HomeMy WebLinkAboutHeating PErmit 94-0317 �� � M (c��- 1. Pink - File
F p � L� D v�s 2. Green - City
�.�� C I T Y O I O R L A K E TYPE OF STRUCTURE 3. Yellow - Contractor
c;� m�iT -; �� D STREET S.E. Permit No. ��"� t� Single Family Two-Family Multi-Family
PRIO E, MN 55372
Commercial t/' Industrial Public Other
HEATING L CATlON / PERMIT
JOB VALUATION FEE
Date C�� g PID# �S "bl��--�
� $0 -$1,000 2% of job value, min. $20.00
Site Address 0 � +
� — $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block I Addition {"• . $100.00 or fraction thereof to and including $10,000.
Owner's Name �l0 /2 �
$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
Heating Contractor � $50,000.
Address c �$50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
� � � tional $1,000 or fraction thereof.
Telephone # 3 J
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Mode�L��l�l 1CS NPE OF SYSTEM Additional ins�ections will be billed at $25.00 each.
� � /�� Warm Air Plants
Model Size � Gravity CLOSED DUE TO submitted with building �ermit number before build-
.
Conn,Load �S�.U�� �(� Mechanical INACTIVITY 8/30/Ol °ued.
Air Conditioning
Fuel _1� / Flue Size �� Vent. System � with number of supply and return openings listed
� lew structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT P � y and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAtLED TO THE CiTY O� PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices
Ciry 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.
� ���'! � `� 7� t T? �"J� / �'T"/ '�/�r l�/�/l �}-'
�� a � , ���_� TYPE OF WORfC I hereby apply for mechanical systems permit and I acknowledge that the information
� above is complete and axurate; that the work will be in conformance with the ordi-
fterations Replacemerrt New Construction
` nances and codes of the city and with the state building/mechanical codes; that this form
Repair "� Est. Comp. Date �c �'�' ��� does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
in accordance with the app ed plan in the case of all work which requires review and
Est. Cost $ Building Permit #�� approval of lans. �
HEATING PERMIT FEE $ �-�- � S h c 0 r' 1 Q
STATE SURCHARGE $ .50 IicanYs Si ature Date
t'rn �10 � �'
TOTAL PERMIT FEES $ ��� �� Receipt # �`1 � v" Buildin Official's Signature Date
�'�':; �, _� .
•,,��..,,• ,.., .
��,.,,.._._.�. . {
�' �
,� :,.°;,
, '� f! ,.- i
� ;
, s.''�°U � ` .
T::3 �
�
: � ��
'` �'`� y
�, - . _ . .
� � . ._
r
�> .
�
�`
� �
�
,,
N
�
T
i
(
�
f
F �
Y