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AF - 45568� � SUBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ____ COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. � "" �,� CITY HALL FRIDLE� 55432 NuMeEa aEV. DArE s� 2-sso-saso 910-F15 6/19 �� JOB ADDRESS 7356 Hayes S7r'eee �N . E. � 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION / DESCR. 18 AUDITORS SUBDIVISION ,i�129 � 2 PROPERTY OWNER MAIL ADDRESS NlEI,ROY KRITGERUD 7356 HAYES STREET N. E. 3 CONTRACTOR MAILADDRESS JOHN OB TSON 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAILADDRESS 6 USE OF BUILDING ZIP ZIP ZIP PAGE OF � � PERMIT . 12191 RECEIPT NO. �� APPROVED BY SEE ATTACHED SHEET PHONE PHONE LICENSE NO. PHONE LICENSE NO. PHONE LICENSE NO. RESIDENT7AL - 7 CLASS OF WORK � NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK CONSTRUCT 22' x 26' GARAGE 9 CHANGE OF USE FROM TO STIPULATIONS pROVIDE A� HARD SURFACE DRIVEWAY. FROST FOOTING NOT IF HOUSE AND GARAGE ARE ATTACHED AT SOME LATER DATE, FRORSTU OOTIN oyWILL BE REQUIRED ON GARAGE AT THAT TIME. SIGNED ON APPLICATION BY OWNERS ��.P�RArtE PE ��`TS ��QUIRED FOR »IF�1NG, �Ii�G, PLI�NlE3t�1G: G�t�� SICI��- �►EA SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPEWDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 ANY TIME AFTEFi WORK IS COMMENCED. NO. DWLG. UNITS I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2, 591 c].() DOES NOT PRESUME TO GIYE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE PHOVISIO�S O�ANY OE�(�TE OF LOCAL �AW REGULATING CON- STRUCTI O� HE P� F CE O� CON�?��'� ?�_.��ti ' ,$'],].�QD SIGNATLlHE OF CONI�i CTfJ' R OR AUTHORIZED AGENT L IDATEI �ccuPANCY GROUP I OCCUPANCY LOAD SQ. FT. CU. FT. OFFSTREET PARKING STALLS GARAGES SURTAX 1029 SAC CHARGE TOTALFEE 12�29 R ID ED THIS IS YOUR PERMIT (�'.—I �i�� PLICATION FOR RESIDENTIAL, ALTERATION, OR AllDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA , *� �.°'%c: ?�`� . OWNER' S NAME :��% �L I^ Dy /��, y C—hGc( gUILDER: C� v�7.v o c ti��a�✓ anDxESS :_ �3 s�'G �/Ay� ��- �v E �� anDxESS :� � y /.35��v, �v',�' � , No:. �� o s�:� LOT: � BLOCK• � - ADDITION • (� . „�3 p , ji • '� /02 G/' . � CORNER LOT. INSIDE LOT: � SETBACK: SIDEYARD; �_ Applicant attach to thia fonn Zt,io Certificates of Survev of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As; ' d c~ Front: �� s Depth: � G' Height: ��( Square Feet • 5^ % o� Cubic Feet ; �%(, Froat; Depth: Height: Square Feet; Cubic Feet: 1�pe of Conatxuction; d� � � l �'��/�l � Estimated Cost; $ �S9/. /� To $e Crnupleted: '�%e� L � � / �? 3 _ The undersigned hereby makes applicativn for a permit for the work herein epecified,� a�reeing to do all work in stiict accordance with tb,e City of Fridley prdirtances and rulinge of the Depaxtment of Buildinge, and hereby declares that all the fact� and representationa stated in this �pplication are true aad coxrect. . L1ATE : � / 1 —� % � S IGNATURE : (See Aeverse Side Far Additional Informati .) . � � � ��i �, . ��a� � '��i o s I �vo7'� :v e,,(� c� �Q�� r�t ro l�� c.� k v�i�L %,c �%usE = �,�., ra �o �4 R �►� � �� 9-r�-ae.��,� l�, s� y, � ��,,�� ,� �✓�i� �2ass 'Fovr�� W��. �3� R��?u��e�c� �,� ��.c �-, T�� `� � � • �� '1��... �1�f.��i�- A � B[1ILT�TNG PERI�IYIT �EE SCHEDt1I.� SECTTON 2. The Tnspector of Building� shall, before issuing permits for the e�ection o� anp building or structure, or for any additioa to any existing buildiag or etxucture, or for any alteration or repairs to any exiating building or etxucture, upon application therefore, require the payment by the applicant for such peranit o� fees to the amount herein below set forth aad in the manner herein prwided to�wit: UNTF07�M �UILDING C�DEo �j►pe ls 2& 4-$2.15 for each o�e thousaad cubic feet, or fxactioa� thereof, in such cubical contents, 1�pe 3& 5-$1.85 for �ach one iclaous�.ud cubic �eet. . ADI�ITIONAL INFORI�T�pN �:'or t�is puxpoe� of ca�puti�g f�e� fo� buildaln� p�rmite� th� cubic�l cont�nte of a�a� bui.ld3ng or addition � ia determtned by multiplyix�� t1�e �xound area cov�red from a point �ix (6) inche� b�low the floox line of the basemea� o� tYte eell�x �o the �vera�� hei�hto mf the upper aur��ce or ta the av�ra�e hei�l�t af the roof aurface of the main �able of a pitch�d rooE. For repai�e or alterations to a� exi�tiag structure, the fee ehall be at the rate of $3.00 pe�r each five hundred dollara ($500.00) or fractiaa thereof ia the ccet of all propoaed work. Tn ao cae� ehall the fee charged for arey pes�nit as set foxth ip Section 2 be lesa than $5.0a, VBRIFICATION OF FOUNDATION NOTE: Pexaiits for eonstructi.on will be issued a miaizm�m of 24 houre fram the time af appliaatioxt4 �o a21aw for propex revfew ai the prapos�d structnse a�d of tt�e coasttuct�on �i�e. A Certified Suxvey of the lot, showia�g tl�e loe�tioa af the fowadatioa, oace it hae b�eea coustructed, will t�e required bef�re,proceedia� wit� �he framiug. CERTIFTCATE OF OCCiJPANCY App13,c�tio� for a Cartificat� of Occupancy shall be �pade tea (10) days prior to the uae ox occupancy of any structure for which a buildiag penait has beea ieeued; aad said s�xucture slaall not be used ox occup�.ed un�il a Ceztificate of Occupancy h�e been i.est�ed. � � - CERTIF'ICATE OF' SURVEY JAM ES L. KURTIi LAND SURVEYOR 4Z01 N.6. bTH STREET COLUMBIA HEIGHTS 5842/ 788-g004 1 MLIlESY CERTIFY TNAT TNIi BYRVEY. PLAN, OR REPORT WA8 pR6PARED SY ME OR UNDER MY DIRECT BUPERVIBION ANO TMAT 1 AM A DULY RlpISTBRED LAND 6URVEYOR YNDER TME LAWS O� TNE 8TAT6 OP MINNESOTA. DATE � ' �1- `'� 3 � SCALE 1°= ' �� ' MINNESC)TA REGISTRATION NO. 5332 0= IRON MONUMENT � / ��"13'l0 _.�.__----- a - - -_— -�a - - _ - - - - - � �` — �9� No.L��v� So'{il�z �g - 1 S�T - '� 0 1� �NI 1 W �L�KL `OT �$ � �'�'135�, .e„�,, '�2' J � !, � � �� Y^ � � � , � �a �� , °�'`' — 1 S"( — —190— N Z4 ( _- -- - - - ' _ ' _ - 33 - .� e0 �� a ��' IJ I `J � z N �I� . r � I� �W I I - -3 3 - --� ,- I - � Survey of The South I/2 of the east 190 feet of Lot 18, Auditor's Subdivision No. 129, Anoka County, Minnesota. Subject to an eosement for road purposes over the east 33 feet, thsreof . � - -- - � ` a I ... �S � �LV s � 0 C c N � � �. � 0 , N � N n c � � � d 0 � 0 � � �. d � � r► � C � � d � � N c s �w ; � A K � � O � 0 N � � O 5� g � ► a � � �• 7 a� w n � m O� r• � F R b� M fA rZi N � O 71 N� HO to �o Nb n� g� tna � �5 0�p7 3 H M N M � 0 0 W w �~ � �o � d � . � � � e N � N 7 ; � '�7 'C „ . • � � R R ` R IP �, 1P ( � �Yp C O �6p ri t�i1 W '�L m p O. H �• � ~ w ° z R f] 1Y (,� � � � � � 0 M �' � � � � � z a 9 O � � �0 m a � � � y � • � H � K �a $ � � g � ° n � � R w � ym :: L` "m � C 6 6 � � � C � � � � � � � r � � 7 I � F� i � � R F� '�J '0 � W N � � 0 0 v �] (p !'� � R m � y G n � � �O m H N N � � rh o �� q ►+ • M (� P� C" N � � M � �O M �o � r � a W M � M 1�' N O � � l+7 � .. � v "� c g � M � y � � � � r M � ' . � � � �. ' Q � � � O 0 . r h~+ M • p DA MO C W \ w 1�'A O �pa � MM � s• � a �w ~ � � W m � � M � •• O 7 M Oo iC N r 0 O 0 a a a cc � a o�ro�+ MN v�q � 0� � � h � y M m $� ^�,� � � O 1��+ h~ r, b m � r� � � � � M R IT � �o � � :C � N id N N 0 0 0 o y�'° . . . . y o O o O t+� 0 0 0 0 V/ N N N N N � �> Q � t+ � � � � � C Nr M � � � �� w d m y n p °n a�$ �nro mhM.� �ea M O h+ M• C H� M� aa �. o. ►�-�o K m 0� h�j W M� � K M m �C p m � m W �J �C G �m� � � £ss K � ��g� m �r+ � r �{' W At a n m ►' � a�� " � � �a� � w D I�e 7 ►Ri � �! 7 � � � � C ►�+ p 6 O � O O� 8 � Z �� ;� . ,� .g3 � � � 6 t R a �� O m � Y � � �o �: � � �� x , H ��; ° ►, "«.�s �o � r ry �n n �o m �� 5. , O Q � n m m � � � � m a S O C Z C T C O m � � O Z m � ar� � 9 Z �"� � O v� 2 v aZ � C z m a � � z N G� �C • N ��rfI n 3 O N y C7 � m m � `n m � H � 0 Z .'C T T � � m D � 0 z a Z 0 c'� -��G O T T � C m � en -., fp 1'f ^ < � � � � � a3 � �Cg pau6�s �Cu ed wo� s �.� ewaa 1t1101 5,f118 �a43o Lld �o s,(ug 6u�leay �e�ol seH •g �)°N i) Sa,� pa��auuo� f118 le3ol pue az�s .�o� s3uawaa�nbaa apo� �ua.�,�n� ��e s�aaW •5 ( ) oN ( ) oN ( ) oN ( ) oN ( ) sa� pa�.�oddns F�aan�as si •ti () saA u�y��M pa6po� s3�afqo u6�aao; ou seH •E () saA uo��e.�o}aa�ap ,�o �sn� wo�; aa,�� si •Z (') sa� pau�wexa �'� �n�a.�e� uaaq seH •T ��e�s ao �tauw�y� 6u��s�xa a43 3ey� sa��.�an �Cqa.�ay pau6�saapun ayl NOIlb�I�I213A ��b1S Gt�f Jl3NWIH� sue�ecr PERMI City of Fridley 2 0 6 2 9 ' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T. No. r � � COMMUNITY DEVELOPMENT DIV. r � v � PROTECTIVE INSPECTION SEC. �� L�� i � � _ � � �'��1 � CITY HALL FRIDLE� 55432 NUMBER fiEV. DATE PAGE OF APPROVED BV �"'"� � �� 612-571-3450 910-F15 10/15/90 / / JOB ADDRESS 7356 Hayes Street N.E, 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. �-$ Parcel 12 0 Auditor�s Sl]�dly].SlOIl #�.2� SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Melroy Krugerud 7356 Hayes Street N.E. 786�-4092 3 CONTRACTOR MAIL ADDiiESS Z�P PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS 2�P PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW � ADDITION �7 ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WOHK Insulate Garage to meet Sta.te Enerc�y Requirements:. 9 CHANCiE OF USE FROM TO STIPULATIONS Gaxage i�s.ulation must �1eet State enerc�y� requirements b:e�oxe gas h�ater is operational. TYPE OF CONST. OCCUPANCY CaROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINf3 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK �S 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 GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVEfiNING THIS TYPE OF WORK WILL BE COMPLIED $5OQ $ e 5Q WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER 5TATE OR LOCAL LAW REGULATING CON- ' $15. OQ �+'li@ SC y�` e SO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $16.00 SIGN�REOFCONTRACTOR RAUTNORIZEDAGENT IDATEI - � WHEN P OPER V 1 T D IS YOUR PERMIT �, �� / ^ SiGNATUR F OWNE F OWNER LDERI � IDATEi �" SP �ATE 1�T [ ] Effeckive 8/16/90 ADDN [ ] i�l AND 1�2 ALTER [ ] Builciing Pertnit Ap�licatian ,/ � cronstxuction �aa. �: 7.� �Co f7`i�'�S S% /l��'. �=1� //, G � � I�ega1 Description: Owner Name & Address: �j��C1.�/� ,� �/Z lJ � �/� �/� Tel. # �� o%a— oontractor: ��. S�',L� Tel . # Addres.s: Attach to this application, a Certificate of SuYVey of the lot, with th,e pra�OSed o�structioai drawn a� it to scale. • - �„i:�;.��,,ia+��4 LIVII�TG ARII�,: Iength Width Height Sq. Ft. C�iR1�lGE ARF�►i: IL'TiCJ�l �(o � Width �� Height Sq. Ft. DECK AREA: Lexigth Width Hgt/� Sq. Ft. o�: � ��/ Sc�� //�/� ��l2l�C-� Corner Lot [] Inside L�t [ J Ft. Yd Setback Side Yard Setba�� Zj�pe of Construction: Est�mated Cost: $ S�d,. Approx. C�pletion Date: Proposed DriveTaay Width If New Opening Is D�sired: Ft. $ $ Width + 6' See Back Page n�: �o --�� 90 �c�r: r �. #�� G -- �Gy� CITY OSE �Y mr++;t Fee $ �� .�� Fee Sc�edule on Reverse Side Fire S�rcharge $ .,�,'C� .001 x Permit Valuation (1/lOth �) state s�r�harge $ ,5 v S.SO/$1,o0o valuation SAC Ci�arge $ $600 pex SAC Unit Driveway Escrdw $ Alt. ��A�� or Alt. "g�� Abave Park Fee $ Fee Detprm; r�l bY g'�l�r'�q Sewer Main C�arge $ Ag�nt N�ssaxY [] Not NeoessaYY .L l 'I10TAL $ . D � STIPULATIOI�LS: :71 / � �� •'�1'J � 31' �'M;lyl� 1 Zhe Chief Building Official shall, before ��>i *� permits for the erection of any fi,;1 ding or structure, or for any addition to ariy existing building or stnicture, or for a� alteration or repair t� any existirig building or structure, upon application therefore, require the payment by the applicant for such �r++;t of fees to the an�unt herein below set forth and in the manner herein pravided to-wit: " Z�0►rAL VAIIJE $1 to $500 $501 to $2,000 $2,001 to $25,000 E�� $15 (Minim�nn Fee is $15 plus surrharge) $15 for first $500 plus $2 for each additional. $100 or fraction thereof, to and including $2,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction ther+eof, to ar�d inclwding $100,000 $100,001 tA $500,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to arid includisig $500,000 $500,001 t� $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction theteof DRIVERpiY DEPZiF�SI�J ESCR'OW (C.bncrete Curb Streets On1Y) Alternate "A": Removal and replacement of curb arid gutter only - Driveway width plus 6 feet t]mes $13.50. Alternate "B": R�ral and replace�ent of curb and gutter and install a 3 faot wide approaah with 6 inch depth - Drivetiray width plus 6 feet times $15.75. � �• . �� .� . � . u �. � .� P+eYmits for oonstruction will be issued a mininaua of 24 hours frcen the time of applicati� to allvw for praper review of the proposed structure and of the wnstruction site. � A Certificate of Sur.vey of the lot, showirig the location of the f�ation once it has it has been constructed will be r+equired before proc�edirig with the framing. �_ a �, ,.. � City of Fridley AT THE TOP OF THE TWINS � U I L D I N G P E R M I T i � � � i LV �� COMMUNITY DEVELOPMENT OIV. r � � PROTECTIVE INSPECTION SEC. � � i � � �"'1 � CITY NAIL FRIOLEY bS132 NUMB@p pEV O�TE �'"'"� � �'' 612-571-3450 910-F 1 S 5/ 25 / 00 �oe nooaess 7356 Hayes Street NE t LEGAL �OT NO. BLOCK TRACT OF ADDITION DESCR. Pt 18 Auditor's Sub. ��129 2 PROPERTY OWNER MAIL ADDRES$ Mel Krugerud 7356 Hayes Street NE 3 CONTqACTOR MAIL ADORESS Westphal Roofing , 486 141 Lane NW, Andover, MN 55304 4 AfiCHITECT Ofl DESIGNER MAIL ADDRESS 5 ENGINEER MAILADOiiESS 8 USE OF BUILOING Residential 7 CLASS OF WORK 8 DESCRIBE WORK Roof repair PAGE Oi � � PfjRI�AIT NO. ' r3�9�� RECEIPT NO. ��/ �6vnovEO er SEE ATTACHED SHEET 21P PMONE 763-786-4092 ZIP PNONE LICENSE NO 754-3294 3937 ZIP PMONE LICENSE NO. PHONE LICENSE NO O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE 9 CHAN(iE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYP@ OF CONST. SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, NEATING, VENTILATING OR AIR CONOITIONING. TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING AUTHORIZED IS NOT COMMENCED Y�1ITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONEO fOR A PERI00 OP 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWI.G. UNITS I MEREBY CERTIFY TFIAT I HAVE READ ANO EXAMINED TNIS APPIICATION 1 ANO KNOW TME SAME TO BE TRUE AND CORREC7. ALL PFOVISIONS Of LAW$ yALUATION ANO ORDINANCES GOVERNING TMIS TYPE Of WORK WILL BE COMP�IED WITH WME7ME/i SPECIFI HEREIN OR NOT. THE GRANTING OF A PERMIT �874 DOES NOT PRESUME T GIVE AU ORITY TO VIOLATE OR CANCEL TNE pERMIT fEE PROVISIONS� F ANY THER ST E �OCAL LAW REGULAT N- STRUCTIQM�OF TM ERFORMA C ��S.7O � TUpE O� CON'aACTOA OR �.s ��.; sGENT iDATEi OCCUPANCV SO.FT STA�LS � $5.00 / OCCUPANCVLOAD OfFSTREET PARKING IGAaAGES $.50 e�� FEE $42.07 NE1N [ ] ADDN [] ALTER [ ] Construction Address: ��` � Legal Description: /P��d' Owner Name 8� Addr ss: Contractor. w� � Address: G�Si'� �G'�� LMNG AREA: GARAGE AREA: DECK AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �ui�Dee�� nrr �PLOC,��oon� �� Effective 1/1/2000 (763) 572-3604 Bldg Insp �,�� \ ---- - �' ��- � � Tel.# �� "�� s- MN LICENSE # � � � � TeL # � ��- �� /� Attach to this application, a�ertificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft Construction Type: � Estimated Cost: $ �7'/, �b Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = DATE �' � � �-C/ CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control x $ -$ Cali (763) 572-3604 for Permit Fees if mailing in application # �s^��' .�� $ e Fee Schedule on Reverse Side $ � � .001 of Permit Valuation (1/10th%) � � �� $.50/$1,000 Valuation $ $1100 per SAC Unit $ 'S��(� $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [] Not IV�ecessary [] TOTAL STIPULATIONS: $ �,� � (� 'a a S P BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection 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 fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,� $2,(}Ol to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $5�,000 $5�,001 to $1,(i00,000 $1,0(�,001 and up FEES $23.50 $23.50 for first $SQa plus $3.05 for each additional $100 or fraction 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 $85,000 plus $10.10 for each additional $1,�0 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 and including $100,000 $993.75 for first $1(}O,ODO 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 �hereof, to and including $1,000,000 $5,608.75 for the first $1,0(}O,IXJO plus $3.15 for each additional $1,000 or fraction �hereof DRIVEWAY DEPRESSION ESCROW (Concrete Ciirb Streets Only) Alterna.te "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway vvidth plus 6 feet times $23.25. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed st�ucture and of the construction site. A Certificate of S�rvey of the lot, showing the location of the foundation once it has it has been constru�t� will be required before proceeding with the framing. New Houses Onlv __.-a :�: ,� ♦ Q sue�etT T NO. City of Fridley 3 i 47 , ` AT THE TOP OF TNE TWINS � � I L D I N G P E R M I T EIPT NO. � � ' COMMUNITY DEVELOPMENT DIV. . �L ----- . ��.� r � � PROTECTIVE INSPECTION SEC. � � � � . L---. A ��'��,'; CITY MALL FRIOLE� SSI3Z NUMaER REV DATE PAGE Of APPROVED BY � '� 612-57�-3450 9�aF�s 10/12/00 / / JOB ADpRESS 7356 Hayes Street NE 1 LEGAL �OT N0. BLOCK TRACT OR ADOITION SEE ATTACHED oescR. Pt 18 Auditor's Subdivision �i�'129 SNEET 2 PHOPERTY OWNER MAIL ADORES$ ZIP PHONE Mel/Carol Krugerud 7356 Hayes Street NE 786-4092 3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO Windowstar Home Improvements 12322 B usiness Park Blvd, Champlin, MN 55316 4 ARCHITECT OR OESIGNEF MAIL ADDRESS ZIP PMONE LICENSE NO. 763-712-8881 20228319 5 ENGINEER MAII ADORESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WOFiK ❑ NEW � ADDITION � ALTERATION O REPAIR O MOVE O REMOVE 8 OESCRIBE WOqK Construct a 14' x 14' Deck and install a 6'0" patio door 9 CHANGE OF USE FROM TO STIPULATIONS � See notations on plan. � es+ ��'? � RE�A�E �ERMI�� Befor� dc99�� c�l� fo� QUIRED fOR: a�� utility Iocation� WIRIt�G H�q�NG a54�oo02 PLUMB11�6� AND SIG�� EQUI��D �� ,��. SEPARATE PERMI7S AqE REOUIREO FOR ELEC7RICAL, PLUMBING, HEATIN(i, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCr LOAD VENTILATING OR AIR CONDITIONING TMIS PEFMIT BECOMES NULL AND VOID IF WOfiK OR CQNSTRUCTION 20NING S�. FT CU FT. AUTMOR12E0 IS NOT COMMENCED V�!ITMIN 80 DAY9. OF If CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 pAYS AT ANY 71ME AFTER WORK IS COMMENCED NO DWLG. UNI7S OFFSTpEET PARKiNG I MEREBY CERTIFV TMAT I MAVE REAO ANO EXAMINEO THIS APPLICATION 1 STA�LS GARAGES ANO KNOW TME SAME TO BE TRUE AND CORiiEC7. ALL PFOVISIONS OF LAW$ VA�UATION SURTAX ANO ORDINANCES GOVEFiNING TNIS TYPE OF WORK WI�L BE COMPLIED WITH WMETMEFi SPECIFIEO MEREIN Ofi NOT. THE GRANTING Of A PERMIT �ZO�7OO �S.3S DOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CNAFGE PROVISIONS O: ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OF THE PERFORMANCE OF CONSTRUCTION $195 . ZS F e SC � IO .%O PLAN CMEC E OTAL FEE A L8J`'�U'� �(� /°°�' d $211.30 S�GN4TUAEOFCON'AALTOAOAAUTNON�ZED4GENi iO�iE� N P L� V ID ED TNIS IS VOUR PERMIT — � ' �O•l� �'�� S�GNO7UREO�OWNEQ��FOWNEABU�IDEA� IDAi�i p� �pgo � O�TE ' s S SEP-21-20� 10�6@ FR�M CITY OF FRID�EY TO NE1N [ , '�D� CITY OF FaII�LEY ALTER [ j $Ildit�lE FAdi�LYAND �IPI,.�6ES R-�9 AND R 2 BUILDIiVC pEf�NllTAPPUCAiiOld Construc�ion Address; I.ega! Descri�+�n: Uwner Name & Addrass; C�ctor. LIYINt! A�'tEp: GAPiAGE Aq�:A; IdEGK AREA: o�eR: �:O�I,IC�IOr1 7128883 P,021'� Effi�cth�o 1/9/2000 {783) 67��3804 Bld� . w ,� "� � � n � �� MN I.ICSNSE �€ � �ra. �i'� 1�...a�.�% Attach to thiS a�tica�ti�n� � Certifc�te pi Sucvey of the lot, with the propo�ed acr�atru�lon drrawn or� it �o ��. D�3CRIpTION O� �Ap'ROY6MF�VT Leng'�h _� °,_ W�ddtl�t „�� Height �' Sq. Ft Length Width."i Hed9ht`_ �G. Ft � � � 'Wkith � Hgl/Ground (�� Sq. F!. �� /LP) � _ w � _ . as n, „ � �- ,. �.� ..�v. �.-.-�o�.=�c: �sr�i,� �� • y . .� �� . !� �', - = • • = �� . � �� / Drfveway Curb Cut Width Needed: Ft. + 6 Ft = Ft X�� a� DATE: d� Appl.�ANT• �Gf/� . TsL %d� 7�y � .,[ GlTY tISE ONLY - Csll (763) i72-3�04 T�or R�rmk F� li mai�t� in applicatlon Pg�� F� � —oZ Fee ScE�du� on Reverse S�ie Flre $Ur�harge $ .009 pf Perrn� V�lu�tion (111�h%) Siate Surcher9e $— —S - , , �.50/$1,0�0 Vafu�tian SAC Ci�erge $ $1100 per SAG Unit Lic�er�se Surcharge � $6.00 {Staie Licen$ed Residentlal Corrtractors) Driv�reY E�nro�w $ Ait. °A" or Aft "6" Above Ero�lon �ontrol $ �tSp.Op Conserv��pon Plan Revi�w P�� F�� Fae Determined by Englneering � Sewer Meln Charge $ A,greement Neces�arY I j Rlct Neo�s��tY I� 7oTAL STIPIJlATfpNS: $ /� V�RY�TCAT'I�N t�F F�bUNDA'�,'IOl� ._ . �'ernaits for cons�tfa� w�ll tre issued a m;n;*�+,��± of 24 h�.rs fra►� t�►e t�e of appli�a�6l�� tQ allow for Fr�r raview of t� pmpose� s�re a�d of the construcxlon site. . � l�11 �� / 1! r►� �. �, �; �,. o�� st�w► t�� t l�r �a �� ., rv trv� u . IM . g ? 3 s �. µ � �s S�. ^/. �. y -� � e/�t , I�w/ SS iI� Z �` -,• _7��, - �/0 9 � 3 . , ► ��►t • q•t�•� � � i .�' s• �loar � 1 � A �' �t�a 3 � � I'�I � 1 v��y 1 �� I � � �� s ��t �c ,� � L A � c,-�',,o� ��-" /�� . 1�=�a"' D �� 1� ��''� Y�„ u� � 6ti� �y�l j?��sa� ��U ��., —, r /rlS3 �OV / �e 6 � y i�c t d• r � � �� ¢ ►�-�� o�� 'w�v ��t� D . �/��c�� Eo o� �o � r��c . �,,� °� s �� , � � . �'�� O �ivi�i �/t �,�� t�s � � s . �! � ..1 o.��u� �`ItM o�r �^� . ��r� �� a�ks � � � �.� k f ,� e� �sd� �`. I►�o� s a�� • CC l�� Z `` � t , The Home Depot #2803, 3°5�0 �124TH AVE NW, COON RAPIDS, NIlV 554�33, Fri Oct 06 0$:48:29 2000 The materials in this deck will cost $701.65 File saved as: f:�dn�decks\A0607BAA.DEK 3D View � � �� , � )N �;�r�S S�� h�q�d —oc�-�. . . _..�. a � ' .9 P � - �ou�d� �v�� b.��N ; `�� / ON �G81�S l..S�� 4-%�4 N -�0�'� �� i�, ►.r�-� S�A�cI c,�1�h �r�s ► vi � � �� x �r�v �- — �o � (J Rove�( � . OIS�- h�u�(�Q� � � `� Nal IS p�s�. h A I�� , � �il �II hol�s � _ �Q�,�°d� �� n�N� �� i :. �p —� Le.�� M iN 9' �� ,,��.s(�-� �v, T, � 1 Ga 4� � s� �. � ,2- . � x io 1 � L ��r L i��' � -- Y � � .1 � 0 '�E�SS � 'Sa=a� Noo� M�X C�AIT � �p� ,� �� . �� `, ��c� �'-�)'x , �_�x�o l�` �J�;��s� � ' � 8 �. ��r �d �� ,, � ,. ,�,�x S�act � �� (/ ��, , a�� .�..� ---�� .��,�� c� �,no�EZ x�aa ?I�a'�SG090`'d�sx�ap�uP�: � : ss pan�s aZi3 OOOZ 6Z = 8fii = 80 90 ��O z�3 'Ml�i �1��i H,��ZT 05S£ ' £08Z# �odaa au=og au,y .,-°°''� CTTY OF FRIDLEY rEx�r o.: 2004-01872 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/14/2004 �63) 572-3604 FAX: f7631571-1287 ADDRESS : 7356 HAYES ST NE PIN : 123024130020 LEGAL DESC : UNAVAII.ABLE : LOT BLOCK PERMIT TYPE : BUII..DING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL VALUATION : $ 6,765.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF TI� 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. REPLACE 8 WINDOWS WITHIN EXISTING OPENINGS. STATE LICENSED CONTRACTOR 1 APPLICANT RENEWAL BY ANDERSEN (20130983) 1920WCORDC ROSEVII.,LE, MN 55113- (763)502-4777 OWNER KRUGERUD MELROY E& CAROL J 7356 HAYES ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construcrion authorized is not commenced witin 60 days or if constntction 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 sazne to be true and correct. All provisions of laws and ordinances governing this type of worl+ 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 regulating construction or the performance of construction. Bldg Insp BUII:,DING PERMIT FEE FIltE SURCHARGE STATE SURCHARGE, VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # 37498 �rm�� ins�cc�ion C�r�s �lill Be Maile� � i�o�eawner'i� Rflst � SEPARATE PERNIITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. 139.25 6.77 338 5.00 154.40 04/02/2004 FRI 13:21 FA% i�� ELDER JONES �� 001/001 . . . .. . . . . .. . � �' `' �� l'`��`��. .. ---- � � N� �� C1TY OF FRIDLEI' Effective 4/1/2004 ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp q�,'� [] SINGL.E FAMILY AND DUPLQCES R-1 AND R 2 (763) 571-128� Fax BUILDlNG PERMIT APPLICATION ConstruCtion Address: �' � � legal Description: � � Owner Name 8� Address: Ci� i%.u1� ��► Tel. ��-1a3-��Lo y yCa �� Contractor. �_MNLICENS�# o�O��JOQ��J Add�ss: RENEWAL BY ANDERSEN Tel. #�a�J 1' � lU't "� T T 1920 COUNTY ROAD C WEST ROSEVII.L�, MN 55113 jCete Of SUNey Of 11'te - ,� drawn on it to: sc�P�: �} LMNO AREA: GARAGE ARE4: DESCRiPTION OF IMPROVEMEN7 Length �, Width Height F' �� • � , , . LengEh __ �dth __ Height__ Sq. Ft� `� DECK AREA: Length OTHER: wdth H Ground Sq. Ft � i� r�ril�� `� � i tii �C i Si"� rl�� i - - - - - - , _ J� :, ¢ 0 Construction Type: Estimated Cost $� �� / priveway Gurb Cut Width Need�d: Ft� f 6 Ft = Ft x$ _$ DATE: APPLICANT: Tel. # � � • � � � • C4 C�� Call (763) 672-36Q4 for Permit Fees if mailing in applicabon. F�c to 763-577-'E2�7 if �sirtg credit card and we will call you for card number. ` j CITY USE ONLY - Perrnit Fee Plan Review �re Surcharge � State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer �Main Charge TOYAL I �S $ $ $ �a��- � 3.�� $ $ ,�a0� - $ $ $ $ $ �� Fee Schedule on Reverse Side 65% of Permit Fee .Q01 of Permit Valuation (1/'I Oth%) �.50/$1,000 Valuation � $1350 per SAC Unit $5.00 (Staie Licensed Residenfial Coniractors) Ait. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] l� � � �� G STIPULATIONS_ � �uilding �nspections 763-572-3604 �a►.� DATE (L' /L /s SITE ADDRESS _ THIS APPLICANT IS ERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTINICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY `x�� Permit No.:��'� � � � � � t3 _ Received By: Date Rec'd:/ � YOUR E-MAIL ADDRES S S• J► g11 n 4' �� ++C," �'1Ca �C Ac,o � I`{'e �' � � C. � r':l ❑ OWNER Qf�ONTRACTOR �/�z� ��°3L 0 STATE LICENSE # o�� .� r1aj�J � EXP DATE ..� I.�I �� ' � I nnnxESS: -?`�y3 G'/��P�icr� �wc cirY /%%r.�f%s�>�r� STATE�acP �;�i/2 E�,L� ��`l��1R-_Ql4�i-i ❑ SINGLE FAMII,Y/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTIOl�i ❑ ADDITION ❑ GARAG ❑ BASEMENT FII�IISH �ROOF �. DECK 13� SIDING ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCF/REPAIIt SIZE STORIES ❑ ADDTI70N ❑ REMODELING ❑ DRAIN TII,E ❑ OTHER DESCRIBE WORK BEING DONE: y11(.�r�e.� � Pa z�e 4. Qz �I� w� F►. 2E�, S� , i��.men+- w � hc�c � i�e p I� �.e �en{- S�� ! 04� r a H OF ROOFING ,c � NUMBER OF SQUARES J 'tOPOSED SIZE: : ROPOSED HEIGHT: SIAING G�CVinyl ❑ Aluminum ❑ Other wnvnows IN EXISTING OPENINGS �1'es ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & f� AJ C+� t��j �'�9.5 O HOUSE ONLY � HOUSE & GARAGE ❑ ATTACHED GARAGE O pETACHED G � ��3c�� ❑Soffit � �aj ( � ❑ Tnm �� ❑ Fascia ] ,� �� «9 LOCATION OF WINDOWS f��*�3� �SAeci y,�� iS2lrs �, v1�- f�a�Sf,' M G e� � NUMBER OF WIIVDOWS FT BASEMENT REMODII.ING SUBMIT: 1. Fxisting Floor Plan 2. Proposed floor plan 3. List of structival members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDTI70NS_ & PORCHES SUBMIT: 1. Sitc Plan/Survey showing the existing structures and pmposed project. 2. Two set� of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WIND(1W. ALL FEE5 ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND MATERIALS: � . (LISIL�IG TH� 1997 U.B.0 �EE SCHEDULE) TOTAL JOB VALUATION Pernut Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control � Pazk Fee , Sewer Main Charge $ ��Z��i ,� � See Back Page for Fee Schedule $ 65% of Building Permit Fee $ ��' .001 times the total job valuation $ �� .0005 x Permit Valuation Minimum $.50 $ �� t��_ $5.00 (State Licensed Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement nec�ssary ( ) Non Necessary ( ) $ �� Make checks n�vable to: Citv of Fridlev Attac THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII. 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 �nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a �ermit 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 approved plan in the case of a11 w k whic equires review and approval of plans. SIGNATURE OF APPLICANT � PRINT NAME �� e� � e� 7L bATE �S'�Z / o��'� O NOTE: SEPARATE PERNIITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK . �- - �''' - � . . , . _ . . . •',�, .. .t. . . . . . . ' . �� `CERTt F'I C�4T�� O�F S U R VEY� " ` `. ' JAM ES L. KURTM ' � � � . � - LAND SURVEYOR � s��'N.a. aTH STREET • • ' COLtJMYIA MEIOMTS 5�421 ' . . � � , , ... . . • 7A�S004 ': . ' 1 MRI�Y C�RTlr1► TMAT TM� iYRYLY. rLAN. OR RsMRT M/Ai Pf�A1fED �Y Ms OR UNQER MY DIRa+GT W�ilf/If10N .' • � ANO TMAT 1•AM A OflI.Y Il�otsTillsD L�ANO �tJwv6lrow uNDaR rile u►ws or T►u srwtt or tA�NNE�Tw. ' . � � � � DATE ` ' �1 • '.� � . � ' � SCALE 1°= '•��° —�_ . MINNES�TA REGISTRATION N�. 5332 o=1RON MONUMENT ; � , �ii'�3'!O ------ -- - � . . ; . � � -. • � � � � � . � ��- : _ --- - - - � • �� ' � - � . - .� � � . . �� _ _ I . - '� - t90- � . .- ` . . . � —1S"�— '� � '— 33 —'� - : Ko.��h� So'lLl.oi 1g o . � . ( d�. . , _ . � « ( �. . . _ ,� �' a � 10 _ - , 4• 51 � (-J - • ' -► � "13 S L a , N: � ' \� ''f� � � Z . i: 1�1 ';. Q f l0 —1 �'• N • � J r .� � . �., I j. � . . . . � � .. l� . .. _ . � - � � � � - . �� - .. `� �G: � �W . , �. . � �' � �-� — 15'"C — � - _3 3 _ J � � so �•K� �� 8.� . l90 - - — : • N . • Z4 . . � _ , ... � , I � � . " '. �'.. . � - ' Survey of .=. : =• .°��- � � _ :... �: •�The South I/2 of the east 190 feet of Lot 18, Auditor's Subdivision No. 129, ' :`-.:Anoka:County, Minnesota. Subject to an easement for road purposes over the � • _east 33��feet therecf. ' � .? - .. s.k � s ' a 1 e ( • � 2. �c G e � � �t2 !-��tG�*►�.� �� —,,� /8 " of� �-. . � �� s�UC. �� . �� q4 . �, �_, 2x 4 Lti.�p(,� ib� 2 �-! �� b L Poqv Z�- �- .. �� , .� . � nereby carnty mae this p�an, 8pecm�aeron, �� or report was prepared by me or u�uler my 3 s� L� Larson d� fon erM thet I am a duty �� ,��,e Laraon specfeNy sc.uetur� �rw �s or the state of nAinr�om. — lL19) 5931 HoM L.ene � P►iM Nartre 1 e ne C. 6 rs n INhife B�r Lske, Minnesote 55110 �,,, 1 BS1 429 6143 Fa�t: 851 429 8761 gO9��g� � warw.mtldredl �comceat�t Deie �'% -��%% Ucense � 7831 Gomm. 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Q� I;rrQr�t� � 60��^ ��I+��a� :�o"'��a� � � ��'��++� o0Q B m�� o o ��"�o � g$� +.°�e�+�•+��o e�� 9 a� �+�@��A�� Q��pMt Y Y�tMr�r�� v�oo�+$+�MiM *+ �" �.� � �. B .. �"�� E M(+OO [YtMWMW tt �� o .° �.W°�a��,�,ryKe �!�p OP� ♦ 4� �'►�«�►t�i � �h ��t$_� e+y,� �r, t ++ O O � � ��_;�� :; �� oo�=� t* . � � oo�� Q�x♦ °� F+ 6 • ��' ��~ �i . � ��r ��' ��.�+ � � OO+I ��Y M��+ ♦ a��.�+ o��a}�i+ �� r �e + b�' • e �' + � � Y � � � v ol Building Inspections 763-572-3604 763-502-4977 FAX DATE 1 U " / �" SITE ADDRFSS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE PHOIdE: MECHANICAL RESIDENTIAL APPLICATION ❑ OWNER COMPANY NAME:_ CONTACT PERSON: CITY OF FRIDLEY EFFECI7VE 7-1-2010 E-MAIL ADDRESS C11'Y Permit No. Received By: ' a � Da ��T �. 'A STATE LICENSE # EXP DATE 1 ADDRESS: �'�� GY�A� �% CITY na��l STATEMNZIP�� D PHONE �6 �Y� S D g— Z�i 3�C FAX TYPE OF WORK: I � � FAMILY ❑ TWO FAMILY ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK � TOWNHOUSE � ALTERATIONJREMODEL FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVM� PROVIDE HEAT LOS5 CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK Equipmerrt Installed MFG: MODEL: SIZFJBTU MFG: MODEL: MFG: MODEL: _A/C $25.00 _FIREPLACE (GAS) $15.00 _AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 B ILER $35.00 _FURNACE $35.00 HIMNEY LINER $10.00 GAS DRYER $10.00 DUCT WORK $10.00 _GAS PIPING $10.40 SIZFJBN SIZEBTU _GAS RANGElOVEN $10.00 _NEW GAS GRILL $10.00 _GAS UNIT HTR $10.00 _POOL HEATER $35.00 VENTILATOR $15.00 TtiIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN17L 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 �l work vYhich requires review and approval of plans. ,_ SIGNATURE OF APPLICANT APPROVALINSPECfORS City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 DATE �a"��"j� City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME 0 MAI�E-UP AIR REQUIRED FOR NEW/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 Chapter 5 with MN Amendments MN Rule 1346 Sec. SOl 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments 4. Heat loss & cooling load per room a. MN Rule 1322, Sec. N 1104.4.13 S. Ventilation a. Per MN Rule Chapter 1322. Sec. 1104 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations.