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AF - 43646Building Inspections 763-572-3604 763-502-4977 FAX DATE ` �t' ��� SITE ADDRESS _ THIS APPLICANT [S PROPERTY OWNER/ TENANT PLUMBING Permit rio.� � / �� RESIDENTIAL APPLICATION Received By:—(�� CITY OF FRIDLEY ���°�. EFFECT(VE 2-19-09 �' _ � YOUR E-MAIL ADDRESS S��`�� L�L /r'7l-1 � / �:� ��11'ij.�l/�/S'�. [-��� f- :�^� __�-_ ❑ OWNER NAME: �' / ! /LfC'!G"//�J. ADDRESS: 7 7�i J: � i " Y %� PHONE: 1 �' -Zi _._ ��' �j_ �'�' � CONTRACTOR NAME: �'�"�������c., � SUBMIT A COPY OF YOUR STATE STATE LICENSE # LICENSE, BOND AND STATE BOND # CERTIFICATE OF ADDRESS: ;.i. r a -rir� �, CITY �7'/c.lC�'s STATE. ��t� EXPDATE EXP DATE CITY �� :4%t,t STATE� INSURANCE - -- PxoNe �����- ��� �/- ,���/ �`` F,sx PERMIT TYPE �' �'NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW I�'R�PLACEMENT DETAILED DESCRIPTION OF WORK P c'� 3� FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. _ BATH SINK/LAV FLOOR DRAINS ' SHOWER WATER PiPING _ BATHTUB _ GAS PIPING (NEED CITY LIC) S WIMMING POOL WATER SOFTNER (� _ CLOTHES WASHER _ KITCHEN SINK �! WATER CLOSET BACKFLOW PREV. SI ) _ DISHWASHER _ LAUNDRY TRAY V WATER HEATER ($35) FOR iRRIGATION _ WATER METER OTHER THIS IS AN APPLICATION FOR A PERMIT—NOT VALID UNTI•L PROCESSED I hereby apply for a plumbing 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 Fxidley and with the Minnesota Construction Codes; that 1 understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case_ f all work which r�quir review and approval of plans. SIGNATURE OF APPLICANT . � p �," �si— ; ,r � �- � PRINT NAME_ � ��'� �'%�� %'V� �=�— � DATE � �� �% C� ` City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX DATE � % � � SITE ADDRESS � THIS APPLICANT IS PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 2-19-09 YOUR E-MAIL ADDRESS l�' v' L--�. ❑ OWNER [.IEQ 1�TRACTOR �: i l =.�uZ /l i Q _ : 7 k '.� .._ --�i`� ;<' •, �7''-2/-c' 1�? COMPANY NAME: �� 67 � L l'' .� l l.? tc' i' (�' ��� CONTACT PERSON: �`' ��— G �l � � � �-_-.-6 CITY Permit No.: Received By: ��' Date ��: � � ll � 2 STATE L[CENSE # EXP DATE ADDRESS: �`,'�a K l,�ji1 ILiV•��"- CITY '�Y L�� STATE '"'�'GIP.J� PxoNE %i,� �,- �����`/' � �iU F,�x ��`��; .S--�I-�'����� y � , �3if�iGLE FAMILY ❑ TWO FAMILY ❑ NEW �CEMENT DETAILED DESCRIPTION OF WORK ❑ TOWNHOUSE ❑ ALTERATION/REMODEL �. ��-- :��.-�,� -y � FEES ARE BASED ON 510.00'PER FIXTURE, EXGEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF �"rCCIi'B�Li3W} ` PROVIDE IiEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK, _ � _ , . ._ � ; : _ _ . . : - Equipment Installed MFG: � ,� �>� MODEL: _��G -+=� SIZEBTU _A/C $25.00 _AIR TO AIR EXCHANGEER $15 _BOILER $35.00 _CHIMNEY LINER $10.00 _ DUCT WORK $10.00 MFG: MODEL: MFG: MODEL: FIREPLACE (GAS) $15.00 FIREPLACE (WOOD}$35.00 �itNACE $35.00 GAS DRYER $]0.00 GAS PIPTNG $]0.00 SIZE/BTU _ SIZEBTU GAS RANGE/OVEN $10.�0 NEW GAS GRILL$10.00 ' ' ' _ GAS LINIT HTR $10.00 POOL HEATER $35.00 � VENTILATOR $15.00 ` 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 ork which requires review and approval of plans. SIGNATURE OF APPLICANT � Gc- (y :.__G ,.�� ^ PRINT NAME ��` � � ✓� �-: � L?��Z� ' � DATE �i /I ,, G' APPROVAL INSPECTORS SIGNATURE DATE __ City of Fridley Building Inspections Department 6431 University Averiue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC D NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES l. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501 3. Venting . a:_ Gas appliances IFGC Chapter 5 with MN Amendments „_ . : _,_. . : ,b. Fuel otk�er than gas IMC Chapter 8 with MN Amendments _ 4. Heat loss & cooling load per room a. MN Rule 1322, Sec: N1104.4.13 5. Ventilation a. Per MN Rule Chapter 1322. Sec. 1104 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations.