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CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
ADDRESS
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SCHEDULeb /' /~It;0c7
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OWNER
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, CONTR.
PHONE NO.
PERMIT NO.
(j-9fol
o FOOTING 0 P _UMBING RI
o FOUNDATION 0 N ECH RI
o FRAMING 0 '" A TER HOOKUP
o INSULATION @t S oWER HOOKUP
o FINAL P _UMBING FINAL
o SITE INSPECTION N ECH FINAL
COMMENTS: ~~
!
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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~ WORK SATISFACTORY, PROCEI ,0
o CORRECT ACTION AND PROCEI '0
o CORRECT WORK, CALL FOR RE NSPECTION BEFORE COVERING
Inspector: ~ . ! Owner/Contr:
-1\.) I
CALL 447-98Sd FOR THE NE::T INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE I OR YOUR PERSONAL HEALTH & SAFETY/
lNSNOTI
Job Address
Heating Contractor
Name 01 Tesler
Dale
Percent 0
Percent CO2
Percent CO
Stack Temp.
t ~lel/ LV()11)5 Ausf.
LOo l-l4,U
SUiTt
10/ZI (2.000
t.G
,.f
n
'2,L'1
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372 ,'f!ji"f
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Date IDI ~ \ 100 HEATING APPLlC::I~N ~S-~MO I '7- ~~-O
. . .
S~eAddress IlplDll Lvon<: Ave. Sf
Lot ~ Block ~A~d~ion {J r ., 0 ( So 1A- ~
Owne(s Name Greq p,() r-e S
J
Address i(ololl L'\fOh<; Ave, Sf
Heating Contractor wahleif'<. MU~~'ide, 1+-\e4. I- AIG, l~
v .
Address jn950 W-e'\+ i4(P..\.h Sh.f'e:t, "*IDI4, ~p\e, Volley--.55.lzL/
19:a~lulI"";; f.! 5'~! i..f~ ~- :~~
Furnace Make & Model Can i.. \'" IS!? IV A VO'II-I'iTYPE OF SYSTEM
, Warm Air Plants
ModelSize 'ifS,OOO Gravity
Mechanical
Air Cond~ioning
Vent. System
)('
Conn. Load
Fuel ",a -h J Y ~Flue Size
Supply Openings
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Return Openings
Input 'ill? 000 Output '10. 1-/00
Edr.
Other Devices
Cfm.
TYPE OF WORK
Merations
X
10/;1.1100
_ Replacement
New Construction
Repair Est. Comp. Date
Est. Cost $ ,),SDO. o.,a
Building Perm~ #
HEATING PERMIT FEE $ '?PI. ~
STATE SURCHARGE $ .50
TOTALPERMITFEES $ L.JO.e!J. Receipt # 3C6fo4S--
TYPE OF STRUCTURE
1. Pink
2. Green
1 Yellow
File
City
Contractor
Single Family )(
Two-Family
Industriai
Multi-Family
Other
Commercial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Healing Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1% of job COS1'@.w:iilifiin1Ii~,:;-
$99.50/ " ! !-:::' '-;z.,Y:: ~p ~
,/)
$64.50 " /; .
~ ,ill 30.
~JLi
$39.50 - ----1&
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 rnust be submitted with !!l!ilifuJg l1lill!lil number before build-
ing certificate of occupancy will be issued.
jjfAI CALCULATIONS BEQUIRED with number of supply and return openings listed per
room with CFM's per opening. New structures or add~ions 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.
C~y 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.
lb~ IL W~
Applic~ Signature
( .M..-.-
Building C{fJIcal's Signature
j D/;) I (aD
Date
lo-3/-ob
Date