P - 37112From: 6506556633 Page: 212 Date: 3t212011 1 Q:11:59 AM
From: Officei Fax: (800) 560-6011 To: Fax: +1 (763) 502-4977 Page 2 of 2 3/2/2011 10:08
Permit No •
Building MECHANZCAL "
Inspections L APPLICATION Received By:
7b3-572-3604
763-542-4977 FAX
DATE � I �
SITE ABDI2ESS ___�.
THIS APPLICANT TS:
PROPERTY �p
OWNER/ qL
TENANT
RESIDENTIA
CITY QF FRIDLEY
EFFECTSV� i-1-2011
YOUR E-MAtL ADDRESS
� O�'1VER �ONTR
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S:�O_�_�_ _i-_��'
'7/„? r- ��7 I —
CON'I'Rr+1CTOR GONSPAi�Y IdAME:_
SUBMIT A COpY OF �QNTACT PER50�1:
YOUR STATE STATE LIC'b�N�SE ���
LiC��SE V4'iTH ADDI2�S/�QS,�v
APPLICATIQN � pHONE n% Z !
�
O FAx
PERMIT TYPE y,��GLEFAMILY ❑ TWOFAMILY
TYPE OF WORK: fl N�x� �PLACEMEI�T
DETAILED AESCRIPTION OF WORK �
,a.
TEM�LIP,
EXP DATE �w ��c
,2, J S� CTiy�/ I���..T � �TATEI�!�ZIP �"Sy+O
C7 TOVvT3HC7ti5b
CI ALTERAT[ON/RE�LODEL
�t �..� I �
FEES Al2E BASED On $10.00 PER FIXTCJRE, EXC�PT WiiERE N4TED. FIXTC7�ES' (IND[CATE TOTAL NT;hxBER OF EACH BELOR�
PItOViI7E IiEAI' LOSS CALC'S PF.It MANTIAI, J 2006 15EIRAE HANDBOOK.
Eqaipment lnstalled MFG: M�DEL: SJZEBTV
MFG: MODEL SIZE'.JBTIi
MFG MODbL: SIZEIBTU
AJC g25 pp FIREPLACE (GAS) $7 S.al GAS RANGEIOVEN $I0.00
�ATR TO AIR EXCHAJ�GESR S15 EIREPLACE {WOOD) $3�.00 _NEW GAS GR1LL $L0.00
_$pR,gR $3j.pp FURNACE $.i5.00 GAS L�TIT Hl'R $10A0
CT-IIMNEY LINER $10.00 �GAS DRYER $10.00 �POOL HEATER $35.00
DUCT WORK �]0 00 GAS PIPING $10.00 VENTILA70R �15.00
THIS IS AN APPLiCAT10N Pf?R A PERMl'7'-NOT VALTD UIVTIL PROCbSSED
I hereby apply for a building permit a acknowledge that the information above is complete and accurate; thar the work wili be in
conformance with the ordinances and code of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a pe mit and w 's not to start without a permit; that the work will be in accordance with the
approved plan in the case of hich r u' and approval of plans. -�
S[CrNATGREOFAPPLICANT G�'� ,.. PR]NT�AME�� !'� �S 1�i�_ :' DATE � 1 l� L�
.�,' City oi Fridley `
���Suilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3644 FAX: 763-502-4977