AF - 37079N° 158
Village �f Fani�iley, l�inn.
�'� �� 1�1 :I� 1� � '���i.�� 1� y
Office of �i�PEC�OR OF BYJII.IDINGS
Lot Block Additfon or Sub-Dfviefoa
�ri . 6. � .. � 18�
of Lot - —
DESCP.IP�'ION O B�T'I'LDING
�. �� _
l�ron +� epth� Height 8toriea Manner of Construction�.� ��'+�+'y�.-- �
� � ��' ,r/ � �
To be aed ��� To �e completed � Es�imated Cost . .�
� � li a - - . , _ � �*. E�?'• �' � � � .' � _ _ .� �- �
�
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Permit is hereby granted to • +°�` i � —,�' +'�r�" T,� �_ �.., v .�� � ...-� —
,•
the building � aRF�I�"'�. `� a,," 0d�eacribed fn the above statement. This permii fa granted
upon the expreas condition that th��peraon f.0 whom it is gr9,nted, anfl hie agents, emPloyees and worinnen, in a11
the work done in, axoimd and upon said building, or`any'part thereof, sI�a11 conform in all respects to the ordi-
nances of Fridley, Minn„ regarding tlie coastructfon, al�eration, maintenance, repa,ir and moving of buildings
withia fihe city limite, a,iid this permit may be revoked ai a,ny time uponFViolation of a.nq of the provieions of said
ordinances.
ctor of Buildings.
AGR �EE1Vd�N'� Al`dD SQVORN STATEMENT - _ -_
In consideration._ of the isaue aaad delivery to me 1oy the Inspectar of �uildin�s of Fri.dley. of
the above permit, I'hereby agree to do the progosed work in accordance with f.he description
above set forth and according to the proviaions of� the orclana.nce� of Fridley, a,�d, beixig first duly
sworn, I hereby atate and say that the facts statec� by me and contained in the above permit are
true as therein stated. ;�,� � j,�
Subscribed and sworn to befare me at Fridley,
day o£ �'�'�,: � A.D. 19.��'.
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City of Fridley, Minn. � 11T° 8086
BUILDING PERMIT
dulg 1, 1965
Date:
B. �d. Porter
�r: 687� Channel Road N. E. �� Harve� Peterson
�� 687o channel �toaa D1. E. A� 151 Glen. creek Hoaa
LOCATION OF BUILDING
No. fi$?0 Street ��el R08.d N. E. Part of Lot
I�ot Bl�k Ad�Iition or Sub-Divlsion
Coraer Lot Inside I�t 5etback Sideyard
Sewer IIevat4on ____ Fo�mdation IIevatton
DESCRIPTION OF BUILDING
To be Used as:
Front I�pth Height 5q. Fk C.u. Ft
Fnont Depth I�eight Sq. Fk Gti. F't
Type of Construcd[on F�t. Coat �7 ��U0.00 To be Completed
Storm c�amage repair
In ca�sideration oP the iesuaacae to me of a permit to constru buflding
the propoeed work in accordance with the dr�scrlption above set f aad in co
orclinan�es of the dty oP Fridley.
M.
I agree to do
provlafons of
Ia caa,aideration of the payment of a fee of 1$�� ,v �t f�� e�reUY �anted to Harvey Peterson
to conal.ruct the buflding or addition as descrlbed above. This �ermit is gi�anteci upon
the express condition that the perafln to whom it is granLed and hfs agents, employees and workmen, in all work
dame fn, ara�md and upon eaid build9ng, or anypart thereo� staall oonform in aII reapecta tfl the ordirianc� oP
Fridley, Minneaota locatton, conatruc�n, alteration, maintenRnce. repair and moving oP bufldinge
wittiia the dty limiffi�3a�� permit may be revok¢d at any �ime upa�► violation of aay oY the provieions of said
ordiaancea.
A11en Jeneen ��s �
NOTiC�
1Ys pumH doa aef es+r� ths �, ��► '�0. P�m9• ia� M�, �enne or water. B� sun to u�
da Bupdiq In�etor tar aparaf� p�r�hs hr th�a I�.
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APPLICATION FOR �UILDING PERMIT:
. CI7'Y OF. FRIbLEY� MINNESpTA
OtdNEB'S NAME S, �. P�rter gp�g,R Flarvey l�te�rson
ADDRESB �70 Qha�nel Road �T.�•. ADDRESS. 1,�. Glen, Creek Road
� LOCATIOPT OF $LTILDING
�o� b870 Channel Road N.E. Street •�art �of LoC
Lot' .�Block . � Addit3ot� or Subdivision �
Corner Lot 'Ias�.de Lot � `� Setback Bide�Yard .
�_
SEWER II,EVATION FOiINDATION ELEVATION '
Applicant attach to thia foYm Two Certificates of Survey of.Lot and pr:opased build- �
iag lacatiou drawn.oa the�e Certificate�. •- '
DESCRIPTIOAT OF BOILDING " ' I
d . � � d-°�-�' .�.�"``' � . � �%� '
To be use as . %�%- �o�e , � ��i.��-�-'-Y . I
l"
° . , � . Frorit. Depth Heigh�t •
._ Sq: Ft:. . . ` Cu . I�t . �
. . �.
Front �� � D�pth �Aeight
� Sq. Ft. � Cu, Ft. .
, ' _ I .
�
Type of Coastructiton � Estimated. Cost �O �.0 �
To be Completed
The unders3gaed hereby makes application Eor a peranit fo� the work herein.�pecified,
agreeing to do all work in strict accordaace with the City of Fridley Ordinances and
rulings af the Department of Buildings, and hereby declares that.;a�.l,tbe facta and
representationa etated in this applicatioa are e and correct..
DATE SIGNATURE `
�(Schedule of Fee Coste caa be found on the Reverse Side).
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City of Fridley, Minn. N° 8227
BUILDING PERMIT
nate: J� 19, 1965
ovener: 3RI�N �. 1'ORTER g�� S1�ME
aaar�ess _ �?o c�ANNEL �to�'1 aaa�
Fridle�, Minnesota
LOCATION OF BUILDING
No 6870 str�t � ROAD Part of Lot _
� �� Addition or Sub-Division
� � — In�ide Lot Setback Sideyard
Se�ver IIevatton
Fo�mdation IIevai3on
DESCRIPTION OF BUILDING
To be vsed as:
D. Garage �t 2!� �� 2�. H��t 14 �. � 576 �� 5�760
P�.-cio �t lo �P�y, 24 xe�ght 10 sq. Ft. 2lt� �� 2'�.00
Type of Construct3on FP2me ���i2sQ00�00 _ To be Completed
DE`TACIiED GA�GE .AND F�.TIO
Ia canstderation of the issuance to me of a permft to conatruct the buildiu descrlbed above I agree to do
� P�P�d work in accordance with the drescription above set fo ce with afl provIsffons oP
ordinances of the cttq oP Frldley. % v
� •�
In caa�ideratton oP the paymeat of a Pee of � 8•00 , permit fs hereby granted to �� �. PORTa�
to construct the building or addition as described above. Thia permit ia gran'te8 upon
the exPress condition that thepe�on to whom it fs �anted aad his agents, employees anfi worl�en, ffi aII work
done fn, around and upon eaid huilding, or enY part thereo� shall coffiorm fn all reapects to the ordinance� of
��d�limits�ti��is location, constructCon, alteration, maintenance, repa3r and moviug of bufldings
tY P�t may be revoked at any time upon violation oP any of the provi�ttona of satd
_ �.i�EN G. J�TSII+J g�� ��
� NOTIC�
'lids peem8 doa � eewr tla eoe�nteflen, tnua�� hr �rideg, plum6tee, oq
���� �� ��P�+ti P� for tha� if�a. �s� awu er �ralfr. B� wra to a�
�
AFPLiCATI016 FOB $UILDII�G PERMIT
CI9'Y OF FRIDLEY, MINNESOTA
OWi+�R' S NA1�II: �� ; A'�� r � f � p� , � �,f�:� � ,�' _,� ' Bit'ILDEB
ADDRESS,,,%`��i/'i��/�./�%F,ti 9� 0 �T- %� �iDDBLSS
LOCATI�N OF BUILnING
�. �
No. �" F` i L� Street ��.�� �f. ,���- ^.���?. Part of Lot
L�T R ADDITION OR SUBDIPtSION
�.�, �
Corner Lot�_Inside LaT Setb�ck ,'� � rF,-F>> Side�Yard 'T
SL+'6�1ER ELEVATION � FOUh't�ATIOR �LEV�TiON �
Applicant attach to this fo�m Two Certificates of Survey of I,ot end propoeed
< bu3lding location drawn on these Cestificatea.
DESCRIPTION OF HIIILDI�TG
used as;
ls� a ,� ��— � Front ��. / �ept�` � � fle3ght � ��
s . 6�
� Sq. Ft. .� � � Cu. Ft. � � �%y°� /P)
� ��� ,� . d
�- . � ,�_ � � � Front , i � II�epth � � Height .� �°'�
�� .
3q. Ft. � � `�' `* , �' , ' .
';� f. Cu. Ft . -�- - �- - ! .�
.�.� � ��.
?ype of �Conetruction ��__�%���� � Estimated Cost � ��`�� °
�
To be co�pieted
'�he undereigned hereby makes appiication for• a permit for the work herein apecifierl,
agreeiag to do all work in etrict accordance with the City of Fridley Ordinances
and rulings of the Department of Buildings, and hereby declares that a11 the facts
aad repreeeoatationa stated in this application are true and correct.
H �ll _,�_ � f � �l % � j�
� --- -_ /,� � SIGNATORE u` - � _ � r � e �. �
(Schedule of Fee Coste can be found on the Reverse Side).
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BU�D� PER�T �_. SCBEDW'.E �
SECTION_2. The Inepector.of Buildings ehall� before issuiug anp �rmit for the
erectioa of any building or strucCure, or for any addition to any existing build-
ing or structure, or for any alterations or repaira to anq esiatin� buildin$ or
structure, upon application therefore, require the papmeat bq the applicant for
such permi"t of fees to the amount herein below seC forth and in ttie;maanet hes'eia�_.
provided to-wit; . , _
2.1. For anq such permit for the erection of any fire-praof building,
other than a garege, warehouse,.factory.or grain elevator, or for the erection
of any fire-proof additiou, for simil�r occupancy, to any existiag building,
shall be at the rate of $1.40 �or each one thousand cubic feet, or fraction
thereof, in auch cubical aontenta. ° �
`�2.�2. For any"such permit for the erection�of any fire-proof garage,
warehouse, ��ctory ox grain elevator, o� for the erection of any fire-proof �
add3t3on, fo� aimilar occupancy, to any existing buildin� shall be at the sate
of $1.25 for each one thousand cubic feet, claseified as "f�reproof" by
S�ctioff 502�oi��ehe Minneapolis Building Code. "
SOIISES � , , � � . . � � ,. . � . • - �
a_ For any such permiC-for the erectioa of any non•fireproof bnilding,
other thaa a garage, warehouse, factory or grain elevator, or aay nau-fireproof
additioa, for aimilar occupancy, to aay exi�ting building - permit $1,00 for�each ;
one thousaad cubic feet.
GARAGLS -._ � ' ._ _ � .. , . _ . �_ ._._
� 2�_ For any auch permit'�for the erection of any non-fireproof garege,
warehouse, fact,or� or grain elevator, or for the ereceion of any non-fireproof
addition;�for s3milar occupancy, to aay eiiistiag buildirig oY for each�such �
buildia� or add3tion - ninety cents ($0.,90� for;each one thousand cubic feet
or •fraction the�*�of, � in the cub�ical� contents 'thereof with the miaimum of $4.00.
, .. ,.
For�the purpose of computing fees for building permits, the culiical contents
of any building or addition to a uniform height throughout by multiplyiag the
graund area tovereit from a point six (b)�inches lielow the floor line of the
basement or cellar to the average height of the upper surface or to the average
height of the roo� su,r�ace of the maia gable ,of a pitchad �roof. � . - �
2.5�.� For�r,egaire or alteratians to an existing struaCure, th�:fee sha11.
be a he rate of.,�3.00 per each Five.Iiundred Dollars (.$500.00} or fractioa �
thereof in the c�et of all proposed work.
2.6. In no case aha11 the fee charged for any permit aa set farth in
Section 2 be laea than $4.00. � �� �
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. HOUSE HEATING TEST RECORD
ADDRESS ���� ��`q°"�� I �� APT. FLOOR CITY �°�SUBURB
OCCUPANT - �' � ������ e'�° �' OWNER
HEAT LOSS DATE HTG. INST. ��—�d �?
SOLD BY ��� �t9�,. �l��. INSTALLED BY �V''�
Eleetrical Work By Gas Line By
TYPE OF HEAT GA FA �HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE �-�"'�%r MAKE OF RBU� NER _
Model � � �s �L� ��°"m% Model �
Seria) ,'�'�� �Z�'�`�� Max. BTU Rating —
(NPUT����� MAKE OF FURNACE
Model
CONTROLS � �
THERMOSTAT �� � Hear Plug Vent S;ze `:%
Valva ���• (�o�e'��•�-� ��������—�� KIND OF LINER �
Llmit �� �/� ��� �� �/�� Droh Hood Regularor �r --,��-.��►°�'
Limit Setting 0`���� Fi Iters Size ��a'��'''0 Number �• ���
Fan SeNing °� _ Chimney Loeation Inside � Outside
Pilot Type ����"'`� °� Chimney Construetion - - �%�,�,1�i �'- �^w�+a�-�--
Pilot Make ��°��' ��-�
Pilot Model �a��'���� Smoke Bomb '� Wiring --
Pilot Timing ���' Draft �-�� Test Tag �� Ut*+�`
L.W. Cut Off Door Pressure Lighting Inst. ��� U�fo�
Prossure '�a,��P ��� Percent CO2 �:��� Date Tested � °��
Input CFH 7� Pereent 0 Company Testing �Q �'
Staek Temp. 36�a� Pereent COZ �/9�� Name of Tester �� �'
Form 235 ' `
CONVERSION
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE V ' � �
SITE ADDRESS �
THIS APPLICANT IS:
I�ITIL'DING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09
YOUR E-MA1L ADDRESS �'
� OWNER ❑CONTRACTOR
PROPERTY OWNER/ N�: �ZQ d Q,, Noa e�s� b�
TENANT pDDRESS:__- G��� C�►� n w c.� Q.o a�.P CTfY
PHONE: ��3 �"t I - /��y �
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTffICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
�i
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING -
NUMBER OF SQUARES _
STATE LICENSE
EXP DATE
ADDRESS: CITY,
PHONE FAX
� SINGLE FAMILYMEW CONSTRUCTION SIZE_
❑ TWO FAMILY/NEW CONSTRUCITON STORII
❑ ADDI1'I�N ❑ GARAGE/SHED O WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SW[MMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR �REMODELING
c�.v��� �t�T�►� , G�t �x,�rb�.� . ; �sr�.lr n.
LENGTH q /�'F WIDTH g
❑ HOUSE ONLY
❑ HOUSE & GARAGE
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING— — __ _ --- – - --- -
O Vinyl
❑ Aluminum
❑ Other
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
HEIGHT
Permit No.: � I J�.3
Received By:
Date Rec'd: -- —�.i�
ATF%��i1� ZIP SSy.�2
STATE ZIP
�-.,e,-�,i� ��1 �G��,a ��,
BASEIvIENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. Lis[ of structural members to be used
_____ _ ___ _ FO_R_NEW CONSTRU_CTION INCLUDING DECKS,
OSoffit ADDITIONS. & PORCHES SUBMIT:
❑ Trim 1• Site Plan/Survey showing the existing structures
0 Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS OYes �No LOCATION OF WiNDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENMG CHANGES 8c
TYPE OF,WAiDOW 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 $ c�_�S�' OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ o_ �S
$
$ �. SZ�
$ , �oZ�
�
$
$
$
$
$ � A
See Back Page for Fee Schedule
65% of Building Pertnit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks aavable to: Citv of Fridlev Attach
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 on site; that the work will be in accordance with the
approved plan in the case of Il work which requires review and approval of plans.
SIGNATURE OF APPLICANT _� �� � PRINT NAME � C � . � � ,. DATE I � `��° �
Page 2- Building Residential Application
BUILDING PERMIT 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 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1� $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each addirional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
• fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the ls` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Pemuts 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 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 Deparhnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATE �Q�a-_O
SITE ADDRESS G�
THIS APPLICANT tS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE, BOND AND
CERTIFICATE OF
MSURANCE
PERMIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS r
�+OWNER �CONTRACTOR
64tr �opQpSo�1
S: 6 �70 ��aan....�
?G3 Sif - ��N7 T
STATE L(CENSE #
STATE BOND tl
CITY
ADDRESS: CITY
PHONE _ FAX
�SINGLE FAMILY
❑ NEW
❑ TWQ FAMILY
� REPLACEMENT
❑ TOWNHOUSE
EXP DATE
EXP DATE
Permit No.!1,�'t -o t �3�
Received By:— !�
Date Rec' d: 1� � —�
ATE�ZIP SS�3 i
ATE ZTP,
DETAILED DESCWPTION OF WORK ���,., �� c,( ��.���6s yp� Q� f e,� sfe � A� i�5''�,� � n a W I�s,� ��� �
f o,� I�t, s:h /� ��ti a,..� r•1�
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED.
5.50.
BATH SINK/LAV FLOOR DRAINS
BATHTUB GAS PIPING (NEED C1TY LIC)
_ CLOTHES �YASHER KITCHEN S1NK
_ DISHWASHER _ LAUNDRY TRAY
FIXTURES: (INDICATE TOTAL NUMBER•OF EACH BELOW). MINIMUM FEE
SHOWER
SWIMMING POOL
� WATER CLOSET
WATER HEATER ($35)
_ WATER METER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED
_ WATER PIPING
= WATER SOFTNER ($�
BACKFLOW PREV.(($1 )
FOR IRRIGATION ��
_ OTHER
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 oniy an application for a permit and work is not to start without a permit on site; that the work will be in accordanee
with the approved plan in the ase of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT � PRINT NAME ��' � y�.� DATE O`�� ��'
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE IU—L_ 0
SITE ADDRESS I
THIS APPLICANf IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
� ��i1r�v1c.1 I�+►o
�OWNER ❑CONTRACTOR
NAME: c„r Q• � �.
ADDRESS: 6� 7 8 �.�nc. nw �� �w e
PHONE: [ �3 Si � � J�.'/ %
COMPANY NAME:
CONTACT PERSON:
STATE LICENSE #
EXP DATE
a,nn�ss: cr�
PHONE
� SINGLE FAMILY ❑ TWO FAMILY
� NEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK
FAX
� TOWNHOUSE
O ALTERATION/REMODEL
Permit No.:�
Received By:�_
Date Rec' d: �" �
TE/�A� ZIP SSS/32
ATE ZIP
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZEBTU
,vc $zs.00
AIR TO AIR EXCHANGEER $IS
BOILER $35.00
CHIMNEY LINER $10.00
DUCT WORK $10.00
MFG: MODEL:
MFG: MODEL:
FIREPLACE (GAS) $I5.00
_FIREPLACE (WOOD) $35.00
_FURNACE $35.00
GAS DRYER $10.00
GAS PIPING $10.00
SIZE/BTU
SIZElB1'U
_GAS RANGElOVEN $10.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
POOL HEATER $35.00
�E�1G'FILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 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 Il work which requires review and approval of plans. �
SIGNATURE OF APPLICANT PRINT NAME �� 9 � r I/. I� 6 ae n,s �., DATE � 6° 2-O�j
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
� NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REOUIRED 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 Cha.pter 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 Manua.l D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
Building
Inspections
763-572-3604
763-502-4977 FAX
1•7vr�1�
srrE,�nnx�ss b�°lC
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERNIIT TYPE
BUILDING
RESIDENTIAL AP�LICATION
CITY OF FRIDLEY
�r�cTtvE �-�.ao�o
YOUR E-MAII, ADDRESS
.� OWNER OCONTRACTOR
ADDRESS:_��i�18 �CL.�,n�••) I�Od.�i CITY
PHONE: �� S� � �%�y-%
STATE LICENSE #
ADDRESS:
� SINGLE FAMII.Y/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
O BASII�IEATT FINISH ❑ ROOF
0 DECK ❑ SIDING
O SWIMM
SIZE
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCFJREPAIR f� REMODELING
DESCRIBE WORK BIING DONE: � 6 ro� �A/',►.
SIZE OF IMPROVEMIIdT LENGTH WID'('H
� G ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
GARAGES
PROFOSED SIZE:
PROPOSED HEIGHT:
❑ ATTACHED GARAGE
O DETACHED GARAGE
n,
EXP DATE
❑ DRAIN TILE
❑ OTHER
Permit No.
Received By:
7'E�ZIP.
STATE ZIP
!ii
BASEIv1ENT REMODELING SUBMIT
1. Existing Floor Plan
2., Proposed floor plan
3. List of structural members W be used
SIDING FOR NEW CONSTRUCT[ON INCLUDING DECKS,
� V�Y� ❑Soffit ADDI1'IONS_ & PORCHES SUBMIT•
����� ❑ Trim 1• Site Plan/Survey showing the existing structures
❑ �� ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Eneergy Calculadons
IN EXISTfNG OPININGS �9Yes ONo LOCA1'IO�(OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF R�,T 6�rcio �• �M o,:t, �Ioa �^ MANUFACTURE S1ICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLID NUMBER OF WlNDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION $� U0� od G __ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$
$
$
$
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
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 on site; that the work will be in accordance with the
approved plan in the case of wor ic r quires review and approval of plans.
SIGNATUREOF APPLICANT PRINTNAME IL9A c,T I��02tn�o�-. DATE S�-%b
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 tlie 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1� $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�$2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1ffi $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1� $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1� $500,000 plus $4.75 for each additional $1,000 or
fraction W and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1� $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for constcuction 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
Fax: 763-502-4977