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City
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CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E. Permit No. !J9- 4-.3 I
Prior Lake, fAN 55372
TYPE OF STRUCTURE
HEATING APPLICATION I PERMIT
Date 1-'_\<4. -Q'1 PID' 25-115- 004-0
Site Address \ \..\ ..~ () A "-\.AI\.\.o ~ '-.P. (..H. A" E.
Lot 2- Block Addition
OWner's Name A Q-NO '-.D ~ A ~ \ Y Y 1- ~ '12~
Address \ l..\~,. '-i 0f\~LA~ ~~~ ^"~
Heating Contractor ~c..,,\Q.f-."-"1 A' ~\\ ~~ ~ ~\.~
Address '~\f) '=.. 4\ 5\ ST. ~ \,.)'"'~ ~ ^
Telephone' 72..'-\ - 19~'7
Furnace Make & Model Tf:.M.pSL1..e.
Model Size N ,L ~a.~
Conn. Load
Fuel ~Al GI\~Flue Size
Supply Openings
Retum Openings
Input 1S. 000 Output
Edr.
Cfm.
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
Residential, Additions & Alterations
Residential, AC Only
1 % of job cost ($39.50 minimum)
$99.50
('$64.~
~
$39.50
$39.50
Remember to add the State Surcharge on the bottom of this application.
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
HEAnNGOR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
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.
l:iEAI CALCULATIONS REQUIRED with number of supply and return openings listed per
mom with t"E:U'~ per opening. New structures or additions send floor plan with supply
ms shown. HEAT LOSS CALCULATIONS, PAYMENT AND
MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
:. PRIOR LAKE, MN 55372.
CLOSED DUE TO
INACTIVITY 1/1/03
; hours are 8 a.m. - 4:30 p.m.
Other Devices
_ .J T BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230
Alterations
Replacement )C
TYPE OF WORK
New Construction
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
OFFICIA4; that the work will be in accordance with the approved plan in the
case of all work whi ~IJ rejiAlires review and approval of plans.
Repair _ Est. Comp. Date '-\ - ~ <::> -q ~
Est. Cost $ 2..0 \ S _.00 BuDding Permit .
HEATING PERMIT FEE $ 6 Y . 5 0
STAlESURCHARGE YI -..50,
TOTAlPERUrrFEESl?'e:,<o)~. .35VB I
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