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PRE 2010 DOCSVf.$g® of *IdjeY9 Mhm BIIEMING PIERIM N° : 365, ; Officeof IINSPIMMI& OF B INGS ' Architect Frid'ey, B+Yinn. + 19 '�' Builder " I,OCATaON' F 1`3MDING No. O Street. a Part of Lot LOt " Block %�� - Addition or Sub-Divisiom. DETIONOF BUR DING + + Constructio* Front �tZ Dep Height Stories Manner of �- To be used as s « To be; complet B I ■' lilstimated Co ab�a ^3 e'. Permit 10 hereby ted to�r to "� o Mebuil > described in the above statexnent. This permit is granted upon the, .o ditiosz "that the person to whom it 'is :granted, and. hia agents, employees and workmen, in 'all; the work done in, and and upon said building; or; any pari thereof, shatY conform in all respects to the ordl- nances of Fridley, regarding the eon�structiou, alteration, maintenance, repair and moving of buildings within the City .limi ., and this permit may be revoked a t any time upon violation of any of the provisions of said ordinances. .XI{� inspector of Buildings. AGREEMENT AND SWORN STAT TT i In conside ion of the issue ' and delivery to me "by the . Inspector of Buildings ' of Fridley, of the above rnii , I hereby agree to.-do the proposed work MI accordance with the "description above set -forth d according to ' }e provi�siaxis of. the ardiitaxices of Fridley, and; Toeing first duly , sworn, I hereby 3ttate, and saq that the faets stated by me and eontained"in the above permit are true as therein ted. A.. Subscribed, an sworn to before me at Fridley, _ Minnesota, ihzs ' 1 //q9 ✓5✓ fr dayMop A9 � y r ,�2r -7 Ven City of Fridley, NUmn. 8178 BU"ING PERMIT • Date: JULY 13, 1965 n U • Owner: MERWIN J. BERHOW Builder SAME Address 5430 - 5th St. N. E. Adams Fridley 21. Minnesota LOCATION OF BUILDING No. 5430 Street 5th St. N. E. Part of Lot Lot 5,6, & 7 Block 11 Addition or Sub -Division _ Hamiltons Addn. to Mechanicsville Corner Lot _ Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. cost $460,00. -...._ To be completed REPAIRS DUE TO STORM DAMAGE 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 21 provisions of ordinaaoes of the city of Fridley. d�C'9 In consideration of the payment of a fee of $--L. 00 , permit is hereby granted to MERWIN BERHOW _ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it pisargtranted and his agents, employees and workmen, ffi all work donces of Fridley Minnesota dregardin upon said ocatio�n,g' °construyction, alteratiou��maiat�en°a�ace� pair and moving all respects to the °of bb idings within the city limitsris permit may be revoked at any time upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN Building Inspector NOTICE: Tbb PMO don W Corer dw 9WdMd1W, kdagatim for whiny, phmbing, gas had t& nWW or WSW. Be son to sse the Building Deter few sopsran pwmNs for thus trona. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME e" w r BUILDER ' ADDRESS % �' :r ADDRESS LOCATION OF BUILDING N0, STREET PART OF LOT LOT �'�� BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT ---'"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 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. _ a DATE °' SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). r City of Fridley, Minn. 1,T° 9558 BUILDING PERMIT 0 Date: November 16, 1967 • C Owner: Mervin Berhow Builder Sussel_.Compg yn _..._ Address 5430 - —5th Street N.E. Address 1850 Como Ave= Fridley, Minn. 55421 LOCATION OF BUILDING No. 5430 _ Street 5th Street N.E. _ part of Lot Lot Block ____1.1 _ _ Addition or Sub-Division.jL=U�Asldi t ion to Nech nicsville Corner Lot ____ Inside Lot — X _ Setback --_ Sideyard Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front 20 Depth Height 10 Sq. Ft X20 Cu. Ft. 5.200 Front Depth Height . _ Sq. Ft..— Cu. Ft Type of Construction Frame Est Cost $1, 900.00_,_..,,,._..__ To be completed 30 days In consideration ithe issuance to h e e a permit to construct the b agree to do thwork in accordance with the description above t f rth and mpVY:hX provisions of ordinances of the cityof Fridley. Inconsideration of the payment of a fee of $ 8.00 _,permit is hereby granted toSUBVCompan 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 vidlatioij of any of the provisions of said ordinances. A 1 Building Official NOTICE: Ibis permit does not cover the construction, InstJlatlon for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these hems. OWNER'S NAME ADDRESSt . •fir'.• APPLICATION FOR BUILDING PERMIT CITY OF FRIOLEy, MINNESOTA f t •.ii :� r BUILDER 14a LQMTzoN' 'OF $,GILDING STREET .: :�RT OF` LOT: LOT -/ �` BLOCKS ^ADDITION OR SUBDIVISION CQ$NER NSIDE LOT .. SIDErVARD SER ELEdATION 'FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot.:gnd'propooeid building location drawn op C•hes�e Ce .,.:I OF.,bUI%DINO Td Be Used = cu Ft . c3 C) Front -Depth.,�� . do Height Sq. Ft. Type of Constructs Estimated C©st To Be Completed The undersigned hereby makes appiicat" for'a••pe�t ,for the work herein specified, agreeingto do all work in strict accordance with th® Cite and rulings of the Department of Builds y cf Fridley -Ordinances and representations stated in this applicatioonnda tr dacadiscorrect, tail the facts (Schedule of Fee Costs can be found on the Reverse Side). 0 �. L - - NAME SIZE •� /- Z® BLOCK ADDRESS VALUE 4 3 1 9®® ADD'N. AREA TYPE 1 1= L? MUST 15C .^T:S7- P'1£qm&H C-11%ic MVsr mir— .4*%T L�easi 3`` I w 1r H N0�sIF-- S 10C b F Tis S,T^ 12T ®F HOU SE,,n5 SHOWN. FQUNT ®F f�AQAl�E Tc� L-lt-tz wrrH IZEA2 ®F H®UMC ^'S ���wN• CA c?'c F 'f I E 4 4 -- ® :scc�wlay-p-_ Fob ,zC^c.T 4-C, TtoN oF- 12v/G..E 0CoQ. ��S�E�i��" �c-�v,e�TlcsN OF 5C_.nB T® � 1�+" ,t��©�£ ��•��£' ^S H ®W N• I s City of Fridley SUBJECT MOVMG F1515315iH AT THE TOP OF THE TWINS BUILDING PERMIT i ` "RECEIPT N `L ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. qpi-5-.o 7 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 812-580-3450 910-F15 4/30/79 JOB ADDRESS 5430 - 5th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5, 6, 7 11 1 Hamilton's Addition to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dan -Lan Development 5430 - 5th Street N.E. 560-2524 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 Garage 7 CLASS OF WORK �p ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR X MOVE ❑ REMOVE 8 DESCRIBE WORK Move garage to neer location on same lot. 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 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT NONE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PRO SIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- T UCTION OR THE PERFORMANCE OF CONSTRUCTION. $15.00 PLAN CHECK FEE TOTALFEE 30 /a $15.00 SIGNATURE OF CONTRACTOR O UTHORIZED AGENT (RATE) xAL�iDATED THIS IS YOUR PERMIT �HENRLY BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) o Pride �liOJEC.T Permit No. r�CARP AT THE TOP OF THE TWIN$ MOVII PERMIT APPLICATION Lq -----� Receipt No. j v,-------COPMVMITY DEVELOPT-2ENT DIV. 1 ' PROTECTIVE cN&MVIOLA MPT, CITY HALL FRIDLaV Oho$ �.1 013-009" 3*30R%1�C4+T t REV. DATE PAGE OP APPRQV D BY 910-F21 1 0 2/15/73 1 1 1 800 Property Owner Address Phone 4470 , L. ah 6C' vt l rte/ e h u V 3 D S S7; A/,F . S-60 -2S 4 resent Lot No Block No Tract or Addition , Legal r -7 To Be _ Moved To 3 Mover/1 Address one i.cense o. eqh ` ��h �eiP /o P Expected Time in or Thru ri ey Estimate Cost Routing Sg do e Io 7� Approved By: Utilities Notified: State whether notified and date Minneapolis Gas Company Engineering Department 372-4850 Northern States Power Company Customer Business Office 330-5540 Northwestern Bell Telephone Co. Business Office 332-4112 Approved By Water & Sewer Department: ,All Bills Are Paid Services Are Disconnected The -undersigned hereby makes application for a permit to move the building 'described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Department of Buildings, and hereby declares that all facts and representations stated in this application are true and correct. ),�L4 i, _/_1 --- Contractor r SUBJECT PE NO. City of Fridley o 15154 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT NO. •COMMUNITY DEVELOPMENT DIV. 16U ----'- r � � PROTECTIVE INSPECTION SEC. �/ 40 1 / -5 i /•"1 CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OFAPPROVED BY "•' ,'� 612-560-34504/30/79 910-F15 JOB ADDRESS 5430 - 5th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5, 6, 7 11 Hamilton's Addition to Mechanicsville SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Dan-Lan Develognent 5430 - 5th Street N.E. 560-2524 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential Garage 7 CLASS OF WORK ❑ X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct garage slab for a 20' x 26' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Garage is being moved onto new slab. Presently located on same lot. 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. $750 $.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- $7.50 STRU TION OR THE PERFORMANCE OF CONSTRUCTION. /.��%� // � /�© % ly 7 PLAN CHECK FEE E TOTA�tfEEOO 1 SIGN/NATUREOO��F CONTRACTOR OR ALArHORIZEDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT 1 ra i 4 �? BLDG )NSP fJATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) • CITY OF FRIDLEY , APPLICATION FOR RESIDENTIAL BUILDING PERMITS ' (NEW, ALTERATIONS, ADDITIONS,' OR REPAIRS) � ' t OMIER: Cat? - L e I, loPy e /j�p4n p N7` BUILDER: 2A •✓ Address: K'130 S11 S7. Address: • Tel. No.: ' t No.: Street: ! LOT: S ,; �'� BLOCK: I/ ADDITION: 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: o �:8 Front: 0 Depth: Height: OV(-, Square Feet: J -,,?o Cubic Feet: I Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ 7S0, O� To Be Completed: 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: 44 -30-q J SIGNATURE: Stipulations: 9 se n 1' July 22, 1981 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Mr. Harlan L. King 5430 - 5th Street N.E. Fridley, MN 55421 Re: Address Change For Residence Effective September 1, 1981 Dear Mr. King: We have to make the following change of address for your residence; NAME: Mr. Harlan L. & Mrs.. Nancy King FROM: 5430 - 5th Street N.E., Fridley, MN 55421 TO: 5436 - 5th Street N.E., Fridley, MN 55421 LEGAL: Lot 5 & N]i of Lot 6, Block 11, Hamilton's, Addition to Mechanicsville We have notified the following companies of this change and also various departments in the City Hall. If you have any questions on this change, please contact me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh CC: Minnesota Gas Company Northwestern Bell Telephone Co. Northern States Power Co. Minneapolis Post Office Department Minneapolis Star & Tribune City Water Billing Department City Assessing Department City Police Department City Fire Department Voter's Registration ADDRESS AND LEGAL OW11 WC0NT1tAGT POSER: CONSTRUCTION DATE: �/ -29 ADDITIONS: A. ZCNING ACTT N: B. SPECIAL USE PERMIT(S): # C. IM SPLIT(S): # ORDINANCE NO: D. VACATIONS) : # ORDINANCE NO: E. VARIANCES APPEALS COMMISSION: APPROVED D SAPPROVID DATE 6---/o --�(J NO. CITY COUNCIL: APFW= ZDISAPPROVEfl DATE -2'-7-pro NO. F. EASEMENTS: Bikeway/walkway Street right-of--vay Utility Drainage Alley K & RECD Other (Specify) G. LICENSE(S) (List): Date of Renewal: H. STIPULATIONS (List): DATE REQUIRED DATE COMPLETED I. MISCELLAIMS: 1 SUBJECT_ -- City of Fridley 29145 AT THE TOP OF THE TWINS BUILDING PERMIT r • _____ COMMUNITY DEVELOPMENT DIV. `V INSPECTION SEC. r � � PROTECTIVE /744 NUMBER REV DATE vAGE OF APPROVED By ----I CITY HALL FRIDLEY 55432 612-571-3450 910-F/5 4/5/99 JOB ADDRESS 5436 5 Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5, Pt 6 11 Hamilton's Addition to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harlan King 5436 5 Street NE 572-8190 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 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 0 ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (22 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. 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 80 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,885 $.94 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- $59.50 Fire SC $1.88 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL E .32 SIGNATURE OF CON'aACTOA R AUTHORi2E0 AGENT iDATEiz,—WHENP OPE AL DAT IS IS VOU PER IT 1/k ' BLD iNSv r�ArE SIGNATURE 0/ OWNER... OWN pBUILDER� MATES 1 NEW [ ] Effective 1!1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ` `/ �� �� Legal Description: fflg�,; t#6 �, j Akuu le 61 kwi s s 1,11 f d' - -1 /Z A- 0 f Vez k Owner Name & Address: /� `�, s a -i 4 r141r e s S Tel. # S-2'2__ 911 9/' 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. ECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER• i `1n t � t��ec Alt. "A" or Alt. "B" Above - !r Construction Type: $450.00 Conservation Plan Review Park Fee Estimated Cost: $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 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 [ ] Not Necessary [ ] ��y TOTAL $ ✓ STIPULATIONS: Building MECHANICAL Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY DATE \l Zg' YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR O OWNER PHONE: �1 5 a t COMPANY NAME: Home En r CITY Permit No. Received By: A k Date Rec'd: / -)- ATE---7,1P--5 CONTACT PERSON: SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE CITY Plymouth STATE MN ZIP-UMZ LICENSE WITH ADDRESS: 15200 25th Ave � APPLICATION PHONE 763-476-1990 FAX 763-476- SIN 63-476-- PERMIT TYPE SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE 0 Nay �7 REPLACEMENT 0 ALTERATION/REMODEL TYPE OF WORK: �iy v S liD DETAILED DESCRIPTION OF WORK cost PER MS 16B.665 the permit fee is a minimum o fixtureexcluding heto the fixturtales. (This greater, $500.0o, whichever is should only thec cost of labor) improvement, installation or replacement of a residential Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor.x.05 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 Equipment Installed MFG. --- MODEL: ___ _ __— SIZE/BT MFG: SIZEMTU MFG: MODEL: - GAS RANGE/OVEN $10.00 A/C $25.00 _FIREPLACE (GAS) 111 NEW GAS GRILL $10.00 _AIR TO AIR EXCHANGEER $15 OOD $35.00 _GAS UNIT HTR $10.00 BOILER $35.00 ✓FURNACE $35.00 POOL HEATER $35.00 R $10 00 TOR $15.00 _CHIMNEY LINER $10.00 — —VENTILATOR DUCT WORK $10.00 GAS PIPING $]000 f .«...»t. >,tFs-0f.A :afa.evyvr'?4i'. . �' .. �"�n'�!IIl % +t�K:.`1Vi Rl s'ti :i Ll . - I — ' 3 niC( '3i �14J2�s, r t�t?a+.Mru:t•i i"s'F:k�';:i3':?4'warn.. a= .:..., w. X $10.00 = Permit Fee $ 3�• ^ Number of fixtures @ $10.00 50 Number of fixtures @ $15.00 x $15.00 = $ Surcharge $ TOTAL DUE $35.50 .5 Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.0 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 s is conformance with the ordinances and codes of the City y ofFridleis noty a d witrt h a permit; that the work will be in that nwith the nneso not a permit app'for a permit an approved plan in the c:Tofae which requires review and approval of plans.SIGNATURE OF APPLIC PRINT NAME i� * M 'r 14 Q DATE 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 HOMESIADDITIONS ❑ 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 Propan&UGC Chapter 3 with MN Amendments 2. Make-up Aar (See note below) & 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 used for combustion and make up air calculations