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CITY OF PRIOR LAKE
16200 Eagle CnMIk Av. 8.E. Permit No.
PrIor Lake, UN 55372 00.
HEATING APPUCATlON I PERMIT
Date ~ - Z..LI- ('() PID, .Q ~ - \
Site Address :J-B50 SoYinC\ Lakf"~ 12r..I.
Lot -K- Blockh7~"".J:t~n~ \,..., b Irll.J"I
Owner's Name 1<()Yl Norr;h-IlI"V\ ,.l
J(p fU.
Address
Healing Contractor ~
Address~5D \,0. 14lPtb. st. - &li-k'lo\n
l'~' -'r'""V"':ll'Q
181epnoneJJ ~ 1>_ J I ,'-", I
^ . - .~ 'TV
Furnace Make & Model . - . PE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning CilrnV-
Vent. System
Model Size
Conn. Load
,:;l -I-on
Fuel
Flue Size
Supply Openings
Retum Openings
Input
Edr.
HEATING OR PO"'-
Steam
Hot Waler \ 0103/'100 \
Radiation C\..OSbD 'ODE 1'0
Special Devices --.:. W!\ C1:Nl1''i
Output
Other Devices
Clm.
TYPE OF WORK
Aileralions X
Replacement
New Construction
5-~3-<xJ
(1)- 04J9
Repair Est Comp. Date
Est. Cost $ ;).500 po. Building Permit' _
HEATING PERMIT FEE $ 3=1 . '5D
STATE SURCHARGE $ .50
TOTAl PERMITFEES $ 4 n 90-
3'1t1QSI
Receipt ,
TYPE OF STRUCTUR~
I. Pink
2. Green
3. Yellow
File
City
Contractor
Single Family
Commercial
><
Multi-Family
Other
Two-Family
Industrial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential. Heating Only
Residential. Gas Rreplace
Residential. Additions & Alterations
Residential. AC Only
1 % of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
~
Remember to add the State Surcharoe on the bottom of this aoolication.
The price of your heating permit includes one rou9h-in and one final inspection.
Additional inspections will be billed at $35.00 each.
House He""~- - st Record must be submitted with buildino oermit number before build-
;~- ,cupancy will be issued.
~ REQUIRED with number of supply and return openings listed per
r opening. New structures or additions send floor plan with supply
shown. HEAT LOSS CALCULATIONS, PAYMENT AND
. BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
_. ...t:. PRIOR LAKE, MN 55372. \:'
(\\,,"'
'1\)'
City Hall business hours are 8 a.m. - 4:30 p.m. 'l. ~ v
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINA~ALL CITY HALL
447-4230
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.
5- Z'--j -w
Date
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