PRE 2010 DOCSPermit is hereby gri
anted to to
the building—
described in the above staitement. This permit is granted
upon the express
clition th.the person to whom it is granted, and his agents, ;employees. and workmen, In all
the work done in
and and pon said building, or any part. thereof, shall, conform in all respects to the ordl-
nances of. Fridley, I
dinn.', regarding the construction, alteration, maintenance, repair and moving of buildings
within: the city limit
, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
r.xk
'LIaspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In considera
ion of the issue and delivery to me by the lnzpectoa„ of 'Buildings of Fridley of
the above permit
I hereby agree to do the proposed work in accordance with the description
above set forth
d according to the provisions of the ordinances of Pridley, and, being first duly
sworn., 3 hereby
to and say that the facts stated by ane and contained in th above permit are
true as therein stated.'
*
Subscribed and
sworn to before ane at Fridley, Minnesota,
day of..D.
1 9
� i
G"VTW WARM AM- "T9 TMAL
Ft� Shelf & Dud Work ... ... -1110.00
Replacement of Furnace 6-00
Repairs & Alterations—up to SM.00 6.00
Repairs & Alterations each add. $500.00 3 00 OL—
$10.00 $-
3.00
6.00
&00
3.00
Furnace Shell & Lines—to 400 sq. It. KDR Steam $10-(00
Furnace Shell & line—to 640 sq. ft. EDR Hot Water 10.00
Each add. 200 sq. ft. EDR Steam a.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
City of Fridley: e
The undersigned hereby makes application for a permit for the work herew�
specified, agreeing to do all work in strict accordance with the City Ordhmancet',
and ruling of the Department of Buildings, and hereby declarm that an the fmls
and representations stated in this application are true and correct.
Fridley, Minn-
Chvner
Kind of Building
Used as
To be completed about
Estimated Cast, $
CId )New. Building Permit No. Permit No.
(BEATING or POWER PLANTS—SUmun, Not Water m —tato /Z
Trade j- po'
Capacity------ Sq. Ft E.D.R- Y Irru— Hp -
Total Connected Load of Mml-
C/
BURNER — TVvft size
IW77M M a'M A 9:11; 4,
f
Dudwn pbo" jj& 7 —S"I
jj�� a
53-8L —s-915.51
City of Fridley
Dept. of BIdqz. Phone M-3490
DESCRIPTION OF WORK� .6022 N. E. 2nd. street
Number, Kind and Location of Fixtures
pp
91
O �
<
q73
g
Future Fixture Opening ...........
x $1.50
2
$
Z �
Y
� �
Z
� �
Z
yy
� Z
a
e
� "' ►
e
q
WATER 14rR.
GAS
ELEC.
Base.
x $2.00
$
3AS FITTING FEES:
NO. RATE TOTAL
1st
1
2nd
3rd
44th_
• Futuro Conminga
a Now Fixturo, Old Openings
Connected with
Sever �
Cesspool E]
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................
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 89,000 BTU) . • . •
x $3.00
$
New Ground Run Old Bldg. .........
x $3.25
$
Electric Water Heater .............. ��
x $2.00
$
3AS FITTING FEES:
NO. RATE TOTAL
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 9-5-74 19_
Owner Gary Hoshel
Kind of Building Frame
Res.
Used as
To be completed about 9-12-74
Estimated Cost, $ 10.00
Old--44*XBuilding Permit No. Permit No.
Signe
By eeiA_AQPA
Business Phone No
ROUGH
FINAL L _� �f- % S
1st 3 Fixtures ......... • • • • • • x $2.00 S
Additional Fixtures .................. x $ .75 $
Gas Range to 159,000 BTU.. ........... , x $5.00 $ 5.00
REPAIRS do ALTERATIONS—Rotor to Code .50 State Surcharge
Description ............................................. ;
TOTAL FEE 5.50
Clans. aW %u_rc6arp .500
City of Fridley
SUBJECT
CE
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
16 ______ COMMUNITY DEVELOPMENT DIV.f-
r ~ PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
op ,`J
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
11/16/87
JOB ADDRESS 6022 - 2nd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
6,7
8
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dave Kelly 6022 - 2nd Street N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Biddle Remodeling 2044 Ulysses Street N.E., Npls. 55418 788-6335
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
1�asidential
7 CLASS OF WORK
❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 181 Addition (Rough.in
Only - owner to Finish. Work With New
Permit)
9 CHANGE OF USE FROM
TO
STIPULATIONS
Smoke detectors to be provided
on both levels of home. See notations
on plan.
pERMITSR>oUlpEj)EoR.
BeforeSEpARAiE
TELEP1l0dN�bEglIoCc.al utilities
ANG/
_oELEcCaTllR
GAS Etc.
PLUMBING AND
.WIRINGp
9 s Py
SIGNS.RF
L� W
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
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 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
$7/oo0
$3.50
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-
$62.50
S RUCTION OR THE PERFORMANCE OF CONSTRUCTION.
N CHECK FEE
TOTAL FEE
15.63
$81.63
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
oAA
WHEN PROPERLY V I ATED THI ,IS YOUR PER
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
BLDG INSP E
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address:
Legal Description: •� �t �`A� d� �tl� _-�_��
�-L y _ Tel. #
Owner Name & Address:_ --�r
Tel. #Contractor•
Address: WLS U1 �i� (a.� �S � A!
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 I �! Height _ �f Sq. Ft.
GARAGE AREA: Length Width _ Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground _ Sq. Ft.
OTHER: _ ...
Corner Loi" [ 'T Inside
. Yd. Set
Type of Construction: L-). -o 1 Fro,—
Approx.
ri
Approx. Completion Date: Q R-141 -_ I__ -t-
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: APPLICANT:Tel.'���
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
101
Plan Check $ 25% of Building Permit Fee
State Surcharge $ e� $•50/$1,000 Valuation
SAC Charge $ $ 525 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ _ ---
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
0 V%, 2,p.A_%,
erictl,�
3"; 14 A 41-
04
C--2 r- -e--
e--.sa�; � i ,
P" Nb 10104C
... . .. . ......
if
wr
wr
SUBJECT
PERMI
City of Fridley
o 19316
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
�
R EIPT N
`y _____ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
o'7/�/ 3y l
1 �
`
l CITY HALL FRIDLEY 55432
��'���,`�
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
•_-.�
L 612-571-3450
910-F15
1/26/88
JOB ADDRESS 6022 - 2nd Street N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6,7
g
Hyde Park SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Dane Kelly 6022 - 2nd Street N. E. 574-19.40
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 f ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Finish 20' x 18' Addition started on permit #19271
9 CHANGE OF USE FROM TO
S"YIPULATIONS
See plans for any notations
SEPARATE PERMITS REQUIRE® FOR
WIRING, HEATING, PLUMBING AND SIGNS,
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
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
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$1'000
$_ 550
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 ANY OTHER STATE OR LOCAL LAW CON-
$17.50
STFTHE PERFORMANCE OF CONSTRUCTION. ONEGULATING
STRUCTION OR
LAN CHECK FEE
TOTAL FEE
$18.00.
SIGN EO CONTR CTOR RAUT EDAGENT (DATE)WHEN
PV D D THIS YOR PER IT
ROPERLY U��
ATURE Of OWNER IIF BUIL IDATEI
BLDG INSP ATE
NEW [ ]i
ALTER. [
Construction Address:
Legal Description:
City of Fridley Effective 4/1/86
�R-1 AND R-21
Building Permit Application
Owner Name & Address: C� ' v �0
Contractor: v L Tel. #
Address
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.
r_auAr_r ARRA.
DECK AREA:
OTHER:
Corner Lot [ ]
Length Width Height Sq. Ft.
Leath Width Hgt/Ground Sq. Ft.
r' L))C a c v` X /C, r At) • -
Inside Lot Ft. Yd. Setback Side Yard Setback
Type of Construction:' 'v/S/Gr /�yZ'o,
Approx. Completion Date: fii0 S
Proposed Driveway Width If New Opening Is Desired:
Estimated Cost: $
Alt. A Alt B
See Back Page for Explanation
DATE: /_ I % - APPLICANT Tel
CITY USE NLY
Permit Fee $�� Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ ® �U $.50/$1,000 Valuation
SAC Charge $ $-®per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
_ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS: 7�l �� ® /l 8
r sL
B 60, od
ig6o_ 10.40
(/VJ
. 11
- LA
16
-
SUBJ&.T
City of Fridley
ATTH
6�1ILDI�I
PERMIT
28115
o,
` (j
� 6
COMMUNITY DEVELOPMENT DIV.
d PROTECTIVE INSPECTION SEC
CITY HALL FRIDLEY 55432
NUMBERREV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/6/98
10B ADDRESS 6022 2nd Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6, 7
8
1 Hyde . Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dane Kelly
574-0037
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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
Reroof house 9 S Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED 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 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
$771
$.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
$29.25
Fire SC $.77
PLAN CHECK FEE
TOTAL FEE
$30.52
S, ATURE FCO - ACT ROR IZEO AGENT iDATE,
WHEN PROM
RO E LY VALIDATED THIS IS YOUR PERMIT
BI DG 7NSP
r
?ATE
vATURE OF NER HERB DERE iDAi
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: (�r? a L5:7L
Legal Description: (o T�
Fee Schedule on Reverse Side
Fire Surcharge
Owner Name & Address:
.001 of Permit Valuation (1/10th%)
State Surcharge
Tel. #
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
Contractor: ��
��
MN LICENSE #
Driveway Escrow
Address:
Alt. "A" or Alt. "B" Above
Erosion Control
Tel. #
$450.00 Conservation Plan Review
Park Fee
Attach to this application, a Certificate of Survey of the
Fee Determined by Engineering
Sewer Main Charge
$
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: fp-P64'
09s
Construction Type:
Estimated Cost: $
(Fee Schedule on
Back)
Driveway Curb Cut Width Needed:
DATE:/ APPLICANT:
Tel. # �� =Q23
Permit Fee
$ �-
Fee Schedule on Reverse Side
Fire Surcharge
$ 99
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.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 [ J Not Necessary [ ]
TOTAL
$
STIPULATIONS:
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-5711287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning -All Sizes
All Other Repairs or Alterations (List on Back)
1961 of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
'Roof- o!g?a
Effective 4/1/2004
APPLICAI FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIG TION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
Few Total
Owner
$35.00 $ �- Building Used As ! .
$10.00 $ ESTIMATED COST �PERMIT NO
$10.00 $
$10.00 $
$25.00 $
Commercial/Industrial/Instiikutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
$
DESCRIPTION OF FURNACE AND BURNER
# of Heating Units Circle One (Steam) (Hot Water) (!?,
91�
Trade ame a Size No. --
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name
BTU
HP
Size No.
EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
$ and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ *so
$36'o
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMMT FURNACE
410 WEST LAKE
FAX # C ( L1-- Y2 G — =1-3ft<D
Approved by7a Rough -in Date Final Date
KIM
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When reMacina an existina furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes (c)1Z No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes (K"' No ( )
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes {) No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes (� No ( )
When instailind a new yentina system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes ( No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type F�-- —� BTU Input 000 Fan Assisted or Nat FA
Appliance #2 Type C_0 TYL-- A BTU Input 0 Fan Assisted or Nat —W-4-7—
Appliance
A—/"Appliance #3 Type _ BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input 3=0-0
1,1 11A w.
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height 3 ft Length ft Diameter L/ 4-ik Type D d 7—
Appliance #2 Vent Connector Height,'� ft Length�ft Diameter in Type C r
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
AL
REWMININ
HEATING CO:- 6'tft"hyV)0�
r
Signed By: Date
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 LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIRT W, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) 3TZE/BTIJ
Equipment Installed MFG: MODEL:
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
$25 Op 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
_CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTII.ATOR $15.KINNEMM
00
Permit Fee $ S Number of fixtures @$10.00—x $10.00 = $
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00- $
TOTAL DUE $ 32 .�22 Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $ a
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 Faidley and with the Minnesota Construction Codes; that i understand this is
not a permit but only an applic6iaon for a ork is not to start without a permit; that the work will be in accordance the
approved plan in the case all o hick r s r view and approval:
pproval of ans. �m(?.aATE l
SIGNATURE OF APPLI ,
`-j City of Fridley
Building Inspections I)epartment
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
MECHANICAL
Permit No.,fX���bCpC�O
Building
Inspections
RESIDENTIAL APPLICATION
xe�91Q SPR 2 1
2
763-572-3604
CITY OF FRIDLEY
DATE
® YOUR E-MAIL AD RESS
SITE ADDRESS
n :a=
0 OWNER CONTRACTOR
F�APPLICANTIS:
PROPERTY
NAME:
g
OWNER/
ADDRESS: ��/ TY
STA IP �7
TENANT
PHONE:4 -�; �� Ll —
CONTRACTOR
COMPANYNAME;____ HEAT4
_STANDARD
CONTACT PERS( +"! ` L, 410 WEST A
SUBMIT A COPY OF
$ ff MN 55408
YOUR STATE
STATE LICENSE
2-�24
STATE ZIP
LICENSE WITH
ADDRESS:
APPLICATION
PHONE FAX
PERMIT TYPE
,SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW ❑ REPLACEMENT RATION/REMODEL
TYPE OF WORK:
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 LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIRT W, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) 3TZE/BTIJ
Equipment Installed MFG: MODEL:
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
$25 Op 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
_CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTII.ATOR $15.KINNEMM
00
Permit Fee $ S Number of fixtures @$10.00—x $10.00 = $
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00- $
TOTAL DUE $ 32 .�22 Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $ a
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 Faidley and with the Minnesota Construction Codes; that i understand this is
not a permit but only an applic6iaon for a ork is not to start without a permit; that the work will be in accordance the
approved plan in the case all o hick r s r view and approval:
pproval of ans. �m(?.aATE l
SIGNATURE OF APPLI ,
`-j City of Fridley
Building Inspections I)epartment
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
F] NEW HOMESIADDITIONS EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXIS.TINtQ Hf OWES
1. Combustion Air (See note below)
a Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or PropanelIFGC 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 .
& 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