AF - 47531�
City of Friclley, Mi.nn.
BUILDING PERMIT
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N° .'7321.
.CATION BUIL ING
No. �.� ..�i_r-.L._• Street _ .__.____ ._.._. Q..�.. ......,�% ...s_.... P o! Lot .___ ...�
Lot _._..._�'.yl!__.._._..__ BI _.�_._,�._......._..__._. Addition or Sub-Divisfon . __.�..___ ._.��'�[L_!��
Corner Lot ___._._.._..._ Inside Lot ._.._ ��._.... Setback ��__�'�..__ Sideyard __._...,�.�__._..sd_�
Sewer Elevation _���o ..— � �. ._._.___._ Pe�tion IIevation _._...���� -' �
e� J/� �o ii �u G _
DESCRIPTION OF BUILDING
T U :/
. _ Front ....�! .,�.. Deptt► _� a Height ...�.�•� Sq. Ft. / 0.�2.a� C:�. F't. �"_....,� �
....__._�._......_....._....___....... Froat .._....__�___ Depth _.._� fTeight _. ��_ Sq. F't. __..�...._. Cu. P't.
Zj�pe of Construction _w_ ........_..._._._ ._. .__... Es� Cost��...���....riTo be Completed _..._...�.
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. ,�. e.rs� o� / a n s f h�!'�-�o �-�.� 4��- S
a � d '� - f -�� S � � -�.-,� e--1-�v. ��d l- -- f� � a � �° a �'i rv �
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In consideration of the issuance to me of a permit to car�sstruct the building described abave, I agree to do
ffi� proposed work in accordance with the d�scription above set fo and in cwmpliance with pro�sions of
ordinanoes of the city of �:id1eY• Q,� �J�L� -_
_.._._._�_ � �.
p� � d
In corisideratfon of the payxnent of a fee of �.,{�,.L._._'�I , permit is hereby graated to
to construct the building or addition as described above. This permit is granted upaai
the express condition that theperson to whom it is grattted and his agents, employees and workmen, ixi all wark
dane in, around and upon said building, or any part thereof, shall c�nform in all respects to the ordinances oR
Frldley, Minnesota regarding location, construction, alteration, maintenance, repair and movinS of bufldings
within the dty limits and this permit may be revoked at a�y time upwn violation of any of the provisians of said
ordinances. _ ^
Buildin8 Inapecta�
NOTICE:
'IMs p�rmie dws not eowr fM eonstrveNee, ioqallMion fer wleinY. P�W Yu hwNno, awK er waM. d� wn fo s»
fIN 6uiW In �
iag ap�elo� for s�puN� p�rmils fer th�a ibms.
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7
A:PPLTCATION FOR BUILDING Fi�..i.1�1IT
CITY OF FRIDLEY, MIidNES�TA
OWNER'S NAME BUILDEP
ADDRESS � y ADDRESS
LOCAZ"tON ' OF BUII,DII�
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No. � �! treet . G T�art .o€ Lot
Lot Block� Addition or Subdivision �� "5"______
�.�—.�r�� � r
Gotner Lot Inside Lot Y Setlisek � a Side Yard ;��
SEWER EL�VATION FOUNDATtON ELEVATION
Applicant attach to this form Two Certi�i�ates o� Surve.y of Lot and proposed build-
ing iocation drgwn on'these Certificates.
L1ES�RIPTION �F BUILDING
To be used as:
-- � � Front ji ��_.�:h 30 Height.
Sq. Ft. Cu. Ft. ��
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction !'� f � Estimated Cost _ ___ __
- , ,
To be Completed
The undersigned hereby makes application for a permiC for the.work herein specified,
agreeing to do a].1 work in strict eccordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts snd
representations stated in'this application are true and correct.
DATE /� ���� SIGNATURE
�(Schedule of Fee Gosts can be found on
_ � N -4 ' M �. ,
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City of Fridley, 1Vlinn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
j��: .�A�g ,� 4 1 9 72
Ownex:
Earl Kommerstad
�� 7647 Jackson Street N.B. �
Builder
Address
Sussel Co
1850 Como Ave., St. Paul
,�j� .3�6
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LOCATION OF BUILDING
Na 7647 S�t Jackson St._N.B, ---_.�__.._._-_---_ Part of Lot
Lot 4 Block _ 1�� �Addition or Sub-Division _..J. Melody Manor 4th Addn
Corner Lot ____.�______ Inside Lot Seiback ._�._____...__.r._ Sideyard
,15ewer IIevatian
Foundation Elevation
DESCRIPTION OF BUILDING '
To be vsed as:
Garage �nt ___. 20 Depth 22 Height _ 10 �. F,� 440 �� 4,400
..._ Front .� Depth Height ._____�. Sq. FL __.___..�.. Cu. F�
Tyl�e of Co�struction _.._.._.Fr�e �� �t � 2,193 .00 To be Completed � 90 days
�, 993 .'10����
Provide Hard surface drive
In consideraiion of the issuance to me of a permit to construct the buflding described above, I agree tq �
'�he proposed work in accordance with the deserlption above set orth and in compliance with all provisions ot
Ca'd�ances of the city of Fridley. 1
� — � ����
In consideration of the payment of a fee of $ $• 5� .�., permit is hereby granted to,....��?8 $ e 1 C o.
_. to construct the building or addition as described above. This permit is granted upoli
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
$One in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinaac�s oi
Fridtey, Minnesota regarding location, construction, alteration, ma.intenance, repair and moving of buildings
WWithin the city limits and this permit may be revoked at any time upon violation of any of the provisions og Said
oxdiinances.
-�_ -- - —
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NOTICE:
This permit does not eover the eonstruetioa, installation fo� w'uing, plumbing, gas heafing, sswer or water. 8� suN to aN
th� Building inspe�for fo� separate permits for thesa items.
♦�
i
APPLICATION FOR �ESIDENTIA�, ALT�RAT�ON,
OR AllDITiON BUILDZNG P��IT
�ITY OF FRIALEY, MINN�SOTA
OW1�11ER � S NAME t�a.tiQ �S om m� s�� BUILDER : �"�s s-a�-Q �
L�DDRESS : %(0 5<% �a c1�s ok c3f /!,/,E� ADD�RESS : /8so C�OYn o l'�ue - c�'� �-Q
�Vp:�,�� STREET
�,OT; BLOCK• ADDITIONt
CORNER LOT: INSIDE LOT: SETBACR: SIDEXARpt�,,,,r,�,�,,.
,Applicant attach to this form �o Certificates of Survey of Lot and propoAed
building location drawa on these Certificates.
HESCRIPTION OF BUILDING
To �e Used As : .D-�"�a�.�.� �'�.�-�� '
2 v Front • Z z Depth • i� `� Height •
Square Feet: � Cubic Feet:�y ��
111 IA�lIR
' Front: Depth: Hsight:
Square Feet; Cubic Feet:
�,j►pe of Construction: ��-e- Estimsted Coat: $ �/93 °—°
.n...�w�r.
To Be Completed: �o o%-,s r� ����
, /
The undersigned hereby makes applicativn for a pes�nit for tl�e .wR�ck �Et���
spec�Lfied, agreeir►g to do all work in ettict accordance with the C,�ty �p�
F��,dley 0ldinauces and sulings of the Departmeat of Buildings, and he�8byr
d�cla�Ces that all the facte and repre8entations stated in this ap�1�,aAl�,pa
a�e true and correct.
AATFi : ��-' ? Z. S IGI�ATURE : �� c(�
(See Reverae Side For Additional Information.)
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�TYPICAL SLAB DETAIL
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The above is a substitute design for frost footings, however, it is not yet
accepted by the State as an amendment to the Uniform Building Co3e, Section 2905,a.
Therefore upon using this method of construction, I agree to hold the City of FridZey
harmless of any possible claim for founda.tion failure or structural damage caused by
foundation failure. �•;
�..,. t•�.�;,,�, .r?,�, ,,i. �!� � �
Witness, Property Owner
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--� �te Address of Froperty /Legal Desc. I
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'� iHE SUSSEL CO.
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1850 COMO AVE. ST. PAUt
� A CAII: 645-0331
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+��- SAkESMAN ��T% f� LEE �_
GONTRACT t�ATE _ ���'��_ �% Z �_.
S I Z E `.Z D X'2 �--
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CONCRETE WORK ORDER �
NAME _��Q.l-. KO_/IA � E(�5 �A l�,_,__ pHONE # 6'�Z67
JOB ADDRESS ?V`J i �SK��J.��I S�' AJ.�_
BLDG. CODE AREA� �ie-I-� I�L—Y
FOR UFFICE USF ONLY
CONTRACTOFi ��A.I ST JOB �F �-- 7 %
SUSSEL JOB # "7/ 4 7, CONTRACT# 300-D '�
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INDICATE THE ITEMS BELOW ON LAYOUT
� ,�Per•mit by�t�S.s�� __ _ ; . � i, ` , ;�.
=.^ Legal Description _ 9 � --� �O' ....__-�._.,1� �
/� , _, ' � .; . . ;
❑ Lot _ ;
rJ Bl�c . � �� ,
a
�. -.: -
❑ Add'n : . .. .. ' :
C] Value � / �I3 : _ ' .. ,.. .:
� Type Const. /�.ii'�o1 i!'f � : . ,
,
,�.Square �Vith __1�"�f7✓ SC`. _
._____ F . .
' l-.i Rnds ,
,
.__.�........_.._ .____.w_.�.._._ ; . , ,
. � . . . . �. . . ' s 4 . ..
;�Mesh , � ...
�Sod Rem. - By S<tS �'� L ; _ , , ;: _
:�� 5-8ag Mix I s � ;
�6 Bag 1111ix r - -
�Tamping !
= No Tamping ii _ . � _:
.� A.B.U. ��
,
- ...�. . ' �.
2-Startings Points Only ; , Zz
! � S.P.L. '
I J�-- _ S.S.P.L.
_ R.P.L. '.
� Alley _r .
� S � House � Co+v�Dul� * -
F. Street � N '
� Other � � � � � � � � � _
� wvo � F� '`� ':
�cQN�UIT i' Ih P R O IV �, �,..,, ;.
• � � ,
� � O.li. Dr. Offset �t M�!'�>'v ��• : .: . '_ �.
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?�S.[?. Location ,,, <.�3 `` ,r
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�Wi�ndows- 1 /C AaUGI`� ' . �,.,/� ,, - . , =
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,��or�;���FvA���:.,scAB � � t "�°-�,'��'� : E #
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r� ��q �.n�r► 6E' �� .� r,�,�� E� 7,'�' t ' � � � � ., �. �
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PART OF CONTRACT ��' J Z r�' bi sL'�S�io
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.. P—�4 REV. :'. '.. . . � .. � ' :.h ,.���.
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��.� _�� ` C1TY OF FRIDLEY Effective oate May �. 1988
riPPLICATtON FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDlT10NING SYSTEMS AND DEVICES
RATE SCHEDULE
�ESIDF1yTUL �
Purnace Shell and Duct Work,
Burnet (J►lso ropl�crwnt furnace)
Gas Piping
(pipinq M«I�d Mith nwr turnaca)
Gae Rang•
Gai Dryes
• Air Conditioning (all siaes�
Al1 Othera/Repairs and 1►lterationa
1• of Value of llppliance or Work
CO!!!lERCIJ►L/ INDUSTR I 11L
lt oi Value o! Appliance or work
RATE
S 2�.00
5 10.00
S 10.00
$ 10.00
S 10.00
State Surcharge
'l+osu ia
Reinspection Fee (515.00)
ltough Insp.
Cate
Fiaal Insp. � — �v ` b
Date
Approval for Pernit _ �a�3dL_
MININUM FEE FOR ANY kIEATING PEAMIT IS i15.00 �
PL118 S. SO STATE SURCWINGS
•J►is Cb�ditiorMSS can not bo placed in side yard aithout
rs�tten poc�i�sion [r4 adjointnq �eighbor.
TO PAL
S� D
S
Job Addresa / �C �/ �l7 l.-�"i,�0/V ,� ���
Department of Buildinqs, 6a31 University J1ve. N.E., Fridlsy, MN 55432
City of Fsidley
Tel. /571-3450
$ The underslgned hereby Aakes application for a p�r�it Lor the wrk herein
specified aqreaing co do all work io scrict accordanc� wilh th� City Codas
s and rulings ot the Departaent oE Buildings, and hereby d�clar�o that all the
facta and repr�aanutionr •tated 1n thi• application ar� tru� �nd oorrsct.
$ Fridley, 14inn. � —Z � , 19 { L%
OWNER �j"► �) � L/ P4�K �
s KIND OF BUILDING �
USED AS
S �ro ae aoNrLe�re� �►earr !/ Y Q .
ESTIMATED COST � ! � /�
$ .SO /�, !
� OLD - Nbii BUILDING PEftlIIT N0. PBPMIT 110. �C� �/�^�_
s�.
DESCRIPTION OF FURNACE/HU[iNBR
HEATING or POWER PLINTS, Stu�, Hot Watu, t� Air- .
�ade � �.� � �v s�� �. u G �E a'�'c t�-L-�-S
Capacity Sq. Ft. EDR 87L NP
'lbtal Connectsd Load Kind ot Fu�l ��_ Fi�/�__� (Tr/T�
BUANER - Trad� Na�e Sis� No.
Capacity Sq. Ft. EDR BTU HP
Co■pany �" �L�' L--"
Signad By
Tel. Nc. � �J / ' �P �V �
Fill out back side for stack verification on replaco�ent furnaces
CHIMt�EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (Jj'
2. Is free from rust or deterioration Yes (v)''
3. Has no foreign objects lodged within Yes (�j
4. I3 seeurely suppor-ted Yes (✓)'
5. Meets all current Code requirements for size and
total BTU connected
6. Has Total heating BTU's of / SG,000
Al l other BTU's i/ s� 6 v
TOTAL
No ( )
No()
No ( )
No � )
Ye s (vr No ( )
Rema rk s � �
Com pa ny �. �4 � ��{
Signed By �
Da te %-- � �� c U
t
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SUBJECT -� #�T •
City of Fridley �,2 7 5 7 2
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� �
� �` COMMUNITV DEVEIOPN�ENT DIV. �
r � L � PROTECTIVE INSPECTION SEC. 1��
� �
i.--.� ��"' �•� CITY HALL FRIDLE� 55132 NuMBER AEV O�iE P�GE O� AVPROVED 8�
Z 612-571-3450 9t0-Ft5 9/4/98 � �
JOB ADDRESS �647 Jackson Street NE
t LEGAL LOT NO. BLOCK TRACT OF AODITION SEE ATTACHED
oesca. 4 1 Melod Manor 4th Addition SHEET
2 PROPERTY OWNER MAII ADDRESS ZIP PHONE
Shari Ko esk 784- 2
3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO.
Northern Crest Inc. 8245 Polk Stre�t -
4 ARCHITECT OR OESIGNER MAIL AD�RESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 2�P PHONE LICENSENO.
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
6 DESCRIBE WORK
Reroof house and ara e 23 S Tear-off• R$�'$x� Reside house and ara e
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code. ,
Call for building wrap inspection before covering.
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TVPE OF CONST. OCCUPANCV GROUP OCCUPANCVLOAO
SEPARATE PERMITS ARE REOUIRED FOF; EIECTRICAL, PLUMBING, HEATING,
VENTILATING OR Alii CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOH A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIfV THAT I HAVE FEAO AND EXAMINEO THIS APPLICATION STALLS GAfiAGES
AND KNOW THE SAME TO BE TiiUE AND CORREC7. ALL PROVISIONS OF LAWS yp�VATION SURTAX •
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIE�
WITH WHETHER SPECIFIED HEREIN Oii NOT. THE GRANTING OF A PERMIT ]S]1 3. %H
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOR ANCE OF CONSTRUCTION. 13].2S Fire SC J.S7
� PLAN CMECKFEE TOTALfEE
License SC 5. 0 15 .60
S�GNATUAE OF CON'AACTOA OA AUTNOAIIED AGENT IOATE� WHEN PROPERLY IOATE THIS IS� PERMIT
�
SiGNATUFiE OF OWNER UF QWNEA BUILDEAI �DATE� BLOG 5� r�°TE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �647 Jackson St. tv�
Legal Description:
Owner Name & Address: Shari Kopesky
Contractor: North�rn CreGt, Inr.
Effective 1 / 1 /98
����
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TeL # 784-9428
MN LICENSE #? 0 0 9 8 415
Address: 324� Polk St. �IE Sprir.c� Lake Park, MN 55432 Tel.#?92-9364
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. '
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Te«r o�f ar_� Ye-shingle and re-side hou�e
Sq. Ft.
Sq. Ft.
Sq. Ft.
��Oo� �s��
Construction Type:2 3 Squ . sh i ng 1 e s. 19 s qu . s�_�ated Cost: $ f g��
(Fee Schedule on Bac ) /����
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 9-4-9�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
r ?92-93�4
APPLICANT: � $s� Tel. #
CITY USE ONLY
$ /� -�4^ Fee Schedule on Reverse Side
$ . S � .001 of Permit Valuation (1/lOth%)
$ �� ')� $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ � �� $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 [ ]
$ /��. �o
CITY::4�F FRIDLEY iNSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
763-572-3604
APPLICATION �OR PLUMBING AND GAS FITTING �ERMIT
- MAF�K NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLQOR
Effective On Jan 1, 2001
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
New Fixtures
Old Opening, New Fixture
Beer Dispenser ,
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas`"
Gas Range**
Gas Dryer*•
Back Flow Preventer Required ()Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00 �,
�10.00
$10.00
Type $15.00
j Reinspection Fee $47.00/Hr
; ALL OT#iERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
a0• � G
���
JOB ADDRESS � � ��C- � SC'J �i �1 f . �f�
The undersigned hereby makes ��pplication for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Divisicn, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Building �sed
S� a,��s,�
-P /�.'�(..J � �
Estimated Cost ��!G• �Z
–,C'�%— c.3�" , 2���
' 3- 7��-- �' %�- �-
PERMIT NO. I �� J / �
PLUMBING COMPANY�C/'i/i C� f�- �i ri S
SIGNED E3Y s ` TEL N0.�0 ��a �~��
Approved By /� U Rough-In Date Final
[��.1
TOTAL FEE $�.� PLUS THE $.SO STATE 3URCIjA$StE �
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK S(OE
��
/
� Building MECHANICAL Permit r�o.: ,- UG�'1—
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY E�4� ��: 2 7 00
DATE `r'1 a-s 10 � YOUR E-MAIL ADDARESS
SITE ADDRESS ��r c�l� S� �+ t�l�-t� l YY1 t�-�
THIS APPLICANT IS: ❑ OWNER �7CONTRACTOR
PROPERTY N�: �'~j S
OWNER/ pDDRESS: "�" CTTY I e STA��`-� ZIPSS��3
TENANT
PHONE: ^
CONTRACTOR co�Arr� NAME: CENTERPOINT ENERGY
SUBMIT A COPY OF
CONTACT PERSON: JOANN T INREN
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH pDDRESS: �320 EVERGREEN BLVD ST8 HrrY "COO1tT�'R1�P.IDS sTArEMN ztr55433
APPLICATION PHD 763 — 757 -- 6202 gp}{ 763--�757--6701
PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE
TYPE OF WORK' ��W �PLACEMENT O ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �•.GnS� � � f(�,.p 0 �a.C.t°_ iAt'G
PER MS 16B.665 the permit fee is a minimum of $I5.00 or 5% of the total cost ap to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of tabor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WI�IERE LABOR EXCEEDS 5500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV� Q����,f
Fquipment Installed MFG: f� MODEL: Ll� N�,. "�}�' SIZFBTU �-}�v�
MFG: MODEL: SIZFJBTU
MFG: MODEL; S1ZF/BTU
_A/C $25.00 FIREPLACE (GAS) $I5.00 _GAS RANGFJOVEN SI0.00
_AIIt TO AIR EXCHANGEER S 15 _FIREPLACE (WOOD) 535.00 _NEW GAS GRILL S 10.00
_BOII.ER $35.00 FURNACE $35.00 _GAS UNIT H1R S 10.00
CHIMNEY LINER S 10.00 GAS DRYER $10.00 POOL HEATER 535.00
DUCT WORK $]0.00 GAS PIPING $10.00 VENTII,ATOR SI5.00
�ermit Fee $ Number of fixtures @$1 UAO x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 � x $25.00 � $ �.d'C�
Number of fixtures @$35.00 x 535.00 = S
State Surcharge = $ .50
Total = S �5 •,Q�
THIS IS AN APPLICATION FOR A PIItMIT-NOT VAI.,ID UNTIL PROCESSED
I hereby appty for a building permit and I acknowledge that the information above is complete and� accwate; that the work will be in
conformance with the ordinances and codes of the CiTy of Fridley and with the Minnesota Constrtcction 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 wili be in accordance with the
approved plan i� the case of all work which requires review and approva! of plans.
SIGNATURE OF APPLICANT �� �' �tr • �rrr rrAME ROGER HUFFHEIN DATEi�� D?
�e�
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 PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS �'EXTSTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
l. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with 1vIN 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
REOUIItED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
_
5. Ventilatian
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.
�