HomeMy WebLinkAboutHeating Permit 94-0359 �__ _._ _
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�.,°� P CITY OF PRIOR LAKE TYPE OF STRUCTURE � 3. Yellow - ConVactor
� m[��L ( 5� DAIK�A STREET S-E- Permit No. ��'`�I �9 Single Family � Two-Family Mufti-Family
PRIOR � , MN 55372
Commercial tndustrial Public Other
HEATING APP ATION / PERMIT
Date � PID #�S ',� y Z�' D�'� - D �OB VALUATION FEE
Site Address ��� 3 ��� �- . �j . $0 - $1,000 2% of job value, min. $20.00
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot Block Addition $100.00 or fraction thereof to and including $10,000.
Owner's Name �
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 tor each addi-
Address �3 � tional $100.00 or fraction thereof, to and including
` -'"' ' ` 1 $50,000.
Heating Contractor � 7� )
Address �.�J�U L� '� z� �� ��` l'� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,�0 or fraction thereof.
Telephone # ��� �� ��
t � The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model ��J�� TYPE OP SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heatin4 Test Record must be submitted with building oermit number before build-
Conn. Load Mechanical :upancy will be issued.
Air co�d��o�i�9 . CLOSED DUE TO
Fuel Flue Size Vent. System _ iONS REQUIRED with number of supply and return openings listed
H�►nNG oR Pc �ACTIVITY 8/30/O l 's per opening. New structures or additions send floor plan with sup-
Supply Openings Steam ;ations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Return Openings Hot Water �� ����� �•��.-- , •�AY BE MAILED TO THE CIIY 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 1 hereby appty for mechanical systems permit and 1 acknowledge that the information
Afterations Replacement New Construction �G� 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 building/mechanical codes; that this form
Repair Est. Comp. Date ���� 1� does not become a permit until signed by the BUILDING OFFICIAL; that the work wilf be
in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ � k ��� Building Permit # approval of plans.
HEATING PERMIT FEE $ �� ' �� `a., �
STATE SURCHARGE $ .5O � �� / ppli ' Sig tu ate
TOTAL PERM{TfEES $ �� � � Receipt # ` lz��sr9
i ing Official's Signature Date
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