PRE 2010 DOCS6
Village of Fridley, Blinn.
BURMING PER rr
IST® 4�1,3
Office of INSYO' CT019 OF BUMDiNGS
I'
Fridley, Minn.,
LOCATTON OF BUILDING
of
Block Addition or Sub -Division
i
DESCR.'ION OF BUILDII4G
Front P ept a Height Stories Manner of Construction %` 'e�►
To be used as To be completed°Estimated C0,41A'd
I
i
Permit is hereby grpnted to ,E^
the building -
"
described in the above statement. This permit is granted
upon the express cox�plition that therson to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon aid building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, 11¢ian., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limit, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. NVQ
� ,A
i
it
.C.,��
spector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit I hereby agree to do the proposed work in accordance vaith the description
above set forth d according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby s to and say that the facts stated by mea contained ua the above permit are
true as therein s ted.` 1
and 11sworn to before me at Fridley, Minnesota, _this �
day of s 11 a A.D. 19
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
.AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
SM41 OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNER- from 100,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES:
1st 3 Fixtures
Additional Fixtures
Gas Range to 199,000 BTU
AIR CONDITIONING
FAN HEATING SYSTEMS See Fee Schedule
RATE TOTAL Job Address
$12.00 $
7.00 $
7.00 $ Department of Buildings
4.00 $ City of Fridley
Tel. #571-3450
x $ 3.00 $
x $ 1.00 $
x $10.00 $
VENTILATING SYSTEMS
ALTERATIONS $ REPAIRS
State Surcharge
TOTAL FEE
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT jj4,9
REINSPECTION FEE
010.00)
$ 10.0
S
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
I DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS; Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name' Size No.
Capacity Sq. Ft. EDR BTU HP
Company
Signed l
,t
Tel. No. 54.5-6700
The undersigned hereby makes application for a permit for the work herein
$12.00
$
specified agreeing to do all work in strict accordance with the City Codes •
4.00
$
and rulings of the Department of Buildings, and hereby declares that all the
7.00
$
facts and representations stated in this application are true and correct.
7.00
4.00
$
$
Minn.
�Fridley,
/D
OWNER � Y RC_ST,d Y
$12.00
$
KIND OF BUILDING
4.00
$
7.00
$
LL
USED AS
6.00
$
/
6 Z1
TO BE COMPLETED ABOUT 0
$10.00
$
Q�
10.00
$
ESTIMATED COST
$10.00
$
OLD - NEW BUILDING PERMIT NO. PERMIT NO. �� 7
x $ 3.00 $
x $ 1.00 $
x $10.00 $
VENTILATING SYSTEMS
ALTERATIONS $ REPAIRS
State Surcharge
TOTAL FEE
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT jj4,9
REINSPECTION FEE
010.00)
$ 10.0
S
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
I DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS; Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name' Size No.
Capacity Sq. Ft. EDR BTU HP
Company
Signed l
,t
Tel. No. 54.5-6700
SUBJECTMIT
IM N
City of Fridley
32326
AT THE TOP OF THE TWINS
BUILDING
PERMIT
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
���
r
1
NUMBER
REV
DATEPAGE
OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
ill / 16/01
JOB ADDRESS 361 66th Ave NE
1 LEGAL
-I
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
ILOTNO
12
2
Rice Creek Terrace Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Russell Hanson, 361 66th Ave NE, Fridley, MN 55432
763-574-1678
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Russell Hanson (same address)
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Dwelling
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION J3 REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof house & garage (tear -off) (20 sq.)
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with 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
$2,144.00
$1.07
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 SC $2.14
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
PLAN CHECK FEE
TOTAL FEE
14
$86.46
ORA T ORQED AGENT i0 TE.
WH N PERLY A
ATED THIS ISSYOUR PERMITRI
VS-GUREOFCON"RACTO
FADG SP
gAtE
OWNER,a OWNER BUILDER, iDATE.
NEW [ ] Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: (o I— �6 0 Aire, N L
Legal Description:
Owner Name & Address: Ru SSe ( I 140. hSon Tel. # IL 3-574-108'
Contractor. _ c�l�Y�e>(' 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:— — res —
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $
DATE: 11 [&101 APPLICANT: Tel. # ')65 5
CITY USE ONLY - Call (7633p) 572-3604 for Permit Fees if mailing in application
Permit Fee $ 8 3. c�S- Fee Schedule on Reverse Side
Fire Surcharge .001 of Permit Valuation (1/10th%
State Surcharge $ /, d'% $.50/$1,000 Valuation
SAC Charge $ $1150 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 [ ]
TOTAL $ a l �&
STIPULATIONS:
Building
MECHANICAL
Permit No.
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
'D OCT 2 7 2000
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE O CJ Q 71 D 1WR E-MAIL ADDRESS
SITE ADDRESSC�
THIS APPLICANT IS: AOWNER OCONTRACTOR
PROPERTY
NAME:
ADDRESS: / V,! a.-W CITY STATZIP. 1 .2
TENNAIT
PHONE:' i� — 15
CONTRACTOR
COMPANY NAME:
NOTE:
SEPARATE CITY
CONTACT PERSON:
LICENSES ARE
STATE LICENSE # EXP DATE
REQUIRED FOR GAS
AND HVAC.
ADDRESS: CITY STATE ZIP
SUBMIT COPY OF BOND
PHONE FAX
ANDINSURANCE
PERMIT TYPE
gSINGLE FAMILY O TWO FAMILY O TOWNHOUSE
TYPE OF WORK:
O NEW O REPLACEMENT 19 ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
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 )
OR
Labor cost under $300 = $I5.00. 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: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
$25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
_A/C
TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR
$35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
_BOILER
LINER $10.00 DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY _GAS
WORK $10.00 _GAS PIPING $10.00 $15.00
_DUCT
u i _VENTILATOR
permit Fee $ Number of fixtures @ $10.00 x $10.00= $
Surcharge S .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
MINIMUM $15.50 MINIMUM $15.50 Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical 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 rdanw with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT,? PRINT NAME /%eg/ e4 U &i C,,VS DATE le)la ?1
APPROVED BY 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 0 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
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. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
Building
MECHANICAL
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
DRMcQCT 2 7 2008
763-502-4977 FAX
EFFECTIVE 1-I-08
DATE 13-2,1 YOUR E-MAIL�ADESS
1 V
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR
PROPERTY
NAME:
ADDRESS:CITY STATE—ZIP—
TATEZIPTENANT
OWNER/
TENANT
_
PHONE:�
CONTRACTOR
COMPANY NAME:
NOTE:
SEPARATE CITY
CONTACT PERSON:
LICENSES ARE
STATE LICENSE # EXP DATE
REQUIRED FOR GAS
AND HVAC.
ADDRESS: CITY STATE ZIP
SUBMIT COPY OF BOND
PHONE FAX
AND INSURANCE
PERMIT TYPE
❑ SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
Y i
—CA S
DETAILED DESCRIPTION OF WORK
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 )
OR
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: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZEBTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
A/C $25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00
_FIREPLACE
TO AIR EXCHANGEER $15 (WOOD) $35.00 _NEW GAS GRILL $10.00
_AIR _FIREPLACE
$35.00 $35.00 _GAS UNIT HTR $10.00
_BOILER _FURNACE
LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY
WORK $10.00 AS PIPING $10.00 _VENTILATOR $15.00
_DUCT
SO "0101,
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50
Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ ��'
OR Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
M $15.50
MINIMUM $15.50 Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical 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 which requires review and approval of plans.
SIGNATURE OF APPLICAN C' PRINT NAME J iPPP/1'! 5' DATE /�%
l
APPROVED BY 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
❑ 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
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. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.