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SUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
; �� _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
L--_�� ��"" ��� CITY HALL FRIDLEY SS432 NuMBER
i 612-571-34b0
s�aF�s
JOB ADDRESS
6231 Carol Dr
1 LEGAI �OT NO. BLOCK TRACT OR ADDITION
DESCFi. 3 3 Shorewood
2 PROPERTY OWNER MAIL ADOpESS
S e Ben�ston
3 CONTRACTOR MAIL ADDRESS
__Siding Plus Wittdows 301 E Z St Fa �
4 ARCHITECT OR DESIGNER MAIL ADORESS
5 ENGINEER MAILADDRESS
B USE OF BUILDING
Residential
7 CLASS OF WORK
REV DATE naGE OF
8/3/98 / /
PHONE
�
PMONE
PHONE
:ERMIT NO. �
26971
����
APPROVED BY
SEE ATTACHED
SHEET
LICENSE NO.
3275
LICENSE NO.
LICENSE NO.
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR p MOVE O REMOVE
8 DESCRIBE WOFiK
9 CHAN(iE �F USE FROM
STIPULATIONS
TO
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBIN(i, HEATING, TYPE OF CONST
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOHK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UN
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A pERM1T �ZOOI
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
TRUCTION OR T PERFORMANCE OF CONSTRUCTION �J�F. JS
PLAN CHECK FE
�C��
SQ
STALLS
Lice e SC $5.
S�GNATUHEOFCON7RACTORORAUTNOfiIZEDAGENT iDATEI HEN PROPERI
SiGNATUREOFOWNERUFOWNERBUILDERi IOATE� piM ��,
a r ., _
NCY GROUP OCCUPANCVLOAD
CU. FT.
0
OFFSTREET PARKING
I GAFiAGES
$1.00
AC CHAHGE
Fire SC $2.00
�TAL FEE
$82.75.
THIS IS YOUR PERMI'
TTEW
ADDN
ALTER
[]
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[l
CITY OF FRIDLEY
SINGLE FAMII,Y AND DI1pLEXES R-1 AND R_2
BUII,DING PERMIT APPLICATION
Effective 1/1/98
.�� �7/
ConstructionAddress: � Z3 / � ,�� �'� ��`��
Legal Description: _ ,���, ��� �a �
Owner Name & Address: �� � /�sla e-. Tel. #�7� � f'3� 7
Contractor: �'� <<.�, - ��� �l,i,4��s MN LICENSE # D8'�7 ,S°—
Address: � / ' �' ,02`�` sy . ?�'/�,5��-,y ,�i`,,,
, Tel. # S� ? –� 3�' �
Attach to this application, a Certificate of Survey of the ��/�
lot, with the proposed construction drawn on it to scale. �'
DESCRiP'rION OF IlYIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: � Length Width Height Sq. Ft.
DECB AREA: n �Vidth � HgVGroun`d _ Sq. Ft.
O�R: � �U � .� • � l � �0��
Construction Type: � �� � Estimated Cost: $ � � � /
. �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ �
DATE: �'�3 C�° � APPLICANT: s��� !�� Tel. �# ,S'�2 -z 3�-/2� 3
CITY USE ONLY
Permit Fee $ ��- .� Fee Schedule on Reverse Side
Fire Surcharge $ �� D�J .001 of Permit Valuation (1/lOth%)
State Surcharge $ �. Q� $.50/$1,000 Valuation
SAC Charge $ -$1000 per SAC Unit
License Surcharge �$_ � O� $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
,
$
$
$
$ ��. ��
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ J Not Necessary [ J
y_ � . m
e
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 pemut 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 $25,0�
$25,Q01 to $SO,Q00 .
$50,001 to $100,OQ0
$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 $1,0(�
or fraction thereof, to a�d including $50,000
$574.75 for first $54,000 plus $6.25 for each additional
$1,Q00 or fraction thereof, to and including $100,Ofl0
$887.25 for first $1�,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, 000, 000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
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 times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
Bu�.�d�ng
Inspections
763-572=3604
DATE �7 — (� — (� r
SITE ADDRESS o73
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
'r N� �"r� � /�y /1�! N 5 .� `f 3 oL.
0'OWNER OCONTRACTOR
Permit No.:�
Received By:
Date Rec'd: �v
PROPERTY OWNER/ Nq�: ,�/a � SI �U�2-� ✓e�N�
TENANT ADDRES$: �D a°C.3 [Cx-�O / ��' /�!� . � c�l�- y STA ZIP S
� CITY�� �
PHOAIE: �G> � SC��. -- Gd `% � � ���iYl`'% ° �% L°.� `° ��'�`J - �%��/�' —
CONTRACTOR N�: �
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE LICENSE ADDRESS: CITY STATE ZIP
WITH APPLICATION pg� F� —
PROPERTY TYPE INGLE FAMILYlNEW CONSTRUCITON SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYpE � �D�ON ❑ GARAC:FJCHFI� n �,,,.r,,..�v�
❑ DECK
�rE oF woxx:
FINISH ❑ ROOF ❑ DRAIN TILE
❑ SIDING ❑ OTF�R
❑ SWIMMING POOL
3•C,
I ❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: F t� 5� � Gr`5 ��y► en�
�SIZE�OF IMPROVEMENT�.� �t�Pd p�i"r�f LENGTH WIDTH HEIGHT Sq. Ft.
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
BASEMENT REMODELING SUBMIT•
1. Existing Floor Plan
2. Proposed floor pian
3. List of structural members to be used
SIDING FOR NEW CONSTRUCTTON MCLUDING DECKS,
0 V�Y� �Soffit ADDITIONS. & PORCHES SUBMII'•
❑ Aluminum ' O Trim l. Site PlanlSurvey showing the existing strvctures
❑ Other ❑ Fascia and proposed project
WINDOWS 2. Two sets ofconstruction plans
IN EXISTING OPENINGS DY�s ONo LOCATION OF WINDOWS 3• Energ,y Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ � e� � OCCUPANCY TYPE
Permit Fee $ `�17� o�� See Back Page for Fee Schedule
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
�3 � a% 65% of Building Permit Fee
,3•J�� .001 times the total job valuation
$ 1,�� .0005 x Permit Valuation Minimum $.SQ
$ $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
� �. �_ Make checks payable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construcrion Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work wh�ch rec�ires review and approval of plans. �
SIGNATURE OF APPLICANT
� .-� - o �
.. �_ .
Page 2- Building Residential Application
BUILDING PERNIIT 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 pexrnit of fees to the amount herein below set forth and in t17e 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
a11ow for proper review of proposed structure and of the construction site.
A Certifica.te 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
Fax: 763-502-4977
--------,,
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Building PLUMBING Permit rio.:a -�• �,�
Inspections RESIDENTIA,L APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date � M AY 2.�< 2 ��
DATE �� /�/ '� YOUR E-MAIL ADDRESS
SITE ADDRESS ��? �� / C ,C,��, / �� r' ,�//�=
THIS APPLICANT IS: I�WNER �CONTRACTOR
PROPERTY NAtv�E: —'� �U �II,��e't �"
E�� ,�nD�ss: C-��� / C�, f b�' /t✓ �' crrx STATE� �1 ZIl'�� 3
PHONE����2 —��'7�
CONTRACTOR N,r�g: f� ,r`��.,�
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE ADDRESS: CITY STATE ZIP
LICENSE WITH pHONE FAX
APPLICATION
PERMTT TYPE '=' �l'JGLE FAMILY ❑ TWO FAMILY � TOWNHOUSE
TYPE OF WORK: ... "EW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK !� �_ � v� C� —�� -� ���,,
�
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 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVi�
� BATH SINK%LAV FLQOR DRAINS 1 SHOWER WATER PIPING
• BATHTUB GAS PIPING �nr�c�rrrrc�sE) SWIMMING POOL WATER SOFINER ($35) ,
_CLQTHES WASHER KITCHEN SINK � WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER O'I'HER
, . ., ,
� �.
��___... �:� _� :._ . `~ �,::. _ . .', °_' '� ; � ..` � '�: ' �'�;� �� ; � a
5
Permit Fee $���j Number of fixtures @$10.00 x$10.00 =$
Surchaz e .50 Number of fi�ctures @$15.00 x$15.00 =$
TOTAL DUE $��.� Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of al work v�hich requires review and approval of plans.
SIGNATURE OF APPLICANT �'G PRINT NAME � � �� ✓`��" ` � DATE �/o�I U �
fi, . �. _ �� �
.
�>�: ¢�' ', � , `� a; �:` �� s� � � r za'
.
.
.� ._ o_'� ., ..w �. � , r"
`e
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building MECHANICAL Permit lvo.: � �e�
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY ��a'�11 N 1 7
DATE ���� % YOUR E-MAIL ADDRESS
SITE ADDRESS 6 C�� � �1� ,� l JY /1/�
THIS APPLICANT IS: �WNER OCONTRACTOR
PROPERTY N�: ' .�' U 1�1 '—
OWNER/ q�DRESS: E��l�/ �af17� D� �� CITY P STATFMv�ZIP 5543
TENANT
PHONE: �_ � � �Gj'
CONTRACTOR COA�I?PANY NAME:
SUBMIT A COPY OF CONTACT PERSON:
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ,�DRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE ���GLE FAMILY 0 TWO FAMll,Y ❑ TOWNHOUSE
TYPE OF WORK• "" '""W � REPLACEMENT ❑ ALTERATION/REMODEL
�c..ya rp7
DETAILED DESCRIPTION OF WO t�1 � � CL�i_ (i'
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 =
FOR PR�JECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
Eguipment Installed MFG: MODEL: SIZE/BT[J
MFG: MODEL: SIZEJBTU
MFG: MODEL: SIZEBTU
_A/C $25.00 FtREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 F(REPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
_BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.Q0
DUCT WORK $10.00 GAS PIPiNG $10.00 VENTILATOR $15.00
, .,...�. ,.
;; � ` ; ° ; ` � `'s�, .=� � . �. ; �� � �
;:�g� ; � ��� � �
�:
Permit Fee $�, c Number of fixtures @$10.00 x$10.00 =$
Surcharge .50 Number of fixtures @$ I 5.00 x$15.00 =$
TOTAL DUE $ ��. �� Number of fixtures @ $25.00 x $25.00 = $
� Number of fi�ctures @ $35.00 x $35.00 = $
State Surchazge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all ork w'ch requires review a.nd approval of plans.
SIGNATURE OF APPLICANT � � PRINT NAME ��� dl�DATE � T%
�_,� ��� ' � � ` 3 � M� �....�, ' � ,.�� , - �� �G.�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
- REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS 0 EXISTING HOME ❑ MAKE-UP AIR
REQUIItED 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 Cha.pter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Cha.pter 8 with MN A.mendments
REQUIRED 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.