HomeMy WebLinkAboutMechanical Permit #01-0502
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CITY OF PRIOR LAKE r'<~'
4629 DAKOTA STREET S.E. p. erm~ No. CJL. '5 ~ J..
PRIOR LAKE, MN 55372 I
HEATING APPLICATION I PER~T
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Site Address /1,00/ 3 - ~ ~
lot ~ Block ;;2... Add~ion~ t.UA~-L>;;AJd
Owner's Name ~ ~
Address 1~~b6- ~ U
Heating Contractor ~ ~ "!f ". k1e.....>>.-.-
Address / () 1 0 tJ - ~ f!J.L-L
'lsa - tt'l- ;-~.s-~
Date
Telephone #
Furnace Make & Model
Model Size
Conn. Load
Fuel,
Supply Openings
Return Openings
Input
Edr.
Cfm.
Alterations
,Flue Size
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER Pl.~-
Steam /'2.00 \ ,\0
Hot Water \ 0/0) E-P -pUb
Radiation C\.;OS 1~
Special Devices , \~~C1\"\T\
x~'
I
Output
Other Devices
TYPE OF WORK
Replacement
New Construction
Repair . E~ Comp.:tte
Est. Cost $ ~ I~ 1'1 Building Permit #
HEATING PERMIT FEE $ t 9~.G7:>
STATE SURCHARGE $ .50
TOTAL PERMIT FEES $ .y'~ ~ (J D Receipt #
B!ib3lt
I
n:ef OF STRUCTUR.E
1. Pink - File
2. Green - City
3. Yellow - Contractor
Single Family _
Commercial
x
Two-Family
, Multi-Family
Other
Industrial
Public
JOB VALUATION
$0 - $1,000
$1,001 - $10,000
FEE
2% of job value, min. $20.00
$10,001 - $50,000
$20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
$132.50 for the first $10,000 plus $1.00 for each addi-
tional $100.00 or fraction thereof, to and including
$50,000.
$50,001 and over
$532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $25.00 each.
House Heating Test Record must be submitted with puildinQ..Permit number before build-
ing certificate of occupancy will be issued.
liF~T -
'.N$ REQUIRI;,Q with number of supply and return openings listed
per opening. New structures or additions send floor plan with sup-
ons shown. HEAT LOSS CALCULATIONS, PAYMENT AND
BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
3372.
-"1 nail business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230.
I hereby apply for mechanical systems permit and I acknowledge that the information
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
does not become a permit until signed by the BUILDING OFFICIAL; that the'work will be
in a.ccordance with the approved plan in the case of all work which requires review and
approval of plans.
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- ~ Applicant's Signature tJ
av-
Building ofIial's Signature
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Date
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Date