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
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