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# CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
s::r3 q
5 27Cf
tL/o ~ Sf
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
COMMENTS:
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DATE TIME
2.-18 -Ci'l /0: 00
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o EXC/GRAD/FILLING
o LKSHORElWETLAND
o COMPLAINT
~PTIC FINAL
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Inspector: \./ Owner/Contr:
CALL 447130 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE R't/UIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No. qq -lJ I () /
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
Date .2~t:h}~ PID# 3..~-oGr; ~I'J()I-(J
I /
Site Address ~.;t 79 /~C1~ s:I ~C
Lot I Block.- Additionl1hldt.c:j~ OClj{5 /l-elcLC1.
Owner's Name :::1EAN h <:" .it"'.#
Address ~ 79 /~()a.5 / Mr:
Heating Contractor ,,::--rA-r~.c'" tZ.s ;S;..et/.:::rctf'J -ZN<':"
Address _ J.JY.:z.. &kA""-' 57 sJ../.
Telephone # U:; / ~") ~.., "7- 7 I <i'S-
Furnace Make & Model ~ ;r~hc. TYPE OF SYSTEM
--I Warm Air Plants
Model Size ff./k'L:JtL7~ k'1v' Gravity
Mechanical
Air Conditioning
Vent. System
Conn. Load
Fuel ~I C~..Flue Size
Supply Openings
Return Openings
Input Output
Edr.
efm.
/6'0
Alterations
Repair
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
'34'
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
Replacement
TYPE OF WORK
New Construction
~,
I. Pink
2. Green
3. Yellow
File
City
Contractor
Est. Comp. Date
Building Permit #
3~~ 5"0
.50
4{J _ Receipt #
TYPE OF STRUCTURE
Single Family
Commercial.
./
Two-Family .
Multi-Family
Other
Industrial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace --L..-
Residentiai, Additions & Alterations
Residential, AC Only
1% of job cost ($39.50 minimum)
$99.50
~
~9 50 -"
-- $39.50
$39.50
Remember to add the State Surcharge on the bottom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
House Heating Test Record must be submitted with buildina permit number before build-
ing certificate of occupancy will be issued.
HEAT CALCULATIONS REQUIRED with number of supply and return openings listed per
room with CFM's per opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
, :pJl:~ew a_nd approval of Plan:~~
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