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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.