P - 59371Building MECHANICAL Permit No.: ` O� 51
Inspections RESIDENTIAL APPLICATION Received By:�
763-572-3604 CITY OF FRIDLEY ��'�e��?R 2 s 2012
763-502-4977 FAX EFFSCTrvE �-�-zo�2
DATE 04/27/2012 YOUR E-MAIL ADDRESS jarleigh@hotmail.com
SITE ADDRESS 6740 4th St NE
THIS APPLICANT IS: L�9 OWNER ❑CONTRACTOR
PROPERTY NAME: James A 8� Patricia A Larson
OWNER/ ADDRESS: 6740 4th St NE CITY Fridley STATE MN ZIP 55432
TENANT 763-571-7850
PHONE:
CONTRACTOR COMPANY NAME:
SUBMIT A COPY OF CONTACT PERSON:
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: CITY STATE ZIP
APPLICATION pHONE FAX
PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW ❑ REPLACEMENT � ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK Replace existing basement shower stall with larger one. Move shower floor drain to accomodate new stall.
Add insulation to outer wall of bathroom, install vent fan and add light above shower. Extend existing flooring into bath.
FEES ARE BASED ON S10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIR TO AIR 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 _P90L HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 t/VENTILATOR $I5.00
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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 City of Fridley and with the Minnesota Construction Codes; that I 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 w c'which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �ames A Larson DATE 04/27/2012
APPROVAL INSPECTORS SIGNATURE'y.� DATE .}"�jTy�A� �j]}ry
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'ii'�?L�7����1 C�TE,
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977