P - 36711,v ` , `��v �� ,,, , ,.�, , From: unknown Page: 2/2 Date: 11/24/2010 11:32:59 AM `
Building MECHAN�CAL p��'�►it No.:a �� u--
Inspections RESIDENT�A►L APPLICATIUN Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'a: ! D
763-502-4977 FAX �SF�GCT[VG2-19-09
p�� 11/24/2010 YOUR G-MAII. ADVRGSS dave(�davesheatlngendafr.com
SITE ADDRESS �400 GlaCier Lane
TNIS APP[.ICANT IS: O OWNIsR QCONTRACTOR
PROPERTY NAME� �AME8 ERICK3QN
OW�� ADDR�SS� 8171 5TH ST NE CITy FRIDLEY STAT� MN ZIP 5��
TENANT �g�_5��_1�53 !'
PHONP.:
CUNTRACTOR COMPANY NAMB: �A��s HEATINO, AiR & ELECTRIC
SUBMIT A COPY OF �NTACT PERSON: AMY MAdVIG
YOUR STAT� STATE I.ICBNS6 # EXP qATE
L[C�NSB WITH qppR�s; 1801 37TH AVE NE �ITy COLUMBIA HEIGMTS STA7'E MN ZIP g�21
APPLICATION �,HO� 783-781-6901 FAX 783-789-9605
PERMiT TYP� �NOLH I�AMILY ❑ TWO PAMI[.V O TQINNHQU3E
TYPE OF WORK: p N�w �EPI,ACF.M6N'T o nt.7�s2n�oN1it13�toDGG
DETAII.BA DESCRIPTION OF WORK �NNOX FURNACE M#SLP88UHO7oV368-ot
FEES ARE BASED ON SIQ00 P�R FIXTLJRF�, CXC�PT Wk�ERC NOTED. FIXTURES: (1NQICATE TO"r'Al. NllMBER OF F,ACN BBLOW)
Ciquipment Inatalled MNG: « MODEL: ���+ . SIZFJBTU ��
MFO: MODEL: SiZ�./I3TU
MFG: MODRL: SfZPJATU
C SZ5.00 FI R4PLACE (GAS) S I 5.00 � OA5 RA NOFlQVEN S I0.00
1R TO AIR EXCHA'NGEER SIS REPLACB (WQOD) $35 00 MEW OAS aR1LL f10.00
�BOILER 535.00 RNACE S3S.00 ,_„_QAS IJN1T HTR !10 00
CHlMNEY UNER 510.tl0 AS DRY�R 510.0� POOL HP..ATER 533.00
�DUCT WORK SI0.00 C3A9.PIPIN� $IO,pO ^VF.1�1'f1LATORSIS.QO
Number of fixtures (a� $1U.00 � x $10A0 = $___�___�„
Number of fixtures Q 515.00 ____ x$15.00 =$
Number of f xtures (c� $25.00 � x$25.00 = S
Number of fixtures ({� $35.00 �.�.� x$35.(}0 = S 3�•�
State Surcharge � S .50
MtN iMUM F�F S3S.50 Total =�
TMIS IS AIV APPI.ICATION FOft A PBRMIT-NOT VAI.ID UN7'iL PROCESSBQ
I hereby apply for a buil 'ng peRnit and I acknowledge that the information above is complete and accurate; that the worls will be in
conformAnce with tha o di nces and codes of the City of Fridley and with che Minnesota Construction Codes; that I understand this ia
not a permit but only a ap icatian for a pennit and work is nnt to start without a permit; that the work will be in nccordt�ca with the
approved plan in the c of I ork which req ires rev'ew And approval of plan
�SIGNATURE OP APP4ICAN RINT NAMB � V� T�'��
PT.BAS� NO'TE: SEPARATE PE . ARE RE U1RE . OR HU[LDMC3 ELBCTii1CAL AT�1D CFIATIFCAL WORK
a.i�y vi r r�aiaey
Building Inspections Department
b431 University Avenue N�,, Fridley, Tv1N SS432
763-572-3604 FAX: 763-502-4977