PRE 2010 DOCSCity of Fridley, 1Vlinm.
Address Address
LOCd4Tlex1fF ILDING
No. - Street , P Lot
Lot - ..._...– Block Addition or Sub -Division ._
Corner Lot . Inside Lot _ _ �� Setback aSideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
T as:
Front Alon Depth Height Sq. Ft. Cu. Ft
InRet Depth ei Sq. Ft. Cu. Ft.
Type of ConstrueU __ _ Est. ' 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 complian with all provisions of
ordinances of the city of Fridley. A/ �i 1 / ®_ J w . � _ ,
�'.0 e
In consideration of the payment of a fee of It ,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 anypart thereof, shall conform in all respects to the ordinances of
Fridley, Nl3nnesota 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 porno does not cover the construction, Inshli en for whine, Plumbing, gas heating, sewer or water. Be euro to see
the Building Igor for separate Permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER ° S NAME /i'aiep �` Coe& BUILDER ' � e -
ADDRESS Glle,s-r �,� �., ,� AbDR$SS �d y�� . dz- Wr, L;Zg1,r,
LOCATION Or AOT%LDTOG
No. Street Part,of Lot
Lot ® Block / Addition or Subdivision Zg&speed ow aeO&
Corner Lot Inside Lot Setback Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
To be used as:
DESCRIPTION OF BUILDING
FrontDepth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction 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 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).
r
City of Fridley
SUBJECT
PERM
14359
AT THE TOP OF THE TWINS
BUILDING
PERMIT
,
r
S
ECEIPT NO.
`L - COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.��
1 . �
CITY HALL FRIDLEY 55432
1---- �J
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
9/14/77
JOB ADDRESS 5761 West Moore lake Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
1
Donnay's
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert Cook J=II 5761 West Moore Lake Drive N.E.
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
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install a 12' x 20' Deck and patio door
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide frost footings if necessary.
AR0V
PERmI!S REQUIRE? FOR WIRING,
Before dig ing cell local o,slliles
SEPERATE
'SIGN
TELEPHONE -ELECTRIC CSS E�.
HEATING, Pl.tlt�tBtNG oANo S
-
REQUIRE® BY LAPIN'.
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
1
ISTALLS 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.
$500
$.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$8.00
8 RE OFC TRACTOR OR AUTHOR AGEN (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG INSP
DATE
S GNA URE OF OWNER IIF AVVi� BUILDERI (DATE)
LW -2
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PEMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: Q>Ccrt- CQQIL: BUILDER: A
. �, �. i a e
Address: � 1 Address:
Tel. No.:
No. Street: WA17 VL LY_
. LOT: BLOCK: H ADDITION: ,�pnxy_____
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach 'to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: , Depth: '2�en -Height:
Square Fetit: Cubic Feet:
Front:
Depth: Height:
Square Feet: Cubic Feet:
Type of Construction:
To Be Completed:
Estimated Cost: $
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for additional information.
DATE: -3 Lq Im SIGNATURE:
Stipulations:
SUBJECT
P� NO.
City of Fridley
- 16.4.4 4
AT THE TOP OF THE TWINS
g U I L D I N G P E R M I T
_
rp
REC
• _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
eip
t i
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J` 612-571-3450
910-F15
110/27/81
JOB ADDRESS 5761 West Moore Lake Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
15
1
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Robert Cook 5761 West Moore Lake Drive N.E. 571-6984
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
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION? ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install free-standing Fireplace (Majestic)
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
1
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
$790
$.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$15.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$15.50
SIGNATIJA& OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPS Y VALIDATED THIS IS YOUR PERMIT
/®^per/ -�
r
J/ Ll� b� q)
SIGNATURE OF OWNER IIFO LD IDATEI
BLDG INSP I OAT
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PER4ITS
(New, Alterations, Additions, or Repairs)
OtJtJER:cl— BUILDER: -
ADDRESS: W 46,7 ADDRESS:
c
TEL NO: _ ��` -- i ,�— TEL NO:
Construction Location
• STRIIST NO: STREET: xf IF -
LOT:
LOT: % BLOCK: �_ ADDITION: 2
G�
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
Front: Depth: Height:
y? Square. Feet.- Cubic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
Type of construction: /=' `T� Estimated Cost:'
7.b Be Cbrapleted:
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 %:vrk' 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: /6 - -7- 7 - SIGNATURE :
Stipulations:
/f,�S' 60
G lsZ
0
SUBJECT
City of Fridley
7330780�
AT THE TOP OF THE TWINS
BUILDING P E R M I T
I `
RECEIPT NO.
____-_ COMMUNITY DEVELOPMENT DIV.
E'r
�®
r , PROTECTIVE INSPECTION SEC
i ' .—. �•� CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
----�3604
L 763-571-3450
910-F15
9/12/02
JOB ADDRESS 5761 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DEscR.
15
1
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Bob Cook 5761 West Moore Lake Drive NE 763-571-6984
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
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ALTERATION [j REPAIR D MOVE ❑ REMOVE
8 DESCRIBE WORK
Change garage roof from flat to pitched; reside house & garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be if sheathing is an approved weatherproof
panel or when the siding is an approved weather barrier. Vinyl siding is not a
weatherproof covering unless the manufacturer states this in their application
guidelines. Call for inspection of wrap before covering. Caulk and flash all
exterior openings. Provide City with copy of truss specs and drawing.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
ISTALLS 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
$5,000
$2.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON.$111.25
Fire SC $5.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$118.75
OF C[CO,NTRACCTTO)R OR AUTHORIZED AGE NT
N P PER (DATED T S IS YOUR PERMIT
(SIGNATURE PIDAATEI
%
BLD INSp nATE
SIGNATURE OF OWNERrF RBUILOERI L iDATI
NEW (] CITY OF FRIDLEY Effective 1/1/2002
ADDN [) 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: J� T 1 — Vj - 4 o a rr. D 3�
Legal Description:
Owner Name & Address: Tel. # S71 -
Contractor MN LICENSE # �-
Address: Tel. #
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: % '� - �, sem- .�- J Q R ?'!
�
Construction Type: Estimated Cost: $ /-S' a o o .
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $
DATE: ` -/� - �-�- APPLICANT: Tel. # J-7) G
Call (763) 572.3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ a Sr
$ S— ' e) -O
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
TOTAL $ d �3� STIPULATIONS:
1 SEP 30 °gg 09 @"+ FR N l•1 TRUSS Sri IHL 1 715 876 5565 TO FRID P•02/02
�f r�i _se _ Y sa � s 'Si •
Aw mstaro � ~srvD cava /�� aq orrtt• • �����
Desbn voUd for Tex connectors. ihjl �� nN upon potometetsztrt/t� 0101 Mual Du$dln0 cs•+n oenanl ro bo
lesiolled and boded vemlltl . l PPkabtlily of dorlon polome)en and plopot Inootpaatfon df r ev of buedIng de serer • not nu+l
de•.Ianm. &actng Mown 4 far blmal suppou of Indlvldual web memb•rr onty, A(ZdObnal Iompo�t;Ai wle efobOO.• durtng c(rrfrructbn b the
Iatponab101y of IM 41641131. Adollbnol pormanenl bioelna of the overo$ enucfuleiIt the responsaWly of Ina building deiFjncr. For at nerot guidance
+pordlhg Iobrbolbn, quaUry conhot slaaoo. delivery, otecllon and braclna, consurl O1T-88 Oualsy Slondord. 069.e9 $toeing Sp•cRkclto-r, and Nls•01
rondlrng Imia7ung and stowing Cow-a-Vmron ovollablenom bust rata incraule, 583 D'Onotdo Onve. Maclean. W16371 P - - _ •,�.
x• ,
** TOTAL. PAGE -02 **
Job
cuss
russ Type
city
Flyb/12
5
J187bbd
5STOCK
22
FINK
1
1
12'2'- STOCK 5112 TRUSS
a�
CLAIRE. a rIS Mi I e us s. on Apr ge
'r2-0-0 53-14 11-0-0 , 1&2-2 , 22-(3-0 _- , 24-0-0 ,
2-0-0 5-9-14 5-2-2 5-2-2 S-9-14°�•tattterrr� 40
ZN
Fp6.' 9
• STEPHEN IN •�" 4x4- 20612
CABLER -M=. STATE OF
5. 10256
•5.00 �` .•�4p1AN P k� �'
12
. � w .� F� .• �. � ..
""024-4e
/OWN tEO ,`a
3
5
�dj
`t,\lie 7I
��`'��� • !'� 3x4= 3x6= 3x4=
y- JOHNATHAN E: *;
�ylr• RUDER
0
001.012617 .4
:0�•
�Ak"AA ♦� 7-6-10 14-5.8
�D�AI� ,®`' 7-6-10 &10-13 7.13-10
ate -_-'�
LOADING fpsf)
SPACING 2-"
CSI
DER (In) (fact Udall
PLATES GRIP
TCLL 40.0
Plates Increase 1.15
TC 0.71
VertiLLl -0.13 10 >999
M20 197/144
TCOL 10.0
Lumber Increase 1.15
BC 0.85
V.rtITL) -0.26 B-10 >991
BCLL 0.0
Rep Stress Incr YES
WB 0.43
Horzl7111 0.07 6 WE
SCOL 10.0
Coe BOCAlANS19S
1st LC LL Min 1/deft -• 360
Weight: 71 Ib
LUMBER BRACING IP)
TOP CHORD 2 X d SPP No.:2 TOP CHORD Sheathed or 2.9-8 on center purlin spacing.
BOT CHORD 2 X 4 SPF No.:2 BOT CHORD Rigid calling directly eppWd or 10_0.0 on center bracing.
WEBS 2 X 3 SPF Stu,)
REACTIONS(ib/size) 2-x1617103.8.6-1517/0-3-8
Max Harz 2-14.Iload case 31 \�
Max Upllfi2-•262llosd case 41, 6--2621load case 41;
FORCES fib) - First Load Case Only 40 `(n
TOP CHORD 1-2-37.2-3-.2387,3.4--2069.4-5--2059,S-6--2397,8-7-37 p
ACT CHORD 2-10-2190. 9-10-x1605. 8.9-1505, 6-8-2190 PROFESSMAL
WEBS 3.10--482, 4-10-660, 4-8- 660, 6.84-482
3074
NOTES
"This truss hos been checked for unbalanced loading conditions.
�� G� p�i��'
21 This taus has been designod for the wind loads generated by BO mph Minds of 25 h above ground level, using 5.0
�Q.
psf top chord deed load and S.0 psi bottom chord deed land, 100 ml from hurricane oceanlino, on an occupancy /Q �• .•p"�
T�
category I, condition I enclosed budding, of dimensions 46 ft by 24 h with exposure C ASCE 7.93 per SOCA/ANS195 Dr�o
It and vnrticels or cantilovnra exist, they are exposed to wind. If porches exist, they ere not exposed to wind. The
lumbar DOL Increase is 1.33, and the prate grip increase Is 1.33
3) As requested, plates have not boon designed to provlde for placement tolerances or rough handfing and erection nerOby cenify that this plan, specs.
conditions. It is the responsibility of the fabricator to Increase plate alzea to account for these factors. IlCalion or report WgS prepared D y
4) All plates are M20 plater tmlosa otherwise Indicated.
5) Provide mechanical connection (by others) of truss to bearing plate capable of withstanding 262 Ib uplfft at joint 2 me of under my direct supervision
and 262 Ib uplift at joint S. and Ilial I am Ouly Registered Pro.
61 This truss has boon designed with ANSI/TPI 1-1995 critsda. fessional Engineer under the laws of
�T11III IN1 106 Stale of Mlnno D
LOAD CASE(S) Standard 44t o'L ci /�dO/g� APR 31998
f t0;A0. • .. e. � tt?,� �`�°urrantey,P��
PROFESS
o��f 5•.1
STEPHEN
.,`�`SCt��S�.
��� REG. W. CABLE({
,�� N0. �• �. STEPHEN W. a
10 I a STUNENIA►
STE4�
CABLER o� ~ i7
w PHtN W 'r' • : ti = e CABLE
sG C PI 0. • ' +- - • - ..4
�f r�i _se _ Y sa � s 'Si •
Aw mstaro � ~srvD cava /�� aq orrtt• • �����
Desbn voUd for Tex connectors. ihjl �� nN upon potometetsztrt/t� 0101 Mual Du$dln0 cs•+n oenanl ro bo
lesiolled and boded vemlltl . l PPkabtlily of dorlon polome)en and plopot Inootpaatfon df r ev of buedIng de serer • not nu+l
de•.Ianm. &actng Mown 4 far blmal suppou of Indlvldual web memb•rr onty, A(ZdObnal Iompo�t;Ai wle efobOO.• durtng c(rrfrructbn b the
Iatponab101y of IM 41641131. Adollbnol pormanenl bioelna of the overo$ enucfuleiIt the responsaWly of Ina building deiFjncr. For at nerot guidance
+pordlhg Iobrbolbn, quaUry conhot slaaoo. delivery, otecllon and braclna, consurl O1T-88 Oualsy Slondord. 069.e9 $toeing Sp•cRkclto-r, and Nls•01
rondlrng Imia7ung and stowing Cow-a-Vmron ovollablenom bust rata incraule, 583 D'Onotdo Onve. Maclean. W16371 P - - _ •,�.
x• ,
** TOTAL. PAGE -02 **
Building
Inspections
7.63-572-3604
DATE__
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PER UT TYPE
TYPE OF WORK:
YOUR E-MAIL ADDRESS
❑ OWNER NTRACTOR
ADDRESS:
PHONE: ��d - <7/- ee
Permit No.
Received By:
Date Rec'd:
ATE&O ZIP
COMPANY NAME: vo c•rr �o�-_ ----
te 31j
CONTACT PERSON: ego I�,�IrRin tli
STATE LICENSE is
ADDRESS: Fax (76i -2908, STATE ZIP
PHONE
FAX
S E FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW >R151aCEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
rA
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
only the cost of labor)
improvement, installation or replacement of a residential fixture, excluding the fixtures. (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 ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
MODEL: �_ � � '�- SIZEBTU L Or
Equipment Installed
MFG:
MFG: MODEL SIZEBTU —,—Z—
�'���� �"Z
A/C $25.00
MFG: MODEL: SIZFATU
_ FIREPLACE (GAS) $15.00. _GAS RANGEIOVEN $10.00
NEW GAS GRILL $10.00
__L
TO AIR EXCHANGEER $15
,_FIREPLACE (WOOD) $35.00
GAS UNIT HTR $10.00
_AIR
BOILER $35.00
—_CHIMNEY LINER $10.00
FURNACE $35.00
00
_GAS DRYER $10.00 _POOL HEATERVENTILATOR $115.5.00
DUCT WORK $10.00
GAS PIPING $10 00 _
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 1 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 requires review and approval of plans. /
SIGNATURE OF APPLICANT f PRINT NAMEZ46!kJ.
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 HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEWIEXISTING 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 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
x
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations