AF - 46036$' ,
Village of Fridley, l��inn.
BUaLDING PElf11'IIT
o,
N. i'.�� 3 Office of 1NSPEGTOR OF B�JII.DINGS
�� a
Owner �'�, . �� L � �
Architect�;, ' _ Frid2ey, Minn•, � , 19'+� �
Builder�' -
� OCATION OF BZJII.,I�ING
R
No. ��� Street ����� °�+ ���t of Lot
Lot � Blo � Additfpn or ButaDivision �� ���.
DE�C�IPTI01'd OF BUxLDIlVG
�'ront��Depth '� � Height� Stories Manner of Construction ��� ,�,
To be uaed a.s � To be f, omplete '� `"� � Eetimated Cost,}�+� '�� � g�
I .�a 3'��: .i� f� .,�. i�T y �i� - �- - °�"" � ...�. .� .,. e� `ar;.�. �_a.. s�:�,� _ �II�+s s.....� M .k9&� ra..�,..._
� _ � 1� ..� � �,� .
� a�
Permit ie heraby granted to��'�,�_-���„- ��"�*7 '�'�°°�..�'�$ tp ���'��
�
the buflding �� � described 'in the above statement. Thi� permft ia granted
upon the espress conditio�n that the p on to whom it ia granied, and his ag'ents, employees aad worlmnen, in all
ihe work done in, arouad and upon �id building, or any part thereof, shall conform in all respecta to the ordi-
nances oP Fridley, Minn., regarding the conetruction, alteration, maintenaace, repair and moving of f�uildings
a�ithin the city limite, and thia permit may be revoked-at an� tfine upon. violation of any oE the provieions o4 said
ordina.ncea. -
N � � 'g� spector of Buildings.
AGR � � ,N'S AND S�VORN STATEMENT
In consideration of the issue and delivery to �.e by the Inspector of �uiidings of Fradley of
the above permit, I hereby agree to do the proposed evork in accordan.ce witla the description
above set forth and according to the provisions of the orciinaraces of Fradley, an being first dul�
sworn, I hereby atate and say that the facts stated by an� c�n�ed ' ove permit axe
true as therein ata,ted. ,� ,�� ` � ,l�
Subscribed and sworn to before me at Fridley,
�- � �
day o�� .D. 1� .
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ADDRESS t 7 APT. FLOQR CITY SUBU '
OCCUPANT OWNE��!�'�� �
HEAT LO DATE HTG. INS .
EOLD B�Y �j` � a INSTALLED BY
e c tr i c I o r k B y G a a L i � e B y
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNI TR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURN
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CONTROLS
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C:himney Construetion
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Pilot Timing Draft Test Tag
L.W. Cut Off Door Pressure Lighting 1 st �
Prossure � o� Percent CO �'`� Date Tssted —��
2 +
Input CFH 1 Percent 02 � Company Testing
Staek Temp. Percent CO ���-� Name of Tsster
Form 235
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Building c��3 � MECHANICAL Permitrlo.: � 607- �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY ���` 2
DATE I' ,�' �� YOURE-MAILADDRESS
SI1'E ADDRESS �� `� l`� C� r e 5� �� 1 V�e `� l�
THIS APPLICANT IS: O OWNER �ICONTRACTOR
PROPERTY NpME:�� ��,r c� �� �,�Q.It
�N� aDDx�ss: �3\� �� � 1\ er e s� A rL crrx �'r ��(-�� STATE �INLIP � s y3
Pxor�: °-i lo ''s S—1 t� 04 �-1 (
CONTRACTOR co�A�v�r N,v�: CENTERPOINT ENERGY
SUBMIT A COPY OF
CONTACT PERSON: JOANN Ti INREN
YOUR STATE STATE LICENSE # EXP DATE
LIC�NSE WITH �D�S: g3�0 EVERGREEN BLVD STE �rrx "C0011i"°RAPIDS sTa,�MN zrP55433
APPLICATION pHONE 763 — 757 -- 6202 F� 763--�757--6701
PERMIT TYPE �INGLE FAMII,Y ❑ TWO FAMII.Y � TOWNHOUSE
TYPE OF WORK• � NEW �REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �T v�� �` ��Z�p r��� � �I-�t r Cp��I �� i o�ne�'
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, wh�chever 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 Wi�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVi� �j� , It�
Equipmeirt Installed MFG; L4�LY'r' � ti-° � MODEL: a i-I IRC� (� ?� o'Z y SIZF/BTU a� "i'oYls
MFG: MODII.: SIZFJBTU
MFG: MODEL: , SIZEBTU
C $25.00 _FIItII'LACE (GAS) $I5.00 GAS RANGE/OVEN $10.00
AIIt TO AIR EXCHANGEER $15 _FIItEPLACE (WOOD) $35.00 NEW GAS GRIL,L $10.00
BOII.ER $35.00 _F[JKNACE $35.00 _GAS UNTT H1R $10.00
_CHINIl�TEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCI' WORK $10.00 GAS PIPING $10.00 VENTII,ATOR $15.00
'�r /�l r� f t .q � r x � ti�- �y ",p� },� (�'� `,y� ..
ry� t �'��� . lr�^��� , ;7. ��N�,S1 �� . ��; �a�� .�� �`: � � H � ��'� �'� � ;�t. , r��ik et��flF �riiA?3.�c �� '., i �" '.�Vil\ 1t:7'%r , �`{?..�} r . �'�.:,. ��.�'.��.
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surchazge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @$25.00 � x$25.00 =$ ot `S,�
Number of fixtures @ $35.00 x $35.00 = $
State Surchazge = $ .50
Tota1= $ o`Z S � SO
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 percnit 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 APPLICANT �. � ° � x� ROGER HOFFHEIN DATE � ' � � �U�
� ���,��L�'�'�'�`�� �Fp.�`�tA� w ��?��IiTSr�RE �.�'��1��3 � `�b�;'Q�;:�L .�:��- ATi;; ��G�,A���� �,.� zE
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 PERNIIT
RESIDENTIAL PERMIT APPLICATION HVAC
�
0 NEW HOMES/ADDITIONS �EXISTING HOME ❑ MAKE-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
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIItED 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. ACZ,`A 1V�TarivaTD — -- - - -
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
Building
Inspections
763-572-3604
DATE ` � '° °� ° � $�
src-E aDDxESS t 31 `�
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
�
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
ICr�c
YOUR E-MAIL ADDRESS
• N'►
❑ owr� �coNrRa,crox
�
Permit No.:
Received By �
D����CT 07 200�
ADDRESS: /��� Il �� � r re c� �' _ f� � CITY � t2 ��1 STATE�ZIP � S� 3�
PHONE: �1 b�`$� �,• l? d-I �-} I
Co�axY
SUBMIT A COPY OF CONTACT PERSON: �' ��'�3 i����
YOUR STATE ST'ATE LICENSE �1 EXP DATE
LICENSE WITH ADDRESS: �ai � � q"� 0� � h ��'JF^ 1eJ � CTT'Y F2 � c� I� STATE M� ZIPe�S � L-
APPLICATION �
PHONE �b� `DS�I �l q �j FAX
PERMIT TYPE
TYrE oF woxx:
�1 SINGLE FAMILY ❑ TWO FAIvIILY ❑ TOWNHOUSE
o rT�w
�ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �,���� � � �� ° �d °'l �d'�`' Z� s� �'�
PER MS 16B.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 WF�RE LABOR EXCEIDS $500, FEES ARE BASID ON $10.00 PIIt FIX7'URE, EXCEPT WHERE NOTED. Fl3CTURES: (II�iDICATE TOTAL
NUMBER OF EACH BELOVi�
Equipment Installed . MFG: `��� �o-� MODEL:�1Aclas�atil � l( SIZFJBTCJ
MFG: MODEL: SIZFlBTU
MFG: MODfl,: SIZE/BTU
A/C 525.00 'ZFIREPLACE (GAS) $15.00 . _GAS RANGFJOVEN 510.00
AIR TO AIIt EXCHANGEER S15 FIREPLACE (WOOD) $35.00 NEW OAS GRII,L $10.00
BOILER $35.00 FUItNACE $35.00 GAS UN1T iiTR $10.00
CI�Q�iEY LINER $10.00 _GAS DRYER $10.00 POnL HEATER $35.00
DUCT WORK $10.Q0 _GAS PIPING $]0.00 VEN'TII.ATOR $15.00
Swcharge
TOTAL DUE
_
$ Number of fixt�ues @ $10.00 x $10.00 =
$ .50 Number of fixtures @$15.00 J x$15.00 =$ FS• o v
$ Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ SO
Tota1= $ �S. � �
THIS 1S AN APPLICATION FOR A PERM�T 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 czse of all work which requires review and approval of plans.
SIGNATURE OF APPLICAN7' C�-�-� o ��.—� _PRINT NAME ��'+�' l b ��►4 L3 DATE I �" �`° ,�
/ / - �p f��vU City of Fridley
�� L Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FA.Y: 763-502-4977