P - 48551Building MECHANICAL
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX FFFECTIVE 7-1-2010
DATE��
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
0
ADDRESS:
PHC3NR ��
YOUR E-MAIL ADDRESS
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Permit No.:
Received By:�_
Dat rRnc��: 20�
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CONTRACTOR COMPANY NAME: � y
SUBMIT A COPY OF CONTACT PERSON: s�(�'.{�J'�G�i/1 ��— —
YOUR STATE STATE LICENS`E # EXP DATE
LICENSE WITH ADDRESS: V`ZD �`�f���-I�]/' _CI-TY e�T� STATE�IP��r
APPLICATION pHONE.� �S1- �, r�-B�-O/ o2d � FAX � Si-a.�8 c1 �� /
PERMIT TYPE
TYPE OF WORK:
�SINGLE FAMILY ❑ TWO FAMILY
❑ NEW �REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
FEES ARE BASED ON $10.00 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: SIZE/BTU
MFG: MODEL:
SIZEBTU
MFG: MODEL: SIZEBN
A/C $25.00 FIREPLACE (GAS) $75.00 GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
BOILER $35.00 �URNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00
THIS IS ANAPPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application f permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case ll �orkwl�'�ac requires review and approval of plans. �� ,l. I � l
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SIGNATURE OF
��
� City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 5�432
763-572-3604 FAX: 763-502-4977
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�£Sl%}�ItiFTIAL LAA[? �LCUTATi�?i�l
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: Purchaser ��{� �,� Sales Rep �J Dete � 5 / Ls / /
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Address �� (_if'1 _O,l�vf�_� �/1il��� , i / i � ��7a�,
Sq. Ft. gross watl belc�w
' Running vualis below grade: _��_, X `� (FC wafl Ht.) �� grade
5q. Et: gross windows and
c�-� doors below grade
- ,� �� Ne� wall below grade
Sq. Ft. gross wali above
Runnin� wails below grad�: �� X � (Ft walf Ht.} ��`� grade (1�t floor)
° {1st Ftoor}
+C3r Sq. Ft. gross wall ab4ve
` Running walis h�low grade: ^� X �a (ft wall Ht.) - �"J �� grade �2nd flaor�
� ! � �„ �. ^ + � .� ,� Sq, Fi, gross wa}) above
(2nd Fluor) 'r geade (1st floorj
_ Total gross Sq. Ft. abave.
` � �cs � �! gr�ade
Sq. Ft� gross u�rindvws and
' (' � doors above grade
, _� c.� �,� ater ur��� a$ov� c�QU�
Wittdcsw 8c Doors r�- ��} Sq. Ft. X {� 'r"J�j MTM BTUH
Fr�f (w$esJa x�..3 ' e�i �, sq. Ft. x' ,�.'� tt"i-M srvH
111E't W�II b�IOW gf3�I� � Sq. Ft. X� HTM ��j B7UH
hJet wall aba�e grade i'�~� �.'"�j 5q. Ft. X � C� HTM .�-'� (,�� � BTUW
E3cpcsed<_Certing L.�J sq. Ft. x'' 'L._.�:.� � HTM STUH
f,xposed Floor �� 5q. Ft. X;� HTM rl.� t� BTUH
�^�w� BTU TtYfAL
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