HomeMy WebLinkAboutHeating Permit 95-0294 1. Pink - File
pF pR ��R f TYPE OF STRU�TUF3E 2' Green - City
,, �, CITY OF PRIOR LAKE 3. Y�'°'" - �°"�°`
� m 16200 Eagle Creek Av S.E. permit No / 5-27`` Single Family �_ Two-Family Mufti-Family
Prior Lake, NIN 55372
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT
Date
��� - , 7 � 9 S p�Q # ,,�� �� j� �� j _ � JOB VALUATION FEE
,� $0 -$1,000 2% of job value, min. $20.00
Site Address � d 1 �� � E,�./ +B��c � I ,C � _�
Lot.�_ Block � Addition� �/l� - CJ'l' ��,J�j� �Q� ���� �$�0,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owne�'s Name �!, �1i a� � �J l�a �'� $10,001 - $50,000 $132.50 for �he first $10,000 plus $1.00 for each addi-
Address 3 y� 9 �r(J e��a 4..� � e r> c h f c �.., '�^al $�_ '` or fraction thtroof, to and including
}50,�U0.
Heating Contractor Qr � a c- �-. � K�, � f c� �s ��C.
Address �� f�� 1�/i�.v �� ��('� 7'� � S'� � $50,001 and over r __ �,��„�,�c,.�h@ fiu�t �5�[�'��" Tor each addi-
Telephone # / / ' • PQf"'��` � ~ �� � —
Q h „� ��'� � S ,� The price of yo � y� � ��; , f/ �c.�r,.( 7� I inspection.
Furnace Make & Model TYPE OF SYSTEM • '� Ob ��"�
Additional inspe � � ��� �
Warm Air Plants �C �Hes�^9 ���Of ` —
Model SizeA`9 XOS�� C� y�X�� ��i�� Gravity House Heating T _ before build-
•Testen/Signaturo
Conn. Load Mechanical ing certificate of ' P ��
Air Conditioning
p,�, r;,,,� Pressure enings listed
Fuel �UA7� Flue Size Vent. System
per room with CF •c�s u�e lan with sup-
Supply Openings HEATING OR POWER PLANT P �y and return I P f°�""� MENT AND
Steam
Return Openings Hot Water APPLICATIONS� insa�ea 9 Dakota St.
Radiation S.E. Prior Lake, PERFOAMATICE TEST
Input Q G�c? Output �� C�'la� Special Devices _ f
City Hall business 'Pe�cent CO2 .�; ���� -- •Pe►�+t co _l�
� �
Edr. Other Devices ALL WORK AAUS �Percent 02 �'� �Stack Temp. � }�ALL
Cfm, ! oace / :7"'_ -� 7-
final lnspection
TYPE OF WORK I hereby apply for �information
Afterations Re lacemer�t New Construction above is complett.�._ ....�.�.; �.�-�..e-..� m the ordi-
P � nances and codes of the cdy and wdh the state building/mechanical oodes; that this #orm
Repair Est. Comp. Date does not becoma a permit until signed by the BUILDING OFFICIAL; that the work will be
e� �� � in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ �_� L1 L� s Building Permit #�.'�-"""� ,� approval of a s.
HEATING PERMIT FEE $ ,��,, ;� S �� - '� � �',S`
STATE SURCHARGE $ .50 ApplicanYs Si _ Date
/2-/3- �s
TOTAL PERMIT FEES $ Receipt # � ��D � -
Buil ' g Official's Signature Date