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CITY OF PRIOR LAKE tJlc
16200 Eagle Creek Av. S:E. Permit No.
Prior Lake, MN 55372
HEATING APPLICATION 1 PERMIT
Date 6r":L \7+/'/ ~rJ PID#_ 25- ~-0d1-6
S~eAddress -L!l:L'7q- ~ Av p,
Lot U- Blocl.!4- Add~io /5:, +-{)..CfA.../
Ownefs Name ::f l 1M {) ('.'1- e \t'S CJ V\
Address /L{7'7~ (;I;~~{J A{j~ ~:~;~'
Heating Contractor .T:"IN S /~ P V &1" 11f! / i eJ F " r '
'Z<!?5-() (1). U 1.1 " \'5 'f5al'flsud/ej JflAJ. 7
- Etti~ 5(' r.r,'" ~ ~ 5"13
Telephone # 1/- (/ /'-> ,..
Furnace Make & ~odel /:kt?N1/~61() - -
1 nO() -r'fJ..
Address
Model Size
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Cond~ioning
Vent. System
Conn. Load
Fuel (l) r:r
Flue Size d I fJ~ /) eM i
G"I'
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Supply Openings
Return Openings
Input J.~(Jno- Output
Edr.
Other Devices
Cfm. II"fi
. ~~
TYPE OF WORK
Merations
Replacement New Construction
Est. Comp. Date _lJilJlI. ?I{J20
Repair
Est. Cost $ j (')(')('l
Building Perm~ #
~950
.50
LjO. -- Receipt # :-3Q' h W
. ~ -......
HEATING PERMIT FEE $
STATE SURCHARGE $.
TOTAL PERMIT FEES $
TYPE OF STRDCTUR~
I. Pink
2. Green
3. Yellow
File
City
Contractor
Single Family
Commercial
y
Mu~i-Family
Public Other
Tyo-Family
Industrial
Fee Schedule
Industrial, Commercial & t~~ ~11 ~~. ~ ,-~. ' st ($39.50 minimum)
Residential, Heating & Aq' ~II!
Residential, Heating Onlyl, ~ e',..,,4.s6i /.' PLEASE NOTE:
Residential, Gas Firepla '39.511 Air Conditioner Units Cannot
Residential, Add~ions & Itera 10"" --. -~~~\"lcroach Into Required Side-
Residential, AC Only . $39.50yfard Setbacks.
-- .
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 must be submitted with buildinq ~ ~ before build-
ing certificate of occupancy will be issued.
HEAT QALCLJLATIONS REOUIF:lEQ. w~b 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 sbown. 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
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
cas{);;;;jj;';S revi ~ and approval of ~t /7fl; !-
m.l~ . /;;;7:1
BUg 9flical's Signature ~ Djfte
Cmt OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED . d/6/o I IcJ: B-O
DATE TIME
ADDRESS 1"-17 '/ .5
.4/~ cUe. Ave-.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
J PLUMBING RI
J MECH RI
J WATER HOOKUP
:J SEWER HOOKUP
:J PLUMBING FINAL
:J MECH FINAL
,EOMMENTi:?tJl -:;,~ c:>--n
~ ~~~.J>'
?I I
). 01!#
o
t9 - 93rf'
o EXlGRADIFILLING
~ 0 COMPLAINT
<.~ 'fll FIREPLACERI
o FIREPLACE FINAL
aI\ ;)iI: GASLlNE AIR TST
~ 0 F:P,.
In L/1 ,~.
V'\
(y~i~> \)\ \ CJ
V f .j~f .
",\OV:l 0"
~/ ,\t
~WORK SATISFACTORY, F,ROCEED
o CORRECT ACTION AND ~ROCEED
o CORRECT WORK, CALL ~OR REINSPECTION BEFORE COVERING
~i
Inspector:
Owner/Contr:
CALL 447-9850 FOR TlHE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUlREMENTf ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IlVSNOT1
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