PRE 2010 DOCSApplication for Power Punts and: Healing, Cooling* Ventilation, .Refrigeration and
Air vnditioning 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 ............
.each add. 60,000 BTU ... _ . ................. .
Replacement of Furnace .........�....................
Repairs & Alterations—up to $500.00 ..... ........... .
Repairs & Alterations each add. $500.00 .......:...... .
STEAM or HOT WATER' SYSTEM
8.00 ,A d
2.00
$
§.00
$
5.00
$
2.50
$
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 $ z r�
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
$ r -
See Fee Schedule
a TOTAL
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 factE
and representations stated in this application are true and correct. , I
Fridley, 1VM= G r � 19 �L
Owner /)"
Kind of Building ?" Ile,
Used as ®/ '� °_e'
To be completed about g 2, / , r__' /
Estimated Cost,
hep®
Old—New. Building Permit No. a Permit No.�
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size
v
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)
Si,
By
d0r_ffi�.42 2M 7-59 Business Phone No •
SUBJECT
PERM[
City of Fridley
281
AT THE TOP OF THE TWINS
BUILDING P E R M I T
i �
COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
,-�
NUMBER
REV.
DATE -
PAGE OF
APPROVED BY
s---' 612-560-3450
910-F15
11/19/741
JOB ADDRESS 100 Rickard Road
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1-lA
T2 2
Garten' s Addition SHEET
PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Daryl L. Kirt 100 Rickard Road N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
SAME
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USEOFBUILDING
residential
7 CLASS OF WORK
❑ NEW Ck ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
New chimney for a wood burning stove
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REWIRED FOR WIRING;
HEATING, PLUMBING AND SIGNS",
*
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
pipe
VENTILATING OR AIR CONDITIONING.
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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
1 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.
$600.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.50
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-
5. 00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$5.50
SIGNAT RE OFCONTR TOR OR AUTHORIZED AGENT IDATE)
WH N PRO ER V DAT THIS IS YOURPERMIT
IN SP DATE
SIGNATURE OF OWNER IIF OWNER BUILD 1 (DATE)
APPLICATION FOR RESIDENTIAL, ALTERATION.-
OR
LTERATION;OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME / JQ enc, it . / I BUILDER: --50.4,f
ADDRESS: C /C a"2 ADDRESS:
NO:. /GZ% STREET:—
LOT:
TREET:LOT: BLOCK: ° ADDITION:-
CORNER
DDITION:—
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
zC`i a ront : Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
v7
Type of Construction: Estimated Cost: d G�
To Be Completed: C-Va�5
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict 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.
c
DATE: SIGNATURE: w
(See Reverse Side For Additional Information.)
CITY OF FRIDLEY
Effective May 1, 1990
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL RATE TOTAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range 0
Gas Dryer
* Air Conditioning (all sizes)
$ 20.00 $ ;L0°0 D
$ 10.00 $
$ 10.00 $
$ 10.00
All Others/Repairs and Alterations
10 of Value of Appliance or
,_Work
N✓/fit eC�/�/G� >f %�r.c? �<G�ili:
COMMERCIAL/INDUSTRIAL
li of Value of Appliance or Work
State Surcharge
TOTAL !SE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp.
Date
Approval for Permit
s / cc
Job Address /� a (/[ SLAM -4 /�&
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Minn. 3 19 � a
OWNER
T n
KIND OF BUILDING,/Q�'�"TT�1L'
USED AS /—/ a dw c' -
TO BE COMPLETED ABOUT
7EW
ED COST v o
BUILDING PERMIT N0. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
4 HEATING or POWER PLANTS. Steam, Hot Wate , Warm Air
no t
Trade Name /a? /�' Size No. /4,C1 Cr E C, 7J
Capacity Sq. Ft. EDR BTU ZS,y o HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neigf"r.
Capacity Sq. Ft. EDR BTU / HP
Company
Signed By /
Tel. No. S 2'. 2!✓r'
Fill out back side for stack verification on replacement furnaces
,f
Ar
CHIMNEY AND STACK VERIFICATION
0
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,) No ( )
2. Is free from rust or deterioration Yes ( ) No ( )
3. Has no foreign objects lodged within Yes ( ) No ( )
4. Is securely supported Yes ( ) No ( )
5. Meets all current Code requirements for size and
total BTU connected Yes ( ) No ( )
6. Has Total heating BTUs of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Date
i
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1.
Has been carefully examined
Yes
No ( )
2.
Is free from rust or deterioration
Yes
No ( )
3.
Has no foreign objects lodged within
Yes
No ( )
4.
Is securely supported
Yes
(
No ( )
5.
Meets all current Code requirements for size and
total BTU connected
Yes
i
No ( )
6.
Has Total heating BTUs of
All other BTU's
TOTAL
Rema rk s
Com pa
Signe
Da to
0
CD
CL
0
N
C`
U1
N
tD
CITY OF FRIDLEY WSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOD
�t71th Wash dl'{rtk Fiaor tra�01 s Auto.
Urinal 4 Shower Srnk T(a k ' '
Y.arif Drain 1$a1[t Washer
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
New Fixtures
$ T.DO
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$5.00
Blow ON Basin
$7.00
Catch Basin
$ 7.00
Rain Water Leader
$7.00
Sump/Receiving Tank
$ 7.40
J
a_ Water Treating Appliance
$10.00
U_
u_ Water Heater -Electric
$ 7.00
o Water Heater - Gas** �_
$10.00
Gas Range""
$10.40
r>-
Gas Dryer**$14.00
Back Flow Preventer Required ( )Yes () No
_
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
`v 1.5% of Value of Fixture or Appliance
W
m
State Surcharge
$ .54
m
N
Q TOTAL FEE
E
Effective On March 1, 1996
Gas lWater Heater
Range FixtGas Mec
JOB ADDRESS.
The undersigned hereby makes application for a permit forthe 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 orrect,
`� , t 997
Owner/�/tea , �%T����Sle i�s 919Cr
Building Used As
Estimated Cost -�� PERMIT NO. /0
PLUMBING COMPANY �L fa- ed,,T7 y,/
Approved By _0�Rough-in Date Final Date
PLUS THE 50 _STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A, MINIMUM SIZE 9 SO INCHES.
m
ri
0
F_
From: City of Fridley To: 651-203-0554 Page: 4/5 Date: 7/26/200612:02:13 PM •-Lv - CMZ
Building
BUILDING
Permit Nom
Inspections
RESIDENTIAL APPLICATION
Received By: I
763-572-3604O
CITY OF FRIDLEY
FeR
DATE NJNJA
YOUR E-MAIL ADDRESS
SITE ADDRESS bo 6
(��1�1C.,Y r.i �� C�6LA257
THIS APPLICANT IS:
❑ OWNER XONTRACTOR
PROPERTY OWNER/
NAME: 2J., u A (-In(iaa
ADDRESS: 100 Yc:a(k- CITY —
TENANT
J
PHONE: I d-,-6 — `18
CONTRACTOR
NAME: CiA)a
STATE LICENSE#�1�?I� EXP DATE U251l ��
�-
STATE ZIP
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS(OWI - VV- C2-L�164 1 CITJCA��
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED IR3VINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING Cl OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING i
DESCRIBE WORK BEING DONE: '171 cazc. kly1
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft.
OR OFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES
E3 ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
13 DETACHED GARAGE
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.
2. Two sets of construction plans
WINDOWS r
IN EXISTING OPENINGSYes ❑No LOCA N OF W DOWS
3. Energy Calculations
OR FOR NEW OPENINGS -D SCRIBE SIZE OF _
OPENING CHANGES &
rd
"t A)
TYPE OF WINDOW TO BE INSTALLED t BER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OY LABOR AND MA -1- .K1AJ-b:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ i0,CZ(XJ �� OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ t� 65% of Building Permit Fee
Fire Surcharge $ 001 times the total job valuation
Surcharge $ L _ .0005 x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ m4ar Make checks payable to: City of Fridley Attach Sti ulations
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 which rMures review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME Vii(! DATED
Building .I l -7-1
S MECHANICAL
Permit No.
Inspections
RESIDENTIAL APPLICATION
Received By. gQ
763-572-3604
CITY OF FRIDLEY
D ' "
DATE1��`l a e� O� YOUR E-MAIL ADDRESS
SITE ADDRESS 1 da Ri C a r 8 °?Y[uA
THIS APPLICANT IS: O OWNER J]CONTRACTOR
PROPERTY
NAME: b wSk`
ADDRESS: lO® ,�y d
� CITY R 1 STATE ZIP su
OWNER/
TENANT
PHONE: "1 jy--,, -S-7 L4 - ®A T9
CONTRACTOR
COWANY NAME: CENTERPOINT ENERGY
CONTACT PERSON: JOANN 2` INKEN
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: 9320 EVERGREEN BLVD STE EITY "COON'.'RAPIDS sTATEMN zIP55433
APPLICATION
PHONE 763 — 757 -- 6202 FAX 763--757-6701
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
❑ NEW AREPLACEMENT O ALTERATION/REMODEL
DETAILED D SQRRIPTION OF WORK
PER MS 1613.665 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)
Equipment Installed MFG: Q a V 'i't v r- MODEL: SfSrYt11 CQ(g® SIZ TU®�ODb
MFG: r r i �N MODEL: A !R (? R � c�a I{ SIZEBTU , O
MFG: MODEL: SIZE/BTU
,LA/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00
TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR _FIREPLACE
_BOILER $35.00 TFURNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 DRYER $10.00 _POOL HEATER $35.00
_GAS
_DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00
PERMIT FEE PROJECTSFOR UNDER $500
PERMIT FEE FOR PROJECTS -OVER $500`:
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 = $ aS -W
Number of fixtures @ $35.00 I x $35.00 = $ 35.66
State Surcharge = $ .50
Total = $ 1n6"e�'o
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 which requires review and approval of plans.
IN
SIGNATURE OF APPLICANT g itINT NAME ROGER HOFFHE DATE
PLEASENOTE. SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK- "
City of Fridley
Building Inspections"Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS EXISTING HOME 0 MAKE-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 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.