AF - 46742�
City of Fridley, Minn..
BUILDING PERMIT N� 7293
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LOCA���_ ��F BB�JILDING
No. ���. stt�t .� .��e Part of Lo�
� e �i� �
Lot � B1ock � Addition or Sub-Division ��. �_- �
C o r n e r L o t _ I n a i d e L o t '-'� Setback �.:�— Side y a rd ,,GG�1 �'
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Sewer IIevati� -�1-��' �� _.._ Fo�on IIevatioa ��C�. ��
%6 P /�� F+m� � fit� �
DESCRIPTION OP BUILDING
T v�a : � o
Front �� Depth _�� Height �� Scl• F� �� Cu. Ft �� ��CS��
Fro Depth I�ei t�� Sci. Ft. Cu. Ft
Zj►pe of Construction � Fast, -'����-.� T be Completed
Ea consideration oP tke issusnce to me of a permit to construct the building described above I agree to do
the proposed work ffi accordance with the d+escrlption above set fa�rth and ia compl3ance with afl provlsiona of
ordinances of the dtq oP Fridley. ,,� ,� e,
— �i'� '
In c�deratioa of the payment of a fee of �, permit is hereby granted to
to construct the buflding or addition as d�crlbed above. This �ermit is granted upon
�he express condition that the person to whom it is granted and his ageata, employees and worl�en, in all work
done in, around and upon said building, or anypart thereof, shall conPorm in all respecta to the ordinanceg oP
Frldley, M3nnesota regardfng location, construction, alteration, mafnteaance, repair and moving of buildings
within the dty ]imita aad this perrnit may be revoked at any time upon violatioa of aay of the paoviaiona ot eaid
ordineacea �, ., �1
Buildin� Inspector
NOTIC�
T6b permh doa net eowr ths �oesteoc�i�, lastall�oe tee vrtrieg� piambine, ga 6aHee, �vnr ee wa�sr. B� wre to sss
Nro BoiWioB I�etor for s�paral� parmUs /or thw i»ms.
. .':—,,:: or; . .: . . .
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APPLICATION FOR BUILDING PE^,A?TT
CITY OF FRIDLEY, MINNESOTA
O�R' S NAME ��lL/��L� G- �t/�'LD �/�S �i�+e_BUILDER � y� Ll! /1�131 � �lYI �S
ADDRESS�'� 2� -, �% ��Y�/✓�!r° �� ADDRESS�.iI�> fiaP,�.�� f�Elff����'r�TdnjTfN/��
/vJ�JZ�S. -3 � �l.�/Y� . .
LOCATIOPi OF BUILDING
No. �o �.� /�60 f'�r� Street 11��„ �!?7 /�1 �'`�A%1�YAl,P�ar�t-i�t--
Lot� /�,�� �(-, Block AdditioA or Subdivision�j /yFR y���r,r �%�(,yTS
Corner Lot�Insid"e Lot�Setback ,�� � S.ide Yard �� ��tF.s°?',�>D�
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach Co this form Two Certificates of Survey of Lot and proposed bui'!d-
ing location drawn on the"se Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front JC�i.�h Heighe
Sq. Ft. Cu. Ft.
grone �e�th Height
Sq. Ft . Cu . Ft .
Tyge of Construction „�/� C��'� Esti�ated Cost�� ���e °
�..
To be Completed F. f AAl,� /9 ���"
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordaace with the Citq of Fridley Ordinances and
rulings of the Department of Buiid3ngs, and hereby de�larea that all the facts and
representatione stated in this applicaCion are true and correct.
DATE SIGNATURE
r{Schedule of Fee Coata can be found on the Revarse Side).
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BUILDING PERi�;T FEE S�Dt1�E
Section 2. The Inspector of Bu3.ldin�s ah�11, before isauiag any pesanit for
the erection of any building or structure, or for any additioa to any ��ist-
ing building or atructure, or for any alterati�ons or repaixs to any esiai:i�ag
building or structure, upoa application therefor, require the pay�ent by the
applicant for auch permit of feea tv the amouat hereia below aet forth ar_d
ia the manner hereia provid�d to-wit:
_ �__ � .. .
2.1. For any such permit for the erectioa o.E anq �ite-proof building, other
Chan a garage�, �rarehouse, factory or grain elevator, or for the-ereetion of
a�ny fire-proof additioa, for similar occupancy, to any exiat�.ng buildirg
ahall be at the rate of $1.40 for each one thouaand cubic feet, or fractis�n
thereof, in such cubical contenta. '
2.2. For any such pern�it fcr the_erection of a�y fire-proof garage,- ware�icuse,.
factory or grain elevator, or for the erectioA.of .aay fire-proof edditio�,
for similar.occupancy, to any exiating buildisag shall be at the ra�e oi $1,25
for each one thousand cubic feet, cla$sified as_°1fireproaf" by Section SG2 of
the iKinneapolis Building Cade. ..- .
flOUSES
2.3. For any such permiC foz the erecti:on of,aay noa-fireproof buildir.� orr��
Chan a g�rage, warehouse, factorq or grain elevator, or anq aaa-firepr.�c>�
additioa, for similar occupaacq, to any exiatia� building - perm3t $�..�0 �or
each one thousand cubic feet. .
=
?.4_ For any such permit for the ere�r��,� ^t �.r:�9 rry�_�tL?�xc+�� �axg�;e�
warehouse, factory .or grain elevato�, ��� r;>;�: 2.`16; ��:cA-:�:�E� �� 2uq na��sa�a�oof
addition, �€or .s3milar occupancy, to :�-,�r .�<{_F ��::�r_:. ���;. �.��.�g or for each eLCh
., _ � building or add3Cioa - ninety r_a*a� �,<���: >�_: ��y;��.� �«;,;� ��e thcusand c�ic feet
or fraction thereof, ia the cc:� �c� ��-., �� rr.�.4 �;�e�°�ei with a minimum of $4.00.-
For the purpose of computiag fees f�� �L.`;�,.��g pg�i�e, the cubical contentsc
of anp buildi� or addition Co a-un�.tox.a �:�ea �blt tiiroL�hout by multiply►�►n� the .
ground area covered from a point six (6) ia�hes be7.:,w the floot ],iae of:i�,e
basement or cellar to the average height of tc?ao .�,:�-�aer s�a�iace or to the �
average height of the roof surface of the main �r�o1e of a p3tched roof.
2_5. For repaira or alterations to an exiating etructure, the fee �hall be
at the rate of $3.00 per ea�h Five flundrefl.Dollare ($54A.00) or fraction
thereof in the cost of all proposed work.
2_6 _ In no case�shail the fee._charged.for.aay permi� a$ Bet forth ia
Section 2 be less. thain $4..00. ,
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LOTS IS' AND i6, BkOCK R, ��h�.
RtVERV1EW NEtGHT � �;; �
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SUBJECT PERMIT N
City of Fridley 3200
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AT THE TOP OF THE TWINS g U I L D I N G P E R M-�I.T '
� � R EIPT NO
� `L _ COMMUNITY DEVELOPMENT DIV. ���
r � � PROTECTIVE INSPECTION SEC.
i 1 �
�� 1 r'�'1 � CITY HALL FRIDLEY SS432 NUMBER REV. DATEg�12�75 PAGE OF APPROVEDBY
----� • •,' 612-560-3450 910-F15 (S��SBX / /
JOB ADDRESS
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1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1 � R• SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
3 CONTRACTOR MAIL'ADDRESS ZIP PHONE LICENSE NO.
4 ARCHITECT OR DESIGNEP MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
residential
7 CLASS OF WORK
❑ NEW �X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
8 CHANGE OF USE FROM TO
STIPULATIONS
X. 1. Provide a hard surface drive.
TE PERN�ITS REQUtRED FOR V�IRI�Go
��P�R�+
HEATING, PLUMBiNG AND �I��S�
SEPARATE PERMITS ARE RE�UIRED FOF ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIH CONDITIONING. � r
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 4GO 4�GOO
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 VALUA ION SURTAX
AND ORDINANCES GOVERNING THIS TYPE �F WORK WILL BE COMPLIED �3,256.00 �.63
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 8.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �
� e /� � PLAN CHECK FEE TOTAL FEE
C ��
SIGNATUREOFCONTRACTO ORAUTHQRj EDAGENT IDAT WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
,^w A%
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SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI � �� " BiDG INSP DATE _
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� . , , � .
� � ' � � - . . . . •
� � ' ' . •APPLICATION FOR Rk:SI'DL'�VTIAL., ALTL'ItA1'ION,
• � OTt AllllITTON• BUILDING P�RI�IIT . . . .. .
• CITY OF FRIDLEY, rIINNESOTA • .�
owriYx � s N�r� : G �' �s�w �suzLV�x : � ` ��i�-� �J'v�i€�.r ��°:
. ADDRESS :. � � i ADDR�S S :,��� �/�.1��7r �� �Gl �/�s• �
� . . .� . � /�� j %�l�� Vr���
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NO : . STItEET : � �' �� �o - .
� T,OT : �� � BLOCK: � � . ADDITIOn : /����'e^ � � � � � �.
CORNER LOT : • • INS SDE LOT :� S� A K: �� SIDL'YAF.D :�_
� ApplicanC attac�: �o this for:r. Tcao CertificaCes ,�f Surve ..of Lot an3.proposed .
� buildi.ng location c:�awn on -these Certificates. :
, � • . .� .
� BESCRIPTIOI�f OF BUILDTiVG • �
, � . . : � .
To Be �Used As : •• � � . ,
.� . e �
! � Fxont :_,�� Depth : �,� Height : � ��/�
� �����°� � . " C9 � " �j'�i
Square Fee� :• Cubi.c . Feet :�� C� ��'
' Front: Depth: ' Height•
. , � Squaxe Feet; � Cubic Feet: " ,�
Type of�Construction: .��d�ii� Estimated CosC• $ �%���
__1�°� ��`' . . `.� �� �,7� � ` �-�° •
To Be Completed: : .
�� Tiie undersigned hereby makes applicativn fox a permiC for the work herei.n
specified, agreeing to do all worlc ir� stiict accordance �aith the City of
� Fxidley Ordinances and rulinss of the Department of Buildings, and her�by
d�claxes tha.0 all Che facts and representations stated in this applica�ion •
� alce txue and correct.
.
�,ATE : � � /� _ SIGNAT[iRE . - — • .
(See I�eve�se Side For Addition�l Iniormation.)' . ' "
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�3UILllING L'.L'1W11'1' !�L'L �l.t�LliuL�
SiC'�iON 2. T1�e�InsPector ot IIuildin�s sha�l, bcipre issuing permits for th�
cxection of any building or strucCure, oic for any addition to r�ny exist�.ng
building or sL•rucCure, or for any a1L-ex�tion or xep��irs Co any existin�
building ox strueturc, upon.application thcrefore, xequire tlie pnymenr by .the
applicant for such permit of fees to the an:ounC herein b,��ow se� �'orth arid in
the manner licrein providcd to-wit: • •
UNII'OItM BUILDIhG COD�: `iype 1, 2& 4-$2.15 for each one thousand cubic
'fee�; or f�action thereof, in such cub'ical conCents. 2jrpe 3& 5-$1..85 fox
each one thausand cubic feet. •: .
.ADDITIONAL INFORbiATION .
' Fox the purpose o£ computing fees for building permits, the cubical contents
� of any building or addition; is determined by multiplying�the ground area
covexed from a point six.(6) inches below the floor line of the basement ,.
ox the celTar ta the avexage heights of the uppex surface ax to the average�.
�height o'f the roof surface�of the main gable of a pitched roof. .
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. . �
• �or•repairs or alterations to an existing structure, the fee shall be at the
- �:a�e of �3.00 pex each five hundred dollars. �($500.00) or f�:action thexeof in ,.
• th, cost o£ all ;�roposed work. ' .
In no case shall the fee charged fox any'fpermit as set for�h in Section 2 be
� less than $5 e 00. �. � � � . . '
'VERIFICAT.ION OF FQUNDATION
-o
. � . ,.
1�pT�; Pexmits for construction will be issued.a minimum of 24� hours fxom the
time of application, to alloca for prbper review of the proposed sCructure and.
o£ the constxuction siCe. , . . .�
A Certified Sui-vey of the lot, shotaing �.he loca�ion ot the foundation, once iG
has been constxucted, will be required be�oxe proceedin� wi.th the fxaming.
. CERTIrICATE OF� OCCUPANC.Y ' _
Application for a Certiiicate of Occupancy shall be made ten (10) days prior
to the use or�occupancy of any structure for which a builclin� permit has been
issued; 1nd said stxucture stiall not be used or occupied until a Cextificate
, of Occupancy has Ueen issued.. . � .
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Surve�'s C�rti ic�te
COMSTUCIC & DAVIS, INC. co��it�� �� �a �a s���yo�
14�46 Co�nty Ro�i J, Mp1�., PViinr�; 55432, 784-9346
LOT SURVEY & flOiJSE LOCATION
LOTS 15 � 16, BLOCK R
RIVERVIEW FiEIGHTS
ANOKA COUN1�i
�
SURV�Y FOR: MRS RIITH McCFi�RX
663 T3[TGO STREET, N.E.
FRIDLEY, MINN. 55432
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DESCRIPTZOIT: Lots 15 & 16, B1o�Dc R, Rie��le� Iit�i�h��, Aas�ka Cos��y, 1`Ltr�ne�o'�
. � �z`,f��
.�I�.�' ' .
_ • O�.urs>e-1 /.sPO.e� /y7o.us��✓�'.e�r �'oss,rev
I hereby certify that this surve�r, plan or report �as prepared by m� or undez my direct
supervision and that I am a duly Re�istcr�d I.and Su�rveyor under the laws of the State
of Minnesota.
'^ � �° g3� - �L� �9%j' 3.s'�
Reg. No. Date Jab No. -
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FILL IN COMPLETELY FOR REPLACEIIfIENi FUEL BURNING APPLIANCE PERMITS
COMMOId dE1VT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacin4 an e�ds�tins� furnace, the undersigned hereby ve 'rrf'ies that the
venting has been examin�! and is fr� from rust, deterioration, obstructions,
and is securely supported and firestopped uvhere required. Yes () No ()
The venting system is plastiGPVC and meets all currerrt caies and manufacturer
spec'�'ic�tions including smng, length, number of eltmws artd termination. Yes () No ()
The undersigne.al also verfies that the replacemerrt unit is a Gst� assembly
and meets the current c:odes and manufacture�'s speafic�tions. This daes
include AGA-GAAAA Category I Central Fumace Verrting Tables for fan
assistpd and natural draft appliances.
The existina combustion air is sized and installed to meet the c�rrerrt c�des
and manufacturer's specfications.
When requirer! to install a nevu combustion air. it will � sized and 'mstalled
to meet the current c�des and man�fad�uer's sp�ific�tions.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When inst�allina a ne�ro ve�nc� svstem. the undersigned hereby verifies that
it is a list� assembly and m�ts the curre� c�oates and manuFacturers
specific�tions. This does include AGA-GAMA Cat�ory I Cer�al Fumace
Venting Tables far fan assist�i and rratural draft appliances. Yes ()
Is the c�mmon vent and vent wnnedor� sized and installed corredly after
an appUanc� has l�en removed from the c�mmon ver�t and verrtecl
separatety as per c�.�rrent codes.
No ( )
Yes ( ) No ( )
An�liance Tvoe and Siae/Common Verrt and Verrt Connecto� I�ormation
Appliance #1 TyRe BTU Input Fan �ssisted or Nat
Applianc� #2 Type BTU Input Fan Assist� or Plat
Applianc� #3 Ty� BTU Input Fan Assist� or Nat
_ T�talApplian� _ Tatal�tuJnput - - - - --
Common Vent Type Ve�rt Height Diameter inches
Appfianr.e #1 Verrt Connecto� Height ft Length ft Diameter in Type
Appfiance #2 Vent Conn�ar Height ft Length ft Diameter in Type
ApRlianc� #3 Vent Connector Height ft Length ft Diameter in T}�pe
ALTERATIONS• (Describe)
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
CITY OF FRIDLEY
6431 ITNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57"1-36U4 r'AX:
: 663 HUGO ST NE
: 033024230154
: UNAVAILABLE
: LOT BLOCK
PERMTT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
571-1"ltf7
�
PERMIT NO. 2004-01217 �.�° �
DATE ISSUED: 07/30/2004
I VALUATION : $ 1,100.00
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AN AIR CONDITIONER.
I# A/C UI�TITS 1 VALUE OF APPL OR WORK 0
# FURNACES
# GAS RANGES
APPLICANT
ROYALTON HEATING & COOLING
4120 85 AVE N
BROOKLYN PARK, NIN 55443
(763) 424-8333
OWNER
PLUNIlVIER LESLIE L
663 HLJGO ST NE
FRIDLEY, MN 55432
0 # GAS DRYERS
0 VALUE (FOR MINIMUM CALC)
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
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 lrnow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
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 constn�tion or the perFormance of construction.
Bldg Insp
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 40046
SEPARATE PERNIITS R�QUIR�D FOR WORK OTI�R THAN DESCRIBED ABOVE.
0
1100
0.00
0.00
0.00
0.00
25.00
0.00
0.50
25.50
ADDRESS
PIN
LEGAL DESC
PERMTT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENITE NE
FRIDLEY, MN 55432
57"L-36U4 l+'AX:
: 663 HLTGO ST NE
: 033024230154
: UNAVAII.,ABLE
: LOT BLOCK
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-1ZtS7
PERMIT NO.: 2004-01218 i��JJ j
DATE ISSUED: 07/30/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL AN AIIZ
CONDITIONER.
# INSPECTIONS 1
APPLICANT
ROYALTON HEATING & COOLING
4120 85 AVE N
BROOKLYN PARK, MN 55443
(763)424-8333
OWNER
PLUNIMER LESLIE L
663 HiJGO ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
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 lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
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 construcrion.
Applicant Date
Bldg Insp
ELEC PERMIT FEE - NIIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 40046
SEPARATE PERNIITS REQUIRED FOR WORK OTHER `1'HAN ll�5C:K113�ll At3UV�;.
20.00
0.50
20.50
I'IHht-�4-�141��
IVCVY ( �
ADpN (I
ALTER [ ]
1'1�b1 L11Y Ur rK1ULtY ��Q� —���' b�
CI'�Y OF �RipLEY Effecdve 4/ /�t 2004
6431 University Ave N�, Fridley, MN 55432 (763) 572-3604 Bldg Insp
SINGLE FAMI�.Y AND DUPLEX�S R-1 AND R-2 (763) 571-128Y Fax
BUILDING PERMiT APPLICATiON
Construction Address: � �
r �-
Lega{ Deseription: v
Ovmer Name 8 Address: o�Q.s ��,�h,�..�- � G 3�f��.� s v� Tel. #,�? i��T 6 6
Contractor. J►��v�- Qo �(',� �,c� MN I,ICENSE #��t� � c� a q C�
Address: ��� 1�' s� ��� eg�' �� Tel. #�� r) �r G 4 Od 3 T
-- .�� . TT_
LIVING AREA:
GARAGE AR�l1:
DECK AREA;
OTHER:
Attach to this applica�ian, a Cert�cafe of Survey of the
bt, with th� proposed construction drawn on it to scale.
DESCRIPTIpN OF 1MPROVEMENT
Length � Widkh Height Sq. Ft.
Lengfh Width Height Sq. Ft
Length � Width � Hgt/Ground Sq. Ft.
Construction Type: �c�� _ -,�,_��� ,. _ Estimated Cost: $ ��2
Driveway Curb Cut �dEh Needed: Ft + 6 Ft � Ft x$ _$
DA7E: � �6 APPLICANT: ----.- - ��n�r�tv� Tet. # � �,�) � �c�-O?'��-
Call (763) 572�604 for Permit Fees if mailing in application. �ax to 763-571-1287 if using credit card and we wili caii
you for card namber.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion C�ntral
Patk Fee
Sewer Main Charge
TOTAL
CiTY USE ONLY -
$ •��� Fee Schedule on Reverse Side
� � �� 65% of Permit Fee
$ - .�� .001 of Permft Valuation (1/10th%j
$ . �� $.50/$1,000 Valuation
$ � �' $145p per SAC Unit
,$ �. zal� _ �5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ � $450.00 Conservation Pian Review
$ � Fee Determined by Engineering
$ _ Agreement Necessary ( j Not Necessary []
$5„Z! - �� STIPUI.ATIONS:
TOTAL P.02
City of Fridiey Building inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
o��� 9
Mechanicai- Pem,�# °Z°���
Residential Application
City of Fridley
See Back Side For Reauired Informa#ion
Date �-X"G .� Site Address:
The applicant is: (cirice one) Owner
Property Owner: �i�,J�S: �,w,in.
City: -
Phone: -
Contractor Information
Company Name:_�
Contact Person: /'A,8
Cit�r:
Phoi
Ema
Cell:
Cell:
of Work (circle one): New
Detailed Description of work:
�,. ��.un-
State: �'2��
Fax:
MN Bond# & Exo Date
AlteratioNRemodel
Equipment installed: MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
Please check all that apply: _Fireplace (gas) $15.00 _New Gas Grill $10.00
A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Air to Air exchanger $15.00 _Fumace $35.00 _Pool Heater $35.00
_Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00 _Gas Piping $10.00
Duct Work $10.00 I� Gas Ranqe/Oven $10.00
Permit Fee
Surcharge
Total Due
$ ��� (Total from above-Minimum fee $35.00)
� �
$ � �� Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical permit and I acknowledge that the information above ls complete and
accurate; that the work will be in conformance with the ordinances and codes of tlie City of Fridley and
with the Minnesota Construction Codes; that I understand this is not a permit but only an application
for a permft and work is not to start without a permi� that the work will be in accordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant: � Date: ��%S
Approval Inspector Signature: Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
co.,��� ai�di�nn�
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
l. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Nat�u�a1 Gas or Propane/IFGC Chapter 3 with MN Amendmen.ts
2. Make-up Air (See note below)
a. 1MC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with N!N Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooli.ng 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 calculations
�
PLUMBING
RESIDENTiAL APPLICATION
City of Fridley
NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- �► UCENSED CONTRACTOR MUST OBTAIN THE P#
OATE g I� l o S' YOI1R E-MAfL ADDRESS
SITE ADDRESS � 3 M k� 0 S�'
THE APPLICANT IS: (ClRCLE ON� OWNER
PROPERTY OWNER/
IENAi�IT
•.• . - . . -
PERbA1T TYpE
TYPE OF WORK
w�e LEsL,� PLc�rh���
- -- -- -
ADDRESS � 6 3 /-! � e-, a s�_ –
CITY F�. � a �� y STA7'� �!!�✓ �P SS�i:� L
PHONE # % G 3 � � � � '- f� � (o L �—
�E , Terry Overacker Plbg Inc UCEMSE # � i y���'''r
�o� 1628 County Hwy 10
cmr Spring La.ke Park, MN 55432 rare z�
��� (763) 572-8880 � �� 3 - °�� L - ��'� 9
� SINGLE FANIILY -- TWO FAe1tLY TOWNHOUSE
O NEW � RERLACEAAENT
DETAILED DESCRIPTiON OF WORK �i ��� u��/ �t�-s+�
FEES ARE BASED ON �10.00 P@R FUC7'URE, pCCEPT INtiERE NOTED
FDCTURES: (INDICATE TO'fAL NUMBER OF EACF�
SATH SINK/L,AV FLOOR DRAINS SHOWER WATER PIPiNG
BATHTUB GAS PIPING (Naed (�iy (JcenseJ SWIMeA1NG POOL WATER SOFTENER ($3�
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACi�LOW PREH. ($1�
DISHWASHER LAUNDRY TRAY ,,,�WATER HTR ($� FOR IRRIGAl10N
WAT�R �IETER OTHER
Permit Fee
Plan Review
Surcharge
TOTAL DUE
$ �3,�(i
$
$ .50
S �Ss �
----_
MINtMUM: $15.00 or 5% of cost of the improvement�arhichever is
greater on work less tF�an $300
Make checks payabie to: City of Fridley
----- -- --_ '_•�••.•-....... . v�� � rcnm� �- nv � vnuu un � IL PKOGESSED
f hereby aPP�Y � e P��bin9 Permlt and 1 acknowt� fhat tF� Irtformadon abow ts cartptete and accurate: that fhe wark �rill be in confomtance w�t
the oralnanres and o�es af aie crty of Fddley arui with U,e t+�nnesota construdion c.odaes: u,at � understaad u,� � r�ot a permlt buc oMy an
appllcaLlon f� a permit and worlc ts not b start wiN�out a Permik �at the v�orlc will be in aa�r�danc� tnr� tl�e approved plan in tlie qse of aU work which
r�u)res revfew and approval of plans. _
NAME OF APPUCAM' _�°�`� �� DATE ��� � �d �
P�ease hrpe or Prh�t
SIGNATURE OF APPUGANT
6431 UNIVESITY AVENUE NE, FRIDLEY, �WN 55432
t7831572-3604