Fillable 310 Commercial Mechanical Permit Application (City of Fridley, MN)

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310 Commercial Mechanical Permit Application (City of Fridley, MN)

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City of Fridley
Building Inspections Department
7071 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
COMMERCIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2014
Permit No.:____________
Received By:__________
Date Rec’d:____________
DATE_____________________________________________ YOUR E-MAIL ADDRESS _____________________________________________________________
SITE ADDRESS __________________________________________________________________________________________________________________________
THIS APPLICANT IS: OWNER CONTRACTOR ARCHITECT/ENGINEER
PROPERTY
OWNER/
TENANT
NAME:________________________________________________________________________________________________________
ADDRESS:_____________________________________________CITY____________________________STATE_____ZIP_________
PHONE:_____________________________________ CELL:________________________ FAX:_______________________________
CONTRACTOR
NOTE:
SEPARATE CITY
LICENSES ARE
REQUIRED FOR GAS
AND HVAC
COMPANY NAME:______________________________________________________________________________________________
CONTACT PERSON: ____________________________________________________________________________________________
STATE BOND MB#______________________________________________________ EXP DATE: ____________________________
ADDRESS:_______________________________________________CITY__________________________STATE______ZIP________
PHONE: _________________________________ CELL:____________________________ FAX: _____________________________
CITY GAS LICENSE # _________________________ CITY HVAC LICENSE # ______________________ EXP: _______________
PERMIT TYPE
MULTI-FAMILY COMMERCIAL INSTITUTIONAL CONDO INDUSTRIAL SWIMMING POOL
OTHER _____________________________________________________________________________________________________
TYPE OF WORK:
NEW REPLACEMENT ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK:
_____________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
EQUIPMENT INSTALLED
MFG: ______________
SIZE/BTU ______________
MFG: ______________
SIZE/BTU ______________
MFG: ______________
SIZE/BTU ______________
___ A/C
___ DUCT WORK
___ ROOF TOP UNIT (RTU)
___ BOILER
___ FURNACE
___ REFRIGERATION
___ CLASS 1 HOOD
___ GAS APPLIANCE
___ STEAM/HOT WATER HEATER
___ CLASS II HOOD
___ GAS PIPING
___ SWIMMING POOL
___ COMMERCIAL KITCHEN
___ POOL HEATER
___ OTHER
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION: $_______________________
PERMIT FEE $____________________________________ 1.25% OF JOB VALUATION / MINIMUM FEE $35.00
SURCHARGE $____________________________________ VALUATION x .0005 / MINIMUM .50
TOTAL DUE $____________________________________ MINIMUM $35.50
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical 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 on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT : ___________________________________ PRINT NAME:__________________________________ DATE: _________________
APPROVAL INSPECTOR SIGNATURE: _____________________________________________________________________________ DATE: _________________
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, PLUMBING, AND ELECTRICAL WORK
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310 Commercial Mechanical Permit Application (City of Fridley, MN)

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Completed 23 January 2021

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