PRE 2010 DOCSCity of Fridley, NUnn.
BUILDING PERMIT N° 5909
Date:
t]avn�!#�✓�+� Builder
LOCA
No. Street `~�e
Lot _ _ Block
Corner Lot Inside Lot
Address
leZ
ation or Sub-Div140P
Setback Sideyard
Sewer Elevation — Foundation Elevation --
DESCRIPTION
__—
DESCRIPTION OF BUILDING
To Used 0
° Front X Depth Height 4% 40 Sq. Ft Cu. Ft.O't ov
From Depth r } Heitght Sq. FL `�� Cu. Ft.
Type of nstruction Est. Cost To be Completed
In 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.
In consideration of the payment of a fee of $ -fI , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done 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, any and mo p g of buildings
ithin the city limits and this permit may be revoked at anyn of the provisions of said
ordinan
Building Inspector
NOTICE
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for then Items.
4
s-
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Naq% _Builder Ai�
Address
LOCATION OF
Address
No. /. Street -it of Lot
Lot Eyoc'_c_�_Addition or Subdivision i
.�_ �a��
Corner Lot Inside Lot�Setback Side -Yard 1
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To bat -,used as: Z/
--el jFront 7 Depth Height
Sq. Ft, A 76 Cu. Ft.
t
Front Depth Height (�
Sq. Ft. Cu. Ft.
�a
Type of Construction Estimated Cost f � d 0
To be Completed
The undersigned hereby makes application for a permit 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 representations stated in this application
are true and correct.
a
DATE g _SIGNATURE�-
(Schedule of Fee Costs can be found on the Reverse Side).
Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470
GRAVITY WARM AIR:
RATE
TOTAL
Furnace Shell & Duct Work ...........................
8.00
$
Replacement of Furnace .............................
5.00
$
Repairs & Alterations—up to $500.00 .................
5.00
$
Repairs & Alterations each add. $500.00 ...............
2.50
$
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM �0-S
Furnace 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—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures x $1.50 $
Additional Fixtures x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE
ROUGH
FINAL
a ' v
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, Minn A;_;�7 / - 19
Owner s �� c
/ csi� 'P�p
Kind of Building
Used
To be completed about
Estimated Cost,
Old—New. Building Permit No.,f/ O Z Permit No. cam–U 1)- 6
DESCRIPTION OF WORK
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. E.D.R- BTU H.P.
Total Connected Load Kind of Fuel
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Signe
By
x.42 2M Business Phone No
SUBJECT
I O.
City of Fridley
-1-6192
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
%.
REC .
`v ___-_ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/19/81
JOB ADDRESS 1382 Onandaga St. N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
4
1
Walnut Add. SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Arlene Cole 1382 Onondaga St. N.R. Fridley 55432 786-9108
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Gilbertson Const. 7704 Riverdale Dr. Brooklyn Pk. 560-6943
4 ARCHITECT ORDESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW g ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Add on a 20' X 30' addition to the middle back of the house.
9 CHANGE OF USE FROM TO
STIPULATIONS
0,I v
call fecal utif�d
Wbfo tliggSng
l; C_�d
TEt_Et'MCrt�1E ���r�.
A
SEPERATE PERMITS REQUIRED FOR W1'R.
'.AFATING. PLUMBING AND SIGNS,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
R-1
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$20,000.00
$10.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$120.00
PLAN CHECK FEE
TOTAL FEE
"5--
$30.00
$160.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEi r(
WHEN PROPERLY V TED HIS IS YOUR PERMIT
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATIa-4 FOR RESIDi NTIAL BUILDING PERMITS
• (fdcm, Alterations, additions, or Repairs)
OWNER: �iu � s'�'��.�. �s-E%� BUILDER: C�i/b ow ise.� �G7te.���ruc��ior�
ADDRESS:/.3b'-Z 0-&QU C%Qa.o ADDRESS: `7-7o./ 11!!e^, --/A4,- 1)r. ,B.P
TEL NO: TEL NO:
Construction Location j
• STRI-T NO : 13,q7
LOT:
STREET: ®AJ ® At „/"n_ L,
BLOC:: �� ADDITION:
Corner Lot: Inside Lot: Setback.: �, J Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building _location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
O Depth: 2 �a Height: Tdr%J� 15
Square. Feet_ (�pV Cubic Feet: 442',00Q
Front:
Depth: Height:
Square -Feet: Cubic Feet:
�®, res
Type of Construction:
Estimated Cost: $
• t
To $e Completed: - (S6A
U• _ Alt. A Alt. B
Proposed.Driveway Width If New Opening Is Desired: — 6 $ $
SEE REVERSE SIDE, OF SHEET
Mie undersigned hereby makes application for a permit 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
representations stated in this application are true and correct.
MTE: - /3- F/ SIGNATURE
Stipulations:
90 g (P
G ®, ej
-ENERGY CONSERVATION SUPPLEMENT TO BUILDING PERMIT APPLICATION
PLANNING AND INSPECTION DEPARTMENT
CITY OF FRIDLEY, MINNESOTA
This supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE
AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING
OFFICIAL.can determine that submitted plans comply with the ENERGY CONSERVATION
DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S
responsibility to accurately compute the data.; reflect the proper DESIGN CRITERIA
in the plans; submit product specifications, if needed to support the "R" and "U"
factors used; and to assure construction is per approved plans.
JOB LOCATION: 13 8z, C NG N Is f
OWNEWC- oNTRACT
ADDRESS: `°7 J ®moi
u� �.
� g��G� sal bW-C
(�f�, PHONE:
(a 0— 9
A. Determine the
Total
Exposed Wall Area as
follows:
1. Total wall window area
2. Total door area
3. Total sliding glass door area
4. Total fireplace wall area
5. Total wall framing area(average.10%)
6. Total net wall area above floor(average 900)
7. Total rim joist area
Subtotal: Total exposes: will area above floor
8. Total foundation window area
9. Total net foundation area above grade
Subtotal: Total exposed foundation area
GRAND TOTAL EXPOSED WALL AREA
9
%Z
0
B. Multiply the GRAND 'TOTAL EXPOSED WALL AREA X .17 =
C. Determine the Total Exposed Roof/Ceiling Area as follows:
10. Total.skylight area
11. Total roof/ceiling framing area (10%) (o
12.. Total net insulated roof/ceiling area 4,00
GRAND TOTAL EXPOSED ROOF/CEILING AREA 4 ® 0
D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 -
Item II 0
E. Determine the "U11
value of
each segment
(1-9) and multiply by the area as
follows:
1. -1
x
fluff
j
, CJ 1
= '3 '3 z/
2. CJ
x
fluff
�l
-
3.
x
llull
S�
= jr- "r/ .
5. ®
x
fluff
_ r
6. �� ��d
x
fluff
7.
x
(lull
8. b
x
?lull
= 6
9.
x
/lull
ADD 1-9 FOR TOTAL WALL SEGMENTS
= ITEM III / 3�• a
F. Determine the "U"
value of
each segment
(10-12) and multiply by the area as
follows:
10. ® x fluff
11.®K x (lull
12.. 0 x (lull
ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS
0
ma 3
/,5,33
ITEM IV
G. If Item III is the same as, or less than Item I, you have met the intent
of State Building Code 6006 (c) .2.
H. If Item IV is the same as, or less than Item II, you have met the intent
of State Building Code 6006 (c) 1.
I. Add Item I 12!8, 5 Z- + Item II ..� o _ / el ell -
K.
, --
J. Add Item III / 38,be + Item IV X33 _ / 5-/. e
K. If the sum of Items III and IV are less than Items I and II, you have met the
intent of the Code for total envelope system.
The undersigned, as applicant for a building permit, hereby affirms the above
information has 1peen prepared and submitted by himself or under his direction,
hereby acknowledges the information to be correct and accurate; and hereby
presents the information with required plans in support of the building permit
application.
By: ���`� _.R�G�%2�2�� _� DATE:
sueJEcr
11
City of Fridley_
kPE
19 3 5 6
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
EIPT N0.
COMMUNITY DEVELOPMENT DIV.
t? PROTECTIVE INSPECTION SEC.
i
71 7%1
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
I
3/28/88
I
I
JOB ADDRESS 1382 Onondaga Street N. E.
I LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
4
1
Walnut Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Thomas Bittman 1120'Gardena Avenue N.E. 571-2308
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑x REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
MR Fire Repair
9 CHANGEOFUSEFROM TO
STIPULATIONS
SEPARATE PERMITS REQUIRED FOR
WIRING, HEATING, PLUMBING AND SIGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
x.15 000
$7 X50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES 'NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$110.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
.PLAN CHECK FEE
TOTAL FEE
�•
. ,.
$118.00
SIGNATOR CONTQACTO Au ORIZEDAGENT (DATE)
WHEN PROPERLY V I ATED THI IS YOUR PE MIT
SI NATURE OF OWNER(IF OWNER BUILDERI DATE)
OG INSP ATE
NEW [ ]
ADDN. [ ]
ALTER. [ ]
Construction Address:_
Legal Description
Owner Name & Address:
Contractor:
City of Fridley
R-1 AND R-2
Building Permit Application
Address : `//
Attach to this application, a Certificate of Survey of the
lot., with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Effective 4/1/86
Tel. #
Tel. # S-2
LIVING AREA: Length
Width
Height
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA: Length
Width
Hgt/Ground
Sq. Ft.
OTHER:
A" za vnr
- - - - -
----
Corner Lot [ ] Inside Lot [
] Ft. Yd. Setback
Side Yard Setback
Type of Construction:
Estimated
Cost:
Approx. Completion Date:�.,�C�
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ = $ `..--00'
See Back Page for Explanation
DATE: o� v� c�/ APPLICANT:�\�� 1/ , �Z�l Tel. #S%���3��
CITY USE ONLY
Permit Fee $ 110 -SO Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ 0 $.50/$1,000 Valuation
SAC Charge $ $ 5,59 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
TOTAL $ 0() Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
_
W. IQ
ln�
OF
SUBJECT
RMIT NO.
City of Fridley
26464
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
_
RECI=TPTi�IO.
�• ______ COMMUNITY DEVELOPMENT DIV.
V
r I PROTECTIVE INSPECTION SEC.
F
'3g�6
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/6/98
JOB ADDRESS 1382 Onondaga Street NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
Walnut Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Richard Hall 1382 OnondAGA Street NE
785-9141
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION j] REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof - STORM DAMAGE - 6 Sq
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$500
@@
$.50
WITH WH IFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOE OT PRESUME O GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
P VISIONS OF AN OTHER STATE OR LOCAL LAW REGULATING CON-
21.00
Fire SC $.50
TRUCTION OR PERFORMANCE F CONSTRUCTION.
PLAN CHECK FEE
AL FEE
7$22.00
IG OF CO �RACTO AUTH Ri2EDAGENT IDATEI
E PRO
°INSP
V VA
ED THIS IS YOUR PERM
qAi
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
OF
VNEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Names:
Contractors 1�'=(!
E
IF
Effective 1/1/98
Tel. # / S
MN LICENSE #
Address:. Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
Length
GARAGE AREA:
Length
DECK AREA:
Length
DESCRIPTION OF IMPROVEMENT
Width
Height
Width
Height
Width
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
OTHER: P
�o is gp-w e** o� 4
Construction Type: tunated Cost: $ 52
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #
CITY USE ONLY
Permit Fee $ VelO Fee Schedule on Reverse Side
Fire Surcharge $ .urb .001 of Permit Valuation (1/10th%)
State Surcharge $ �v�b $.50/$1,000 Valuation
SAC Charge $ $1000 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS:
or
Building
Inspections
763-572-3604
DATE
SITE ADDRESS/3d
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNW-TYPE
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER RCONTRACTOR
Permit N
Received BY:
7
Date Rec'd:�
ADDRESS:_/�®l�t� J �'�°o� J 1J -L_ CITY 4Z&!gj --ST,
PHONE:
COMPANY NAME:_
CONTACT PERSON:
STATE LICENSE # EXP DATE
ADDRESS: ���""—P� CITY �i� � �-sr� STATE �' ZIP
PHONE s 2 ' r'vy - 9a FAX
TYPE OF WORK: I ❑ NEW
FAMILY ❑ TWO FAMILY
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
H
PER MS *16B.665 the permit fee is a minimum of $15.00 .or 5% of the total cost up to $500.00, whichever 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 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) MODEL: CWyg --/O5c SIZE/BTU%GI eQo[�
Equipment Installed MFG: N _ SIZE/BTU
MFG: MODEL: SIZE/BTU
MODEL:
A/C $25.00_FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 _FURNACE $35.00 GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
^DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
--
SLI:','.i'I'��.L'tL'iliz7JIGA;+.'LJ.L'.V.i�sar,�✓uaa,:.vr. .,s .:..: ..............: .....—.. ._._�: .. _... _-._-
Permit Fee $ Number of fixtures @ $10.00 x $10.00 =
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 I x$35.00=$ 60
State Surcharge = $ .50
Total= $J3 5 -5z
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 ork which requires review and approval of planes.
SIGNATURE OF APPLICANT PRINT NAME ( tC /! �l i�� �/� DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a Oil or solid fue11MC Chapter 7 with MN Amendments
b. Natural Gas or Propane ]FGC 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