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HomeMy WebLinkAboutHeating Permit 94-0283 1. Pink - File �O PR ��R� ' � ��� TYPE OF STRUCTURE 3. Yellow - C ntractw � 3 �� PRIQ LAKE � 4629 DAKOTA ST#�ET S.E. � Permit No. ��28 Single Family Two-Family Multi-Family � �Pb1�AK 55372 Commercial Industrial Public Other HE T G APPLI N/ PERMIT Date - °-=���€�ID # .�•S' � G-S Q 6L O JOB VALUATION FEE Site Address / �� � � �)°(,Q,a� ��� � _ $� - $�'�� 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 Nam � $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- � 7c tional $1,000 or fraction thereof. Tetephone # T "' �� �.-'� � !� The price of your heating permit includes one rough-in and one final inspection. Furnace Make & Model TYPE 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 buildin r�ermit number before build- Conn. Load Mechanical �na certificate of occupancy will be issued. Air Conditioning CLO -'� with number of supply and return openings listed Fuel Flue Size Vent. System 'SED DIJE TQ Vew structures or additions send floor plan with sup- Supply Openings HEATING OR POWER PLANT INACTj�jTY HEAT LOSS CALCULATIONS, PAYMENT AND Steam 8�34/O1 i TO THE CITY OF PRIOR LAKE, 4629 Dakota St. Return Openings Hot Water Radiation �•�• • � Input Output Special Devices City Hall business hours are 8 a.m. - 4:30 p.m. Edr. Ot er Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL Cfm. 447-4230. TYPE OF WORK � r� 1 herebY aPPly for mechanical systems permit and 1 acknowledge that the information Alterations Replaceme� ��lew 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 codes; that this form Repair Est. Comp. Date does not become a per ' unti! signed by the BUILDING OFFICIAL; that the work will be ' accordance ith th pproved plan in the case of all work which requires review and Est. Cost $���� �� Building Permit # -� ap roval pla s. . HEATtNG PERMIT FEE $ � � �� � � 7� � � � 1 STATE SURCHARGE $ .50 , ApplicanY ignature Date T4TAL PERMIT FEES $ , Receipt # aZ�7L-T 4_ � _ � Buii ng Official's Signature Date �9 �� m 1' A� �� � � . • .. � � .� ._ v. i,.� . ' �. ,. � y t .r ; f ,� � F 4 L ' � �.. � .w�� a Z '. y Y: M k �, ' � .� ;!� . , r' '�� ; �' HA �. 't K r �y �' �. i . � � � ��