P - 39912,,,, o, 4J ,,, Frorn: unknown Page: 6!7 Date: 8/23/2011 4:58:38 PM
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Bui�Id�g MECfl.ANICA►� l'e�xnit No.r��
�ataspections �ESIDEI`TTIA,L Ax'��XC,A��'ION �eceived sy: � ��;(r
'763-572-3604 CITY UF FRID��� ��'����
763-502-4977 FAX --_--- _ _
ST'!'E ADDR£SS L i [ ��I
THIS Al'PLICANT L5: ❑
4WNER!
1'�NANT
..
vvi. � iwc��, a vn COMPANY NAME:
SUBN�TT A COPX OF CONTACT t�50
YOUR STATE STA1'� LIGENSE #�
LICENSE WITH anDxESS:�
x
AFFLICATION P�o� � _,�-i _ �
�1!)i.--�
���Xx'�"7Cp� TNGLEFAMILY
TYPE Q�' wORI�: a N�w �
1pETA.zL�D I�LSC�Z' 1"TON O� WO�,T�
ADDRESS
�.."�_ EXP DATB
GITY
�'7�7�} Fn�c � � �
b TWO FAMILY O TOWNH4USE
6MENT ❑ ALTERATIONIREM�DEL
FEES ARE BASED �N SI0.00 PER FATURE EXCEpT WSERE NOTED• FDC['[�.s• (Qt�ICaTE TOT.aI. NrJMBER OF CH BELQw}
PRQVIDE H�AT Loss cnLC�S P�r Nrp�r L o06 a E FuxnsOOxc. u��y�J D W U
Equipment instalied MFG: MOT3E . � ��ri
�'G: MODEL:
��� MODEL:
A/C 525.00 FIREPLACE (CrAS) E15.00
ATIt TO AiR EXCi�ANGEER S1 S �IREFLACE (WOOD) 535,00
_BOILER 335.Q0 _FURNACE 535,00
_,CF�A�VEY LINER 510.00 GAS ARYER 510.00
,_�1UCT WOT�It $10.44 �CrAS FIPING �10.00
Nmrib�r of fixtures (c� $7 O.OQ �, x$14.00 �$
Number of �ixtures (c� $15.00 x $1.5,00 �.$ � � f
Number:of�ixfisres (�} $25.00 �c $25,00 ��$ ,, : `
. --..__,,_ : '.
Nuzn�er of fuctures r(� $35.00 ' x$35.00 �����
SIZFJSTU
SIZE/BTU
GAS RANGFJOVEN 510,00
NEW GAS GRIi.L Tl �,c1U
,�,GAS tJNIT HTR 510.00
PG►OL t�ATEIt SsS.00
vEMILATOR 515,00
State Surcharge � $
MTIYIMUM FEE S4Q.p0 'fatal a $ -�
THTS TS AN APPLICATION FOR A PERM17•NOT VA;LID UTii'IL PRDCE55ED
I hereby apply �'or a buiiding permit and I aeknowled st the infom�ation above is complete and accucate; that ihe wwl: wiIl be in
confo�nance with the ordinances a�d codes ofthe Fridley and wi� the Minnesota Gonstruction Codes; tttat I undecstand this is
not � pennait but onIy a a tication for a i r is not to start without a permit; that the work will be in accordance with the
appt�oved plan in th e af all ' re and ap�roval o plans,
SIGNA'f IJRE OF LICANT _ . PRfNT NA �.l l�U �/d1! %�11 / n e;rr �e� "�' �I �
City of �'rfdl�y
il �ng Inspect�ons Department
643I iversity t�.vez�ue 1�, �"ridley, Mt�1 55432
763-572-3604 �',�:763-50�-4977
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