AF - 41817City of Fridley, Minn.
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BUILDING PERMIT N� s o s
Date: �'� --�f -�-��
,� #� a
Owaer: � Builder � .. _.
�S
Address Address
-�'� ' LOCA�'ION O B y_ ING
No. '`� �Siaeet Part o t
a+ ,,�
Lot '����� Block Addii3on or Sub-Divis�ton
Coraer Lot _ Inaide Lot � 3etback ��— Sideyard _ti�� ��..'__._..__
Sewer Eleval3on Fo�mdation IIevation
DESCRIPTION OP BUILDING
To Use�l
Front � Depth �s! Height � Sq. Ft. _���� Cu. Ft�_'L+��t'_..�`+�+''
Froa�t,�; Depth �i�ht Y._.. Sq. F't. Cu. Ft.
T�►pe of Constructioa -� ���._-��,._ Est. Cos" t..�. � To be Completed
Tn consideratlon of the issuance to me of a permit to conatruct the building described above, I agree to do
the proposed work 3n accardance with the description above set forth and in compliance with all provSsions oP
ordinanc�s of the dty of Fridley.
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In consideration of the payment of a fee of $.�.� "'""'`�, permit is hereby granted to
to construct the buildiag or addition as described above. Thispe rmit is granted u�n
�he express condition that the person to whom it is granted and his agents� employeea snd workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding la:al3on, construction, alteration, maintenance� repair and moving oP buildings
��th�e dty limits aad this permit may be revoked at any tune upon� h�,any of the proviadona of eaid
Inapector
NOflC�
Thh permlt doas eot eover t6s eonstruetioe, instaqa8on foe wirine, plvmbtner e� h��e. �►e* or wafer. Be sure to as
1he BuildU�g Inspeete� for aeparate pemdts fo� fh�e hanu.
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�.'�DUSTRIAL �� �f ��I U� SURVEYS IN:
GOMMERCIAL ANOKA,
CI� �OTS ..AIYD asSOCIAT�s IIVC. �N EP�N,
TOPO�RAPHICAL �
LAKESHORE • ' � " ° '$HERBURNE
PLATTINO L A N D S U R V E Y O R S COUNTtES •:,
SHOPPIN(i CENTER — W�gT MAIN STREET
ANOKA, MINNESOTA • ,
• HARRISON 1-6340 .
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COMM6RCIAL AhOKA, a
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TOPOdRAPHICAL � NENNEPlN, i
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L/lKE8F1011E. SNE�l11WE I
PLATTINa L�►!�D SURVEYORS `�""`�" '
iN0'PING CENtER — WEiT MAIN iTRtET �
ANOI(A, MINN�ipTA
< . HARR1� �-6340
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HEAT LOSS CALCULATIONS DEPARTMENT OF BIIILDINGS MINNEAPOLIS, NIINN.
Weatherstrips A.S.H.V.E, Construction No. Iasulation
Guide
Windows Doors Reference Out.'WaU Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No ( Yes—No 19_
Fl.� , ° Room�Length :/ Width ��' Height � Fl.� � Room Length Widthlr�=GHeight
Windows and Doors—Crackage and Area Windows and Doors—Crackage an Area
�Vldth Helght No. ot Ltneal f. Area Wldth Hefght No. ot Lineal tt. Area
No. ot pane o[ pane lighte of crack eq. ft. No. of pane o[ pane tlghte � ot crack eq. tt.
1 sv /' � > LO �6,� � � �, �j--
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/ � %6 9� � � � ° Coef. Btu Coef. Btu
Infiltration � �'� � � � Infiltration � � �-�`� , �� �
Glass � �� �,� �,� � Glass �=r .<<� �.�
Eap. wall 7/� Esp. wall �. �
Net exp. wall '� �O , `'� � � �•- ; � ; ^ �� C=��? �
Net esp. waD ,
Int. wall Int. wall
Ceiling �+f? ���"� Ceiling ���'-' �;:� r" ���
Floor �' �✓ � , ;� �� ;,� ,�
.�-�' - � ,�' ,� a� < Floor ,
Total Btu. �; ��� `�''� Total Btu. �-/;�, r�,�
Required sq. ft. E.D.R. or sq. ias. W.A. Leader area Required sq. k. E.D.R. or sq. ihs. W.A. Leader area
F1.� T , Room � Length :/�Width �/•0 �� Height � �,I a Room � Length �" %� Width �' �, Height �
Windows and Doors—Crackage and Area Windows and Doors—Gackage and Area
Wldth HetghL No. oL Lineal tt. Area Width Hefght No. of Llneal ft. Area
No. ot Dane ot pane Ilghte ot crack ea. ft. No. ot pan oL pene IlBhte o! crack eq. tt.
�� � h '�' � �� �1� � � �..- .. �� (� /' ° e `•-�l�' - �? % � ��+
Coef. Btu
In6ltration _��-t�� -"-� ,;' ;��
Glaas f :%; �, �_ � ; � �_�
Exp. wall �; �'�
Net esp. wall � '� '� � �'� `�`-.`1
Int. wall
Ceiling "�- ,a ^ �=���'r�
Floor ^ � ��' %' ,'� � =�
Total Btu. r-"`�' .�� �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. .- Room ( Length � Width ;�' °� Height ��'
Windows and Doora—Crackage and Area
Wldth Helg6t No. oL L1nea1 Lt. Area
No. ot pane ot pane Ifghte ot crack eq. ft.
� . � �� � �;-� -�
lnhltration � �� ��
Glaas f"�/' �
Exp. wall �� �
Net exp. wall ��F /' i' _�
Int. wall
Ceiling ��i ���
� �w
l�loor �--� -�' �"
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area
In6ltration
Glass
Eap. wall
Net esp. wall
Int. wall
Ceiling
Flaor
'I'otal Btu.
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rr�- '. , {a, � (�
ft. E.D.R. or sq. ins. W.A. Leader area
Windowa and Doora—Crackage and Area
W1dth Hefght No. 01 Lineal Lt. Area
No. of pe.ne ot pane IlBhte of crack ea. tt.
,/ � � � ��� .� �,�`' - _ �
P, -,��- � - y
Btu
;�". r � Infiltration
�,�-��',� Giass
Eap. wall
�;,;�� -. - �� Net esp. wall
Int. wall
%�;� ,�� Ceiling
a,�� Floor
1'otal Btu.
� �.
� <—.
Coef. Btu
�� �� �� �
� /�-�
IRequired sq. ft. E.D.R or sq. ins. WA. Leader area
�
�
1
�
City of Fridley, Minn.
�
n BUILDING PERMIT N� 6 4 93
aate: �'� �' � p 5-- �, �
�
o�: �� �,c ij� B�a�
Adc]reas Address
�
�
t LOCATION BUILDING
No. y��� Street ���y�-�„��-L�'.,p Part t
�� �
Lot � Block Addition or Sub-Di an _ ��C�� .�
Coraer Lot -" � Inside Lot � �tback Sideyard .�� �
Sewer IIevation _— — Foundation IIevation
DESCRIPTION OP BUILDING
T ea:
Ftnnt �L�.. Depth � Height �:-L! Sq. Ft c;�� Cu. Ft.���
Depth _...__.�r fTeight � Sq. Ft. Cw Ft.
Z�+pe oP Construction ._ � F.st. CostDV/��� _ To be Completed
In considerat[on oP the fssuance to me of a permft to construct the building described above, I agree to do
� P�Posed work in accordance with the description above set forth and ffi compliance with all groviaions oP
or�linances of the dty of FrYdley. � � n ��
_ ,¢ii e.s'�
Ia consfderation of the payment of a fee oP $� ., permit is hereby granted to
to conatruct the builaing or addition as descxibed above. Th�ta permit ia granted upon
the expresa condil3on that the person to whom it 3s granted and his agents, employees an�� workmen, 3n all work
done in, around and upon said building, or anypa� thereof, shall �nform fn all reapects to the ordinance� of
Fridley� Minnesota regarding locat3on, conatruct�Ton, altera.tion, maintenance, repair and moving of buildiugs
o��� dt3► �mi1's and thia permit may be revoked at aqy � upon violati�of eny of the provisions of said
Building Inspector
NOflC�
7W psnet� d� no� eewr the eomfruetioe, tmtatl�im Por wWe9. P��+�9. 6� 6�8, �u' er wa�er. B� ams /o as
11n Bnilding les�e�sr for pp�rd� p�rm6s /or fh�a k�aa.
C 3 �
APPLICATIQN FOR BUILDING PLRMIT
CI�Y OF FRIDLEY, MINNESOTA
�i� � � s � � � O � � �� � ,�P �� �BUILDER
�npwss_ _S" � � ��-, � � �`� �, r �nn�ss
LOGATION OF $TJ'tLDING
No. ��� Street ��'j� /,�%, Part of Lo�
•
T�ot �'� �S�Block � Additioa or Subdivist �
Corn.er Lot �Inside Lot SeCback Si -Yard
3EWL� ELEVATION FOUNDATI�DN ELEVATION
Applicant attac& Co thia form Two Certificates of Survey of Lot and pxoposed build-
ing locat�.on drawa oa these Certificates.
DESCRI�ION OF BUILDING
To be use as ; ��� /
���� � � Front / Depth � � Height � a
Sq. Ft\�l� � Cu. Ft. �_ � � �
FrOIIt Depth Ae3ghC°
q. Ft. Cu. Ft.
Type of Construct3on EstimaCed Coet
To be Completed
�he u�dexsigned hexeby makes �pplication for a permit for the work herein specified,
agreeing to do all wo�k ia strict accordance wieh the City of Fridley Ordiaancea and
r�slings of the Depaxtr�Pnt of �uildings, and hereby declares thet all ehe facte and
represeaatations at�ted 3a this appl3cation are Crue and correct.
_ �
DATE '� �� �r � SIGNATURE �� „��
(�chedule of Fee Costs can be fouad on the Reverse Side).
r •. r+ / \ s s x a 1 1
0
e
BOII.DING PEIiNQT FEE 5CHEDULE
Sect�on 2. The Inspector of Buildiaga shall, before ieauin� anq permit for
�he erection of any building or structure, or for any addition to anq exist-
ing building or atrueture, or for any alCerations or repaire Co any eaiaring
buiZding or s�ructure, upon application therefor, require the gaymea� by �he
applicant for such permit of feea te the amount herein below set fosth and
ia the manaer herein provided to-wft;
2.1. For any such permit for the erectioa o,f any fire-proof building, ot�e:
than a garage� warehouse, factory or grain elevator, or for the erectfan of
any fire-proof addition, for similar occupacicy, to any existing building
shall be at the rate of $�..40 for each.one thousand cubic feet, or fraction
�.hereof, in such cubical conte�rt�.
2.2, For any such permit for �he erectioa of any fire-pro�f garage, warehoa�sea
factory or grain elevator, or for the erectioa of any iire-proaf edditiQn,
�or sim3l�.r occupaacy, to any existing buildiag shall be at the r�te of $1.25
for ench one thousand cubic feet, classified as "fireproof" bq Sectioa 502 of
the Minne�poi.is Building Cade. ' '
�OUSES �
2.3. For any auch permit for the erection of any non-fireproof buildiag other
than a garage, warehouae, factory or grain elevator, or any noa-fireproof
addition, for similar occupancp, to any exieting building - permit $1.00 for
each oae thous�.n,d cubic feet.
GA�A�ES
2.��. For aay such permit for the erection of anq non-fireproa� gasa�e,
w�rehouae,�f$ctory or gra3n elevetor, or for the erection of anq non-firepr�f
additi�, �or s3milar occupancy, to any existing building or for each such �
vu3ld3ng or add3.tion - ninety ceata ($0.90) for each oae �housand cubic feet
or fraction Chereof, in the cubical contents thereof with a minimum of �4.04.
For the purpose of campue�Lug fees for building perm3ts, the cubical contents
of any bui�.ding or additfoa to a uniform height throughout by multiplyinS the
gsound area covered fram a poiat six (6) inches below the flaor lin� of the
b�.semeat or cellar to the average he3g�it of the upper�surface or to the
average height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an exiatiag structure, the fee shall be
at the rate of $3.00 per each Five Sundred Dollars ($5 00.00) or frsction
thereof in the cosC of all proposed work.
2.6. In no cas� ahail the fAp.charg�d ��r g��s �rmi� as set forth in
SeCtioa 2 be lesa than $4.00.
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SUBJECT
City of Fridley / 7 � � � � -
AT THE TOP OF THE TWINS gU I L D I N G P E R M I
r
� �
� �
� ; y �_��� COMMUNITY DEVEIOPMENT OIV
r � � PROTECTIVE INSPECTION SEC. "1 � Q�
1 . � p°� Cd
' � �'��1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BY
�----� � ,•� 612-571-3450 910-F15 7/27/95 � �
JOB ADDRESS 548 Fairmont Street NE
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �F�F,45 J Riverview Heights SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
Debra Langer 548 Fairmont Street NE 783-0645
3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO
Panelcraft of MN 3118 Snelling, Minneapolis, MN 55406 721-6628 2179
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDfiESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW �] ADDITION ❑ ALTERATION ❑ REPAIFi O MOVE ❑ REMOVE
8 DESCRIBE WOFiK
Construct an 18' x 12'3" Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
.
������V�
Before digging call for
aA utility locatians
�54•0002
R�QI��.R�D 8Y .LAUIi
SEPARATE PERMITS ARE REQUIRED FOR ELECTHICAL, PLUMBINCa, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTION ZONING SO. 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 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 5 402 L.7O
DOES NO PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVIS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU 10 OR THE PERFORMA �CE OF CO STiiUCTION 8],.0� Fire .5�.' .5.1F�
� � �� PLAN CHECK FEE TOTAL FEE
�' License SC 5.00 4.10
SIGNATURE ON7RACTOAOAAU7HORIZEDAGENT IDATEI �HEN PNOP � LV VALIDATED THIS IS VOUR PERM�T
� � � Z�i ��
S�GNATURE OF OWNEA ��F OWNEA BU�LDER� IDATE� 8 G� SP DaTE
NEW [ ]
ADDN � ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applicadon
' � FJ
� ,:
_ _ �J _ ����o
Construction Address: � � � !A-1 � M n �� � -S� � i �-
Lega1 Description:
Owner Name & Address: � �3� ����� > 6 � �, �� � Tel. # '`� � � - � Co-� �
Contractor: ��, � 1 c�� ,� r;�n ,� MN LICENSE #
Address: 3 U.P� 4�.� �-� ,� � . Tel. # °y Z/ - C� (O z�
Attach to this application, a Certificate of Survey of the
lot, with the proposed constructian drawa on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
,
Length � � Width . `Z �3 Height � �
Length Width Height
Length Width Hgt/Ground
� ,����y, �
sq. Ft. ' <�° .
Sq. Ft.
Sq. Ft.
Comer Lot [] Inside Lot �j Ft. Yd Setback �J � Side Yard Setbacks iv �
Type of Construcdon: c,�}}�a� 3 � � �.,� � . J ��d �= $ � � =� `
�
Approx. Completion Date: ��� �� c�,� �', y��, ai�
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: /3 � I APPLICANT: �� � � Tel. # 7z I - � [� z- °�
CITY USE O
Permit Fee
Fire Surcharge
s�� s�n�ge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
, -
$ �10, �
$ �. �/'cJ
$ � 7�
$
$ `i'. �
$
$
$
$
$ .r�
Fee Schedule on Reverse Side
.(�1 of Permit Valuation (1/lOth%)
$.soi$i,�o v��a�
$850 per SAC Unit
$S.(� (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary j] Not Necessary []
�cuu.uirvc: !'I:KM1"1' ri3E SC(iEDULr_
�'I�c: (;lii;:t i3uildin�; U�ticial �hall, (x:fqre issuing permits for the erec[ion of any huiiding or stnicture,
ur ti�r any a�iclitic�n tu any cxisting buildin1; c�r s[ructurc, or for any altcration or rc��air to any cxisiin};
(�uiliiing <�r- s�rucwre, u�n aPpiication therefore, require the payment by d�e al�Plicant for such j�ermit
c�(� t�c:s t<� the: amc�unt hercin t�eibw set 1<�cih and in th� manaer hereia Prcividui to-�vi(:
"CO"I'AL VALUt?
� i to $500
�501 to �2,000
$Z,001 to �25,000
$25;001 to �50,000 -
$50,001 to �100,000
$100,001 to $500,0�0
$500,001 t,o $1,000,000� -
$1,000,001 and up
r-r_��.s
$15 (Minimum Fcc is $15 plus surcharge)
$15 for fust $S00 pius $2 for each additional $100 or
fraction ffiereof, to and including $2,000
$45 for first $2,000 plus $9 for each additioaal $1;000
or fraction thereof, to and includiag $25,000 '
$252 �for first $25,000 ples $6_SO far each additional $1;000
or fraction thereof, t,o. and inclading $50,000 '-
$414_50 for Cust $50,000 plus $4S0 for each additional
$1,000 or fraction tha'eof, to .and including $100,000
$63950 for €irst -$100,000 plus� $3_SU for each additional-
$1,000 or fraction thereo� to and inciuding -$500,000
$2039.50 for ti� 5rst $500,000 pMs $3 for each additianal
$1,OOD or fraction thereof, to and including $1,000,000
$3539_50 for the fust $1,pU0,00p pius $2 for each additional .
$1,Q00 or fractioa t�ereof -
DRIVEWAY DEPRESS[ON ESCROW
(Concrete C�ub Streets Only)
Alternate "A": Removal and replacem�t of cu� and gut�er only - Driveway width plus 6 feet times
� 13 _S0.
Alternate °Q": 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.
VCRIFICA"f(ON OF FOUNDAT[0[Y
('ermits for consu�uction will be issued a minimum of 24 hours from the t�me of application to allow
for proper review of the propc�sed stnacture and of the co�straction site_
A CertiGc;ite of Survey of die lot, showing the IocaUon vf the fou�ciation once it hac it has t�een
constructeci will be re;yuirexl i�efc�re proctxding with lfie framing_
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FROM :City of Fridl�y
�uilding
xnspecti�ns
7f13�572�3d�Q .
FAX hJQ, :763571�2B7 Jun. 16 �006 L��:12PM F'2
�
BttJi�I)YNG ����t �n.: � ���� �
I�.ESID�iV�T1A�I., �l,PPLIC�TIa'1�oT Receivad By:
�.1� �� ��L� i �&� �fC°C�: e�rr�- �D
317'L AUURF:SC �� �—�
'1'H1:► ApP1.,iCMJ7' IS' R l)WSVF.R
9'�NAIVT
fiUt3MIT A CUPY OF
YC/LR STATE LIC�+Mt�l?
WIT1F A,ppLICAT10Id
_ YUITR F-A4A1L. AUDRN,y'y --- � .. `
FI30T1E.�_ . ,� �� S �'
N�: E'6Z` Gv Y
STA'i'Fs L,iCEt�E fl,�4 7 D_.
����s�:_ 22'Z__�{ �
�}iANF A� \ (� Z��C/ ..A9/A
� B�15LMGIJ'f FIN15H
0 I}FC:K
TYPE OF WARiC: � ❑ �
• " CE
DESCRIBE WORK HEINCi DClNF:
51PL OF 1MPROVEMF.NT '
�.A90I'�
0 31UIN{a
���' _.... . S7ATE ZO?
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la IJIiAIN 1'[I�
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A1LIM6k�k UF SQUAtt�S . DU9E & QARAG�
PItUPUSEn SI�� [] A7`!'AC•1�D aAltAdE
�RUPC).9Ef� HB?(iHT: �CNP,17tARAGE
`'' • "'�' OSuFlit
0 q,luntim�m O Trim
� �� -- ., 0 Fe�oia
iN�R
t30PLTNA+IC;S OY�s CINo L�OCATION C}F WtTJL?OW'S
OR P{N1 NEW trP�ttNCiS.DP.5CRt3E SIZ� c9�
4PEIuA10 CiIANTQES de .�.'. .—
't`YA� OP'iV3NDOW i'a 8E IN(9TAl,LE��D PJUM[iIIt OF WINDnWS
EE9 ARE R,d,��;� �� VAI.UATIUlV, lNCLUDING Ti�IF. Cpi51' (
3 I� J (�JJS11vG � 97 .'.0 FEE 5CHEDUL.
�r sr..rnnvwe n.ti•er.�.i m - - - - ----
rsrrm�C r �
sn eviaw � ' `'�
Fire Stt�harge � . � �'�
9tncharge � �,i��
a.icenae Surch�,rge E� � �°+`L�
SAC Cb�rgm
Curb CuC F�c�'ow
Ero$ion Caum+ol
Park Fe�
5ew�r Main �harAe_ _ e
•
ir
R.4S�MEhi'J' ��pDiLIPIC7 S11BA�''T•
� . �'.�cistir� Floor rl�n,
3 Pm�aeti llcb�r ptnn
3. Lfst oP�tnatturel me�nbeca �u bc w�ed
P(1R NF:W C.Ui�tSTRUGTIQN INCLt1DiNd 17ECN:9�
ADD1TlAV� ��1'tGH�CUqnarr•
1. Sltt PlaalSiarvey shitwinp tha axiating Atracwrze
and ptnA� P�4i�wt.
2. Two s�xs of oon�cttuc�ims pl�s
3. Enmroy Ceic�latisir�s
�AAOR AI,TD P�YA'
� -_ see B�ck Pa�e for F� Sehedule --
65°l0 of Buildin� Pennit Fee
$ .001 nint�s tho tptal jnb valuati�n
� .p005 x Permit Valuation Mir.imum $.SO
- � -- --.e�—��' $5.00 {9tate L1c�:lCti Rt�idCrltit�l Gotlk'actoTS)
� $155(� par SAC Clnit (plens to MWCC Fnr detprminatir,n)
$ ft'�' 6 tt a FY x S21 =$____^e _`.
$ $45Q Camse�rvat�ion Plan Review
Fee I3eterrnln�i by Englneerir,g
�— Ap.�emant npc,,�ry ( j Nen Nec�ssaay {�
- - — °° , . � � r , � • �a� enecks a blr to: Cf of Fridl AttaeZ �tt e�lattoa�a
TH1S tS LT,@�,ATtAN F. a PFRp1IT-\IOT VtV,ln iJl`''!1L PROI"•GS3ED
i 1�eroby appdy for a buiidin �
��t�mit and a+�knCtiwledga thc� nnEiarmatian above ts completa antt eccura�e; lh�t th� wprk wi�t b:, in
confrn���nce with eho ordinanco� and, s of �2ie Ciry o 'dlcy snd wifli the Minnesotn Cansmactton Cocf�a; �l�at i emder��tar,d this is no� a
pormit but only an �ppltuntian for ft � wnrrk is to �a�t Hrithaul e pomtit• hnt chs �a�or will be In accardance ith Ch appr�vvd
pl�n in 1he c� of all work whlcla view and p of plan5.
51C)NA'fl)fl8 OF t1PFLIC�Vd'1'_,,,,.. PRIIaT NAMB � i/f�✓ ISATB � Q�
9
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Building ���
Inspections C�
763-572-3604
763-502-4977 FAX
MECHAlvICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
DATE i � �? �� I � YOUR E-MAIL ADDRESS
SITE ADDRESS .� �•( g �C� i r �'Yt �✓1 S� 1 v�
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
❑ OWNER
'1 l0 3 -
�1CONTRACTOR
Permit No.:'� C
Received Byz
i. �-
.
`i �1
� SSy3�.
CONTRACTOR coMPANYNAME: CENTERPOINT ENERGY
SUBMIT A COPY OF CONTACT PERSON: JOANPI ZINKEN
YOUR STATE STATE LICENSE # BOND 22013346 EXP DATE � �
LTCENSE WITH �D�ss:9320 EVERGREEN BLVD NW SllITE B ct�rC00N RAPIDS sTATE MN ZIP55433
APPLICATION pHONE 763-757-6202 FAx 763-757-6701
PERMIT TYPE �INGLE FAMILY � TWO FAMILY
TYPE OF WORK: � NEW �[,REPLACEMENT
DETAILED DrSC� TION OF WORK
C[�v�d�'�icne�''
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EA BELOW)
Equipment Installed MFG: e Gi,r r i er MODEL: � 1Yl U (Q O SIZF�(�� QOO
MFG: r � �-°r MODEL: e�'�P�� oi.� SIZEBTU �'�►'1
MFG: MODEL:
1 A/C $25.00 FIREPLACE (GAS) $15.00
AIR TO AIR EXCHANGEER $ I S FIREPLACE (WOOD) $35.00
_BOILER $35.00 �FURNACE $35.00
CHIMNEY LINER $10.00 _GAS DRYER $10.00
,_„DUCT WORK $10.00 _GAS PIPING $10.00
S1ZE/BTU
_GAS RANGE/OVEN$10.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
_POOL HEATER $35.00
_VENTILATOR $15.00
THIS 1S 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 all work w�h r�4uire eview and approval of plans. .�
SIGNATURE OF APPLICA.T�'�1�' �' ,�� �"'°p�T NAME ROGER HOFFHEIN � � a� � c d
DATE
City of Fridley
Building Inspect�ons 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 PERNIIT APPLICATION HVAC .
❑ NEW HOMES/ADDITIONS �EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. l�iatural Gas or �ro�ef�FGe �hapter � witYi A�IN Amendmerrts
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
: 1 11: 1 1��I�.i�[�] ilx.y
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. ACC�ua� _H _-- - - ---
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
$ui�di�g BUILDING Permit rio.: ,�� bzb `3
Inspections RESIDENTIAL APPLICATION Received By: -
763-572-3604 CITY OF FRIDLEY vate��: M � �
763-502-4977 FAX � �c�-�v� 1-1-zoio
DATE YOUR E-MAIL ADDRESS �
SITE ADDRESS 0. � �
THIS APPLICANT IS: �OWNER �CONTRACTOR
PROPERTY OWNER/ N�:
TENANT ADDRESS: � A.l�� � CITY STA�ZIP����
rxo�: 7 Le 3—? $ 3— D�a-��'
CONTRACTOR N�:
SUBMTI' A COPY OF
YOUR STATE LICENSE STATE LICENSE # E}CP DATE
AND CERTIFICATE OF ADDRESS: CITY STATE ZIP
INSURANCE pHONE FAX
PROPERTY TYPE �SINGLE FAMILY/NEW CONSTRUCTION SiZE � q
❑ TWO FAMILY/NEW CONSTRUCTION STORIES s/ �
PERNIIT TYPE ❑�DrrION ❑ GARAGE/SHID Wnvnows �r�5 K-� x t� o
�ASEMENT FII�TISH O ROOF ❑ DRAIN TII,E 'fD t2�u"F' I� °� atcMr�� ,
❑ DECK ❑ SIDING ❑ OTHEIi � � � ,� �� (>
❑ SWIIVIMING POOL
TYPE OF WORK: � NEW HOME COAISTRUC170N ❑ ADDTI'ION
❑ MAINTENANCF/REPAIIi MODELING
DESCRIBE WORK BIING DONE: 'L g X W%
SIZE OF IMPROVII�i'f LENGTH X �� X Bd�H HIIGHT �j�� S FI' ��
ROOFING ❑ HOUSE ONLY BASII�IENT REMODELING SUBMIT:
NUMBER OF SQUARES ❑ HOUSE 8c GARAGE
1. Existing Floor Plan
GARAGES 0 ATTACHID GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structmal membeis to be usad
PROPOSED HIIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vuryl OSoffit ADDITIONS & PORCf�S SUBMIT•
❑ Aluminum � Trim 1. Site Plan/Swvey showing the existing structures
and proposed project.
❑ Other ❑ Fascia 2. Two sets of construction plazis
WINDOWS 3. Energy Calculations
IN EXISTING OPININGS ❑Yes ONo LOCAIION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANiJFACTURE STIC�t ON V�V�W. /
OPENING CHANGES & �t.J�1,�4l�OINh- � W ��aw �}j�n �
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS , p e,�q,�p
Ai.T. FF.F.0 ARF. RACF.1) ()N VAi iTA'IT(1N_ iNfT.TTiIiN!`_ Tt�F. !`(1CT (1Ti 7.A7ini� ANn iur�m�ui�r e. �awP
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Swcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Chazge
Total Due
$
$
$
$
$
$
$
THE 1997 U.B.0 FEE SCHEDULE)
OCCUP,
TYPE
,�,$ See Back Page for F� Schedule
�$ 65% of Building Permit Fee
. tJ� .001 times the tobl job valuation
,�'� .0005 x Permit Valuation�Minimum $.50
$5.00 (State Licensed Residential Conhactors)
$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 pavabte to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII., PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; thax 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 ttus 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 1 work ich requires review and approval of plans.
SIGNATURE OF APPLICANT I\ PRIIVT NAME � j^t� ,(�,y� a ei DA'I'g S� �`�O
. E
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK
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BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, - u , understand that the State of Minnesota. requires
tha.t a11 residential buil ' g contractors, rernodelers and roofers obtain a sta.te license
unless they qualify for a specific exemption from the licensing requirements. This license
requirement applies to owners of residential real estate who build or improve such
property for purposes of speculation or resa.le.
By signing this document, I attest to the fact that I am improving this house for my own
use and am not building or improving this house for the purpose of reselling it. I hereby
claim to be exempt from the sta.te licensing requirements because I am not in the business
of building or remodeling on speculation or for resale and that e house for which am
applying for this permit, located at _,� �'( �_,'Y-,,,,��.� S�; � G, �%j�f ,j,�`%Z
is the only residential structure I have built or improved in the past 24 months. I also�
acknowledge tha.t because I do not have a state license, I forfeit a.ny mechanic's lien
rights to which I may otherwise have been entitled under Minn. Stat. §514.01.
Furthermore, I a.cknowledge that I may be hiring independent contractors ta perForm
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota.. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is a
misdemeanor under Minn. Stax. §326B.082, subd. 16 and can also result in a fine of up to
$10,000. I further state that I understand that the filing of a false statement with
The Citv of Fridlev may also result in criminal prosecution and/or civil penalties
to applicable city ordinances and/or state statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to The Citv of Fridlev for compliance will
all applicable building codes and city ordinances wit the wo k being preformed on this
property.
Signature of Pr erty Owner
JY � �D
' Date
For questions or information on contractor licensing, or to check the licensing status and enforcement
history of a pa.rticulaz contractor, call the Minnesota Depariment of Labor and Industry, Construction
Codes and Licensing Division, at (651) 284-5069. The web site is: httu:/1www.dli.mn.gov/Ccld as�
Building
Inspections
763-572-3604
763-502-4977 FAX
SITE ADDRESS =
THIS APPLICANT IS:
MECHA1vICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
O` O YOUR E-MAIL ADDRESS
��i rrnc�n'�' J�'�- iVrG
� OWNER KICONTRACTOR
PROPERTY NAME: ���ro� �r. r
O�� �wnxESS: SL\8 �• � S
TENANT t r'vrlon
PHONE: `1 �e�✓' ' 1��J ' �(o �i 5
Pernut No.:
Received By:
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ATE�ZIP �5u3�
CONTRACTOR coMPANYNAME: CEPJTERPOINT ENERGY
SUBMIT A COPY OF CONTACT PERSON: �OANN ZINKEM
YOUR STATE STATE LICENSE # BOND 22013346 g}tp DATE - �
LICENSEWITH ,�Dx�ss:9320 EVERGREEN BLVD NW SUITE B crr�rC00N RAPIDS sTaTEM�N zir55433
APPLICATION pHONE ]6�-757-6202 FAx 763-757-6701
PERNIIT TYPE I��GLE FAMILY � TWO FAMILY
TYPE OF WORK: I � �W � �PLACEMENT
DETAILED DESCRIPTION OF WORK �11 e w c r k
❑ TOWNHOUSE
�AL.TERATI ON/REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZEIBTU
� MFG: MODEL: SIZFJBTU
MFG: MODEL: SIZE/BTU
A/C $25.00 . FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $IS FIREPLACE (WOOD) $35.00 IVEW GAS GRILL $10.00
_BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 �rAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $]0.00 _VENTILATOR $15.00
THIS 1S AN APPLICATION FOR A PERMIT-NOT VAI,ID 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 all work whi h r uire review and approval of plans. .�
SIGNATUREOFAPPLICA.T� �' �` � o ' PRINTNAME ROGER HOFFHEIN DATE S I�( I C�
,
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
REQUIRED 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
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.
�uilding
Inspections
763-572-3604
763-502-4977 �AX
DATE "�'� �
SITE ADDRESS �
THIS APPLICANT IS:
PROY'�+ RTY
O�YNER/
TENEiNT
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S��EI�T'���b� AP�Y��CA'�'��I�T
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�I'�'Y �F F�DI.E`�I
EFFECTIVE 1-1-2010
YOUR E-MAIL ADDRESS
❑ OWNER $�ONTRACTOR
ADDRESS: ,YriQ/ `J CTTY
PHONE: 1��'� ��
Petmit No.:
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CO1VTItACTOIt NAME: �I t�
SUBMIT A COPY OF STATE LICENSE # ,i� �� �TO-PM EXP DATE �` V
YOUR STATE 651 _g65-1
LICENSE, BOND AND STATE BOND # EXP DATE
CERTIFICATE OF ADDRESS: o CITY STATE ZIP
INSURANCE pHONE ' FAX
PEItNIIT TYPE
�Y'YPE O�' WO1tYC: I ❑ NEW
FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
DETAILED DESCRIPTION OF WORK
�PLACEMENT
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINKILAV FLOOR DRAINS SHOWER _ WATER PIPING
gp'I'g'I'�g GAS PIPING (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35)
CLO'CHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
— WATER METER _ OTHER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED
3
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 of wor c uires review and approval of plans.
SIGNATURE OF APPLICANT � .� PRINT NAME �G/Y���. ��G �DATE �'1 a I�
�fl�y o� �r����y
�uilding �nspectgons Deg��r��aent
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
' FAX: 763-502-4977
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