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CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permk No. 0
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
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S~eAddress \15~OO ~-ThO Rr<t
Lot z. Block I Add~ion. J<ASPB6~ I2ID~E;
Ownefs Name T'\\Yv\. b NlsU"
Address \ 5?-OD l'-{o..<{A-t0 ~6 _
Healing Contractor -.&)("'(WI it \1 0. \-\ 0 (). .~..;'fI{A ~ AI (' .
Address \ QU ~\. ~('Y'( 0 \.::, ~~ Pl1. .s .
lelephone #
gql-/ -DCc:;;-
Furnace Make & Model
AIR CONDmONERUNITS CANNOT
ENCROACH INfO S1DEYARD SETBACKS.
TYPE OF SYSTEM
Warm Air Plants
Gravity
Model Size
Conn. Load
Fuel Flue Size
Supply Openings _ CLOSED DUE TO
Return Openings INACTIVITY 1/1/03
Input
Edr.
Output_
Cfm.
Radiation
Special Devices
Other Devices .Lijl'- 1:::-)( (' ~
TYPE OF WORK
A~eralions
Replacement X'"
Est Comp. Date
Building Permk .
(")() -I 04-3
New Construction
Repair
Est. Cost $
HEATING PERMIT FEE $ 3c).5lJ
STATE SURCHARGE $ .50
TOTAl PERMITFEES $ 4 t> . D D Receipt'
38~11
TYPE OF STRUCTURE
Single Family X
Two.Family
Industrial
Public
Commercj~1
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Healing Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
I. Pink
2. Green
3. Yellow
File
City
Contractor
Multi.Family
Other
1 % of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
,. $39.50
$39.50
J:lt:lornoOmtUlr tn !:Inri the-State- SurcharQ9 gn the ggttgm of this 391'3IiGatic~.
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 puildina oermit number before build-
ing certificate of occupancy will be issued.
HEAT CAI CLJlATIONS RFOIJlRED 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
Phone:(952)447~850
Fax: (952) 447-4245
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~h r~qUireS ~iew and approval of plans. ~ ,
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lApplic~9~re Date
-12- - f1; -() ()
Date