HomeMy WebLinkAboutHeating Permit 94-0333 � ,
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t. Pink File
F PRl 2. Green - City
�.�° N �� �C�1f�F I�R LAKE - TYPE OF STRUCTURE �. Ye���, ' Contractor
� �6�'�AK TREET S.E. Permit No. �Q "�J� Single Family �_ Two-Family Mufti-Family
PRIOR I , N 55372
Commercial Industrial Public Other
TION / PERMIT
Date ��� PID #�' ,Z3 �- D.3 ��D JOB VALUATtON FEE
Site Address �D�J3 �•� �_S=G�JCS t�I�QC�� S� . $0 -$1,000 2% of job value, min. $20.00
Lot Block Addftion $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 �...)� � "�'� ► eC�,�.�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ��0�3 �-�, ���� �j� tional $100.00 or fraction thereof, to and including
Heating Contractor�-�-�\� 1 \``���C�- � ��- +�-�- ��O $50,000.
Address �`� l�• ��� `3 , Fj'U,�{�('��1� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # ��' ��5�
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 7est Record must be submitted with building �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System HEAT CALCULATIONS REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT Per room with CFM's per opening. New structures or additions send itoor plan with sup-
Supply Openings ply and return locations �►+�..-� "� •� '- iLATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATN CL�SED DUE T4 ��OR LAKE, 4629 Dakota St.
Radiation S.E. Prior La
Input outp�t Specia! Devices �p,CTIVITY g�3 ��� 1
Edr. City Hall bus
, Other Devices �C�� ALL WORK .��.-��. Nnu FlNAL) - CALL CITY HALL
Cfm. �l�c� �\reD�Ge— - •---v
447-4230.
. TYPE OF WORK ! hereby apply tor mechanical systems permit and I acknowledge that the information
Afterations Replacemerrt New Construction )C' above is complete and accurate; that the work will be in conformance with the ordi-
� nances and codes of the ciry and with the state building/mechanical codes; that this form
Repair Est. Comp. Date �Z' �--� 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. Cosi $ �� s�� Building Permit # p al of plans.
HEATING PERMIT FEE $ o� �� � � ��- �
STATE SURCHARGE $ .50 Ap li t' igna e Date
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TOTAL PERMlT FEES $ � ' �C..J Receipt # � ��� �
ilding Official's Signat Date
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