HomeMy WebLinkAboutHeating Permit 94-0356 t. Pink - File
F PR/ �� '��"`��—__ 2. Green - City
��� �� � - E TYPE OF STRUCTURE 3. Yellow - Conuactor
9
� m 4629 Permit No. 9Y 3�
�tRR MN 5$ --�— Single Family _'� Two-Family Multi-Family
` ,r i, Commercial Industrial Public Other
ING APPLI 10 �/� ERMIT
Date a�j �J �5- _ j �-�—_ Q � Z„� �OB VALUATION FEE
$0 -$1,000 2°l0 of job value, min. $20.00
Site Address 1
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 tor each additional
Lot � Block 2. Addition $100.00 or fraction thereof to and including $10,000.
Owner�s Name _ 1 �1 � �n �� \ $10,001 - $50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 1��C� �M\ ��.Q�,E �rG tional $100.00 or fraction the�eof, to and including
I $50,000.
Heating Contractor ��� 1�Q� �tPS�c��, � t� ��b
Address 3�� t.C� •`�,�,� ��J , g�,y�_)� �� �3'3� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
r tional $1,000 or fraction thereof.
Telephone # ��— ��7
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 $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building rzermit number before build-
Mechanical C, OS `^^^��pancy wil4 be issued.
Conn. Load Air Conditioning _ L ED
DUE TO NS REQUIRED with number of supply and return openings listed
Fuel Flue Size Vent. System +
A CTI�ITy 8�3 o/O 1 Per opening. New structures or additions send floor plan with sup-
Supply Openings HEATING OR P01 �tions shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water �Y BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, nnN. 55372.
Input Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE {NSPECTED (ROUGH-IN AND FfNAL) - CALL CfTY HALL
Cfm. � ,�t • 447-4230.
TYPE OP WORK I hereby apply for mechanical systems permft and I acknowledge that the information
Afteratwns 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 with the state buildingtmechanical c:odes; that this form
Repair Est. Comp. Date ��, � does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
in acxordance with the approved plan in the case of all work which requires review and
Est. Cost $ � ���Q • O(� Building Permit # ---�� app I of plans.
HEATING PERMIT FEE $ � � � e
I����
STATE SURCHARGE $ .50 ApplicanYs S' ature Date
TOTAL PERMIT FEES $ � � Receipt # ��02,�� / � r � ^ �
Buifding icial's Signature Date