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P - 45501Building MECHANICAL Permit No.: � � Inspections RESIDENTIAL APPLICATION Received By: �63-s�2-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-1-2011 Dat��. ;� . x� � DATE � C� �/ `� YOUR &MAIL ADDRESS �.�/?c�vc,,-��L�{ �S r��,; C'ti;Y: 51TE ADDRESS � �� I�; i �-cs� �- �' � � � THIS APPLICANT IS: ❑ OWNER �EONTRACTOR PROPERTY NAME: �;,�; c�in.�- l�enrt�r��'•c� OWNER/ ADDRESS: �� G>i¢•"�c�E:rc? v ,,,�� TENANT � '� � ��TY ��'� L <y STA"i"Erdi�f ztP �'^s�f � PHONE: 7G1� '77.�1`v ��5� CONTRACTOR COMPANY NAME: � e�� vr �%'%�%c'%i�C�«�G"�z � � L�- SUBMIT A COPY OF CONTACT PERSON: ��.r .-�� •-Yt, �. YO[JR STATE STATE LICENSE # jV�� `��, 17�' EXP DATE `✓ I �d I rr�-✓I v� LICENSE WITI-I ADDRESS: �C� f!�.s� '�j(,�jC—� CITY j L�, �7`t9GC` STATEI`�� ZIP SJ�� APPLICATION i � „ PHONE C� (,� � I[? �-� �� FAX PERMIT TYPE �SINGLE FAMILY C7 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW �REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF W ORK ��J(,�� .��+�n-� �-,}-�� ,� T� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (ItVDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 20Q6 ASHRAE HANDBOOK. Equipment Installed MFG: c��f•L�Cry1 MODEL: (gi��l �� lU 3i�� SIZE/BTU ��ti� �v �''U MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU _A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _AIR TO A1R EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 �/FURNACE $35.00 GAS UNIT HTR $10.00 _CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 _DUCT WORK $]0.00 ,GAS PIPING $10.00 VENTILATOR $15.00 � � � � � � � � - 3� � � ' � � '� �.t � :� � � ��.,, ,� �� '. � a ��, � ��. �' :� ` ��'� � , f �`•�,',"��ut" �°�g �y a� ,,�� ' � �. � � �� r'� �� ` ��'� : v��''�� .y ��'�`� �� x�,,.� � ��-r�'Y�� ,� �� :�a'`� °#" �� ".a��` -�t �� ,,�. - y�"`� '� � �i �f��: \ ��"�C��,�� W�, � - z�l� �s� },F�„ +x sk � �s3 a� $�S• � s a ,�� 5�� „� +� �� , �iy � ,t ,e�t� � `� .� ��r�, � � �� y �� ,� ,� a _T _�� _v,� � ��" . � ' � � � � � ��'� �� ,� �� t` � � �s �` �r � �a � r � ' � �� «� � `�a. � �� •� \�� '� �� , q�� .��sv, '"�a2� � �. �c, �„��y� � � �� `" y�� ' `�' ��.� �, �` � � �.�k a .:�� : � ar �� ''��, ��.�w� ".""'"'.. '�� .� ,� . x,� `w,� �,, k � � �' � �� '�. � y ��: � � � � k. ��ae �SV � �' y . �� 4 � � � .�'a� � �� ` �4 �„ � ��S �,. � _ ,�� . \�� z� �,y� �'� . ,� `t�i��'��%�� `�}� �� '�, �` ��r �� S� �� ` � � �� '�,. �' �� ` �� , '? � ,�� , �,� � � � ' �. � �� r� � � �� . � � +�� '�`+'r�° � � �. ��'�`t�•"T 7 �. � � 3� l � � �'� � &'�"' ,� �,x : .�js,f . ��. -'� ��,� *� �'*,� � � „��t � � 7 : }A 3�.: .d� w�� '� _� a�' w� � � �"..'. � � .N � �a ��. .� ��- �� '� 'w - �t: � %�"�' �� ' ��. .� l �y � � ��: �� * z , �` � �{-�y�. y� � � �� ,� �� . �� P � �� s� �� ` �� •- ��. � ,� ��+sF� ,�.�� _ s"i � :.; _;�� ..y � ,"'�.s .s .°- :�.� ..�.._ _.•�� ,... " �'� �i ? a� �. �.9I . ..,.: ,..:,_ .. .... =,�m . �_`f.� „ ._a�� , ._ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and aecurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not a permit 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 whj�i�e ir s r view and approval of plans. ; ;1 , � SIGNANRE OF APPLICANT � �V- � PRINT NAME .YAr( ��-�-�. �f� j DATE I fl �-� �. 1 APPROVALINSPECTORSSIGNATURE DATE �� ,..��'�i��;s�i�� ..�„ �'�z�`a�� " �` �r��it :��.. '��.��.'�� > ' �'� � . ,. ... , ' p ' "�'�,�, „ .. .. . .. .,,., . ,, . ... .. .... _ .. . , 7 ��' �;ity of 1+'ridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 ��