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CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372
1. Pink
2. Green
3. Yellow
File
City
Contractor
99-1/7
Single Family .
)(
Date
HEATING APPLICATION I PERM
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Site Address
Lot Block Addition
OWner's Name )4 ~ 6~~ \U::)()O
Address .
Heating Contractor ~I? (J Alf/,~,.
Address _ 1,/;~2. IT ~ 8/.
Telephone' (oS"/-777- ~JJ
,., AV/;f. 'AJ
"6C- qz..
Furnace Make & Model
~'tt..<. flKl'
Model Size
Conn. Load
Fuel
Supply Openings
Return Openings
Input
Edr.
Cfm.
Alterations
ef~5
c:. F!O'll.4 Q ~4.~J.,,*C-
~ ()!JLe
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Flue Size
CLOSED DUE TO
INACTIVITY 1/1/03
Output
TYPE OF WORK
Replacement )d
INT
- --_.......\.111
Special Devices
Other Devices
New Construction
Repair Est. Comp. Date
Est. Cost $ W'~W/~i1ding Permit.
HEATING PERMIT FEE $ 3' . s.-v
.50
~O. 0 ()
STATE SURCHARGE $
TOTAL PERMIT FEES $
Receipt'
XZ-71
TYPE OF STRUCTURE,
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 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
case O~f W.O.,/..k w. h.i....C...h re.q.u ires .r.e.V.iaw and approval of plans. -;jj_
~ .. .... ~ _ . 9 9t
~ APpl~~'S Sign~r: l Date
.,'5 Ii ( A "I- ----%h.~/cCj
Building Offical's Signature ~~