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CITY OF PRIOR LAKE
INSpECTION NOTICE
ADDRESS
OWNER
pHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
p-J '1 '70
DATE TIME
SCHEDULED 1123/00 "1:00
p/x:; E II. (!jilt
CONTR.
pERMIT NO.
()-")q7
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUp
o PLUMBING FINAL
Jl! MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREpLACE RI
o FIREpLACE FINAL
o GASLINE AIR TST
o
COMMENTS: ~po~~
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~ WORK SATISFACTOI<lY, PROCEED
o CORRECT ACTION A ~D PROCEED
o CORRECT WORK, CI LL FOR REINSPECTION BEFORE COVERING
Inspector: ~, Owner/Contr:
CALL 447-9850 F( IR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUlREMJ 7VTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNS/'iOTl
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B RNSVILLE
He 'ng & Air Conditioning, Inc.
1248J Rhou /s/ond Av.. So.. Sav.,.. MN 55378 . 894.0005
Orstrt Test Report for Jobl
Address 14170 p:~;" ft', "U,f City
Occupant fJ.I, u: t.... Ot), ,,; d.(,'
Date of Install 'l - 7 _ DO
Type of HT. F/A X H W Space HT Unit HT
Other
Make g rv .a....}
Model ,338'1-.10(,,01').0
Serial ~ fi71'i3Ti
,''''D/o~)
Input ....
PilotType Ho+ 5o( Fi'a'
Pressure "3.; ; C02 '8
Input CFH );'0, ;PO 02 7
Stack Temp . 7...:sC) CO 0
Date Tested q - 7. 00
Companv 6\J(I,.b....,II~ \.\e~~.I\~. C\:r
Name otTester It Q".')
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No. oo-o7C17
Prior Lake, MN 55372
HEATING APPLICATION 1 PERMIT
Date ,. 9-\-00 PID#-2-6-0tJ..7-0((P- 2.
S~eAddress \4o.i() \)ix\ e 'V6\'f\t r J- S E
Block Add~ion
Ownefs Name 1=\\'11' ~
Lot
1L.0.. Y\ (le.a " p".\eJ
()
Heating Contractor ~O(,^N \ l 0 W-P f'-\,.-!-'\Y,,\('^ 4- l"t Ie
Address ~X I Ehc0..c.... \b \o...nr9... AJ P oS
:slepheRer. <:)C) /-D~~
Address
Furnace Make & Model ~^j..
Model Size 333€>AVClDO 1;)0
Conn. Load \'d-O ,COO
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Cond~ioning ~II "*
Vent. System
TYPE OF STRUCTURE
1. Pink
2. Green
3. Yellow
File
City
Contractor
Single Family
'X
Multi-Family
Other
Two-Family
Industrial
Commercial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
Remember to add the State Surcharge on the bottom of
The priDe of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
Fuel
NO.-\--
Flue Size
. House Heating Test Record must be submitted with buildin') ~ number before build-
:'i.,~x.o4~ing certificate of occupancy will be issued.
.4.ul'l
Supply Openings
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Return Openings
Input \.;lO,OOl'LOutput
Edr.
Other Devices
Cfm.
TYPE OF WORK
Merations
Replacement X
Est. Comp. Date
Building Perm~ #
O(), 0717
/
New Construction
Repair
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
'S C, 6U
.50
'-10- 00 ReDeipl# 332B8
HEAT CALCIJI ATIONS REOIJlRFI) 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.
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 Domplete 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 i ccordance with the approved plan in the
case of j"/Jrk Whi~h require 7iew ~ approval of plans.
~h /JW~ 9-/-00
( ~11lIJI'W1J01RllIr'e
BUil~ffiDal's Signature
Date
15- 0{)
Date