Loading...
PRE 2010 DOCSCity of Fridley, 31inn. BUIIDING , PERMIT M 5632 1 1' Date: Owner: Builder— Address Address No. _s f VOCATION OF treet Lot — _ Block tion or Corner Lot ___ _ _ Inside I.ot -�"° Setback -Part o Lot Dn ., Sideyard Sewer .Elevation _ _ _ _ Foundation Elevation DESCRIPTION OF BUILDING To ,� Used ,�.. ,� Front �` _..,�` _ Depth �.� Height Sq. �19. Cu. Ft t Z041Depth Height Sq. Ft. a. Cu. Ft. Type Construction Est. Cont`, Wo '" 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 m compliance with all provisions of grdinanoea of the city of Fridley. In consideration of the payment of a fee of _, permit is hereby granted to 4 to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, 'employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, 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. Building Inspector NOTICE: This permit, does not cover the construction, installation for wiring, phimbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these items. 4 m . rr APPLICATION FOR BUILDING PERMIT CITY OF FRIDIZY, MINNESOTA Owner's Name Builder Address Address No. /;? 0 Lot Block LOCATION OF BUILDING Part of Lot &4.-"� tion or Subdivision I Corner Lot Inside Lot I' ---Setback 3-5 r Side -Yard ," 0 SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: % FrontDepth__,;Ly Height Sq. Ft. f�,�/i Cu. Ft.�h`f� FrontDepthJi' Height Sq. Ft. Cu. Ft. Type of Construction, 0 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 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. DATE SIGNATtA?K (A Schedule of Fee Costs can be found on the Reverse Side.) FIEN 02 1 11 Ai�� fj►1:611]I� 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 build- ing 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 $1.10 for each one thousand cubic feet, or fraction thereof, in such cubical contents. 2.2. For any such permit for the erection of any fireproof garage, warehouse, factory or grain elevator, or for the erection of any fireproof addition, for similar occupancy, to any existing building small be at the rate of $1.25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. 2.3. For any such permit for the erection of any non -fireproof building 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. GARAGES 2.1,,. For any such permit for the erection of any non -fireproof garage, warehouse, factory or grain elevator, or for the erection of any nor -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 04.00. For the purpose of computing fees for building permits ,the cubical contents of any building or addition to a_uni:"orm 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. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 for each Five Hundred Dollars ($500.00), or fraction thereof in the cost of all proposed work. 2.6. In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. Application for Power Plants and. H , Cooling, Ventilation, Refrigomflon 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 $— v 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 NO RATE TOTAL 1st 3 Fixtures ...................... Furnace Shell & Lines—to 400 sq. ft. IDR 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 uu GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ -f GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $--/ —1-1-0 Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH FINAL Dept. of Bldgs. Phone SII 4-7470 g City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn ^ 19 Owner C �Myj Kind of Buildingm.�m Used as��ss" To be completed about 1,:9— 3 cy— C 0 Estimated Cost, $S%a '-4—c" Old ew. uilding Permit No. a � `�� Permit No. z DESCRIPTYON OF WORK HEATING or POWER PLANTS—Steam, Hot Water, arm Air No Trade NamOc Size No G '� _ 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) Signed 44' c By I�REi98�; �E ��'Rack .42 2M 7-59 Businesshohe o �� TE L. HA. —!q - City ' of; Fridley Appliccition for PlumMito,' Gas Fitting Permit n%aut_ of Blclera. Phnnp R4 4_747n DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE ��aa11 a x $1.50 $ i YY Z $ Z x 1.00 g Catch Basin ............................ U' 2 -.: • P • N WATER NTR. GAS ELEC. $ O Base 1st4 v 2nd _ 3rd 4th • Future Connection Openings Connected with Sewer � New .Fixture. Old Openings Cesspool [] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL.._ Number Fixtures ....... .............. x $1.50 $ i 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 .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code 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. , Minn 19_ Owner Kind of Building Used as To be completed about 9— 3 6- 4 -111 --- Estimated Cost, $ Ol a Building Permit No ermit No. o Signed 0 lffifla By 9 - Business Phone No. - ROUGH--/ A FINAL Description...................$ ............................. TOTAL FEE $ / -5 - -D dz 2M 7-59 01 SUBJECT PER City of Fridley 16 3 3 2 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT COMMUNITY DEVELOPMENT DIV. �� 1 PROTECTIVE INSPECTION SEC. 1 � = CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY l 612-571-3450 910-F15 8/7/81 / 10B ADDRESS 180 Stonybrook Way NE 1 LEGAL LOT N0. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 8 Pearson's.Craiway Estates 2nd SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Doucrlas A Brawn 180 Stmybrook 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 J ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK r t 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R.-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS I 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 $2,180.00 $1.09 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $38.50 PLAN CHECK FEE TOTAL FEE ! 49.21 SIGNAT RE OFCONi ACTOR OR AUTHORIZED AGENT IDATEI WHEN PROP RL VA ID T D THIS IS OUR PERMIT BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 01 CITY Of FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PEMITS (New, Alterations, Additions, or Repairs) ADDRESS: 1�® D����®� l/,f y '41E TEL NO: X7/ ®'723/ • STRUT NO: / 0101,Z) STREET: LOT: � BLOCK: BUILDER: ADDRESS: TEL NO: Construction Location 01 at y ADDITION: %,E.4,0f®N Nq Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION C,k Front: Square. Feet: _V,00s414- 1,)d4le Front: Depth: /If Cubic Feet: �ft0 Height: Depth: Height: Square -Feet: Cubic Feet: _ �G CC CPI � d 0V Type of Construction: 494W Estimated Cost: $ ;0,00- 710 Be Clompleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . Tile undersigned hereby makes application for a permit for the tork'herein specified, agreeing to do.all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this applicz DATE: of lql�l SIGNATURE: Stipulations: BUILDI•NG P•E•RMIT FEE. SCHEDULE The Inspector of buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any bxisting building or structure, or for any alteration or repairs 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 VALUATION FEES $1.00 to $500.00 $10.00 Minimum Fee $15.00 plus surcharge $501 to $2,000 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 and up $443.00 for the first $100,000 plus $2.50 for each. additional $1,000 or fraction thereof PLAN CHECK: 25 percent of building permit fee DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only Alternate "A": Removeal and replacement of curb and gutter only Driveway width plus 6 feet x $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 x $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 been constructed will be required before proceeding with.the framing. IM MIN 1N t NEW NES' IWeIM� low WWI 7,:_ IN SUBJECT PE City of Fridley 20630 AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r i ,.� CITY HALL FRIDLEY 55432 NUMBER REV. GATE PAGE OF APPROVED BY --_- 1 d` 612-571-3450 910-F15 JOB ADDRESS 180 Stonybrook Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 8 Pearson is Craigway Estates 2nd Addn. SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Douglas Brown 180 Stonybrook.Way N.E. 571--7231 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (32 squares) 2nd layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be 2nd layer but not 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. 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 NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 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 $1 6Q0 $.80 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT F 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- $37.Q0 Fire. SIC $1.60 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $32.40. NATURE OF ONiRACTO IDATEI PROPERLY VALI ATED THIS IS YOUR PERMIT Oj::�ZEDENT r r��WHEN BLDG INSP E SiGNATU OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] Effective 8/16/90 ADEN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: IXD S�ONy� lrVA��y &L Legal Description: liDj _7 Ifl-o cir ®'L�s,•e1d1/J �l.l/CGr/�f�/ xg,,<r 2 -,yo. W19J Owner Name & Address: Contractor: sEk'4' -5041' 61fJ r) Tel. # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length Width GARAGE AM: Length Width DECK AREA: Length Width oma: pe F Ille u-rE 31z s49 Height Sq. Ft. Height Sq. Ft. Hgt/Ground ICT -700F - Sq. Ft. A'2s 9L �- T 700 F Corner Lot [ ] Inside Int [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: A#114,47211 Estimated Cost: eAlp 00 .do- Approx. Completion Date: Xl W7 -f-( Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: Cil` 6�° APPUCANT: Tel. # s91_723% CI'T'Y USE ONLY Permit Fee $ c� % Q b Fee Schedule on Reverse _ Side Fire Surcharge $ 1,60 .001 x Permit Valuation (1/10th %) State Surcharge $ el3d $.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Perk Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ �:=3' �?- X/O The Chief Building Official shall, before issuing p nrL is 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: $1 to $500 $15 (Minimum Fee is $15 plus sur u-aVe) $501 to $2,000 $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3538.50 for the first $1,000,000 plus $2 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. Permits for construction will be issued a minimum of 24 hours frcan 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 MECHANICAL Permit No.: ` -6 c Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY D ec'd: ^ DATE eg5 ! YOUR E-MAIL. ADDRESS SITE ADDRESS c Q, IA ® � Q THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY NAME: l QQ i h c� ADDRESS: 5"a4 e" e CITY 'Fr /'l b y STATEi� &1-P -5- S Y-7 OWNER/ TENANT PHONE: CONTRACTOR COMPANY NAME:,�v1 CONTACT PERSON: /Col U SUBMIT A COPY OF STATE LICENSE # 700 3 o`— EXP DATE YOUR STATE LICENSE WITH ADDRESS: CITY STATE ZIP APPLICATION PHONE 29,3 Y -A 1A SSG FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK ti 'n EC 'e PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) ®� a l� Equipment Installed MFG: f d MODEL:. / SIZElBTU MFG: MODEL: SIZEIBTU MFG: MODEL: SIZE/BTU 30 $25.00 F LACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _A/C TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR _FIREPLACE $35.00 $35.00 _GAS UNIT HTR $10.00 _BOILER _FURNACE LINER $10.00 DRYER $10.00 _POOL HEATER $35.00 _CHIMNEY _GAS DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 .r gl Permit Fee $. — Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $, (9.__rT Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 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 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 re uire _�evie and approval of plans. ® PRINT NAME DATE SIGNATURE OF APPLICANT q r i'. .-s. xux[r ,: -'•r.,. ., _- c.,.'aa ....>I"a r ,r... r ..n x+i., .,.x�.v .... r� o.. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 0 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 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. Building ffC ICAL rG11111L 1V V.. Inspections SIDENTIAL APPLICATIONReceived By:INVA 7.63-572-3604 CITY OF FRIDLEY nU. YOUR E-MAIL ADDRESS SITE ADDRESS I A L 16 w t, 64' � A ' N � THIS APPLICANT IS: [3 OWNER -- *CONTRACTOR NAME: 14 Q,t �(n ZH,oe�tSo 6&STATEKO ZIP PROPERTY OWNER/ ADDRESS: * 9 b i o �� Is Of CITYhl t _Kq_�— TENANT PHONE: T6�)-- �� a- a d I I LI CONTRACTOR COMPANY NAME: '-V'- C k- t-0– r -t' A I CONTACT PERSON: C'_"r v j SUBMIT A COPY OF YOUR STATE STATE LICENSE #1 EXP DATE LICENSE WITH ADDRESS: ��I c�c`+ CITY E� STATE!jW ZIP 3� APPLICATION PHONE 6 �., 5 `-f ®1 d FAX SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE PERMIT TYPE TYPE OF WORK: 0 NEW 0 REPLACEMENT )_'�ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK _:ran 54..%j 1 6, 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. (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: MMICATE TOTAL NUMBER OF EACH BELOW) ..1j Installed MFG: K®" III 6–t MODEL: .Ib�� Itisd` L �! S�, U Equipment MFG: MODEL: MFG: MODEL: S1ZF/BTU A/C $25.00 [FIREPLACE (GAS) $15.00 . —GAS RANGE/OVEN $10.00 NEW GAS GRILL $10.00 TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 UNIT HTR $10.00 _AIR _BOILER $35.00 FURNACE $35.00 —GAS LINER $10.00 —GAS DRYER $10.00 —POOL HEATER $35.00 _CHIMNEY _DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 b x $15.00 = $ .9 5• o TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ 15.1 � 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. / C'Itia �.Q PRINT NAME k C ,S DATE SIGNATURE OF APPLICANT , ', Ai.:A _TTb�Tr*n7a C��Rt�a �:.� o ®� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977