PRE 2010 DOCS4)360
City of Fridley, Mmm X9 9739
BUHDING PERMIT
Date: May 17, 1968
Owner: Homedale Blders Builder Homedale Blders.
Address 5217 Wayzata Blvd.. Address 5217 Wayzata Blvd.
LOCATION OF BUILDING
No. 7524 Street Tempo Terrace _ part of Lot
Lot 31_ Block 6 Addition or Sub -Division if 11 3xXMelody Manor kkgk 4th
Corner Lot _ ___ __ _ inside Lot — x Setback 35 _ _ Sideyard — 10' - 5 r
Sewer Elevation 880.12 .—M- 883.12
Top of Footing
To be Used as:
Dwelling Front 46 Depth 24/28 Height ._._.20 Sq. Ft.1152 Cu. ft23,040
� Garage Front 18' Depth24' —3t— Height 10' Sq, Ft 432 Cu, F, 4320
Type of Construction Frame Fat. Cost 20 000 __ To be Completed Oct . 1968
SEWER LOCATION -83.5' S. W. of Manhole
WATER LOCATION - 73.5' S. W. of Manhole
In consideration of the issuance to me of a permit to construct the building described above I agree to
the proposed work in accordance with the description above setfpm and in mpliance with provisions
ordinances of the city of Fridley. W/ _� 7
MOD Sewer Connection Charge
In consideration of the payment of a fee of $ 46.00 , permit is hereby granted to._._Homedale Blders .
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 of :the provisions of said
ordinances.
i
CLARENCE BELISLE
NOTICE:
This permit does not cover the construction, installation for wiring, phrmhing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permhs for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAMEBUILDER
ADDRESS: %
_ _ 1.1DDRESS.
LOCATION-. QF : BUILDING.
-NO._`r STREET _
LOT=r BLOCC' ADDITION Q;SDIVISTflN ao
�" ... t:
01
CORIZR LOT INSIDE LOT SETBACK `w 0 SIDEYARD%
SEWER ELEVATION T#O OF FOOTING'
Applicant attach to this' fo,ii 'Two' Certificates of Survey -of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front z - Dcpt_1%ight�'
Square feet / S�7S Cubic Fera 'v- -
/� Front ---r---��--�4 Dep - Heigbtell
/ �I
-— �-----t4 ark t --
Sq'uare feet. Cubic Feet _
Type of Construction Es4imated 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 rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
Ir•
-BU.=I.M IUMT 'FZ9,,,,9.M4ZDULF
I U
SECTIOW_21`:`, The Inspector, of Buildings shall,.. befo'6'Asi ii. As
permits for
the erection I of any building or structure, or for any..addition to allY
existing -'a. -iructureor building, or for any alterationor repairs to any
existing building or structure upon a:pplicat.ioh therefore, require the
. f * permit of fees to the amount herein
the payment by the ApPlidaiat' oV.s.ch
below set forth and in the manner herin provided to -wit:
Ty .1, 2, 4 4— $l Jt 4,6r.each one thousand cubic
feet* or fraction thereof, in such cubical conk6nts. Type 3.-& 5- $1.50 for
each, oi�q_thousand cubic- ,,.f0et-.
For the,. itirpose. of. ej6jkitin& -fdOb f6rbuildLhg-pGrmtts,' the cubical
contents of any built-, or ddO.t i6n;fe a uaff6rklAkht'thioughout by
nultiplying, the ground area covered from a point six (6) inches below the floor
line of the baseiiht- or"'. Che ijili' r - to the average height of the upper surface
or to the average height4f the roof surface of the main gable of a
pitched roof.
Tor repairsor
-alterations to an 'existing structure, the -fee shall be at the
rate of $3.00 per eachfive hundred.dollairs ($500.00) or fraction thereof
in.-, the �.doit of, 411,proposed work.
in no case shall thqjeo charge& -for -any permit ..as -set forth in Section 2 be
less than $5.00.
NSSSD Connection Charges based on location- Area I or 2.
A.
Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE
TOTAL
Furnace Shell & Duct Work ...........................$10.00
$
Replacement of Furnace .............................
6.00
$
Repairs & Alterations—up to $500.00 ..................
6.00
$
Repairs & Alterations each add. $500.00 ...............
3.00
$
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
$10.00
$
each add. 60,000 BTU .......................
3.00
$
Replacement of Furnace .............................
6.00
$
Repairs & Alterations—up to $500.00 .................
6.00
$
Repairs & Alterations each add. $500.00 ..............
3.00
$
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam ..................... 3.00 $
Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $
OIL BURNER—to 3 gal. per hour ........................ 6.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) ....................... 5.00 $
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x$ 2.00 $_-_—
Additional Fixtures ................. x .75 $
Gas Range to 199,000 ........... x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
$
See Fee Schedule
TOTAL FEE $
Dept. of Bldgs. Phone 560-3450
Location����.
City of Fridley:
The undersigned hereby makes application for a permit for the work herek
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,-jand correct.
Fridley, Minn -�
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $ 1
Old a Building Permit No. Permit No.
DESCRIPTION OF WORK
BEATING or PO -PLANTS—Steam, Hot Water, arm Air No
Trade Nam �"(" ���' Size No
Capacity Sq. Ft. E.D.R '�� BTU H.P.
Total Connected Loa Kind of I
6 _
BURNER — Trade Name- Size No -
Capacity—
o Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS— VER
Sign Y N.WELTER HEATING CO.
4637 CHICAGO AVE.
ByeAbIbAK—AIRDLIS M. MINNEZOrA
ae Business Phone No_���
City of Fridley
Application for Plumbing and Gas Ming Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... --7 x $2.00 $
Future Fixture Opening ................ x $1.50 $
New Fixture Old Opening .............. x $1.50 $
Catch Basin ............................ x $3.25 $
Water Heater (Up to 99,000 BTU) ...... x $3.00 $
New Ground Run Old Bldg . ............ x $3.25 $
Electric Water Heater s $100 $
GAS FITTING FEES: NO. RATE TOTAL
20'
1st 3 Fixtures .......................... 3 x $0 $��
Additional Fixtures x $ .75 $
Gas Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................
TOTAL FEE $
Dept. of Bldgs. Phone 560-3490
City of Fridley:
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 fact
and representations stated in this application a °e true and correct.
dley, 1%r=19
Owner
Kind of
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit A Permit No.
Signe
By
Business Phone No --9 22 2
ROUGH
Y �j
oS
8� z
+��
U
Ci
<
�°d
W
(�9Sa
i
�U' O
•
R
•
N
WATER HTR.
GAS
EIEC
Base
l
1st
6
2nd
_
3rd
4th
• Future Connection Openings
New Fixture, Old Openings I
Connected with
Sewer ❑
Cesspool El
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... --7 x $2.00 $
Future Fixture Opening ................ x $1.50 $
New Fixture Old Opening .............. x $1.50 $
Catch Basin ............................ x $3.25 $
Water Heater (Up to 99,000 BTU) ...... x $3.00 $
New Ground Run Old Bldg . ............ x $3.25 $
Electric Water Heater s $100 $
GAS FITTING FEES: NO. RATE TOTAL
20'
1st 3 Fixtures .......................... 3 x $0 $��
Additional Fixtures x $ .75 $
Gas Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................
TOTAL FEE $
Dept. of Bldgs. Phone 560-3490
City of Fridley:
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 fact
and representations stated in this application a °e true and correct.
dley, 1%r=19
Owner
Kind of
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit A Permit No.
Signe
By
Business Phone No --9 22 2
ROUGH
HOUSE HEATING TEST RECORD
ADDRESS'>"�' FJoOOR CITYU UR
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST. GAS CO. METER BADG
SOLD BY INSTALLED BY
Electrical Work By Gas Line By
TYPE OF HEAT GA FAHW STEAM SPACE HTR. UNIT HTR. OTHER
GASIGPCONVERSION
MAKE �** ��® �' �- MAKE OF BURNER
Model Model
Serial �� °�� % ��- Max. BTU Rating
INPUT ey jne!!%j MAKE OF FURNACE
Model
CONTROLS A
THERMOSTAT r,!P 7Jp��eat Plug Vent Size ® a�
Valve 14k968;9 KIND OF LINER ZEA—NONE
Limit 9:52A—SE Draft Hood-4� Regulator
Limit Setting . Filters Size dumber
Fan Setting 17 -
Pilot
Pilot Type
Pilot Make
Pilot Model
Pilot Timing-��
Chimney Location InsideOutside
Chimney Construction
Smoke Bomb Wiring
Draft Test Tag
L.W. Cut OffDoor Pressure Lighting Inst.
e�€eP
Pressure P dr�°' CO d —�D Tested
Input CFH ,�� Y7 Ppony Testing t
Stack Temp. Percent CO , ®r 0 Name of Tester
Form 235
Applicatim for Power Pian is and Heathag. Cooling. Ye n. R rali®n and
Air Conditioning S"ems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......... ..... $10.00 $
Replacement of Furnace 6.00 $
Repairs & Alterations—up to $500.00 6.00 $
Repairs & Alterations each add. $500.00 3.00 $—___
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ........
..$10.00 $
each add. 60,000 BTU ....................
.. 3.00 i
Replacement of Furnace
..... 6.00 $
Repairs & Alterations—up to $500.00
6.00 $
Repairs & Alterations each add. $500.00 .... ..
&W $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.
Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam 33.00
Each add. 320 sq. n. EDR Hot Water 3.00 $
OIL BURNER—to 3 gal. per hour 6.00 $ —
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 1M,000 BTU_) ... $.00 $
over 199,000 BTU See Fee Schedulo
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures x$ 7,00 $
Additional Fixtures x .78 $
Gas Range to 189,000 x$ 5.00 $
AIR C®I4DITIOIdINa
FAN HEATING SYSTEM
TING SYSTEM
ALTERATIONS It REPAIRS
ROUGH
FINAL--/
f`` r
�4 V'
See Fee Schedule
TOTAL FEE$'
(SURCHARGE $_,50)
Dept. of Bldgs. Phom SM -MM
City of Fridley:
The undersigned hereby makes application for a permit for the work :hereir
specified, agreeing to do all work in strict accordance with the City Ordibancee
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_ / 1S
(honer --
Kind of Building
Used as _ . ___ ._._. .
���
To be completed abut/— 7
Estimated Cost,
O dew. Building Permit No. Permit No.��/I
- r
OF WORK
team, Hot
Water, Warm Air—No
Trade Name F1 (C' y Sin No fl(O IV
Capacity Sq. Ft. E.D.R BTU_`_- ' HY
Total Connected Load Kind of Ftael
BURNER — Trade Name Size No
capacity Sq. Ft. E.D.R BTU
(REMARKS -OVER)
Ideal Sheet Metal inc
544 .Summit St. N.E.
Shull MPI& Minn. 554.81
Business ftme No—'2 �' ��
SUBJECT
City of Fridley
2 5
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
`y -------COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
q1J3
NUMBER
REV
DATEPAGE
OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7-13-98
JOB ADDRESS
7524 Tem o Terra e
1 LEGAL
LOT N0.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
31
3
Melody Manor 4th SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Norm Woods 780-4260
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Quality Contracting,]YNYIN/IIl'YW-YAidIldli4iYllId illdI111iidIIffli
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
11412 W. River Rd, Champlin, MN 55316 427-7733 7035
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
'Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Tear-off and re-roof (23 Sq)
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 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,918
. 96
DOES NOT PRESUME TO GIVE AUTHORITY TO VIbLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF A Y OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OPwfAE PERFORMANCE OF CPOSTRUCTION.
$62.25
Fire SC $1.92
N CHECK FEETOT
FEE
IZ4��: —zz&jy
Licens SC $ .00
$70.13
-,
%iGNATURE OF CONT ACTORORAUTHORIZED AGENT (DATE
N OP VALID THIS IS YOUR PERMIT
--
U -,C— F- 5 k:5=L
B INSP GATE
SIGNATURE OF OW NER�IF OWNER BUILDERS IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY..OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �-� a
Legal Description:
Owner Name & Address: o o v", (J ®O s Tel.
Contractor: 0, I ®rrc� c/ �c MN LICENSE # 70 Sr
Address: / r{ (2 .c J to c � � � Tel. # Z�'Z 7-7 ? 3�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EAPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER: 23 sz r
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: Ln C,- ® tJ` w ®tea " Estimated Cost: $ �
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 F = Ft x $ _ $
DATE: APPLICANT: Tel. —7 r7 K�
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ s 4e
$.50/$1,000 Valuation
SAC Charge
$ ��
$1000 per SAC Unit
License Surcharge
$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
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ J
TOTAL
STIPULATIONS:
BUII.DING PERNIIT 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
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for "first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$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.
MECHANICAL
Permit No.: 1 - Cid
Building
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDL.EY
c
DATE YOUR E- RESS
SITE ADDRESS ;k -
THIS APPLICANT IS: ❑ OWNER CONTRACTOPA
THIS
PROPERTY
NAME: 8 r S
OWNER/
ADDRESS: .9- (i�TY • STA ZIP
TENANT
PHONE: n — O
CONTRACTOR
COMPANY NAME;__ STANDARDHEATING&A'
_
CONTACT PERS( ;! ; L 410 WEST LAKE STREET
SUBMIT A COPY OF}�,
MN 55408
YOUR STATE
STATE LICENSE II 2.824 -STATE ZIP
LICENSE WITH
ADDRESS:
APPLICATION
PHONE FAX
PERAM TYPE
SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE
rl NEW REPLACEMENT ❑ ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK Q GZ 1 aC.
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
only.the cost of labor )
improvement, installation or replacement of a residential fixture, excluding the fuctures..(This should reflect
-Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05
FOR PROJECTS WHERE LABOR EXCEEDS $500 FEES AREBAjEDGN.$j0.00 PER FIXTURE, EXCEPT WHERE NOTED. NX URE .: (INDICATE TOTAL
��
NUMBER OF EACH BELOW]
� �✓�
MODEL: S�- S u
Equipment InsWied MFG. . . .
MFC,: MODEL.
MFG: MODEL: SLMBTU
AIC $25.00 _FIREPLACE (GAS) $15.00 GAS RANGFJOVEN $10.00
NEW GAS GRILL $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00
$35.00 FURNACE $35.00 GAS UNIT HTR $10.00
BOILER
CHU,,MY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
GAS PIPING $10.00 VENTILATOR $15.00
DUCT WORK $10.00
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00= $
Number of fixtures @ $25.00 x$25.00 = $
TOTAL DUE $
Number of fixtures @ $35.000 x $35.00 = $,:35-M
Surcharge = $ .50
Total = $�
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowl a that the information above is complete and accurate; that the work will be in
Hnnesota-Constmction Codes; that i understand this is
conformance with the ordin and codes of oFridley and with the
but ` o d wor is not to start without a permit; that the work will be in accordance with the
not a permit only an R
approved plan in the a of all 'ch r i revi and approval of s.
�rnQ �
ATE
SIGNATURE OF APPLI
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 NIN 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
PLUMBING
Permit No.•
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
DATE Sho YOUR E-MAIL ADDRESS
SITE ADDRESS `7�'f Te ry\pr, % i-fqC'L ME—,
,
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: 37
OWNER/
ADDRESS: STATE �� 3
TENANT
��Z
PHONE:
CONTRACTOR
NAME:_— to fV
SUBMIT A COPY OF
STATE LICENSE # ( EXP DATE I
YOUR STATE
ADDRESS: Cf Y\ c3 e , CITYC STATEWI��> �y
LICENSE WITH
PHONE FAX
APPLICATION
PERMIT TYPE
GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW )(REPLACEMENT
DETAILED DESCRIPTION OF WORK 2
PER MS 168.665 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)
_ BATH SINIULAV FLOOR DRAINS _.. SHOWER _ WATER PIPING
_ BATHTUB —, GAS PIPING (Amw craucnz) — SWIMMING POOL _. WATER SOFTNER ($35)
CLOTHES WASHER —KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15)
—
—DISHWASHER _ LAUNDRY TRAY „WATER HEATER ($35) FOR IRRIGATION
_ WATER METER —OTHER
I'FR+ItR t l'ltf)JFCTS FOR. Ul'�I3F11$50Q
PER1ti+IIT FEE F(bR PR€) S VERi500
Permit Fee $ Z�—,: f,�0
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $ -5-_- >
�?
State Surcharge = $ .50
Total = $
TnI S 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 ak work whicq ' es r vie and approval of plans.
SIGNATURE OF APPLICANT �+ - PRINT NAME
i` PLWEN(J1L: SSP T1r P R1VfITS"ARE 2E UIRID FOR BUILDiNG;'ELEGTRiCAL AND IViECkI hNICAL OIti '
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977