PRE 2010 DOCSCity of Fridley, Minn. N° 8573
•
BUILDING PERMIT
Date: OCTOBER 29, 1965
Owner: DEAN FERGUSON Builder RICHARD MILLER SONES
Address Address 8256 Monroe- St . N. E.
Minneapolis 32, Minnesota
LOCATION OF BUILDING
No. 5980 Street 5th Street N. E. _ Part of Lot
Lot 1 __ Block 14 Addition or Sub -Division — HYDE PARR
Corner Lot __X — Inside Lot — Setback -- Sideyard
Sewer Elevation _ _ _ _ Foundation Elevation
11
DESCRIPTION OF BUILDING
To be Used as:
HOUSE Front 36 Depth 24 Height 20 Sq. Ft. 864 Cu. Ft 17,280
GARAGE Front 12 Depth 24 Height 10 Sq. Ft, 288 Cu. Ft. 2, 880
Type of Construction Frame Est. Cost _A14, 0011__ 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 orth and in compliance with ail provisions of
ordinances of the city of Fridley. n ,i , "I ,
In consideration of the payment of a fee of $ 20.00 , permit is hereby granted to RICHARD MILLER
HOMES 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
ccttfppfoanrrtt thereof, shall conform in ! respects to the ordinances of
Fridley, a cite ota14- regarding Ott may revoked at any "m upon violation of any of thand e proovisiving ionbs of said
ordlIn—
�nancce& city limits and
NOTICE
Ub pump don nor cam As Iona mefto, WaWan for wkk& phmbino, On hsatlno, awn or wdu. Be am to ao
the SuNin higmtsr for aparata pnrmbs for than Nava.
Y% .
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER
h
ADDRESS_ ADDRESS_
LOCATION OF BUILDING
Street W ; Part of Lot
LOT R �� ADDITION OR SUBDIVISION �A
Corner Lot ./Inside LOT Setback Side,; -Yard
..SEWER ELEVATIM FOUNDATION ELEVATIOIIT
Applicant attach to this form i4d Cet'ti#hates of purvey of Lot and proposed
building location drawn ori thd$e Gertflcates.
�J
DESCRIPTION OF $UliDiNG J
To be used as:
Front Depths_ ! Height
Sq. Ft._., Cu. Ft. �-
-�T
a 4? a .2!e—_ Front Depth �/ Height
Sq. Ft. Y i Cu. Ft.
Type of Construction Estimated Cost r-)
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.
(Schedule of Fee Costs can be found on the Reverse Side).
4.
a - 0o �Z'
SUBJECT
T NO.
City of Fridley
24541
AT THE TOP OF THE TWINS
BUILDING
PERMIT<
r
RECEIPT NO.
1 v —_-___ COMMUNITY DEVELOPMENT DIV
PROTECTIVE INSPECTION SEC.
t4 ;_4®
r 1
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/9/96
JOB ADDRESS 5980 5 Street NE
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
1
14
I Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Sherry/Mike Perreten 5980 5 Street NE
571-5987
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Lloyds Home Improvements 1012 42 1/2 Ave NE, Columbia Heights 55421 788-5602
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
1798
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 24' x 8' Garage Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
Variance approved on August 26, 1996 for
a strept side setback from
25 feet to 10 feet. Provide a hard surface driveway.
WARNING
Before digging call for
all utility locations
SEPARATE PERMITS REQUIRED FOR
454-0002
WIRING, HEATING, PLUMBING AND SIGNS R�QUiRED BY LAIN
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
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
$1.76
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,517
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
PLAN CHECK FEE
TO AL FEE
Y'e , � dAa.A�Lice
se C
$5 0
$97.53
SICAATURE Of CONTRACTOR OR AUTHORI DAGENT IDATEI
PR
Y VA ID ED THIS IS YOUR PERMIT
bG IN
04TE
SIGNATURE OF OWNER iIF OWNER BUILDERI IDATEI c
NEW
ADDN
ALTER
ConstructionAddress:
Legal Description:
Owner Name & Address:
Effective 3/1/96
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application��
Tel. # S? f - S 81
Contractor: 41,- MN LICENSE #
Address: /p / ( �., �4 y zg— Ale Tel. # %��`S� ° �-
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width �' Height r Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback
Type of Construction:
Approx. Completion Date:
Side Yard Setbacks
Estimated' COSI: $
G
(Cost on Back)
Drivewaab Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DA APPLICANT: Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ h �, c2S—
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ �, `J
$.50/$1,000 Valuation
SAC Charge
$
$900 per SAC Unit
License Surcharge
$ C'�'j
$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 [ ]
TOTAL
$ / S
STIPULATIONS:
� ,•
111 �
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orf,
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MINDER ENGINE G CO., INC.
ENGINEERS AND SURVEYORS
L^t4o SuvkvmYlNo SOILS TESTING
CIVIL L. MUNICIPAL ENGINEERING LAr-40 PLANNING
6418-SGTw AVENUE N.
MINNEAPOL15 77,MINN.
KE -t- 3r.37
c4er-tificalte of r
51ill P\M
116
1TWA,
Xx
z
t
I
Su9JECT
PER
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
D C R A A I T
1 1�
2 9 1 I �}
r
[ C 'v1 1
CEIPT N
VV-----_COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
(O
I =
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
�'' 612-571-3450
910-F15
3/31/99
JOB ADDRESS
5980 5 Street NE
1 LEGALLOT
NO.
BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
14 Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
Michael Perreten 5980 5 Street NE
571-5987
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE Wo-
OLlo
ds Home Improvement Inc 1012 42 1/2 Ave NE, Columbia Heights, MN 55421
Lloyds
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
788-5602 1798
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW 0 ADDITION ❑ ALTERATION ❑ X REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House & Garage; Reroof House & Garage (28 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code. Call for
building wrap inspection before covering.
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
$8,119
$4.06
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
$149.75
Fire/19C $8.12
`� ;.' ". `,
PLAN CHECK FEE
TOT F E
L"` s S/)// `J
License -Sl
5.
66
SIGNATURE OF CON 'R CTOP OR AU(' RIZEO AGENT IDA AE,
MEN ROP
AT.93
L ALIDI1 IS UR PERM T
SIGNATURE OF OWNEROF OWNER BUILOERI IDA TEI
Bl G INSP
TIATE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMH.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 5980 - 5TH. ST, NE
Legal Description:
Owner Name & Address: MICHAEL PERRETEN
Contractor: LLOYDS HOME IMPROVEMENTS, INC.
Effective 1/1/99
Tel. #612-571-5987
MN LICENSE # 0001798
Address: 1012-42-1, AVE. NE Tel. # 612-788-5602
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA:
Length
Width
Height
Sq. Ft.
GARAGE AREA:
Length
Width
Height
Sq. Ft.
DECK AREA:
Length
Width
Hgt/Ground
Sq. Ft.
OTHER:
NEW SIDING,
TEAR OFF & REROOF
HOUSE & GARAGE
28 SO,
Construction Type:
S994,d"
Estimated Cost: $
(Fee Schedule on Back) dj /
Ft x $ _ $
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
DATE: 'yn t L 3 y y`7 APPLICANT:SCG : y2 i Tel. # -1 S 6 a
u
CITY USE ONLY
Permit Fee $ %�% �� Fee Schedule on Reverse Side
Fire Surcharge $ n.1,- .001 of Permit Valuation (1/10th°)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1050 per SAC Unit
License Surcharge $ ®y $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 [ ]
TOTAL $ l > Q3
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIViS10N Effective On January 1, 2001
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS., j �A-
RATE SCHEDULE -
OWNER—fn- - Yl rl P L
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1%.of Value of Appliance or Work
Commercial/Industrial
1.25°Jo of Value of Appliance or Work
Rate TOTAL
$ 30.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $
$
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
1.
$_�.50
BUILDING USED AS
ESTIMATED COST�a� � PERMIT.NO.
®ESCRIPTIOPI OF FURNACE AND OR BURNER
No. of Heating Units 9 Circle One (Steam) (Hot Water)arm Air)
Trade Name ) Size No.
BTU HP EDR_
Fuel Total Connected Load
Burner trade Name Size No.
BTU HP 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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct -
DATE 2 t Tchl-L
TEL #It i�'
When rqppilaac-inW an existing furance, the undersigned hereby verifies that the
has been examined and is free from rust, deterioration, obstructions,
Yes No( )
venting
and is securely supported and firestopped where required.
BTU Input
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
Fan Assisted or Nat
and meets the current codes and e AGA-GAMA Category I Central FurnacesVnti g Tables for fan
include
Yes
Yes No { )
assisted and natural draft appliances.
Common Vent Type
The existing combustion air is sized and installed to meet the current codes
Yes No ( )
and manufacturer's specifications.
ft Length
When required to Install a new combustion alit will be sized and installed
Yes (� No ( )
to meet the current codes and manufacturer's specifications.
ft Diameter
Diameter in Type
When installina a new venting 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
yes (�N®( )
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an_ appliance has been removed from the common vent and vented
Yes (,4 -No( )
separately as per current codes.
Appliance Type and Size/Common Vent and Vent Connector Information
ALTERATIONS: Describe
HEATING CO:
Signed By:
BTU Input _ � � an Assisted or Nat
Appliance #1 Type
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances �.
Total Btu Input
Common Vent Type
Vent Height ,
Diameter _ _ _ __ inches
Appliance #1 Vent Connector Height
ft Length
ft Diameter in Type _
in Type
Appliance #2 Vent Connector Height
s Length
ft Lengthft
ft Diameter
Diameter in Type
Appliance #3 Vent Connector Height
ALTERATIONS: Describe
HEATING CO:
Signed By:
CITY OF FRIDLEY BUILDING INSPECTION
6431 Universtr Ave NE
Fridley, MN 55432
763-5723604 FAX 763-5711287
0,
1
Furnace Shell and Duct Work, Bumer &
also Replamment Fumace
Gas Piping (New Furnace;, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sims
AH Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Real or 5% of cost of
Improvement whichever is greater
Effective 4/1/2004'
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
EM
$35.00 $
$10.00 $
$10.00 $
CCommerdl/Ind ai/M onal
1-25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commerclal/industrial/1nsUtutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
110):U010).4
Am
Budding Used As
ESTIMATED COST PERMIT NO
$ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
--�— BTU . HP EDR
Fuel Tom Connected toad
Burner Trade Name Size No.
BTU HP 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.
*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 REPLACEMENT FURNACE
Approved by Rough -in Date Final Date_
FILL IN COMPLETELY FOR REPL ACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an exkOna 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 ( ) No( )
The venting system is piasticJPVC 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 -LAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes( ) No( }
The exledna cambustlon air is sized and Installed to meet the current codes
Yes () No ( )
and manufacturer's specifications.
When required to ira8tatl a new aombusidion air. it will be sized and installed
to meet the current codes and manufacturers specifications.
Yes (} No ( )
When Insitilina anew venting su m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
ate. This does Include AGA-GAMA Category I Central Furnace
Yes( No ( )
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and Installed correctly after
an appliance has been removed from the common vent and vented
Yes {) No ( )
separately as per current codes.
A ®llanc® Tvae and SixeJCommon Vent and Vent Connector
Inforrr�tlon
Appliance #1 Type BTU Input Fan Assisted or Net
BTU Input Fan Assisted or Nat
__.__.�._
Applies #2 Type
Appliance #3 Type BTU Input _ Fan Assisted or Not
Total Appliances Total Btu Input„______._.
Common Vent Type Vent Height Diameter
___ Inches
Appliance #1 Vent Connector Height .___.. ft Length it Diameter . _
ft Length Diameter
in Type
to Type
Appliance #2 Vent Connector Height .
Appliance #3 Vent Connector Height _.__ ft Length r.it Diameter
in Type _
HEATING
Signed BY
MECHANICAL
Permit No1U() 1 (j'
Inspections RESIDENTIAL APPLICATION
Received By:
763-572-3604
Dat MAUG 0 20
CITY OF FRIDLEY
763-502-4977 FAX
EFFECTIVE 2-19-09
DATE YSUR E-MAIL ADDRESS I S U
SITE ADDRESS
THIS APPLICANT IS: O OWNER CONTRACTOR
PROPERTY
NAME:
CITY STATEIP
TENANT
PHONE:
PHONE:
.41
CONTRACTOR
COMPANY NAME:
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
STATE LICENSE # EXP DATE 1a 10
LICENSE WITH
ADDRESS: CITY STATE ZI I--sy—
APPLICATION
PHONEjoS 0 FAX
PERMIT TYPE
INGLE FAMILY 13TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
0 NEwEPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTUREXC OTED. FIXTURES: (INDICATE T�Q�y�� NUMBER OF EACH BELOW)
Equipment Installed MFG: ��
MODEL:[-lO_'JiK t SIZEIBTU e ,
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
IYWC
$25.00 'FIREPLACE (GAS) $15.00 RANGE/OVEN $10.00
_GAS
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 _FURNACE $35.00 UNIT HTR $10.00
_GAS
CHIMNEY LINER $10.00 _GAS DRYER $10.00 HEATER $35.00
_POOL
DUCT WORK $10.00 _GAS PIPING $1.0.00 VENTILATOR $15.00
:, ? f x- g£y Y € , ^£ �z i l ;r,•¢�.: i ay, ',gip€( 3� S :a F
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s: ,�£ � x. ��ti� ����^ � Y 2Tu Y`�,ue.4 ^L.,C ��� ��'u� �R3i's'i �b=�� tt � 3 � •� ^«�^« yf ..f'yyS 4 ��.
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y'�➢a s re �� ��, � y J � t `� .��q��"' y� �} r� `�, •� �,�n`•n Ex '� �'�.o. `�� .... � ,r �v� az ��"
'm ��444�?� � .'.Ab �i b'}�• i ����a ".�' e �7'i+.5�,a« ..a :f� T' ;a�, 1`��F�s. a�' ��
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I h or a building perm' 1 a owledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances d odes oity of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applica on perm' d w is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all or w 'c re es ew and approval of c
SIGNATURE OF APPLICANT PRINT NAMEpl11
`r 5.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS 0 EXISTING HOME 0 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 Propane/IFGC 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. -RCCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
Building
PLUMBING
Permit No.: ()1
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
n p
763-502-4977 FAX
EFFECTIVE 1-1-2010
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR
PROPERTY
NAME: 091, ry F AJ
ADDRESS T9 � / S- ./V .� CITY V STATE�%NZIP S
TTENANT
PHONE: 7/-3- S-7 -52n
CONTRACTOR
NAME: Ae l !s P l U -a; &-
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE, BOND AND
STATE BOND # DATE
CERTIFICATE OF
/EXP
ADDRESS:.23 6 S � OL' / 5 4-M� 4 AV - A CITY L STAA4 N ZIP
INSURANCE
PHONE FAX
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW )<REPLACEMENT
DETAILED DESCRIPTION OF WORK G P'2' l P,
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
_ BATH SINK/LAV _FLOOR DRAINS SHOWER —WATER PIPING
_
BATHTUB PIPING (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35)
_ —GAS _
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
_
_ DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Number of fixtures @ $10.00 x $10.00 $
Number of fixtures @ $15.00. x $15.00-= $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge $ .50
-� 5 5 "'
INIMUM $35.50 Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approva'/ f planes.
PRINT NAME'��/ % " C!�G�//►��f
SIGNATLAE OF APPLICANT DATE
00
PLEASE NOTE: S R BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
0