HomeMy WebLinkAboutHeating Permit 94-0253 1. Pink - File
� s 2. Green - City
�.�°� pR � O '� � CITY OF PRIOR LAKE + TYPE OF STRUCTURE 3. Yellow - Contracror
� rn 4629 DAKOTA STREET S.E. permit No. �J �� Single Family _� Two-Family Multi-Family
PRIOR LAKE, MN 55372
Commercial Industrial Pubiic Other
HEATING APPLICATION / PERMIT
Date gIBI CI �/ PID #�-'I �(0 —' djI � D JOB VALUATION FEE
Site Address _�_ ' �IZ e Cc-l- S'�'rQ�� SG $0 -$1,000 2% of job value, min. $20.00
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot 14�15 Block Addition �2c.�c•e.a�S Cov�-e_ $100.00 or fraction thereof to and including $10,000.
Owner's Name aC`I ' Gt,Ti'Ji"�pI'L �" p Y3'I 1�('Y1 '��� 'J
$10,001 -$50,000 $132.50 far the first $10,000 plus $1.00 for each addi-
Address �� tional $100.00 or fraction thereof, to and including
� $50,000.
Heating Contractor S �
Address ��)02 C ��•i.a,�Q� D i'1"(/�P.V1I� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone# __��S�c�J�S
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model�Y��?1�5� NPE OF SYSTEM Additional inspections will be billed at $25.00 each.
� Warm Air Plants
Model Size �/(�s �"',1C�17 Graviry House Heating Test Record must be submitted with buildin��ermit number before build-
9Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
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 ,/� Y'L xJ 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 1 acknowledge that the information
Alterations ReplacemeM New 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 cades; 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 $ o� �'�3�� Od Building Permit # ��,� .� approval of plans.
HEATING PERMIT FEE $ Y� � s0 �/�
� STATE SURCHARGE $ .50 li nYs Sign ure Date
- � _�� ,
,.TOTAL PERMIT FEES $ c�i3� � Receipt # � `���
� ding icial's Signature Date