AF - 47924�`
City of Fridley, Mi.nn.
BUILDING PERMIT
Date: _.__Ju �._20_�_1 _97 0 __,___.__.._..._.._.._...__._..._
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. 10758
Ovvner: _._Robert . Ledin _._.._.._.._.._.__.__...._ Builder ........�.i.� �.�.e.�:a.a1...._......__.__....__...._.._.._._.._.._.._._..
Address ___1923_ Lincoln Street.__N„E.,,,,Mpls_,_ Address __.,5�_1_]h��.,p,yenu.e..1Q.�2.r.th...�..._..�.�
LOCATION OF BUILDING
No. _624-�--•-._._ Street __.._Ker�r__��.�4.�...��.�...___w...---_.._._...._.._.__.._ Part of Lot _.
Lot _..__ 7.___...._..._ Block _._.._..�__._...___._.._..__. Addition or Sub-Division .....�s3.th�L.Hi.�.l.S_A�l i� Qn .
Corner Lot ...__......_.._..._.. Inside Lot -------_X...._.._.._..._.._. Setback _. �� �.-•---.....__._.._ Sideyard __..�_.8.._�c._.LQ'_.__.�...
Sewer EIevatiari .__..._.�.._._.�.___.�_.__._.�.._......_.._...._._ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
_ Dwelli�.._._._...__ Front 46 �_._ Depth �6&24' Height ?� �_.._ Sq. Fk 1196' Cu. Ft 2_ 3.,.�2�0 �
�Garage �W � �nt 19 ��� �p� _ 24 � W Height _._10 � � � � ` 456' � � 4560'
Type of Construction _._._.. Frame ...___.._.___ Est. Cost __.$22, .000..00 ... To be C�npieted ...._.. 9/30/70
Contractor has already received copy of print with changes required.
In consideration of the issuance to me of a permit to construct the building 'bed above, I agree to do
the proposed work in accordance with the description above in com anc�e 'th a1L pravisions of
ordinances of the city of Fridley.
In co�sfderation of the payment of a fee oP �.,..53.00 __� pe�t is hereby grauted to�Fred R. Ledin
to construct the buflding or addition as d�cribed above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all wozlc
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinanoea e�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and. moving of buil�
within the dty ]imits and this pernut may be revoked at ar�y time upam violation of at�y of the provisiana o� said
erdinanc�a
.
NOTICE:
TMs p�rmh do�s not eowr th� eonaweNoe, iedallattoe for wirin� Plumbini. Yas M+Nn�, r�ww er waN' 8� a� fo aN
fh� BuiWine Insp�o� fer a�p�r� p�rmils for 1h�a iNms.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : o b e r�" � E' p�i �t BUILDER : �� P c� - L E GY � �7
/ q a.3 L,`ri c d lri ST- �/-�' . �r' �/.5--" / c, o h�` ,� .
ADDRE�aS :_i--r�rs - .�� �.,� . ss yr� ADrn�ss :_ �� �s . �f-.-�.� .
NO • . �'" 7 3 STREET •
/ Q .n E ./j//� ,
LOT : � BLOCK: 3 ADDITION :/�L°, C� %�%�I e1^ �ir/�..J'
' � j �= N s,°t!e
CORNER LOT: INSIDE LOT: .��C SETBACK:.� SIDEYARD:�=S S,'��
Applicant attach to this form �tao Certificates of Survev of Lot and proposed
building location drawn on these Certificates.
�ESCRIPTION OF BUILDING
To Be Used As:
� � fd� � r .
C1c�.el�/�/1 c�_Fz'ont: � Depth: o��i� ��r aG` Height•
Square Feet : � Cubic Feet : f-�` ��°� � � '� � ��
� �. Front; , � �
� a r�t Depth ; � G% Height •
Square Feet;� � Cubic Feet:_ `7 �� �
Type of Construction: T/'�Q �s-� � Estimated Cost: $ a-�� O�O, O Q
�
To Be Completed: ��,3 O—% Q
The undersigned hereby makes applicativn for a germit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinancea and �lings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are ttue and correct.
r
D�ATE : � � ` �/ S IGNAT[1RE :
(See Reveree Side For Additioaal Informati .)
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Application �or Power Piants and Heating. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems ond Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work . . . . . . . . . . . . . . . .. . . . . . . . . . . $10.00 �
Replacement of Furnace ............................. 6.00 �
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . 6.00 $
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . . . 3.00 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTIT . . . . . . . . . . . . $10.00 $ 0 � �
each add. 60,Q00 BTfJ ............... ... . . .. . 3.00 �
Replacement oi �rnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 . . . . . . . .. .. . . . . . . 6.00 $
R.epairs & Alterations each add. $500.00 . . . . . . . . . . . . . . 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 3.00 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 3.00 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . 6.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ v , Q U
over 199,000 BTU See Fce Schedule
GAS FITTING FEES: NO RATE TOTAL
lst 3 Fixtures ...................... —.� x$ 2.Op $ 2. U J
Additional Fixtures ................. x ,76 $
Gas Range to 199,000 . . . . . . . . . x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
.
�N�, 9-/3- �/
�
See Fee Schedule
�
TOTAL FEE ; / %, D o
Dept. of Bldgs. Phone 560-3430
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City of Fridley:
The undersigned hereby makes application for a permit for the work hereir.
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
FridIey, Minn.,:�c..l,��� �i� , 19 ��
• �/.'/.��7_�/.%%!/��1'/.I_'IL�
. . : � • L tI_ //L �
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Used as
To be completed about ._�...Q � � q��
(� �
Estimated Cost, $ '"'[ � �
Old ew Building Permit No. Permit No._ 7
DESCRIPTION OF WOAK
HEATING or POWER PLANTS-�team, Hot Water, �i4arn r No.iLL�
"�,,-_ ,, ���
Trade Name!/.�LCl�(1�� Size No.
Capacity � Sq. F't. E.D.R. BTU H.p,
Total Connected Load Kind of Fue
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BT[J g,p,
1 (REMARKS-OVER)
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jCROA�' TROMS HTG. & AIR COND.� INC. 1ob Nome
D-56 4410 Exceisior Boulevard, Minneapolis 16, Minn. � Z� `��� ` �� ,
HEAT LOSf CALCYLAt10Nf Job Address 1
A.S.H.V.E.
Weatherstrips Construction No. I Insulation
Guide
Windows ( Doors Reference Out. Wall Int. Wall Ceiling ' Roof F1oor i ➢Cind How Applied
Yes—No Yes—N 19_
Fl. "� d' oo Length Zo Width /� Height Room Length f.� Width/�— Height �
Windows an Doors—Crackage and Area Windows and Doors—Crackage and Area
�Vidth Hefght No. ot L1nea1 ft. Area Wldth Height No. ot Llneal tt. Area �
No. ot pane of pane lighta ot crack � eq. ft. No. of pane o[ Dane Ilghts of crack � sQ. tt.
� S i Z � 4��' /
/ ?a % � � /4 � _
Coef. , E
In6ltration � � (
Glass S �
F�cp. wall
Net exp. wall�o,�'� /Go S� o./'a (
Int. wall �' � (
Ceiling ,ZQ /S � �
Floor
Total Btu. (
Required sq. ft. E.D.R. or sq. ins. W.A. l.eader area
Fl.� Room � Length / 6 Width / � Height
Windows and Doora—Crackage and Area
Wid'th Helght No. o[ Lineal tt. Area
No. o[ pane ot pane Iights o[ crack �q. tt.
L� `
!� .�d / / /6
Coef.
Infiltration 3 3
Glaaa Z �
F�cp. wall
Net exp. wall L.r�"�' � — — �o
Int. wall (Q �
Ceiling 6 a ��p s
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
' Pt. " Room � Length O Width d
Windows and Doors—Crackage and Area
Wldth Aelght No. of Lineal It. Area
No. of pans ot pane Ilghts ot crack p. tt.
_ 2 .3 " � � � � t�o
Infiltration � �
Glaas o ;
Exp. walt
Net exp. wall 6 ;�b — o� a ,
Int. wall
Cei�ing p (d �
Floor
Tbtal tu.
Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area
� l� In6ltration
"� Glaas
Eap. wall
��° Net e:p. wall s; �
� �O Int. wall
+ � Ceiling /.3 � �L
� Floor liira��-
Total Btu.
��LS- lP= I/6� I�� I �0 2�
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area
I�f1:� Room ( L.ength ?� Width /
Windows and Doors—Crackagt and Area
Wldth Helght No. oL Lineal tt. Area
No. ot Dane oL pans ll�hts ot crack sa. tt.
"� � I
�( � Infiltration
!.C� Glaaa
Exp. walt
��° Net ezp. wal1,Z S,rc
� � Int. wall
�o Ceiling lZ ,r �3
Floor �j�vU,..�
� � Total Btu.
.
—L�—IP'=
Required sq. k. E.D.R. or sq. uis. R/.A. Leader area
�4'�' %yl/.3'iQ. Room I Length l�+ Width
Windowa and Doors--Crackage and Area
Wldth Hefsbt No. ot Lineal tt. Area
No. ot pane ot-Daas tlght� ot crack W tt.
3 � 3� l 33 .z_�
� s� --1—
r�� Infiltration
�� Glaaa
F.�cp. wall
� Net exp. w
Int. wall
• .
Ceiling �"G �'' ! y
Floor ��,,,,_
'fotal Btu.
�..cly --CI = c
Required aq. h. E.D.R. or aq. ins. WA. l.eader area
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,
Btu
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•�Cx1�0�STROMS HTG. & AIR COND.� INC. .lob Name
D-56 4410 Exeelsior Boulevard, Mieneapolis 16, Minn. �� � _
NEAT LOSS CALCYLAt10N� Job Addres
A.S.H.V.E.
Weatherstrips Construction No. I Insulation
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor � �Cind How Applied
Yes—No Yes—No 19_
' Room � Length 1/ Width �� Height � .� Z Room l.ength Width ,,� Height '�
Windows and Doors—Crackage and Area Windows and Doots—Crackage and Area
�Vldth Height No. o[ Lineal ft. Area Wtdth Hetght No. o[ Ltneal Lt. Area
No. ot pane of pane lighta ot crack � eq. ft. No. ot pane ot pane Itghts of crack eQ. tt.
� �3 4 i �'�
Coef. Btu
Inhitration � �
Glass ,So �d
Exp. wall "
Net exp. wall �.x � �� — /D �%O
Int. wall
Cei{ing Z 3
Floor ��.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
.� ' Room � Length.z, Ce Width L
Windows an Doora--Crackage and Area
Width Helght No. ot Llneal ft. Area
No. o[ Dana ot Dane 1lBhts o[ crack �q. ft.
20 .� � � LLSL .�
In6ltration
Glasa �
Exp. wall
Net exp. wall,��' 7 Cp. —„�"= Z!t (
Int. wal!
Ceiling
F1ooT 2 G ,r / L
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room � Length � Width
Windows and Doora—Crackage and Area
� Wldth HelBht No. ot Lfneal it. Area
No. o[ Dane o[ pane Ilghts ot crack sq. tt.
7i Lo � (a / � Z /ti
In6ltration � .Z, Z
Glasa
Exp. waU
Net exp. wall.7, � %• (p � ` ;� ! � =
Int. wall
Ceiling
Floor �l ,e ! Y
Tbcal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
�
Btu
�y
�—
�Z Lo
�
a�
In6ltration
Glass
Exp. wall
Net ezp. wall '�
Int. wall
Ceiling ��
Floor //K S
Total Btu.
A
�
Required aq. ft. E.D.R. or aq. ina. W.A. Leader area
�'f�oom � LengCh 'v Width
Windows and Doors--Crackagt and Area
Wldth Helght No. 01 Llneal [t. Area
No. ot pane ot pans 1161�ts of crack sa. tt.
/ 20 3 �. i / / 7
�
In6ltration
Glaaa
Btu
,
Exp. wall
Nec exp. wal a ?��. = — - �
Int. wall // X • 4 � a
Ceiling � '
Floor o // o
Total Btu. 3
Required aq. k. E.D.R. or aq. ina. W.A. Leader area
F7., Room 1 Length Width _ Height
Windows and Doors—Crackage and Area
Width Hel[bt No. ot Llneal [t. /
No. ot uane ot uaas Ileht� ot crack �
Btu �
� Infiltration
�_ Glaas
Exp. wall
Zyp Net exp. wall
Int. wall
Ceiling
r.�' y, c� Floor
r
Total Btu.
sq. ft. E.D.R. or aq. i�s. WA. L.eader arca
Btu
�
Original • •
PERMIT for Power P ants and Heat�ng, Cool-
ing. Ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of . � Neciting Plants_ i;�'L, � to b ins Z ltered—repaired
Make ( �C�'Yt��� , Size %�L F ��O ;
Oil fired_�; Coal �red ; Gas fired �; Gas Authorization No.
Remarks
Approved
E�
Final Inspection Date , 19_
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Inspector
S'3 �-��
P�t N� -_ - 4'79'7
F� $ �`� ao -
Of�ice of the Inspector of Buildings
City of Fridley
c�cy of �ttey, Minn. o� , 19 �Q
Owner - JL�� o�..�/�i�c% ,��`�=u��i-
Location
Kind of Building �!�'xp
How Occupied �-/��' ��
Work to be Commenced ,19_
To be Completed ,19�Q
Estimated Cost, $ �%Dl% v'd
�ld ew, uilding Permit
Permission is hereby granted to ' to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that th.e person to hom it is granted, and kis agents, employees and workmen, in all tlze work
done and materials used under this permit, and in the operation of the devices herein ntioned sh.all conform in all respects to the ordinances of tlie City of Fridley
relating to or governing the work to be done and the operataon of the devices h.erein named, and to the specifications et f h in the approved application for this
permit on file in the ofj°ice of the Inspector of Buildings. / )
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City of Fridley
�►PP�ic�aKon � Pf�t9 and Got Rtfi�4 perndt ,", �
Dsp3. of Bldqs, Phons 5�0-3450
DESCBIPTION OF WORR � � �� ��� , ��
Numb�r. Kiad a�td Locatioa of Fixfures �� y'� i i%� ��, j ,.'�},-L,,'--'�.'
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� 3 � � � � � � � c � � g o t� � Z 3 � � 3"e� � $
Base � ,a, �
lat
2nd
3rd
4th _
• Putur� Coan�eHoa Op�nin�s
* Ii�i/ iiX�11l�• Did Op�II�flqs
PARTIAL RATE SCHEDULE
WATEA MTR.
• t
I N GAS ELEC.
Sh/K
C�sspool
PLIIMBING FIRTURE RATEB: NO. RATE TOTAL
0 6'
Number Fixtures ____� x $2.00 $ Ly.
Future Fixture Opening __�. x $1.50 $� `s �
New Fixture Old Opening x a1.50 �
Catch Basin . . x 53.25 �
06
Water Heater (Up ta 99,000 BTi7) ....—�_ x$3.00 E �'
New Grnund Run Old Bldg. X�g,� $
IIectric Watsr ii+atu� : �2.00 =
GAS FITTING FEES: MO. RATE TOTAI�
0' O
ist s�xc,u� ..�_ x s2.00 s--�—
Additional PYxtures ..... .......,...... x f .?b �
Gaa Range to 199,000 BTLJ . . . . . . . . . . . . . . x a5.00 �
REPAIRS It ALTERATIC1i�—R�%s !o Cod�
Deacription .... .... ........................ . ..........._
1"O'PAL FEE ��1., � �
City of Ftfdiey:
The undersigned hereby makes application tor a germit for the work herei
specified. agreeing to do $11 work in strict accordance with the City Ordinance
and ruling oi the Department oi Buildings, and hereby declares that all the fact
and representations stated in this applicat3� are true and correct.
FridleY, Minn- ,///�L�%�%C� �
� 19��
Owner � /: r/� L, �%%/1'lf
Kind of Building � ._-
Used as ��l/i� G L.�,•,✓Y( ,r
To be completed about - ./s7►�i �
Estimated Cost, a �-�S � ��"
Old—New. Building Permit No.-- __ _Permit No.
.—_. — —
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Signed. l� �
c,;� � �:�-
a.?_ `i./�'t�liu�JJ r�%� c'ti�L..�_:. �-.'t.
B3'- --
Business Phune No-� �� "Y� � �-"
ROU�H
FINAL l_ c- �. �S ��—
s�e�ecr IT N O.
City of Fridley ' ') �. �, �=;5
AT THE TOP OF THE TWINS gU I L D{ N G P E R M IT
r
; � RECEIPT NO.
� COMMUNITY DEVELOPMENT DIV.
' j V��'���', ��V /
r � � PROTECTIVE INSPECTION SEC.
' ' ����I � CITY HALI FFIDLEV 55432 NUMBER AEV DATE PAGE UF AVPRpVED BY
�'""'��� ,�� 612-571-3450 910-F15 10/11/9 / /
JOB ADDRESS 6243 Kerr Lane NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 7 3 Heather Hills Addition SNEET
2 PROPERTY OWNER MAIL ADORESS ZIP PHONE
B�S� Patrick 0'Hern 6243 Kerr Lane NE 771-7558
9 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
6 USE OF BUILDING
Residentiai
7 CLASS Of WORK
❑ NEW ❑ ADDITION O ALTERATION X REPAIR O MOVE O REMOVE
8 DESCRIBE WOFK
Reroof House 22 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONOITIONtNG
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SO. 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
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WOiiK WILL 8E COMPLIED
WITH WHETHER SPECIFIE� HEREIN OF NOT. THE GRANTING Of A PERMIT �1,815 $.91
DOES NOT PRESUME TO GIVE AUTHORI7V TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION S9. SO Fire SC � 1. HL
PLAN CHECK FEE T AL FEE
62.23
S�G 1URE O� C N' CTOR OA AUTHOAIZE AGENT IOATEI ROP VAL A THIS IS YO/U�R PERM T
�V / •
S� N OWNEAUFOWNERBUILDEAi �DATEi y G iNSP OFTE
NEW
ADDN
ALTER
�l
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: _ �� 1r! � �.¢��
Legal Description:
Owner Name & Address: /�'% � � c. ��
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effective 3/1/96
#_ �7 �% %.� �4�
NIN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposal construcdon drawn on it to scale.
DESCRIPTION OF Il1IPROVEMENT
Tel. #
�ng� Width Height Sq. Ft.
�ng� Width Height Sq. Ft.
Length Width Hgt/Ground S. Ft.
2� � �.c-�-� �"�
Corner Lot [] Inside Lot [� Ft. Yd Setback Side Yazd Setbacks
Type of Construction: Estimated Cost: $ �S -�
Approx. Completion Date: - "
(Cost on Back)
Driveway Curb C�t Width Needed: t. + Ft — Ft x$ _$
DATE: jQ �l / ��! lo APPLICANT: Tel. # S� Jt- �J �J �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
i..icense Surcharge
�riveway Escrow
:rosion Control
'ark Fee
�cwer Main Charge
TOTAL
�TIP LATIONS:
CITY USE ONLY
$ �l: � Fee Schedule on Reverse Side
$__ %. ��� .001 of Permit Valuation (1/lOth%)
� � / $.50/$1,000 Valuation
$ $900 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 Ne�essary [ ] Not Necessary [ ]
$ �-��
Building
Inspections
763-572-3604
DATE IL
S.ITE ADDRESS _(�
THIS APPLICANT I5:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
M�C�NICA�
R�S��EN'�'IA� A��'LI�A'��I�N
CIT�SI (�F ���LEY
�❑
COMPANY NAME:�
CONTACT PERSON:
YOUR E-MAIL ADDRESS
❑CONTRACTOR
Permit No.: ;;'C^�,�- . � -�
Received By:
Date Rec' d: /�
ATE NN ZIP
STATE LICENSE � EXP DATE
ADDRESS:�% �%%� i�Q%%% d T. rUL �u�f� r STATE�ZIP,
PHONE � �1a3' 7� �I ' �� � % _ FAX �T l[� ' ��l..7�
�SINGLE FAMILY O TWO FAMILY
❑ �W C�,tEPLACEMENT
O TOWNHOUSE
❑ ALI'ERATION/REMODEL
DETAILED DESCRIPTION OF WORK � � �
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whicbever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.Q0. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS Wi�RE IABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (ll`IDIC�A►TB TO'['A1-
NUNBER OF EACH BELOV� (�, C//1 �� MODEL:r,��%�1�0 NL.�� s�, � 9 UOD
Equipment InstaUed , MFG:�/'��s . o v
MFG: MODEL: SIZFJBTU
�G; MODEL:
_A/C 525.00 _FIREPLACE (GAS) $15.00 . ,_GAS RANGElOVEN 510.00
�AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00
BOILER 535.00 �FURNACE S35.Q0 ^GAS 1JNIT HTR S 10.00
CHIMNEY LINER $10.00 GAS DRYER S10.00 POOL HEAT'ER $35.00
DUCT WORK 510.00 GAS PIPING 510.00 VENTU.ATOR 515.00 _
_ � .� �...
�u°:r•r,�:,:cs...,��a.,.y� �,.�:.w. .,�..y�. �v.._._„_ �. ., _.., _ ,. ...... ... , _
Permit Fee $_��.� Number of fixtures @$10.00 x$10.00 =
Surcharge $ 50 Number of fixtures (n; $15.00 x$15.00 =$
TOTAL DUE $� Number of fixtures @$25.00 x$25.00 =$�_
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Tota1= $
TH1S 1S AN APPLICATION FOR A PERM�T-NOT VALID UNTIL PROCESSED
I hereby apply 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�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 wi11 be in accordance with the
approved plan in the case of all wo which re es review and approval of plans.
SIGNA7URE OF APPLICANT PRIN1' NAME �r�. QRO DATE r-0
City of �ridley
�uilding Inspections �epartment
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
r.4X: ?63-502-4977
�
REQUIRED WFORMATiON NEEDED T� PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATiON HVAC
❑ NEW HOMES/ADD1T10NS
y ; . ,
❑ EXiSTlI�G HOME � ❑ MAKE-UP AIR' ` '
� . . . . , . '� Y y. .
♦. �. . . rv. �� } . 4 `..
�
REQUIRED FOR NEW/EXI�TING �fOMES � � , , ' ,
� . . ��.,,.
1. Combustion Air (See note below) .
, . ; , � , ,.. .
� Oil or solid fu�l IlV�C Chapter 7 with 1�1N Ame�dments �, t. `� -,�. ,'
. :.. . _: .�. , '� �, ., - , ��. , ; ,. . ';
b. Na�u'al Gas or FropanellFGC Chapter 3 with MN Amendments �
2, Make_up Air (See note below) ��'
a. IMC Chapter 5 with MN Amendm.ents � .
3. Ven.ti�g ,� , � ..
. , .. . �' . .,. �; .. ,. ', . ' ` c; .. . . � , , t `_ _ `
a. Gas appliances IFGC Chapter 5 with MN Amendments
� b. Fuel other than gas IlVIC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
E � . _ ,,
. ;
4. Heat loss & cooling load per room
a, Required on new covstiv.ction 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
� . y . ,
z
N�'I'�: Centerpoint Ener� Mechanical Code Guidelines software may be used for
combusfion and anake up air calculations