AF - 35380ly+t
. SUBJECT PE .
City of Fridley , 12902
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
; � REC .
� ; L ___�__, COMMUNITY DEVELOPMENT DIV. �'��L�i
r � � PROTECTIVE INSPECTION SEC. `�1�(�)Q��'7
1 1 �
� 1 /"'1 � CITY HA�� FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�...__� • ••� 612-560-3450 910-F15 � �
4/14/75
JOB ADDRESS 6160 Benjamin Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. l� 4 Rice Creek Estates SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Pine Tree Builders Incorporated 84].3� �enter Drive 784-6011
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEEH MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 46` x 24' Dwelling and�a 22' x 24' Tuck Under Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway. Provide a verifying survey before
capping.
SEWER LOCATION: "Y" 81' North of Manhole �■ ������
"Y" Elev: 90�.32 Before digging call local uti4itiQr
Top of Footing: 910.32 Mi.nimum TELEPHONE - ELECTf;iC - fi�f�S E�C.
North Inv. Elev. of Manhole: 907.63 ��y,
R������� �� i.a��, i;�'
WATER LOCATION: Stopbox 8.5' South of Sewer ,
SEPERATE PERMITS REQUIREb FOR W!R!l�G,
HEATING, PLl1MBING AND SfG1YS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTFiICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR A!R CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID tF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R 1
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBV CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION �' STALLS GARAGES
AND KNOW TIiE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S2S�ZSE 12.62
DOES NOT PRESUME TO GIVE AUTHORITY TO YIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU I OR THE PERFO OF CONSTRUCTION. � $4�-•8O $325.00
PLAN CHECK FEE TOTAL FEE
'� ' 407 . 80
SIGNATUREOFCONTRACTORORAUTHORI GENT 1DnrE� WHEN PROPEFiLY VALIDATED THIS IS YOUR PERMIT
c�.� � c�JZ.�zJ / � '? S`
J SiGNATUREOFOWNERIIFOWNERBUILDERI � IDATEI BIOG.�NSa DA E
APPI.ICA'TION FOR RESIDENTIAL, ALTERATION,
OR AllDITiON BUILDING PEItNiIT
CITY OF FRIDLEY, 1�1INNESOTA
OWi�IEK' S NAME : S �J �t r BUILDER: P !�/� ���E /E7al !C`�E,QS. -l- �v7 .
ADDRES S : 7f � ! S C,� .v��c-' �P l� /1 ADDP.ES S • � � �'N f�.. �' �pl3/�
.
NO • LQ � � S TREET • � �� �S �! i�1 � � .
LOT :_� BLOCK: � ADDITION : ��-`' �rs�k �' 3�i9"fr-5 ,
CORNER LOT: INSIDE LOT:_`�SETBACK: �j� , SIDEYARD: u' fd� So-1 q�
Applican� attach to this form �tao Certificates of Survey of Lot and praposed
buildir.g location drawn on these Certificates.
IiESCRIPTION OF BUILDING
To Be Used As:
� w��r;�el��tklf an �l� 2�'z�k
�� H/ 41P �'�''-�'1 Fxont : �`�t3" Depth : 2 U Height • j�
// �/�' •
Square Feet:��iCubic Feet; /,,�, �%'7(�
�
/u� G1�1.)�,�. �,,�,,����� Front : ,::1 � Depth : <2 S! Height : �;
Square Feet; S.�c�; Cubic �'eet:_ '�/;�,�7K/
2`ype of Construction: � 1�� � �� `tdcku+-�rFstimated Cost: $ �
To Be Completed: .�v,.�. �S "t � �.S',,�75�. _Rc�
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all worlc in stxict accordance with the City of
Fxidley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representati s stated in this application
are true and corxect.
i .
DATE : '��� ' � S S IGNATtTRE •
(See Revexse Side For Additional Information.) _
�ttw� ► c.. = 4�,8a S 9� � 3�S. �o
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$UILDING RLPS�IIT FEr SCHEllULE
SECTION 2. The Inspector of Buildings sh�ll, befoxe issuing perma.ts for the
exection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or rePairs to any existing
building or structure, upon application th4refore, r.equire tr.e payment by the
applicant for such permit of fees to the amount hexein below set forth and in
the manner herein provided to-wit:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
ieet, or fraction thereof, in such cubic�l contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIOI�AL INFORMATION
For ihe �>uxpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.F
height of the roof surface of the main gable of a pitched roof.
For r.epairs or alterations to an existing stxucture, the fee shal� be at the
rate cf $3.G0 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all pxoposed work. .
�n no ca�e shall the fee charged for any permit as set forth in Section 2 be
l�ss than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Pexmits for construction will be issued a minimum of 24 hours from the
timc. of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once iL-
has been constructed, will be requixed before proceeding with the framing.
CERTIFICATE OF OCCUPANCI'
Application for a �errifi.cate of Occupancy shall be made ten (10) days pxior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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' ' COMMUNITY DEVELOPMENT DIV.
� .ti: -
r � � PROTECTIVE INSPECTION SEC.
, .
, .
l'_--� ��"' ��� CITY HALL FRIDLEY 55432 NUMBER aEV.
L 612-560-3450
910-F15
10B ADDFiESS 6160 Benjamin Stxeet N.E.
1 LEGAL LOT NO. BIOCK TRACT OR ADDITION
DESCR. 4 4 Rice Creek Estates
2 PROPERTY OWNER MAIL ADDRESS
l�bert J'arvi 6160 Benjamin Street N.E.
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNER MAII AODRESS
5 ENGINEER MAIL ADDRESS
6 USE OF BUILDING
Residenti,al
7 CLASS OF WORK
❑ NEW X ADDITION ❑ ALTERATION
8 DESCRIBE WORK
Construct a 10' x 14' Deck
9 CHANGE QF USE FROM TO
STIPULATfONS
DATE I PAGE OF
d/�ti/7ti � �
° 134
RECE 0
�0��
APPFOVED 8Y
SEE ATTACHED
SHEET
��� PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
Z�P PHONE LICENSE NO.
❑ REPAIR ❑ MOVE ❑ REMOVE
SEPERATE PERMITS REQUtRED FQR MIIRI�G�
HEATING, PLUN�BIN� AND SlG�V�..
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING. �dwpOd
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATfON 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECiFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5OO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- &rj.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �
PLAN CHECK FEE
AUTHORIZEDAGENT }dfATEI
BUILDERI �/ A 1 � BLDG I
OCCUPANCY GROUP OCCUPANCY �OAD
SQ. FT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
.50
SAC CHARGE
PERLY
)TAL FEE
$5.50
T1{IS IS YOUR PERMIT
�J � a� - �,�
4ATE
0
APPLICATION FOR RESIllENTIAL, ALTERATION,
OR AllllITION BUILDING PERI�4IT
CITY OF FRIDLEY, MINNESOTA
�
OWNER'S NAME: � BUILDER•
ADDRESS• Q � �°
� ( ADDRES S : � ,!�'/-`s-e.--
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NO . . �� S3REET • ��/ ,r�'1� �
LOT • BLOCK • L _ADDITION :-����C,��-" �T-i�`�`�
c
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant atta^h to th?s form Z�ao Cert.ificates o.f SurueY of Lot.an.�: propos�d
building location drawn an these Certificates.
�ESCRIPTION OF BUILDING
To Be Used As ;
/
Front•_� Depth:� Height• � '
� Square Feet: Cubic Fee�•
Front: Depth: Height•
Square Feet; �Cubic Feet•
Type of Constructi5n':'p Esti.mated Cost: �
_ _$
To Be Completed;
The undersigned hereby makes appZicativn €or a permit for the work herein
specified, agreeing to do ali woxk in stiict accardance with the Ci�y of
Fridley Ordinances and rulings of the Department of Build:ngs, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE : Z� �_-�--- SIGNATURE :
(See Reverse Side For AdditionaZ Informa,tion.)
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BUILDING PERMIT FEE SCHEDULE
SECTiON 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure,.or for any addition to any existing
• building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for_such pe-nnit of fees to the amount herein below set forth and in
the manner herein pravidad to-wit:
�
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tTNIFQRM BUILDING CODEs 7.`ype 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contenCs. Type 3& 5-$1.85 for
each one thousand cubic feet. �
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average:.�
height of the roof surface of the main gable of a pitched roof.
For repaixs or alterations to an existing structure, �he fee shall.be at the
rate of $3.00 per each fi�ve hundred dollars ($500.00) or fraction thereof in
the cost of all pxogosed work.
Tn no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for eonstruction will be issued a minimum of 24 hours from the
time of application, to allow for groper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceedin� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) da.ys prior
to the use or occupancy of any structure for which a building pennit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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CERTIFICATE OF SURVEY
Pine Tr�e Builders, Inc.
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� De.no-�es Iran Monurne.nt
Rev ised 5-19 -�S To . Show Foundo-t ion
Pescri�tion: Lot 4, Block ��, RICE CREEK
ESTATES, Arioka Count,y, Ninn�sota
�ou�n �� � oun trc�
�suruec�or�
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Nr�,ukr��n Park h1fV �54�8
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I ht�refr,� cf;rtify that this !s a tiue and correct representation of a wrvey of
th�e houndar ies �f tht� ahuve d�scr ibe�d�land anri of the location of a!I I�;��Idings,
if any, then:c�n, �nd �II visible ericroachr,ients, if any, from or on said land.
Ati s�n�.���yrcl liy nie ttus ___28 -��'1 ___ day of --.j�Gir_C%1_------ , T9 �5.
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NOTE: 0�1 through 4�8 required when using a side vent furnace.
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S�IIML�tEY AND TA _K VFRiF([`ATinN
The undersigned hereby verifies that the �xisting chimney or stack:
1. Has been carefully ��amin�
2. Is free from rust or deterioration
3.
4.
S.
Has no foreign objects lodged within
Is se�urely supported
�+Ieets sII cvrrent Code requiremeaits for size
and total BTU's connecbed
6 Has total heating BTU's of %S�
All other BTU's ��i ��
TOTAL BTU's I jS, �v
7.
$.
Has a liner been provided far water heater
Has cc>mbus#ion air been provided frn� water heater
Retnarlcs:
Yes (� IVo ( )
Yes(�No()
Yes (D� No ( )
Yes (� No ( )
Yes ( kj No ( )
Yes ( } No Q�)
Yes (DQ No ( )
. _ � :_: _ � � :,' _ � � I��� � -
HEATING CO:
Signed By:
Date:
���������� -�
HEATING & AlR CQNDlTlOf����!r, C0.
89101'�EhT�ORT�t �4'E. S0.
MiNNEAPO�{S. k!PJ 5�42G-2fi53
f�/d��� � �/ - - `�VI"�-G�t�
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�•"^ ���� �ryu � q�R CONDITIONING CO.
.'VYORTH AVENUE SOUTH • MINNEqpOUS, MN 55420 •(612) 881-gp00
.JDRESS �/C(� �E'„. � f�c-c �{/��
OCCUPANT ��ti I�r./�t„� �
SOLD BY_SC'��� ,� /�
l
MAKE � a.i
SERIAL NO. � u l.i L � � l � 2
THERMOSTAT � � ' � U (���
VALVE ��a yr c G,_ . / /
LIMIT � i r �
LIMIT SETTING � t� b �
FAN SETTING��� (L
PILOT TYPE ��� ! 1 f• C
IGNITION MODEL � �^� � i
PILOT TIMING _ 7�i ' �/ Nj •" y�li .� ,L
PRESSURE ��S � � L" �� PERCENT COZ � �G
INPUT CFH 7� PERCENT OZ � f+
G
STACK TEMP. ��.Z B '
-----_ PERCENT CO O ;
FORM 235 (REV. 17/8g) -
CITY �'f�t �
OWNER _ ._
INSTALLED BY -
HEATING JOB NO. `� �`� 5 �?
TEST RECORD
MODEL G Z b �3Q�(J
INPUT L a G O
VENT SIZE y �
TYPE OF LINER U�- L<r-� -{
LINER SIZE C ��
FILTERS: SIZESaAC� c� � 7 Z dG NUMBER �
WIRING 'vG r' •� . .
TEST TAG ✓
LIGHTING INST. ✓
DATE TESTED � � - 7 � - �i' �
COMPANY TESTING � � cL , c C
NAME OF TESTER � S�E.. E r ax /�.� �
FORM DISTRIBUTION: WHITE COPY - JOg FILE
� YELLOW COPV - CITY �
c�ty of Fridley S�a,E`T �T N° ,
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T �� �� �
r
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� � RECEIPT NO.
; �V__ COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC. / _ � , \/
' � l% v
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`.--- A,�����;•j CI7Y HALL FRIDLE� SS432 NUMBER REV DATE PAGE UF qPPqOVED BV
L �� 612-571-3450 4/9/96 / /
910-F15
JOB ADDRESS
6160 Ben'amin Street NE
t LEGAL �07 NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. [� 4 Rice Creek Estates SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
Bob Simon 6160 Ben'amin Street NE _ 6
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO
Richard Hastin s Contr 6 1 R'
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE UCENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION p� REPAIR � MOVE O REMOVE
8 DESCRIBE WOFK
Reroof Dwellin I8 S 2nd La er
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OFi AtR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHOFiIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICA710N 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �1 �OHO �.54
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEt THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �37.SO Fire SC �I.OH
PLAN CNECK FEE TOTA� FEE
--������% �°�'�� 'r �� License SC $5.00 $44.12
SiGNATUAEOFCON'RACTOAORAU OAiZEDAGENT 1DATE� WHEN PiiOPE VA�IDATED THIS IS YOUR PERMIT
- Grl, � " '�� �G
SiGNATURE OF pWNEFl i�F OWNEA BU�LDERI IDATEI 8� �NSP f� TE
NEW [ ] Effective 3/1/96
ADDN ( ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application �
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ConstructionAddress: 6'�� 0 3�-,r� r,� ,c,� ;,�
�
Legal Description:
Owner Name & Address: �o,� �i,�,t o,y Tel. #� S7� -.� 6��/
Contractor: /� i ��, p� 9 ,�-� A S� i CU6 S MN LICENSE #�c. S�
Address: �� 3 i R:�� tZ u i=� 7-� i2 Tel. # 5� 7�-�� C b
Attach to this application, a Certiiicate of Survey of the
lot, with the proposed construction drawn on it to scale.
,
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Comer Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: 1` � f� o� 1c Estimated Cost: $_�$-t�;-„-� /� °"'
Approx. Completion Date: �� � 6
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �� 6 APPLICANT: �,��� /:���%�" TeL # 5�7`� -9�i6
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcha.rge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 3 so
� /. 0 �
� • S�
$
$ � UU
$
$
$
$
� �� ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$90Q per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minunwn Fee is $21 plus surcharge)
$21 for f�rst $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or ftaction thereof, to and including $1,000,000
$5012.25 for the first $i,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets t�nry j "
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Altemate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15. 75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
: z ��
3,
i
!
Building
Inspections
7G3-572-3604
BUILIyING �
RESIDENTIAL �PPLI�ATION
CIT� QF FRIDLEY
pramit No.: °' "`'�'
Received �y�.
Date Rec'd:_,...... � .." ����
un,�r� June 26 �_ 2006 y�k �,_��L ���,�� susie@beisselwindaws . o�►
_..�
SiTE ATN)RRyS _ 6�-60 B2I1 'amin Street Fridley, MMt�TT 55432 "--
. ._...
. . . ......
rHts af�l�I.it:AN•r �s: o owNfR '�:c:x�rrx�c"rc.Nt -__
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PIIUNE� _
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� . Sidi n� __._ . . ,.... _.
_ ___
srx����� � cxfNV Ur• srn� c[ecrr�E a__E453 exp v�r� _. 3_/_� 07
YUL►R STATE LiCENSE �ntutPSS� 1635 Oakd.ale Avenue .__ c7rKn1. St. PaLI sTnrr•.;�t� 55.�1$
Wt'I�1 A�'P[.t(:ATIUTt p�; p N� 6 5 1— 4 5 1— 6 8 3 5 r.�Y F S l _ a S � _ n�� �
YII�FGW
O H�.SBMSNT FiNtSi[ O Rix)k �T-�. .._ "�'��'
t� DECK ❑ �tN '1'i 1.H
j�(StllIN(i ❑ tyT'HF:K
..�_ _ _ _ ❑ SW�iMtNCi 1'WL
TYPE UF
iJL'a7�.+ItiOL'. 111�V�a1 oG�t1�j: W1,C::._.:�.��7[�0 lv�i�oo E�� N k�e��� 1- /F ---
�-�a_� •- ._.._.
SIZE UF 1MPROVEMENT L�NN{;'!'H WLDT'Ii H�tGH'!' , gt,
MI� H StjUA1tES O� tlSt? d�t GARAGE FiAStiMfildT R6AAC�i]�Ft n�u: Ct iRt�tf�r-
GARACFS ❑ ATTACNEt? CAkAEi� C. Gxtsiin� Fhxn F'I�t �
pRt3M13ED SiZE: C! DETACEILD QARAGE 2. Propa¢0 lloor �tlan
PRnP(�SEb H�ICHT: 3. Licl ufslruc9ural �mlu� W bo t�sed
Yid}fl
Atumiru�
O tki�x
ws
iN EXiSTlNG �PEAiiNGS OY� OAfu
�t FOR MI:W ClY�ntlNt;x.Dt.tiC;REAH SiZE �'
OPL•NiNtt Ci�IANG�5 &
TYPE oT Wti�iDt)w Tn BE iNSTAi,1.,EU
ALL �EES ARF, $ASED O1�I �'
Y.
; Permit Nee
Ptaa Rcvicw
Fire S�urcharge
Surchatge
License Surcharge
sAC: Cht�go
Curb Cut Escrow
�:rosion Gan[rot
!'ark F�c:
Sewer Main Cha�ge
Tota! Due
run
Ytetaa
I.�C:ATt(3N qF VYINDOWS
NUMDL-.R 4F U
(USIAiC THE 19�9?'
�.....�
S
$ '1
� .aa
$
S
S
$
S
�tG THE C(k�3T OF
FEE SCHEDULEj
FUii NEW CONSTRUCTIflN 1T�LIJIitNC I�X:KS.
A171lf'I'K7f�tS_ �. Pc�tt['HFt tf tw�,trr•
1. Site PIrn/Survey yhc+wing tlro cxiumg agucd�rea
+� proposcd praject
2 r,mu seu uf «n�auc�iun puuis
3. E�gy Calcut�m
AND MA'
sc.�e 8+�k P�e for Fe� Scheciule
65°�h of i3uilding Pent�it Fce
.�1 tirru3 tha ti�tul jrtb valuation
.Qf105 x Percnit Valuation Minimum $,SO
55.4� {Stute Lict�s�d Resida��tiai Comractors)
$ISSO per SAC Unit (E�iang t�r MWCC �or detereninatian)
fl+bft= ftX�21as
S�5[! G�nservation Ptaa keviaw
Fee i)etennined by �nginecring
Agreement r�cas�aty () Nw� NeeessarY i)
Matkt Ch�ks DayablC #o: C:itv ot Fridlev Attan
Ti[LS IS AiV AYPL1(:A 1'1(� FUR A I'ERMIIT•N(7T 11ALEU l!N'I ii.. NRUC:ESSED
I hettby Spply ftN' u builditlg pecm'tt eud I ACk�tOV�rl�g,e t11at the iflf`ocmetio�t 8bav� is Cc��plete E�d eCCUtsEt� thgt the wa�-k will !u in
conformanca with tt� ordinances anci eod�s af the City �f Fridiey xnd with the Minnesnta Consirwciion Codee; that 1 und�tamd this is not a
pcxmrt iwt only an application for a permit and wock is not to sinrt withuuc a partnit; that the wark wi11 be in ac;c;nrda,ice with the ap�ovc�d
plan in the c�se uf a11 work w`ch rtqu' es review and eppreyvat of pla�s.
r�
sii;��'i'1ttt� Uf' ,�{'i'WCAN _.!�-�!�.? C �_ PR1NT NAME„ �Ll ���Yi 4. Ni K u��rc �/a� l Uy
tid Wdb0:Z0 900� 9Z 'unt LB�Ti�5�9L: 'Clrl Xtl.� fiatpt.�� fo f,�tJ; W��
I SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� •
� �
; �� _ COMMUNITY DEVELOPMENT OIV.
r j •� PROTECTIVE INSPECTION SEC.
,
l•-_-� �"'�,� CITY HAII FRIDLE� 55432 NUMBER REV OATE
L 612-571-3450 9�0-F15 5/20/98
J08 ADDRESS 6160 Benjamin Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. (� 4 Rice Creek Estates
2 PFOPERTY OWNER MAIL ADDRESS LIP
Robert/Marjorie Simon 6160 Benjamin Street NE
3 CONTRACTOR MAIL ADDRESS Z�p
_ Sawdust Memories Inc 106 S France Ave, Mpls., MN 55416
< ARCHITECT OR DESIGNER MAIL ADORESS ZIP
5 ENGINEER MAIL ADDRESS ZIP
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
O NEW
8 DESCRIBE WORK
Kitchen Alteration:
9 CHANGE OF USE FROM
PAGE Of
� /
�PERMIT NO.
26075
�_��i
RECEIPT NO.
�5�'0
AVPROVEO BV
SEE ATTACHED
SHEET
571-6604
PHONE UCENSENO.
723-7532 2604
PHONE IICENSE NO.
�MONE LICENSE NO.
❑ ADOITION � ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
light, window, closet chan�e, widen arch
TO
STIPULATIONS
� Install smoke detectors to meet the State Building Code - in each
sleeping area and on all levels of the dwelling.
SEPARATE PERMI7S ARE REQUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOFi A PERI00 OF 120 �AYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DW
I HEREBY CERTIFV THAT I HAVE iiEAD ANO EXAMINEO THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATI
AND ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIED
SO.
STALLS
WITH WHETHER SPECIFIED HEREI OR NOT. THE GRANTING OF A PERMIT ] HOO
OOES NOT PRESUME TO GIVE HORITV TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER S A OF; IOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORM NC OF CONSTRUCTION. $1,3].2,5
PLAN CHECK FEE
License SC $5.00
AE OF CON'RACiO OR AUTMORi D GENT IDATEI _.....�.. �_____. .. .
A BU�LDERi IOATE� �
� -
OCCUPANCVLOAD
CU. FT.
EET PARKING
IGAfiAGES
$3.90
SAC CHARGE
Fire SC $7.80
TOTAI.FEE
$153.95
D THIS IS VOUR PERMIT
r��TE
�-1Ew
-��DDN
°\1LTER
[l
[l
[l
� ,�nstructionAddre
+:,egal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
x
Effective 1/1/98
��
�o �0
� ��
� 9wner Name & Address: _�o(�,yr �,���Q� � F `S 1 r� D 1�'�_ Tel. # S7 I!o � d�.
Lontractor: � �� � � �-7. �F ,,,,� � � , ,�� � u �, MN LICENSE #�_c�..,
�lddress: ��11�5 r=-2 f� � C� � � Tel. # � 2'?� --'�. � 3 Z..
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. �
�IVING AREA:
GARAGE AREA:
�ECK AREA:
DES ION IMP OVE
�
Length Width Height
Length Width Height
Len�th { , Width HgdGround _
UTHER: `�
�� o,,�
�onstruction Type:
".)riveway Curb Cut Width Needed:
�
Sq. Ft.
Sq. Ft.
Sq. Ft.
- � �
Estimated Cost: $`�] !� o O. o�
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ _$
:�ATE: 20 M� �°n �PLICANT: "S c o'r-r � � � � Tel. # � 2 3 -'�`S3 �
—Q
:'ermit Fee
`=ire Surcharge
atate Surcharge
SAC Charge
�icense Surcharge
Jriveway Escrow
�rosion Control
?ark Fee
��wer Main Charge
TOTAL
CITY USE ONLY
$ �'%- .��� Fee Schedule on Reverse Side
$ � � C� .001 of Permit Valuation (1 / lOth %)
$ 1 � (7 $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ � . �?(�? $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ )
�
$ �� S
STIPULATIONS: �/12t� �2�CZ��S
,� �y�1.�- o� �'�'
�!'t:dt.- �
� �
��
�r -'�
�� �� �.�r���l
�������
< < -
�0 1�c/
�
BUII�DING PERMIT FEE SCHEDULE
The Chief Buildi�g Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, ar for_.any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$SOl to $2,000
$2,001 to $25,000
$25,OOlto $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2,75 for each additional $100 or
fraction thereof, to and including $2,000 -
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, OOQ
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraetion thereof, to and including.$1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWA',Y���PRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFI�,�IO,N OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time �of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of � Survey of the �ot, sl�owing the location of the foundation once it has it has been constructed
will be rec}ui�ed before proceeding with the framing.
_.� , '
r .
�
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Bi�il�jn� PLUMBING
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-5�2-4977 Ft� EFFECTNE 1-1-OS
DATE�
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
_ --�NS���NCE
PERMIT TYPE
TYPE OF WORK:
❑ OWNER
NAME:�
ADDRESS:
STATE LICENSE #
STATE BOND # /
S�UR E-MAIL ADDRESS
�M / " �
)NTRACTOR
e ' C.�,� � � ►�
� ci� , � t
—S — �`tv
�..�c�-- l r3
v(Q � S�S'—� /Yl E,�
� 5 `i� ? ,� = 1 Exr
ADDRESS:��_/5� 5� -
_ _ - - _
PHONE �� ( — Z .! D (�
�NGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY
�PLACEMENT
S
FAX � s ( ^
❑ TOWNHOUSE
Sy 5
Permit No.:
Received By:' ' `'
Da�c�EC
ATEd�`'J�ZIP�1j�
� �aJ�o��o
TE �/�.l�f�
__ ST FYY/i/LiZIPSG.��/7
��-� � � -
��--.
PER MS 16B.665 the permit fee is a minimum 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. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXNRES: (INDICATE TOTAL
NUMBER OF EACH BELOV�. MINIMUM FEE $ I5.50.
_ BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
_ BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
_ CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
_ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ WATER METER OTHER
Permit Fee
TOTAL DUE
E�l
_ __ . . .. .... .....: �,;,� , m,�;� ,,., ,�,,. q;�_..,,.�.,
$�_• a'' Number of fixtures @$10 00 x$10 00 =$
.50 Number of fixtures @ $15.00 x $15.00 = $
$ � .5-�7� OR Number of fixtures @ $35.00 % x $35.00 = $ .�,5: tO
State Surcharge = $ �
. MINIMUM $15.50 Total = $ .s' ./
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 applicati ermi �wvrt� is not to start without a permit on site; that the work will be in accordance
with the approved pl in th of which requires review and approval of plans.
SIGNATU OF AP T PRINT NAME �y/����j .�r1 DATE 7 v
APPROVED BY
DATE
City of Fridley
Building Inspections Department
6431 University Aven�e NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
I�I
SITE ADDRESS � / I� Q
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF IMPRnVFMRNT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other _
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09 i
YOUR E-MAIL ADDRESS � r �a � h
OWNER �ONTRACTOR
Pernut No.� —��?5j
Received By: �
Date Rec'd: � �-' � �" �
ADDRESS: CITY STATE ZIP
PHONE:
STATE LICENSE #
PHONE_b «-' L.) t I1Ca l
�SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ ADDTTION
❑ BASEMENT FINISH
AI.DECK
❑ NEW HOME CONSTRUCTION
❑ MAINTENAN�E/REPAIR
EXP
S1ZE
STORIES
❑ ROOF ❑ DRAIN TILE
❑ SIDING ❑ OTHER
❑ SWIMMING POOL
❑ ADDITION
, ❑ REMODELING
�A%/
,_i
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
7
�
,�
BASEMENT REMODELING SUBMIT•
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
2
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT•
❑ Trim 1. Site Plan/Survey showing t6e existing structures
❑ Fascia and proposed project.
2 T t f
wo se s o construchon plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDpWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USIN�G� T 1 97 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �I� %S- "7��CJ OCCUPANCY TYPE �'��� ��
Permit Fee $ a See Back Page for Fee Schedule
Plan Review $ ,� 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ �� .0005 x Permit Valuation Minimum $.50
License Surcharge $ �;,� $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due $ . Make checks pa able to• City of Fridley Attach Stinulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
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 � Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application fo� ' 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,,�+ork h re review and approval of pl �,,..�
SIGNATURE OF APPLICANT PRINT NAME /,J /"!!4 h`��^ �U'bSUYI, DqT��� �/Q"GG�Z�/
PLEASE NUTE: SEPARATE PERMITS ARE REQiJIRED FQR PLUMBING,'ELECTRIGAL AND MECHANICAL WORK'`
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATE�oZ � I _
� SITE ADDRESS �
,.` THIS APPLICANT IS:
� PROPERTY i•IAME:
�W�� ADDRE
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
Permit No.:
Received By:
CITY OF FRIDLEY Daj��'�
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS
�m�n �-F nE.
OWNER K7CONTRACTOR
� C�_� � i ��� -
.Qilan rYi 1'nih �'� 11�, CITY �iPle�.�Q,u STATE�
� ��� ��
CONTRACTOR coMPANYNAME: CENTERPOINT ENERGY
SUBMIT A COPY OF coN-ra,cT PERSON: JOANN ZINKEN
YOUR STATE STATE LICENSE # BOND 22013346 EXP DATE � �
LICENSE WITH ADDx�ss:9320 EVERGREEN BLVD NW SUITE B cITYC00N RAPIDS sTATE MN ZIP55433
APPLICATION pHONE ]63-757-6202 FAX 763-757-6701
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: � �W �REPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
� ALTERATION/REMODEL
d l.i� i
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: �(j V n MODEL: �� `�f � SIZE/BTU �,��� W L
MFG: ��_ MODEL: L� iY1d2,.�-�- SIZEBTU a.."ip (i
MFG: MODEL: SIZE/BTU
� A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN 510.00
_AIR TO AIR EXCHANGEER $]5 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL 510.00
_BOILER 535.00 �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 510.00 _VENTILATOR 515.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L 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 all work whi h r uire r view and approval of plans.
SIGNATUREOFAPPLICAN�� �° �` � • PRINTNAME ROGER HOFFHEIN DAT
E
City of Fridley
Building Inspections Department
6431 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-LTP AIR
REQUIRED FOR NEW/EXISTIN� HOMES
1. Combustion Air (See note below)
- - _ __ _--
---- a: 6i1 or sord��'uel IIv1C CFiapter 7 with 1VIN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2: Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
__ - --
6. Duct Desi n�L Per I_MC 1346.0603.2 ___ -- -- -- - -- -- -- - _ _ _ _
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.