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CITY OF PRIOR LAKE
INSPECTION NOTIC~
ADDRESS
OWNER
ib \e. U" . or.E /
\\J1 8Po.: SCHEDULED ~O
r~2 14- M<+ }.'...,' ~
TIME
CONTR.
PERMIT NO.
00 -lctS8
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
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS: t1..fIr4-AI~ ~ /Lese;
I
UJu,LrL.,.
~WORK SATISFACTOR ,PROCEED
o CORRECT ACTION N PROCEED
o CORRECT WO FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FO~ THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUlREME1T.S' ARE FOR YOUR PERSONAL HEALTH & SAFETYI
, INSNOTl
~
File
CilY
Contractor
Pink
Greon
Yellow
1.
2.
3.
TYPE OF STRUCTURE
MC
Permit No.
CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E.
Prior Lake, MN 55372
Multi-Family
Other
Public
Two-Family
ndustrial
Single Family
Commercial
PERMIT
I
PID#
B-'€~
HEATING APPLICATION
Date
($39.50 minimum)
1 % of job cost
$99.50
$64.50
$39.50
Fee Schedule
$39.50
$39.50
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential. AC Only
Site Address
Block
Owne(s Name
Lot
Contractor
Address
Heating
Address
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
AIR CONOITIONERUNITS CANNOT
ENCROACH INTO SIDEYARD SETBACKS.
buildino Dermit number before build-
House Heating Test Record must be submitted with
ing certificate of occupancy will be issued.
l:!.ElII CALCULATI REQUIRED w~h 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.
TYPE OF SYSTEM
Warm Air Plants _
Gravity
Mechanical _
Air Conditioning_
Vent. System _
HEATING OR POWER PLANT
Telephone #
Furnace Make & Modei
Model Size
Conn. Load
Flue Size
Fuel
Supply Openings
Return
Openings
City Hall 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Phon.: (952) 447-9850 447-4245
business hours are 8 a.m.
Steam
Hot Water
Radiation.
Special Devices
Other Devices
Output
Input
Edr.
Clm.
(952)
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 w, which requires review and approval of plans.
Fax:
New Construction
TYPE OF WORK
Replacement
Merations
Comp. Date
Building Permit #
~
Est.
Repair
Est. Cost $
V}s'r(/IJ
Date
7g,f1)
Date
17-
[2
3K'l:si
Receipt #
.50
30/
-+tJ.o 0
HEATING PERMIT FEE $
$
$
STATE SURCHARGE
TOTAL PERMIT FEES