AF - 43768R `70(�� —� �7Lff��7
�.uilding MECHANICAL Permit No.: ' �I -
Inspections RESIDENTIAL APPLICATION Received By:
7. 63-572-3604 CITY OF FRIDLEY Date Rec'd: J
DATE M AY 2 YOUR E-MAIL ADDRESS
SITE ADDRESS I u�i�"�� � S i"
TMS APPLICANT IS: � OWNER .Q!(CONTRACTOR �
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
LEN �
C1TY �RS�i �Y STATE�ZIP
PHONE: 7�— 5�72 � 8$90
co�Arnr N.v�: M A�+aN .�E-�?�aG A*�D i4�x C+�� ✓+-�� N�`� ,�
CONTACT PERSON: l ��
STATE LICENSE �l EXP DATE
ADDRESS: �PT�E Lf1ke�� /� /�� CTTY STATE ZIP
PHONE
J�SINGLE FAMILY O TWO FAMILY
❑ 1•IEW J�REPLACEMENT
FAX
❑ TOWNHOUSE
]� ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK R.aP'�^� ���+"'� .�""�''rd`'e'� �' � �`"'� �'"� '� — � ��'�
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FtXTURES' (INDICATE TOTAL
NUMBER OF EACH BELOVI� (Seal ed C.o.+�+.+s."�j
EquipmentInstalled . MFG: �e4''� MODEL: GS�MPZyBO� SIZE/BTLIyS��+
�G; � MODEL: 1�1529 0 Z`I SIZFJBTU 2V, oor o
MFG: MODEL: SIZEBTU
,�A/C $25.00 FIREPLACE (GAS) $I5.00 . GAS RANGFJOVEN 510.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRII.L 510.00
BOILER $35.00 ,�FURNACE $35.00 _GAS UNIT HTR S 10.00
CHIMNEY LINER $10.00 _GAS DRYER 510.00 _POOL I-�ATER $35.00
�TDUCT WORK 510.00 GAS PIPING 510.00 VFNTII-�°.TOR S15.00
..m�s.� m._zw.L7'�.��J+.rwTn�e"',i��9ra-�aa�nrn
13s�1,�"}ia?+3+�ai a� �+,.,,,,,uar�urr?� .., -^.'�✓ .,,, . . • s..�..��y _;.. �.c.��-� ,.v, . , -,�:�.. .. ... .___ .__ __.._ . .. .
Permrt Fee $ Number of fixtures @$10.00 x$10.00 =
Surcharge $ .50 Number of fixtures @ $15.d0 x $15.00 = $
TOTAL DUE $ Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surchazge = $ .50
Tota1= $,�,5�
THIS IS AN APPLICATION FOR A PERM�T-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accwate; 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 work which requires review and appro��al of plans.
SIGNATURE OF APPLICANT--1�� �%,�O'`� PRiNT NAME K.�1 � I"�A�S!( DATE S 2 07
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�
REQUIRED tNFORMATION NEEDED TO PROCESS PERMIT ---_
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS �EXISTlNG HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. 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
3. Venti.ng
a. Gas appliances IFGC Chapter S with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Hea.t loss & cooling load per room
a. Required on new coustruction IMC 1346.0312
5. Ventilation .
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be u�ed for
combustion and make up air calculations
Date: 05/24/2007 Revision Date: 05/24/2007
Site Information
Address 1: 641 Buffalo St
Address 2:
City: Fridley County:
Appiication Information
Business Name: Marsh Heating and Air
Conditioning
Contact Person: Kelly Marsh
Office Ph: 763-536-0667 Fax: 763-536-0226
Address 1: 6248 Lakeland Ave no
Existing Construction: Pre 1994.
Project #:
Lot: Block:
Subdivision:
MN Contractor License #:
Cell Ph:
City: Brooklyn Park State: MN Zip Code: 55428
Minimum Mechanical Code Reauirements Met
Will you be replacing or adding a water heater, furnace, or boiler?
Will you be installing a decorative solid-fuel appliance?
Will you be installing an exhaust fan 300 CFM or greater?
You have met the minimum requirements for make-up air and combustion air as
required by the international mechanical code, as adopted by the state of Minnesota
with amendments.
NO
NO
NO
,�
Applicant Name (print):�`���/� _ Signature/Date: r
Code Official (print):
Signature/Date:
� 2004 CenterPoint Energy Minnegasco. 2004 Mechanicat Code Guidelines.
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