AF - 45642Village of Fridley, Minn.
BUILDING PERDZIT
....,..��',y,n� r- �-;..
Date : .. .... ..............'...
O�vner .......................................
Address��...� ...................................
�T° 1624
P�uilder f.F�/,f � .��:�.... ���-'.Ll . .�
�r �(,,. ....... �g ./J
Address . . . .� :�. � �. . . . . .Cl.".<:,.h ' /�-t'.:e,{ . !:'°..T '
�,�� �..., �.LOC�T� p� ,��Il,DING
� No ....... . Street �..:: -'�- , . `.' ........�.r.✓.�.°.�! ....... Part of Lot
.....
� ` � .
2 � . .. ,�•��,•�:��
. Lot ....... ...., Block ..... ........... Addition or Sub Division . � �.`:�,.......`„"".�.-..... ���"'�
. .. �� �. ............
'~ '� r •r'i ' /d�: r�r ..
�� Corner I.ot Ir.side Lot Setback ..�'....... Sideyard
L�E�CREPTdQh.! GF QU�LDEI�G
'Po be lised,as:
�,.
,Y.. . �,.; ,. - .
-::�.. ��::...... Front : ::.. Depth .-�.:�... F-I�ight .::, . Sq. Ft. ........ Cu. Ft. ........
...........�.......... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. rt. ........
z
TyPe of Construcfion �����%-�`���
...-......:-....... Est. Cost ..................... To be Completed ..................
ii;�%y��d`�"` f"��`"''`!f�
� �� In consideration of the issuance to ne of a permit to construct the building described ahova, I agree W do
tHe proposed work in acrnrdance with the description aboce set forth and in compliance with all provisions of
�� ordinances of the village of Fridley.
. , . ........ .... .....
. .. . / �f � � l : �
: In consideration of the payment of a iee of $.:..�....�.��., pern�yt is hereby granted to '� � � J�'"`�;
. . � , ... �. .....
� • • • • • • • • • • • • • • • .. .. .. , , , to construct the building or addition as described above. This permit is granted upon
.. � the express eondition that the person to whom it is granted and his agents, employees and worlmien, in all work
� � � done. in, around and upon said building, or any part thereof, sUall conform in all respects to the ordinances of
� � Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
� in �the viliage limits and this pernvt may be revoked at any time upon violation of any of the provisions of said
� � ordinances.
sC: F w s
� % �{t',-. �
... 1..' .... -��............ Building Inspector
!
NOTICE:
� 7his permi4 does not cover the ConsYruction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. . Be sure to see tF uitding Inspector for separate permits for ' ; items.
i'�
//
From the desk of
NASIM QURESiIi
CITY MANAGER'S OFFICE
�
DAtE: August 11_> 1981
iUBJECT: Inquiry by t4r. Ben Ho to the Mayor
Regarding his Hot-cool tub
ri�]
_, J__�'�;/`� ,; �
,,
f..
,
MEMORANDUM JF-105
See the attached letter and quote the exact requirements the City has and the
rational behind these requirements for the Mayor's information and review.
Thank you for your assistance.
NMQ/ms
0
Nf0
� 1 _�
�
BEN HO
112 Glen Creek Road
Fridley, Minnesota 55432 hlgtlBt 7� 1981
Mt�pOr Ne@
City of F�idley
FMdley, t�II�T 55432
Dear Bill,
I plan to build a Patio/Deck stlth a 6� W. %
8+ L. s 4� D. i€OT-COOL TUB. x intena to cover
the tub securely when it ie not in use. Thie
�zLll also keep the t�ater alean and conserve
energy.
I pas iaformed lry Steve Olsoa that I require a
permit to build the tub and muat�either erect a
6' fence or enc].oae the entire 19� g 21� patio
area. I must also install selY latching gates
or doors.
Pleese advise me on rd�et I�y do to aontirnze
sa planned.
�
�
:,
P.S. I may be contacted at 571-5216, pre-noon�
or 43a-713z after 1 p.m.
-`\'�
� � pN ORDINANLE ESTRBL[SNING LHAPTER 115 OF THE FR[�LEY WTY COOE
'— ' • ENTiTLED SWIMMiN, PoOLS AND REPEALINC, PRIOR CI�PTER 115
�/I-P�
iHE W1Y COUNCIL OF THE C1TY OF FRIDLEY DOES OR�A711: �
T f Y'� ~ � beeregulatedtas�Pollowstion and licensin9 of swimminn pools shall i
i
��.` /�.p�p �� j 715.01 Oefinitions The followinn definit�ons shall apnly in [he interpretation �,
J/ CHC — en�ation of this Chapter and the followinn words and terms whenever they
�/— occur in this Chapter are defined as follows: ,
L{fF /�AJE / u%� EX�S�NC ���� 1. Health Department, Health Offlcer, State BoarE of Heal[h used ,
� at any p1a<e in this Chapter and fn the requirements aEOpted 6y reference
d_ '� �� ��6 shall mean the City. -
f�r rH 8 s r��
2. Person shall mean any individual, natural person, firm, association,
—»� organization, partnershiq, business institution, anency, or any Fe0eral, .
�� I� ,�,v ow r po�k ra 6 State or local 9overnment agency or instrumenWlity or other entity rewqnized
M � , by law, as the subject of riahts and duties, and shall inGude, but rwt be
� limite0 to, enployees, li<ensees, tenants, caretakers, lessees, manapers and .
Bu�a�v�a�� Cr . wN p �����:o:,. �� ��,;�.,:,� �,,,..
R� �y�'f 3. Privtte residential pool shall mean any swimmin9 pool locateC on private
�N�� Pi��'"'.' � proDerty under the control of the homeowner, permanent or porta6le, the
1 u� use of which is limited to swiaonina or bathino by the resident famfly or their
�E eY�+ EJ'T1�^ �'�/I �T r i^�ited guests, and havin9 a deDth of more than Mo feet (2C inches) at a�y
point and a surfate area exceeding 250 square feet anC a volume over
� 3.250 gallons �
w D»�R�z �2'
(N�7s F'rQ.i%- �,s�.��� 4. Public swirmina p�ol shall mean any swimninq 000l, other than a private
residential pool, intended to be used collectively by numbers of persons for
T � SNimming and bathing, operateG Ly any persons whether they be oaner, lessee,
�EG T %'V �� � v��� �� � operator, licensee, or concessionaire, reaardless of whether a fee is charped . �
, ; for such use.
� 5. Special purpose �rool shall mean any swimming pool used as a treatment 000l, �
H C� ��,r, I,r ��� �� E therepeutic poal, or a special pool for water therapy. '
W�,'j f 6. Swimning pool shall mean any structure, basin, chamber, or tank canta�nino
�� �� an artiticial botly of water for swimnin9, Eivin9, relaxation or recreattonal
�p���p ..IA bathin9.
pC /�� /— Iv ��A'� 7. Xadin9 pnol sAall mean any swimminq pool used or designed to be used �,
'�,�p,�� ezdusively for wadin9 or bathing anC havinp a mazimum depth of 24 in<hes. �
���Cx�.,p P/f{�-p-/ �. �� 0 r�'v $. InTlatable swimnin9 pool enciosure shall mean any temnorary shucture rhose �
�� . primary means of support is air pre55ure.
(�(�O �1 ��� � ~� � P�^��5 Oz 2eneral Requirenents � ''
1. Plans and BuitEinn Permits �� l��,� ,
T ��}�yejy7/l�Ef�E /N�7istt- II f� ++
a� � ��N d� f �� person s all construct,.enlaroe, reoair, move, convert, or alter any
(nS � � svimmin9 Dool witnout first suMittinn plans an0 obtaininn approvai from the
e tity arM the aDProprfate permits frwn the City. No buildinn permits sha11 �,
I t N�� �,E �F/k fi1� Qi r b¢ issueA unless prior apDroral from the City has Ceen qranted in writin9.
� �� 2. Plumbinn. Electrical, Mechanital
� � E��J'F R�r►�
{� ' ,� �� �3 R11 plumbin9, etectrical anC mechanical installations and equipnent sha11
CK •� � ceet the requirenents of the FridlGy tity Code. i
ca+ F� � �-„v r �;vre�Q �R�7�fc�,r„ !
��s 3. SDecial Uze Permit ReWired -
T�T
C�� A[� infiatable srimminq pool enclosures shall requtre a spedal use permit -
��h /� r�C S ( r I1 �� . � prior to.their fnsWilation as outlined in Section 205 of the titv Co�e. — ;
Ai ii �p.i✓�Ti �PL� A BN Fi n_s,�/G Ij�i...i't -----
,r y���i��y . %� S�J'i,p�,
�{DK� 81� !�-d��s %r Di
r�E .,�►1�R aer.�`t �
�! p SIS I r1'J� ��► i Qlro t
/
�A%.'tran � � 7� 6' 8�
�¢•.� k�v.•�-n.-1" N,�as' 6
715
� r„/ L_nance No. 610 . Paoe 2
N'�
4. �ocation
�`� n� All swimmi�g pools nust be located a minimum nf 10 feet horizontal distan<e
. fr� any overheaE electrSCal wires.
� '�IJ 5. Fenciig �
i
Fmcfn9, or other effectfve nieans incluOin4 but �rot limited to aalls
�d.T.��f pr hullGin9s, accepta6le ta the Cfty, shall be pravided ta posltively eontrol
!� all access to public and private res�dential swimmina pools.
�p Fenci� shall meet the following triteria:
�"� a) The fendng shall prevent the entrance of children and be without
han0 or foot Irolds that arould enable a person to climb over it.
�e1� b) i�e fe�rcing shall be at least 6 feet ��gh arM ent�ances sha11 be
v • equipped vith self-closfm and self-letchinn �ates caoabie of
� being locke0.
e) Self-closin9 anE setf-latchinu devices shall be placed at the too af the
9ate or otherwise inaccessi6le to sirall children.
�
d)� The openin9 betr�een the bottom of the fence and the oround or other
surface shall bx not more than four in<hes.
6. Equipmen: StarAards
qll new equipnent purchased or {nstalled on any swimmin9 pool shall ronD1Y
with the following applicable standards of the National Sanitation Foundation:
a) Standard No. 9- Diatomite Type Filters for Swimminn Pool Cquipment,
October, 1966.
.. �'__'__. .�_ .n e�..w n...., r.i.e�� a..� c.,...�.�n PnN Fouiwnent.
SUBJECT NO:
,� City of Fridley _ 16 6 61
"TT"E'°P°FT"ETw'"S gUILDING PERMIT
,�
� COMMUNITY DEVELOPMENT �IV. � ' �
, ; �------ � t� (� 3 (�
% � � PROTECTIVE INSPECTION SE0. . � .
�
� � �"'1 � CI7Y HALL FRIDLE�� 5503Z �+umeea aev DATE aace oF nvvaoveo sr
: '""� i .�� � .
612-571-3450 gt0-Fts 7/2/82 / /
JOB ADORESS 112 Glen Creek Road N.E. � � �
1 LEGAL LOTNO. BLOCK TRACTORADDITION SEEATTALHED
oESCR. 2 2 Oak Creek Plat 2 sHeEr
2 PROPEtiTYOWNEP MAILA�ORESS ZIP . PHONE
Benedict Ho 112 Glen Creek Road N.E. 571-5216
3 CONTpACTOR MAILADDRESS 21P PMONE LICENSENO.
Same
4 ARCHITECTORDESIGNER MAILAD�RESS ZIP PHONE LICENSENO.
5 ENGINEER MAILAD�RESS ZIP PHONE �lICENSENO.
6 115EOFBUILDING � , . � �
R251d2Rt,7.31 �
7 CLASSOFWORK
❑ NEW � ADOITION ❑ ALTERAT�ON ❑ REPAIR ❑ MOUE ❑ REMOVE
8 �. DESCRIBE WORK
Construct a 10' x 20' Patio
9 CHANGEOFUSEFROM TO �
STtPULATIONS � �
N�aRNING
sEP�RAre PFRMrrs ;� �E� ;r,�.� �„ �r +r�as�
HE�1iNG. P�U�BING � . . ����fi�:
�va �,��°R �'� ���: � �.�,
TVPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPAPATE PERMITS ARE REOUIFED FOR ELECTRICAL. PLUMBING, HEATING,
VENTILATINCa OR AIF CONDITIONING. � �
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO.FT. CU.FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, Ofl IF CONSTRUCTION �� �
OR WORK IS St1SPENDED OR ABANDONED FOR A PERIOD OF 120 �AVS AT �
ANY TIME AFTER WORK IS COMMENCED. . NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED TH�S APPUCATION 1 STALLS GARAGES
ANDKNOWTMESAMETOBETRUEANDCORREGT.ALLPROVISIONSOFLAWS VALUATION SURTAX .
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPEGGIED HEREIN OFl NOT. THE GRAN7ING OF A PERMIT $Zr OOO � $I.00 �.
DOES NOT PRESUME i0 GIVE AUTHORITY TO�VIOLATE OF CANCEL 7NE pEF±MITFEE SACCHARGE � .
PROVISIONS OF ANY OTHER.STATE OR LOCAL LAW REGULATING CON-
"STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $32. SO� .
PLANCHECKFEE TOTALFE&
$33.50
' SiGrv EorcorvTRn_ cjoaqqnyry g�E EHr ��� s� WHEN PROPER VALIOATED THIS IS �OUR PERMIT
// // ?ri
I/� sf� /I
� v..�� � � �
rr s�cTSn'ruAECrowr�cAi�FOwr�eRaui�oEa�, ioa. � a�oc ��+s� nn c
CITY OF FRIDLCY Effective Aug. 1, 1981
APPLIC11TI4W fOR RESID[iVTI/1i. [3UILDIi�G PLRidITS
(t�c�•�, Alterations, lldditions, or Repairs)
OFlNER: �p�kp,��c'� L�v
ADDRESS: �/Z �,ot, Ch��,LC ie�P
TEL d0: S7/- S Z� �
STRITT NO: I I Z
IAT: Z.
6UILDER:
11DDRESS:
TEL t�0:
Construction Location
STItEET- (X/P�Gt �htGlG �°�
HLOQC: Z. ADAITION: OCfdL ` MpG� ��4.� Z
Corner Lot: insii3e Lot: �_ SetbacY.: Sideyards:
Ap�licant attach to this fozm two Certificates of Slirvey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOI� OF COhISTP,UCTION
_�7 a Front: LO Depth: Z U Height: 3�•
Square Feet:
Front:
Qibic Fcet:
�P�=
Heiglit:
Squar.e Feet: GUbic Peet:
'lype of Corstruction: r ���(j�f�� Estimated Cost: $��v��v
9b Be Oor,�p2eted:
Alt. A Alt. B
Yroposed Driveway Y:idth If New Openinq Is Desired: ¢ $
SEE I�VERSE SIDE OF SHEET
Riie under signed hereby ma3:es application for a pezmit fcr the work herein spec3fied,
agreeirn3 to dn,all Wor}: fr, strict accordance with the City of I'ridley Ordinances aiid
rulings of the Delkirtment. of Duilc3ings, and hereby declares that all the facts and
representatiens stated sn this �pplication are true and correct.
n,,Te: �3%f/ sicNnzv�: 7�C��1�
Stipulatioas:
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� ' � �� � sue�cti . � � - � � P .
� City of Fridley 3 2 5 8 3
, �7'�ET°°°"ME�„NS gUILDING PERMIT TNO.
r
.
� �y ���� COMMUN�TY OEVELOPMENT DIY. .` ���
J � PROTECTIVE INSPECTION SEG- Ij�
i
`•_-. �; °�� � C�TY XALL FRIDLE� SS�37 NUMBER NEV O�TE PAGE Of �ivqOVED BY
ti '� 612-571-3450 9t0-F/5 5/10/02 � �
ID6 ADDRESS 112 Glen Creek Rd �NE -
I IEGAL �OTNO. BLOCN ���� TRACtONAODITION SEE�TTACNE�
DESCR. Z 2 Oak Creek Addition Plat 2 SHEE7
t PROPEPTYOWNER MAILAOOAES$ Z�P PMONE
Benedict Ho 112 Glen Creek Rd NE 763-571-5216
J CONTqACTOR MAILADDRESS ZIP CMONE LICENSENO
Same
� ARCHITECTORDESIGNEN MAILADDRE55 ZIP PNONE LICENSENO.
S ENGINEER MAl1.AODRE55 . ZIV PNONE UCENSENO
fi USE OF BUILDING
Residential
7 ClA55OPN�OFN � �� � � � � �
O NEW ❑ ADOITION ❑ ALTERATION. �� REPAIR O MOVE �� O REMOVE
8 DESCRIBE WORK �
Reroof House & Garage (20 Sq) Tear-off; Replace chimney brick from roof upward
9 CHANGEOFUSEFROM TO
S7IPULA710NS
Underlayment must comply with the State Building Code.
TYP�OFCO ST.� OCCUVANCYGROUV OCCUPANC�LOAD
SEPnRATE PENMITS ARE fiEOUIFED FON EIECTRICAL, PLUMBING, NE�TING.
VENTILATING OR AIR CONDITIONING.
lHtS 9ERM1T BECOMES NULL J�ND �OID 5f WORK OR GONSTRUCTION ZONING � $O.FT CU FT
AUTMORiZED IS NOT LOMMENCEO N(ITHIN 60 OAVS. OR IF CONSiRUC710N s
OR WONI( I$ SUSPENOEO OR ABANQONEO FOR � PERIOD OF 170 OAY$ A7
ANY TIME AfTER WORI( IS COMMENGED. ' NO. DW4G. UNITS OFFSTREET PARKING
I HEREB� CEATIfY THAT 1 MI,YE READ ANO F%AMINED TMIS �PPLIC�TION 1 ST�LLS GARAGES
AN� KNOW TME SAME TO BE T9UE AND COBpECt. 4LL PRpVIS10N5 OF ��WS �ypLUpTION � SURTA%
AND ORDINANCES GOVENNING THI$ iVPE OF WONN WILL BE COMPUED �'Z�Z46� � $1.12
WITM WNETHEN SPECIFIED MEREIN OR NOT. TNE GRANTING OF A GERMIT
DOES NOt PRESUME TO GIVE AUTMOA�TV TO VIOLATE OR C4NCEL TMk pERMIiFEE� � SACCMAPGE
PAOVISION$ OF ANY OTMEA STATE OR IOCAI lAW REGU�ATING coN. �g3.25 . . Fire SC �L.ZS
STqUCT10N OR 7ME PEpFORMANCE Of CONSTRVCTION �
PLAN CHECNFEE TO@TAL
y. .62
�S�G,N,���h1N�E0��CON�'N�C 40A�O1MOAIZEO<GEM! ip��Ei MEI! �i�V VALIDATED N1515 YOUR PEAMR
�`� � � l0 DZ /
S�GN�iUAFO�OWNEA���OWNfABU�LDfAi � � i6��� ' • � �rD
Bi ��NS� ncrt
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NEW [] CITY OF FRIDLEY Effec6ve 1/1@002
ADDN ( j 6431 Universily Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: I I Z C-r I C� �ree k. 2c�Q�X
Lega� Description:
Owner Name � Address: �� N E a� c.. � L, k-�-o °� t�°"� Tel. #`7 6�°• S 7l ^ S 2 I�
Contractor. ��2 P' MN LICENSE #
Address: Tel. #
Attach to this application, a CeRificate of Survey of the
lot, with the proposed constructian drawn on it to scaie.
DESCRIPTION OF IMPROYEMENT
LMNG AREA: Length Width Height Sq. Ft
GARAGE AREA: Lengfh Vlfidth Height Sq. FL
DECKAREA: Length Width HgVGround Sq. Ft
OTHER: �' �•. , o.n ��s � � �«c l K
1-�a4s� -� .�a -� ^�P� c�c�uVe S L'
Construction Type: Estimated Cost: S �� 5O0 •� ��a �
� �aY�
Driveway Curb Cut Width Needed: _Ft + 6 Ft =_Ft x$ = 8
DATE: [o OZ— APPUCANT: ��.G�.Q�X-e.c�C r� Tel.# �6��y �`��� �O
Call (763) 5723604 Tor Permit Fees if mailing in application or Fax to 763577-1287 if using credit card and we will
wtl you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ . as'
$ S
$ ,f, f�
$
$
$
$
s -8(�, l�a
��s13
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 ( ]
STIPULATIONS:
Building
Inspections
763-572-3604
DATE��
S1TE ADDRESS �
THIS APPLICANT I3;
O�tlNERI
TENANT
SUBMIT A COPY OF
YOURSTATE
LICENSE Wi1�H
APPLICATIQN
PERSYIIT' TYPE
TYPE OF WORIC:
MECI�AlrTICAL
R�SIDENTIAL APPLICATION
CI'I`Y (OF FRIDLEY
y YOIJR,`E-MP.IL A�DRESS _�---
' \ � V
❑ OWNER �7d'IRACTOR
� >
ien,iF �� �
4DDRE55: ���� (' J P i' (� I� ('1 _CIT'Y��
>xot�:ll e� �—! � — 'L I Le
�DMPANY NA1�4E: + . � . J. � .._ � ea—
COT7TA, T PERSQN� C C c EXP ➢ATE y
STATE��� � �
PHONE
gSWGLE FANQLY ❑ Tu'0 FAMILY
❑�W �EPLACEMENT
DETAILED DESCRII'TION OF �TJORIC
FAX�1 nl :Z �J� ', S�1
❑TpWNHOUSE
❑ qL1'ERA'IIDN/ftElvfDDEL
Permit N
Received By: �
Da�'�EB
Ai �ZIP._J��%
PER MS 168.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whicbevu is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
x.05=
Labor cost under �3�0 =$15.00. Labor cost between �300 to $SDD = cost of labor I�p�TOTAL
EXCEPT WFiERE130TED. FIXTURFS: (II�
FOR PROSECTS WNERE LAB�R F3CCEF.DS $SDD, FEFS ARE B�ED ON �10.00 PER �LL, S7ZEBI'U Z ��
NUWffiER OP EACH BELOV,� NffG: r
Equipmcntinstallcd . . ��, J�r _ MODEL: I 1 t��li SIZEBTU �U C`ti J
� � SfZPJBTU -
� MC825.D0
_AIR TO AIR £XCHANGEER $1�
BOtLER 535.60
—�ptp„Q,iEy L[NER $10.D0
—nucT WORIf 510.00
Permit Fee
Surcharge
TOTAL DUE
��,: MODEL: Gp G R,qNGFJOYEN SIO.DO
pIREpLACE (GAS) 515.00. _ —�W GAS GRSLL SI0.00 �
�FIItEPLACE (WOOD) 535.00 —�p� �ytT �R SI0.00
. LFURNACE $35.OD � . - .. - - . . .. —POOL HEP.TER S3i.0�. - . . -
GAS DRYER 310.00 —y��„qTOR 515.00
- - —r.as PrPiNG 410.0� � - - -- � _
� r�aa.a, -�.a..�..-...__ - -
.. ,. � •.: �. .. ..�.. .
. ..... ._.',. . ...... �-;,. . . v. . .,. _ _ .
$ Number of fixtures (a� $1 D.00 -_ x •
g .50 Number of fixtures Q$15.60 _ x�I5.00 =$
$ Number of fixh�res (� $25.00 I x$25.00 =$ Z�
Number of fixtures (a� �35.00 �_ x$35,D0 =$'� 50
State Surcharge = �
Total = $�.
7HI5 IS AN APPLICATION FOR A PERMTC NOT VALID UNT[L PROCESSED
I hereby apply for a building permit and I acimowledge that the informadon ahove is complete and accurate; that the work wi11 be in
conformance with the ordinancationfor ae ermitan 1workFslnot o start�with u a permit; th t th� wo k w�ill be in accordeance with the
not a permit but only an app P
approved plan in the cas� ork which requ' s review and approval of plans. -. �
��PRIN'CNAME�•,:-�x� DATE I� % —
SIGNATURE OF APPLiCANT � ? --
----�. �-v°,r =a�t is-,uz'az�
City of Fridley
SuiIding Inspections Department .
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
*- . zr. �C� G!�'1 A O']?
REQU{F�ED WFORMATION NEE�ED TO PROCE55 PERMIi
RESIDENTIAL PERMIT APPLICATION HVAC
] NEW HdMES1AD�{3fONS ❑ EXlSTl�lG HOtVIE ❑ MAKE-UP A1R
REQUIRED FOR NEWIEXISTING EiOMES
1. Combvstion A�r (5ee note below)
z. 01 or solid fuel ]MC Chapter 7 with MN Amendments
b. Naiural Gas or Propane/iFGC Chapter 3 v✓ith MN Amea�ents
2, Make-up Air (See note below)
a. 1MC Cl�apter 5 with IvIN Amendments
3. Vanting
a� Gas aPPliances IFCrC Chapter 5 with MN Amendments
b. Fuel other than gas IMC ChaPter 8°''ith MN A�endments
RE�UlE2ED FOR NEW HOfNES
4. Heat loss & cooling load per room
�, gequired on new covsi�uction IIvIC 1346.0312
_ 5. Ventilation . . _ _
a Per MN Energy Co3e 7670 or 7672 .
6. Duet Desi� Per IMC 134b.0603.2
a ACCA Manual D
�OT�: Centerpoini Energy Mechanical Code Guidelines sofiware may be u�ed for
comliustion and make up ai� calculafions