PRE 2010 DOCS*City of Fridley, Minn.
BUILDING PERMIT No
Date: ..... ........ F...._.fX...l...:._`b/ _.
Owner:
Address
4232
Builder........._..........._..... . v......_...._ .............__._.....__...__ _._
Address -...... - ............
._..............
_._._......._._..._.. _ _.._..
CATION OF BUILDING
No..J�� Street ....._ : ..� ... ^............... _.............. Part o Lot - -
OyiQ --....... _. Block .. --.....I ................_.................. Addition or Sub -Division ...._.. .. ._....�:.......
i v t .�
V 91 Corner Lot ................................. Inside Lot ...................................... Setback :`�..�.�.....:_�.............. Sidey.......... ........... .......... ........... ....
Sewer Elevation .................................................. -..................................................... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
./...
.._...----------------. Front ..7._.....� Depth.0Height." 104-3Sq. Ft. /lCu. Ft.0/1—V
.... ...................................... ................. Front ................:....... Depth .................... _.. Height ........................ Sq. Ft. ............. .......... Cu. Ft. ..... -.................
Type of Construction ..... ................ ............. _............... ........ Est. Cost......1j..47J7....��........�..�. 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. �) _ .4 - ( I
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 any time upon violation of any of the provisions of said
ordinances.
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 items.
4
Application for Power Plants and: Heating. Cooling. Ventilation, Reh igeration tind
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
1.
Furnace Shell & Duct Work .......................... 8.00 $�
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & •Duct Work to 120,000 BTU ............ 8.00 $
,r
each add. 60,000 BTU .... .................. 2.00 $
Replacement of Furnace §.00
Repairs & Alterations—up to $500.00 ... ............ 5.00 $
Repairs & Alterations each add. $500.00 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam....... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE
ROUGH
FINAL
DepL of Bldgs. Phone SII. 4-7470
City of Fridley:
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 representations stated in this application are true and correct.
Fridley, Minn /o--12—e19-ir-9
Owner
Kind of Building
o Used as
i/,
To be completed about '-9-1-662
vim
Estimated Cost, $ 0
Old—New. Building Permit No.permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS -Steam, Hot Water, rm No 07'fne�
Trade Name c Size No C5' /slump
Capacity. Sq. Ft. E.D.Rpr00 00 0 BTU _ H.P.
Total Connected Load /7 02 7 Kind of Fuel 414f�
BURNER — Trade Name . Size No
Capacity Sq. Ft.
(REMARKS—OVER)
d z 2M 7-59
BTU H.P.
Business Phone Ned -1 WC1 e/
9
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN.
Weatherstrips A.S-uie . Construction No. Insulation
Gude
Windows D rs Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
r2" ii I, W. J* 14a;ahr P!'
indows avV
oors—Crackage and Area
Glass1.
Width Height No. of Lineal ft. Area
No. of pane of pan lig is of crack aq. ft.
Width eight No. of Lineal f . Area
No. of pane 00F1 pane llghts of sq. ft.
•crrack
Int. wall
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Ceiling
J� Q
Floor
Coef.
Btu
Coef.
Btu
Infiltration
0 j 1
Floor
Glass
e
�/
Glass
Net exp. wall
Required sq. ft. E.M. or sq. ins. WA. Leader area
Exp. wall
F7. o Room I Leasrth�/' Width -)V'
0'a
Exp. wall
Net exp, wall
/®
/
/
Net exp. wall
Int. wall
Floor
/IP'le
;?Ape
Int. wall
Floor
Ceiling
%
6
Floor
Lj
Total Btu.
Required sq. ft. . or sq. ins. W.A. Leader area
enzth/% Width,/,J./ Heiirht
WI dows and Doors—Crackage and Area
d" 6
Glass1.
Width Height No. of Lineal ft. Area
No. of pane of pan lig is of crack aq. ft.
Exp. wall
Net exp. wall
/� ".-60
Int. wall
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Ceiling
J� Q
Floor
Coef.
Btu
Infiltration
Btu
0 j 1
Floor
Glass
e
Total Btu.
Net exp. wall
Required sq. ft. E.M. or sq. ins. WA. Leader area
Exp. wall
F7. o Room I Leasrth�/' Width -)V'
Reis
Net exp, wall
/®
/
/
�®
Int. wall
Floor
Ceiling
Floor
%
6
Total Btu. &&
Required sq.,fx. &D.R.- qr sq. ins. WA. Leader area
Windows and Doors—Crackage and Area
Width Heigbt No. of Lineal ft. Ar
No. of pane of pane light. of crack eq.
Btu
Infiltration
d" 6
Glass1.
tj Q
Exp. wall
Net exp. wall
/� ".-60
Int. wall
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Ceiling
J� Q
Floor
%
Total Btu.
/
Required sq. ft. E.D.R. or sq. ins. W.A. leader area I
Fl.1
oom eng �- 1
Windows and Doors—Crackage and Area
NY
No. of panne
Height No. t Lineal ft. Area
of pane light off cra/ck sq. ft.
IJe7
�ia �L. - I ✓� 10
Btu
Infiltration 7
t/
/
Glass
f�
Exp. wall
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Net exp. wall
Btu
Infiltration
Int. wall
Coef.
Btu
Ceiling
0 j 1
Floor
Exp. wall
e
Total Btu.
Net exp. wall
Required sq. ft. E.M. or sq. ins. WA. Leader area
F7. o Room I Leasrth�/' Width -)V'
Reis
Windows and Doors—Crackage and Area
Room I Length ' �k Width,,K"
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
/Jt d, d
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Coef.
Btu
Infiltration
Coef.
Btu
Glass
0 j 1
3
Exp. wall
/Q
e
Net exp. wall
Int. wall
/Q
Ceiling
/®
/
Floor
'7 1
Total Btu. 6—S-6 1
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
Total Btu. 10�-y 16 1
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room I Length ' �k Width,,K"
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Coef.
Btu
Infiltration
0 j 1
3
Glass
/Q
e
Exp. wall
Net exp. wall
/Q
Int. wall
Ceiling
®(i
Floor
Total Btu. 10�-y 16 1
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
City of Fridley, Minn.
BUILDING PERMIT N® 4 s s 3
Date: ...._
r � �
Owner:4_�..... Builder
Address Address
L
O ION QF BUILDING
No.
{� S., ------ Street _ : .�'':'_,_._ .._. y .... i:.._ .._.__..... Part o t ---_-_ .._... __._ ._.....-- _.._. _
Lot ._.m[ - ...... Block ._............. -9 ..........._..... l --....... Addition or Sub- ion . ��
Corner Lot ......... ..................----.. Inside Lot ....._.::................... _........ Setbacl :: .... ideyard ..... _......_.............. :............ .................... .......
SewerElevation....--............._............_........------............._............._............._........ Foundation evation..................................... ... ................... _------ -....................
DESCRIPTION OF BUILDING
abesed,r� ° 4...�.._ Front .. Depth ..+4-x. Height/--.._.. Sq. Ft. _�.. Cu. F't.5.'
_............. .............. _...................... Front ..... -........... . Depth .... _....;:.:.....__ He t ..::.:..........._ . Sq. Ft. .... _........`..._.. Cu. Ft. _....................
.o',ivv
Type of Construction .---_�..ia.ti%:..... Est. Cost... ................ 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 any time upon violation of any of the provisions of said
ordinances e
-=—� ..:._ 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.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Builder Owners Nerve Builder a
Address ���-� G ' G Address 5 ;�..
LOCATION OF BUIL('DIING
No. "��� .�r , Street
Lot Block, Addition or Sub.
P
Corner Lot Inside Lot Set Ba
SEWER ELEVATION FOUNDATION ELEVATION ---
Applicant
,_
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front O Depth � � Height
Sq. Ft. 271f 6) Cu. Ft,
Front Depth Height
Sq. Ft. �Cu. Ft,
Type of Construction lf`/��.c . Estimated Cost
To be completed 0 -
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.
DATE /d SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
•
SIJ
City of Fridley
�4
Application for Platnbing and Gas i= Mng Porndt
Dept. of Bldgs. Phone SU 4-747,0
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location • i �, r '!-� v%
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixturesc C�
............... x $1.50 $�
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heater (Up to 200,000 BTU) ......e� x 2.00 $
New Ground Run Old Bldg. x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description G
TOTAL FEE $�—
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do al1 work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fr'Tey, Minn
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No -_3 �Petmit No.
i
Signe
By
Business Phone No & --);?
ROUGH JAN 14 9960
FINAL
42 2M 7-59
Lum�
N
WATER HTR.
GAS
ELEC.
3
o�
u.�
t)
<3
d
(�94c
�O
R
Base
1st
2nd
_
3rd
—
4th
• Future Connection Openings
I
Connected with
Sewer
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixturesc C�
............... x $1.50 $�
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heater (Up to 200,000 BTU) ......e� x 2.00 $
New Ground Run Old Bldg. x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description G
TOTAL FEE $�—
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do al1 work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fr'Tey, Minn
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No -_3 �Petmit No.
i
Signe
By
Business Phone No & --);?
ROUGH JAN 14 9960
FINAL
42 2M 7-59
��11 So
�J�'
•
SUBJECT
PERMI
City of Fridley
84131/
AT THE TOP OF THE TWINS
BUILDING
PERMI T
v
,.572 3Q04
RECEIPT N
`L __---_ M NITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
10/26 98
JOB ADDRESS 505 54th Avenue NE
1 LEGAL
I LOT NO.
ADDITION
SEE ATTACHED
DESCR.
24A, 24B
ISLOCKTRACTOR
1
L ndale Builders 4th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jerry Reiland
572-0391
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Tabor & Sons Inc. 1805 Polk St NE M is MN 55418 789-1902 20014248
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Rk REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (24 Sq) Tear-off
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
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT
2056
$1.03
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
74.75
Fire 2.06
allwriki�//- �e �(�
C)
PLAN CHECK FEE
TOTAL E 11
Lice S
$5-0/
284
SSG NA TURE OF CON'RACTOR OR AUTHORIZED AGENT TOATE,
N O
LI ATE S IS YOUR PERMI
BL iNBR OF
�_ r7
BATE
S.GNATUREOFOWNER ,iFOwNERBwLDER, iDATE,
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FA ULY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 15,C) 5 �'� v�
Legal Description:
1
Owner Name & Address: 3 e f C 14 �J Tel. # 5 72- - 0 3 9 I
Contractor: eV - t"e MN LICENSE #
Address:(c S� �� 9 a �' ! s i� �� 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:
Construction Type:
J���"���(' 6e1
e 6� r-
Estimated Cost: $
CSS
(Fee Schedule
on Back)
Driveway Curb Cut
Width Needed:
Ft. + 6 Ft =
Ft x $
_ $
DATE: %� �� APPLICANT:
�i�L`�
��
- - Tel. #�-
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
7
SUBJECT
IT NO.
City of Fridley
3 808
AT THE TOP OF THE TWINS
BUILDING PERMIT(
COMMUNITY DEVELOPMENT DIV.
RE EIP��TNO.
yy
r � � PROTECTIVE INSPECTION SEC.
NUMBER
REV
OAT
PAGE OF
APPROVED 8r
CITY HALL FRIDLEY 55432
j 763-571-3450
910415
8/15/03
II
10B ADDRESS 505 54 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
24A & 24B
1
Lyndale Builders 4th Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jerry Reiland 505 54 Avenue NE
763-572-0391
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 ❑ ADDITION CR ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace window with bay window within existing opening
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels
of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
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
$1,000
$.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-
Fire $1.00
STRUCTION OR ZHE PERFORMANCE OF CONSTRUCTION
$38.75
SC
PLANTOTAL
CHECK
F E
�- %
$40.25
SSG UREO CON 'RAl;TQRORAUTHORIZED AGENT SDA E.
MENP OPER P&ERV T IS IS YOU ERMI
BLDG 5
PATE
S,GNATURE OF OWNERo6 OWNER BUILDERS [DATE,
7
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDIS! [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION '
Construction Address: -5a'� T' / d 1 RVcl
Legal Description:
Owner Name & Address:
Contractor.
MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: c Estimated Cost: $ OO
G6-�in eJ
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #
Call (763) 572-3604'for Permit Fees if ilin " application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL $ !2t,#
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [ ]
Building
MECHANICAL
Permit No.: 2,0 l
Inspections
RESIDENTIAL APPLICATION
Received By:�
763-572-3604
CITY OF FRIDLEY
763-502-4977 FAX
EFFECTIVE 2-19-09
`
DATE �' Q q YOUR E-MAIL ADDRESS (n Af ge G O
SITE ADDRESS 57-0 5- Ac� ✓ I / '�L/Z
THIS APPLICANT IS: �wNER ❑CONTRACTOR
PROPERTY
NAME: r' H , 4
OWNER/
ADDRESS: 5-05— SyA .4,.,e --,Al G'-- CITY As r le , STATEMN ZIP�SZ/2I
TENANT
PHONE: 763 - 232 -X72 0
CONTRACTOR
COMPANY NAME: NAl
CONTACT PERSON:! OwhG/
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW ❑ REPLACEMENT ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORKJ!.,
FEES ARE BASED ON $10.00 PER FIXTURE; EXCEPT WHERE NOTED; -FIXTURES: "(INDICATE TOTAL NUMBER OF:EACH BELOW)
PROVIDE HEAT LOSS CALL'S PER MANUAL J 20 A.SHRAE HANDBOOK. 11-1 4
Z7DG - 7D.�OD
Equipment Installed MFG: .r.. -Frac MODEL: SIZEBTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
A/C $25.00 IREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35:00 NEW GAS GRILL $10:00
$35.00 $35.00 _GAS UNIT HTR $10.00
_BOILER _FURNACE
_CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
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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 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; that the work will be in accordance with the
approved plan in the case of all work w ich requires review and approval of plans.
Zoe t`
SIGNATURE OF APPLICANT PRINT NAME iej^. e_ DATE
APPROVAL INSPECTORS SIGNATURE DATE
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
0 NEW HOMES/ADDITIONS ❑ 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 Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501
3. Venting
a._ _ _Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel otter. than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. N1104.4.13
5. Ventilation -
a. Per MN Rule Chapter 1322. Sec. 1104
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.