HomeMy WebLinkAboutHeating Permit 94-0344 __.._--------
1. Pink - File
a � �' 2. Green - City
-� , n
OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contractor
� 9 DAKOTA STREET S.E permit No. `�� ��� Single Family Two-Family Mufti-Family
IOR LAKE, MN 55372
Commercial industrial Public Other
�ii APPLICATION / PERMIT
JOB VALUATION FEE
PID# �,��/7—���
Site Address ��/ � $0 -$1,000 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 C� G� y �C.J.`�c; ns � ti
/ �/ $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �G�S`3� >i�G n f-� �" �!w'� ��� -�� �. tional $100.00 or fraction thereof, to and including
� $50,000.
Heating Contractor G'✓.� f S� s /���..�,`�-„�.
Address �°? � a� ,/!/�. �?'� ya �Q S� � � �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tronal $1,000 or fraction thereof.
Telephone # �s`� �' ��'6� CLOSED DUE TO 9 P 9 P
�eatin ermit includes one rou h-in and one final ins ection.
Furnace Make & Model �'- �/� S�D ✓�e TYPE OF SYSTEA �ACTIVITY g�3 O�O 1 s will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity Record must be submitted with buildin�r�ermit number before build-
Conn. Load 3os �-(7 f' ?1J Mechanical _..;, __ �pancy will be issued.
Air Conditioning
Fuel .� G Flue Size � Vent. System ,'re� �, 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 and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
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.
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 permft and I acknowledge that the information
Alterations Replacemer�t New Construction /\ above is complete and accurate; that the work will be in conformance wfth 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 all work which requires review and
Est. Cost $,9� Building Permit # �-�'�� approval of la
HEATING PERMIT FEE $ „Zd_ OO � ,l'� �7� �'�+''
STATE SURCHARGE $ .50 p IicanYs S' Date
. ,� � � 7 � 1- 23-9
TOTAL PERMIT FEES $ ,ZU � Receipt # �
Building Official' ignature Date
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