HomeMy WebLinkAboutHeating Permit 94-0300 r ,
1. Pi�k - File
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L� ��� RIOR LAKE � TYPE OF STRUCTURE
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� rn� 4629 D�KOTA STREET S.E. permit No. � Single Family � Two-Family Multi-Family
6 �RI KE, MN 55372
Commercial Industrial Pubtic Other
HE TING LICATION / PERMIT
Date � -�- PID # �' _ � �OB VALUATION FEE
Site Address _ ��t "�J�.O ��, �� . �7 ��. $� � $�'�� 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 ��`(p�� l� CvG��� $� -¢� $7
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ��� �v a�ti. Gv . ��� tional $100.00 or fraction thereof, to and including
Heating Contractor Q\� � � ��`r�1C�Q, � �� " (v — �� b $50,000.
Address _� �• �'�1.�1�1 _� �j��� �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # b �� �� �
p,�� �, `��� � �� p� � � � The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model `-� �� T1fP� OF SYSTEM � ���.,� Additional inspections witl be billed at $25.00 each.
�,�/ �re� V Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building nermit number before build-
Conn. Load Mechanical ing certificaie of occupancy will be issued.
Air Conditioning
Fue! Flue Size Vent. System HEAT CALCULATIONS REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT Per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings Steam ply ar�d return locations shown. HEAT LOSS CALCULA710NS, PAYMENT AND
Return Opertirtgs 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 FlNAL) - CALL CITY HALI
� 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the informatio�
Afterations Replacemerrt FVew 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 ��\ � a does not become a permit until signed by the BtJILDtNG O�'FtCIA�; that the work will be
in accordance with the approved plan in the case of all work which requires review and
Est. Cost $��� •C](� Building Permit # roval of plans.
HEATING PERMIT FEE $ 0 •OC� V� � D �
STATE SURCHARGE $ .50 AppiicanYs Signature Date
TOTAL PERMIT FEES $ �-�� Receipt # � 7�IL
o�rv"R�
Bu ing Official's Signature Date
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