AF - 35470�
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City of Fridley, Minn,
BUILDING
PERMIT
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N° .7034
�, ,� �L�,7 /L�CATIOt�,_QF BU_�G�.y�
Na �E 8hget �,pLrj_�f',�.. oP Lot _.
._ 'P� ...�� ,�
� _. ___ � __._l.._.._�_ Additlon or $u6-Divletm ,1�-�F=���/ q-/----. �!
Coraer I.ot _�..�_ Insifle Lot ._�� .._ 9etback .�.�_._� ._ $ideyard _..L_Gl_..-----
C� . ,
$ewer Elevatiaa '3._ L�`._.--._.._...._._..._..---- ;�froa IIevation .._r�_ %� �i! � .—_.
.._ ._ .� �.__.__.._...—._
fi'�P aF r'� •r�ni�
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DESCRIPTION OF
�t -Z-l'�- I�eP� �_� Height
�— . t _._____ Deptti .
T,9Pa Ot Coosh'ltCtion - --'- __ Est
In eaodderatloa of the issuance to me of a perm{t to c
� P�Baed work Sn accoidence with the deecription above
mdinano� at the dty of Fcidley.
/
g4• F't.�� G5L F`t.��.�Q
Sq. Ft. _..__....._. Cu. EY.
o be C�pleted ..,.-.---_
Ea uo�dderatlm K t6e �[�
PsYmeat of a fee ot a�_..._.___., Bem�it hereby
to do
�16 of
to oonstruM the building or additfam as des bed above. This P�t is granted upon
tbe e�rees coaditton that the Pereon to whom it ia granted and � hia . ta, employees and worlmren. in all work
� 1+4 arouad and upao�n nea�id bullding, w' a4Y P�'t ffiereof, shall oa�m in all reapecte to t6e ordinances a�
t61n the�limi�and this�a�• consh'uction, alteratloq main � rePau' and moving oP buil��g
� P�'mit mey. bB r�wdced at any Ume �. �vIolatiory.qP eRY oP the B�vlsions of sald
HW1din8 ImpeCto�'
N07106
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APPLICATION FOR. BIITLDING PgtMIT
F.;
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, : CI`Pl' OF F$IDLEY, MINNESOTA `
OWN�? 'S NAME f B�.- .. �o �l. 0 �, �� a�, BUIS,li�i���
qpDgggg i G G�-C _ �¢-�4.�-!a ., 2 ,j� 1', c�
g�Dgg9S7GS'/— Qe...,l/ty-� .f•�.t,�v�e
7!�c� LOCATION OF BIIILDING
x0. Sz�r Q,�sw� .8.t. ?T-t• .�
�, -��.�,.,..,.,.,.$�'��_ADDITION OR- SIIBDIVISION�` 'F QYl"' /N a u K„
C0� L�_INSIDE L(Yl' SETEACK SIDE74Rp
_ -.--��
S�WF,R I�I+�VATIpii TOP OF FOOTING
Applipapt attach to thia £orm Two Certificates of Survey of Lot a,nd
Propv�ed bui],cli.ng location drawn o.n these Certificatea.
�'0 8s II��d Aa:_
�o � 2�s 9e -- .. kro�
DESCRIPTION OF BIIILDING
� — xeignt � U
SQuare £eet Cubic F'eet
�ont Depth Heig�ht
-��-------........-,--
Square feetT_�.Cubic Feet
Typ� qf Constzvotion ,�7u��— Eatimsted Coat ��Pd'�
To �e Completed
The uridare�.gzied hereby malcea application for a permit for the work
hereui e�fqqiliad, agreei.ng to do all work in etrict accordancs with the
Oity of I?p�d3ey Ordina,ncee and riylings of the Department of Buildi�g�a,
and hereby deqZa�es that a11 the facts and repreeexitations stateyi i:n
thia ap��ipstiptt are true and correct. �` �� P
UATE�/'�' �-� (� % c�r_arnmrro�.+ � A� (%,..` D. w e s
, -
(Schad,ule of k'ge Coete can be found on the Revexe -Side.)
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: 1 1 11' '�'1 71 :lal! 1
SECTION 2. The Inepector of Buildinge ahall, be£ore iseuing pexmita
£or the exection of any building flr struature, or for any addition to any
axigtitr�'"�t�ucture br building, or £or any alteration or repairs to any
� existing building or�etruc€ure, upon appl�cation therefore, requ7se the
payment by the applicant for such permit of £eea to the amount herein
below aet forth and in the manner herein provided to-wit:
IIniform Suildin�' Cod�: Type 1, 2, & 4-':�•75 £or each one thousa.nd
cubic feet, or fraction thereof, in euch cubical cnnte.nte. Type 3& 5-
$1.50 for each one thousand cubic feet.
For the purpoae of computi�g feee for building permits, the au6ical
. troittente uY'sizq'b"a'iittiYig'E2r8dt13'ttolc�'CD 8, un'tform Ke'ig'Kt�C'tl!'8tigltuti�'t1Y `_ � .
multiplying the ground ares covered £rom a point six (6) inches below '
the floor line of the beaement or the cellar to the average height o£
the upper eurYace or to the averag'e height of the roof eur�faae of the
main gable of a pitched roof.
For repairs or alteratione to an existir� structure, the fee ehall be
at the rate o£ $3.00 per each five hundred dollara (=500.00) or
£raction thereo£ in the coet of all proposed work.
In na case ahall the £ee eharged £or any permit as aet forth in Saatiozti
2 be leas than $5.00. �
NSS3D Conneetiorr Ehsrg�es bae�d on locatio.n - Area 1 or 2.
� '. . s ,: �
, � ,;,. ._ ,
__ � :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 IJ1vIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-sbua r�Ax:
: 7664 ARTHUR ST NE
: 123024120Q38
: MEADOWMOORTERRACE
: LOT 4 BLOCK 1
: BUILDING
: RESIDENTIAL
: ROOFING
�-il-iia i
�
PERMIT O.: 2004-008:i9
DATE ISSUED: 06/04/2004
VALUATION : $ 2,315.00
NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (20 SQ) TEAR-OFF
STATE LICENSED CONTRACTOR 1
APPLICANT
SUBURBAN HOME IMP (20267333)
32 MAPLE LANE
LITTT,E CANADA, MN 55117
;���;7
DENISE HEUSS
7664 ARTHUR ST NE
FRIDLEY. MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
suthorized is uot commenced witin 60 days or if construction
or work is suspended or abandoned for a period oF 120 days
at any tirue after work is commenced.
I 6ereby certify that I have read and examined this
application and lmaw the same to be true and cocrect. All
provisions of laws and ordinances governing t6is type of work
will be complied with whether speci5ed herein or not. The
gmnting of a permit dces not presume to give authoriry to
violate or cancel the provisions of any other state or local law
regula ' g o hvct n or the perfo� rmance ofDait uctipn.- f
Appflcant ; (,� �.�
Bldg Insp Date
BUILDING PERM[T FEE
FIItE SURCHARGE
STATESURCHARGE,VALUE
LICENSESURCHARGE
TOTAL
PAID WITH CHECK # 5986
_. �
SEPARATE PERMITS REQUIRED FOR WORK OTHEK "1'HAN ll�:JGKlt3�ll AtS V v�.
83.25
232
1.16
5.00
91J3
NEW
ADDN
ALTER
��
[1
[1
Construction Address: _
Legal Description: _
Ovmer Name & Address:
Contractor.
LNING AREA:
GARAGE AREA:
DECK AREA:
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUIIDING PERMIT APPLICATION
Effective 4/1/Z004
(763) 5723604 Bidg Insp
(763)577-1287 Fax
�a�-cc��39
�Tel.# r%�o�" ���^o�Oo�S
MN LICENSE # ��67�3-�
� SS/�`�Tel. # 6Sl- �-3�'" S.' 7
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width
Length Width
Length Width
Height _
Height _
HgtlGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
. �/lQ[fi�.�J"i,'Lu•r�ai.s��r���1 �� .��.��
. • •- � �` -� � // I� �
Driveway Curb Cut Width Needed: Ft + 6 Ft =_Ft x$ _�
DATE: �' y" d 7 APPLICANT• �•• �1 '2 �+ � Te�. # �S/ �3�-5-767
Call (763) 57236U4 for Pertnk Fees if mailing in application. Fax to 763-571-7287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Suroharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ 83-aS�
$ �� `Z
$ /. / �
$
$ S. G1C� __
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
TOTAL $ 91.23 STIPULATIONS:
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pemucs 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
$50,601 to $100,000
$100,001 to $500,00�
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for fust $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or frac[ion thereof, to and including $25,000
$391.25 for fust $25,000 plus $10.10 for each additional $1,000
or fracdon thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each addidonal
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction tbereof, to and including $500,000
$3,233.75 for the fust $500,000 plus $4.75 for each additional
$1,000 or fracdon thereof,to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each addirional
$1,00� or fraction thereof
CURB CUT ESCROW
(Concrete C�rb Str�cs Only)
Removal and replacement of curb and g�tter only - driveway width plus 6 feet, times the annually determined
rate
Petmits for construction will be issued a minimum of 2A hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding wich the frazning. New Houses Onlv
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
VALUATION
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
: 7664 ARTHUR ST NE
: 123024120038
: MEADOWMOOR TERRACE
: LOT 4 BLOCK 1
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
r�:
PERMIT NO.: 2004-01443
DATE ISSUED: 09/Ol/2004
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFT'ER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH.
#INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
C� ./I"U�I7
DENISE HEUSS
7664 ARTH[JR ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or conshvction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certi£y that I have read and examined this
applica6on and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a pemilt does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
ELEC PERMIT FEE - MIN (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID V✓ITH CHECK # 117431
.+.+a ru� a a., i uau.0 a.� au:�t�ia�cu r vR w vRA V i tib1C 11]H1V Lr.Jl.lCli3r,L AtS V V C.
20.00
0.50
20.50
N� I1
ADQN [l
u�R [ 1
Construction Address: �%G� y
Legal Desaiption:
Owner Name & A�
Contractw: C�i
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
VC.
'�3 =<-�r� � �-cba��
CITY OF FRIDLEY ` Effective 4/1/2004
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
�
#� y(o�3-78'b-3o��
MN LICENSE #_ �D 1 {�
� 3 s-- Te�. # 7(p 3— 7�S'S �/ Z/7 a—
Attach to this application, a Certficate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: �e����;��,� �oc-� �'fuir5 Estimated Cost: $ �j t�0. �
Driveway Curb Cut Width Needed: _Ft + 6 Ft =_Ft x$ -
DATE: —� APPLICANT: Tel. #%�0 3� 7�v��/y7�.
Call (763) 5723604 for Permit Fees if mai ng in application. Fax to 763-571-7287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ a3. �o
� >5�8
$ "Jd
$ ,.
$
$ S�
$
CITY USE ONLY-
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Ait. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary ( ] Not Necessary [ ]
TOTAL $ � 7 STIPULATIONS:
BUII,DING P�RMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts for the erection of any building or structure, or for any
addition to any existing building or smicture, or for any atteration 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,OOlto $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.'75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fracdon thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof,to and including $1,000,000
$5,608.75 for the fust $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Pernuts 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 consmiction site.
VERIFICATION OF FOUNDATION
A Certificate of S�rvey of the lot, showing the location of the existing foundation will be required before
proceeding with the framiug. New Houses Onlv
Seamless Sted Siding ual•Ve �
Premium �ndaws -
Roofs, Trim, Vinyl Srding Contracting
Seamless Gutters, Covers
Steel Roofutg Systems "w sa..wao�.aeedr
mm.�w�
Sa27 cxmrer Drive Ne Julie Quarve
Spriog Lake Park, MN 55432 Vice Presiden[
�,o�e:,b3_,85_�4,2 �03 3c» ��53 c
Fax:763-085-6954
Web site: www.quarve.cam querve4quarvecom
MN Lic 6016
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REVIEWED
F0�2 CQDE
Building
Inspections
S,� �D�ss �..c�
THiS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WiIkI
APPLICATION
PERN17'f TYPE
TYrE oF woiuc:
MECI3ANICAL
RESIDENTIAL APPLICATION
CIT�.' UF FRIDLEY
o�
CONTACfPERSC .,�; (.� I�O
�
STATE LICENSE A
PHONE
❑ NEW
FAMII,Y ❑ N10 FAMIl.Y
DETAILED DESCRIPT'ION OF WOF
FAX
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55408
S7ATE ZIP
❑TOWNHOUSE
❑ pLTERATTON/REMODEL
PER MS 16B.665 ihe permit fee is a minimnm of 515.00 or 5•h of the total cost up to $500.00, whichever is geater, fw the
improv�tent, installation or replacemant of a residential 5xtuie, exeWding }he fneWres. ('Ihis should ieflect only the cost of labor )
Laboi cosf unda� 5300 = 515.00. Latior cost bdween $300 to 5500 = wst of labor x.OS =
FOR PROJECI'S K�RE 1ABOR EXCEEDS 5500 Fffi ARE BASED ON I10.00 PER FlXTURE, EXCEPT� W[�R� NflTED. �3(TURES: (AIDICATE TOTAL
NUMBFR OF EACH BELOV� - � p
E9uiPmeM Insfellai. � MFG: .� �� MOD6L: �_ SIZFJBTU bO t� . .
� A�ffG � MODII,: � SII.F/BTU
� MFG: MODEf.: � SIZFIBTU�
�NC �� (GAS) S15.D0 GAS RANGFIOVEN S 10-00
AIR TO AIR fiXCHANGEER SIS �^,,�-'. CE (WOOD) S35.OD NEW GAS QRII.L SI0.00
BOII.At 535.00 �V vn�CE 535.00 _GAS UNff HTR 510.00
CHIMNEY LINER 510.00 GAS DRYER 510.00 ����?�5 �
Surcharge
TOTAL DUE
a _ 7� of fixtures�$1o•8U- -_ x S� v.uv = a---
S .50 Numba of fncdues a� $15.00 x S15.00 =$
s Number of fixtures Q 525.00 � x$25.00 = S��
— Number of 5xtuces � 535.00 ,� x 535.00 =$.Z S.�
State Surchazge = $ 50
Tota1= ��f . ��
TkffS IS AN MPUCA170N FOR A PFRMIT-NOT VALID UNTIL PROCESSID
I hereby appty for a building pesmft and I acknowl e that the infom�ation elwve is wmplete and accivate; that die work will be in
conformance with the ordinances and c�s of the C' ridley and with the Mumesota CAnstruction C�1�s� 1� ��ders4and this is
not a parmit but oniy an app . o ' w not to start withwt a Permit; that 1he work will be in accor with the
approved plan in the case all w revi and approval of ans.
SIGNA7URE OF APPLICANT � l — "YRWI' I�A . �/YI ATE... � �. � � .�
" City of Fridley�
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572 3604
FAX: 763-502�977
���
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS EXISTlNG HOME ❑ MAKF-UP AIR
REQUIRED FOR NEW/EXIST.ING, Hf3!M�S ..,: _ _ _
.� :� t ?::�;4 � ..
1. Combustion Air (See note beIotiv j' ;''.�
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
6.-`Nafii-ra7Gas or PropanellFGC`Chapt�Y'3"with Iofi�i Ainendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC ChaQter 5 with MN Amendments
b. Fuel other than gas IMC Cha�t� 8 wi� MN Amendme.nts
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new consi�uction IMC 1346.0312
5. Ventilation .
a. Pcr MN F�e�gy C�de 7670 or 7b72
-- _ — _,—�— __ _ - -- - ---
6. Duct Design Per7MC 1346.0603.2 _
� ACCAManual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combusfion and make up air calculations
It�spe;ctians
763-:57�-360�#
a�is nrrucnNr�s:
'l°GNANT
ST)BAll7' A COPY
YpUR STA'CE T.TCI
wrrH nrrtacn�i
P1tQ�E(YI'Y T'Y
TYPIa OF
DPSCR[BE WORK
BUTT�DINC --
RES7i)ENTIAL APPLICAT�Qrf
CTTY OF FRIDL�Y
oowNSR �cxm�nuc�vK
� BASFhfENi' PINI5H
� DECK
I S�BaSid� i
I PR�POSID SIZE: �
��� PRJPO31'A H@I6H7'. _._—
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WIN�f�lYS � �
IN fi%ISTING OPfiMNGSf�' OY�s �No
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OP6NINCi CHAN6EV @ �
rc�tt t cc
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Surohuge ,
Lir.rnuc Su:clWtge !
SAC Charge
Cur6 Cu.t Hscrow
�rv�sion Conhnl
Paic Fa
3caer h[ein C6arge ;
PertniY N�
Rece;ved
�AiA �"T• ��a 4y.,v�riOfA' 9'
� FAX IfR�"ZI�^31� I
RUCftON 512� � _,
CI'ION �;TQRIGS
GARAG�P —�qMD�]WS
❑ a0of O 0&Nta 17I:3
O SIDING ❑ OTHER �
❑ SWihIMING Pl7UL � �
O ADD17'IOK � ' � �
lQrtratouei.�NU aq�aMrr�.r �ArQxroem.
R.t.. _na�.� 4L4.,.� �;I��r-Floer�� �
O HOUSE @. GARAGE
. � ATTACHED GARAGE
. O DEI'ACHED GARAGE .
ox�rt
Q Trim
O F�
wcA�oN oF wiro�ws
NIIMRFR nF Wt�lbn'
LUATION, INCLUDIIVC T
SllV(:'fHF; ]997Il.e.0 FEE
j
B�� � •
I. Fxi9ti FlpprPhn
7. PmDOCmdflourp4vn �
�� 3- Liqt of YnrAUal mcm6cq W bc Wlti
Y�)IC PIiiW CONSf&UCTION W CUJUW G DECKS,
L1 DITI�NS&P�ltCHf5Sl1MMYl` �
i. s��wws����x�.x���xw�N�
'. andP�M'aJ� �
2. 7Wo ub ofcontruatioo pims
..3. PneiSY�Calculationa.
65%ofBUiiding Pettnit Pet
.001 tnnes ehe total jeb valuation
.0005 x Permit Va�uat[on Minimum E, iU
$5_00 (Statc Liccnscc. Rexidc�lial �:.onlracluis) '� ��
51675 pe� SAC Unit (hlans tu M1��CC for deterinination}
St�F6Il= Rx$i:1=i
5450 Cauervatioa Plan Reviaw
Pce Determined by 8ngineoring
A�cemcn� aeaessery i) Non Necass:u]+ () I
Mer. ��...r.......,�.�. r,.. rtw..�'7..:�a.., ., se��
���, , THIS IS AN APPUCA710N POR A 6RRMIT N(Yf VA.WD UNTIL PROCB:SED �
I ticnby appiy foz a building permit and i aclmowlcqgc that �he mfomation c,Qove is corcplet� and accWate; that the work will bc in
coi�fmmence with �FiC qrdin8neee fnd ecdrs of the City of Fridley and wi[I� the Minnaota-ConstntcROn Cadts; fhst I underslaod this is nol a
peivtit 6ut oAty aai applica3on fa a�.mnit aixl worlt is not ta start wiEhout a pennit; that thc Hork will be in aawrdance wlth i6e appmved
pls+n in the cace of all work `ihich r�c�CY+t�v aM SPp��3�flf planx. _ _ ' _ I / _
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Building
Inspections
763-572-3604
SR'E ADDFtPSS _�
TTiIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBM[T A COPY OF
YOURSTATE
LICENSE WITH
APPLICAITON
PERMIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
_ CITY OF FRIDLEY
YOUR &MAIL
❑OWNER ,ffCONTRACCOR
STATE
DATE
Permit No.
Received By:
Date Rec'd: '
TE Z[P
ewuwaav i�� �ry�nf�iv f}yy CITY_A�+�� STAT�%^�Z� �t �
et�o� �G3-d� --S/ G� Fa7c 7t,� df�-d�6
RCSINGIE FM�IILY
O NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMQ,Y ❑ TOWNHOUSE
❑ REPLACEMQd'f
PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvemeM, instapation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost imder 5300 = a 15.00. Labor wst between $300 ta $500 = cost of labor x.OS =
FOR PROJECfS W[iERE LqgOR EXCEEDS 5500, FEES ARE BASED ON SID.00 PER fIXTURE, EXCEp'f \y}{E]2E NOTED. FIXTURES: (INpICATE TOTAL
NUMBER OF EACH BELOl1�
f BATH SINK/LAV F[AOR DRAiNS Sy / � SHOWER WA7'ER PIPING
—�THT�B �� '�GAS PIPING �cin�G� SWIIvII�fING POOL WATER SOFCNER ($35)
_ CLOTHES WASHER KITCHEN SWK 1 WATER CLASET BACKFIAW PREV. ($15)
_DISHWASHER : �LAUNDRYTRAY �WATERHEATER�(S35) FORIRRIGATION
� _ WATER METER OTHER
ivumoer oi nxaues L y 1 U.UU _ x$10.00 =$
•50 Nwnber of fixlures @ S 15.OD x$15.00 =$
— Number of 5xtures Q$35.00 x$35.00 =$
State Surchazge = $ .50
TH7S IS AN APpLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSED �
I hereby apply for a building perntit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cades of the City of Fridley and with the Minnesata ConsWction Codes; that I understand this is
not a pe�xnit 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 appmval of plans.
SIGNATUAE OF APPLICANT ��/[ ���� pRINp NAMEd�'Li�I�C
/�'m� DATE /.0 '
City of Fridley
Building Inspections Department
6431 Universiry Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Buil,�ig
I�pections
'763-572-3604
FAX
Tf-IIS APPLICANT IS:
TENANT
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CER"CIFICATE OF
INSURANCE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�,OWNER
STATE LICENSE
YOUR &MAIL
OCONTRACTOR
a.SINGLE FAMILY/NEW CONSIRUCTION
❑ IWO FAd4ILY/NEW CONSiRUC170N
O BASEN¢.NT FINISH O ROOF
❑ D� �SIDING
TYPE OF WORK: ❑ NEW HOME CONSTFtUCT10N O ADDI170N
�.MtA1NTENANCFIREPAIR � REMODELING
DESCRIBEWORKBEINGDONE: � i wltko�6 o U
SIZEOFItu1PROVEMENT LENGTH WIDTH
ROOFING ❑ HOUSE ONLY
NIJMBER OF SQUARES ❑ HOUSE & GARAGE
GAHAGFS
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ A77ACHEDGARAGE
0 DETACHED GARAG6
❑ DRAIN TILE
❑ OTHER
Permit No. • �d (} O� �
Received By:
Dat�, � N � �e�
SS'F3 '2._
BASEMENTREMOD IN Ct gMIT
I. Existing Floor Plan
2., Proposed floor plan
3. List of swctu'al members to be used
SIDING FOR NEW CONS7RUC770N INCLUDING DECKS,
O Vilryl OSoffit ADDITIONS. & PORCHFS SUBMIT�
❑ Ahuninum Q,�n ❑ Trim 1. Site Plar✓Survey showing the wcis[ing swctures
j�Other��G1� GEM�l�%r ❑Fescia andproposedprqxt.
WINDOWC � 2. TwosetsofcansWCUOnplans
3. Energy Calcula[ions
INEXI3TINGOPENINGS OYes ONo LOCATI NOFWj NDpWS FORWINDOWS—PROVIDEU-VALUEAND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF �,j � Y`�,p}�� � 8(Fi h- MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES & y.�.� L� �
TYPE OF WINDOW Tp BE AISTALLED NUMBER OF WINDpWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
Permit Fee
Plan Review
Firo Swcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosioo Control
Park Fee
Sewer Main Charge
THE 1997 U.B.0 FEE SCHEDULE)
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
55.00 (State Licensed Residential Contractors)
52100 per SAC Unit (Plans to MWCC for detertnination)
ft+6ft= ftx$24=$
5450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCFSSED
I hereby apply for a buildiag permit and I acknowledge t6at the information above is complete and accurate; that the work will be in
conformance with the ordinances aod codes of the Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application f r a ermit and work is not to start without a permit on site; that the work will be in accordance with the
approved ptan in the cese of a1 ich requiros review and approval oF pla.ns!. ,/� L/—/
SIGNAil7REOFAPpLICpN'[ pRINTNAME N�'L fl�✓SS ne� �/LX/'ZD/n
>
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall,,kefore issuing permits for the erection of any building or'
strttcture, or for any addifion to any ezisting building ol� strUCture, or for �nx alteration, or repair
to arry 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 jn the manner herein
provided to-wit:
VERIFiCt1TION OF FOUNDATION
Permits for conshvction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site. -, ;,
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceedi�g with the ftat�arrg. New Houses On14
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Faac: 763-502-4977
�.\J
f' � �
� vU0
��
1�
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8�
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—oru i s u{,�G,�� r� n,
�'
Building
Inspections
763-572-3604
763-502-4977 FAX
SITE ADDRE55 T �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTf A COPY OF
YOUR S7'ATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMTI' TYPE
TYPE OF W ORK:
DESCRIBE WORK BF]NG DC
SIZE OF IMPROVEMENT
� F SQUARES _
GeLRAGF3'
PROPOSED SIZE:
PROPOSED HEIGHT: _
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
,2f,OWNER OCOMRACTOR
'�L���t.'"%i �j ��
STAI'E
rem,�t
Received
2
EXP DATE
ADDRESS: CITY STATE_ZIP.
�1 SINGLE FAMILYMEW CONSTRUCTION
D INO FAMILY/NEW CONS7RUCI[ON
❑ BASEMENT FIMSH O ROOF
❑ DECK O SIDING
NEW HOME CONSIRUC770N
SIDING
O Vinyl
❑ Alwninum
❑ Othu
WIIVDOWS
MEXIS'fINGOPIIVINGS �Yes �No
OR FOR idEW OPENINGS-DFSCRIBE SIZE OF
OPENING CHANGFS �
ARE BASED ON
�
Plan Review
Fire Surchazge
Surchazge
License Suroharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee �
Sewer Main Charge
O ADDI770N
p HOUSE ONLY
� HOUSE & GARAGE
❑ A7TACHEDGARAGE
❑ DETACNED GARAGE
OSoffit
� Trim
9S.Fescia
LOCA�7 ON OF WINDOWS
F /�iJT
❑ DRAIN T[LE
�OTHER �r'jesc�.�so��r
CION, INCLUDING THE COST OF
THE 1997 U.B.0 FEE SCHEDULE)
RASEMENTRFMODEL[NGSUBMIT
I. Ezisting Floor Plan
2. Proposed floor plan
3. List of stmctural members to be used
FOR NEW CONS7RUCI70N INCLUDING DECKS,
ADDITIONS_ & PORCHES SUBMIT:
l. Sice Plan/Survey sfwwing the existing strucNres
and proposed project.
2. Two sets of wnswction plans
3. Energy CalcWazions
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE ST[CKER ON WINDOW.
See Back Page for Fee Schetlule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Conuactors)
$2100 per SAC Unit (Plans m MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Detertnined by Engineering
Agreement necessary ( ) Non Necessary ( )
checks
THIS IS AN APPLICATTON FOR A PERA9IT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; tF�az the work will be in
conforniance wit6 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 r rt and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of� hich requires review and approval of plan �� �� R� ,
SIGNATURE OF
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Buildiog 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
providedto-wit
VERIFICATION OF FOUNDATION
Permits for construction wilt be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed struchare and of the construction site.
A Cer[ificate of Survey of the lot, showing the locatio� of the existing foundation will be
required before proceeding with the framing. New Houses Onlv '
CiTy of Fridley
Building Inspections Departrnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
0
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