HomeMy WebLinkAboutHeating Permit 94-0291 1. Pink - File
2. Green - City
�.y�� pR'OR 9 CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contracror
� m 4629 DAKOTA STREET S.E. permit No.�'T 2 G► Single Family Two-Family Multi-Family
PRIOR LAKE, MN 55372
Commerciai Industrial Public Other
` HEATING APPLICATION / PERMIT
Date PID # oZ� ' v J,� — DI �- 0 JOB VALUATION FEE
Site Address �� _-�-�'(� Z n�[� d� U h��� ��t �° i'�. �'L�/ $0 -$1,000 2% of job value, min. $20.00
Lot Block Additio $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
,/� =100.00 or ftactan tFwraof So and inciuding $10,000.
Owner's Name �CJ �p � h �`� l�
$10,001 - $.�0�0 . ,"_ -.- ,,,,., �.SO #ar.3h�-��-"�°'� -, 1.04 for each addi-
Address / � SU ?_ �di �' ���� h cr �,c� �s�+1� �r� `�J LT/ � �y - ,� �/ t to and including
� •PermK+� 4
Heating Contractor � � r1 l��_a� �. ,L� /�,�o f�; % ti •�� naa���� Sd�i � � uo �°�� ��o�i �'
.50 for each addi
so�� � �G �� �/� vI^ l�a � , �� � $50,001 an .Heating Contracta ` - fr '�
Address �� f � ,�
Telephone # �� � `— d r� � 7 � •Testers/Signature ^ —
The price Pounds final inspection.
Furnace Make & Model ��ipt�1arr� TYPE OF SYSTEM Additionai in p T;,ne Pressure
a��S ' 7� 6 Warm Air Plants �
Model Size Gravity House Heati •Ga� une er before build-
Conn. Load
Mechanical ing certificai Pf°
Air Conditioning i�sa��
F��1 � Flue Size �� �'� Vent. System n openings listed
PERFORMANCETEST
HEATING OR POWER PLANT P�r room wit Q5 or plan with sup-
Supply Openings Steam ply and ret� "Percent CO2 �S� •P°�`°"t co Q pAYMENT AND
APPLICATIG�, •percenc o 9��' •Stack Temp. L- `� 4629 Dakota St.
Return Openings Hot Water 2
Radiation S.E. Prior La� F�nal Inspec6on Date ���� �
Input ��c'tX� Output �o a Special Devices � ,
City Hall bus7 i
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
Afterations Replacemerrt � New 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 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 $/S� C3 Building Permit # �_ app val of pl .
HEATING PERMIT FEE $ aZ.�O • �Z� � � �'
STATE SURCHARGE $ .50 IicanYs e Date
TOTAL PERMIT FEES $ �. - 7S Receipt # o� �7V � � �� " �
Buildin Official's Signature Date �