HomeMy WebLinkAboutHeating Permit 94-0236 1. Pink - Fife
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� R LAKE TYPE OF STRUCTURE
� 28 DAKO STREET S.E. permit No. 9�3�� Single Family � Two-Family Mufti-Family
�7 "�� LA N 55372
Commercial Industrial Public Other
P ION / PERMIT
Date � '� � � D # IS �/ J ! _, a �6 — (� JOB VALUATION FEE
�S
Site Address 1��.3� �/�'/�`,�,,,�/ $0 -$1,000 2% of job value, min. $20.00
Lot 2 Block � Addition - ��� �, _ 1_ $� �001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
'W� $100.00 or fraction thereof to and including $10,000.
Owner's Name / !�l'L �iVLlT�SO� .
/� / $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �3J`� � L.� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor � , �•
Address ��� � �� /y �� ��(�- ��oz3 $50,001 andover $532.50 for the first $50,000 plus $7.50 for each addi-
��� �/ // tional $1,000 or fraction thereof.
Telephone # 4�
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additio� •••�" `�� �°'^'' °' Q " ^^ °�^h
Warm Air Plants
Model Size Graviry House CLOSED DUE TO �ilding Rermit number before build-
Conn. Load Mechanical ing cer �ACTIVITY 8/30/O l
Air Condition HEAT supply and return openings listed
Fuel Flue Size Vent. System
HEATING OR POWER PLANT per roc... __._.. __.._, , „ 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 MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices
Ciry 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 permft and 1 acknowledge that the information
Afterations L� Replacement 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 �� d�� does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
�/l� � O � in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ � Building Permit # 9�� �� approv I of plans.
HEATING PERMIT FEE $ �� ' � �, � � �f 9
STATE SURCHARGE $ .50 plicant's S' ure Date
TOTAL PERMIT FEES $ �� •� Receipt #���^�T Buildi Official's Si nature �_� Da�
9
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