PRE 2010 DOCSCity of Fridley,
BUIMING PERMIT N°727
Date: —" `.,..' I r
timer: Builder
Address
Address
No. �_ :Street
Lot. Addi
Corner Lot ...: _.:. _ . Inside Lot ___. _:.._:.._ Slg6
Sewer Elevation
®ESCRIPI
FrontDepth
9
r .
Type of
5
47- of Lot
�Gr Sub -Division _A,+!�
ick Sideyard
Foundation Elevation
.OF BUILDING
iieiglit Sq. Ft. Ft `
_ HeightP,V Sq. F't. Cu. Ft.
.�To be Completed
1
r" ... ✓
lR
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 $ 410 permit is hereby granted to_.._.
to construct the building or addition as described above, This permit is granted upon
t#ie 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, maintenance,_ repair and moving of buildings
within the city limits and this permit may be revoked• at any a upf v,�r�atio of any of the provisions of said
ordinances. ,s"?I .,
NOTICE:
This pormit does not cover the construction, installation for wiring; phifti n9, SOS' heating, sewer or water: Be sure to see
the Building Inspector for separate permits for these hem&
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
owner Is Name uild®r
Address PlAAra,ca z2ef,
LOCATION OF BUILDING
NO. _ street Part of Lot
Lot Bloc._....,Addition or Subdivision
Corner Lot Inside Lot Setback side -Yard 1
SEVMR ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
To used ass
DESCRIPTION OF BUILDING
Front Depth Height
sq. Ft. Cu. Ft.
Front _.__Depth Height
sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
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 ruling of the Department of Build-
ink`s,, and hereby declares that all the facts and representations
stated in this application are true and correc
DATESICGNATtTRE 1410,
c;f
(schedule.of Fee.Costs can be found on the Reverse side).
City of Fridley
A►ppiication for Plumbing and Gas Fitting Permit
DepL of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK T—+9—T—+9—- 437
Number, Kind and Location of Fixtures
q I�
4O1
rn
3
Number Fixtures ......................
�N
�,F
�_
x 1.20 $
xy
Zrz
�c
pZ
<�Z
p�
,
�
�
(�90
•
R
y
N
WATER HTR.
GAS
ELEG
Base
x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ...............................
...........$
TOTAL FEE $ 'S—'
1st
2nd
3rd
4th
' Future Connection Openings
New Fixture, Old Openings
Connected with
Sewer El
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
RATE TOTAL,
Number Fixtures ......................
CNO.
x $1.50 $-���
Future Fixture Opening ................
x 1.20 $
New Fixture Old Opening ..............
x 1.00 $
Catch Basin ............................
x 3.25 $
Water Heater (Up to 200,000 BTU) ......
� x 2.00 $2� U v
New Ground Run Old Bldg. ............
x 3.25 $
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 $
REPAIRS & ALTERATIONS—Refer to Code
Description ...............................
...........$
TOTAL FEE $ 'S—'
City of Fridley:�0eF-1
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 faci
and representations stated in this application are true and correct.
- e- /
Fridley, Minn / 1 19-4-?
Owner 1
Kind of Building
Used as
To be completed about
Estimated .Cost, $
Old—New. Building Permit No Permit No.
Signe a
By
Business Pho e
ROUGH .3 �.9
FINAL
4z 2M
Application for mer Plants and. H , Cooling, Ventilation® Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
AVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ..............
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 .............
RATE
TOTAL,
8.00
$
5.00
$
5.00
$
2.50
$
Gas Range to 200,000 BTU ...........
8.00
$
2.00
$ _
5.00
$
5.00
$
2.50
$
STEAM or HOT WATER SYSTEM
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 BTL)�a ^
.......... 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
$
'S12
ROUGH
FINAL
Dept. of Bldgs. Phone SII 47470
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 OrdinanceE
and ruling of the Department of Buildings, and hereby declares that all the factE
and representations stated in this application are true and correct.
!, Fridley, 1tilinn FEB 2 21962 y 19 —
Owner
Kind of Building
Used as
To be completed about L®RME 45 & 1M04
Estimated Cost, $
building Permit No. Permit No.
77
DESCRIPTION OF WORN
HEATING or _ �e - , Warm Air—No-
Trade
ir—No Trade Name o Size Nod" 2
Capacity Sq. Ft. E.D.BTU H.P.
Total Connected Loa `,-I a � �cN. ✓ ` Kind of Fuel
BURNER — Trade Name® '. `- j' Size No,,
Capacity Sq. Ft. E.D.4ZA _ � V-�yzff_4TU H.P.
(REMARKS—OVER)
'-a 4j a z 2M 7-59
Sign
By
Business Phone o.
HEAT LASS CAIXUL AIIONS
Weatherstrips Guide
Windows Doors Reference Out. V
Yes—NO I Y� erNo 19—
F1.1
9Fl. d b a!MAI, Room I Unwth 12 1 3 Wi
%3, /_5
�
DEPT �+
OF B�ia.DINGs MAGE OF ST..
Construction No.
Kull Ceiling Roof Floor
Height Fl.l j�) Room I
Windows and Door*—Cracltage and Ana
I LAugtn
Width Height No. of Lineal ft.
No. of pane of pane lights of crack
Width Height No: of Idaeai ft. Area
No. of pane of pane lights of crack eq. 1t.
g
757
�#
4
Coef.
Coef.
Btu
Infiltration
_7777,
Infiltration.2
Class
Exp. wall 7(-- X X
". 4132
Glass
Exp, wall ,M x
&U'
a en e, 0
Exp. wall 3 67
Net exp. wall
Zeiling' ,�' °
Net exp,. wall
hit -wail Ftp "�� =
Floor
C ( 0
Ceiling 3 x
Exp. wall
Floor
TEL
91 -
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
_'Fl.l _`m P .. )Vdkoom I Lenath l iq t-. Width / 1 Height Y
Windows and Doors—Crackage and Area
I LAugtn
Width Height No. of Lineal ft.
No. of pane of pane lights of crack
Area
D¢. ft.
e 0jk�V
�#
Coef.
Btu
Infiltration T/-;':
1 y
Coef. Btu
Infiltration.2
Exp. wall 7(-- X X
". 4132
Glass
Net exp. wall 419
&U'
a en e, 0
Exp. wall 3 67
'
Zeiling' ,�' °
Net exp,. wall
Glass .
Floor
Int. wall
Exp. wall
Ceiling 2_'5'6 x I
TEL
91 -
Floor
Total Btu. ( '
Required sq. ft. E.D.R. or sq. ins. WAL Leader area
Windows and Doors—Crackage and Area
I LAugtn
w Wawa
Width Height No. of Lineal ft. Area
dog .of pane of Dayyne Ilghte of crack sq. ft.
s acagna
Windows and Doors—Crackage and Area
Coef.
Btu
Infiltration T/-;':
1 y
class
Exp. wall 7(-- X X
Net exp. wall 419
91
43 j2
Int. wall
'
Zeiling' ,�' °
Glass .
Floor
Windows and yrs --Cr+
Width Height No
N0. of pane of Dane lig'
�` � �'i 2
Insulation
Coef. Btu
Infiltration
Blass
Exp. wall LT 123 1
Net exp. wallaI] ,;Y, o
Int. wall
Ceiling f _�,t°`,e�
Floor
Total Btu.
sq. ft. E.D.R. or sq. ins. WA. Leader area
Fl.l f3 �� Room 1 Length /g fW
Windows and Doors---Crackage and Area
Width
Height No. of Lineal ft. A
of Dans ` of Dane lights of crack e
Utu
Infiltration
Glace
Exp, waU 2,-7 S
Net exp. wall
Int.. wall
Ceilings
Floor
Total Btu.
Required sq. ft. E.D.R. or sqi ins. WA. Leader area 1
!'t. Ip'ROOM
I LAugtn
w Wawa
/ w
s acagna
Windows and Doors—Crackage and Area
No.
Width Height No. of Lineal ft. Area
of pane of pane lights of crack sq. tt.
1 y
Coef.
Btu
Infiltration
'
Glass .
Exp. wall
f
Net exp. wall
Int. wall
Ceiling
Floor
�'
a w;
�` 414,
Total Btu. , II Total Btu.
Required sq. ft. E.D.R. or sq. iris: WALeader area. U Required sq. ft.. MR. or. sq. ins. WA. Lea r area
wri o.�
pl
Windows and. Doors-Crackage and Area
Width Height No. of Lin"IM Area
No. of pane of pane lights of crack sq. it.
1 30
HEAT LOSS CALCULA71ONS
DEPART1Ii EN`f'. OF BURDM
VIUAGE OF ST. MM
Weatherstrips
Guide
Construction No.
Inaulaton
Windows
Doors
Reference
Out -Wal
Int. WaU Caeiiing Roof Floor
Kind How
?e N
Yle�
19_..._
Floor1-7%771 F
' Fl.I FA i `Room
I Length Width
Height
F1•1 f3,4 'r IW
Room I Length 6 Width
Windows and. Doors-Crackage and Area
Width Height No. of Lin"IM Area
No. of pane of pane lights of crack sq. it.
1 30
Coef. Btu
Infiltration
3-
Glass
S
Exp. wall -A V -i+-
x
Nei exp. wall/
1
7
Int. wall
Ceiling
Floor1-7%771 F
Total Btu. I
Required sq. ft. E.D.R. or sq. ins. W.A. leader area
F1.1 , f d - Room I Length // Width JA ' Height '
Windows and Doors-Craokage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack_ 1q. ft.
1 30
Coef. Btu
Infiltration
3-
Glass
Exp. waIl
J
Net exp. wall
1
ZQ,2"
Int. wall
Ceiling
FloorWt f1.6-4/
5, 3 6 311
Total Btu. " l
Required sq. ft. E.D.R. or sq. ins. W:A. Leader area
j FI. T t� E 0 Room I Length 15- Width I el c Height
Windows and Doors--Crackage and Area
Width Height No. of Lineal ft. Area
Qo. of pane of pane lights of crack sq. ft
Q
Coef. 'Btu
Infiltration J
Class
Exp. wap >r
Net exp. wall
-77
Int. wall
:tailing
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. -ins: WA. Leader area.
Windows and Doors--Crackage and Area
Width Height No. of eal ft. Area
No. of pane of pane lights of crack sq. ft.
Infiltration 3
Glass
Exp. wall 7 >, Y
Net exp. wall;
Inc. wall
Ceiling
Floor IIII' o At 9
Total Btu. " �.
Required sq. ft. E.D.R. or sq. ins. W.A. leader area
F1.1 0S,- J3' Room I Length / Width
Windows and Doors—Crackage and Area
idth Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
F
t
Infiltration,
Glass
Exp. wall 12 y
Net exp. wall
Inc. wall
Ceiling
Floor PMAILLO
Total Btu.
Required sq. ft. E.D.R. or sq, ins. W.A. Leader area
F1.1 Room I Length - Width
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef.
Infiltration
Glass .
Exp. waU
Net exp. waU
Int. waU
Ceiling
Floor
Total Btu. .
Required sq. ft.. E.D.R. or sq. ins. W.A. Leader area
Btu
01
SUBJECT
City of Fridley
�,OF 18 8 7 4
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
RE
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 11-1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/13/87
JOB ADDRESS 5181 St. Moritz Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
3
5
Innsbruck,
2nd .Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Dale Bowen same
574-0567
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Authentic Construction Co, Inc. 2047
Grand. Avenue, St. Paul 690-3185
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
❑ NEW IX ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
251 x 191 one story addition
9 CHANGE OF USE FROM
TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood,
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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS
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
$29,350.00
$14.68
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
aROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON -
'RUCTION OR THE Rf FORMANCE OF C NSTRUCTION.
$215.50
PLAN CHECK FEE
TOTAL FEE
G/
'a
$53.88
$284.06
,NATURE OF CONTRACTOR AUTHORIZED AGENT (DATE)_
.
WHEN PROER ALIDATED
IS IS Y U%i/pE IT
BLDG )NSP
!/J 3
DATE
..ORE OF OWNER OF OWNER BUILDER) IDATEI
01
NEW [ ]
ADDN. []
ALTER. [ ]
Construction Addri
I
City of Fridley Effective 4/1/86
R-1 AND R-2
Building Permit Application
Legal Description: 1W—MW>��.__%JI,/lil�:��t�
•
s� 7
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width / Height L!�N
Length Width Height
Length Width Hgt/Ground
Corner Lot [ ] Inside Lot
Sq. Ft.
Sq. Ft.
Sq. Ft.
9a t7-�X Lf75 z agn3Lf0.')3
Ft. Yd. Setback Side Yard Setback
Type of Construction: Wvt/y
Approx. Completion Date: 09 Q I
Estimated Cost: $ &% 3S6,86
Klk Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired. $ $
See Back Page for Explanation
DATE: v APPLICANT• Tel. # ® 'eM0
IN F
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
'IPULATIONS : �-L ox-_
CITY USE ONLY
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$525 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
y,;So .
'9s,boo - f 7®,-'®
l6}C ', 21
GEORGE E. HOPKINS a Registered Land Surveyor and Civil Engineer
Phone SO. 1-8856 10701 Nicollet Avenue South
Minneapolis 20, Minn.
PLAT OF SURVEY
Scale 1 inch 4o _ feet
PROPERTY OF J?, o d _fid. g_11lm_cxn .3 0 D 0 — 3 L = A ve
Described. as Lot 3Block 5- Znnabraek 2nd Addition
Ce%lei iron mviumen} N
This survey was made and certificate drawn for the purpose of showing the
boundaries of the lot and the easement of record. There are no encroachments.
Building stakes were not set by the surveyor.
CERTIFICATE OF SURVEY
I hereby certify that on _Ilea• 19_% I surveyed the property described above and that the above plat 1.9 a correct
representation of said survey.
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $
($15.00)
$ 5.00
$ 3.50
$ 1.50
$ 4.00
$ 5.00
$ 5.00
S 5.00
$ 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
TOTAL
r
S
S .50
Ettective Aug. 1, lynl
Job Address
Department of Buildings
City of Fridley
Tel. 0571-3450
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
--r
Fridley. Mn. �+ , 19j
OWNER
KIND OF BUILDING _-1 '�� Y' Com'
USED AS
TO BE COMPLETED ABOUT �— =,2,S 5- /
ESTIMATED COST V4g;Q(!2?
` OLD NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP. /0 ' ;� -2,
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
O
m
ao
U
x
d
Water
ul
W
ro th
00. ,,
Wa,Heater
M
d
b
C
N
3
~~�
�
u .,Ci
0 x
U
d
u
o w°
rn
t�.o.
u a�
3
tai
o
as
lac
1
lat
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
V) - New Fixture, old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $
($15.00)
$ 5.00
$ 3.50
$ 1.50
$ 4.00
$ 5.00
$ 5.00
S 5.00
$ 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
TOTAL
r
S
S .50
Ettective Aug. 1, lynl
Job Address
Department of Buildings
City of Fridley
Tel. 0571-3450
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
--r
Fridley. Mn. �+ , 19j
OWNER
KIND OF BUILDING _-1 '�� Y' Com'
USED AS
TO BE COMPLETED ABOUT �— =,2,S 5- /
ESTIMATED COST V4g;Q(!2?
` OLD NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP. /0 ' ;� -2,
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
O
..... I.v.• retry. .. .Tref
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RATE
TOTAL
Job Address Z)Y .
\ 1 Mir �z N
lESIDe1rTIAL
Furnace Shell and Duct Work,
(Also replacement furnace) $
20.00
$ �,®�
Department o[ Buildings 6411 University Ave. N.E., Fridley, tat 55432
Burner
City of Fridley
Gas Piping $
10.00
$ \0 00
Tel. 1571-]{50
(piping needed with now furnace)
$
10.00
$
The undersigned hereby waked application for a permit for the work herein
Gas Range
specified agreeinq to do all work in strict accordance with the City Codes
Gas Dryer $
10.00
$
and rulings of the Departiment of Buildings. and hereby declares that all the
facts and representations stated in this application are true and correct.
•Air Conditioning loll sizes) S
10.00
$ IrD 00
Fridley. Minn.
All Others/Repairs and Alterations
OWNER
11 of Value of Appliance or work
$
RIND OF BUILDING
COMMERCIAL/INDUSTRIAL
USED AS
11 of Value of Appliance or Work
$
70 BE COMPLETED ABOUT
ESTIMATED COST T? '0 'D C:)
State Surcharge
$ .50
OLD -NEM BUILDING PERMIT ND. PERMIT NO.
TOTAL ITZ
$
Reinspection Fee ($15.00)
$
DESCRIPTION OF FUFIACE/BURNER
Rough Insp.
HEATING or POWER PLANTS, Steam. Not Water, Maes Alt- No.
ate
Date �
h
Trade Name 1�`���a��i Olae tom. G
Final Insp. d (
Date
Capacity 'J V03 10�111 Sq. Ft. CDR BTU HP
Approval for Pereit4 1Total
Connected Load Rind of Fuel
BURNER - Trade Name NMONIA0V Size No. GME -
Capacity E501000 Sq. Ft. EDR BTU 50,0C30 NP
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 Company(�\ �'� til C?'
PLUS $.50 STATE SURCIU\RGE
Signed
Attach stack verification fors with re•placnment furnace permits Te•I. No. (®'k( — L\ 1
*Air Conditioners can not !w• placed in -:td.- yard witlwut
written purmtsston from aduotning nr-►.tla.or.
CITY OF FRIDLEY
'?e eop -.7-0
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
4ESIDEILTIAL •
Furnace Shell and Duc k
Burner (Als replacement furnace
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
* Air Conditioning (all sizes)
All Others/Repairs and Alterations
1% of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
RATE
TOTAL
Job Address s
$ 20.00
$
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
$ 10.00
$
Tel. #571-3450 ^-
$ 10,00
$
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
$ 10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
$ 10.00
$
Fridley, Minn. 6 —_. 19
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp.
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00-
PLUS
15.00PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
$ .50
OWNER
KIND C
USED AS
TO BE COMPLETED ABOUT -
ESTIMATED COST _/®2��, Q eD
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam,,/ ,Hot Water, Warm Air- No.
&Trade Name , 'Aly'Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load ��� 100 ® Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
0
Company _
Signed Bi!'40
Tel. No. ,9 �,j
Fill out back side for stack verification on replacement furnaces
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
(✓f
No ( )
5. Meets all current Code requirements for size and
total BTU connected Yes No ( )
6. Has Total heating BTU's of / 0 o, o d 0
All other BTU's yd, 000
TOTAL
Rema rk s
Company A/T Il .0 w #Fii -
Signed By
Date l
i
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
�
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C
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N
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~
N
U •.ui
U a
U
E�
O .c
4 3
a
�
K
a.
U
�
w
cqi
d
o
Water
Heater
as
lec
S
Blow Off Basin
$
5.00
$
Catch Basin
$
5.00
S
Rein Water Leader
$
5.00
$
Hydraulic Valve
$
5.00
S
Sump or Receiving Tank
lot
5.00
$
Water Treating Appliance
$
7.00
g
Hot water Heater
/ S
5.00
Gas Range
$
10.00
$
Gas Dryer
$
10.00
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(') - New Fixture, old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$
5.00
$
Future Fixtures
$
3.50
$
Old Opening, New Fixture
$
1.50
$
Beer Dispenser
S
4.00
S
Blow Off Basin
$
5.00
$
Catch Basin
$
5.00
S
Rein Water Leader
$
5.00
$
Hydraulic Valve
$
5.00
S
Sump or Receiving Tank
S
5.00
$
Water Treating Appliance
$
7.00
g
Hot water Heater
/ S
5.00
Gas Range
$
10.00
$
Gas Dryer
$
10.00
$
Back Flow Preventer Required. . . Yes ( ) No ( )
Type $ 5.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $ State Surcharge
($15.00) TOTAL FEE
S
$
$ .50
Effective May 1, 1990•
Job Address 51 /' ge', // �
Department of Buildings
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 oorrect
Fridley, Mn. �� , 19
OWNER
KIND OF BUILDING
USED AS 454V, -'P ////, /
TO BE COMPLETED ABOUT
T �
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
ROUGH INSP.
Date
Company
Signed By✓
Tel. NO.��
,J77ple ®%Co QiaJ�
-?
FINAL INSP. — � (�
Date
APPROVAL FOR PERMIT
!1INIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996
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
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
64.,q s pf"o / � V-ed—
Commerciai/I dustrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $
$ �-da
State Surcharge 50
TOTAL FEE
?MINIMUM FEE FOR ANY HEATING/CgOL-1 VLgL1/ENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB ADDRESS
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.
,1996
OWNER ���C^t 4:2
BUILDING USED AS
ESTIMATED COST
PERMIT NO.
DESCRIPTION OF FURNACE AND OR 13URNER
No, of Heating Units
Trade Name
BTU_
Fuel
Burner Trade Name
BTU
Circle One (Steam) (Hot Water) (Warm Air)
Size No.
HP EDR
Total Connected Load
IS
Size No.
EDR
HEATING COMPANY__2;° Pry "(a,,r
Signed By'0� Tel No. 73q-5,
Approved By Rough—In Date Final Date
FILL OUT BACK SIDE OR STACK VERIFICATION ON
REPLACEMENT FURNACE
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHESMY 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
( )
S.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No
( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes ()
No
( )
8.
Has combustion air been provided for water heater
Yes ()
No
( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
SUBJECT
O.
City ®f Fridley
25515
AT THE TOP OF THE TWINS
BUILDING
PERM
P
EEC EIPT
COMMUNITY DEVELOPMENT DIV.
y J
rPROTECTIVE INSPECTION SEC.
ii
NUMBER
REV
DATE
9/17/97
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
JOB ADDRESS 5181 St Moritz Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
5
Innsbruck 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dale Bowen 5181 St Moritz Drive NE
574-0576
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Tabor & Sons Inc 3716 St Francis Blvd, Anoka, MN
55303 789-1902
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20014248
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO,
6 USE OF BUILDING
Residential
7 CLASS OF WORK "
❑ NEW ❑ ADDITION ❑ ;ALTERATION Ek REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK x`
Reroof House & Garage (23 Sq) Teak -off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State
Building Code.
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
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
$1, 918
$.96
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-
$62.25
Fire SC $1.92
ST CTION OR THE PERFORMANCE OF CONSTRUCTION.
�/1
PLAN CHECK FEE
Li s SC
TOTAL FEE
$5 14$70.13
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDA EI
N OP
L ALIDA THI IS R PERMIT
BLD INS
6A7E
SIGNATURE OF OWNERUF OWNER BUILDER) IDATEi
NEW [ j Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER ( ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION°
ConstructionAddress: bklJ�)E
Legal Description:
Owner Name & Address: Tel. #=�
Contractor: j�� �,�d �, MN LICENSE
Address: 371,e,' f���.�� `� � � ✓' Tel. # �?8 `7 /9a
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP'T'ION 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:
'93
Construction Type:
Estimated Cost: $
OU
���
ov
(Fee Schedul on
Back)
Driveway Curb Cut.Width Needed:
Ft. + 6 Ft = Ftx* $ _
$
DATE: Alr — APPLICANT:��/Z�
Tel.
CITY USE ONLY
Permit Fee
$ �. �2S
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation,(1/10th%)
State Surcharge
$ qL
$.501$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
60
$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
:3ewer Main Charge
$
Agreement Necessary [ ] Not Necessary [
]
TOTAL
$ 0,
'�TIPUI.ATIONS:
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK'NUMRFR nF FIXTI IRFS Tn RF INSTAI I Fn nN FArr" 1:1 nna
crrecuve un may -iv, iyaa
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer"
Back Flow Preventer Required ( )Yes () Nc
Type
NO. RATE
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
_L $10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
TOTAL JOB ADDRESS_ 3 t K4 -r 5 /J15Z 13�w�
State Surcharge $ .50
TOTAL FEE S 20- W
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 41vision, and hereby declares that all the facts
and representations stated in this application are true and correct.
BOWEN, DALE
Owner 5181 ST. MORITZ DRIVE
FRIDLEY, MN 55421
(612)574-0576
Building
cow
Estimated Cost �' PERMIT NO.
PLUMBING COMPANY,G
SIGNED BY
Approved By
TEL NO. rZ 7 - Vo_33
Rough -In Date Final Date
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
11
MifIrWash
+i:43.::r is
Uri nal
::::..:::::: Wash
)•`•.<`v
'i:f:i'ii::•:ti: i'i?•:
;};ii �.
ho e
>�«_� Shower r
:.. ..:..�.
.....:......
:��::��:. Drain
:.::.:.....:..:.: - -
:.:#'.:.:....:...:::,.:
i�itr<=� Washer P�
a
Ran a
f_ y'ry: Water Heater
Stories
��-�'•'- }:
f.:.
. f...
:.: .:
..... ........
;i�iy}ii
,:fi;� Gas Elec
Basement
sem nt
Floor 1
oor
F( 2
11
`>f>
Floor 3
:{
Floor
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer"
Back Flow Preventer Required ( )Yes () Nc
Type
NO. RATE
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
_L $10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
TOTAL JOB ADDRESS_ 3 t K4 -r 5 /J15Z 13�w�
State Surcharge $ .50
TOTAL FEE S 20- W
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 41vision, and hereby declares that all the facts
and representations stated in this application are true and correct.
BOWEN, DALE
Owner 5181 ST. MORITZ DRIVE
FRIDLEY, MN 55421
(612)574-0576
Building
cow
Estimated Cost �' PERMIT NO.
PLUMBING COMPANY,G
SIGNED BY
Approved By
TEL NO. rZ 7 - Vo_33
Rough -In Date Final Date
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
11
Building
BUILDING
Permit7QPNo.: ,2
Inspections
$
RESIDENTIAL APPLICATION
Received By
763-572-3604
CITY OF FRIDLEY
Date RRecc'd:
YOUR E-MAIL ADDRESS K01C GgC e—t j -e- oO'�i CS
DATE 1
SITE ADDRESS
a7 Y�
% • e 6 (1 +z 1)c-
)c•THIS
THISAPPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNERI
NAME: —bQN—e T—�nt Q -f
ADDRESS: CITY
STATE ZIP
TENANT
PHONE: �J • s �" 4LO
CONTRACTOR
NAME: PELLA WINDOWS & DOORS
STATE LICE 15300 -25TH AVE. N. STE. 4100
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:— PLYMOUTH, MN 55447 CITY
STATE ZIP
WITH APPLICATION
PHONE 763-745-1400
❑ SINGLE F LICENSE # 20165884 '
PROPERTY TYPE
❑ TWO FAM.., . TRIES
- -- -
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE k[j-C3 (,�� UJ5 WC4'y1 4J & `
, N% 0
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
an
Existing Floor P an
Proposed floor plan
PROPOSED SIZE:
❑ 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
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 THTOTAL JOB VALUATI N � 1 1'+- 0 3.B.0 FEE SOC CUPD AECY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
I hereby apply for a building
conformance with the ordman
permit but only an application
plan in the case of all work w
SIGNATURE OF APPLICANT
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( }
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
,rmit and I acknowledge that the information above is complete and accurate; that the work will be in
and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
a permit and rk is not to start without a p it; that the work will be in accordance with the approved
e es re 'e dapproval of
1 � DATE
$
$
�•/?
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( }
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
,rmit and I acknowledge that the information above is complete and accurate; that the work will be in
and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
a permit and rk is not to start without a p it; that the work will be in accordance with the approved
e es re 'e dapproval of
1 � DATE
Building MECHANICAL Permit No.: b07- f
Inspections RESIDENTIAL APPLICATION Received B�:
763-572-3604 CITY OF FRIDLEY DER a:
DATE ` YOUR EAWL ADD S
SITE ADDRESS Mort z
THIS APPLICANT IS: 0 OWNER CONTRACTOR
PROPERTY NAME:
OWNER/ ADDRESS: ST zt�y
TENANT ------
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
COMPANY NAME;_
CONTACT PERS(
STATE LICENSE It_
ADDRESS:
PHONE
SINGLE FAMILY
410
MIN
FAX
0 TWO FAMILY
TYPE OF WORK: 0 NEW LACEMENr
DETAILED DESCRIPTION OF WORK
MN 55408
0 TOWNHOUSE
0 ALTERATION/REMODEL
STATE ZIP
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 BASEP ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: 71cr
NUMBER OF EACH BELOW) SIZFATU 4
Equipment huwlled Gia MODEL:
MF MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
_ PLACE (GAS) $15.00 GAS RANGEIOVEN $10.00
TSO 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 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTII,ATOR $15.00
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 @ $25.04 r x $25.00 = $
Number of fixtures @ $35.00 x$35.00=$ -
State
$35.00=$State Surcharge = $_____j0
Total =
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 of tfidley and with the Minnesota Construction Codes; that 3 understand this is
not a permit but only an ap lication for a d rk is not to start without a permit; that the work will be in accordance with the
approved plan in the of o w 'ch s re ew and approval of
�1i�1 ATE L
SIGNATURE OF APPLI /
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 HQI ES
1. Combustion Air (See note belo�vy
a. Oil or solid fael IMC Chapter 7 with MN Amendments
b. Natural Gas or PropaneUGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
& IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances 1FGC 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