P - 48127Buildirlg
Insp�ctions
763-572-3604
763-502-4977 FAX
DATE J J �/ / 1
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
�YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
M�CHANIC�L
RESIDENTIAL r�PPLIC.��'IUN
CIT� O� F�2IDLEY
EFFECTIVE 7-1-2010
YOUR E-MAIL ADDRESS
❑ OWNER
NAME ��h n �E__�) �°./ ��%
ADDRESS: 1 �v �(�M�� !ti � ��
PHONE:�� ` �-�'_��S "" I I ?l �
COMPANy NAME:
CONTACT PERSON Home Energy Center
- 2415 Annapolis Lane N# 170
STATE LICENSE tl_ Plymouth MN 55441
ADDRESS: 763-�376-1990 fax 763-476-t 143
PHONE_ ____ _ FAX
FAMILY O TWO FAMILY
Permit No."L
Received By:
Da 1��1. U�1�"
7'Y STA
D TOWNHOUSE
,
TYPE OF WORK: � NEw „�'REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPT]ON OF WORK �Q.� �ii1(, -2 �Y1r'1.G C�-Q -
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FE$S ARE &ASED ON $1R.00 PER FIXTURE, EXCEPT WHERE NOTED. FI�TUR�S: {II�DiCATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. (;�y-� ___ ..
Fqu4p�ent InstaUed NfFG: d✓1�,, ,. _ �O1��L: _ Q _ � I
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_ ,, �. �� ;,, , , nrMFG. ,. , , ,. . .. _. ,,,NtC7L7EL: S[ZE1BTll
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_ -' : < ` MFG. ` MODEL: StZ6/BTU
��_A!C S25.U0 � � � � � � FIREPLACE (GAS) S I �.00 GAS RANGEJOVEN $10.Q0 � �,,
_ AIR TO AlR EXCH,4NGEER $15 �F[REPLA OOD) �35.00 NEW GAS GRILL $10.00
BOILER $35.00 ACE 3�S.QQ_-""._.> GAS UNiT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
_DUCT WORK $10.0(1 _GAS PIPING $10.00 VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that fhe information above is complete and accurate; thar the w�ork will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codzs; that 1 understand this is
not a permit but only n applic tion for a permit and work is not to start without a permit; that the work will be in accordance with the
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approved plan in the ca of al ork which r ui s revie and approval of lans.
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APFROVAL 1NSPECTOR$ SIGNATUFE DATE ' ` '
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977 -
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