HomeMy WebLinkAboutHeating Permit 94-0017 , �� a�� F 1. Pink - File
2. Green - City
R � CIT PRIOR LAKE `` °�'"� TYPE OF STRl1CTURE 3. Yellow - Contractor
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� ! �� 46 KOTA STREET S.E. permit No. t� � ( Single Family Two-Family Mufti-Family '
P LAKE, MN 55372
Commercial Industrial Pubiic Other
HEATING A PLICATION / PERMlT
Date /�S�I 9� PID #�� �(� �"' ��'7 � �OB VALUATION FEE
Site Address ��� /� � g� $� '�� ��� 2% of job value, min. $20.00
Lot � Block Additio �-, $���� -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
. $100.00 or fraction thereof to and including $10,000.
Owner's Name P�ID�V� �" 6t�� �f� $10,001 -$50,000 $132.50 for the firsi $10,000 plus $1.00 for each addi-
Address � � � S1�'-� �� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor `S E � � N
Address /��� E $ _��� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # 5���
'�� The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Modei U S/!�D TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size l�. O'�'v Gravity House Heating Test Record must be submitted with building nermit number before build t;
Conn. Load Mechanical ing certificate of occupancy will be issued. ��
� Air Conditioning �`-
Fuel /�.f�'� Flue Size Vent. System HEAT CALCULATIONS REQUIRED with number of supply and return openings iisted
HEATING OR POWER PLANT Per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
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 Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE tNSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WOR1C I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations ReplacemeM � FVew Construction above is complete and acxurate; that the work will be in conformance with the ordi-
nances and codes of the city and with the state build'+ng/me�hanical codes; that ihis form
Repair Est. Comp. Date � does not become a permit until signed by the BUILDING OFFIClAL; that the work witl be
in accordance with the approved ptan in the case of all work which requires reyiew and
Est. Cost $ /S��• fX� Building Permit # approval of plans.
HEATING PERMIT FEE $ /���v7�i�a` /Iy�,9�
STATE SURCHARGE $ .50 nYs Signature � Date
TOTAL PERMIT FEES $ � �? � ! � Receipt # r (� " _ �� � �
ding Off"�c ignature Date
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