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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. � �. / ' �, -- -__/ �, � 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 � — ,.�- �. r. � �, 4�� } n�t � .. �i�. .1 .: p . , . ..: ,. � . . ` .. . ' : ��� ' � :< , .,:. ,. . , , . �, . :�� . -� , - r,. �,t� � �' z 'N� � ��f,�� � � � � � - '��� �s', 1_ l. . � '� �,' � �" �, _ �,A { * �� � - - � ;�' � y t'. " � �� � }.,:f f _ > „ ': -" ' � , ' � : ' � �..... .� . . , � -+ . ' 'E�. f � y � - � 3 . `. � ��' � � i„ � � , . _' � , �: , � , >, y . � > ,. � �. =i ! 2 , . , - £, 'F .r ,.� � .. ^ , .: 3 .' 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' ' �:s �R'= . . . .;. ...r. . i . �.... _.,. ,.. � v... . a.ir'!- '�• _ . . r y _ . . . �,.... , .. . ,_ ., x.-,� . , ..... _ , 'ak" . ., x +:�,.-, ,X.�'.`4'. � -„ 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