P - 48155Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received B�11�(C�
763-572-3604 CITY OF FRIDLEY nat�E�'C�: �� t�
763-502-4977 FAX EFFECTIVE 7-l-21111
1�A't l': �U� ��' �� 1'OUR E-MAIL ADDRESS
s�� �: �»���ESS �(u�°I Nla v 1�,o�r, `DY�Ve - -.
fI11S nPP1..ICAN"f i$: ❑ OWNER 6K'i)NTRAC"COR
PROPERTY NAME: 1X,�
OWNER/ ADDRGSS: Y V� I� �V� CITY ��
TENANT r1 �'���� �in'rr_ M!jll/zi�
PIiONF?: ��U3"':)TZ ��Oii2
CONTRACTOR �,OMPANY NAME: R�Tl � s Mechanic_a 1 Tnr_
SU$MIT A COl'Y OF CONTACT PE2SON: Ll I1CId
YC)UR S'I'A'TF.. S7ATt: LICENSL# EXP DATE
t..iCENSEwiTt� AI�nR�SS: 12010 Old Brick Yard Rd ���-Y Shakopee yiA�i-FMN iii. 55379
APPI.,IC�A'i'ION PHONG 952-445-8585 Fnx �
PERMIT TYPE �iNGLE FAMILY O TWU FAMILY O TOWNHOUSE
TYPE OT WORK: � Nr::w I�1tEP1.ACF.MEN7' ❑ AL'fERA"1'lUN/REMODf.il..
DETAILEll DESCRIPTION OF WORK j�'f Q.��111� Yeo�aceme►�t Y n�L�l
HGIsS AKti BASED ON $10.00 PER FIXTURE, GXCEPT WHERE NOTED. FIXTURES: (INllICATE'P01'AL NUMI3ER OP EACH BGLOW )
PROVIDIs HEA"f I..OSS CALl."S PER h1ANUA 1 201H� ASHRAE HANDBOOK. y� ,�1(��
Equipment Installed MFG: , Y�Y MODEL: ,e MT sizH.;ri'r�u V � v_.
MFG: MODEL: SIZE/[3l'U
MFG: MODEL: SIZ6i13"fU
q/(' y;2i,(Ip FIREPLACE (GAS) i15.O0 GAS ItANGE/OVF.:N $ IO.UO
AIR'f0 i�iR L•XCHANGGER $IS FIRGPLACE (WOOU) $.35.0(1 NEW GAS GRtL.L.51U.U0
1301Lf�R $3j.1)(l �[FURNACE $35.00 GA$ UNIT }i'fR � 10.1111
CFi1MNf�,Y I..INf;R $lO.OQ GAS DRYER %IO.l1U Y001., i-IEAI'1-:R M3S.00
DUCT WORK �10.1!(1 GAS PIPING 510.00 VENTILATOR $15.IIU
Number of fixtures @ $3.U.(�T x $14.U(1- $ ' _
Number of iixtUres @ $15.OQ x $3S.OQ :- $
Number of fixtures @ �?5.00 x $25.UQ = $
Nurnber of fixtures �$35.Q0 � x S35.fl0 =$��
State Surcharge - $_ S.f�?
(1k1INIMUM FEE �4A.04 Tota1= $ .�
T'HIS IS AN APPLICATION FOR A PERMI"I�-NOT VAI.ID UN"fiL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; t.hat the work will be in
cunl'ormance with the ordinances aiid codes of the City of Fridley and with the Minnesota Construction Codes; th�it I undcrstand this is
not a permit but only an application for a permit and work is not to start without a permit; that tlie work will be in accord�ince wiih the
approved plan in the case of all ork wh' eq ' s review and approval of plans. .
SIGNA`I'URL-:OFAP}'LICAN'1' PRINfNAME �Iri��rnQ �UAl'F.. �a �3 ,�
APPROVALINSPECTORS5IGNATURE DATE
PLEASE N(1TE: SEPARATE P MiTS t1IREll FDtt BUIL.DING, EL IC BCNAMCAL WQRK
City of Fridley
ui ' g Inspections Department
6431 University Avenue NE, Fridley, MN 5543z
763-572-3604 FAX: 763-502-4977
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