conditioninq � C'L
Fuel IJ / Flue Size _�_ Vent. System � OSED DUE , FQ with number of supply and return openings fisted
T T Q . New structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANI 11V �CTI�TITIT 8 f n, HEAT LOSS CALCULATIONS, PAYMENT AND
Steam � O jOI ED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Return Openings Hot Water
Radiation S.E. rn�� __
Input i9 *�� � Output .�a � Special Devices
Ciry 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. /� �a 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and 1 acknowledge that the information
Alterations Replacement �„_ New Construction above is complete and accurate; that the work will be in conformance with the ordi-
/ nances and oodes af the city and wfth the state building/mechanical codes; that this form
Repair Est. Comp. Date �7�?� �'� does not beoome a permit until signed by the BUILDING OFFICIAL; that the work will be
�f in accordan it e ian in the case of a11 work which requires review and
Est. Cost $ 3 �� o Building Permit # approval n.�;�'
F �2�': S� ..�4.�'�.__ � '` S
HEATING PERMIT EE $ � � 5'
STA7E SURCHARGE $ .5O ApplicanYs ' gn �re Date
TOTAL PERMIT FEES $ °�� • � U Receipt # � �^�D � � � y
uildin icial's Signature Date