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CITY OF PRIOR LAKE Me (~
16200 Eagle Creek Av. S.E. Permit No. _ '9;,qo7
Prior Lake, MN 55372
HEATING APPLICATION / PERMIT
Date a ~ G, - Cjq PID #. Z$" Cfoz. -a!!:J{-o
Site Address ~ J'519t:J 1?/~1It~,vr Av
Lot Block Addition M t:;,7ES R-N.1:J .& 0 VIVOS
C ~ lf1 t!'~ PF- \ e (l... LA't:.6-
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TYPE OF STRUCTURE
1. Pink
2, Green
3, Yellow
File
City
Contractor
Single Family
Commercial
. Two-Family
Industrial
Public
Multi-Family
Other
Fee Schedule
Fuel _ (9- c.l, S
Flue Size
Industrial, Commercial & Multi-Family 1 % of job cost ($39.50 minimum)
Residential, Heating & ~ $99.50
Residential, Heating Onl $64.50
Residential, Ga\ Fi I $39.50
Residential, Additi~AI r tions $39.50
Residential, AC ~-;;r ' $39.50
dmem~d the e ate Surch"'1le on the bottom of this application.
price of your~n~rmit includes one rough-in and one final inspection,
itional i""'7ilis will be billed at $35.00 each.
V House Heatin~est Record must be submitted with buildinq permit number before build-
~ing rtif~e of occupancy will be issued.
H C'fLCULATIONS RI;QUIRED with number of supply and return openings listed per
~m ith CFM's per opening. New structures or additions send floor plan with supply
d return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
~ A L1CATIONS 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.
Owner's Name
Address
Return Openings
Heating Contractor r: r~~c1u._h.L JVtccLt..CLiJ ICa. L. ~ 1-1'"
Address &;l3 ~' K ~ lLQ90 Au e... S - ~Vi k -:u..'I
MJJ[.s M~ SSo/JY
Telephone # r, Cf;J, Lf - I tJ";j. J
Furnace Make & Model e v V a.. 0'\" r (Z \ TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System ,
HEATING OR POWIi5lI)LA,
Steam , _.t
Hot Water I
Radiation
Special Devices
Model Size
g....va....... r(/J. ) Ale...-
, -
Conn. Load
Supply Openings
Input
Output
III
Edr.
Cfm.
Other Devices
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
TYPE OF WORK
Receipt #
3~5BO
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
~~/'1() :: ZBfi'. - case 0}111 work which requires review and approval of plans.
~ d ,0 8-(o.-7Cf
,fj () A"l}9c '~t '. ~e
I r~ - /2-
Bdilding Ottical' Si - ! Oat
Alterations
Replacement
New Construction
y../
Repair
Est. Comp. Date
STATE SURCHARGE $
TOTAL PERMIT FEES $
Est. Cost $ 1'i1.!j1J 0
,
HEATING PERMIT FEE $ Z-B 5""
.50
Z:f35.5O
Building Permit #, :;- ~ ---!j