AF - 45329. �.
BUILDING PERMIT
Village of Fridley, Min.m. N° 2 3 91
,� � �. � �' -�-,- :S '''7
Date� ...........................................
Owner �,�. LIr��..`. ��'.��....' ^�`�'�`.::.�`-�``-�''�°�r+ �"�,trBuilder -r'°;.�-.'�.�stA�' .............................
Address......................................... Address .........................................
LOCATION OF BUILDWG
t� if �� `"�a !�'�^� �'%.-+� �I��c
No. .....,��... ��...... Sfreet . ................................. . Part of Lot .......................
,.� `
.� v
Loi . . . . . . . :4t . . . . . . . Block . . +�.':�. . . . . . . . . Addition or Sub-Division ... . . . . . �r ��'� �'r'�'� : �: �. . . . .
�.., �
Corner Lot ............ Inside Lot ..'�°:`....... Setback �`�:''...:�'�.. Sideyard �Q.:?'�� ...............
DES�CRIPTION OF BUILDING
To be Used as:
„�'�+',�}.l.��rt�•�i .�re f.� f !I�x
.................... Front . .... Depth . ... Height ! . ....
l
.................... Fron ..... Depth ...... Height .........
�'r,�,; f �� ..
Type of Construction �.��:� ' . . . . Est Cost . : ``k . . . . . . . . . . . . . . . . . .
Sq. Ft. . .... ... Cu. Ft. ... .. ...
Sq. Ft. ........ Cu. Ft. ........
To be Completed : !. : ���.� �. . .
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 a11 provisions of
vrdin�nces of the village of Fridley. •
��eration of the payment of a fee of $. ��T.'�. . , permit is hereby granted to . . .. : .�. � : .. .. . . .. . . . . . . .
..+: :'. .......:!�!� ..... to construct the building or ad dition as described above. This pern�it ia granted upon
the express conc]ition tha.t the person to whom it is granted and his agents, employees and worlunen, 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 location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any tim� n violation of any of the provisions of said
ordinances. S
�� `�., y..,�...,...
.�.; . . . t�: . �. . . . ; ': '`�/%�•� j/. . Building Inspector
NOTICE:
This permit does not cover the.construction, installation or altera#ion for wiring, plumbing, gas heating,
sewer or water. Be su�e to see the Building Inspector for separate permits for these items.
� �.
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-- -__/
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Building
Inspections
763-572-3604
DATE O � I L �
S.ITE ADDRESS _,,�
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT 'I'I'PE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CIT� OF FRIDI�EY
E-MAIL
� OWNER
�
COMPANY
CONTACT
a�
Pernvt No.:
Received By:
Date Rec'd: � �'
A'
--- - - MINN���.�, MN 55408
STATE LICENSE # 24 �
ADDRESS: STATE ZIP
PHONE
`�SINGLE FAMII.Y ❑ TWO FAMII_Y
❑ �W �PLACEMENT I
DETAII.ED DESCRIPTION OF WORK
FAX
O TOWNHOUSE
❑ p1,TERATION/REMODII.
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 vnder $300 =$15.00. Labor cost between $300 to $500 = cost of lalior x.05 =
FOR PROJECTS W�fiERE LABOR EXCEEDS $500, FEES ARE BASED ON SI0.00 PER FIXT[JRE, EXCEPT Wf�RE NOTTED. FIIfifURES: (II�ICATE TOTAL
NiJMBER OF EACH BELOWj � MODEL: � S�� t9�-�=—�
Equipment Installed . MFG� SIZE/BTU ._
�G: MODEL:
MFG: MODEL: � SIZFJBTU
(GftS) $15.00 GAS RANGE/OVEN $10.
�A/C $25.00 � (y�JppD) $35.00 NEW GAS (3RII.L $10.00
AIR TO AIR EXCHANGEER $15 F�ACE $35 00 Gps UNIT H'1`R $10.�
BOII.ER $35.00 �GAS DRYER $10.00 POOL HEATER $35.W
CHIMNEY LWER $10.00 G/� PIPING $10.W VENTII-ATOR $15.0{1
DUCT WORK $10.00 ° „ `
, r. , , p. : � � _ ���~��. �_` ,�� �,., � , ,__. _. , _. ._ .. . _ .
Permit Fee $ Number of fixfiires �$10.00 x$10.00 =$
Surcharge � .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixt�res @$25.00 �, x$25.00 =$�
Number of fixtures @ $35.00 � x $35.00 = $_K :�
State Surcharge = $ 50
Tota1= $�
THIS IS AN APPLICATION FOR A PBRNIIT NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that 1�e `'vork will be in
conformance with the ordinances and cades of th 'ty of Fridley and with the Minnesota �Consh uction Codes; that i understand this is
not a permit but only an ap � e` an ork is�not to start without a permit; that the work will be in accordance with the
a p p r o v e d p l an i n t h e case f all w'ch r ires re ew and approval of s.
�/Yt A� � O l0
SIGNATTJRE OF APPLI - _ _ _ ,,.
� City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley,. MN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTlMG HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTIN .C� HQ�IIES ..:,: .
_, . _ ;: �:. �s.�i� ,.
1. Combustion Air (S ee note belov� � _, �, � ' � .
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 oiher than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new conshuction IMC 134-6.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IlVIC 1346.0603.2 . -�
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air ca.lculations
Engineering WATER AND SEWER Pemut No.: � �
��63-572-3551 pERMIT APPLICATION Received By:
763-571-1287 fax CITY OF FRIDLEY D`j����UN
EFFECTIVE 4/8/09
APPLICTATION DATE: O YOUR E-MAIL ADDRESS: —
THIS •APPLICANT IS: ❑ O ER '�9NTRAC"I'OR
JOB ADDRESS: ���� ���-^^-A-� n � �
NEW CONSTRUCTION PERMIT# (IF APPLICABLE):
PROPERTY NAME: � 1 � � �
EN�AN,r� ADDRESS: ��0� r I�t� ��a r� C1TY '�� STATE ZIP
PHONE: � [�D � ^° .�2 I - � .5 �/
CONTRACTOR Na,NtE: �A °l�2 � .., a—%�
SUBMITA COPYOF �DRESS: �0 3�'f C� � ° °�'^"�'�} �'` °��C�TY �°►`�e.�-� �'� STATE ��ZIP �5�� �
YOUR STATE , 2 _ .� � � � �-�
LICENSE WITH PHO� eo CELL PHONE: �D/ Z'�°� �! °�7 �`�
APPLICATION STATE LIC # STATE BOND: EXP DATE:
• 1. Narr,�tive/written description: � .^c, �' �� � / S ��-� �� � � � o,.;g c���dL
��Ge•Qa.or �..o+�l� { m�
F
'� �oy/►� j io3i+
2. Please attach sketch showing curb line, utiltty line, building, etc. wit6 distances.
PERMIT TYPE
❑ SEWER CONNECTION PERMIT $50
� ❑ WATER CONNECTION PERMIT $50
�r� f
�JATER LINE REPAIR $40
❑ SEWER LINE REPAIR $40
0 ADD STATE SURCHARGE $.50 �S�
❑ SAC CHARGE @ $2000 =
�����
OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING
NEW WATER METER COST — SEE UTILITY BILLING
SPECIAL ASSESSMENTS — SEE FINANCE
WATER TAP — SEE ENGINEERING
NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / wEEx�vns & HoLtDAYS $125/HOUR-BILLED
THIS 1S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but
only an application for a pe wo ot to rt without a permit.
SIGNATURE OF APPLICANT PRINT NAME:
L� r C DATE: � ' ^A �
� 6' � .�Y
APPROVED B . DATE:
COPY G N TO: ❑ irrn. B LING (only if new meter) � PUBLIC WORKS G NGINEERING
f'itv nf Fridlev
Engineering Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3551 �
FAX: 763-571-1287
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATE (��
SITE ADDRESS '
THIS APPLICANT IS
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
Oli OFING
N[JMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
V YOUR E-MAIL ADDRESS
C � v�Cy 6`� �l"'e
❑ OWNER ,�ONTRACTOR
N�: S '`r
ADDRESS: ; Y
PHONE: � — �
NAME: ���� �c� �lSl-!�%[ ��-�`�+
STATE LICENSE # Z � �
,�DxESS: �O �ZG l�:s�� S•
PHONE C��� � �%g � ���
�49aSINGLE FAMII.Y/NEW CONSTRUCTION
❑ TV✓O FAMILY/NEW CONSTRUCTION
❑ ADDTIION O GARAGFJSHED
❑ BASEMENT FIIVISH O ROOF
❑ DECK 0 SIDING
Permit No.: �' �'� e � �� - a � �
Received By: �` '
���C' � � � I
EXP DATE _ _� S [
CITY ��'cl� e
FAX
SIZE
STORIES
WINDOWS
❑ DRAIN 17LE
� OTHER
❑ NEW HOME CONSTRUCTION ❑ ADDI1'ION
❑ MAINTENANCF/REPAIR O REMODELING
❑ HOUSE ONLY
O HOUSE & GARAGE
O ATTACHED fiARAGE
O DETACHED GARAGE
A7�'LIP_ ��
��
BASBMENT REMODELING SUBMIT:
1. Existing Floor Plan
2.. Proposed floor plan
3. List of structural members to be used
SIDIlVG FOR NEW CONSTRUCT[ON INCLUDING DECKS,
❑ Vuryl �Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1• Site Plan/Survey showing the existing swctures
❑ Other ❑ Fescia and Pro�sea P%lect.
2. Two sets of conshvction plans
�p�yg 3. Energy Calculations
IN E}QSTING OPININGS �lYes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FORNEW OPENINGS-DESCRIBE SIZE OF MANUFACNRE STICKER ON WINDOW.
OPEhTING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USI�TG�'HE 199�.B.0 FEE SCHEDULE)
VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
._Ii�Cy'�
$ l�' �I �� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ (� .001 times the total job valuation
$ � �� .0005 x Permit Valuation Minimum $.50
$ ((� $5.00 (State Licensed Residential Contractors)
$ $2100 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$24=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ I� Agreement necessary ( ) Non Necessary ( )
$ ���a,, Make checks payable to: City of Fridley Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PRQCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accwate; that the work will be in
conformance with the ord'mances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is nof 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 all wo k which r u' es e iew and approval of plans.
SIGNATURE OF APPLICAN'� �'/,�/.•-�,,�/., /�� �� PRINT NAME Cii I���Q� S 7 l7 J DATE �`� S�` I�
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:
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