AF - 39486SUBJECT P ,
City of Fridley ° 16 8 9 9
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RE�E�PT N
r
� ; L ______ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ��
�
i� i �
----� ����',,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
z 612-571-3450 910-F15
12/22/8� � �
JOB ADDRESS 5419 East Br.enner Pass N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. L� 11 InnsYiruck North Townhouse Plat G SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Darrel A. Farr Denelopment Corp. 46Q0 Lake Road, Robbinsdale 55422 536-9936
3 CONTRACTOH MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residenti.al
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION 0 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
18' x 28' TownhouSe Uni.t "BT"
8 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOC� Er�e
THIS PERMIT 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 ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS CaARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALI. PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 33, 750
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT $ y��.G.SS
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $`Z�.�..00 $42S.00
� PLAN CHECK FEE TOTAL FEE
/�'��'�7' None $652.88
SIGNAT R OFCONTRACTORORAUTNORI2EOAGENT (DATEI WHEN ROPERLY HIS IS YOUR'�PP�ERMIT
- �i' Ji �CJ�'Y � s�
SIGNATUREOFOWNEAiIFOWNERBUIIDER� �DATE� BLDG �NSP �pTE
C1TY OF FkIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS). .
OWC7ER: DARREL A. FARR DEVELOPMENT CORP. gUILDER:� S�
Address: 4600 LAKE ROAD" Address:
R ,
� Tel. No.: 536-9936
No.: 541A Street: East Brenner Pass
LOT: 4 BLOCK: 1], ADDITION: 6th
CORNER LOT: X INSIDE IAT: S,^:TBAQC: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
" nBn - . .
To Be Used As: '
H USE Front: �R Depth: 28 Height: _a$
�
�.
' Square Feet �332 Cubic Feet:
Front: Depthc Height:
Square Feet: Clibic Feet: �
� Zj►pe of Construction: WOOD FRE�ME Estimated Cost: $ �����
•Zb Be Completed: June 1983 = . '
-- � Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $ "
(SEE REVERSE SIDE OF SHEET) .
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley�Ordinances and rulings of the Departmen� of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: 1 r�r SIGNATURE: c
Stipulations: _
�l�•�b � � -
I (, . ��
� � q ,J
� �5
Yo- V V� .
sus�ecr PERMIT
City of Fridley � 1 3 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� � i: ------�
r � � PROTECTIVE INSPECTION SEC. a�
� � � ��
i
' r���� � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� • •�� 612-571-3450 910-F15 1/17/84 / /
JOB ADDRESS 5419 East Brenner Pass N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 �.0 �nsbruck North Townhouse PZat 6 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Darrel A. Farr Development fbrp. 4600 Lake Rd. Mpls., NIl�T 55422 536-993
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
8 USE OF BUILDING
Residential Townhouse Ga,ra e
7 CLASS OF WORK '
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
x
8 DESCRIBE WORK
Construct a 10' x 22' Gaxa e
9 CHANGE OF USE FROM TO
STI PU LATION S
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. W�QCI FX'�L
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTHUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 22O 2
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2 34� 60
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TH , PERFORMANCE OF CONSTRUCTION. 38,
� PLAN CHECKFEE TOTALFEE
�� ��� /�/9- �
SiGNaTURE CON� ACTORORAUTHORIZEOAGENT IDATEI 1IVHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
� r � 1
SiGNATURE OF OWNER iIF OWNER BUILDERI IDATEI LOG INSP �AT
rffective �ug. l, 19�1
� c�TY or �ltIDLCY '
�('P'LIGnTIQ�1 �O�t RCS1DLi�TI/'.� IlU1LDIf;G PLI'.+��1TS .
�tich•�. A1 ter�tions, lldditions. or Rc�airs)
O��IaER: Darrel A. Farr Develovment Corn. '�UILD�R: � -
g�D�(;�$S: 4600 Lake Rd. Mpls., MN 55422 91DD+'tCSS:
7EL �30: 536-9936 TEL I10:
F
�onstr�etion Location
�TJtI�T AO: . 5419
IA7': 2
�q•�p;T; East Brenner Pass
Y�I.00X: 10 AD�ITIO.t: 6th
Corncr Lot: Znsic3c I�t: � �etback: Sideyards:
�p, lic�v�t attach to this form t�.�o Certificates af �rvey of lot �nd
proposed building locatio�n dra:+n on certificates �o sc�le.
DE S CR I PT I 0�� OF CO:; S7 i:�J CT I ON
Garage gront: 10
Square i'eet:_
Fsont:
Square Fcct:
:j�pe of Co:.�tzuction: Wood Frame
�b Be Cbr.:pl�ted: November 1983
�ept�: 22 h�ieight: 20
�ul�ic Fcet:
�epth: Eieight:
�.1�bic Y'eet: _
Estimated Cost: _S 1.80�_
Alt. A T�lt. �
Fropos�d Drive+��ay 6+iath If A7ev Opening Is Desired: ' � S
. . S�i PiVF.FLI: �I9E OF StIF.�T �
25��+ unJessioned hereb;� ma1:c:;, arplic�ticn foz a p^rr_it ic: the ��xk he-ein sp�cified,
agzeein3 to �o .all aork ii, strict a�ccozdanee brith the Ci��� of iridley �rdi��ances 2�icl
zulii��� of tlu Del�.irlme��i of Dui:�in�s. and h�eby dec]�zes �hat all t)�c• facts and
�c�.~esc��itiens sta2cd � 4his �ppiic`scion �re grue e:..nd cosrec�s
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City of Fridley 310 8 9
AT TME TOP OF THE TWINS g � I L D I N G P E R M I T
r
� � RECEIPT NO.
� `v __��_ � COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIYE INSPECTION SEC. ����
�
' i '
� /'�'1 � CITY MALL FRIOLE� SS132 NUMBEP NEV DATE pAGE OF AVPqOVEO 8Y
�.._.�' '•� 612-571-3460 9t0-F15 6/27/00 / /
�oe nooaess 5419, 21, 23, 25, 27,29 East Brenner Pass
1 LEGAL LOT NO. 9LOCK TRACT OR AdDITION SEE ATTACNED
oESCR. 1-6 11 Innsbruck North Townhouse Plat C) SMEET
2 PROPERTY OWNER MAIL ADDRES$ 21P PNONE
Innsbru�k Townhome Association 651-224-5482
3 CONTRACTOfi MAIL ADORESS ZIP PHONE LiCENSE NO
Garlock-French Roofing Corp., 2301 E. 25th St., Mpls., NIlV 55406 612-722-7129 0000142
1 ARCNITECT OR OESIGNER MAIL ADORESS 21P PMONE LICENSE NO.
S ENGINEER MAII ADDiiESS 21P PMONE IICENSE NO
8 USE OF BUILOING
i3ssidential
7 CLASS OF WORK
O NEW O AODITION O ALTERATION C� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof Townhouse Building (Tear Of�
9 CHAN(iE OF USE fROM TO
STIPULATIONS
Underlayment must comply with the State Bui.lding Code.
P��rnit Inspection Card�
�'ill �e Malled
�+� ��nteowner To Post
SEPARATE PERMITS ARE RECUIRED FOR ELECTi;ICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
VENTIIATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING SO. FT CU FT.
AUTMOR12E0 IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED 01i ABANDONEO FOR A PERI00 OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING
I MEREBY CERTIfV THAT I HAVE READ AND EXAMINED TMIS APPLICATION 6 STA�LS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. A�L PROVISIONS OF LAW$ yp�UATION 22 � OC)%. OO SURTAX
AND ORDINANCES GOVERNING THIS TVPE Of WORK Wlll BE COMP�IED •� ,�],],.00
WITH WMETNER SPECIFIEO NEREIN Ofl NOT. TNE GRANTING OF A pERMIT
OOES NOT PRESUME TO GIVE AU7MOFITY TO VIOLATE OR CANCEL TNE pERMIT FEE SAC CMARGE
PROVISIONS OF ANV OTHER STATE OR �OCAI LAW REGUTATING coN. �363. ZS Fire SC a�22 . OO
STRUCTION OR 7NE PERFORMANCE OF CONSTFUCTION
PLAN CMECK FEE TOTAI fEE
96.25
S�GNATUpE O� CON'AACTOp ON AUTMOA�2ED AGENT IOAiEi EN RO � ID T THIS IS VOUR P�RM� \
- v
�
SiGN4tUAEOFQyyNEp���OWNEABWIDEAi �O�rE� Bl0 �NSo r�ptE
g�-� 3I� � y
N�y � � _ Effective 1/12000
ADDN [] CITY OF FRIDLEY 612,5T2�604 Bldg Insp
q�.�R [ J SINGLE FAMILY AND DUPLEXES R-1 AND R 2
� � BUILDING PERMIT APPLICATION -
Construction Address: "�'� �� � �I � � 1 � a 3 �S a7, � � � �S� � 1`e�� . �`1.���:5 �', . —.
Legal Description:
Owner Name & Address:
Contractor.
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
ss �a,-horn�i. # l�5 i- aa �1- s�l ��
MN UCENSE # �bD I �ia3
N SS�-1o�Te�. # �ol�- �l�a--11� �'-►
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF 111llPROVEMENT
Length Width Height Sq. F�
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
Construction Type: � � In Estimated Cost $ � � � v�� . � �
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: �� APPLICANT: �'� u��,_�� Tel.# t,�a-�aa-��a�
CITY USE ONLY - Call (612) 572�604 for Permit Fees if mailing ln appUcatlon
Permit Fee $.��D�, a�� Fee Schedule on Reverse Side
Fire Surcharge $ �C'�• �.001 of Permit Valuation (1/10th%)
State Surcharge $ A� e $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ $1100 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 [ ]
$ ��6�/ s��
��
,_..,
BUII,DING PE�MIT FEE SCHEDULE
The Chief Building Official shall, l�fore issuing �rmits for the er�tion 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 f�s to the amount herein
below set forth and in the manner herein provided tawit: _ �. .
TOTAL VALUE
$ i to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$SO,QOl to $100,�0
$100,001 to $500,000
$500,001 to $1,000,000
$1,OQ0,001 and up
FEFS
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fracdon thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to aad including $100,000
$993.75 for first $100,0� plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRFSSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
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 constcuction site.
A Certificate of S�rvey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
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CI"IYOE
FR[DLE,Y
FRIDLEY MUNICIPAL CENTER • 6431 iJNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
f aIIL111'y ZJ�, 2�
Ms. Mary Everson
5419 East Brenner Pass NE
Fridley, MN 55432
Re: Final Inspection at 5419 East Brenner Pass NE
Contractor: Norblom Plumbing
Dear Ms. Everson:
A plumbing pemut was issued on August 4, 2000 to install a water heater at your
address. According to Section 4715.2800 of the State Plwnbing Code, a final
inspection shall be conducted on the work authorized by this permit. As of this date,
no final inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was
completed according to the Code. We will keep your permit open for another 30
days and if we do not hear from you within this time to set up the inspection, we will
mark the permit "no inspection called for" and take no further action.
To set up the inspection or to have any questions answered, please contact the
Building Inspecrion Division at (763) 572-3604.
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3H1210 S3�MdI�ddH JNIN2�fl8 �3f1� JNl�brld3tl N3HM NI a3T11� 381Sf1W M0�38 3Hl
Building
Inspections
763-572-3604
DATE /' ✓ �� D C
SITE ADDRESS � i�
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTUR
Sfi��f �£OP1f-OF-
YOUR STATE
LICENSE W1TH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR ��� ADDRESS
r `F' �. 5�S
O OWNER
PHONE:�(,2�� "' 'J'—%I " I �% %
PHOATE �( e �" h �i� — � � �
I�SINGLE FAMILY ;
o �vEw
O TWO FANIILY
., • :,• • � ��
E3�1' DATE
O TOWNIiOUSE
DETAILED DESCRIPTION OF �VORK � c n I r� c P oQ �,�7 0.'�f. r�� a�°i n P r
Permit
Received By:.
�—N�'�y
PER MS 16B.665 the permit f� is a mmimam of $15.00 or 5% of the total c�t np to �.00, whichever is greater, for the
improvennent, installation or replacement of a residential fixEure, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $3� _$15.00. La�r c�st between $300 to $500 = c�st of labor x.OS =
FOR PROJECTS WFIL'RS LABOR EXCEEDS $500, FEFS ARE BASED ON $10.� PIIt FIX1'IJRE, EXCEPT WI�RE NOTED. F[XTURFS: (INDICATE TOTAL
NUMBER OF EACH BELOVIn
BATfi SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB • GAS PIPING (rv� crrruc�) SWA�IlVIIIVG POOL Z WATER SOFfNER ($35)
CLpTHES VyA$HER KTfCHEN SINK WATER CL03EI' BACKFLOW PREV. ($1 �
DISHWASHER LAiINDRY TRAY WATER HF1�TFdi ($35) FOR IRRIGATION
WATER METER OTEIIIt
Petmit Fee
TOTAL DUE
UNDER $SQO PERMIT FEE FOR PROJECTS OVER $500
$ �,�.� Number of fixt�ues @ $10.Q0 x $10.00 = $
.50 Number of fixtures @ $15.00 x $15.00 = $
$ . 35.,� Number of fnctures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
TEIIS IS AN APPLICATION FOR A PERNIIT NOT VALID UNTII. PROCESSED
I hereby apply for a building �rmit and 1 acl�owledge that the information above is complete and accurate; that the work will be in
cotrformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand 1#�is is
not a permit but oniy an appGcarion far a permit and work is not to sta�t without a permi� that tk►e work will be in accordance wit�► the
approved plan in the case of aq work which requires review aad approval o£plans.
SIGNATURE OF APPLICANT lNl� e� �,����. PRINT NA�C' h a � I� 5 I\ (� L_DATE ���— � d
PLEASE NOTE: SEPARATE PERMTfS ARE REQUIRED FOR
MECHANICAL
City of Fridley
Building Inspections Department
- - — — — --- b43I i�niversity-av�tue i'�,�ri�l� , - -- --
763-572-3604
FAX: 763-502-4977
�
Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE ��� 3� / B y YOUR E-MA[L ADDRESS
srrE fwnxESS �y� 9- 4s �- j� ren n� ��•.ys
THIS APPLICANT IS: 0 OWNER �CONTRAC7'OR
PROPERTY
OWNER/
TENANT
E�
PHONE: %G '? • S %/ � f gg %
Permit No��rb
Received By:
D���'e�
ATE�4/�ZIP�"�
CONTRACTOR COMPANY NAME: .�� .. _ —_ T..........i„�.�s_ I�.
T
SUBMIT A COPY OF CONTACT PERSON: dea Fi eside Hea� & Home
YOUR STATE STATE LICENSE # EXP DATE Lfcense 205
w wl Cai�vje� /`�.
LICENSE WITH ppDRESS: CITY ROSeVI��e. �dl�� 3 ZIP
APPLICATION pHONE FAX � '
PERMIT TYPE 0 SINGLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: �EH' O REPLACEMENT
J�OWNHOUSE
❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK i I� 3�- �. << Na wti �� r� P� q'- t .�+ I G A S.%�-e
FE�S��RE 13ASED Ql�f $10.00 PEff EIXTURE; �7FCEPT 1VAERE NOT'ED. FIXITJRES: (INDICATE TOT;4L N[]MBER OF E:aCA# 8��. .:
P,ROi'ID�iIErAT LOSS CALC'S 1'ER illAll�U�L J:2006 ASHRp1E.H,ANDBOOK. , , . , , � c :;: ,. w �.::; : .. . : - �: .
Equipment Installed MFG: MODEL: SIZEBTU
MFG:
MODEL:
MFG: MODEL:
A/C$25.06 FIREPLACE (GAS) $15.Q0
,4Ilt TO AIlt EXCHANGEER $15 FIREPLACE (WOOD) $35.00
BOILER $35.00 _FURNACE $35.00
CI�/IDv1NEY LINER $10.00 GAS DRYER $10.00
_DUGfi WORK $IU,00 �GAS PIPING $IQ.00
SIZF/BTU
SIZFIBTU
GAS RANGF/OVEN $IO.OU
TTEW GAS GRILL $IQ.80'..' . : ;-'� ; �� _: _ - ' _ ::
GAS LINIT HTR $10.40 -
POOL HEA1'ER $35.00 ° - . _
VENTILATOR $15.00 _ . ,: . , : ,' ,�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNfIL 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 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 w r hich r es review and approval of plans.
SIGNATURE OF APPLICANT i���"�--'��� PRINT NAME fC�✓� /l F� 5�''C DATE O �
APPROVAL WSPECTORS SIGNATURE
DA'
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-UP AIR
�:,�.� - .. �, ,
f ,;, .
REQU;IRE�i',ROR i�1EW/EXISTING HOMES
.
1. Combustion Air (See note below)
a. Oil or solid fuel IMC 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 Cha.pter 5 with MN Amendments MN Rule 1346 Sec. 501
3. Venting -
dments
,_ _,. . . . -
a. Gas, appliances IFGC Chapter 5 v�n Amen
��,:; -,� b. Fuel ptl�er than gas IMC Chapter 8 with MN �n.Q:end.r.n,e�its . _
4. Heat loss & cooling load per room
- a. MN Rule 1322, Sec. N1104.4.13
5. Ventilation �
a. Per MN Ru1e Chapter 1322. Sec. 1104
6. .Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoin,t Energ,y Mechanical Code Guidelines software may be used for -
combustion and make-up air calculations.
�uilding
Inspections
763-572-3604
763-502-4977 FAX
DATE —'
SITE ADDRESS _�
THIS APPLICANT IS:
PILOPERTY
OW1iTER/
'H'ENANT
COli'I'&�CTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PE�tli'�I'�' TYPE
TYPE OF' WOflZ%:
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E-MAIL ADDRESS
❑ OWNER V%TCONTRACTOR
CITY
�
Permit No.: ��
Received By:
Date Rec'd: ��
A'
STATE LICENSE # � o�� r u-r �v� EXP DATE
STATE BOND # EXP DATE
ADDRESS: ����n� MN 5ti� �� CITI' STATE ZIP
PHONE
�INGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY
�REPLACEMENT
FAX
❑ TOWNHOUSE
FEES ARE BASED ON $]0.00 PER FIXNRE, EXCEPT WHERENOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). IviINIMUM FEE
$35.50.
BATH SINK/LAY _FLOOR DRAINS SHOWER _ WATER pIPING
BpTHTUB GA5 PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
CLOTEIES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
� DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER _ OTHER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing petmit and I acknowledge that the information above is oomplete 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 on site; that the work will be in accordance
with the annroved nlan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT
c�iy o� �+ ri���y
$uai�ding ��spectioa�s Departane�t
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
' FAX: 763-502-4977
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