HomeMy WebLinkAboutHeating Permit 94-0258 1. Pink - Fjle
" 2. �reen - Ciry
� PR�� � CITY OF PRIOR LAKE G � TYPE OF STRUCTURE 3. Yellow - Contracror
� , m 4629 DAKOTA STREETS.E. permit No. ` �1-258 Singie Family � Two-Family Mufti-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
HEA ING APPLICATION / PERMIT
' / JOB VALUATION FEE
Date ������ PID#���(����1{�
Sfte Address ��� ��.rn �; ��� $0 -$1,000 2% of job value, min. $20.00
.p � � $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block , Addition eCc.K� i� /�/�.¢,M.�.�r2 $100.00 or fraction thereof to and including $10,000.
Owner•s Name �l � tZ�'� �--� l�� y�
` _ $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address � �ti,hr._. ' t r' tional $100.00 or fraction thereof, to and including
�� "� $50,000.
Heating Contractor C�`� C� �� v t'S � cs T'h&�..� -/�.%-- �-.�
Address �C� �i . '�,,� �-�'�'�, �,,�� y-���\� $50,001 andover $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # _ ���-' � �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model �11� r��'��5� 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 building r�ermit number before build-
Conn. Load Mechanical ing certificate of occupancv wil� ho ���� �^a
Air Con�itioning HEAT CALCULATIC CLOSED DUE TO �turn openings listed
Fuel Flue Size Vent. S stem
HEATING OR POWER PLANT per room with CFM's I floor plan with sup-
Supply Openings ply and return local INACTIVITY g�3O�O g, pAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MA` E, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. .,.,,.,�.
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
�m. 447-4230.
7YPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations � ReplacemeM �Vew Constr ction 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 y 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 $�,� .�� Building Permit .��_� � ap val of plans.
r� n t;�' �� ,,
HEATING PERMIT FEE $ � � � �,5� p �l,�,�� � ' � �� � ')
STATE SURCHARGE $ .50 plicanYs S' natur Date
TOTAL PERMIT FEES $��� �5� Receipt # d��t� uildin ficial's Signature � D 8����