PRE 2010 DOCSCity of Fridley
SUBJECT
PER
®431�08
AT THE TOP OF THE TWINS
BUILDING PERMIT
•
r
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 � i
"t CITY HALL FRIDLEY 55432
---- �'� 612-560-3450
RECEIPT NO.
/�
O'�j`
NUMBER
910-1715
REV.
DATE
B-27_7
PAGE OF
APPROVED BY
JOB ADDRESS
6261 VAN 13UPEN
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
1
1 SHOREWOOD SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
WALTER T. JOHNSON
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.
6 USE OF BUILDING
RESIDENCE
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION [XX 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.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$500.00
.50
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.
$5.00
PLAN CHECK FEE
TOTAL FEE
SIGNATURE OF CONTRACTOR AUTHORIZEDAGENT (DATE)
I S5.50
WHEN PROPERLY V LIDATED THI IS YOUR PERMIT
SIGNATURE OF OWNER IIFO RBUILDERI (DATE)
BLDG INSP DATE
e . 1/- r ---T10 - s
. , A !' L' ALTLii�T ION
PLICATION FOR RhSIDLNTIA ., a
OR ADDITION•BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAt1E BUILDER:
ADDRESS:' ADDRESS:
140:_. STREET • -�✓ - 'r/
LOT: BLOCK: / ADDITION: .2k��
CORNER LOT: C INSIDE LOT: SETBACK: SIMARD:
Applicant attach to this form. Two Certificates -if Survey -of Lot and.proposed
building location c., awn on •these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: •
7 Front: Depth: Height:
Square Feet: Cubic.Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $ D
To Be Completed:
The undersigned hereby makes application 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.
DATE: `� �� SIGNATURE
..(See Reverse Side For Additional Information.)'
OU
BUILDING V -ER IT FL'L SLIH' DULL
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 herein below set fortis and in
the manner herein provided to -wits
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
-For the purpose of computing 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 average.
-height of the roof surface'of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
($500.00) or fraction thereof in
rate of $3.00 per each five hundred dollars.
the cost of all proposed work.
In no case shall the fee charged for any permit -as set forth in Section.2 be
Jess than $5.00.
'VERIFICAT.ION 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.
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 fox which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued..
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:(�
RATn
TOTAL
� VIAJ .J BLF? G 6J i
Job'Address I� 1E ,
Furnace Shell & Duct Work
$12.00
$
*Replacement of Furnace
7.00
$ Department
Repairs & Alterations -up to $500.00
of Buildings
Repairs & Alterations each add. $500.00
4.00
$
dle
City of Fridley
Tel. #571=i450
MECHANICAL WARM AIR:
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$
specified agreeing to do all work in strict accordance with the City Codes
each add. 50,000 BTU
4.00
$
and rulings of the Department of Buildings, and hereby declares that all the
*Replacement of Furnace
7.00$
facts and representations stated in this application are true and correct.
Repairs & Alterations -up to $500.00
7.00
$
Repairs & Alterations each add. $500.00
4.00
$
Fridley, Minn. , 19_
STF_V-1 OR HOT WATER SYSTEM:
OWNER \I%1!�, LTi C" -I __ �-10 I�i � 0 A)
Boiler & Lines up to 100,000 BTU
$12.00
$
�.
KIND OF BUILDING �OC.�+m1 P —
each addn. 50,000 BTU
4.00
$
F
Boiler only up to 100,000 BTU
7.00
$
USED AS 0
each addn. 50,000 BTU
6.00
$
�q
V
A U6, j -i,7 q
TO BE COMPLETED AB UT
OIL BURNER- to 3 gal. per hour
$10.00
$
- 7 //11 ev
®CJ.
each add. 3 gal. per hour
10.00
$
ESTIMATED COST /
GAS BURNER- from 100,000 BTU to 199,999 BTU
$10.00
$
f )
OLD - NEW BUILDING PERMIT NO. PERMIT NO. lg l
(over 199,999 BTU see Fee Schedule)
$
GAS FITTING FEES:
lst 3 Fixtures x
$ 3.OG
®
$T
�.
/� DESCRIPTION OF FURNACE/BURNER
Additional Fixtures x
$ 1.00
$
O
Gas Range to 199,000 BTU x
$10.00
$
HEATING or P R PLANTS, Steam, Hot Water, Warm Air- No. �K_
AIR CONDITIONING
$
Trade Name �k� [-�f Size No.
FAN HEATING SYSTEms See Fee Schedule
$
VENTILATING SYSTEMS
$
Capacity S Ft. EDR BT� HP
ALTERATIONS & REPAIRSS
$
�' y q'
State Surcharge
$ .50
Total Connected Load Kind of Fuel
TOTAL FEE
$C1
BURNER - Trade Name Size No.
ROUGE: INSP. REINSPECTION FEE
Capacity Sq. Ft. EDR BTU HP
Date ($10.00)
FT.T%
INSP. I�^ I ^ �
CompanyJAL
Date
/•
A2PROVAL FOR PERMIT d&le
Signed By W
Tel. No. 5--7 /3 900
M.INII•U-M FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
*Attached stack verification form
SUBJECT
T
City ®f Fridley
� 2 6 0 33
AT THE TOP OF THE TWINS
BUILDING PERMIT
t
T NO.
1 16______ COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
� 7p��
((��
NUMBER
REV
DATE
PAGE OF APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
5/22/98
JOB ADDRESS 6261 Van Buren Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
1
1 Shorewood
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Walter Johnson 6261 Van Buren Street NE
571-1398
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Steven Lee Contr. 9465 Irving Ave, Brooklyn Park, MN 55444 424-1198 5758
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION j REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage 18 S) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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 1 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
$1,501
$.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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$51.25
Fire SI,', $1.50
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$58.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY LI DATED THIS IS YOUR PERMIT
//,/ 4'�!z
4
�, BL INSP
-�� L '�
GATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND BUILDING PERMIT PAPPIX,IECATIOAND R-2
ConstructionAddress: 6, 6 % V,,
Legal Description:
Owner Name & Address: a Irs _Tel. #
Contractor: X. L MN LICENSE #
Address: �l/c/ �/c Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height. Sq. Ft.
Length Width Hgt/Ground S . Ft.
r
1
Construction Type:
T��.� �� r t mated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE:
—��—
Permit Fee
$ S),
sire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$ , C
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $
STIPULATIONS:
Tel. # �� %— )J 9�
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 [ ]
. . a
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 fust $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
DATE 7L% —,IU
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
MECHANICAL Permit No.:2,,o U "
RESIDENTIAL APPLICATION Received By:
CITY OF FRIDLEY Date WD��
EFFECTIVE7-1-2010 1 /�
YOUR E-MAIL ADDRESS '�� 420&Dr 1 (1? (OAW& 57 JM' T
❑ OWNER )&ONTRACTOR
ADDRESS: CITY Ier�l+1L3(�2J CITY %��G�� STATE&ZIP
PHONE:
COMPANY NAME: oagWC2.5 .5a ✓ UiG t
CONTACT PERSON: _T A .
STATE LICENSE # EXP DATE
ADDRESS: cry CITY �" sL,STATI6v`ZIP.rS/!
PHONE FAX
FAMILY ❑ TWO FAMILY
❑ TOWNHOUSE
IITYPE OF WORK: I ❑ NEW PLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL
J 2006 ASHRAE HANDBOOK
Equipment Installed MFG:
MODEL:
SIZEBTU
MFG:
MODEL:
SIZE/BTU
MFG:
MODEL:
SIZEBTU
A/C $25.00
(GAS) $15.00
GAS RANGEIOVEN $10.00
TO AIR EXCHANGEER $15
_FIREPLACE
(WOOD) $35.00
NEW GAS GRILL $10.00
_AIR
_BOILER $35.00
_FIREPLACE
FURNACE $35.00
_GAS UNIT HTR $10.00
LINER $10.00
DRYER $10.00
_POOL HEATER $35.00
_CHIMNEY
DUCT WORK $10.00
_GAS
_GAS PIPING $10.00
VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I a owledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and co of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only antcatio permit and wok is not to start without a permit; that the work will be in accordance with the
approved plan in the a of all rew and approval of plans.
AL
DA
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
❑ NEW HOMES/ADDITIONS 0 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 MN Rule 1346 Sec. 501
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. N1104.4.13
5. Ventilation
a. Per MN Rule Chapter 1322. Sec. 1104
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.