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CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372
HEATING APPLICATION I PERMI
Date 9":;.'- ~ PID# Z5"-401-00S;--O
Site Address /f:,.t:J b Ht4Nk/,"v h Lh<.II'r-
Lot Block Addition
Owner's Name /-1 p~ ~ ~()O ~/-5
Address
Heating Contractor L , I. /:) All h ~~r- / i:k ~ fi.~4/.~,.,
Address b9;;2 S-~.{.... 4J- ~~ti4~e.. J:~/2.''it-
Telephone # (", \ / ' 77? 2-'715
F{Q~ L.AA" I
Fur:;o...... 'odel ,tr'dl~'vv TYPE OF SYSTEM
:3:Jt... lf2. Warm Air Plants
Model Size
~r!:ll\lit\l
Conn. Load
CLOSED DUE TO
INACTIVITY 1/1/03
Fuel Flue Size
Supply Openings
Return Openings
Input. Output.
Edr.
Cfm.
Hot Water
Radiation
Special Devices
Other Devices
TYPE OF WORK
Alterations
Replacement .
New Construction
Repair
Est. Comp. Date
/ ~O.Ol,,) . Building Permit # .
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
39.>0
.50
qO. () c)
,
Receipt #
3~z-{1
TYPE OF STRUCTURE
1. Pink
2. Green
3. Yellow
File
City
Contractor
Single Family
Commercial
Two-Family
Industrial
Multi-Family
Public Other
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1 % of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
$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 buildinq oermit 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
case of all Qvork which requires review and approval of plans.
9-2r;-~
Date
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Date I