P - 36712Building
Inspections
763-572,3604
763-�02-4977 FAX
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SITE ADDRESS
THIS APPLICANT IS:
OWNEW
TENAIYT
SUl3M1'I' A COPY OF
YOUR S"i'A'f'f:
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APP[.ICA�'IOIV
MECHANICAL
R�SIDENTIAL APPLICATIQN
CITY OF FRI�LEY
EFEECTIVE 1-1-2011
Permit Nt�.;
Received By:
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❑ C)WNER �JCQNTRA('TOR
ADDRESS: CITY STATE Z[P
PHONE�
coMPArrYr,nME: �arson rium�ing, �nc,
CONTACT PERSON: W$i1��! N8`ISOiI
ST�\TE LICQ+ISE �1 58757 (3341) ExP nnTE
N,nnR�:�,: 3095 162nd Lane NW c�TY Andvver 5
�HC)�6 /t73-4L/-
}•A,c� 763-427-9448
PERMlT TYP� ; 7�"�r'CLE EAMiLY ❑ TWt} FAI�i1LY ❑ T01�'NHt3FiSE
TYPE, OF WORK; �� NEW ❑ RF.PI.ACFMENT �Q AI.TERATIt)NiRF..MODF.C.
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D�TAILCD DCSCRIP''t't{?N OF WORK
ATEM N �P 55304
FEES ARE BASED OY 510.00 PER F1XTI�RE, EXC�PT ��"HERE NOTED. FI?�CTI?R£Sc (I1�DIfATE TOTAL NUp[BE[t OF EACH BEL9W}
PRQV[DE HEAT LpSS CALC'S PER h1A�ittAL J 20U6 .4SHRAE }{�1NDBpUK_
Eqeipmcnt [nstaiCed MFfi: IviQDEL: 5lZElB'1'[7
MFCi'
Mf)�EL:
MFC'r MODEL:
_A/C $25.00 �M������m FIREPLACE (CiAS} $15.00
A1R T'O tUR EXCHANGEER $15 _FIREPLACE (WOOD) $35.U0
BO[LER $35.Q0 FURNACE $35.00
�CH[MNEY LINER $1a:06 GAS DRYER $lO.Oa
_DUCT WQRK $10,U0 GAS PIPING $10.d0
SIZEBTU
SIZEJBTU
GAS R.4NGE/()VEA1$ l0.(HI
NEW C;AS CiRILL 310.00
GAS IINIT HTR $]0,�0
PCX7L HEATER $35.00
VENTILATOR S�S.O(l
TIi1S IS AN aPPLIC.a710N rO(Z A f'ERhiIT-NOT VALID l.i�TIL PRC}CESSELI
t hereby apply for a buildin� pennit and 1 acknowled�e that the infaimation above is ec�mplete and accurate; that the work wiU be m
conformance with the ordinances and codes ofthe City of Fridleti• and with tE�e Minnesota Cvnstruction Codes; that 1 understand this is
not a permit but only an application ior a permit and work 'rs not to start withoe�t a pennit; that the wark wifl be in accordanee with the
appraved planin khe case af all�rk which requires re<<iew,�nd approval ofplans, ,
Sl(iN.AT1JRE OF AFPL.IC'ANT
APPROVAL INSPECTORti tiIGNATL�RE
DATE � � � � � l �
� City of Fridley
Iiuilding lnspections Department
fi431 L;niversity l�venue NE, Fridley, MN 55432
763-�72-36(}4 FAX: 502-4977
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