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CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372
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HEATING APPLICATION I PERMIT
Date \ -:;::tq - q'j PID# 33 ~ iL\.4-DO)~O
Site Address ~n '1 0 r ~ YY'I r<\ ~_ r"(.€. t:k,1 e. .
Lot , Block I Addition J A Ih~,,> \ ~ Ai> 0
Owner's Name B A1Lro~ ",-,VY'\a S
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Address 4 3J.J~ Iff ( tor..,
Heating Contractor . 4~,~ ~ &0
Address L/q P D :Q"dd
Telephone # q~~ - 114:":J
~; It ~ TP--. .pt' , e.,1
~.LL..h""... -rc.or':. "'Vlt, me..,.
, J J'
\2. orl d,. 8 dt'.,.L....', M r0
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LA14, .
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i Furnace Make & Model
Model Size
Conn. Load
Fuel Flue Size
,
Supply Openings
Return Openings
Input ...: Output
.: Edr.
,
Cfm.
TYPE OF SYSTEM
Warm Air Plants .X
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
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C.W ,(II- ~. ~{/
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TYPE OF WORK
Alterations
. Replacement
New Construction
Repair . Est. Comp. Date It,.:, L
Est. Cost $. ~ ~ no.o Building Permit #
J~
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(J,4/ "'l W
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HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
'::2~. DO
.50
1. &0 I 50 Receipt # or ~ ~ f3> tJ
FEB-I.
), "ink File
~n - City
How - Contraclol
TYPE OF STRUCTURE
Single Family
Two-Family
Multi-Family
Commercial)( Industrial d pu~ Other
:::~:'d;:m~~~,~~ ~ l !l$39.50 ~::imUm)
Residential, Heating & AC $99.50
Residential, Heating Only $64.50
Residential, Gas Fireplace $39.50
Residenlial, Additions & Alterations $39.50
Residential, AC Only $39.50
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 ~ ,number before builc;
ing certificate of occupancy will be issued.
.I:iE& CALCULATIONS BEQUIREQ with number of supply and relurn openings listed p'
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
447-4230
I hereby apply for a mechanical systems permit and I acknowlpdge that the
information above is complete ~lnd accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanic:,
codes; that this form does not become a permit until signed by the BUILDIN(.
OFFICIAL; that the work will be in accordance with the approved plan in thf'
case of all work which requires review and approval of plans.
&ux UL
/) (}f(AP~-
~~ Offical's Signature
~ -1- 0/)
Date
2-5-77
Date