P - 35058Building MECHANICAL Permit No.��j ) �i7�(�fD
Inspections RESIDENTIAL APPLICATION Received By: r�
763-572-3604 � �'ec'd: ��j %�_
763-502-4977 FAX CITY OF FRIDLEY
EFFECTIVE 1-1-2011
DATE � � YOUR E-MAIL ADDRESS
SITE ADDRE S fo�/ �! i4 r��, � r S� N,�
THIS APPLICANT IS: ❑ OWNER �ON1'RACTOR
PROPERTY N�: �}/I; /C� P�• !�: llo n
O�'�'NE�t/ ann�ss: (oY�� ,4��f�.� SE. N.E. ci�rx�.'��� � STAT�NZIPSS�
TENANT
PHONE: 7� 3� 4r % 5� 'r/, %� 7 .: -�
CONTRACTOR �oMp,e,�,�y N�: @iear�h & Home Technologies, Inc.
a iresi e ea ome
SUBMIT A COPY OF CONTACT PERSON: �Pnca �n�i �nan
YOUR STATE STATE LICENSE # EXP DATE 2�00 N. Fairview Ave.
LICENSE WITH pDDRES5: CIT1651/633-2561 STATE ZIP
APPLICATION �
PHONE FAX
PERMIT TYPE �SINGLE FAM[LY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK' �NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK j��<. l� G ti s � � t� l a e e j n S,c r. ,f �,,,� G�. f�, .��,
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. ��7�
Equipment Installed MFG: �� l p MODEL: �I'Gt�'+ ,� SIZEBTU 3s�
MFG: MODEL: StZEBTU
MFG: MODEL: SIZEBTU
A/C $25.00 �FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER �15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00
_BOILER $35.00 FURNACE 535.00 _GAS UNiT HT'R $10.00
_CHIMNEY LINER �10.00 _GAS DRYER $10.00 POOL HEATER 535.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of fixtures @$10.00 x$10.00 =$ �o , vr�
Number of fi�chtres @ $15.00 � x $15.00 = $ / S� vt� .
Number of fixtures @ $25.00 x $25.00 = $
Nwmber of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 5.00
FEE $4a.00 Total = $ 7l% � G'U
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 pemut but only an application 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 case of all work which requires review and approval of plans.
SIGNATURE OF APPLICAN'I' �-�-� AME C/� � ri ��� DATE 3�//
APPROVAL INSPECTORS SIGNAT � � ��A'I'E ,
PLEASE NOTE: SEPARATE PERMITS ARE RE tJIRED F R BUILDING E' C CAL AND MECHANICAL W4RK
City o Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977