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PRE 2010 DOCSVillage of Fridley, Minn. BU.dDING PERMIT N° 703 Office of INSPECTOR OF BUILDINGS � F a Architect Builder Fridley, Minn.,. = tee_ o. 19� "0' LO OF BUILDING �. No, '`� streets Part of Lot Lot Block Addition' or sub -Division ✓" ` c:u DESCRIPTION OF BUILDING Front' Depth stories Manner of Construction t: ,w To be used asp' To be completed F� Estimated Cost C' s',..1.'.#',.:.j ,lc'_:>-tr,x. e�,i:-x•.� C:>-.�-- "�;i .4.=UIG.--t �` . a P Permit is hereby grant to � � '"" to the buildin described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, kion., regarding the 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 11 AGREEMENT AND SWORN STATEN[ENNT 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 with the description above set forth aid according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. i Subscribed and ,,sworn to before me at Fridley, h day of ;� ,�,.c.r:��,.r:��`dp_D. iS 11 Minnesota, this 0 STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD 1. LOCATION OF WELL MINNESOTA UNIQUE WELL N0.1 (leave blank 1f not known) County Name Anoka Township Name ITownship NRange Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed Fridley 30;r 24 Er 14 ''S4�` `NW 11 84 rc, 9/22/89 S Numerical Street Address and City of Well Location or Distance from Road S. DRILLING METH00 (if known) Intersection 10 Cable tool 40 Reverse 70 Driven 1C Dug 375 66th Ave. 20 Hollow Rod SD Air 80 Bored 110 Show exact location of well 30 Rotary 60 Jetted 90 Power Auger (in section grid with 'X') Sketch map of well location r 6. OBSTRUCTIONS N Well obstructed 0 Yes 0 No W Obstructions removed [:I Yes 0 No If obstructions cannot be removed, contact MOH E ' I before sealing. T 7. USE S w, IN Domestic 40 Monitoring BD Heat Loop 2r3 Irrigation 50 Public g0 Industry 1 30 Test Well 50 Municipal ICO Commercial S 1 ..jL -+ 70 Air Conditioning 110 2. PROPERTY OWNER'S NAME Octaze L. Sayther Nailing Address if different than property address indicated above S. CASING(S) 110 Black 40 Threaded 70 20 Ga Iv. SD Welded 30 Plastic 60 Stainless Steel in. to ft. HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well, in, to ft. 9. SCREEN 0 Screened well from _ ft. to _ ft. (ii known) 0 Open Hole from _ ft. to _ ft. 10. STATIC WATER LEVEL ft. 0 below 0 above land surface Date Measured 11. WELLHEAD COMPLETION 10 Pitless Adapter 40 Found Buried Basement offset 10 30 Well Pit 16. REMARKS. ELEVATION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC. 12. GROUTING INFORMATION kHeat Cement 20 Bentonite 30 3" well, 84' deep Under front step Grout material Portland from 0 to 84 ft. cu. yds � kgs 13. NEAREST SOURCES OF CONTAMINATION feet direction type Well disinfected before sealing? [] Yes 14. PUMP PL Removed 0 Not Present Type: 10 Submersible 30 L.S. Turbine 5o Reciprocating 10 Jet 40 Centrifugal 60 15. EXISTING WELLS (Please sketch locations of abandoned and active :rolls in remarks section or on back.) Other unused well($) on property? 0 Yes �yqq No Abandoned: 0 Permanent 0 Temporary 0 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. Licensee Business Name License No. Address Signed Ll ' a . ate 9/25/89 Date Name of Driller OFFICIAL ABANDONED WELL RECORD (Nay be used for Property Transfer) IXPMrANTt PILE N7TN DMW CITY OF FRIDLEY Effective Date May 1. 1g88 (e) APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL ` Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer Air Conditioning (all sizesl All Others/Repairs and Alterations 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work RATE TOTAL $ 20.00 $ 10.00 $ $ 10.00 $ 0. to $ 10.00 $ $ 10.00 $ .&o State Surcharge S .50 TOTAL FEE xeinspection Fee ($15.00) $ ®.O0 Rough Insp. // Date Final Insp. C� "�p ��/ get) Date Approval for Permit ls« MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00' PLUS $.50 STATE SURCHARGE *kir Conditioners can not be placed in side yard without written pezmission from adjoining neighbor. Job Address _E-7< Q (�-} ,Js- kA . Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Tel. 0571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Godes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. OWNER KIND OF BUILDING USED AS TO BE COMPLETED.ABOUT ESTIMATED COST OLD NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name/�/ 1� Size No. Capacity Sq. Ft. EDR 8TU HP Total Connected Load Kind of Fuel -A-1W% /070S BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company Signed Tel. No. Fill out back side for stack verification on replacement furna:Ps DJ ' CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; I. Has been carefully examined Yes ( ) 2. Is free from rust or deterioration ' Yes() 3. Has no foreign objects lodged within Yes ( ) 4. Is securely supported Yes ( ) 5. Meets all current Code requirements for size and total BTU connected 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s No ( ) No No ( ) No ( ) Yes ( ) No ( ) Companyfs!,� /,• Signed By Date a n `3 --7 I, (,, Q,��HOUSE HEATING TEST RECORD ATiDRESS" ^� /y ld� ark4 4— n% APT.—FLOOR—CITY SUBURB OCCUPANT OWNER HEAT LOSSDATE HTG. INST. SOLD BY �.y INSTALLED BY Electrical Work By Gas Line By Lk TYPE OF HEAT GA FA HW —STEAM SPACE HTR. UNIT HTR. OTHER MAKE Model Serial INPU AS DESIGN MAKE Model OF BURNER Max. BTU Rating — T �� MAKE OF FURNACE Model CONTROLS THERMOSTATHeat Plug Valva Limit Limit Setting Fan Setting ( Pilot Type Pilot Make Pilot Model tt Pilot Timing S es L.W. Cut Off Pressure Percent CO IT Input CFH Percent OZ Stock Temp. Percent CO CONVERSION Vent Size 3 KIND OF LINER SIZF��` NONE Draft Hood Regulator Filters Six* .—bar Chimney Location Inside L000,Outside Chimney Construction Smoke Bomb 8i Wiring Draft Test Tag - Door Pressure Llahtino inut.' Date Tested Company Testing �+ Name of Taster 93 J SUBJECT PERMIT �"'� City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 22596 -1 - i - COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 6 r � I rAPPROYED NUMBER REV DATE PAGE OF Y CITY HALL FRIDLEY 55432 612-571-3450 910415 6/8/94 JOB ADDRESS 375 66 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 4 & 5 2 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ed/Mary Luniewski 375 66 Avenue NE 571-2227 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Panelcraft 3118 Snelling Ave S, Mpls., MN 55406 721-6628 2179 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW Ck ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10' x 12' Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement. WARNING Before digging call for all utility locations SEPARATE PERMITS REQUIRED FOR 454-0002 WIRING, HEATING, PLUMBING AND SIGNS. REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $ 13,000 $7.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER ST OR LOCAL LAW REGULATING CON- $144.00 Fire SC $13.00 STRUCTION OR THE PE O MA C OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $169.50 7 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT 10 TEI N LY V LIDATED THIS IS YOUR PERMIT • "p-W1071 BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDERi IDATEI SIGNATURE 93 J NEW Effective 1/ 1/94 ADDN CITY OF FRIDLEY ALTER (( SINGLE FAMILY AND DUPLEXES R-1 AND R-2-�/�� Building Permit Application Construction Address: _.3-76-(o (o i (.1 ,AVy-, 1U • C — _ ----------------- .---.. Legal Descriptioa;L Owner Name & Address: VD* MAfY,4ysyaSW%K1 Tel. # J'-7/-ZZZ Contractor: 1PA4yz&_—a k F r MN LICENSE # 6of) Z l `79( Address:'8t19 5AvEf-l.e i.v< lfi/,ffr_ MELS ted✓ -5-s-i Tel. # 'TZ!-lolo� 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: fox la'x� Z T Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: -3ik 5�a f Estimated Cost: $ t 3 pOO 5Qvv e Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. +.6 Ft = Ft x $ _ $ DATE: _6--ZI -4y APPLICANT:,/ Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ Q .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $800 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 $ STIPULATIONS:�� SUBJECT PE City of Fridley 5 4 9 16 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. Ir COMMUNITY DEVELOPMENT DIV. 1 PROTECTIVE INSPECTION SEC. r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/24/97 JOB ADDRESS 375 66 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, Pt 4 & 5 2 1 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Ann Liniewski 375 66 Avenue NE 571-2227 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Panelcraft of MN 3118 Snelling Ave S, Mpls., MN 55406 721-6628 2179 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Cj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install gutters and downspouts 9 CHANGE OF USE FROM TO STIPULATIONS Install per State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED 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 1 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 $1,116 .56 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. $40.25 Fire SC $1.12 PLAN CHECK FEE TOTALFEE License SC $5.00 1 $46.93 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN PROPERL LIDATED THIS IS YOUR PERMIT BLD fNSP '3 BATE _ SIGNATURE OF OWNER IIF OWNER BUILDER( (DATEI NI -- %y I i Lilective 1/094 ARAN [ I CITY OF FRIDLEY ALTLit I I SINGLE FAMILY AND DUPLEXES R -I AND R-2 Building Permit Application Construction Address: 325=6�oM 110e.Yl UP, AUE Legal Description: Owner Name & Address: r(,(n—Tel. // 57 / - a02�;L:Z, CortUaclor:__1 C e/er-r t� ��_ AIV MN LICENSE !/_ ddress:__ 3 / I Z +,9� �e_ 1 /'�� •�-C�� Tel. # zoo 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 Sy. Ft. GARAGE AREA: Length Width Height Sy. Ft.- DECK t.DECK AREA: Length Width Hgt/Ground Sy. Ft. OTHER: Corner Lot [ Inside Lot r I Ft. Yd Setback Side Yard Setbacks Type of Construction: � aHLrS d -D� ,e.,f5 Estimated Cost: $ 11162.or _GYM Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. _t. G Ft = Ft x $ _ $ DATE: -!6-5-q7 APPLICANT: Tel. // to / 7 a S�OCl CITY I1SE 01sLLY- Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL job# Oz83 STIPULATIONS: r $ ti SSA Fee Schedule on Reverse Side $ _ /. / .001 of' Permit Valuation (1/10th%) $_ $.50/$1,000 Valuation $__ _ $800 per SAC Unit $___ on $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ _ Fee Determined by Engineering $ Agreement Necessary I I Not Necessary I I job# Oz83 STIPULATIONS: r 01 SUBJECT City of Fridley 26304 2 6 3 0 4 AT THE TOP OF THE TWINS BUILDING PERMIT - r T NO. COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. r � I I NUMBER REV DATE PAGE OF APPROVED BY ` CITY HALL FRIDLEY 55432 '.j 612-571-3460 910415 6/22/98 10B ADDRESS 375 66 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 4,5 2 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Ann Luniewski 375 66 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Jayson Lindsay Roofing 2638 Clearvierw Ave, Mounds View MN 55112 792-1857 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20098263 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION I� REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (24 S) 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 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 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 $2,001 $1.00 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 AN STATE OR LOCAL LAW REGULATING CON - $74.75 Fire SC $2.00 TR CTION OR TH PERFOR NCE OF CONSTRUCTION. 1 PLAN CHECK FEE TOTALFEE - -� License SC $5.00 1 $82.75 SIG TUREOFCONTRACTO ORA ORIZEDAGENT IDA EI WHEN�PROPERL LI DATED THIS IS YOUR PERMIT IN(s[o v L . %NSP F OF 2 MATE - SIGNATURE OF OWNERIIF OWNER BUILDERi IDATEI 01 JUN -12-199B NEW [ ] ADDN [ ] ALTER [ ] 12:16 FROM CITY OF FRIDLEY TO CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R -X AND R-2 BUILDINGr PERMIT APPLICATION 7860893 P.01i01 Effective 1/1/98 Y 0"A6 �,� � ConsttuctionAddress: 6 6 � � #-,� 0, E, Legal Description: ��'� Ueda Owner. Name & Address: _ l VI Ani ,JTel. # Contractor: L f�dS ', MN LICENSE # 9WO p a 6 5 Address: (, yr rl e..s Tel. # -2?,P -1-8t -f 7 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to DESCRIPTION OF nVIPROVE�oZ 5 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: /ZQ�j d� �_ Estimated Cost: $ �� Q d 1_� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $4 _ $_ (�1 DATE: APPLICANT: Tel. # TOTAL $ (� 9 STIPULATIONS: TOTAL P.01 CITY USE ONLY Permit Fee� $ `r �� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $_ / OD $.50/$1,000 Valuation SAC Charge $ $1000 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 $ (� 9 STIPULATIONS: TOTAL P.01 Building MECHANICAL Permit No.• -` Inspections RESIDENTIAL APPLICATION Received By:(YN) ' 763-572-3604 CITY OF FRIDI�EY Date Re 763-502-4977 FAX CV t - t'& EFFECTIVE 2-19-09 DATE f:)P1 30 10 YOUR E-MAIL ADDRESS SITE ADDRESS ,7-1 5 LQ � • AO e 1 vE THIS APPLICANT IS: ❑ OWNER XICONTRACTOR PROPERTY NAME: M 0- s, OWNER/ ADDRESS: e -' V _NR CITY i - STATE UM IP `S!L-sa TENANT PHONE: —t (Q-3 - 5-1 I - -3L a R CONTRACTOR - COMPANY NAME:- CENTERPOINT- ENERGY----- -- - - ---- -- - --- -- - --- SUBMIT A COPY OF CONTACT PERSON: JOANN ZINKEN BOND 22013346 08/19/2009 YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS:9320 EVERGREEN BLVD NW SUITE B ciTYC00N RAPIDS STATE MN ZIP 55433 APPLICATION PHONE 763-757-6202 FAX 763-757-6701 PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL DET ILED ESCRIPTION OF WORK V0,(1_ C e En FEES ARE BASED ON $10.00 PER FIXTURE i C W ERE NOTED. FIXTURES: DICATE TOTAL NUMBER OF EA BELOW) Equipment Installed MFG: EPT MODEL:IC'AZL-rjc�c, SIZ TU ` MFG: l C i Lc� MODEL:��! d� -1 SIZE/BTU off► MFG: MODEL: SIZE/BTU -LA/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 GAS GRILL $10.00 _NEW _BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 —VENTILATOR 15.00 W$i xz+ .'ft 1N'n';T 4.t ( �iY ?yxq,R'i Jy yy'.. >4 * _.::.. 5,� b i�,.+ '.. "k:114 b ,1' X�, v�5+'''lyn, 'i.i i '�i.,>e mi 2"" ''' .%f_- yam' 4"Ys $`,L{+i' '➢ '� �5k +, . '5.: fu4 ?x �$ c-. N '1 �,3yP..'g },�{/^r.� R✓ J,"�m.> ':•`n : rrs t x`. y 3 7 1'48, �' .%.� �a.'. 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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 approval of plans. approved plan in the case all work whih r��PRINTNAMEROGER HOFFHEIN SIGNATURE OF APPLICANT DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 01 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS OEXISTING 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 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.