AF - 35545r��
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City of Fridley, ll�inn.
BLiILDING PERMIT
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Owner .......................................
Addre�ss ......................................
Builder .��� ,
N° 3�70
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Address .............................................
LC�CATIO�V OF BUILDINC
No. .�.�.� .... Street ...�-�:..... ... . ....... ..... Part of Lot ...............................
, +
LoC rner•Lot•...... Btock .................. Additfon or Sub-Dfvision ... . ...............
.......
$
. . . Inside Lot . ' . . . . . . . . . Setback . �: . .! �.�". . Sideyard . /� . . .��. . �. . . . . . . . . .
DESCRIRTION OF BU[LDING
To Used ,�
�g �
.R . . Front .�k': . .i� Depth �� . � Height ��.'� � 5q. Ft.
• �D. �� c�. �. ��� .�.��°
. .. . . . . . . . . . . . �. . . . lrrorxt . . . . . . . . Depth . .. . . . . . Height . .� . . Sq. Ft. . . . . . . . . Cu. F't. . . . . . . . .
Type of Construcl3on . . . . . . . . . . . . . . . . . . . F�t. Cost. . �� �. � .�. . . . . . . To be Completed . . . . . . . . . . . . . . . . . . .
In consideration of Yhe is$uance to me of a permit to construct the building degribed above, I agree to do
the proposed work in accordanc:e wlth the description above set forth and in compliance wfth all provisions of
ordinances of the dty oP Fridley. � � �
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.,
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In consideration of the payment of a fee of $.. ........, permit is hereby granted to ...................
..... .. .... ....... ....... ta construct the bwllding or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and hfa agents� employees and worlunen, fn all work
done in, around and upon said building, or any part thereof, shall conform in all resgects to the ordine.nc�es of
Fridley, A2innesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the dty limits and this permit ma.y be revoked at a7►y time u�on violation of any of the provisions of se3d
ordinances. :
NOTICE:
... Building InsPector
v
Thla permlt does not cover the construotian, Installatlon o� alteratlon for wlring, plumbing, gas heating,
sewa� or water. Be sure 4o see the Bullding Inspecsto� fo� separata permits for thess Items,
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APP�;�GATIaN FflR BUILDING,PERMIT
CITY OF�FRIDLEY, MIINNN�SOT�"""
Owners,Name- _ r , ,��;�
Builder_ ���� 4� e �y�� ���c.i �
_ �
Address . �.; - , . . - Add�ess ���� � a'�"" �' �7'Q ��. ' ��
. .. � , .
_ .
-- - ,�; .-.:
LOCATION OF BUTLDIN�� �
. . . ; � �.. ;
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No f��% Streat ����.�-.�!�!� P€rxt of _Lot -
' _ ,, .. Q > l �
Lo� ,��. ;Blq;ck �, . _ . �ddition _or Sub. Di:v-;
Corner Lot. � Tnside Lot � Set Back ':�� � -.
App,licant: ;�attac,h to -�his :form Certificate of Survey of; I,at: ,and proposed .. ,
bu.ilding location� _ ' -
-�-�: ._ _ _ _ _ _
, _ . ,_ ,
� DESCftIPTION OF BUILDING - � - ` �
� � � _ _ ..
., To be used as
P � �. _� _ . _ ( %l . � ` +
�� Front �� �, Y7eptY��Heig�t ,�;. �.�.. . .
,.; :,
,. ; t
-�q. Ft. - , Cu. Ft. -. . ; .
Front Depth Ne3ght
Sq. ,Ft. ..,,-,. �. . Cu.. .-F'i., �,_ . , _ _
..- ; . �
e of Co,nstructi�on ��� �?�'� :...
T3�P . Es�ima�ed Cost .
', To' be completed �� _ . • _ _ : .
�., - .�_ :' . _.: ,.
The undersi�ned,hareby ma.�tes application for a p�rmit,for the work
her-�}n sp�cif3.edr agreeing to do all work in��str'ict.�accordance with the..�
, . __
C�.�y, Ordi.na�ac�s �.zad ruling . of the Depa,rtment of Buildings, and her�by." :
declares that all the facts and representations stated in tn�.s application
�
-,�,
are �r,ue. and` cor.rect. �:: . . , _ . , ' _
Date a'� �� �'�� Signature �-----�. �,,��
�(A Schedule of Fee Costs can be found on the Re�rerse �ide')
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BUILDING PERMIT �"EE SCHEDULE . �, .
Section 2. The Inspector of Buildings sha]-1, before issuing any permit
for the erection of any.building or structwre, or for a.ny addition to
any existing building�or structure; or for any-alterations or rep�a.irs to
any existing building or_.structure, upon applica.tion therefor, require
the p�.yment b�r the--apglicant for such permit-of fees to the amount
herein below set forth and in the mann.er herein provided to-wit:
2.1 For any sueh perr�it for the er:.�ction of any fireprooi building�
other than a garage, warehouse, factor�r or grain elevator, or for the
.:.,..
erection of an� fi�eprQOf �.ddition, for simi.lar occupancy, to any
existing building shall be at the rate of-�1�4a-for e�.ch one thousand
cubic feet, or ira c-t�.on thereof, in such cubical contents.
2.2 For any auch permit-for-the esection of any fireproof garage, ware-
houae, factory or grairi'elevator, or for the erection of any fireproof
addition, for similar occupancy; to any existing buildirig shfa.l.l be at the'
rate of �1.25 for each one t•housand cubic.feet, classified as "fi.reproof"
by Section 502 of the Minneapolis Building Code�
HOUSES � � -
2�3 For any s�.e� per�it iox the erection of any non-fireproof building -
other thari a garage9 warehousr�, factory or- grai.n e7��vator, or any -
non-fireproof addition, for similar occupancy, to any existing building. --
Permit �1.00 for each one thousand cubic feet: - • � _ „ ,
GARAGES _. - .. -- � _. . ,
2.1� For any such�permit for the erection of any non-f'ireproof garage� -�
warehouse, factory or grain elevator, or for �hE erectir�n of any non- . `
fireproof addition; for similr�r occupancy, to any existing building or
for each such building or additione �Nirie�ty �ents for .each one .
thousand cubic feet or fraction thereof, in the cubical contenta thereof
with a minimun of �4.00 � - - . .. _ . _ _
For tfie purpose of computing fees for building permits the cubical •
contenta of any bu:ilding or addition to a uniform hei ht throughout by
multiplying.the ground area covered from a point six �6) in�hes below
the flaor line of the basenent or_ cellar to the average height of the
upper. surface or 'co the a,rerage heignt of the roof surface of the .main�
gable of a pitched roof� .
2.5 For repairs or a.lterations to an existing structure, the fee sha.11 �
be at the rate of �3�00 for eacli Five Hundred Dollara (�50�.��), or ,
£raction'thereo� in-the cost of all �roposed work,
2.6 In no case ��hall the fee charged ..�'or any permit as set forth in ~� � �
Section 2 be 1ess�than �4e00�
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Phone: GReenwood 3-8352
ARLEIGH C. SMITH
Aegisfered Psofesaional Eagiaeer and Land Surveyor
16215 Wayzata Soulevard Wayza3a, Minnesota
OF PROPERTY OF.
PLaT QF SYRYEY
�
described as follows: �+�' � �
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Scale: 1 inch ���' feet. //! i� ����`iL�,
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CERTIFICATE OF LOCATION OF BUILDING
I hereby certify that o �- �' ��`�' 19-� I
made a survey of the proposed location� of the building
on the above described property and that the location
of said building is correctly shown on the above plat.
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CERTIFICATE OF SURVEY
I hereby certify that on �''���.�'`.,._____"� 19 4°� ��
surveyed the property desc�'bed�above and that the
above plat is a correct representation of said survey.
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Cit� of Fridley, Minn.
BUILDING �'ERMIT
Date: �une 7.la., 196�'
p�r: Fred Bo��
Adar�� 7l�9 Bennet� Dri�e
� /
� � /
N° 7��3
B��, Chester Mae�.as�ek
aaa� 6380 �c� �t. �t.E.
No. ��'9 stceet
Lot 8 Block
LOCATION OF BUILDING
Be�aae�� l3ri�e
Part of Lot ._
1' Addition or Sub-Div3si�► Ch�istie
Coraer Lot _ 7neide Lot Setback — Sideyard
SeWer IIevatia� — Foundatton Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft
Front Depth I�eight Sq. Ft
Type of Construction F�t. Cost 13s� _ To be Completed
Cu. F't
Cu. F't.
ftepa3r �torm Damage
In consideration oP the fssuanoe to me of a permit to construct bu3lding described above I agr+ee� to do
� P�P� work in accordance with the d�scription above set f 3n compliance with e�11 proviafons of
ordinancea oP the dty of Fridley.
� �
In ca�ideratian oP the Pa3�ment of a fee of $ 1��� �e8$er
�iac�asZek , Pe�t is hereby granted to
to conatruct the builaing or addition as d�cribed above. Tl�ts permit is granted upon
'Ehe exPress conndi'Lion that thepers on to whom ft fs granted aad his agents, employees anc� worlrnaen, 3n all work.
done fn, around and upon safd building, or an3' Pert thereo� shall oonform �n all reapects to the ordinaaces of
FridleY. Minnesota regarding la:ation, construction, alteration, maintenance, repair and moving of bufldings
within the dtq ]imits and this permft may be sevoked at any time upon violation of aay of the proviaions of safd
ordinaacea.
AZl.en Jenseta �� �r
NOTIC�
7'W peemif do� �rof eo� t6s eo�hveHoe, t�talltlion fop rri►te9� P�+�e. 6p 6�8. ssw�r er watar. 8� weoe fo as
t6e Buildioe I�Or tm' pPa►ata � foe f6�w N�nn.
APP'LiCEiTIOIQ F�R BUfLDING P&RM[T
. CITY OF FRIDLEY, MII�INESOTA - _ ,
owrr�R � s ri�r���.�i�_;��� � � BUiLDEB �¢�.�.��� �' �,� d��'i���' �
. . .,
ann�ss� �� ���,�'� ,.�„�� ���°. . �nnx�ss- � a � a� ', r'� �� f`,�✓ ��' �'' i ��s � .
� LOCATION OF BUYLDING '
No. � r�'� � . Street� ����',�� ,� �a�.f �'��art ofP Lot,.
. , .,.
LOT� ^ HL�R /� ADDI�ION OR SUBDIVI�aION ��F'`� �ft` ����
Co�ner L�ot�Inside LOT �- Setback Side Yard
3EF�ER ELEVATION � FOUNDATZ0�1 LLEVATIaN�
•,. • , . _
ApplicanE attagh to this form.Two CerCificates of Surveq of LoC and praposed
building locatfon drawn on,t�iese CertifieaCe§. �� � � •
., :, . 1
1�� �',, `I'� ,' 4 ;&'���iiio� � Y��Y�V.., . . r �. .�_.,/ .
�� � ���y �� .�� �.��
To be us Sd as : ���' o�`" Q .
�� ` � '� ` � � Frant - Depth �eighC. •
�_ ,
� � . � , ..� ..,
3q. Ft, Cu. Ft.
Frent Depth ` Aeight �
. Sq. Ft: Cu. Ft. ' ..
Type of� �ar�gtruction Estimated Coat ,�� ��
To be completed .�,, `� ,�,r�'� � :�
. ,
The undereigned tiereby makes application`for�a permit for Che work herein epecified,
agreeing to do�all work in str3ct accordance�wi'tt� ehe City of.Fridley Ordiaances
aad rnlings of tlie DepartmenC of �Buildings, anct"�t�e�eby� declares that a11 the facts
and rep�esentations stated ip this application'�re true and correcC. �
, .
P
DATE . _ `
'�e �'.,i `G� �--� S�GNATURE � � o. " � 6,� .
(Sche ule of Fee Coet� caa be found on the Reverse Side).
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BUILDING PER1�T FEE SCHEDIILE
SECT_ ION 2. The Inspector of Buildings shall, before issuing ang permi.t for the.
erection of any building or sCrucCure, or for any additian to any esisting build-
ing or strv.cCure, or for any alteraCions or repairs to anq e�isting building ar
structuse, upoa agplication therefore, require the;payment bp,the applicant for
such permit of fees to the amount herein below aet foreh and in the manner here�Ln
provided to-wit; .
2.1. For any such peranit for the e�ection of any fire-proof buildin�,
other than a garage, wa�rehouse, factory or grain elevator, o� for the erection
of any fire•proof addi�ion, for aim33ar occupancy; to any existing building,
shall be at the,r�te of,$1.40 for each aiae thousand cubic feet, or fraetion
thereaf, in such cubic�i contents.
�� 2. For anq �uch permit ior tite erection of anq fire-proof garage,
War�hou6�e, factory or �rain eleva�or, or for the erection of any fire-proof
addition, �o� �imilar bccupancy, to anq existing buildiag sha11 be at the rate
of $1.a5 for each one Chousand cubic feet, classified as "fireproof" by
SecCioa ��2 of the Minaeapolis Bulldiag Code.
flOIISES �
2.3. For anq such perm3.0 for the erection of any aan•fireproof buildin�,
other tban a garage, warehouse,,factory or grain elevator, or any non-fireproof
addition, far similar occupancy, to any exieting buildiag - permit $1.� for each
one thousand cubic feet.
GARAGES
_.__..__....
2� . For any such pesmit for the erection of any non-fireproof garage,
`aarehouse, factory or grain elevator, or £or the erection of any non-fireproof
add�eion, for similar occupancy, to any enieting building or for each such
building or addition - niaety cents {$0.90) for each oue thousand cubic feet
os fraction the�eof, in the cubicai contents thereof with the minimum of $4.00.
For the purpose of camputing fees for building permits, the cubical contenCa
of any build3a� or addiCion to a uniform height throughout by multiply3�ng the
ground area covered fram a point aix (6) inchea below the floor line of the
basement or cell.ar to ehe average height of the upper surface or ta the average
height of the roof surface of the maia gable of a pitched roof.
2�.5. Far regaira or alterations to an ex3sting atructure, Che fee ehall
be aC the rate of $3.00 pez each Five Hundred Dollars ($500.00) or fraction
thereof in the cast af ail proposed work.
2.6. In no case sha11 the fee charged for any permft as aet forth in
Section 2 be lass then $4.00. '
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CHIIVINEY AND STACB i�ERIFICATION
The undersigned hereby verifies that the .exiscing chimney or stack:
1. - Has been carefiilly examined � � Yes ('�j No O
2. Is free from n�st or deteriordtion Yes (� No ()
3. Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of �
All other BTU's
�
Yes (�C ) No ( )
Yes (?U No ( )
Yes (X) �To ( )
TOTAL BTU's �
7. Has a liner been provided for wat�r heater Yes () No (�)
8. Has combustion air been provided for water heater Yes () No (�)
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
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C17YOF
FRlDLEY
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FRIDLEY MUNICIPAL CENTER • 6431 UNNERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
May 17� 1999
Fred Bosak
749 Bennett Drnre NE
Fridley, MN 55432
Re: Final inspection at 749 Bennett Drive NE
Contractor. Marsh Heating 8� Air Conditioning
Dear Mr. Bosak:
A mechanical permit was issued on April 12� 1998 for the property located at 749
Bennett Drive NE for a new fumace and air conditioner. According to Section 305(a) of
the 1991 Uniform Mechanical Code a final inspection shall be perFormed on the
mechanical permit. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do not
hear from you� we will expire the permit and any inspections on this installation will
require a new permit.
Any questions can be addressed to myself at (612) 572-3603.
Sincerely,
�/. �
Barry Riesch
Building Inspector
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CIlYOF
FR[DLEY
FRIDLEY MU1vICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
October 2, 2000
Fred Bosak
749 Bennett Drive
Fridley, MN 55432
Re: Final Inspection at 749 Bennett Drive
Contractor: Robillard Plumbing
Dear Mr. Bosak:
A plumbing permit was issued on April 28, 1998, for the above noted address,
to install a gas water heater. According to section 4715.2800 of the State
Plumbing Code, a final inspection shall be conducted on the plumbing authorized
by this permit. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we will expire the permit and any inspections on this
installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DRbf�"��d'E�JSEN
Buildyfig�t4ispector
sue�ecT PERMIT NO.
City of Fridley 2 710 3
AT THE TOP OP THE TWINS g � I L D I N G P E R M I T
i � RECEIPT NO.
� �
COMMUNITY DEVE�OPMENT DIV.
r � �' � � PROTECTIVE INSPECTION SEC. ��
� i
1 � �
( /�"1 � CITY HALL fRIDLEV 85432 NUMBER REV DATE PAGE OF APPROVEU BV
�°"� � �'' 612-571-3460 910-F15 8/11/98 � /
JOB ADDRESS
749 Bennett Dr
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 8 1 Chrisf�e Addition SHEET
2 PROPERTY OWNER MAIL ADORES$ ZIP PM�NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Stock Roofin Inc 289 Libert St Fridle 780-3561 3112
< ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 2�P PHONE LICENSENO.
8 USE OF BUILDINO
Residential
7 CLASS OF WORN
� NEW ❑ ADOITION 0 ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and ara e 24 S Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY (3HOUP OCCUPANCV LOAD
VENTILATING OR AIH CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTpUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GAHAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER $ ATE OR LOCAL LAW REGULATING CON-
STRUCTION OR T ANCE OF CONSTRUCT�ON. F+�I'0 SC .00
PLAN CHECK FEE TOTAL E
.7S
SIGNATURE OF CONTRACTOp OR AUTMORIZED AGENT IDATEI N P OP IDAT NIS IS R P MIT
•
y �
S�GNATUAE OF OWNEFI�IF OWNEA BUILDERi IDATE� BLD �NSP �747E
- - s s
NEW [ ] ' Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY �
ALTER [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION � � b ')
� �
�
ConstructionAddress: � �i� /� �2,ns e 7f
Legal Description:
Owner Name & Address:
Contractor: S-,
, ��-
, �
Tel. #
MN LICENSE # 3 lr�
Address: � � d� `�6-�$�,� �� {���� Tel. # � ��- � �� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
DESCRIPTION OF IlVIPROVEMENT
Length
Length
Length
��
Driveway Curb Cut Width Needed:
DATE: � �% �� �'APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License 5urcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Width
Width
Width
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground 5q. Ft.
Estimated Cost: $
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ _$
�
CITY USE ONLY
Tel. #
�
$ �. � Fee Schedule on Reverse Side
$ � �� .001 of Permit Valuation (1/10th%)
$ /, Q� $.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 [ ]
$ c��- ��
BUII..DING PERMIT FEE SCHEDULE
The Chief Building O�cial 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 (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,(100 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 $1�,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $S4U,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,�0
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "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.
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 construc�ed
will be required before proceeding with the framing.
Building
Inspections
7. 63-572-3604
�I.
MECHANICAL
ytES�EleTTIAL APPLICATION
CITY OF FR�LEX
Permit No..
Received By:
ec1� �
DA7'E /` d° ° b� YOUR E-MAIL ADDRESS
srr� �DxESS ��l e. �� L l�-F- �� ' F�e r o(
THIS APPLICANT IS: 0 OWNER r�CONTR.ACTOR '
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
NAME: ��-�'O %3�S,Q l�
ADDRESS: "7 '-0 g 1� L✓� +� �. �' � l� r CITY �R i!J I � STATE �-'l �ZIP,��l J--
PHONE: � 63 - S 7 �'.3 y b�
COMPANY I�IAME: t v� r �. � 51� .� L 9'"'l ��.a I
CONTACT PERSON: C. �-+ �: � ��
STATE LICENSE # EXP DATE
ADDRESS: r� �� v ��- �"' S"� �� CITY l�� � U I� STATE �? cl ZIPJ J`I b L
PHONE `7 `� 3'� J�J �I i�1 FAX
Ap SINGLE FAMILY ❑ TWO FAMILY
p�W �(REPLACEMENT
O TOWNHOUSE
a n�x.ynoN�MOn�a.,
DETAILED DESCRIPTION OF WORK .-L� �A� l ��- �°����°�'��
P`v.,2.,�AL�-
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
i m provemen t, 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 =
FOR PROJECTS WI�RE 1-ABOR EXCEEDS $500, FEES ARE BASED ON SI0.00 PER FIXTUIZE, EXCEPT VJHERENOTm. FIXTURES: (II�IDI�'TE TOTAL
NUMBER OF EACH BELOV� MODEL: fl� �L 0 bf e'1A � 5 SIZEBTU (� 0 a � o
Equipment Installed , MFG: � `�'v'�' SiZFJBTU '
MFG: MODEL: SIZFJBTU
�C,; MODEL:
A/C $25.00 _FIREPLACE (GAS) $15.00 . GAS RANGFJOVEN $10.00
_AIR TO AIR EXCHANGEER $IS FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOII.ER $35.00 �FURNACE $35.00 GAS UNTT H1R $10.00
—CHINd�igy LII•IER $10.00 _GAS DRYER $10.00 _POOL HEA1'ER $35.00
—
_GAS PIPING $10.00 _VENTZLATOR $IS 00
DUGT WORK $10.00 .._ __.......,,�,v . �:,�;.:�r�..:...��rt;,�-���--r;ti�v��:t�i+�+�+�a3:' :�'�r5
. '�,��..�.��,3�','... ..�.°�.,.,..�...:�'.Pa2V.A�,YJ,?LL�7uirsra�-+v.':?;.w�q?mncr. .:u «r ; . .,r.:, _ .,-.... ._.__._......__
Perm�t Fee $ ''> �. � o Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DiJE $�_•� Number of fixt�ues @$ZS.00 x$25.00 =$
Number of fixtures @$35.00 f x$35.00 =$ 3.S . J"
State Surchazge = S .50
Total = $ .� S. Sa
THIS 15 AN APPLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accwate; 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 petmit 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 (. �!Ll o A� .�—PRTNT NAME �� r<S �.t�,p� DATE �' c� ' 6�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
...
REQUtRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC �
❑ NEW HOMES/ADDITIONS ❑ EXISTtAIG HOME ❑ MAKE-UP AtR
REQUIRED FOR NEW/EXiSTING HOMES
-1.___ �o�busti�Air (�ee note below) .
a. Oil or solid fuel ]MC Chapter 7 with MN 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 Am.endmen.ts
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendm.ents
b. Fuel other th.an gas IMC Chapter 8 with MN Amendm.ents
REQUIRED FOR NEW HOMES
4. Heat loss & cooli.ng load per room
a Required on new constru.ction IMC 1346.0312
5. Ventilation .
a, per MN En.ergy Code 7670 or 7672
6. Duct Design Per ]MC 134b:0603.2
a. ACCA Manual D
,
N01'E: Centerpoint Energ3T Mechanical Code Guidelines software may be u�ed for
comb.ustion and make up air calculations
� �k
�.
��6������
RE�iDEN�'9�►� APPLICAii�N
�:i� �f {�9'9t�1@lf
� _ `�' �'
Permit NtanAer
Recanred By
Date ReoBivetl
Bd0'TE: IF PROPERTI 6S iVQT OWNEii/OCCl1PIED- A UCENSED �NTRACTOR MUST OBTAIN THE PERMR.
DATE 6�'� -�� YOUR Ed1AA1L ADDRESS
SITS ACDRESS �'-I �i 3t n � � i-jc � ✓ ��
YHE APPLICANT IS: (CIRCL� QNE� CNYNER
NAME �c � p d�s� b A k_
PROPERTY OWIJERJ ADDRESS �`f 9 � L✓1 i� L�-� � r (� d=
TENJ0.WT
CtN �� _� �� S'f/�TE � i9 ZIP �; �¢ � �—
PHONE 2� % � � ' � "? ! � � � 6 �
e,oS�DQ,� ° NAl1E ��., llrc,r �C�` �� ��-� 4�LE-A 1
1-°� � G� a-✓1 lG'0 I UCENSE #
. ADCRE69 � � � ° � 0.-� .-� S� N '�
' r.��'rora � �= � �I sra'rE e--a � _ z� S, �f3 �
PHONE ��I b 3-° �.9 �' o� I FAX#
PERMIT iYPE
TYPH OF WORK I ❑ N�Y
�
1W0 FAINlLY
� RSPLACEMENT
DEiAiLED DESCRIPTlON OF WORK �� S�A i C ���o ( a� c i�d a n-¢- (e� A d�� Yd4 � E*-'�
FEES AR� SASm OW S10.OQ PR_Ft FD�iNRE, BXCLPT WNERE N07ED
FIXTURE9: (INDICATE T07'AL NIlIVIBER QF EAt�i)
BATH SpUWlAV PWOR DRA�IS SHOMYEIt 1M1IATER PiPIMG
BATHTU6 GAS PIPINL3 (Need CHy Cicertae) S11Y�INll�G POOL 4YAT� SCFrENER ts351
CL�T1iE9 WASiiER KITf�1EN SIMK WATER (�qSEI' BACKFLOW PREV. ($95}
D6�3NWJ18FIER LAl1NDRlr TRAY ,�WA'iFaR FftR (�36� FOR 1liRIGA710N
. WATER ME7ER QTHER
Permit Fee
Plan Review
SurGharge
TOTAL DUE
� � .�. O C.�
S
S .54
5 °J�-J °
MINIMUM: $98.00 or 5'/0 of Co� of tHe improvement-whiCtfevet is
greatec on wark less Eiran $3Q�
Make clt�cks payable to: City of Fridley
� r.•v w.... .�-ra.��n� wn rvrs e� rc�cml l�^ I�V 1 YN{.W Ylf �IL WK{74C55�{7
I herebY sPP�Y int a plumb}ng p�rmit a� I adcnowledge that tttts i nEormatan sbove is aomptete and aocuratA: that the worlt ariil be (n CatfOdnatroe wi�
the ardinanoes and codea of tha Clb of Fridfey arnf wiUt tha NGnnesotet Go�ctlon COd9s: thet I undeisland t1u.S is not a pertrtit but orrly an
applioation for a pem�it and work is not to start rrilh�t a perrmk that the w�lc wiH bp in accordance wifh ths apprpv�d plan in the case of a8 work which
requir�,a rav{�ar antl approYai of pl�
tVAMEOFAFsPLJCANT DATE �3 �v
Please fype p print
StGtyATURE OP APPLiCARIT
TOTAL P.01