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CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Perm~ No. nO .
Prior Lake, MN 55372 .
Date
S~e Address
Lot _ Block Add~ion
Owne(s Name ~,v 1I>>,t;,4
.z '
Address t2fi'/5 - /stL/ S/-ft/L
Healing ;"ntractor /'ZkJ .?:.,~I'X" / ~N'A//~.i,~a,#~A/~,If
Address. /P1f/tI-UJL.S/4dU~/~u#+ ~/f .aJ fff11
,,_ I I . __ ' /
Telephone# fR'/-1}.~7/~7,5T
Furnace Make & Model
AIR CONDmONERUNITS CANNOT
ENCROACH INTO SIDEYARD SETBACKS.
Model Size
TYPE OF SYSTEM
Warm Air Plants
Conn. Load
Fual)fJ"l-c"S Flue Size
Supply Openings
~......:...
CLOSED DUE TO
INACTIVITY 1/1/03
Return Openings
Input Output
Edr.
Hot Water
Radiation
Special Devices
Other Devices.
Cfm.
TYPE OF WORK
Meralions
x
Repair
Replacement New Construction
Est. Comp. Dale /0 T ;{n
~c I
dOt:? <--- Building Perm~ #
Est. Cost $
/
1. Pink
2 Greon
3. Yellow
File
City
Contractor
TYPE OF STRUCTURI;
Single Family
Commercial
Two-Family
Industrial
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Rreplace
Residential, Add~ions & Alterations
Residential, AC Only
Public
Multi-Family
Other
1% of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
PLEASE NOTE:
Air Conditioner Units Cannot
Encroach Into Required
Side Yard Set-Backs
"Iemember to add the Stale Surcharge ~ft .h~ h?llom of this applicaticft
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 w~h buildino IlmIIIit IIWIlIlm before build-
ing certfficate of occupancy will be issued.
HEAT CALCULATIONS REQUIRED w~h number of supply and return openings listed per
room with CFM's per opening. New structures or add~ions send floor plan w~h 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.
c~ 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~
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; thatthi does t become a permit until signed by the BUILDING
OFFICIA' at the w r ......jJtJ&e in accordance with the approved plan in the
case all work re<fuif'es review and approval of plans.
// b-o,k
. Date
-.-1/ .2?l/J 0
. Dille
~,UlO
STATE SURCHARGE $ .50
TOTALPERMITFEES $ #/J50 Receipt # "3~l.oM - BUildiriCal'SSignature
Jhp~d 'y/ C~.>4c ~tft'to~R; ~~~;; f~k~
HEATING PERMIT FEE $