HomeMy WebLinkAboutHeating Permit 94-0302 1. Pink - File
� TYPE OF STRUCTURE 3. Yellow - Conuactor
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.� � CITY OF PRIOR LAKE
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� m 4629 DAKOTA STREET S.E. permit No. "�''t ' 3 � z- Singie Fami{y Two-Family Multi-Family
PRIOR LAKE, MN 55372
Commercial � Industrial Public Other
HEATING APPLICATION / PERMIT
Date �L� — �c °— �� PID # nZ,� d D�— 6�- � �OB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Sfte Address
7L 9 a�,e�.� $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
T Lot Block Addition $100.00 or fraction thereof to and including $10,000.
Owne►"s Name �� � e, �.n���
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
`Address _� �� � �r�/.c,'��� �" tional $100.00 or fraction thereof, to and including
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Heating Contractor Pr � � �- ��c� ,F, E ,� ��1� $50,000.
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Address �(e 9�cr ,� I��.N cX ����.p �^� �� � �_� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # � �/ 7 -- �') / �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model S� ��_ NPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size C�bv��° t'c+��ad' Gravity House Heating Test Record must be submitted with building nermit number before build-
Conn. Load Mechanical ing certfficate of occupancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System �`�t��( c.�`►n����' HEAT CALCULATIONS REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT Per room with GFM's per opening. New structures ar additions send ffoor p{an with sup-
Supply Openings � Steam ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMEN� AND
Reiurn Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITI OF RRIOR 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 1 hereby apply for mechanical systems permit and I acknowledge that the information
Atteratians Replacement 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 alt work which requires review and
Est. Cost $ /�b� Building Permit #'� app al plans.
HEATING PERMIT FEE $ � �D, Q� ,> �d -�/' -_ � �
STATE SURCHARGE $ .50 Applicant's Si n re Date
TOTAL PERMIT FEES ,� Recei t # � " ( � ��� � � �
$ p �� � Building Official's Signature Date