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AF - 46355� ,� � City of Fridley, lY�Iinn. BUILDING PERMIT Date: - AIIGIIST 16 , 1965 N° ��e'�� 8365 Ovaaer: JAMES PROCTER g�� METRQ B�jZ�RS,�� 5397 $ORIZON DRTVE R_E. �jd� 2�09 Ni nn11 r�t e�,y.V€�•z7,9ye, SA�a�� _ Fridley 21, Minnesota MinnP n1i�a� MiTTGeQ1'� LOCATION OF BUILDING No. 5397 S� HQ�t?20N' �RTTi.�..- Part of Lot I�t 9 Bl�k 6 Addition or Sub-Divisian ' , ADDN. Coraer Lot Inside Lot Setback Sideyard Sewer IIevatlan Fouadat3on IIevation To be vsed as: F�ront Frant Type of Conatruct4on DESCRIPTION OF BUILDING Depth Height Sq. F`� Depth� I%ight Sq. Ft. ��, �_$2, 000, 00 To be Completed Cu. F't � �'L REPAIR.S DUE TO STORM DAMAGE In conslderation oP the issuance to me of a permit to the proposed work fn accordence with the d�scription abo orrlinances oP the dLy oP Fridley. nstruct the building d�cribed above I agree to do set forth and in com� with af 1 prov3aions of �-�� _: a/ . �. t�_ .-� _� � �� '-�--a- In camsdderatian oP the payment oP a fee oP � 10.00 , p�nit fa hereby granted to 'N�mRn um-r_�nFUC� INCORPORATED to canstruct the buflaing or addition as described above. This pernnit is granted upan the expres,s csondition that the peraon to whom it fa granted and hia agents, employees and worlmiea, ffi all work. done 9n, around and upon eaid building, or anypart thereof, ahall conPorm in all reapects to the ordinanc� of Fridley, Minnesota regarding la�tion, construct�on, alteration, maintenance, repair and m�vin� of bufldfuga wittiin the dty limits and thia pernnit may be revoked at any time upon violation of aay of the Praviafona oP seid orclinaacea. ALLIIV G. JENSEN $��g � NOTIC� 11ils p�emb do� �f eorar i6s eoestrueHon, les�allalten 16er �teia6� P�+� 6a 6udeg, sswar o� wNsr. 8� atn to se� da BuUdiuB In�eto� tor separw pum6s fo� tha� Uemr. _.y APP'LxC�.TION FOR �Bi�ILDING PERM[T . � , . CITY OF Fi�IDLE'Y, `MINNESOTA � . . . . � ., � ., , ,�. � � owr�R�s rt�r� ��^�� !°��' � °`B�DER� �'�� -�;��' �,��'� . �-' � �"'� � e� ,� j� ,,f'� �-- �, r �A r r % �' �� E-� ,f,+�'�� y � ADDRESS_ .�� .�. if, �.f �,,_,',=,��F; F �� __ ADDRESS �� " � - � �r�� LOCATION OF `BUILDIATG , . No. Street Part of �Lot ` � � r� �� t.`��,�..�� ^ � � � �F � LOT /� BLOCR �� ADDITION OR SUBDIVISION e,� , �� Co'rner Lot Inside.LOT' � Setback � � Side�Yard � _ � SEWER ELEVATION ' � FOUNDATION ELEVATION Applicant attach to thia form Two Certificate� of Survep of Lot and proposed building l,ocatioa drawn on these Certificates. � �- To be 'usec� as; �• DESCRI�ION OF �DILD�TG�' F�ont Depth ^____ fleight Sq. Ft�. Cu. Ft . � ' Fronti Dept �_,�Iei�ght' � Sc�. Ft: " � Cu: Ft. . Tqpe of �augtruction `1/'�� '' �^ ! � � f�%".� ' `� �� Eatimated Cost � �� . . � . . . .. .�� , - ,� '/ . To�be compleCed� � �,=, � �� , �� -�� . � T1ae undera�.gned hereby makes applfcatiori for a.permit for the work herein apecified, ;agreeing to do a11 work 3n strict accordance with the City of Fridley Ordinancea and rulings of the Department of Buildings, and herebq declaree that•a1l�the facts and �epresentati:ons etated'in this application e true and correct�. . ,; � ,�� . �'�� , � ''�' ��/�� DATE � �" � � �: � %'� �� SIGNATURE _>� ` � , � ;�Z�� r - �• . (Schedule o£ F'ee.��os�ts caa be found on �he Reverae Side). ^ •: � c i. M . , . - � �=�' - � �- � 3 � BUtLDE1� P1:1�T FEE SC�IEDULL SEG°r_ ON 2. The Inspector of Build�n�s ahaiZ, b�fd�e is�uing aag permit for the erection of any building o� sltrdcCure, or for any addition to any existin� build- ing or structure, or for any alterations or repaira to any existing building or atructure, upou application therefore, require the payment by the applicant for auch permit of fees to the amount herein below aet forth and in the m,anner herein provided to-wit; 2.1. Far any such permit for the erection of any fire-proof building, other tban a garage, warehouse, factory or grain elevator, or for the erection of aay fire•proof addition, for similar occupaacy, to anq existing building, ahall be at the rate of $1.40 for each one thousand cubic feeC, or fraction thereof,, in suEh cubical contents. 2.2. For any such permit for the erection of any fire-proof garage, Warehe e, factory or grain elevator, or for the erection of any fire•proof additiou, for similar occupancq, to anq eacisting building ahall be at the rate of $1.25 for each oae Chousaad cubic feet, classified as "fireproof" bq Section 502 of the Minneapolis Building Code. IiOIISES 2+ 3. i�or any auch permit for the erection of anq nan•fireproof building, other than a garage, warehouse, factory or grain elevator, or any non-fireproof addition, for simflar �cupancy, to any exiating building - permit $1.00 for each one thoueand cubic feet. GARAGES �_ 2,,,_.4. For any such permit for the erectioa of anq aon-fireproof �arage, raarehouse, factory or grain elevator, or for the erection of any noa-fireproof addition, for similar occupancy, to a� existing building or tor each such building or addieion - ninety cente ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical coutents thereof with the minimum of $4.00. For the purpose of camputing f�es for building permita, the cubical contents of any building or additioa to a uniform h�f,ght thraughout by �ltiplying the graund area covered fram a point aix (6) inches below the €�.00r liae of the besameat or cellar to the average height of the upper surface or to the average height of Che roof surfac� of the anain gable of a gitched roof. 2.5. For repairs or alterations to an exieting �tructure, the fee shall be at the rate of $3.00 per each Five �undred Dollars ($500.Q0) or fraction thereof in the cost of all propoeed work. 2.6. In no case ahall the fee charged for any perm3t a8 aet forth in Section 2 be less than $4.00. � �.,, . ..,,., � ,� s i % 'a —"T_ _'"' I i � 1 % � _�''-,�=c� t �° ��'E'C ' _ �� r�_i_ � '` e r;*"-/.+� . ��c�%% �//./�'.,✓.S�..y+ / '� • • j" � .�- ,,�° �^'°` /' �-= _'�.-,�` .9,9,%''� i�../.�!?!`r_':`r�� ' �"�=` ��'%X,�,'`.�'i��>�ea''I �i �'-�? �a: J` . � � � ' ,-- —' J' _,"C� — � � -------- ' '— _ ' , .. /n �/� � - d . _�__, � /L �%E�"__ ... l�l� ..�Q�G�.0 t=,'r'�.;�.'`�- r''_.� � .� - --------_.��.�._ _._.__. _._ L' J . r` _�.��_ _�_ __.__.__—.._�.—�r..____._. _�_---- -- -- _ ° __�-.��E=_�_"=�.. � .�'°.': �G� �%.:�-^ -'i/ ' w '` `'��:' � `� .,- �� ..:+ _ , -- --- r T ^ . . _ , �. .��._ .."` - � �± .�.._.—_.._------- �--`-" -� ---_._.._ . j f � ' r . . �✓ . 0 �+-� '_� ._._%J j.,,�� . �. ' % � f.� C ct � .�/'i� i�i�4�� cr"''�C'y/�.'." �.,_.___ -r._..-_'-_-. --__._� ......_:.<_.._...._�..__._....�._ _. �__ .._. - � '? ' �� S. 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P_ �+• � o• FIX. �' � aas � � � APPL. � m� �' � RAN6E :'� ro � °� s � � � 0 _ � � �� H m a � q9, � �• � p � sy � � b ti, ~ �� l � � J � �� py � �� M � �� I � I ,n , � �I l � \ '� � � � � � � � N N z � � o �D 0 � O H •• z � � t� � M n p � m �yf •o � "'� .0 �1 � r Vj M Z � � � 7 � �' C �` Y m a n � s K K n i�r �S � �r a«+ r 'n � m m o o[r G W �-a � M t+ p � til r1 � y • O r° � O� F° Q � n O a � G� M � o r�r % � a n o n r n.c �c "*� � 0 9 5' �n •�i � n �pf � ° h � -° F � yc p � � � � i�e � K A M H 1 � � � `� �o C � o a�� i vi � r � pa►� �n .� o . � a � m k1 � � '~ � m O W 1+ �Y o N' � � N N � ~ � � O 7 � � l'7f —�I 0 o m N ..., � � � ° � 1_' 7 O ' C� � . � . . y . _m t� O f • rn • x x x x x K x x x x x. x a, � y �p Y N N f/l f/1 N F�' N f/l N N N N{A O 1-' W tJ� Y� �l O N tA N N W O O O O O - O O O O O O O O O �i 00 0 0 0 0 0 0 00 0 0 0 0 � fA N N W Oo- � � a� n' ��, G� � n . a lYrj 2 ��' � 3 M CO O ?o � b c3 M Cf �y M M .� N v ' w 0 �p {p y yJ {Il N N N f/► N tA N � � � � b �d � r 0 � �O 3 H 0 N C'� M N ro � 0 .� � M � ro � � W N N StOI1C� : �, �x a a n � � ..� ci Closscts C � • ' � � •v=i�wi$ �m � • : Hath 9vbs � 1i85 �Z13 . �o O p - p~, p � Sinks �O � O � wash Trays - � M- cp Drinking. a m c� Fauntains ,.� ShOwP.!'S � Floor Drai � �a � ��h O � � 1 oo• � r O F�-� Q Basins n � . Automatic � � tdasher 1- � c,as r+�i. a �' � -� lliBC. Fixt p Z � � Gas Range 0 R �E 'Z �°t M Othez .� E `' °m o a • 3 — • p rt py ...� pn O K ~ 4 � � C i ��o� • ' t�l � � M p � o � M �� . M�+ p O Q � � � � D O bl p y C!� O 0 H �, � � o �y r�+ a �8 � G� - I � o $' � � x � 1 � . � � � m' D N A O � b � H 0 � • . � � �� D � z e '� a � � a c `' � �' n �x�� mw�� o "Tt _ re¢►{Wm ''��{{ bp, . -�1 p N W G v M� � Z � �n � a m in a m -v � 01�° m aao m m O+ p�t 1� v� r►f � ro m � �� H '�O T 7 �W r -i �i m �G � Or. � � o � m � t O'� te � � pr H 0 o r w � � ~ m m N.� �► o►* � � p . H � R. r 7 ►` O . r a m � - � � rr � M O `� � Yi A � i� � A � � m a � °e n m \� � m 6 �O N A M W m N 1 h �t ta ►" -�1 M � S O • 0 � � � � � � �'rwd � �n�r~c I a � n n " rt — SUBJECT P . City of Fridley � �� o AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � . R � �` ��__ COMMUNITY OEVELOPMENT DIV. ^ r � V � PROTECTIVE INSPECTION SEC. J� � i � � C/ �� /'��1 � CITY HALL FRIDLE� 55432 NUMBER pEV DATE PAGE OF APPROVED BY �"""'� � �'' 612-571-3450 9t0-Ft5 6/17/96 � � JOB ADDRESS 5397 Horizon Drive NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 6 Carlson's Summit Manor South Addn SHEET 2 PROPERTY OWNER MAIL ADORESS Z�P PHONE Tom Forsythe 5397 Horizon Drive NE 572-9583 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO D& D Home Improvement Inc 7401 Central Ave NE, Fridle MN 55432 784-7543 4840 4 ARCHITECT OR OESIGNER MAI� ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WOFiK Reroof House & Garage (18 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION 20NING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERT�FV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTA% AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED WITH WHETHEFi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �ls 116 �.56 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIO OF ANY OTHER STATE OR LOCAL LAW REGU�ATING CON- STRUCT N R THE PERFOH ANCE OF CONSTRUCTION. ��FO.ZS Fire SC �1.12 PLAN CHECK FEE TOTAL FEE � �� $5.00 License SC $46.93 IGNATUAEOfCON'RACTOAOPAUTHOA�ZEDAGENT � E� WHEN PqOPERL ALID TED THIS IS YO R PERMIT ~ � /�-�.� S�GNATUAEOFOWNEAi�FOWNEABU�LDEAi �DATEi BLD �NSP f�6TE NEW ADDN ALTER C] I] [l ConstructionAddress : Legal Description: Owner Name & Address: C1TY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R 1 AND R-2 Building Permit Application �/�/�`�� rf� Effective 3/1196 ��D � . Tel. # ,�� ..�� Contractor: D& D Home Improvement , I nc . MN LICENSE # d� Q n Address: 7401 Central Ave NE Fridley, MN 55432 Tel. � 784=7543 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT LIVING AREA: Length Width � Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECB AREA: Length �Vidth Hgt/Ground Sq. Ft. OTHER: �omer Lot [] Inside Lot [] Ft. Yd Setback Side Yazd Setbacks Tyge of Const�uction: �,-� C � � Estimated Cost: $ Approx. Completion Date: � �, ��PS�� s,�t�� ' �'�- �� ,(Cost on Back) ��%� Driveway Curb Cu Width Needed: Ft. + 6 = Ft x$ _$ DATE: � APPLICANT: � Tel. �i ��`� �.�� Permit Fee Fire surcnarge 5tate Surcharge 5AC Chazge License Surcharge Driveway Escrow Erosion Control Park Fee 5ewer Main Charge TOTAL W � � $ P, /2 $ � $ $ � GU $ $ $ $ $ �� . q CITY USE ONLY Fee Schedule on Reverse Side .QOl of Permit Valuation (1/lOth%) $.50/$1,OW Valuation $900 �rer SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.(�0 Conservation Plan Review Fee Determined by Engineering Agreemeirt Necessary [ ] Not Necessary [ ] STIPULATIONS: .. sue�ecr P . - City of Fridley 3 3 5 0� AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r RECEIPT NO. � �• COMMUNITY OEVELOPMENT DIV. � �� ; V �� r � � PROTECTIVE INSPECTION SEC. � _ � � /'�'1 � CITY NALL FRIDLE� SS�S2 NUMBEii REV DATE PAGE O� AVPROVED BY �'""� � �� 763-571-3450 910-F 15 5/ 1 Z/ 03 / / 108 ADDRESS 5397 Horizon Drive NE t LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oescR. 9 6 Carlson's Summit Manor South Addition SFiEET 2 PROPERTY OWNER MAIL AODRESS 21P PMONE Tom & Mary Forsythe 5397 Horizon Drive NE 763-572-95$3 J CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO Windows America 559 Shoreview Pk Rd, Shoreview, MN 55126 651-203-0149 4 ARCNITECT OR DESIGNEf; MAIL ADDqESS 21P PMONE LICENSE NO. 20248265 5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION O ALTERATION � REPAIR p MOVE O REMOVE B DESCRIBE WORK Replace windows within existing openings 9 CHANOE OF USE FFOM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels o� the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash a�I exterior openings. TYPE OP CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING. MEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOIO IF WORK OF CONSTqUCTION ZONING SO. fT CU FT. AUTHORIZED IS NOT COMMENCED WITMIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED fOF A PERIOD OF 120 OAYS AT ANV TIME AfTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREE7 PARKING I MEFiEBV CERTIFV THAT I HAVE REAO AND EXAMINEO THIS APPIICATION � STAILS GARAGES AND KNOW TME SAME TO BE TRUE AND CORNECT. A�L PROVISIONS Of LAWS VALUATION SURTAX AND ORDINANCES GOVEFNING THIS TVPE OF WORK WILL BE COMPLIED �8��00 ��F.3S WITM WME7HEii SPECIFIED HEREIN OF NOT. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE pEpMIT FEE SAC CMARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �167.25 Fire SC �ps.%O STRUCTION OR THE PERFORMANCE Of CONSTRUCTION PLAN CHECK fEE _ TOTAL FEE Lic nse SC $5.00 ' $185.30 S�GNATUAEOFCON7FACTpRQAOUTHOAiZEDAGENT �O�TE� ' WHEN PROPE:ZIV VALIDATED THIS �S VO A PERMI I $�GN4TUpEO�OWNEp��OWNEpBU�lOEA� �D�TE� LOG �NS� ��tE s` i �n NEW [] CITY OF FRIDLEY Effective 1/1/2003 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) 571-4287 Fax BUILDING PERMIT APPUCATION - . Construction Address: .� � Legal Description: Owner Name 8� Address: Contractor. + Address -��7 �3zc e�. # �(03� 5?oZ-�l' S �3 MN LICENSE # o��a�So�� ll� 55�� Te�. #�,�5f-�:� -[�l �( Attach to this application, a Ce�ificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROV�MENT LIVING AREA: Length Width Height _ Sq. Ft. GARAGE AREA: Length Width Height _ Sq. Ft. DECK AREA: Length Width HgUGround Sq. Ft. OTHER: Construction Type:� a�--�!� � � �'!� �?� � ��stimated Cost: $ �� Driveway Curb�"Cut �dth Needed: Ft. + s Ft = Ft x$ _$ DATE. J APPUCANT: _ ��C '� . ��57� � Tel. # - �-��S�p Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763,571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ /� 7� Fee Schedule on Reverse Side $ $'. �d .001 of PermitValuation.(1/10th%) � - $ �� 35 $.50/$1,000 Valuation $ $1275 per SAC Unit $ 5� O!� $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 [ ] . .. _ . .. . . _. GTIPL) ATIONS� .. ,.. .. .. . . .. � . _ ,.... TOTAL . . ._. _ . $ . . • � : . . � BUII.DING PERNIIT 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 t0 $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1, 000,001 and up FEES . _. ..._� .. ... . « � �� f. ... � . ... ' � - ,'tF $23.50 $23.50 for first $500 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 $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $SO,Q00 $643.75 for first $50,000 plus $7.00 for each additional �1,�9-,,. �,n-z=�+�rt#��f� ts--and-i�cludi��I.QQ,�Q _ $993.75 for first $100,000 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 thereof, to and including $1,000,000 $5,608.75 for the first $1,OOO,IX?0 plus $3.15 for each additional $1,000 or fraction thereof cuxs curr Escxow (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00. Permits for consfruction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. , VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv s k- � Bu�cl�ig Inspections 763-572-3604 SITE ADDRESS � THIS APPLICANT IS: PROPERTY oWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERNIIT TYPE TYPE OF WORK: R-�7�s MECHANICAL RESIDENTIAL APPLICATION CITY QF FRIDI�EY YOUR E-MAII. ADDRESS !�d'� a �% �/� • �� ❑ OWNER �CONTRACTOR PHONE: %b� � sa z - � s�� CoMPANY N.4ME:_ CONTACT PERSON: � Permit No.: Received By: Date Rec'd: �% � A�M� z� a�.SyZ 1 STATE LICENSE # � E3� DATE ,�y� annxESS: 6 2 y!P ��/� �� e9� s✓� crr�r �� su. ,► ��k STATE b' "��"�ZIP .isy2 � PHONE 7� 3'S36 `�bb % FAX �ias � ��b � O �.Z {m �(SWGLE FAIvIILY ❑ TWO FAMII.Y ❑ NEW �REPLACEMENT DETAILED DESCRIPTION OF WORK ❑ TOWNI�iOUSE ❑ ALTERATION/REMODEL �� PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to 5500.00, whichever is greater, for tlie improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$I5.00. Labor cost between $300 to 5500 = cost of labor x.OS = FOR PROJECTS WHERE TJABOR IXCEEDS $500, FEES ARE BASID ON $10.00 PER FIXTURE, EXCEPT Wi�RE NOTED. FD�'f[JRES: (IIQDICATE TOTAL NUNBER OF EACH BELO� EquipmentInstalled MFG: P��' /�'� MODEL: i�aivla°�ad3�07� STZEBTU Q9 c`� � 1V�G: � ,/} f � �toDEt,: �,�x �a a.ro �.7 SIZEBTU + v�� MFG: MODEL: SIZFJBTU ,�A/C $25.00 _FIREPL'°'CE (GAS) $15.00 GAS RANGF/OVEN $10.00 AIR TO AIIt EXCHANGEER $15 FIREPLACE (W�D) $35.00 _NE�W�T � $ $�10�.00 BOII.ER $35.00 ,�F[JRNACE $35.00 C�EY LINER $10.00 GAS DRYER $10.00 PC�L HEATER $35.00 DUCT WORK $10.00 GA5 PIPING $10.00 VENTILATOR $15.00 �. .. . �:. ., r�-�,�.. � ._ .... � ,_ �.. ..n � . Permit Fee $ �_• � N�mber of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DiJE $�.� Number of fixtures @$25.00 x$25.00 =$ Number of fixtures @ $35.00 x $35.00 = $ State Surchazge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERIVIIT NOT VALID UNTII. PROCESSID I hereby apply for a building permit and I aclrnowledge that the information above is complete and acciu�ate; 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 wor�which requires review and approval of plans. SIGNATURE OF APPLICAM � ��'�� PRINT NAA� �/�,��'�� DATE � Z � 6 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 .� REQUIRED INFORMATION NEEDED TO PROCESS PERMIT _'° RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMESIADDITIONS EXIST(NG HOME ❑ MAKE-UP AIR REQUIRED IFOR NEW/EXISTING HOMES 1. Combustion Air (See note below) . a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Naiural. Gas or Propane/IFGC Chapter 3 with MN Amendmen.ts 2. Make-up Air (See note below) a. ]MC Chapter 5 with MN Amendmen.ts : 3. Venting a. Gas appliances IFGC Chapter 5 with R�N Amendments b. Fuel other than gas IMC Cha.pter 8 with MN Amendments REQUIRED 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. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calcula.tions � _ .. . _. _ � �;.`� , ,';:'; � ,, �_ Date: 06/29/2006 Revision Date: 06/29/2006 Site Information Address 1: 5397 Horizon Drive No Address 2: Existing Construction: Pre 1994. Project #: Lot: Block: City: Fridley County: Hennipen Subdivision: A�alication Information Business Name: Marsh Heating and Air MN Contractor License #: Conditioning Contact Person: Kelly Marsh Office Ph: 763-536-0667 Fax: 763-536-0226 Cell Ph: Address 1: 6248 Lakeland Ave no City: Brooklyn Park State: MN Zip Code: 55428 Combustion Apqliance Water Heater: Natural Draft Input BTUs: 40,000 Independently Vented Furnace/Boiler: Direct Vent/Sealed Combustion Input BTUs: 70,000 Independently Vented Other Combustion Appliances Gas Fired Direct Vent Fireplace(s): No Gas Fired Natural Draft Fireplace(s): No Gas Fired Power Vent Fireplace(s): No Solid Fuel Appliance(s): No Exhaust EQUiament Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135 Exhaust Fan Rating (cfm): 75 Make-Up Air No Make-Up Air Required by Code Combustion Air Minimum Combustion Air Requirements Met. Applicant Name (print): ��C � �' ��/� Signature/Date: ��`�,� ��`"'`' �� Code Official (print): Signature/Date: OO 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines. Page 1