AF - 47699L_J
City of Fridley, Minn.
BUII.DING PERMIT
�te: .. /..�.'. ��.: . ��.. .. .......
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LJ
N° 3493
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Own�r ....................................... Builder .�l��i�.! ...........................
Address...................................... Address .............................................
LOCATION OF BUILD[NG
17 ,/ �
No. . . l. �. !. . . . Street . !��<Z! . . .�.�.1. . �../�i. . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . .
Lot . . . �. . . . . . . Btock . . . . � . . . . . . . . . . . . Addition or Sub-Division . . . . . . . . . . .��!�lK,�..�.�
Corner Lot . . . . . . . . . . . . Inside Lot .X . . . . . . . . . Setback3:�.— �. . � . Sideyard � .U}. .':�! . a . . . . . . . . . . . . .
DESCRIPT[ON OF BUILDING
To be Us�fed,� a�s: �
��'��1N:�K�! V i n Q c �
... �ont .�/ : Sr ��, �75=,(? �� Height I. 7. .-! � sQ. r�. ./.0 v cy,. Ft, c,'�i. o a�?Q....
.................... Front ........ Depth Height .... Sq. Ft. ........ Gti. Ft. .......
Type of Construction ................... �st. �..�............... To be Completed ...................
In consideration of the iss�uance to me of a permit to construct b desribed above, I agree to do
the proposed work in accordance with the desr.ription above se d campHance witn all prov3aiona oi
ordinances of the city of Fridley.
li.. .. ......................................
In consideration of the payment of a fee o $ °l.�l. . .f .��. . . ., pernut is hereby granted to . .. . . . . .. . . .. . . .. . .
. . . . . . . . . .. . . . . . . . . . . . . . . to construct the building or addition as described above. This permit is granted upon
r the express condition that the person to wham it is gi�anted and his agents, employees and worlmnen, in all work
1� done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinancx� oi
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
' �f Building Inapector
SA/ �i.,i � _._.
NOTICE:
This permit doe� not cover the consiruotion, (nstallation or alteration fo� wirin�, plumbin�, gas heatinp,
sewer or water. Be sure to see the Buiiding Inspector for separate permits for these itema
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�
City of Fridley, Minn.
BUILDING PERMIT
nate: _._. �'� 7, 1965
Owner: _ Lavertt Thompao� .�..._ Builder _.� Ss�e
ada�ess ?51 �ennaston ___._.__._. aadress .�_ .
�7 J�'� ��--
N� 8136
LOCATION OP BUILDING
No751W_._._..._ Street K@�6'kAn .._..______ -------__.____..---.._ Part of Lot _
Lot ____ 9�.__ Block _�l .._..._._..._.__..._. Addition or Sub-Divisi� . B?'��4�L-�.6�C�!
Coraer Lot �___..._....__ Inside Lot ._..___...___�._._ Setback ._..____ Sideyard __
Sewer Elevatia� __________.._.. _._.._.. ___._.�__ Foundation IIevation ._.__. �
To be Used as:
Garage �& Breez-�t
�� _..._._.___�.._..._. Front
Type of Construction
DESCRIPTION OF BUILDING
Depth .....__�— Height ._._._.___._.. Sq. Ft.
Depth _.._._.�._ F3eight ._._.._..._.__ Sq. Fk _.._
...__ Es� Cost ..�r.L�!�..�._._._._........ To be Completed _
c�i. Ft
Cu. F't
Garage and Breesa�ay
In consideration of the issuance to me of a permit to construct the building described abave, I agree to do
th� proposed work in accordance with the description above set orth and in ' ce with all provIsions at
ordinanoes o! the city of Frfdley.
In canaiderati� of the payment of a fee of � 6�� _..._...._., permit is hereby granted to I,. ThO��_
to construct the building or addition as described above. Thia permit is granted upoa
the expre�s ca�►ditio� that the person to whom it is graated and his agents, employees and workmen, in all wark
da�e in, around and up� said building, or any part thereof, shall conform in all respects to the ordinances o�
Fridley, Minnesota regardir►g location, construction, alteration, maintenance, repair and movfng of buil�in�
within the dty ]imits and this permit may be revoked at aqy time upo� violation of auy of the provisians of sa�d
ordinanc�.
Allen Jenaea Bu�ains �ns�ect�
NOTICE:
ilds paroil doa nof eowr fM eon�eueNoe, �thllNien for wki�0. P�+�& 11� � aMne er waNr. d� awr fo aN
ih� duiRiinY �n�P�e1a' fo► np�ratr P�i1s for fMs� iMas.
, ,�..... .�. �_ .
APFLICATION FOR BUILDING PERMIT
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' 1 1 ' � �i� i / �„t�n,�i ' 1 1 ' � /� . . � �
LOCATIOAT bF BIIILDING
No. �� sz��r � PaR� o� r,ox '��--�'N- n/
y '�J
LOT BLOCR ADDITION OR SItBDIVISZON
CORNER LOr tNSIDE LOT SETBACK SIDE-YARD
SEWER EL�VATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and propoaed
building locaCion drawn on these Certificates.
DESCRIPTION OF BUILDING
�
`, To be used as ;
i �
Frant�+Depth � O Height r" � � /
� a
Sq. Ft. /�� Cu. Ft. /: � U�
i � � � �'
Front il� e Depth�Height ` `�
i � -
Sq. Ft. ,,,� �� Cu. Ft. �'J ,� ��
T e of Constructi.on /.%� �dd ��
YP .f�e�'�iu�� Estimated Cost /,
�
To be completed
The undersigned hereby makes app],ication for a permit for the wark herein
specified, agreeing to do a11 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 representations stated in this application
are true and correct.
DATE_ � - �-' SiGNATURE
(Schedule of Fee Coststc,�n t�ee found on the Reverse Side).
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CI7Y OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997
6431 University Ave NE
Fridley, MN 55432 . APPLICATION FOR POWER PLANTS AND. HEATING, COOLING, VENTILATION,
572-3604 AEFRIGERATION AND AIR CONDITIONING-SYSTEMS AND DEVICES
RATE SCHEDULE
Residential '
Furnace Shell and Duct Work, Burner —
Also Repiacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditio�ing — All Sizes
Ali Others/Repairs & Afterations (LIST ON BACi�
1°/a of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 �'D.DO
$10,00 $
$ �o.00 �
$10.00 $
$ 25.00 � $
$
$
State Surcharge
70TAL FEE
$ .50
_ �'._ i
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
•: �r�� — .Ir / � i .
The undersigned hereby makes application for a permit forthe work herein
specified agreeing tn do all work in, strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
_�� . . .� • ,1997
�f �.2 7S�S�
BUILDING USED AS ��'�����yG _
ESTIMATED COST __ �_ �� PERMIT NO._ �L�C ��
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_� Circi One (Steam) (Hot Water) (Warm Ai
Trade Name G��-,�,Gi�,�° Size No. �
g�1 7� O HP � EDR `-
Fuel 7'`' Total Connected Load �d
Bumer Trade Name ,r, Size No. �
BTU HP EDR
HEATING
�
REINSPEGTION FEE $42.00/Hr
Approved By Rough—In Date Final Date
*Air Conditioners can not be piaced in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
C�iIlVINEY AND STACB VERIFICATION :
Tl� undersigned hereby verifies that the:existing chimney or stack:
1. . Has been carefiillY examined Yes (�Na O
2. Is free from n�st or deterioration Yes (� No O
.3. Has no foreign objects lodged within Yes i) No (�
4. Is securely supported Yes (�%j No ()
5. Meets all curreat Code req�irements for size
and total B�'U's connected Ye� �-,k�No ()
6 Has total heating BTU's of '/0 O 4 O
Ci
iill Ot�1Cr BiU'S ��, QOC/
TOTAL BTU's j04, QG? d
7. Has a lin�r be:�n pmvided for water heater
8. Has combustion sir been provided for water heater
Remarks: .
List ALTERATIONS Bein� Done:
HEATING CO:
Signed By:
Date:
�
Yes oO
Yes (�No ( )
(�.,c�� - / / S'��
�
Y� sue�ecr PERMIT
City of Fridley 2 8 2 01
AT THE TOP OF THE 7WINS g U I L D I N G P E R M I T
� � �72-3604
RECEIPT N
� • COMMUNITV OEVELOPMENT OIV.
' i V'�"'� , . . . /
f � � PROTECTIVE INSPECTION SEC. /��Q
� � �v
� � �'�'� � CITY MAL� FRIOIEY SS132 NuMBER REV O�iE v�GE Of AvvqO�ED Br
�""'�� �'' 612-571-3450 9t0-Ft5
10/13/98 � �
108 AOORESS �51 #$idn���� Drive NE
1 IEGA� �OT NO. BLOCK TRACT OR AOOITION SEE ATTACMEO
oesca. 9 1 Brookview Terrace s►+eer
2 PROPEiiTY OWNER MAtL ADOR�S$ ZIP PMONE
Lavern Thom son
3 CON7RAGTOR MAIL ADORESS ZIP PHONE UCENSE NO
Advance Alum. Su 1 INc -
� ARCHITECT OR DESIGNEp MAIL AOORESS ZIP PMONE LIGENSE NO-
5 ENGINEER MAIL AODFiE$S 21P PHONE LICENSE NO
B USE OF BUILOING
Residential
� CLASS OF WORK
❑ NEW ❑ AODITION O ALTERATION � REPA�R p MOVE , O REMOVE
8 DESCRIBE WORK
Reroof house and ara e 25 S Tear-off
9 CHANGE Of USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYP OF CONST. OCCUPANCV GROUP OCCUPANCv LOAO
SEPARA7E PEFiMITS AqE REOUIRED FOR ELECTRICAL, P�UMBING. HEATING.
VENTILATING OA AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTFIUCTION ZONING SO. FT CU fT
AUTMORIZED IS NOT COMMENCED VyITHIN 60 DAYS. OR IF CONS7RUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 CAYS A7 �
ANV TIME AfTER WORK IS COMMENCEO. ' NO DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTtfV 7HAT I HAVE READ ANO EXAMIN�O TMiS APPLICATION 57A��S GARAGES
AND KNOW THE SAME TO BE TRUE AND COFiRECT. ALl PROVISIONS QF LAWS VALUATION SUFTAX
ANO OROINANCES GOVERNING THIS TYPE OF WOAK WILL BE COMP�IEO
WITM WHETMEF SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT 21�{2 �L.O7
OOES NOT PRESUME TO GIVE AUTMOii1TV TO VIOLATE OR CAMCEL 7NE pEqMIT FEE SAC CNARGE
PROVISIONS Of ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTtON OR THE PERfOqMANCE Of CONSTRUCTION $7�}.]rj Fire SC �2.I�F
PLAN GMECK fEE TOiAL FEE
License SC 5.0 82.96
SiGNATUpEOFCON"AA(;TOQOpAUTHOp�2E0AGENT iO�iE� WHEN PROPEp `ALI TEO THI$ IS� R PERMIT�
J / f
$�GN4iUQE O� OWNEQ��� OWNEpBWIOEA� �OAIE� � � � �D �NSP � � � �— 4niE
� � a 612 571 2260 qDUqNCE ALUMINUM 02
NEW • [ )
Effcctive 111/98
ADDN � 1 C1TY OF FRIDLEY
ALTER [ J SINGLE FAMILY ANA DUpLEXES R-1 AND R-2 \
IIUILDING PERMIT APPLICATION • �
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ConstructionAddress: fI ti i G �v D� �'
Legal Descripcion: _ . _ � - -
Owner Name & Address: L AL�.2��. �T /��,.�.r'! �'� __Tcl. ll
Contractor: 13 U�^- G� A� �� .� ���a�� � f'� � ��c:- MN LICLNSE �/ �_� �.3
Address:�7U � �,��5 7� � r£ ��-�AG•� � _Tel. # �. S 7f� 3y�10
Attacb to thia application, a Certi�catc of Survey of chc
lot, with the proposed construction drawn an ic to scalc.
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRYPTION OF IMPROYEIVIEN'I'
Length Width � Height Sq. Ft.
Length Width I•Ieight Sq. Ft. ____r
1„er�th Wid�h I�gVGround Sq. l�t. �
�� Q ���a
Construction Type: 12�� �� IN � ?.� Estimated Cost: $,
(Fee Schedule on Baek)
Uriveway Curb Cut Widttz Needed: Ft. -I• G F� = F� x$ _$
t1
llATF,: Li�� AY�'LICANT: Tel. #_ �/— 3rYv
CITY USE ONLY
Permit ree
Fire Surcharge
State Surcharge
SAC Charge
License Surchargc
Ariveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. S'CIPULATIONS:
� '7�.'7s
$ �.1�1
$ 1�0�
$
� ���
$
$
$
$
$ Sa-9�
Fee Schedule on Reversc Side
,001 of Pennir Valuacion (1/lOth�)
$.so/$1,000 Valua�ion
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Ahove
$�450.00 Conscrvation Plan Review
Fee Determined by Engineering
Agreement Necessary �] Not Nccessary ( j
���
�`��g ��q� �y�� ��s��
oa�o �
� � SuB�ECT � " .
City of Fridley ' 32615
AT TME TOP OF TME TWINS � U� L D I N G P E R M I T
r
� �
� � •
� • COMMUNITY OEVELOPMENT DIV.
� y' PF07ECTIVE INSPECTION SEC. '
r , �
,
l____�,��"' �,� CITY MALL FRIDIE� SS132 NVMBfP pEV O�TE v�GE O: �PVROVEO Bv
L 612-571-3450 910-F15 5/20/02 / /
JOB ADDRESS
751 Kennaston Drive NE
t LEGAL L07 NO. BLOCK TRAC7 OR ADDITION SEE ATTACMED
DESCR. C� j BrOO�C.V1eW TflY'Y'SC2 SMEET
2 PROPEfiTY OWNEF MAIL ADOR�S$ 21P PHONE
Dennis Johnson 751 Kennaston Drive NE
3 CON7RACTOR MAIL ADDRESS Z�P PMONE IICENSE NO
Gre Wills Exteriors 4246 Ro ce St VE Columbia Hei hts MN 763-788-0529
� ARCHITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
55421 20037840
5 ENGINEER MAIL AODRESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential �
7 CLASS Of WORK
O NEW ❑ AD�ITION O ALTERATION � REPAIR O MOVE O REMOVE
9 DESCRIBE WORK
Aluminum soffit/fascia; utters/downspouts
9 CHANGEOFUSEfROM TO
STIPULATIONS
Install soffit ventilation to meet the State Building Code.
TYPE OFCONST. OCCUPANCVGROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTqICAL, PLUMBING, HEATING.
VENTI�ATING OR AIR CONDITIONING '
TMtS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION 20NING SQ. fT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION �
OR WORK IS SUSPENOED OR ABANDONEO FOR A PERI00 OF 120 DAYS A7
ANV TIME AFTER WORK IS COMMENCEO. ` NO OWLG. UNITS OffSTREET PARKING
1 HEREBY CERTIFV THAT I MAVE REAO ANO EXAMIN�D TMIS APPIICATION 1 STA��S GARAGES
AND KNOW TME SAME TO BE TF1UE AND CORRECT. ALl PROVISIONS Of LAWS yp�VATION SURTAI(
ANO OROINANCES GOVERNING 7MIS TVPE Of WORK WILL 9E CQMPI,IEO
WITN WMETMER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A PERMIT $2,500 $1.ZS
DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL TME PEqMIT FEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION R THE PERFpRMANCE CONSTRUCTION �H3.25 Fire SC �Z.SO
` P�AN CMECK fEE TOiAL:EE
Licen C $5 0 92.00
S�GN4T O�CON"NA(;TOpOA�UTHOA�LEO�GENt IDATE� EN PiiOP . ALIp,�T THIS IS VOUR PEpMI�
GJ �
/ r
$�GhaT�aE O� ONiNEA��� OWNEpBU�LOEp� ���TE� � � � 0�p �Nsp - ' f�6lt
rvEw [ l
ADDN [J
ALTER ( J
Construction Address:
Legal Description:
Owner Name 8 A�
Contractor.
CiTY OF FR�DLEY Effectivve 1/1/2002
6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
MN LICENSE #
�MNG AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed constnaction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width HgUG�ound Sq. Ft
OTHER: '
� m��u.� Sot�-1' 7�-���� 3-�
Construction Type:,���'�� r Estimated Cost: $
�S,�Gc7"�'
Driveway Curb Cut Width Needed: Ft + 6 Ft = y Ft x$ _$
DATE:
Tel. #
Gall (763) 57Z�6U4 for Pertnit Fees if mailing in application or Fax to 763-577-9Z87 if using c�eclit carcJ and we wi11
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$�3•�� Fee Schedule on Reverse Side �
$ s? S!� .001 of Permit Valuation (1/10th%)
$ /�,�� $.50/$1,000 Valuation
$ � $1200 per SAC Unit
$�� lS o $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Pla� Review
$ Fee Determined by Engineering
$ Agreement Necessary [ J Not Necessary [ J
$ �2��U
STIPULATIONS:
.
�
Building
Inspections
763-572-3604
763-502-4977 FAX
Da�� � l � L' �—
SITE ADDRESS �_
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING DC
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
❑ Atuminum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-O8
Permit No.: ���� L �
Received By:�
Date�� c�:
• ' • ��' �' 1/. � � I. '/I.� .
�-
OWNER %CONTRACTOR
PHONE L lD� •
STATE LICENSE #
� SINGLE FANIILY/NEW CONSTRUCTION
I� TWO FAMILY/NEW CONSTRiJCTION
O BASEMENT'FRVISH
❑ DECK
O NEW HOME CONSTRUC'TION
wnvnows
IN EXIS1'ING OPENINGS 6dYes DIVo
OR FOR NEW OPENINGS-f�ESCRIBE SIZE OF
OPENING CHANGES 8c
TYPE OF WIlVDOW TO BE INSTALLED �
ATF.��ZIP���
//1t�' %���i/I���
r r���
�� � � ,
O ROOF 'ObRAIN TILE
❑ SIDING ❑ O'1'f�R
❑ SWIlVIl�IING POOL
O ADDITION
❑ REMODELING
❑ HOUSE ONLY
� HOUSE 8c GARAGE
❑ ATTACHED GARAGE
O DETACHED GARAGE
�,
�
B,�SEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed 800r plsn
3. List of structural members to be usod
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑�ffit ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing fhe existing shuctures
❑ Ttim �1 ProP�� Pm.l�
❑ F�� 2. Two setc of consiruction plans
3. Energy Catculations
• • • • �•
:� ��� i. i
NUIVIBER OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA
�iG THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ �C�D�� � OCCUPANCY
Permit Fee
Plan Review
Fire Surcharge
Siu�ch�ge
License Surcharge
SAC Chazge
Curb Cut Escrow
Emsion Control
Park Fee
Sewer Main Chazge
Total Due
$ �%, � 5 See Back Page for Fee Schedule
$ 65% of Building Pern►it Fee
$ -QO .001 times the total job valuation
$ .0005 x Permit Valuation Minimum $.50
$ �� $5.00 (State I,icensed Reside�nrial Cont�actors)
$ $1825 per SAC Unit (Plans to MWCC for deteimination)
� ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineerpig
$ Agreement necessary ( ) Non Necessary ( )
$ i C� ,:� Make checks uayabte to: �ityo uf Fridley ' Attac
THIS IS AN APPLiCATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby appty for a building permit and I aclmowledge that the information above is complete and accuratc; that We work w�71 be in conformance with the ordiasnces �d 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 end work is �t w start without a
permit on site; that the work will be in accordance with the appro plan iu the c�se of all work which ra{uires review and approval of plans.
SIGNATURE OF APPLICANT ����/Y( (rU�' ..��,� PRINT NAME ����(,t G� `� I(P f_S �/✓1 DATE��
APPROVED BY DATE
Building
Inspections �;��t��
763-572-3604
763-502-4977 FAX
DATE L(1 � o� S I C' (�
SITE ADDRESS �� �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-]9-09
1 ��-.)�
❑ OWNER
YOUR E-MAIL ADDRESS
1� �v ,P ��t.
K7CONTRACTOR
�raME: �� e r� ,r� ►� J�� � r� SU r'l
ADDRESS: ��� �.+E'Y1Y1aS�C��-� ��L N� CiTY
PHONE: `�, (p'?� - 5�S (o - � � O � r
r
Permit No.:
Rece��ed<�iy:
Date'RC�'�i: `
STATE_�A�I P
���
CONTRACTOR coMpwNVN.aME: CENTERPOINT ENERGY
SUBMIT A COPY OF coNTAC7 PERSON: JOANN ZINKEN
YOUR STATE STATE LICENSE # BOND 22013346 EXP DATE `
LICENSE WITH ADD�ss:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN ZtP55433
APPLICATION pHONE J63-757-6202 Fa,x 763-757-6701
PERMIT TYPE ��-SINGLE FAMILY � TWO FAMILY
TYPE OF WORK: I� NEW I�LREPLACEMENT
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
�
e
FEES ARE BASED ON $10.00 PER FIXTURE EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTA NUMBER OF EACH BELOW)
Equipment Installed MFG: �.s.�.c,c�. MODEL: S,� 1a � �..bo?� SIZEBTU 62 -'EOV1
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZFJBTU
�A/C 525.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN 510.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) 535.00 _NEW GAS GRILL S10.00
_BOILER $35.00 _Fi1RNACE 535.00 _GAS LJNlT HTR S 10.00
_CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER E35.00
_DUCT WORK $10.00 _GAS PIPING 510.00 _VENTILATOR 515.00
THIS I3 AN APPLICATION FOR A PERMIT-NOT VALID UNTlL 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 cas��ll work which r uire review and approval of plans.
SIGNATURE OF APPLICAN �' �` � PRINTNAME ROGER HOFFHEIN DATE�o7S C�
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 HOMES/ADDITIONS �EXISTING HOME 0 MAKE-LTP 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.