P - 42230Building Inspections COMMERCIAL RE-ROOF Permit No.: ���d � j�
763-572-3604 APPLICATION Received By °
763-502-4977 FAX CITY OF FRIDLEY Date��►!�: � u� !$ �
EFFECTIVE 1-01-2010 �
DATE � I� YOUR� MAIL ADDRESS
INSTALLATION ADDRESS: r
THIS APPLICANT IS: ❑ OWNER ❑ CONTRACTOR 0 ARCHITECT/ENGMEER
PROPERTY OWNER NAME: C� 1
ADDRESS: � I�� ��_�]/� CITY STAT�YI ZIP
PHONE: CELL PHONE
CONTRACTOR NAME: !� YC�G�✓ �-��-7'�i(//p/LS ! NC
A15DRESS: C ,�t� CITY Gv! /K STATFLY/�tIZIP�
PHONE G ^ 'CI CELL (o FAX ��3 ^� 2. Z���tQ
�
STATE LICENSE# EXP. DATE:
ARCHITECTBNGINEER NAME:
CITY STATE ZIP PHONE: FAX
STATE LICENSE # EXP DATE
QUESTIONNAIRE
Please answer the questions below.
1. Are all the existing roofng materials being removed to the structural deck?
� Yes �No
2. a) How many sq. ft. is the existing roof?��b) How many sq. ft. are being replaced? �
3. What type of roofing system currently exists? �uilt-up ❑ Membrane ❑ Other
4. What type of roofing system is proposed? ❑ B�ilt-up �IVlembrane ❑ Other '
5. Will the new roofing materials reduce or increase the current dead load?
❑ Increase ❑ Reduce '� No change
6. If loading is to be increased, has a structural engineer been hired to review all allowable loads?
❑ Yes ❑ No If yes, attach an Engineer's report.
7. Are any new drainage devices being added or altered as part of the re-roof? ❑ Yes ❑ No
8. Per International Building Code Table 1505.1 what class designation is the new roof system?
❑ A ❑ B O Non-classified �_ �
9. What overall R-value will the new roof produce? 2-
10. Per International Building Code Sections 2603.4, 2603.4.1 and 2603.4.1.5, will a thermal barrier be
required as part of the re-roofing project? ❑ Yes� l�o
11. Will any electrical, plumbing, gas or mechan'cal items on the existing roof need to disconnected and
reconnected as part of the re-roof? ❑ Yes �No
12. Are any electrical, umbing, gas or mechanical items being replaced in conjunction with the
re-roof? ❑ Yes No
OVER
REQUIRED
Two copies of each of the following items must be submitted with the application.
1. Full written scope of the project submitted 7. Any Documentation from Minnesota
to owner. registered structural engineer.
2. Shop drawings/section view of new installation 8. Copy of manufacture's installation
3. A listing (name) of each specific manufacturer's instructions.
products being installed. 9. Provide design detait to meet the
4. The flame spread documentation for any foam requirements of Sec. 1504.4 of the 2006
products being installed. I.B.C. ANSI/SPRIE ES-1.
5. The thickness of all products being installed. 10. Provide manufacture and detail of edge
6. The fire tested assembly number designation. sucurement per Sec. 1504.5, 2006 I.B.C.
(UL, Factory Mutual, ICC). ANSI/SPRI ES-1.
PROJECT DETAILS
Estimated Completion date: �'-' ��"' �� Estimated valuation: �� � �/ v U
D�q ption of work: �L �S� �
1< P_ -�� �iV �� � � �o Hl��/ Sc�,�,�v�S
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a commercial re-roof 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 pe it but only and application for a permit and work is not to start without a permit;
that the work will be in accordanc the a proved plan in the case of all rk which requires review and approval of
plans.
SIGNATURE OF APPLI PRII�iT NAME �C� �'�✓ DATE C^�"' /d
APPROVED BY
t�
to $50
to $10
I to $5
lto$1
Permit Fee
Fire Surcharge
Surcharge
Total Due
ALL FEES ARE BASED ON VALUATION
for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and incl
i for 1° $25.000 nius $10.10 for each additional $1.000 or fraction, to an
additional $1,000 or fraction to
or fracfion to
$3,233.75 for the 1" $500,000 plus $4.75 for each additional $1,000 or fraction to and
$ �<j�, � S See above for Fee Schedule
$ .001 times the total job valuation
$ '"j .0005 x Permit Valuation Minimum $.50
$�'j?�� '�'j�_ Make checks payable to: City of Fridley Attach Stipulations