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City of Fridley, Mirm.
� BUILDING PERMIT No . s41�
Date: °`f — .� �— � �
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Oarner: Buflder
Adaress _ Address
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LOC�►TIO��F BUILDING
11To. `J street _. ��- .��i.��__._ Part oP Lo
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Lot Siock Addition or Sub-Div�isfan ��. �
Corner Lot _ Inside Lot _.._..�9 S.etback --`� o- Sideyard � �� '
�� �a�q� _ _ Foundation IIevatlon
� DESCRIPTION OF BUILDING
To v�a • / �/ %/�� se � � ''���,
F`ront �� e th _¢��:� Height �—.. Sq• F't. ����� Cu. Ft�1/�:��
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Front epth /�Teight � S�l• F� ��� Cu. Ft ���
7j►pe oP ctfon F.st. �a��a�. ���To be Completed
in consideration oE the iseuance to me of a permit to construct the building described above, I agree to do
th� ProPosed work in accwrdance with the d�acription above aet forth and in comp ce with all provisions of
ordinances of the dty of Fridley. _,�. � _ -� s, �
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In consfderation of the payment of a fee of $�l ' J �, Permit fa hereby granted to
to construct the buflding or addition as de�crlbed above. Thispe rmit ia graz►ted uPon
fihe eupresa conditfon that the person to whom it is granted and his agenta, emPloyees and worlunen, in all work
dane in, around and upon said building, or any part thereof, shall conform in all reapecta to the ordinanc�s oP
Fridley� Minnesota regardiig loc:ation, construction, alteration, maintenance, repair and moving of buil8ings
within the dty ]im�its and tbis pernait may be revoked at an3' ti� �pon%,�i�� of aay of the P�visions oP said
ordinancea / )
Building IasPector
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sue�ecr PE NO.
City of Fridley 16 515
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T REC NO.
r
� ' COMMUNITY DEVELOPMENT DIV.
' �ti: -."' ,
r j � PROTECTIVE INSPECTION SEC. _� "'� ��
�
1 = �
, /'���1 � CITY HALL FRIDLEY SS43Z NUMBER HEV DATE PAGE OF APPROVED BV
�'.---� • •�� 612-571-3450 910-F15
4/7/82 � /
JOB ADDRESS
314 Ironton St. N.E
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 4 1 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Randall I,�bash 314 Ironton St. N.E. Fridley 55432 784-1122
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Owner
4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
6 USE OF BUILDING
RES].C�eII't13�.
7 CLASS OF WORK
❑ NEW C}Y ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10' X 24'.additi.on to the attach d ar
9 CHANGE OF USE FROM TO
STIPULATIONS
I�ocation and contructi.on as per inspection by Building Official on March 30, 1982.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCI Fl^a,IIIB
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 �1
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINEO THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2 2($ OO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
SIGNA REOFCONTRACTOR RAUTMOR12EDAGENT IDATEI WHEN PROPE Y V L ATE THIS IS VOUR PERMIT
` � � _��r����� ,.��� ��
SIGNATURE f OW - U OWN R BUILDERI IDATEI BLDG �NSP DATE
�
CITY OF FRIDLCY Effective Aug. 1, 1981
APPLICATI�J FO(� RCSIDCi�TIlti I3UILDIfiG PL•i2i�lITS
�N�►r, Alter�tions, Additions, or Repairs)
�l•JNFR: �,��J ��Y,d�'�, I3UI LDER : � c� -
ADDRESS: �/ � C,���,,,�n, �; �j. �. 1►DDRCSS: e,r-��.�o _
�� n�o: _ 7��— i� zz- TE� Flo:
Construction Location
• STJZiTT NO: 3I � STI2EET:
�����
IAT: . BLOQC: � ADAITION:
Corner Lot: Insic3e Lot: �_ Setback: �_ Sid�yards :
Ap�licant attach to tliis form taao Certificates of S�rvey of lot and
proposed building locatio� drawn on certificates to scale.
�
/� %� 02 e%` DESCRIPTIOIJ OF C�hJSTP.UCTIOPJ
P � Front: Depth: Height:
S,GeQ.e R�a��• Square. Feet: C'Libic Feet:
G�. o _.
, Front; Depth: Height:
Square� Feet: Glibic Teet:
Rype of Cor,structi�n: (� ��
Rb Be Cbr.�pleted:
Estimated Cost: $ � *�(� G C
Alt. A Alt. B
Proposed Drive�•ray Width If New Openinq Is Desired: $� $
. . . SE� REVERSE SIDE OF SHEET .
T'iie undexsigned hereby ma}:e� application for a permit for the �•.orl:� herein specified,
agreeing to c?o ,all work in strict accordanee with the City of I'ridle}• Ordinances Paid
rulings of the Del�artmen� of IIuilc3inc�s, and hereby declares that all the facts and
representations stated in this applicati are true and correct.
D.7T�: ` ' .
2 SIGNATUF2E:
Stipulations: �
f'� `'"''"� � `��� � �
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BiJILDING PERMIT FEE SCHEDULE
The Inspector of buildinqs shall, before issuing permits for the
erection of any building or structure, or for any addition to any
bxistinq building or structure, or for any alteration or`repairs
to any existinq buildinq or s tructuze, upon application therefore,
require the payment by the applicant f or such permit of fees to the
amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUATION
$1.00 to $500.00
5501 to $2,000
S2,001 to $25,000
$25,001 to $50,000
$50,001 tc $100,000
FEES
$10.00 Minimum Fee $15.00 plus surcharge
$10.00 for the first $500 plus 51.50 for each
additional $100 or fraction thereof, to and
including �2,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction thereof, to and
including $25,000
$170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$283.00 for the first $50, 000 plus $3. 00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$100,001 and up $443.00 for the first $100,000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN CHECK: 25 percent of building permit fee
DRIVF�n1AY DEPRESSION ESQtOW: Concrete G1irb Streets Only
Alternate "A": Removeal and replac�nent of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B": Renoval and replacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimwn of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, shawing the location of the foundation once it
has been constructed will be required before proceeding with.the framing.
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En9ineers � SurvecJo�s
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SUB UR 8AN ENG/NEERING , INC.
EnqinerrS &' _Sur'reyor.f
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sus�etr PE .
City of Fridley 31317 \
AT TME TOP OF THE TWINS � � I L D 1 N G P E R M I T
r
� � RECEIPT NO.
COMMUNI7Y DEVEIOPMENT DIV.
r j � � PROTEC7IVE INSPECTION SEC. ����
�
� . ,
i_-_.�� �"" �'� CITY HALL FRIOLE� 53�32 NUMBER nEV D�TE PAGE oc •OvnOVED Br
� 612-571-3450 s�aF�S 8/16/OD / /
JOB ADDRESS 314 Ironton St NE
t LEGAL �OT NO. BLOCK TRACT OR AOOITION SEE ATTACMED
oescR. 4 1 Herwal � Addition SNEET
2 PROPERTY OWNER R�I1dY LOb�JRAODRES$ 21P PMONE
314 Iranton St NE 784-1122
3 CONTRACTOR MAIL ADDRESS ZIP PNONE LICENSE NO
New Ha.ven Const. 4208 83rd Ave N Brookl Park MlV 55443 566-5225 20077950
d ARCMITECT Oii DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION � ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof House and Garage 26.sq Tear-Off
9 CHANf3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS AqE fiE0U1RED FOR ELECTfi1CAL, PLUMBING, MEATING, TYPE OF CONST OCCUPANC� GROUP OCCUPANCV �OAD
VENTI�ATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK Op CONSTRUCTION ZONING SO. FT CU FT
AUTHORI2ED IS NOT COMMENCED WITHtN 80 OAYS. OR IF CONS7RUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOF A PER100 OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 MEREBY CERTIFY TMAT I HAVE READ AND EXAMINED TNIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVEFNING THIS TYPE OF WORK WILL BE COMP4IED �2 272•OO �1.14
WITM WHETHER SPECIFIEO HEREIN OR NOT. TME GRANTING OF A PERMIT s
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEfiM17 fEE SAC CHARGE
PROVISIONS OF ANV OTHER ST TE OR l CAL LAW REGULATING CON- d,
STRUCTION OR THE PERFORM E OF TRUCTION .'1j83.2S Fire SC .�L•2%
PLAN CMECK FEE TOTAL FEE
- l� - ° Li ce e C$. 91. 66
S�GN E F CON'aaCTOa AUTMO� ZEO AGENT �O�TEi ME ALID D TNIS IS P� V�
� 1 �
S�GN4TUpE O� OWNEp��� OWNEA BUiLDEpi �DAiE� BL �NS� ���tE
� • ,
a
N� I ] Effective 1/1/2000
ADDN [] CITY OF FRIDLEY (763) 572-3604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address:
Legal Description:
Owner Name 8� Address:
�.
LMNG AREA:
GARAGE AREA:
`�
�
`� � �
� ��
_ �
�e�. # i�� �/�'L ,
=NS� � '�`%���� s
Tel. # �C.� (� '° �°�2�
�`3 `�' ��. N a `� e�N
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. F�
DECK AREA: Length
OTHER:
Width HgUGround Sq. Ft
Construction Type: ` r �-�� �� ��� Estimated Cost: $ �� ��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ �� ��
c---
DATE: ����' C� APPLICANT: T@�, #,�(� (p �'���e
CIT1f USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ U� �S Fee Schedule on Reverse Side
Fire Surcharge $ �� �� .001 of Permit Valuation (1/10th%)
State Surcharge $ � ��/ $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ S DQ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ l- �o �
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing germits 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 to $500
$501 to $2,000
$2,Q01 to $25,000
$25,001 to $50,(�0
$50,001 to $100,000
$100,001 to $500,000
$SOD,001 to $1,Ot�,000
$1,000,001 and up
FEES
$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 $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,0� or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,�0 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 $1,000,000 plus $3.15 for each additional
$1,Q00 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issual a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed �
be required before proceeding with the framing. New Houses Onlv
sue�ecr p _ -
City of Fridley 3 3 4 8 3
AT THE TOP OF TME TWINS g � I L D i N G P E R M t T
r
; � RECEIPT NO.
� • COMMUNITY OEVELOPMENT DIV.
� ; V ��'�� '� °°'°`k�1C�
1 � � PROTEC7IVE INSPECTION SEC. �
1 .1 �
� 1 ����� � CITY MALL FRIOIE� 35132 NUMBER NEV OATE PAGE OF APVROVEO BY
�'""� � ��� 763-571-3450 9� aF � s 5/ 1/ 03 / /
JOB AODRESS 314 ironton Street NE
1 IEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
oesca. 4 1 Herwal Addition SFIEET
2 PNOPERTY OWNER MAIL ADDRESS ZIP PMONE
Randy i,abash 314 Yronton Street NE 763-784-1122
3 CONTRACTOA MAIL ADORESS ZIP PMONE LICENSE NO
RSJ Construction 1630 H 10 S rin Lake Park MN 55432 763-780-0950
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
20318533
5 ENGtNEER MAIL ADDFiESS 21P PHONE LICENSE NO
8 USE OF BUILOING
Residenti.al
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTEfiATION p REPAIR O MOVE O REMOVE
X
B DESCRIBE WORK
Reside House & Gara e& re lace windows within existin o enings
9 CHANf3E OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uni#'orm Buiiding Code, requires that a weather resistive
barrier be piaced over exterior sheathing to protect the intexior wall covering.
Exceptions for this provision wouid be if sheathing is an approved weatherprooi�
panel or when the siding is an approved weather barrier. Vinyl siding is not
a weatherproof covering unless the manufacturer states this in their application
guidelines. Call for inspection of wrap before covering or take pictures. Caulk
and flash al2 exterior opeaiags.
Provide smoke detectors in all sleeping rooms and on al� levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk aad f�ash all
e<.terior openings.
SEPARATE PEFiMITS ARE REQUIqED FOF ELECTRICAL, PLUMBING, MEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCV lOAO
VENTILATING OR AIR CONDITIONING.
TMIS PERMIT BECOMES NULL AND VOIO IF WORK OFi CONSTRUCTION ZONING SQ. FT CU FT
AUTMOR12ED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
Ofi WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY 71ME AFTER WOpK IS COMMENCED. NO DWLG. UNITS OfFSTREET PARKING
1 HEREBY CERTIfV THAT I MAVE READ AND EXAMINED THIS APPLICA710N 1 STA��S GAFAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UAT�ON SURTAX
ANO ORDINANCES GOVERNING TMIS TVPE OF WORK WILL BE COMPUEO 11�000 �S.SO
WITH WMETHER SPECIFIED HEREIN Ofl NOT. TME GRANTING OF A pERMIT �
DOES NOT PRESUME TO GIVE AU7MORITV TO VIOLATE OFl CANCEL TME pEfiM17FEE SACCNARGE
PROVISIONS OF ANY OTMEFi STATE OR LOCAL LAW REGULATING coN- �195.ZS Fire SC �ZZ.00
STR 1 N O TME ERfOF;MANCE OF CONSTRUCTION
,�+"' PLAN CMECK FEE TOTAL FEE
� / � Lice�ise SC $5.00 $216.75
S�GNATUAE O� CON'AACTOp OA oUTHOA�ZED oGENT iD�rE, HEN PROPERLV VALIDATED TMIS IS U PEFIMIT
�
S�GN4TUAE O� OWNEQ ��� OWNEA BUILOEpi IDA�Ei _ � 8 OG �NSp � �l�tE
NEW
ADDN
ALTER
[] CITY OF FRIDLEY Effective 1/1/2003
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Descrip6on:
Owner Name & Address:
1�C ��a���. S
Te�. # �63 � 7�f` /!� 2
Contractor. E�-� S `- a����'v-�� e� MN LICENSE #
Address: ��3d r71� °� �� Tel. # 76� 78� �� S�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certi�cate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT '
Length Width Height Sq. Ft. "
Length Width
Length Width
�es � �. � cQ �.� '�
Height Sq. Ft.
HgUGround Sq. Ft.
�
� w
Construction Type: Estimated Cost: $ � �, BBc�
(,���.�.D�
Driveway Curb Cut �dth Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �' ' `" 3 APPLICANT: Tel. # ��3 �� �g-S `�
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.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ �� ��� Fee Schedule on Reverse Side
$ ; ��e �'°� .001 of Permit Valuation (1/10th%)
$ � . � � $.50/$1,000 Valuation
$ $1275 per SAC Unit
$ a ��� $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 [ ]
$ �6I � � 0�� �TIPIJLATI�NS�
BUII.DING PERMIT 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 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1�,000
$100,001 to $500,000
$500,001 to $1,OOO,Q00
FEES
$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 $50,0�
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1�,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
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
cux� cu�r EscROw
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00.
Permits for constivction 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
Building S MECHANICAL Permit No.: ��C>o5
Inspections � �SIDENTIAL APPLICATION �jVe� •
763-572-360 CITY OF FRIDLEY Date Rec'd:
DATE `l ' � ° �� YOUR E-MAIL ADDRESS
srrE aDDxESS 31 �I lrorn �°� - � �E
THIS APPLICANT IS: 0 OWNER �]CONTRACTOR
PROPERTY N�: p�,n� � l ag I�
OWNER/ ADDRESS: ���1 �f'��1'\ O�► � � CITY f i STATEM DZIP���
TENANT PHONE:_ ���i ° �I��° � I �.}.
CONTRACTOR co�A�v�r N�: CENTERPOINT ENERGY
SUBNIIT A COPY OF
CONTACT PERSON: JOANN � INREN
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH �Dx�ss: 93�0 EVERGREEN BLVD STE �rrY "COO11i �°RAP.IDS sTa�MN zrn55433
APPLICATION PxoNE 763 — 757 -- 6202 F,� 763�757--6701
PERMIT TYPE /�SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK' ��W PL�'LACEMENT ❑ ALTERAI'ION/REMODEL
DETAILED DESCRIPTION OF WORK ��S � Ci� �,
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residenrial 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 WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $] 0.00 PER FIXTURE, EXCEPT WfiERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV� ^�
Equipment tnstalled MFG: n�° ,� MODEL: u_��� � SIZEJBTU p� � Ir1 �� �
MFG: MODEL: SIZE/BTU .
MFG: MODII,: SIZF/BTU
✓A/G $25.00 _FIREPLACE (GAS) $I5.00 _GAS RANGF/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $] 0.00
BOII.ER $35.00 FURNACE $35.00 _GAS UN1T H1R $10.00
_CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEA1'ER $35.00
DUCT WORK $10.00 GAS PIl'ING $10.00 VENfILATOR$15.00
t�_..._ , �.���. . ,�i ��� r�t?.��F�1�tl_ ��.` S ., � �:. � ��n4�:Y�t ik��a �:f9i.: '�y`,w3d ��.� ��'Y"Wi, rk �����4rc A,.,�aa3''�F� S �,�j} '������ ' m R' ., �� �d�S•1� y�l., �r . . �� � .,1.�-ti
�. �,� .
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DIJE $ Number of fixt►ires @$25.00 � x$25.00 =$�iS.QU
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Tota1= $_ a�, so
THIS IS AN APPLICATION FOR A PERNIIT-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 case of a11 work which requires review and approval of plans.
SIGNATURE OF APPLICANT , �. �� � NpME ROGER HOFFHEIN DATE C�
�Sk���.H�s y�, ��1C�t'.�4 r�,,. ����t'7���. ,�_ �.i ,�� a�; >1 ..�,'f`�±1. `.'��U'� �i�.w . „5����'���'�z:;;
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 PERNIIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �EXISTING HOME 0 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
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
-- -- - f�.-- Dact I�esi� Pe� IMG 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combusHon and make-up air calculations.