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CHIMtJEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes �'
2. Is free from rust or deterioration Yes (�
3. Has no foreign objects lodged within Yes �f
4. Is securely supported _ Yes �
5. Meets all current Code requirements for size and
total BTU connected
6. Has To tal hea ti ng BTU' s of ��� ���
Al l other BTU' s ��o ���
TOTAL ������
Rema rk s ��/ � � LO �� �--%��/�
No ( )
No ( )
No ( )
No ( )
Yes (�j No ( )
Canpany ���i�//� �'"C � /��
— ----- —
-- - - --
_.
�
_- --
S i g ne d By ���—�-
Da te �� ��� �'� �
sue�ecr p
City of Fridley � ;� � 2�-� �
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
i�
' � R T NO
� `y ______ COMMUNITY OEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC. !7 / � .
' ��. (
� �
i
i--_- �,��'�'i,,; CITY HALL FRIDLE� 55432 NUMBER AEV DATE PAGE OF pPpqOVED Br
L J` 612-571-3450 910-Ft5 6/6/95 / /
JOB ADDRESS 6211 Carol Drive NE
1 l EGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. S 3 Shorewood SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Rathleen Gilman 6211 Carol Drive NE 571-0352
3 CONTRACTOR MAIL ADDF;ESS Z�P PHONE UCENSE NO
Same
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP pHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW C� ADDITION p ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOHK
Construct a 12' x 10' Addition to rear of building
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
W�R[�I�IG
�efore diggfng call for
aii utility locatfons
454•0002
REQUIRED BY LAIN
SEPARATE PERMITS ARE HEOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2�9�FO �],./{]
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PEFIFORMANCE OF CONSTRUCTION. �Jr�4.0� Fire .5'�'i �2.9�}
PLAN CHECK FEE TOTAL FEE
$58.41
q/ Si TUAE OF CON'RACTOR O au NOAl2E GENT (DATEi HEN PROPER VALIDATED THIS IS YOUR PERMIT
a� ` �e
Si TURE OF OWNEFl ��F OW ER BU�LOEA1 IDATEI BLD �NSP f�NT
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConsiructionAddress: �; �
Legal Description: __����
Owner Name & Address: �
Contractor: � � / ,�'
Effective 1 / 1 /95
��1�
�
Tel. #�'��/ - a��.s�Z—
MN LICENSE #
Address: � � � � Tel. # SQ � �
> Attach to this appHcation, a Certificate of Survey of the
lot, with the proposed construction drawa on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length � Width /o � Height � Sq. F#. � v
Length Width Height Sq. Ft.
Length Width HgtlGround Sq. Ft.
Corner L.�t [] Inside Lot [ j Ft. Yd Setback Side Yard Setbacks
Type of Construction: c, J p�, �1 ���, �,� Estimated Cost: $�� F1 e o.,��
Approx. Completion Date: � �r� /, i ��� k'a y, � ' � %�� �
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: / �-- s - J �APPLICANT: Tel. # �- �J o _3 s-,�
Permit Fee
Fire Swcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosioa Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
e
s
$ � y.
$ _,L�'f
$ /���
$
$
$
$
$
$
$ y/
�ITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation {1/lOth%)
$.50!$1,OD0 Valuation
$850 per SAC Unit
$5.00 (State Licens� Residendal Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
F� Dete,rmined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
i;ui�.l)IN(: }>i:RMI'[' FEL' SCHEDULr_
'I'hc Chi�t� 13uilding Otticial shall, tx:forc issuing perrnits for thc ercction of any building or structurc,
c>r ti�r Iitly a�lcfitic>r� tt� any cxisting building or structure, or for any altcratioa or rcpair to any cxisting
(�uiliiing c»- s�ructurc, u�n a{�plication t��erefore, reqaire ttte naymcnt by d�e applicant for such Irermit
c�f tecs t<� ttie aniount hercin tfeibw set f<�rtl� and ia the maaner i�erein pmvidcxi to-�vit:
"1'O"I'A L V A I.11 l:
� 1 to $500
$SO1 to $2,000
$2,001 to $25,000
�25;001 to $50,000 �
$SO,OQ1 to �100,000
$100,001 to $500,000
$500,001 to $I,000,000� -
$i,000,001 artd up
r-r_��s
$15 (Minin�um Fce is $15 plus surcharge)
$15 for fizst $SQO ptus $L for each additioaal $1(}0 or
fraceion thereof, to and including $2,000 �
$45 for first �2,000 ptvs $9 for �each additioual $1;Q00
or fraction �xeof, to and iucluding $25,000 �
$252 �for first $25,000 ptns $6.50 far each additional $1;000
or fraction thea�oof, tA. and inclading $50,000 '-
$414_50 far first $50,000 plus $4S0 for each additional
$1,OOQ or fradion fi�ereof, t�o and includinEg $100,0(?0
$639.50 for €irst -$100,000 plus- $3_50 for each additional� �
$1,OOt1 or fractioa dteroo� to and including $SU0,000 -
$2A39.50 for the first $�?0,000 ptas $3 far each addirional
$1,OQ0 or fractioa there�f, to and including $i,000,000
$3539_50 for ttze first $1,000,000 plus $2 for each additionat
$1,i�0 or fradion thereof -
DRiYEWAY DEPRESSION ESCROW
(Concrete Curb Sbreets Only)
Alternate "A": Removal and replacem�t of curi� and gut� only - Driveway width plus 6 feet times
�13_50_
Alternate ° Q": Removal and replacement of curb and gubta- and install a 3 foot wide
approach with 6 inch deptli - Driveway width plus 6 feet times $15_75.
VLRIF[CA'C(ON OF FOUNDATION
Permits for constniction will l�e issued a minimum of 24 houcs from the time oF application to allow
for proper revicw of ti�e pro�scxi stnucture and of the construction site_
A Certitic:itc of Survey of ttie lot, shvwing the loc�ttion of the foundation once it ha.e it has becn
constructeci will t�e re;yuirui i�efc�re proceoding with the framing_
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SUBJECT P�TMI I NO. �
City of Fridley � � � � � �
' , AT THE TOP OP THE TWINS g U I L D I N G P E R M I T �\'' �
' � RECEIPT NO.
' • COMMUNITY DEVELOPMENT DIV.
� ; V ����� , �� ��
r � � PROTECTIVE INSPECTION SEC.
� ,
i
l_-_- ��'��;-� CITY HALL FRIDLE� SS432 NUMBER REV DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-Ft5 Sj22/96 � �
JOB ADDRESS 6211 Carol Drive NE
t LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED
oescR. 5 3 Shorewood SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jim Gilman 6211 CArol Drive NE 571-0352
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO
D& D Home Improvement Inc 7401 Central Avenue NE, Fridley, MN 55432 784-7543
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
4840
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR O MOVE � REMOVE
X
8 DESCRIBE WORK
Reroof (16 Sq) Tear-off; Vin 1 siding and trim
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAHAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT WJr,960 �Z.98
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISION OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT N R THE PERFO ANCE OF CONSTRUCTION. �LIZ.ZS Fire SC �5.9�7
PLAN CHECKFEE TOTALFEE
' � � License SC $5.00 $126.19
SIGNpTUAEOFCON'FACTORORAUTHOFIZEDAGENT IDA EI WHEN PqOPE VALI ATED THIS IS VOUR PERM17
- � �� � -S = --��
SiGNaTURE OP OWNER iiF OWNER BUIlOERi �OATEi BL G�NSP qa7E
ti
r�w
ADDN
ALTER
C]
Il
�l
ConstructionAddress:
Legal Description:
0
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/ 1 /96
� � �
�
Owner Name & Address: ��, �� �,��,��1 . Tel. # ��°°��'�
Contractor: _D & D Home Improvement , Inc MN LICENSE # a R 4 n
Add1'ess: 7401 Central Ave NE Fridley, MN 55432 Tel. � 784=7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed constiuction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IlViPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
,
Type of Construction: ��i!/� 1��` r�r� Estimated Cost: $ .S �� �r(�
Approx. Completion Date: � �� �����(� / s° ,�f °�'
�� L'i L �
.(Cost on Back) �'d'� t°�a�i'—�'��,��
Driveway Curb G�t Width Ne�ied: Ft. + Ft = Ft x$ _$
DATE: , ,�' APPLICANT: . �� Tel. # ��� ���
Permit Fee
Fire Surcharge
State Surcharge
SAC Chazge
License 5urcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ // � ���
� J I�-
� �1. s�'�
$
$ �'
� -� ��
$
$
$
$
$ ��� ��
CITY USE ONLY
Fee Schedule on Reverse Side
.(�1 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$9� per SAC Unit
$5.� (State Licensed Residential Cornractors)
Alt. "A" or Alt. "B" Above
$450.(� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�
SUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R f�ll I
i �
� t
; �L _ COMMUNI7Y DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
l� = i
�-__� ��"' ��� CITY HALL FRIDLE� 55432 NUMBER qev
i bl 2-571-3460
910-F15
JOB ADORESS 6211 Carol Dr NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCH. ,5 3 Shorewood
2 PROPERTY OWNER MAIL ADORES$
Jim Gilman Same
3 CONTRACTOR MAILADDRESS
_ Steven R Lee 9465 Irving Ave N Brookl n Park
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
DATE PAGE Of
9/14/98 / /
ZIP
ZIP
571
PHONE
F-1198
PHONE
PMONE
27744
� �
er
SEE ATTACHEO
SHEET
LICENSE NO.
5�8
LICENSE NO.
LICENSE NO.
❑ NEW ❑ ADDITION O ALTERATION � REPAIR ❑. MOVE O REMOVE
8 DESCRIBE WORK
___ Reroof house & garaee (20SO1 Tear—nff
9 CHANOE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITSARE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING, ��rtvr ��rvs�. ocGUPI
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTpUCTION ZONING SQ. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED fOR A PERI00 OF /20 DAYS AT
ANY TIME AFTEfi WORK IS COMMENCED. NO. OWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1�]1G,.00
WIPH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �SG.7S
PLAN CHECK FEE
9'� �i �'p Licens SC $5
°SiGNATURE OF CON7RACTOR OR AUTNORIZED AGENT 1DATEi �., .,,.,.� ...
IDATEI
IP OCCUPANCVLOAD
CU. FT.
STREET PARKING
IGAFiAGES
ITAX
$.86
CHARGE
Fire SC $1.71
/ EE$64.32
0
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION ��
�� G��
ConstructionAddress: � �, � 1 � �,.� � j' � �
� �
Legal Description:
Owner Name & Address: ��'� � �- , ° / r� � � Tel. � .S %/ — 'o � �02
Contractor: _ � %-e�� �. � � MN LICEN5E # s 7-r`�
Address: � � � � ,� Y- v � �, � �v�, ���',, klyc,��el. # _ ��. �/— G% %
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF Il�ZPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
v�� �°�_
Construction Type: �-e-0-j- ��- Y-�.►r�-- Estimated Cost: $ � J�%/�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �°�/ % /e'�APPLICANT• � 9 � Tel. # �� �/' � >% 9.G
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �-`7�
$ �. % 1
$ �o
$
$ S: ��
$
$
$
$
� �
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valua.tion (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 [ J Not Necessary []
� - -
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 $SO,OOQ
$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 first $25,000 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 additional
$1,000 or fraction thereof, to and including $1Q0,000
$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
$1,000 or fraction thereof, to and including $1,OOO,Q00
$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.
Altemate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet tunes $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._
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COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifles 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 () iVo ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specfications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existinq combustion air is sized and installed to meet the cuRent codes
and manufacturer's specifications.
When required to install a new combustion air, 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 venting system, the undersigned hereby verifles 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 () No ()
Is the common vent and vent connectors sized and installed cor�ectly after
an appliance has been removed from the common vent and vented
separat�ly as per current codes. 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 Total Btu Input
Common Vent Type Vent Height Diameter inches
-- -
Appliance #1 Vent Connector HeighY ft Length fi Deameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Conne�tor Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
HEATING CO: RON'S MECHANICAL, INC.
Signed By: Date :
�
�
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE �J f�L� �� U tj
STTE ADDRESS � % � ,
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF
DESCRIBE WORK BEING D(
SIZE OF IMPROVEMENT �
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
IDING
❑ Vinyl
❑ Alwninwn
❑ Other
❑ OWNER
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTNE 1-1-08
PHONE��
STATE LICENSE #
YOUR E-MAIL
.-.
SINGLE FAMII.Y/NEW CONSTRUCTION
TWO FAMII,Y/NEW CONSTRUCi'ION
/1DDITION ❑ GARAG
BASEMENT FRdISH ❑ ROOF
DECK ❑ SIDING
❑ SWIlVIl�1
❑ NEW HOME CONSTRUCI'ION
❑ MAINTINANCFJREPAIIt
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
� DETACf�D GARAGE
Permit No.:
Received By:
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, FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDTITONS. & PORCi�S SUBMTf•
❑ T� 1. Site Plan/Survey showing the existing structures
❑ Fascia and proposed project.
2. Two sets of construction lans
P
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS OYes �No CATION O � OWS
OR FOR NEW OPENINGS-DESCRIBE SIZ F(Z� �� )�
OPENING CHANGES & ��Pnew e e'!Js w1 ij Q� j1� Yj ' ��Q'ii 1(��CIJ �'Pif I/rn
TYPE OF WINDOW TO BE INSTALLED NUMBER OF IrT�OWS 1 �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(U G'I'HE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ �. CX� OCCUPANCY TYPE
Permit Fee o� .'� See Back Page for Fee Schedule
Plan Review $ ��. q 65% of Building Permit Fee
Fire Surcharge $ •0 .001 times the total job valuation
Surcharge $ �'�. �� .0005 x Permit Valuation Minimum $.50
License Surchazge $ •� $5.00 (State Licensed Residential Conlractors)
SAC Chazge $ $1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Chazge $ Agreement necessary () Non Necessary ()
Total Due $ `�,. Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTII, PROCESSED
I hereby apply for a building permit and I acknowledge that the infonnation 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• I understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work cordance ' pro 1 in tha case of all ork which uires review and a roval of lans.
SIGNATURE OF APP IC NAME��U t�� �e) d'�� ��ATE ��
APPROVED BY
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St. Louis Patk� MN 55498
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6211 Caro! Drive NE
�r���eY, MN 55432
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This is the egress windowr sectlon we forgot to send with the plans for the project at:
Kisha Delain and Charles Schmidt
6211 Carol Dr NE
Fridley, MN 55432
Please put with the other information that we sent. i`hank you!
Amanda Marlow
Busfness Development Manager
Direct Line 612.435.7086
Orfleld Design & Construction, lnc.
4Sd1 Minnetonka Blvd. - Suite 300
Saint louis Park, MN 55416
952.920.6543
952.927.7262 fax
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City of Fridley
Project for
Kisha Delain & Charles Schmidt
6211 Carol Drive NE
Fridley MN
Building residential application question
#3 list of structural members to be used.
We are not changing or altering any structural members
Wall framing as follows.
2x4 pressure treated plates (floor)
2x4 pressure treated to masonry (walls)
2x4 hem�r wall studs and top plates.
1%" foil faces thermax walls
Sincerely Yours.
Ron O�eld
Page 2- Building Residential Application
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:
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 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 proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Faz: 763-502-4977
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6211 Carot Drive NE
Fridley, MN 55432
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Building MECHANICAL Pernut No.:
Inspections RESIDENTIAL APPLICATION Received By�
763-572-3604 CITY OF FRIDLEY va a�AY � 5 �
763-502-4977 FAX �cTn�,-,-0s ��
DATE �' °°I ° � � YOUR E-MAII. ADDRESS
srrE.�nDxESS � D� 1��'RV� d!I �
THIS APPLICANT IS: 0 OWNER ,I�ONTRACfOR '
PROPERTY N,�:
OWNER/ pDDRESS: O� CITY STATE ZIP
TENANT PHONE: �I n�— cG`°] I
CONTRACTOR COMI'ANY NAME: �
NOTE:
SEPARATE C1TY CONTACT PERSON: � � �� .
LICENSES ARE STATE LICENSE # EXP DATE
REQUIRED FOR GAS �DRESS: ��C$Q l� GY�► I C�j,YY� i��(�� CTfY ,��" '. �[S .[ r� STATE�ZIP S5�
AND HVAC. f °� �i d�
SUBMTf COPY OF BOND PHONE ����� —/I,����� FAX ��Af- ��" d' I�Groi'
AND INSURANCE
PERMIT TYPE SINGLE FAMILY � TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW ❑ REPLACEMENT ALTERATION/REMODEL
DE AILE DESCRIPTION OF W RK 'ei
�1
PER MS 16B.665 the pernvt fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residenrial fixture, excluding the fixtures. (This should reflect only the cost of labor )
OR
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of ]abor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
Equipment Installed MFG: MODEL: SIZEJBTU
MFG: MODEL: SIZFIBTU
MFG: MODEL: SIZFlBTU
_A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGF/OVEN $10.00
_AIR TO AIIt EXCHANGEER $IS _FIREPLACE (WQOD) $35.00 NEW GAS GRILL $10.00
_BOII.ER $35.00 _F[JRNACE $35.00 _GAS UNTT HTR $10.00
CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
�DUCT WORK $10.00 GAS PII'ING $10.00 � VENTILATOR $15.00
„ , —
PERMIT�FEE PKbJECTS' FOR UNDER $SUO ` ; � , .. ;; .' = PER],VIIT �'EE FOR PROJEG"i'S QVER $500`-
Pernvt Fee $ Number of fixtures @$ I 0.00 � x$10.00 =$ i��� G
Surchazge $ .50 Number of fixtures @ $15.00 � x $15.00 = $ 15 . 00
TOTAL DLJE $ OR Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
MINIMIJM $15.50 MINIMUM $15.50 Tota1= $�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNfII. PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the infonnation 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�it; that the work will Ue ' accor � with the approved plan in the case of all work which requues review and approval of plans.
��I�1�� � � ,���1I�DATE�
SIGNA OF I A PRINT NAME ,
APPROVED B DA'T�
PLEASE NQ :` SE TE PERIVIITS ARE RE LJIItED FOR BUiI,DING„ELECTRICAL;AND 1tiIECHAATICAT: WORK :': "�
City of Fridley
Building Iaspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residen�ial Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERNIIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �°EXISTING HOME ❑ MAKE-UP AIR
R�OUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REOUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
Building PLUMBING Permit rto.: �% �b�
Inspections RESIDENTIAL APPLICATION xeceived By:
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX �°��
EFFECTIVE 1-1-OS
DATE (O `%"` D 6 YOUR E-MAIL ADDRESS ��//1 I Gt ..i �� 4"ri I � � o��
STTEADDRESS 6 2.l l e��, / 7�R.. /v� �'
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY NAME: G%1w'4.j G,n c�. C! i
OWNER/ „�D�SS: 6 z, � C'.�-a � j�� NL�' crrY �,t,r�c,y STATf�ZIP �s�
TENANT
PHONE:
CONTRACI'OR N,�: / �J yr�
SUBNIIT A COPY OF STATE LICENSE # S/ 3� P EXP DATE l Z' d'Y
YOUR STATE
LICENSE, BOND AND STATE BOND # / y G 3 a 8' S/ EXP DATE � Z.. '°�
CERT'IFICATE OF ADDRESS: /% 7 y G�h9'? �'GG G! CITY W/ L/�- STATE�ZIP S�T'�/?J
INSURANCE �-j 7� 3 S7 y o Fa�c r� S'� 77'3 �7b
PHONE
PERMIT TYPE SINGLE FAMILY _❑ TWO FAMII.,Y ❑ TOWNHOUSE
TYPE OF WORK: � �' ��P�CEMENT
DETAILED DESCRIPTTON OF WORK �{.G,�,,,,,,,G,,,..�%',��i.�,�rta,,•� /�G.�r �_
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $SOO,yF�ES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
��M� ER OF EACH BELOVi�. MINIMUM FEE $�.50.
/ BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
� BATHTUB GAS PIPING (NEED CITY LIC) SWIMbIING POOL WATER SOFTNER ($35)
_ CLOTHES WASHER KTI'CHEN SINK � WATER CLOSET BACKFLOW PREV. ($15)
_ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ WATER METER _ OTHER
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Permit Fee $ Number of fixtures @$10.00 x$10.00 =$ 3�� , c�t�
Surch e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ OR Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
b�1IMUM $15.50 $15.50 Tota1= $ .�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 on site; that the work will be in accordance
with the approved plan in the case o k which requires review and approval of plans.
SIGNATURE PLIC � PRINT NAME C/G�i`�G ����'�s DATE ��/'� �a
APPROVED BY DATE -- � - �
�� � �. �� � � ��
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977