AF - 43434�
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City of Fridley, Minn_
BUILDIIiTG PEI�MIT
Date: J�e 22, 1965
�: � Chester Maciaszek B�d�
Ada� 6684 Fridley St. ft. E. A�
Chester Maciaszek
��.,� q� �
N° '79��
6380 Quincy St. N. E.
LOCATION OF BUILDING
No. 6684 s� Fridley Street 1Q. E. p� og �t
Lot2� 3 _ Block 2 Addition or 5ub-Divieian �ak B�i$ Grove Add.
Coraer Lot Ins�ide Lot Setback Sideyard
Sewer Elevation Foundation IIevatlon
DESCRIPTION OF BUILDING
To be Used sa:
Single Dwelling �t Depth Height Sq. FL Cu. FL
. Front Depth I�eight Sq. Ft. Cu. Ft
� op ����� Wood Frame �, ��14., 000.00 To be Completed
Single Dwelling
In conaideration oP the issuance to me of a perrnit to conatruct building described above I agr+ee to do
the proposed work fn accordance with the d�script9on above set land in pliance wlth afl provisfons of
ordinsnces of the dLq oP F'rldley. �
/ � 9JA
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In co�adderat[on of t%►e payment of a fee of ; 2� 0.00+, permit ia hereby �an,ted to Chester Ma.c3aszek
to c�nstruct the bufldin� or addition as described above. This �ermit is granted upon
the expres,s conditia�n that the person to whom ft fs grented and hia agenta, employ�s and worl�nen, in all work
done in, arouad and upon eaid building, or any part thereof, shall coffioim fn all respecta to the orrlinanc� of
Fridley� M3nnesoffi negardiig ��,� be crevo�'ked t aqy�'time upon�Na'tioa o�f a�► of the Provis�i� ona oP�saild
within the dty ]imiffi and thi�
o�d9nancea
A11en Jensen g�� �r
NOTIC�
TI� p�emB dea eet � t6s ceadrudioe, � tee �rtetey, PU�mb6�g, oa� 6ea1�, awu or wNsr. B� ans to a�
Ha Ba��dm9 I�or iar stpuata � for tMa Nwu.
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a
APPLZCATIOR FOR-BUILDING PERMIT
CITY OF FRIDLEY, MIIJNESOTA
ow�'s rr� ��'�rF„ Btmn��i�',�sJ`��' /��l�3.r,�
ClY�Ni55 � / r rr�r�.r�.�.���lJAri�79 � J O /O � 1/ /A �Gy C..�� �/ /- � r
r
� LOCATION OF BUILDYNG �
.-.Ha+ �^ e� � � Street � _ _ � , Part of Lot . — .
L�T v� R���ADDITTON OR SUBDIVISION p�,q' ��p p l/,F •��� _
Coraer Lot�_Inaide La v Setback ,� �� Side�Yard_ �Q �� Q�
SEWFR ELEVATION � FOUNDATION EL�V�TIdN -
Applicant attach to this for•m Two Certificates of Survey of Lot end proposed
building location drawn on these Certificates.
DESCRIPTION OF BUII�DING
To be used as:
_S/�fs E�� ,b I�/�� �/N� Froat � Q � Depth, �� y� eight ��
Sq. Ft. �� � Cu. FC. l G% o? �
Frent Dept �_$eight
Sq. FC. Cu. Ft.
�qpe of Can�tructfon �✓eoj.� �_,�,���. Estimated Cost �� �`=
To be completed_ G�j,� .�� S/S -
� . ■—�----
�he undersigned hereby makes application for a permit for the work herein specified,
agreeiag to do all work in strict accordance raith the City of Fridley Ordiaances
and rulings of the Department of Buildings, aad herebq declares that all the fac�ts
aad representations etated ia this application are true and correcC.
(Schedule of Fee Coata can be found on the Iteverse Side).
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SE=. The Inepector of Buildinga sha].1. before issuiag aap �rmit for the
erection of any build3ng or atructure, or for any additian to any existin� build-
in� or structure, or for any alteraCioa� �r repgira to anq esisting building or
structure, upoa application therefore, rec�uire the payment by the applicant�for
such permit of fees to the amaunt herein below eet forth and ia the.manaer`itare3s�--
provided to•wit; , `
2.1. For anq such permit for the erection of any fire-+proof buildiag,
other tUan a garage, warehouae, factory or grain elevator, or for the erection
of any fire•proof add3tion, for sim�t.lar occupancy, to any existing building,
ehall be at the rate�of $1.40 for each one thousaad cubic feet, or fraction
thereof, in euch cubical contenCs.
2.2, � For any such permit for the erection of any fire-proof garaSe,
Warehause, factory or graia elevator, or for the erection of any fire-proof
addition, for similar occupancy, to any existing building shall be at the rate
of $1.25 for each one thoueand cubic feet, classified as "fireproof" bq
Seetion 502 of the Minneepolig Building Code.
80IISES � . � _ • �
2.3. � For any such permit for the erection of $A31 IIOII�firepraof bu3ldfn�,
other than a garage, warehouee, factory or grain elevator, or any non-fireproof
addition, for similar occupancy, to any exiating building - permit $1.OU for each
one thousaad cubic feet.
GARAGES
...._._.
2_.4. For any auch permit for the erection of any non-fireproof �arage,
warehouse, facto�ry or grain elevator, or �or the erection of any non-fireproof
addit3on, for similar occupancy, to any e$iating building or for each such
buildiag or addiCion:- ninety cente ($0.90) far each ane thovsand cubic Eeet
or fractian thereof, in the'cubical contenta thereof wiCh the minimum of $4.00.
For tbe purpose of comguting fees for building permits,, tlie cubical eoneenta
of anq building or additioa to a uniform height throughout by multiplying the
ground area covered from a point aix (6) inches below the floor line of the
basement or cellar to the average height of the upper surface or to the average
beight of the roof su,rfaee of the maia gai�le of a pitched roof.
2.5. Fo; regairs os alterations �o�an exiating structure, the fee shall
be ae the rate of $3.00 per each Five Sundred Dollars ($5.00.00) or fractioa
thereof in the cost of all proposed work.
2.6. In no case aha11 the fee charged for any permit as set fosth in.
Section 2 be lese than $4.00.
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sue�ecr T NO.
City of Fridley 2 71 b 0
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
; � RECEIPT NO.
� ; v �_�__ COMMUNITY OEVELOPMENT DIV.
r � � PqOTECTIVE INSPECTION SEC. �/ � �
i = �
� /"'1 � CITY HALL FRIDLEV $$432 NUMBER REV OATE PAGE OF APPHOVED B�
�----'�'� ,•' 612-571-3460 s�aF�S 8/12/98 / /
JOB ADDRESS 6684 Fridle St
1 LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2�3 2 Oak Grove Addition SHEET
2 PROPERTY OWNER MAIL AOORESS ZIP PHONE
Ste hen Ranallo 6684 Fridle St 574-0195
3 CONTRACTOq MAIL ADDRESS Z�P PHONE LICENSE NO.
Owner
a ARCHITECT OR DESI(3NER MAIL AOORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOFiK
Reroof house and ara e 23 S Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
Refunded license surcharge collected in errore
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBIN(i, NEATINO, �PE OF CONST. OCCUPANCV (3ROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OF CONSTRUCTION ZONIN(i SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED fOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOFiK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE FEAD AND EXAMINED THIS APPLICATION STA��S GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORFECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND OiiDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT (
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEpMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW RE(3ULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. F�Ie SC 1.9L
PIAN CHECK fEE T07 L FEE
-r3 65.13
SIGqNAT�URE OF CONTRACTOR OR AUTMORIZED AGENT �y IpATEi EN RO VAII T THIS IS � Ufi P� MI
iCl�"V��'�. l. I'``°�`��'v�N�" �!' �' eoL ' i1 O � r
SiGNA�I E Oc OWNER iic OWNER BU40ER� IDATE� BlD iNSP �1F7E
NEw
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ��, g� �;���a I e.� $ f �',�� �( �t;�
Legal Description:
Owner Name & Address: S
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
0
Effective 1/1/98
i�b� �
� ���
� Tel. �# .5'� 7 y-(� l 9 S°
MN LICENSE #
Tel. # � �'
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
I(� e l'C d T'" )�7� u s�- '� �ct r ct c� t. ° /�a r c� " o:? 3 s �
Construction Type: �� Estimated Cost: $ _:�i�� � / ��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � � �� - `1 � APPLICANT: .��,c�w ��� Tel. #{ .S°' 7 �/ - U i 9S
Permit Fee
Fire Surcharge
State Surcharge
SAC Charg�
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ ,(�� �� Fee Schedule on Reverse Side
$ l % .001 of Permit Valuation (1/lOth%)
$ � $.50/$1,000 Valuation
$ � �$1 00 per SAC Unit
$ . G�� .00 (State Licensed Residential Contractors)
$ Alt. " or Alt. "B" Above
$ $450.00 nservation Plan Review
$ Fee Dete ined by Engineering
$ Agree nt Necessary [] Not Necessary []
$
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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 $100,00U
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,OOQ
$62.25 for first $2, 000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,Q00 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,U00 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,0OO,OflO
$5012.25 for the first $1,OOD,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": 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.
VERIFICATION OF FOUNDATION
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 construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
� � .� �
SuB�ECT
c�ty of Fridley
AT TFIE TOP OF TME TWINS g � I L D I N G P E R M I T
�
� �
� ; y ��__� COMMUNITY OEVELOPMENT DIV.
r � � PROTEC7IVE INSPECTION SEC.
`..•.� �"' �'� CITY HALL FRIOLE� SS132 NuMBER nEv
L 763-571-3450 9t0-Ft5
JOB ADDRESS 6684 Fridley Street NE
1 LEGAI �OT NO. BLOCK TAACT OR AODITION
DESCR. 2,3 2 Oak Grove Additioa
2 PROPERTY OWNER MAIL ADORESS
Steve Ranallo 6684 Fridley Street NE
3 CONTRACTOR MAIL ADORESS
S�E
d ARCMITECT OR DESIGNEF MAIL ADDRESS
D�TE PAGE OF
11/12/02 � �
33243
�
RECEIPT NO.
AGpROVED BY
SEE ATTACMED
SFIEET
ZIP PMONE
763-574-a195
ZIP PHONE UCENSE NO
21P PMONE LICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PMONE LICENSE NO
8 USE OF BUILOING
Residential
7 CLASS OF WORK
❑ NEW C� ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct an 18' x 18'
9 CHANOE OF USE FROM
and
STIPULATIONS
See notations on pian.
SEPARAT� PERN�aTS
REQUIRED �OR:
PLUMBIN� AND�SIG�IS
TO
�� ' ' . - ,
�efor� digging ��� fof
�ii �mi��r'o�t�o�,�
454000�
REQU�RE � ��t�
TYPE OF GONST.
•S.EPARA7E PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, NEATING.
VENTI�ATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTpUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED- NO DWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICA710N 1
AND KNOW THE SAME TO BE TRUE ANO CORFECT. A�L PROVISIONS Of LAWS yALUATION
ANO OFDINANCES GOVERNING TMIS TVPE Of WOFK WI�L BE COMPLIED
WITH WHETHER SPECIFIE� HEREIN Oii NOT. TME GRANTING OF A PERMIT �SO�OOO
DOES N07 PRESUME TO GIVE AUTHORI7V TO VIOLATE OR CANCEL TME pEqMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING• CON• $643.75
STRUCTION OR TME PERFOiiMANCE OF CONSTRUCTION
PLAN CMECK f EE
S�GN4TUAEO�CON'AACTOQOfiAUTMOp�2EDA GENT IDA
: 1 � _ "i�� sK � _� t.�/�d'/ � �
�
SQ.
P IOCCUPANCVLOAO
CU f T
STALIS GARAGES
SURTAX
$25.00
SAC CMARGE
Fire SC $50.00
TOTAI,FEE
$718.75
VALIO ED TMIS IS VOUF1 PERMIT
_ //-/�—D'Z
NEW
ADON
ALTER
[] CITY OF FRIDLEY Effective 1/1/2002
�j 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bldg Insp
[ J SINGLE FAMILY AND DUPLEXES R-1 AND R-Z
BUILDING PERMIT APPLICATION
Cohstruction Address: ���� �d' � c� 1 e y s`�" ,�r � e� � e�r l?'/ �� ,S'S y�3 �
Legal Description:
Owner Name 8 Address: S'i�. V e, R�. � c� I I o 6 6�S �l F�� c� �e � S fi- Te�. # 763 s" 7 SI — O l 9S
Contractor. O W�'l ��` MN LICENSE #
Address: Tel. #
LMNG AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length ` Width ` Height �_ Sq. Ft
Length Width Height Sq. Ft,
DECK AREA: Length Width HgUGround Sq. Ft
OTHER: � C�1. e n IB E C� r� j'►1 �� ��t !� � � � ca S ��'t e.�. �"
�� �;� � I +r� a� �'
Construction Type: stima ed os :$ ���, d � D
Driveway Curb Cut Width Needed: Ft + s Ft = Ft x$ _$
ttor�e 7�3 s �y -d� ys
DATE: J (� ° 3 � - � s� APPUCANT: ��" ` Tel. # � 1 °eL S �.5 � � �v 6 � e ��
Call (?63) 572-3604 for Pertnit Fees if mailing in application or Fax to 763-571-128T if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
�� �
$
$ �a � ex�
$ a5� E�^i
$
$
$
$
$
$
$' � �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ )
�
STIPULATIONS:
BUILDING PERMIT FEE SCHEDULC
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 sucli permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5(�
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,0�
$100,001 to $500,000
$500,001 to $1,�0,000
FEES
$23.50
$23.50 for �rst $5(� plus $3.05 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 fraction tliereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,OQ0
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $5�,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction diereof, to and including $1,0OO,OQO
$1,000,�1 and up $5,608.75 for the first $1,(�0,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRE5SION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
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 construction site.
VERIFICATION OF FOUNDATION
A Certificate of 5urvey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Oniv
�
N ^�i- S
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MECcheck Compli�nce Report
2000 Minnesota Energ,y Cale
MECcheck Software Version 3.3 Release 1 c
Data filename: C:1Program Fil�\Ch�k�MECcheck�Ranallo Addition.cck
TITLE: Kitchen Addition
COiJNTY: Anoka
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 11/04/02
DATE OF 1'LANS: 9/18/2002
PROJECT INFORMATION:
Steve Ranallo
6684 Fridley St
Fridley MN 55432
COMPLIANCE: Passes
Maxamum UA = 84
Your Home = 55
34.5% Better Than Code
Permit Number
Ch�ked By/Date
Gross Glazing
Area or Cavity Cont. ar Door
Perimeter R Value R Value U-Factor UA
Ceiling 1: Flat Ceiling or Scissor Truss 324 38.0 5.0 8
Wall 1: Wood Frame, 16" o.C. 141 19.0 5.0 6
D�r 1: Solid 20 0.033 1
Wa112: Wood Frame, 16" o.c. 141 19.0 5.0 6
W'iudow 2:
Above Grade, Vinyl Frame, Donble Pane with Low-E 13
Wal13: Wood Frame, 16" o.c. 141 19.0
I�ar 2: Glass 24
Basement Wall l: Masonry Block with Empty Cells, 7.9' ht/5.5' bg17.9' insul
141 13.0
'Window 1:
Basement > 5.6 ft2, Vinyl Frame, Double Pane with Low E 20
Basement Wall 2: Masonry Block with Empty Cells, 7.9' hd5.5' bg/7.9' insul
141 13.0
Basement Wa113: Masonry Block with Empty Cells, 7.9' ht/5.5' bg/7.9' insul
141 13.0
Proposed and A�Ia�mnm U Faetor Averag�
0.028 0
5.0 6
0.033 1
0.0 8
O.d28 1
0.0
0.0
9
9
-v
Above-Grade Windows and Glass Doors
Includes Foundation Windows > 5.6 ft2
Proposed
Average U-Factar
0.030
Maximum
Allowed U-Factor
0.370
COMPLIANCE STATEMENT: The proposed building design descn'bed here is consistent with the building
plans, specific�tions, and other calaulatians submitted with the permit applic�tion. The proposed building has
bcen designed to me,et the 2000 Minnesota Energy Code requirements in MECcheck Version 3.3 Release lc and to
comply with the mandatory requirements listed in the MECcheck lnspection Checklist.
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
G011�ll��l` <�I�T ��I�T �I�I�EGT(]R AI`D G�MBl1CTIC�N AIR VERIFICATInN
When � �n.tn+ an _Yie in0 �r�n __, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes ( i No ()
The venting system is plasbcJPVC and meets all current codes and manufacturer
speafications including sizing, length, number of elbows and termination. Yes ( I No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specificafions. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The pY�� emh���en a�r is sized and installed to meet the current codes
and manufacturers specifications.
When required to ���+au a r,ew _eme �e+ien airi it will be sized and installed
to meet the current codes and manufacturers specifications.
�gn jp�j�jp�a ne�•� vc�ntin�i�►c_tpm, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes.
Yes ( ) No ( )
Yes( ) No( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes( )No( )
�.. . �ti- .- . �• r - .ui�•� -� . �• -� .� �-N • � .rn. �.�
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type _
� 1 � 1•► �:- .•�
HEATING CO:
Signed By: Date :
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APPUCATION WILL BE RETURNED
C(�MMnN NT� NT nNN .TnR AND �MB 1STInN d�IR RIFI ATION
When � �n a,�n� an _Yieting �ran _, the undersigned hereby verifies that the
venting has been examined and is free from nast, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plasticJPVC and meets all cuRent codes and manufacturer
speciflcations including s'izing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's speciflcations. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The eYi��n�ceme�stien air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to in�a�� a n_w _omb ��en air�,it will be sized and installed
to meet the current codes and manufacturer's specifications.
Wh211 ine alline a new ventine cv�,�m, the undersigned hereby verifies that
� is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connecto�s sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes( ) No( )
Yes( )No( )
� � • . � ' /• ' . � � ' • 11 11 � � ' � . � � ' � • � � ' y • � � �11 . 1 • �
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
r � r•► .- ..-
HEATING CO:
Signed By: Date :
Building BUILDING Permit No.: 'D '� �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Dat�e dNOV g
763-502-4977 FAX EFFECTIVE 8-19-09
DATE � �� l J � y\OUR E-MAIL ADDRESS
SI7'E ADDRFSS .C�� ��� P�f ��1
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY OWNER/ NAME: V� � k q I d
TENANT �DRESS: b� g�_ �'� (� �1L CITY STATE ZIP
PHONE: � b g r�/�I "6I a
CONTRACTOR NAME: L �UA �
SUBMIT A COPY OF STATE LICENSE #_ C"� [i� � � G1 EXP DATE
YOUR STATE LICENSE ��� �
AND CERTIFICATE OF ADDRESS: �� `'U`�`�d� � 6 ct�lA,kh('1`k S�� STAT�ZIP ��
INSURANCE pHONE FAX
PROPERTY TYPE GLE FAMILY/NEW CONSTRUCTTON SIZE
O TWO FAMII.Y/NEW CONSTRUCI'ION STORIES
PERMIT TYPE O ADDIIION �❑ �,rARAGE/SHED ❑ WINBOWS
❑ BASEMENT FINISH �'$OOF ❑ DRAIN TiLE
❑ DECK ❑ SIDING ❑ OTHER
0 SW[MMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUC770N ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: ��i �9 �' �� 4 S �t G u
SIZE OF 1MPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING na ffi�HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES �C. O ,�7 HOUSE & GARAGE
l. Existing Floor Plan
GARAGFS ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Viml ❑Soffit ADDIT[ONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1• Site Plan/Survey showing the existing structures
and pro�sed project.
❑ Other 0 Fascia 2, Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISIING OPENDVGS OYes ❑No LQCATfON OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPEMNGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINBOW TO BE INSTALLED NUMBER OF WINDOWS
ALL rL+l�:� Al(P; ifAJ�U V1V VALUA11V1V, 11V(:LUll11VC: 1�HL�' C;V��I' VN' LAI3UK ANll MA"l�L�'K1A1.5:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
P(an Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$ °��) � t�� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ � .001 times the total job valuation
$ O .0005 x Permit Valuation Minimum $.50
$ � $5.00 (State Licensed Residential Contractors)
$ $2000 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$22=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ i Make c6ecks payable to: City of Fridle_y Attac6
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 perm' 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 al work requires review and approval of ans.
SIGNATURE OF APPLICANT PRINT NAME ,J � I� �C 1�) S C v DATE �J ✓ �� ��
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�$500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1� $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $]0.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for l�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $I,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977