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CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, UN 55372
HEATING APPLICATION I PERMIT
Date 1\ -J - q 9 PID'....z.5-133-0~- 0 ""
Site Address .2 q tf lo ..s.J rj n a. " ~ 0 .J -K m.C2
Lot Block Addition~~ 8out-JDS -gIS.D
OWner's Name rY\ ~ r "- -t\U a. S _ /'I
Address 2Q'1 ~ \( SJ)Y' i Y\0\ LoJ<e....- -Kc::P.0
Heating Contra;;- l 0+ ~+A~ -....L 'n c.."
Address 19 23 \.0. ~ ~ ~ \Jtt 'e...- 4J kw '/
Telephone' ~9L\--l 4-11- .
Furnace Make & Model
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditionin~, ..
Vent. Syst~ \I e (\ fY\ (). y" T\ I r'
-to v.JV c.~CA'\~
HEATlN R POWER PLANT G
Steam
Hot Water
Radiation
Special 0, REQUEST FOR INSPECTION
SENT TO HOMEOWNER 1/03.
Other Del NO RESPONSE. CLOSE FILE
Model Size
Conn. Load
Fuel
Flue Size
Supply Openings
Return Openings
Input
Edr.
. Output
Cfm.
TYPE OF WORK
Alterations
><
Replacement
New Construction
11-3\)~9q
qq-/357
Est. Comp. Date
Est. Cost $ :2 b 0<0 0 D Building Permit ,
HEATING PERMIT FEE $ c -=iq. 50
.50
1.J.() '~Receipt'
Repair
STATE SURCHARGE $
TOTAL PERMIT FEES $
3&53&
I
,
--------
TYPE OF STRUCTURE
I. Pink
2. Green
3. YelIow
;/
File
City
Contractor
Single Family
Commercial.
~
Multi-Family
Other
Two-Family _
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.~:~,' "n"
$99.sfl m_~_~_g_~_ "~i i
$64.50 ,d i ;
i ! I !
$39.50 \, NOV I 5 009 ;! t
$39.50 \ I~! ,
\ \ P ~/
$39.50 U... - ---IV
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.
.I::I.EAI ,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
..nn, '.....ATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
IE. S.E. PRIOR LAKE, MN 55372.
usiness hours are 8 a.m. - 4:30 p.m.
K MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230
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 work which requires review and approval of plans.
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Date
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