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HEATING APPLICATION I PERMIT
Date r; - 1'-/ -e:O PID, as- O~c..-
S~e Address /531-/ 3 t:~A i htDr-CLtah AI leY\') E' N{-" Fee Schedule
Ljj:' Block . Add~ion ~'~. .v'l... _ .~N.... ~Industrial, Commercial & Multi-Family
De..hh I Residential, Heating & Ac
Ownefs ame "\.I - Rid 'IH . 01
,Y - es entIa, eating n y
Address /5. i4. ~ t-:~ f r::J:brN JC\.b Aue..ru ~ tv. (;" Residential, Gas Fireplace
. ~J ..., - I \ /l _":t (~ _+ Residential, Add~ions & Alterations
Heating Contractor (' JtrL\ U:>' . , ,r " Residential, Ac Only
Address / d 'R-CO ~ ~[55 "PI u rr.l\c')I-h
'-1I7_JC>J_~":>O"" I
I elepnone Jf I~ '-' -' u..- 0 -.....J 6.........J
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Perm~ No.
Prior Lake, MN 55372
Furnace Make & Model
AIR CONDmONER UNITS CANNOT
ENCROACH INTO SIDEYARD SETBACKS.
Model Size
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air CondmoningirKD3la LIrtJt1
Vent. System
HEATING OR POWER
Steam
Hot Water
Radiation
Special Devices
Other Devices.
Conn. Load
Fuel Flue Size
Supply Openings
Return Openings
~
LIO IdD
File
City
Contractor
1. Pink
2. GreeD
3. Yellow
TYPE OF STRUCTURI;
Single Family
Two-Family
Multi-Family
Other
Commercial
Industrial
Public
1 % of job cost ($39.50 miniO'llml)...__
$99.50 ~II @1Ii1\Y7 g f... \
$64.50
$39.50 Ii i'
$39.501 .
$39.50 Iv \
RAmAmnAr In J:!Irtrt tnA ~tJ:!lt~ !=:llrf"h::lorg~ on the bottom of tfllf:: apP!tcatrc:-:.
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 Il!illD.il numher before build-
ing cerlffieste of occupancy will be issued.
IiEi'J: ~Lr.I" .--
~ REOUIREO with number of supply and return openings listed per
pening. New structures or additions send floor plan with supply
own. HEAT LOSS CALCULATIONS, PAYMENT AND
E MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
R LAKE, MN 55372.
are 8 a.m. .. 4:30 p.m.
Input Output
Edr.
\0/03/200\
CLOSED DUE TO
11'l ^ Cl1VTI'i
Cfm.
Aherations
TYPE OF WORK
x:
New Construction
Replacement
Repair Est. Comp. Date
Est. Cost $ / G 33 ; cf) Building Perm~ # _
HEATING PERMIT FEE $ .1 q ......CS ()
Cl('J - 0 rose..
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
^lO.oO Receipt# 0&"OS~
-- ..uRK MUST BE INSPECTED (ROUGH-IN AND FINAL) . CALL CITY HALL
Phone: (952) 447-9850
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; 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.
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Date
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