HomeMy WebLinkAboutHeating Permit 94-0354 � �j �'r � � � �'�� 1. Pink - File
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$, Permit No. Single Family Two-Family Multi-Family
PRIOR LA N 55372
Commercial Industrial Public Other
PPLICA ON / PERMIT
� 2 �' _ � JOB VALUATION FEE
Date � PID # .�,�� �7L — � 6 � �
Site Address �� J T2 ��(�}� $0 -$1,000 2°Jo 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
t $100.00 or fraction thereof to and including $10,000.
Owner's Name �.Jd'�w�.�� � `
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �i � � o�� �, tional $100.00 or fraction thereof, to and including
Heating Contractor ` $50,000.
Address � U �� l ��C ��Yr # ZL �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # �� �� �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.� each.
Warm Air Plants
Model Size Gravity _ House Heating Test Record must be submitted wfth building Rermit number before build-
Mechanical �" -'- �' ^^^��pancy will be issued.
Conn. Load Air Conditioning _ CLOSED D
Fuel Flue Size Vent. System _ UE T� �NS REQUIRED with number of supply and return openings listed
HEanN� oR Po� INACTIVjTy g/30/O 1 '�r opening. New structures or additions send floor plan with sup-
Supply Openings Steam �tions shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Return Openings Hot Water lY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, nnN. 55372.
Input Output Special vices
v �� 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
Afterations �/ Replacement FVew 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 � Z�' 2 d �� 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 $ � �� � Building Permit # approval of plan
HEATING PERMIT FEE $ , 3� 7� � � Z '� � � ��
STATE SURCHARGE $ .50 Appli S ture Date
TOTAL PERMI7 FEES $ e3 �.�� Receipt # �,��� /Z � ' �
ding ' al's Signature Date