HomeMy WebLinkAboutHeating Permit 94-0269 ���� \
1. Pink - Fite
2. Green - City
� PRI TYPE OF STRUCTURE 3. Yellow - Contractor
.� 9 CITY OF PRIOR LAKE
� ��p�
� m 4628 DAKOTA STREET S.E. permit No. ��%�'�'� Single Family Two-Family Multi-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT
Date C� � p"� PID #�ZS ^� �(J �-(� JOB VALUATION FEE
Site Address �� ���"�'CYI�.�('� ��CQ, $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 Block Addition $100.00 or fraction thereof to and including $10,000.
Owner's Name C' �,
� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor `� �
Address � � �„�� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
������ tional $1,000 or fraction thereof.
Telepho #
The price of your heating permit includes one rough-in and one final inspection.
F ce e ��(�'�[� TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
H� Warm Air Plants
Model Size 1 c)���� Gravity House Heating Test Record must be submitted with building permit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuel _�� Flue Size Vent. Syste I N I with number of supply and return openings listed
H�►T�N� < CLOSED DUE TO � CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings rn locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water INACTIVITY 8/30/O 1 NS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation �e, MN. 55372.
Input �F)' (� Output Special Dev�.,��
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. e{47-4230.
TYPE OF ORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations Replacement �Vew Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and codes of the cfty 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 $�/�o�• Building Permit #°-�"� a val of plans.
HEATING PERMIT FEE $�• W �-" t q-- �•Q,
STATE Sl7RCHARGE $ .50 Appli n Signature _ Date
TOTAL PERMIT FEES $ , Receipt #,�'�� �� `� 3� Z�
uilding Official's Signature Date