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City of Fridley, 1Vli.nn.
BUII�DING PERMIT
nate: ..� ` .�:: .':����' .......................
N° 3254
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Ovener ....................................... .�, ..:. ... . . ... ........
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Addre�ss ...................................... Address .............................................
LC�CATIO�VV OF BU[LD[NG
No. � � ��.. . 5treet ��'� ��'� �4:?.�.:� : -�``f ... ... . . .. .. . . . Part ofF,Lot . .. .. . . . .. . . . . . . � �
�. f. �... �. ..... . . '-' ..... .4f
Lot . . . . . � : . . . . Biock �. : .: :-: :a . :�'. Addition or Sub-Division .��:'� . '�' =`�. . �'. • . ��..� . :� .-� ,'4 �'� � �
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Caraer Lat . .... .. .. .. . Inside Lot . .. .. .... ... Setback .° �: :� . .. .. . Sideyarrl .j.� . . .. c�.:: :.".. .. .. .. . .
DES�CRIPTION OF BUILDING
T�Used as: .":.. ' �' ... . . ^ ...
� '"�*� ^ �, ET "r 4 :. . �` a � �-?' .? r,1 �:�'
� �^ • Front : i Depth � :�. �-. . : : , Height Sq. Ft :�' Gyi, Ft, �
.................... Front ........ Depth ........ Height ........ Sq. Fk ........ Cu. F't. ........
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Z�►pe of Construction . . . . . . . .. . . . . . . . . . . �at. Cost. � �. . ��- . . To be Completed . . . . . . . . . . . . . . . . . . .
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In consideration oP L'he issuance to me o4 a permit to construct the building desribed above. Y agree to do
the proposed work in accordance with the descrlption above set forth and in compliance with all provisfons of
ordinances of the caty oP Fridley.
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In consideration of the payment of a fee of $!"� :,. ."`�., permit 3s hereby granted to �°^`�r?: ':� .(.""``': �'�`�'-�' `"`
. . . .. . . .. .. . . . . . . . . . .. ... to construct the bwilding or additton as described above. This p�mit is granted ugon
the egpress condition that the person to whom ft!s granted and his agents, eanployees and worl�en, fn all work
done in, around and upon said building, or any part thereof, shall c�nform in all respects to the ordinances of
Fridley, Minnesota regardinS location, construction, alteration, maintenanc�, repair and moving oP buildings with-
in the dty limits and this permit may be revoked at az►y time upon violation .of any of the provisians of said
ordinances.
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NOTICE: /
Thts pe�mlt does not cover the construotlon, Inatalla#lon or alteration for wi�ing, plumbing, gas heating,
sewer o� water. Be su�e to see the Building Inepecto� fo� eepa�ate pa�mits fo� these Itema
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ENGI NEERS AND SURVEYORS
u►wo auavev�n�o so�ta TEST�NC3
GIV4L di. MtJNIC10AL BNQINSERINCi (.I�Np PLAHLNINO
6418-56TK AVENVE N.
MINNEAPOLlS 2T, M4t►1N•
KE 'i- 3637
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WE hlE�lEBY CERTsFY 7NRT 1'N35 IS A TRUE MiD CORREGT REPRESENT11T10N OF A SURYEY OF THE BdUNQARIES OF THE
UWD A�?YE OESLRIBED AN� OFTII� LOCATION OF ALL 9Ull�iNGS, IF IWY, TNEREON., AND AI.L Y1S18LE ENCROACHM�NTS'
ti� a��r, �QOM oRON s�.io u�NO. 1�lItNDER ENGtI�lEE�lNG CO., INC.
OATED 'f1U5 Ot�`r DG �Fa`� �' �.��8 �� ' �lSCs1�.1'�ER$ Allf� �SUy�LYaeYORS
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Ciity of Fridley, inn
BUILDING 1'ERMIT
Date: SEPTEMBER 1, 1965
N°
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8425
LOCATION OF BUILDING
No. 6840 S�t JE;EFER��N ST. N'vE. Part of Lot
� 6 _ Bl� 3 Addition or Sub-Divis�tan Rice Cre�k Terrace, Plat 6
Corner Lot Inside Lot S�tback Sideyard
Sewer IIevation ____ Foundation IIevation
To be Used as:
Front
Front
Type of Constsuctfon
DESCRIPTION AF BUILDING
Depth Height 5q. Ft
Deptln I�eight Sq. Ft.
r, �, � ,.��.,.�.._ To be Completed
f��. FL
Cti. Ft.
REBIIIGD FROM CAP IIP � STORM DAMAGE
in consideration of the issuance to me of a permit to construct the building described a}mve I agree to do
th� propased work fn accordance with the d�scription above set Porth and in campliance with a�l pr�tons of
ordinanc�es oP the dty oP FricIIeY• �"�°' � !� � ,� � /�� /f�
Ia ca�siideration of the payment oP a fee of 1$ �•�� , pernzit is hereb3► �ranted to �'�-R� ��F �-
INCORPORAT�D to construct the buflding or additlon as described above. This permit fs granted upon
the express condit%n that theperson to whom it is graated and hie agente, emPloyees and worl�en, in all work
done in, asotmd and upon safd building� or anypart thereof, shall conform 3n all respects to the or8inanc� of
Fridley� 8iinaesota regarding lacation, construcl3on, alteration, maintenance, repair and maving of bufldin�s
within the dty ]imfta and this permft may be r�voked at aTMY �ne upon violatlon of any of the provisiona og Batd
ordinanc.�.
ALLEN G. JENSEN g��g ��
NOTIC�
71� pqemB doa ao� ee� t6s eomirucHen, trt�ta0eton fs� �ri►tae, plumbh�g, en 6aHee, sewa� or w�ar. B� sun to as
da Boildt� i�e toe separat� pamNs for tha� It�nn.
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APPLICATION FOR BtT�bING PERMIT
CITY OF FRYDLLY, MINNE$OTA
OWNER' S NAME ��� ��������--e - BTJILDER �r �.���. ��, �=��-�-c, .
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ADDRESS � � ADDRESS �°Z � � �'-�—��%��
f�OCATIO�T OF BIIILDIDTG
N0. STREET PART OF LOT
LOT BLOCR ADDI1`ION OR SIIBDIVISION
CORNER LOT INSiDE LOT SETBACK SIDE YARD
SEWER ELEVATION FOUNDATION ELEVATI014
Applicant attach to this form Two Certificates of Surveq of Lot and proposed
building location drawa on these Certificates.
DESCRIPTIOR OF BUILDTNG
To be used as ; � ����� �. � _ �� v
Front�_ th Height
Sq. Ft. Cu. Ft.
Froat Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost � �,�
1"
To be completed
The undersigned hereby makea application for a permiC for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and repreaeatations stated in this application
are true and correct.
DATE �. �SIGNATUItE .'�� C���
(Schedule of Fee Coste can be found on the Reverse Side).
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BUILDIIJG PE1tMIT FEE SCHEDUL� � .
SEL'T20N 2. The Inspector of Build�ngs shall,��beiare iesuing any permit for
the erection of any building or atrticture� or for any addition Co any existing
build�.ng or structure, or for any alterationa or repaira to any existing
building or structure� upon application therefore, r,equire the payment by the
applicant for euch pe=mit of fees to the amount herein below 8et forth and in
the manner herein prov3ded to-wit;
2.1. For�auy euch permit for the erection of any fire•proof building,
othei than a garage, warehouse, factory or g�'ain elevator, or for �he erection
of any fire-proof �additionf for similar occupancy, to any esistiag building,
ahall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical conteats.� �
2.2 For any auch pera�iz for the e�ection of any fire-proof garage,
warehouse, factory or gxaia elevator, or�for the erection of any fi�e•proof
addition, for similar occupancy, to any exi�sting building shall be at the
rate of $1,25 �or each one tliousand cub�t�;f�et, ciassified as "iireproof01
by Section 502,:of the Mi�neapolis Building Code.
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HOIISES � � � .:
2.3. For any such permit for the erection of ariy�noa•fi�eproo� ..
buildiag, other than a garage, warehouse, factorq or �rain elevator,.or
any non-fireproof addition,.for aimilar occupancy, to aay esisting bui,ldittg »
permit $1.00 for each one thousand�cubic'feet; � _
GARAGES
2.4. For any such permit for the erection of aay non-fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non-fire-proof
addition, for similar occupancy, to any egisting buildiag or for each such
building or additioa - niaety ceata ($0.90) for each oae thous.and cubic feet
or fraction thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of computing fees for building permits, the cubical contents
of any building or addition to a uaiform height throughout by multiplying the
ground area covered from a poiat six (6) inches below the floor line of the
basement or cellar to the average hc��tght of the upper surface or to the average
height of the roof surface of the main gabla of a pitched roof.
2,5. For repairs or alCerations to an e$isting strucr.tzre, the fee ahall
be at the rate of $3.00 per each Five Hundred Doliara ($SJ�3.GJ} or fraction
Chereof in the cost of a11 proposed work.
2.6. 2n no case sha11 the fee charged for any permit as aet forth in
Section 2 be less than $4.00..
STORM REPAIR DAMACE �?rES:
Residential;
Commercial;
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Esti:nsted Cost of work up to $5��.00 -$5.�D0
Esri�a�ted Coat of wo�k over y.S�J4:d�� •$i.GoL10
Est�?m.ated%'`�at of wor.k up to ;;5!��a a0 -$10�
Estimated „�st of we�t°�e -a�r $.�C0.00 - $`0. _J i �
n���i_ �.uy ui r��vroy IU. (VJ/ ILICidJ rQ�G. IlL LJQIG. WG�7/GWf �J.LJ.W � Ifl
�LllIC11Ylg BUILDING' PeTmit No.°
Inspections . RESIDENTIAL APPLICATIC�N R�iv� B3'= °
7b3-572-3604 �ITy aF FRIDLEY Date Rec'd:
DATE i0� �D$� YOUR E-MAII. ADDRfiS3 _�G,u�� a0� otea I� •�1� r..al o�
31TE ADDRF�S (r��il� �,�FFic�c�r�v �i �
THI5 APPLIGANT LS: ❑ O�UIVER �GONTRACfOR
PROPERTY OWNERI N�; �,� �-p���A�1e,�
TENANT ,�ntt�ss: loSy� rT`F�,e,�� s,° � crrsr fn�o�v s1'AT�L�.�}%3z
p�r�: ��03".��/ _3Y�� . ,
CONTRACTOR N�;��� �`;,:�
SUBMTT A COPY OF �TATE LfCENSE 31 �77v// Z/�� E3� DATE ,�I3/ �D9
YOUR STATE LICENSE ADDRES3: !�Q� �/3�z At•te. ClTY C�/�na/i.✓ STATF�/�(�ZIP,�S3//�
9JITH APPLICATTON pHp� �g -�iZ - 0757 FaX °�� 3- 9/� -
PRUPERTY TYPE � sINGLE AAMIt-YRVE9V CON9TRUCTIdN s�
❑ T6�10 FAMIiY/NEDC CONSTRUCfION STORIES
PERIVIIT TYPE � �Dr�orr ❑ c�axA�Flsi�D ❑ �vnvnoevs
I ❑ BASEMENf FIIVISFI �OdF ❑ ARA.IN TII,E
_ � DECK O SIDING Q OTIiER
❑ 3WII4flNIII�T(3 POOL
TYPE OF WORK: ❑ �w ❑ nn�rrriox
❑ MAINTENANCFIREPAIIt O RE&IODII.ING
DESCRIBE WORK BEING DONE: PE�-��
SIZE OF IlY�ROVEMERTT LENGTFi WIDTH HEIGIiT . Ft
TtQOFING D FiOUSE ONLY .
NUMBIIt OF SQUARES �(�_ �EiOTJ3E & C3ARAGE BASEMEN� REMQDELING SUBMIT:
� , tL�ATTACHED GARAGE Z: E�ng ��� �
PROPOSID SIZE: O DETACFIED GARAGE 3. L� �ncdual�members to be �sed
PROPbSF.d HEIGHT:
SIDING ' FORNEW COPiSTRITCTION INGiUDING DECK5,
❑ Virryl OSaffit ADDITION5 � PpRCHE.4 SL3SMIT'
❑ Alumim►m ❑ T[im 1. SRe P�.nt3urvey sfrowing the e�ng structures
❑ Other ❑ Fa�cia �d P►'��d P�.I�
WIIVDOWS . 2. Two s�s o€con�rucEion glar�
IN EXISTING OPENIIdG3 QYe� CINo IACATIQN OF WIIVDOWS 3� �� ����ffi
OR FOR NEW OPEN1rTGS-DESCRIDE SIZE OF
OPENING CHANGFS 8c
TitPE OF WIIJIIOBV TO BE INSTALLED NUMBER OF WINDQW3
ALL FEE5 ARE BASED ON VALUATION, INCLUI?ING THE COST OF LABOR AND MATERIALS:
�
Permit Fee
Pl�n Review
Fffe Surcharge
Surcharge
License Surcharge
SAC Charge
C,iub Gt�t Escrow
Erosion Control
Park Fee
Sawer IVIain Gharge
!� / (USIl�TG THE 19S'7 U.B.0 FEE SCHEDULE)
vA1;IIATION OCCUPANCY TYPE
$ � See Back 1'age for Fee Schadule
$ 65% of Buildsng Pern►it Fee
$--��-- .(HTl times the total job valuation
$ t' .00US x Permit Valuetion ivtinimuxn $.50
$ � , $5.00 (State Licensed Residenti�l Contraetors)
$ $1675 per SAC Unit (Plans tv AtIt�CC for determiaatian)
$ ft+6�= 8x$21 =$
$ $454 Cons�rvation Pl�n. Review
$ Fee Determined by Engineering
$ Agr�ment necessaiY ( ) A7crn 1Vecessary ( )
R a MaEze ch8eks navable to: Cit9 of Frid�y Att�c
TEII3 IS AN APPLICATION FOR A PERI�IIT NOT VALID UIVTIL PRQCESSED
I hereby apply far a bwlding permit ancl I acImowledge that the mformation aboee is complete and accurate; that t�e �vark wi11 be in
conformance with the ordinances and codes of the City of Fridley and v�ith the Minnesota Constructi+on Codes; that I understand tlus is aot a
p�rrmit but only an applicaRion far a peamit and wvrk is not ta start veithotrt a permit; that the wark w1I be in accordanee wiih the approved
plaa in the case of all work whic raquires review and approval of plans. `
SIGNl�TURE OF APPLICANT ��,/ PRINf NAME-l�r�`- c- ia,^wf.��-„DATE �•S —
Building
Inspections
763-572-3604
763-502-4977 FAX
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
� �o� �l �J�o EFFECTIVE 2-19-09
�� aO I� YOUR E-MAIL ADDRESS
❑ OWNER �1CONTRACTOR
Permit
i� - -. : ��7J\ I
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Ewnxsss: (a$,�k,U J�e 4-F�e.r�'son �f N�'c» E-v- � d l-�e.�.� STATE MNLIP SS4�
PHONE: ��O�J'SZ � • 34'18"
comr,�r�YNa,ME: CENTERPOINT ENERGY
CONTACT PERSON: JOANN ZINKEN
STATE LICENSE # BOND 22013346 EXP DATE � '
a,nDx�ss:9320 EVERGREEN BLVD NW SUITE B cr�C00N RAPIDS sTATE MN ZIP55433
pHONE_763-757-6202 FAx 763-757-6701
PERMIT TYPE ��GLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: � �W �PLACEMENT
0 TOWNHOUSE
O ALTERATION/ftEMODEL
DETAILED DESCRIP ON OF WORK 'S,�s�wll I�e�\a�� �u.rnG� � p",n � Q�,r
��ci. c �i 01r'1 � �
FEES ARE BASED ON $10.00 PER FIXTURE, CEPT WHERE NOTED. EIXTURES: IN CATE TOTAL NUMBER OF EACH B LQW�6
Equipment Installed MFG: MODEL: (��C�OO SIZE/BTU � Qe
MFG: f �r MODEL: au ���J a�{ SIZEBTU OZ.�
l A/C $Z5.00
AIR TO AIR EXCHANGEER $ I S
_BOILER $35.00
_CHIMNEY LINER $10.00
DUCT WORK $10.00
MFG: MODEL:
. _FIREPLACE (GAS) $15.00
FIREPLACE (WOOD) $35.00
�FURNACE $35.00
_GAS DRYER $10.00
_ _GAS PIPING $10.00
SIZE/BTU
GAS RANGFJOVEN $]0.00
NEW GAS GRILL $10.00
_GAS UNIT HTR $10.00
_POOL HEATER $35.00
VENTILATOR $ I5.00
THIS 1S AN APPLICATION FOR A PERMIT-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 all work whi h r uire �eview and approval of plans. .�
SIGNATUREOFAPPLICATIT� �' �` � B • pRINTNqMg R06ER HOFFHEIN DATE S l ld
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 PERNIIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �EXISTING HOME 0 MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
-- -- ---a. 4ii�-sa�id fue��ivl£ Ci�apt�� �kr�#A���dmer�ts — -- — ---
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. anua -- - ------- - -
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.