PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N°4 s s
Date:_.__.._.._._. --
Owner: �I iL�ld.�� Builder _.__._..._......_...—�
Address .....2.:._.__. �L�;^fr� Address _.
,[ �.O IO BUILDING
No. _` .._ Street __.._ ._`fL _et.....— _.._.._' Part of Lot.
Lot.....�!'..' ......_ Block ............ ...__............ Addition or Sub -Division �_._.. ...._... /._.. - ...._..' ..'................. _
Corner Lot .......................... ......... Inside Lot . .._...-.._......._........ Setback ....._...�,;�.._....- Sideyard ...../r _........_.
Sewer Elevation....._................._..._...._......._...._............._............._.................._.:. Foundation Elevation ................................. ....... .
DESCRIPTION OF BUILDING
To boXsed as:
Front ..,f. _.. Depth :",�'_.. Height . ._.............. Sq. Ft. -- Cu. Ft. R! ! =
- ....._.........- - ............ _..... Front ..............::.._.. Depth ...............:.:rVeght ......:..... Sq. Ft......_...:......:..- Cu. Ft. - ... -.....----..._...
.......Type of Construction .. rr�riF'`...... Est. Cos ..........._.>...... 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 city of Fridley.
In consideration 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
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 anytime upon violation -9f any of the provisions of said
ordinances. 'n ''./7
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Builder
Address V1Address`��-e—
LOCATION OF BUILDING
L� r
No. / ® Street �� Part of Lot
Lot Block Addition or Sub.DivLZ 17.
Corner Lot Inside Lot_,Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach.to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To b used ass
t Depth Height—L'/—S—X
Sq. Ft. �-_ . Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Fte
Type of Construction /1, �`' 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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true. and correct. p
(A Schedule of Fee costs can be found on the Reverse Side.)
•
C
W . , a
SUBJECT
P
City of Fridley
1
19246
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
REC O.
COMMUNITY DEVELOPMENT DIV.
_
r PROTECTIVE INSPECTION SEC.
4(03 -5
1 ; �
CITY HALL FRIDLEV 55432
NUMBER
REV.
DATE
OF
APPROVED BY
,j
612-571-3450
910415
10/20/87
F�PAGE
/
JOB ADDRESS 4630 - 3rd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7,8
10
Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ronald Hartse 4630 - 3rd Street N.E.
572-8894
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 Ek REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling C15 Squares)
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.. Install ridged galvanized
valleys.
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
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
$.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$750
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. T
$15.00
rFLA,N CHECK FEE
TOTAL FEE
',4
$15.50
SIGNATU CONTRACTOR RA ORIZED AGENT IDATEI
WHEN PROPERLY A DATED THIS IS YOUR PERMIT
LIG INSP
l
DATE
SIG TU EOF OWNER I� OWNER BUILDERI I ATEI
NEW
[
] City of Fridley Effective 4/1/86
ADDN.
[
] R-1 AND R-2
ALTER.
[
] Building Permit Application
Construction Address: `7/�3® - �r-� 5.7-
Legal
.Legal Description: '40 r 2/�//LUCK /a P/- YC 7/-1
Owner Name & Address: _LoV-4LD ef( 9TSE Tel. # .572 -S -if
Contractor: �e•-",!F 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.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: - ROOF Estimated Cost: $ �
Approx. Completion Date: /I I/ /,/ 7
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: D%7 APPLICANT:
Tel. # S
STIPULATIONS:
CITY
USE ONLY
Permit Fee
$
AS'
Fee Schedule on Reverse Side
Plan Check
$
25% of Building Permit Fee
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$ 525 per SAC Unit
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
��- �jb
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
SUBJECT
PERMIT NO.
City of Fridley
® 5
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
PT NO
1
COMMUNITY DEVELOPMENT DIV
v PROTECTIVE INSPECTION SEC.
r ;
NUMBER
REV
DATE
PAGE OF
APRROVED Br
"'\ CITY HALL FRIDLEY 55432
A'I 1.j 612-571-3450
910-F15
JOB ADDRESS
4630 3rd ST NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7 8
10
1 PLYMOUTH ADDITION
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
JASON ELLIOT 4630 3rd ST NE FRIDLEY MN 55432
574-0980
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
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
Tear off entire roof of garage and rebuild.
9 CHANGE OF USE FROM TO
STIPULATIONS
UNDERLAYMENT MUST COMPLY WITH THE STATE BUILDING CODE.
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
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
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION uv
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
.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-
21.00
FIRE SC .50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
22.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATE�II
WHEN PROPER VAL ATED THIS IS YOUR PERMIT
`_
4
] NA UR OF OWNER OF OWNER BUILDER] IDATEI
L INSP
gATK E
NEW [ ] Effective 8/1/95
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2��
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name & Address: Q CAA CIL, j QQ�. Tel. # Li- 0 �
Contractor: '5y 1-k _ MN LICENSE #
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
GARAGE AREA: Length Z�! _ Width 2_C) Height
DECK AREA: en�- Length Width Hgt/Ground
Corner Lot [ ] Inside Lot [ ]
Type of Construction: _
Approx. Completion Date: _
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
Ft. Yd Setback Side Yard Setbac's
Estimated Cost: $�
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: %%Y1iCSA.Q Tel. # C-1 -cc"
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ 1,_ C2r-, Fee Schedule on Reverse Side
$ ,rap .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $850 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ s $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
5-4-14 , 10-0 , 14-7-2 SIR -0
I hereby certify "that ttS�.41a14
,pacification or report was prepared
3y me or under my direct personal
6upervislon and that i am a duly
Registered Professional Engineer
under the laws of the State of Iowa
and that I am competent to prepare
this d current.
DENNIS S. NELSON
Date Z --/B -914 Reg No. 11033 ,
3X8
1
NELSON
=_=
ENGINEER
�^
No.
.==««A. C
. E . S Version
5.6B>>>>=========[
011057
] =======—=««MIDWEST B»»=== •
`112:03:3,4; 199 2
Customer
Project:
: TRUSS
STOCK
Truss ID :
20ST
Mon Feb
Family #6 �'sA;10
Span
• 20-0
Quantity :
Q 1' -------------
1
Top Pitch : 4. 12
_ '
----_--
I hereby
aoRD
BOTTOM CHORD
wEBB REACTIONS
- slzE
3.50
certify' thatP � p
fication, or report was prepared by" me
:-'_-2568
2-3--2132
5-6- 2425
6-7- 1717
2-7--516 1--1423
3-7- 540 5--1423
3.50
or under my direct supervision find that
3-4--2132
7-1- 2425
3-6- 540
I am a duly registered Frdfessiona(
4-5--2568
4-6--516
Engineer under the laws of the State
of Mianesota.
Date 2–/9 2- R,egimtration No. 18047:;„
5-4-14 , 10-0 , 14-7-2 SIR -0
I hereby certify "that ttS�.41a14
,pacification or report was prepared
3y me or under my direct personal
6upervislon and that i am a duly
Registered Professional Engineer
under the laws of the State of Iowa
and that I am competent to prepare
this d current.
DENNIS S. NELSON
Date Z --/B -914 Reg No. 11033 ,
3X8
1
NELSON
=_=
ENGINEER
�^
No.
32208 -
2208IF10r,
IF
10�r,FESSIVO
I
L. HL TO PX: 0-6-8
4-7-2
� 7
2X3
2
4-7-2 a 5-4-7.
4X4
3
8X3
4
LEFT HEIGHT:0-3-15 SPAN:20-0 RISE:3-7—i5
-----------------------------------------
LOADING (PSF) MAX STRESSES MINIMUM.G
I; D TOP 1-2-0.573 'TOP CHORD
TOP 40 10 BOTT 5-6=0.726 BOT CHORD
BOTT 0 10 ______DE_FL.@7=_0.17_< L/360WEBS
___
STR. INC. - LUPM = 1 15 PLATE = 1.15 SPACING
REPETITIVE STRESSES USED NO. OF
r iaaa. D5NNIS`,S 1'"y%
*: NELSON,''`
E-19164
:... • . .''�.. ,.•ick
310
�{8^
•' :062.042799ti• `
9
REGI STEREDi'
PROFESSIONAL'"�
ENriNFFR . '�:`:
1R. HL TO" Pt."'B i
RIGHT1HEIGHT:.B
PLATES ARE MITEK M20-199,146 MANUFACTURED FROM ASTM A 446 ORD A GALVANIZED STEEL(EXCEPT AS SHOWN) " +
PLATE MUST BE INSTALLED ON BOTS FACES OF JOINTS, SYMMPTRICALLY(EXCEPT AS SHOWN)DESIGN CONFORMS'WITB NDS DXBIf�'SP&C8 :AND;UBCiT1
THIS DESIGN IS FOR TRUES FABRICATION ONLY.FOR PERMANENT AND TEMPORARY BRACINO(WHICB IS ALWAYS REQD)CONSULT BLD( ARCRITSC OR Z.
This design conforms with Minnesota Building Codes and
the latest additions of N.D.S. and/or TPI -85 specifications...
9
t
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
17') 9.99
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Effective On March 1, 1996
JOB ADDRESS J " J4� 11
The undersigned hereby makes application for a permit for the work herein
Rate TOTAL 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
$ 30.00 $ representations stated in this application are true and correct.
$10.00 $ - 71 a ,1996
OWNER =��.� � � S 5-71Y `" C� 91O
$10.00
Gas Dryer $ 10.00
*Air Conditioning — All Sizes 0�4-eln $ 25.00
All Others/Repairs & Alterations (LIST ON BACK)
I% of Value of Appliance or Work
Commercial/industrial
1.25% of Value of Appliance or Work
BUILDING VSED AS��_,��n
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
$ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No,
BTU HP EDR
$ Fuel Total Connected Load
State Surcharge .50
TOTAL FEE
@MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU HP EDR
Tl�l 0, AIR C+a,a
HEATING COMPANY fs' +10 V'ENTV V`%H I 11
vhl
Signed B&""
Teli-OOi9
Approved By Rough—In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHE%INEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or
stack:
1.
Has been carefully examined
Yes ()
No ( )
2.
Is free from rust or deterioration
Yes ()
No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( }
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes (
) No ( )
8.
Has combustion air been provided for water heater
Yes (
) No l )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763)571-1287
4630 3 ST NE
263024330020
PLYMOUTH
LOT 7 BLOCK 10
ELECTRICAL
RESIDENTIAL
ADDITION/ALTERATION
PERMIT NO.: 200401501
DATE ISSUED: 09/01/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
[C7 t�7
BRYAN STARRY
4630 3RD ST NE
FRIDLEY, MN 55421
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 117431
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp.
Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
;?00 -S7 - di r)o
qEW [ ] CITY OF FRIDLEY
kDDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
kLTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: 11050 3 R9 "� Iy E
Legal Description:
Owner Name & Address: _T7K`/�1 lv I IJI�� `y�v� ��� JT uv�Tel. # 3 " S 7J- / �i��
Contractor. 0 W NR 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: E Kx0 - 0 RE S ME N ® -5
{� 1 i 2 R E Incl^ tv���dfi f 1 S C( 1ZC*9
Construction Type: 11005E c GARAGE Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: -715-05 APPLICANT: Tel. # J&3 - S 71 . epbf--E
Call (763) 572-3604 for Permit Fees if mailing In application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ���3• Fee Schedule on Reverse Side
$
$
$
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 [ ]
STIPULATIONS:
Building
Inspections
763-572-3604
DATEZ U
SITE ADDRESS Li �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
3b9 MECHANICAL
YOUR E-MAIL ADDRESS
0 OWNER CONTRACTOR
COMPANY NAME:
SEE f ,000K HEATING & AIR CONDITIONING LLC
CONTACT PERSON: 891 _ Wentworth Ave.
STATE LICENSE I!_
ADDRESS:
PHONE
FAMILY 0 TWO FAMILY
TYPE OF WORK: I 0 NEW PLACEMENT
DETAILED DESCRIPTION OF WORK qL
FAX
TOWNHOUSE
0 ALTERATION/REMODEL
Permit No..
Received By:_,A�
Date Rec'd: /9—
TE
a
ATT~ ZIP $ S LLiZ-
STATE ZIP -
13
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 FIXTURE, EXCEPT WHERE NOTED. FIXTURES: RMICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: Wiy i L.X MODEL:6� 3b01 L;7 v SIZE/BTU fid, 0 U 0
MODEL: SIZE/BTU
MFG: VIAMOLAM
MFG: MODEL: SIZE/BTU
FIREPLACE(GAS)$15-00
A/C $25.00 . _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 VENTILATOR $15.00
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 = $ 3SyG
State Surcharge = $ .50
Total = $_3 5' Z-0
THIS IS AN APPLICATION FOR A PERMITNOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application fora permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the cas5� work whic rrec�u mt eview aV approval of plans. I a
SIGNATURE OF
�0j
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
.TE (2-091040
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESAADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propan&UGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas 1MC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346:0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be u$ed for
t
combustion and make up air calculations