P - 48058Building
Inspections
763-572-3604
763-502-4977 FAX
1dIECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-1-2010
DATE 7' ��p ' 1 1 YOUR E-MAIL ADDRESS
SITE ADDRESS � 7/ 7 � tiol `'ii !✓ g/
THIS APPLICANT I5: ❑ OWNER J�]CONTRACTOR
PROPERTY
OWNERJ
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
NAME: �� G� (�P w+� l2 � C? u� O��l �.—�
ADDRESS: o� Li p.1`-�--- CI7Y
PHONE: % CP ?� — S ^7,�„ - � � O �
COMPANY NAME:
CONTACT PERSON: Home Energy Center
- 2415 Annapolis Lane N #170
STATE LICENSE #_ plymouth MN 55441
ADDRESS: 763-476-1990 fax 763-476-1143
PHONE FAX
FAMILY ❑ TWO FAMILY
TYPE OF WORK: I� NEW �'�EPLACEMENT
DETAILED DESCRIPTION OF WORK
O TOWNHOUSE
❑ ALTERATION/REMOD£L
---� �. ,. �.n�¢.�'
P�nmit No.:
Received By:
���R�c'�i: �
TATE ZIP
ATE Z[P
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUA J 2006 ASHRAE HANDBOOK
Equipment Installed MF . �/� MODEL: G� h SIZE/BTU .UO�
MFG:
MODEL:
MFG: MODEL:
A/C $25.00 FIREPLACE (GAS) $i5.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00
BOILER $35.00 �FURNACE $35.00
CHIMNEY LINER $10.00 GAS DRYER $10.00
DUCT WORK $10.00 GAS PIPING $10.00
SIZEBiU
S IZE/BTU
_GAS RANGE(OVEN $]0.00
_NEW GAS GRILL $]0.00
GAS UNIT HTR $I0.00
POOL HEATER $35.00
V ENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordin ces and codes of the Ciry oi Fri�iiey and ��ith the ��innesota Construction Codes; that I understand this is
not a permit but only an ap icati fo permit and work is not to start without a permit; that the work wilf be in accordance with the
approved plan in the case of 1 w�l�whic reqt� review and appr�l of plans. �
SIGNATURE OF
APPROVAL INSPECTORS SIGNA
0
C/ City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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