PRE 2010 DOCS1. BUILDING PERMIT
Village of Fridley,. Minn. � 2158
Date .... .. .
Owner .. .. .. .. .. .... Builder ...
Address......................................... Address ......................
CATION OF BUILDING
No. ..... 11.Q ,,,... Street ... ......... . ......... Part of Lot ..... ............ .
Lot ....... iR..... Block .... ....... Addition or Sub -Division ...
Corner Lot ............ Inside Lot .... Setbacks .. Sideyard ......................
DESCRIPTION OF BUILDING
To 'Used as:
... ........ ... Front .. ..�.. Depth Rq. Height .6 ..... Sq. Ft. .
.................... nt ........ DepthHeight ......... Sq. Ft...
Type of Construction .. ....... Est. Cost .fiA ........... To be Compl�
.... Cu. Ft........ .
..... Cu. Ft.........
-ted I 1�0.........
In consideration of the issuance to me of a permit to construct the building descri ed above, I agree to do
the proposed work in accordance with the description above set forth and in complian with all provisions of
ordinances of the village of Fridley.
....�...................:...... ............
In consideration of the payment of a fee of $ %.+ d ,' permit is hereby granted to .. .. . .
....................... to construct the building or addition as described above. permit i gran upon
the express condition that the person to whom it is granted and his agents, employees d workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all resp s to. the ordinances of
Fridley, Minnesota regarding location, construction, alteration, aintenance, repair and oving of buildings with-
in the village limits and this permit may be revoked at any upon violation of any of the provisions of said
ordinances.
..f:.... ...... ... ..... uilding Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing; gas heating,
sewer or water. Be sure to see the Building inspector for separate permits for these items.
52-84-5915.51
City of Fridley
Application for Plumbing and G, n luting Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK 112 Panorama Ave
Number, Kind and Location of Fixtures Location
�ei
rn
NO. RATE TOTAL
Number Fixtures ......................
x $2.00
a�11
Future Fixture Opening ................
x $1.50
Z�zn °�Z
� G
<�ri
V �
<
(�'� °1
(�9
0
Z
0 O
•
R
•
N
WATER HTR.
GAS
ELEC.
Base
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
Gas Dryer
1st
5.00
2nd
3rd
4th
• Fugue Co —sedan Openings
New Fixture, Old Openings
I
Connected with
Sewer �
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ......................
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ...... .....................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg. ............
x $3.25
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
Gas Dryer
1
5.00
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE5.00
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
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 fact
and representations stated in this application are true and correct.
10-31-67
Fridley, Minn 19—
Owner ilex Kurak
Kind of Building frame
Used as res
To be completed about 31-6-67
Estimated Cost, $ 10.00
Old—New. Building Permit No PermUtNo.
m
t
By
Business Phone No
ROUGH
FINAL
42
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ......................
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
,�
Z
$
K Z
x $3.25
W
Water Heater (Up to 99,000 BTU) ......
W
01
?
0OZ
•
F
•
N
WATER HTR.
GAS
ELEG
Base
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
2 x $2.00
$ 2.00
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
install (1) gas grill & (1)
lite
6.00
1st
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings I
Connected with
Sewer El
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ......................
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ............................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
2 x $2.00
$ 2.00
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
install (1) gas grill & (1)
lite
6.00
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTA ;-MM $ 8•oo
City of Fridley:
53-84-S915.51
The undersigned hereby makes application for a permit for the work herei
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 fact
and representations stated in this application are true and correct.
Fridley, Minn Jul -r 14., 1970 , 19—
owner Alex Kurak
Kind of Building frame
Used as residence
To be completed about —
Estimated Cost, $ 20.00
OldANew. Building Permit No Permit No. �
Si e
0
By
4
Business Phone No
GAS Co.
ROUGH
FINAL a- I - % /
42
53 -84 -s -915.51' -
City of Fridley
Application for Mmddng and CGs Femb
Dept. of Bldgs. Phone NO -34.50
DESCRIPTION OF WORK Laea�s 112 N. E. Panorama. Ave.
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $2.00 $
Future Fixture Opening ............ x $1.50 $ _
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 99,000 BTU) .... x $3.00 $
New Ground Run Old Bldg. ........ x $3.25 $
Eleatric Water Heater .............. : $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .............. • ... x $2.00 $
Additional Fixtures .................. x $ .?b $
Gas Range to 199,000 BTU .............. 1 x $5-W $ 5.o
REPAIRS it ALTERATIONS—Refer to Code
City of Fridley:
The .undersigned hereby makes application for a permit for the' work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that aA the fact
and representations stated in this application are true and correct
Fridley, Wnn 12-1-71 , 19,
Owner Alex J. Kurak
Kind of Building Frame
Used as Res.
To be completed about 12-8-71
Estimated Cost, $ 10.00
QZX-New. Building Pe m •rm
Sig!ByMl
- -
Business Phone No
ROUGH
Description ............................................
Eyrsharge $.50
TOTAL FEE $
5-00
class wA'x
(SURCHARGE $_,50)
at�
1{
°e�
Ny�
Z
N
z
t
V
�Qj
<Z
�J{
(�Y
(7!
•
♦
•
N
WATER IR•.
GAS
ELEC.
Base
1st
1
2nd
3rd
4th
ii�H
• Futuro Connection Openings
+ Now Fixture. Old Openings
connected vitt,
eew.s ❑
cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $2.00 $
Future Fixture Opening ............ x $1.50 $ _
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 99,000 BTU) .... x $3.00 $
New Ground Run Old Bldg. ........ x $3.25 $
Eleatric Water Heater .............. : $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .............. • ... x $2.00 $
Additional Fixtures .................. x $ .?b $
Gas Range to 199,000 BTU .............. 1 x $5-W $ 5.o
REPAIRS it ALTERATIONS—Refer to Code
City of Fridley:
The .undersigned hereby makes application for a permit for the' work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that aA the fact
and representations stated in this application are true and correct
Fridley, Wnn 12-1-71 , 19,
Owner Alex J. Kurak
Kind of Building Frame
Used as Res.
To be completed about 12-8-71
Estimated Cost, $ 10.00
QZX-New. Building Pe m •rm
Sig!ByMl
- -
Business Phone No
ROUGH
Description ............................................
Eyrsharge $.50
TOTAL FEE $
5-00
class wA'x
(SURCHARGE $_,50)
.
r=
J
City of Fridley
4T THE TOP OF THE TWIN$
r L -----" COMMUNITY DEVEWPMENT MV,
1 PROTECTIVR wsftCTIOM bA'L
CITY HALL /NIft9Y OME
s
112 N. F. Panorama Ave.
Alex S. Furak
ontractor
MINNEGASCO
ind of Building
Frame
omp etion Date
3-13-75
MaNra
ova
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OVID
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53-84-S-915.51 �y�8
PLUMBING, PERMIT APPLICATION
560-5116
733 MARQUETTE AVENUE
e mpts, mim.
Res.
timated Cost 1
Gas Fitting Fees:
1st 3 Fixtures x $2.00
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
See
Description: Install Dryer Code 5•oo
State Surcharge 'Class "W Surcharge .50¢
.50
TOTAL FEE $ 5.50
!The undersigned hereby makes application for a permit
for the work herein specifiedo agreeing to do all work
in strict accordance with the City Ordinances and Tulin
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
ap lication are true and correct.
'Signatur#AI NEGASC? Date ;
10.00
Plumbing Fixture Rates:
NO.
RATE TOTAL
Number Fixtures
x
$2.00 $
Future Fixtures
x
$1.50
New Fixture -Old Open.
x
$1.50
Catch Bastn
x
$3.25
Water Heater -99,000 BTU
x
$3.00
Ground Run Old Bldg.
x
$3.25
Elec. Water Heater
x
$2.00
Gas Fitting Fees:
1st 3 Fixtures x $2.00
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
See
Description: Install Dryer Code 5•oo
State Surcharge 'Class "W Surcharge .50¢
.50
TOTAL FEE $ 5.50
!The undersigned hereby makes application for a permit
for the work herein specifiedo agreeing to do all work
in strict accordance with the City Ordinances and Tulin
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
ap lication are true and correct.
'Signatur#AI NEGASC? Date ;
SUBJECT
MITI o-.---- _
City of Fridley
2 2 3 9 3`
AT THE TOP OF THE TWINS
BUILDING
P E R
M I T
i
PT NO.
COMMUNITY DEVELOPMENT DIV.
1 L
r PROTECTIVE INSPECTION SEC.
#59
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIOLEY 55432NUMBER
A 612-571-3450
910-F15
3/31/94
JOB ADDRESS
112 Panorama Ave NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
1 Carls
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Margaret Rurak 112 Panorama Ave NF
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
R & M Associates 3482 AugAr Ave. Wbite Rear
lake, MN
770-9322
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 ❑R REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof & Reside Dwelling (15 Squares) Tear -off; and add new doors
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the
State Building
Code. Install smoke
detectors as per UBC 1210 adjacent to all sleeping areas and
in basement.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
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
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
@@
`P7.9640
$3.82
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$99.00
Fire SC $7.64
S�R�CTIO THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
�y
3-Y-
//�\/
!
License SC $5.00
$115.46
SIGN�2k=��==-
AT CONTRACTOR ORAUTMORIZEDAGENT IDATEI
HE OPE Y V
BLDG INSP
ATED THIS IS YOUR PERMIT
DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/94
ADDN CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 )3G1
Building Permit Application I r
Construction Address:f 1,2- PeL fuop o, M A
Legal Description:
Owner Name Address: _M
Contractor: SAI As 1�
Tel. # 6-% 2 -
MN
MN LICENSE # "- S
Address: 3/ Z �s r , Tel. # '7 %® 3 2- Z -
Attach to this application, a Certificate of Survey 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
t.DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
F
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setbac�, / Side Yard Setbacks
Estimated Cost: $ �
Type of Construction: � w p , . � - L �, � �,, y y �
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ = $
DATE: APPLICANT:
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ C/9, o0
$ 17��
$ v
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$800 per SAC Unit
Tel. #�? "7o
5 . 0® $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by, Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
JOB ADDRESS 112 Panorama Ave. N. E.
The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Fumace Shell and Duct Work, Burner -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$ 20.00
$
representations stated in this application are true and correct.
6-27-94 ,19ga.
Gas Piping (Needed with new furnace)
$10.00
$
OWNER Margaret Kurak
Gas Range
$10.00
$
..BUILDING USED AS residence
Gas Dryer
$10.00
$
ESTIMATED COST 1250.00 PERMIT NO. '116(14
*Air Conditioning - All Sizes
$10.00
$ 10.00
'
DESCRIPTION 9F FURNACE AND OR BURNER
All Others/Repairs &Alterations (LIST ON BACK)
I% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
Commercial/industrial
BTU HP EDR
1% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
TOTAL FEE
REINSPECTION FEE
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU HP EDR
HEATIN MP NY Dependable Indoor Air Quality, Inc.
sig TGINO.-757-504-0
Approved B Rough -In Date Final Date 7
FILL .OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes
(
) No
( j
2.
Is free from rust or deterioration
Yes
(
) No
( )
3.
Has no foreign objects lodged within
Yes
(
) No
( )
4.
Is securely supported
Yes
(
) No
( )
S. Meets all current Code requirements for
size and total BTU's connected Yes ( ) No ( )
G. Has total heati.nq BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
Building
Inspections
7.63-572-3604
DATE �-�
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
PHONE:
MECHANICAL
RESIDENTIAL APPLICATION
.CITY OF FRIDLEY
D � a l% 7 �QUR E-MAIL ADDRESS
.✓� wiGe r.
0 OWNER I CONTRACTOR
CONTRACTOR
COMPANY NAME:��
CONTACT PERSON:
SUBMIT A COPY OF
STATE LICENSE #_J_S_
YOUR STATE
LICENSE WITH
ADDRESS:
APPLICATION
PHONE A Q —
PERMIT TYPE
XINGLE F
I
TYPE OF WORK:
EXP DATE
Permit No.:
Received By:
b NEw 0 REPLACEMENT
DETAILED DESCRIPTION OF WORK
17 TOWNHOUSE
"TION/REMODEL
A
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. (Ibis should reflect only the cost of labor )
Labor cost under $300 — $15.40. r 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: gNDICATE TOTAL
NUMBER OF EACH BELOW) MODEL: SIZE/BTU
Equipment installed MFG: SIZE/BTU
MFG: MODEL:
MFG: MODEL: SIZE/BTU
A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.D0
_AIR TO AIR EXCiiANGF,T�t S 15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER smm _FURNACE $35.00 _GAS UNIT HTR $10.00
_CHIMNEY LINER $10.00 DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING 51 O.OD VENTAATOR 515.00
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
50 Number of fixtures @ $15.00 x $15.00 = $
Surcharge $
TOTAL DUE $ /y� _ 0 Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $ As
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 Muvnesota-Construction Codes; that I understand this is
not a permit but only an appli r a pe d work i t to start without a permit; that the work will be in accordance with the
approved plan in the cas ork which es rev' d approval of p i
SIGNATURE OF APPLICANT r� NAME �
City of Fridley
Building Inspections Department .
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
MECHANICAL
Permit No.:
Inspections
RESIDENTIAL APPLICATION
B
30ec'
763-572-3604
CITY OF FRIDLEY
cT
763-502-4977 FAX
EFFECTIVE 2-19-09
DATE C 1 YO E-MAIL ADDRESS
SITE ADDRESS Cl.
THIS APPLICANT IS: ❑ OWNER QONTRACTOR
PROPERTY
NAME:
ADDRESS: CITY STATE ZIP
OWNER/
TENANT
':110
-_ 5 r —.5,_ � 6
PHONE:
CONTRACTOR
COMPANY NAME:
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
LICENSE WITH
STATE LICENSE # XP DATE
�iZ✓ STATE�ipjS
ADDRES CITY_ch� (1
APPLICATION
PHONE &I/ --,472 Gl 6 FAX
PERMIT TYPE
0(SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW ❑ REPLACEMENT >�-ALTERATION/REMODEL
ETAILE DESCRI % OF W RK i.� A
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZE/BTU
$25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR
_BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 IGAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
i}�. .::tl .4,'�' �,p.pss�� "iw ^�,,t� � ).. '4 +m:'`i �'Ki o�y� M1b '� 13 b'� e^s,.. 9: +flx«"'• �' ?�t` �"..._� t �4t � Sia* 'sri )kJ`?-
.✓.1R� ro� `� S,�'S T�!�q h x�?%�""+;Y`" J�Y�i.e '"�i° 4 ,'�,1 r.l . � `' � Y � ': C' ,S �"1�� ���'Y`.< .. i� ����g�g- in..�j TF �� T' �.w�� 5 7 .. y3��r`
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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 ork which reqpkehjreview and approval ofplan s. p , b:��
OF PRINT NAME �-1 'v DATE
SIGNATURE APPLICANT
- 01
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 ❑ MAKE-UP 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 S 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.