AF - 468314 � _T _
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City of Fridley, Mirm..
.,., BUILDING PERMIT No s�o2
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Date: _L.:._ '�
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Owaer: ' Buflder
Adar�as
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LOCATION BUILDING
No. .��� ��--.`�- Stceet _�,�' ...�_ ..��. P f t
��- Bl� =--d Addition or Sub-Divfsian -�� s
��� �- Inside Lot �� Setback __�:� z Sideyard -- d�� �
�� II�'8�� — ...... Foundation IIevation
DESCRIPTION OF BUILDING
T Used • �
Front _��� Depth � Height ,�.�� Sq. FL ,�Cl��Cu. FtvS���� �
-- Fro t.�� Depth H'eight ��C �� Sq. Ft ��� Cu. Ft �,���
Type of etion��$��� Est Cost _�""R o�e Completed
In consideratYon of the isauance to me of a permit to construct the building d�scril� ab�ve, I agree to do
the ProPosed work in accordance with the descntpt3on above set forth and in comp ce wIth all proviafons of
�dinanc�s oP the dty of Fxidley, f
Ia consfderation of the Pa3►mex►t of a fee of $���° ,�t fs herebY graated to
to conatruct the building or addition as described above. Thiaperm� t fs granted upon
the express condition that the person to whom it ia greated and his agente, employees anc� worl�en, in all work
8one iq around and ugon safd building, or anY part thereo� shall cunforin in all respects to the ordinanc� of
FridleY, Minnesota �g lacat3on, consstructi�on, alteration, maintenance, r+epair and mov]ng of bufldings
ordin�an�c�es. dtY ]imYts� an�this Permit m�y be revoked at aqy time upon violation of any of the P�vlsiona of said
n Nonc�
'IWS Wemh doaa aw eorsr ths censtru�toe, Ies�alldioe fo� wirieg, piumbie8, ea 6aHng, rswu or wa�sr. B� suro to iss
����d�n8 les�er for aparal� pamhs for fhea Uemt.
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City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit# t�- ��
Residential Applic�ation
City of Fridley
See Back Side For Required Information
Date 11 1� 0 5 Site Address: -��o Zrotn'�or �s�- �1 �,
The applicant is: (cirlce one) Owner ontracto
Property Owner: C, � ;
Address: S,o,�rn�c.�
City: State: Zip:
Phone: �1�03 — S�S-9 S� 4� Cell: Fax:
Contractor Information
Company Name: River City Sheet nAetel, Ina
Contact Person: --- 82�Q MSi11_ t .� �.hs�s ��nn
Address: FrldleV, MN 55432.
C�� �---� �1 3i�5'4-�8 �p'
�a� � �5 A8
Phone: ell� Fax:
Email: MN Bond# & Exp Date
Type of Work (circle one): New Re I c AlteratioNRemodel
Detailed Description of work:
�$�o,.QR� ��,. �a c� m� n� �.►� rac.e.
Equipment Installed: MFG: '��w,..� Model:l�pKonFt�me�Size/BTU: '7S doo
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 �C 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 Gas Range/Oven $10.00
Permit Fee $ 35�- da (Total from above-Minimum fee $35.00)
Surcharge � 0.50
Total Due $ 3 S. S v Make check payable to City of Fridley
� n�s �s an appucaiion ror a perm�t- not vaua unin processea
I hereby apply for a mechanical permit and I acknowledge that the informa�on above is complete and
accurata; that the work will be in conformance with the ordinances and codas 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 case of all work which requires review and approval of plans.
Signature of Applicant: � Date: �� ll Q S
Approval Inspector Signature: � Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Revised 6/14/2005
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
.o
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendmen.ts
b. Natural Gas or Propane!lFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendm ents
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with N1N Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new constru.ction IMC 1346.0312
5. V entilation
a. Per MN Energy Code 7670 or 7672
— 6. Dact ]�e�g� Per �I� 1�.0603.2 --- - --- __ _
a. ACCA Manua1 D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
e
Building
Inspections
763-572-3604
763-502-4977,
0
From: City of Fridley To: 6124362300 Page: 4/6 Date: 5/5l2009 2:57:35 PM
MECHANICAL Permit No.:�
RESIDENTIAL APPLICATION Received By:
CITY OF FRIDLEY D���'��
tHr•�.cTiv�2-�9-09
llAT�, O�/ (SJ�'� / �—�
S1T�. AllUR�;S5 �� (� �
--�a—
THIS APPUC:ANT IS: ❑ O
PROPERTY NAM�.:
OWNER/
TE1�IANT AUllR�:SS:_
PHONE:
CONTRACTOR
SUBMIT A COAY OF
YOUR STATE
LICENSE W[TH
APPLICATION
P�RMI'1' TYPE
TYPE OF WORK:
R E-MAIL
A
COMPANY NA$M ':
CONTACT P�,kSC�N: � �/� �p)C�T �A��TREE7'
—g�v�re
STAT� LIC�,NS�, t� (��NNEAPOLIS, MN 55408-Z9OQXP DAT�,
ADUR�;SS: 6�2-824-2656 C�Ty STAT�. 'L1P
PHONE
FAMILY ❑ TVa'O FAMILY
❑ N�W ��PLACtM�NT
DETAILED DESCRIPTION OF WORK
r•�;�;s A�t�; sAS�u ov $io.00 rr;H rixruK�;,
�quipment lnstalled MNG:
�C $25.00
AIRTO Allt EXCHANG�,E12 $IS
BO1L�.R $35.00
_CHIMNEY L1NER$IO.QO
_DUCT WORK $10.00
MNG:
NAX
❑ TOWNHOUS�:
❑ AL7'�12AT10N/R�MOU�L
r-ixruK�,s: �ljoy�A-�o�ra►L vuns�:K �� TUH � ow
MOD�L: �— {Q
MOD�L:
MNG: MOD�.L:
NIREPLACE (GAS} $ J5.00
FIREPLACE (WOOD) $35.00
NURNACE $35.00
GAS DRY�,R $10.00
GAS PIPING �10.00
Sl"G�/BTU
SI'L�,/BTU
GAS RANG6/OVEN $]0.00
NEW GAS GR1LL $10.00
_GAS UN1T HTR $]0.00
POOL HtAT�R $35.00
VENTILAT012 $15.OQ
TH1S 1S AN AAPLICATION NOR A PEIiMIT-NOT VALIU UNT1L PROCESSED
�
I hcrcby apply for a building permit and I acknowlcdgc that thc information abovc is complctc and accuratc; that thc work will bc in
conformancc with thc ordinanccs and codcs o City of Fridlcy and with thc Minncsota Construction Cod�; that I undcrstand thiti is
not a permit but only app ' i for a it a d work is not to start without a permit; that thc work will bc in accor cc with thc
approvcd plan in th c of which ui s rcvicw and appraval of pl
SIGNATUR� OH APPL AN -' "" �-' I I�1NT NAMt T� � LJr
.,:..:..:u.::.y.::._._ .:.:.:..:...:::, _. ,,._, .. . — /
City of Fridley
�uilding Inspections Department
b431 University Avenue NE, Fridley, MN 55432
?b3-S72-3bQ4 FAX: 763-SQ2-4977