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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS
5/7Z-
DATE TIME
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,
9:30
hI(JlJc J7;
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTIC N
COMMENTS:
o PLUMBING RI
~9MRt"
WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
!fi MECH FINAL
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O-/Od)S
o EX/GRAD/FilliNG
o COMPLAINT
o FIREPLACE RI
~ FIREPLACE FINAL
IIQ:))lll GAS liNE AIR TST
o
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Ji WORK SATISFA ;TORY. PROCEED
o CORRECT ACTII IN AND PROCEED
o CORRECT WOR C. CAll FOR REINSPECTION BEFORE COVERING
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I
CALL 447-9Bl'O FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Inspector:
Owner/Contr:
INSNOTJ
CODE REQUIJ 'EMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
AIR CONDITIONER UNITS CANNOT
ENCROACH INTO SIDEYARD SETBACKS.
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
CITY OF PRIOR LAKE MC
16200 Eagle C(cHk Av. S.E. Permtt No.
Prior bike, MN 55372
HEATING APPLICATION I PERMIT
Date 12- (-00 PID#---2.S-03D-OO'
StteAddress. 5/72.. !-lOPE: S77eEf::;;;- I
Lm B~ Addtt~n
~ ~ UDll~\L-
tIiJIIItIB 5" /7 Z. Ho P 6
ST.
'PL-.
,
Heating Contractor
Address
Telephone #
GtA,RAGo6
Furnace Make & Model I H 11...- U:-n:;>
... r. ....
Model Size
Conn. Load
Fuel Flue Size
Supply Openings
Return Openings
Input _ Output
Edr.
Clm.
TYPE OF WORK
Merations
Repair
Replacement
Est. Comp. Date
Building Perm ~ #
New Construction
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
:.~,q 60
.50
4000
Receipt #
.3PJBo I
TYPE OF STRUCTURI;
I. Pink
2. Greoo
3. Yellow
File
City
Contractor
Single Family .
Commercial
Two-Family MuRi-Family
Industrial Public Other
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Addttions & Alterations
Residential, AC Only
1% of job cost ($39.50 minimum)
$99.50
$64.50 PLEASE NOTE:
$39.50 Air Conditioner Units Cannot
$39.50 Encroach Into Required
$39.50 Side Yard Set-Backs
R,,~hQr In ~ Ih-=- ~t!:lot,o, ~11,.,.h!:lrgA on thA hnttnm nf thi!l:l l:Ippli~J:lti(\n
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 !2l!i!l!i!!g wmil nllmhAr before build-
ing certificate of occupancy will be issued.
!:!fAI CALCUj,ATIONS REQUIRED wtth number of supply and return openings listed per
room with CFM's per opening. New structures or addllions send floor plan wtth 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.
GH-IN AND FINAL) - CALL CITY HALL
Phone: (952) 447-9850
-
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
5:'CIAL; that the work will be in accordance with the approved plan in the
of work which equires review and approval of plans.
~, ' ,.,.. ~z/t!2fV
- - -&fIj;}L ' .
BUfl's Signature
Fex: (952) 447-4245
/"l.-I.OO
Date