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PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560-1570 69th Avenue N.E. City of Fridley, Minn.. 1 1 3 3 7 6431 University Ave. N.E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: February 22,E 1972 Owner: Map Creek Development •up...nBuilderApproved contractors. Address -RiAde ri le PineS, ZLM. Address 1052 Osborne Road N -R-, Frid Cy 786-3680 1638,1636, 1634.11632 No. _ Street_ Parcels 10 200, Lot B ock LOCATION 68th Avenue N.E. Section 13 OF BUILDING Part of Lot Addition or Sub -Division Corner Lot _-__ __. _ Inside Lot _ Setback Sewer Elevation Sideyard. Foundation Elevation _..-... DESCRIPTION OF BUILDING To be Used as: Each Unit 4 Townhouse Units Front 20' Depth - 32 _ Height 21'1 13' sq. Ft..�_ Cu. Ft. Front . _ Depth Height Sq. Ft. Cu. Ft. Type of Construction — Wood Frame Est. Cost See 11 315 To be Completed 1 year In consideration of the issuance to me of a permit to constru the building described ab e I agree to do the proposed work in accordance with the description above se and in comppan wi provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ See #11.31, permit is hereby granted to Rice Creek Dev. Co. to construct the building or addition as described above. This permit is granted upon, the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinances Of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLAR NCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to no the Building Inspector for separate permits for these items. C SUBJECT IT N . City of Fridley 27025 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED 9Y CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/6/98 JOB ADDRESS 1632-38 68 Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Parcels J0 & 100 Section 13 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rice Creek Develo ement 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO AAAmerica's Best - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 4— lex 37 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. 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 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 3085 $1.54 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PR VISIONS O ANY OTHER STATE OR LOCAL LAW REGULATING CON- ' ST CTION TH PERFO ANCE OF CONSTRUCTION. $87.25 Fire SC $3.08 PLAN CHECK FEE TOTAL FEE 91.87 GNATU EOFCONT RACTOR THORIZEDAGENT i ATE) WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT _ r t di a +NSP GATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI Prepaid Plan Check $ Estimated Cost $ Receipt # Effective 1/1/98 CITY OF FRIDLEY R-3, COMMERCIAL & INDUSTRIAL �0 -4 BUILDING PERMIT APPLICATION �cl� construction Address / 9 3Z 39 46fl' Z" eye Zoning Legal &- ee�- owner & Address Tel# CJONTRACMR & ADDRESS Ai% 444 cr i c- l �;PS `7� %/%®/ rg• �• 13fi. Tel# 70;;' O/®® EeP�se.d e S's 3`�riR Architect Reg.# Engineer eg•# BUILDING CONSTRUCTION �� [� / TYPE OF WORK [] New [] Addition [] Alteration -Describe i� �8©l �� e�z 172 T to r ^ D )0 OFC. AREA: Length Width Height Sq. Ft. qHSE AREA: Length Width Height Sq • Ft • CIIHER : lezx;th Width Height Sq. Ft. APPLICANT - � Tel #®7 D/ OD Date 6 b—s VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) Q 8 Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ c3C Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TCI'AL VALUE Building Use Construction Type Occupancy yup Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No Performance Bond Amount $ See -Reverse for Schedule Received []Yes []No Pexmi.t Fee Plan Check Fire Surcharge State Surcharge SAC Charge $ Erosion Control $ Paris Fee 1 $ Spec. Assessments $ Driveway Escrow $ TOM $ l See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th 0 $.50/$1,000 Valuation (See Sched. for > $1 Million) $1000 per SAC Unit (Plans to MWCC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering Agreement Necessary [] Not Necessary [] feet x $13.50/foot ATTACH STIPULATIONS qZ l a(0 Effective 1/ 1 /04 CITY OF FRIDLEY MOVING [ ] WRECKING 0 PERMIT APPLICATION 6431 University Ave NE Fridley MN 55432 (763) 572-3604 FAX (763) 571-1287 n,jr AA II Job Address: 16.3Z - 3�J �� JLC AA- � Legal Description:� Owner & Address: T11" k 8992 j Tel. #95Z-a-VY-77jr Contractor: gNAtiC(= on%46Atj ( tliL Tel. # Address • Ly60 Q--uyW- AJa State License # yt(2-3 DESCRIPTION OF BUILDING HOUSE: Length 3`� Width 2- `I Height l (o Sq. Ft. 1446 Cu. Ft. III j Za GARAGE:Length Width OTHER: Length Width Estimated Cost $ Height Sq. Ft. Cu. Ft. Z. . Height Sq. Ft. Cu. Ft.,PAI-OWD Approx. Completion Date CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE. Water Bill Paid: Yes [zor Collect [$ ] Signature Moving Route: The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application are true and correct. ALL Movin Wrecking Principle building into Fridley .... $300.00 For each 1,000 cubic feet or fraction ...... $1.25 Accessory building into Fridley ... $ 42.00 For structures which would be impractical to Through or within the City ...... $ 20.00 cube, the fee shall be based on the total cost Move a building out of City ....... $ 20.00 of wrecking at the rate of $6.00 for each $500.00 or fraction. PERMIT FEE: a�48-9�P MINIMUM $20.00 STIPULATIONS: WW , CITY OF FRIDLEY INSP. DIV. 6431 University Avenue NE Fridley, MN 55432 (763) 572-3604 211 HYDRANT RENTAL AGREEMENT (Effective April 1, 2004) XJOB SITE: 163 2- f 3 6�-V�b (%(� k1 (1-5 Applicant: AL43ca CCJ4eAKltU lac-- Tel. #: 763' S?z -ZCyo Address: 61LIC0 A -is P(:= RENTAL CHARGES Service Charge: $50.00 Water: Minimum $10.00, $1.25/1000 gal. with meter Tanker: $10.00 per fill TOTAL CHARGES $ 6-®, 0�) $ L 57 $ 62 a Receipt # EQUIPMENT USED & DEPOSITS HELD Meter Deposit: $200.00 Meter # $ Meter Reading: Start End TOTAL GALLONS x $1.00 = $ Equipment Deposit: (wrenches) $150.00 $ TOTAL DEPOSIT CHECK $ List Equipment Borrowed: Above Equipment Returned to: I/We agree to make the above deposits and pay the water and service charges for the use of hydrant connections and equipment borrowed. In the event that the above meter or equipment is lost or damaged, the cost of repair or replacement shall be made by the applicant stated in this agreement before the deposit is refunded. Date Deposit Check # Signature Deposit Amount Returned By Date CONSTRUCTION WATER & EQUIPMENT RENTAL Application is filled out, deposits are held and charges are paid at City Hall, Building Inspection Division. Application is then taken to filtration plant. All equipment is, picked up ,at Commons Filtration plant at 601 -'61 st Avenue from Water Department personnel. Water Department will list on application what equipment was borrowed and the meter reading on the meter if used. Application is left at filtration plant until equipment is returned and the final meter reading is Of on application. EQUIPMENT MUST BE RETURNED IN GOOD CONDITION TO GET DEPOSIT BACK. Call City, Hall before bringing equipment back to insure that. someone will be at the filtration -plaint to receive it. Bring signed application back to Building Inspection Division, City Hall to get deposit back. Y ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE VALUATION : 1632 RICE CREEK RD NE 133024440002 UNAVAILABLE LOT BLOCK HYDRANT RESIDENTIAL DEMOLITION ADVANCE COMPANIES INC 6400 CENTRAL AVE NE FRIDLEY, MN 55432 (763) 572-2000 PHILLIPS LEVI F 1632 RICE CREEK RD NE FRIDLEY, MN 55432 2005-00952 06/21/2005 WATER LINE REPAIR/RELOCATION 50.00 WATER PERMIT FEE 12.50 TOTAL 62.50 PAID WITH CHECK # 98126 Building BUILDING Permit!,To.: + D Inspections COMMERCIAL/INDUSTRIAL Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: p DATE (-2®' ©, YOUR E-MAIL ADDRESS SITE ADDRESS 163Z, 3q, 3(0/ 38, ALL l i L -- ? TENANT TENANT Suite No. PROPERTY OWNER NAME: JlP--+ MZ A -r Cc). ADDRESS: S-) � 2. A�& S CITY &0"'(wM',STATE MxYlP — $ $450 Conservation Plan Review PHONE: L7.-)'?-- 8-5-v- '17 r ARCHITECT NAME: LAmA--*--r ARS-VkIT-6c-15 ADDRESS:i 3r3 7 r` IUCecu,), 57 fit; -CITYAhLJ,4Jc6 STATE"IP ,Y3e4 $ CONTRACTOR NAME:QvA1J ji(L-3 Ix ADDRESS: 6460 a_V'L c� MO �-� CITY &ILS= STATE�W ZIPIJ05Z- ft + 6 ft = ft x $20 = $ notal Due PHONE:? 93 - 572 - 2CV6 FAX 763 - 5 72 — q73 3 ,ET Make checks payable to: City of Fridley Attach Stipulations *NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COMMERCIAL/INDUSTRIAL JOBS PROPERTY TYPE TOWNHOUSE ❑ COMMERCLUJINDUSTRIAL ❑ INSTITUTIONAL ❑ MULTI -FAMILY PERMIT TYPE ❑ ADDITION ❑ NEW CONSTRUCTION ❑ OTHER ',REMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUILDING TO BE USED AS:ss WHS SF OTHER SF TOTAL SIZE: STORIES FIRE PROTECTION (Y/N) AC(Y N) DETAILED DES RIPTION OF WORK THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work w i h require r w and approval of plans. �- -7 SIGNATURE OF APPLICANT D dil PRINT NAME DATE c ALL FEES ARE BASED ON VALUATION Sq. ft. x $ Sq. ft.'x $ Sq. ft. main -X$ TOTAL JOB VALUATION: $ Cost/sq. ft. = Valuation $ Cost/sq. ft. = Valuation $ Cost/sq. ft. = Valuation $ ems' OCCUPANCY TYPE" Permit Fee $ S' See Back Page for Fee Schedule Plan Review $ / 65% of Building Permit Fee Surcharge $ . 4 0, �) (.0005) times the total job valuation - Minimum $.50 ?ire Surcharge $ '1 . 6J9 .001 x Permit Valuation (1/101/6) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) 3rosion Control $ $450 Conservation Plan Review ?ark Fee $ Fee Determined by Engineering Special Assessments $ Agreement necessary ( ) Non Necessary ( ) :�urb Cut Escrow $ ft + 6 ft = ft x $20 = $ notal Due $ ,ET Make checks payable to: City of Fridley Attach Stipulations (&06k S CtV4 b- Aid—W, i i 11, City of Fridley Building Inspections Dept 5431 University Ave NE Fnd iey MN 55432 (�. Mechanical Ph: 763-572-3604 FAX: 763-571-1287 Residential Application City of Fridley Sea Rar_ic NP Fnr RPrmired Information ,:)��3k Pen -nit # a30!; -V';2 - Date Site Address: The applicant is: cirl a one Owner Contractor ate' Property Owner. -- Address:165'2 owl City: Je?4Wr1S4 State: AA1 Zip: S'2ro-VZ Phone: Cell: Fax: Contractor Informa't( n Company Name: Contact Person:.r Address- City:iC State: �l Phone: sl �r� Vie- Cell:y9® 6(e-4 'i Fax: 1g,411 Email: C, -a anie;hMN Bond# & Ezp Date ��/�� e. Type of Work circle one): New Replawment Alteration/Rerrwdel Detail erf Description of work: %k- -OW Equipment Installed: MFG: Model: Size/STV: MFG: Model: Size11EITU: MFG: Model: SizefBTU': Please check ail that apply. _Fireplace (gas) $15.00 New Gas Grill S 10,00 AIC $25.00 ,_Fireplace (wood) $35.00 _Gas i_dnrf HT!? ?10.09 Air to Air exchanger $15.00 Furnace $35.00 _Foot Heater S35.00- '_Cas Boller $35.00 Dryer $10.0 1 _Ventilator $15.M _Chimney Liner $10.00. _Gas Piping $10.00 °� Duct Work $10.00 Gas Range/Oven $10.00 J t''i,� r- i./ , Penpjt Fee $ (Total from above -Minimum fee $35.00 r 70AZ Surcharge Z 0.50 �+�" Total Due $ Make check payable to City of Fridley Q. This is an application for a permit- not valid until processedand" A e--4 I hereby apply for a mechanical penult and I acknowledge that the information above is completa accurate; that the work will be in conformance with the ordiriances and codas of the City of Fridley and with the. Minnesota Construction Codas; that I understand this is not a pernA 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 e f?'� approved plan In case of all work which requires review and approval of pians. Al / Signature of Applicant: Approval Inspector Sig K Not ate permits are r u , ...,..,..•...3........,.:-- - =-dal Zrrc�N,, d Lb90 '°N p �' u i �eaH pine ou i gtun ld e i n i;.„t,,n' 7 7 Building MECHANICAL permit N Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd.'_- DATE _ 2,1-05- YOUR E-MAIL ADDRESS SITE ADDRESS / b b e' THIS APPLICANT IS: O OWNER MeO TrRACTOR PROPERTY NAME: OWNER/ ADDRESS: CITY STATE ZIP TENANT PHONE: COMPANY NAME: ' CONTRACTOR CONTACT PERSON M � l�.11CCUI-7 SUBMIT A COPY OF YOUR STATE STATE LICENSE N EXP DATE G o LICENSE WITH ADDRESS: //V5 2 (of -t" IV , t • CITY ^ / C {�/�� STATES LIP- APPLICATION PHONE 1097-4--31 FAX WNHOUSE PERNIIT TYPE ❑ SINGLE FAMILY [3 TWO FAMILY TYPE OF WORK: I 0 NEW M46PLACEMENT 17 ALTERATION/REMODEL DESCRIPTION OF WQRK a'(v elk 5 5 C� r"l�z e- 0` 7 /ii i )L1j 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 onlythecost of labor �) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labof' �%�v 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) MODEL: SIZE/BTU Equipment Installed MFG: SIZE/BTU MODEL: SIZE/BTU MODEL: A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00— FURNACE $35.00 GAS UNIT HTR $10.00 —DUCT LINER $10.00 —GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ . Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ 50 Total = $ 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 which requires review and approval of plans. zz __ PRINT NAME �%'+�l l3��s✓�h r DATE ZCr- SIGNATURE OF APPLICANT ��. rwrw City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 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 PropaneUGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a_ IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances 1FGC 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 PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY mate Rec'd: DATE 10 - 21- OS YOUR E-MAIL ADDRESS sITE ADDREss 1(a3 S Avje-- THIS APPLICANT IS: ❑ OWNER EeONTRACTOR PROPERTY NAME: ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR NAME: STATE LICENSE # EXP DATE ADDRESS: )) G, Sb Z bi `'^ 5 Al, CITY S, - ^4 /c ly/iFL STATE1k1�✓LIP .ice 276 SUBMIT A COPY OF YOUR STATE LICENSE WITH PHONE 031 FAX APPLICATION PERNUT TYPE 0 SINGLE FAMILY ❑ TWO FAMILY OWNHOUSE ®'REPLACEMENT TYPE OF WORK: ❑ NEW DETAILED DESCRIPTION OF WORK 7a2�iu v��ti F 1P,�. PER MS 1613.665 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 ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor ,00x.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) BATH SINKILAV DRAINS _ SHOWER _ WATER PIPING _ _FLOOR GAS PIPING (NEzD c yLicE W _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK —WATER CLOSET _ BACKFLOW PREV. ($15) _ _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION —DISHWASHER _ WATER METER OTHER Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ 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 which requires review and approval of plans. lwwork SIGNATURE OF APPLICANT / PRINT NAME %^! rv� �Elal+Jii✓L- DATE /0 -Z/ -6k5_ City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Building Inspections Dept. 6431 University Ave NE Mechanical Fridley MN 55432 Ph: 763-572-3604 FAX: 763-571-1287 Commercial Application City of Fridley Permit # Date Site Address: Jg' if' Att Theapplicant is: cirlce one Owner C2Contractor Architect/Engine r Property Owner: Address: City: State: Zip: Phone: Cell: Fax: Contractor Information Company Name: ZI a.- 64 Contact Person: Pl,* A !-f '4�!2 Address: 1105-0 City: ,q i4,� ' l State: Zip: Phone: (J g172 Cell: Fax: Email: MN Bond# & Exp Date Permit Type (circle one): Multi -family Commercial Institutional Condo building Industrial building Swimming pool Other: Type of Work circle one): New Re lacement Alteration/Remodel Detailed Description of work: f&'k k., icAs -t Equipment Installed: MFG: MFG: Model: Size/BTU: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Duct Work _Roof Top Unit (RTU) A/C _Furnace _Refrigeration Gas Dryer Steam/Hot Water Heat _Boiler I Hood ,Gas Piping _Swimming Pool _Class II Hood _Gas Unit Heater _Temporary Heat _Class Kitchen Pool Heater Other _Commercial All fees are based on valuation, including the ipt of labor and materials: Total Job Valuation: _ Permit Fee $ 3- -tom Surcharge $ (1.25% of Job Valuation / Minimum fee $35.00) < or = to $1000: $ .50 surcharge OR >$1000: valuation'` .0005 Total Due $ Make check payable to City of Fridley 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 case of all wor which requires review and approval of plans. Signature of Applicant: Date: 12—.92-6-f' Approval Inspector Signature-,�—� �� Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 Building Inspections 7.63-572-3604 DA /o - 06 SITE ADDRESS TIES APPLICANT IS: PROPERTY OWNER/ TENANT MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS Permit No.: Received By: Date Rec'd: 0 OWNER 0MNTRACTOR NAME: f�-0it ADDRESS: CITY STATE ZIP PHONE' CONTRACTOR CoMpANY NAME: ° SUBMIT A COPY OF CONTACT PERSON: YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: �iei�l Z��/�� STAT)/�LIP �SOZ. APPLICATION PHONE IOST % �,�� FAX b S'� & - PERMIT TYPE 0 SINGLE FAMILY 0 TWO FAMILY pffTOWNHOUSE TYPE OF WORK: 0 NEW 0 REPLACEMENT id"RATION/REMODEL DETAILED DESCRIPTION OF WORK ID S &- 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. ('Phis should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor _z.!!�__ 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) MODEL: SIZEBTU Equipment Installed MFG: MODEL: SIZEBTU MFG: MFG: MODEL: SIZEBTU A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 NEW GAS GRILL 00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 GAS UNIT HTR $10.0SIO0 O.0 _ BOILER $35.00 _FURNACE $35.00 POOL HEATER $35.00 LINER $10.00 _GAS DRYER $10.00 VENTILATOR $15.00 _CHIMNEY DUCT WORK $10.00 GAS PIPING $10.00 .aa.�vara .. ,xV�,c+i#itwYA Permit Fee $ 1:L .'00 Number of fixtures @ $10.00 x $10.00 = Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ 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 applica on or a p 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 or whi q ' esrev ew and approval of plans. l �� SIGNATURE OF APPLICANT PRINT NAME S� �jGrGk DATE City of Fridley Building Inspections Department - 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 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. TMC 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 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Mechanical Permit #�� Fridley MN 55432 Commercial Application �- City of Fridley Date Site Address: The 4pplilant is: (cirice one) Owner tr Architect/Engineer Property Owner: A& rzev Address: CRY: State: Zip: Phone: Cell: Fax: Contractor Information Company Name:��C'/�// Contact Person: 5q5iy T���'IGL��o�✓ Address: City: State: Zip: Phone: Cell: Fax: Email: MN Bond# & Exp Date Permit Type (circle on ulti-fami Commercial Institutional Condo building Industrial building Swimming pool Other: Type of Work (circle one): New SDeplacemenj Alteration/Remodel Detailed Description of work: G Equipment Installed: MFG: Model: Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Duct Work _Roof Top Unit (RTU) YA/C _Refrigeration _Furnace _Gas Dryer _Steam/Hot Water Heat _Boiler I Hood _Gas Piping _Swimming Pool _Class II Hood _Gas Unit Heater Temporary Heat _Class Kitchen _Pool Heater _Other _Commercial All fees are based on valuation, including the cost of labor and materials: Total Job Valuation: $ 1-7,00-0 " Permit Fee $ 35-00 (1.25% of Job Valuation / Minimum fee $35.00) Surcharge $ .- Valuation X.0005 Total Due $ S'--�5 Make check payable to City of Fridley 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 withoutXpermit; that the work will be in accordance with the approved plan in case of all wor which r uires review and approval of plans. Signature of Applicant: Date: Approval Inspector Signatu Date: Please Note: Separate permits are r uired for Building, Plumbing, and Electrical work Revised 6/14/2005