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AF - 45636� City of Fridley, Mi.nn. BUILDING PERMIT ��; _ Aug 18, 1H69 p�; ___ Clemron, Inc. g��. Same Address ..�. 4411 Central Ave N. E. A� Same " �'" LOCATION OF BUILDING �� ::�_.� No. .___7518 __. Street ..._..__... Hayes S�_.�...Yft' �.E' ....._......_.._...._._._ Part of Lot _._.._._._ Lot .�.. 2�__ Block _ 3 Additioa or Sub-Divisian ._. Don's 5th Adda. Corner Lot __�..� Inaide Lot —.. x. Setback _.._ 35 � r._ Sideyard _ 10' - 10' sewer IIe�,atian �.,_.____885 .96 _._---_- � 888.9 Top of Footiag /� � DESCRIPTION OF BUILDING / / � N° 10372 To be vaed as: 1, 000 �e11i�g Front 40 � Depth �25 � xeight ?� � &1. F't. �e..E��. Ft 20, 000 ....._�.��a.ge._....._ Frant ��._.__ Depth ___._.2.i. � Iieight ._..1Q'__ Sq. F't. __L�.Q_ Cu. P't. 46 00 �pe of Construction ____.__.F.�.� .�.._._._.. Es� Coat _._._..�23.z000.00.._ To be C.ompleted _.._ SEWSR LOCATI Oft - 92' South of Manhole �ATBR LOCATION - 81' South of Manhole PILASTBRS Oft BASffi�PT WALLS OVSR 32' In condc3eratlon ot the issuaace to me of a permit to c the building tha proposed work in acxordance with the desCrlption ab and in aa�dinano� of the city of Fridley. /�� Iprov�'isio s a�[ $100.00 Sewer Connection qliarge Ia candderat[an oi fhe peymeat oi a fee of a� 37 .00 ��t ��, �� Clemron, Inc . to construct the building or additiar► as described above. This permit is granted upan the expreea c�onditiaai that the�perso� to whom it is granted and his agents, employees and vwrlunen, in all WoTk done in, around and uPoa eaid buildin8, �' �v P�rt thereof, shall conforra itt ali respects to the ordinancea of FridleY, Minnesota regarding locatio�y construc:tioz�, alteration, maintenaace, repair aad. maving o! build�n� withiu the dty limits and this peimit may be revad�ed at aqy time upon violat3a�► of aqy o! the P��s oi sa�d ordinaaoes. ,�h...�-.-.-'�r.• NOTICE iW p�ewil dea �et eewr IIM se�a�rodke, ��e vrirt�Y. P�w W�N. �wK ee waur. i� wn to s� Na wildip M�eio� for s�p� Pu�Y� for fl� iNw�. q�, , �r _ - � • _ • APPLICATION FOR BUII.DING PII�MIT • • � �, • / i , � i � �. . i � i�i!✓� �% : i � :� • �_ ii ��/. /� I�C%�� • �, . � � • �. �i_ � LCCATION OF SiTTLDING xo. � 1 sTaffir IAT BLOCK �DITION OR SIIBDIVISION ��/� ,�i i�'!% % ' i r CQR.'�ER LOT INSIDE LOT SETBACI�,�-�SIDFYARD_[�}'`/O -Q SEWSt EI�VATION TOP OF FOCTING Applicant attach to thie form Two Certificates of 3urvey of I,ot aad propoeed building locatio� drs,wn on thea� Certificates. DESCRIPTION OF BG�ILDING / [�eight � �- o �quare feet ��/� Cubic Feet , � ont �� Depth ��-d Height Square ��et ��Q Cubic Feet i 40 Type of Construction�� Z��_Eatimated Coet �,�Gt'!�� u,l To Be Compl The undersigned hereby makee application for a permit for the work herein epecified, agreeing to do all work in atrict accord.ance with the City of Fridley Ordinances and rulings of the Depertment of Buildinge, and hereby declaxes that all the facts and i� � r.tations etate n thie application are true and correcta DATE �,CL� / S'^ /��oT 5" iG*1ATURE (Schedule of Fee Coete can be fourid on the Reverse Side.) �? � �) / /v` � �, c �l ,� � �/,r°,..�:? ..; . u �S' G L. i i .�� - .t � ' c� � � � � ".�� ,�°'. (;,+�>� �� : 6 , .:% Q v �%� � � � ^ � � _..� - , — _> >. • - - � Bt1ILDING P�IIT FEE SC�IILE SECTION 2. The �.nspector of Buildi.xigs ehall, before issuirig peraite for the erection of any building or structure, or for �.ny addition to any exiating etructure or building, or for any alteration or repe�ire to say eaieting building or etructure, upon application therefore, require the payment by the applicant for such permit of fees to the amount heretn below aet forth and in the ma.nner herein provided to-wit: Uniform Building Codes Type 1, 2, & 4-�1,75 for each one thoueaad cubio feet, or fraction thereof, in such cubical cAntente. Type 3� 5- i1.50 fox each one thoueand cubic feet. For the puxpoae of computing fees for building permite, the cubical caritente of any building or addition to a uniform height throughout by multiplying the ground axea covered from a point eix (6) inchee below the floor line of the baeement or the cellar to the average hei.ght of the upper aurface or to the average height of the roof surface of the main gable of a pitched roof. For xeps,i�s or alterations to an existing atructure, the fee ehall be at the rate of �3.00 per each iive hundred dollare (i500.00) or frac�ion thereof in the cost of all proposed work. In no caee shall the fee charged for any permit ae eet forth in Section 2 be lepe than x5,00� NSSSD Coxinection Charges based on location - Area 1 or 2. � i ., � ^ i 1 b 1, � v i . ..,,,�,w. �. -. .. • . . . �g : ' � � � . v► !'1.; ^. �-+E^1� , . ..,��...��i±�r..�:r,�..�� " � / co�d Sc,^�r,� .Sals �i:,y c,w� �,�.,�,�i / / � .x1.. u ,, {� � u "I�a s�� .: ±1 't�< , . +f � . ,�� M;�:.. a�:,�►�1�'y�c � �7i. ENGINE�R��dt�, Ih��. � � zi . �� E�'� — En9rneers � � Su�ve�urs --- . �- ;� : 1 F �Gles�t��it� o� �i� ��: ��1�ON /,�tiC. " 3 �d�� ;�� ,�N��iTN � �� ' a � i � � ,y : ;� ' o j � � � �i I ' I � �, �� ;. 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'� . ,!� '�a. , �� '.l�'� .�:r r ; 4 f:._ :, ��. � �� ' .�3 .}�; �' �.:� - fi r 's ��t: . .. `� �� _ „1'1!;; �. .r 4s+ � �-, <, ' @.: ,� - ,� '+- ;` y . �_ . Y ", � : - - -� .: _ _ , _ �� , �� - ��-. -� . .. ,,, .�,� �. . . _ .:;., _ , � , . , , . . � � . . . . ' . _ . . .. . . . . E ,. > , ,.. ..�� , r. . . ,.. .._.. � � . - - � . .�. .,; _ . . ;:: �� . � ,�'`b, . . � ., �� . � :. . . -� . .. a��.. . SuBJECT - . City of Fridley AT THE TOP OF THE TWINS g� I L D I N G P E R M I T r � � � � COMMUNITY �EVELOPMENT DIV. r � ~ � PROTECTIVE INSPECTION SEC. � � i . � � � �"'1 � CITY HALL FRIDLE� 55432 NuMeER pE� �""'�'� ,�� 612-571-3450 910-Ft 5 JOB ADDRESS �518 Hayes. Street NE 1 �EGAL �OT NO. BLOCK TRACT OR ADDiTION DESCR. 2 3 Don�s 5th. Addi,tion 2 PROPERTV OWNER MAIL ADORESS Lee Johnson 7518 xayes Street NE 3 CONTRACTOR MAIL ADDRESS D& D Home Ilitprovesnent 7401 Central Avenue NE 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAIL DATE 3/27/91 ZIP ZIP 6 USE OF BUILDING Residential 7 CLASSOf WOFK � NEW ❑ ADDITION O ALTERATION (� REPAIR 8 DESCRIBE WORK Rezoo� D�uelling (18 Squaresl 2nd layer 9 CHANGE pF USE FROM TO STIPULATIONS TYPE OF GONST. SEPARATE PERMITS ARE REQUIRED FOR EIECTRICAL, PLUMBING, HEATING, VENTILATING OH AIF CONDITIONING. THIS PEHMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING AUTHORI2ED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AfTEFi WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO $��6 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE pEqM1T FEE PROVIS S OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRU 10 OR THE PERFORMANCE OF ONSTRUCTION. S2S.00 pLAN CHECK FEE SIGNATURE OF CON i RACTOR OR AUTMORIZED AGENT IDATEI WHE SQ. STALIS VAGE Of � � RMIT NO. 073 � � %S�- y APPROVED BV SEE ATTACHED SHEET PHONE 786-9811 PHONE LICENSE NO. 784-7543 PHONE LICENSE NO. PMONE LICENSE NO. ❑ MOVE O REMOVE OCCUPANCYLOAD CU. FT. ' PARKING GAAAGES $. 50 iAC CHARGE k'�xe SC $ . 93 fOTAIFEE $Z6.43 � THIS IS YOUR PERMIT � I�1 [ ] EffeCtive 8/16/90 AD�T [ ] 1�1 AND �2 AI��t [ � Buildir�g Permit Applicatian oor�stn�tioa� Aaaress: %S/� �`7/i�t1�'S �-S'`/ - i��. Iegal Desc;ription: Owi�ex Name & lsiddress: �� .��/l/�.Sb/i� Tel. # ! �v- �gi ( oontYactor: � � ��/n� �-e� Te1. # �J`'�75�3 Address: �`f.l�l ��''l//i�� i�- �� Attach to this applicatioaz, a�xtificate of S�vey of the lat, with the prq�osed �tiv�cti� drawn ori it to scale. Dl�SCx2IPPI�T �' II�'t�VFa�Ti' LIVIIJG ARE�1: Lei�gth Width Height Sq. Ft. (�iRAGE ARF�: Ie.r�gth Width Height Sq. Ft. D�CdC AREi�: Lergth Width Hgt/Grau�d Sq. Ft. 0►li�R• Cornex Iat [] Inside L�t [] Ft. Yd Setback Su1e Yani ,Setbacks Type of C)onstructi�: i°•- 7'� Or Estimated dost: $.--��c� ,�,� Approac. �letiari Date: ..S = � l $ S�u�Es Pr�osed Driveway Width If New Is Desired: Ft• S S W' + 6' See BaCk Page DATE: ''�- (' APPI�CANr: Tel. # 17� %�S/3 Permit Fee $ � � . 0 D Fire S�arge $ � State Surcharge $ SAC Ci�arge $ Driveway F�row $ Park Fee $ sew�er Main charge $ • v� STIPUTATIONS: $ � ,1 � QTY DBE �II,Y Fee Sdiedule ari Reverse Si.c�e .001 x P�ermit Valuatiort (1/lOth $) $.50/$1,000 Valuatio�l $600 per SAC Unit Alt. ��A�� or Alt. ��g�� Above Fee Determined by �gir�eerin9 Ag�s►t Neo��sarY [ ] � �-��Y [ ] R C _ :'1 � � � f ' :N'� � ` �I` ]-�:I�� 1 Tt�e Cizief Buildirig Offici.al shall, before i�suiryg permits for the erectian of at�y builciing or structure, or for ariy addition to z�ny existir�g buildir�g or structure, or for ariy alteration or repair to ariy exi.sting b�ild�rg or structure, upon application therefore, require the payment by the applicant for such �r++; t of fees to the amount herein below set forth ar�d in the manner herein provided t-.o-wit: � ZOTAL VAILTE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 �+y. $15 (Minim,un Fee is $15 plus su�azge) $15 for fiYSt $500 plus $2 for each additiomal $100 or fraction thereof, to and incl� $2,000 $45 for fiYSt $2,000 plus $9 for each additional $1,000 or fraction thereof, to ar�d inclu�ding $25,000 $252 for first $25,000 plus $6.50 for each additio�a�al $1,000 or fraction thereof, to at�d includirrg $50, 000 $414.50 for first $50,000 plus $4.50 for each additio�nal $1,000 or fraction thereof, to arid including $100,000 $639.50 for first $100,000 plus $3.50 for each additiona]. $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the fizst $500,000 plus $3 for each additional $1,000 or fraction there�f, to ar�d including $1,000,000 $1,000,001 ar�d up $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction thereof D[tIVE�iY DEPRESSI�T E�W (Concxete C1irb Streets On1Y) AlteYnate nA�� ; Re�nvval and replaoe7nent of curb and gutter only - Driveway width plus 6 feet times $13.50. A1�ernate "B" s R�maval ar►d replaoement of curb ar�d gutter arxl install a 3 foat wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. ' �1' � M• •; • ' •'II I� • •; Pie,na,its for c�.stnxction will be issued a minina.nn of 24 houYS from the time of applicatior� to allaw for praper reviera of the Prq�o''.,ed stru�cture ar�d of the co�structian site. � A Certificate of Survey of the lot, shawing the location of the fau�dation onoe it has it has been constructed will be required before prooeedi.ng with the framirx� � � . ,.i sus�eti � PERMIT N City of Fridle� AT TNE TOP OF TME TWINS � u I L D I N� P E R M I T �" " O"" r ; ` RECEIPT NO � • COMMUMITY OEVELOPNlENT DIV. � j V ��'•� , . r � � PRqTECTIVE INSPECTION SEC. '�j� � � v � � �"'1 � CITY MAIL FRIOIE� 55�32 NUMBEp REV O�TE P�GE O� AVCROVEO !Y �.---�: �., 612-57�-3450 9�aF�5 9/21/98 / / 108 AODRESS 7518 Hayes St NE � 1 LEGAL �OT NO. BLpCK TRACt OR ADDIiION SEE ATTACMED oescR. 2 3 Don's 5th Addition SHEET 2 PROPERTY OWNER MAIL AQGpES$ Z�P PMONE Paul Henrich 783-9925 3 CONTqACTOR MAIL ADCRESS St LOt1�S Park zia PNONE UCENSE NO Northstar Aome Improvement Inc 6121 Excelsior Blvd 4�207 8�55416 929-1888 5336 a ARCMITECT OR OESIGNER MAII ADDRESS ZIP PNONE UCENSE NO. 5 ENGINEER MA�L AQORESS 11P PMONE UCENSE NO 8 USE OF BUILDING Residential 7 CIASS OF WOFK O NEW � AD�ITION O A�TERATION Q REPAIR p MOVE O REMOVE 8 DESCRIBE WORK Reside - storm dama e 9 CHANGE OF USE FROM TO STiPULATIONS Call for building wrap inspection before covering. TYp CF CONST. OCCUPANCY GROUP OCCUPANCV �pAO SEPARA7E PERMITS AqE REQUIREO FOR EIECTRICAL, PLUMBING, HEATING. VENTIIATING OR AIR CONOITIONING TNIS PERMIT BECOMES NULL ANO VOIO IF WORK Ofi C(�f�STRUCTiON 20NlNG SQ. FT CU FT AUTHORIZED IS NOT COMMENCEO WITNIN 60 DAYS. OR IF CONSTRUCTION � OR WORK IS SUSPENOED OR ABANDONEO FOii A PERIQD OF 1i4 pAVS A7 ANV 71ME AfTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIfV TMAT I MAVE REAO ANO EXAMIN�O TMIS APPL�CAT�QN STA�LS GAiiAGES ANO KNOW TME SAME TO BE TF1UE ANO CORRECF. ALl PROVISIQNS Of LAWS VAlUAT10N SUATAx ANO OROINANCES GOVERNING TMIS TYPE Of WORK Wlll B� CGIMP�IE� �SOO.00 �y.SO WITH WHETMER SPECIFIEO MEREIN Ofi NOT. TME GRANTING Of A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL TNE pEqMIT fEE SAC C ARGE PROVISIONS Of ANY OTNER STATE Op LOCAL LAW REGULATING CON• $21 . 00 re SC �. SO STRUCTION OR TME PERFORMANCE Oi CONST:;UCTION P�AN CMECK fEE T FEE Licens C $5.0 $27.00 S�GN�TUAE OF CON'AACTOp Op AUTNOA�ZEO �GENT � �OATE� EN R V UO TMIS IS UF1 E �T � �- �r 1 $�GN�TUAE O� O�NNEp�� OWNEpBU40EA� i� �DATEi � � 8l �h5� ' � � � pcft / % 1 7, NEW ADDN ALTER � � �� ConstructionAddress: Legal Description: Owner Name & Address: Contractor: (1.. � Address: �P � a� � LIVING AREA: GARAGE AREA: DECK AREA: OTHER: � CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �!� �f �-s �.5� u� �� +'►�- w�.�" �Ll.�_� � t11�.r„rr v:� Effective 1/1/98 �� h� � �p� Tel. # �?Z- �f �.�.� MN LICENSE # �33.�. Tel. # _�—{ �� 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 Length Width Height Sq. Ft. Sq. Ft. Length Width Hgt/Ground Sq. Ft. 5!D �r.11,� �E�rQ�2 51 l��S �7 �r'9 1��bY•�C � Construction Type: � Estimated Cost: $ ��v 1{�� t�� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: °E � l�P �aI $ APPLICANT: Tel. #��I�� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge s�). o� $ ` r $ . �O $ �o $ $ �.C�O $ $ $ $ TOTAL $ r a� a°� STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) " $.50/$1,000 Valuation $1000 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 [ ] _ „ t BUII,,DING PERMIT! FEE SCHEDULE The Ctuef Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, o� for any alteration or repair to any existing building or structure, upon application therefore, require th� �ayment by the,,��pl�dant for: s�c�i"� permit of fees to the amount herein below set forth and in the manner herein provided to-wit: ' ` r ,'. °:+� �'O�'�; VALUE $1 � to '$500 � .� ri *. ;� $501 t0 $2,000 $2,001 to $25,000 $25,001 to $50,000 ,�*F!��w- ' a ai • a�� -' i . $2i' �I�riii�fium•�e��is�$2�tpIt�s su�`�liargej � , ; . � ° i� S 1� ., �°.:r . .: r �� t.. .:"° a �'.. $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 � $62.25 for first $2,000 plus $12.50 for each additional $1, 000 or fraction thereof, to and including $�5,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 " .. , ° .. ... � � � ,. .. . F $100,001 to $500,000 � $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additi;�nal • � . , ,, , . - � " "• ,` -.= ��1;000 or�fracYion thereof, to and including $1,0(�,OOQ `v � � $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional $1, 000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Oniy) R � : Alternate "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 $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once=it �as it has been constructed will be required before proceeding with the framing. ►.. . -, sus�EtT � c�ty of Fridley 30885' � � AT THE TOP OF TME TW�NS g � I L D I N G P E R M I T RECEIPT NO. ; : �� o�� /� � ; y �� COMMUNITY OEVELOPMENT DIV. f � � � PROTEC7IVE INSOECTION SEC. � _ . � �"'1 � CITY MALI FRIOIEY SSI�i NUM4Ep REV D�TE v�GE O� �PVnOVEO Sr �""�" �'' 612-571-3450 9t0-Ft5 5/1/00 / / 108 ADpRESS 7518 Hayes Street NE t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED oesca. 2 3 Don's 5th addition SMEET 2 PROPERTYOWNEp MAIL AOOiiES$ 21P PMONE Henrich 7518 Hayes Street NE 3 CON7RACTOR MAIL ADOIiES3 iIP PHONE IICENSE NO Mike Mohs Construction Co Inc 3414 Snelling Ave S, Mpls, MN 55406 721-1107 1 ARCHITECT Dii OESIGNEfi MAI� ADORESS ZIP PNONE LICENSE NO. 5456 5 ENGINEER MAII ADOpESS tIP PMONE UCENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O AODITION O ALTERATION C� REPAIR O MOVE O REMOVE 6 DESCRIBE WOf;K Reroof House & Garage (20 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. ?YPE OF ClSN T. OCCUPANCV GROUP OCCUPANCV LOAD SEPARA7E PERMITS ARE REOUIRED iOR EIECTRICA�, PLUMBING. NEATING. VENTI�ATING Op AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VOIO �f WORK Ofi CONSTRUCTION 20NING SO. FT CU FT. AUTHORIZEO IS NOT COMMENCED VyITMIN 60 DAYS. OR IF CONSTRUCTION OR WOfiK IS SUSPENOEO OR ABANDONEO FOR A PERIOD OF 120 OAYS AT ANV TIME AFTER WORK IS COMMENCE�. NO. OWLG. UNITS OfFSTREET PARKtNG I MEREBY CERTIFV TMAT I MAVE REAO AND EXAMtNEO THIS APPLICATION 1 STA�LS GAi1AGES ANO KNOW TME SAME TO BE TRUE AND CORRECT. A�L PROVISIONS Of LAW$ VALUA?ION SUATAX AND OROINANCES GOVERNING THIS TVPE Of WORK WIIL BE COMP�IED 1 748 r �� 87 WITM WMETMER SPECIf1ED MEREIN Ofi NOT. TME GRANTING OF A PERMIT � � DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE Op CANCEL TME pEpM1T FEE SAC CNARGE iiOV Y OTMER STATE OR IOCAL LAW REGUUTING coN- �63+15 FlY' SC �p1.7S AUC OA THE PERfORMANCE OF CONSTRUCTtON P�AN GMECK FEE TOT FEE ,P p � Lice C $5.0 0.77 UQE O� CON'A�CTO Op �UTMOp�ZED �GEN1 � �O�t � HE PpOP VA�IO TE TMIS IS�R �RMIT _� � %� $�GN�TUQEO�OWNEA��FOWNEpBWLOEp� � �rE� � �NSo � �i��f St. -° N� I l Effective 1/1/2000 ADDN [] CITY OF FRIDLEY (763) 572-3604 �dg I�p ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �� \ Construction Address: � �� -��f C.S S T� �-,/ � ' �l �� Legal Description: Owner Name & Address: �% ��v (Z tC h Tel. # Contractor: /V t l Q �v$� � MN LICENSE # S7� S� Address: �t/e !� U�r �u Tel. # 7�� — � � �� LNING 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. GARAGE AREA: Length DECK AREA: OTHER: �� Construction Type: �d� � Width Height Sq. Ft. �C�I�oo � � _ Hgt/Ground Sq. Ft C% �c� _ / �. /`�i� - U� —r Estimated Cost: $ � / ��T� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: l � APPLICANT: �� Tel. # 7Z,�,- �l6"7 CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ �v._�: /S Fee Schedule on Reverse Side Fire Surcharge $ /� �%S^ .001 of Permit Valuation (1/10th%) State Surcharge $ , c�`% $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control $ $1100 per SAC Unit $ �, 0 b $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [] Not Necessary [] TOTAL STIPULATIONS: $ � �% � � 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 $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,0p1 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each addidonal $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 thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or firacdon 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 $500,000 $3,233.75 for the first $500,000 plus $4.75 for each addidonal $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concre�e �rb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Altemate "B": Removal and replacement of curb and gutter and install a 3 foot wide ap}�roach with 6 inch depth - Driveway width plus 6 feet times $23.25. 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 fou�ation once it has it has been constructed will be required before proceeding with the framing. New Houses On1X �- - .. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �63) 572-3604 FAX: (763) 571-1287 ADDRESS : 7518 HAYES ST NE PIN : 123024120011 LEGAL DESC : DONS STH ADD : LOT 2 BLOCK 3 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOWS/DOORS PERMIT NO.: 2006-01142 DATE ISSUED: 06/23/2006 VALUATION : $ 1,500.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. CONSTRUCTION M THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY THROUGH FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY LEGAL HOLIDAY UNLESS AN ALTERNATE WORK HOUR PERMIT HAS FIRST BEEN ISSUED. H/0:763-786-2904 CONT:612-240-6816 1NSTALL EGRESS WMDOW STATE LICENSED CONTRACTOR? 1 APPLICANT DENMAN CONSTRUCTION 6044 E VIKING BLVD WYOMING, MN 55092 (612) 290-6816 20345675 OWNER WWEFEL, DANIEL 7518 HAYES ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this applicarion and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. The granting of a permit dces not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bidg Insp Date BUILDING PERMIT FEE FIRE SURCHARGE STATE SURCHARGE, BLDG VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # CC �� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 54.00 1.50 0.75 5.00 61.25 Building Inspections � 763-572-3604 DATE� SITE ADDRESS _ THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS ❑ OWNER �CONTRACTOR Pernut No.: Received By: Date Rec'd: PROPERTY OWNER/ NAME: (�il�TiL�— TENANT qDDRESS: ,S �' - 2 CITY �i217 C� y STATE�!t�IPS.�r'�i.3� PHONE: 7Ej -' 7� �- %Q y CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: STATE LICENSE # � D 3�/5 E TS� EXP DATE �T��2.1 L �� ' �f ADDRESS: E' G�/�/ ,E • �//G �� 3[. V%� CITY WyO��'t /i✓l STATE ZIP .S U�1 PHONE FAX O ADDITION O GARAGE/SHED ❑ WINDOWS O BASEMENT FINISH O ROOF O DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER O SWIMMING POOL ❑ MAINTENANCE/REPAIIt I� REMODELING DESCRIBE WORK BEING DONE: ��S /`AC L % c�� 5 S �/� /� o� SIZE OF IMPROVEMENT NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING O Vinyl O Aluminum ❑ Other _ _ _ WINDOWS IN EXISTING OPENINGS ❑Yes �No OR FOR NEW OPEN[NGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED �C,! TH O HOUSE 8c GARAGE O ATTACHED GARAGE ❑ DETACHED GARAGE OSoffit � Trim ❑ Fascia LOCATION OF WMDOWS -y. 3 Exy�� HEIGHT BASEMENT REMODELING SUBIvIIT: 1. Existing Floor Plan 2. Pmposed floor plan 3. List of structural members to be used Ft. FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing struc� and proposed project. 2. Two sets of conswction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U�.0 FEE SCHEDULE) TOTAL JOB VALUATION $/, �� .=`— OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ �t�' (xi $ $ r _� $ � .''1S $ � . OU $ $ $ $ �_ $ 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) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make c6ecks navable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acla►owledge 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 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 whic e' es re ie and approval of plans. .-�� / SIGNATURE OF APPLICANT � ' �L- PRINT NAME � (1S ( � � ��"I�r�/DATE �,�//� Page 2- Building Residential Application _� BUILDING 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: VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to a11ow 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 wi�l 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 �� . G * . � J I` �-�- 3 --,p . �sc.�7r ��'b��- �j�r.' l�f��.� �X�ST��j ,`�loo� ta�;;i �.��'''; .. . ... ,... . . . ..,,....,...�.�� . .......,. . . -._ ? ,� l� 'i-O ( �7 L-fct S � � �3� �X�� -�� = �� \� �¢.,� ^— � �"�� &,GN ,.___.� .. , ,�..��_.___ �._._......._..�. ......_...... _� y f . f 1;�,,.; ,,: � �,,, � ��,. ��,'� �A' .. : '' , : ,,;- � . `� ';. ��:.�'',��" �� ,k:-- (,t,) tL L (� / � � w y , . �� m N � . � A � r I� � � r N : 2'-10" W�i. �" � � �; a X � Q �Q � X� N 3 11'-11" ��x �� n � � � 3 � �''� 3 �� X � W � T � � Q3 � � � � \ _.., •� � . .� A .( � ! `'��t. N A J � f t0 i Gl � � � � 3 n� `�I �ti' �~'", �'�.r �+._.a � .`V \ �`,y�•M a.,.r,(�.. * \ (. \ �'' .� �`> � y..ti Building Inspections 763-572-3604 763-502-4977 FAX DATE `2- �1/�.4y Z.O O SITE ADDRESS THIS APPLICANT IS: G�OWNER PROPERTY NAME: OWNER/ ADDRESS: TENANT CONTRACTOR SUBMIT A COPY OF YOURSTATE LICENSE. BOND AND CERTIFICATE OF INSURANCE PERMIT TYPE TYPE OF WORK: DETAILED DESCRI PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY i� NAME: STATE LICENSE # STATE BOND # _ ADDRESS: PHONE �SINGLE FAMILY �NEW OF WORK YOUR E-MAIL ❑ TWO FAMILY '� REPLACEMENT Permit No.: G� Received By: o��MAY 20 8 CITY TK- STATF�V ZIP� Z EXP DATE EXP DATE _CITY STATE ZIP FAX ❑ TOWNHOUSE PER MS 166.665 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 under $300 =$15.00. Labor cost between $300 to $S00 = cost of labor x.OS = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (IND[CATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. �BATH SINK/LAV FLOOR DRAINS � SHOWER WATER PIPING BATHTUB _ GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35) _ CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) _ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION _ WATER METER OTHER PERMIT FEE PROJEGTS FOR UNDER $500 PERMIT;FE� �{?R PR.4JECfS U�ER $5€TO Permit Fee $ . Number of fixtures @$] 0.00 � x$10.00 =$ Q Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE OR Number of fixtures @$35.00 x$35.00 =$ (MINIMUM $15.50) State Surcharge = $ .50 MINIMUM $15.50) Tota1= $ 0 . THIS IS AN APPLICATfON FOR A PERMIT-NOT VALID UNTIL PROCESSED 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 c s f all work which req re review and approval of plans. SIGNATURE OF AP C � PRINT NAME�� e� ( DATE 1 � II► � v� ° APPROVED BY DATE �� Ci PLEASE N TE: ARATE PERMITS ARF. RF,t7i ITRF.T3 Ff1R RiTTi:l`ltlrTf� 'Fi F["r'R�l�e� et�tn A,t�rue�irr�ti r�:�nnu City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building � BUILDING I Pe�lt No.: Inspectio�as J 763-572-3604 763-502-4977 FAX DATE 1 {. 1 � S[TE ADDRESS THIS APPLICANT IS: RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-08 YOUR E-MAIL ADDRESS OWNER' ❑CONTRACTOR PROPERTY OWNER/ I NAME: 1 TENANT q.pDRESS CITV �1—iQ Received By:� Dat�dMAY ATEM�V ZlP NAME: CONTRACTOR ADDRESS: CITY STATE ZIP SUBMIT A COPY OF pHONE FAX YOUR STATE LICENSE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCR[BE WORK BEING DC $lZE OF [MPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: STATE LICENSE # Ijjf SMGLE FAM(LYMEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCT(ON n_ennrTrnU n r.naer �BASEMENT FINISH ❑ ROOF , ❑ DECK ❑ SIDING � SWIMMING POOL ❑ NEW FiOME CONSTRUCTION ❑ MAfNTENANCEfREPA[R SIDING � Vinyl ❑ Aluminum ❑ Other wnvnows iN EXIST[NG OPENINGS OYes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & EXP DATE SIZE STORIES ❑ WINDOWS ❑ DRAM TILE ❑ OTHER �0 DDITION EMODELING LENGTH 4U� ❑ HOUSE ONLY 0 HOUSE 8c GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE W r � HEIGHT �� FI' � BASEMENT REMODELING SUBMIT: l. E�cisting Floor Plan 2. Proposed floor plan 3. List of structural members to be iued 2008 L FOR NEW CONSTRUCTION INCLUDING DECKS, D�g� ADDITIONS. & PORCHES SUBMIT: ❑ Trim 1. Site Plar✓Survey showing the existing structures ❑ Fascia and proposed projecL 2. Two sets of construction plans 3. Energy Calculations LOCATION OF WINDOWS � TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS � , ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING TH�j 1997 U C FEE SCHEDULE) TOTAL JOB VALUATION $ �_ , l�iO�� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due S`�o(S Z�See Back Page for Fee Schedule $ �!� 3,� � 65% of Building Permit Fee - $ � s.v4 .001 times the total job valuation $ �� '� .0005 x Permit Valuation Minimum �.50 � 55.00 (State Licensed Residentiat Contractors) $ 51825 per SAC Unit (Plans to MWCC for determination) � ft+6ft= ftx$21=� � �450 Conservarion Plan Review $ Fee Determined by Engineering S Agreement necessary () Non Necessary () � Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VAL(D UNTIL PROCESSED I hereby apply for a build' ermit and [ aclrnowiedge that the infarmabon above is complete and accurate; that the work will be in confortnance with the ordinances and codes of tlte City of Fridley an wi the Minnesota Co�struy,��es; that I undastand this is not a pertnit but only an application for a permit and work is not to start without a permit on siu; that the work wt I be in accordance w�di ap ved plan in the case of all work which requires review and approva! of plans. SIGNATURE OF PRINT NAME DA n»:Zi]��i�l 3.L�/%� IL��-��✓✓/_it��:r �. Page 2- Building Residential Application �_,� , . _, � BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, be�ore 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 Faz: 763-502-4977 ,. _ _• �n � � ••c�� °C �v� �� ° � 8�� ,��r,�:, �0. �,. � '-> 4;: �7 '"��' L' `': �..� �- '"'" 13 !.il !!) � �-�- �: i'� "P 1:..' C,�) �y C:ti - ��: C� l.`J �� -2 � (.�:. ��t�Q � � 5... � .r'i W = d � � H Q � .� . 3 � � � �� U � ' �� - '2 c`1� � � s�-„• � s'�� ,��-,« wa�-.z � - W' J � �--s �� -F� �� ? �s � ' �" �� .N � Z � a � � � �� - � � � , � � � � ,� �' �° �� 0 Building PLUMBING Permit No.: - Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY ��'S� DATE � � YOUR E-MAIL A—DD/�RESS N�� C SITE ADDRESS � G� PS 7' K- Z- THIS APPLICANT [S: � WNER ❑CONTRACTOR PROPERTY NAME: OWNER/ ADDRESS: N CITY 7"�I �i� STATEI�ZIP�L TENANT PHONE: % � CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH pHONE FAX APPLICATION PERMIT TYPE ��NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: �NEW ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK pa I"(J6� 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 under $300 =$15.00. Labor cost between $300 to $500 = 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 NU}v[BER OF EACH BELOW) +/ BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING yG BATHTUB _ GAS PIPING Mee� cmc�c�vsE) WIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK �/�WATER CLOSET BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER �� " �� . ; , ; .. � . �S: ;�� , �: �".a � x � F � ...c� , < ,. , .. : . .. . .. .... . . . .: : Permit Fee $ Number of fixtures @$10.00 3 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 w rk is not to start without a permit; that the work will be in accordance with the approved plan in the case of al wor hich r ui re ' w and approval of plans. SIGNATURE OF APPLICANT PRiNT NAME .1) �� -1 �--'� DATE �� -y-��CY"�'� 1�1L,��' �. .;r� ,. �: . ��` �^° �',� ,:i��: City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX SITE ADDRESS � THIS APPLICANT [S PROPERTY OWNER/ TENANT CONTRACTOR NOTE: SEPARATE CITY LICENSES ARE REQUIRED FOR GAS AND HVAC. SUBMIT COPY OF BOND AND INSURANCE PERMIT TYPE TYPE OF WORK: DETAILED WESCRI MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECI'IVE 1-1-08 YOUR E-MAIL ADDRESS Q�OWNER � ❑CONTRACTOR NAME: ADDRESS: L PHONE: / �� ' Z COMPANY NAME: N CONTACT PERSON: STATE L[CENSE # Permit No.: � �Q � � Received By: � Date Rec'd:P � CITY �-� )�JV"1 STA EXP DATE ADDRESS: C(TY STATE ZIP PHONE �SINGLE FAMILY ❑ TWO FAMILY ❑ NEW ❑ REPLACEMENT FAX ❑ TOWNHOUSE �ALTERATION/REMODEL PER MS 16�.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 ) OR Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS 5500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELO� Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: IviFG: MODEL: A/C 525.00 AIR TO A1R EXCHANGEER �15 BOILER 535.00 �f� IMNEY LINER $10.00 V DUCT WORK S 10.00 FIREPLACE (GAS) $15.00 _FIREPLACE (WOOD) 535.00 FURNACE 535.00 GAS DRYER $10.00 ^GAS PIPING $10.00 SIZE/BTU SIZEBTU GAS RANGE/OVEN 510.00 NEW GAS GRILL 510.00 GAS UNIT HTR 510.00 POOL HEATER $35.00 VENTiLATOR $ I 5.00 Permit Fee $ Number of fixtures @$10.00 x$] 0.00 =$ Surcharge .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ OR Number of fixtures @$25.00 x$25.00 =$ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Tota1= $ THIS [S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED 1 hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in confom►ance with the ordinances and codes of the City of Fridley and with the Minnesota Conswction Codes; that I understand this is not a permit but only an application for a pertnit and work is not to start without a permit; that the work will be in accordance w' the approv pl rr�n the case of all work which requires review� �pproval of plans. SIGNATURE OF APPLI�� TT �___ PRINT NAME ��iVI �� I DATE l�� U� APPROVED BY 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 NEEAED 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 �mendments 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.