AF - 42722City of FridleX, Minn.
BUILDING PERMIT lv� 6 2 5 9�
Date: ��. "`�' .'�� -� Gi �` _
Owner: � �-�'�" ��.°�-�t�'2"{'�-�'�''i Builder �..
Address � Addr�se —
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L� TION F BUILDING
No. Street - ^� _..t .��. P Lot
Lot __ Block Additfon or Sub-Diviaion -�-:�"'����
Coraer Lot _ Inside Lot �� Setback ' �� Sideyard ' ��
Sewer IIevatian ____ � Foimdation Elevation
DESCRIPTION OF BUILDING
To U �,,��
Front _�� Depth _.���� Height -.�-'*� S�l• F''� �'-+r�.:�-s'� C�u. Ft .��
Front �. Depth ITeight _� Sq• Ft, -�i��" Cu. Ft ��
.,, �y
Type of nstruct3on Fs� Co ���c�---�-"i° T be Completed _._.
Ea conaideral3on oE the isauance to me of a perm4t to construct the building described above, I agree to do
the proposed work in accordance wlth the description above set forth and in compliance with e11 Provisions oP
ordinances oE the dty oP Fridley.
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In consfderation of the paqment of a fee of ��p,[� , permit fs hereby granted to
to conatruct the building or addition as deseribed above. Thia permit is granted uPon
the express condition that the person to whom it is granted amd 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 lacation, construction, alteration, maintenance� repair and moving of buildfngs
within the dty limits and thia permft may be revoked at any time upon violation of aay of the provisions of eaid
ordinanoea
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Buildin8 Inspector
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Nonc�:
11ds p�m�h dea eof eow� ths eoestrueNoe, IeshOaHae fo� vrieley. 'lumbtno, �as 6�at6iy, sww� or �raf�n 8� sun to s�
fh� Bnildteg lesp�etor foe ap�raM p�neih Poe f6�a itsms.
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6B7S-Ni�hwoy �GS ,V.E.
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ENGINEERING, INC. �n��'°
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— En9ineers � Su�vecJors
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`� t�'�±�'�'er A•��• SUBURBAN ENG/NEE2/NG, INC.
, ineers/� fr� Sur'gveyors, ,.
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2��45 I"'1 f°`� �
APPLICATION FOR BUILDING PERMIT
CI�Y OF_FRIDLEY, MINNESOTA
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ow�R ° s r��
BUILDER
ADDRESS ADDRESS
LOCATIOPT OF BUILDING
No. Street Part.of Lot
Loe Block Additioa or Subdiv3sion
Corner Loe Znside Lot Setback Side-Yard
SEWER ELEVATION FOUNDATION ELEi1ATION
Applicant attach to this form Two Certif�.cates of Survey of Lot and proposed build-
ing location dra`an on these Certificate�;.
DESCRIFTION OF BUILDING
To be used as:
Front � Depth �n � Height ���` __
Sq. Ft.. Cu. Ft.
Front `-�; � � Depth �� r _ Height / �� _
Sq. Ft. Cu. Ft.
Type of Construction Estimated Coat
To be Completed
The underaigned hereby makes application for a permit for the work herein.specified,
agreeing to do all work in strict accordance with the Citq of Frfd].ey Ordinances aad
rulings of the Department of Buildiags, and hereby declarea that all the facte and
representations stated in this appl3cation ar�e and corr�-.
D ATE
SIGAlATI1RTz
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(schedule of Fee Costs can be found on the
y� • h
( `
Side).
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BUII,DZNG PEItMTT T8E SCAEDULE
Section 2. The Inspector of Buildings shall, before issuing any pertait far
the erPct3on of aay buildiag os structure, or for any additioa to any exis�-
iau bi��lding or structure, or for any alterations or repaira Co any e�i�t�.ng
building or structure, upon application therefor, require the paymen� by the
applicant for such pernutt of feee te the amount herein below set forth and
in the manner herein provided to-wit:
2.1. For any such permit for the erection o.f any fire-proof building, othes
thrn a garage� warehouse, factory or grain elevator, or for the erection of
any fire-proof addition, for simiiar mccupancy, to any exi.ating build�x��
shall be at the rate of $j,.40 for each oae thousand cubic feet, os frac��.e�a
thereof, in such cubical contents.
2.2. For any such permit for Che erection of any fise-proof garage, wmrehouse,
factory or grain elevator, or for the erection of any fire-proof additioa�,
for similar occupancy, 'to any existing building shall be at the ra�te of �1.25
for each oae thousand cubic feet, classified as °1fireproof" by Sectioa 502 of
tae Minneapolia Building Code.
�`€}USES
2.3. For anq such permft for the erection of any non-firepsoof building other
than a garage, w�rehouse, factorq or ffixain elevator, or anq non-fireproof
additioa, for similar occupancy, to any existing tauilding - permit $1.00 for
each one thousend cubic feet.
�AitA�ES
2.L�. For any such permit for the erection of any non-fireproo� garage,
�.��rehouse, factory or graia elevator, or for the erection of any non-fi.�epro�f
a�dit�on, £or similar occupancy, to any existin� building or for each such
building or �ddition - niae�y centa ($0.90) for each one �housand cubic fe�t
oz fr.action thereof, in the cubical caatents thereof with a minim�mn of $4.0�.
�'or the purpose of compu�ing fees for building permits, the cub3cal coatents
of any building o�^ additioa to a uniform height throughout by �ltiplyin� the
gsnund area covered from a poiat six (6) inches beio�r the floor liae of the
b�sement or cellar to the average height of the uppes aurface or to the
ave�age height of the roof surface of the ma3n gable of a p3.tched roof.
2.5. For repa3rs or altesations to an existing structure, the fee siiall be
at the rate of $3.U0 per each Five Hundred Dollars ($500.00j or frsction
thereof in the cost of all proposed work.
2.6. In. no case shall tYie feQ char�Ad �or anp perm,tt as set forth in
Section 2 be less than $4.00. •
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CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND�STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION � ,�S" `� ° � i �� � S /` DATE .� �l � �
� ,
OWNE � � d; � � � � , � � ADDRESS _�°�,� �
The undersigned hereby verifies that the existing chimney or stack:
1. Nas been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are 1adQed within
4. That it is securely supported
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
All Other BTU
ToTa�
REMARKS '
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HEATING PERMIT # '
SIGNE��
censee
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by ,
Address •
Telephone � �'=�- U(�'?� �
Fridley.City License �
---
Buildir�g ���s �� MECHANICAL Permit No.: �- � :
Tnspections RESIDENTIAL APPLICATION Received By:
7. 63-572-3604 CITY OF FRIDLEY Date Rec'd: �'� ��'��
DATE � � � ����� YOUR E-MAIL ADDRESS
S1TE ADDRESS Lc`-� �-� � �r : c� l�- �� �� ��.
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY NpME: �a,� z Cc� �-� �=��
OWNER/ ADDRESS: �'�� �l �r �� �-� i-� S� � E CITY �'r � �- �-1 STATEV�1 I�ZIP SS��31�
TENANT PHONE: � k' � - `� —I � ' ; ��-S c�
CONTRACTOR CoMP,��NY NAI�: �OII� L�'i1TERGY
SUBMIT A COPY OF
CONTACT PERSON: JOAN�i ZI�T
YOUR STATE STATE LICENSE # E3� DATE
LICENSE WTTH pDDRESS: 13562 C�TBAI. AVE iBZE CITY ANORA STATE MNZIP 55304
APPLICATION PHO� �63�7§�-62p� Fp�; 763°757=6701
9
PERNIIT TYPE ��GLE FANIILY O TWO FAMILY O TOWNHOUSE
TYPE OF WORK: � �W ��PLACEMENT ❑ ALTERA'fIOTI/REMODEL
DETAILED DESCRIPTION OF WORK �� E �� � C � ��-° `� '� °`� � �-� � � �` `� �-�'�' � � �' E''�
PER MS t6B.665:the germit fee is a miaimum of $15.00 or 5% of t6e total cost up to $500.00, whichever is greater, far the
improvement, installation or replacement of a residential fixture, excluding the fixtwes. (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 PROIECCS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT R'I�RE NOTED. FIXTURES: (IIdDICATE TOTAL
NUMBER OF EACH BELOV� �, pc0
Equipment Installed , A�ffG: C cA r r.-c r MODEL: S��� C3 b�' � SIZEBTU � � i
IvffG: a� r c e� MODEL: ;3f' TL'�c .� � SIZE/BTU ��•-�
✓ MFG: _FIREPLACE (GAS) $15.00 ODII.: _GAS RANGFJOVEAI$10.00
_A/C $25.00
AIR.TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW OAS QRILL $10.00
BOII.ER $35.00 _�`URNACE $35.00 _GAS IJNTf HTR $10.�
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL I�ATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VEATfII.ATOR $15.00
— ,:. , , . -' . �
�.: ' � , � � .i�,:� , , .� J ' '. �.: . � s
� Permit 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$25.00 =$ o� S��
Number of fixtures @$35.00 l x$35.00 =$ 35 , c.G
State Surcharge = $ .50
Tota1= $ �c,�G. 5 O
TI-IIS IS AN APPLICA'I70N FOR A PERMIT NOT VALm 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 applicarion 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.
SICrNATURE 0F APPL1 ��. � ` PRINT NAME ROGLR �idFI�HEII+T DATE L� � � �i �
r . . . . ..: .. . � . . -
.., .. ., _.
` - '�� r
(:ity of !+'ridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
r� � v. ni� cn� nn•f'f
�.-
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT '
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �EXISTIAIG HOME ❑ M,AKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below) .
- -� Ui.� or solid fuel lMC Chapter 7 with MN Amendments
b. Naivral Gas or PropanellFGC 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 Amendm.ents
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load pe7 room � ,
a. Required on new co�struction IMC 1346.0312
5. Ventilation .
� P_er MN Ener�y God:e.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
, � �
combtistion and make up air calculations
Building pI,UMBING Permit rio.�
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY nate Rec'd: :' ����
DATE �� 7� YOUR E-MAIL ADDRESS
SITE ADDRESS �� �dI �P y ��
THIS APPLICANT IS: � OWNER ,�CONTRACTOR
PROPERTY NqME; , �(�-,�SPi�
OWNER/ qDDRESS: ��� �vIGY/� `/ �� I" CITY F�i�i��P � 1 STATE IP��
TENANT pHONE:,�/. r�--� 7/ �.5�'l
CONTRACTOR N,y�:
SUBMIT A COPY OF STATE LICENSE #�L/ EXP DATE I� ���f�
YOUR STATE ADDRESS:� 7/� li �L�/rl `S� CITY��%h/.Yi STATF�IP�,/�
ZI�EI�SE�VTI1�_-- PHONB���-�7 ���� - gAX f�� �.S?��/,�i�l--= -- ---- --- - -
APPLICATION
PERMIT TYPE �GLE FAMILY � TWO FAMILY � TOWNHOUSE
TYPE OF WORK: � ��'`' � �p�CEMEN'P
DETAILED DESCRIPTION OF WORK ��/i/'��;���9�
PER MS 16B.665 the permit fee is a minimum of 515.00 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 $30Q =$15.00. Labor cost between $300 to $SOD = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATH'TUB GAS PIPING R+� cmuc� SWIMNIlNG POOL WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET _BACKFLOW PREV. ($IS)
DISHWASHER _ LAUNDRY TRAY �WATER I�ATER ($35) FOR IRRIGATION
WATER METER OTF�R
PfiRbIIT:�EE�R�3��`�'���0.,�,{�; _ .. ��� . ���`�" � �`���•�k��� ���,�„^���`-�'�����F"�,'�,�'' ������`�r�r�����"±`�� `' ..: �;�rQ: �3.�7�..��T��3;�ER-$500:
Permit Fee $ Number of fixtu.res @$10.00 x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ 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 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 re uires review �nd approval of plans.
SIGNATURE OF APPLICANT 9 PRTNf NAME ��� L���,�f DATE �� ���
�PL£A���C���`.���'�1.,��. s' ..,�.. �, �� ..i��Q�='�'$,. '��..�?`�:� p.� � �, ��� `',���°.��,`�Q�i�.�,�.,
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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