P - 41196Building
Inspections
763-572-3604
763-502-4977 FA.X
1l�iECHANICAL
RESIDENTIAL APPLI�ATION
CITY OF FRIDLEY
EFFECi'IVE 7-i-2010
DATE �`! o� -� I YOUR E-MAIL ADDRESS
STI'E ADDRESS � � � `-'l� /� �
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
P�rnnit No.:
�- -. :
��Iiri �' :`
NAME: C't.U. � �l � -1 ,,,�,'l
ADDRESS:�i, �F' � � � .� Ci7'Y t� . STATE�''W�ZIP�,3
PHONE: �J� � "' �% �% '` U Cj t
-- _ -- __ — -__. __—
__. _..— ---
COMPANY NAME:
CONTACT PERSON: Home Energy Center
- 2415 Annapolis Lane N #170
STATE LICENSE #` Plymouth MN 55441 —
ADDRESS: 763-476-1990 fa�c 763-476-1143 STATE ZIP
PHONE
❑ SINGLE FAMILY ❑ TWO FAMILY
� NEW `L�REPLACEMENT
FAX
Q TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK •C �Ct G ��r'� aC F'_
FEES ARE BASED ON $10.00 PER FIXTiiRE, EXCEPT WHERE 1VQTED. FIXTURES: (TNDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANU��006 ASHRAE HANDSOOK. -p � p��--7
Equipment Installed MFG: {'�'eE'rri MODEL: 1�. �� 1 SIZEBTCJ
A/C $25.00
AIR TO AIR EXCHANGEER $15
�BOTLER $35.Q0
CHIMNEY LINER $10:00
'DUCT WORK $10.00
MFG:
MODEL:
MFG: MODEL:
'�t�3') $15.00
OD) $35.00
FURNACE $35.00
AS DRYER . 0
GAS PIPING $10.00
SIZE/BTU
SIZE/BTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL $10.00
GAS UNIT i-ITR $10.00
�POOL HEATER $35.00
VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN1'IL 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 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 applic �o or a permit and work is not to start without a permit; that the work wii( he in accordance with the
approved plan in the case�of alt�o cr�hich re�ires pcv.�ew a�nd approval of pians. I �
SIGNATURE OF
�Illl�]
NAME ��� Gt In0
�-�City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977