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I --
CITY OF
FRIDLEY,
APPLICAFI4N FOR RESTDENTIAL BUILDING PERMITS
�NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
���
; �
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OWNER: r � �L�4��A%ln�t!-Y "jL�' BUILDER: �W� �:� '-'vc�"� .
Address: � �. ��j Address: �:Z�.I— � �� /��.
Tel. No.:
No.: �" �% Street:
LOT: � BIACK: � ADDITION:
CORNER LOT: INSIDE TAT: ✓ SETBACK: � S SIDEYARDS: I���°��/ 3
Applicant attach to this form RWO Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
- To Used As: � ��i � � . �� .
J
� Front: .3� Depth: �7 7 Height: � �
square reet: /G 30 cubic Feet: �Zj �j O I!
���i Front: �-3 Depth: 2- L Height: 111
. Square Feet:���cN Cubic Feet: J�Q F� .
Type of Construction: �� °L-''.�� '!` � Estimated Cost: $ 7�_._L.__
7b Be Completed: _�!Q ��d � Alt. A Alt. B
�
Proposed� Driveway Width If Ne�r Opening Is Desired � $� �$ __
� (SEE REVERSE SIDE OF' SHEET)
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 Ordinar.ces and rulinqs of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
/
are true and correct. See reverse side for 'tional info tion.
DATE: J/��6 J �7 SIGNATURE: �
stipulatians: � � , y /� G //
�* T,
i�� ���'�
t',L, -�"�'
.?.`.J�: �n..�..:4 ,�%s sw�
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F s .��s��.�J
3,� ��f+✓e�-t
Gp°1fi� ?M CtrJ!
3% (yG �88.30
� �
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6�C. �37;5 �
urB7, z�
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_._.--_.__.
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BUILDING PERt�IT FEt SCHEDULE
SECTION 2. The Inspector of Buildings 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 repairs to any existing buildinq or;structure, upon application
therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and ih the manner herein provided to-wit: -
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1y000 cubic feet..
PLAN CHECK: 25 percent of building permit fee.
DRI{7EWAY DEPRESSION: (Concrete C�rb Streets Only) .
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$15.40
:��7�K�+P�l:L�l► � ' : i[�Ii�
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basesnent or the cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof_
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.SO state surcharge.
YERIFICATION OF FOUNDA7ION
NOTE: Permits far construction will be issued a miniminn of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeduig with the framing.
: ' � " \
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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' Page 1 of 4
� � EXTERIOR ENVEIAPE AVERAGE "U" COMP[3TATION
� :
' OWN$Re (/"L+�.( ����i�— DA �'_/ ('i ' '% �
siTS ann�ss: J�Ei 7f L�I:.+1�.1.,�,F ,�...,�t,t, �aa 3"� y- 9 d 7/
� CbNTRACTOR: `�'�,GiR.f.w,. ��
Detesmi.ne working square footage of each
1. Total exposed wall area..... a 7 a'� sq. ft. x .17 = ��/ !
2. Rbal roof/ceiling area ..... '��� sq. ft. x .OS = ��
Rbtal exposed wall area above floor = ����.�
a. Total wall window area......., ..........................
b. Rbtal door area .......................................
c. Sbtal sliding glass door area, .........................
d. 2btal fireplace wall area ..........................,...
e. Total wall�framing area faverage 108) ..................
f.; Total rim joist area ..............r:..................
g. wall•area above floor ..........................
h. wall area above floor ..........................
i. wall area above floor ..........................
7• .._._ wall area above floor ..........................
Total exposed foundation area = �_
k. Total foundation window area., .......................... N a Nc„
1. Tota1 net foundation area abohre qrade ................. ��
Determine "U" value of each wa11 seqment
(e.g. wi.ndow, door, each segarate �kl section)
H• I�'I X�u• I�s� = o� g.3s�
h. 5'S. yI X�U. . r$ = 3�..i3
�. 'i.'F� R n�w '�= al.q�
[r. � `'.- � ii nUn • �� � a. ���'�
1'� p, l v • I�— ��—
e. +1h•a� x"U" • i3 = 6• 1!
f. � L� X aU« .O�s � a.0� `�
g. r `�3- �� X R�„ . o-� _ �► � �`1���
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s, � � 3
s. .................. ........ lvtai m .
If item #3 is the same as,;,
or less than itam #1, you :;
have m�t the intent of
SSC 6806 {c) 2.
�
H�cterios EnveloPe Average "U" Capputation Page 2 of 4
� Total exposed mof/ceiling ar� � 'r �O �
m. 1Utal skyliqht area .,,, ........................
n. 'FOta2 roof/ceflirig framinq area (average 2�8)...
o. Total;net insulated roof/ctiling area.......,... �
Determir�e °U" valus for each roo#/ceilinq seqment ,
m. X �Un
. . . . . . .. n. � .X. nUn. _ . . .
O. �'� g � xUn . ,� z � . . � .
4 . . .................. TOt$L ° �
18 ts3tal o£ #4 is the same as, or less than #2, you have<met the intent of
SHC 6006 (c} 1.
Axternate Buildinq F•nvelope Design
Tb utilize the total envelope syffit� method, the valuas established by the sum of
itema �k3 and #4 sitall not be gre�ter than the st� of items #1 and #2.
1. + 2. _
3. + 4. _
a
wi� 5£CTIQNS Page 3 of 4
NOT�: use s 107c of opaque wall ar.ea for
frame aonstruction Construat
`' i.4� - R-Value
. � ,,;;,� > � ' .
_• � fl, l q 1. intesios �.�,x" fi]m 0.68
M
. ` 4: �{ i' 2. �.;"`. S.,": c#t 0. y
� � 3 S'
y�3��. � ;. s y.
c ,. ri a. _'�Y' ii'A�t�s�' ►- �Y
B� St�«o 6.so5, yl' n►Ai'�,� A:7t 0•C'►
_�� , �?6. Exterior air film 0.17
. `,qe� = .IN Tota� 7 N6 _ ►g
82G, $i TOPViEi9 OF
' ` FR� t�AIS.
-- -- ' 0.6�1. Interiox air Pilm, 0.68
. : . � • . : o.qf�. '4" sH�c7 R.�k o_ �►�
,' � .� It 3.'3:�� NiS11L �f
_"'_'�:J �..`
�. � 1.1�.4. . v� ���i�+��S'` !. ly .
FZG. '�,�.�.: . a' Sivcco 0. ao5. � Mg StaM r i 6 �. `'%
� � �. �q 6. Exterior air film . 0.17
�� . �� Total II. s ' a7
.---�--�� j3,{.9 = .o'j 1 //
`•':��� . � �-------Q
�� �'°�'^'-- �il B.I.j1, Znterior air film 0.68
_.,! L+��t.�„� ` K -- 3� i i 2. 3 i° i N S V • il
P�e:a3. ���� . '.��. y
,. ��'� �, � � i-t�s. ti., � I. �q
., � �,����.,,�..` '�,'• :�I p. ` . G� �. �'!4. � a ilt� sa , �
�,t, t�' a � �l+a. 9 sds. 'J/,G 17) terl ., o. t'%
.
`�i 1,�` :�' '. 0• 1� 6. Exterior ai f ilm 0.17
� �.�/♦ /� .�
t -} �� �.+� p.. ' . � p0 � .'Ob.. .. Total �1.Sf ` •� .
r1L�b k. . ' - .
j l �SCT
) : � ,0: . -,
�j . n �Rnvc
t �� 'n � F• i� .J 1. Interior ais film 0.68
- f •� 1 � ;i' � 2•
e: �• . . 3. 1�-�� ji o�:Z
q,
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�6. Exteri r air film 0.17
r �•
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Total S, . � 3 = ' 7 �
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y � � �
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. //� ._ !ff = (/f �
NQBr.: Indicate tyne, "R" value, depth and
placement of insulation. '
, Page 4 of 4
� : fi00F/CEILING
s"
n
Constructiori . R-value
..r
r1. Znterio�G air : film 0.61
�,�-- • f--�3 h � 2 . '4; ' s rl�c�i�� � e - y � ,
�'�(t] ff"p' �� ,rTj'i 3. 1�., Ft�lakGtliSS (3Lov�l� ,.v
%'"- 1 I�4rr.1' i
� t� 1i1;� �`�l �1�� �� �, 4. F�cterior afr film (still) 0.61
• PEt�T Q;�!!! ,L 1� f 1,
; \\� `� -----" �rora� ,�,� � 6 � `, °T%
� __�! � �
ifented Heat flow
� up ;
FIG. #5 '
.. . ` ' 1. In 3or air fi 0.61
. - - Z}
ss.r u.S1F.�:sL�:' "�"_-l�:r_�."...YL_�::.'+�.T.R.'_e�ea�,ca� _ . � . . .�.
3.
, �_ '_ -��j�rY 4. Exteri r air fi (still) 0.61
k` :
/j�{ 1 I i J iy )�l I iJ I� V �_I 1 � tt�/L{/ 11 il,
. i� � 3 ¢_•
�
�Heat flof� up -,vented.'
- • : -.' : _
. 1'IG. $6 �.. _ . . . _ � 1.
' . — 3 ----� � . 2.
' Q' w _ ( ,�e� .i'`L"°� u 4.
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�• �
' � usu�e�nN
t�`
� . q� NO,NttR/Na
lNi,
�,
��a Cwet' Munacipal & Environm�ental Engineering
n
Land Surueying • Land Planning • Soit Testeng
� ❑.
«.
Y
�
,
K
Mr. Dave Harris
6279 Universlty Avenue NE
Fridley, Minrtesota 55432
Re: Lot 24 B1ock 2, Harris Lake Estates
Dear Qave:
`' Mein ONice 571 •b066
6875 HigMNay No, 65 N. E.
Min�eapolis, Minnesota 55d32
Stwth 4Nics 890•6510
1101 Cfiff RpaQ
Burnsville, Minnesota 55337
May 18, 1977
`� f _
At the request of the builder, Tom Brickner, on i8`M5y'
1977, we examined the house excavattOn and dritied several
hand auger hoies on the above subject lot. We found bTack
sand undertain by brpwn sand on the perimeter of the excava-
tioa. Two holes drilled in the center of the excavation
shovEed 6" ta 8" of bfiack organic -soils v�hich we feel Wi}1
cause cracktng o#-the basement floor. Tan Brickner was
informed to remove'the 6" to 8" of black organic soils and
backfill with sand using Lhe �veight of the equipment for
con�paction.
The garage area has not been excavated at this time
and rw barings were dritled. Tom Brickner anticipates the
frost faotings will be in the sand material, hawever if
any black organic soils are encountered, we wauld recamlend
the builder contact us so we can examine the situation and
give further direction.
ble also would riecamiend ttie two #4 re9nforcement bars
be placed in alt footings.
_ _ _ __ �_ _ . __
If you should hawe any questions, please call.
PJM/3P
cc: Tom Brickner
City of fridley (Building Dept.)
Sincerely,
SUBU ENGINEERING, INC.
'��������
eter J. hbt�naro
Project Engineer
Rober' Miiadar, Rtl. �f. � E. A. Aaehbun. Rrl. ewv. �� �. . Wm. E. Prtee. ReB. 6Ml. CwY R. Hw�v. Re/. 9nru.
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City of Fridley 2 4 i g �
,� ATTNETOVOFTNETWINS gUILDING PERMIT
� �� _�__ COMMUNITY DEVELOPMENT ON. RECEIPT NO.
f � y � PROTECTIVE INSPECTION SEC. �'3a"{O
' �
1 ` /'�'� � CITV MALI . FRIDLE� SS032 NUMBEN NFV D�TE v�GE U� �vnROVED Bv
�'"'"� � �'' 612-571-3450 9t0-F15 5/22/96 / /
JOB ADDRESS 1671 Camelot Lane NE
1 LEGAL �OTNO. BLOCN TRAC70HADDITION SEEATTACHED
DESCR. Z(y 2 Harr3s Lake Estates s"EET �
2 PHOPERTYOWNER MAILADDRESS ZIP PNONE
Bill Zbikowski 1671 Camelot Lane NE 571-0429
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO
D 6 D Home Improvement Inc 7401 Central Ave NE, Fridle MN 55432 784-7543
d pRCHITECTORDESIGNEF MAILAD�RESS ZIP PHONE UCENSENO.
4840
5 ENGINEER MAIIADDRESS ZIP PHONE UCENSENO.
8 USE OF BUILDING
Residential
7 CIASSOFWOFlN -
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
%
e DESCRIeE WORK
Re-roof House (26 S ) Tear-off
9 CHANGE QF USE FROM TO
STIPULATIONS
Underlayment must comply w3Ch the State Building Code.
SEPARATE PERMRSANE REOUIRED FOR ELECTHICAL, PWMBING, HEATING, TYPEOF CONST. OCCUPANCVGNOUG OCCUPANGV LOAD
VENTILATING OR AIR CON�ITIONING.
THIS PERMIT BECOMES NULL ANO VOID If WORK OF LONSTRUCTION ZONING SO. FT. CU. FT.
AUTHONIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSGENOEO OR A6RNOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOpK IS COMMENCED. NO. OWLG. UNITS OFFSTPEET PARKING
I HEREBY CERTIFV TNAT I MAVE READ pND EXAMINED TMIS AGGLICATION 1 STAlLS GARAGES
ANDKNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOfLAWS yp�UAT10N $UNTA%
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WMETHER SPECIFIED HEREIN OH NOT. THE GRANTING OF A PERMIT WZ�OBO �I.O�i
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE ON CANCEI THE pERM1TFEE SAC CHARGE
PAOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTIO THE FEiifORMANCE OF CONSTRUCTION. �%�i.JS Fire .SC. �2.08
.�./1 - PLANCNECKFEE � TOTALFEE
{/+�q�1./ ^/ License SC 5.00 $82.87
GNSiUAEO%CON�T . 0 OnnuinOA4E�aGENi � ��. iDniE � W�{EN GqOCEq VpLIDATED THIS IS VOUR QPERMIiJJ
� + i`��11ff (�ry{{/r//�/
SiGNAipREO�OWNEPUlOWNEPBUILDERi �O�TEi 8� G� 50 p<� rp
NE�V [ J Effective 3/1/96
ADDN ( ] CiTY OF FRIDLEY
ALTER [] SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2 �
Building Peanit Application 2J�p
ConsnucttonAddress: `�%� ��/�1�1 `��� �(/�.
I.egal Description:
Owner Name & Address:
Tel. /� S—"'Z/—���9
Cont[aCtor: D& D Home Imarovement, Inc MNLICENSE1f aaan
Addt+ess; 7401 Central Ave NE Fridley, MN 55432 Tel.�i 784=7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed consttuction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
I,ength
un8th
unSth
DESCRIPTION OF Il14PROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground _ Sq. Ft.
Cor�r Lot [] Inside Lot [] t. Yd Setback Side Yard Setbacks
Tyge of Construction: ��y Fstimated Cost: $ �O�(j
Approx. Completion Date: �,�r, `�Q9� oZ�2 �+�s
.(Cost on Back)
Driveway G� Width Needed:
DATE: _����� APPLICANT:
Permit Fee
Fire Su�harge
sm� s,�n�
SAC Charge
License Surcharge
Driveway Escrow
Erosion CoMrol
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 7 . �S�
$ o� O�
$ �. o y
$
$ S Ol�
$
$
$
$ ���. �7
,
.
.�l,� L%I%_ :
CITY USE ONLY
F� Scl�edule on Reverse Side
.001 of Permit Vahiation (1/lOth�)
$.so�si,000 v�,�tion
$900 per SAC Unit
$5.00 (State Licensed Residential Comractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agrcemern Necessary [ j Not Necessary []
.
y t: I
�
CI�IYOF
fRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
March 10, 1997
Mr. Bill Zbikowski
1671 Camelot Lane NE
Fridley, MN 55432
Re: Construction Without Obtaining a Building Permit at 1651 Camelot Lane NE
Dear Mr. Zbikowski:
On October 21, 1996, you were left notice by the City of Fridley Building Division that
a building permit needed to be obtained for the deck that you were rebuilding at the
above noted address. As of this date, you have failed to apply and obtain a building
permit for this work.
We wiN expect you to correct this violation on or before April 4, 1997 and a special
investigation fee wifl be added equal to the permit fee. If the permit is not obtained
by April 4, 1997, this matter will be turned over to the City Prosecutor for his Iegal
consideration. ,
Please contact me at 572-3603 if you have any questions on this matter.
Sincerely,
� C %r�.�c
BARR RIESCH
Building Inspector
BR/mh
soeiccr PERMI7 NO. �
City of Fridley ��� y 9
ATTHETOPOfTHETWINS gUILDING PERMIT
i�
�
� RECEIPT NO.
' COMMUNITY DEVEIOPMENT DIV. /�
i lV ������' /
r � PROTEGTIVE INSPECTION SEC. /O
�
� �
(_---�' �'��;', CITY NALL FRIDLE� SS/�I NUMBEP REV OATE G/.GE UF •PPRpvED BY
y � 612-571-3450 g70-F15 3/12/97 � �
JOB ADDRESS 1671 Camelot. Lane NE
t LEGAL ��TNO. BIOCK TqAGTORADDITION SEEATTnCMED
oesca. 24 2 Harris Lake Estates sneeT
2 PROPEPTYOWNER MAILADDRESS 21P PHONE
William Zbikowski 1671 Camelot Lane NE 571-0429
3 CONTRACTOR MAILADDRE55 21P PNONE LICENSENO.
$BllIB
< ARCNITECTONDESIGNER MAILADDRE55 ZIP PHONE UCENSENO.
5 ENGINEER MAIIA�ORESS 21P PMONE LICENSENO.
8 USEOPBUILDING
Residential
7 CLASSOFWORK -
❑ NEW ❑ ADDITION ❑ AITEFATION ��l REPAIR ❑ MOVE ❑ REMOVE
8 DESCNIBE WORK
Rebuild 20' x 12' Deck
9 CHANGEOFUSEFROM TO
STIPULATIONS �
No plan submitted. Deck constructed without permit.
TYPEOFCONS7. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMItS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING.
VENi1LATING OR AIR CONDITIONINCa.
THIS PERMI� BECOMES NULI AND VOID IF WORN OR CONSTRUCTION ZQNING SO. FT. CLL FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OFl WORK IS SUSPENDED OR ABANDONED FOfl A PERIOD OF 120 OAYS AT
ANV TIME AiTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARNING
I MEREBY CERTIFV TMAT I HAVE READ AND EXAMINEO TMIS APPIICATION 1 STALLS GAPAGES
ANO KNOW TME SAME TO BE TRUE RNO CORRECT. ALL PROVISIONS OF lAWS yp�UATION Sl1R7AX
AND OROINANCES GOVEfiNING THIS TYPE OF WORN WI�L BE COMPLIED
WITH WHETMER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEiiM1T �2> 1ZH �I.O7
DOE$ NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE pERMITFEE SAC CMARGE
PROVISIDNS OF ANV OTMER STATE OR LOCAI LAW REGULATING CON- 1��(�. �S Fire SC �Z.I.3
STqUCTION OR TNE 7ERFOFMANCE OF CONSTRUCTION. W
PLAN CMECKFEE TOTALFEE
- $77.95
SIG EOiCONTR4�iOROR• n eon ru* marE� WHEN PNOPERL ALIDATE� TH�S IS V UA PERMIT
— � � �/ ' 2
ti- , -
�GN/LUREO�OWN ^ OWNEPBUIL�ER� IO.�iO 8L �NS> 441E
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FA,MII.Y AND DUPLEXES R-1 AND R-2
BUII:.DING PERMIT APPLICAT[ON
consrruoaonAaaress: /� 7/—C�,1�f��o T ,c./,r/'�
Effecdve 1/1/97
�9��
Legal Descrigtion:
Ow�er Name & Address: �L,C/.f� �,8/�fC•r�S'C( Tel. � 5 %f '�iyo2 �/
Contractor: S.C'-�C � MN IICENSE #
Address: Tel. #
Att�h io this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
,
DESCRiP`PION OF AZPitO�iVT
LIVING ARF.A: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECg AREA: Length � Width /o� Hgt/Ground � Sq. Ft.�
OTHER:
Construction Type:
.f/b a� Esdmated Cost: $ o°���d6 � �Z , 4`-'
(Fee 3chedule on Back)
Drivcwsy Curb Giat Width 1�Iee�d1: Ft.. + Ft s Ft a; _$
na�: 3 -/�-9 �.�: , ��. � 5�1= oy�
Permit Fee
Fire Surcharge
State StiucY�azge
5AC Charge
Lic.�nse Surchazge
Driveway Fscroev
Erosion Control
Pazk Fee
Se�ver Main Charge
TOTAL
6`yY '��7111/rYL�7►%YI
r
� � , �5�
$ 2, I3
$ /.d�
$
$
$
$
$
$_
$ ��
CITY USE OAILY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.5�/$1,000 Valuadon
�so � sac un�c
$5.�0 {State Licemsed Resideatial Co�cactors)
Alt. "A" or Alt. "B" Above
5450.00 Conservation Plan Review
Fce Determined by F �'ne�+�
Agi+eement Necessary [ ] Not Necessary [ ]
-�- -
�-
1;
�. ..... .....� `.�..:�.'.. h��.�.�:��.'•: :.���. • .�.��i:
BUILDING PERMTT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or suucture, or for
any additiou to any existing building or structure; or for any aiteretion or repair to any existing building or
structure, upon application therefore, require ihe paymern by the applicant for such permit of fces W the amount
herein below. set forth and in the ma�r herein provided to-wit:
TO�'AL �V.�LUE ; : F�F.S " . ; �, � � � .
� `` '`
, � " �� � - � _
$1 to $500 <$21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2_75 for each additional $100 or
fraction thereof, to and i�luding $2,000
$2,001 to $25,000
$62.25 for first $2,000 plus $12.SO for each additional $1,000 °
or fracrion thereof, to and including $25,000
_.
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each addifloml $1,000 = -
.: or fracUon thereof, to and includinp, $50,000,
$50,001 to $100,000 $574.75 for first $50,000 plus $6.�5 for each'additiomrdll
$1,000 or fraction thereof, to and including $1p0;060
$100,001 to $500,000 �: �88']-25a�ori;fisst $100,00b Plus $5 00 fo%each additio�t f
�
$1,000 fract�onthereof, taandancluduig.$500,000�*,���
.�u . -_ , � _: � .,�� e*va�'�' +> r'�„id,�2wb 4.k��n n ��. �.
� � s% �' : ��. F t
.$SOQ,001 t0� $1,OOD,000 � ,$288l�S�f ��fus� $SbO�QOb�lus'.$4 „for � � '�
., $L,000 or f�acfion`,1i�ere��; to a�xlS � lu ' �Cq��,:
.. a 7 y sk , .� pA;'' �ird l�Yde�i�c twyi,L"'
.t vih
x
� ! r'.:='
. . .,..� _ <. .:. ,...._ ,.�.. < _....._.. �. _._ .._, �.;. _. � .. � .: n; �.
$1,000,001 and up $501225 for the'first $1,000,OOOplus � 5 for each additional
Q
$1,000 or fracaon thereof �
� ,��r,�. , a
. . . ._ttV y :H y . . . .
DRIVEF�AY,D�PRF.�SION,ESCROW � ,
(co� c� s��,o�y� , -
� ' 4 -.: �i . . 31':?�.�±d'4`� .r�Y t.J 9 . . . ..
Alternate "A": Removal and replacement of curb-aud gutfer only'- Driveway�:width plus 6 feet times $13.50.
Altemate "B": Removal and repiacement of taub; and gutterand;iffitall=a 3 foot wide '-
approach with 6�nch depth Driveway width plus 6_feet times $15.75. ,,'
� _ . �., � . . ��a�*�. rs��s � �.� ._ _ �.
„;
VERIFICATtON �OF FOUNDATiON - -A-
�.,�.�� ry�� * �di 4 , x r _: , �'� �.:� �,
Permits for consiruction will be issued a mtn�of+24 hours from the time of apphcahon to allow for proper
• . .. ±.I.# M'A Ml i 2� ..F.... . .. . .. .� �. ... �
review of the proposed structure and of the'constnichon'site.
_..
R � � �
A Certificate of Survey of the lot, showing the locadon of the foundation once it has it has been constructed
will be required before proceeding with the fcaming.
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COINMON VEWT /�NT CONNECTOR AND COMBUSTION AIR VE FICATlON
VNun reolecirta an eristi , the unders�qned hereby verifieg that the
venGng has been examined and is free from ��, �e��n, obstrudions,
and is saurely supported and firestopped yyhere required. yeS �„�j,b ��
7he veMing system is plasticlpVC and meeEs ail current codes and manufaGurer
sper.ifieations including siting, length, numbe� of elbows and terminadon. Yes (�No ()
Tfle undersigned also verifies ttiat the replacement unit is a listetl assemby
and meets the currerrt codes and manufacturer's speafications. TFiis does
ir�ctude AOA-CAMA Category { CeMral Fumace Ve�ting 7ables for fan
accisted and naturat dralt appiiances.
The exlstino eombustioo air is sized and installed to m�t the ament codes
and manufacturefs specificalions.
When required to instai( a nevr eombasiion air. it will be sized and instatled
To meet the Curcent codes and man�aGurers specifiqtipns.
Yes (�No ( )
Yes (-�'No ( )
Yes (-�'Flo ( )
Nfien inamlling a new veMina svstem, the undersigned hereby verifies that
it is a Usted assemply and meets the curreM codes and manufacturer's
epeafications. This does indude AGA-GA#AA Category ( Cerltrat Fumace
Venting Tables for fan assisted and naturai draft appflanees. Yes ¢.)'NO ()
Is the common veM antl ver�t connedors sized and instaAed co�etly ai4er
an applianca has beerr removed from the :ammon vent �d vented
separately es per currerrt codes. Yes (✓J Nu ()
/�oliance Tvoe and SizelCommon Vent and Vent Conneetor InfortnaHon
Appliance #1 Type � A A n !�4 BTU Input� Fan Assisted or Nat
Appliance #2 Tyye BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Inp�t Fan Assiated or Nat
Tota� Appliances TotalBtu Input
Common Vent Type
Vent i-IeigM Diameter inches
Appl�nce #1 Vent Connector keight ft Length ft Diameter in Type
Appliance #2 Vent Connector NeigM ft Length �R Diameter „_�n Type
Applia�ce #3 Vertt Connector Height ft Lertqth � ft Diameter in Type
AL7�RaTiONS:(Dese�bel
HEATING
Fl �1�'I:�
Z0�Z8'd S698G8L Ol J,3�61213 �0 AllJ WOb� BS:ZL 000Z-SZ-fiON
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FRtDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSI7'Y AVE. N.E. FRIDLEY, MN 55432 •(763) 5713450 • FAX (763) 571-1287
August 23, 2002
Mr. Bill Zbikowski
1671 Camelot Lane NE
Fridley, MN 55432
Re: Final Inspection at 1671 Camelot Lane NE
Contractor: Daves Appliance Heating & Air Cond
Dear Mr. Zbikowski:
A mechanical pennit was issued on December 18, 2001 to install a furnace at your address.
According to the 1991 Uniform Mechanical Code a final inspecdon shall be conducted on
the work authorized by this pernut. As of this date the inspection has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your pernut open for another 30 days and if we do
not hear from you within this time to set up the inspecdon, we will mark the pernut "no
inspection called for by homeowner after notification" and take no further acdon.
To set up the inspecdon or to have any questions answered, please contact the Building
Inspecdon Division at (763) 572-3604.
DJ/mh
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Building
Inspections
763-572=3604
BUILDING Permit No.:eY
RESIDENTIAL APPLICATION Received By:,
srrs qnD2FSS I tP ! l �(�IYt�!(9T (11!
TFIIS APPL[CANf IS: . ❑ OWNER
PROPERTY OWNER/ Nq�: `
TENANT .i,pD[tFSS: !
rxo�
SUBMIT A COPY OF ���
YOUR STA'IE LICENSE ADDRF
WITH APPLiCATION acrnu�
❑ BASEMENf FQ.lISH
❑ DECK
DESCRIBE WORK BEING
GARACFS
PROPOSID SfZE:
PROPOSED i�IGH'f:
SIDING
❑ Vinyl
O Aimninwn
o antt .
CITY OF FRIDLEY - � t�ate xeo
YOUR E-MAIL
❑ ROOF
❑ SIDING
❑ HOUSE R GARAGE
❑ ATfACHED GARAGE
❑ DECACHED GARAGE
OSo6t
❑ Trim
O Fascia
WQiDOR'S
IN E7QS17NG OPENINGS �Ya �No IACpT1pN OF
OR FOR NEW OPENRiGS-DESCRIDE SIZE OF ��
OPENWGCHANGES& tl � ( V/NYI /
Plan Review
Fire Surc6arge
S�rchazge
License Siuctiazge
SAC Charge
Curb Cut Escrow
Erosion Co�ol
Park Fee
Sewer Main Ch�ge
Y'P �
U.B.0 FEE SCHEDULE)
❑ OTF�R
HEIGHT
BASEMFN7'R�ODELR�1 MIT:
1. Fxistmg Floor Plan
2. Proposed floor plan
3. List of struca�rat members to be used
FOR NE W CONS'fRUCTION MCLUDING DECKS,
ADD1710NS R PORCF�S SIBMI'C�
.1. Site PlenlSurvey showing the ncisting strucNres
� m�d ProPosed Prolect
2. Tw urs of conswction plsns
3. Enwgy Calculations -
AND MATERIALS:
$ee Back Page,for Fee Seheduk
65% of Building Permit Fee
.001 dmes the totsl job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residenrial Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Ageement necessary ( ) Non Necessary ( )
to:
�� 7'HIS GS AN APPLICATION FOR A PERMIT-NOT VAI.ID UN7'IL PROCESSED
I hereby apply for,a building perntit and I aclmowledge that the information above is compleu and accurate; that the work will be in
conformance with the o and codes of the City of Fridley and with the innesota Construcdon Codes; thaz 1 understand this is not a
permit but only an applieati for a permit and work is not to start wi[hout a rt; that t6e work will be in accordance wj'� th pproved
plen in the case of al1 wor�.�quires rAview and approval of plans. �, � � . �./ �
SIGNAT[TRE OF ABPLIG�AN7' �.
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
'�'he. Ctuef, Builc�ing Offcial shall, before issuing permifs for the erection of 'any �uilding �r,
gti'uchue, ot �o`r'any addi'cio'§� to any existing building or structure, or for any, alterah¢n or repair
to any e�sting buiiding or structure, upon application therefore; : require' tfie paymenf by the
applicant for such pernut of fees to the amount herein below set foith and in the manner herein
provided to-wit: . . ,
,; - �
VERIFICATION OF FOUND�ITION
Permits for construction 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 thq loeation of the existing foundation will t�e
required before pmceeding with the framing. New Houses Onlv ;,,
Ciry of Fridley
Btulding Inspections Deparlment ` � `
- - _ _ _ _. - - _
6431 Universiry Avenue NE .
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
� �� � � � �. ' A � �
Building
Inspections
763-572-3604
DATE, lI7 �e'U 1
SITE ADDRESS,�„JQ
TFI75 AP?UCAT�T iS:
OVr'NER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
ADDRESS
Permit No.:
Received By: '^��
Dat�.�u�� $
CONTRACTOR CowrnaNYNaME:
CONTpCT PERSON: ��// Anderson Heating and Air-Conditionmg
SUBMIT A COPY OF N�„ - 4347 �pttal Ave N.E.
YOUR STATE Stn7E llC�SE a
UCENSE WIi'Ei pDDRESS:
APPLICAT[ON PHONE 7fy�'�I- GS// COI, HtS� I�M SS4Z1
PERMIT TYPE
TYPE OF WORK:
'I�.SiNGLEFAMILY ❑'fWOFAMILY
❑�W �REPLACEMENT
n
DETAILED DESCRIPTION OF WORK
❑ i0WNH0USE
❑ pLiERAT7UN/REMODEL
STATE_ZIP
PER MS 16B.66S the permit fee is a minimum of 515.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, exduding the fuctures. (This should reflect only the cost of labor )
Labor cost under $300 = 515.00. Labor cost between $300 to 5500 = cost of labor x.OS °
FOR PAOJECTS W]�RE L4BOR EXCEEDS 5500, FEES ARE BASED ON S10.D0 PER FIXTURE, EXCEPT WHERE NOTED. F[XTURES: ([NDICATE TOTAL
*Il;M3ER OF EACH BELOw� MODEL: SIZEBTU
Equipmentlnstalled . . MF�' MODEI.: S��T�
�c:
TqpG; MODEL:
�NC S25.D0 _FIREPLACE (GAS) SI5.00
AIR TO AIR EXC}iANGEER S15 FIREPLACE (WOOD) 535.00
BOILER 535.00 � _FURNACE 535.00
CHIMTIEY LRJER S10.00 GAS DRj'ER SI0.00
DUCTWORKSI0.00 . GASPIP7NG5l0.00
SIZEBTU
RANGE/OVEN 810.00
GAS GRILL $1 D.00
SJNIT HTR $)0.00
i, HEA7'ER 535.00
TILATOR SI5.00
�li.L']-'+eY�.r��vr�wa-v......r..._ e:�.--�_._ .._.._. _
Permit Fee $ .�_ IQumber of fixteues Q S1D.00 _ x$10.0 =
Surchuge $ SO Number af Fixtures @$I5.00 _ x$15.00 =$
TOTAL DLJE $ c� 5._,j� Number of fixtures Q$25.00 _ x$25:00 =$
Number of fixtures @ $35.00 x $35.D0 = $
State Surcharge = $ 50
Tota] _ $
� � TtDS IS AN APPLICATION FOR A PERMIT-N07 VALID UNT1L PROCESSED
I hereby apply for a building permit and I acknowledge that the informa[ion 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 pertni6and work is not to sta[t without a permit; that the work will be in accordance with the
approved ptan in the case of all work which requires review and approval oF plans.
SIGNATURE OF APPLICANT C GI/{2� �•^'�l—��{� ,. PRINT.NAMEC. N.�Ii �'l�%I k7�rq � DATE
City of Fridiey
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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