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P - 45777Building MECHANICAL Permit No.: � � Inspections RE�IDENTIAL APPLICATION Received By:—Y�� 63-s�2-3604 CITY OF FRIDLEY Date�s�:�,.1-1,�� 763-502-4977 FAX EFFECTIVE 1-1-2011 DATE 2 � � � YOUR E-MAIL ADDRESS SITE ADDRESS (�Q � 0 � �'d �7 �- E�� 2�� y i'i � j � �� ..-- THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY NAME: �/Nr"�/� 7�G�� OWNER/ ADDRESS. C�� / v .3°zd �'�` /✓ � c1�rv (_/�-� t7 C� `'r 1�( TENANT STATE [P � y PHONE: �� Z� S� Fr gy�i c� CONTRACTOR COMPANY NAME:Q�C /'7' 1 /7�`�'T7�/ �- /� � �f' �/✓PL. /A/��CC SUBMIT A COPY OF CONTACT PERSON: Df�l�/1� �/�f�✓.s7�//�+✓S-o YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS:1� 7g � �v32 �1 /"�V _ CITY r� �G- L�i�E STATE�'"ZIPSS�`'Q/ APPLICATION pHONE��i 3 2-� g 9�s�3 FAX PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW ❑ REPLACEMENT �ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK %r✓Si"/� [ C E.D �/ i�C-"A'T „s'�vc PP/E"S eF �/C��Tu 2 i✓ FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $I5.00 � °= i i5�° � s .�`� a' ai ��, � .� 4 � � � �, . ' _ � _,,, '�p 3' � ?z�'i '� �� "`�� R '��^ ' :. � . r-_ .. a :�� , x�; a� r. ��tq �� r �� r �� '`�� i , �` � �»s F:�x.� �� .. ra �x .sa . �: � ,. ; ``�� ' � � � .., h� : %��'� ": .�" � s � i � 1��'�`` i 1 � ��*, °` �'y� �� ' ,�� y % ava � t�� ,,� , a"�z �f � � � � � � ✓m a � � � � ��h� . - �, a- � .. �v ,�. `�'��z _ 3 �' - }� � g -- � t �^,n*� 3r�.� n3 �c/ �•�. f�c : �i�, �� i� 3�, � � 2� : „� : %1'�`�-. � a�r a� - �'" � � �� .� � � � � � -. � l ,�� 'e�i- 4 - C f c � l�" � t a a � � �'�#� � � y7£� �� 5 � ` '�+ .�`�i \ i.�i�� j�r� '� �� ` r YF � � �5 � � , ,� �, : r � `�.. -� � � : F r� � �'3z� : a � � y�� :. y � �x: yy �. ��'� �� "�' � �.1�. �, '"��. ,� Z �,`€a' .. �.�. ~ �- � s� � � m �` �� s r. � :: ��' �� s � �� , � � � � �� ,� � � � �� '� ,� � �� ,. � �s$� _..� F ._ � � X � � �} � ,� � �., ri �'�.c�,��`�� y ,':� � � ��X��'� ��., � _ � b �� '�+�� ,��t � :. N "� �t � � .� � � � � �' �, :�3 1�,� � i�� wa A r�' .`� i � \ {�'r's." � C '" � F � k ✓� '�s �" i a� � - � � �� '� �� ,� � ��r, � . rk� � �x . � �zr�"r. � �rr . � �s,�� : '�s �'� `� �� : �s� . ��s m'�� ..��"`,, � a'2 �c � �� %z�: sr ��.�' �� [�JC.�+��itF��%�%k��„ $� ,•" ,,�� p � � � .t �7 �� THIS IS AN APPLICATION FOR A PERM[T-NOT VAL1D UNTIL PROCESSED 1 hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work wi(1 be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a 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 a work which req 'res review and approval of plans. SIGNATURE OF APPLICANT � ---- PRINT NAME L//9`�ld G- ��'��/f✓'�f1�ATE !l/ J`�� APPROVALINSPECTORSSIGNATURE DATE � �. � ,;�, .. , �� . u.'� .. �' : . '�'�y�_� . . � ..� 1��i� :'i� �7i1�� {3i�;� E �ZY�'�7�; "' ,�..�'� �3C��, �� ,� �Ti��x�� , � City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 1�