HomeMy WebLinkAboutHeating Permit 94-0360 �- ��OV �
1. Pink - File
2. Green - Ciry
.� y � PRIOR LAKE NPE OF STRUCTURE 3. Yellow - Convacror
v � ! 5�62 t OTA STREET S.E. permit No. �� Single Family � Two-Family Mufti-Family
P KE, MN 55372
Commercial Industrial Public Other
P LICATION / PERMIT
Date � JOB VALUATION FEE
PID # 3 � - � �- (I d� ' 0
�� ��,� . $0 - $1,�0 2% of job value, min. $20.00
Site Address �j�l
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot 81ock Addition $100.00 or iraction thereof to and including $10,000.
Owner's Name __ �G''///�/.��G $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
Heaiing Contractor �` $50,000.
Address 8910 WENTWURTH AVE. S0. $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
IN POLI , MN 5542Q-2853 tiona! $1,000 or fraction thereof.
Telephone # 881•9000
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model _�.s TYPE OF SYSTEN '''----� ������+��ns will be billed at $25.00 each.
Warm Air Plants _ C'LOSED Dj.TE TO Record must be submitted with building �ermit number before build-
Model Size ��Q� Gravity
Mechanical 8/3 0/O 1 ��ncy will be issued.
Gonn. Load ACTIVITY
Air Conditioning _
Fuel Flue Size Vent. System _ )NS REQUIRED with number of suppiy and return openings listed
HEATING OR POWER PLANT r"' �---- � per opening. New structures or additions send floor plan with sup-
$upply Openi gs Steam ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Return Openings Hot Water APPLICATIONS MAY BE MAtLED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input ��! Output 70, �_ 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 permit and I acknowledge that the information
Afterations ReplacemeM // . 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 building/mechanical codes; that this form
Repair Est. Comp. Date 1�",� ���t S� does not become a permft 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 $ (oeSS� Building Permit # '-'—'—"'" approval of plans.
HEATING PERMIT FEE $_ �..�f �I� `d „�� .L'[�
S7'�ATE SURCHARGE $ .50 Appli n s Signa e �7�-�� Date
TOTA� PERMIT FEES $ �� et..S Receipt #__ �� a� 9 "� • 12�� S- q �l
Building Official's Signature Date
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