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Date
CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E. Permit No. cr~ -c::o~
Prior Lake, MN 55372
HEAnNG APPLlCAnON I PERMIT
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Site Address '6 '20,.
Block
Heating Contractor "'V-.E=b\ OE::I\J", ItL
Address . I~ \-:> E:.. 4. \ sr ~ ~~
Telephone' 12'-1- ,g~,
Furnace Make & Model, \"E:."",P s,.. ^f......
N '\ c... b c/6
Lot
Owner's Name
Address
Model Size
Addition
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TYPE OF SYSTEM
Warm Air Plants
Gravity .
Meehani
Air Cone REQUEST FOR INSPECTION
Vent. Sy SENT TO HOMEOWNER 1/03.
SHEATlN NO RESPONSE. CLOSE FILE
team.
Hot Water
Radiation
Special Devices
Conn. Load
Fuel MAl. ('~6Flue Size
Supply Openings
Return Openings
Input i5.o0b Output
Edr.
Cfm.
Alterations
Repair
Est. Cost $
Other Devices
TYPE OF WORK
Replacement I' New Construction
Est. Comp. Date 2 ~ \ ~ - q 'l
<k - od
) u 2 ~ BuDding Permit #
b.... . 6..Q....
.50
65.00
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
Receipt #
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TYPE OF STRUCTURI;
1. Pink
2. Green
3. Yellow
File
City
E1'aClor
Single Family
Commercial
x
Multi-Family .
Other
Two-Family
Industrial
Public
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
$39.50
$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.
4tV1itiM'i1 inspections will be billed at $35.00 each.
~ating Test Record must be submitted with buildina oermit number before build-
cate of occupancy will be issued.
.LCULATIONS REOUIRED with number of supply and return openings listed per
I CFM's per opening. New structures or additions send floor plan with supply
n 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 0 dinances and codes of the city and with the state building/mechanical
codes; th~ t this form does~ become a permit until signed by the BUILDING
OFFICIAL\that the wo~rk wi e in accordance with the approved plan in the
case of al work which q ir s review and approval of plans.
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I ~Jcant'fl ~ature _ Date
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'-- eiJilding ~ignature Date. (
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