P - 36807Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY �ate Rec'cl:
763-502-4977 FAX "�s `{ . ., �'
EFF'EC'fIVG 1-1-2011 i
DATE Q���_ YOURE-MAII,ADDRGSS I S-/�cl!'cP5 � y�.����-�t _C��!-�
SITEADDRESS (�(.Q ��*-r►ww,,�) �i!'c�C �G�
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY NAME:��N�����(� Sp�T�s�'
OWNER/ n�DaESS: I�FO f��
TENANT ���.c�C'�c/� �crrY F.eic�lea .��✓ s�rnTr�Lir tis-�3�(
PHONE: % (��_5��.� �E� //
CONTRACTOR �pMPANY NAMF: ��,�,y��saE.,p �� f��s� �.� ri-i.r 4�7�L`a�j,C�st�+ _t..t JL
SUBMIT A COPY Ol� CON"I'ACT PERSON: �T'"�.� S_� c
YOUR STA7�E STATE LICENSG # __ GXP DATE _
LICF,NSE WCI'll ADDRESS: ID)OI _�I�I ��,J CITY._.���Q�t ��2 Y STATG h/tiLlP S�S 16s
APPLICA'I'[ON .��_��_� �3 �_ 3� �� �d� _��o
PI�IONE FAX
PERMIT TYPE �STNGLE FAMILY ❑ TWO FAMILY � TOWNHOUSE
TYPE OF WORK: � NEW � REPI.ACF,MENT ❑ AL'1'ERATION/RF,MODGI.
DETAILED DESCRIPTION OF WORK _�7 �Q C .�iCy',�,t,�o [t� a,,ly��Qj�__�� '
FN:F.S ARE BASED ON 510.00 PER FIXTURF,, F,XCF,PT WHERE NO'1'F,D. FIX"I'URES: (INDICATE TOTAL NUMBER OF EACfI BF,LOW)
PROVIDE HEA7' LOSS CALC'S PER MANUAL J 2006 ASHRAE HANUBOOK.
EquipmentInstalled MFG: �,t�i�f MODF.I.:3j�OS(y/O(o� S17.E/f3TU (�p_Q�
MFG: „/'p,Q�q,�tiy�- MOD�L: /si(q�OO�� SI'7_E/I3TU j/��
MFG: MODEL; SI'LE/[3TU
�( A/C $25.00 FIRh:PLACE (GAS) $15.00 GAS RANGF;/OVI:N $10.00
AIR'I'O AIR F.XCHANGEER $15 �IREPLACE (WOOD) $35.00 NEW GAS GRII.L $10.00
BOILER $35.00 ��URNACF. $35.00 GAS UNI'f tfI'R $10.00
CHIMNEY I.INF,R $10.00 GAS DRY�R $10.00 POOL HEA"I'F;R $35.00
DUCT WORK $10.00 GAS PIPING $10A0 VEN"1'ILA'fOR $I5.00
Number of fixtures �a, $10.00 x $10.00 = $
� •e
Number of fixtures (a� $15.00 x $I5.00 = $ �� ''OO�
*jS-
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures (cr�, $35.00 x $35.00 = $
State Surcharge = $ 5.00
MINIMUM FEE $40.00 Tota1= $
��s
THIS IS AN APPLICATTON FOR A P[:RMIT-NOT VALID UN'fIL 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 o hich u' es review and approval of plans.
SIGNA'I�URE OF APPLICANT _ P INT NAMIi�.L�� C DAII? ew(�_� /((
APPROVAL INSPE(:"1'ORS SIGN U DATE /�
PLEASE NOTE: SEPARATE PERMIT AR QUIRED FOR BUILDING, ELECTRI AL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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:�"L�/f�1'ATE/I'�'ASTER� Whole Nouse INorksheet
_ ,.,; ;::lorm�tion
._ � ,aJ �7fL�iL'. Phone:
=.�;rct.:. - � Fax: —
_,.� �.:; � �,�, F e�rh .�rv 'sF3 aia� No�es:
e.L
��'; :::,r�u C�es�gn T�mP ' U minus Outside Htg Design Temp= —� G f Ily Temp Ditl � e>�-,
--'�"�' ���'9�' -�r'u l/� minus Ins�de Clg Design Temp= ��j Cig Temp Grtf
�.,�c .. � neating la Doors and Windows
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..,:.]'vw �1�(.cs
Sr�g�,a Gi;i;s
DcuUir, Gl:iss
Srgle w;storm
Tri{.�e �1:,55
- Ga�Gif: nls�orm
Srr�ie Glass
Doutle Gass
Trwla Gt�ss
- ,�,..,:s.a ..istC.rm
�.r.,c sk:� SviyfE Do.r
Gour,� r,a,r
,'' --.. Gnry
� vvStCrrn cr W.S.
� w/$lorm i 4V j.
, __: =t: _✓-ir �.d$tCNrn:;f W$
1 Assume 2 per50ns per beciroom
2 Cakulate only it duct in unconditionec7 space
3 For crawl or baSemeM use 1.Q5 muhiplier in COOling -
Hig Factor
�so
9.5
9.0 _.
7.0
50
14.0
8.5
5.5
71.0
16.5
i25
35 0
240
f�
X Area I = EiTUH
Loss
Table B- Cooling 1w Doors and Wlndows
Single Glass UouWe Glass
Temp Di8 Temp Difl
Direcpon t5° 2(P 25° Is° m �5
NE 8 NW 35 40 45 3p 3,5
E 8 W 55 55 60 45 50
SE 8 SW 45 50 55 40 a0
S 30 30 35 25 25
Doors 13 13
Factors assume windows have insk3e
shading by draperies or Winds
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J�
A�O�
doo
�
Ternp Dltt I X Area I = dn�r'
(�ain
�
To�es:
Tabie C - Adjusvnent Factors (Heating)
Temp Difl °F 30 q0 50 60 0 �U A
Adjusunent Factor 3 4 5 6 7 B 9
^
3
L�w� �c �n�� �an�bil�iy ol weather, system inslallation, and iiving habits this analysis is to bo consfcicr;:d �n est�mate.
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