HomeMy WebLinkAboutHeating Permit 94-0329 . ..- .�. ...ear �r,.F._ ._ _ .
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F P � 2. Green - City
.�° CITY � RIOR LAKE A TYPE OF STRUCTURE 3. Yellow - Contr�ror
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Permit No. Single Family � Two-Family Multi-Family
PRIO E, MN 55372
Commerciai Industrial Public Other
HEATING APP ICATION / PERMIT
Date �!� 3� �y � PID #�.� 076 0� �-d �OB VAI.UATION FEE
$0 -$1,000 2% of job value, min. $20.00
SfteAddress �!S"� Fs.( P otti� � 5
, r $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block Add'Rion /1� !��t�.� f s* /���;d-;v� $100.00 or fraction thereof to and including $10,000.
Owner's Name � c,a � ��;. F..o..,� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address j 7�ss� /���� G� Pr�o� �.�e.. f'✓1 /�/S 72 tional $100.00 or fraction thereof, to and including
Heating Contractor ����
Address $50,001 and over 3_�3�.�Q fer th� first �5�n.nb,� sz.�a.�•a -!r1 -= i_
I ��t� `�
Telephone # I -P° "�'� * � � -� � � �
The price of your heating •Job Address C y ''�
Furnace Make & Model (�TtC9¢ �� o NPE OF SYSTEM Additional inspections will be �,
Warm Air Plants •Heeting CoMrecta "'''°
Model Size /�{� t'.. ,� � R�.,�'ww� Gravity House Heating Test Record •Testera/Sig�ature -
Conn. Load Mechanical ing certificate oi occupancy wi Pounds
Air Conditioning Date Time Pressuie
Fuel a 5 Flue Size �(�_ Vent. System
�'� HEATING OR P p � Per room with CFM's per open P e� � Z� -
Su�ly Openings /��/ ply and return locations sh
Steam
Return Openings /��/ �� Hot Water RC APPLICATIONS MAY BE MA �nspected
Radiation S.E. Prior Lake, MN. SS37Z. PERfORMANCE TEST
Input /(y�� � o Output �3,�a � �
—`►'_�'� $P6CIA� �@VtC@S •Peroent CO2 � o � � •Percent CO � ��
Edr. City Ha11 business hours are 8. t.� , ��p •Stack Temp. �
�h8f �BVIC@S Percent o2
ALL WORK MUST BE INSPE lf
�i p'1, i Final InspecGOn Date z���"
`
� TYPE OF WORK I hereby apply for mechanical (,_ ,____._ __-- -_.....,.,...w �,,,n me ,rnorma�on
Alt�erations Replacement �_ New Construction above is complete and accurate; that the work will be in conformance wfth the ordi-
nances and oodes of the city and with the state buildinglmechanical 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 $ � � gs� oo Building Permit # "'�
, approval of plans.
HEATING PERMIT FEE $ � 1• 7� � 1f �'.-- -rf'�
STATE SURCHARGE $ .50 li Ys Si ure Date
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TOTAL PERMIT FEES $ o� � • � �y Receipt # � � �aL.- �
uilding Official' ignature Date
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