HomeMy WebLinkAboutHeating Permit 94-0355 F PRI R � � � � � � � ! 2. Green - Ciry
� �� � TYPE OF STRUCTURE 3. Yellow - Convactor
�.� D �IT� �P R LAKE
� ' dS TA ET S.E. permit No. � 3� Single Family Two-Family Multi-Family
PRIOR LAK 55372
Commercial Industrial Public Other
PLICATI N / PERMIT
Date ���' /`f' PID #� :Z�Z �- Q UI �V JOB VALUATION FEE
Site Address _ 7�Os /°►'GlJy. /,� ,SO • $0 -$1,000 2% of job value, min. $20.00
, � c $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block �_ Additiorr��.�th. �t.�,n� 1 �.-�✓ $100.00 or fraction thereof to and including $10,000.
Owner's Name C��UIVl'� ��/� �r �`Q4/,�.s $10,001 -$50,000 $132.50 for the fi�st $10,000 plus $1.00 for each addi-
Address `f' l�`� j��y� �� SO • tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor ��%0� L��� �L!//y�/3jI(/lp
Address �� 9(p � a�Q r�'� s�, $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
,/ tional $1,000 or fraction thereof.
Telephone # y �/ � /���p
CLOSED DUE TO tating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM will be billed at $25.00 each.
Warm Air Plants _�AC'I'IVITY g�3 ��� 1
Model Size G�avity scord must be submitted with building permit number before build-
Conn. Load Mechanical ,_ancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System HEAT CALCULATIONS REQUtRED 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 Openir�s Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input J4�1d, t'd Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
her Device ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm.
447-4230.
TYPE OF WORK 1 hereby apply for mechanical systems permit and I acknowledge that the information
Afterations Replacement 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 buildingJmechanical codes; that this form
Repair Est. Comp. Date does not become a permft unti! 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 $'�I Oc�'�- Building Permft # "'�`�~ approval f plans.
HEATING PERMIT FEE $ 0• �'� ��_ ���
STATE SURCHARGE $ .50 plicanYs Si ture Date
, �2 _S�
TOTAL PERMIT FEES $�� '`S d Receipt # o�.��� � Buildi Official's Signature Dat
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