AF - 380655 UBJ E C T �,.EEi�'M��,.N .�.. .,
City of Fridley �, 2 6 42 S, .
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T ��sMn
r
� ` RECEIPT NO.
� ` __.____ COMMUNITV OEVELOPMENT DIV. �/
r � V � PROTECTIVE INSPECTION SEC. �j ,Q �/
� �
1 i �/ I/
, � �'��� � CITY NALL FRIDLEY 55432 NUMBER itEV OATE P�GE OF APPROVED BY .
�""� � �'� 612-571-3450 910-F15 7/2/98 ' / /
108 ADDfiESS 6407 Christenson Lane NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 47 1 Christenson Crossing SHEET
2 PROPERTY OWNER MAIL ADDFiESS ZiP PHONE
The Rottlund Company Inc 2681 Long Lake Rd, Roseville, MN 55113 638-0500
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO.
Same 1335
♦ ARCHITECT OR DESIGNER MAIL ADORESS 21P PHONE LiCENSE NO.
5 ENGINEER MAtL ADDFESS 21P PHONE UCENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
l� NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
B OESCRIBE WORK
Construct a 48' x 25` Townhouse and a 21' x 20' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Paid Park Fee of $350.00.
������� .
Before .digging call fot
`�ARATE PERMtTS RFQtI��p � a�i �ti�ity �ocations
�I►IRiMG. f�El�'i��, PtU�B�N� AND StG 45a-oQO2
t� R�QUiRE� BY LAW
tYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPARATE PERMITS ARE REOUIREO FOR EIECTRICAI, PLUMBING, HEATING,
VENTILATING OR AIH CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2E0 IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTpUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WOFK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TMAT I HAVE READ AND EXAMINED THIS APPLICATION ], STA��S GARAGES
AND KNOVV TME SAME TO BE TiiUE AND CORRECT. ALL PpOVIS10NS OF LAWS VALUATION SUATAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTiNG Of A PERMIT �79 � 989 $39. 99
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE pERMI? FEE SAC CMARGE .
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $762.25 Fire SC �79.99
STRUCTION OR THE PERfOFiMANCE Of CONSTRUCTION.
�� PLAN CHECK fEE TOT FEE
�" � ' g License $5 . , 887 . 23 + PF
uFlE 0� C � n R OR AUTNOAIZED AGENT �DA7Ei EN R P VALID T THIS IS YOUR PERMIT
I
� �
--S�GNATUREOFOWNEA�iFOWNEABU�LDEAI iDATE� �p5p � naTE
NEW �
ADL'N [ )
ALTER [� ]
ConstructionAddress:
LegaI Description:
CITY OF FRIDLEY �
SINGLE FAMILy A,ND DUpLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
3
�
r
Effective 1/1/97
a��ra� �
���
_ - �_
Owner Name & Address: � u� ��-�-L��� (�, �-a�,, ti�� ( N C�.. Tel. #
La�..� O
Contractor: S)q m� � MN LICENSE #__ ���r
Address:_ ,��a$ � �,� ��G -����� � L�E M I�i 5J ! Tel. # _ !� �$ -- p �C)p
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
- .' DESCRIP'rION OF-Il�IPROVEMEI�IT_
`1t�3�-s - �� 11 �
_ �G s
LNING AREA: � Len - � �r
��X�•� = ��
. S� � �� Width -t�u Height �f � � �� Sq. Ft. 3
GARAGE AREA: I.eII �" �„ r h --�� %
� �/ � Width �-0 Height /� Sq. Ft. _���
D�CK AREA: Len g t h W i d t h H g t l Groun d Sq. Ft. �
UTHER:
, . . � l7 lt3 7, �
Construction Type: ' '
Fstimated Cost: $ / ,�j
- ,
� (Fee ScheduZe on Back)
Driveway G�rb C�it Width Needed: Ft. + b Ft = Ft x$ —$
DATE: __ �O - �q- � APPLICANT: � L� ,C._C� - Tel. # OSGt�
��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
:rosion Control
?ark Fee
iewer Main Charge
TOTAL
TIPULATIONS:
CITY USE ONLY
$ 7�. � S Fee Schedule on Reverse Side
�_..�_ % .001 of Permit VaIuation (1/lOth%)
� � 9_ ,�_ $.50/$1,000 Valuation
�� G� $+�S�per SAC Unit �
$�- � v $5.00 (State Licensed Residential Contractors)
$ -�''' Alt. "A" or Alt. "B" Above
� •$450.00 Conservation Plan Review
�_ ��d- �� Fee Determined by Engineering
$ � Agreement Necessary [ ] Not Necessary [ ]
$ ���3
I3UII,DING PEIZ���[T CEE SCHEDUI,Ei
"I'he Ctiief Building Ofticial slia(l, before issuing pern�its for the erection oC any building or stcucture, or fi�r
an}� addition to any existing building or structure,� or for any alteration or repair to any existing buildin� or
sttucture, upon application therefore, require ihe payment by the applicant forsuch permit of fees to the amount
herein below set forth and in the manner herein provided to-wit: � .
TOTAL VALUE
� 1 to $S00 �
$�O1 to $2,000
�2,001 to $25,000
�25,�1 to $50,�00
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,OOp
$62.25 for first $2,000 plus $12.50 for each additional $1,000 '�
pr fract'ion 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 $SO,ppp �
S50,001 to $100,000 $574.75 for. first $50,000 plus $6.25 for each additional
. $1,000 or fraction thereof, to and includiug $1p0,OQ0
�100,001 to $5Q0,000
aS00,001 to $1,000,000
>1,0�,001 and up
$887.25 for fust $100,000 plus $5.00 for each additional
$1,OOO�or fraction thereof,.to and inctuding $SOO,OOp
$2887.25 for the first $500,004 plus $4.25 for each �addidonal
$1,OQ0 or fraction 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
DRNEWAY DEPRESSION ESCROZ'V
(Concrete Cti,trb Streets Only)
�lternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
�lternate "B": Removal and replacement of curb and gutter and install a 3 foot wide •
approach �vith 6 inch depth - Driveway width plus 6 feei tiines $15.75. . .
VERIFICATION OF FOUNDATIO�'
.
e:�nits for construction will be issued a minimum of 24 hours from the time of application to allow for prop�r
:�•iz�t• of the proposed stcucture and of the construction site.
C:r�eiiicace of Survey of tlic lot, showing the location of the foundatio�i vr�ce it has it has been construct;:::!
�.: ��� r�quir�d hefore rr��c;eciiin� �vith Nte frainin�.
Sheet1
EXTERIOR ENVELOPE THERMAL TRANSMITTANCE WORKSHEET
ROTTLUND CO. INC. PRODUCT: ASHTON
DEVELOPMENT: CHRISTENSON CROSSING CITY: FRIDLEY
SITE ADDRESS: 6407 CHRISTENSON LANE DATE: 6-19-98
ASSEMBLY AREA (Sq Ft) U-FACTOR U-FACTOR X AREA
CEILING/ROOF
EXPOSED WALL
INSULATED AREA 1924.57 0.047 90.45
FRAMING AREA 339.63 0.107 36.34
WINDOWS 162.00 0.500 81.00
DOORS 37.80 0.350 13.23
RIM JOIST ;,,. ; `� 0.00 0:045 0.00 ;
.. ;-
FIREPLACE WALL .. = :` . ;: • 0'sOQ 0 0.00 °:
ABOVE GRADE FOUNDATION WALL ' 0.00 ' 0.084 0.00
FOUNDATION WINDOWS ' 0:00 ' ' "' . 0.00
FLOOR OVER UNHEATED SPACES (U = 0.04) 0.00 0.00
OTHER 0.00 0.00
TOTALS E 2464.00 F 221.03
AVERAGE U-FACTOR: F / E = G G 0.090
REQUIRED U-FACTOR (from Energy Code) (U = 0.110) I3 0.110
If C is greater than D, or G is greater than H, revise the design as necessary to meet the envelope criteria
of the Energy Code.
1) U-Factor for skylights and windows must be deternuned by the Nauonal Fenestrauon Rating Council Standard 100-91 or
ASHRAE 1993 Handbook of Fundamentals, Chapter 27, table 5.
2) Thermal Transmittance of opaque components (including integrally insulated masonry and metal stud framing)
use part 7670.0450, subpart 4.
Page 1 � , ,
, : . ,.; , . .. . � � . . ..- _ _ _ _ . . �. ,.
_. _ . ,: , , � .,
' ' � HOUSE HEATING TEST RECORD � �r�J`'' ���1
� f'° �'' ., � -- � , , i / ,, � � � � �
ADDRESS ' - ' °'"�� PT. FLOOR CiTY �_SUBURB
OCCt1PANT f OWNER
HEAT t05S DATE HT INST. �° rr `N"
._ , ,-,� �� .,� .
' OLD BY ��� INSTAI.LED BY �F f
l�ctrieol Wor� Gos Lin� By '"
YPE OF HEAT GA FA � HW 57EAM SPACE H7R. UNIT HTR. OTHER
,�. . S EbIGN CONVERSION
MAKE MAKE OF BURNER
AAod�1 . ,..Model _ �- .�"` - — – -
�
S�rio1 Mea. �TI � R�r;..�
tNPUT �`MAKE-0F FtJRNACE �
_.,;Model �
CONfiROLS l � f� /.%
THERMOSTAT -� � H Ivg �`f Vent Si:e �� ,
Yciv� KIND OF LINER SIZE N.O�NE..L�
Limit Draft Hood R�qulator �� a�
Limit S�ttiny � Filters Size ��' � Numbsr ��`
Fon Settinq Chimn�r Location / Insid� Outsid� � !
Pilot Typs Chimney Constroetio�
Pilot Moke ��./`%���.,�`('".
Pilot Medel � �p Smoke Bomb _Wiring
Pilat Tirning '� �!' '� �`' Draft Tsst 7og ' _..
L.W. Cuf Off ' '`r� Door Pressuro Lighting Inst. - •
''� ...;--
Pressure M•� psresnt CO2 � De.re' Tssted °. � a �
Input CFH Psrosnt OZ Compony Testing �, ��
Stock Temp. PeresM CO Nams of Testsr �� '"
Fwm 235 `�� r
.
� �. �;�.... . .� ,.
�,�, r GITY OF FRIDLEY INSPECTION OIV.
� 6431 Universiiy Ave NE
�• Fridley, MN 55432
572-3G04
�g�� ��
RATE SCHEDUIE
Et(ecli n January , ( ggl
'v APPI.fCATION FOfi POWE�i PI.ANTS AND 1{F.J1TiNG, COOI,ING, VENTIUITION, ��� ��
F1LI�I�IGL"IUITIUN ANU 111(i CUNOtT'IONING SYSICMS ANO OEVICCS
JOB ADORCSS b � l./�I -lj� �,� .�
Residential
Furnace Shell and Duct Woik, Durner -
Also Replacemenl Furnace
(Side Ven! - FiII O�t 8ack)
Gas Piping (Needod wiNi new (uri�ace)
GAS Aange
Gas Oryer
"Air Condilioning - All Slzes
AN OlherslRepairs 8� Alteralions (L1Sl' ON 6ACI�
1% of Value of Appliance or Woric
Commetcial�l ndustrial
1.25% ol Valuo ol Appliance nr Work
I�iale
$ 30.0()
$ ( U.Op
7he undetsi�ned hereby makes applicalion for a permil for Ihe wo�k herein
1 O1�Al. s�cci(ied agrealnc� to do ail work in siricl accordence wiih ine Clty Codes and
� O"� rulings ol lho Bullding Oivislon, and hereby decla►es Ihal all Ihe (acis and
$ represenl�ilions staled in Ihls applicalion ar Uu and correct.
� O • � ,199
� (�
OWNEFi � I�71 I I l In
$ 10.00 �
BUILDING USED AS
$ 10,00 $ � _
CSTIIv1ATE� COST �O P�RMITNO, j , �
� 25.00 $ �
Slale Su�charge
DESCRIPTION OF FURNACE AND OR BURNER
� No, of Heaiing Units , Circle One (Steamj (Hol Waler) arm Air
7rade Name �r)' �' Sixe No. 5�� o�( --��--
bTU �d� IiP EDA
� ___, f'uel �(,� Totai Connecled load
$ .50
TOTAI FE� , �V
��.
�S �'L�f Ol�l
V� �M N�UM FEE FOp ANY�HEATING C00
/ LIN_ GNENTIlA710N
REFRIGERATION/AIR CONDITIONING PCRMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSpECTION FE� $42.00/Hr
RAir Cond�ione�s can not be placed in a side yard wilhout
wrillen permission Irom adjoining property o�vner.
8urner Trade Name
eru
HP
Size No,
EDA
HEATING OOMPMIY� e C
Signed t3 Tei No. 5 a'' I�p
Approved By - Rough-In Dale FinalOale %� 2��
FILL OUl' BACK SIDE FOR STACK V�RIFIC�TION O�V ��=�
�EPLACEMENT FURNACE
.
�
Client:
Address:
City:
Phone:
Fa�c:
Comment:
Rottlund Homes
2681 Long Lake Road
Roseville, Minnesota 55113
638-0500
638-0501
YOUR BUJLDER FOR LIFE
Project Name:
Reference City:
Daily Temperature Range:
l.atitude:
Elevation:
Winter:
Summer:
Outdoor
�k
-20
95
Total Building Supply CFM
Square feet of room area:
Company:
Representative:
Address:
City:
Phone:
Fax.
Comment:
Ashton
Minneapolis, Minnesota
Medium
44 Degrees
834 Feet
Outdoor Indoor Indaor Grains
�LBL� .B�l� ,Qqr Bulb Difference
N/A N/A 72 N/A
75 50% 75 36
556
1,200
Flare Heating & Air conditioning, Inc.
Randy
9303 Plymouth Ave. N.
Golden Valley, Minnesota 5542i
542-1166
542-3101
YOU CAN FEEL THE DIFFERENCE
CFM per square foot: 0.463
Square feet per ton: 836.493
Total heating required with outside air: 42,595 Btuh 42.595 MBH
Total sensible gain: t 2,231 Btuh 74 %
Total latent gain: 4,304 Btuh 26 °�
Total cooling required with outside air: 16,535 Btuh 1.378 Tons (based on sensible + latent)
1.435 Tons (based on 75% sensible capaciiy)
Ca�ulations are based on 7th edition of ACCA Manual J.
All computed results are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
Component Area Sen. Lat. Sen. Total
Descri tion Quan Loss Gain Gain Gain
4A Window Double Pane & Storm Clear Glass Wood Frame 123 3.859 0 2,836 2,836
8M Giass Door pouble Clear Glass Wood Frame 40 2,028 0 1,200 1,200
11 C Door Metal Potysty�ene Core 38 1.643 0 422 422
121 Wall R-19+ 1/2" Asphlt Board(R-1.3) 960 4,857 0 1,246 1,246
131 Part R-19 + 1/2" Asphlt Board(R-1.3) 171 433 0 141 141
161 Ceiling R-44 Insulation 1,200 2,539 0 1,214 1,214
23D Slab/Warm Duct 2" Edqe I nsulation(R-11) 148 i 2,663 0 0 0
Subtotals for structure: 2,680 28,022 0 7,059 7,059
Active People: 4 0 920 1,200 2,120
Inactive People: 0 0 0 0 0
Appliances: 0 0 300 1,200 1,500
Lighfing: 0 0 0
Ductwork: 0 0 0 0 0
Infiltration: Winter CFM: 54.0, Summer CFM: 36.0 201 5,465 881 792 1,673
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: �2,23�
Tem erature Swin Mulb lier: Xi .00
Buildin Load Totals: 42,595 4,304 12,231 16,535
Total Building Supply CFM: 556
Square feet of room area: 1,2U0
CFM per square foot: 0.463
Square feet per ton: 836.493
Total heating required with outside air: 42,595 Btuh 42.595 MBH
Total sensible gain: 12,231 Btuh 74 %
Total latent gain: 4,304 Btuh 26 %
Totai cooling required with outside air: 16,535 Btuh 1.378 Tons (basea on sensible + latent)
1.435 Tons (based on 75% sensible capaciiy)
Calculations are based on 7th edition of ACCA Manual J.
All computed results are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
CIIY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572— 3604
Water
Stories Closet Urinal
easement
Floor 1 ;�?;
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Bath;: Wash Drinks Fiooc Catch Auto.
Tub : Shower Sink! Tray Fount. ' Drain 6asin Washer
� � I t
��
NO. RATE TOTAL
New Fixtures �
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas**
Gas Range**
Gas pryer**
Back Flow Preventer Required ()Yes () No
TyPe -- ----
$ 7.00 �_CJ�
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ �.00
$ 7.00
$10.00
$ 7.00
$10.00 �� �
$�o.00 /D.DU
$10:00 O,
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATtONS
1.5� of Vatue of Fixture or Appliance
State Surcharge
TOTAL FEE
$ .5d
$�SZ�
Effective On January t, 1998
Gas Gas
Appl. Ran
Misc. Wate� Heater
Fixt. Gas I Elec
JOB AODRESS � 7� 7 ��d�'S�iq-�- Soti ���
The undersigned hereby makes application for a permit for the work herein
specitied agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
1� � �� , 1998
i
Owner
Building Used As ���"
Estimated Cost PERMIT NO. /���y�
PLUMBINGCOMPANY v��� �1��/��r
�
SIGNED BY �i���o''J�L N0. �,j�'—o1 �%
Approved By Rough-ln Date Final Date �� / y�
___ .�, _����.
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS a20.00
PLUS THE 5.50 S7ATE SURCNARGE
•"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SC� INCHES.
_
_
CITYOF
FRiDLEY
� FRIDLEY MUNICIPAL CENTER • 6431 UNNERSTTY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-F287
January 7, 1999
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 6407 Christenson Lane NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on January 7, 1999 for the above noted townhouse. We found
that the construction of the building complies, to the best of our knowledge and belief, with all
the requirements of the building codes of the City and the State of Minnesota relating thereto,
and permission is hereby given for the occupancy of said building.
If you have any questions on this matter, please feel free to contact me at 572-3602.
Sincerely,
RON JU
Building
RJ/mh
.
CITY OF FRIDLEY
FIRE DEPARTMENT
FIRE MARSHAL'S OFFICE
DEPARTMENT OF FIRE PREVENTION
NOTICE OF BUILD/NG FIRE
To: Building (nspection
Assessing
Water Billing
City Manager
From: Ralph Messer, Fire Marshal
Date: December 3, 2009
Subject: Fire Damaged Building
Location of Fire: 6407 Christenson Lane, N.E.
Date of Fire: December 3, 2009; 0505 hours
Other pertinent details:
This fire was reported at 0505 hours as a furnace fire in the single family dwelling. Arriving
FPD officers reported heavy smoke and an active fire upon their arrival. All occupants had
evacuated the dwelling prior to arrival of fire crews. Fire crews shut down the furnace and
related equipment, check for fire extension and ventilated the building. Although the fire was
confined to the furnace, there was heavy smoke throughout the residence. There appears to
be no damage to building structural elements.
Due to the nature and potential of this fire, automatic mutual aid fire departments from Spring
Lake Park-Blaine-Moundsview, Columbia Heights and St. Anthony responded to assist us in
extinguishing the fire. Quick action by Fridley firefighters resulted in Columbia Heights and St.
Anthony departments being cancelled prior to their arrival.
There were no injuries to firefighters or civilians and the fire is currently under investigation by
our department.
If you have questions concerning this fire, please contact me at x3621.
O �q 1 �„ —`}o �-j
O
Building MECHANICAL Pernut No..
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date R'd: 9
763-502-4977 FAX EFFECTIVE 2-19-09 RE��D
DATE 1�-' �'" �-I YOUR E-MA1L ADDRESS � n C o� C io..cz,`�ec,,� �n:c� . Ca �
SITE ADDRESS lo�-l�� Gl'121t�i�C IL' �O� �.-l�hi<�-
TH[S APPLICANT IS: ❑ OWNER �ICONTRACTOR
PROPERTY NAME: � °C. �P"�i�
OWNER/ �DRESS: ��{O� C.iiQ��'f4.�v�ayV �U�c. CITY FRtpL`t`-1 STATEMtiZIPSS�I3Z
TENANT PHONE: ��,e3 �' S� �� 1a842.
CONTRACTOR COMPANY NAME: F�LP.R�c., 1� �A'� � rt�t� � A� Cr � tC� _
SUBMIT A COPY OF CONTACT PERSON: �0.Ut,`t_ �8R.1�S
YOUR STATE STATE LICENSE # EXP DATE
LICENSEWITH pDDRESS: 93�3 ei.v►�^Ot,'i'►� (al9i.� iJ CITY ��c���ctJ �rS(,1.4y STATE I�ZIP �JSyZ�
APPLICATION PHONE � 1�3 - 54�-- ��� � FAX � L> �-�t-i Z- " 3 10 j
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY � TOWNHOUSE
TYPE OF WORK' � �W ��PLACEMENT ❑ ALTERATION/REMODEL
DETAII,ED DESCRII'TION OF WORK !�4„A � A t,r-�.M`�n�'f O'� �►b'f l vvt� �►�n �,�A tSc., lal�rntfl i4 t¢c.�
P�o �i►?c-rtwan,K �+u A��ic. �
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
Equipment Installed MFG: C.H2R14.2 MODEL: 5�`�`tAo'9•a SIZE/BTU 60�
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
A/C $25.00 FIREPLACE (GAS) $15.00 GAS RAI�CF/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 ' NEW GA�'�RILL 510.00
_BOILER $35.00 ,1FURNACE $35.00 _GAS UI*ll`�;�iTR $10.00
CHIMNEY LINER SI0.00 _GAS DRYER 510.00 � ,Q Prv��,i, �'ATER $35.00
�DUCT WORK S 10.00 GAS PIPING $ t0.00 -- N i�cn�p�� t� _vENTtGATOR S I5.00
Number of fixtures @ $lO.OQ 2 x $10.00 = � �fl ,00
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 1 x $35.00 = $ �� • �
State Surcharge = $ .50
MINIMUM FEE $35.50 Total = $ J� �J � �
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 11 w � w i r quires review and approval of plans.
SIGNATURE OF APPLICAN PRINT NAME 'J�N� tS i r► o riPS��.l DATE �Z' 9' 0�
PLEASE NOTE: SEPARATE PE UIRED FOR BUII.,DING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977