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PRE 2010 DOCSV .040 W'* BUILDING PERMIT Village of Fridley, Minn. N° 2793 Date '.. ®` .. .� ................... Ownerp. ... Builder ........................................... Address 4/. %` .../j9 ....... .... Address......................................... LOCATION OF BUILDING No. ..A-340 ..... Street,Aa??�.. .................... Part of Lot ....................... Lots.'. -3.:' 1� ..... Block .1............ Addition or Sub -Divisions ...... ' ..................... . v ® Corner Lot ............ Inside Lot ..I ........ Setback .. tri. Sideyard ............... DESCRIPTION OF BUILDING To be Used as: Front 40 ... Depth.... Height �.�° .... ........ Front aZQ.... Depth . ?-.f ... Height Type of Construction ......... Esi. Co .......... Sq.. Ft. %��.�% Cu. Ft. ........ Sq. Ft. A449. Cu. Ft......... 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 village of Fridley. I ... ZZ... ... ation 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 e 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 with- in the village limits and this permit may be revoked at any time�}pon violation of any of the provisions of said ordinances. �! "re "'� oF. ....... Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring) plumbing, gas heating, sewer or water. Be sure to see the Building Inspector, for separate permits for these items. City of Fridley, Minn. BUILDING PERMIT N? 3930 Date: ... .. ` ............ Owner....................................... Builder .......:.1/.......... ...... Address ...................................... Address ............................................. LOCATION No.. Street leua O���I= B�J[i.DINC %�.,.�. ,a Part . Lot �..1�.., .. Block ..:°� ... . .. .. _ ..... .... Addition or Sub -Division of t ......... . ............ . ...... .... . ............ . ............... Corner Lot . '%� .... ... ..... .. Setback . Inside L'ot ..... 4r�. :�. •� Sideyard w DESCRIPTION OF BUILPINq r /�` i �. To Used .. Front !. (Depth ..� Height .... # . Sq. Ft. /..� Cu. Ft. ... ... Front ,l.9.�. Depth ` Height �� Sq. Ft. � Cta Ft. O.C.SO Type of Construction ................... Est. Cost. .,���.��.�...�. To be Completed 4 .................. In consideration of the issuance to me of a permit to construct the b g desribed above, I e to do the proposed work in accordance with the description above set forth compliance wi ions f ordinances of the city of Fridley. 'A... ..................... ............. In consideration of the payment of a fee of $.!,T 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 regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. . .'!:r ... ... Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building inspector for separate permits for these Items. K APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners :Name /� Build J Address* z ' 'qddress LOCATION OF BUILDING d No.`s Street �!/�'�' Peart of Lot Lot A2: Block.. Addition or Sub. Div. Corner Lot Inside Lot Set Back ' Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING • To be, u ed as Front' Depth_ Height Sq. Ft. Cu. Ft.� 1� Front Depth Height Sq., Ft. Cu. Ft. 3116 �F_ � el 0 Type of Construction Estimated Cost To be completed" The undersigned hereby makes application for a permit for the work. here n.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 `��✓ Signature (A Schedule of Fee Costs can be found on the Reverse Side) BUILDING PER14IT 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, req`i1te the payment by the applicant for such permit of fees to the amount here nF.below setr-forth and in the manner herein provided to -wit: 2.1. For.any such perrit for the erection of any fireproof building,, other than a garage, waehouoe, factory er• gral elevator, or for the r erection of any fireproof addition, for similar occupancy, to.any. existing building shall be at the rate of $1,.4b for,leach one thousand cubic. -.feet, or fra coon -thereof, in Euch cubical contents. 2.2 For any such permit for the erec'c,icn of any fireproof garage, ware- house, factory or grain elevator, or for the erection of any fireproof addition, -for simil& occupant,;?, 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 1,,Laineapolis Building Code HOUSES 2.3 For, any such permit for the. erection of any non -fireproof building other:th`an d- garage, warehouse, factory'or grain elevator, or any non-fireproof.addition, for similar occupancy, to any existing building. Perm#t $l•o00 . for each one .thousand cubic feet. .GARAGES 2.4 For any such permit for the erection of any non - warehouse, factory or grain elevator, or for the erection of any. -non - fireproof addition, for similar occupancy, to any existing building or 11 for,each such. building or additions Ninety Cents for each one - thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of 54,00, For the purpose of computing fe^o for bul_lding permits the cubical ` contents of any building or add -1 -tion to a uniform height throughout by multiplying the, ground a -2_-a- c,�vp-�^ccl from a point .six (6) indhes below the floor line c?f-2r to the average height of the upper surface or to ,.tho ac c H :' a}iL of the roof surface of the main gable of a pitched roof.. 2.5 For repairs or to a -n e; ist_i_ng structure, the fee shall be at the rate of 43.00 fog i3.1.ncred Dollars (6500.00), or fraction thereof in -�l:Lo cost c.f aILI ropc sd worms 2.6 In no case shall U ayry perr i.t as' set forth in Section 2 be less than 6A, Applicatlon for Power Plants and Heating, Coaling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE T AL 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 ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM 8.00 $_ 2.00 $ 5.00 $ 5.00 $ 2.50 $ 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 GAS BURNER (up to 400,000 BTU) ....................... 5.00 $� GAS PIPING (Up to 3 Fixtures) .......................... 1.50 (Add 50c each over 3) Dept. of Bldgs. Phone SU 4-7470 City of Fridley: The undersigned hereby makes application for a permit for_Afe 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 ar "andect. ft -oft Fridle 195 Owner I" ✓'" Kind of Building Used as To be completed about 195- 195— Estimated Cost, $ d!` Old New. uilding Permit No. DESCRIPTION OF WORZ HEATING or POWER PLANTS—Step, Hot Water, Warm Air—No P Trade Nam Size No o ®® 61 Capacity Sq. Ft. E.D.R BTU 01990 H.P. 10, Total Connected Kind of Fuel AIR CONDITIONING $ BURNER — Trade Name -Size No FAN HEATING SYSTEM See Fee Schedule Capacity Sq. Ft. E.D.ft BTU H.P. VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE /'I�AfA��A REMARKS: Siga By i t ppn IM -8-58 Business Phone No—Ag- 74 0 0 .Weatherstrips A'J vz'Construction No. Guide Windows I Doors Reference Out. Wall.- Int. Wall Ceiling Roof Yes— Yes—* 1 19_ F1.1 1 tj Room I Length p.' 4 Width j F1.1 Windows and Doors—•Crackage and Area Width Height No. of Lineal ft. Area Noe of pane of pane lights of crack I sq. ft. - 3 0 4-/ Int. wall Btu Ceiling ® ;; Floor e Total Btu. 1 L41 461 6 14 J. 11 310111 i W ii D L40 Coef. Btu Infiltration atm }' Glass y-6 Exp. wall lCoef.1 Btu Net exp. wall - 3 0 4-/ Int. wall Btu Ceiling ® ;; Floor e Total Btu. 1 L41 461 Required° sq. ft. E.D.R. or sq. ins. W.A. Leader area J9 Floor '71U:L 113�z I F1.1. ° &A Room I Lenath 1&1 L to Width to / Heiaht 9 Windows and Doors—Crackage and Area _ T Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 7- lCoef.1 Btu Infiltration - 3 0 4-/ Coef.1 Btu Infiltration Glass ® ;; f e O 1, Exp. wall Net exp. wall Int. wall Ceiling Flood IJ71 J9 Floor '71U:L 113�z Floor Net exp. wall 7— Ceiling Total Btu. 1 41.6 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area. / Fl.l �J Room I Lenath 13 / Width R / Heiaht S Windows and Doors—Crackage and Area _ T Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. D lCoef.1 Btu Infiltration - 3 0 4-/ Glass Exp. wall q5 b Net exp. wall ® ;; Int. wall e Ceiling 1,9 Flood IJ71 ^/: Tbtal�� Requir Floor Kind Rmm I Length Insulation How Applied Width S1 Heiaht S / Windows and Doors,-Crackage and Area l Width Height No. ofLineal ft.' Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane or pane lights of crack sq. ft. Coef. Btu Infiltration - 3 0 4-/ Glass q5 b Exp. wall ® ;; Net exp. wall e Int. wall D Ceiling ,9 A Floor '71U:L Total Btu. S, 3.5— Required sq. ft. E.D.R. or seg. ins. W.A. Leader area r /rf lK —3.1. G O fi+EJe:..l,. c Windows and Doors—•Crackage and Area l Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft Width Height No. of Lineal ft. Area No. of pane or pane lights of crack sq. ft. Coef. Btu Infiltration 31 ® ;; 1L, Glass' t D Net exp. wall Exp. wall 13 Int, wall Net exp. wall Ceiling Int. wall 1 Floor Ceiling / % 2. Floor Total Btu. 1.9, j J7 Required sq. ft. E.D.R. or sq. his. W.A. Fader area / IFI.I /.1 r Boons L-Lenath 1 � ` Width I /' Height J � Windows and Doors;--Crackage and Area l Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft Coef. Btu. Infiltration Glass 31 ® ;; Exp. wall -?( 401 Net exp. wall 13 Int, wall Ceiling 1 Floor / % Total Btu. ft. E.D.R. or sq. ins. W.A. Leader area 1 II It sq. ft. E.D.R. or sq. ins. W.A. Leader area (,av3 6104�-R,t 2, NOTICE OFET ATE OF MINNESOTA DEPARTMENT OF HUMAN SERVICES 444 LAFAYETTE ROAD - ( _ ST. PAUL. MINNESOTA 55101 Date City of Fridley Zoning Authority 6431 University AVe. N.E. Street Address Fridley, MN 55432 City State Zip Code r DHS -2722 (9-85) PZ -02722-02 All—.'7 RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE Subject: P Type of License: Name of Day Care Bome Applicant P Group Family Day Care �� (g 6)��_ � Family Day Care St eet Address °� Lf Licensed Capacity ( �- City State Zip Code Phone No. 5-7 4 - S � This is to inform you that we are in receipt of an application for licensure under Minnesota Rules, parts 9502.0300 to 9502.0445 (formerly Rule 2), Family Day Care and Group Family Day Care Standards. Issuance of this license is subject to compliance with the provisions of Minnesota Statutes, Sections 245.781 to 245.812 and 252.28, subdivision 21 known as the Public Welfare Licensing Act and the rules of the Department of Human Services. You should note that under Minnesota Statutes, Section 245.812, Subvision 3, a licensed day care facility serving 12 or fewer persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi -family residential use of property for purposes of zoning. If we do not hear from you within 30 days after receipt of this letter, we will consider the above-mentioned day care home to be in compliance with your local zoning code. COMMUNITY HEALTH &SOCIAL Sincerely, Y',JA, 4",_ i — Licensing Wo ker Street Address SERVICES DEPARTMENT COUNTY OF ANOKA COURTHOUSE, FOURTH FLOOR Name o A ency Organization City State Zip Code AN EQUAL OPPORTUNITY EMPLOYER SUBJECT PE City ®f Fridley 22017 AT THE TOP OF THE TWINS BUILDING PERMIT r 1 , TNO. _ COMMUNITY DEVELOPMENT DIV. ,0 PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 IL"""K NUMBER REV. DATE PAGE OF APPROVED BV I.J 612-571-3450 910-F15 8/6/93 JOB ADDRESS 6360 Van Buren Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. 2, 3, 4, Bloc 5, Florence Park Addn. to Fridley SHEET 2 PROPERTY OWNER MAIL ADDRESS. ZIP PHONE Dawson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Shaw Chamberlin Roofing 999 E 4 St, St Paul MN 55106 224-2864 8106 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 ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroo>? House (2nd Layer) 9 CHANGE OF USE FROM TO STIPULATIONS R,00fi.ng can be 2.nd laxer but not 3rd. Provide smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement. Provide adequate attic ven til ati on . 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 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 $2. OOO $1, 00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $45.00 Fi.re. SC $2,00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. _ PLAN CHECK FEE TOTAL FEE License SC $5.00. $53,00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN P OPERL! VALIDATED THIS IS YOUR PERMIT BLDG i P GATE SIGNATURE OF OWNERIIF OWNER BUILDER) IDATEI mompmpw Effwive 5/26193 CITY OF FRIDLEY 3-N(R,E'zAMAY ANP D0PY3l,'XT"' A. 1 AND R-2 A J YA MN Li -f VNSU # ?- R -,q - k, i 0 1, 1 M MCI, VU hl t I ";DA I Vii, A It a4c P":1 mil 1 C16 Firt, 'Sun'. rul, 00 Park !R Building BUILDING Permit No.: (3001-01') a�- Inspections `%. C56 RESIDENTIAL APPLICATION Received By: 763-572=3604CI'IS OF JFRIDI AT D to Reed: SATE ( YOUR E-MAIL ADDRESS � f `� S 31TE ADDRESS 1 HIS APPLICANT IS: 0 OWNER NTRACTOR PROPERTY OWNER/ NAME; TENANT ADDRESS: CITY STATE ZIP PHONE: z CONTRACTOR NAME; P G ? v ey SUBMIT A COPY OF STATE LICENSE # (� DA E `�� / 9 3 AC YOUR STATE LICENSE ADDRESS:_ </ ! CITY 'ice STATZIP WITH APPLICATION PHONEtir7 0 ` FAX 7A T i —,/ %l PROPERTY TYPE INGLE FAL 'MWCONSTRUCTION SIZE ❑ TWO FAMII.Y/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK SIDING ❑ OTHER ❑ SWMIMING POOL TYPE OF WORK: ❑ ADDITION RREMODELING MAINTENANCE/REPAIR DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, Vinyl ❑soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures ❑ Other °Fascia and proposed project R'iNDOR'S 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF•WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ '7 0 ®O OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due I hereby apply for a building conformance with the ordinanc permit but only an applicatio plan in the case of all work wbi SIGNATURE OF APPLICANT $ $ `%. C56 $ 3, D $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= $x$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED the information above is complete and accurate; that the work will be in y and with the Minnesota Construction Codes; that I understand this is not a tart wilb, tap it; work .ill be in accordance with the approved .f pl/ 'RMT NAME ► V / DATE Page 2 - Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permiis 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 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1' $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1s' $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1" $50,000 plus $7 for each additional $1,000 or fraction to and includin $100,000 $100,001 to $500,000 $993.75 for l- $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the I- $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1- $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 0 l City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN .55432 763-572-3604 FAX: 763-502-4977 MECHANICAL Permit No.,o OOS'GD®1® Building Inspections RESIDENTIAL APPLICATION Received By:� 763-572-3604 CITY OF FRIDLEYC'M N 2 4-W 763-502-4977 FAX EFFECTIVE 1-1-0$ DATE Ii IR ':�' Y YOUR E-MAIL ADDRESS SITE ADDRESS Ila U o f -e^ v Z THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: jr("C- Cis, E, l e ZIP S � L 3 ADDRESS: L03 & 0 1/& n 9 ",r e r, 6 v G CITY el :�STATEiI!� TENANT PHONE: CONTRACTOR COMPANY NAME: 0 RIO Heartl► &Home T NOTE: SEPARATE CITY CONTACT PERSON: iba Fire8lde i}1t HQet! 12090 License amizueu 270o N. Fad 1111 LICENSES ARE REQUIRED FOR GAS STATE LICENSE # 2700 N CaIndo r "F -XP DATE Roeev111e, iY1N i19s CITY 8S1/�-2�1 STATE ZIP AND HVAC. ADDRESS: 65 1183&-2581 SUBMIT COPY OF BOND PHONE FAX AND INSURANCE PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ANEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK 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 ) OR Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor y 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:` �' r e- MODEL: jvv) f e`" —4— SIZE/BTU MFG: MODEL: SIZE/BTU MFG,: MODEL: SIZE/BTU A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 —_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00 HEATER $35.00 CHIMNEY LINER $10.00 _GAS PIPING GAS DRYER $10.00 _POOL DUCT WORK $10 00 $1000 —VENTILATOR _ Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ fixtures $35.00 x $35.00 = $ Number of @ State Surcharge = $ 50 MINIMUM $15.50 Total = $ 23 MINIMUM $15.50 THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances I this is not a but only an application for a permit and work is not to and codes of the City o ley and with the Minnesota Construction Codes; that understand permit start without a permit; that the ork will be in accordance with the approved plan in the case of all work which requires review and approval of plans. — � i SIGNATURE OF APPLIC NT PRINT NAME Y -e,1 , n Fr , S L e DATE DATF��T APPROVED BY 5..�.. 46 WR l 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 ❑ EXISTING HOME ❑MAKE-UP AIR S P T ' i oR tnaA REQUIRED FWNWMEXISTING HOMEPW 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.