AF - 45617City of Fridley, 1VIinn.
BUILDING PEI�IVIIT N° 54'73
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No. � �� . 5treet�
Lot --_...----°—� B�,/lo�ck _.....-.-�
Corner Lot __.....M._'�_.._ Inside Lot
Sewer IIevation
Addition or Sub-Diviston ._.�.,'�..
.._. Setback " .�...._._ Sideyard
_�.._.... Foundaflon IIevat3on -.--...—
DESCR[PTIOfV OF BUILDING
T , e Used • ` � �}} /'�� /j
� � : ` � P €°^ f g /"�
. � � � . � �� . � _... Front De th Hei ht �SL._... Sq. Ft �.L=���^' �u. Ft. �����
! "§ ,{ Q`
.. : ...�. . � � . ...� Front ,�....,� Depth __ �..��...�.r�ight ..�%��. �54. Ft �E..�..L'.. Cu. FL ..._ . _ �L'�
,.�
Type of C truction _.._��gr��L- Est. Cost ......�i�.�.._._. o be Completed ..._...._ .............._........_....._.._
Ea consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set fosth and in compliance with all provisions of
ordinances oP the citY of Fridley. y
In consideration of t6e payment of a fee of $..y7�___.., permit is hereby granted to..___—__ —
.. .. _ to construct the 6uilding or addi4on as described above. This peraut is granted upon
the express condition that the person to whom it is granted aad his agents, employees and workmen, in all work
done in, around and upon said buIIding, or any part thereof, shall conform in a]1 respeMs to the ordinances of
Fridley, Minnesota. rngarding location, construction, alteration, maintenance, repair and moving of buildings
wlthin the city ]imits and this pernut may be revoked at any.time upon violation oE any of the pmvisions of said
ordinances. ..r�^+.,.ri .If f"`l
Building Inspector
NOTICE:
ihp psm�il does nof cever Ihs canshu<fioM inMailtlion fer rviring, plumbinp, pa� heNing, sewar or waror. B� sun ro sM
Ih� Buildi�q Impstlor for asparefs p�rmi4 for Ihe» Ihms.
4
9PPLICATION F� BIIILDING PEft1+IIT
CITY OF FRIDIEY� A
� ./ �
�WTI@T � S N8ID8�� - �;,i.��.�i//l/S�� B11�ZC19T � ,� � / � .��'�",�%�
�ddreea 9ddress 3.�c_o -- �� AiLr �Nl_.
, ' � LOCATYON 'OF BIIIfAING
� �
No. I � %o street / �il , �Ax�� Part or _Lot . . .4�rs�B.,
Lot � Block 3 Addition or 3ubdiviaion n1/� ��
Corner Lot Inaide Lot 3etback Side-Yard
SEWEit ELEVATION FOUPmATION ELTITATION
�pplicant,attach�to thia form Certificate o� Survey of Lot aad proposed building
lccation. ' . _ : .
. . ,
... ,
DFSCRIPTION OF BIIILDING
To be used as:
Z `�
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Sq. Ft. �/., il D Cu. Ft.
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/
i
Sq. Ft. � �'' Ct1. Ft.
Type of Constsuction '�"/��!�+�r O_ - t Eatimated Co�i �'��"�'� �
To be Completed
The undersigned hereby makes applicati.on for a permit for the xork herein specified,
a� eeing to do ell work in strict accordance with the City 6rdinances and ruling oP
tho Department of Buildings, and hereby declares that all the facts and re reseatati
stated in this application are true and correct. �_/JJ,���., '�,,«���
G�- o - — �
DATE O '� � — lo � SIGNATikiB . , . .
(A Schedule of Fee Coste can �e found on the Reners�iSid�.)
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HEAT LOSS CALCULATfONS DEPARTMENT OF BUILDINGS M1NNF11POLIS, l4IINN.
A. .H. E,
Weat6erotiips Cooatruction No. Insulation
I _ I Guide I
Windows Doors Referenee Out. Wall Int. Wall Ceiling Roof Flaor Kind How Applied
Yes—No Yes—No 19—
Fl.� (. ' Room Length 3 Width 13 Heig6t $ FI.� F ' Room Lengt6 !� Width ! Height
Windowa and Doors—Crackage and Area Windowa and ra�raekage and Area
� Nftllh HeiBht No. o[ Llneal fL Area Wldt� Rel[ti� No, ot Lineal [t Atoa
Na � o[ pane ot 9ena fiEhte ot crsck aq. tt No. ot pave a[ pnm � IteDte ot crack eV. I.
a � 1 1 $ �� � 2 y � s � i �(3 I
I �� � 1 ! 1 I
Coef. Btu CoeE. Btu
Infiltration O 3g �F� �` Infiltration �3 �5
Glaaa ''j9 50 �gy� �j� 3 �j
Exp. wall �p. wall �, 3 (o
Net exp. wall � g �JS Ne[ exp. wall
Int. wall let. wall
Ceilin6 23 1` �.9 �� li`1 � �i Ceilin8 j 1-� y� i=� i°� ` 3
Floor Floor '
Total Bm. : Tota] Btu. �
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area Required sq. #o E.D.R. or aq. ins. W.A. Leader area
� FI•� iwit+ Room Length � Width /� Height g �,� Room�Length Width �2 Height
Windows and Doora--Crackage and Area Windows and Doora--Crackage and Atta
WIAt� Helght No. ot Llneal ft. Area Wldth Helght No. of Llneel [l. Area
No. o[ D��e o[ ysne ll��b o[ et�ek tp. tt No. o[ yans o� Wne ItBRb o[ crack p. f[.
3a `7 C�j 2g 4 ! `� (�
�J ( i ' � � 1 1 �! J
Coef. Btu Coef. Btu
In6ltratioa 'jg � 4 �-1 In6ltration � -
Gl,se 50 0o Glass 4
F�cp. wall I X Eap. wall K Z.Q g
A1et eap. wa11 ( 3' 1 (j Net eap. wall ! �
Int. wall Int. wall
Ceilin8 1 I I 17�! Ceilin8 �iX 12 f�0 g
Floor F1oor
Towl Btu. Total Btu.
Required aq. h. E.D.R. or aq. ina. W.A. l.eader area Required aq. ft. E.D.R. or sq. ina. W.A. Leader area
�• '�te►t Room � Length j Width Height F7,� �' Room I Length } Width 1 1 Height
Windows and Doors—Craekage and Ama Window� and Doors—Crackage and Area
Wldlh HlI66t No. ot Llneal tf. Area w�a�e Hel��t Na ot Llneal [0. A�ea
No. af Oan� of Dpine 116bt� ot enck ea. ft . No. �a/[ pfana ot-0�n� tlQlte o! creck �e/a. tt. 4j�
� V t 1� L O � �w �J
�; 1 3 2'. f E i
Coef. Btu Coef. Btu
Infiltratioo !Zj 38 Infiltration R^� � $
Glas� 1J �.� Glaaa 3$
Exp. wall X$ °-(',� Exp. wall ZZ
Net e:p. wa11 3 Net exp. wall Lj � ;`� �,�,' ip�
Int. wall Int. wall
Ceiling �� E j � � Ceiling k k Z� S
Floor Floor
Total Bta Total Bm.
Required aq. ft. E.D.R. or aq. ins. W.A. Leader area Requ'ved aq. ft. E.D.R. or sq. ins. WA. Leader arca
IYt6 �> s
HEAT LOSS CALCULA7IONS DEPARTMfM OF BUILDINGS
A.S.H.V.
Weatheratrips Conatruction No.
Guide
Windowa Doors Reference Out. Wall Int. Wa11 Ceiliog Roof Floor Kind
Yes—No I Yes—No 19—
F{.� Ep Raom Length � Width .`� Height fl.� Room � 1
Windows and Doors—Crackage and Area I) Windows and Doors—Cn
W1dlh HefgT[ No. ot Llneal f. A�ea Widl� Halg�t No
No. ot oane o[ nane Ileh[a ot cnek aq. fL No. o[ Dane of pane 116
Exp. wall ) I�
Net exp. wall
let. wa11
Ceiling 3 k ( p� `
Floor
Total Btu.
Requircd sq. ft. E.D.R. or aq. ina. W.A. Leader a.
�F7.` gq-r}� Room�Length Q Width
Windowa and Doora—Crackage and Area
Glaaa
F�cp. wall
Net exp. wall
Int. wall
Ceiling �X'r',J
Floor
Total Btu.
Required sq. ft. E.D.R. or aq. ina.
Fl.� Room �Lengti
Windows and Doora—Crackae
Glasa
Fap. wall
Net exp. wall
Int. wall
Cei�ing
Floor
Total Btu.
'� 9
Coef. Btu
area
and Area
neat [t. Ares
' enet ea. [[.
ft. E.D.R. or aq. ins. W.A. Leader area
V
Btu
BiLL
Glaas
FzP. watl
rta �=P. wau
Int. wall
Ceilin
Floor
Total
119NIVEAPO
Insulation
How
Width
and Ama
�esi n. .
cnck e
ired sq. #t. E.D.R. or nq. ina. W.A. Leader area
%l.l Room ( Length
Windows and Dooro—Crackage and
In6ltration _�_
Glaaa
e=P. Wau
Net ezp. wall
Iat. wall
Ceiling
Floor
Total &u.
Requ'ved aq. ft. E.D.R. oT sq. ins. W.A. L.eader area
F{,� Room I L.ength Width
Windows and Doors—Crackage and Area
Infiltratioa
Glasa
Exp. wall
Net exp. wall
Int. wail
Cei�ing
Floor
h. E.D.R. or sq. ins. W.A. I.eader arca
.�
Btu
SUBJEQ
City of Fridley
ATTHETOPOF7HETWINS BUILDING �PERMIT
r,
, .
� • COMMUNITV DEVE�OPMENT DIV.
� �y"""'�
r � PROTECTIVE INSPECTION SEC. . .
1
� � �-'9 � CITY HALL FRIDLE� 55632 �+uuBEa ae�. oaTe
�"-'� � �'� 512-571-3450 9i0-F15 6/2i
JOB ADDPESS 1470 Glaciex Lane N.E.
1 LEGAL �OTNO. BLOCK � TRACTORADOITION
DESCR � 1 3 Innsbruck lst Addition
2 PPOPERTV OWNER MAIL ADDRESS
FXlward Nunn 1470 Glacier Lane N.E.
3 CONTRACTOR �� MAILA�DRESS
L. R. Tabor & Sons 4046 Central Avenue
4 ARCNITECTORDESIGNER MAILAD�RESS � �
5 ENGINEER
6 USEOFBUILDING
7 CLASSOFWORK
9 CHANGE OF USE F
❑ NEW ❑ AODITION ❑ ALTERATION
%
70
� �
ZIP PHONE
788-6665
ZIP PMONE
1758
REC
/3385
qvvaovEO ev
SEEATTACHED
SHEET
❑CENSENO.
LICENSE NO.
LICENSE NO.
d REPAIft ❑ MOVE ❑ REMOVE
STIPUTATIONS
Roof can be the 2nd layer but not the 3rd. Install ridged galvanized
valleys � where necessary.
SEPARATE PERMITS ARE FEOUIRED FOR ELECTRICAL, PLUMBING, MEATING, T�PE OF WNST�. OGGUP<
YENTILATING OR AIR CONDITIONtNG. �
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTflUCT10N YONING . SQ.FT.
AVTHORIZED IS�NOT GOMMENCED WITHIN 60 DAVS, OR IP CONSTRUCTION
OR �WORK IS SUSPEN�ED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. . NO. OWLG: UNITS
1
I MEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]_. STALLS
ANDKNOWTHESAMETOBETRUEANDCORRECT�.ALLPROWSIONSOFLAWS yqLUATION
AND OFDINANCES GOVERNING THIS TYPE OF WOflK W�LL BE COMPLIE�
WITN WHETHER SPECIFIED NEREIN OR NOT. THE GRANTING OF A PERMIT S4/OOO �
DO OT PflESUME TO.GIVE AUTHOFITY TO VIOLATE OR CANCEI THE pERMITFEE
�PR VIS S OF ANY OTHER STATE OR LOCAL LAW REGULATWG CON-
TR CTIO H THE PERF�RMANCE OF CONSTRUCTION. �y44. SO
PLAN CHECK FEE
� BiGNNiUREbFC, TORORPUTHORIZEDNGEN� ��I�� WHEN PROPERLY
_�. ° -
��CIf,NiTtlRGOCl1wNERJFOWNERBWI�ERI IDATEI winu irvGG
GPRAGES
$2. Q�
$46.50
NBW [ ]
ADDN. I J
pLTER. [ l
City of Fridley
�R-1 AIID H-2
Bu3lding Permit Application
Construction Address: ��� d G�"�� 2
Legal Description
Effeetive 4/1/84
Owner Name & Address: �4u1R32-[l ,VraN/,aJ /t°fi0 �-LI¢CcF/L Li9 ' Tel. # 5 � � —.3��'v
Contractor:
L�— Try-�d'L r� cS'an,�4 � Tel .#�f—(°� �
Addresa: �O '-fG ccti/�� �--
LI9ING AREA:
QARAGB AREA:
DBCR AHBA:
pTE1ER:
Corner Lot [ ]
Attaeh to this application, a Certificate of Survey of the
lot, uith the proposed conatruction drawn on it to scale.
DBSCRIPTIO� OF IMPROY$l1SNT
Length Width Height Sq. Ft.
Length Nidth Height Sq. Ft.
Length liidth Hgt/Ground _ Sq. Ft.
Inside Lot [] Ft. Yd. Setback
Type of Conatruction: TEA" � �'� ���0 �
Approx. Completion Date: � — �� —8 7
Side Yard Setback
Estimated Cost: $1�O�Z]�
Alt. A Alt B
proposed Drivexay Midth If Neu Opening I$ 1�Sired: gee Saek Page for Explanation
DATE: 6— 2� —�`'� APPLICANT: � Tel . 0?g��(D ��
CITY 03E ONLY
Permit Fee
Plan Cheek
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
YOTAL
STIPULATIONS:
� � . S�
$
y a.00
�
$
�
� ��
Fee Schedule on Reverse Side
25i of Huilding Permit Fee
E.50/31,000 Valuation
E425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ J Not Neoessary []
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Building
Inspections
763-572-3604
SI7'E ADDRFSS��
THLS APPUCANT IS:
PROPERTY OV
TENANT
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
�1 Y11
BUILDING
RESIDENTIAL APPLICATION
OF FRIDLEY
YOUR E-MAn. ADDRESS
❑CONTRACTOR
Permit No.
Received By:
Date��: �UN " 4 2�
Ted�ir—�=�'�/2/
STATE LICENSE p EXP DATE
ADDRESS: CITY STATE 2IP
PHOTIH FAX
O BASEA�NT FINISH �.ROOF
❑ DECK ❑ SIDING
DESCRIBE WORKBEING
xun�m oF sQun�s �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDIIVG
❑ Vinyl
❑ Aluminum �
❑ Otha
WINDOWS
IN EXISITNG OPENQdGS
OR FOR NEW OPENAIGS
OPENPIG CHANGES &
Plan Review
Fire Surcharge
Surc6arge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Maiu Charge
❑ HOUSE R GARAGE
❑ All'ACF�D GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
OYes @Io LOCAT70NOFWWDOWS
DESCRIBE SIZE OF _ _ _
S
S
S
S
S
VALUA
(USING
❑ DRAIN T7l.E
❑ OTHER
HEIGHT
BASEb1IIJT REMODELMG SUBM17:
1. ExistingFloorPlan
2. Pmposed flaor plan .
3. List of structlual members to be useA
Ft.
FOR NEW CONSTRUCTION MCLUDING DECKS,
ADD1770NS. &. PORCHES SUBMIT:
l. Site Plan/Survey showing the existing sWCWres
and proposed qoject
2. Txro seLS of construGion plens
3. EnergyCalculations
1G TfiE COST OF LABOR AND MATERIALS:
FEE SCHEDULE)
See Back Page £or Fee Schedule
65% of Building Permit Fee
.001 times the total job valuazion
.0005 x Permit Valuation Minimum 5.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
5450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformence with the ordinences and codes of the Ciry of Ftidley 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. j�
SIGNA7UREOFAPPLICANT��_h,Q� PRINTNAMEL�/�n���1SDI\ DATE��T'O,�
_�- f�� 1 t 36 g
DATE TESTED 3 3 HEATING TEST RECORD �oB r,o. c� I 1 S
ADDRESS l�JS) �J (-�C.�� R �A N� p�7y _��_
OCCUPANT _ _ OWNER � ` IV I�f �
SOLD BY __ ____ __ INSTALLED BY �L Q_f?�{�� �' I�N �
MAKE ��3 �{ �_Q i� ___ —�-��MODEL � c1 � 3 /y � - l b p —3
SERIAL NO. ��Qa �O � 4"t ____.__ INPUT_� O, C7 U O
THERMOST�AT� 1 aIOOoC ___._ VENTSIZE__s,�'__.
VALVE �_L� Z� aO -F -._ .. _ __.,-.. -_. . ._. . _ _ TYPE OF LINER_ _ � L.�S 5- � _ ___._
LIMIT I�T�, L`�1 �IMIT SETTING Zt> � LINER SIZE G� 1 __ �
FAN SETTING ��.'y�q ��Ci __
PILOT TYPE � P A 2K I G N 1T�.p 1.� __
IGNITION MODEL � P Z � � __ _
PILOT TIMING
PRESSURE
INPUT CFH
PERCENT COz � S _ PERCENT Oz �
COMPANY TESTINGY� G l 4^I L�BiTI IV G'
FOPM 235 (REV. 1 i192)
FILTERSIZE 6 A C NUMBER
WIRING� .____
TEST TAG � .__
LIGHTING INST. \� __
STACK TEMP. y ( O �
PERCENTCO CS. O
NAME OF TESTER �+l�h �
�uild�ng
IrZsp��tior�s
763-572-3604
763-502-4977 FAX
DATE //i/.
--�-�7 �
SITE ADDRESS �
THIS APPLICANT IS:
TENANT
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIF[CATE OF
INSURANCE
PERMIT
TYPE OF WORK:
DFSCRIBE WORK BEING
ROOFING
NUMBEROFSQUARES_
GARAGES
PROPOSED SIZE:
PROPOSEDf�IGHT:
5m�,�
o �;m�
❑ Numinum
❑ Other
�,, , , �i,TILDING rz��t No.:
RESIDEN1�I�iL APPL'�CjATIION Re�e��ed sy: �
CITY OF FRIDLE''Y �� '� �� r. 2 2009
O OWNER
STATE UCENSE
❑ SINGLE FAMILYMEW CONSTRUCiION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMM
❑ NEW HOME CONSTROCTION
O MAINTENANCEIREPAIR
W[NDOWS
fNEXISi7NGOPENINGS OYes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
ALL
TOTAL JOB VALL
Permi[ Fee
Plan Review
Fire Surcharge
Suroharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Conuol
Pazk Fee
Sewer Main Charge
❑ ADDITION
�I9.REMODELING
❑ HOUSE ONLY
❑ HOUSE & GARAGE
C��
EXP DATE
❑ DRAIN TILE
9a OTHER
❑ ATTACHED GARAGE /. /!ir ,
❑ DETACHEDGARAG uT
�1
osoff� b � � �
6 Trim
❑ Fauia
I
LOCATION OF WINDOW b �
�
Existing Floor
Proposed floor
18EINSTALLED NUMBEROFWINDOWS /�/ � o i
ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
_�(USING THE 1997 U.B.0 FEE SCHEDULEI
S See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 [imes the total job valuation
$ .0005 x Pertni[ Valuation Minimum 5.50
$ $5.00 (State Licensed Residential Contractors)
$ $2000 per SAC Uni[ (Plans to MWCC for detertnination)
$ ft+6ft= ftx$22=$
$ $450 Conservazion Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
of Fridlev Attach
THIS IS AN APPIICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
FT
ezisting
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
confonnance with the ordin s and d of the City of Fridley and with the Minnesota Construction Codes; that I understand this is no[ a
pertnit but only an appli ion for a it � o is not to s[art wi[hout a permit on si[e; [hat the work will be in accordance with the
approved plan in [he cas of all w i review and approval of plajn�s�.((�� ��J� � ��,�
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Building PLUMBING P��;� N�.:
It�spections RF',SIDENTIAL APPLICATION Received By:
763-572-3b04 CITY OF FRIDLEY o�a�A� � 2�4
763-502-4977 FAX �,:,;�,,-�ivE �-,9,„,
DATF.Jan rt b d� VOURfi-�w�nDURfiss Y�C�u,�enin(?.n,';n.Cnr��i ,
sITEADA1tE4s ( 1`I7o CofaLar �.a��E.' ..
TIOSAPPLICANTIB: OOW'NER OCONPRACTOR .
PROPERTY NAA7E:
OWNER/ AUUNESS,_,,. CITY_„ STATE_2IP_ ._
TENANT —
PHONS:
GONTRAGTOA Nanau: P I ,' C _ _
SUBMYPACDPYOF SI�TELIC5N5eM C'� - F�f�1 SXPD�75 le7 ;31 �JPiD
Y011R STATTi
LICENSE, BOND AN� STATE BOtvo N EXP oarE
CERTIFICATEOF ppDft855:,,�°�'��� ('7�v `�Jt. F��.k.. CITY M�nr,��ml�` SfATR_T�.LI21P-55yifl
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C1A'I'HE3WASE�iR KIT(:Hl:NS�NK 1 WATERCIASET BACKFUIWPRCV.(SIS)
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— — —wa�en��e orr+r�e
Nienl+rof6zhoa�SloAO 3 xS10.ao-S o.ot+
NuMher of f6tdra (� 515.00 _ x SI5.00 = S
Nwth� of Calaa � 533.00 _^ X T33.00 = S
s�e 3�¢dw�e S .30 n,
ToW =S . O ��U
� TF�S (S AN APPLICA7[ON FOR A P6RMIT•NOT VALIU UNTIL PROCPtist�17
[ F�Creby q�ply FM e plumbing pamit and ! aclmowtedge thst the infomietion abovo is oompleh aod accurale: dbt the vrork will be in
conformance with the ardinences and cades of the City of Fridley and with 8u Minnesota Cunsauction C.ades; that 1 understand this is
not a parmit but mly an appiicalion for a pemtit and work ia not to stet without a permk on sik: that the work will be in accordance
with the approvad plm� in the caee of all work which rcquires review and tpprov�i of plans. I
� ^ M .1LrJ.UA7E 1 • F• _�
SIONAIVRBOPAPPLICA ��� .. !� f'�� rn^a r�PRINTNAw�E J�aJAi�� Pr7��L�� ...—
r�r.�,se xors: asp�uTa re�rs � v�BO rroR arm.nMa e�acrwcu. nxn MseFUrr�cu, wonx
City of F'ridley
Suilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
7b3-572-3604
FAX: 763-502-4977
Building MECHANICAL Permit No.: O-4
Inspections RESIDENTIAL APPLICATION Re�e`°ed By: t�
763-572-3604 CITY OF FRIDLEY �i�k�i�� 15 2o�n
763-502-4977 FAX �aECnve i-i-zoto i
DATE YOUR E-MAIL ADDRESS �'l �C.��'�C�'1'P-I Od1. �' L Y�
sr�nnn,�ss t�10 ��[fyriev I a/IP.
THIS APPLICANT IS: ❑ OWNER I�CONTRACTOR
PROPERTY pp*g: �
�WN�� ADDRESS: CITY STATE_ZIP
TENANT
PHONE.
CONTRACTOR �p�,�y Nq�: � ; �
SUBMIT A COPY OF �NTACT PERSON: V t S f 5
YOUR STATE STATE LICENSE M n E?CP DATE �11
LICENSE WITH ADDRFSS: I�RIn C�i.tti � J2. CITY O la :V12 STA'1'F/�F A„�ZIP�{,�'_�
APPLICATION pHONE LP l a- c3� G?� a�'N FAX .
PERMIT 7'YPE �INGLE FAMII.Y ❑ TWO FAMII.Y ❑ TOWNHOOSE
TYPE OF WORK: � � � �PLACE�9IIdT �ALTERATION/REMODEL
DETAILED DESCRIPTTON OF WORK Z S
FEES ARE BA5ED ON S10.00 PER FIX1'IIRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NI7MBER OF EACH BEIAWj
PROVIDE HEAT LOSS CALC'S PER MANUAL d 2006 ASHRAE HANDBOOK
FquipmentInstalled MFG: MODEL: SIZFIBTU
MFG� MODEL: SIZE/BT[7
MfG: MODEI,: SIZFJBN
_A/C $25.00 - _FIREPLACE (GAS) 515.00 GAS RANGEKIVEN $10.00
_AIRTOAll2EXCF3ANGEER315 FIREPLACE(WOOD)535.00 _NEWGASGRILLS10.00
BOII,ER $35.00 F'URNACE 535.00 GAS UNIT HTR $10.00
CHIbllYEY LINF.R $t0.00 GAS DRYER 510.00 POOL HEATER $35.00
' DUCT WORK $10.00 GAS PIPING SI0.00 I�VEN'I'ILATOR SI5.00
Number o£fixtures'@ $10:00 _ x $]0:00 = $'
Number of f�tiuesQ $15.00 x $15:00 = $
Number of fixtures @ $25.00 _ x $25.00 = $
Number of fixtures Q$35:00 _ x$35.00 =$
Shdte Surcharge = $ .50 �
MINIMUM FEE $35.50 Totat = $ ✓'-� " �
7EQ5 IS AN APPLICATION FOR A PERM[T-NOT VALID i)NTII, PROCESSED
I hereby apply for a building permit and 1 aclmowledge that the infortnation above is complete and accurate; that the work will be in
conformance with the ordinan es and codes of the CiTy of Fridley and with the Minnesota Construdion Codes; that I understand this is
not a permit but ' arion for a rmit and work is not to star[ without a permit; that the work will be in accordance with the
approved plan in e o9 0• ' trt�qc ' e• review and approval of p`lan�s.
SIGNATURE OF APPL � _ PRIIJT NAR� 1�.475� �{�C`,� ���X-V �AiE� `_l �{�l u
APPROVALINSPECTORSSIGNATURE DATE �
PLEASE NOTE: SEPARATE PERMITS ARE RE UIRF..D FOR BUILDING, ELECTRICAL AND MECHAMCAL WORK
(;ity oiN'ridley
Building Inspections Department
6431 University Avenue NE, Fridley, NIN 55432
763-572-3604 FAX: 763-502-4977
�
Building
Inspections
763-572-3604
763-502-497T FAX
unrt 2-/8-�c
sirtnouKrss 1 N7
TH1S APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRAC`I'OR
SUBMIT A COPY OF
YOURSTATE
410ENSE WtTH
APPLICATION
PERMIT TYPE
�ee oF wo�uc:
of Fridley To: 6577870569 Page: 4t5 Date: 2/19120101:14:13 PM
MECHANICAL Permit Ni
RESIDENTIAL APPLICATION Receivect
CITY OF FRLDLEY
t-MAIL AUURtSS 'i I te n'�er�i � eS ui��r t n. o w�
;�er Ln• Fr,'c�IEy
❑OWNtR pjCONT1tACTC1Ii
' ��l
COMPANY NAME'. TLT Evl tGf�Y15Q5
cxmracTreKSON: T'`., 'IOenS�°n�
STATt L1CtNSt fl tXP UATE
nuuKtss: 57�1 V°L�<�` Lane- c�TV Shoreview sTnrt�yNiir SS�2fo
rrion,e�Sf-787-0636 �AX �s!-�%�-os69 i
I�SiNCLtk'AMiLY O7WOF'AMILY
Q�NtW ❑RtPLAC�MtNT
D8'CAILED D6SCRIPTION OF WORK
i c , i ' - r' '1
❑ TOWNHOUS!
❑ ALTt1UT10WRtM0UtL
F6L�5 AN6 BAS6U OY SI0.011 PER FIX'N RE, tiXCL�PI' W HCNB VO"fCD. FlX'1'UNL+S: (IV UICA'fL+ T47'AL VUM 868 UF L+ACM 68LOW)
PNOVIDENBA"fLOS3CALC'SPENNAVUALJ2006ASHHA6HAVDBOOK j �
k:qiii�xrcntlncdlled MFG: � h10UtL: MaNT�S SILkR3TU 600'�'O.ZSj60J
M�,�;: �-/K-(i lo tdout�: fB 1/� -S s�r�uru O o00
n/c SZS.�a
AlRTO AIREXCHANGttRS15
H(1lLF:R S35.OU
CHIMNtY LINERSIOAO
�uucr wowc sio.00
MbTi: AK1UtL: SILtiHTU
�M7Rk.PLACE(GAS�515.00 GA$ RANC:FJOYENS�0.00
PIBEPLAL't ( W�#1U) 535.00 NEW GAS ORILL $10.00
MI RNACE 535.UQ GAS UNtT HTIt S10 Af1
GAS UItY tli S I0.0(1 M)OL HtATlR 575.00
9 GASPIPwGS10.00 VrNTILATORA�5.00
THIS lS AN APPLK'.ATIOP! M(SA A Pk:RMtT-NOT V AllU UNTII PftOCtSSF:U
! luxcby apply for a buildin� permit and I acknowlodgc that thc info�mation abovc i.4 complctc and acwcatc; that thc work wiil bc in
oonfortnancc with 9w wdinsnccs and wdac of Mc City of Fridlcy snd with dic Mimaaota Construcrion Codcx; that 1 undcrxtand thix is
not a pertnit but only an epplication for a permit a�xl work is not tn stazt without e permit that thc work will bc in accordancc with thc
approvcd plan in thc carc of ally�prk w rcqui� rcvicw and approval of plans.
./J/�, ,�'� b !'�
$If.NATURE ON APPLICANT u^" __. _ �'7 PR1NT NAME / � YvL / Ol.°YIS/ 1] � UATE .�C — I S^�O
City of Fridlcy
Buildieg inspectioos Department
6431 University Avenue NE, Fridley, MN 55432
763-572-36Q4 FAX: 763-502-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE��
S1TE ADDRESS _
THIS APPLICANT IS:
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
.G � G YOUR E-MAIL ADDRESS
c,l O,e i e,�' Lc� '1�'
❑OWNER �L7CON'CRACTOR
�,o,�r� eckeS
�. � ts =i n�,.1 n� I..
Permit N
Received
..,�,�_a.
CONTRACTOR coMa.aNVNnMe: CENTERPOINT ENERGY
coNTncrPexsoN: JOANN ZINKEN _
SvaMtr n Corr oF BOND 2201334 Exe onTe
YOUR STATE STATE LICENSE# M 55433
[,icsxsEwirt-t n�oxess:9320 EYERGREEN BLYD NW SUITE B cirvC00N RAPIDS srnre N z�e
APPLICATION pHONE 7l'iR-7�,7-670i - FAX 763-757-6701
PERMIT TYPE
TYPE OF WORK:
�SINGLEFAMILY ❑TWOFAMILY
❑NEW �ijiEPLACEMENT
DETAILED DESCRIPTION OF WORK �Su��G �1
❑ TOWNHOUSE
❑ ALTERATION/FEMODEL
FEES ARE BASED ON 510.00 PER FIXTURE CEpiW �ERE NOTED. FIXTURES: (['7'�1D^ICA�TE, �TOTA UMBER OF EA BELOW)
Equipment Installed MFG: MODEL: �¢�L' "6� SIZ T �15 000
MFG:
MODEL:
MFG � MODEL:
AfC E25.00 . FIREPLACE (GAS) 515.00
AIR TO AIR EXCHANGEER $I S FIREPLACE (WOOD) 535.00
BO]LbRS35.00 . � �URNACES35A�
CHIMNP.Y LINERSI0.00 GAS DRYER 510.00
DUCT WORK $10.00 _GAS PIPING $10.00
SIZE/BTU
SIZEfBTU
GAS RANGE/OVEN $10.00
NEW GAS GRILL 510.00
GAS UN[T H1R SI0.00
POOL HEATER 535.00
THIS 1S 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 witk� 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�np'yall wo�r�k w�h rgq,uire vc�approval of plans.
SIGNATURE OF APPLICANT , l� � - PRINT NAME ROGER HOFFNEIN . ppTe �'��( � �O
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 PERNIIT APPLICATION HVAC
� NEW HOMES/ADDITIONS �EXISTING HOME ❑ MAKE-UP AIR
REOUIRED FOR NEW/EXISTING HOMES
1. Combus6on 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 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
REOUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
_ __ - ___ _a. A�C7i 11�Iannal"B. __ . _ _ _ __ _ _
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
com.bustion and make-up air calculaHons.