HomeMy WebLinkAboutHeating Permit 94-0315 � � � Q M � � �0 � 1. Pink - File
v 2. Green - Ciry
�� � C OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
�� DAKOTA STREET S.E. permit No. �-31.5 Single Family �_ Two-Family Mufti-Family
OR LAKE, MN 55372
Commercial Industrial Pubiic Other
HEA IN APPLICATlON / PERMIT
Date D PID #�5" O Q� — O� "Q JOB VALUATION FEE
� $0 -$1,000 2% of job value, min. $20.00
Site Address
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot 9 Block Addition $100.00 or fraction thereof to and including $10,000.
Owne�'s Name ��.1�,tn,/
� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ��i ���/ tional $100.00 or fraction thereof, to and including
Heating Contractor � �., . . $50,000.
Address � $50,OOt and over $532.50 for the first $50,000 plus $7.50 for each addi-
t��al $1,000 or fraction thereof.
Telephone # �� � � CLOSED DUE TO it includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTE �ACTIVITY c��3 O�O 1 at $25.00 each.
��— � Warm Air Plant
Model Size , Gravity oe submitted with building r�ermit number before build-
Conn. Load Mechanical „ _ _ _ _ , _ issued.
Air Conditioning
Fuel Flue Size Vent. Sysfem HEAT CALCULATIONS RE�UIRED 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-
Suppl Openings Steam ply and return locations shown. FIEAT LOSS CALCl1LATIONS, PAYMENT AND
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Input Output �, (� �� Radiation S.E. Prior Lake, MN. 55372.
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 I hereby apply for mechanical systems permit and I acknowledge that the information
ARerations Replacemer�t � New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and codes of the city and wfth 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
E � . �� $ j�jO �• tl� in accordance with the approved plan in the case of all work which requires review and
/ � Building Permit # '—�'�� app val of plans.
HEATING PERMIT FEE $ �l� aZS ���� `!I �/
STATE SURCHARGE $ •` .50 Applicant's Signature Date
TOTAL PERMIT FEES $��� �` Receipt # �� � 2
Building OfficiaPs Signature Date
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