PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Builder �"— -- —
Address
C IONF WILDING
No. , _ _ Street _ __ P
Lot _ _ — Block --� Addition or Sub -Division
Corner Lot — ____ Inside Lot Setback ' 02 0 _ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
Used&
T'r_Front
Depth Height ' Sq. Ft Cu. Ftj:;.':VZu '
DepthHe t Sq. Ft. Cu. Ft.
Type of Construction ��A Esta C���-_ Tobe Completed
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 21 provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ , permit is hereby granted to
to construct the building or addition as described above. This permit its 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. ... --,-%
Building Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sura to we
the Building Inspector for separate permits for these hems.
s `� - 4 0
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builder
2
Address Address 6 s t -e, (-P/W� '90f t) o
LOCATION OF BUILDING
No. Z/ StreetWz ZPart of Lot
Lot W Block 2- Addition or Subdivision
77-
Corner LotInside Lot le' Setback Tfr Side -Yard 2 ✓7
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
DESCRIPTION OF BUILDING
To be used ass
��- FrontDepth Z, Height
Type of Construct
To be Compl
Sq. Ft. -J' —45� Cu. Ft.
FrontADepth „rHeight
Sq. Ft. Cu. Ft.
stimated Cost /�'Z�� C-0
The undersigned hereby makes application for a permit for the work
herein specified, agreeing to do all work in strict accordance with
the City of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correct.
J
DATF,% J SIGNATURE
.�,
(Schedule of Fee Costs can be found on the Reverse Side).
NO
City of Fridley
Appgcation for Plumbing and Gas Wng Pemdttt
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
�j
Fw
it
w0
Z
•
•
WATER HTR.
ELEC
(90
Base
I
1
1st
-
2nd
_
3rd
4th
• Future Conneetfoa,0P9aYa9s.
Connected with Sever �
New Fixture, 014`-openin"
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIBTU RATES: > NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $ O
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25 $
'Water Heater -(Up t* 200,000 BTU) ..... — x 2.00 $ en --
New Ground. Run Old Bldg. ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
4
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 450
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.
Owner
Kind of
Used as
To be c
Estimated Cost, w
Old ew. Building Permit No `� Permit No. �Z�� -�
i
Signe o
By
Business Phon No a8
ROUGH // —o2 - 6
FINAL
d z 2M 7-59
N
APP6mion for Power Pkoft and Heating. Cooling. Ventilation..Reftierat% and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
4GRAVITY WARM AIR: HATE 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 AM
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. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ... 8.00 $
Each add. 200 sq. ft. IDR Steam ...................... 2.50 $
Each add. 320 sq. ft. IDR 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 $
GAS FITTING FEES: NO RATE TONAL
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
� c
ROUGH
—
I
FINAL
DepL of Bldgs. Phone SII 4.7470
- -- �f / f!, Z,e � / / o,
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.
Owner /L✓��1
Kind of Building
Used as
To be completed about
rx,
Estimated Cost, $ 4529® `
New uilding Permit No.\'�- :3 4 Permit No.
DESCRIPTION OF WORK
19
HEATING Bob Weber Warm Air—No- 4
Trade NameSize No
Capacity Sq. Ft. E.D.R'47 ®� L� BTU ' y H.P.
Total Connected Loader �' �"'" Kind of Fuel m
J-�tvt/
BURNER —Trade Nanl��(���2�,� �' Size No-/��
Capacity Sq. Ft. E.D ,
O. SEDGWOCK HTG. & AIR-COND. CO
®� 1001 Xenia Av. S.
M nneza o'is 16,
Signe
f"
.tVle�.42 2M 7-59 Business Phone �To
(REMARKS—OVER)
Windows and Doors—Crackage and Area
o
Width Height No. of Lineal f . Area
No. of p ne f p ne lights of crack sq. ft.
D ?�
Q
D-56 r v
" f
�I
37,
Btu
HEAT LOSS CALCULATIONS
DEPARTMENT OF BUILDINGS
MINNEAPOLIS. MINN.
Weatherstrips
A.S.H.V.E.
Guide
Construction No.
/ ey
®
Insulation
indowaDoors
Reference
Out. Wall
I Int. Wall Ceiling
Roof Floor
Kind
How Applied
es No
I e No
19_
�. f
Ceiling -V I
Infiltration (, `V
/a'—'
/ Sra O
F1.1 Room I Length Width
Height
Fl. / Room Length
Width /( Height
Windows and Doors—Crackage and Area
o
Width Height No. of Lineal f . Area
No. of p ne f p ne lights of crack sq. ft.
D ?�
)oc
Windows and Doors—Crackage and Area
Width Height No. of Lineal Ft—
No. of pane of pane lights of crack sq. ft. e J /
y l (
Z T Y,
Coef.1
Btu
Infiltration
Coef. Btu
Infiltration
6
Exp. wall 3
Glass
/ ey
®
4N 3vo
Exp. wall 3
Floor
Net exp. wall
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
O
Int. wall
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
1 J I ��
Coef.
Ceiling -V I
Infiltration (, `V
/a'—'
/ Sra O
Floor
Total Btu. 11A.4
(o S
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Height
Room I LengthyP Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal Ft—
No. of pane of pane lights of crack sq. ft. e J /
y l (
Z T Y,
Coef.1
Btu
Infiltration
4!3
Glass S-0
;_'2 O
Exp. wall 3
Net exp. wall
/ ey
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
Fl. q 4 Room I Length 10 Width --
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
1 J I ��
Coef.
Btu
Infiltration (, `V
6
Glass 4,'vo
Exp. wall
Net exp. wall t 3
Int. wall
Ceiling b 1C (e P (� a' !L /ova
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
L;
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area A
No of pane of pane lights of crack sq. ft. G 10,-
Coef.
Coef. Btu
Infiltration
CIA., Li -A /(/A is
Exp. wall [Ise
Net exp. wall A X—C, 1 9 1 / 0 V
Int. wall
Ceiling:1 P
Floor
Total u.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room I Length t d Width I I
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of cane of pane lights of craclf eq. ft.
Coef.Btu
Infiltration W.J
Glass —b / O
Exp. wall.
Net exp. wafl7 �}
Int. wall
Ceiling / X // / ✓ 1 /! ►�
Floor
Total Irtu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FLW 3 Room I Length Width /!
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft -
t.//
/7/
7
i
Infiltration 1 17
Glass
Exp. wall �C O
Net exp. wall C
Int. wall
Ceiling?,16 k 116
Floor
Total Btu.
ft. E.D.R. or sq. ins. W.A. Leader
City of Fridley, Minn.
BUILDING PERMIT
Date: - May 21, 1970
Owner: Robert W. Thompson Bider
Blanski Construction
Address 9-1 S -69th Avenue N.E. Address 4629 Silver Lake Road
/7 9G
10657
LOCATION OF BUILDING
No. 218 Street 69th Avenue N.E. _ Part of Lot
Lot 4 Block 2 __Addition or Sub -Division . Ri s., Cr P�1 a7za N4yth Addn
Corner Lot — Inside Lot X— Setback —_ Sideyard
Sewer Elevation ___ — — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 20' Depth 22' Height 10' Sq, Ft. 440' CU. Ft. 4400'
Front Depth _ _ Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cast J2t1_00. 00 _ To be Completed June 15, 1970
Provide Hardsurfaced Driveway
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 ;hprovisions of
ordinances of the city of Fridley. -I,, �A _
In consideration of the payment of a fee of $ 9.00 , permit is hereby granted to Blanski Construction
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 andmoving 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.
Building Inspector
AL D. BAGSTAD
NOTICE
M permit does not cover the construction, installation for whine, plumbing, gas heating, sewer or water. Be sun to see
the Building inspector for separate permits for these Neva.
w
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S. NAME : OC7fr1 I a�%3/ .1�i�� BUILDER : h XIiD o� �T/
ADDRESS • b2 /D ' n/1� / r ♦ L1 ♦ DD YLl�lia7 ES
9 r , S
NO:. STREET: 0/0-
LOT:
D0—
LOT: L BLOCK: ADDITION: /-",f OZ6,644' ��Zy %'�71 AIV
CORNER LOT: INSIDE LOT: A--- SETBACK: /Z SIDEYARD: .3"
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: 2'0 Depth: z z Height: /6
Square Feet: 1/4/40 Cubic Feet: W A10®
Front: Depth:
Height:
Square Feet; Cubic Feet:
Type of Construction: �� df e".7 e— Estimated Cost:
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agieeing'to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: SIGNATURE:
(See RevezeerSide For Additional Information.)
A--,
3 Y
0 0 0
GERALD T. C
LOQ'
SURVEYS COMPANY
CH
R�ATMOINDA`'0 AVAS4
I'VE
,;.);",FN VA.,,Ey. MILAN
tv
LAND StIl EYOBS
BRC:OKLY"J CART' •,1:r4^l
21
REGISTERED
UNDER LAWS OF STATE OF MINNESOTA
�
�d,
LICENSED
BY ORDINANCE OF CITY OF MINNEAPOLIS
6917 Idalrn
Ave. N. $33-9922
4
Minneap -6, Minn.-„tu i.i128
^' 30 YF e pS JF
NM,;Ip;At- JI-DI'-IAl • :'J I.1 �1,..,. tr ,Wr i-1
Ir'F'IX•RAPNIGA:. tiro porgy eriificdte -1.,C SJ�•'- :..:ER'cNFF IN iH'
CITY LOT'S, ' PLAITING'JfTR�)F �l :'A•-1 ARTA
Invoice No.�i.
ROBERT THOM.PSON F.!?. I3:1-4
01)enot e Iron
?Cale 111 = lr
! 69TH AVE. N. E
—•77.0—
'...' 7 7. 0 — r
O
to
N
D.aSt
LO'. L:, 13 U-1-C�•: 2, FICF CijEEK PT, AZA NJ TH ADMT'I
We hereby certify that this is a true and correct representa-
tioa of a survey of the boundaries of the above described
land end the Iocarion of all buildings and v;sible encroach-
ments, if any. from or on said land 73'
Sceveyed by us rh,s 1-1thdey of 19 --..
Signed /w
— "U -T SURVEYS COMPANY
tv
21
�
�d,
ttzi B
p
4
r. /
I
_ N
i
N
3.0
7-0
V
N414< N
'...' 7 7. 0 — r
O
to
N
D.aSt
LO'. L:, 13 U-1-C�•: 2, FICF CijEEK PT, AZA NJ TH ADMT'I
We hereby certify that this is a true and correct representa-
tioa of a survey of the boundaries of the above described
land end the Iocarion of all buildings and v;sible encroach-
ments, if any. from or on said land 73'
Sceveyed by us rh,s 1-1thdey of 19 --..
Signed /w
— "U -T SURVEYS COMPANY
01
SUBJECT
P NO.
City of Fridley
30385
AT THE TOP OF THE TWINS
BUILD
I L D I N G PERMIT
r
�.IPT
NO.
COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
646
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1 /---1 CITY HALL FRIDLEY 55432
612-571-3450
910415
_J
10/12/99
JOB ADDRESS 218 69th Avenue NE
1 LEGAL
LOT NO.
BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
2 Rice Creek Plaza, North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Steve Thompson
574-95491
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
John Pederson Constr. 897 Lund Ave NE Sprinjg Lk Pk 55432 920-2344 20100361
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 X® REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 28 S Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Permit Inspection Car6s
Will Be Wailed
To Homeowner To Post
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
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
$2447
$1 a 22
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
Fire SC $2.45
PLAN CHECK FEE
TOTAL FEE
Licens 5.00
1.92
SIGNATURE OF CON'RACTOA OR AUTMORiZED AGE NT iDATEi
N R L VALID THIS IS YOUR PERMIT
/d - 3
S,GNATURE OF OWNER,iF OWNER BWLDERI ,DATE,
BLD NSP DAiE
01
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address: 5-\-t540_ Tel. # 57 q 9.-/-/ J
Contractor:'�a�•� �� o')r" Ca MN LICENSE # a01 QoZ(0
Address: `� 7 v r, f�-ire. ti �. , S,p f �n� l�cjCe J�, Tel. # Ct q 0 - a 3,q
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWPROVEMENT
LIVING AREA:
Length
Width
Height Sq. Ft.
GARAGE AREA:
Length
Width
Height Sq. Ft.
DECK AREA:
Length
Width
Hgt/Ground Sq. Ft.
OTHER:
te. -t'0G'-\-
i\Oy
Construction Type:
V -Q-- �-ora
11 00
Estimated Cost: $
License Surcharge
$
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft.
+ 6 Ft =
Ft x $ _ $
DATE: 16 APPLICANT: Tel. #
CITY USE ONLY
STIPULATIONS:
'011�1
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
,�.'�S-
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.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
$
C(I
STIPULATIONS:
NEW C),5-6.) 9 q v
[ l CITY OF FRIDLEY Effective 1/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R_1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: ez
IAZIf
Legal Description:
Owner Name & Address: 9 ® REMODELING, INC. . Tel. # ��' 1<24
Contractor. 91°: LOUIS P K�440 � 54i6 MN LICENSE# '
Address: ID 00001050 Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft,
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction T pe: Estimated Cost: 5�
Driveway Curb Cut Width Needed, Ft + 6 Ft Ft x $ =
DATE: 11
APPLICANT: �%- Tel. #,0/,
Call (763) 572-3604 for Permit Fees If mailing in application. Fax to 763-5714287 if using credit card and we will call
you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
2/1' d vsz ' ON
CITY USE ONLY
$ //./ , Q Fee Schedule on Reverse Side
$ q • 770 ,001 of Permit Valuation 1/10th%
$ d ® $,50!$1,000 Valuation
$ $1350 per SAC Unit
$ C $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. T" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ 10�Q.S5
STIULATIONS:
S37HS ONIdOON d -13S WNBS : L soot ' SZ ' Nflf
Building
MECHANICAL,
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
a ct'v 200
CITY OF FRIDLEY
763-502-4977 FAX
EFFECTIVE 2-19-09
DATE j —
YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER
CONTRACTOR
PROPERTY
NAME:
ADDRESS:
CITY STATE—ZIP-
TATEZIPTENANT
OWNER/
TENANT
3—
�j
"- D& S_
PHONE:Ily
5
CONTRACTOR
COMPANY NAME:
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
LICENSE WITH
STATE LICENSE #
XP DATE
TATEML11`d
ADDRES
CITY uboY1
APPLICATION
PHONE 4PIiX -3a/
"� 'C1 6 FAX
PERMIT TYPE
[*NGLE FAMILY
❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK'
❑ NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
D TAILED D SC OF VV1O
;1?TTON
DNA
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG:
MODEL: SIZE/BTU
MFG:
MODEL: SIZE/BTU
MFG:
MODEL: SIZE/BTU
A/C $25.00
_FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
TO AIR EXCHANGEER $15
_FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR
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
m7e
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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
approved plan in the case of all ork which
SIGNATURE OF APPLICANT
requir review and approval of pl s. / ,,
PRINT NAME G_-! 1 J DATE
e
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME' ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
From: unknown Page: 2/2 Date: 9/7/2010 10:35:48 AM
4Alt llll�'. BUILDING
Permit
Il Spections RESIDENTIAL APPLICATION Rcc�iU
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'11118 t.4 AN APPI.ICA110N FO K A PERM -NOT vA1,11) UN'rll. Mr)cL6SED
I hereby apply for a building permit Chid i acknowledge that the Infomiatlan xbtsve is conq)lete ttnd accuole,; that (hc work %Nill be In
callforntattce with tits tvdinl%HM and codes of the 0tv of Fridiey and with the Mtimesotn C.'.onstruetien Cedds;ithat S unndecrstand thi3 s nota
pernlL but oltly art upltiiutitiun or a permit and work is not to start without o perm+:; Ibmi the wuik will bu in Accurdance with tho ,1ppraved
plate iat the mu uf' aN wttr hi r/euires I cview and pruval of plans. -�-
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