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PERMIT NO. :iJ - L? 7 ~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS , l)'2.Z; ,
OWNER
CONTR.
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
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OA TE TIME
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
~IREPLACE FINAL
o GASLlNE AIR TST
o
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~RK~SFACTORy.PROCEED
o CORRfCT ;~'ON AND PROCEED
o CORP'E~~ . CALL FOR REINSPECTION BEFORE COVERING
Inspector\ I; \ Owner/Contr:
CAL~ ~850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
HEATING APPLICATION I PERMIT
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Date
Site Address
Owner's Name
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No. qq- / z-7~
Prior Lake, MN 55372
Address
-"Contractor ~T'O~.~' ot-._
Address \ ~") ~ti\~
Telephone # q~l- ~CC:>
t!:.1? \ '- - "- .
E ..~ Make & Model ~ ~ ~
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Model Size ~
Conn. Load
Fuel-G'~~
Supply Openings
Return Openings
Input,
Edr.
Cfm.
Alterations
Repair
Est. Cost $
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~c\ ~
Flue Size
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
Output.
HEATING OR POWER PLANT
Steam
Hot Water
Radiation _
Special Devices
Other Devices
TYPE OF WORK
, Replacement
New Construction
. Est. Comp. Date
Building Permit #
91-1.2- 7t?
I
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
..39.50
.50
+0.00
Receipt #
3~45'7
I
I. Pink
2. Green
3. Yellow
File
City
- ~ctor
Single Family
Commercial
TYPE OF STRUCTURE
/' Two-Family Multi-Family _
Industrial
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
~
$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 Dermit 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 work which requires review and approval of plans.
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