PRE 2010 DOCS3311-30
City of Fridley, Mnm N9 9053
BUMDING PERMIT
Date: OCTOBER 13 ,1 1966
Owner: _ Bider ERGO' INCORPORATED
Address Address 3 231 CENTRAL AVENUE N, E,
MINNEAPOLIS, MINNESOTA
LOCATION OF BUILDING
No. 6 021 Street WOODY LANE N E part of Lot
Lot — 2 _ Black 1 Addition or Sub -Division .. OO E MIKE IMIS - 2_ADDITION
Corner Lot — Inside Lot - X Setback 35. _ Sideyard 14.5 and 12.5
Sewer Elevation 898.17 Elevation 901.17
TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used as:
DWELLING Front 48 Depth 26 Height 20 Sq. Ft. 1, 248 Cu, Ft, 24, 960
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction FRAME Est. Cost _ 2$ 0, 000.00 To be Completed
SEWER LOCATION - 150.5' south of Manhole
WATER LOCATION - 11' North of Sewer
In consideration of the issuance to me of a permit to c
the proposed work in accordance with the description above
ordinances of the city of Fridley.
14=09
to do
nro Nona of
In consideration of the payment of a fee of $ 25.00 , permit is° hereby granted to ERCO, INCORPORATED
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 any of the provisions of said
ordinances.
CLARENCE BELISLE Building or
NOTICE:
'fide permit does not cover the construction, Installation for wiring, phunbing, gas heating, mover or water. Be aro to no
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY., MINNESOTA
OWNER'S NAME BUILDER
ADDRESS AJJDRESS �--�
LOCATION OF BUILDING.,
N0. STREETLf PART 0' LOT
LOT `�� BLOCK ADD TION OR SUBDIVISION
CORNER LOT INSIDE LOT 7�.. SETBACK �' SIDE -YARD
SEWER ELEVATION® FOUNDATION ELEVATION �•-!-
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height T
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cosi
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 T -l-�-(-�' S
(5cnedule of Fee Costs can be found on the Reverse Side).
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 ........................... 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 ..............
8.00 $ K >'�)
2.00
$
5.00
$
5.00
$
2.50
$
STEAM or HOT WATER SYSTEM
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 FITTING FEES:
NO RATE
TOTAL_ ,
1st 3 Fixtures
....... x $1.50
$
Additional Fixtures ................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL
ROUGH
Dept. of Bldgs. Phone SII 4-7470
City of Fridley:
The undersigned hereby makes application for a permit for the 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 are true and correct.
Fridley, Minn //` f19 I�
Owner ">
� j
Kind of Building
Used as _
To be completed about
Estimated Cost, $ -•
Old—New. Building Permit No.
Permit
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
-Trade Name 4 Size No- A
Capacity Sq. Ft. E.D.R- BTU / - H.P
Total Connected Load %^ %�% Kind of Fue c —
BURNER — Trade
Size
Capacity Sq. Ft. E.D.R BTU H.P
FINAL
(REMARKS—OVER)
Signed
=RSM MTN & SHEET METAL
By,19 r
, IL 9 t
w Business EMA9 OSIS 328 MINNESOTA
City of Fridley
Application for Plumbing and Gas Fitting Pernit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures x $1.50 $ /S
Future Fixture Opening ................ x 1.20 $ .
New Fixture Old Opening .............. x 1.00 $
Catch Basin .... ....................... x 3.25 $
Water Heater (Up to 200,000 BTU) ...... Z x 2.00 $
New Ground Run Old Bldg. x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ....... ...... ........... x $1.50 $ 15--o
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ g o. �! 0
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 are true and correct.
Fridley, Minn
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old Newco uilding Permit
ROUGH
FINAL
4z
p
,7� �� ✓�' Permit No. /
ne °f
By
Business Phone No �-`
Z
w
o x
w
c�
Z
z
�O
F
•
N
WATER HTR.
GAS
ELEG
Base
di
g
1st
2
2nd
3rd
4th
• Future Connection Openings
Connected with
I
Sewer El
New Fixture. Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures x $1.50 $ /S
Future Fixture Opening ................ x 1.20 $ .
New Fixture Old Opening .............. x 1.00 $
Catch Basin .... ....................... x 3.25 $
Water Heater (Up to 200,000 BTU) ...... Z x 2.00 $
New Ground Run Old Bldg. x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ....... ...... ........... x $1.50 $ 15--o
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ g o. �! 0
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 are true and correct.
Fridley, Minn
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old Newco uilding Permit
ROUGH
FINAL
4z
p
,7� �� ✓�' Permit No. /
ne °f
By
Business Phone No �-`
Applicafto for Power Pknft and H Cooling. Ve a R
Air Con&foning 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 $
Furnace Shell & Duct Work to 130,000 BTU ............ $10.00 $
each add. 60,000 BTU ....................... 3.00 x
Replacement of Furnace ............................. 6.00 -$
—
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $50040 .............. 3.00 $
STEAM or NOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... .$10.00 $
Furnace Shell & Line --to 640 sq. ft. IDR Hot Water .. 10.00 $
Each add. 200 sq. ft. EDR Steam 3.00 ' $
Each add. 320 sq. ft. EDB. Hot Water .... ............ 3.00 It
OIL BURNER—to 3 gal. per hour ..... ' ....... ...
..... &OD
$
over 3 gal. per hour --See Fee Schedule
GAS BURNER (up to M.000 BTU) ..... ........:.:......
800
$
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 ...........
is sa►
$
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
' See�Fes S '
$
TOTAL FEE $
L 0 3d 7s- 7
Dept. of Bld[ga. Phone 580-3180
City of Fridley:
The undersigned hereby makes application for a permit for the work hereie
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 facts
and representations stated in this application are true and correct.
Fridley„ Affirm_ - j' A S ,. 1B
Owner
r�
Kind of Building
Used as
To be completed about & ` -3 e, -- 6 c�
Estimated Cost, $
Old—New. Building Permit No. Permit No.
DESCRIPTION OF WOR'{
HEATING or POWER PLANTS --.Steam, Hot Water, Warm Air—No
Trade N Size No
Capacity Sq. Ft E.D.R. BTU H.P.
Total Connected Load Bind of Fuel
BURNER — Trade Name Size No
Capaci Sq. Ft E.D.R BTU Rib.
(REMARKS -OVER)
Signeda
By '
Business
Phone 8' _ 6,
PERMIT for Power lants and Heating. Cool.
ing. ventilation. Refrigeration and Air
Conditioning Systems and Devices.
DESCRIPTION OF WORK
No. of Heating Plants to be installed-altered—repaired
Make �J , Size
Oil fired ; Coal fired ; Gas fired—; Gas Authorization
Remarks
Approved
Final Inspection
19-
Inspector
4 �176plj
Permit N° ---45-30
Fee $
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. , 19
Owner ja&2a?
Location ®xvj a-.-t-e—
Kind of Building—
How
uilding How Occupied
Work to be Commenced—, 19—
To be Completed ,19_
Estimated Cost,
Old -New, Building Permit No.
Permission is hereby granted to to install—erect—use the material and devices described in the
above statement. This permit is granted up n the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein nand to the specificao' ns s forth in the approved application for this
permit on file in the office of the Inspector of Buildings.
Inspector of Buildings
42 2M11 -VV
CEIfor Pourer Pkwb and Heatht , Coo1ingR rentihs n. RAndwW!l�otm and
Air Conditioning Sysfem 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 AM
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 $
Dept. of Bldgs. Phone 880-M
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 Ordinance. -
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridl y, Mian
Owner
Kind of Building
STEAM or HOT WATER SYSTEM To be completed about
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. _ Estimated Cost,
Furnace Shell & Line—to 640 sq, ft. EDR Piot Water 10.00 $_ �-�/
Od New. Building Permit No. Permit No. 1 / Q _-
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
over 3 gal. per hour—See Fee Schedule
GASB (up to MOW BTU)
star 199,000 BM See Fee Sclsedule
GAS FITTING
1st 3 Fixtures
Additional Fixtures
Gas Range to 199,
ROUGH
PINAI. % - 13 - ag
6.00 $ —
6.00 $ �6—' ° U
NO RATE `DOTAL
— x$ 7.00
— x .7b $
X$ SAO $
(U �HARGE�o���
HEATING or POWER , Hot Water, Warm Air—No
Trade Name Size No
(REMARKS -OVER)
53 -8b -s-715.51
R, mlo�lfl
momllow
PARTIAL RATE D; �
Q[ass "A® Surcharge :,()r
f
0. Rk= T®TAL
Ni ................
Zan�
.... o......
80"mm
mxftue am Owning ®........
Tam 9
Cow%see ¢ ®« .......
- . to ....
p
E SA
N IM ........•
@
moftbWaftrumamo ..............
9� ga
...............
.. . . ... ....... .
aw BMW to M.M........... 1
R $ 5.00
State Surcharge
$ .Stt
....................................� 5.50
razes
Q[ass "A® Surcharge :,()r
f
• • 53-81 —9915051
CHY 04
F-aidl-y a
'
`� r
' • a
CIFI'c i 1..
s ' .,,,.. 0'-? s .M X0.5, •.►
�•i.d5h
•
„r,, _-•l.,.._-._.
I3opt. of Bldgs. Phone S:0.3;50 �•
DESCBIPTI01i 0: V,'Or :
""-
Lol-A L, 6n21 Wn�AU
F utur a Fixture Opening .. • • • • • • • • • ------
PlumSrr. Y.i d and L*cr_ion of Fixtures
Bussn��.s Phone Xo
New Fixture Old Opening...... •. • • --
X $1.50 $-___.:._
(w�Tt�•
City of Fridley:.
Z - '
1 K �
z 7 z t i Z i� s I7 W r W
�- a 7
wTa.
c.�s cue,
The undersigned hereby sakes appticatron for a permit to the QorY herrt
the Cit? O:dln;n;
o t<
5 < < <
? s g 1 , ; o w 3 u o d to $
I
+ strict acco:da^ce with
specified, a� Icing to do a1 work .n ..ri
P ttir to
,ice
iS .•,
and rutins of the D�:pa:tment of Euil,.:ngr, and hereby declares that a:I
E3,r
I
and ropreser:tations state !n h's aPPUcAL' are true u+d co:red'
im tal 1 gr 1
5 -12-76 19-
I,• I
--
__.___•_--
Fridley, M=-
: =2:d
2 d
No. R L,
TOTAL
Owner clz ar
3:d
x $2.00 S
Kind of Building "
-• --
• FL`.:o
Gca:.t: rd with
Cen o.::.et6 C-pz, rr..?%
ucxfar ❑
Used as
s Old trrs^.i.^.gt
Ccs:.pool ❑
•
Additicnal Fixtures ...............---•------
To be co repleted about
PARTIAL RATE SCHEDULE
10 00
Estimated Cost, $
Old -?j . Building Permit No.— Par�it:�a.
L,101110 Fl:CTUAE RATES: K0.
RATE
TOTAL
Signed a
x 57.00. $
-
Number Fixtures ................ •-.�—•---
_
X $l.FA S
""-
� By _ �niMftgFG®Sri -
F utur a Fixture Opening .. • • • • • • • • • ------
Bussn��.s Phone Xo
New Fixture Old Opening...... •. • • --
X $1.50 $-___.:._
•
x $3.25 $
' ; -
Catch Basin .................... �_-
•
Water Iieater 'L'p to 93.000 BTU) • • • •----------
x `3.00 S
ROUGH '
:*ew Cround Run 013 Bldg....:.... ------------
x ;3.25 S
s $2.0J 3
FIN, /D - te-7 7—.�
il.ctr'•c Yater Haatas.....:........._--.
-
No. R L,
TOTAL
.
'
iAS nI TTING FEES:
x $2.00 S
'
Ist3Fixtures •••••••••�••••••'• -
x + .75
Additicnal Fixtures ...............---•------
Gs FU ;e to 199,000 BTU ...........
x $5.00
Class
W SurchargQ .500
50
_
State Surcha ge
k AL T FRATIONS--P.afeT !o Cod*
5
r=
TOTAL F 5.-----
--
SUBJECT
P IT NO.
City of Fridley
AT THE TOP Of THE TWINS
BUILDING PERMIT
.
22092-,
i
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
��
r
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
9/3/93
JOB ADDRESS 6021 Woody Lane NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
1
Moore Lake Hills 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Wayne/Marcia Lindblad 6021 Woody .Lane NE 571-7009
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
Construct a 161 x 161 XNNX Screen Porch Addition
8 CHANGE OF USE FROM TO
STIPULATIONS
See. notations on plan,
WAR'
Z.
p B*re (tom ne call "t a.
all utility ImtIans
49.0002
LEQUIRE® BY LAW,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
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
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
$7 68Q $3,84
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
M'00 Eire SC $7,68
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTALFEE
$110,52
SIGNATURE OF CONTRACT5F OR AUTHORIZED AGENT MATE)
WHE O ER ALI/DAT`ED THIS IS YOUR PERMIT
6 4AUqRPF
W RUFOWNERBUILDER � i
NEW [ ] Effective 5126/93
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: GCS 2-( WOOD"-_ L[' ` z(9 �.C-�j An �\1
Legal Description:
Owner Name &Address: i /'Ci ht QL � J as - S�cY C Tel. #�71-� U 0--1
Contractor: MN LICENSE #
Address: 0 Tel. #
LIVING AREA: Length
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length 144'-01'. Width I Hgt/Ground-$� , Sq. Ft. ZSR C'�2
Corner Lot [ ] Inside Lot N' Ft. Yd Setback
Type of Construction: Lk-�ybQ t-R�Ayr tz�
Approx. Completion Date: l I - (- q
Side Yard Setbacks 2-2-' 4. � .7
Estimated Cost: $ 4 7,/m
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: ? (- Z U �j
Permit Fee $ ' / CC)
Fire Surcharge
$ %
State Surcharge
$ .
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$750 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Conservation Plan Review $450.00
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ Z STIPULATIONS:
Building M[E+ CgIA,NICAL Permit No.:.92
Inspections RESIDENTIAL APPLICATION R.ecetved By.
763-572-3604 CITY OF F . LEY D 'AL
DATE /I� 6'
YOUR E-MAIL ADDRESS
SITE
THIS APPLICANT IS:
❑ OWNER 13CONTRACTOR
PROPERTY
NAME: r, " ' s
3 r
OWNER/
ADDRESS: " `'� re J 2 0 _ CITY r i ��
-- STATES -ZIP
TENANT
PHONE:
COMPANY NAME• 111171? 6' 0� Lf
CONTRACTOR
CONTACT PERSON: 9
SUBMIT'A COPY OF
YOUR STATE
STATE LICENSE # EN? DATE
LICENSE WITH
ADDRESS X10 L/6 CITY-
0ZIP di 71-1A �
APPLICATION
PHONE'7Bl- _73,'L—,)0ge! FAX
PERMIT TYPE ° SINGLE FAMILY ❑ TWO FAMILY D TOWNHOUSE
TYPE OF WORK: I ❑ NEW 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 )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE TABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (WDICATE TOTAL
NUMBER OF EACH BELOW) rr
Equipment Installed MFG: sc a �C= MODEL:.' R ! e a' ` SIZEIBTU „� e
MFG: MODEL:
MFG: MODEL: _ SIZEIBTU
A/C FIREPLACE (GAS) $15.00. GAS RANGEJOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 :, :FURNACE $35.00 —GAS UNIT ITER $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTIATOR $15.00
' W.,. .: J ..?di?... ,Y..Rw+.�rax«.-...n. m�....�..n,,,..�,- ..: .: -..�: .._,.. ...._.. _...
Permit Fee $ c, `'' Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $6, f" Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 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 `r ; PRINT NAM DATE J h � — 0_2
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 NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural. Gas or PropanevUGC 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 TMC 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 snake up air calculations