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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
COMMENTS:
DATE
TIME
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7 f.:(--'V /~(;)
o EXC/GRAD/FILLlNG
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
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ORY, PROCEED
PROCEED
FOR REINSPECTION BEFORE COVERING
Owner/Contr:
Inspector:
OK.
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CALL 447-4r.30 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE ~MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
Date 3/; /q9
Site Address 594 5
Lot S-Slock I
,
Owner's Name
Address
Heating Contractor
CITY OF PRIOR LAKE rO-
16200 Eagle Creek Av. S.E. Permit No. qq ~ (.5""6
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
PID # d'S -()Z3 ~ ?OC;:O
HIDDEN OAKS CIRCLE C:~b
Addition jkacut't. OC~ 7~ktd~ ~
DOUG LOEBERTMANN/LISA KING 447-4317
5945 HIDDEN OAKS CIRCLE
RON'S MECHANICAL
SHAKOPEE
Address 12010 OLD BRICK YARD ROAD
Telephone # 445 -8 5 8 5
Furnace Make & Model
Model Size
Conn. Load
Fuel
Supply Openings
Return Openings
Input _
Edr.
Cfm.
Alterations
Repair
Flue Size
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Output
Qther Devices"i rut?( (Sus lirt,Q
Kl.u.~ 6--L~ 1I~. .
J
TYPE OF WORK
Replacement )(
New Construction
Est. Comp. Date
clQ -0(3<6
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
Building Permit #
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.50
J-/tJ,CJo
3Lf'7~
Receipt #
I. Pink
2. Green
3. Yellow
File
City
Contractor
TYPE OF STRUCTURE
Single Family
Commercial
~
Two-Family
Multi-Family
Industrial
Public.
Other
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1% of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
<$39.59)
$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 permit number before build-
ing certificate of occupancy will be issued.
HEAT CALCULATIONS 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.
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 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 W,jork which re?uireS review and approval of plans.
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