P - 83520Building 1VVJ[�ECHANICAL
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRII)LEY
763-502-4977 FAX EFFECTIVE 7-1-2010
DATE I ^
SITE ADARESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
XOUR STATE
'LICEIVSE WITH
`APPLTCATION
PERMIT TYPE
TYPE OF WORK:
�'�/�
S� S
YOUR E-MAIL ADDRES�
� S�- ��
Q OWNER ,0'C�ONTRACTOR
NAME: d' � "'� ti
ADDRESS: q h m—tt-e--.
PHONE:
---- - — _ _ _
_— --
COMPANY NAMfi:
CONTACT PERSON: Home Energy Center
- 2415 Annapolis Lane N #170
STATE LICENSE # Plymoutl� MN 55441
ADDRESS: 763-476-1990 fax 763-476-1143
PHONE FAX . ____ _
❑ SINGLE FAMiLY ❑ TWO FAMILY
❑ NEW /PTREPLACEMENT
DETAILED DESCRIPTION OF WORK
Pe:::��t No..
►- -. � �� . . i�
�� � � � - 1 r
�.-•- .
CITY STATE ZIP
_ STATE ZIP
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
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 2006 ASHRAE HANDBOOK � Sr Q�v
Equipment Installed MFG: ��-�,d4-,h,J MODEL: �/Vi /�' �'/S SIZE/BN
MFG:
MODEL:
MFG: MODEL:
_A/C $25.00 FIREPLACE (GAS) $15.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD} $35.00
_BOILER $35.00 y�F�RNACE $35.00
CHIMNEY LINER $10.00 _GAS DRYER $10.00
AUCT WORK $10.00 GAS PIPING $10.00
SIZEIBTU
SIZElBTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL $30.00
GAS UNIT HTR $]0.00
POOL HEATER $35.00
VENTILATOR $15.00
THIS fS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowled that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the C' f Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applica o for a it an w rk is not to start without a permit; that the work will be in accordance with the
appmved plan in the c�se of all �k w,k�ch �req 'r re iew and approval of plans�
SIGNANRE OF
APPROVALINSPECTORSSIGNATURE
City of Fridley
B ' ing Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
. / Z�'
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, NIN 55432
163) 572-3604 FAX: (763) 571-1287
: 5357 4 ST NE
: 233024340057
: UNAVAILABLE
: LOT 0 BLOCK 0
: HEATING - FIXTURE BASED
: RESIDENTIAL
: FURNACE
NOTE: REPLACE 2 FURNACES
BOTH:
GOODMAN MODEL: GMH95 45,000 BTU
#FURNACES
APPI.ICANT
HOME ENERGY CENTER
15200 25TH AVE N
STE 128
PLYMOUTH, MN 55447
(753) 476-1990
OWNER
BRENEivIAN, RICHARD
13225 JAMES AVE S
BURNSVILLE, MN 55337
E
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances goveming this type of worl�
will be complied with whether specified herein or not. The
granting of a pern►it does not presume to give authority to
violate or cancel the provisions of ny oth r state or local law
regulating construction or the pe�rmanc�of construction.
Bldg Insp
PERMIT NO.: 2006-02501
DATE iSSUED: 12/15/2006
FURNACE FEE
STATE SURCHARGE, MECH FLAT
T01"AL
PAID WITH CHECK # b 1552
SEPARATE PERMITS REQUIRED FOl`t�VORK OTHER THAN DESCRIBED ABOVE.
70.00
0.50
'70.50