AF - 38014,�
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Ca.ty of Fridley, Minn. I,T° 9 816
BUILDING PERMIT
Date: July 2 1968
p�r• Somedale Blders . Builder .���P
Ade�s� 5217 Wayzata B1vd. �,g�.e� Same
��/��, LOCATION OF BUILDING
No. ....._:�.�. Street Co�certo C��y�, .�... part of Lot
Lot 8 _ Block 2 — Addition or Sub-Division ..� M�lody Manor 3rd
Coraer Lot ._ Inaide Lot � X Setback .�.3.�. �__—_ Sideyard w 5' �14 �
Sewer Elevation 880.12 8 3.12
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
D�aelling �t � 46' Depth 24 28 Height �' Sq. Ft 115.2_ Cu. Ft .�23,040
Gara e F'ront _._..1� Depth 24' xe3�t .�..Q' Sq. F't. �SS.._ Cu. Ft _._.._�60
Z�pe of Construction � Frame F�t. Cost �.�1.2,QQS��__.._ To be Completed —_n�- �; 1 Ahg
^ SEWER LOC�iTION' 16' West of Manhole
WATER LOCATION - 6' West of Ma.nhole
�
In conaideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above sex forth and in compliance wlth afl prov�iafons oP
ordinances of the dty of F'ridleY• �� �; �� � G .,a
43.00 Homedale �lders. '
In consideration of the payment of a fee oP $ , permit fa hereby granted to
to construct the buflding or addition as described above. Thispe rmit is grantsd upoa
the express condil3on that the persfln to whom ft ia granted and lus agents, employees and worl�en, in all work
done in, around and upon seid building, or any part thereof, shall conform in all reapecta to the ordinanc�s oP
Fridley, Minnesota regardfig locat3on, conatruction, alteration, maintenance, repair and moving of buildln�s
within the dty limits aad this peranit may be revoked at aqy time upon violation oE aay of the provi�lona of eatd
ordinances. �
�
Butltlin8 Inepectflr
Clarence Bel e
NOTICE:
i�s psrmh d� not eorsr �6s eo�trnefioe, testallallon tor wirtne, plumbine, ea h�aNeg, arrar er water. B� am to ae
Nw Bnildiu0 lospeator for aaparats parm� hr t6ess tt�u.
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�r�zce�TteN FoR Hun��vc P�s
.. ,,., . . .. -; : � �
CIT`Y OF �R.IDLEY, I�I'ir1�TESOTA �
OWNES'S 1�A1��:,' ..� ' . :t . �, . Y-BUILI2ER .'
A�?DREBS�;,_:.:, � ' , . .. . ' - . . . .�DDI�,ESS� ��� ��� - - ��
, . : ., , .� _,. -.�.
. I:�i.�'ON �F SV1[�'liJING ` � . , ::�: .
NO.����STREET_��_�����—�—�.Z��l'� � .
' �' ��
... , . � • .
� L�T ���� "�� BLOCK•. �� ; ' ADDITION O�.i. ��II8Di�8I'DN , � '
�_ ��
: .a_., _ : � � - � � � _ -
�,;:,
COR�d�B LOT INSIDE LOT��SETBACK� �► � SIDEYAI3D • �
�. -.�.�. � - / %
SEWER ET�L'V.��'ION� �l �•/ 2. TOP OF FOOT�NG ��3 _[�� „
�. // �,2y �i
�� cent aCt�Ch � to•�Chi�form �'ro �exE� icate� :��f Svrvep of �Lo�,.,aad- proposed
building-°locatiori�'diawa�on t1��s GerCi�,�'�cates� ., . ' • ,. • ,'. .
�a� � �' �• � ��. �_ . . .. . . . � � '�. .
, DESCRIPTIt?N OF':�;'iTtLDING � , . .
. � .. � ��: . ...
To Be Usad Ass
. ��1� ..:i:i:..;i�.. • •i.!•�c f� ' ' � ' . f►.�w*1�� �+
. ,� �y [�
, . ��, . -. . 'S uare �feet �� ``�� ' � Cubic Feet -1- ,'� -�
, t . 4 , "� ' De �th .::: , � Sei ht �
. � >. 1�rint �. _ ! t
. Square feet��'� Cub,i,s�• FeeC �
;, , •.;•r . �
Type of Conetruction EstimaCed Cost � d
���%
�.
To Be
The unders3gned hezeby makea appiicatioa #or a permit for the �ork hereia
specified, agreeing to do all �ork in strict accordance with the Citg af
Fridley Ordinances and rul3n�s of the Depar�ent of Buildiugs, and herebq
declares that all the facts aad represeatatioae s�ated in thia applicatioa
are true and correct.
D�lTE _ ��, �_,� SIGNATURE _ �
(Schedule of Fee Costa can be found on the Sevesse Sid�).
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` $UII.DING PERMIT FEE SCHEDI3LE
. , SECTIQN 2_. _.The, TaopecCor of Buildinge _.shaZl,. before issuiag permfts for
the erection of +�ny building or structure, or for any addition to anq
existing et:ructure or'buiiciiri�,�or f�rYanq alteration or,rep�frs to any
existing building or atructure, upoti applicaCiots�.ltli:.re£e�e, requir.e., the
, the pay���C by the applicant for s�ch.permit' of ���es to the amount�liereia
below set forth and in the manner herin provided to-wit:
� • � _� • �
. '., , ' -
.__ IIaiform auildiA� Cod�s ... Tgpe 1., 2, .6 4- $1.75 for each one. thousand cubic
� feet, er £raction_thereof, in eucb cubical conteat�. Type 3 6 5-. $�,.50 for
. . eac� on�_ thou�aad cub3c - �e�E . • � •: ... . ... . . e .:�
. •. . � . .�. . � . . .. -. ,. .�.
... . • . � � � . . . �,.t
Fir the �ur�o`se ef cnmputiag fees for building permi�s, �tbe cubical
eontents ef any building or additioa t���`ii�3€orm hei-ght throughout by
multip�.ying the grounrl area covered frsm a po�.nt ais (6) .inches b.elow the floc.
line �f Che basement or the�cellar te the average he3ght' of��'he"upper surface
or te the avera$e height ef the ro�f surface of the main gable of a
pitc�h'ed �sRoof . . � ' � ..., . . . .. - � • . . .. .. ... .:
.- For re��ss or aLter�eions _to..an . e�tsting �'structute, . the fee $hall be at the
rate of $3.00 per eac6 five hundred doliara ($500.00) or fraction thereof
in �hg �cost mf ali pzo�o��+d .w�rk._ . '..; , , ...
. In,.no .ease� �s�il the fee _�ha.rged fc�r anq `perm3t_. as aet #-�rCh ia S�cticm 2 be
less thaa $S.AO.
�. ' . ' :. . , ��:'. . . ' � � � . . .
��� � NSSSD ��nneetion Charges based on locatien- Area 1 os 2.
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HOUSE HEATING TEST RECORD
ADDR@SS ���� ��— APT. F OR ITY U
OCCUPANT OWNER �-
Fi°�AT LOSS DATE HTG. INST. ^AS C0. METER BADGE
SOLD BY INSTALLED BY
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
� GAS SIGN ,�,��. CONVERSION
MAKE --��°����� L����� ►�qKE OF BURNER
Modsl � Model
Serial - �� � " Mox. BTU Rating
INPUT ��.l� ��°I MAKE OF FURNACE
Model ____
CONTROLS �
THERMOSTAT � at p��g Yent Size .� /�� a
���
Valve --� � KIND OF LINER E NONE
Limit � Drok Hood x„/°'� Rsgularo�
Limit Sefting -� Filfers Size Num
Fan Setting �-`�� ���� Q�imnsy Loeation Inside Outaide
Pilot Type Chtmney Const►uction
Pilot Make
Pilot Modal � Smoke Bomb �q Wiring �
Pilot Timing � ��� Draft G� Test Tag `�
L.W. Cut Off ��� Pressuro Lightinp InsT. ��
�� �
Preasura-- � � Psr Y,n�t C � �-`*�Dcte Teated ° �� �
(nput CFH _f�-�� Pq�6rff '�E��.� ;,� �mpany Testing
Staek Temp. �� Percent CO -f�'' e� Name of Tester ��
Form 235
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CHIMtJEY AN� 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 ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and
total BTU connected
6. Has Total hea ting BTU's of
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
Yes ( ) No ( )
Cam pa ny
Signed By
Da te
�
SUBJECT � , � '
c�ty of Fridley 2 J�0 3
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T -
�
� � `�- RE�E-FPTIVO.
� • COMMUNITY OEVELOPMENT DIV. �"' »
' j L ����� , �Q/ �
f � � PROTECTIVE INSPECTtON SEC.
1 ` �
� r���1 � CITY HALL FRIOLE� 85432 NUMBER REV OATE PAGE OF APPROVED BY
�.._.'�'' '•' 612-571-34b0 910-F15 9/15/97 / /
JOB ADDRESS 7436 Concerto Curve NE
t LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACNED
DESCR. S 2 Melody Manor 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP pNONE
Darrel Ritzema 7436 Concerto Curve NE 780-8401
3 CONTRACTOR MAIL ADDRESS 21P PMONE IICENSE NO
Sawyer Built HOmes 7091 Hwy 65 NE, Fridley, MN 55432 572-9442 20057629
4 ARCHITECT OR DESIGNEF MAIL ADORESS 21P PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW �J ADDITION ❑ ALTERATION ❑ REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Construct a 19` x I8' Addibon to Living Area
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Install smoke detectors to meet the State
�uilding Code.
WARHI��
Befnre diBQ+ng rail for
ail uti�ity tocations
�-�0�'
SLPARATE PERMITS R'EC�UIt�D fOR �EQ�1���� B� 'LAVI�
WIRtNG� HEATING� PLUMBING ANp giGNS
TYPEOFCONST. OCCUPANCY(3ROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
V6NTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED 12�292 �10.33
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GiiANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTHOfiITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PqOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. �299. 7S Fire C�LO. C)S
�� f/� S � PLAN CHECK FEE TOTAL F E
�, ��i. � � ��� /� ��� Li S$5. 0 335. 73
SIGNATURE O� C NTRAC70A OR AUTMOA D AGENT iDATE� N p j j L I D A T E O S I S ���
�_ . I
S�GNaTURE OF OWNEp i�F OWNEA BU�LDEA� iOATEi BIDG � P qaiE
NEW
ADDN
ALTER
tl
[1
ll
' CITY OF FRIDLEY
StNGLE FAMILy pND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICi�TION
Eff 've 1 / 1 /97 �
�i�
�
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ConstructionAddress: � � �3
. ��� ������� �
Legal Description:
Owner Name & Address: '/ Tel. �_��p.� ��fp%
Conttactor: � MN LICENSE # ,� pp ��' �'p�e�
Address: � S� � L Tel. #�"�� .. o� � I�
ttach to this applicati n, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEME\T'T' .
�n� �_ �I�� �� Height �
�n� Width Height
�n� Wid� Hgt/Ground
Sq- F�. � ��G�
Sq. Ft. s , �
Sq. Ft. �J�� �
Construction TyPe: ��c�,y� , ��� F.stimated Cost: $ ' e � �-� .
(Fee Schedule on Back)
Driveway Curb C�t .Width Needed: . Ft. �+ 6 Ft = Ft x.$ � -$
DATE: � -� � APPLICANT: Tel. #i�� .-� c�rc� �
'�,� G�i� �
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
:icense Surcharge
)riveway Escrow
jrosion Control
'ark Fee
�ewer Main Charge
TO'CA L
C(PUL,�'I'[ONS:
$ '. �
$ ,
�---�1�'-d -�—
$
$ �
$
$
$
$
� � `_ � � / .
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%) -
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt_ "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineerin�
Agreement Necessary [ ] Not NecessarS� [ ]
• �
«vi� u<<�c f�F it�r<<���.rFE scE{cuvE.t�.
"Clie Chief I3uilding Official shall, before issuing pern�its for the erectioi� c�f any building or structure, or li�r
any�addition to any existing buii�iing or structure, or for any aiteration or repair to any existinn building or
structure, upon application d�erefore, require the payment by the aQplicant for such permit of fees to the amount
herein belo�v set forth and in the manner herein provided to-�vit: �
TOTAL VALUE
$1 to $500
$501 to $2,000
�2,001 to $25,000
$25,001 to $50,000
$50, 001 to $100, 000
$104,001 to $500,000
$50�,001 to $1,000,000 �
$1,000,001 and -up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $5� plus $2.75 for each additional $100 or
fraction thereof, to and including $2,Ot?0
562.25 for first 52,000 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 $�0,000
$574.75 for fust $SO,OUO plus $6.25 for each additional
�1,000 or fraction thereof, to and including $1(}0,(�0
:$887.25 for firs�t $1�,OQ0 plus $5.00. for each addition�l
$l,��or fraction thereof,.to and including $SOO,OIXI
. $2887.�5 for .the �fiist $500,000 pius $4:25 for each .add.itional .
$1,OQ0 or_fraction�ther�f, to and including $�1,�,000 �
$5012.25 for rhe first $i,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION �SCROW
(Concnete Giirb Streets Only)
Alternate "A"•: Removal and replacement of curb and gutter on�y - Drive�vay width plus 6 feet times $13:50. .
Atternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach� with b inch depth - Drivewaywidth plus 6 feet times $15.75.
VERIF[CATION OF FOUNDATION
'cr�liits for coizstruction will be issued a minimu�n of 24 hours from the timc of application to allow �or pro��r
c�� ie«� of the proposed st�ucture and of the construction site_
���e[-lifiCale o�� Survev c�f� thc lot, sllowin�* the location of�tl�c foundation �+��ce it has ii has hc:�n c�nsiructi:c{
:: i�_ r�c�uirui 1��1i,r� r�r�r_:�.�ciin�� u•itii t}�e fr:�mi���_
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l'lvi� fr,�l�ic,97/Ci0(7� ' _ .fi�71P%Q�D�b
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CO�CE-R�0 CURVE
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� �ENOTES IRON"—"-p�N07ES DRAINAGE ANO l?TIL.ITY EASEM�N?
LOT $__$LpCK 2� M�L.00Y MANOR 3RD Aoo�T�o�v
A1�►OKA t T7
� here&� :e�Pf�y th�t this �s a h-ue a�rd r�tf r-e�serrt,�frru� Q`'o scrwey �'ihe �rr�s � dbam of�u,►�d lraz8, �rar�
� �"� /�o ��n r�%�f1 t�al�mr�s , i1,�r�� , �Qi/ ,�sibde u�owLhrn�.ris , �l'rs� , fnvn ar nn sa� larncl. As s�st-��ed � m� fl.�s �" _ ',�
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EX'i'ERIOft �NU�LOD� AUERR�i� "U" COMpUtATIQN
COMTRRCTOR: �Sd���,o�__ _���� DATE a � PHQNE: ,�,�� � , ,�-
D@TfiRMINE MCttK2N4 �t�tlAlt� ROOTAO� OF EACHt
1. TOTAI �XPOSlD MALI AREAt �°�% sq. tt. A"iJ" .� i�� • �3 �
P. TOTAL RQOi/CEI�IM3 RRERt 'i ;`�`"� sq. t`�. x"U" ..OP6 • �'i
�J. TQTAI. �Xp��l� YAtL AREA CALCt1LATIQNSt
Total •�pos�d w�Il ��
•r�e abow tloor�-��-.� �q. tt.
a) Tdtal M�11 Nindow a�e�a�
xns�tl�ted Gl�ss gla:�d 2 t� � sq. tt. x"U" ��,.��
�o� � O�ass qlaxe� etq. tt. x "U" �„3 = • _�
bf Tata! daor xr�ea �� v l sq. ft. x"ll" �12�� s , 2�
ci Tntsl slidin� glass door aru�t
In�ui���d Giiss �1a:�d � sq. ft. x"u" �.�,,,, •��
�ew � Olas4 � laz� � sq. t�. x"U" �,�, *�,,,,,
d) te�al rir�pl�ce Mall are�t� � sq. tt. x"U" �,�a9• _� �,,,,�
e) Total Yal! FraMing area► 1�
�Average 10x) �v�' sq. tt. x "U" ,,.o9iw• �„�, �„�°�
�) Totai Net ii4i1 arca abave
TAiiO* �iRSUiiti�i ��� �q• ��• x ~Up_,�Oa3�� w
�) Tolal Rt■ joist �res e� 'sq. tt. x"t1" •�,,,�y.— � ��
Tetal found�►tio� �r�a '
t�:pee�d� �� sq. �t.
. �
h) To��l Foundation �
N�ndo+r aMa aq. tt. x"U" �3_ *..�.,,....�,.
i) Totai F1�4 �'aurd.�ion �
a*��► abOw o*�d• �F� � +�q. tt. x"U" �.Q�, . D,
. . �oTia. .i tiir:� i i i ' �� s�(f ..
I� itl�s �3 i� the saMe as� ar lr�s ihan it�r �I1, rou h�v� a�rt
th�t �rtettt ei 8.8. C. S�rtio++ 6006 t�? L'�
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CITY OF FRIDLEY
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX: (763) 571-1287
PERMI�' T�O.: 2004-00818� '
DATE ISSUED: 06/02/2004
ADDRESS : 7436 CONCERTO CRV NE
PIN : 113024130068
LEGAL DESC : MELODY MANOR 3RD ADD
: LOT 8 BLOCK 2
PERMIT TYPE : BUII.,DING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING
VALUATION : $ 2,778.00
NOTE: UNDERLAYMENT AS PER STATE BUII.,DING CODE. REROOF HOUSE & GARAGE (24 SQ) TEAR-OFF
STATE LICENSED CONTRACTOR 1
APPLICANT
D & B HOME IlVIPROVE (7773)
4901 105 LANE NE
CIRCLE PINES, MN 55014
OWNER
RITZEMA DARRELL E& KATHI,EEN M
7436 CONCERTO CRV NE
FRIDLEY, MN 55432
BUILDING PERMIT FEE
FIRE SURCHARGE
STATESURCHARGE,VALUE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 5187
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and laiow the sa.me to be true and correct. All
provisions of laws and ordinances goveming this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the prraNisions ofanv othex s�te or local law
Bldg
Date
CRPAR ATR PRRMTTC RF(1TTTRFTI F(1R W(l� �l'iXi7:R TN�AT T1FC!'RTRRTI ARf1VR
�
83.25
2.78
139
5.00
92.42
NEW
ADDN
ALTER
�� CITY OF FRIDLEY �� �0�3 Effectnre 4/1/2004
�] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Constru�tion Address:
Legal Description:
Owner Name & A�
Contractor.
LMNG.AREA:
GARAGE AREA:
DECK AREA:
QTHER:
Construction TyI
��
Tel. #
MN LICENSE #
�Tel. # ` � �
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
HgUGround
Sq. Ft
Driveway Curb Cut Width Needed: Ft + 6 Ft =
�'
DATE: �P�—� APPLICANT:
�
�
Tel. # � ��� ��
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$
��� ��f Fee Schedule on Reverse Side
$ 65% of Permit Fee
$ . ?� .001 of Permit Valuation (1/10th%)
$ , $.50/$1,000 Valuation
$ $1350 per SAC Unit
,$ � �� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ o�. STIPULATIONS:
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 $50,000
$50,001 to $100,000
$100,001 to $SW,000
$5�,001 to $1,000,000
$1,000,001 and up
i� �
$23.50
$23.50 for first $500 plus $3 .OS for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fracdon thereof, to and including $25,�0
$391.25 for first $25,000 plus $10.10 for each addidonal $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,0(}0 or fraction thereof, to and including $100,000
$993.75 for first $1Q0,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $SOO,OOQ
$3,233.75 for the fust $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,OQ0,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fracdon thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
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 construcdon site.
VERIFICATION OF FOUNDATION
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
Building MECHANICAL nermit Ivo.:
Inspections RESIDENTIAL APPLICATION Re�eive � :
763-572-3604 �t�ec �
. CITY OF FRIDLEY
DATE o O o/ YOUR E-MAIL ADDRESS
srrE,�wDxESS "� �-13 �o ►1e e o C.u�.r � c 9�1E
THIS APPLICANT IS: ❑ OWNER �]CONTRACTOR
PROPERTY NpME: �-r�`
OWNER/ ADDRESS: � 3 �f ITY t-Y�i STATE���
TENANT PHONE: �I lo °3 ' 1�C) °�CE o I Ll��ZIP ssu'3
CONTRACTOR co�� N,v�: CENTERPOINT ENERGY
SUBNIIT A COPY OF
CONTACT PERSON: JOANN T INKEN
YOUR STATE STATE LICENSE # E}� DATE
LICENSE WITH �D�S: 93�0 EVERGREEN BLVD STE �rrx "�Op11'i'�:°R�fP.IDS sTA�MN zrn55433
APPLICATION PHO� �63 — 757 — 6202 F,� 763--�757--6701
PERMIT TYPE �INGLE FAMILY ❑ TWO FAMII.Y ❑ TOWNFiOUSE
TYPE OF WORK: ��'' ��c�rrr o ni.�ur[orr�onII.,
DETAII,ED DESCRIPTION OF WORK T �c,� t-t� r c� � � o e.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, installarion 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 lahor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASID ON $10.00 PER FIXTURE, EXCEPT Wf�RE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVi� (1a ,l
Equipment Installed MFG: W.r r� e Y' MODEL: ��1 R P�AS' � J� SIZEBTU OZ � 2 O 1�
MFG: MODEL: SIZEBN
MFG: MODEL: SIZFJBTU
`�A/C $25.00 FIItEPLACE (GAS) $15.00 _GAS RANGFJOVEN $10.00
_AIIt. T0 AIIt EXCHANGEER $15 FIREPLACE (WQOD) $35.Q0 _NEW GAS GRILL $10.00
_BOIL.ER $35.00 FLTRNACE $35.00 _GAS IJNIT HTR $10.00
_CHIM��TEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
� � +� � � '� �" �.�yy' �� � -.
��4 ., � �f-� � `��.� �at�`�tr,�k � '.r''�e�4''Y .;n�''�'' +R xr� �,u1�; .� '�'-. , �. '�n�, _ � �� �..,� �
e.�t.
Y�ermit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 � x $25.00 = $ �5, �
Number of fixtures @ $35.00 x $35.00 = $
State Swcharge = $ 50
Tota1= $ 0?5,
THIS IS AN APPLICATION FOR A PIIiMIT NOT VALID UNTII. 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 i� the case of a11 work which requires review and approval of plans.
SIGNATURE OF APPLICANT �. �' � � tvaME ROGER I�OFFHEIN DATE g O O
A iN*:'h ��: u 7'R� ����s l i:. .; 'i` t� � �` ���� .4: _
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
' REQUIItED INFORMATION NEEDED TO PROCESS PERNIIT
RESIDENTIAL PERNIIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �XISTIl�TG HOME ❑ MAKE-UP AIR
REOUIRED FOR NEW/EXISTING HOMES
1. Combust�on 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.