HomeMy WebLinkAboutHeating Permit 94-0026 1 G ��Y�B
1. Pink - File
� O�� 2. Green - Ciry
� OF PRIOR LAKE � TYPE OF STRUCTURE 3. Yellow - ConvaCtor
m 9 DAKOTA STREET S.E. permit No. (�—�� Single Family �` Two-Family Mu1ti-Family y ,
� RIOR LAKE, MN 55372 ' '
Commercial Industrial Public Other '
HE G APPLICATION / PERMIT r�
�„� � �� JOB VALUATION FEE
PID # 7 � �
S' ddress � D(o' $� '$ ��� 2% of job value, min. $20.00
� Cntru'f $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
L t� Block Addition ;1pp.pp or �xtion thereof to and including $10,000.
Owner's Name ��, a I V� h-V VI,�iCN ,,. w,� �l!f. FA ire_ U!w f,..� stn nnn �aa �� fr�c q.ach addi-
$10,001 - $50,000 � �- � q.
Address ''`���Q � pV'd S�'1p�, j (�y � ciuding
Heating Contractor �'� , �'�'� Job Address / �� ��� �
Address l�o� (a0 �"�_�� �� � $50,001 and over Heating Contractor _�j /� �C(,�„��� ch addi-
Telephone # � " 7 7
Name oi Testsr �� Jat�
/ �p c ,� /��„ The price of your h Date )/ pection.
Furnace Make & Model �' �m "TYPE pSYSTEM Additional inspections �`f'
Warm Air Plants -
Mode( Size /�C�, DC70 �� Gravity Nouse Heating Test 2 � 6 � o re build-
Conn. Load Mechanical _ � ing certificate ot occu P�rcent O
Air Conditioning Percent CO 7 y�" �
gs listed
Fuel /U L�Z�"' Flue Size �=• Vent. System Stack Tem � d
HEATING OR POWER PLANT Per room with CFM's P• with sup-
Supply Openings ply and return locat ��-- �-v, Q� NT AND
Steam
Return Openings Hot Water APPLICATIONS MA �, akota St.
Radiation S.E. Prior Lake, MN. � ��`�' 3� �,,G,
Input Output Special Devices �
City Hall business ho
Edr. �
Other Devices ALL WORK MUST B� m�rw i c., �r,.�...,..-.,. ,-.. __ _____ �, _____ LL
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations Replacement � New Construction above is complete and accurate; that the work will be in conformance wRh the ordi-
nances and codes of the city and with the state build'+ng/mechanical codes; that this form
Repair Est. Comp. Date 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 $ J� Building Permit # approval of plans.
HEATING PERMIT FEE $ ��,j. aJ� / /g �
STATE SURCHARGE $ .50 A' Ys Signature ate
�
TOTAL PERMIT FEES $ � I • - 7� Receipt # ��`�,,�,� � � S �
ding cia s ignature Date
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