HomeMy WebLinkAboutHeating Permit 94-0281 � � � � R/] �r., t. Pink - File
V L5 2. Green - Ciry
�.� 9 IT � PRIOR LAKE '2$�"'/ TYPE OF STRUCTURE 3. Yellow - Conuacror
� ( 3�462 OTA STREET S.E. permit No. ��"� Single Family _ 1�� Two-Family Multi-Family
P KE, MN 55372 2� `
Commercial Industrial Public Other
N TIW A LICATION / PERMIT
/ JOB VALUATtON FEE
Date PID # o�J�— dUb— Ql7 - �
Sfte Address � `�-� �-�-. �� $� " $� ��� 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.
Owner's Name �� E� t.�-r'� �P �(''».,�f^� � � ��
� 1 ����� � $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
"1 $50,000.
Heating Contractor � �-�1 r,eS - � b
Address ��1.� - �tJ��� ��-�1�1� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
-- tional $1,000 or fraction thereof.
Telephone # [°�7U �— lJ ►�
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Modet��� �(� TYPE OF SYSTEM Additional insnAMinn� w�►► tio �.�+...+ �• �^` ^^ '
Warm Air Plants
Model Size Gravity House CLOSED DUE TO �ilding �ermit number before build-
Conn. Load Mechanical '" HEATr INACTIVITY 8/30/O1
Air Conditioning suppfy and retum openings iisted
Fusti Flue Size Vent. System
HfATING OR POWER PLANT �� fO° - ., --- --.-_._..,.. .,, additions send floor plan with sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCULA710NS, 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 INSPECTEq (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfri�.
447-4230.
' TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
ARerations _� Replacemerrt New Construction above is complete arrd 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 wil{ be
r�,fl'�����" in �ccordance with the app�oved plan in the case of all work which requires review and
Est. Cost $ ��v 8��0 Building Permit #�'7'1��+�1�.y� a roval of plans.
HEATING PERMIT FEE $ D � h,` �� �
STATE SURCHARGE $ .50 ApplicanYs Sign re ate
_ �Q�,���� $ � . - �� ���.�_ - - --_ .
�- 2-Z F
B' ing Official's Signature Date
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