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Cit of Fridley - 2 8 38
� 5�2:�sQ� THE TWINS g U I L D I N G P E R M I
; � RECEIP .
� `y _____ COMMUNITY OEVELOPMENT DIV. � �
r � � PROTECTIVE INSPECTION SEC.
�
1 � �
i•--- A,��"';.; CITV NA�L FRIDIE� 55�32 NUMBEN NEV DATE PAGE OF AGGNOVED 8Y
t �� 612-571-3450 9t0-Fi5 10/23/98 � �
J08 ADDRESS
6320 Ab1e Street NE
t LEGAL LOT N0. BIOCK TRACT OR ADOITION SEE ATTACHED
oescR. 11 12 6 Florence Park SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Ra. Melin -2
3 CONTRACTOR MAIL ADDRESS 2�P PHONE LICENSE NO
Nutzmann Bros. Const. 7 -
1 ARCHITECT OR DESIGNEii MAI� AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS IIP PHONE LICENSE NO
6 USE Of BUII�ING
REsidential
7 CLASS OF WORK
O NEW O ADOITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof house and garage (20 Sq) Tear-off
9 CHANGE O� USE FROM TO
STIPULATIONS
Underlaym.ent must comply with the State Building Code.
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAO
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, MEATING.
VENTILATING OR AIR CONOITIONING.
THIS PERMtT BECOMES NULI AND VOIO IF WORK OR CONSTRUCTION 20NING SO. FT CU FT
AUTHORIZEO IS NOT COMMENCEO WITMIN 60 OAYS, OR IF CONS7RUCTION
OR WORK IS SUSPENDEO OR ABANDONEO fOii A PERI00 OF 120 OAYS AT
ANY 71ME AFTER WpqK IS COMMENCED. NO DW4G. UNITS OFFSTREET PARKING
I MEREBY CERTIFV THAT 1 MAVE READ AND EXAMINEO TMIS APPLICA710N STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND COpRECT. ALL PRpVISIONS OF �AWS VALUATION SURTAX
ANO ORDINANCES GOVERNING TMIS TYPE OF WORK WI�� BE COMP�IED
WITH WHE7MEii SPECIFIEO HEQEIN OR NOT. 7ME GRANTING OF A PEFMIT �I7I.�F .HC)
OOES NOT PRESUME TO GIVE AUTHORITY 70 VIOLATE OR CANCEI THE pERMIT FEE SAC CHARGE
PAOVISIONS OF ANY OTHER STATE OR IOCAL lAW REGUTATING CON-
SIRUCTION OR THE PERF qMANCE OF CONSTFUCTION �SE).JS Fl SC �1.�1
'' �� � PIAN CMECK FEE TOi � EE
� License C 5.00 $ .32
S�GN�tu FCON'fiA(;TQROpAU�MOQ�ZED�GENT iD�rE� N P OP VA IDAT D HIS I$ VOUR PERMiT
- /D � �
S�GH�iUAE O� OWaEQ��F Owr+EQBw�AEAi �DAiE� BIDG So OttE
`
a �+._
NEW�....-�-�' .. �._ .
ADDN - - - � [ - J - - � � � CITY OF FRIDLEY
ALTER [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: � �o�U ��'✓�3/� � `�� .
Effective 1/1/98
��
�� ��
1
Legal Description:
Owner Name & Address: / C�.6 � i rt/ Tel. #�%/� �SU �
Contractor: .�TZ..,�. �,,.� D�,� s• MN LICENSE #�o ay.�YS��
Address: 3 � S' � u�. lr�JW µ,, �►K���7 0� Tel. #��- ���/d� �l
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Construction Typ���- / ��rfU Estimated Cost: $�
h d I
Driveway Curb Cut Width Needed: Ft
DATE: / APPLICANT�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee �
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ S��7s.`
$ /. %�
$ (v %
$
$ �,�vv
$
$
$
$
$ �. 3�
(Fee Sc e u e o
+ 6 Ft = Ft x $
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
Sq. Ft.
Sq. Ft.
Sq. Ft.
i
n B�ck)
_ $
Tel. # .�'� '�� -'Olo�-�
$.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 �
Agree�nent Necessary [ ] Not Necessary [ ]
0
.� .
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:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $SOO,OOQ
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minunum 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,OQ0
$349.75 for first $25,Ot)0 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additionaT
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,0U0 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
$1,000 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)
Altemate "A": Removal and replacemeni 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 times $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 �oundation once it has it has been constructed
will be required before proceeding with the framing.
�o��: �c�c�
CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION �
763-572-3604 FAX 763-571-1287 REFRIGERATtON AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace. Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5°� of cost of
Improvement whichever is greater
Fge Total
$35.00 $ � s
$10.00 $ ��
$10.00 $
JOB ADDRESS G� � ? /5 fZ/ �'�
Owner �-17 �5����t/�i�'
Building Used As��� r
00
ESTIMATED COST_� GY��i PERMIT NO
DESCRIPTION OF FURNACE AND BURNER
$10.00 $ # of Heating Units�_ Circle One (Steam) (Hot Water) Warm Air)
Trade Name Size No.
$25.00 $�� BTU G HP � EDR
Fuel �,,� . Totai Connected Load c_f3L7��
Commercial/Industrial/institutional
1.25% of Value of Appliance or Work (List an Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
$ Burner Trade Name Size Na
BTU HP EDR
$
� r ,�6
$��
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do ail work in strict accordance with the City Codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
HEATING
,1'.�'1�'��iN�,!!�� r•.
-- _ `
' � _ - i i►s
Approved by Rough-in Date Final Date
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTfON AIR VERIFICATION
When replacina an existinq furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet #he current codes
and manufacturer's specifications.
When required to install a new combustion a�r, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventinp s sv tem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes() No()
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type ��'��� BTU Input (�� Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances � Tdal Btu Input �_T
Common Vent Type ����.Nt. Vent Height �` Diameter �``' inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
HEATING.
Signed By
�r�=� �S�