Fillable 321 Residential Mechanical Permit Application (City of Fridley, MN)

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321 Residential Mechanical Permit Application (City of Fridley, MN)

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Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 07/01/2015
Permit No.:____________
Received By:__________
Date Rec’d:____________
DATE_____________________________________________ YOUR E-MAIL ADDRESS ____________________________________________________
SITE ADDRESS _________________________________________________________________________________________________________________________
THIS APPLICANT IS: OWNER CONTRACTOR
PROPERTY
OWNER/
TENANT
NAME:_______________________________________________________________________________________________________
ADDRESS:_____________________________________________CITY____________________________STATE_____ZIP________
PHONE:_____________________________________
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
COMPANY NAME:______________________________________________________________________________________________
CONTACT PERSON: ____________________________________________________________________________________________
STATE LICENSE #______________________________ EXP DATE _______________________________
ADDRESS:_______________________________________________CITY__________________________STATE_____ZIP________
PHONE _________________________________ FAX _______________________________________
PERMIT TYPE
SINGLE FAMILY TWO FAMILY TOWNHOUSE
TYPE OF WORK:
NEW REPLACEMENT ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK ___________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
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 2009 ASHRAE HANDBOOK.
Equipment Installed
MFG: ______________
SIZE/BTU ______________
MFG: ______________
SIZE/BTU ______________
MFG: ______________
SIZE/BTU ______________
___A/C $25.00
___FIREPLACE (GAS) $15.00
___GAS RANGE/OVEN $10.00
___AIR TO AIR EXCHANGEER $15
___FIREPLACE (WOOD) $35.00
___NEW GAS GRILL $10.00
___BOILER $35.00
___FURNACE $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
Number of fixtures @ $10.00 ____ x $10.00 = $_________
Number of fixtures @ $15.00 ____ x $15.00 = $_________
Number of fixtures @ $25.00 ____ x $25.00 = $_________
Number of fixtures @ $35.00 ____ x $35.00 = $_________
State Surcharge = $ 1.00
(MINIMUM FEE $35.00 plus surcharge) Total = $_________
THIS IS AN APPLICATION 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 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 approval of plans.
SIGNATURE OF APPLICANT ______________________________________PRINT NAME________________________________DATE______________________
APPROVAL INSPECTORS SIGNATURE ________________________________________ DATE___________________________________________________
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
7071 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
NEW HOMES/ADDITIONS EXISTING HOME MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 – 2015 Minnesota Mechanical Code
b. Natural Gas or Propane/2015 MN Fuel Gas Code Chapter 3 with MN
Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 – 2015 Minnesota Mechanical Code
3. Venting
a. Gas appliances IFGC Chapter 5 – 2015 MN Fuel Gas Code
b. Fuel other than gas IMC Chapter 8 – 2015 MN Mechanical Code
4. Heat loss & cooling load per room
a. 2015 Minnesota Residential Energy Code 403.5.17
5. Ventilation
a. 2015 Minnesota Residential Energy Code 403.5
6. Duct Construction & Installation Per Sec. 603, 2015 MN Mechanical Code.
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321 Residential Mechanical Permit Application (City of Fridley, MN)

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Completed 23 January 2021

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