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P - 48611„„, _� `�,_` _� �v V � From: 7637854937 Page: 2/3 , Date: 3/12/2012 5:09:40 PM V` � ` v Building M�C.�ANX�AL t�erm'�No.: ��i �a. z:nspections �SYY]�1V�TYA�. AP�LICATIOI�T Recerved By' 7��-s��-��oa. CY"CY O� ���]L�Y ° . , 763-502-4977 FAX D���- `� '. ° � - � �� GFF'ECTIVG 1-1-2012 DhTE Z- Yi}Lla I?-MM4 Aq[)RM?, S�,}���far�(r ,��t��-�TV���,� .0 �[TE ADDRL�SS � ll�il5 Al'1'L1CAN'I` IS: Cl C) W�NK �C".(1NTitAl,: f�7R p��p��T�' NAME: OWN�R/ — . _.. ..... _ .. Y . .. _...._ '['�NANT ^�'�K�;ss: r.rrv s7'n�r��zir� PHONEr CONiRACTOR CUMYANY NAM�: , SL) k3Mrl” A CDPY pF CONTACT PERSON: � YpUR STATE STATS i.1C�NSf3 #� LxP DA'1'L"• LICENSE W[TH ADbitP$5:..,��..�� 'C'X crrY "�'�p s'rn�,�1 ,��rn�� APPi.iCATfQN ri�[orre ��81 7(p� �8� ��� rnx rj�.�'7Rr �-F�7•�1 P�RMtT TYP.E ���'�'Q NAMiLY C]'t°wo �AMs�,v CI �rowxxousE "r°1''P� OF WURx: � rr�w Q i�c�t.nc�M�rr �yAL'['CRATION/REMQI?EG DETAII,ED pESCRLPTTON OF WORK ° •f– , 'f �" FEES ARE DASED ON S10.Od pRit FIXTURF., ERCEPT WIiERE NOTGD. F'IXTURE3: (fNDICAT� TO'CAL NifMDER OF EACH P&L4V1� PAQY[DE HEAT LU$S CA1,C'S PL�R MANl1 i 200fi ASHRAE FIANDBOOK. �y y�� � Hqui�nt InataliCd MFG: �,�„� M(3DEL: r��3u� {�v-� � SiZEBT1,1 � MFG: � MODEf,: � (} �jlv0 ZQ 812E/BTU ��u Mr•a: MaoE�: srzeio�ru �QAlCS1S-���} �FtttI�PLA�'N (CAS) x15-�� r,AS RA.NGI�f)vRN SiO.(1fi AIR TO AI.R E7CCHANG��R SIS _RrR�P[.ACE (W�OD) S3S-oo NEW GAS GRIi,[, a10.00 son:uc ��s.ou ��rxrtnc� s3s.00 GA5 UNPr �-��rx sio.00 �Cli.lMNf�Y I�IN�R S� o.00 �GAS l]kY�R S i o.on 'T.roO� hEA1'�It S3S.on UCT WORK $10,00 GAS P[PING $10,00 VFNTTLATOR $IS.00 Numbar of fixtures (u3 $10.0Q x $10.4(1= $ � Numbcr of fxtures (v� S 15.UU ,____ x$1,5.qp =$� Numher qf fcxtures C� ��S-Q� _..� x$ZS.00 =$�,� Number of �xtures Q $35.00 � x �3S.QA = $ ��� U� Scate Surchargc = $ 5,00 MiNIMUM FE.E 540.00 Totel = � THTS ►� AN APPT.iCATfON FOR A PERMIT-N{►T VAIMtf� t11YTIL PROC�SSED i. hcroby apply for a builclipg r�it stnd T. aClrndwlCCige lh�.t. khe inf�r�tns►tipn ahove is complcte and aeCUrnte; thut the wark will be in ennfnrmance with the ordi�iances and cndes of the City of Fridley and with Chc Minntsota Construction COdas; that I undersu►nd this is not a pern�it but anly ;u� applieution f r a 't �d wark i� noc tu sturc rvithout u permit; that the wark will be in uecordance with the approvCd plAn in thc Casc k whiCh uirc rcvicw and apprqval Uf ptf�rts. 5IGNATURE OF APPLICAN PitfNT fYAMH,,,�� *�K�. A'C�; APPROVAL INSFEC7Y7RS SiGNAT T)ATF Pi.�A$E NO'I'L: SL�PAIZA"r'Li YI� I"E` " lt� U(RL.D .1+0lZ..�U1.�.DtNG ELECTRI I� .. CHAN[CAI. WORK C3ty 4f �'ridley ui ding Inspec�ions Deparkment � y, _,� 643.1. [Jniversity Avenue NE, Fridley, NIN 55432 '� <<: ,1 I I U 763-572-3104 FAX: 763-SQ2-4977 `Y �� �. }