PRE 2010 DOCS0
City of Fridley, Mmm
BUILDING PE I
N?55E10j
Date: 51.
«r...
xa �
Owner: �'* cry" �'' der
Address _ _ _ _ Address
/21 LOICA ION F BUILDING
No. _ . _w ttreet
Lot
Corner Lot W inside Lot
Addition or Sub-Divisio
—Setback Setback : _ _ Y Sideyard
Sewer Elevation __ __ _ _ Foundation Elevation
DESCRIPTION OF BUILDING
To Used ir
N
"
Front Depth,0. Height Sq. Ft. Cut.
_4,
. Fro Depth ."Height ___ Sq. Ft. Cu. Ft. _
Type of Construction Est. c6st 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 $ 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, iNnnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
I 1' '"�_ 'Building Inspector
If
NOTICE:
This permit does not cover the construction, installation for whing, plumbing, gas beaflno, sewer or water. Be sure to see
the Building inspector for separate permits for these items,
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEYo MINNESOTA
Own . er.'. s' Nam�Z�, LZ ilder
rl
'-Address Address
NO.
art of Lot
Lot
BIOCK ,I
Aaaixion or suoalva.sao m,
Corner Lot
Inside Lot
SetbackSide-Yard
SMMR ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
DESCRIPTION OF BUILDING
To a used as:/
FrontDepth eight
Sq. Ft.. Cu. Ft.6A 6
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Constructi Estimated Co
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-
ings, and hereby declares that all the facts and represen�ions
stated in this application are true and cor
DATE ® .f -5__ --
(schedule of Fee Costs can be found on the Reverse Side).
BUILDING PERMIT FEE SCHEDULE
Section 2. The Inspector of Buildings shall, before issuing any
permit for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alterations
or repairs to any existing building or structure, upon application
therefor, require the payment by the applicant for such permit of
fees to the amount herein below set forth and in the manner herein
provided to -wit:
2.1. For any such permit'for the erection of any fire -proof building,
other than a garage, warehouse, factory or grain elevator, or for the
erection of any fire -proof addition, for similar occupancy, to any
existing building shall be at the rate of $1.40 for each one thousand
cubic feet, or fraction thereof, in such cubical contents.
2.2. For any such permit for the erection of any -fire -proof garage,
warehouse, factory or grain elevator, or for the erection of any fire-
proof addition, for similar occupancy, to any existing building shall
be at the rate of $1.25 for each one thousand cubic feet, classified
as "fireproof" by Section 502 of the Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any non -fireproof build-
ing other than a garage, warehouse, factory or grain elevator, or any
non -fireproof addition, for similar occupancy, to any existing building
`Permit $1.00 for each one thousand cubic feet.
GAGES
2.4. For any such permit for the erection of any non -fireproof,
garage, warehouse, factory or grain elevator, or for the erection of
any non -fireproof addition, for similar occupancy, to any existing
building or for each such building or addition. Ninety Cents for each
one thousand cubic feet or fraction thereof, in the cubical contents
thereof with a minimum of $4.00.
For the purpose of computing fees for building permits the cubical con-
tents -of any building or addition to a uniform height throughout by
multiplying the ground area covered from a point six (6) inches below
the floor line of the basement or cellar to the average height of the
upper surface or to the average height of the roof surface of the main
gable of a pitched roof.
2-.5,4• .. For repairs or alterations to an existing structure, the fee
shall be at.the rate of $3.00.per`each Five Hundred Dollars ($500.00)
or fraction thereof in the cost of all proposed work.
L._6. in no case shall the fee charged for any permit as set forth in
section 2 be less t- $4.00.
City of Fridley
Application for Plumbing and Gas Fitting Porn*
Dept. of Bldgs. Phone *#,4-7
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
F
+'
y�yl
�^ Z*
3
�L
N
6
H
S Y
3
Y
Z
o
'
Z
S
a
Z
Q
U
p 2
Q 3
,
�V'
w
G
�U' n4
Z
Z
(�9 O
#
F
#
N
WATER HTR.
GAS
ELEG
Base
Water Heater (Up to 200,000 BTU)
...... x
2.00
$
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
Z x
$1.50
$
Additional Fixtures ....................
1st
.50
f
Gas Range to 200,000 BTU ..............
x
2.00
$
2nd
3rd
4th
' Future Connection Openings
New Fixture, Old Openings I
Connected with
Sewer
Cesspool �
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL �
Number Fixtures ......................
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
$
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
Z x
$1.50
$
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE,
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 Ordinance.
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are trued c9frect.
Fridley, Alinn . k_,- `-
lov
Owner
Kind of Buildin
Used as
To be completed about _
Estimated Cost,
J, ,19--e /
Old—New. Building Permit No— Permit
Sign • -
1 7�1
Business Phone No-
ROUGH
o
ROUGH
FINAL
r
Application for Power Plants and Heating, Cooling, Ventilation, Refrtgeraflon and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
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
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
'J�e ty J
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
$
Al' --!0jING
$
'TEM See Fee Schedule
TOTAL FEE
Dept. of Bldgs. Phone SU. 4-7470
M
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, n Z/ loeo'__4 o 19 —
Owner P
Kind of Building % F
Used as
To be completed about
Estimated Cost, $
old—New. Building Permit No. 5 /" Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS- te of Wate , Warm Air—No Z
Trade Name J C_1_ - Size No -C a -r -
Capacity OLl Sq. Ft. E.D.R 7 29 0 BTU H.P.
a3 _
Total Connected Load L/0 Kind of Fue e
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
Signed -4.
By
MEMO PLUPASU A HEATT SWIG
A ORA, MINN. TEL. HA. 1®1382
42 2M 7-59 Business Phone No
., INC. Job Name
ze NEAT LOSS 4ALCULATIONS Job Address
A.,
Weatherstrips .SH.V.E
_ Guide Construction No. I Insulation
W�indowo" Doors . Reference Out. Wall Int. Wall Ceiling Roof Floor i Kind How Applied
Yeti No
Y41410 19_
I Fl.l O Room I Length /!9 Width JV Height c,,' II Room I Length IQ Width OHeight
Windows and Doors—Crackage and 'Area
Room 1 Length
Width Height No. of Lineal ft. Area
No, of pane of pane lights of crack sq. ft.
O jy 2
o
L ® 117,417KA-
Windows and Doors—Crackage and Area
Coef. Btu
Infiltration
Coef.
qO O 1Q iv
'Glass
19ray
I Y ® 4
Exp. wall
hir O
Glass
Net exp. wall
/Y
o
Int. wall
Exp. wall
7
Ceiling
Floor
Net exp. wall
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.I Bz, PO, Room I Length J V Width. /0 Height
Windows and Doors—Crackage and Area
Room 1 Length
Width Height. No. of Lineal ft. Area
No. of pane of pane lights of orrack e,. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
o
L ® 117,417KA-
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.1
Coef.
Infiltration
Infiltration
19ray
to 96
hir O
Glass
/Y
6
Exp. wall
Exp. wall
7
Net exp. wall
Net exp. wall
Int. wall
7 ;k -
jLILL
a
0
Ceiling
/
�0
Floor
Ceiling
Floor
/
0
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
.R Fl.l Reem I Length ® a Width / i Moiaht
Windows and Doors--Crackage and Area .
Room 1 Length
Width Height. No. of Lineal ft. Area
No. of pane of pane lights of orrack e,. ft.
J
I i
o
L ® 117,417KA-
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.1
Coef.1 -,Btu
Infiltration
19ray
to 96
Glass
Infiltration
Exp. wall
4yo
Exp. wall
Glass
7
Net exp. wall
Int. wall
7 ;k -
jLILL
go
Int. wall
Net exp. wall
/
Floor
Ceiling
Ca
Floor „per
Ceiling
423 *62
S" 0
Tbtal Btu.
Windows and Doors—Crackage and Area
Room 1 Length
Wl th
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
o
L ® 117,417KA-
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.1
Btu
Infiltration
19ray
Glass
f�
Infiltration
Exp. wall
'ya
J;2,0
Glass
Net exp. wall
rpe 1.916
0
Int. wall
7 ;k -
Ceiling
Net exp. wall
/
Floor
Int. wall
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
0 V` G r
'd H ' h
Fl.1
Room 1 Length
Wl th
P
elg t
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
-7 Ile
Infiltration
Glass
Coef.:
Btu
Infiltration
Net exp. wall
'ya
J;2,0
Glass
IfO
AO 0
Exp. wall
7 ;k -
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1_I Rnnm I Length Width Height
Windows and Doors—Crackage and Area
/yam
f'?
d
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.
Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
ft. E.D.R. or sq. ins. W.A. leader area II Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
INC. Job Name
ee HEAT LOSS vla ' U0118 Job Address
Weatherstrips A.S.H.V.E, I
Construction No. I Insulation
Guide 1
Windows Doors Reference Out. WaU Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No I Yes—No 19— I
11
I Fl.l 1 IV Room I Length D ✓ Width ,/ Y He;.ht Room I Lensfth JAI Width / fl Height
Windows and Doors—Crackage and Area
I JZ v® I
AO0
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
0, 0
%-,V- P
6 L
-
Net exp. wall
Coef.
Btu
Infiltration
,�
•.
? a
a ® Al 0
Glass
Floor
47
J5-cl
A7S
Exp. wall
Net exp. wall
tJ��
fie' P®
Net exp. wall
Exp. wall
00
Net exp. wall
Int. wall
'PO
D''
Net exp, wall
Ceiling
6t Q►
t4l
/
"
Floor
/Aj
/4'j,
Total Btu. 1 Z115F�
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I F1.1 Aa-vnom.. Room I Length S7 Width „F) Height e a-
WindO and Doors—Crackage and Area
I JZ v® I
AO0
Glass
WidthHeight No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
%-,V- P
6 L
-
Net exp. wall
/S 0 .
/5'7
Coef.
Btu
•.
Infiltration
°l®
0
Floor
Ala
'r, ®
0
Glass
Net exp. wall
tJ��
fie' P®
// P
Exp. wall
00
Net exp. wall
fa
'PO
D''
Net exp, wall
Int. wall
ef- 3
t4l
/
Jr
Floor
Int. wall
/4'j,
t
Floor,/
Ceiling
Floor
(,�j &n --i
Total Btu. I Zv 7.
Required sq. ft. E.D.R. or sq. ins.. W.A. Leader area
Fl. a - Room Length / Width /0 Height jE
Windows arg Doors—Crackage and Area
Width I Height No. of Lineal tt. Area
No. of pane of pane lights of crack eo. ft.
Infiltration
I JZ v® I
AO0
Glass
3-4- 5-0
%-,V- P
Exp. wall
-
Net exp. wall
/S 0 .
/5'7
Int. wan
Infiltration
•.
Ceiling
°l®
0
Floor
/ 1 m0-
/ Al 2
Total Btu. 1-1-41
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
;1L '/ O
"7-® 3�
Coef.
Btu
Coef.
Btu
Infiltration
90
41 C)Y
N
O
®�
Glass`
Exp. wall
Net exp. wall
Exp. wall
fie' P®
// P
lbq
00
Net exp. wall
fa
'PO
D''
Int. wall
t4l
Jr
Floor
Ceiling
/4'j,
t
Floor,/
,
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
• rn 1 ` n _ --- l r ---L avf:-1.1- &Y- f..r_:.t. ..
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
;1L '/ O
Coef.
Btu
Infiltration
Infiltration
YD
90
Glass
/ 0
Glass
0
Exp. wall -
Exp. wall
Net exp. wall
/0
"5-0
Int. wall
lbq
00
Ceiling
fa
Floor
Ceiling
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 F1.1 A Reem I Lenath 19- Width /9 Height 9
41 Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of -pane lights of crack sq. ft.
;1L '/ O
Coef.
Btu
Infiltration
-p C,
/ 0
Glass
Exp. wall
�o
Net exp. wall
lbq
00
f6
Int. wall
Ceiling
t4l
Jr
Floor
_ -
S- A
Total Btu.
W
ft. E.D.R. or sq. ins. W.A. Leader area
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Effective On January 1, 1991
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 eplacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
Rate TOTAL
$ 20.00 $
$ 10.00 $-
$10.00
$10.00 $
$10.00 $
*Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commerci aUl ndustrial
1 % of Value of Appliance or Work $
State Surcharge $ .50_
TOTAL FEE $ S-0
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB
t
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 ruling of the Building Division, and hereby declares
that all the facts and representations stated in this application are
true and correct. 9-276 ,1991 -
OWN
WE
BUILDING USED AS
ESTIMATED COST lJ✓ PERMIT NO.
t
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units l Circle One (Steam) (Hot Water) (Warm Air
Trade Name Size No. ,
BTU Y H _ EDR
Fuel—� Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
finnond F_. Snns Elm. Inc. dba
HEATING COMPANY
Signed By WiwTel No.
Approved By/ Rough -In Date Final Date
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 ( )
2.
Is free from rust or deterioration
Yes
No ( )
3.
Has no foreign objects lodged within
Yes S,4
No ( )
4.
Is securely supported
Yes "
No ( )
5. Meets all current Code requirements for
size and total BTU's connected Yes No ( )
6. Has total heating BTU's of 6�4zv
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date /1JScP 26 1994 - rl�n v A Air Cc!
G
SUBJECT
PERMIT NO.
City of Fridley
28463
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
► COMMUNITY DEVELOPMENT DIV.
L_____
e
r � PROTECTIVE INSPECTION SEC
c
—1
e �
+ CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/28/98
JOB ADDRESS
160 Stone brook Fa -
4
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
8
g
IPearson's Craigway, 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Wesley D. Jensen
571-6260
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Westurn Cedar Supply 705 N. H 169 Plymouth 55441 541-0304 20014207
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 JEx REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 21 S Tear -off
9 CHANGEOFUSEFROM 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 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
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
1799
$.90
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACGE
PROV SIGNS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STR TION OR THE PERFORMANCEAF CONSTRUCTION
$56.75
FirCH C $1.80
PLAN CHECK FE
TOE
/ -
4"�L
is s S
5
5
SIGNATURE OF CON7RACTOR OR AUTHORIZED AGIV(DATE,
ENO
A ID HIS IS Y PE I
S,GNATURE OF OWNEROF OWNER BUILDER, IOATEI
BLD INS-
BATE
G
'NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: N&L A ox-',
Legal Description:
Owner Name &Address: �1)T Sr�CO ?). O�A)SFdv �5T. Tel. # QS -7 - GL 2-& 0
Contractor: MN LICENSE # ZOd /c,G207
Address: Tel. # SV/-®36�
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 AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction TyEstimated Cost: $ -� / do
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT�✓c�y Tel. #
,�
$ X80
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$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 [ ]
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to -wit:
TOTAL VALUE FEES
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR
Permit No'�W q -®16 �
Received By:
SITE ADDRESS
MODEL:
SIZE(BTU
THIS APPLICANT IS:
❑ OWNER
O ACTOR
PROPERTY
NAME:
NEW GAS GML $10.00
OWNERI
FURNACE $35.00
GAS UNIT HTR $10.00
_CHININEY LINER $10.00
ADDRESS:
ZIP
TENANT
GAS PIPING $10.00
VENTILATOR $15.00
PHONE:
d
CONTRACTOR
CONIPANY NAME:
tan and Heating Air Gonddloffing
SUBMIT A COPY OF
CONTACT PERSON:.
�j��H�
YOUR STATE
STATE LICENSE #
F17_R7d-7W DATE
LICENSE WITH.
ADDRESS:
CITY STATE ZIP
APPLICATION
PHONE
FAX
PERNIIT TYPE
SINGLE FAXIILY
13 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:I E3 NEW ACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SDN/BTU
MF yk„ MODEL: SIZFJBTU�7078
MFG:
MODEL:
SIZE(BTU
A/C $25.00
FIItEPLACE (GAS) $15.00
GAS RANGWOVEN $10.00
AIR TO AIR EXCHANGEER $15
FIREPLACE (WOOD) $35.00
NEW GAS GML $10.00
CBOIL ER $35.00
FURNACE $35.00
GAS UNIT HTR $10.00
_CHININEY LINER $10.00
GAS DRYER $10.00
POOL HEATER $35.00
DUCT WORK $10.00
GAS PIPING $10.00
VENTILATOR $15.00
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
J NEW HOMES/ADDITIONS )(EXISTING HOME U MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
& Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/dFGC Chapter 3 with MNI 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 WIOMES
4. Heat loss & cooling load per room
a. Required on new Construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7612
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.
JfAAS-t k-\,
D
10/16/2009 Revision Data: 10/19/2009 Existing Construction: Pre 1994.
Site Information
Address 1: Project #:
�
Address 2: 1 �S40N Lot: Block:
City: County: d ` o o� Subdivision:
Application lnformation
Business Name: Standard Heating MN Contractor License #:
Contact Person: A:�tdsay-', Iwey- W -r- ev, ,
Office Ph: Fax: Cell Ph: 612-207-9705
/address 1: 130 Plymouth Ave N
City: Minneapolis State: MN Zip Code:
Combustion Appliance
Water Heater: Natural Draft Input BTUs: 40,000 Common Vent Combustion Zone 2
Combustion Zone 2
Fumace/Boiler: Natural Draft Input BTUs: 96,000 Common Vent
Other Combustion Agaliances
Gas Fired Direct Vent Fireplace(s): No Gas Fired Power Vent Fireplace(s): No
Gas Fired Natural Draft Fireplace(s): Yes Solid Fuel Appliance(s): One
Exhaust Equipment
Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135
Exhaust Fan Rating (cfm): 50
Make -Up Air
No Make -Up Air Required by Code
Combustion Air
Combustion Zone One: Minimum Combustion Air Requirements Met.
Minimum Combustion Air Requirements Met.
Applicant Nar
Code Official
x 1q,6' xera
�
Signature/Date: /0 It 0 /
signature/Date:
0 2004 CentcrPoint Energy Minnt;gmcu. 2004 Mechanical Codc Guidriines.
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