P - 35063Building
Inspections
763-572-3604
763-502-4977 FAX
From: unknown Page: 1/2 Date: 12/6/2010 4:52:16 PM ,
MECH.A.NICAL Permit No.,,
RESIDENT�AL APPLICATION Received .By:
CITY OF FRIDLEY '�.�'��
DATE � 2�QI2�10 YUUR E-MAII, ADDRESS dav6�deVDSheStfngendaif.lb111
SITS ADDRFSS �587 Able St �ig
THTS APPI,TGANT ISr IJ OWN�R ON'1'RACTOR
PROPERTY
OWN�R/
TENANT
CONTRACTOR
SUBMIT A CON\' OF
YOURSTATE
LICTNSE WITH
APALICATION
PERMIT TYPE
TYi'E OF WORK:
sarbara overlien
pppRF��. 32f 0 39th Ave Ne C�TY Minneapolis sTpT� Mn z1P 55418
aunuc. $12-788•736$
C(IMPANY NAME• �ave's Headng and Air
CONTACT 1'GRSON: �Y Med�9
STATL� LICBNSE t! EXP DATB
ADDR�SS: �601 37th AVe Ne GITY COIumb18 HBlghte S�A�; MN Z�p G5421
PHONI: 783-781-8801 �� 783-788-8805
�'SfNOI.R FAiN1.LY ❑ TWO FAMILY
D NL�W O REPLACBMP.NT
O TOWNIi0US5
Cl ALTBRA'fION/RL�MOAGL
DETA I LED D�SCRIPTION OF WORK �Piace tumace wl aqufpment listed below
I'C�S ART I3ASED ON 510.00 P�R FIXTURE, FXCEPT WFIERE NOTEA. FIX'1"IfRES: (1NDICATR TO'i'AI. NUMAER OF �ACR HF.I.OW)
PROVIDE flEAT LOSS CALC'S PER MANUAI. J 2M16 ASIlRAE NANqBOOK. �� � Q� �
Equipment Installed MFG: •� MODEf : SIZE/pTU
MFG:
MODEI.: SIZFJBTU
M F� G: MODLI.: fil7 R/BTI J
�!C $25�0� FIREPLAC6 (L'iAS) 515.00 GAS RANOFJOVEN SI0.00
1A TO ATR EXCIiANC3hTiR $IS �--{' iRGCLACG (WOOn} 515,00 ^NEW QAS GR1LL 510.00
iF301L6R $35,Q0 � J FURNACE 535.(10 �GAS UNIT htTR SIO.OD
�Ctl►'MNBY LINERSI0.00 I�)pS DRYGR 510.00 POOI. FfP.ATER 535.00
DUCT WORK 510.00 GAS PIPINQ SI0.00 ,_._.V6NTII.ATORSI5,00
af fixtures (cr� �10.00 _T. _ x �l 0.p0 =
Number oPfixtures (�a $15,00 ____, x $1 S.Qa = $�
Number of fixtures @$2S,OQ.� x$ZS.00 =� T
Number of.fixtureS (a� $35.00 ? x $35.00 - $ 3g•�
State Surcharge = $ 5.00
Total = $ A0.00
TFIIS IS AN APPLICATION PQR A PERMIT-NO'P VAI.TD UNTII. PRdCi:SSED
[ hereby apply far a bu' 'ng permit and I acknowledge that the information above is complete and accurate; that the work will be in
con%rmance with the rdi � nces and codes of the Ciry of FridlBy and with the Minnesotzs Construction Codes; that 1 understand this is
nat a permit but onty n ap licatinn 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 1 work whi h uires r view and approval of platt .
SIGNATURE OF APPLIC NT RINTNAME ��+ _ ��,
APPROVAI.INSPCCTORS ATURG � bATF __
City of Fridley
Buiiding �nspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-36Q4 FAX: 753-502-4977
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