P - 44563Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
F.FFECTIVE 1-1-2011
DATE "` � / �
SITE ADDRESS ,�
THIS APPLICANT IS: ❑ OWNER
PROPERTY NAME: ' �
OWNER/ ADDRESS:�"�
TENANT �.�/ r�
PHONE: 1 �i� ` —
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
�J�1:7�ii(1WY•/��I
TYPE OF WORK:
COMPANY NAME:_
CONTACTPERSON:
STATE LICENSE #
ADDRESS:1�.Ri
PHONE��
C�SINGLE FAMILY
YOUR E-MAIL ADDRESS
�
0 TWO FAMILY
�NEW +Q $EPLACEMENT
N
DETAILED DESCRIP'I'ION OF WORK
,�.,_, ��I
�,
�_�%� � � v�
��
�' � • 17
� • :��.
�
�
_ .
■ • •
I�I:f�yY�i:7_rYC��/I'�� u � �
Permit No.:
Received By: �`�����
�t��(��'a18 2011
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FiXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 20 ASHRAE HANDBOOK �n
Equipment Installed Mk'G: MODEL: `��(�� cILQQl�i�-.. SiZE/BTU�
MFG:
MODEL:
SIZE/BTU
MFG: MODEL: SIZEBTU
A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGFJOVEN $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
CFIININEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTII.,ATOR $I5.00
Number of fixtures @$10.00 x$ l U.00 =$
Number of fixtures @ $25:00 x $15'.00 = $
Number of fixtures @ $25.00 x $25:00 = $ '
Number of fixtures @ $35.00 � x $35.00 = $�S � �
State Surchazge = $ 5:00
fMINIMUM FEE $40.00) Total = $ �-i�w _— --_
THIS IS AN APPLICAT[ON FOR A PERMIT-NOT VALID UNTIL PROCfiSSED
I hereby apply for a building permit and I aclrnowledge 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 or 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 'c re uire eview and approval of plans.
SIGNATURE OF APPLICANT Y � � PRINT NAME �'��'�1-������Z�A.I.E �O % 7�--�-
APPROV.
SEPARA'
. .. . � ..ri �� ' . .
_ ' DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977