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AF - 39007j}� •: YS - I N° 1'75 Viilag� of Fradley, ld�nn. �IJII.IIIN(i PER.MIT Offace of IIOTSPEC'�OI� OF B�TII.DINGS , �� - :, ,-�, }' ��°°` O�vner ". �"` Architect Builder �✓��'"�` � No. � "�� / ,-� t . � k r�„ f� Frid'ey, Minn., - '� � �-"` ` ""— � , 19 -� ✓ � , LOCATIQN OF BUILDING Lot -� / Block D�S��'�,IPTICsIu �F BLTILDII�TG Front �`� Depth Feight - Stories r_ �:.. Manner of Construction t To be used as � To be completed - '� Estimated Cost �' ,� . � :: _ , ,' . , ,. _ � � . /.;, � ,.�. , . r � ;. .�. - � � _ �,� : .�, Permit is hereby granted to / �.��::•_.��"'"'��°�",�"� � �f �+,,,�.,.,;s � ��G �;;;� �� to ��.*,.-✓. c. the buildin �� ,....t � g described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alter�,tion, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ,,� �, �'' � � ` '`� �"°� � .rty MF ``` =.,r`,� Inspector of Buildings. AGREEll�El°dT AND SWOR.N �TATEItiENT In consideration of the issue and delivery to me by the �nspector of I3uildin�s of Fridlev of the above permit, I hereb,y agree to do the proposed work in accordaiice with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the a�ove per�nit are true as therein stated. , `� E.., `��,��..�.;� -�� . ��.../�f f � - Subscribed and sworn to before me at Fridley, day of � �i ' ��..,� ' A .D. 19 % � . # , . . .. Mannesota, this ,, �� t- ' �, - �•� t � � '"�`� ��..a�'�l�.l'"�„ � • • Ci of Fridle M • tY Y� BUILDING PERMIT �;;�y/. N° 6421 Date: _...._.��....�... �"...'....�.L!'..._..:�._.� :�......._....__.._...__.........._._._ / �� ........_ ............._............._......._...._......._...._....._ Owner: �y�...��__ _._ . . 4.��.-.......� Builder .._ -�L�.�.�.'�� Address....._.._..._...._......._....__.._.-•-..._.._..._...._..._ ..................._.........._..._......._.._. Address _..._....._....._._......._............._..._.._........------......._......._...._..---...._........._. CAT F rBUI G ¢ . No. �_.�.�--.sl..�.. Street ... . .. . .�.- --- . . ........... . . L, of Lot .................-� --••---•-----,�.... ..------_.. ...._. ._ Lot ....._�....L......_....__ Block ._.------....-.-•-•-----••--.---.--.._ .............. Addition or Sub-Division /((.L�"�!'�i�.��.. •--.-- -._.._... .. .---�� ...�� I Corner Lot ...__.............-.-•-.--- Inside Lot ---.._.lF�.:.� ................ Setback ...�,�.......---.-_------.... Sideyard ........��.._.....-----• -- Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T U .. .. - t -,�--.._---.. Depth .�._. Height ...,� .�..z .----. Sq. F� .�� Cu. Ft �.� �_.__._.____.___...._..._..__...._ F -----_...._..__ Depth _...__... Height �� Sq. Ft. _..--•---._...._.. Gii. F� ....._.........-•-- Zj��e of Construction --- •--..._...��,,Q,,,... __.. Est. C sd t.. ,�..C2 .�-..._ ............._........ To be Completed ....._..._.._.._..._. In consideration of the issuance to me of a permit to construct the building described a ove, I agree to do the proposed work in accordance with the description above s�t orth and in co 'ance all pr '' ns of ordinances of the city of Fridley. L x_. _.____ In cansideralion of the a ._..�� ' p yment of a fee of $.... ...._......._.., pernut is hereby granted to._._...._.__�.___._.._..— .. ......... to construct the building or addition as described above. This permit is granted upon ._..__.......----.._..._...._......---•--•--•- •-- � the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at a�y time upon violatiyx�f any of the provisions of said ordinaaCes. � n il / / Building Inspector � NOTICE: This p�rmh de�s ne1 eev�r 'fh� eonshuefion, inslaflMien fe� wl�ino, plumbing, o�s h�Niny, a�w�� o� waM�. B� wn fo s« th� Buildiag In�p�etor for sparat� p�rmiti for tha� It�ms. . � _. � APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA � OW1�P.' S NL� ' �L /% /y�t iL` (� �,�'��/7 / BUILDER � �/ /.'.'� ADnRESS (��f 3 j A,�� L G'� �'�"� vJ�llfL ADDRESS S�¢� L� LOCATXON OF BUILDING No. �i �� l�i%�,L G'�i�'�� i� /i�,( �� Street Part of Lot LoC � 7 Block Addition or Subdivision Corner Lot Inside Lot � Setback Side-Yard SEWER ELEVATION FOUNDATION Et.EVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as; /i ali/ I l D/L' � Cs�/d fflG i= Front�/ Depth � v Height Sq. Ft. Cu. Ft, Front Depth Height Sq. Ft. Cu. Ft. Type of Construction ��f� /�� Estimated Cost To be Completed The undersigned hereby makes application for a permit for the work herein specified, a�reeing to do all work in strict accordance with the City of Fridley Ordinances ancl rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. �� DATF�''�_ S IGNATIIRE �� (Schedule of Fee Costs can be found on the Reverse Side). � � - " � � . . J v • '� - _ City of Fridley, Minn. 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: _..__.....Se}�.�emhex._11�y.__1.9.�1 ._.._ Owner: Vern Smith ,...._.___ Builder _._Ri.�h�d�ias.t' _.--- ings___�_.__._.._ Address ....._....�SR....nellw.o.acL.Dr.iue---�----------------_.....__..... Address _--�q.�.car*�� c}r��* _}v..�. 6437 LOCATION OF BUILDING y G� 11181 No. .....___6437____.._..___ Street .._._Dellwood__Driye__N,E�_,._....______ Part of Lot Lot .---------27-----.------- Block ----..------•----.------------------.---------- Addition or Sub-Division --------MS2s?r£�_LSk.�.Hi ghl ndG 1 c Corner Lot -.---------.---------- Inside Lot .----------.------ ............. Setback _�..._._.._.._.----_ Sideyard Sewer Elevation --.--.---_--•----.--.-----_...----•.-.--------------------------•-------•------•-- Foundation Elevation _�.� DESCRIPTION OF BUILDING To be Used as: _._Re.-Roof ................._.._..... Front __.--.•-----_ . Hei ht . Depth _._------- _. g ._.._..._......... Sq. Fk ._ Cu. Ft Front ..__.___._._.. Depth __._._._..__ Height ______.__.. Sq. Ft. __._.._� Ct1, F� Type of Construction .__._.As.gh3l.t___.�._.____.. Est. Cost .__.._...$fiQQ_-QQ.___._____.. To be Completed _._..1r w�°�. In consideration 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 set forth and in compliance with all provisions of Ordinances of the city of Fridley. // �(1 � J�_ ) f. "C: /� f.'Y., 'Ci'...`�.�/1 .50 State Surchar�e `� In consideration of the payment of a fee of $__.___..�...Q.Q__._.., permit is hereby granted to R i rha rrl Na c t i ngg ___._......._..__......_._.._ ..............................._ to construct the building or addition as described above. This permit is granted upoA the express condition that the person to whom it is granted and his agents, employees and workmen, in all WoTk done in, around and upon said building, or any part thereof, shall conform in all respects•to the ordinances Of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildirigs Within the city limits and this permit may be revoked a t any time upon violation of any of the provisians of Said o7cdinances. �S � .Q �..'[' p � ' � .��_�° .�_t3i�i din8 Inspector CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or watsr. Bs sun to sM ths Building Inspector for separa}a permits for these items. � i APpLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITiON BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME :�� Z K 5'i'� �t tG� BUILDER • I( � C� A�' l� N.I�I S�� G S A,DDRESS :�� l- w vo � � l� • ADDRESS : 6 3 o T� o n! 1��C�1 S T r NO :.�� 3� S TREET :� Iz L L w o a� IAT: BLOCK: ADDITION• CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD; Applicant a�tach to this form 1�ao Certificates of Survey of Lot and pxoposed building l.ocation drawa on these Certificates. To Be Used As: H�SCRIPTION OF BUILDING Fxont; Depth• Height: Square Feet: Cubic Feet: Fxonts Depth; Height• Square Feet; Cubic Feet: 1�►pe of Cona�ruction: � Estimated Cost: $ ,��0 ^ c�p To Be Com�leted; ��/�? ( The uadexaigaed hereby makea applicativn for a�ermit for the work herein spec�fied, agreeing to do all Moxk in attict accordaACe with tha C�,ty of Fxidley Oxdiaence• aad rulinga of the Depart�ent of Buildinga, and heraby decl�,rea tl�at all the facts and repreeentationa stated ia this applicatioA are true aad correct. D�ATE : i� �_ �7�_ SIGNANRB : �c-c�k�- % �t�� ^..�, (Sea Raverqe Side For Additional Info�aation.) �- �--� . Sb S�a7-c ��,��a 1/ ' -- ------� . � �6 SUBJECT City of Fridley AT THE TOP OF THE TWINS gU I L D I N G P E R M I T r � � � � � • COMMUNITY DEVELOPMENT DIV. ' � �: ----^� r � � PROTECTIVE INSPECTION SEC. 1 1 � � �"'1 � CITY HALL FRIDLEV 55432 NUMBER aEV DATE � ----�'� �•' 9 612-571-3450 910-F15 g� JOB ADDRESS 6437 Dellwood Drive N.E. 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION DESCR. 2% Moore Lake Highlands lst 2 PROPERTY OWNEF MAIL ADDRESS Vern S�rtith 6437 Dellwood Drive N.E. 3 CONTRACTOR MAILADDRESS Pilgrim RemQdeli.ng 10091 Pilgri.m Way, Osseo 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW MAIL ADDRESS ❑ ADDITION 8 DESCRIBE WORK Install aluminum trim 9 CHANGE OF USE FROM STIPULATIONS [� ALTERATION X ro ZIP ZIP ZIP PAGE OF � � PER O. 16367 RECEIPT �/ � / � APPROVED BV SEEATTACHED SHEET PHONE 571-9357 PHONE LICENSE NO. 425-1011 PHONE LICENSE NO. PHONE LICENSE NO. ❑ REPAIR ❑ MOVE ❑ REMOVE TYPE OF CONST. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICA�, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�..�OOO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE pERMIT FEE PROVISION OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTIO R THE PERFORMANCE OF CONSTRUCTION, S�-%. SO � � � PLAN CHECK FEE SIGNA RE O C NTRAC Fl OF7 P.UTHORIZED AGENT IDATEI WHEN PR� SiGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG INSP OCCUPANCYGROUP IOCCUPANC`fLOAD SO STA�LS CU. FT. OFFSTREET PARKING IGARAGES SURTAX $.50 SAC CHARGE AL FEE �I8.�0 iIS IS YOUR PERMIT � �/ �4TE CITY OF FRIDLCY Effective Aug. 1, 1981 Af'PLIC/1TI�'d FOR RLSIULi�TIR� I3U1LQIi�G PERi�ITS (tde►•�, Alter•�tions, Additions, or Repairs) O1�! Id E R: V�-lit�� .� ��fo . ,� ADDP,ESS: ��!/�� TCL h0: S%/ � ��.5� �UI LQER : . , 11DDRESS: O � � � efl TEL td0: �� /D/,r Construction Location STRL•'�T NO: 3 STREET: L07': p7 BLOQC: _ Corner Lot: Inside Lot: ADDITION : D�''�._ � � �Q.Qr T Q"` / SetbacY.: Sideyards : Ap�licant attach to t2iis form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIOid OF COF�STRUCTIOPd I'ront: Depth: Sc�uare Feet: Qibic Fcet: H eight : Front: Depth : Heiglzt: Squar.e FeAt: Gvbic I'eet: Type of Cor�struction :�� ,�� Estimai:ed Cost: $�dQd� Zb Be Oor,�pleted: ' / �^�� Alt. A Alt. B Proposed Driveriay Width If New Opening Is Desired; $ $ S�� R�VER:E SIDE OF SHEET Ziie undersigned hereby ma};es application for a permit fcr the �•nrk herein specified, agreeing to �,all work ir, strict accordance ��ith the City of I'ridley Ordii�ances aiid rulii�gs of tlie Department. of Buildings, and hereby declares that all t}�e facts and representatiens stated �i this upplication e true and correct. D1:TE• � e7 � SIGNI�TUF.t^� : - Stipulations: � � � - ��, L �1 ��.VU �K r . . r s�a�ec, P E City of Fridley L? ;� ,:, � � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � ' ECEIPT NO � �• COMMUNITY OEVELOPMENT DIV. ' ��.-'--"-, r � � PROTECTIVE INSPECTION SEC. � � � - ' � �'��1 � CITY HALL FRIDLE� 55432 NUMBEA FEV DATE Pe.GE UF APPROVED B� � ""'�"� ,'' 612-571-3450 910-F15 10/4/96 / / lOB ADDRESS 6437 Dellwood Drive 1 LEGAL LOT NO. BLOCK TRACT OR AD�ITION SEE ATTACHED DESCR. 2% 1 Moore Lake Highlands lst SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Smith, 6437 Dellwood Drive, Fridley, MN 55432 571-9357 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO First Choice Ext, 2405 Annapolis Lane N, Plymouth 55441 553-1918 4266 4 ARCHI7ECT OR DESIGNER MAIL ADDRESS Z�P PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBEWORK Tear-off and re-roof 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. THI5 PERMIT BECOMES NUL� AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS. OF IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED NO DWIG. UNITS OFFSTREET PARKING I HEFEBY CERT�fY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS 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 �1 485.00 State SC �.%�F WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT � DOES NOT PRESUME TO GIVE AUTHOR�TV TO VIOLATE OR CANCEL THE PERMIT FEE SAC CNARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING -CON- �(FH.SO Fire SC �I.�FH STRUCTION THE PERFO A CE OF CONSTRUCTION " PLAN CHECK FEE TOTAL F icense Fe $5.00 $5 72 SiGNaTUREOFCOn�'aqCT OAAUTHOAQEDAGENT �DATEi ROPE UDAT D T I IS YOUR PERMI /j� • V S�GNA7URE OF OWNEa iiF OWNER BUIL�ER� �DATEi iNSP r�F iE NEW ADDN ALTER I� [l � ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application /�w�zo� �J� Effective 3 / 1 /96 Owner Name & Address: `� � �,� �S �-�.-. , � � � � 3 � �� w ;,��-� 9✓ Tel. # � 7 / - i 3 � 7 Contractor: �= � Y s� �''° �, � ,� ,� x � � d Y � � MN LICENSE # � d (... � Address: �� n � � ��, �o /� j � t'�-/- ��y,i,�� 7 �, , /'�-r � Tel. # 5��3 � � S� J� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT Width Width Width - Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks - Tyge of Construction: %�� - o`�(� d/'C� c��`�' Estimated Cost: $ � 's'� �� _ . i•l�; ; � i Approx. Completion Date: / � -� lJ � � � ; � � �J�` — (Cost on Back) -- � �. � �� , Driveway C�irb Cut BVidth Needed: Ft. + 6 Ft = Ft x$ _$ DATE: /d °- S- 5� APPLICANT: � R Tel. # 5 5� 3` ��/� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS : $ f�� - - � ;;a ; i $ $ $ -" $ � i. $ $ $ $ $ �CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $900 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 [ ] CI I Y uF f rl�ut_L 7 ��v:�i-t_� + �vN u�v G431 University Ave NE= Fndiey, MN 55432 (763)572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 L �tective Un Jan 1, �u02 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Water Bath Wash Drink. Floor Catch Auto Gas Gas Mlsc. Water Heater Closet Urinal Tub Shower Sink Tra Fount. Drain Bastn Washer A I. Ran e Fix� < Gas Elec PLUMBING FIXTURE RATES NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" �_ Gas Range•• Gas Dryer" Back Flow Preventer Required ()Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 / �–�-- $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTALFEE C � � +. �S •: •��' /,y '- �L� The undersigned hereby makes application for a permit for the worlc herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. , 20� Owner �� Building Used As_ �1(�i`tn C� Estimated Cost �J(�— PERMIT NO. _ ! � / �' �' PLUMBING COMPANY ��(`�� `�(`�I� �'�'1�/ h SIGNED BY � � � _ TEL NO FAX # – – ` Approved By _ Rough-In Date Final Date �� i/� \� �.� MINIMUM FEE �OR ANY PLUMBING/GAS PERMIT I PLUS THE $.50 STATE SURCHARGE C�MBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A COMMON VENT INFO ON BACK SIDE � Building � Inspections �� 763-572-3604 DATE L � "1 S.iTE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERNIIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY _ YOUR E-MAIL ADDRESS ❑ OWNER �CONTRACTOR ��m e ADDRESS: l.o`i �7 1 1��-\ \ WC�oc+ PHONE: COMPANY NAME: �.-._. __.-- - --- - CONTACT PERSON: sOANI3 ZINKEN STATE LICENSE � EXP DATE r� /% ' Permit No.: � � ' Received By: Date Rec'd: 1 " "�" �� '�` ATE�P ADDRESS: 13562 CENTRAL AVE NE CITY ANORA STATE MNZIP 55304 PHONE 763-757-6202 p,�; 763-757-6701 �SINGLE FAMILY ❑ TWO FAMILY ❑ idEW �REPLACEMENT DETAILED DESCRIPTION OF WORK ❑ TOWNHOUSE ❑ ALTERATION/REMODEL �, � 1 � ...� _ > > r � Ga !'� E� Q 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 WF�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FDCTURES: (INDICATE TOTAL NUMBER OF EACH BELOV� � MODEL: <X'�Pk -G� SIZEBTUI� iCJ�-� Equipment Installed . MFG; • `` �'v � MFG: �� .j MODEL: � 1� �G3�F SIZEBTU �-Eo:� T3,5 S�� G: MODEL: SIZFlBTU I A/C $25.00 FiREPLACE (GAS) $I5.00 GAS RANGEJOVEN 510.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL 510.00 BOILER $35.00 �FURNACE $35.00 _GAS UI1IT HTR $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR 515.00 — .... . ...... ..., �,,..:...,. __ �.—�Lw...,�.:ar�:�.s:�w.�...:c5;:n:•.��E;iJiwti�"?tirrvri:.:r:��'"t.. .n'#e�0:�t;h 1L1f3"l�CDrit};:6+iu,.,y,�;+�,zi�„.a....�.y�,. , �r,•r,� , a:•y„ <,,:„��, .,,..-...... .. . <:�.. . _._ _..... . _ Perntit Fee $ ivumber of fixtares @$10.00 x$10.00 =$ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @$25.00 1 x$25.00 =$ as, � Number of fixtures @$35.00 1 x$35.00 =$? S•� State Surcharge = $ .50 Tota1= $� . S d 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 all work which requires review and approval of plans. SIGNANRE OF APPLIC,�4�,f��.�- �• �`r�� P�T NAME ROGER HOFFHEIN DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 ��_5��_z�na a.. REQUIRED INFORMATION NEEDED TO PROCESS PERMIT � RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS �EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) . a.. Qi� ar solid fuel IMC. Chapter ? with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments � 2. Make-up Au' (5ee note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter S with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room - a. Required on new construction IMC 1346.0312 5. Ventilation . a. Per IvI�T E�erby Code, 7F�70 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 No.: � ��f1 : - , � Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vate Rec'd: �� -.�:7 -� ��i'' DATE YOUR E-MAIL ADDRESS SITE ADDRESS �I �J�I C'i �( � � � THIS APPLICANT IS: ❑ OWNER �CONTRACTOR PROPERTY NAME:�r ,-� l� r�;, , ,� OWNER/ pDDRESS: _t�-�- CITY STATE ZIP TENANT PHONE: CONTRACTOR NAME: � ! c � � �` SUBMIT A COPY OF STATE LICENSE tt Z— EXP DATE / C 3� �`� r �, i � �� YOUR STATE ADDRESS: / U�r' I C� %`.1"� �`�5 , C�' � l31 U�'�. CITY Cc� � STATE�ILIP LICENSE WITH pHONE �1 � �`/� `�jU �'j �FAX %�-�O� ��1� % j ' APPLICATION PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � �W �3 REPLACEMENT DETAILED DESCRIPTION OF WORK �� r� Gc ;n i�> S� vc.� �?- ��Sc �' �'� ; �� PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the totai cost up to 5500.00, 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 $500 = cost of labor x.OS = FORPROJECTS WHERE LABOR EXCEEDS°$SOO;FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT t�VHERE NQ'I'£D. FIXT-i3RES:...(INDICATE TOTAL NUMBER OF EACN BELOV� � BATH SINK/LAV =FLOOR DRAINS _ SHOWER _ WATER PIPING BATHTUB GAS PIPING p✓� cnrucFrrsE) SWIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) DISHWASHER LAUNDRY TRAY WATER HEA7'ER ($35) FOR IRRIGATION WATER METER OTHER � _ . � - . � � �' „ ^ �� ^�-�;.. �' �:�'m`� ��-� rr _� . �:,� .n ,�. , �_. . �. . .,.- , ., -.._. . ,, . ._.. �. � ....__ �- ..�. _.. . ..� �,. . __ _ ._ _�._ __ Permit Fee $ : -, Number of fixtures @ $10.00 x $10.00 = $ Surchar e �— .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DLJE $�_. '`'1 i Number of fixtures @$35.00 x$35.00 =$ State Surcharge = $ .50 Tota1= $ 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 applic tion 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 rk which requ' es review and approval of plans. SIGNATURE OF APPLICANT /�✓�� PRINT NAME �JpV�-V�,��'I�1'� DATE � f�._ � „ � ,. � �sM � .w�� . D: �� _ City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 � ��ss Building BUILDING Inspections RESIDEI�ITIAL APPI�ICATIOl�I 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-I-O8 DATE ' " V O SITE ADDRESS �_ TI-IIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR Si�'8'IdITi ?i �tYP`f O�F YOUR STATE LICENSE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DES�G7RIBE ii{DRK BEL1�('i DC YOUR �MAIL ADDRESS _ _�_\\v�o��- . n E ❑ OWNER ONTRACTOR NAME: Cl ADDRFSS� � " �rarr�: • 5 - c.�. NAME: � ,�nn � ' PHO STATE LICENSE (�� a �Q � ❑ SINGLE FAMILY/NEW CONSTRUCT[ON S[ZE ❑ TWO FANIILY/NEW COIVSTRUCTION STORIES ❑ ADDITION ❑ GARAGFJSFIED i�WINDOWS ❑ BASEMENT FINTISH O ROOF �f] DRAIN TILE O DECK ❑ SIDING ❑ OTHIIt ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCT[ON ❑ ADDITION � MAINTENANCE/REPAIR ❑ REMODELING Permit No.�l;uG' �'r�'-I� Received By: _ ` Da��t:gPR ►T�Af' . . � 11"� • � • • iiU � 11.' . • I� � � • • � �� ROOFING L�1,I1kf8E.�QE Si(.�I.LAB.E,S GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Virryl O Aluminum ❑ Ofher WINDOWS IN EX[ST[NG OPEMNGS ^{�'es ONo OR FOR NEW OPENINGS-DESCRIBE S1ZE OF � ❑ HOUSE ONLY a EUJILSE.�CcAB.ACsE. ❑ ATTACHED GARAGE O DETACHED GARAGE � HIIGHT FT BASIIvIIIdT REMODII.ING SUBMIT: 7. ExistmgFloorPlan 2. Proposed floor pian 3. List of structural memb�s to be used F'OiR i1�'7i'COATSTRLiCTfOi1Ti.1�CLL�i51�C'rDiEC'KS, O�t ADDITIONS_ & PORCiiES SUBMIT: O Trim 1. Site P1anP5urvey showing the e�usting struchues ❑ Fascia � � P�l�� 2 Twnsds��on�lans 3. Fnetgy Calculations LOCATION OF W[NDOWS 'OPENING CHANGES & �Iy� � TYPE OF WINDOW TO BE INSTALLED \�C��MLY�tNUMBER OF WIND�WS �� ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION S �� 1997 UBC FEE SCHED�CUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge S $5.00 (State Licensed Residential Conttactors) SAC Charge � $1825 per SAC Unit (Plans to MWCC for determination) Cttr6 CtrC Escrow $ ft+ 6 ft= ft x$21 =$ Erosion Corrtml $ a450 C�servation Plan Review Park Fee $ Fee Determined by Engineering � �,c�+�ge � ��s ( 3'�+"�� ( 3 Total Due $ Make c6ecks a able to: Ci of Fridle Attach SN ulations THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I �5ereby appfy far a bruia�ng pe�mit �d I ackrtowtedge Y�mC Yhe u�f'o�mmtun a8ove is wmpfete azd acauaCe; d�C The wonF wrif be m oombr��ce with Gte ord�cxs m�u' eoales of the City of Fridley and with the Minnesota Constr�tion Codes; that I urderstsnd this is not a permit but only an a�lication for a permit �d wmk is not to start without a pem�it on sitc; that the work will be in accordance with t�1 approved plan in ihe case of all work which requiies rev ap�oval of plare. � SIGNATURE OF APPLICANT , PRINT NAME-�-��(1 DA'I�I I-� \ APPROVED BY DATE PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK