PRE 2010 DOCSCity of Fridley,-gfinn.
URDING PERMIT N?
,r •
Date: tea'
Owner: 6116=1-41z�'- 9Builder
Address Address
LOCATION OF BUILDING
No. Street of Lot -.--
Lot /22 __ Block Addition or Sub -Division -
Comer Lot ._ Inside Lot �� Setback l'� -.� __._ Sideyard—®
Sewer Elevation _ tea 9 F4vndwdon Elevation
7—o
F— ®C— C-R+Cy'r®f(a!4�
DESCRIPTION OF BUILDING
T Used lei
®®�,,
10 V AV
Front -4&=—Depth Height Sq. Ft. Cu. 1?'t�.L nO
zIMFro t Depth eight Sq. Ft. Cu. Ft. ID
.ff,9.*ctiofi Est. � TO be Completed
In consideration of the issuance to me of a permit to c e b ding described e, I to do
the proposed work in accordance with the description above forth and in complian all , r sions of
ordinanoes 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, Minnesota regardinq location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any upon viola on of any of the provisions of said
ordinances. Ql]
Building Inspector
NOTICES
This permit don not corer the construction, Installation for miring, plun*lne, an heating, sawar or crater. Be sate to we
the Building hapector for separate permit for then hems.
f
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name CLFMRON INC. Builder SAME
Address 2500-22nd.A.VE.N.E. Address-__,®
LOCATION OF BUILDING
No. 7362 Street, SYMPHONY ST Part of Lot
Melody
Lot 10 Block 5 Addition or Subdivision Manor
Corner Lot Inside Lot x Setback 35' Side -Yard 10 & 5' Plus.
SEWER ELEVATION FOUNDATION ELEVATION3oL
Applicant attach to this form Certificate of Survey of Lot and,
proposed buildihr location.
DESCRIPTION OF BUILDING
To 'be used as:
Dwelling Front al2Depth_,2 ' kleight 8'
Sq. Ft. 1050, "Cu.. Ft.
Garage Front 12' Depth 24' Height. 91
Sq. Fte 288' Cu. Ft.
Type of Construction Frame Estimated Cost 14,000
'To be Completed 2/1/6!4
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 representations.
.stated in this application are true and correct.
DATE 11/13/63 SIGNATURE
fSchedule of pee Costs can be found on'the neve 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 seat 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 garagaj warehouse, factory or grain elevator, or for the
erection _of any fire -proof addition, for similat 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 $1025 for each one thousand cubic feet, classified
as "fireproof" by Section 502 of the Minneapolis Building Code.
FY V ES
20.
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.
-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„ 1,, For repairs or alterations to an existing structure, the fee
shall be at the rate of $9.00 per each Five Hundred Dollars ($500.00)
or fraction thereof in the cost of all proposed work.
226. in no case shall the fee charged for any permit as set forth in
Section 2 be less th, $4.00.
---(; 'Q41, , .. -
J
SUBJECT
PE713:19
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
0-/
r SEC.
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-560-3450
910-F15
7-25-75
JOB ADDRESS
7362 SYMPHONY ST. N E. FRIDIZY,
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
10
5
MELODY MANOR SHEET
-2-PROPERTY OWNER MAIL ADDRESS ZIP PHONE
PAT ABEGGLEN, 7362 SYMPHONY ST. N.E., FRIDLEY, MINNESOTA
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
LINDGREN ROOFING 5006 - 71ST AVENUE NORTH
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
RESIDENCE
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION XIX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
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. 3HINGLES
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 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
$463.00
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. -
STRU TION OR THE PE RMANCE OF CONSTRUCTION.
$5.00
PLAN CHECK FEE
TOTAL FEE
_
/ '� 1 7F
SIGNATURE OF ONTRACTOR CfAUTHORiZED AGENT (DATE)
HEN PROP RLY A/AL'IDATED THIS IS YOUR PERMIT
all(l-' �Z'j �'ULY 25, 1,975
BLDG. INSP DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
---(; 'Q41, , .. -
J
• ' -APPLICATION FOR RESI'DE'NTIAL., ALTL'RATION,
OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY, MINNESO'T'A
OWNER'S NAME :Pn461e / BUILDER : �► tl Cly ew 01► y
ADDRESS 73C� �- �' may' 47
ADDRESS: ®� °� 7/ v-e /Yo
i
NO:. STREET:
LOT: BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: _ SIDEYARD:
Applicant attach to this form Two Certificates.-if Survey. of Lot and.proposed
building location di-:wn on these Certificates.
e
DESCRIPTION OF BUILDING
To Be Used As: `
Front: Depth:-• Height:
Square Feet: Cubic.Feet:
• Front:' Depth: Height:
Square Feet; Cubic Feet:
40
Type of Construction: ���� %�- AOU4 �e Estimated Cost:
To-Be Completed:
The undersigned hereby makes applicativn•for a permit for the work herein
specified, agreeing to do all work in sttict 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.
T
S • &Cel
i07•
DAM, c®/ � � SIGNATURE .
•
.(See Reverse Side For Addition 1• T+formation.)*
° .• BUILVI U b'1: 011.1 rL•L- .btAI L)ULG
SECTION 2. The Inspector of Buildings 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 repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount hereinbelow set forth and in
the manner herein provided to-wit:
UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
r
For the purpose of ::omputing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying-the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to-the average heights of the upper surface or to the averagee
height of the-roof surface of the main gable of a pitched roof.
• For repairs-or alterations tollan 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. °
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF'FOUNDATION
NOTE: 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. i
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF' OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.. ° f
I
SUBJECT
P
City of Fridley
2 7 0 6 9
AT THE TOP OF THE TWINS
BUILDING
RMIT
r
RECEIPT NO.
v ------ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY $5432
612-571-3450
910-F15
8/10/98
JOB ADDRESS 7362 Symphony St
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
10
5
1 Melody Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jim Kruger
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Disanto Const 26103 Verdin St Isanti 55040
444-0024 20069323
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (18 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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
$1501.20
$.75
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-
Fire SC $1.50
STRUCTION OR THE PERFORMANCE OF CONS TION.
$51.25
PLAN CHECK FEE
TOTA7LF ELice
$5.00
$58
,SfG_NATURE OF CONTRACTOR OR AUTHORIZED AGENT (DA T
EN P OP
BL NSP
Li ATED $ 1$ Y PEF�i IT
s
[//
r
715.
Da TE
SiGNaTURE OF OWNER pF OWNER BUILDER) IOATEi
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY PA
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 a(®�
BUILDING PERMIT APPLICATION 1 Y
6
ConstructionAddress: %.? 4� 2 -
Legal
Legal Description:
Owner Name & Address: \,/ i ---i 61 &�-Ac Tel. #
Contractor: 4�A2 / c �, �-_s ;;:-'Az , o a _ MN LICENSE # -27,:P ele� 3 Z 3
<6i2
Address: G s Tel. # L/
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 Type: /,�'c /lo o / £? -":N /`
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
DATE: "Z/-- 9 -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Estimated Cost: $ SP> 2 O
(Fee Schedule, on Back)
Ft x $ _ $
APPLICANT: — i o
$ 5�g• 50
CITY USE ONLY
Fee Schedule on Reverse Side
(Cr;�)
Tel. #
.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 [ J
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.
. A
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN '5543.2 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 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,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/ Industrial
1.25% of Value of Appliance or Work
Rate TOTAL;
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/.Hr
*Air Conditioners can not•be placed in a side yard without
written permission from adjoining property owner.
$ 50
JOB Al
OWNE
BUILD
ESTIMATED COST ��� S PERMIT
DESCRIPTION OF FURNACE AND OR B.LIRNER
No. of Heating Units Circle One (Steam)'. (Hot -*,Water) (Warm Air)
Trade Name Size No.:
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU _HP Wlf
The `undersigned hereby makes application for a permit.'fQr the work herein
specified agreeing to do all work in strict accordance,' th the. City Codes an
rulings of the Building Division, and hereby declares that•all the facts and
representations stated in this application are true and c 'rrect.
STANDARD AIR
RMI> ING O410 QST . I
MINNEAPOLIS, MN 554D&2588
DATE
612-8242656
HEATING C f
Effective On January 1, 2002
J
.Signed►#
Approved By Rough -In Date Final Date. �y
+THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VENT, VENT CONNEC OR AND mmmiISTION AIR VERIFICATION
.When rte, In acing an,;bAsting#urance, the undersigned hereby verifies that the
venting has:een eXmined and, is free from rust, deteiioratior>< obstructions,
and is securely supported:and ",stopped wh:6re raga{red. Yes 'No (:)
The venting system is plasbctPVC and meets all current codes and manufactures
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA -LAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. = Yes () No ( )
The existing combustion .air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( No( )
When required to install a new cembustinn Mr. it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When installing a naw v _n ing system, the undersigned hereby verifies that
itis a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central FUmace
Venting Tables for fan assisted and natural draft appliances. Yes () No( )
Is the common vent.and vent connectors sized andinstalled correctly after
an appliance has been removed from the common vent and vented_ -
separately as per current codes. Yes ( )No(
)
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 7;61 Btu Input y
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector. Height ft Length ft .Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
HEATING CO:
Signed By: Date:
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAx (763) 571-1287
June 29, 2004
Mr. Tom Eyons
7362 Symphony St NE
Fridley, MN 55432
Re: Final Inspection at 7362 Symphony St NE
Contractor: Standard Heating & Air Conditioning Co
Dear Mr. Eyons:
A mechanical permit was issued on February 14, 2003 to install an air conditioner at your
address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date the inspection has not
been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do.
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and the permit will be expired.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
Building
MECHANICAL
PermitNo.•00 �J
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
D &M.11y 3 200
DATE c2 YOUR E-MAIL ADDRESS
SITE ADDRESS `a k
THIS APPLICANT IS: ❑ OWNER" OR
PROPERTY
OWNER/ADDRESS:
NAME: n
STATE.��P-��
TENANT
J o
PHONE:- -
CONTRACTOR
COMPANY NAME: d J
SUBA COPY OF
CONTACT PERSON: s 0
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS:
APPLICATION
PHONE �/ -i- c%ff _ FAX
PERMIT TYPE
PGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW ❑ REPLACEMENT �ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK _
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5%0 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: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
$25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00
_A/C _FIREPLACE
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
$15.00
DUCT WORK $10.00 GAS PIPING $10.0y{0{
_VENTILATOR
�
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 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 0
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 ark which requir By, review, and approval of plans.
PRINT NAME �/ �/ l�it�5 DATE
SIGNATURE OF APPLICANT
�7'i'.T. EA`1,"',ERMITS,ARERE.` itED'F4�t.B;(~<ILIh.II'G,ECTRX,C�,AN...DE' , . ...',,.
ypl✓L`S.E
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.-HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or PropanoUGC 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 TMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction 1MC 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
PLUMBEqG
Permit No.: o
Inspections
RESIDENTIAL APPLICATION
Received By
763-572-3604
CITY Off, LES,
0U
763-502-4977 FAX
EEcrlyE I -I-08
DATE 1p if I� !Q� YOUR E-MAIL ADDRESS
SITE ADDRESS T-0 (° 2- S 6U �
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY
NAME: e OY I a
_M�1
ADDRESS:_313(a2- S' s CITY �rfe Ify% STATE PU4ZIP�?z-
�M
NANT
PHONE:110 " 1
CONTRACTOR
NAME: V WA- U41 VIS iAA Cn mak—
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
ADDRESS:yi® awn, s " At "q CITY vi STATE ZIP �� Z
INSURANCE
PHONE ��! �" 2,4% FAX �� �7 =� ' I W O
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
0 NEW REPLACEMENT
DETAILED DESCRIMON OF WORK Cl✓IS ii(�` �n y bum
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 = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW). MINIMUM FEE $15.50.
BATH SINK/LAV _ WATERPIPING
_ _FLOORDRAINS —SHOWER
—BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL —WATER SOFTNER ($35)
CLOTHES WASHER _ KITCHEN SINKWATER CLOSET _ BACKFLOW PREV. ($15)
_:`WATER
_
LAUNDRY TRAY HEATER ($35) FOR IRRIGATION
—DISHWASHER _
WATER METER OTHER
T,i5�n-..s� .,%" .•�i;,. j,'�
Permit Fee $ 3f'
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
OR Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $ ii
State Surcharge = $ .50
MINIMUM $15.50)
(MINIMUM $15.50) Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cojofity of Fridley and with theMinnesota Construction Codes; that I understand this is
not a permit but only an application ford work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of requires review and approval of plans.
SIGNATURE OF APP PRINT NAME1Iv__ CL�S12�C1' DATE
APPROVED BY DATE/i'/14
�t---------
FA
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977