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City of Fridley, Mian.. BUILDING PERMIT Date: .__ye U" d' ... ... ................ 0' Owner:....._.. i ..: .._.. Builder --------- -- _ mac_ ,__._._._.�� _ __..--•--_ _ _ y. i:0 Address ....__,�t.c�;'ff ddress LOCATION OF B I DING No. _......tj. ......... Street _..._.._._ i ,.._'....._ Part ot ... Lot ....._...............-- ._...--... Block ....._.... ....... -...............Addition r Sub-Divisfon --._ .:.... ._.'. ._....---- r Inside Lot ......................... Setback Setback ..... ... Sfdey . Corner Lot Sewer Elevation Fqundation Elevation - .................._.,_..._...._ _ _.�._...... DESCRIPTION OF BUILDING To Usedoe k? Front J Depth af®H .+ eight ... " Sq. Ft p!r _.. ... ........ I ont /Y... .. Depth ...: Height�i; ......--- Sq. Ft. �� a� r e.' Type Construction _. Ew-4%4�....... Est. Cos . r/w,! ......... _........ To be Completed ... Cu. Ft. ,r� Cu. Ft...... ... .. 6 CAUTION THIS PERP):T 001".', N(.') -I- AUTHORIZE VIOLAT. ION OF ANY LAND COVENANTS AND BUILDING RES1;ilC7lON5. 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. f In consideration of the payment of a fee of $.;.et.- permit is hereby granted to ..... _.......... ..._....._........... ............ ..-- _ to construct the building or addition as described above. This permit is granted upon the express conditionthat 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 ordinances. city limits and this permit may be revoked at any 77"olation'o1 any of the provisions of said Building Inspector 4 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 Nems. 4 APPLICATION FOR BUILDING PMWT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING No. /° ® Streeia Part of Lot q Y Lot Block . ;j l Addition or Sub.Div. Corner Lot_ side Lot Set Back Side -Yard •� S ;; SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING T be used ass 1 .r Front �� Depth ....._„Height /�S Sq. Ft. r !.�_ Cu. /V ,, narth A -2 ". � "' Sq. Ft. /-� Cu. Ft.,2 u �A Type of To be ted Cost /fir 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 repres®rits= tions stated in this application are true and co 'ect. , DATE 7,_ 6 SIGNATURE " 10 (A Schedule of Fee costs can be found on the Reverse Side.) • Cot( City of Fridley Appiication for Plumbing and Cas Fitting Permit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... 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 BTL) ...... �° x, 2.00 $ WATER HTR. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL,, 1st 3 Fixtures ...................... I'F Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. So S� 63 � �� �p F N GAS ELEG Base % f 1st 2nd 3rd _ 4th • Future Connection Openings ected ConnwithI Sewer � New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... 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 BTL) ...... �° 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 ................................................$ TOTAL FEE $ Sr / P_ /_ / 114. 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 & 1 7 , 196 O Owner Kind of Building Used as r To be completed about —ly 0 Estimated Cost, $ Old ew. uilding Permit No 'Y 3 / Permit No. '1�12 Signer];e�(� ROUGH a z VA 7-59 Business Phone �1 / Application for Power Punts and Heating. Cooling, Ventilation. Re%igeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL 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 $ each add. 60,000 BTU ....................... 2.00 $ _ Replacement of Furnace ............................. 5.00 $ 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. IDR 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 $ �• GAF 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 _ $ REMARKS: Dep:. of Bldgs. Phone SU 4--A-7470 T_wwnfinw � � "•! {Yo p �e City of Fridley: e i R 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 Minny 19 � Owner • )vr k1 ��� 195_ Kind of Building Used as e To be completed about ,/ y < — A Estimate st, $ 0r, � " 195_ DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No� Trade Namewh !'�aC�6�1 16I e ! � f l` ' ` ; �'2, Size No.- e!k& Capacity Sq. Ft. E.D.RIA, BTU HP. Total Connected Loa Kind of Fuel U 7• 6 BURNER —Trade .Nam Vii' r Size No. Capacity Sq. Ft. E.D.R- /L-2, e r BTU H.P. Signed ��®r Iq 112 l t- 'l,! ,I,3o=2V By -41W11 POST 1M-12-58 Business Phone No" r� Application hr Power Pkuft and Heating, CoWngs Vendlolons Rsftigeration and Air Conditioning Syd nes and Devices PARTIAL RATE SCHEDULE GRAVITY WARD! AIA: NATE TOTAL Furnace Shell & Duct Work ................ $10.00 $ Replacement of Furnace .... 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 3.00 $—__ MECH. WARM AIA Furnace Shell & Duct Work to 150,000 BTU ........ .. $1o.00 $ each add. 60,000 BTU .................... .. 3.W = Replacement of Furnace 6.00 Repairs & Alterations -up to $500.o0 6.00 $ Repairs & Alterations each add. $500.00 .... 3.00 $ STEAM or HOT WATER SYSTEM &00 Furnace Shell & Lines --to 400 sq. ft. EDR Steam $10.00 $ _ Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00Each add. 320 sq. ft. EDR Hot Water 3.00 OIL BURNER—to 3 gal. per hour 6.00 $ over 3 gal. per hour—See Fee Schedule Dept. of Bldo.. PhoEr. 8190-:� City of Fridley: v fly The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordibancef 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 _ 19 — Owner *',,r l'1 l�C- Kind of Building Used as --- - 1-- - To be completed about d 71 Estimated Cost, Id, `New. Building Permit No. Permit No. DES=PTION OF WOW HEATING or POWER P1.AINTS__Steam, Hot Water, Warm "—No GAS BURNER (up to 198.000 BTU) &00 ; Trade Namp Size No, over199,000 BTU See Fee Schedule GAS FITTING FEES. NO RATE TOTAL Capacity Sq. Ft. E.D R BTU gp. 1st 3 Fixtures x$ 7.00 $ Total Connected Load Kind of Fuel Additional Fixtures a .75 $ Gas Range to 198.000 .. AIR CONDIiONIllG $5.00 ; 6 BURNER —Trade Na.neSize capaci No BTU Sq. Ft. E.D.R FAN HEATING SYSTEM Sae Fels schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE Signe 7 ROUGH Business PhAL N2 FINAL ex4 (REMARKS—OVER) �� a• U1 -1Y OF FKIDLEY , 97-84-87906( APPLICATION FOR PLUMBING AND GAS FITTING 4WIT • Job Address 18 66 WAY NE .. .. ,Department of Buildings City of Fridley Tel. 0571-3450 The undersigned hereby makes application for a pertoit for the Mork herein specified agrocing to do all work in strict accordance with the City Codes and rulings of tho Departmont of Buildings, and hereby doclares that all the facts and representations stated in this application are true and correc Fridley, Mn. 4"3.2"79 � 19 OWNER MaGarin , XIND OF BUILDING frame USED AS res, r TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST 30.00 ' • b+ TOTAL Water PERMIT N0. 1� •: .J e .+ $3.00 N •• ' 0% Cu a n. low ' a u w 4. $2.00 $ __- Heater lyiN(dEGASCO Signed By Catch Basin x $5.00 $ �' Water Heater - to 99,000 BTU__ x .$5.00 $ Tel. No.. J A C• l ..�i- $ �• C Water Softener x V M a ��. V Ifew Ground Run Old Building d $5.00 $ • ROUGH INSP. Electric Water .Heater x $5.00 �_� ... Date :AS FITTING FEES: FINAL INSP. 1st 3 fixturesx' '$3.00 $ ' Data w u M R $1.00 C as lec $10.00 � APPROVAL FOR PERMIT ' • . '.EPAIRS 6 ALTERATIONS , First $100.00 $5.00 $ ' each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLVS $.50 STATE kmcnT.CE State Surcharge TOTAL FEE $ 8.00 •, AEINSPP.Ct*7nu vrry d r ti11 ;R) - -Future Connection Opening Connected with Sewer '•) - flew Fixture, old Opening Water Job Address 18 66 WAY NE .. .. ,Department of Buildings City of Fridley Tel. 0571-3450 The undersigned hereby makes application for a pertoit for the Mork herein specified agrocing to do all work in strict accordance with the City Codes and rulings of tho Departmont of Buildings, and hereby doclares that all the facts and representations stated in this application are true and correc Fridley, Mn. 4"3.2"79 � 19 OWNER MaGarin , XIND OF BUILDING frame USED AS res, r TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST 30.00 ' 'L%1BING FIXTURE RATES: NO.' RATE TOTAL OLD - NEW BUILDING PERMIT. N0. PERMIT N0. 1� •: It=ber Fixtures X $3.00 $ ' Future Fixture Opening x $2.00 $ Company flew Fixture, Old Opening x $2.00 $ __- lyiN(dEGASCO Signed By Catch Basin x $5.00 $ Water Heater - to 99,000 BTU__ x .$5.00 $ Tel. No.. 100,000 BTU'to 199,000 STV x $10.00 $ Water Softener x $7.00 $ Ifew Ground Run Old Building x $5.00 $ • ROUGH INSP. Electric Water .Heater x $5.00 �_� ... Date :AS FITTING FEES: FINAL INSP. 1st 3 fixturesx' '$3.00 $ ' Data ,. Additional Fixtures X $1.00 , Gas Range to 199,000 STET x $10.00 � APPROVAL FOR PERMIT ' • . '.EPAIRS 6 ALTERATIONS , First $100.00 $5.00 $ ' each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLVS $.50 STATE kmcnT.CE State Surcharge TOTAL FEE $ 8.00 •, AEINSPP.Ct*7nu vrry SUBJECT R City of Fridley 2221 6 AT THE TOP OF THE TWINS BUILDING PERMIT i RE _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. 59(010 NUMBER REV. DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 11/1/93 JOB ADDRESS 18 66th Way NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2A & 2B 5 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Amy Hoffman 18 66th Way NE 571-8300 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & B Home Improvements 1568 Ballantyne In NE Spring Lake Pk 784-0922 7773 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 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & Garage (.29 Squares) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Provide adequate attic ventilation, Provide smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement, 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 80 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 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 $2900 $1.45 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT X PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PR OVI IONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 Fire SC $2.90 TRU TION O E P RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE / License SC $5.00 $63.35 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT 1 ATEI WHER ALIDATED THIS IS YOUR PERMIT r 11-3 7 INSP OA SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEIBLDG NEW [ ] Effective 5/26/93 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 g �� Building Permit Application Construction Address: it '� k� �( Legal Description: owner b Contract Address: LIVING AREA: Length GARAGE AREA: Length DECK AREA:. Length OTHER: Tel. # MN LICENSE # cvd 777 3 Tel. # 78"S�-090 Z Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Corner Lot [ ] Inside Lot C ] Type of Construction: Approx. Completion Date: DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground 4' Ft. Yd Setback Sq. Ft. Sq. Ft. Sq. Ft. r Side Yard Setbacks. Estimated Cost: $ C'� (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: ii i 13 APPLICANT- Tel. # Permit Fee $ C G� CITY USE ONLY Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ �, Sf $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge _ $ CLQ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ Conservation Plan Review $450.00 Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: 00 t CITY OF FRIDLEY INSPECTION DIVISION 6431 Ufliversity 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 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% of Valu6 of Appliance or Work Effective On January 1, 2000 JOB ADDRESS ZJ Id(� OWNER Rate TOTAL ' $ 30.00 $�BUILDING USED AS � ESTIMATED COST f G PERMIT NO. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units_ Circle One (Steam) (H Water) arm Ai $ 10.00 $ Trade Named 7llJx Size No. BTU HP EDR $ 25.00 $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR 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. $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE HEATING COii Sige) e Approved By Rough -In Date Final Date /0 a3 /O/ �� 6OMMON VENT VENT CONNECTOR ND COMBUSTION AIR VERIFICATION t When placing aExisting furance, 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 (j No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes k) 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-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes W No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes k) No ( ) 5 When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturers specifications. Yes (x) No( ) When installing 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 Venting Tables for fan assisted and natural draft appliances. Yes (X) No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes (x) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type LjeN&kDx BTU Input 70,- "' Fan Assisted or Nat -O",/�< 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 Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) 010 WenhwMih Av~ Smgh, HEATING CO: R''Al; C w Signed By: ` Date: ml- CITY OF FRIDLEY INSPECTION DIVISION 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 RATE SCHEDULE 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) I% of Value of Appliance or Work :ommerciai/fndustrial 1.25% of Value of Appliance or Work el Rate; -TOTAL $ 30,00 $ ti $ 10.00! $ - $10,00, $ $ 10,00 $ $ 25.00 $ State Surcharge TOTAL FEE 1.1 I. a_ Zt :. ►.� ► - 'itl• � � s � • .- ..i4k,` - tEINSPECTiON FEE $47.00/Hr Air Conditioners can not be placed in a side yard without mitten permission from adjoining property owner. $ .50 O Effective On January 1, 2002 JOB ADDRESS �0 6, 7A �V'y V� OWNER vj ko peyY) w - BUILDING USED A$ - Du)iUa YjG- ESTIMATED COST PERMIT NO. 3� • ► • • 111 � ►..1 • .i � _ _�. 1. a No, of Heating Units ' Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burster Trade Name Size No. BTU C� D liq*a rd ✓ 3ati X{'�YU 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. D DATE HEATING COAwa C - s -e' &ntL Q iJPi'AS Signed J0 TEL # FAX # 7103- Approved By Rough -in Date' Final Date 0 "©d- CITY OF FRIDLEY PE NO.: 2004-01039 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 7/06/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 18 66 WAY NE PIN : 153024140032 LEGAL DESC : EDGEWATER GARDENS : LOT 2A BLOCK 5 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 6,136.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. BUILDING WRAP TO MEET THE STATE BUILDING CODE. RESIDE HOUSE & GARAGE; REROOF HOUSE & GARAGE (34 SQ) TEAR -OFF. APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 139.25 6.14 JOHN & AMY WEBER 18 66TH WAY NE STATE SURCHARGE, VALUE 3.07 FRIDLEY, MN 55432 TOTAL 148.46 PAID WITH CHECK # 6301 OWNER JOHN & AMY WEBER 18 66TH WAY NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or c cel the provisions of any other state or local law regulating o tructio or the perf ce of construction. Applicant Date, -t?' 10 /a4 Bldg Ins p 4 SEPARATE PE S REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [l ADDN [ ] ALTER [ ] Construction Address: Legal Description: CITY OF FRIDLEY 36& Effective 4/1/2004 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION '00® Owner Name & Address: 0 h n N UJ -e b--e� Tel. #—,5- 7 1 Contractor. J 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: L th _ Width Height _ Sq. Ft. DECK AREA: Leng La� gt/Ground q Ft OTHER: Construction Type: cX R® Estimated Cost: $ S-0 O // kik Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x DATE: -C9 '(D APPLICANT: UV --e-- Tel. # /3 Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $-i� �102-K- Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ 1v —IL—STIPULATIONS: �4't 4,500 .y CITY OF FRIDLEY PERM O.. 2004-01292 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS 18 66 WAY NE PIN 153024140032 LEGAL DESC EDGEWATER GARDENS LOT 2A BLOCK 5 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL VALUATION : $ 3,600.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. REPLACE 17 WINDOWS WITHIN THE EXISTING OPENINGS. APPLICANT BUILDING PERMIT FEE 97.25 JOHN & AMY WEBER FIRE SURCHARGE 3.60 18 66TH WAY NE STATE SURCHARGE, VALUE 1.80 FRIDLEY, MN 55432 TOTAL 102.65 PAID WITH CHECK # 6329 OWNER JOHN & AMY WEBER 18 66TH WAY NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating c truction or the perfo ance of construction. A lican Date 'G Bldg Insp Da SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 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: a ti Legal Description: Owner Name & Address: Acv -,-a P,`0 Tet. # (9 3 S (� 8 3_00 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 HgtlGround Sq. Ft. Construction Type: Uk) ► 0 5 Estimated Cost: $ 3(-000 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: <R ' -0 APPLICANT:LTel. # 3 Si 8 3 Call (763) 5724604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ 0 C�- LJr:L STIPULATIONS: Building BUILDING Permit No.: 1aC0-7-AT@19 Inspections RESIDENTIAL APPLICATION. Received By: 763-572-3604 CITY OF FRIDLEY DamwVr? goo DATE G` L4 - C) 1 YOUR E-MAIL ADDRESS SITE ADDRESS 1-5 " b IQ+'G', (A) THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: S®h n (A)'b -o-c TENANT ADDRESS: CITY Gr t o L:45 STATBnItIP SSS 13 p PHONE: -7 c-- _ 3 ocj CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYINEW CONSMU22ON STORIES PERYHT TYPE ❑ ADDITION )kGARAGI1J1HaED 1 ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING 5WT HER ❑ SWIMMING POOL TYPE OF WORK: NEW ❑ ADDITION C3 MA NTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:_ SIZE OF IMPROVEMENT 19 LENGTH oil WIDTH g HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed.project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF.WINUOWS ALL FEES BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: U5 -Z) (USING THE 1997 U.B�FEE SCHEDULE) TOTAL J B VALUATION $L e 0 OCCUPANCY TYPE Permit Fee $ 11)(;, to See Back Page for Fee Schedule Plan Review $ ?� aj. t: % 65% of Building Permit Fee Fire Surcharge$ - /a �a .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = R x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( } Total Due $ Make checks payable to: City of Fridley Attach Stipulations 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 ch requires review d approval of plans. �j (� /1 �J SIGNATURE OF APPLICANT r \ _ = PRINT NAME v V'P4� "t/Y DATE I — `1 - y / J' ©O) /e fto ---..s Y)®q ©4 sav-9) U') L15ysCIt �V, �Woal� _DMA10 -13 44 ,L- ba a 7 \A -O �^a � 6 �d55}a✓� Ta,tAaaLool1LSV =IIVHS 4v�3 3H1 UOJ .. O 3 'BVIIVAV Sl.s ool ®NV G3�i33MON3 1 _ - N - 1r I -i -V n a) --a: o" I /aI ®R J qL 1 v u v .Wk byy.µ `' ,`-'4''aU'9:a 4 -"l% tis':-L,^R% lSL"EJwe,w�-T�,"1 _.•...yf' y4 ' t.." � -�.. - �,r,_.y �4" '-•i4a +`-q�t'� -�-br-.kc s,., .. 4,"�f�• '+•r!51. {'.,,� `k OV .n. �, aka ,�y �• s�t�a "�' "�"� y a^ a`F,�" `�n�,'^G�w ,� w? t h�, �• �+"4 ,amu%,.. 4r �„ 4 'a! k. '*+.0 r,,.. ., �'4•� ia`a,r�.. � ,4.,,r, r � . � + .ice„ ~4Ilk c 4 �� rw. ._ .. ,. X.'' ,Y *a„ �q � — �F }..rte.&F, h �bi'`�l �y,,�+`dv��si, 'ay�,',t `- _,'�`•�-� sk Building AND MATERIALS: BUILDING Permit No.:�r20'107 Inspections TOTAL JOB VALUATION $ ` 0o v • co OCCUPANCY TYPE RESIDENTIAL APPLICATION Received By:763-572-3604 17, S See Back Page for Fee Schedule Plan Review CITY OF FRIDLEY D %'(S' DATE -/ /0 ` 7 YOUR E-MAIL ADDRESS SITE ADDRESS J S 66TH WAY /✓e THIS APPLICANT IS: ❑ OWNER MCONTRACTOR PROPERTY OWNER/ NAME: 014AI A 04/1-1 y ►/V FBlelos J TENANT ADDRESS: / er a714 kV,4 y N,6 CITY FlqlOt ufy STATEN IP $ PHONE: CONTRACTOR NAME: Go ti o1,r2F 5A,��-0,WS V8A )?AM.54C /� af' SUBMIT A COPY OF STATE LICENSE # ptO 7 .73 7 7 EXP DATE 3 '311-18 YOUR STATE LICENSE ADDRESS: 5'Y&a c/ /—D00A) OK CITYA0(,4&K47'-0STATE1k'ZIP s'66o1 WITH APPLICATION PHONE o7 387 OSoo FAX S,v7 Sal S' 33 YY PROPERTY TYPE IP SINGLE FAMILY/NEW CONSTRUCTION SIZE $ ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS / D l?. a r Make checks payable to: City of Fridley Attach ❑ BASEMENT FINISH ❑ ROOF JXDRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION IN MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: /NSr& L RASEMfHr ORAw rt LES X&�/e oeam?FXl fiC�toi? 0/sc*oR6E L/y SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ` 0o v • co OCCUPANCY TYPE Permit Fee $ 17, S See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ y..0 o .001 times the total job valuation Surcharge $ a. Pa. .0005 x Permit Valuation Minimum $.50 - License Surcharge $ S--,00 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ / D l?. a r Make checks payable to: City of Fridley Attach 41V IS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a buildinand I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinaodes f the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatiormi d 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 re view and approval of plans.,/,/qSIGNATURE OF APPLICANTPRINT NAME (/MrO4 444/ � DATE / V d 7 l0C1 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ cAW 0 ) OCCUPANCY_ TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks navable to: Citv of Fridley Attach 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 on site; that�APPLi' in acco ccapproved plann i_n the case of all work which requir s review and approval of plans. p� SIGNATURE OF NT ✓' PRINT NAME YY��I W E, 3 DATE �- -I-O 0 BUILDING Permit No.: 3uilding [nspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd:01 763-502-4977 FAX EFFECTIVE 1-1-08 Oy^, C- Ru o ��R ucz (w' )ATEP YOUR E-MAIL\o MAIL ADDRESS iITE ADDRESS T i)t PHIS APPLICANT IS: XOWNER CTOR PROPERTY OWNER/ NAME: Ohe TENANT ADDRESS:'0 U o -e AJ G CITY (tel �.1. STATE�ZIP PHONE: �sr I a - -1 ( 4? -5s- NAME: 3 ZIPS- Li CONTRACTOR ADDRESS: CITY STATIy 1u SUBMIT A COPY OF PHONE - - FAX_ JQ 3 ^ -7 CQ 1<33 9 YOUR STATE LICENSE STATE LICENSE # OkO CA '-{ 7> a 5-(-) EXP DATE 3 ' 2n � PROPERTY TYPE SINGLE FAMILYNEW CONSTRUCTION SIZE TWO FAMILYNEW CONSTRUCTION STORI PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ASEMENT FINISH ❑ ROOF ❑ DRAM TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: rocyn I S'e (� e SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl []Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum 13Trimand proposed project ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes []No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ cAW 0 ) OCCUPANCY_ TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks navable to: Citv of Fridley Attach 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 on site; that�APPLi' in acco ccapproved plann i_n the case of all work which requir s review and approval of plans. p� SIGNATURE OF NT ✓' PRINT NAME YY��I W E, 3 DATE �- -I-O 0 PL -A9% Fot AMY * 36tiri 1p--* e5 CASA 180lo(04rl% "%f W *46 (D -'St -A4-7" C(..:wjZ 5 v.s 1),SwVJ. 38" opq-,\(nc� 3,4 X Ufal �-'!)W�AP SSP fit- El O Lkt l-eld- (2) - V- C SeZ CAN calms v�-r«b '-:*Pp v In (a� 3 t; z k� ?I:- 4: �-7 (* cf I '� ( *.scP.e,E oe'ovI . ► acjoCa l eC (z7, LAJ o� L.JL+h �M?4& 7 4\ REVIEWED Y� CKlMrl,4 1-3 2. Building MECHANICAL Permit No.� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY D 763-502-4977 FAX EFFECTIVE 1-1-08 DATE -;— -�— E-MAIL ADDRESS nYOUR SITE ADDRESS Z e (p�o %� �/ Y N� THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: V/ ADDRESS: % 610 T4%/t/A- ci CITY jF f' ( STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR COMPANY NAME: / i¢ , / CONTACT PERSON: n r NOTE: SEPARATE CITY LICENSES ARE REQUIRED FOR GAS STATE L10EN E # EXP DATE STATE:?9'4LIi�s-?D3 AND HVAC. DRESS: U IT Bi�/ CITY 1t SUBMIT COPY OF BOND ^ 41 PHONE 71, 'r� FAX 76 3— �3y f0'7 AND INSURANCE PERMIT TYPE �KINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ❑ REPLACEMENT J�ALTERATION/REMODEL 2 v DETAILED DESCRIPTION OF WO IZv 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: SIZE/BTU MFG: MODEL: SIZEIBTU 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 DRYER $10.00 _POOL HEATER $35.00 —CHIMNEY _GAS DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR $15.00 p_ 7-"k dVgK 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 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 rdance wi the r ed plan in the case of all work which re �i s revi w and pro al of plans. SIGNATURE OF APPLICANT PRINT NAME i //' i0 DATE9 2 4� APPROVED BY DATE AMt; City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC 0 NEW HOMES/ADDITIONS ❑ 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. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations.