P - 48402Building
Inspections
763-572-3604
763-502-4977 FAX
DATE C1/��� � �(
SITE ADDRESS J"T �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
U
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-1-2010
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❑ OWNER
Permit No.:
Received
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YOUR E-MAIL ADDRESS �it/YI�%C,( S` S��c� -�i LcJ/� .� I7-CG f7Ylq .0
A /,c —� J
�ONTRACTOR
ADDRESS: 5��� �'��' S� ✓/j%� CITY /�le%���L� STA
PHONE:_ �1/�,�%— /�%�"�3�5— �
COMPANY NAME:
CONTACT PERSON: 1408 NoAhla�1 DriVS Sui1B 310
STATE LICENSE # (�� 81-89A� DATE
ADDRESS: CITY STATE ZIP
PHONE FAX
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: � NEW �REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK,
Equipment Installed MFG: MODEL: SIZEBTU
MFG:
MODEL:
SIZEBTU
MFG: MODEL: SIZE/BTU
�A/C $25.00 FIREPLACE (GAS) $I5.00 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 $]0.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
�umberoffixtures�� `�,)a $��l:�b �c.�1U,09=$ �� � �
°�lumber offxtures°� $1�:00 �c�1�;04 �.� � � ,
�
Number of fixtures @ �25.U0 � �c $25.00 = $ ��
Ga
Number of fixtures @ $35:U0 � x $35.00 = $ ?J�
State Surcharge = $ S,QO
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(1VIINIMUM �'EE:$4Qs00) Tota1= $ (� J� ��
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 ermit and ork is not to start without a permit; that the work will be in accordance with the
approved plan in the case of alJ,,work which equire�view and approval of plans. _ �
SIGNATURE OF APPLICANT
APPROVAL INSPECTORS SIGNATURE
DATE
City of Fridley
uilding Inspections Department
1 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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HEATING 6� AIR COriDITIONING CQ R E S I D E N T I A L H E AT I N G D ATA S H E E T
Comfort,you can count on
JOB NAME: ,�- DATE l� �i
ADDRESS: ��
OUTDOOR TEMP: INDOOR TEMP: TEMP. DlFFERENCE:
RUNNING FEET
CEILING HEIGHT X
WALLS GR05S WALL =
WINDOWS & DOOR AREAS -
NET WALL AREA ��
FRAME WAII
NO INSULATION
R-11, 3" INSULATION
R-13, 3-1/2" INSULATION
R-13 + t" POLYSTYRENE
R-19 + 1/2" POLYSI'YREf
MASONRY WALL
ABOVEGRADE
NO iNSULATION
R-5, i" INSULATION
R-11, 3" INSULATION
R-19, 6" INSULATION
MA50NRY WALL
�ElOW GR/iDE
SQUARE
FEET
SQUARE
FEET
S�UARE
FEET
TEMPERATURE.DIFFERENCE
DESIGN TEMPERATURE DIFFERENCE
BTU H
HEATLOSS
BTUH
HEAT LOSS
BTUH
HEATLOSS
R-5, 9" INSULATION � � 2.6 3.0 3.5 3.9 4.3 4.8 5.2 5 7 8.1 6.5 7.0 7.4 7.8 8.3
R-tl, 3" INSULATION 1.8 2.1 2.4 2.7 3.0 3.3 3.6 3.9 4.2 4.5 4.8 5.1 5.4 5J
R-19, 6" INSULATION 1.2 1.4 1.6 1.8 2.0 2.2 2.4 2.8 2.$ 3.0 3.2 3.4 3.6 3.8
HEAT LOSS SUBTOTAL �% `�
� ..
��.���
CEILING
NO INSULATION
R-11, 3" INSULATIpN
R-19, 6" INSULATION
R-30, 10" INSULATIOI
R3A, 12" INSULATI01
FLOOR OYER AN
UNCONDiTIONED SPACE
NO INSULATION
R-11, 3" INSUlAT10N
R-19, 6"INSULATION
R-30, 10"INSULATION
SQUARE
FEET
SQllARE
FEET
Heat Loss Subtotal from Page 1
�■
TEMPERATURE DIFFERENCE
�7, �s�
B��
HEATLOSS
BTUH
NEAT LOSS
CONCRETE SLAB WITHOUT
PERIMETER SYSTEM
NO EDGE INSULATION
1" EDGE INSULATION
CONCRE7E SLAB
WITH PERIMETER SYSTEM
NO EDGE INSULATION
t" EDGE INSULATiON
2" EDGE INSULATiON
LINEAR
FOOT
UNEAR
FOOT
�
/
DESI TEMPERATURE DIFFERENCE
8TU H
HEATLOSS
BTU H
NEAT LOSS
An additional infiltration load is calculated only if the home is loosaly constructed or whan window infiitration is grsater than .5 CFM per
linear foot of crack.
HEAT LOSS SUBTOTAL
TOTAL HEAT LOSS ��
N07E: All }ieat Transfer Muitipliers from ACCA Manual "J" Sixth Edition.
FI�-841-�7 0�23A4 Litho U.S.A.