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AF - 43032Village of �ridley, Minn. BUIL�ING PERMIT N° 926 -- Office of 1iNSPECTOR OF BUILDINGS .� �"'; * � ,i" , . � � � Owner t�d""�``"'�R..�v' �..�-'�,.�s�c:z'.+�`��'t�✓. � f ,� � , Architect � �" ��'` � `" � •~� l Fridley, Minn., �° � , 19�._ Builder LOCATION OF BUILDING . � �,r � �, �,,, No. �" "�--�` � Street�,�' j'� ...�`"�"�"'"""� Part of Lot Lot Block Additioa or Sub-Division ' Front .A� �.. Depth To be used as Y?ESCRIPTIQIV OF BUILDING � :.h, f . � -� �.. . Height Stories �' � � �� anner of Construction �- -*•-- xW-°= - �-�- - . To be completed Estimated Cost 1 ',.�'.✓,R+s"�.' ., i. . t t' ,# f r � `�-... .r� Permit is hereby granted to i�:.�' . 1..��,.�.�c-��.�`'�� to ��'��'`..�c�"'"" the building ��'"`""`"""� described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, empioyees and workmen, fn a11 the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. - �.; ��;� .�i � ? � : '� f"s ��°�-^�"'� �"` '��`'�'�� ector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and accordiag to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby sta,te and say that the facts stated by me and �ontained in the abo e permit are true as therein stated. r � � ,� ,; 1y,� �� , �.. ��€. � '°�� - � r.C:H.�(_:�}' �=�.>. y�r°'�. r� Subscribed and sworn to before me at Fr�y, day of ��t .D. 19�. � F,,� G� � Minnesota,��hi� ,� �" ' �; �,,, ..r^,�r r' �,.. '�.C„e�:�;, �`�`d,. , f � ' C.»....�. :�r � N° 926 Village of l�ridley, Minn. BUIL�ING PE�iMIT Office of IlNSPECTOR OF BUILDINGS �Z:�„ ��' � ' �'�. �� Owner � ��rt:3i'i+�•t,�,�t�Z.�, � �� 1�� Architect jA�' ��`, � � r,.�.., Fridley, Minn., 19� Builder LOCATION OF BUILDING � �� _ No. ? �.,..�1^ Street � X .,��.,�^'_�'7��#'^�*-. .. Part of Lot ` Lot Block Addition or Sub-Division r�° � DESCRIPTIO�N OF BUILDING Front /� � . Depth r ""J' t � `=' Height Stories t't�" % t-0 Nianner of Construction �` ••`� �`�-- x W. r: _<�.-.. � `.,°' � ^---- To be used To be completed Estimated Cost � ... . h i � , .-� Permit is hereb �' "�' � � "'" � Y �'anted to � .�. � � �.��.+e�...r �� c.+� to �,� /.4�.. . . . �a�Y� � �t � � the building �"'"` described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmett, in all the work done in, around and upon said building, or any part thereof, sha,ll conform in all respects to the ordi- nances of Fridley, Minn,, regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any tfine upon violation of any of the provisions of said ordinances. �_ � � .�1 � �"`�''�"'"��r� ��`"�'N*pector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley- of the above permit, I hereby agree to do the pro�osed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first dul� sworu, I hereby state and say that the facts sta,ted by me and ontained in the a;bo e permit are true as therein stated. ,� � � � f � �� .� ` ,�,.�,.�� Subscribed �nd sworn to before me at Frid "� y, Minnesota.,,.,..:thi -~"'"�� .� `' � �4 � * � aay of "�` .n. is � . �:.,�=�.--�`f�;�'�--�,-�.r. rw, � V �'` � �� SUBJECT MIT . City of Fridley . 15135 AT THE TOP OF THE TWINS g U I L D I N G P E R ! � , RECEIPT NO. � ` _�__ COMMUNITY DEVELOPMENT DiV. r � v � PROTECTIVE INSPECTION SEC. y � � / .� � � � � � ��"1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV �--�'� � ,'� 612-560-3450 910-F15 4/18/79 � � JOB ADDRESS 6379 Dellwood Drive N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oescR. 22 Moore Lkae Highlands lst SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert B. Tourville 6379 Dellwnod Drive N.E. 574-9609 3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE N0. 5ame 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO. 5 ENGINEER MA1L ADDRESS ZIP PHONE LICENSE ►JO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION p ALTERATION O REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reside house 9 CHANGE QF USE FROM TO STIPULATIONS SEPERATE PERMITS REC�ti�RED FOR WiRlN1�, NEATING, P�UMBING AND SiGtWS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIF CONDITIONING. A].�. THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION l, STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED �. 5O WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1� OOO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAGCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �j•7� 5O STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 1 PLAN CHECK FEE TOTAL FEE $$.fl� SiG EOF oN- C RAUTHORIZEDAGEN IDn7Ei WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT � '—� '� NATU OF NE UFOWNE lDE 1 DATEI T BLDG. WSP - DATE � 0 . . - CITY or- r-�ziv�cY . � ' APP�I C/1'f I 0i� FO[t RCS I l)(:tJl`IliL. I3U I I..D i NG f'ERN1I TS . ' ' (�VCiJ, �ILTL=R/iTIONS, ADDITIOt��,' OR REPAI(ZS) �-- � .�-- � ' . � awc��: �1� � / �- /l�u�i `/j�C IIUILDI:R: ,d�� e .�' Address : ��'��,%�, �J,�rY � 1lddress : � ��//4 D CY ,��i Tel . No . : ��0 � . No.: Street: LOT: � 71DDITION: l'�%l>1Z� .11�►�� J�%1.�Nds ��- BLQCY.: COItNER LOT: INSIB� TAT: S,rTBACY.: SID�Y11ItD5: App�.icar.t attach ta this form �ao Certi�icates of Survey of Lot and proposed building loc�tion drawn on these Certificates. . DESCRI PTTOfJ OF BUI LDI I�G To se uSEa r.� : ��,��' Front: Depth: � ' Height: " Square Feet: Cubic Feet: Front: � Depth: � Height: ' Square Feet: � Cubic Feet: � Type oi Construction •�f-i�M.`„iyi� Estimated Cost: $/ ��0 D Zb IIe Completed: ��"��'� t, Alt. A Alt. B Proposed Driveway S9idth If New Opening Is Desired $ $ , (SE� R�VERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work llerein SpeCifiedr agreeing to do alI eaork in strict accordance with the City of Fx'idley �rdinances and rulinc�s of the Deoartment of i�uildings, and hereby declares i:hat.all t}1C facts and representati s stated in this application are true caI1C� COYr'CCt. See reverse S1C�@ �O C� �10I731 inforcnation DATE:� .� - 7 SIGNATURE: � Stipulatioiis : • � �. �� . . � � � C� ,. , �. J .. ... w.. . . . . . . ._ ., �� . . . . .. . , _ . ..... ._ . . .. �-. .� ... { . .... ♦� i J � • .«........... . ...�:.....�� .:...♦ . .�. .... .. .�._., � ........ .....`.... . ......�.. .�. .. . . . BUILDIfJG P�Rt�IIT FEE SCNEDULE SECTION 2. '1'he insl�ector o� }3uilQings shall, before' i�suing pez�nits for the crection of any bvilding or �i�ructure, or for any addition to any exis�ing building ar structu.re, or for any alteration or repairs to any existing building or structure, upon api�lication therefore, require the paymen� by the applicant for sucli permit of fees to the an►ount herein below set forth and in the manner herei.n provi.ded to-wit: NEFJ CONSTRUCTION: Single I'amily iIomes �nd Garages: $4.00/1,000 cubic feet. pLAN CHECK: 25 perc;ent of buildi.ng permit fee. , DRiVEWAY D�PFtESSION: (Concrcte Curb 5treets Only) • Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 ieet x$b5.75 Alternate B: Removal and replacement of concrete cuxb and gutter and install a 3 foot wide approach with • 6 inch depth; Driveway width plus 6 feet x"a17,85 :�� • � 1 �• ' �► Far the purpose of computing fees for building permits, the cubical contents of any building or adciition, is determined by multiplying the gro�nd area covered from a point six (6) inches below the floor line of the basement or th� cellar to the average heights of the upper surface or to the average height of the roof suriace of the main gable of a pitche� roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.Op Per each �ive hundred dollars �-($500.OQ) oz fraction thereof in ttie co'st of all proposed work. In�no case shall the fee charged for any permit as set farth in Section 2 be less �han $7.50 plus $.50 state surcharge. ' : � � � ►1' � N07.'E: Permits for construction will be issued a minimimn of 24 hours from the time of a�plication 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 i.t has been constructed will be required before proceeding with the framing. C ' • �=� - Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building pernlit has been issued; and said structure shall not be used or accupied until a Certificate of Oceupancy has been issued. " . .� � 0 � _ CITYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FR[DLEY, MN 55432 •(6121571-3450 • FAX (6l2) 571-(287 September 10, 1993 Mr. Dave Swanson Asphalt Specialties Co 2828 S Anthony Ln St Anthony, MN 55418 Dear Mr. Swanson: PW93-204 We appreciate your timely response and repair to the street that was damaged at 6379 Delwood Drive in the City of Fridley. We hope that consideration will be given on future projects to reduce the potential for damage to City streets. Again, thank you for the quick response and we wish you the best on your projects in the City of Fridley. If you have any questions of City requirements or permits, please call me at 572-3551. Sincerely yours, G�� Scott Erickson Assistant Public Works Director SE:cz sue�ecr fr, .'P.ERMIT NO. c�ty of Fridley ,�'`` 2 5� 3 g, AT THE TOP OF THE TWINS g �{ L D I N G P E R M I T`�_ � f ; � RECEtPTIC(O. � • COMMUNITY DEVEIOPMENT DIV. r � v �� PROTECTIVE INSPECTION SEC. �'�� /"'\ � CITV HALL FRIDIEV 55�32 NUMBER REV OATE PAGE Of APPROVED BY �'""�"� �'' 612-571--3450 9�0-F15 9/24/97 / / JOB ADDRESS 6379 Dellwood Drive NE t LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHEO DESCR. 22 1 Moore Lake Highlands I.St . SHEET 2 PROPERTY OWNER MAII ADDRESS ZIP PHONE Robert Tourville 6379 Dellwood Drive NE 574-9609 3 CONTqAC70R MAIL ADDRESS Z�P PHONE UCENSE NO. Same A ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING ' Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE O REMOVE 8 OESCRIBE WORK Reroof House (16 Sq) Tear-off 9 CHANGEOFUSEFHOM TO STIPU�ATIONS Underlayment must comply with the State Building Code. TVPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAO SEPARATE PERMITS ARE REOUIRED FOF ELECTRICAL, PLUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTEF WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION SURTAI( AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI 8E COMPLIED WITH WHETHEA SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �1,334 �.GH DOES NOT PRESUME TO GIVE AUTHOiiITY TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CMARGE STRUCT ONSORFTHE PE FORMANCE O FCONSTRUC ONEGULATING coN- �45. %S Fire SC �1 . 33 PLAN CHECK FEE TOT L FEE $47.76 � PE CON'RAf:T0�7 OF� AUTH0�7�ZED AGE �IOATEI EN R VALID T THIS IS V P�� (//��,� � 7 ��._��- - f.. , I / l� ''N � 7 ! /� �GNA RE •Fi�fOW PBU�LDEf7� iDAiE� B� �NS� qATE NEW ADDN ALTER [) � ) �� CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1 / 1 /97 �o � � �� ConstructionAddress: _ �9� /� � �/��f � j�� _ Legal Description: Owner Name & Address: �_ � ° � Tel. #��/f —9�0 � Contractor: `�� MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height L,ength Width Height Length Width Hgt/Ground Driveway Ciub Cut Width Needed: DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL :S'I'IPULATIONS: APPLICAN'I': Tel. # _ Sq. Ft. _ Sq. Ft. _ Sq. Ft. � �. Estimated Cost: $ �� 3, lJ �.� (Fee Schedule on Bac J�� 33� c1g Ft. + 6 Ft = Ft x$ _$ CI1'Y USE ONLY Tel. # $�'�� Fee Schedule on Reverse Side $ % 3 � .001 of Permit Valuation (1/lOth%) $_ , �v� $.50/$1,000 Valuation $ $950 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 [ ) � � �, � � .� . � � � � � SuB�ECT . . . � - � . c�ty of Fr�aley �� 572 360�TME TW�NS gU ILD1N� PERMIT � • COMMUNITY QEVELOP�ENT DIV. �V�� f � � PiiOTECTIVE INSPECTION SEC. � � � . . � � �"'1 � CITY MALL FRIOLE� SS�32 NUMBER �'""'�"� ,�� 612-571-3450 910-F15 108 ADDRESS 6379 Dellwood Drive NE ' 1 LEGAI �OT NO. BLOCK TfiACT Oii ADOITION DESCR. 22 1 Moore Lake H 2 PiiOPERTY OWNER MAIL ADDRESS Robert Tourville 3 CONTRACTOR MAIL ADDRESS Murphy Bros. BuildinQ 1613 93rd Ln. Blai � AiiCHITECT OR OESIGNER MAIL ADORESS 5 ENGINEER MAII ADORESS 6 USE OF BUILDING Residential OATE ZIP 21P oAGE O� � � PMONE PMONE PHONE '28634 RECEIP . 793� APVROVED 8� SEE ATTACMEO SHEET LICENSE NO ��ti LICENSE NO. IICENSE NO 7 CIASS OF WORK ❑ NEW O AODITION O ALTERATION � REPAIR O MOVE , O REMOVE 8 DESCRIBE WORK Reroof house and �araQe (20 Sa) Tear-off: Reside house and Qaraee 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for building wrap inspection before covering. TrPE OF CONST SEPARATE PERMITS ARE iiE0U1qE0 fOF ELECTRICAL, PLUMBING. HEATING. VENTILATING OR Alii CONOITIONING. � TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION LONING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTFUCTION OR WORK IS SUSPENDED OR ABANDONEO FOA A PEH100 OF 120 OAYS A7 ` ANY TIME AFTER WORK IS COMMENCED ' NO DWLG. UN 1 MEREBV CERTIFV THAT I HAVE REAO ANp EXAMINEO THIS APP�ICA710N ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL B� COMP�IED WITM WHETHER SPECIfIED HEREIN Oii NOT TME GRANTING OF A PERMIT DOES NOT PRESUME TO GtVE AUTHORITY TO VIOIATE Ofi CANCEI THE pEqMITFEE PROVISIONS OF ANY OTHER $TATE OR IOCA� LAW REGUTATING CON- STRUCTION OFi TME PERFORMANCE OF CONSTiiUCTION II �� PLAN CMECK fE S�GNATU E FCON'AA(;T qOQ�uiHOQ�ZED�GEN* IOA E� N S�GN4TUqE O� OWNEQ�� OWrvEABU�IDEQi IOATE� � BIOG DCCUPANCV GROU SO.f7 OFf STALLS �5 OCCUPANCVIOAD CU iT f PARKING GAiiAGES NEW � ADDN ALTER [l [l [l ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ca �7�� i?�-�l�v��c%�� (�'i1�'� N, Effective 1/1/98 �� Owner Name & Address: �,�%��Lti� ��U"�9'1/�/(-1� Tel. # ��— ��'�� Contractor: �'v��'N 'l��'�5.�/��4/�1✓�� %(,1��,1 '/�'�y�,�r C��. MN LICENSE# �-��' Address: l �v� f ; �j ''r�� f,ti^�' �,�� 9a'f,�, Tel. # ��C ' �� 1� 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: Length Length Length DESCRIPTION OF IMPROVEMENT Width Width Width Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. u'�� ,�� r„�.:. � � `�.i'� �� L, i� S i ��> ° �� Construction Type: �``" '" , � � ��° Estimated Cost: $ e,.� _ � �� (Fee Schedule o ack) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: i � I �� % �' APPLICANT: � ��ll ' Tel. # ��" �<--�'<=% Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � $ 1��.�5� $ -� 1 $ �3.�0 $ � s" �v $ $ $ $ $ 1��3�C�� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.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 [ ] Building �� ` Tnspections 763-572-3604 DATE S � .3 ' U �° S.ITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WTI'H APPLICATION PERNIIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS � OWNER �CONTRACTOR r -�- �0�� \� a.DnxESS: 103�1 �1 Oe 1�.� c� o c+ PHONE: � Co '3 ` S -1 �-i - �' (� 0 9 COMPANY NAME: ••.... �..._._ .. _-- - -- CONTACT PERSON: JOANIZ ZI�N STATE LICENSE EXP DATE Received By: Date Rec'd:. ATE ZIP a,DDttESS: 13562 CENTRAL. AVE NE ctTY ANOKA STATE 1�lNZIP 55304 PHONE 763-757-6202 F,�; 763-757-6701 �SINGLE FAMILY ❑ TWO FAMILY ❑ I•IEW �REPLACEMENT DETAILED DESCRIPTION OF WORK ❑ TOVVNHOUSE ❑ ALTERATION/REMODEL a c+ .e �vr-n c�e �e Cir� � 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 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (WDICATE TOTAL NUMBER OF EACH BELOVI� /� Equipment Instal{ed , MFG: l_.c�r ��e r MODEL: 'S ��-' V'(� �j�( O SIZE/BTU �e � O � �G; � � MODEL: , U. R N D 6 a�-1 SIZEBTU a�° `'` MFG: MODEL: SIZE/BTU 'I A/C $25.00 FtREPLACE (GAS) $15.00 GAS RANGFIOVEN 510.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRII.L 510.00 BOILER 535.00 TFURNACE $35.00 _GAS UNff HTR $10.00 CHIMNEY LINER $]0.00 _GAS DRYER $10.00 POOL I-IEATER $35.00 DUCT WORK $10.00 _GAS PIPING $10.00 _VENTII-ATOR 515.00 $�;.,� a.Y�.�-Y. �-�..�-�.� . _, , --.-,_-w _...H.n.,. , . . ._.:..._, _ __. . . _ _ Permit Fee $ Number of fixtures @$10.00 x$10.00 =$ Surcharge $ .50 Number of fixtures Q$15.00 x$15.00 =$ TOTAL DUE $ Number of fixtures @$25.00 t x$25.00 =$ as•pO Num ber o f f ixtures @$ 3 5. 0 0 1 x$ 3 5. 0 0 =$ 3 5. v o State Surcharge = $ .50 Tota] _ $ l� 0 . SO 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 of all work which requires review and approval of plans. SIGNATURE OF APPLIC��,,� �• �� P�T NAME ROGER HOFFHEIN DATE S/��O C� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 r � �r. �� cn� nn77 �. REQUIRED INFORMAT(ON NEEDED TO PROCESS PERMIT � RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS �EXISTlNG HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) . a. Oil or solid fuel IMC Chaa�ter 7 with MN Amendments b. Naiural Gas or PropanellFGC 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 co�struction IMC 1346.0312 5. Ventilation . a. Per M1�T E�er�y Code 75?Q or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for comb'ustion and make up air calculations