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PRE 2010 DOCSCity of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3450 Q DESCRIPTION OF WORK Location (y ' , Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin.... . ..................... Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg. ............ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x 1.20 $ x 1.00 $ x 3.25 $ x 2.00 $ x 3.25 $ a 0 WATER HTR. GAS ELEC. Base 1st 2nd Rj 3rd 4th 7Lt7-1 I I • Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin.... . ..................... Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg. ............ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x 1.20 $ x 1.00 $ x 3.25 $ x 2.00 $ x 3.25 $ NO. RATE TOTAL x $1.50 $ X .50 $ x 2.00 $ Description ....................................... .$ .60 50 5 . _ TOTAL FEE $L City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all, work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, LM�inn19 93 Owner _/l•L.:•L F73 . ��Q/r1�J Kind of Building Used as To be completed about Estimated Cost, $T�� �� Older. Building Permit No Permit No. ,/ Signed �.,c o o+� �� _ g .�b 6 Co. IQ Bye_/,, Business Phone No_ 9.22'- 3 -% tZ ! ROUGH FINAL � % y d2 �Lta.RGLVI.b D�L1.�Lt'i SUBJECT PERMIT N. City of Fridley �ff_ AT THE TOP OF THE TWINS D[Rv BUILDING r; , R EbSZLINO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 , I �---I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---- 1Lt 612-560-3450 910-F15 10/23/73 JOB ADDRESS 410 67th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 5 Rice Creek Terrace SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Marvin Asp 410 67th -Avenue N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS Check for frost footings at existing slab SEPERATE PERMITS REQUIRE® FOR MRING�. HEATING, PLUMBING AND SIGNS. %W9 UNb BNlswnld : 1SILL 3H. W3 dminMH S11W,83d 31VN3d3S TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 120 1,440 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 $3900 1.95 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $10 00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $11.95 REOFCONTRACTOR ORAUTHORIZED AGENT (DATE) - W N PROPERLY VALIDAT IS IS YO PERMIT Zx"�Olf' G INSP DATE SIGNATURE OF O ER IIF OWNER BUILDERI (DATE) �Lta.RGLVI.b D�L1.�Lt'i APPLICATION FOR RESIDENTIAL, ALTERATION, OR JDITION BUILDING PERMIT CITY OF I-IZI DLLY , \1J NNESOTA OWNER'S NAME: ADDRESS :_�D - �v T% -'�i /� ADDRESS :_ f3 07 5 5%1�• `jam NO:. STREET: LOT: -BLOCK:-15- ADDITION: , c e &C e e1� CORNER LOT INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed bui.ldirig location drawn on these Certificates. .DESCRIPTION OF BUILDING To Be Used As: r z / i a �� Front : �Z Depth: / ® Height : /a Square Feet: a Cubic Feet: Front: Depth: Height: Square Feet; Type of Construction: To Be Completed: Cubic Feet: Estimated Cost: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that i11 the facts and representations stated in this application are true and correct. DATE: % J'� -2 SIGNATURE:_ (See Reverse Side For Additional Information.) -W, C4 s* -4. S ti a- L F y` A r P, rV ; rx " fto S a SUBJECT PERMI _,_ City of Fridley 13 7 6 AT THE TOP OF THE TWINS BUILDING PERMIT T Or COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1p ��/ CITY HALL FRIDLEv 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 6/4/92 JOB ADDRESS 410 - 67th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 5 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mark Follmer 410 - 67th Avenue NE 571--7650 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 ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (22 Squares) Tear—off 9 CHANGEQFUSEFROM TO STIPULATIONS Underlayment must RKV comply with. State Building Code. 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 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 $1,166 $.58 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 STATE OR LOCAL LAW REGULATING CON- $ 29.00 Fire SC $1.16 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $30.74 SIGNATURE OFON�AUTHORIZEDT IDATEI ATED THIS IS YOUR P �RMITSIGNATURE �NRRL OF OWNiDATEI 4ATE MRW [ J Effective 3/1/92 ADDN [ l ALTER [ J Construction Address: CITY OF-FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Legal Description: Z-10 i . 4 t o G-7"`-' A�- Owner Name & Address: Noc k '�) r Tel. # Contractor: 13C 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 IN[PROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER:12E = '►Z ®� 9 7-0,61L S(A. Corner Lot [. ] Inside Lot K Ft. Yd Setback Side Yard Setbacks Type of Construction: PC— 000'7 - 'TW-ag Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: - 4_ qZ APPLICANT. �� - Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow $ 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 $700 per SAC Unit $5.00. (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ J Not Necessary [ J SUBJECT PER City of Fridley 2.8 14 7 AT THE TOP OF THE TWINS BUILDING PERMIT i 5. O COMMUNITY DEVELOPMENT DIV. � � PROTECTIVE INSPECTION SEC. 1dpr E . i NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 IL""A. 612-571-3450 910-F15f' 10/8/98 _F f! JOB ADDRESS 410 67th Avenue NE T LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 5 1 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jean Nuo le 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Erick Kallerup Const. 7400 1st Ave S Richfield MN 99423 79,9-1647 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 O NEW ❑ ADDITION 0 ALTERATION j REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (26 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I 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 $2228 $1.11 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- STR CTION OR THE PERFORMANCE OF CONSTRUCTION $74.75 Fire SC $2.23 PLAN CHECK FEE TOTAL FEE License SC $5.00 1$83.09 SIGNATURE OF CON-RACTORORAUTMO IZED AGENT qrE HEN PROPERLY LIDATED THIS IS YOUR PERMIT LDG �Nsp I'AiE SIGNATURE OF OWNER,IF OWNER BUILDER) iDATE. NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: I 10 (�-7 �h Au ( A) r Legal Description: Owner Name & Address: 7 C cc V, / " C- Cc J c Tel. # S 7 % — Contractor: E r l L f< 1< r u Ste` MN LICENSE # -7 5— 9 1 Address: 7XLC)-G ! � 4— & cr, S . Tel. # 7 9 9-- l(�f 7 Attach to this application, a Certificate of Survey of the CC l / 70/ — y g' l Z lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width GARAGE AREA: Length Width DECK AREA: Length Width OTHER: `e&o ;?% Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. Construction Type: TCCC,. (� —U Ell die 1 o o Estimated Cost: i (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: /094 APPLICANT: �I �dG Tel. # -7 0 / — -1 ?— TOTAL STIPULATIONS: $ 83.0 CITY USE ONLY Permit Fee $ �%� S Fee Schedule on Reverse Side Fire Surcharge $ �.a3 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ oo $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: $ 83.0 Building BUILDING Permit N10.. -2_(0q_, Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY D MMM 4 2004 763-502-4,9//77 FAX EFFECTIVE 1-1-09 DATE �p�N' ©yYOURE-MAIL ADDRESS SITE ADDRESS�C.L� /% ce M. E. THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: (I(P . CITY STATE IPS PHONE: '7 —j< % — 76!FQ CONTRACTOR NAME: `/ SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # n �Z&e720 EXP DATE�_tw CERTIFICATE OF ADDRESS: ,rq_ *, zL_m U , ��//�AND CITY nx (,�STATT/�,y�ZIP4,g� INSURANCE PHONE 7 FAX PROPERTY TYPE ❑ SINGLE FAMILYNEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHEDWINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ EW HOME CONSTRUCTION ❑ ADDITION AlMTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: a2 ' SIZE OF IMPROVEMENT J LENGTH WI HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 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: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl Y ❑Soffit ADDITIONS, & PORCHES SUBMIT: ❑Aluminum ❑Trim I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGSYes []NoL CATION QF WINDOW OR FOR NEW OPENINGS- SCRIBE SIZE OF lie,3 =Jed . 3. Energy Calculations OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED ejMr NUMBER OF WINDOWS ALL rLLN ARE BASED ON VALUAI7UN, INCLUDING THE COST OF LABOR AND MATERIALS: rOTAL JOB VALUATION $ S� SING 1997 U.B.0 FEE SCHEDULE) 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) $2000 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 payable to: Citv of Fridlev 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 1 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 the work will be in accordance with the approved plan in the case of all work whic r fres view and approval of plans. SIGNATURE OF APPLICANT PRINT NAME / /LPD? G/d { DATE � ��� Building BUILDING Permit No.: z'60 C1 1__6 (bq q Permit Fee $ 125 Z See Back Page for Fee Schedule Inspections RESIDENTIAL APPLICATION Received B . 763-572-3604 Fire Surcharge -T 9 .001 times the total job valuation J �- CITY OF FRIDLEY Dat=d 763-502-4977 FAX License Surcharge $ EFFECTIVE 5-19-09 SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow DATE � YOURE-MAILADD ESS Erosion Control t'!`�-�� SITE ADDRESS $450 Conservation Plan Review Park Fee THIS APPLICANT IS: 0 OWNER ) ONTRACTOR Sewer Main Charge PROPERTY OWNER/ NAME: T Total Due TENANT Make checks savable to: Citv of Fridlev Attach Stiuulations ADDRESS: CITY r STATE ZIP PHONE: CONTRACTOR o NAME: L- ` SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # C' O 1Z %�lii ��--� EXP DATE AND CERTIFICATE OF ADDRESS:0�`�L[2 Zi, CITY ATrr�/r�ZIP INSURANCE PHONE — FAX — — PROPERTY TYPE WSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES__ PERMIT TYPE ❑ ADDITION 0 GARAGEISHED NDOWS ❑ BASEMENT FINISH ❑ ROOF 0 DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER 0 SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION 0 ADDITION MAINTENANCE/REPAIR ❑ REMODELING p /- ,� DESCRIBE WORK BEING DONE: '&ffeye? g!5 �!6 ` zky< e� � ! ala 1 je-W SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES 0 HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: 0 DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum 0 Trim I. Site Plan/Survey showing the existing structures ❑ Other 0 Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS 4es ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. 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_&C FF.E SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ 125 Z See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ l_7 .001 times the total job valuation J �- Surcharge $ D .0005 x Permit Valuation Minimum $.50 ` 7 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ (- Z!� Make checks savable to: Citv of Fridlev Attach Stiuulations 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 the work will be in accordance with the approved plan in the case off all whichq-reu ires r . w and approval of plans. Q �, SIGNATURE OF APPLICANT //t/ c S�IU� PRINT NAME//LP U'('J�L� DATE 1e9 20 Building MECHANICAL Permit No.: AnIVURT Inspections RESIDENTIAL APPLICATION Received By:� 763-572-3604 CITY OF FRIDLEY �C Dtft 763-502-4977 FAX EFFECTIVE 2-19-09 /Z Z DATE YOUR E-MAIL ADDRESS SITE ADDRESS .Z5 THIS APPLICANT IS: ❑ OWNER TOR PROPERTY NAME: j EAq, (. M r- �-- ADDRESS: C'> AVE— 1V6CITY STATI»dLJ*<<IP SS`f3 OWNER/ TENANT PHONE: CONTRACTOR COMPANY NAME: CONTACT PERSON: S ,5 SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS:4�oP,� e`Yi o4vg Al CITY SSGJ 1jL4A1i9-Z- STAIP �cJ APPLICATION PHONED- �"i - �3 �3 1 FAX PERMIT TYPE1 E NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW 0-9PLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK }�� c���C F� (��i I�r�� L FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED:; FIXTURES: (INDICATE TOTAL -NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALCIS PER MANUAL J 2006 ASHRAE=HANDBOOK. Equipment Installed MFG: MODEL: SIZEBTU MFG:72,9svG MODEL: 5(V9 5 SIZE/BTU MFG: MODEL: SIZEBTU _A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 TO AIR EXCHANGEER $15 FIItEPLACE (WOOD)' $35.00 NEW GAS GRILL $10.00 _AIR SFR $35.00 : TGkNACE $35.00 _GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 DRYER $10.00 _POOL HEATER $35.00 _GAS DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 � � g z b t =! ., F Stl '� ` � ,� � it "r{? � ' -vC.i eF �` ��S 4 '� .r ��.!`1a`•G y�r 3 � �1 S '9."' ��4 - t � S 5�' �vL. v SY `� �Y�„ � �` -: i'"• �{'' �(� h f�R .... - 1 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 al c w ' r s view and approval of plans. SIGNATURE OF APPLIC I PRINT NAME C P t7i 17:)'" DATE i Z - 22 -o �' APPROVAL INSPECTORS RE DATE 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 ❑ 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 other 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.