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CITY OF PRIOR LAKE MC .. ., .~.. " . c',"
16200 Eagle Creek Av. S.!. Permit No. ~l!} - ~~,...
Prior Lake, MN 55372 . -
TYPE OF STRUCTURE
1. Pink
2. Green
3. Yellow
File
City
Contractor
HEATING APPLICATION I PERMIT
S?-c,-qq PID#.25-/{)7-00fo-O
Site Address ~ '-\ ~ ""+ L) , ~ " ~G:P\C'<-\ ~\. ~/SOFee Schedule
Lot Block Addition 1'1€7GS ANO !3()(./,vOS Industrial, Commercial & Multi-Family
r ~ Residential, Heating & AC
Owner's Name ~ "D cD\,)~ ~ (- R 'd ti I H t' 0 I
--.... esl en a, ea 109 n y
Address 3Lt 5 -=1:- r ~ ILL 0 W ~ (:..A~~. \ ~.A- ~ '- Residential, Gas Fireplace
IV " I ^ Residential, Additions & Alterations
Heating Contractor ~E::..S I L>~~.....es1- )t, "'-l\ ~ G. ~ \ C<. Residential, AC Only
Address \~ l5 ~/.. ~ fS r "5 "(. ~ (lj;T~ A
hi z.. 7Z4 ...lg~9
Single Family
X'
Two-Family
Date
Commercial
Industrial
Public
Multi-Family
Other
1 % of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
Telephone #
Furnace Make & Model ~eS'^ ~
Model Size ~,. C. (0(.:) C S
Remember to add the State Surcharge Dn the bDttom of this applicatiDn.
Conn. Load
Fuel rV' ~ 6 A~ Flue Size
Supply Openings
Return Openings
Input. 7~_ oeo Output
Edr.
Cfm.
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning ~ ~ "t~ ~
V~ntSystem
HEA'fING OR POWER PI A.....
Steam /2001
Hot Water 10/03 TO
Radiation CLOSED DUE
Special Devices _ INACTIVITY
The price of your heating permit includes one rough-in and one final inspectiDn.
Additional inspections will be billed at $35.00 each.
ce>House Heating Test Record must be submitted with buildinQ permit number before build-
2.;:;' ing certificate of occupancy will be issued. .
I-I~I'''' -. - \IS REQUIRED with number of supply and return openings listed per
opening. New structures or additions send floor plan with supply
;hown. HEAT LOSS CALCULATIONS, PAYMENT AND
BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
lOR LAKE, MN 55372.
_ ...rs are 8 a.m. - 4:30 p.m.
Other Devices
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
Alterations
TYPE OF WORK
Replacement.)(" New Construction
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
LJ 6 ~ eO Receipt #
35"~70
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; tha~ the work will be i9,accordance with the approved plan in the
ca.a of all~oJ:;~~:7c:;:nd approval of Plan.~ ''1 ' 1 '7
~i 'j" S~I. tJJ@"";f"Date
/4/"\ ~ _' " .,~
. ./1:'.'c~:;;~'I-:~~ f3//3/qq
Building Offical's Signature / . Dali .
Repair
Est. Cost $ .
Est. Comp. Date
l-14 0 <6 ..0 C> Building Permit #
$Q..e
99- /OQE
HEATING PERMIT FEE $