P - 45112Building MECHANICAL Permit No.`�
Inspections RESIDENTIAL APPLICATION Re�e'ved By:
763-572-3604 CITY OF FRIDLEY ����'� �
763-502-4977 FAX EFFECTiv� �-�-2oi1
DATE YOUR E-MAIL ADDRESS dave@davesheatingandair.com
SITE ADDRESS 6060 Woody Lane
TffiS APPLICANT IS: ❑ OWNER OCONTRACTOR
PROPERTY NAME: �ASHMERE TOMCZYK
OWNER/ ADDRESS: 6060 WO�DY LANE CITY FRIDLEY STATE MN Zip 55432
TENANT 763-571-0446
PHONE:
CONTRACTOR COMPANY NAME: DAVE'S HEATING AND AIR
SUBMIT A COPY OF CONTACT PERSON: AMY MADVIG
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: �601 37TH AVE NE C1TY COLUMBIA HEIGH7S STATE MN Zip 55421
APPLICATION pHONE �63-781-6901 FAX �63-789-8605
PERMIT TYPE �INGLE FAMILY �WO FAMILY n['OWNHOUSE
l_J
TYPE OF WORK: I� NEW _�PLACEMENT ❑ ALTERATION/REMODEL
�• �
DETAILED DESCRIPTION OF WORK REPLACE FURNACE AND CENTRAL AIR W/ LISTEd EQUIPMEfVT
FEES ARE BASED ON $10.00 PER FLYTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NIIMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 A5IIRAE HANDBOOK.
EquipmentInsialled MFG: LENNOXCENTRALAIR MODEL: XCta-036-230.03 5��� 370N16SEER
�4JC $25.00
_AIR TO AIR EXCFIANGEER $IS
_BOILER $35.00
_CHIMNEY LINER $10.00
DUCT WORK $10.00
�.U.. LENNOXFURNACE MODEL: C'77MPP-36C-090.03
MFG: MODEL:
FIREPLACE (GAS) $I5.00
FIREPLACE (WOOD) $35.00
QFURNACE $35.00
GAS DRYER $10.00
GAS PIPING $10.00
SIZE/BTU 95 % 90,000 BTU
SIZEBTU
_GAS RANGEfOVEN $10.00
NEW GAS GRILL $10.00
GAS ITNIT HTR $10.00
POOL HEATER $35.00
VENTILATOR $I5.00
tvumaer vs fixtures � artv.vv x,�iv.vv -- �
Number vf fixtures @ $iS.00 x �33.U0 = $ ;
Number of fiXtures � $25:00 � x $ZS.OQ.= $ �'€�o
Number of fixtures @$35:OU s x$3S.QU =$�5:t�0
State Su�charge = $ S.UU
�nvmrt��t r+�� �t� ue� motat = � s�.�v
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 accurate; that the work will be in
conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an lication 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 cas �1 work which requires review and approval of plans.
SIGNA'PtJRE OF APPLICAN _ ' J� _ '� \,�{ ' R1NT NAME ! � �l..t ,�� ��' ` 1 �?�� `�� ` �
AL INSPECTORS SIGNATURE � 1�.e�!�T� - DATE '���
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977