.��.� ....:. �...r..,n.Y.���-..�-.�.rYi� .. .., wu.�.`.--•�.. . .
<br /> Cir�Y o� ����� APPLICATION FOR
<br /> ��cha�n��aIl Pe��it
<br /> GENERAL INFORMATION
<br /> 1. vou way apply (o+t ■cchanica� peanito by mQIC oa Ln penaon at fhe C.ity a66acee. �lalfed-in penmlte arte aubject io !he
<br /> po�tage a�d AaedLE�g 6ac♦ ♦tiowM below.
<br /> t. ae1■il caade wi�l be ♦eni by 1etuln wa<L the eam¢ day the applicat4on <e nece.ived. PEk6f1TS AkE NOT VALID UNTIL YOU
<br /> RECEIVE A FtRN11 CAQD. WORK 11US7 N07 SEG1N UN7IL 7NE PER�11T CARD IS POSTED ON 7NE JOB SJ7[.
<br /> S. Whtn any new eonetauction on 1er�od¢Cing ie �nvoLu¢d, a oepanat¢ buiCding p¢4m4L mudl be o6tatncd.
<br /> I. AL[ wo�M wuet be doee En aceoldanct with Stat¢ Building Code aeQuiatrnenie. p� '
<br /> MAR 2 6 I ` !�
<br /> 5. A�[ wott wu�t bt ie�pected (Rough-in and bi.naCl. Ca[1 173-1351 21-houn nol�ee aequ[rted. . �p4
<br /> 6. Houec Ne¢ting Te�t Recoad wuet be eubn�itted be6oae 64na1 - •ee attached. 4`���� Y 1'
<br /> Cowp[etc a!l itewe on thi� a l.ication. Com uie th¢ � ���'� }�� ��"
<br /> INSTRUCTIONS pp p penmlt 6e¢, S<gn`'d'r�'Q"`Q$.CY-��eh�i6ication.
<br /> INCOYVLf7E APPlTCA7JONS WTIL NOT BE VROCfSSfD, i6 yau hav¢ Queet<ona, call 173-1357
<br /> (�'ALK- IN PFRMITS App.�y a.t C�,.ty O�b�.ced , 1335 Sau.th Bnowvt Road (c�y. Rd. 14G )
<br /> MAIL- TN P�RtitITS Fne�2aae �ee - Ma�.� �a : P. U. Box G6, Cny�S.ta.2 Bay, Mn. 55323
<br /> * � s *,► �*��►y*�►��vs**�►�k**����►k��s�r*�►s******+►�v�*�****�*��k**��**��**���a*******s**
<br /> JOB S ITE � � �GL �� � L� �.J�t�/!%�-_
<br /> Occupancy 7ypt+ _ 1t�4dteti � � eow■eacial; Othea
<br /> Owner' s Name � L?jG Telephone Number
<br /> Mailing Address � �-� � � ���
<br /> Contractor' s Name RAY N. WELTER HEAT4��G CO. Telephone Number �I,�.J vd�/
<br /> 3 �cago ve. o.
<br /> Mailing Address Minneapolis, fVlN 55407-3592
<br /> *********************,r*****t�•2r��8"0q**********************************************
<br /> MINIMUl1 FEE (520.00 p�r pzo�act)
<br /> •••..•.••..•.••••••••.••••••••••••••••••.••e••••.••r••••i•r••••••••••••••••�•.•.•r•�••�••••••••.•••*•�••..••••.w••••■�*f••.•
<br /> HEATING SYSTEMS $15.�Geach unit
<br /> FUEL ✓nat, gae, lp gae, ail, elect. �
<br /> ocher (�pecify if combination burner) ��S ��2G� �i�� ����� �J(,���
<br /> EQUIP. (if tnore than 1 uait per bldg., liet each eeparately)
<br /> No. Type 8tuh Inpu[ �rand Name Model No.
<br /> Lf. a, furnace "_�� � � � �G//f-J
<br /> hw boiler '
<br /> _ unit heatez
<br /> solar htg. %��G�
<br /> _ equipment �SU•U�each syetem Total
<br /> •����������f������������1ff1���A�����A��r�f���iff���ff�����}*f����iff��i�fA���kA�►fffw��ff�tff��lf���rt���f�ff�if�lMlr����t�•
<br /> A--I�A C —ITIO—NING $1�j.�� each unit
<br /> 1/ Central Aiz � Separace Central Air Syetem
<br /> w/furnace / ���}
<br /> Brand Name %�- Hodel No. / �� �� Tone �
<br /> -��=.f.^t�'_ � Total ��. _.�,
<br /> •�������ff�►�f�f���f►���tf��ffi�ff��f���f*fl�fff�f��it���r�tR+f��tifA���fA►• i�k�1�t��f��}�f1�fr��A�A�f�Afif�ff�ff�►fi/rf�Rk4�fi
<br /> tipoD BL�F�NtNG EQI7IPMENT (attach copy of mfgr'e inatallation speca.) �15.VU each unit Wood stove with flue
<br /> Fectozy Fireplace(s) freestanding built-in $3�.�� each unit Wood combination or udd-on unit
<br /> wood Stove(s) _ franklin, other
<br /> $15.�Q each unit factory fireplace with flue
<br /> Bzand Name Nodel No.
<br /> Mfqr'� Min. Cleazances, side , reaz , Min. Flue Dia. Total
<br /> •���������������l������f��d��R}������f�►���lfff��te�\��flfff�riiAR���t��/�it�i��fr*►�if��4�������Miif���#*f������ff�f*k����1
<br /> �T�Ti� - S 5.00 each exhaust fans (bath, kitchen,
<br /> No. _ Kitchen Exhaust _ ducted _ recirculating __ cfm attic, etc.)
<br /> No. Bath Exhauet (must be ducted outside) cfm
<br /> No. _ Other Fans: Locetions _ cfm Total
<br /> •�����t����ff����������f����������������t�fii�f��i����it��f�f�i�plwfif►f�f��if�����1t�f�����fi�r�I�f���r►►�►���f�f�rff�r�0�0•
<br /> rT i 520 n^. . (must be approved by fire marshal)
<br /> _ Fuel Oil, _ qallons _ underground � inside ^ outside
<br /> Lp Gas, gallona
<br /> Other,
<br /> •�•�����•������r���������������r��rr���►�:����r�►�aa�t�r*r+rrrs�.���+���►r�rr*���tr�r��►*i*���r*w���*�tf*►�r�.��:��.,*��t���r•
<br /> �P SNKi.F$��SmgMS_ c�� Tit_'S'1C1eI1C1�11 �Z�.�U
<br /> ($20.00 minimum; $100.00 ma:cimum)
<br /> Number of Heads No. ot Riaoza b� Commercial a��.00 Plan Review
<br /> Type of System (3 sets of plans required for review) �2.00 per head Total _
<br /> •����������t����f���f1�r������►��r�����t����if�l��ff�����i�1��Rf�►�f��A����1�������1�fii�i������ff������f���fAt�Rf�t�/���t�r�•
<br /> Commercial, Industrial t Multi-Family see Fee Schedule
<br /> PERMIT FEE CALCULATION
<br /> 1 . Total of above Installations or P�Iinimum Fee (�20. 00) $ ,�Q, �
<br /> 2. State Sureharge Add tke Siate 8uild<ng Code Dtvieion Suachaage ta ¢ach pean4t � . 50
<br /> 3. Postage and Handling Un aLG wa�Ctd-in appt�eat<on1, add th¢ po�tage and handCLng 6ee $ 1. ��
<br /> ,,...—,,—�,?;-,T,�,�-._..-......
<br /> add f4nee 1-3 nbove :`!;;>'::`.".''�'�:.`;,'�`i`,!`:, '�i;i:;
<br /> 4 . TOTAL PERMIT FEE t: ...�.:::..
<br /> �..
<br /> $::::'::;,':::::`.;.. ::�t�::...:.<::::>:�:
<br /> he uRd¢a�<gned heae6y applie♦ to the C<ty o6 Ononu 6on leeuance o6 a Meehanicat Penrntt, agrte¢e to do aCC wo2k Ln 6I4LC.L •
<br /> ccnldance with Lhe oadinancee o6 tht City and Zl�e ntgulafione o6 Lhe Ninneeota S4ate Bu<fding Code. and cenLi64ee that
<br /> fl etate.�cnie wade oe thie appCicatton a4e ca�fptete, taue and coaaect.
<br /> , '�� ���� ��!���� �`�`
<br /> �-.� .___
<br />
|