HomeMy WebLinkAboutHeating Permit 94-0298 ,. --- , t:.Pink -'File
.y�� pR �� IOR LAKE 3. Yellow - Co
TYPE OF STRUCTURE
�
� pG �, �46�A STREET S.E. Permit No. �-�- r Sin �le Family �_ Two-Family Multi-Family
R , MN 55372
Commercial Industrial Public Other
ATION / PERMIT
Date PID #� ��' OJZ�� �OB VALUATION FEE
��� � 1 ��, ^ ��� � ^ A � $0 - $1,000 2% of job value, min. $20.00
Site Address '�N �_� �rr- �
$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 _��-1 t��
$10,001 -$50,000 $132.50 for the first $10,000 plus $1,00 for each addi-
Address ,`-t�-Y� t•'�__ ��,. � �-� tional $100.00 or iraciion thereof, to and including
Heating Contractar Q.�,, LQG� �reS1L �� tJ - L�� $50,000.
Address �� �• �t rV�Q..�..� �.-_-Q._ $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # � � - d� �
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model ��� ���t OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heating Test Recard must be submitted with building permit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
�g if supply and return openings listed
Fuel Flue Size Vent. System per r CLOSED DUE TO fr additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT ply <�ACTIVITY 8/30/O l �ALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water +�PP OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E.
Input Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WORK ! hereby apply for mechanical systems permit and I acknowledge that the information
Afterations Replacement New Construction �_ above is complete and accurate; that the work will be in conformance with the ordi-
7 � nances and codes of the city and with the state building/mechar�ical codes; that this torm
Repair Est. Comp. Date �1.J1�� does not become a permit until signed by the BUILDtNG OFFICIAL; that the work will be
E � �� $`�` '�� in accordance with the approved plan in the case of all work which requires review and
i t `""tiU Building Permit # approval of plans.
HEATtNG PERMtT FEE $ �� aS ��, � �j
STATE SURCHARGE $ .50 A ca 's Signat e Date
� ��� ��� ��'� �
TOTAL PERMIT FEES $�� �S Receipt #
' uilding Official•s Sig ture Date
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