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PRE 2010 DOCSCITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer i *Air Conditioning - All Sizes j All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 Ir APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $1 $10.00 $� $10.00 $ $10.00 $ $25.00 $� $l o Co JOB ADDRESS SIN I MCC. n !`l� Owner i�c�iRkC.—F(kf Building Used As ESTIMATED COSTIC,0 PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Unit s_ Circle One (Steam) (Hot Water) Aim Air) TradeName R1fY 1 Size No. BTU ()I ono HP EDR Fuel Total Connected Load Burner Trade Name BTU Size No. HP EDR The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ HEATING CO R(C-C.Ojr" LA—&Amck TOTAL FEE $�� Signed Tel it c L ``ICM REINSPECTION FEE $50.00/1-IOUR FAX # Date C� *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by_-.ough-in Date Final Date f FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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 ( ) No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustlog air is sized and installer) to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No( ) 'Nhen installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace °.senting Tables for fan assisted and natural draft appliances. Yes O No ( ) he common vent and vent connectors sized and installed correctly after an ,, i 3pliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type . Vent Height I Diameter inche- 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date: Permit Number REScheck Compliance Certificate Checked By/Date 2000 Minnesota Energy Code RES checkSoftware Version 3.5 Release 1d Data filename: Untitled.rck PROJECT TITLE: SPEC COUNTY: Anoka STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Multifamily DATE: 06/01/05 DATE OF PLANS: 5-26-05 DESIGNER/CONTRACTOR: NOVAK-FLECK INC 8857 ZEALAND AVE NORTH BROOKLYN PARK MN 55445 COMPLIANCE: Passes Maximum UA = 263 Your Home UA = 176 33.1% Better Than Code (UA) COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code requirements in RES checkVersion 3.5 Release Id (formerly MECchec4 and to comply with the mandatory Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1109 44.0 1.8 29 Wall 1: Wood Frame, 16" o.c. 1109 19.0 4.0 43 Window 1: Above-Grade:Vinyl Frame:Double Pane with Low -E 225 0.051 11 Door 1: Solid 45 0.051 2 Basement Wall 1: Solid Concrete or Masonry 1100 10.0 0.0 63 Wall height: 8.0' Depth below grade: 8.0' Insulation depth: 8.0' Floor 1: All -Wood Joist/Truss:Over Outside Air 1109 36.0 4.0 28 Proposed and Maximum U -Factor Averages Proposed Maximum Average U -Factor Allowed U -Factor Above -Grade Windows and Glass Doors 0.051 0.370 Includes Foundation Windows > 5.6 ft2 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code requirements in RES checkVersion 3.5 Release Id (formerly MECchec4 and to comply with the mandatory requirements listed i the RES chpection Checklist. Builder/Designer Date Date: 6/1/2005 Revision Date: 6/1/2005 Site Information Address 1: 5841 MAIN ST NE Address 2: City: FRIDLEY County: ANOKA Application Information Business Name: Novak- Fleck Inc. New Construction Project #: Lot: Block: Subdivision: MN Contractor License #:0001631 Contact Person: Lisa Peterson Office Ph: 763-424-4955 Fax: 763-424-1030 Cell Ph: Address 1: 8857 Zealand Ave N City: Brooklyn Park State: MN Zip Code: 55445 House Details Square Feet: 2209 sq. ft. Avg. Ceiling Ht: 8 ft. Number of Bedrooms: 3 Ventilation : Balanced Total Ventilation Capacity: 77 cfm. Minimum Continuous Ventilation :60cfm. Intermittent Ventilation: 17 cfm. Combustion Appliance Water Heater: Power Vent Input BTUs: 45,000 Independently Vented Furnace/Boiler: Direct Vent/Sealed Combustion Input BTUs: 105,000 Independently Vented Other Combustion Appliances Gas Fired Direct Vent Fireplace(s): No Gas Fired Natural Draft Fireplace(s): No Gas Fired Power Vent Fireplace(s): No Solid Fuel Appliance(s): No Exhaust Equipment Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135 Exhaust Fan Rating (cfm): 80 Make -Up Air No Make -Up Air Required by Code Combustion Air Round Rigid Required: 4 inches or Insulated Flex: 5 inches Applicant Name (print): Signature/Date: Code Official (print): Signature/Date: © 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines. Page I Date: 6/1/2005 Revision Date: 6/1/2005 Site Information Address 1: 5841 MAIN ST NE Address 2: City: FRIDLEY County: ANOKA Application Information Business Name: Novak- Fleck Inc. New Construction Project #: Lot: Block: Subdivision: MN Contractor License #:0001631 Contact Person: Lisa Peterson Office Ph: 763-424-4955 Fax: 763-424-1030 Cell Ph: Address 1: 8857 Zealand Ave N City: Brooklyn Park State: MN Zip Code: 55445 House Details Square Feet: 2209 sq. ft. Avg. Ceiling Ht: 8 ft. Number of Bedrooms: 3 Ventilation : Balanced Total Ventilation Capacity: 77 cfm. Minimum Continuous Ventilation :60cfm. Intermittent Ventilation: 17 cfm. Combustion Appliance Water Heater: Power Vent Input BTUs: 45,000 Independently Vented Furnace/Boiler: Direct Vent/Sealed Combustion Input BTUs: 105,000 Independently Vented Other Combustion Appliances Gas Fired Direct Vent Fireplace(s): No Gas Fired Power Vent Fireplace(s): No Gas Fired Natural Draft Fireplace(s): No Solid Fuel Appliance(s): No Exhaust Equipment Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135 Exhaust Fan Rating (cfm): 80 _ _.Mahe-tJu Air .. No Make -Up Air Required by Code Combustion Air Round Rigid Required: 4 inches or Insulated Flex: 5 inches s� Applicant Name (print): LSignature/Date: tOl 1 I6 ) Code Official (print): Signature/Date: C 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines. Page 1 Permit Number REScheck Compliance Certificate Checked By/Date 2000 Minnesota Energy Code RES checkSoftware Version 3.5 Release Id Data filename: Untitled.rck PROJECT TITLE: SPEC COUNTY: Anoka STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Multifamily DATE: 06/01/05 DATE OF PLANS: 5-26-05 DESIGNER/CONTRACTOR: NOVAK-FLECK INC 8857 ZEALAND AVE NORTH BROOKLYN PARK MN 55445 COMPLIANCE: Passes Maximum UA = 263 Your Home UA = 176 33.1 % Better Than Code (UA) COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code requirements in RES checkVersion 3.5 Release I (formerly MECchebl and to comply with the mandatory Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1109 44.0 1.8 29 Wall 1: Wood Frame, 16" o.c. 1109 19.0 4.0 43 Window 1: Above-Grade:Vinyl Frame:Double Pane with Low -E 225 0.051 11 Door 1: Solid 45 0.051 2 Basement Wall 1: Solid Concrete or Masonry 1100 10.0 0.0 63 Wall height: 8.0' Depth below grade: 8.0' Insulation depth: 8.0' Floor 1: All -Wood Joist/Truss:Over Outside Air 1109 36.0 4.0 28 Proposed and Maximum U -Factor Averages Proposed Maximum Average U -Factor Allowed U -Factor Above -Grade Windows and Glass Doors 0.051 0.370 Includes Foundation Windows > 5.6 ft2 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code requirements in RES checkVersion 3.5 Release I (formerly MECchebl and to comply with the mandatory requirements listed ' heckInspection ecklist. Builder/Designer Da Z . NEW �) %OJ CITY OF FRIDLEY �%( N 56432 63 6724604 Bid [nap AODN ! � `'�31 UnNersfty Av0 NE, Fridley, M C1 ) 9ALTSIN E FAMILY ANDDUPLEXES R 1 AND R2 (763) 671.1287 Fax �yO UILDING PERMITAPPLICATION Construction Address: _ 15B41 M I n !—f re e_± Legal Description: Lac `2y 1'Z5 111 C'iC-k N H \i Owner Name 8, Address: _int OVA K.- F"i..-.F.0 V-_ i Li Q Tet. e -7(03. Contractor: :t�C Novak -Fleck, Inc. MN LICENSE #_(-)Qn I (Q]�> Address:- -Brooklyn ftrk, MN b0445 ZealandAve. N. Tel. # Attach to this(j#*Alficate of Surrey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: �__-4 %) Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft x $ _ $ DATE: APPLICANT: Tel. 0 TAIAN - i- 9 '!�)5 X 10G Call (763) 572.3604 for Permit Fees if mailing In application. Fax to 763-5714287 N using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. " B" Above $450.00 Conservation Plan Review Fie Determined by Engineering Agreement Necessary [ ] Not Necessary [ j STIPULATIONS: f. City of Fridley 6431 University Ave. NE Fridley, MN 554324383 763-571-3450 02 -Jun -05 Special Assessment Search And Statement of Charges TO: On all that tract or parcel of land lying and being in Anoka County, Minnesota described as follows to wit: Parcel No: 23-30-24-23-0100 Lot: 24-25, Block: 24, HYDE PARK LEVIED SPECIAL ASSESSMENTS This is to certify that I have examined the records in the office of the Clerk, City of Fridley, Anoka County, Minnesota, and for such search, certify that the following special assessments appear unpaid with respect to the above described tract or parcel of land: Term Certified Initial Interest Remaining Current Current Proiect Number Project Description Type (Yrs) Date Amount Rate Balance Principal Interest 9100-0000-00 OO REG SA(Water/Sewer 5400 15 12/31/1960 $451.11 5.00% $0.00 $0.00 $0.00 4000 -0005 -OC 00 SS 4400 20 05/08/1967 $206.73 6.00% 6000-1978-00 OO ST 6400 10 05/14/1979 $1,621.07 7.50% Amount Cert led to Anoka County Auditor for Current Year Taxes Is: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 PENDING SPECIAL ASSESSMENTS For the purposes of this document, the City of Fridley has determined that an assessment is considered pending after the City Council passes a resolution ordering the improvement, the approval of plans and the advertising for bids. This is prior to the City Council adopting the final assessment roll. If you seek further information, you should do so upon your own independent inquiry. Any amount given as to pending assessments is informational only and may or may not be the amount ultimately assessed. Term Initial Interest Estimated Proiect Number Project Description (Yrs) Year Rate Pending Amt. NONE MISCELLANEOUS FEES Description Status Date Fee Amt. NONE UTILITY CHARGES You shall be responsible to verify the status of any outstanding utility charges. To check utility charges ( water and sewer) contact Fridley Utility Billing Department at 763-572-3529. The records referred to above are public and may be inspected by anyone during regular business hours. The search of these records was made by the undersigned as a public service on request. The undersigned certifies that the above indicated searches were made and are believed to be accurate, however, the undersigned or the City of Fridley does not insure the accuracy of the above statements and does not assume liability for errors and/or omissions. The above figures are good through November 15, 20 Date Prepared: Thursday, June 02, 2005 By Page 1 of I 9~ i ru�-..x�-cuw iu• u.� �.a i j kir rr..uL-r- i r �^ r.vJc/ tJ.J NEW [) CITY OF FRIDLEY ADDN [) 6431 University Ave NE. Fridley, MN 56432 (763) 672.3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 679-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: L®$ `Ly °25 e- Z4 dCLS z Owner Name & Address: M 0\d 4G.- l--EClL i ia.i G Tel. # ?(�S 2-0 - L4q 75 Contractor: �/'�N G: Novak -Fleck, Inc. MN LICENSE Address: 8357 Zealand Ave. N. Tel. # raric, MN 05445 Attach to this(JAX l , Mrtificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVWG AREA: (GARAGE AREA: DECK AREA: OTHER: DESCRIPTION Of IMPROVEMENT Length Width Height Sq. Ft. Length Width Height . Ft Length Width Hgt/Ground Sq. Ft Construction Type: II CLO h c2 me2 Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft x $_=$ DATE:�„ APPLICANT: Tel. #'7 % - Z -(_ _I lbs j� X 10G Call (763) 572.3604 for Permit Fees H mailing in application. Fax to 763-571-1287 it using credit card and we will call you for card number. CITY USE ONLY - Permit Fee �. Plan Review $ Fire Surcharge $. State Surcharge $ SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee SewerMain Charge 5�ra TOTAL -71 Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1110th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A' or Alt. "O" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ STIPULATIONS: (763) Water New Co: Existing Date: koel - d is Job Address: Name of Applicant (Plumber): Name of Property Owner: Existing Structure Permit # Permit Type: Sewer Fee: Water Fee: Meter Fee: Repair Fee: Relocation: State Surcharge: SAC Charge: Special Assessment Fee: Total: $ Applicant Inspector approval: City of Fridley 31 University Ave NE Fridley MN 55432 -3602 or Fax (763) 502-4977 Sewer Permit Application MR Utility Line Repair/Relocation Water and Sewer Connection Water Meter R air — Week d & Holidays $125/hour Water Connections Permit $50 Sewer Connections Permit $50 ection Fee for Water/Sew r Line Repair $40 Special Assessments See Engineering Cost of Water Meter See Utility Billing SAC Charge $1450 State Surcharge $ .50 Water Tap See En ' eerie 04/04/05 CITY OF FRIDLEY INSPECTION DIV, 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 D �� APPLICATION FOR PLUMBING AND GAS FITTING PERMIT �00� 0 MARK NI IMRFR nF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS I/J/I I i kL., c' New Fixtures L.L $10.00 Old Opening, New Fixture $10.00 Beer Dispenser $10.00 Blow Off Basin $10.00 Catch Basin $10.00 Rain Water Leader $10.00 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 Water Heater -Electric $35.00 Water Heater - Gas** $35.00 Gas Range" $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance ��, d 0 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: L� � �P- — , 20 OWNER /V P Yz F, r-/' G G T BUILDING USED ESTIMATED COST � 0aD PERMIT NO. PLUMBING COMPANY SIGNED Approved By Rough -In Date TEL N0. Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $ tS 0 OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE k FILL IN COMPLETELY FOR REPLACEMENT FUEL 13UIkNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSYION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the Fan Assisted or Nat venting has been examined and is free from rust, deterioration, obstructions, BTU Input and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer Fan Assisted or Nat specifications including sizing, length, number of elbows and terminatidn. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly Common Vent Type and meets the current codes and manufacturer's specifications. This does Diameter inches include AGA-GAMA Category I Central Furnace Venting Tables for fan ft Length assisted and natural draft appliances. Yes ( ) No ( ) T(ie existing combustion air is sized and installed to meet the current codes ft Diameter in Type and manufacturer's specifications. Yes ( ) No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No ( } VVhen installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's; specifications. This does include AGA-GAMA Category I Central Fumice Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Building $ BUILDING Plan Review Permit NO.: Inspections Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Date Rec'd: DATE r ^ YOUR -MAIL ADDRESS SAC Charge SITE ADDRESS Curb Cut Escrow THIS APPLICANT IS: ❑ OWNER #CONTRACTOR Erosion Control PROPERTY OWNER/ NAME: Park Fee ADDRESS: CITY STATE ZIP TENANT $ PHONE: Total Due CONTRACTOR NAME: STATE LICENSE # CQn EXP DATE ADDRESS: S? !Pa �c �v 0 4;?_ CITY` TATEZIP�C/� SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PHONE % FAX 'r PROPERTY TYPE ,SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF RAIN TILE ❑ DECK ❑ SIDING THER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE 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: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC UnitQPlans to MWCC for determination) Curb Cut Escrow $ 162�ft + 6 ft = x $20 = $� Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks Pavable to: Citv of Fridlev Attach Stipulations THIS IS 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 of all work Mich requires re }{iew and approval of plans. SIGNATURE OF APPLICANT 11 " , LD X - /. - - 0 PRINT NAME JJ (,) e- ✓ -) Y,1 K -e-- DATE Tt / — D lidding` ;pections ,3-572-3604 ADDRESS L; g APPLICANT IS' tOPEItTY OR TENANT l0 BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR F.,MML .4DDRESS 1 4Slali4 1 Received By: Date Rec'd: )kOwm CONT L,CTo NA G; STATS ADDRESS; NAIAE' LICENSE 4.J�� • •• , _ .. FItP DATE TATE LICENS SUBMTT A COPY OF CITY— STATE___P? OUR STATE LICENSE ADDRESS WTIH APPLICATION PHONE _ FA.X """"•• �,- BAST FINISH d ROOF l7 SIDING DECK O SWn&4 tESCRME VWORK BEING DOIN - ILJMBP.R OF SQUARES .A 'ROPOSED SIZE,_ OROPOSED HEIGHT: RM 3 vinyl 7 Altuninum D Otho (N EXISTING 0PE41NOS DYet ONO OR FORNEW 0PMNGS-DESCR18fi SIZE OF opSA- NG CHANGES & O HOUSE &GARAGE D ATTACHED GARAGE Li DETACHED GAR4GE OWN 0 T:itn El Fascia LOCATION OF'%MM vS I O DR414 TILE O OTHER Ft. BASF'T Existiag Flow Film 2. proposed Door plan 3. List of mewal members to be used FOR NES' CONSMUCTION 1NCLLTDTNG DECKS. IT 3S f . 1, Site PIaNSeY $bowing the existing swotmes and proposed Proket. 2. Two sits of constructiin plans 3. Energy C"lffiiow TYPE F WIII3DOW TO BE INSTALLW - - vx Atv'YL^ JL ,a.,.�..� • FEES ARE BASIEA ON VALUATION, INCLUDING THE COST OF LABa.r ALL (USIN THE lggy �F31E SCHEDULE) OCCUPANCY TYPE TOTAL JOB VALUATION S gee Back Page for Fee Schedule Permit Fee $ �" 650/6 of Building Permit Fee Pian Review S (.0005) times the total job valuation -Minimum $.50 �- I� Surcharge $ -• 001 x Permit Valuation (1/100/6) Fire Surcharge $5,00 (State Licensed Residential Contractors) License Surcharge . $ � $1450 per SAC Unit (plans to MWCC for determination) $ SAC Charge $ R + 6 8 = R x $20 Curb Cut Escrow $450 Conservation Plau Review $ Erosion Control S Fee Determined by Engineering Park Fee $ Sewer Main Charge _ Agreement necessary ( ) Noa Necessary ( ) Moke checks eavable to: City of Fridle Attar Total Due- - THIS Is AN APPLICATION FOR A PER)AIT•NOT VALID Vt PRgCbSSED hereby apply for a building, permit and I acknowledl;e that the information above is complete and accurate; .hat the work will be in on that I s is not a conformance with the ordinances and codes of the city f s MA W1 o Without perrnit; that tahe Minnesota e workawi l bz n �acccordance rwith ahetappru ed permit but only as application for a p it and work is not toPlan in the ce of all work ich re it revie nd a proval of plans. asmoi^ JQ_ Mn SIG'.JATURZ OF APPLIC 8/a5 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 000,6 //76? Mechanical Permlt # Residential Application City of Fridley See Back Side For Required Information DateSL Site Address: The applicant is: (cirlce one) Owner 6atvraci63 Property Owner: zVo 9 IZc Address: City: State: Zip: Phone: Cell: Fax: Contractor Information Company Name: '' Contact Person: Address: City:A, e; State: G�1� Zp: SS It Phone: -Z<3- g4 7-2ji(6! Cell: Fax: , Email: 4- -S MN Bond# & Exp Date 9','32 976 Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: Equipment Installed: MFG: *; r e Model:l7 UQ 3 6 Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: Fireplace (gas) $15.00 New Gas Grill $10.00 _A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 _Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ Jr 00 / (Total from above -Minimum fee $35.00) Surcharge , Total Due Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical 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 case of all work which requires review and approval of plans. / MI -0-9 Signature of Applican Date: Approval Inspector Signature: Date: (1, o , 'L (4'ks A�-rl / T Please Note: Separate permits are required for Building, Plumbing, and Electrical work CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS-5—SM ft\� Fee Total $35.00 $ Own Building Used $10.00 $ACE!�R- ESTIMATED $10.00 $ $10.00 $� $25.00 $ Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR Ali PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP 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 $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ 15® HEATING O� $� Si ed *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City ,r FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE FAX # _ Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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 () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Com,:.,,,-- dent Type _ 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 HEATING Signed By. 2