AF - 42069: City of F�.-idle , Minn. � � 3 8 6
Y
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: _...�pr�.l_.21.Y ].� � �
py�,tter; Tri-Co Builders Inc. Builder _ Same _._ _______.,.._..___�
,Aadresa 7 555 V anBuren S tree t N. E. Address S ame �____ �__`_ __��__�
LOCATION OF BUILDING
Na 2 8 0 Street .—...._�_.,.5 t r ee t N.` E_._...._..._.-----.__....---.._._.__ Part of Lot
ypt 4�3_ 44__,,,,_ Bio� __.__ll �,.,__�_. Addition or Sub-Divisian __� S�prin„g_Brook Park
Corner Lot .�_.._..�...._..__ Inside Lot W_X—__r..__ Setback ..._--•_______....._�__.._ Sideyard _--_--...___._ ___.._...
:"�yb�p�IIevation ._._..$��.__ _. �'Qt,�(c��{�/��(t�dr�/--_--.850,_65__.�APProx.�
_ Wve Top of Footing
DESCRIPTION OF BUiLDING
To be Used as:
Dwellin� __ Front 24 �._ Depth 40 � Height _...20_�..___ Sq. Ft. ----960' Cu. Ft ....._
raraoa ...__..._... Front ..2..Q� -• Depth _�.�.,-..$.��. Hei�ht _�Q.�._.._.. Sq. Ft. _------_�k��.� Cu. Ft. __._�:�.��
'!`ype of Construction ..�_�1c2.s�s1..F.�.m�_ Es� Cost .._..�1 � �.2.� �k_...._._.__..___ To be Completed __S g� t �..._1 � 19 7 2
Stipulations: Provide a hard surface drive and verifying survey before capping.
WATER LOCATION; 10.4' E. of Sewer Service SEWER LOCATION: 162.5' E. of Mannole
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
'�he proposed work in accordance with the description above �t forth and in compliance with all provisions o!
O�'dir►ances of the city of Fridley. ;/ n�
9.15 �tate Surcharge
In consideration of the payment of a fee of $ �...��.._:..__,, permit is hereby granted to___Tri_Co Builders, Inc.
_ to consiruct the buiIding or addition as described above. This permit is granted upoit
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conforxn in all respects •to the ordinances of
I�'ridley, Minnesota regarding locatian, construction, alteration, maintenance, repair and moving of buildings
yyithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said
a7rdinances. �
' __._ ----- ��� ,
CLARENCE BELISLE
NOTICE:
This permi! does not cover the eonstruetion, installation fo� wiring, plumbing, gas hsating, sewer or wafsr. Bs sur� to sw
ths Building inspeeto� fo� separata parmits for these items.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : � � , � _ Gj JJ��I/r � BUILDER : /f � —� � ��i� s ��v �-
ADDRES S: i� a� S�S �/iti.t�' h�1�.�.. ,� ADDRES S: � 4.�$� l%A�t/ �a r.v•r�
NO : . �' C� �' S TREET • � � y
LOT : �3� f` z/ BLOCK:_��/ ADDITION : Sy,� �-� �� � �Yd c /C � ��
�
CORNER LOT: INSIDE LOT:,� -�(. SETBACK: SIDEYARD:
AppliCant attach to this form 7.t,io Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
�ESCRIPTION OF BUILDING
To Be Used As:
5����� I`-�� �/d�� Front : �� Depth : �� Height • � y S��'�-J
Square Feet: �B� Cubic Feet•
G.av� y� Front• �,�� Depth: �/��J� Height: $�.v /
. �
Square Feet; `f,� � Cubic Feet: �/} 3 c3
Type of Construction: ��{ Estimated Cost: $ � � � �� '��/' �.
To Be Completed: /�� / p 7�—
The undersigned hereby makes applicativn for a permit for the work herein
specified, agxeeing to do all work in stiict accordance with the City of
Fridley Qrdinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
UATE :�� G''.�.�� �Z- S IGNAT[TRE : Q�� �' c ft�v-z�
(See Rev�xse Side For Additional Informa.tion.)
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MINNEAPOLIH L�CEN6ED
J`��
DONALD H. DEU i 5CH
LAND SURVEYOR
722-0235
PHONE: '"�.C�
��. � j ' 2}.�.�'G'.'1 �'3' �T1U 3 S OU't11
MINNEAPOLI5, MINNESOTA 55406
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I her��y cer��s^y th�t the pla� hc�rson i.� €� �r�e a�d corroct represen�tion
of a survey of v;�o bourr�a�ia� of Lo�s I�3 �r.d iri�, F31oak lI, "Spr��� Brook Patrk,
Anol�-a County, Minn.", �s surveyed by me �c�e 29th day of Marah, lgc�.
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�►PP�ieatio� �a' Pow�r PIaMs and HtaNng, Cooiing, Yentitat�n� Re�ig�r�tion �d
Air Conditioning Syat�n�s ond Devic�s
at
PARTIAL RATE SCHEDULE
GRAY*'1'Y WARM AIA: ltJ1'�!: TOTAL
I+Lrnace ShetI & Durt Work . a10.00 =
Replacement of �rnace . . g �p ;
Repairs & Alterations—up to j500.00 6.pp a—____ __. --
Repairs d� Alterations each add. s500.00 g,pp =_ .
MECH. WARb! 1lIR
Furnace Shell dz Duct Work to 190,000 BTU ... .. .$10.00 :�� . u 0
eaCh add. A0,000 BTU' . . . . . . . . . . . . . . . . . . . . . . 3. W i
Replacement oi F1�rnace 6.00 E
Repairs dc Alterations--up to ;500.00 g.pp a
Repairs & Alterations each add. :500.00 3.pp ;
STEAM or HOT WA'PEA SYSTEI�t
F�rnace She2l & Lines—to 4Q0 sq. ft. F.DR Steam $20.00 $ ____ __
Flu�nace Shell & Lina—to 640 sq. ft. EDR Hot Water 20.00 $__—
Each add. 200 sq. ft. EDR Steam 3,� �__
Each add. 320 sq. ft. EDR Hot Water 3,00 �__
OIL BUR1�iER—to 3 gal. per hour
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,00p BTU)
over 199,000 BTEJ See Fs� Seludul�
GA
6.00 3— —
8.00 ; .� a
S FITTING FEEB: Ii0 RATE T07AL
lst 3 Fixtures . xa 200 S.�=e u
Additional Fiatures x .�6 i
Gas Range to 199.000 :i b.0� i
.�
AIR COlfDITI0AfI11G �
FAIi HEJITII�G SYS?EN $� FN �ltsdn4
VEl�TILATII�G sYBTEM �
ALTERATIOI'IS � REPJLIR3 TO?J1L FEg = %7 '�
xovaH
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(S'JRCNAR�E $ _.5�)
Dss,t. oi Bldys. Phon. 560-3490
L��� 280 Ely St. N.E.
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city oi Frid]ey:
The undersigned hereby makes appllcation for a permit for the work hereir
speciiied, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Depai•tment of Buildings, and hereby declares that a2} the lacts
and representations stated in this application are true and rnrrect.
F�idley, Minn -� — � 1� L�
--•
Owner _______ __ TY'1—CO B1dL'S .
Kind �f Building .___.___
rJsec3 as - -- —
To be completed about _
Estimated Cost, �_ _____
Frame
_ _ DW�.
Old—NewX Building Permit No. _. F�rmit No.
DEdCAlPTi01� OF WOA1[
HEATING or POWER PLANIS--Steaw, Sot Water, Warm Air-�No_ 1
Trade Neme Singer �� No GB 1104—OHD
Capacity___ Sq. FL E.D.R_ 1 O O� O O O g� gp
Totai co���a t.oaa 4 4, 6 6 9 ���,�� Nat . Ga s
BURNER — 1Y�ade Name g;u �o
Capadt3' 3q. !'t. E.D.R BTU �P.
(REMARKf-OYER)
si� Mill City Heating Co,
Hs !9U � Nz �s��r-Ya--�-
Buslness Phone xo 5 4�-15 O 1
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H�AT LOSS CALCUL.ATIONS DEPAR'TMEN1' OE ftiSPEC770h '
Weatheruripa ' ' Construction IVo. Insulation
Guide � j�ow Apptie
' w� ( ra Refereace Out. Wall Int. Wall Ceilin� Roof Floor Kind
e o x: 19—
�. l oom Length �Width �iei ht Fl.� Room Length —''OVidth �Eleiaht
Weadows and rrCrackage and Area Window nd Doors—Crackage and Area
Wldth Hei[ht No, ot Llneal tt. Arsa wlCth HeiRhc No. ot Linul tt. Ar�� ��
No. Ot o( Dane Ils�b o! Rc r. _
No. p s of a ht■ of crtck W. tt.
r�
o B Coef. B u
lnfiltration _ ln6itration
_ . �,
Glass
Eup. wall
Net...— 11
� int. irall
Cei....�--
FI.�
ToW Btu.
/ / �--°.
Fl, m l.engch J =J1i�idth �—Height
r
Window� and Doors—,Crackage and Area �
ldth He1`ht No. ot Llnerl ft. Area
Na ot pan• o[ D�na 11[ht• ot erack p. tt /
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�
In6ltration
Glaa
F�cp. waU
Net e:p. wall
Int. walt �_
Ceiling /� ..�
Floar
Total Btu.
No.
�
In6ltration
�
�
■
ft. E. . or aq. ini. W.A. der area
Room � Length �'Width /EIei61
and Doors—Crackage and Area
H�16ht No. ot Llneal t. Are
i ot Pa e Il�hts ot �V�
_ i
Glass
�p. w�l��
Net e:p. wa�l
Int. wall �--�—
Ceiling / ! �--
Floor
� Glass
�p. wal�
� Net exp. wall
Int. wall
Ceiling
Floor
T al Btu.
�Required sq.
_ Fl.�y _
Windows and 1
Rl'IACh H
ho. ots'ere _ot
Total &u. . �' ' 7 �
h. F.D.R. oi ins. �►.A. l.asder aTea
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or aq. ins. W.A. ader area
oc,m � L.ength �'�Rr'idtk► Hei
loors—Crackage and Aroa /�
dsht No. ol Lineai t. Area �"
ea e ll hts . ot aC �a � ),
1
/
In6ltration _,_ _�`� u
Glnsa . � ^ �
Exp. wait '-'"
Net exp. wall _ ,___
� Int. wall _
��Ceilmg �-
f� l�or
Total Btu.
Required aq. ft� D.R or aq. ins. W.A. .�ader area
fil. - m I l.ength Width ����
W►ndowa and Doors—Cracl�age and Arta D
Wldth Hel t N ot Llnewt [t. Ar�� �
No. D�n� ot t • ht• ot cr�ck M. �•
� s� � / /
Inhltration
Glasa
Exp. wall —
Net exp. wsll
dnt. wall ---�---
Ceiling ` „ / / �- �
Floor , _
Total Btu.
Requiced p.#�.�r.D�R. �
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k-��. t � {,.�, . � , ._ .._ __ _ _. .___..��_ _ __-_- - --- °- ,
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_� --�- � -- � - -= . _ ._� ��:.., �-� _� � : -: _ .,
__
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Weatherstnps �``� 5.r�.�r.E.. � f Insulat�nn '�
C�nsirucu�+n � . � ----_.... _.__.____ _. �__..�--_-
�� Guide � --
— _�__. �� �___� � ��_ _- �_ __ __ � ; How Applied _ .
W:ndows I I��ors��! Refercnce �� Out. �L all � ln � ail � Ce:lGn� 3�u.,f r �'ioor �i ��n� � . __.__,_ - .— ---
I —. . - - -- - - _ _ _ ,; - - _ ,
.�_ -�----� i ,� :
No es-Na ; 19� !; � �-- � — z._ � A- - _ _ _--
�-_
-- � � �
_ - -=
-
Fi,� e� �� � Lengtti Width� ..�� h .,� !'i Fl�„���,._01�.-'-�'1 Lergth ;���iidth _�-- He►ght �
`.�--�en'--- - - — � -- i -.�-_� ___ � --- �„
.
Windowa and Doors-Crackage an Area ' � Wrnduws and Doors--Crackage an� Area �
� �, --- ----- -- __ ._
{Vidth Heiqnt No. ot Lineal tt. Area /1 �� WldthT. HeiKht Tti+� ot Lfnea t � Area
No. �"o ane of Va e li6hta o crack e4 ft. ' � . _'��.� of Dane � of n ne U�T.te nf �ra 'c xq, ft
-i - ;; .,. �'� � ,� � ;!! �_ � �� �� . - -- � __-- /
_ _
;
--_ 1 �'--- �-_'--' — - 7 .. ,r �.� .
lnfiltration
Wd83
Exp. wall
Net exp. wall
I�t. walll�
Ceiling
Floor ,'
TOta� B .Ut
�
� Windows and Door
Wldth sietBht
� No; � pane �f rsne
:�_
�
ir ' _ _
InbltrataoA
r^
or aq tns � A r area
,�,,— � `� - --
:n � Lc n t� ^' ' � =-�Jsdth
� � _�_.. _
=-Crackage ar.3 Area
� tio. of'-Wneal Cl. Arew
,trnc�� j ot �ac/c w tS,., •
4:iass - ,� `7',
f..�cp. wall ___��-._�� _ _. _�'
Net exp. wali _,__ - __ `,��_
}nt. wall }�
Ceilirrg _ __i �"'�~�
_ _. .
Floor �T��- ___ .� � •
'�'otal Btu. f
-- __. _ __ __
$c. �,D � or sq �ns. W t� �.. ader arca
,��'�: Length ��dth Height
�indows anc; Doar Crackage aracl Atea
Wldth }ielght No. oCTl.ineal Lt. Area
ane o,° pn r IlShte � ot r ck �p. 1S.
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a
1r
Btu
D � �' _�
Ln6ltration
G1asa �..��.�.
Exp. wal! ��/ � �
Ntt exp. wall
lnt. wail
Ceiling " ��
F�loor � X
Total Btu.
Ree�ired ta. ft. �.D.R. or W ins. �/.A.
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I 12eG.�rred.aq. ft. E-- or sq tins � A. ader area
i_,,,� - -- ----�-
`�7 Fl 4�.._ .wrr, Lenbth � �-W �dch t..
�' - --- ---
Win�ow.� nna Doors--�reckagc an3 Area � a
, --- _._ _.. T. .9c .� �i.: c �t :� � Area � �
V�lit � Hefg
� Nc, oT Dti a � �i �w� e 1 iR'h�a ot . k {�'�
--- — _..
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i ln; �ication --- -
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Gi3ss ;_
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r� .___. _. _ ,__ �
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-- -- ---- - - . _ _
I "�et exp w'al1
--- -- _ _ _ - --
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{i Cei� n�. _ .. _, � �_ �
f�,-"' f�lo,' .�__��� _� _ `-=�----�-_1_ _ ,
I Tota. Btu. ----- __ _.. _ —
;; -- ---
____._.. ----_.__�
� ... _._ . �
Requ,red sq ft. E D R. �. gc�. ins. W.A. l.cadPr area
. _._ . _ _�._A
t. ' _- . ... __ ... .. ._ ... . _ _�__��
. ...� _. ..__�
y� -Fj � FCao;n' �Lr.ngth Width
�I ~ iG'indows and_Guors--Crat�age and Area
� �� � Wtdlh Helah[ TNo_ of Llneal :!. Area
, ���,;, �t Oane oT pa �e�,_i6hte ot crack a� ft.
, .. � � .._ ___---} .
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I� _- �___� ___ _ _�__ ._._� __ _
Infiltration
i,iass i
' _ ExP. wa��
Net exp. w
� Int wall ~
�ei�ing --
,,,�„ FI oor _�_
Total Btu.
Btu
;,� .
Neight
e-+*---_-_
H��ghc ^_
Co�f.� Btu
Required t�.f4 �.D•R oi sQ.,�uis• WA l.eade� arc�
�
�
�ity of Fridley _
�►PPticallon �►or �bfiq aud C,�s Fi�q hn�if
Dapt. of Bldqs. P�►oru 560-3430
DESCRIPTION OF WORlC
Niumb�r, Kiad and Localioa oi Fixtu:es
N
� 3� � S� i � �� ° �
� A 3 . o �
Base %l� %
lat � �. � �
2nd
3rd
4th
• Fvx�u� Coaa�el�oa Op�ni�s
� N�w Fixturr. Old Op�nin�s
�Ig�I3�I��I��l��l�$I .I N �s,��....
PARTIAL RAT� SCHEDULE
�
8�r�s
�
PLIIMSIPTG FIXTURE RATES: NO. RATE TOTAL
Number Fixtures . . . . . . . . . . . . . . . . v x a200 E ���. D 0
F�ture Fixture O��ening . . . . . . . . . . . � x $1.50 ; � • � 0
New Fixture Old Opening . . . . . . . . . . . x a1.50 E
Catch Basin . . . . . . . . . . . . . . . . . . . . x a3.25 $
Water Heater '.Up to 99,000 BTU) .... _�_ x E3.00 $ .� D 0
New Ground Run Old Bldg. . . . . . . . . x a3.25 $
Electric Wat�r H�at�s . . . . . . . . . . . . . . : =2.00 =
3A8 FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures . . . • • • • • . . . . . . . . . / z lt2.00 ; °Z � U d
Additional l�Yxtures . . . . . . ..... . . . . . x = .7b 4
Gas Ran�e to 199.000 BTU ..... ....... x 56.00 i
r
• /�.G. •
City of P�idley:
�
�
The undersigned hereby makes application for a permit tor the s�k herei
speciiied, agreeing to do $ll work in strict accordance with the Cit� Ordinance
and ruling of the Department of Buildings, a� hereby decluea that al� the tacl
and representations stated in this appHcation are true and rnrrect
P'rialer� Minn �' Y� „ l a�.
.
Owner �� '� �•? %f a/ C DtrR S
x;r,a or Buiia�� _ ,I�R/f�Y. �'
Used as ���L• L /��
To be completed about J G�Y � s/ S
Estimated Cost, a ��0 0• � .
�ii.--New. Buiiding Permit No. Psrmit No.�_�
Signed /' , • �� //Y CV+
By • �.
Business Phune No. f�+ C" y'��
ROUGH
i'INAL G/ �''— .
AEPAIRS k 1►LTERATIOIfb—R�i�r to Cod� ,$� Jd�C.-� """'"- — ���
Descriptlon ........................ ...................�
i 1�OTAL �EE �
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
: 280 ELY ST NE
: 033024310104
: UNAVAILABLE
: LOT BLOCK
: BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : RESIDING
' -�
PERMIT N .: 2004-01363
DATE ISSUED: 08/18/2004
VALUATION : $ 18,315.00
NOTE: PER R703, 2000 INTERNATIONAL RESIDENTIAL CODE, REQUIRES THAT A WEATHER RESISTIVE BARRIER BE
PLACED OVER EXTERIOR SHEATHING TO PROTECT THE INTERIOR WALL COVERING. EXCEPTIONS FOR THIS
PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATHERPROOF PANEL OR WHEN THE SIDING IS AN
APPROVED WEATHER BARRIER. VINYL SIDING IS NOT A WEATHERPROOF COVERING UNLESS THE
MANUFACTURER STATES THIS IN THEIR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE
COVERING OR TAKE PICTURES. RESIDE HOUSE & GARAGE.
STATE LICENSED CONTRACTOR
APPLICANT
PACESETTER CORP (2414)
4343 S 96 ST
OMAHA, NE 68127-
(402) 331-9400
� . � :
MAAS DAVID G& CAROL D
280 ELY ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of war�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regul ing c ucti r the performance of construction.
A�plican Date �-Ilr-0��1
Bldg Insp Da�C
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 4327
0
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
307.25
18.32
9.16
5.00
339.73
__ ___ _ _ ._ __ _ _
NEW [] CITY OF FRIDLEY ���� � Effective 4/1/2004
ADDN [ j 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
� � �oo�'• 0/3��
Construction Address: � � �' �� S� �tJ �
Legal Description:
Owner Name 8� Address 1��}}v �cJ d� Ccr�,�0� l/� f�39'S Tel. #'7� J" �3-`�LYY_�
Contractor: Y�5;2,�-�-2� CvRP�.��c�'1 MN LICENSE # v�y l�
Address: �--i� y 3 50�1�1 �C4�'�'' S'�'. C�U�c�1� �l1'� ���I �-�i Tel. # t o�(� (�3i� �`� O
LIVING AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
DECK AREA: Length Width HgUGround Sq. Ft.
OTHER:
�y o�
Construction Type: �2. "�'� Cl �- Estimated Cost: $ � b.��� �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �-� y APPLICANT: � C'_�i` `r V C>�.��� Tel. #� I"` (o�� ^��C�
�ex�. a
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we wiil call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
$ �30� ���
$ --'
$ 1 °. �
$ ,/
$
� d L O�
$
$
$
Sewer Main Charge $,
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
:001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [° j
TOTAL $ �� ! � STIPULATIONS:
Building
Inspections
763-572-3604
DATE �J � �� �' C°
S.ITE ADDRESS oZ�U
THIS APPLICANT IS:
PROPERTY NqM
OWNER/ �D�
TENANT ____
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
MECHANICAL
RESIDENTIAL APPLICATIQN
_~�-��_� CITY OF FRIDLEY _
YOUR E-MAIL ADDRESS
O OWNER �CONTRACTOR
c� + � O�
�: �C� - L�..
—� l0 3- `-1 B 3�' O
COMPANY NAME: .,---. __-- ---- -
CONTACT PERSON: ��A� ZI�N
CITY
Received By:
Date Rec'd: `
STATE��IP
STATE LICENSE # EXP DATE
.4DDRESS: 13562 CENTRAL AVE NE CtTY ANOKA STATE MNZIP 55304
PHONE 763-757-6202 F,y�; 763-757-6701
FAMILY O TWO FAMILY
TYPE OF WORK: I � �W ��pLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWM-IOUSE
❑ ALTERATION/REMODEL
PER MS 168.665 the permit fee is a minimum of 515.00 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: (INDICATE TOTAL
NUMBER OF EACH BELOVI�
Equipment Installed , MFG: ��r �� r MODEL: 5� m U� 6 lo � SIZFJBTU �n � ��a
tv�G: �-' e,� MODEL: � y SIZFJBTU �
MFG: MODEL: SIZEBTU
✓A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN 510.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRII,L S10.00
BOILER $35.00 ✓fiURNACE $35.00 _GAS UN1T HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEA1'ER $35.00
DUCT WORK $I0.00 _GA3 PIPING $10.00 _VENTILATOR S15.00
., �- _r-�.: c.,. . .�-: . . . � , ..: — _ - - . .,,:,� .. . . . ........ . _ . .., ..__ _ _
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DLTE $ Number of fixtures @$25.00 1 x$25.00 =$ a� ��
Number of fixtures @$35.00 1 x$35.00 =$ 3 S��
State Surchazge = $ .50
Tota1= $�Q��
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 APPLICl� .�`�-� •� �..�.• PRINT NAME RUGER HOFF�HEIN DATE 3� a--� ��_
�--- __ �. ._, .�. u.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
r �.�r. �7�1 cn�1 dll�f�7
...
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �XISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Comliustion Air (See note below) .
�. �il or solid fuel IMC Chanter 7 with MN Amendments
b. Natw�al Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venti.ng
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 consfruction IMC 1346.0312
5. V entilation .
a. per IvIl�T E�ergy Coc�e 7570 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
comliustion and make up air calculations