AF - 35638Building
Inspections
763-572-3604
DA� �- r—o 8
SITE ADDRESS Le
THIS APPLICANT IS: �i'�j���
PROPERTY
OWNER/
TENANT
�
MECHANICAL
RESIDENTIA� APPLICATION
CITY OF FRIDLEY
YOIJR E-MAIL ADDRESS
❑ OWNER J�ICONTR.ACTOR
Permit No.:
Received By:
�.�:��-�.
NA.ME: V 0
ADDRESS: 5�� CITY STATE ZIP
PHOrrE� '�`7 / - �3y'7
corrrxacTOR I coMr,�rrY
SUBMIT A COPY OF ��'°'� PERSON:
YOUR 3TATE STATE LICENSE # F}� DATE-�- SS�1,32
LICENSE WITH pDDRESS: S2�ar, rnni ✓l �i-'P�S '�39 CITY �i-v'�-�� • � STATE ' ZIP
APPLICATION PHONE �G3 --75Y-�1 Y �I F,4X
PERNIIT TYPE �SINGLE FA1vIILY ❑ TWO FAMILY
TYPEA.F WORK: � �W ��PLACEMENT
)ETAILED DESCRIPTION OF WORK ��.�r ���
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
PER MS 16B.665 the permit fee is a minimum of 515.00 or:5%;of the total cost up tQ �SOO.OQ, whiche�er is greater, for the
improvement, installaxion or replacement of a residential fixture, excluding the fvctures. (This °shoul�retTecC oml� the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $S00 = cost of labor x.OS =
FOR PROJECTS Wf�RE LABOR EXCEEDS $500, FEES ARE BASED ON S 3 0.00 PER FIXTURE, EXCEPT ��N�T�- ���t (�'�IC�'TE TOTAL
NUMBER OF EACH BELO� /�� � '�-070-1Z SIZEfBTU%
Equipment Installed . MFG: l..Gt!' 1' 1'dt- MODEL: �. ���,I,�
�G. �_ MODEL:
• N(FG: MODEL: SIZFJBTU
_FIREPLACE (GAS) S15.00 . GA�•RERNGFGQ�T1.S10.00 <
k A/C 525.00 NEV� GAS GRII.L 510.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (W�UDJ'a3S.00 _GAS"t7NI3' HTR ST0.00
BOILER 535.00 ,�FURNACE 535.00
_CHIMNEY LINER S10.OD ._GAS DRYER 510.00 POOL HEAT'ER 535.00
DUCT WORK 510.00 GAS PIPING $10.00 VENTZI.ATOR S15:00
.. x�e r � ..����s� �'.�'
L`J�.�$?FLj?T✓Yr�.b . «. � �IG� �ut�?a*<�a,9ti'# .. �,.;;f`�, . . 'x' : �. . . _ w�:r:u a•„.. ..:�._ .: .:.. . .... ..... . _ . __
Permit Fee $ �ro_ D d . Number of fixtures @$10:00 x$10.00 =$
Surchazge $ .50 Number of fixtures (cc�, $15.00 x $15.00 = $
7'OTAL DiJE $ �,� Number of fixtures (a3 $25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERNIIT 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 w which r�ires review and approval of plans.
SIGNATURE OF APPLICANT' PW1dT NAME DATE 7'—�'t% a
City of Fridley
Building Inspections: Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
1
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLlCATION HVAC
❑ NEW HOMESlADDITIONS
❑ EXISTING HOME _ ❑ MAKE-UP AlR
REQUlRED FOR NEW/EXISTING HOMES
L Combustion Air (See note below) .
a. Oil or solid fu�l IMC Chapter 7 with MN Amendm.ents :
b. Natural Gas or PropaneJIFGC Chapter 3 with MN Amendments
2, 1vlake-up Air (See note below)
a. �G_Chagte,r 5 with MN Am.endm.ents
�
3. Ventin:g_ ;
' a. Gas appliances IFGC Chapter 5 with 1vIN Amendm.ents
� b. Fuel,other than.gas IlvIC Chapter 8 wifih IviN Amendm.ents
REQUIRED FOR NE1N HO�MES
. ,�
4. Heat loss & c�boling load per room
a. Req�t.ir�d.:on new construction IMC I346:0312'
5. Ventilation . .
a, P�r MN Energy Codc,7670 or 7b72
6. - Duct Design Per lMC 1346:0603.2
a. ACCA Maaual D
,
NOTE: Centerpoint Energy Mechanical Code Guidelines sofiware may be: used for
comb.ustion and make up air calculations
� .1
City of Fridley
AT THE TOP OF TNE TWINS
' �,572�36�
17Y OEVELOPMENT DIV.
r � y � PFiOTECTIVE INSPECTION SEC.
i .
l•__•�; �"' �'� CITY NALL FRIOIE� 33�32
L 612-571-3450
10B ADDRESS 6321 Able Street NE
t LEGAL �OT NQ.. 1/2 BLOCK TRAC'
DESCR. 5
of 21 2 Moo;
2 PROPERTY OWNER MAIL ADDRESS
Su81ECT
�UILDING PERMIT
91Q-F15
OR AODITION
28417
E EIPT NO.
O�TE P�GE OF AvnROvED Br
10/26/98 � �
SEE ATTACNEO
SNEET
L\VLLiCIll JVlllla� .J/1�G..74!
3 CONTRACTOR MAII ADDRESS ZIP oHONE LICENSE NO
PTL Contractins 2526 N Fe��� S An�ka 55�(1� ���-��nn 5�9L►
4 AqCMITECT OR DESIGNEfi MAIL AOORESS ZIP PHONE LICENSE N0.
5 ENGINEER MAIL ADDFiESS ZIP PHONE LICENSE NO
8 USE OF BUIIOING
Residential
7 CIASS OF WORK
O NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE � REMOVE
8 OESCRIBE WORK
Reroof house and gara�e (27 Sa) Tear-off
9 CIiANGE pf USE fROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
rrPE oF
SEPARATE PERMITS ARE REOUIREO FOFi ELECTRICAL. PLUMBING. MEATING.
VENTILATtNG OFt Alq CONOIT�ONfNG
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 2pNING
AUTMORIZED IS NOT COMMENCED WITMIN 60 DAYS. OR IF CONSTFUCTION
OA WOAK IS SUSPENDED OR ABANOONEO FOFi A PEAlOD Of 1pp pAYS A7
ANV TIME AFTER WORK IS COMMENCED. NO DW
I HEREBY CER7IFY THA7 1 HAYE READ ANO EXAMINED TMIS APPLICA710N
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF LAWS VA�UATI
AND ORDINANCES GOVEiiNING THIS TVPE OF WORK WILL 8E COMP�IE�
WITH WMETMER SPECIFIED HEREIN OA NOT. THE GRANTING OF A PERMIT
OOES NOT PRESUME TO IVE AUTHORITY TO VtOIATE OR CANCEI THE pEqMIT I
PROVI NS OF ANY H q STATE OR I.00AL LAW REGULATING CON•
STR T ON R E P FI RMANCE OF CONST UCTION
PLAN CF
Si ATU�iE OF CQN' ,TQR O ♦urHOQ�ZEO �GEtiT iOarE�
�
S�GaniuAE O� OwNEQ ��F pwHEA BuRDEp� iO4iEi
SO
UNITS
STA�LS
P OCCUPANCVIOAp
CU FT
STREET PARKING
IGARAGES
�I$
•
A
r�c rE
. h
NEW [ ]
ADDN [ l
ALTER [ ]
ConstructionAddress:
Legal Description:
Owner Name &
Contractor: 1
Address: .�s
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
Effective 1/1/98
Tel . # .�%/�„ .2 ,� 4�%
�.
MN LICENSE # 5�-- � f
Tel. # �2.? "'7 �,` °U
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
. . '� � � - v�' S �� C-''G.' .
� � ' //
Construction T � ` Estimated Cost: $ � ...3! /�
(Fee Schedule on Back1
Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft x$ _$
DATE: � `�C�- � APPLICANT: Tel. #� Z 3� -- � �PTj
Permit Fee
Fire Surcharge
State Surcharge
SAC Ch�arge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ `�L� _
$ '�
$ � �/�
$
$ ��
$
$ .
$
$
$ 3- �
2
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation �
$1000 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 [ ]
�
� a
BUII.,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit: �
$1 �
$501
TOTAL VALUE
�.� . ,
to $500
to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES ,
;
$21 (Minimum Fee is �21 plus -surcharge) - �
- . ,., � . , , , .
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for iirst $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 pius $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
�,�-. $1,OOt) or fraction thereof, to and including $1,000,000 �`
$5012.25 for the first, $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only) �
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet fimes $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. �
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.