HomeMy WebLinkAboutHeating Permit 94-0330 � - . _ 1. Pink - File
� pR� 2. �Green - City
1�.a�� � ��� LAKE / TYPE OF STRUCTURE 3. Yeilow - Convacror
� A�THEETS.E. permit No. "��t' Singie Family �� Two-Family Mufti-Family
• ��� P��O�I�AIC�," N 55372
�`�' i Commercial Industrial Public Other
HEATI G APPLI ON / PERMIT
Date p� # „�.5� OII — D�—O JOB VALUATION FEE
Site Address 1��� ��� ` C..�c�(�.� 1 rG� ,� $0 -$1,000 2% of job value, min. $20.00
Lot � 81ock ` Addition � ��(,Q,� $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owner's Name �Vl � mQ�U���� �(.:.Y1 l�l-�-"�tC� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address , � C JS `�1 ���.��-.�`!C� (� 1� �, � S.� tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor�``�QL� �1�(��' � �-�, ►..3- �9��
Address � �g� �� - `�L�-v� � � �jj\�l.Y�j)��� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # _ �� — ��i
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Record must be submitted with building permit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning ,
Fuel _�Flue Size Vent. System HEAT CAt( �fy and return openings listed
HEATING OR POWER PLANT Per room wi CLOSED DUE TO ions send floor plan with sup-
Supply Openings ply and ret LATIONS, PAYMENT AND
Steam APPLICATI INACTIVITY 8/30/Ol tIOR LAKE, 4629 Dakota St.
Return Openings Hot Water
Radiation S.E. Prior L
Input Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
�(Other Devices S `+-� � ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. SlV T 1r, 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations ReplacemeM New Construction � above is complete and accurate; that the work will be in confo�mance with the ordi-
nances and codes of the city and wfth the state building/mechanical codes; that this form
Repair Est. Comp. Date � ���-� does not become a permft 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 $ �������� Building Permit # approval of plans.
HEATING PERMIT FEE $�,5�. �� 1�,� ��Q�,��� �� �a g
STATE SURCHARGE $ .50 plicant's Signatur Date
��— 8 �q�{-
TOTAL PERMIT FEES $ �• C7� Receipt # o� 4�9�3 Building Official's Sign e Date