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CITY OF PRIOR LAKE
INSPECTION NOTICE
'1~Cb
SCHEDULED
DATE
~
TIME
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
0- (pq 2.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
PLUMBING RI
MECH RI
WATER HOOKUP
SEWER HOOKUP
PLUMBING FINAL
MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
,ff~ 0 FIREPLACE RI
((1;)~IREPLACE FINAL
7 0 GASLINE AIR TST
o
~~
~
.4.T:'
trL
~WORKSATISFACTORY. PR CEED
o CORRECT ACTION AND PR CEED
REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS A E FOR YOUR PERSONAL HEALTH & SAFETY/
INSIVOTl
File
City
Contracto'
Pink
Green
Yellow
L
2.
J.
TRUCTURE
TYPE.OF
DO-Ofor 2-
MC
Permit No.
CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E.
Prior Lake, MN 55372
~
Multi-Family
Other
1 % of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
heating permi' rough-in and one
inspections will be billed at $35.00 each.
final inspection.
Public
Two-Family
Fee Schedule
Heating & AC
Heating Only
Gas Fireplace
Additions & Alterations
AC Only
your
includes one
Industrial, Commercial & Multi-Family
Residential
Residential
Residential
Residential
Residential
Industrial
Single Family
The price of
Additional
Commercial
PERMIT
AIR CONDmONERUNITS CANNOT
;-L ENCROACH INTO SIDEYARD SETBACKS.
'/ TYPE OF SYSTEM
Warm Air Plants
I
HEATING APPLICATION
Date
S~e Address
Lot .!3..-.
Ownefs Name
Heating
Address
Telephone #
Address
building ~ number before build-
House Heating Test Record must be submiUed with
ing certificate of occupancy will be issued.
Model Size
Conn. Load
Fuel /lJ r; Flue Size
!::!EAI LATIONS REQUIRED 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.
Gravity
Mechanical
Air Conditioning
Vent. System _
HEATING OR POWER PLANT
Supply Openings
CALL CITY HALL
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL)
447-9850 447-4245
Steam
Hot Water
Radiation
Special Devices
Other Devices
Return Openings
Input ~OOO Output
Edr,
(952)
I hereby apply for a mechanical systems permit and 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 ork which..r' uires review and approval of plans.
, gf~
Date j
g .00
Date
Fax:
(952)
Phone:
. Building Perm~ #
, 5"V
.50
4tJ. dV
TYPE OF WORK
Replacement
Est. Date ft I
Comp.
HEATING PERMIT FEE $
Cfm.
A~erations
Cost $
Repair
Est.
.<lI Of>5'
Receipt #
$
$
STATE SURCHARGE
TOTAL PERMIT FEES