HomeMy WebLinkAboutHeating Permit 94-0341 - - - _ - �,,,..., 1. Pink - File
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TYPE OF STRUCTURE
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� rn 4 6 2 9 D A K O T A � E T S. E. p e r mi t No. r 3 � Sing le Fami ly 1\ Two- Fam� ly Mu l ti- Fami ly
�V �F��KE,! 5372
�` �� Commercial Industrial Public Other
" ! � L!C N / PERMlT
Date ' JOB VALUATION FEE
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Site Address �'a (�'; 7 ��ir,� S'�' 0� �� $� -$� ��0 2% of job value, min. $20.00
,�c1c
Lot Block Addition $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
n $100.00 or fraction thereof to and including $10,000.
Owner's Name VCt, � m d e- r� e.'�' e
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address _.�o�� �7' (Fr o a,'� �'� C���� tional $100.00 or fraction thereof, to and including
n $50,000.
Heating Contractor 0"I` i 6, c- �.. a k�C, N 'f`a a- JQ� �
Address ��o g�� ��,� �4 (� G, KL T� L $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
��`� �/ l � tional $1,000 or fract+on thereot.
Telephone # � < �, _
heating permit includes one rough-in and one final inspection.
Furnace Make & Model ��►+cvJ� o�w-� TYPE OF SYSTEII s will be billed at $25.00 each.
�� y� �> /� �,,, Warm Air Plants _ CLOSED DUE TO
Model Size /`i/7' 1 Gravi Record must be submitied with building nermit number before build-
Conn. Load Mechanical INACTIVITY 8/30/O 1 i�ncy will be issued.
i � �, Air Conditioning _
Fuel /V�..'''� Flue Size ��_ Vent. System �. ������ ��uNS REQUIRED wfth 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 ply and return locations shown. HEAT LOSS CALCULATtONS, PAYMENT AND
Steam
Return Openings 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.
Ot r D�vices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. ` ��c.�, � 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and 1 acknowledge that the information
Afterations ReplacemeM __�___ {Vew Construction above is complete and accurate; ihai 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
oo ,�-= in accordance with the approved plan in the case of all work which requires review and
Est. Cost $� a�S� °"'- Building Permit # app al plans.
HEATING PERMIT FEE $_ 7`�, � ��. -- 9�
STATE SURCHARGE $ .5O Applica s' re Date
TOTAL PERMIT FEES $ � 9• ,Zv� Receipt # q 7� 1 ���-�—
Buit ing Official's Signature Date