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PRE 2010 DOCSDate ' II �. f! . Owner .i'tk �,���t a Address BUILDING PERMIT Village of Fridley, Minn. N' 2119 ;2 .......................... ,rte 4,,,,.f.�•�ty Builder ........................................... ..f'17..... Address ......................................... LOCATION OF BUILDING No.. � a ... .Jl • . .. Street . ,�• • • ......'"i le+ ............ Part of Lot ....................... Lot ... .....IIS Block . ............ Addition or Sub -Division -_ .... . Corner Lot ........I'r ... Inside Lot .. �,r....... Setback ..... 7ideyar ,,. To be Used as Type of In consideration the proposed work t ordinances of the vi] DESCRIPTION OF BUILDING Front ; ... Depth &Lk .. Height .... Sq. Ft......... Cu. Ft........ . Front ...... Depth ........ Height 4........ Sq Ft Cu Ft .. Est. Cost V' 1'.�r'....... ... To be Completed ` .... rl' 0 th&:'issuance to me of a permit to construct the building described above, I agree to do !cordance with the description above set forth and in compliance with all provisions of % of Fridley. nsider on 01f the payment of a fee of $. permit is hdeby granted to �CG��.s o .F tl• • :. . 5� ..' to construct the building or addition as described above. permit s granted upon the express co ion Tat the person to whom it is granted and his agents, employees and workmen, in all work one din, around and �i n said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota re�arding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits aid this permit may be revoked at any time upon vi�ation of any of the provisions of said ordinances. ".4 / V/7 NOTICE: This permit sewer or water. Inspector s not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sure to see the Building inspector for separate permits for these items. 0 0 City of Fridley, Minn. N° 8698 ELUDING PERMIT 70 Date: March 9, 1966 Owner: Roger & Marcel Brenny Builder Bre2Z Brothers Construction Address 6011 Third Street N.E. Address 6011 Third Street Northeast LOCATION OF BUILDING No. 6041 Street Sixth Street Northeast Part of Lot Lot 13 Block 1 Addition or Sub -Division _. _Bonny Addition, Corner Lot _ Inside Lot .__ Setback Side—yard Sewer Elevation ` Foundation Elevation STORM DAMAGE AND ADDITION DESCRIPTION OF BUILDING To be Used as: 1019- / ® 9�6 Dwelling Front 421 Depth 26 t Height 101 Sq. Ft 1272 Cu Ft 1272 New Garage Front 9), t Depth 24t Height Sq. Ft 7 cu. Ft 516 Type of Construction Est.Cost 17 900.00 _ To be Completed June lE 1966 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 ;h provisions of :%.W% of the city of Fridley. A A In consideration of the payment of a fee of M._., permit is hereby granted to Brennv B*',otbars Conn • to construct the buildiag Or addition &8 described above. This permit is granted upon the express condition that the �e�oa to whom it is granted sad his agents, employees and workmen, in ell work. done in, around sad upon said buildiag, or say part thereof, shall conform in aII respect8 to the ordineacrs of Fridley, Minnesota reg�d�a� k+cati�, oonatruatlon, alteratton, maiutenaace, repair sad movlag of build�n� wt i nom. city limits and fids permit azay be revoked at aqy time upon violation of aqy of the provisions oP ea�d NOTIC& fhb permit don not corer the naatroada, Inift0aftoa for Who, &mbino, on butte o, ewer or water. Be an to as the Beihfhro Im Oftr for uparare permha for thee hems, APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME Ael ; BUILDER �� C ADDRESS ADDRESS LOCATION OF UILDING NO. l STRE9T PART OF LOT G cam' LOT BLOCR� ADDITION OR SUBDIVISION 9 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 fn these Certificates. DESCRI ON OF BMWING To be, used as:444 Depth. Height --Z 6- - —� Sq. Ft. Cu, Ft. Z�Lo 2 Front Depth Height Sq. Ft.,1 Cu. Ft. Type of Construction Estimated Cost To be completed` /4( 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 /1^�� % % SIGNATURE (Schedule of Fee Costs can be found o*eReverse Side). SUBJECT City of Fridley N E-.- AT THE TOP OF THE TWINS BUILDING PERMIT r IPT ` • COMMUNITY DEVELOPMENT DIV. 1 V ' r PROTECTIVE INSPECTION SEC. � � NUMBER REV DATE PAGE OF APPR VED BY CITY HALL FRIDLEY 55432 �'j 612-571-3450 910-F15 10/31/95 JOB ADDRESS 6041 6 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 I Bonn SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Ehlert 6041 6 Street NE 571-3670 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Twin City Exteriors Co 9060 Zachary4 25 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP NE LI ENO 2535 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 12/1/95 Reside Dwelling (per Building Inspector, also to cover replacement winciams) 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9,500 $4.75 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 $162.25 Fire SC $9-50 PLAN CHECK FEE TOTALFEE License SC $5.00 $181.50 SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT (DATE) WHEN PROP LY VALIDATED THIS IS YOUR PERMIT BL15G INSP 10. DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW I) ADDN (( CITY OF FRIDLEY ALTER (( SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Effective 8/l/95 S.*L11 9� `� / Owner Name &Address: S � Tel. # 7 -0 6 76— Contractor: TWIN cTTY RWERTORS_CD— _ MN LICENSE #253 Address: 9060 ZACHARY LANE N S =1018 MARIE RUMS MN 553 9 -Tel- # 429-4737 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: Comer Lot [ ] Inside Lot ] Ft. Yd Setback Side Yard Setbac Type of Construction: - S1: Estimated .Cost: $ _ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: APPLICANT: CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ 1�; r';� _ Fee Schedule on Reverse Side �V Tel. # $ 5� .001 of Permit Valuation (1 / 10th %) $ r7 5 $.50/$1,000 Valuation $ $850 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Park Fee $ Sewer Main Charge TOTAL STIPULATIONS: Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] (Wzfr q,o6 9/a21j� 6AO I CITY OF FRIDLEY INSPECTION DIV. Effective On January. 1, 1997 6431 University Ave NE Fridley, MN 55432. APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Rate TOTAL ,.--Fumace Shell and Duct Work, Burner — $ 3 L")L) Also Replacement Furnace $ 30.00 (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $_ Gas Range $10.00 $ Gas Dryer $10.00 $ .---*Air Conditioning — All Sizes $ 25.00 $— All Others/Repairs & Alterations (UST ON BACK) .1 % of Value of Appliance or Work $ A• � Commercial/Industrial O 1.25% of Value of Appliance or Work $ 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 $42.00/Hr JOB ADDRESS 6 DY1 b Y4 S 7—IUC7 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. ' 1997 OWNER. OWNER BUILDING USED AS Sf+�G �� I"aow0 ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No, of Heating nits Circle One (Steam) (Hot Water) (Warm Air) Trade Name M Size No. BTU 7)116r HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU ,MF EDR . HEATING CO Signed By Approved By *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE written permission from adjoining property owner. REPLACEMENT FURP (612,,7alNOA-9 _ Rough—In Date Final Date STACK VERIFICATION ON CE9M NEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefidly. examined Yes (.) No ( ) 2. Is free from rust.or deterioration Yes O No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes () No ( ) S. 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 1 SUBJECT PERMI City of Fridley 7 91 AT THE TOP OF THE TWINS BUILDING PERMIT r ry e� ' • _ COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. �jO 9 Jam(' 1 � NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-571-3450 910-F15 9 22/98 f' JOB ADDRESS 6041 6th St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 Bonny SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Ehlert 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Premium Roofing 6680 Lucia Ln NE Fridley 55412 571-3973 20097688 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 ❑ ADDITION ❑ ALTERATION j7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (25SQ) 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 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 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 $2 142. OO $1.07 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- $74.75 Fre SC $2.14 STRUCTION OR THE PERFOR NCE OF CONSTRUCTION PLAN CHECK FEE TOT E �?l Licer $82.96 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI j0fEN qOP VA ID THIS IS UR PERMIT -70 S-GNATURE OF OWNER,,F OWNER BUILDER, (DATE, G #NSP BATE 1 NEW (] Effective 1/ 1/98 ADDN [ J CITY OF FRIDLEY QQ ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description:�9�P Owner Name & Address: Ji- Lin eSc� r Tel. # Contractor: MN LICENSE Address: 6/47 Tel. # ,j 7/- 3 73 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 Widthgt/Ground Sq. Ft. OTHER: r �- ,%L Construction Type: ("c"Ie'l(L& Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: �J ;,�. y a' APPLICANT: jt. , Tel. #-571-3277? TOTAL STIPULATIONS: USE ONLY Permit Fee eCITY $ °%S Fee Schedule on Reverse Side Fire Surcharge $ /4% .001 of Permit Valuation (1/10th%) State Surcharge $ 109 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ S7, & 6 $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 STIPULATIONS: WELL MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 26875 9 Name me BORING LOCATION ng WELL AND BORING SEALING RECORD Mi nl esota Unique Well No. Minnesota Statutes, Chapter 1037 °W,serie�s, No. Anoka S —1 Mlle Township Name Township No. Range No. Section No. Fraction (sm. -» Ig.) Date Sealed Date Well or Boring Constructed Grouting Material from to ft. Fridli 1 30 1 24 1 23 I Nff,T1E;NW 04/01/08 Unknown GPS Latitude degrees_ minutes_ seconds Depth Before Sealing 15 ft. Original Depth 15 ft. Diameter Depth LOCATION: Longitude_ degrees_ minutes_ seconds A IFER(S) STATIC WATER LEVEL 4 Single Aquifer ❑ Multiaqu'rfer Measured E] Estimated Date Measured 4/1/08 14 below E] above land surface Numerical Street Address or Fire Number and City of Well or Boring Location 6041— 6d' Street NE WELLIBORIN© [)4ater-Suppiy Well ❑ Monit. Well ❑ Env. Bore Hole [I other Show exact location of well or boring in section grid with °X° Sketch map of well or boring location, showing property CASINGTYPE(S) 1431 M.N [ lines, roads, and buildings. .,,....s „ --- -- - 1 r� steel ❑ Plastic ❑ Tile ❑ Other --i--- W --t-- ---t-- ---t-- EI T WELLHEAD COMPLETION Outside: ❑Well House El Grade Inside: Basement Offset 6 tome ❑ Pitiess Adapter/Unit ❑ Buried ❑ well Pit .� ❑ Buried ___t__ F-1 wAn art egv OF DATA, Geology From: 5336 — 6h st ne Water Level in Above Well: 46' Date Water Level Taken: 06/1954 Unique: 206684 LOCAL COPY H268759 HE -01434-10 IC# 140-0423' S —1 Mlle e GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., onbe of bentonite - 50 [be.) lh Other ❑ Other Grouting Material from to ft. PRQj',ERTY�jNNER'S NAME/COMPANY NAME from to ft. CASING(S) from to ft. yards bags J lm jijljert Diameter Depth Set In oversize hole? Annular space Initially grouted? 11/4 in. from n __S[� to ft. in. from to It. El Yes jg'No ❑ Yes ❑ No ❑Yes ,.en No ❑ Yes ❑ No E] Unknown ❑ Unknown Property owners mammg address 0 different than well location address indicated above 6041— a Street NE Fridley, MN 55432 E.H. Renner& Sons, Inca 1431 In. from to ft ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown WEI,l, OWNERS NAME/COMPANY NAME ame SCREEWOPEN HOLE Screen from 12 to 15 ft. Open Hale from to ft. Well owner's mailing address if different than property owner's address indicated above OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill e No Obstruction Type of Obstructions (Describe) Obstructions removed? [:]Yes ❑ No Describe -\ GEOLOGICAL MATERIAL COLOR H FON OR FROM TO PUMP GYPS ❑ Removed Not Present ❑ Other "If ut known, Indicate estimated formation log from nearby well or boring. Sand 033 Sandy Clay 33 40 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: Dry Sand 40 54 J No Annular Space Exists F1 Annular Space Grouted with Tremae Pipe El Casing Perforation/Removal In. from to ft. ❑ Perforated ❑ Removed Sand & Gravel 54 82 In. from to ft. El Perforated ❑Removed Type of Perforator egv OF DATA, Geology From: 5336 — 6h st ne Water Level in Above Well: 46' Date Water Level Taken: 06/1954 Unique: 206684 LOCAL COPY H268759 HE -01434-10 IC# 140-0423' m 4/3/08 Certified Representative Signature Certified Rep. No. Date Kevin Scheiterlein Name of Person Sealing Well or Boring 5/07R ; ❑ Other e GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., onbe of bentonite - 50 [be.) lh Neat Grout 0 15� Grouting Material from to ft. yards bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report Is true to the best of my knowledge. E.H. Renner& Sons, Inca 1431 IJcensee Busin s Name Lkense or Registration No. m 4/3/08 Certified Representative Signature Certified Rep. No. Date Kevin Scheiterlein Name of Person Sealing Well or Boring 5/07R ; Thank you, Katie Renner E. H. Renner & Sons, Inc. 763-427-6100 r ; 'S.`• +F .Fa " S - t ... p ry ...: .' r p Bim ` w wuay i p:. y� i'w,ry�,,. t '_� • .`.t � '� f. - .S '., t vi'S'ay � v;w This is a copy of the Sealing Record f�,�-a�Xached property. This record is being given to the state, the homeowner and this copy is for the city or twp. Please keep it with any paperwork for this address as in the future the homeowner might need to pull information on their property. This record has been sent to the state alsoH Thank you, Katie Renner E. H. Renner & Sons, Inc. 763-427-6100 ry ...: .' r p Bim ` w m 57 y 4 Building Inspections 763-572-3f SITE ADDRESS _ THIS APPLICANT IS PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY ❑ OWNER NAME:IIS `✓ ADDRESS: PHONE: COMPANY NAME;_ CONTACT PERS( STATE LICENSE Ij^ ADDRESS: PHONE `SINGLE FAMILY ❑ NEW DETAILED DESCRIPTION OF WORK E-MAIL L 410 WE L `�lMinn � , MN 5540 2- 24-� FAX ❑ TWO FAMILY ❑ TOWNHOUSE EMENT ❑ ALTFRATION/REMODEL Permit Received By: i., �: 0 II, STATE ZIP, 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 ' should reflect only the cost of labor) improvement, installation or replacement of a residential fixture, excluding lite Vis. (rias . . Labor cost under $300 = $15.00. Labor cost between $300 to 9500= cost oflabor x.05. = WHERE LABOR EXCEEDS $500, FEES ARE EASED ON $10.00 PER FIXT[ PA -0 CEPT WHERE NOTED. FLXTIJR ,: (MICATE TOTAL FOR PRomm NUMBER OF EACH BELOW) MODEL: J Z MFG:'VCF SIZE.. ("'o Equipmentholz led MFG:MODEL Sga%Tu )(A1C MODEL: AS) $15.00 SIZFJBTU GAS RANGFJOVEN $10. $25.00 AIR TO AIR EXCHANGEER $15 WOOD) $35.00 GAS GRILL $10.00 GAS UNEP HTR $10.00 _BOILER $35.00 CHUANEY LINER $10.00 ZFURNACE $35.00POOL GAS DRYER $10.00 HEATER $35.00 VEN171.ATOR $15.00 ^....T mnov c+ n nn GAS PIPING $10.00 Permit Fee $ Number of fixtures @ $10.00 x $lu.uu = 4 Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixt m @ $25.00 Z x $25.00 = $� Number of fixtures @ $35.00 x $35.00 = $ S+ State Surcharge = Total = $46,90—W THIS IS AN APPLICATION FOR APERMIT-NOT VALID UNTIL PRISED I hereby apply for a building per a and I acknowledge that the information above is complete and accurate; that the work will beit conformance with the ordinances and codes o of Fridley and with the N1mnesota. Construction Codes, that I understand this i not a permit but only or a an work is not to start withouta permit; that the work will be in acco ce 'th the approved plan in the of �� view and approval of/ lk_s/ 1 _ _ - — — " IM Lgl' SIGNATURE OF 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 NEW/EXISTINABOWS 1. Combustion Air (See note belo'v)? 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 thm 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 WN energy Code 7670 or 7672 6. Duct Design Pef1MC 1346.0603:2 a. ACCAManwd D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations