HomeMy WebLinkAboutHeating Permit 94-0137 — 1. Pink - File
�F PR! � � 2. Gr`een - Ciry
�-> � � LAKE / Tr PE OF STRUCTURE 3. Yellow - Convactor
� 9 m q T S.E. permit No. l � ���� Single Family �_ Two-Family Mufti-Family
�Id�E, 372
Commercial Industrial Public Other
/ PERMIT
Date �. �5- a(� - a�s -� JOB VALUATION FEE
Site Address '3 S� S $0 -$1,000 2% of job value, min. $20.00
Lot�� Block Addition $1,001 -$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 t /Q
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Addres S� - Zj tional $100.00 or fraction thereof, to and including
' $50,000.
Heating�Contractor d.�L' lL� �
Address'� tS�s �� >U /�a �— � �'`�� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
� tional $1,000 or fraction thereof.
Telephone # � ��J
The price of your heating pe►^-" rough-in and one final inspection.
Furnace Make & Model � TYPE OF SYSTEM Additional inspecti�^�
�\ Warm Air Plants ��
Model Size � Gravity Hou � ��� wilding oermit number before build-
Conn. Load Mechanical ing c� CI, �
Air Conditioning HEAT �p � ..,cn number of supply and retum openings listed
Fuel Flue Size Vent. System
HEATING OR POWER PLANT per roo ,„ upening. New structures or additions send floor plan with sup-
Supply Openings ply and �.�rn locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices
Edr. _ ,i+ City Hall business hours are 8 a.m. - 4:30 p.m.
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
ARerations Replacemertt 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 U`� ' 9 � does not become a permit 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 $�2 (P� . I� Building Permit # " a val of pl
HEATING PERMIT FEE $ � 3, 7,5' T j�7� �
STATE SURCHARGE $ .50 ' nYs ignature Date �
TOTAL PERMIT FEES $_ .7�, �a Receipt # _ �� D�.J � �' ��
uilding Officia nature Date
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