HomeMy WebLinkAboutHeating Permit 94-0282 • 1. Pink - File
2. Green - �iry
.�°� RIOR LAKE � TYPE OF STRUCTURE 3. Yeliow - Contractor
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� � m 4629 TA STREET S.E. permit No. � c �� Single Family � Two-Family Multi-Family
� � ��RI KE, MN 55372 282
Commerciai Industrial Public Other
� HEATI G ICATION / PERMIT
JOB VALUATION FEE
Date � � �= '�"�� PID # �3'- � 97— U� �' —�
` �/� —�� $0 -$1,000 2% of job value, min. $20.00
Site Address 1�o w �� 'TM.�(� S.�
Lot Block Addftion $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 ��
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address � S. tionat $100.00 ar fraction thereof, to and including
(� \ � • � c� $50,000.
Heating Contractor �.iLa 't' -
Address ��� �/l7 �`�M� �� �'��{Y.��� $50,001 and over $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.
Furnaae Make & M�e TYPE OF SYSTEM "�"`- '' ms will be billed at $25.� each.
Warm Air Plants
Model Size Gravity
3 Record must be submitted with buildin r�ermit number before build-
CLOSED DUE �.
Conn. Load Mechanical :upancy will be issued.
A��co�dn���ns _ INACTIVITY 8/30/Ol
Fuel �_Flue Size Vent. System _ �NS REQUIRED with number ot supply and return openings listed
_. .__... ...��� ..�m's per opening. New structures or additions send floor plan with sup-
Supply Openings HEATING OR PO..�� �u�n� P�y 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 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 I acknowledge that the information
Atterafwns Replacement � New Construction �_ above is complete and accurate; that the work will be in canformance 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 will be
in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ Building Permit # � a roval of plans.
HEATING PERMIT FEE $ v'� . L� � �� � 1 � oZ.�
STATE SURCHARGE $ .50 ApplicanYs Su�nature Date
p �'�-2 Z R �
TOTAL PERMIT FEES $ �� �� Receipt # a'� 7.�� /
Buil ' g Official's S�nature Date
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