AF - 47604City of Fridley, Minn.
BUILDING PERMIT
N° 526 �
nat�: ._.._�Jw_,"""`�.! '"'.' Gp.� ____--_._.. _�
�
Owner: _... �._._ ._�__��. ...z� . tulder
.
_._. __ . _ . ---�......------......_._.--•.._...____
Address....._...._.._.._...._.........__.._..___�.�_..._.___....._.._.._...._.._..._...------_ Address __.....__...�..._._..._.._.___.---._._._._.__.....__._...._..._.._..�..._.�
% �
LOCATIQ . F B G
No. :QR � -._._._ treet _.__ . �j_''� . . Part t ----_..._-----;�.• _�
Lot ��.. ` ._._. lock .- ----_-_-__• -----....__.... Addition or Sub-DivisiQn .. ..... - _. _. _..__ ._.__
� �r – r� • �----•• �
Corner Lot ..._._.......---.._....._ Inside Lot _.-----..1!''-.._..----.------ Setback _.��.....__.__._ Sideyard �...----.�...�......___._.._.______
Sewer Elevation _.__....--_-_----__.._w......____._....__._._..._.._---�-•_--_--- Foundation IIevation
DESCRIPTION OF BUILDtNG
T U '
,
..... .._ Front _.�'l � � . Sq. Ft �.Y Cu. F
_� Depth _��: _ Height _
.. ..
_ ..__ n,�.�..�...._�_ Depth _.��� Height �__�.�.�� Sq. Ft. ii�.-� _`Cu. F� �
Type of nstruction _._��.,,„.�.!� ::.i21!�.Q•., Esk Cost ... .. _...._..----• o be Completed .----.....__.__..._._..__.._...�_
1,��...��-,r-
Ea consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
�_.._._.. _..—.
.�.,...r....r
In co�nsideration of the payment of a fee of ._..�...__. ._.._.., permit is hereby granted to....._.
....._._....._.._..._.._..__.__.......__.._.._.._. to construct the building or addition as described above. Thispe rmit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in a.II work
dane in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildinga
withixx the city limits and this permit may be revoked at any time upon violation of at�y of the provisions of said
OTd1II8I1CR& ..r�. _ w 'l i
��
NOTICE:
This permit does not cover fhs eonstrue�ion, installaHon for wiring, plumbing, yu hsaling, ssw�r or wN�r. B� sun to sN
1hs Building Inspseror for s�paraH p�rmib fo� th�s� items. •
� `�` � .._p _
-�- . - -
APPLICATION FOR BUILDING Pk�MI?
CITY OF FRIDIEY, MINNESOTA
Owner's Name ` �,,�,�:�.,��-' Builder �/� .G� /� _
Address _��� f v-►�— ✓�-.� Addresa J`
No.
LOCATION OF BUILDING
��9 �4 � s li i�C L F Fart ai Lot
Lot �f�/ z : (/ �� Bloak . � Addition or Subdivisioa / [�F/21��,��,�,�'S
Corner Lot Inside Lot � Setback `� Side-Yard T�
SEWER ELEVATION FOUNDATION ELEITATION
�pplicant attach to this form Certifica.te of Survey of Lot and proposed building�
location.
DFSCRIPTION OF BUILDING
To be used as:
/� � / Front_,,�„_Depth �� Height
Sq. Ft. 1��i � Cu. Ft.
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
To be Completed
The undersigned hereby makes application for a permit for the work herein 8pecified,
agreeing to do all work in strict accordance with the Cit� Ordinanees and rulirig of
the Department of Buildings, and hereby declares tha.t all the facts and representations
stated in this application are tsue and correct.
_ � /% .7 i , f%>_
.
(A Schedule of Fee Costa can be found on the Reverse 3ide.)
, • Y� l �> �
City of Fridley
App�ic.a�tio� for P'I�umbing and Gas Fitting Perm�it
- Dept. of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK ,.,
Number, Kind and Locatioa of Fixtures Locatio �
N � N � Z • ` WATER HTR.
W�'�' �� xw z =s zz �n pz V z ox � U�' z
� O � � � � Z `�� � 0 = O� <�� rj`Z <aO..'�Z< `2a F N GAS ELEC.
�� 7 C� m Uf � 1-� � LL V1 LL n U m �� C� ` C� OC C� O
Base " / _
ist � �
2nd _
3rd _ _
4th
• Future Coanection Openings CoanecYed with
I Sewer �
* New Fixture, Old Opeaings Cesspooi �
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAi.
Number Fixtures ......................� x $1.50 $ Q �
Future �xture Opening . . . . . . . . . . . . . . . ..—�- x 1.20 $ � � �
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin ...... ..................... x 3.25 $
Water Heater (Up to 200,000 BTfJ) ...... x 2.00 $��._
New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $
GA3 FITTING FEES: NO. RATE TOT �
lst 3 Fixtures .......................... x$1.50 $ % s
Additional Fixtures .. .. . ................ x .5U $
Gas RanBe to 200,000 BTTJ . . . . . . . . . . . . . . x 2.00 �
REPI�IRS & ALTERATIONS—Refer to Coda
Description ................................................$- 1.�
TOTAL FF.F. $
City of Fridley:
�i r�
,�
�
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department oY Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
�' �
Old ew. ilding Permit No._�(� Permit No. '�
Signe
By
Business Phone No.
ROUGH
FINAL
a a 4M 7-59
.
�
� �
�
Application for Pawer Pfe�nts and He�ing, Cooling. Ver�titation. Refrigeratio�n ca�d
Air Conditioning Systems and Device�s
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TO___ TAI�_
Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . 8.00 $ �
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alteratians each add. �50b.Q0 . . . . . . . . . . . . . . . 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,QOQ BTCT . . . . . . . . . . . .
each add. 60,000 BTU .. .....................
Replacement o4 Furnace .............................
Repairs & Alterations—up to $500.00 . .. . . . . .. . . . . . .. .
Repairs & Alterations each add. $500.00 ..............
C�
8.00 $�
2.00 $______._.
5.00 $
5.00 $
2.50 $
STEAM or HOT WATER SYSTEM
Fumace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour-5ee Fee Schedule
�m��..—
GAS BURNER (up to 400,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . 5.00 $�—
�AS FITTING FEES: NO RATE TOTAL
,. lst 3 Fixtures ......................�_ x $1.50 $�
� Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU . . . . . . . . . . , x 2.00 $
AIR CONDITIONING �
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS � REPAIRS
See Fee Schedule
TOTAL FEE $-���-=—
����
Dept. o# Sidgs. Phoae SU 4-7470
Location �Z�l� r/ fir /��= S' l�1 L�� -
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
�-�• Fridley, 1VIinn. „��- �/ , 1�
t �O / O 6
6wner --�-.4 � GC��4 — 195—
Kind of Building� -?/f�I�� 195_
/1 ) � /l / 6
Used as
To be completed about /� �� 0
�
Estimated Cost, $ ����`—
Permit No. � � 6
DESCRIPTION OF WORK /
HEATING or POWER PI.ANTS�team, Hot Wa Warm ' No.
Trade Nam , Size No. ���'�O �%
Capacity Sq. Ft. E.D.R. BTLT H,p,
Total Connected Loa °'2� Kind of Fuel /v.4/.� ��.J`
BURNER — Trade Name Size No.
Capacity Sq. Ft. E.D.R BTU H,p,
REMARKS:
11 pOST 1M-12-58
"fRANK'S HEATING
AND SHEET METAL
Signe 2505 MAR
sy
Business Phone No. / J �°�C �
�QL lt/%LLii��,s .. . . �
D46 �s � y� �-,�,�Fs�<«� �,�,o«
HEAT LOSS CALCULATIONS ?i DEPARTMENT OF BUILDINGS y��•
Weatherstrips A.S.H.V.E, Construction No. Insulation
Guide
Wind s Doo Reference Out. Wall Int. Wall C,eiling Roof Floor Kind How Applied
Y No I —No 19_
Fl.� �'�/ Room � Length Z, Width f Height % Fl.� Room Length /�Width //Q� Height
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area
�Vidth HelBht No. of Llneal ft. Area Width AeiBht No. of Lineal ft. Ares
No. of pane of pane lights o[ crack aq. ft. No. ot pane of pane Ilghte of crack eq. tt. 1' ��
- -8 � .3 O d
a y i i o. G r
� ..r .
/ Z� ;2 D Z S /Q y Coef. Btu Coef. Btq
Infiltration y J 3 ,3 �
Glass ,3G
Exp. wall '1 y
Net exp. wall / /9�' O
Int. wall
Ceiling � Y 2 ��f a
Fioor � ► %
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.� /�' Room � Length/ ` idth /% ight 8'
Windows and Doors—Crackage and Area
Width HeiBht No. o[ Lineal ft. Area
No. of pane ot pane llghta ot crack eq. tt. .
Z- L-8 P ,8
�.� z.o s. , Za,
3- / ! �• ! , 3 7
Coef. Btu
In6ltration
Glasa � �
Exp. wall � � L,3 y
Net exp. wall f � �
Int. wall �
Ceiling � 1�( I O O �Q7I �
Floor �� 11/I � �Q
Total Btu. ,�
Required sq. ft. E.D.R. or sq. ins. W.A, Leader area
Fl. Room �Length „3 Width %� Height
Windows and Doors—Crackage and Area
Wldth Height No. ot Lineal tt. Area
No. ot Dg�e o[ pane lighta ot crack aq. ft._
^ Coef. Btu
Inhltration � '
� l�laas ' �
Exp. wall 3 q,
Net exp. wall
Int. wal{
Ceiling
1� loor 1
Total Btu. '
Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area
Infiltration
Glass
Facp. wal� I�c-I�
Net exp. wall
Int. wall
Ceiling �d�( �
Floor I �
Total Btu.
a
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.� Room I 1..ength Width
Windows and Doors—Crackage and Area
Wtdth AefBht No. o! Ltneal Lt. Area
No. ot pane of pane If6hta of crack __ sa. tt.
� I _
Infiltration
Glass
Exp. wall G �
Net exp. wall
Int. wall
Ceiling x �
Floor ')
�a
'Total Btu. � 1
Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area
F7.� Room I Length Width y Height
Windows and Dooro—Crackage and Area
Width Height No. ot Llneal [t. Area
No. of Dane ot.Dane lighte of crack ea. tt.
Infiltration
Glass
Exp. wall /�_
Net exp. wall
Int. wall
Cei�ing � �
Floor � i
'fotal Btu.
IRequired sq. ft. E.D.R. or sq. ins. W.A. Leader area
�
Btu
08%
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�631572-3604 FAX: (763) 571-1287
: 648 JANESVILLE ST NE
: 033024230142
: UNAVAILABLE
: LOT BLOCK
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
PERMIT NO.: 2004-00262 '� � �I �
DATE ISSUED: 02/24/2004 ,
VALUATION .
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
REPLACE FURNACE (WARM AIR, CARRIER, 66,000 BTU'S)
VALUE OF APPL OR WORK 0 # FURNACES
# GAS DRYERS
APPLICANT
SUPERIOR CONTRACTORS INC
6121 42 AVE N
CRYSTAL, MN 55422-1601
(763) 537-8491
OWNER
HANSON TAMMY J
648 JANESVILLE ST NE
FRIDLEY, MN 55432
0 # GAS RANGES
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 know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
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
re�g con�truction or the performance of construction.
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 16375
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
1
0
30.00
0.00
0.00
0.00
0.50
30.50
Effective January 1, 2003
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE -
Fridley, MN 55432 " APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287 ' '
JOB ADDRESS (g �� TR N�S�91 LG c� S� 'v'L
RATE SCHEDULE
Residential
Furnace Shell and Duct: Work, Burner -
Also Replacement Furnace
(Side Vent - Fill. Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer .
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1%0 of Value of Appliance or Work
Commercial/Industrial
1.25 Jo of Value of Appliance or Work
Rate TOTAL
$ 30.00 $ �-�
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
OWNER �A'H,�t � �i9-�%SO�
BUILDING USED AS � ��iNd �'
ESTIMATED COST �5�� PERMIT N0. �CC�'� ' �+��:��'.�
��CRIPTION OF FURNACE AND OR BURNER
No. of Heating Units� Circle One (Steam) (Hot Water (Warm Air
Trade Name���r Size No. S$��A-� Ia
BTU � � HP EDR
Fuel N G Total Connected Load
Burner Trade Name
$ BTU HP
$
$ .50
��
Size No.
EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
SUPERIOR CONTRACTORS ING L!
612142ND AVENUE NO DATE ���'� 7
CRYSTAL, MN 6642�
H EATI N C
Signed �
FAX #
Approved By Rough-In Date
TEL # 7�-53'I-�Y`l�/
Final Date�
FILL OUT BACK SIDE F�R STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE
APPLICATION WILL BE RETURNf D
C�MMnN VFNT� VENT CnNNECTnR AND C�MBl1ST1nN AIR V RIFI .ATInN
When ►+� �n a_in0 an eYistin� furan __, 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�(�1 No ()
The venting system is plastiGPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specificatians. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The pY �t�n�me���t�en 9ir is sized and installed to meet the current codes
and manufacturers specifications.
Wi1611 feqUlfed t0 inctall a npw cemb�ctien air�lt WIII b@ SI'L@d 8fld I(lStall@d
to meet the current codes and manufacturer's specifications.
Yes ( 1 No �
Yes�lj No ( )
Yes ( ) No �'
Yes �' No ( )
WhBn jpS�jjpa a new ventina��j, t�e undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
speafications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes� No ()
�.. .� .- .�. .����.� -� .�. -� .��- . � ..��. .�
Appliance #1 Type ����✓R�� BTU Input � an Assisted N
Appliance #2 Type �/�- BTU Input �?_ � an ssis ed a
Applia�ce #3 Type BTU Input Fan Assisted or Nat
Total Appliances � Total Btu Input �!�
Common Vent Type �C�S �i 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 __
� r r�► �- ..,-
HEATING CO:
Signed By: Date : �— v`�3 —�? �
SUPERIOR CONTRqCTORS INC
6121 42ND qVENUE NO.
CRYSTAL, MN 55422
Building o�°
Inspections �
�� � '�
763-572-3604
-- ��r -
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
T�vArrr
BUILDING -�-` � i � } �
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOURE-MAjL.� DRESS
,Q.✓!GS V,' IL� �� /l.�
O OWNER ,j�EONTRACTOR
,�E: %r4�+'�i''i `� /�iJ9-/�f/.S6/1
,Permit No.: i, n �l �� �c�.
Received By
Date Rec'd: I.0 � i �i �;
ADDRESS: �J Y � S �n�V � 11e- $ �- ��- CITY /���90� �� �/ STATEr="Zll' SS5�3Z
PHONE: 7� �_ 7�O '" O�i 3 5
CON112ACTOR NA�: /�'pr�-ti b e,r l�nd �.��e�-✓or�`
SUBMIT A COPY OF STATE LICENSE # Zo `lYZ 1 Y 8 EXP DATE J' 3 1- O 7
YOURSTATE LICENSE ADDRESS: ��� �q4�� ���g ���• CITYS�/'/<<.ug��'' STATFX� SSOPL
WITHAPPLICATION pHONE 6Sl-�39-/Jla g� 6 S�- yss�t -���/
PROPERTY TYPE
PERMTT TYPE
TYPE OF WORK:
O BASEMENT FIMSH �"ltOOF
❑ DECK �SIDING
O SWIlbA9
DESCRIBE WORK BEING DONE: �e -.�'oo F e� /Ze -��ld e--
OF
� DRAIN TILE
❑ OTHER
HEIGHT
❑ HOUSE ONLY
NUMBER OF SQUARES � '�-HOUSE & GARAGE BASEMENT REMODELING SUBM[T:
�RAGES �"ATTACHED GARAGE 1. Existin� Floor Plan
PROPOSED SIZE: � DETACHED GARAGE 2' PmP°sed fl°°rplan
PROPOSED HEIGHT: 3. List of sauchual membeis to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
Vi�l 05offit ADDITIONS. & PORCI�S SI7BAI�I'T:
❑ Alumiaum O Trim 1. Site Plao/Survey showisg the erci�ing stzuduros
O Other ❑ Faacia and pm�waed pmject.
wixnows 2. Two s�s of con�cuction plsns
IN EXISTING OPBNINGS OYea ONo LOCAITON OF WINDOWS 3. Energy Calculstions
OR FOR NEW OPENINGS-DFSCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION SIN �.��% /°7° J$•C F� O C�IJP� Y TYPE
Permit Fee
Plan Review
Fi�e Surcharge
Surcharge
License Surcharge
SAC Charge
Curb G�xt Fscrow
Erosion Control
Pazk Fee
Sewer Main Charge
Dne
$ See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ '� . .001 times the total j ob valuation
$ .3 . 4 .0005 x Permit Valuation Minimum $.50
$ _S, C� $5.00 (State Licensed Residential Coutractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21 =$
$ $450 Conservation Plan Review
$ Fee Determined by Engineerirtg
$ Agreement necessary ( ) Non Necessary ( )
$ 1'1 O• 0 o Make checks pay�ble to: City of Fridley Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALm UI3TIL 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
conforma.nce with tl�e 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 req s review and approval of plans.
SIGNATCTREOFAPPLICAN�!�� %h�---" PRIlVTNAME�I�%�'�� JvKUSO'�'J DATE ��`�` '��
Building ``q '�
Inspections Cw
763-572-3604
763-502-4977 FAX
DATE 7 ' � " � �
SITE ADDRESS ��^t� '
THIS APPLICANT IS:
PROPERTY I•IAME:
OWNER/ ADDRE;
TENANT
� PHONE:
MECI3ANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS
❑ OWNER K7CONTRACTOR
,a ��:���. �.- � �,� ; a,
TY
Permit No.:
Received By:_
D��'d1�' �.
A
CONTRACTOR coMPwNYNa,ME: CENTERPOINT ENERGY
SUBMIT A COPY OF coNTACT PeRSON: JOANN ZINKEN
YOUR STATE STATE LICENSE # BOND 220133 EXP DATE � �
LICENSE WITH ADD�ss:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN ZIP55433
APPLICATION pHONE 763-757-6202 FAX 763-757-6701
PERMIT TYPE
TYPE OF WORK:
�ainiGLEFAMILY OTWOFAMILY
❑ NEW CYREPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
O ALTERATION/REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: i�C�t�C`�PJ�i MODEL: ��'�o'L� SIZElBTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZE/BTU
�A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN 510.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00
BOILER $35.00 FURNACE $35.00 GAS UNIT HTR S 10.00
_CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER 535.00
_DUCT WORK 510.00 _GAS PIPING 510.00 VENTILATOR SI5.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D 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 caseT�all work whi h r uire review and approval of plans.
SIGNATURE OF APPLICAN ��' �` � PRINTNAME ROGER HOFFHEIN DaTE ^-� _Co' p�I
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
0 NEVV HOMES/ADDITIONS �EXISTING HOME ❑ 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
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.