AF - 46566City of Fridley, Minn.
BUILDING PERMIT �����
N° '7315
� , �
��: ��
;
�• � ��
,e�d�s Address
�"1
� r�
LOC��,�ICtN OF BUILDING
No. street �. �+ � P oP I.Qt
�i /
Lot !L'� Block �.._.. Addition or Sub-Dfviaian �� �;��' �'.��'-� �
Corner Lot _ Inaide Lot r. — Setback —..�._�:.�� Sideyard �
Sewer IIevatfon �����1� F�on IIevation � ' � �
�o'� �f� �e� o %/.t� C�
DESCRIPTION OF BUILDING
T U . -� ��f ;��J'
Froat � DePth � Height �.� 84• F� ��.�-� Cu. Ft�°`---s'_��
�ont Depth ���L fTeight � Sa1. Ft Cu. F'L
7j►pe of Conetructioni��� J F�t. Cost '' �� _ To be Completed
in consideration oP the issuanc+e to me oP a germft to construct buildiug described abave I agree to do
the P�P� �k ffi accordance with the d�+esscription above aet� an in compliance th a'll proviaions of
ordinances oP the dtq of Fridley. /J
In conbdderation of the payment oP a fee of $.�.�L� , pera�it 9e hereby granted to
to construct the buflding or addition as de�xYbed above. Thiape rmit fs granted uPon
the eupress condition that thepe�son to whom it fs gra.nted and 1ue agents, employees and workmen, in all work
done in, around and upon safd buildiag, cr anypart thereof, shall conform fn all respects to the orainanceg of
Fridley, Minnesota rega�ing location, construct[on, alteration, maintenance, repair sad moving of buildings
withiu the dty limfts and this peranft maq be revoked at any tiaae upon violation of any of the P�vls�tona of eaid
ordinanc�s. _ .� .�a A�
Buila9nS Ins�c�or
NOflCEs
�"'� 71� perndt do� eet ce�rer t6s eoeatrudton, le�allallen �ee �rhie�. PMmbte6. 0as 6adng, �nr ee vnfsr. B� w» to �
th� Boildiea 1�� fe� pp�rw �rmNs Por fh�ss N�nn.
,,.�
�:-
.
Lond Rlannin9 68Y.S-Ni�h�ray �tS NE
Land Sw�reyir� IGlim�a�n/s32,
.��,ST�t;�9 -� EN G I NEE R I N G, I N C. �°��°�°
C/vil frMLOO'�aprl SUnsetd-6066
�
Enqineeriny �/?�►ineers � Surveyors —
cetts�3�cai�e o� s��ve ��: ��� r��� �� � �
T
. . . �
.,
/ Scale�.t =30
���.��`�� 2s
� `�� � �C2no��5 ��'4h
`
��
\ S'SOQ� St'��
lo
D _
�,.- ,
.
0
` _n.
1
� �r
rr
\
♦ \
�
/
%
`
G
1c, ' �,,..-
' ���
4��'E �S k
� r-�o�-� . �, °�'S ,e\ �aS
� ZS ,��,�b�' S��
o " �'' U ��i
- _ � �'` �'`(j� ,O`cJptZ
� `
Lo�°s Il, 4� ��� !�, ���cr� �'a,
� � Rr�vER�,�«��v 1� E� �w Y 5
HENNcPkFt C.�3Ut�1i'�'
1/rtne� �r� ��iis rs o�i�e � mrr�cf reprerenfofran o�'a sr�wet, �'ihe bormdor�es �'�e oba,os d�cr�l�d lmrd, and
o�'}i�,+lavf�n o�'at/ burldin�s, �on, n�d d/ risib/e aw»a�fiin�fs, ��l'm�, �i a� ar�soid /ond. As �reyed 6� nn�e f/y3�_"_ ab.rf
`�'—����'� �� �� �' SUBURBAN ENGJNEERING , IAIC:
� t 9! 51 - ;;�,�. ;,�. � .�. ,�
911A � ,',��� ,
-,
,,
�t
`_� u�
,�
�
City of Fridley, Minn.
BUILDING PERMIT
Dat�: AIIG'q'ST 19, 1965
O�ea�r: R. E. KAUSLER, JR. Builder SAME
� �17 Hngp St_ N. E. ��
Fridley 32, Minnesota
N� 83�7
� �d���
LOCATION OF BUILDING
No. 517 Street H[TGO STREET N.E. Part of Lot
��1 s19..1 �_ Block � Addition or Sub-Division RIVERVIEW HEIGHTS ,
Coraer Lot Ins�ide Lot Setback Sideyard
SeWer IIevatfan Foimdation IIevation
To be vsed as:
DET. GARAGE �t
Front
Type oP Construct[on
DESCRIPTION OF BUILDING
22 �� 22 ��t 10 �. � 484
Depth ITefght Sq. Ft
� �, � �yfi1,452.00 To be Completed
�, � 4, 840
� �
In con�deratlon oP the issueac� to me o4 a permit to construct the building described above I a.gree to do
the p�aposed work in accordance with the drescription above set f and in liance wlth ell provisfona o!
onlinances oP the dty of Fridley.
In caoos4derat[� of the gayment of a fee of � 5. 00 _, permit 9a hereby graated to RICHARD E.
KAUSLER JR.. to croastruct the buflaing or addition as de.acribed above. Thie �ermit fs granted upon
the express c�nditian that the person to whom it is granted aad his agents, employees and worl�en, 9n all work
done 9q around and upon said building, or anypa� thereof, shall conform in all respects to the orainances of
Frld1eY. Minn�ota regarding la:atiam, conatruct[on, alteration, maintenaace� repefr and moving oP bufldings
wlthin the dty ]imits aad this permit may be revoked at any time upon violation of any oP the provisions of esid
ordinaacea.
AT,LEN G. JENSEN B�� �
NOTICEs
iids pumb doa ee! eavar ths cee�cH�, � ter vdrte9. P�9mbWe. �a 6faNes, s�wu er w�tsr. B� sma to su
t6a BotW1nH In�er tor apuafa p�rmW Ior tlna hana.
� ✓ .,
_�
�'-
APFLICATION FOR BUII.DING PERNIIT
CITY OF FRIDL�Y, MINNSSaTA
.��
owr�R's rTar� � � , �s���� ��. Bu�nr�
ADDRESS �% �% ��� �- d'(I�'� �� ADDRESS
LOCATIOAT OF BUILDIDiG
N0. STREET . � M� r�i PART OF LOT
� ° ,y
a `
LOT �- ,��� � '� BLOCR � ADDITION OR SOBDIVISION � �' �,9 � dH , � �°� �
� � ��
CORNER LOT INSIDE LOT SETBACR �� �c�� SIDE YARD
SEWER ELEVATION FOUNDATION ELEVATIOft
Applicant attach to this form Two CertificaCea of Survey of Lot and propoaed
building location drawn on these Certificates. .
DESCR��OA OF BtJILDING
To be used as;
���Ae.�/� � �'4 �4�� Front Z � � Depth 2 � � fleight /O �
Sq. Ft. ��� Cu. Ft. '� �'��
.
Front Dept � Seight
� Sq. Ft. ' Cu. Ft.
Type of ConBtruction ���� Estimated Coat �� ��L�
To be completed __
The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do all work in strict accordance,with the City of
Fridley Ordinances and ruliags of 'the Departmeat of Buildings, and hezeby
declares that all the facts and representationa stated in this.application
are true and correct.
DATE �� � f °`�'� SIGNATURE e � - `�
�(Schedule of Fee Coats can be found on the Reverse Side3. ,e.
�� �
�'1 __ ' � �1 . , :_
r
+�e �
BII�DTNG PEItMIT FEE SCHEDOI.E
SEG°r_ G°rION 2. The Inspector of.$uildings shall, before iasuing any permit for
the erection of anq building or�structure, or��tor an� addition to any existing
building or structure, or for any alterationa or repaira to any exiating
building or atructure, upon application rhefefore, require the.,payment by the
applicant_fnr such germit of fees to the and'ount herein below aet f'drCh.and in
the ma.nner herein provided �o-wit;
2.1. For.any such permit :for the�erection of any fire•proof building,
other thau a garage, warehouse, factorq or graim eleyator, or for the erection
of any fire-proof addition, for s�mil,ttr occugancy, to any existing building,
ahall be_at the rate of $1.40 #or each one t�ious'and:cubic feett or fraction
theraof, in.such cubtcal contenta.
�2.2 For any suGh peimit for the erecCi.on of any fire-proof garage,
warehouse, factory or �raia eievator, or for`the�erection of an� fire�-proof
addition, for simi.lar ocpt�pancy, to any.,e�i�ting building shall be at the
rate of $1.25 for each one�thousand cubic-feet; classified ae "fireproof"
by Sectiou�-502 of �he Minn�apol#s,Buildiag Code.
HOUSES
2.3. For any �uch permit for.Che erection.of auy aon-f3reproof
building other than a garage, warehouae, factory or �rain elevator, or
any non-fireproof addition,:for.eimilar occupaacy, to aay esisting bui�ding -
Permit $1.00 for each one thousand cubic feet.
GARAGES -
�2.4.• For anq such permft for tha erection of any non-fireproof garage,
war�house, factorq or grain elevator, or for the erection of any non-�ire-proof
additi.on, for aimilar •occupancy, to anq esist�ing buildiag or for each auch �
bu3lding or addition - ninety cents ($0.90) for each oae thous.and cubic feet
or fraction rhereof,-�in the cubical content� thereof with the minimum o£ $4.00.
For the purgose of computing fees for building permits; the cub�.cal contenta
of any building or addition to a uniform height throughout by mult�plying the
grouad area covered from a point � six (�6j inches below the fZ�o�c 9.ine� of the
basement or cellar.to the average he3ght of tha upper aurfa�:e or to the average
height of the roof surface of the neain gable of a pitched roof.
2,5. For repairs or altesations to an esisting atru�ture, the fee shall
be at the rate of $3.00 per each Five H+�n��ed Dollara ($5i�0.G0) or fraction
thereof ia the cast of all proposed worlc:
2.6. In no case sha11 the fee charged for any permit as aet forth in
Seetio 2n be lesa than $4.f�0. •" .
STORM REPAIR DAMAGE ??�FS; � .
ResidenCial: Eatimated Cost of wozk up to $50�.00 -$5.40
Estima�ed Cost of work over $�00,0� -$;.U,00
Commercial; Estimated�at of wogk u�s°ta�5n��00 -$10,�°'�
--� , Eatimated ,st af work over $500.00 -$20. �
V.i ai ¢- Y�►
-,,
� ,
v �
a 5
`o' �
� r
� �
04 �
O G
� a
m
O �
� C
�
m t
o °
o�
� �
� �
� L
n �
� �
D
v
v
0
m
a
�
0
�
�
�
�
rt
(D
_n
�
m
�
��-r
(D
�
m
z
�
�
n
'�
O
Z
'7l
m
m
�
�
0
Q
\
_
0
�
�
X
�
�
�
�
�
�
�
3 F-'
3• c.NTI
c °
� o
� �
� �
�m
o
D
O -�p
O �
� �
3 �
�� �
N
\ r
-�-I � a '�
D �p C O
r ,N� �
� �
m � °' °�'
� ��
o� N
�
� �
�
s
_
v
� �
�
�
�
rt
m
�
� �
�
�p �
W
CR
�
��
�
�
3 � o D
� � \ o
o � ° 3
� � < m
� v �
m -n � m
�' N O �
� � D in
�, Ul -�p O
� o � �
m o � �
• 1T
� ~ O 0
m N.��
m n, o cn
����
,� �
� O
O �
�
U'I pWj
o �
0
�
�
0
�
�o. a m m
m c �i �
� � � fl. °a
m
O � N � U7
rt O � Q�4
r�r, 3 �• Q
�
N W � �
� Qo�
Q��'�
.o-�
=<:o�
3N.��
_ � � ��
�_
�-�p � � ci
� a rn-F �
� � � �
7
, 7 a O O
� Q
m o- � °'
� c�i c�i m
c � m �
���
�� N � �
a � � °
o � � 3
� � c) �
� o
� � O T'
� a �'
y N m
�
�
� �
�
m
�
N
Q
(D
z
�
3
�
=I '�
�
��
� o
�F
�
0
�
a
�
O
�
�
04
D
Nm7�
V!
� L� G� a� -n �
N !�A N p � �
� °' a � � N
�
�o
m � � � � �
z � � �
� � v
7
� � a
T v ��
� � '�* r�
`° °' � ,w
� v'
�
� T 2
-o W m
v
� � �
N
� �N
N
�
cn o 0 o u�i
°o °o °o o °o
� � � � �
-n a� -� �
m � a o
m =
z�
w �
fD 0'0.
C
�
�
�
-� �
o �
� = o
o _° fD
7
7 �
(D r.i.
� �
rn �
a �
0
v =
a a
m�`�
� � m
o �
N
�
D
3
� �
D �
v N
� �
� �
�
�
3
�
Z
0
I�D
co
�
�
W � W �
a �in ,� N
N � ? O
c'a z � -n
O (3i N TI
� � � �
� N � 0
z m
� m �-�
� W
W C
�
� r
�' v
N
� �
�
'�
m
�
0
z
� a
m�
� r
� D
rn �
�°z
°zo
a�
z -o
vo
v�
m
o � � �
� � O �
c�D DQ z ["
� v z
� � �
� O
�
�
Z D
Z
�v
_
��, v' �
�. I m z
v! � �
, i � n
� j v O
� '' 1
� I 0 �
I � �
' m
m
�� �%i �
��; �
� Z
'V
O
�
v 1
i
0
�
�
�
�
�
<
(D
�
�
N
O
O
�P
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existin�p #urnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all cuRent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existinq combustion air is sized and installed fo meet the current codes
and manufacturers specifications.
When required to install a new corr�bustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventinq svstem, the undersigned hereby verifies that
it is a listed assembly and mee#s the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes ( ) No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Tatal Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
Building
Inspections e
763-572-3604
srr.� Annx�ss �
Tf•II5 APPLICANT I3:
PROPERTY OWNER/
TE1vA1�TT
i wn�. vuy �i � �nuay �v. � wr ����w � uy�., vt vraw. w<...� ...... ........�� ....
B���� Permit 1'�0 .
RESIDENTIA►L APPLI��TICIN R�v�a �y:�
CITY QF FRIDLE`Y'
• • �_
��i�i� i�J . �-,,
.._. a. , � �.
�l..a� r - i
, . a �
�_ y �-:� z.r:_._ 'r . u ,.
- - �j�
���� 3TATE,�Z� "
CONTRACTOR ��.`�;
sTA� �c� # � � l�Zl � � na����l / �
SUBMIT A COPY OF ., , ' �A� -���
YQUR STATE LICINSE �D�: � �� � 0 � �� �� � ���
9TITH APPLICATTON PHONE ��` �L l� �✓��� FAX 'l �'e��� �� � ��
PROPERTY TYPE O 3IIdGLE FAlt+III.Y/NEW CONSTRUCTION s�
0 T8U0 FAMILY1NEtiV CONSIRUCTION STORiES
PERNIIT TYPE O ADDITION O Q�ARAC�FJSI�D � W��'s
❑ BASEP�ffidT FINISFI �tOdF ❑ DW�IN TbE
, ❑ DECK �13IDINCr CI 4TFIER
❑ SWII�4�}'Q POOL
TYPE OF
DESCRIBE WORK BEINt3 DONE:
OF
LENC�TA
F�
.�vvru�v .......,...,._ -
NiJMBEROF S(?UARES 6'� ,�fiOTJ3E dt (�ARAGE BASF.MEid'f ZtEMQDELING SUB
GATtAGL'4 . ❑ ATTACHED GARAGE 1• E�st� Fio� P1an
❑ DETACFIED GARAGE Z� ��� �p�
PROFOSFA SIZE: 3. Li� of shnduiat membe�s to � used
PROFdS� FIEIGHT:
SIDII�TG FdRNE9Y COAISTRUCTION INCLUDING DEGKS,
❑ Vit�yl OSof6t ADDITION3 & I�RCHES 3UBMIT'
❑ AlumirEUm ❑ Trim 1. Site Piao/Simrey sf�o�eing ttee e�ing slrudares
❑ Otlter �d �
O Fasci� Z. Two � o€ co�ction pta�
N�iDQ'R�9 . 3_ F�ergy C�alea�l8tioa,
IN E7QSTING OPEI�TING3 �Y� mVo IACATTON OF WIIr1BOWS
ORFORNEW OPEhT1ATCiS DESCRIDE SIZE QF
OPIIJING GHANGFeS 8c
TYPE OF W1NDO�V TO BE IIw`',TALLID NUMBER OF @YINDOVPS
ALL FEES ARE BASED ON YALUATION, INCLiT.QING THE COST UF LABOR AND MATERL�iI.S:
(USIN��HE�9q7 U.B.0 FEE SCHEDIILE)
TOTAL JO� VALII�iTIOl�T $ �°� OCCUPANCY TYPE
Pemut Fee
Plett Review
Fire Surcharge
Surcharga
License 5urchasga
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ o- r� See Back Page for Fee Schedule
$ 65% of Bu'slding Pernut Fee
$ .O(31 times the total job valuation
$ .(1(�}5 x Permit Valuation Ritinimum $.50
$ $5.00 (Staxe Licensed Resideatiat ContEactors)
� $I 675 p�r SAC Unit (Plans to MVU'CC for detcnm+�*±vn)
$ ft+6ft= ftx$21 =$
$ $45(? Canaervation Pl�. Review
$ Fec Determined by Engineering
$ AgreemanL necessary () N'on Nacessary i)
� f P Make ehecks aa�able to: Cit� of Fridley Att��
THI3 I3 AN AFPLICA1TdN FOR A PERMIT NOT VALID UNTIL PRC�ESSED
I hereby apply far a building perutit and I acImowledge that the information above is complete and accuiata> that the �ozk R`ill b� �
conformance vvith the ord.inances and codes of tha City of Fridley and wzth the �+Iinnesota Canstruction Codes> t� I under�nd this is not a
p�rmit birt cmly as applicatioa far a permit and work is not ta statt without a penuit; that the work w11 be, 'rn accordanae with the aPPraved
plan in the case of a11 work e�hich requi� es revis�e aad approvai of plans. '
� � _ ,
SIGNATTJRE OF APpLICANT
�
��s: t.� I -i!'�.-�`�����'� �.��
Building
Inspections �
763-572-3604
763-502-4977 FAX
DATE�
S1TE ADDRFSS �
THIS APPLICAN7' IS:
PROPERTY
OWNER/
TENnrrr
CONTRACT'OR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
11VSURANCE
PERNIIT TYPE
TYPE OF WORK:
DET.
❑ OWNER
PI.UN.�TI�TG
RESIDEI�TTIAL APPIJICA'I'I�l�T
CITY OF FRIDI.E�
YOUR E-MAIL ADDRESS
a.DDRESS: S/ % �-U-l'G� � T-
PHONE: � � 3 � 7 l �t — 1 � �'�
wi�srt�• `/ ,� .,r..� � I�C� �'Q. �� if LL
STATE UCENSE
STATE BOND #
Permit No.:� ���
Received Bx:
Dat�'��° d��
�dl�
EXP DATE
_ EXP DA'1'E
��zrn �5 �
ADDRESS: CITY STATE ZIP
PHONE
SINGLE FAARILY
o t�w
'IQ�T OF WO,�K _
❑ TWO FAMiLY
C
FAX
O TOWNHOUSE
� u t/'
PER MS 16B.665 the permit fee is a minimum of $15.U0 or 5% of the total cost up to 5500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the'cosso 1�� �ge
Labor cost under $300 =$15.00. Labor cost between $300 to $54O--Rc6st of labor x.OS = p
FOR PROJECTS WHERE 1.ABOR EXCEEDS $500, FEES A.RE BASED ON $]0.00 PER FIXTURE. EXCEPT WHERE NOTED
NUMBER OF EACH BELOV�. M1NiMUM FE� $I5.50. SHOWER
BATH SII�TIULAV FLOOR DRAINS ._
—Bp���g . _ GAS PIPING (NEED CTfY LIC) _ SWIMMfl�1G POOL
—CI,pTHES WASHER ,_ KTTCHEN SINK _ WATER CLOSET
DISHWASHER _, LAIJtQDRY TRAY WATER HEATER ($35)
— WATER METER
Permit Fee
TOTAL DUE
pI}C7'URgg: (INDICA'['E TOTAL
WATER PIPING
WATER SOFTNER {$35)
BACKFLOW PREV. ($IS)
FOR iRRIGATION
_ OTHER
... � • ~ �- .:. S` "�:. �=�a ;t..� _� �-F���-�ti�an .� ..��.�. - _ _ ..��.u., -m:-,,,.... __..
$ � Number of fixtures @ $10.00 x $10.00 = $
.50 Number offixtures @ $15.00 x $15.00 = $
g OR Number of fixtures @$35.00 x$35.00 =$
. State Su;charge = $�P50
INIMUM $15.50 MIMMiJM $15.50 Total = $
THIS IS AN APPLICATION FOR A PERMTT-NOT VALID UNTIL PROCESSED
I her'eby apply for a plumbing petmit 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 on site; that the work will be in accordance
with the approved plan in the e o�/` all k which re ires review and approval of plans.
�� // � ..��n _........�....,- Y � ._ � C�r('D � l C � DATE / v �/� a
SIGNATURE OF
APPROVED BY
'�
City of Fridley
�uilding Inspections l�epartYnent
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
DA'
Building MECHANICAL
Inspections RESIDENTIAL APPLICATION
763-s�2-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECI7VE 7-1-2010
DATE ! (� - o�
STI'E ADDRESS _
THIS APPLICANT IS
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
-!o
YOUR E-MAIL ADDRESS
O OWf�1ER �ONTRACTOR
Permit No..'
Received By:�
Date�'�I:
Ftt�:'U
��i , COfh
ADDRESS: CITY STATE ZIP
PHONE:
COMPANY NAME: �r' � i/V G/�`' ' r CO+� .- „�N i
CONTACT PERSON: � O1 ul I C i.� e r
STATE LICENSE # yI ��� l'YJ a EXP DATE I a- �- O�
�
PHONE 6� o S.SZ'I I°I
�SINGLE FAMILY ❑ TWO FAMILY
❑ NEW O REPLACEMENT
DETAILED DESCRIPTTON OF WORK V e�v f /,/ r
�•v• �.iii iiw•
FAX
❑ TOWNHOUSE
--�,�,4LTERATI ON/REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: MODEL: SIZFJBTU
IVIFG: MODEL: SIZE/BTU
MFG: MODEL: SIZFJBTU
_A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGF/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
_BOILER $35.00 �. _FURNACE $35.00 GAS UNIT HTR $! 0.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 L HEATER $35.00
_DUCT WORK $10.00 ' GAS PIPIIdG $10.00 �TILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L 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 f a perm' 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 wo hi quires review and approva! of plans.
SIGNATURE OF APPLICANT PRRV'f NAME s�ev �.�f �� � I' �'j DATE I Q-° ��°��
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
1,
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REOUIRED 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. 501
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
5. 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
combusNon and make-up air calculations.