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AF - 348981 1 � City of Fridley, Minn. � � I 11 ' ' I , �� ; r .:: ,� --,, .• � ,� � : , . . • _, �. / � ..�._.c: �_ -�,-��� /' , ; .�.. ,:'�_� :> ' ��...�.K:.; ..-;�' - ..:. � � � " — f �i 7 • „ � >' '�.��.-1r..1/.-1�/• ,e'�� �./ � . - - = �� , � . • , . � � ^c� . � - ?�.�.... . �%L.��"�i:. .!-;.:�� ..� �7 � ; - � - � �.,./,/ Sewer Elevati� _ Founda.tiaa� IIevat[� � • • � _.,/;! � f r A �.r .f _a= � .�Yi� � 1 � � � � _ _� 1 ' ��� I ` � �� .// -i �/�/� �)� � �',_ ,�� " � v� �• � / C�� � _ •�1 « � / _ � /. 1 - �71: �JI _�%/j��i � �/\ ' � � II � T11 CO218�dBT8�{OA Oi �},l@ �U&IIC@ t0 Il� Of 8 jJQTn1�t t0 CO118'b tht� proposed work in ac�r8ance wlth the d�rlption above set ordinanaea oP the dty of Frldley. / Ia camaideratton of the �►m�nt of a fee of e builaing de�ibed above I a�ree to do and in cromnplian�ae wi af 1 provisions oP �� ��is� Q � � Permit 9s hereby granted to to t�atract the buflding or addition as descTibed above. Thispermi t is granted upon the exArese c�ndition that theperson to wham it is granted and his a�ente, employees and workmen, fn all work done in� asaimd and upoa said building, or any thereo� shall conform itt aII r�peclB tfl the ordinanc� of FridleY� �ta �g lacatlo�, vaaslt�uc� alteration, maintenaac� repair aad movittg oP bt�il�s wl�� dty limitai� thia permtt m�► be revaked at an�ae u� vi�an of aay af the P��� oP ea�d e� F:,�rit{T� �_�'�'�K� ,� No�nc� 'll�. � aou �t eera, t6s �, � t�:vrleiea P�s. s�+ �. ,ar� � waM. 6. ar. te ,.. ����+�P�hr�at�. r 6` �_ ' 06�it' S NAME� ADDRES3 .. APPLICATION F08 BOILDING, , FER1�T .' CITY `OF F$iDLEYi; �SC'�A '_ ; G�E�� ' : , � °�Ann�iss . 6 . _ _,..... L(1CATION OF BOII.DII�. � �o y��� �� _ �. ,�� .- � �..�'� �: �; No._�;,v �� Stxeet G����� �'° .- � grt of Lot , .� � � Loe � Block � Additica o�c Subdivieion . +� ` �� � �'� � "� _ � Cosrer I;ot � Inside L.oC�_S�tbqck ���, � ; .S3de Yerd - , � �� �-' �� SBWER ELSVATION �.'FdUNDATION ELE9ATION App�icant attach to thia form_Twa Cert�ficates of 3urvey.of Lot and proposed build- ing location' dratan on these Certificates .`. ,, . DESCBIPTIO� OF BDII.DING To be used as: ( _( I � �y / � � � D���-�— Fraat � Depth , . .He��ht D 1. Sq. Ft. � Cu. Ft. - �Front � ' Depth�� Height �' / , . Sq. `Ft . Cu . Ft . , Tppe of Conatruction ��.���tS��' ' P Tstimated Cost _...�....�_. =. r To be Completed_ _ �� � The undersigned hereby makes applicat3on �or a,parmit,for the work;herein specified, agreeing to do all work in strict accordance raith the City of Fr3dley Ordinances and ruiin�s of the Departmen� of Buildi�qgs,, and .h�reb.y �declaxeQ,� ��aa��."al]. �he facte aad represeatations atated 3n this applicetiori are true.as�d corzect. DA�E Ce��i�� ��� I9�� Si[l1�tATtt�� � �.. /����� ����'�'� • �. v � / � � (Schedule of Fee Coats cen be found on �fie He re Side). e� •_ � ,�,� ._ <-�.� � �- � � / .. � . a � .• s • BUILDIA� PEIi1+�T FEE SC.HEDi1I.S SeGtion 2. The Inspector of Build9.nga shall, before 18suing any perm�t for t�ie erectioa of aay buildin� or structure., or for anq addition to any euist- ing buildiag or struceure, or fos� euy alterations or repaiTs to any e�isting bu3lding or seructure, upoa agplication therefor, requira the paymen� by the applicant for auch permit of feea te the amo�t herein below set forth end in the mannes hereia provided to-wft: 2.1. For any su.ch permit for,the erection c�r anq fire•proof buildiag, othex than a gara�e�-warehouse, �#actory��or �raia�elevator, or for the erectioa of aay iire-proof additioa, for similar occupancy, to any exiating building ahall be at the rate of $1.40 for each one thouaand cubic feet, os fractioa �hereof, in such cubical Coriteat�'. 2.2, For any auch perinit �or the erection of any fire-proof garage, iaareh�use, - factory or �rain elevator, or for the erectioa of an�r fire-proof �slditioa, . for simiYar occupaacp, �o eap exfeting buildiag shal� be at the rate of �1.25 for each one thousead cubic ieet, claeaified as °1fiseproof" bq Section 502 of the Mi.aneapolta Butiding � C�le. . � . �AUSSS . �,. 2.3. Far aay sucb parmit`�or the erectioa of any nan-fireproof buildin� other than a gara�e, warehouse, faotorp or �raia elavator, or aay noa-firegroof addition, for eimilar occupancy, to anq existin$ build3n� - permit $1.00 for each one thousand cubic.feet. GARAGES 2.�. For anq such permit for the�e�ae�tion of aay-noa-fireproog gara�e, warehousa, factory-or graia elevator;--or for Che erectioa-of aa� non-fire�soaf addit3o�►, for �.imi.lar occupancq, to any esistia� bu3lding or for each such � bu�lding or addition - nisety cents ($0.90) for each one thousan�d cubic faet ox fractian thereof, ia th� cubicai caoateute thereof with a minf�um of $4.00. For the purpose of computiag iees for build,ing permita, the cubical coatents of aay buildiag or add3tioa to-a uuiform iiei�bt throu�hout by muLtipiyia� the �rouad area covered fr� a poime eis (6) iaches below �he flocr i�ae of tbe. b�semeat ar. cellai to the aver�e height ofJ tt►e uppes surface or to the average height of the roof surface of �he maia �able of a pitched roof. 2.5. For repairs or alterations to aa existing structure, the fee aha11. be aC the rate of $3.00 per each Five Hundred Dollara ($500,00) or fraction th�reof 9.n the cost of all propc>sed' work. 2.6. Itb tto CBSe�sliall the fe�, chaxgc�d for a�y permit ae set forth ia Section 2 be less tban $4.00. � _ - .,�-Q, . ... ��'�► � > . � �"'1 �1 � $ � Y �- �°-���e�': -. ,� �R.�- _ - .,� _ � � . . %i � ' � � . . F M��F.�2. ENGII�r:�RIN(� CO. INC.. ENGINEERS_ �ND SVRVEYORS � u►ND avavev�NO 801��8 TESTINO CIVIL A�, MVNIGIPAL EN01N6HRINp LANO P[.,ANNINB 6418-56T" AVENUE N. " MIMNEAPOLIS 2T. MtNN. KE 7- 363T ������0���� 4� � ����� �or� Cq�/ /�er��eff Ca/�If C. � �� �:- �,� �� .� � `� � ;,�w �ry,�.,. \�p� � � ��? �� . �� � �� - � �,> � C�LE ��=�0� � ° �, .- ,�:�.�� � � L�r 3 B LK S PEAR 5�1�1 S�ar����v�a� �ST�TE� 2�'DA�D N e , . r WE HERE6Y C�RT�FY iNAT TMIS t5 A TRUE A1dD CORREGT REQRESEN�?1TION OF A S�RVEY OF THE BOl1NOAR1E5 OF 7HE u►NO ABovE DESCa�BED AN� OFTHE L�ATION OF ALL BUItDINGS� �F AuY, TKEREON, ANO P.t�;v�S18tE Er�CRoACHMEt+1T5, IF MtY, FROM OR ON 5MD LAND. `` Di►TED TfuS ' p�Y GF - D E��r ,,�.,,5g M I N DE R E.N G N�.F R;1 N G CO:, I N C. �-���t1�: � oaa� � -���su GYO - � • �-c,ss'n s- � - "T � . �\ , .y�e: , . , .: ,- � � � � � � 0 � � � � � � a .. � W � � Y � � � � � O x�� Q�� ��� �� �-.�-- � � o � � � � � -p O r 7 b� .� I � � � O � � � � b � � Es O � � � � �'� � �° � � �,�� � � � �y � � � �� � � � � �� o x � � � ��a�� ��� ��� �°�°�� �� og��� ���m �� ����� �'� ����� �� � �� ��. � � � �Q� � �� g��� � �� o �� ���� � �� R �� �.� � � �� o ��� m s�: �°`' � �: .��'- � � � � � � � . � a � a� B . °' : � � : : - o � o : : � ' � ' � � ° � : ' . � o $ : : 0 � o. . . � o o, o �& : � : o � : : : : � : : � : � ' ' : m� R � ' : : : ' : ' : : � : � : � : : : : � : � : � �. � ���� ��;��� �;��.��° � $ S � 8 � o $ � � � � � o � � � 0 � � � y O � gj -�. � a � � ��-z� � � � 0 � � � � �� � �� � 0 d� hq O � b � � 0 � � �� � � � � ~ O ��.� � � O F-� ro g � � � ° 0 �° ° `�� � I����� � � ��� � � � S � � o H � N � � m • � � i �� c �. � . ���� ��� ��� � � ° ��� � � � d��. � °' �� ° � � � ���� �� � �.� �+o° C1 p � M p C� �' OC � �° �, bd�� �- �' � � �� � '� .° �" �� �p,� d A �y�� ��.� m �.`� ��. a� � � ��o N � ►i �� � �� � m ~ � � i � �� a � � r � m y _ fl7 v r m � � p � � m � � a � � 'R 7�0 � � Z G� � � O �_ � � � a v � n � v � � � ' �� � �� �' �p' �. r' u3�,.�..x� ,v a � �. � � � � s� �r��� ����` ���� � ��. �fJ1T l�3 ��'IR� A� �JI�IIdGS �►� � Conetruccioa No. Wi�o�w Da►» Refereaoe 0�. �N�II Int. Wall CeJie� Roof Floor ICiod ' Y�Ae �0 19_ .Roam Leasth Width Heig6t / Fl.1 �.�Q . Room I L W� aad n—Cnckasa a� Area W�dowa aad Doon--�Caa� en a�e e. i. wre. �/ ia� x• aee Ho. No. or „n. or n. � et. ot 1c w. ee. �� � Iro. oe y.n• ot v.e. � e / � � / �' � 3� Coef. �tn I�oa �a F�p. �.atl � ��� I�. wa� R. EDR or p. ins. WA. Leadrr area ' �E�Oea, t.ea�el, wic�/ . Nee aeed Door�—Cracka�e a� Area t a �rr � 04 osa� U�Sb ot enet sp. t� � /6 a. / �` �.tioo � � w+� � / ° IN� esp. vv� lat. waU � F�r 1a61tration . C�laa Esv rr�ll .�.� • Ne4 esp. wa� Iat. wall Ceilio Floor Total &u. m t�v. � lnaulateo�n HoMr Width ed �q. k. E.D.R. er �q. inso WJ�. l.eader ans � � �� a� �ad DoorO--Craeka�e and Area th e � t a o[ ne�i roa ot e� e! ��s� Il�hb ot eriak p. [t. S•� :9 C � z• l� .e� B� _ , � e . In6lteaeion i�' �. . Glau Eap. wall �� / / Q.S.�. Nct e:p. w�ll lat. �►�1! : D Ceiling .r t,�,/ a I % � Floor T�al &e. � E 1 r / h. ED.R. or q. ina. WA. Leeder area Reqp�iced p. k. E.D.ft. or sq. ies. W.A. Lea�r ae+� / t� �� w� �� � t� � e�� w� � and �n--Crackage aod Area 1�/'�vs and Doon�--Craekage aad Area ds e e. or tc. wna t asee a ot tdeea� rc. wr.s � st oaM t{<DU o[ enei p. [t. No. ot oao� o� sau� It�AU ot encic so. !t. �rati.� ( CJw � �ll ' �a�� �. � C.�i�i� f� Tetal Btn. Req�eed �. h. ED.R or p. ies. WA l.eader a�ea � � In6ltratioo 3 � e , Glaa Es�. wall �' . � Net e:p. wall P Int. drall �'/ y� Ceiling .�.i 3 Floor Total &n. ' � R�d W. h. ED.R. � �q. w�. �IA. Lcader area � � , � • � � �� l�/� l��.�7LA.VLl\�V1�7 VGI'M 11�1G1\ 1 V�' �VliLllAa7 l�ldl\1\rJ'�f"6JL.Is7e �. Wea�rttrips �� Conatructioet A(o. �eulat�n W� Diaora Refuaace Out. WaU lnt. WaU Ce�iios Roo� Floor Kind l�w Do 0 � � 09_ Fl. ° . Room L.eeath Width Haight � Fl.� , Room Le4QCh VVi�h Wendowe arid rs—�CrackaQe and Area Wiadows and Door�—Ctaekage a�d Area Idth a1�At No. s! Lin�al t. Ares WIAtA Hel�st Na ot lo�ai tt. ♦rsa No. of a� ot pane 11 bt� ot er�ck �. tt. � Ne. ot pans ot pae� Il�st� ot araot p. tt. , c � `, ���Q(� ' 1 Coef. &u l�hration � O f�p. waU � Nat esp. wal! I � , In� wall Ceiliag f7oor 'fotal Btu. • Requ�ed W. ft. E.D.R. or p. iaa WA. L.eader area , Fl. E3ooa► Leegth Widtl�( . He� W ied Doon--Crackage aed Area t N� t No. o ee Area _ Na o[ pap of pa� Il�bt� ot crset �a. !t. � ,i� l�tr�tildi Ciaa Etp• wall ZS' ° 1Vmt esp. wall let. �rall Ceilieg �_ F�r t� y�_ Total �tn. . k. E.D.R. or �q. in�. W.A. i..eader area — Wiedowr aad Doon--Crackage end Arca Wth ![N�ht No. ot Lfneal tt. Aret _ l�a ot y�as ot p��a II�Ab et crack w. tt. � l�eneaa �. �� O �, T�^�-__�- � f�. Wtu Ist. waq /6� � Ce�B 7 30 v u � � �Y �loor `+f _ . � Total i�. , Reqiured sq. fe. E.D.R. ot p. ias. Q/.A. L.eader are. / �� Glsa - --- - Fap. wall 3 1 � I�et esp. wall Ia� waU � Ceiliag � Floor � Total &n. � � IRaryired �q. k. E.D.R. or �q. ms. WA Leader �na Fl.I Room I 1.,eaQth �Vi�h Wiadowa aad Door�—Craekege and flrea 1dtA el�t►t o. ot a�al t. Ara No. o[ y�ne o[ paTe� Il�bts ot c�ack p, tti � I &n 7� 4o s In6ltration Glaa Fsp. waU Net e:p. wall Iet. wall Ceiling Floor Tocal Bcu. Requued eq. ft. E.D.R. or aq. me. WA. Leader �rea Fl. Rooa� I Length Widch Heiehc Window� and Doon--Craekage and Area IdtA e1�At No. ot Llneal tt. A�ea No. ot pan� ot yan� Il�bq ot er�ck p. tt. Infiltration Glasa �. Wa�� Net ezp. wal) Int. wall Ceiling Floor Toea) �cu. Required �q. h. ED.R or p. ias. W.�l. l.eader aeea &u __� � � � � � � � � � � � � � � � � � x x �. o W y�j � `� �' � � � "� �� �� � �o� �� p� � � ��� � : �, � ��. o .� � �$ � - � � 4 .� . � � +� . � ' , �� - . ` c3 . _ � . rs. � : . '��. : � -� ' . � � • bd °o : . 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N.b ? - Q � � W Q. � � �� > 0 a 0 7 7 OR a N l�9 N c� d H v c�o � a�i � Dc v�, N � ���m A � �N��w � ��d�m C Z � � � ''� � .��r � IIl 3 Q . > > •-�r 0' �1 �1 0 c v�O�o � ��� � � � � � O � � n � v � v � c � � � t� t� t�r w .. c�'i� o 0 0 0 °o °o °o o° o° � m tff Eff 69 69 69 . O � � C � '� o fjj � cn C Q ' _i � �, � � � 3 °1 0 e `° � � � C � � � -� � ^« N �° `�. _ �o � n � A � n� � � � � o � m •A�r V� � a �� � �m�3 z� Q- v Z � �-O = _� O Z y� o �� � v � . _ _ �_ _ 3 _ _ ... .. �I I m C Z � c � m v �� � � � ,, i O � � W Z _ : C ^ � rn c� � v� wc:w� 4= r-� t ' ., � o U v ' � �� wZ� � � v' � m taiA� N � Z z� m� n _-I � Z v_ � A � '� Z � r �� �O L� Z � �� �o �� O� Z� Z� � � a� � z _ oN gz �v °z� iii Z -C � -�'+ o � 0 NZ . > Z� � G �6 � �a ��n N O z . � m A � � 7 t� Ot � C m � ,. N O N, TfIE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIA(1SCES OR THE O�ePPLICATION WILL BE RETURNED � � •,,,,•. i .r � .r �►► •: �►� •,,: r•► � - ��cII�T : i��► �Q�j �DI9[`Ir1Q'a17 PY�CtIr19 ,ran __, the undersigned hereby verifies that the venting has been examined ar�d is free from rust� deterioration, obstrudions, � and' is secure(y suppo�ted and firestopped where required. Yes � No ( The venting system is plastic/PVC and meets all cx�rrent codes and manufacturer speafications inciuding s¢ing� length� number of elbows and termination. Yes ('� No () The undersigned also verifies that the replacement unit is a Gsted assembly and meets the currer�fi codes and manufadurers speafications. This does indude AGA-GAMA Category I Cer�tral Fumace Venting Tables for fan assisted and natural draft appliances. 'me �ce�r,Q _err, -���+r± �ir �s sized �nd instaUed to meet the curreni codes and manufac�urers speciflcations. Wh@f1 �QUl�2d t0 ����� a new cemh�_c±ien ai� it will be sized and installed to meet the current c�des and manufadurers speafications. . Yes (� No ( ) .. Y���110 ( ) Yes � No ( ) When in�,�+atl�n�a new ventin0 � �„� the undersigned hereby verifies that it is a I'isted assembly and meets the cxarrent codes and manufadurers specifications. This does indude AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appiiances. • Yes (� No () Is the common vent and vent connectors sized and installed e:orrectly after an appGance has been removed from the common vent and vented' separately as per cx�rrerrt codes. Yes�No () � . . . . «- ,.�- . � . .,- . �� �� . . - . _ . . - .� . . . �.,�. �<<.:�,� .�, . . AppGance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat App(iance #3 Type BTU Input Fan Assisted or Nat Total AppGances Total Btu Input � . Common Verrt Type Verrt Height Diameter - �c�$s AppGance #1 Vent Connedor Fi�eight � ft�gth ft Diameter in TypB AppGance #2 Vertt Connedor Height ft Length ft Diameter in Type Apprance #3 Verrt Connedor Height ft Length ft Diameter in Type � - 1 • ► �:- . .:- -- i ---- - - .. _ � ' Center Point Energy MGCO °� - 13562 C,entral Ave NE . ' HEATING CO: �ka, n�nv s�oa - � . . � Signed By: �' Date :-� o� ltJ ..3 : M � = ---- -- _ � . _. _ _ _ _ HEATING AIR CONDITIONING AND ELECTRIC. INC. AQDRESS � �10� OCCUPANT � HEAT LOSS DATE HTG. INST. �' U SOLD BY � �✓i Elecvicel Work By TYPE OF HEAT GA FA HW STEAM SPACE HTR. �.- � • �, : .�l t - .�: S!' ' � `i�' �r�i� � i ,.�?� ; ; i i1 � CONTROLS HOUSE HEATING TEST RECORD APT.-� FLOOR CITY� d SUBURB OWNER �w�LQ INSTALLED BY � /� `� G� Lirre By UNR HTR. OTHER CONVERSION �. Vent Size KIND OF LINE� SIZE �S�` � NONE Draft Haod Regulator Filtera Size 9e� Nu�� Chimney Locedon Inaide Outaide Heat Plug_ Chimney Conatructian Umit Setti � Fan Setd Pilot Type !A � Pilot N�ke Pitot AAodel Pilot Timing �GC� _ �..W. CiUi Qn Pressure S`l � PeroentCOa � InputCFH �j�_0�9� Percent0l 7a Stack Temp. �eQ � Peroent CO: ����_ �s Smoke Bomb Vlfiring [� Dratc Test Taa i DQor Preasure Lightir� Inst Date Tested Company Testlng '� Name of Tester . �4 Presaure Peroent COa Input CFH Percent OZ Stadc Temp. Percent CO i. Building lYI�CHAI�TICAL Pe�t No.: Inspections RESIDENTIAL APPLICATION Received By: 7. 63-572-3604 C�y OF FR�LEY Date Rec'd: ��a � DATE 5�- � I�-D CO YOUR E-MAIL ADDRESS SITE ADDRESS �I �! �,� �1'V �!� �� THIS APPLICANT IS: ❑ OWNER 'L�60NTRACTOR � PROPERTY Np�; L'i��6rb OWNER/ ADDRESS: ��Yn'R CITY I� STAT�J�,ZI��3 Z 'rEN�v'r Pxor�: �'I/ 3_�71- 3 �o �' corr�c�roR con�Ax�r ru�: Riv�r Ci Sh��t �, nc. SUBMIT A COPY OF ��TACf PERS�N: 2g0 AAsin St. N.E., u� YOUR STATE STATE LICF.I�ISE � Fridley, IV1l� LICENSE WI'I'H ADDRESS: /7�R'dl 7�.2'i9� FaJ( 4763) ��`2� � STATE ZIP APPLICATION PHO� FAX — - ---- -- -- - --- , — - -- PERMIT TYPE ��GLE FAWIILY 0 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � � �LACEMEN7' ❑ a,LTER/+.TTON/REMODEL DETAII.ED DESCRIPTION OF WORK '�' �' �- PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the totsl cost up to $50Q.00, whichever is greater, for the improvement, installation or replacement of a residential frxture, excluding the fDCtures. (This should reflect only the cost of labor ) Labor cost under $300 a$15.00. Labor cost between $300 to $S00 = cost of labor x.OS � FOR PROJECTS WHERE IABOR EXCEIDS $SOD, FEES ARE BASID ON $10.00 PER FIXIVRE, EXCEPT VV�iERE NOTID. F1X1'URES: (II�IDICATE TOTAL NUMBER OF EACH BELO� Equipma►t InstaUed . MFG: �_ MODEL: �� � SIZFJBTU ��X% MFG: MODEL: SIZFJBT(J �� N1FG: MODEL: SIZFJBTU � H/C $25.� _FIREPLACE (GAS) $15.� . _GAS RANGFJOVENI $10.� AIR TO AIIt EXCHANGEER S15 FIREPLACE (WOOD) $35.00 NEW GAS GRII.L $10.� BOII.ER 535.00 FURNACE $35.00 _GAS iJN1T HTR $10.00 CF�NIlVEY UI�IER $10.00 GAS DRYER $10.00 Pt30L iiEATER $35.00 DUC7' WORK $10.00 QAS PIPING $10.00 ' VENTILATOR $15.00 — — . . . ... .,. . .... . _ . . _ , _ .. . . .�.. - .. - 3 •�.. . �.. ., AN � . .. . . . ' �. .. ., ..:.. �. �. . . .. ' . . . .. . Permit Fee $ 4 Number of fixt�ues (n� $10.00 x$10.00 =$ Surcharge $ .50 Number of fxtures @ $15.00 x $15.00 = $ 'TOTAL DLJE $ Number of fixtures @$25.00 l x$25.00 =$��-dG Number of fixttues @ $35.00 x $35.00 = $ State Surcharge = $ .50 Tota1= $ . S THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSID T hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in confomiance 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 germit; 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 %%� �% p�NT NAME� � S ��� DATE � 3/ /�%G .A ... ......y,. . . ... . ... . �. .. ., ._ � - '. _ . ����, ��.'.. , , , - (:ity ot r�ria�ey Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �.� - � REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESlDENTIAL PERMIT APPLICATIDN HVAC � ❑ NEW HOMES/ADDlT(ONS ❑ EXISTlMG HOME � ❑ MAKE-UP AlR � REQUIRED FOR NEVN/EXISTING HOMES 1. Combustion Air (Se,e note below) . a. Oil or solid fuel IMC Cb.a�ter 7 with MN Amend.ments b. Nahu�al Gas or Propane/IF'GC Chapter 3 with MN Amendments � 2, Make-up Air (See note below) a. IMC Chapter 5 with NIN Amendmen.ts � 3. Ven.ting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapt�r 8 with MN .Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooli.ng load. per room a. FZequired on new construction IMC 1346.0312 5. Ven.tilation . � - a. - �erMN E�erg�-��e 7�70 or �672 6, �uct Design Per IMC 1346:0603.2 a. ACCA Manual D � NOTE: Centerpoint Energ� Mechanical Code Guidelines software may be u�ed for comb.ustion and make up air� calculations Building PLIJMBING � Permit lvo.•� - o�� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY UF FRIDLEY Date�f��:� Q 4 2 7 DATE �� D% YOUR E-MAIL ADDRESS /C. ��C� �� �'H �' N SITE ADD S � / THIS APPLICANT IS: OWNER �CONTRACTOR PROPERTY NpME: � .g �' Z' �. ��E� ADDRESS: 7 (i{%' CITY {rl, "� fi1 STATE /' d TENANT PHONE: CO� `3l'°% ,�J D � CONTRACTOR Np�; SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH pHONE FAX APPLICATTON PERMIT TYPE SINGLE FAMILY O TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: � �W REPLACEMENT DETAILED DESCRIPTION OF WORK � �P�.t.� O� G. O�� !�-[ 11e- O 7/i. � � PER MS 16B.665 the permit fee is a minimnm of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labar cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $5�, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WI-IERE NOTED. FIXTURES: (WDICATE TOTAL NUMBER OF EACH BELOVi� BATH SDQK/LAV FLOOR DRAINS SHOWER WATER PIPWG BATHTUB GAS PIPING �n crrrucFrvsE) SWIMMWG POOL WATER SOFfNER ($35) CIATHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS) DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER ME'fER �C OTHER � � � �`- - � �,. 2 , � Permit Fee $�_. Number of fixtures @$10.00 x$10.00 =$ Surchaz e .50 Number of fixtures @$ I 5.00 x$15.00 =$ TOTAL DUE $ S.� Number of fixtures @$35.00 x$35.00 =$ State Surcharge = $ .50 Tota1= $ 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 wnderstand 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 a11 work which requires review and approval of plans. SIGTIATURE OF APPLICANT -� /.L�����P�� PR1NT NAME �o �/'� J, G/Gt.�� �,� �� �� !�� .� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 ' FAX: 763-502-4977