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CITY OF PRIOR LAKE Me
16200 Eagle Creek Av. S.E. Permit No. CJ1l ~ (J-l;;lQ
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
Date '5 - 24 ~ DO PID #06 -07,') -tfn-n
She Address _ &j" io~ .- \~() 1b S-t. S. E..
Lot 4- Block Addhion t)DJr J2~ ~Ill'l ~
Owne(s Name ill.me.-s i< If- ..... i \'\ . -() - ~
Address-,~/("'~- lSOi:h St: s. C.
Heating Contractor \I\l nbJer.s s. DU +h s. ide 1:fi9'
Address 1L/150 W. 11./0 fr (St - Suiio IOIt:;
Telephone# ~
COX V- 'leI'"
Furnace Make & Model 5R'MXAO\a')-I'Z.
Model Size \O{'), DOO
Conn. Load
Fuel r1'::TtUm...1 Flue Size L1
Supply Openings
Return Openings
Input ~D,rro Output 55. ri.Cf:',
. -
Edr.
Cfm.
TYPE OF WORK
Merations
Replacement
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical )(
Air Condhioning ['iAV'"r-iE':'r '2.. t'Dn
Vent. System.
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
New Construction
Repair Est. Comp. Date
Est. Cost $ ~ 6. ];2P- Building Permh #
HEATING PERMIT FEE $ gCJ . 50-
STATE SURCHARGE $ .50
TOTAL PERMITFEES $ 1D ,_a.;.-
Receipt #
'},., Ltc, Sf'
TYPE OF STRUCTURE
I. Pink
2. Green
1 Yellow
File
City
Contractor
Single Family
Commercial
x
Two-Family
Industrial
Public
Multi-Family
Other
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1"10 of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
Ci39.50 'I
$39.50
RAmpmbAr to ::IrJd thA StatA RlJrch::lrgA nn thA hnttnm nf this applic~tinn
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 buildino WlI!il nllmhAr 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. '1-<jSl
City Hall business hours are 8 a.m. - 4:30 p.m. \A~ 1. ";)
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAlS - CALL CITY HALL
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
OFFICIAL; that the work wili be in accordance with the approved plan in the
case of all work which requires review and approval of plans.
5-2tj-OO
Date .
d3io/)
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 57 Ca 5
/50 f:b. s+
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL ff\J\ I? ~UMBING FINAL
o SITE INSPECTION (~}l"MECH FINfL
COMMENTS: Fi..l.lV'\CJ'~ / AL
"
l.Po- ~ ..CL._ ..2
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~
TIME
q ~ a::>
0-41.0
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
-......---....
0~ <.Jk' ";
. .... T______
;& WORK SATISFACTC RY, PROCEED
I D' CORRECT ACTION, .ND PROCEED
o CORRECT WORK, C ~LL FOR REINSPECTION BEFORE COVERING
Inspector:
lfri
Owner/Contr:
CALL 447-9860 F DR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREJIJ ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!