AF - 47067City of Fridley, Minn..
BUILDING PERMIT
Da�; April 14. 1+�b9
��,: Rict��rd Grumbo
Bwtlder
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Ad�reas 680 irontcxi St. N. E. A� �
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N° ���0186 � �
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LOCATION OF BUILDING
No. 680 Stceet TronCon St. A. E. Part of t.ot
�34 b 3g _ Bl�k R Adc3ition or Sub-Division _ Rin��e� �'��g�t�
Corner Lot _ Inside Lot Setback Sideyard
Sewer IIevatfan
Foundation IIevation
DESCRIPTION OF BUILDING
To t� v�a �:
Ga�aae �t 2�+ � Depth 24 � xe��t 1�� �, �, 576 �� 5 i6 0
Front Depth %Teight Sq. Ft. Cu. Ft
Type of Construction FlST�e Faa� Cost �$15Q0.40 To be Completed
Subject ta Carege floor elevation to b� the same as a� 690 Ironton St. N. E. �
In cbnsideration oP the issuance to me of a permit to construct the bwilding described above, I agree to 80
the proposed work ffi acc�rdance with the description above set forth and ffi compl�tance with all provlaiona of
orciineaoes of the dty oP Frldley.
Ea co�stderation oP the payment oP a fee of $ 9•�� , permit is hereby granted to R�chard Gruabo
to construct the buflding or addition as descrlbed above. Thia permit is granted upon
the elcpress condition that the person to whom ft ia granted and his ager►te, emPloyees and worl�en, fn all work
doae in, around and upon said building, or any part thereof, shall conform fn all respects to the ordinances of
Fridley, Minnesota regardi�g location, conatruction, alteration, maintenance� repair and moving of bufldinge
within the dty limits and tbis permit may be revoked at any time upon violation of any of the prov3sions of seid
or�inaac�es.
Building Inspector
Clarence B�liele
NOTIC�
iW p�rmit doa ao� eowr f6e eoestrusitoe, losfallallon tor vrWeo, plumbing. 0a bude�, awu oe wat�r. 8� sura to aN
�h� Building leqaeror for aparat� �rmih Po� �6a� hu�.
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.QPPLICA�'ION FOR BIIILDING PERMIT
- CzTY OF FRIDLEY, MINNESOTA ..����
OWNEft ' S NAME P� _ p,��,� �� � wi �,, BIIILDER � e.�.� ,V �' !r'
�Dx�s � � e , � ��, r�� ,� � t` �f��x�ss � ��
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LOC�,TION OF BIIILDING � �.� �. � � �% 5 .
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NO.��C� STREE'r -�' aP o,� e �v /V ..
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LOT BLOC� ADDITION OR SIIBDIVISION,�,�L�� vi P�,^, drfei9 �Y�S
CORNER LOT INSIDE LOT � SE°I'BACK SIDEY$RD��_
SFWF,R F,,�EVATIpN TOP OF FOOTING
Appliaant attach to this form Two Cer'tificatea of Sur'vey of Lot and
proposed buildiqg 1oca,tion drawn on theae Certificates.
DF,SCRIPTION OF BIIILDING
To Be Used A�:
GA � q�, E'.. F�ont ..o�� Depth a� Height / o
Square feet ,�7 � Cubic Feet ��7� �
Front Depth Height
Squax� feet Cubic Feet
Type of Conatruction Eetimated Coat /S`o a.
To Be Cqmpleted !�i ¢2,�,! �� - Z J�
The unders�.gned hereby makes applicatio� for a permit for the work
h�re�. speaii�.ed, a�reeing to do all work in strict acco�dance with the
City oi Fridley Ordin�.�ces and rulings of thE Department of Buildi.n�s,
and her�by declarea that all the facte and repreaentat�.ona �tated in. �
this application are true az�,d correcte
D�TE SiGN9TIIRE � ,�,,� ��•L.... _ /
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(SchedulQ of Fee Costs cax� be found on the Reveree S�deo)
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BIIILDING PF�EtMIT � FEE SCH�DUI,E
SECTION 2, The Inspector of Buildinga shall, before iesui�a.g permits
for the erection of any buildi_ng or et�ucture9 0� for any addition to at�.y
�xi�tin.g �tructure or buildingy or.for any alteration or repaixs to any
existing buildi�.g os st�u.etu�e, upoxs application therefore, xeq�.i:ee the
payment by the appliea.nt for such per�it of fees to the amount he�eein
below set iorth and in the manner herein provided to-wit:
IIniform Build.in� Code: Type 19 29 & 4-�1075 for each one thousand
eubic feet, or fraction thereof, ir such cubical c.antents. Type 3& 5-
$1050 ior each one thousand cubic feeta �
For the purpose of computing fees for buildi_ng permits, the cubical
�ixt�nts of �any��%ildiri'�'�0addi�i0�"°�'o°"a tzni"form hei��$h'�'�ghout�hy � °
multiplying the ground area covered from a point aix (6)- inchea below
the iloor line of the basement or the cellar to the average height of
the upper suxface or to the avera.ge height of the roof au:rface of the
main gable of a pitched roof.
For repairs or alterations to an exiati.ng atructure, the fee ahall be
at the sate oi $3.00 per each five hundred dollare ($500.00) or
fraction thereof i:n. the cost of all proposed worko
In x�o case ahall the fee charged for aza.y permit as set iorth in Sec�ion
2 be 1ea� than $5v00o
NSSSD Coxin.ection Ch.argea based on location - Area 1 or 2.
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•Tl:e p:at a}�ae 'ehorm indieates eorreetly the qi�e and loeation ot - �'q;, �•
the b�:ldinis.on pra�'aee,herein•ln�uredi also'the !mprovemante nov 'a.r� „�:?�
:;�acad on promieea !n queo-tion ar� entirelq ►�thin the lot lines, c��ru��
atsd the txprovemonts on ad�olning premises do not tncroae� Qe► the
psamiaes herein insured." ��
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sueaecr PERMIT
City of Fridley � 13063
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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; ` RECEIP .
� • COMMUNITY DEVELOPMENT DIV. � �� �
� Ly �����'�
r � � PROTECTIVE INSPECTION SEC.
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�l /"'{ � CITY HALL FRIDLEV SS432 NUMBER REV. DATE PAGE OF APPROVED BV
L��°� � ,'� 612-560-3450
910-F15 6/30/75 � �
JOB ADDRESS
680 Ironton Street N.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. SHEET
34,35 R Ri
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Dennis Ber 68 I
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
S�AR;CHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE IICENSE NO.
8 USE OF BUILDING
re id
7 CLASS OF WORK
❑ NEW �7 ADDITION ❑ ALTERATION �_ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22 x 12' deck and repair the roof and trim
9 CHANGE QF USE FROM TO
- STIPULATIONS
l. Deck to meet all specifications of building inspector.
oR ���'t�G,
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P'��M1�s PN� S,���.
s����P� Q�-'���,���
��P�`�,G�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING, �Od
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 ANO EXAMINED THIS APPLICATION 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 3SO.00 .�JO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL I.AW REGULATING CON- $�j.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$5.50
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT (DATEI HEN PROPERLY VA IDATED THIS IS YOUR PERMIT
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SIGNATUREOFO EHIIFOWNER ILOERI IDATEI BLDG.INSP �T
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j� '. . •APPLICATION FOR R�SI'DL'NTIA�, ALT�RATION,
// .
OR AllllITION.BUILDING P�R1�4IT .
� CITY OF FRIDLEY, hiINNESOTA •
OWNER' S NArr1E : �•�-'�• � ��-�! �UILVER :�
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ADDRESS : C� 0 O -�7` %I �— ADDRESS :
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NO : . � � � STREET : d�-2��'� '
LOT: 3 �i � 3 S BLOCK: � ADDITIOI� :_ � ,
COItNER LOT: INSIDE LOT: SETBACK: __ SID�YAP.D:
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Applicant a.ttacr. �o Chis form Zt�o Certificates. .�f Surve ..of�L�ot an3.pxoposed . �:.
�uilding location drawn on these Certificates. �
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� �HESCRIPTION OF BUILDING
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Ta Be Used As : � .
�-�c.�-� � � "Fxont . I � Depth • ' �- � H�eight •
.. _ Squaxe Feet: Cubic.Feet:
� Front. Depth• Height• .
. . � Squaxe Feet; Cubic Feet: � "
' ���i� Estima.ted Cost• $�J'��� �
Zjrpe of �Construction: ,
To� Be Completed: � ��'�-ee•�/a- . • � .
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� The undersigned hereby makes applicativn for a permit for the work herein
specitied, agreeing to do all worlc in st"rict accordance with the City of
� Fxidley Ordinances and rulings oi the Department of Buildings, and her�by
declares�that all the facts and representations stated in this application
axe true and correct.
' 3 d - 7�5 sicr�� • � ��
• nASE : -�� .
(See I�everse Side For Additional Information.)�
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City of Fridley
AT THE TOP OF THE TNlINS
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� �` ___� COMMUNITY DEVELOPMENT DIV.
� L � PqOTECTIVE INSPECTION SEC.
r � ,
� . ,
� t �'•'1 � CITY HALL FHIDLEv 55432
�""� � �'� 612-571-3450
SUBJELT
BU ILDING PERMIT
NUMBER REV. DATE PAGE OF
910-F15 4/15/92 / /
' 212�7
CEIPT NO
��� 1 (
APPROVED BV
J08 ADDRESS 680 Ir,'onton Street . NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 34,35 R Rive�iew. Heights SHEET
2 PROPEHTYOWNER MAIIADDRESS 21P PHONE
Jay/Nana Sogge 680 Ironton Street.NE 784�9509
3 CONTRACTOF; MAIL ADDRESS ZIP PHONE LICENSE NO.
Cities Home �mprovement Co. 5310 Ceda.r Lake Rd, St, I�ouis Pk 591-0332 1839
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER
8 USE OF BUILDING
Residentia.l
7 CLASS OF WORK 0 NEW
MAIL ADDHESS
❑ ADOITION
ZIP
❑ ALTERATION �J REPAIR
8 DESCRIBE WOHK
Reside b�elli:zigl Steel.door �e�lacement; �utters & downspouts.
9 CHANOE OF USE FROM
STI PU LATION S
�
TO
TYPE OF CON57.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHOHIZED IS NOT COMMENCED WITHIN 60 DAYS, OH IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNIT;
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPUED $4 2SQ
WITH WHETHER SPECIFIED HEREIN OR,�VOT. THE GRANTING OF A PERMIT (
DOES NOT PRESU TO GIVE AUT RITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIO OF Y OTHER STA OR LOCAL LAW REGULATING CON- $72��Q.
STRUCT � PERFO A E OF CONSTRUCTION.
t '�.— PLAN CHECK FEE
SO.
STALLS
� ; � �. Ll`CeT1SH $C $5e00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI �yyH� p�PE�1L� V9
PHONE LICENSE NO.
❑ MOVE � REMOVE
GROUP OCCUPANCYIOAD
CU. FT.
OFFSTREET PARKING
IGARAGES
SUfiTAX
$2.�3
Fi�e SC $4q.25
OTAL FEE
$83.38
THIS IS YOUR PERMIT
� ��/ � / .�i
- oaTE
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NEW [ ]
ADDN [ ]
�-'� I�
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
Buiiding Permit AppL'cation
Construction Address: �j��
Eff�tive 3/1/92
. Legai Description:
�- �c�c� � Tel. # '7�C/�- �'n��'-
Owner Name 8c Address: ;�� O�cw� _
Contractot': � � �'i �� a � ��r � Cv MN LICENSE # / �'".3��
Address: S 3� c� v�'�. l� ��� � Jr- ����s U/��-- Tet. i� S�i'/-6 2�
Aitach to this application, a Ce�tificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIUN OF IIVII�ROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DBCR AREA: Length Width Hgt/Ground
o�t: l.e �'o-� wl �� H� i s-+ ,P
�.�a�-�.����
J
Sq. Ft �
Sq. Ft.
Sq. Ft
Corne� Lot [] inside Lot j] Ft Yd Se,tback Side Yard Setbacks
Type of Consau+etion: � Estimated Cost: S�f�..S?�J � c�
Approx. Completion Date:
(Cost on Backj
Driveway. Gu�U Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
c
-�?A�E: Y L � APPLICANT: ����� ����' Te�--# ��%��:�-3 � �
Permit Fee $ �,��- �"��'
Fire Surcharge $ - � �
State Surcharge S � � /�
SAC Charge �
License Surcharge $ � � � ��
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL $ �'� .� �
STIPULATIONS:
(�iTY USE ONLY
Fee Schedule on Reverse Side
.001 of Pemut Valuation (1/lOth%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00. (State Licensed Residential Contira.ctors)
Alt. "A" or Alt. °B" Above
Fee Determined by Engin�ring
Agreement Nacessary [ ] Not Neces.sary [ ]
r -�
BUII,DIN(� PERMIT FEE SCHEDULE
The Cluef Building Official shall, before issuing pennits for the erection of any boilding or stxucture,
or for arty addition to airy existing bnilding or stivcdffe, or far any alt,�ation or repair to any existing
building or slruct�ure, upon aPPlica�ion therefore, require the paymem by the applicant for such permit
of fees to the amount hereffi below se� forth and in the manner herein provided- to-wit
TOTAL VALUE
$1 to $500
$501 to $2,0�
$2,001 to $25,OQ0
$Z5,001 to $SO,OOU
$50,001 to $100,000
$1�,001 to $500,000
$5�,001 to $1,000,�
$1,OOU,001 and up
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $S00 plas $2 for each additional $100 or
fraction th�eof, to and including $2,000
$45 for first $2,000 plus $9 for e�ach additional $1,000
or fiaction. thereof, � and�cluding $ZS,Q00
$252 for first $25,000 pins $6.50 for e�ach additional $1,000
or fiaction thereof, to and including $50,000
$414.50 for first $50,OOU plas $4.50 for �ach additional
$1,000 or fraction thereof, to and iacluding $100,�0
$639.50 for fnst $100,000 plus $:i.50 for each additic�nal
$1,000 or fraction thereof, to aad including $500,000
$2039.50 far the first $500,000 plus $3 for each additional
$1,000 or fi�tion thereof, to and including $1,000,000
$35�� -� for �h� -� $�;O�,OO�D glus $2 for ach additional
$1,000 or fraction �thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete (�ufi Stre�ts Only)
Alternate "A": Removal and replacement of curb and guiter only - Driveway width plus 6 feet times
$13.50.
Alternate "B" : Removal and replacement of curb and gutt,er and install a 3 foot wide �
approach with 6 iach depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Pem4its for coastruction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the propos� structure and of the construction site.
A Cefi�ficate 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 frdming.
�
sue�ecT IT NO.
City of Fridley 0960
AT THE TOP Of THE TW�NS g � i L D I N G P E R M I T
r
� �
� �
� ; v _ COMMUNITY DEVELOPMENT OIV. � � `
1 � � PROTECTIVE INSPECTtON SEC. ,, T�
1 � �
i.-_. A;�'��,'� CITY HA�L FRIDLEV SSIJZ NUMBER pEV DATE PAGE OF ACPROVED BY
t �� 612-571-3a50 s�aF�s 5/22/00 / /
�oe nouRess 680 Ironton Street NE
1 IEGAI �OT N0. BLOCK TiiACT OR AODITION SEE ATTACNED
oesca. 34,35 R Riverview Heights SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
Robert/Jane Dirkes 680 Ironton Street NE 780-5789
3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO
Same
4 ARCNITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
S ENGINEER MAIL ADORESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
❑ NEW ❑ ADDITION O ALTERATION �7 REPAIR O MOVE O REMOVE
8 DESCRIBE WOiiK
Reroof House & Garage (18 Sq) House 2nd Layer;Garage Tear-off
9 CHANGE OF USE FFOM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
TVPEOFCONST OCCUPANCYCiROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE iiEOUIRED FOR ELECTRICAL, PIUMBING, MEATING.
VENTILATWG Oq AIR CONDITIONiNG
TNIS PERMIT BECOMES NULI ANO VOID IF WORK OR CONSTRUCTION ZpNING SO. fT CU FT
AUTHOR12ED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANDONED FOR A PER100 OF t2p DAVS AT
ANY TIME AfTER WORK IS COMMENCED. NO DWIG. UNITS OFFSTREET PARKING
I MEREBY CERTIfV THAT I HAVE READ ANO EXAMINED TMIS APPLICA710N 1 STA�LS GApAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED � 1 181 �.59
WITH WHETMEFi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERMtT fEE SAC CMAFGE
PqOVISIONS OF ANY OTNER STATE R LOCAL LAW REGULATING coN- �44.85 Fir SC � L. iH
STR N OR TME PERFORMANCE CONSTRUCTION
PLAN CMECK FEE TOTA FEE
,�` ��- $ .62
GNAtUpE OF CQN�AACtOp O su� O�2E0 Ni OA7Er MEN PR VALIDA 7HIS IS VOUp PEQMI�
�, , = 3 v
S�GN4TUAE O� OWNEA ��F OWNEp BWLDEpi iDATE� c'- � G'�NS� ��`�E
N� Il
ADDN [ ]
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� �. � .��
Effiective 1/1/2000
(763) 572-3604 Bldg Insp
��6
�al �.. �v�,�
Legal Description:
Owner Name � Address: ��h �r-� �Se,.•fo�. � i �- ��� Tel. �,� �`a-� �f � �J — S `1 � �
Contractor. � �� � _ e_ _ MN LICENSE #c i� � �
Address: �1 � �A Tel. # 1J �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIOIV OF IMPROVEMENT
LMNG AREA: Length Width Height Sq. Ft
�r-
GARAGE AREA: Length Width Height Sq. Ft , l�
DECK AREA: Length Width Hgt/Ground Sq. Ft �
OTHER: �--� C?.� o. � Q �- � t�-�-lS2 ��c� \ � � q . �� �� ��
�,
.
Construction Type: ' � Estimated Cost: $ ��� `�c��
�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: S �-� u� APPLICANT: !�`f��. � � `c' �o' � S Tel. # �2 �a � b=� `l � `j
CITY USE ONLY - Call (763)
Permit Fee ��, ��$��
Fire Surcharge l, l � $ �
State Surcharge � $_ /
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
��i'
Permit Fees if mailing in application
ee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$ � $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Consenration E'lan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not IV�ecessary [ ]
�
i1L.Y.���
BUII.DING 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,�1 to $25,0(}0
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,�,�1 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $1� 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,OQ0 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,0(� or fraction thereof, to and including $100,000
$993.75 for first $100,OQ0 plus $5.60 for each additional
$1,000 or fraction thereof, to and ineluding $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,040 or fracdon thereof, to and including $1,000,000
$5,608.75 for the first $1,000,(�0 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete G�rb Streets Only)
Alterna.te "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applica.tion to allow �or proper
review of the proposed structure and of the construction site.
A Certifica.te of S�rvey of the lot, showing the location of the foundation once it has it has been cons��l �vill
be required before proceeding with the framing. New Houses Onlv
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FRIDLEY MUr1ICIPAL CENTER • 6431 UNIVERSITYAVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
BUILDING PERMIT APPLICANi: HOMEOWNER
I understand that the State of Minnesota requires that all residential building
contractors, remodelers and roofers obtain a stat� license unless they quaUfy for a
specific exemption from the licensing requirements. By signing this document, I attest
to the fact that I am building or improving this house myself. I hereby claim to be
exempt from the state licensing requirements because I am not in the business of
building on speculation or for resale and that the house for which I am applying for this
p�rmit, located at �� �� ���M1� �� ��• ��' '�, is the first residential structure I
have built or improved in the past finrenty four (24) months. I also acknowledge that
because I do not have a state license, I forfeit any mechanic's lien rights to which I may
otherwise have been entitled under Minn. Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construc#ion or improvement of this house and I understand that
some of the�e contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund " in the event that any contractors
I hire are unlicensed.
�� �
� %�;' -� �� � �%��.�
atur� of Homeowner
� �' �� �' o
Date �
' Ucensed residentlal building con6actors and remodelers are covered by the recovery tund. Ucensed reslden�al roofers and
manufadured home installers are not �vered by the recovery fund but are required to hold a surety bond.
To determine whether a particular contractor is required to be licensed, or to
check on the licensing status of individual contractors, pl�ase call the Minnesota
Department of Cornmerce, Enforcement Division, at (612) 296-2594, or toll-free at
1-800-657-3602.
*
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICQ►TION WILL BE RETURNED
C�MM(]R VEI��T� 1/EI��T CAf�REGTC)R AI�D COMBIISTI(�I� AIR �/ RIFI _ATIC)I`
�e� � la _in0 an e�cietinQ ,ra� , 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 � o()
The venting system is plastiGPVC and meets all current c�des and manufacturer
speciflcations including sizing, length, number of elbows and termination. Yes () No �j
The undersigned also verifies that the replacement unit 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.
The pY���ar.ame�,�t�en 9ir is sized and installed to meet the current codes
and manufacturers specifications.
Whet1 �qUI�Bd to ine+all a ne��� cemhuctien air it will be sized and installed
to meet the current codes and manufacturers specifications.
Yes(�No( ) �
Yes �} No ( )
Yes �j No ( )
When iostallioa a�+�w ���o,iy� p,,,, the undersigned hereby verifies that
it is�a listed assembly and meets the current codes and manufacturer's
speafications. This does inGude AGA-GAMA Category I Centraf 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 current codes. Yes (�j No ()
8�nlianep TXne and Si� / emrr�en ��pnt �nd 1! n C`ennpcter Ir,formatinn
Appliance #1 Type �r✓�iv°� BTU Input �%' C� Fan Assisted or Nat _J�
Appliance #2 Type GZ�/�,a���►� BTU Input��T Fan Assisted or Nat ,ott'�T-
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances _ Total Btu In�ut � _ _ _ _ _
Common Vent Type �� � Vent Height �_ Diameter � inches
AppGance #1 Vent Connector Height /�f 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•� .- ..-
HEATING CO:
Signed By: r, Date :
Building
Inspec�ians
7G3-S72-361)4
763-502�4977 FAX
srrE afe�ss �(j
'IiIIS APPLICANT'(S:
TENA111T
9UBI�IIt' A COB'Y OF
Yo�rn srAT� r�c�vsE
ANb CBRTQ+ICATE OF
INSlyRA1VCB
Frorn: 763 5371882 Page: 1/2 Date: 3/1 7/201 0 1 2:14:07 PM
�LTILDIN G'r � Permit Na,
R�+ SID�+ NTLAL APFLICATION j 1�ec���ea �►:
CITY t�F FRIDL�Y
�cfiivE �•1•zoio _
B.�wr. annxsss
� OQrNBR ��NTRACTOR
��
�
NAMB:
ADDRE85: �
PTiO1V8: —
NAME:
s�rnrsr�c�ts�+� v�
AUL1RF59:
PxoNr3. �af-�..�/� � ��
❑ SIId¢iiLE BAMIY.'YlATHW CQN9TR'fJCTION
0'f WO FAM�Y.YlNEVJ GONSTRUCCIOfd
A ATTYON ❑ GARAG
O HASE�NT FiNIBFi � ROUF
C] ABCTt O SIDiN4
TYPE OF WdRYCt ❑ NEW HQM� CON9TRUGTION O AUDITidN
0 MAU�1'I'LNANCFAREPA�L 0 tiEMQDF.Y.IN�
D�SCAIB� WORK BE1NC3 D�NE: `
SYZE OF A�ROVEMBN�' �dT� TH
o xovsa o�u..'�
NUMBER OF SQUARES Q iipUS� � frARAdE
�
PRQPbSEb S1ZE:
PROP09Lb FgJt3HT:
�t
0 Yinyl
O Alumlaum
D Orhor _
G ATTACT�D OARACiE
Q DBTAC�D (iARAGB
OSoBit
❑'I�im
9 Fesels
1N�Ci UPIId�IG6 �'Yra C�Vo L�ATION OF WINImWS
OR FQR NSW bpBNIN�S-DESCRIBE SIZE QF -
OPBNIl�TCi CHP.Nt3p9 & — -- - ---
FF�S ARE
Permit Fea
P1sa Review
Fu�e Surcberga
��8�
�.icen�e 3tucharge
3AC Chs�e
Curb Cut Eacrow
Erasiaa Contral
Padc Fee
Sewer Mam Charge
' S'CATE ZIP
1997 U.B.0 FEE SCFYEDULE)
ra�
�SEMSNT REM�bEC,it34 Si��;
1, E�xis�sg Floor Ptau
2. �ogoaed floor plao
3. Liat nf aauctltr�cl membars W bo usad
FOB N�VII CONS'CftUCTfON INCLUDIIdG bECKS,
1. Site PlaN�tlt'vey sbowiag tha aaiating s4uCCiue�
anfl propo�d Pm9ec�.
2. Two �rte a@ooIIawation plsns
#. Enmgy Celouleda�s •
FpTt WCN�OWS — PR�VIDE U-VALY,I�+ ANb
MA1JiJfACiURE 6TICKL+R oN W�TD4W.
AND MA
S� �aok Page for Fe� 5chadule
65°� of Building Pernait Feo
.OQI timts the toffi1 job valua�oa
.0005 x Permit Vahiatian Minimum $.50
$5.00 (3t�,ta Liceneal Yiesidentisl ContraCtars)
$2100 pes SAC Unit (Plans w 1V[VI�CC for detern1iaation)
ft+6ft= ftx$24=$
$450 �onservation Plan Rsrviaw�
Eee I7etorminad by 8ngineering
Agreement necess�xy ( } Non Necessary ( )
Tl�S IS AN APPLICATiON FOA A P'ERNQT•NOT VAI.1D LTNTII. PRdG'�SSED
I hcrreby �ppty for � batldiug permit and i ackao
canf�ae with the ordi�ncea �nd cod� of t�
petmit but anly an app ' an far e pormit
approved plan in tha of all w
9ItiNATURE OF APp'1.
�� abqve i8 c�npl�te eatd eooucate; that t6e work will bc in
th� Mmncsats Conetruction Cod�; �at I imderetand this ie nat a
n
t without a permit on eite: that the work v�r;11 bo in accardence with tho
a
approva! ofplsna � , . . f .,,.,, _ / _ �
Building
Inspections
763-572-3604
763-502-4977 FAX
BU I�,�►�t1�TG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
Pernut No.: � 0 —d� � � `�
Received By:
Date Rec'd: � �
DATE�I/D YOUR E-MAIL ADDRESS �@� C'�h✓1 . GO �l
SITE ADDRESS �('� 1ror) �I�en .�i�c.�
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERNIIT TYPE
ADDRESS: _�O �imh� Sl�ie� CITY,
PHONE:
.,
STATE LICENSE #
PHOAIE l(►� i /�' e`?�$�j
�SINGLE FAMII.,YMEW CONSTRUCTION
❑ TWO FAMII..YMEW CONSTRUCI'ION
❑ BASEMENT FWISH ❑ ROOF
❑ DECK O SIDING
❑ SWIMM
SIZE
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCFIREPAIR ,'� REMODELING
DESCRIBE WORK BEING
SIZE OF IMPROVEN�Mf
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED S1ZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminwn
❑ Other
R'INDOR�S
IN EXISTIlVG OPENINGS OYes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPEN1AiG CHANGES &
TYPE OF WINDOW TO BE INSTALLED
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUIV�ER OF
� 3SY.3?
EXP DATE
A��z� S`S l
� DRAIN TILE
�OTHER
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION IIJCLUDING DECKS,
ADDTTIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WIN�W.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LTSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 3�fj °° � OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surch�rge
SAC Charge
Curb Cut Escrow
Erosion Control
Patk Fee
Sewer Main Charge
Total Due
$ �
$' c �—
$ �.Z�
$ ��
$
$
$
$
$
$ : °7�
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 detennination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable 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 aclrnowledge 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 case of c ic equires1review and approval of plans.
SIGNATURE OF APPLICAN PRINT NAME�A ���no7 DATE 3Io�I !tl
Page 2- Building Residential Application �
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of a.ny 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 perm.it of fees to the amount herein below set forth and in the manner herein
provided to-wit: �-
VERIFICATION OF FOUNDATION
Permits for constntction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the constructior� site.
A Certificate of Survey of the lot, showing the location of the e�cisting 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
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATE �` C��'
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTf A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMTT TYPE
� --. BUILDING
�
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
YOUR E-MAIL ADDRESS
m
I■ • .[ ii+��
�.
Permit No.:
Received By: � �� '
Date Rec'd:°� � '�
�
,annxESS: (o�U ` �rr��1 crty � STATE I�IAJZIP �3a
PHONE: �% r 7� t'C" 7��l..S^
NAME: �C��se r� �i ��► � n 1�'� ��-C., ,
STATE LICENSE #`� r�b� 3'�51,1 ExP DA� � 3� � �
,e,DDxESS: I 5el 3� �c,,�, � �F (ti�� � crrsr STA'f�ZIP �
PHONE Fp}t
� SINGLE FAMILY/NEW CONSTRUCTION SIZE �
❑ TWO FANIILY/NEW CONSTRUCTION STORIES
�,BASEMENT FINISH
❑ DECK
TYPE OF WORK: 1❑ NEW HOME CONSTRUCTION
� ❑ MAIIVTENANCElREPAIIt
DESCRIBE WORK.BEING
OOFIIVG
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPUSED HEIGHT:
�Vinyl
❑ Aluminum
❑ Other
wn�mows
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENII�iG CHkNGES &
TYPE OF WINDOW TO BE INSTALLED_
❑ ROOF ❑ DRAIN TILE
O SIDING ❑ OTHER
❑ SWINIMING POOL
❑ ADDTTION
�I REMODELING
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
O Trim
❑ Fascia
LOCATION OF WINDOWS
NUNIBER OF
S
FI'
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the e�cisting structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINBOW.
ALL FEES ARE BASED ON VALUATIOAT, INCLUDING TI� COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �-�O C9Q �' OCCUPANCY TYPE
Permit Fee
- - - _ _
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
C�
$
$
$
$
$ � � n a�
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
Agreement necessary ( ) Non Necessary ( ) -
Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 pemut 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 work which requires review and approval of plans.
SIGNATURE OF APPLICANT V PRINT NAME DATE
Page 2- Building Residential Application �; _
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, 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 fi-action, 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 $10.10 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 addirional $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 includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each addirional $1,000 or
fraction to and including $1,000,000
$1,00O,OOl and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each addirional$1,000 or
fraction
VERIFICATION OF FOUNDATION
Perm.its 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 founda.tion will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
b431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
,�. ._
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Building
Inspections
763-572-3604
763-502-4977 FAX
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFr-�c� �-i-ao�o
DATE �� Z�' Zv � V YOUR E-MAIL ADDRESS
SITE ADDRESS (�' r7SD 1'. �v .� � o a� S.} � L�
THISAPPLICANTIS: �'OWNER ❑CONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMTT TYPE
TYPE OF WORK:
�-s� ►�
ADDRESS: Cfl �G 1 ro n+c� t� 5� N� CITY
PHONE:__ �`f �"3 � 232-53'GG�
COMPANY NAME:
CONTACT PERSON:
STAT'E LICENSE #
EXP DATE
Permit No:
Received By:
1� ZIP S'�`r�/3Z
ADDRESS: CITY STATE ZIP
PHONE _ _ FAX
�SINGLE FAMILY � ❑ TWO FAMILY
❑ NEW 0 REPLACEMENT
DETAILED DESCRIPTION OF WORK
.. ,
O TOWNHOUSE
�ALTERATION/REMODEL
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE AANDBOOK
Equipment Installed MFG: MODEL: SIZFJBTU
MFG: MODEL: SIZFJBTU
MFG: MODEL: SIZEBTU
A/C $25.00 _FIREPLACE (GAS) $IS.� GAS RANGFJOVEN $10.00
_AIR TO AIIt EXCHANGEER $15 _FIREPLACE (W�D) $35.00 NEW GAS GRILL $10.00
_BOILIIt $35.00 _FURNACE $35.00 _GAS IJIVIT H'IR $10.00
_CHIIVIlVEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
,�DUCTWORK$]0.00 �(GASPIPING$10.00 y VENTILATOR$I5.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L 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 work is not to start without a permit; that the work will be in accordance with the
approved plan in tUe case of all wqrk whiclyrequires review and ap,�roval of pdans.
SIGNATURE OF APPLICANT
�
� �✓ DATE 3"Z�-7d1�
3 �-' /d
City of Fridley
ilding 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 NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIItED 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 MN Rule 1346 Sec. 501
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. N 1104.4.13
5. Ventilation
a. Per MN Rule Chapter 1322. Sec. 1104
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guideliaes software may be used for
combustion and make-up air calculations.
,
Building pLjJ��G. Permit No.�
Inspections � RESIDENTIAL APPLICATION Received By �
763-572-3604 CITY OF FRIDLE� ����� L�� �
DATE YOUR E-MAIL ADDRESS
src�rwDltESS $a,,,,,.� � p..,��„� Joe Thorson
THISAPPLICANTIS: ❑ OWNER �(:ota�[tacTOx 680 Ironton Street Northeast
PROPERTY N�: Fridley, MN 55432
OR'NER/ ,�,DDR�ss: 7637847445
TENANT zIP
• PHOATE:
CONTRACTOR N,�: �
SUBMIT A C{�PY OF STATE LICENSE # CJ EXP DATE
YOUR STATE ADDRESS• �� I / S CITY '�' � DI/J STATE�LIP SS�yO�
LICENSE WITH , pHONE %- y03 FAX 2.
APPLICATION -� '
PERNIIT TYPE �SINGLE FAMILY 0 TWO FAMILY - O TOWNHOUSE
TYPE OF WORK: � �w ' � �x��c�rrT .
DETAILED DESCRIPTION OF WORK
� PER NLS 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.shouldzeflect only.the cost of labor )
Labor cost under $300 =$15.00. L.abor cost between $300 to $SUO = cost of labor x.OS =
'•ROR:�.'ROJEETS WI�RE LABOR IXCEED�$300;�EES ARE BASED ON $10.00 PER FIRTIJRE,�EXCEPT?J��EIEREA�T�H :FI�{T33R�ES: .(�DIC�,TE TO�TAL
NUMBER OF EACH BEIAV� '
_ BATH SINK%LAV - - _FLOOR DRAINS _ SHOWER - _ WATER PIPWG
_ BATHTUB GAS PIPWG �n cr�rucnrsE) SWAM�ING POOL WATER SOFTNER ($35)
_ CLOTHES WASHER _ KITCHEN SII�iIC WATER CLOSET BACKFLOW PREV. ($1�
_DISHWASHER =-LAUNDRY TR�Y ,�WATER I-�ATER ($35� FOR IRRIGATiON
_ WATER METER p�R
,� �
� � �:� �, �
Permit Fee $ ? Number of fixtures @ $10.00 x $10,00 = $ �
Surchar e .50 Number of fixtures @$15.00 x$15�:00 =$
' TOTAL DUE $ Number of fixtures @$35.00 � x$35.00 =$ 3S Oo
� � . State Surcharge = $�
Total = $
THIS iS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSID '
I hereby apply for a build"mg permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conforma�e with the ordinances and codes of the City of Fridley and with the Minnesota Co`nstrucrion Codes; that I understand this is
not a permit but only an applic ' n for a germit and work is not to start without a permit; that the work vkill be in accordance with the
approved plan in the case 1 o w' r uires review and approval of plans.
SIGNATURE OF APPLICANT PR1NT NAME_ Je.'� /T/p/p/O/y� DATE ` � I�
P F" _ � .I ��� _ F "r ^ e5: _ ,.
. City of Fridley
Building Insp�ctions Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977