P - 35055Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
�63-s�2-3604 . CITY OF FRIDLEY Da��'a� �� 1 2�
763-502-4977 FAX EFFECTIVE7-1-2010
DATE �y6/2010 YOUR E-MAIL ADDRESS dave@davesheatingandair.com
SITE ADDRESS �567 Able St Ne
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY NAME: Barbara Ove�lien
OWNER/ ADDRESS: 3210 39th Ave Ne �I-py Minneapolis STATE �� Z[P �� 8
TENANT 612-78&7368
PHONE:
CONTRACTOR COMPANY NAME: Dave's Heating and Air
SUBMIT A COPY OF CONTACT PERSON: Amy Madvig
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: 1601 37th Ave Ne CITY ��umbia Heights STATE MN Zip 55421
APPLICATION pHONE �63-781-6901 FAX �63-789-8605
PERMTT TYPE �GLE FAMiLY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCWPTION OF WORK replace fumace w/ equipment listed below
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL N[JMBER OF EACH BELOVI�
PROVIDE AEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: � MODEL: SIZE/BTU �� ��•� �
� MFG: MODEL: SIZFIBTU
MFG: MODEL: SIZE/BTU
C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGF/OVEN $10.00
IR TO AIR EXCHANGEER $IS REPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 �ACE $35.00 GAS UNIT H'I'R 510.00
CHIMNEY LINER $10.00 AS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR 515.00
Number of fixtures @ $10.00 x $10.00 = $
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @$35.00 � x$35.00 =$ 35.00
State Surcharge = $ 5.00
INIMUM FEE $40.00 Tota1= $ 40.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN1'IL PROCESSED
I hereby apply for a b,u' ' g permit and I acknowledge that the information above is complete and accurate; that the work witl be in
conformance with the rd' ances and codes of the City of Fridley and with the Minnesota Construcrion Codes; that I understand this is
not a permit but only ap lication for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the c e o al work wh' uires r view and approval of plan��.
SIGNATURE OF APPLIC NT RINT NAME _ TE ��_�
APPROVAL INSPECTORS S ATURE DATE
PLEASE NOTE: SEPARATE PE TS ' RE UI FOR BUILDING ELECTRI CHATTICAL WORK
; City of Fridley
Buil ing Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977