HomeMy WebLinkAboutHeating Permit 94-0156 , � � / / t. Pink - File
� � � 2. Green - City
�� R_�` r � rr�lOR LAKE ��� TYPE OF STRUCTURE s. Venow - convacwr
-EITY � KO7A STREET S.E. permit No, qy'� v
.� � tl � Singie Family Two-Family Mufti-Family
IOR LAKE, MN 55372
�� A�� Commercial Industrial Public Other
APPLICATION / PERMIT
PID # o� - a�O 'U.ZI —D �OB VALUATION FEE
Site Address sJ � Q j�2� �(� $0 -$1,000 2qo of job value, min. $20.00
$1,001 -$10,000 $20,00 for the first $1,000 plus $1.25 for each additional
Lot Block Addition $100.00 or fraction thereof to and including $10,000.
Owner's Name � UQi f � �
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address v�n� a S a � v u tional $100.00 or fraction thereof, to and including
Heating Contractor Burnsville Meatln� & A/C, InG. $so,000.
Address Sava e MN 5����•� 12� $50,001 and over,. ._. _� ,_. .,_.$?32.�0_fqr the first $50,000 plus $7.50 for each addi-
894•0 05 ' •
Telephone # ' •
�-� p� The price of you� .�� ��� „tys`S S�.a� T"•, .,c� � spection.
Furnace Make & Modei 6 l� TYPE OF SYSTEM�� Additional inspecti� _
Warm Air Plants •H°•`"'9 �O1""`''«
Model Size �� Gravity House Heating Te •Testers/Signature --` �-----�-�' before buifd-
Conn. L ad Mechanical _ ing certificate of
Air Conditioni C f� � Pounds
Date Time Pressure nings listed
Fuel •� Flue Size Vent. System
per room with CF '�� �"e an with sup-
Supply Openings HEATING OR POWER PLANT Aly and return I P�essurized MENT AND
Steam Inspected
Retur� Openings Hot Water APPLICATIONS 9 Dakota St.
Radiation S.E. Prior Lake, PERfORMANCE TEST
Input DUtpUt Special Devices `Percent CO �//'� •Percent CO �
City Hall business � �
Edf. •Percent 0 �/� •Stack Temp. �"� `�
Other Devices ALL WORK MUS HALL
Cf�Tt. � Finat Inspection Date �� ��
TYPE OF WORK I hereb a I fo information
Y PP Y l-- -- - - --- - - -- - -
Afterations Replacement �FVew 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 does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
Est. Cost $ �Jv 0(�� � in �rdanc� with the approved plan in the case of all work which requires review and
Building Permit # approv of plans.
HEATING PEFtMIT FEE $ 5 �a 7� /�/
STATE SURCHARGE $ "°":5 (icanYs Signature Date
T07AL PERMIT FEES $ Receipt # 7'�aZ 7`"
Building Official's Signature Date
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