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' F CI7Y OF FRIOLEY � -
�� -``". • ��APPLICATION FOR HEATING REPLACEMENT
, . . • :. . , ..
. CHIMNEY AND STACK VERIFICATtON
'• THIS FORM�MUST ACCOPIPANY STAPaDARD APPLICATION FOR HFATING PERMIT FORM.
LOCATION ; ��`� �jt„����,���i' �� DATE %� / �/� ��
OWNER �� ,� � AODRESS �/�/�lc�
� The undersigned herehy verifies that the existing chimney or stack:
�. Has been carefully examined �
,----
2. Is free from rust or deterioration
' 3: F�o foreign objects are lodQed within ���co�-�
4.. That it is securely supported . � � �m
- . �
5o That it meets all current Code requirements �
� for size and total BTU connected .� "
6. Total Neat i ng BTU �D, d� � •
� .
. A11 Other BTU �L�� -
TOTAL �0� 0�� �
,
� • . .� i e ♦ /� • i
HEATING PERMIT � "
SIG
by
Add
Tel
Fridley City License � a��
� � ����
�
i
� p,� �G /r �d�r���1 �'��
HEAT LOSS CAL�[1LA'fIONS ��,� 9� DEPARTMENT (
Weatheratrips �� Construction N�
Wicdows Doon Reference Oue. Wall In� Wall Ce�iog
Yea— o Y�o 19
Fl.� Room I.engch ,� �' Widcl� 6 Heighe c�'
Windowa and Doora—�rackage and Ana
Width Ha16�1 No. o! Llneal tR Aroa
Na ot pane o[ p�ae 11`�u o[ craet �p. tt �
� � .�a � ���� �.� �
����
In6ltratioa
Claaa
Fap. wall
Net eap, wxU
in�. wau
c�a;,�g
Floor
Totai Btu.
:quired sq. ft. E.D.R. or aq. ws. Q/A. L.eader area
F7.� Room � Leagth Width Heighc
Windows aad Doors--Crackage and Area
wlate Belset No. ot Lln�at [t Araa
� . ot vane .of oans II�bU ot cnok �a. tt
�
1n61tratioa
C.la�s
Fsp. wall
Net e�. wal)
Int wall
Ceiling � � if
Floor 3 � j(
Total Btu.
quired sq. k. E.D.R. or eq. ins. QIA L�ader area
J � I�� w'�: _
Qlindows aad Doon--Crackage and Area
�
InLltration
Glau
Esp. wall
IVet e�cp. wap
Int. waU
CeJiag
��
Floor
Btu.
red �q. k E.D.R or �. im. WA Leader uea
�
��
���
Btn
Ca ��
� � i�� HOUSE �HEATING TEST RECORD
%,
ADDRESS ��' ' ° � ' APT. FLOOR CITY SUBURB� • " ��'�
OCCUPANT � OWNER `
HEAT LOSS AT TG. I ST.
SOLD BY INSTALLED BY
Elsehieal Work By �s �,��e gr
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
°GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model — — �i — C ° / � Model
Serial � � Max. BTU Rating
INPUT p MAKE OF FURNACE
Model
CONTROLS
THERAAOSTAT � Heat Plq
Valve „ ��
Limit
Limit Setting
Fan Setting -
Pilot Type —
Pilot Make
y � e
Vsn4 Size
KIND OF LINER � SIZE `� � NONE
Drah Hood Regulamr
Filters Size Number
Chimney Loeation (nside utside �
Chimney Construetion `',��'G�v
Pilot Model Smoke Bomb Wiring
Pilot Timing � h iL> � Draft `� Test Tag �
L.W. Cut Off Door Pressure Lighting Inst.
^ `� ^�
Pressure 5 i� Pereent CO2 �� � Date Tested ��
Input•CFN�� Pereent O Company Testing -�� �
Stack Temp. � � Pereent COa �� Name of Tester
Form 235
SUBJECT PE NO.
City of Fridley 16 0 8 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� ' R
� � ,
� ; L _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �� / �
� . ,
� � /��'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""� � ��' 612-571-3450 910-F15 3/31/81 / /
JOB ADDRESS 561 Ironton �treet N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 23�24 F RivervieHr Heights SHEE�ACHED
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Don Backstro�n 561 Ironton Street N.E. 786-9874
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548
4 ARCHITECT OR.DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
R@S 1f3P.i1.'t131.
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside and install alw.ninimm trim
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PEFiMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3i QQQ $1. J'rO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. y��.S.00
PLAN CHECK FEE TOTAL FEE
$19. 50
SIGNATUREOFCONTRACTORORAUTHORI2E�AGENT IDATE) ��-�y�/HEN PROPERLY VALIDATED THIS IS YOUR PERMIT
,r
SIGNATURE OF OWNEP iIF OWNER BUILDERI IDATEI BLDG iNSP � E
.�....n..�._.._,_-.a..:.�, _....,.��.....:_-....._..: �_::......s...,_. ,�.:........v...__.-u....... •.... ..�.aYk....._....._, �
CIiY Or Fft?DLCY � •
APPLICI1T10i� FOR RCSIDEPITIAL [3UILDIPlG PCRP�IITS
" (tdeti•r, A1terations, liddii:ions, or Rep�rs) ' �
'-
Ol�lldEft: S d ►a'� GUILOER: -
�� �� � �a �� � � � s r � � �
/�DDRESS:��% ���o� j-oA1 �T G�°'L � AQDftCSS: 2.a I 3 C� y�,� �%��-��•...._
TCL P�O: � b � �' �% �7 `� 7EL (��p: i �/ -- � � `� �
� Construction Location
STP.I�T NO : ��� � S9'i2E�T: —l.- �0 N Tc� r� � I , � � -
a.o�: _ ��,;, �� �LOC�:: � �vnzTZOr.s: �� ✓��2v��lp �, f ��_ �6 i�� �C� ..
Corner Lo'�: � Xnsicle. Lot: � SetbacY.: Sideyzrds: �
Applicant attach to this form tvra Certiiicates of Survey of loL- and
pzoposed huilding ].ocation drawn on certificate� to scalem
DESCRIPTIOW OF CONST�UCTION �
I'rant: Depth : H eight :
Squaie. Fe�t: Cii.bic Feet:
Front:
Depth:
Height:
Square� I'eet: Cubic Feet:
��
1 d' � / � � 1 � � �1 L'stimated Cost: $ � � `
T��pe o£ Const:cuc�ion : � /,% ,e� - I . '
Rb Be O�mpleted:
Alt. A Alt. II
Proposed Driveway Width 21: l�ew Op°ning Is Aesixed: $� $
• . SEE ]Rr.VERSF SIDE OF SHEET• ,
�'Ize undei: signed hercay makes ap�lica�tion �ar a peaznit ioa: tlie w�rk� hexei.n specii'ied,
ac�r_eeing to do all �vo:-k in strict accordance ��ith the City of I�ridley Ordinances and
xu1.:i.nqs oi the Aepariment of Bnildings, and hereby dec].ares thaL all the facts and
Yepresentations sta�ted in this application are true and correct.
- - IGNATUI'� : � � �
r�hTr•.: � � i � e s
Sta.pulations s
/8-c�o
. 1 s�
�9. �.�
6 � �'� •
`
/' . BUJI_l)11JG P(�R(11T FCt� SG{IrllUl_E' ,
;;1:C`i'7Ul•a 2. 7'lie 7n�.c��ectar. of 13�aS,l.Qa.n�1:� :.:h�111, }.,efor.c a. �:;uing k�enniL•� �or L•he erccL3.on
t�f• any l�ui.l.rl�.nc� ur, :;l:ructairc:, or. �o�- ar�y aQdS.��i.an L•o atry cr.istinc� l�uildi.ng or strucLure,
. oz fc»' ar,y .Z1Lcration or. �:e��rair.:; to •a��y e>:i�.Ling l�ui.J.ci�.ng or .Lr.ucture, u���r� ariplic:at�.on
'tl�cr.�for.c� zequir.a Uic; paymenL by thc ap�,�].i_canl: fvr- :;ucl� j�crmS.L• o� fces to. L•l�e amounL-
har.cin J�C�.041 scL• furL•h �;nd in t�lie mannc�- hcrein provic�c�t Lo-wiL-: •
1�I;Vd CUt��S�'I;UC'7'JUi3: 5ingJ�c l'ami].y 1Jomc:s ai�d Gaa:ages : $4 . 00/l, 000 cubic ieet. • �
J.'J,At1 Cltl: 'Y.: 25 per.cenL- of )�ui.] di_ng )�ex7na.t ice. .
- J�lt]:vr•.t•IT�Y 1�T:PRESS�OI�: (Concretc, Curb :;trcets Only) � �
• A1L•er.naLe n: Removal and reY�lacement oL• concrei:e curb and
gutLer only; Driveway widtti plus 6 f•eeL x Y�,5.o75
1�,l.tcrn�ite I3: Removal and replac�meni: of concxete curb and
. ' gu�ter and i.�i:�ta].7. a 3 iooL- wide approach with �'
' .. G inc}i c3.ept}i; Urxveway wi.dL-h plus G feet y$17.85
. .�DDITION/� I FOR�9IITI�
ror tl7e purpose of compuL-a.ng fees i'o� bui�ding Per�nits, the cubica]. contents of any
' build�.ng or addition, �.s det-ermined by rnultip7.yiny the qround area covered from a
, pa�nL- six (6) iriches below the floor line of i:he basc�me�it or the cellar to the
�.verage heights of the uPper �urface or i:o ihe average heighL- of fhe roof surf_ace
ot -�he ;nain gable of a pitched root. �
-- " kor repairs or a].i:�rai.ions to an existing structure� L-he fee shall be a� the rate
. o� $3 .00 �er each iive hundred dollars -� ($500.00) or fraction there�f in the cost
oi' �11 pxoposed work. . . �
Ir� �no case shal.l i:he fee charged for any pexmit as set iorth in 5ection 2 be le�s �
L-han $7.50 plus $.50 state surcharye. '
� • � V`RIFICATIO�! OF FUUNDATIOfJ
' �iOT�: rexmits �or constructian will be issued a minimum of 29 hours £rom tl?e t9me
of appli.cation to allow for proper review of the proposed st�cucture and of the
construction si.te.
A Certificate of Survey ai the lot, sho�aing the locai:ion of the foundation once it
lias been constnicted will be rec�uired before pr.oceedinc� with the f:raming.
C�RTIFICAT� OF OCGUPANC�y �. �.
TsPplication for a Certiticate oi Occupancy shall be made i:en (10) days prior to the
use or occup3nc�� oi any �tructurc ior wliich a� buildi2ig pei�iit }ia� been issued; aiid
said sta:ucture slial]. �ia� be used or occupied uni:il a. CertiLicate. oi' Occupancy has
becn issu�d.
, .�„ .
�
• • ,
SuBJECT
c�ty of Fridley � � :� ��
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIP NO.
� ; V �
COMMUNITY DEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTION SEC. �
� �
i
' � ����1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BY
�"""� � �'J 612-571-3450 910-F15 / /
11/30/95
JOB ADDRESS 561 Ironton Street NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. Z3�2/� F Riverview Hei hts SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Rarin Grand/Jim Konold 561 Ironton Street NE 484-7521
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Lauren Sirotiak Roofin 8465 110 St S Cot a e
4 ARCNITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDFiESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION [� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Gara e 17 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OF AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOqK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1,360 �.68
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ��F.5.75 Fire .S�', �1.36
�p PLAN CHECK FEE TOTAL FEE
--..�,��t ��Au°���i� License SC $5.00 $52.79
SIGNATUREOFCONiRACTORORAUTHOA�ZEDAGENT iDATE� WHEN PFiOPE Y VALIDATED THIS IS YOUF PERMIT
- .°r � �K. b �I �/ �__
SiGNATUREOFOWNEAI�FOWNERBUILDERI IDATEI OG �NSP � ��iTE
NEW
ADDN
ALTER
�l
[l
��
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 8/ 1 /95
ConstructionAddress: !S"61 .Yre�r1�-o�n �ri �'i�� l��t; -
Legai Description: S � I s ron +an .—
Owner Name & Address: �1�r� n�run+ �..1 ���. k an � t �) Tel. # �/ �r y- 7.� �)
Contractor: �.,au �en S; re�l-i � k MN LICENSE # �� 3��
AddteSS:�� )(e�Fl, St, Sn e Cv-i{�.5@ arou e, �iu SS pl b Tel. #�/S� -0917
Attach to this application, a Certificate of Survey of the
lot, with the propos�d construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECg AREA:
OTHER:
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
F�
r-
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] F� Yd Setba,ck Side Yard Setbacks
�----
, " p 'L:
Type Of Co�LStructiOn: reron� hous� ��,ar4g Es�mated COSt: $--a�r-6t> . z5c� �'r ��� ��
Approx. Completion Date:
{Cost on BackJ
Driveway Curb G�it Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: 1 I- 30-- p S_�'PLICANT: L� ��-�„ S; ro+, �. tC Tel. # yS� - e�i t �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Drivewa.y Escrow
�rosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� �°
$ 'i � � ���
$ %. > �-
� �;-��,
$
$ � � � �,
$
$
$
$
� �� � ��
$ _",�, �,
�ITY USE ONLY
Fee Schedule on Revers� Side
.001 of Peam�it Valuation (1/lOth%)
$.50/$1,000 Valuation
$S50 per SAC Unit
$5.00 (State I,icens� Residential Contractors)
Al� "A" or Alk "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engiaeering
Agreement Necessary [ ] Not Necessary [ ]
BUILDING PERMIT FEE SCHEDULE
The Cluef Building Official shall, l�fore issuing permits for the erection of any building or structurE, or for
any addition to any exisbing building or structnre, 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 $SQO
$501 to $2,Q00
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1(JO,Q(IO
$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,�0
$62.25 f� first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,(�30
$349.75 for firs� $25,000 plus $9.00 for each additiona.t $1,000
or fraction th�of, to and including $50,000 .
$574.75 for first $50,000 plus $6.25 for each additional
$1,�0 or fraction th�eof, to and including $100,000
$887.25 for fir� $100,0(10 plus $5.00 for each additional
$1,000 or fradion thereof, to and including $5�,000
$2887.25 for the fnst $500,000 pins $4.25 f� each additional
$1,000 or fiaction thereof, to and inclnding $1,000,0�
$5012.25 for the first $1,OOO,tmO plus $2.75 for each additioaal
$1,000 or fraction thereof �
DRIVEWAY DEPRESSION ESCROW
tcon� c� s�� o�y)
Alternate "A" : Removal and replacen�nt of curb and gutter oniy - Driveway width plus 6 feex times $13.50.
Alternate "B": Removal and replaceme�nt of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway R►idth pius 6 feet time.s $15.75.
VE1tIFICATION OF FOUNDATION
Pe�mits for consfruction 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 Certific�te of Survey of the 1�, sho�ving the lvcation of die foundation once it has it has �en constructed
�+ill be required before proceeding with the fiaming.
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COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinq an existinq furance, 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 () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications incfuding sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's spec�cations. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existinq combustion air is sized and installed to meet the current codes
and manufacturer's speciflcations.
When required to install a new combustion air it will be sized and installed
To meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes( ) No( )
When installina a new ventinq svstem, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after �
an appliance has been removed from the common vent and vented
separately as per cuRent codes. Yes () No ()
Appliance Tvae and Size/Common Vent and Vent Connector Information
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 Ty�e Vent Height _ Diameter inches
Appliance #1 Vent Conne�tor 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
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
�uilding
Inspections
763-572-3604
763-502-4977 FAX
DATE�
SITE ADDRESS _
THIS APPLICANT IS:
, �
BUILDII�TG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-08
YnOU,jt� MAIL ADDRESS
0 v C.
OWNER �CONTRACTOR
PROPERTY OWNER/ NpME:_�
TENANT . �__�,... �
—%XQ - %
Permit No.
Received By:
Date R�c'_d:
r/J/f C Z
CITY / � 'E'- STATE�ZIP.
CONTRACTOR ADDRESS: CITY STATE ZIP
SUBMIT A COPY OF pHONE FAX
YOUR STATE LICENSE
STATE LICENSE # _ EXP DATE
PROPERTY TYPE
PERMIT TYPE
B-3INGLE FAMILYMEW CONSTRUCTION
❑ TWO FAMILYMEW CONSTRUCTION
O ADDITION C�GARAG
❑ BASEMENT FINISH �LROOF
D DECK ❑ SIDING
❑ SWIMM
TYPE OF WORK: I❑ NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
DESCRIBE WORK BE1NG BONE:�
SIZE OF IA9PROVEMENT
ROOFING 1 �
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
SiZE
NG POOL
❑ ADDITION
❑ REMODELING
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑ WINDOWS
❑ DRAIN TILE
❑ OTHER
HEIGH7'
f�l
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDiNG DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Trim 1• Site Plan/Survey showing the existing structures
❑ Fascia and proposed project
2. Two sets of conswction plans
3. Energy Calculations
LOCATION OF WINDOWS
TYPE OF WINDOW TO BE INSTALLED NUIvIBER OF WINDOWS I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING THE 1997 UBC 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 Ma.in Charge
Total Due
$ �,�o�� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ �d �� �» .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+dft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �� � Make checks pavable to: City of Fridley Attach
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 ConsVuction 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 proved pl in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLI,CA�d'� � i���' INT NAME `T �'j(P��`JL, Pd �l �� L�- DATE 'J�'
. . . . • � : ��J��f�'I � •
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:
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
including $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,OU0 plus $] 0.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for ls` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $I,000 or
� fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the l�` $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
Faz: 763-502-4977