P - 42750f�AR-23-2a11 �7:2bF FROM: T0:7639512547
Building MECHAN�CAL P��►t �vo:
Tnspeciions RE5IDENTIAL APPLICATIUN R�ceivea �
763-572-3604 CITY OF FRIDLEY E� �
763-502-4977 FAX e:rFSCnvF i-i-2oi i __
DATE 3�Z2/2011
SITE ADDRESS 5860 4th St Ne
THIS APPLSCANT 1S:
PRUP�RTY
OWNEi2/
TENANT
SUBMIT A CUPY OF
YOURSTATE
LICCNSE WJ'1'1-t
APPLICATTON
PERMIT TYPE
Y011R &MAII. ADDRGSS dave�davesheatingandeir.com
CIOWNER ❑CONTRACTOR
P.3
NAMN: 3obn MaJewski
ADDRESS: 105 12th Ave NW �E��y New Bri9hten 57A'fC MN �r�, 55112
PMONE: 612-822-2835
CQMPANY NAMF,� DAVE'S HEATiNG ANp AIR
GON'I'AC'f k'ERS�iV: AMY MAbVIG
STATr LICGNSE # LXP DATE
AUDRESS �601 37TH AVE NE ��Ty COtUMBIA H�IGHTS STATG MN 7,IP ��z�
PhION� �fia-781-6901 �q� 763-789-86Q5
FAMILY �'WO �AMILY
LJ
TYPE OF WORK: � n rrr:w _�Pr,nc�MLN�r
jJ
�f'OWNFIOUS3:
i i
❑ aLrexn'rtorrrtt��non�[.
DETAiLEI� DESCRIPTTON OF WORK Replace Furnace w! ilsted equipment below
F'ELS ARC BASF.p ON $1.0.(10 PER FIXTlJRE, EXCF,PT WII�RF. NOTED. FIX7'URES: pNDICATIi TATAL NlfM13CR OP EACH BELOW)
PROVIDE HF,AT LOSS CAI.C'$ PEIi MANUAI. J 2011( ASHRAR IIANDIi00iC. GqouH-24A•Q7o 8096 70,000 97U
Gquipment Installed MI�U: �E�r+ox MODEL. $�Z�'aBT�
M�G:
MOD81.:
SIZFJE3TU
MFG: �iODfsL: SiLliA3TU
]1!C $25.00 FIREPI.ACC (GAS) $15.00 GAS RANGE/OVEN $10.Q0
AIRTO AIR EXCNANGGER S!S �FIREPLACE (WOOD) $35.00 NL=W CAS GRILL SIQ.00
401L8R $35.00 aFURNACE 535.00 �GAS UNIT H't'R $10.00
CHIMNEY LINF.R $10;00 GAS DRYGR $10,00 P�OL HEATER $35 00
�DUCT WORK $10.00 GAS PIPING $10.00 �VENTILATOR $I5:00
Number of fixtares @$ I O.UR _____ x$10.00 —$
Number of fixtures @$ l S.OQ ___T_ x$ l 5.00 =$�____,_____'
Numbcr of fixtures @ $25.00 _____ x $25,00 = $�
Number offixtures @ $35.40? x �35.00 = S �•!�
Seate Surcharga ° $ S.OU
Tota! _ $ `►0.00
1'HlS IS AN APPLICAI'ION POR A PERMtT-NOT VALtp UN'1'16 PROCESSED
1 hereby apply for a 1iu' g permit and 1 acknowledge that the 9nformation above is complete and accurnte; that the work will be in
conformance with the rdin nces and codes of the City of Fridfey and with the Minnesota Construction Codes; that f understand this is
not a permit but only ap 'catio�i�a pe i a irk i� not to start without a permit; that the work wiil be in accordance with the
approved plan in the c e af I� yYhi�i r v ew t�d�oval of p{ans.
SIGNATURE 01'
AMY MADVIG
City of Fridley
uitding Inspections Department
6431 University Avenue NE, Fridley,lV1N 55432
7b3-5'i2-3604 FAX:7b3-502-4977
� '
ANb!
�.� 3/22/11