AF - 47570i
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City of Fridley, Minn.
BUILDING PERMIT
Date: __May 241_�1967.___._.._._..___.._.._...._......__..__.._.
N°
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9 2'7 �
�r, Rob���DeGardner Builder
. _..__.__ _��._._____. _..__.__.._.obe�t.._De-ga��.��..�...._--.--.._�..____._.�
Address ...__.....�A�A17th Ave.__North_. _ 2010 17th Ave, ftorth
_. __.._------_._ Address �__....�_..._.__..._______._.._...__R._. i _
LOCATION OF BUILDING
No. _..__557_.._._.._ Street .__...�anesYi��,e____.__.....____....._............_...._._--- Part of Lot _._..._...__.__._..
� 20-21_-22..._ Block _._. E._._..---._.._._.._.___. Addition or Sub-Division .....�I.:Y..��Yi.�.�LH,�3ght8._---•
� �
Corner Lot _.___..........._.__.. Inside Lot _-�----_.._..__----._ Setback ._._.._35 .5_._._._ siaeyard __._: 15___ .�
Sewer Elevatian __....$4�_.$.4..._.._.._._.._.._._____._.___------_ 1��� ...._---.�.4.R,.$.4
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
� Dwe 11 ing .._._...... Front � Q.'____ DePth .�..�'__.._. Height .._.....1,�_'. Sq. Ft. ..3.�2.�._.. Cu. FL _.1Z,.�90
_._.._.._..______......_..._.�.__ Front ___.___� Depth ________. Height _.._.._......_ Sq. F� _.._ Gtit. I+'t.
Type of Construction _. Frame _._...._.�__.. Est Cost _._._..$11,5_00.__------- To be Completed ._._..
SEWER LOCATION 3' East of l�anhole
WATER LOCATION 12' East of Sewer
In consideration of the issuance to me of a permit to construct the building described abave, I agree to do
th� proposed work in accordance with the description above set � and in compliance with all ProvYsiona o!
ordixianoes of the city of Fridley.
, ° C��� �_..._�5..���-.:2ea��'3��'�✓
$100.00 NSSSD
In ca�sideratfon of the payment of a fee of $._ 26 ._00 ����t is hereby granted to_ Robert DeGardner
to constxuct the buflding or addition as descxibed above. Thispermi t is granted upoa
the �express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances o�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buil�
within the city limits and this permit may be revoked a t ax�y time upon violation of any of the provTisio�s of sa�d
ordinances.
CLARENCE BELISLE B�� �
NOTICE:
This p�nntt dws no1 eover th� eonshueNoe, in�hllallen fs� wirin�, plumbing. �u hufin�, aw�r er wNa. d� mn fe sN
f6� Bvildiag Insp�eMe for s�paraN p�rmils for fh�a iMms.
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APFLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER�S NAME O UILDER
ADDRESS � O � 0 !'j � �J'% � ADDRESS �
� LOCATION OF BUILDING
� ,. - - : ��
N0. � `� � STREET ",� � � �. % `f' S U � ,�� �. � * PART OF LOT ` ���
LOT�p 2/ ���J BLOCK �_ ADDITION OR SUBDIVISTON �
CORNER LOT INSIDE LOT SETBACK a�,S' SIDE-YARD /�
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form two certificates of survey of lot and proposed
building location drawn on these two certificates.
DESCRIPTION OF BUILDING
To be Used as :
/
��,-eiQ�,�....� -- Front �a Depth '3�,% Height ��
Sq. Ft. � L �/ Cu. Ft. �� i G�-'�
T-
- Front
Depth Height
Sq. Ft. Cu. Ft.
Type of Construction � _ Estimated Cost '����'`�d-rJ
To Be Completed
The undersigned hereby makes application for.a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Qrdinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE � SIGNATURE _
(Schedule of Fee Costs can be found on the Reverse Side).
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Application for Power Plants and HeaNng. Cooling, Ventilation� Refrigerotion and
Air Condi�oning Systems and Devices '
PARTIAL RATE SCHEDULE
GAAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ...........................$10.00 �
iteplacement of Fumace . . . . . . . . . .. .. . . . . .. . .. . . .. . . . 6.00 �
Repairs & Alterations—up to $500.(?0 . . . . . . . . . . . . . . . . . . 6.00 $
Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . . . 3.00 $
MECH. WARM AIR �
Furnace Shell & Duct Work to 120,OOQ BTIT . . . . . . . . . . . . $10.00 $
each add. 6U,000 BTU . . ........... ... . . .. .. . 3.00 �
Replacement of �xrnace . . . ... . . . .. .. . .. . . . . . .. . . ... . 6.00 $
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . 6.00 $
Repairs & Alterations each add. $500.OQ . . . . . . .. . . . . . . 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......$10.00 $
Furnace Shell & Line--to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 3.00 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 3.00 $
OIL BUR1vER—to 3 gal, per hour . . . . . . . . . . . . . . . . . . . . . . . 6.00 $
over 3 gal. per hour—See Fee Schedule �
GAS BURNER tup to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . b.00 $
over 199,000 BTLT See Fee Schedule —f
GAS FITTING FEES: NO RATE T�L
lst 3 Fixtures ...................... x$ 2.00 $
Additional Fixtures ................. x .7b $
Gas Range to 199,000 . . . . . . . . , x$ 5.00 $
AIR COMDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS 8t REPAiRS
ROUC3H
FINAL
;
See Fee Schedule
�-�3cs '
TOTAL FEE s�L,�.
Dept. of Bldgs. Phone 560-3450
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City of �Yidley:
The undersigned hereby makes application for a permit for the work hereir.
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are t�e and correct.
Fridley,
• I/.I1�.�A���,��►=5�'Tl✓i7'//.%�IL
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Used as
�
To be completed about
Estimated Cost, $ -s�':s� � . r�
"l�i�J �'' � l
Old ew 'lding Permit No. Pezmit No. � f�
19�.%'�'
DESCRIPTION OF WORK �
HEATING or PO R PLANTS—Steatn, Hot Water,�S�L3�y-Ads� No.
Trade i�iame_ �iE��i���. Size No �%r�� .j
Capacity Sq. Ft. E.D.R. BTiJ H,p.
/ ��' r
Total Connected Loa ` Kind ot Fue
BURNEft — Trade Nam ' Size No- ������
Capacity Sq. Ft. E.D.R �� � BTLJ H.P.
�o4E
RAY I�. WELTER HEATING CC].
Signe � 63'TL"HTC.,�G .
By ltINdEAPOLIS 7. MINNE�OTO
Business Phone No• ��� �O G �
(REMARKS—OVER)
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�s� � . 53-8l, -s-915.51 �
� .�iifi'� G'� �3'lG�3}/ I . '
� ?���i���-.�j'.#ii� �LZ� ��12YTwii � � +4,a K���..��'J � �)1i� �43:i ii ' •
ne�. of sia�. phon. �.sasa ... . .
� DESCRIP7t0:i O: V10iZ:: � � 557 N. F. Jamesville Street
Nu��xr. Y.i�.3 nnd Locr2ien of Fixh:ros . i'Ot��"� . .-
L I: = � .
J? j� � ? �S � 3
Ba�e
Ist
2 r.3
3:d
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p WAT(� MiR.
�' .� t v T O •
i' � " ' � $ z �u 3 0 � U z
i��:.�-��� �'i� �< 7� 7< 7 r N.c�s n�c.
v, _; . {o � _ � ,. o ;v < 3 �u u � ju �i �
{::� L � � t� i r
• Funiz• Goa.:o:.t:ca Opoa:nr.s
; 3{�w Fi:ch:zti. O:d O�oair.r,s
PARTIAL RAT� S�N�DULE
I '
���a�r �
Cc«Pool ❑
7LIIMBING FIXTL'RE RATES: NO. RATE T07AL .
Nurr.ber F:xtures . . . . . . . . . . . . . . . . _.____._... x S2.G0 S
' F1�ture Flxture n�,cning . . ... . . . . ... x 51.50 S -.-
;�ew Fixiure OId Operur.g.... .:.... x 51.50 i---
Cstc� Basin . . . . . . . . . . . . . . . . . . . . x 53.25 S
�4a:er Fiea;er '4'p to 99,000 BTU3.. .. x 53.G0 5
• tiew Crcund Run Old B:dg. ....•..:. _r_____._ x 5,3.25 S
E,:�Ctz'FC i'�a:o2 Fisatat. . . . . : . . . • . . . . _ �2.CJ S
."i1S FITTI�IG FEES: NO. RnTE TO?AL
ist 3 Fixtuzes • • • • • • • • • ••• • : • • • • x S2.G0 ;
Ad�'itional F:xtures. .. . . . ... . . . ... x S .75 j
Gas RanTe to 1�A.000 BTtT ..... ...... 1' x S5.00 6. 5.00
0
City of �'Y�idley: , .
Thc undersi�ned hereby rra�es apalication for a permit fcz thc aoz3c he:ei
specifi�d, a.;ree:rg to do a:l �ti•crk ia s:r'c: acco:dar.,e k:::s the C:� C`:-ci:.:::a
and ruling of the I?epar:meni ef Builc�'n�s, and he: �by declzres L�at aII Lhe f:ei
and rearese:liations statc�i in ihis ap�Lca:+uc are trlr :.nd correct
lo-i-75 29�
Fridley, D'.ian •
Owner �cha.el G. Moki�ta ___ '
Klnd of Buildir.g Fr3me •
Used as Res. ' _
To be completed about l�rl-75 ----
'Estimated Cost. S 10,00 __ _
�o4�'ew. Bui:diag Pesmit ro � P•r 't No. �z'��
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Susinrss Phvae : io
ROJGIi �
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PINAI. � 1. - �- � - 7 S � •
p.EPAiR3 �r ALTERATIOXS—A•i.r so Cod. .50 State 5urcharge
. Descri�tion . . . . . . . . . . .. . . . . . . . ... . . . ... . ... . ... . ... . .��--- •
' ' � ' . . TOTAL FEE ; 5• 5� �!Class "�A�' .�urcharg� .5Q¢
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City of Fridley, Mi.nn..
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PE��MIT
Date: _.._..N.Qx.embe��9..�...l.s_Zl_
Owner: ....._Rodne_y__Sandmon �--..__.__..__.._..__._:_..�. . Builder Same .
Address _.__5.57._�Js�.��it:1,�..1..���S��.t_.�.,.E - _.___.. Address ��`
LOCATION OF BUILDING
No. _..._.557___._____.._. S�.�t __�Janesville Street N.E. _ p� of Lot
Lot .2.����-�.�.2.__.Block __.._..:._.._...__E.._._ .................... Addition or Sub-Division .�..._Riverview Heights
Corner Lot ...___.__....._:._.._.__ Inside Lot _.__X _.._ ___ Setback __ ...Y_.._... Sideyard
Sewer Elevation ...-----_...-------------------__.__.---•---.��•--.._....�_ Foundation IIevation .; •-----•---- "
DESCRIPTION OF BUILbING
To be Used as:
�a$e.-W._._-----•--------•- Front _._22.� _. Depth _2Fi � .._. Height _.._.lII.�_... Sq. F� � Cu. Ft �.5Z.�0.�
.____LL.----•---•----•-----•------ Front � DePth � Heipht ._ __ Sq. F't � Ct1. 1� t.
Type of Construction ___Frame..�� ��, �t �,�2505.00.--�_ To be Completed 1�Y_� 1972
Set slab elevation to drain to existing driveway. Provide a hard surface drive.
In consideration of the issuance to me of a permit to construct the building desc;ribed above, I agree 'tQ clv
the proposed work in accordance with the description above set orth and in mpliance with all pro�visions ot
Ordinances of the city of Fridiey.
1.25 State urcharge
In consideration of the payment of a fce of $�._ 11.00 �� ��� is hereby granted to Rndnp� SmnAman
...�___._.._..__.._..._.._....._...._._._._._._._� to construct the building or addition as described above. This permit is granted upon,
the express condition that the person to whom it is granted and his agents, employees and worlunen, ia alt Work
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinaace8 oi
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of builtiiri�
tyithin the city limits and this pernut may be revoked at any time upon violation of any of the provisions of said
o�rdinances.
` j�l�.bGl�.� r �i Buildin8 �
HANK MUHICH
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NOTICE:
Tfiis permit does not cover the eonafruefion, insfalla�ion for wiring, plumbeng, gas heafing, ssw�r or waNr. 6� sun to sN
the Building Inspector fo� separafa psrmits fo� ihese items.
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APpLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER � S NAMI; : Gs c� � ��dI1� /U BUILDER : `.S
ADDRE$ S S �� 7 _..��.c. S� N,�: �, ADDRES S� �
t�i0 : . �� � STREET :
LO�: .Za1 zl. � Z BLOCK:
ADDITION: ��
CORNER LOT: INSIDE LOT:�,_SEIBACK: SIDEYARD:
ApplicanC a�tach to this form Two Certificatea of Surve of �,ot and pzopoaed
bu�.lding locatiox� dxawri cm these Cextificates. ti 7�m
P�SCRIPTION OF BUILDING
To Be Used As:
s /.`�S
7-8- � °°
4� � k °
� ZO
/o ��'Zva
�Q�-e,c.�� Fs'�t : Z .Z Depth : Z � Height : /I'� /
T
Square Feet: �%2 Cubic Feet: �%� j � Z
i ,3 f'
Fxonts Depth; Height: u� ,� �
Squaxe Feet; Cubic Feet: f!��
T�►pe of Coastruction: �/��,�,,.,,,�d� ` Estimated Cost: $��c'° o0 2� � 3 G
��---- ���7`� '
�, °ZS�oS.3�
To Be Completed� �'I� ,Z2, � .�.
�25z � ��
1fie unde�sigaed hereby makes applicati�n for a�ermit for the work herein
epeciiied, agreeing to do a11 Mo�ck in sttict �ccosdaace wi.th tba Cl,ty of
�+'aci,dley Oxdiaance� and zvliqga of the Department of Buildings, and heraby
decl�;res that all tba facta and representations stated iu thia application
are true aad correct.
naT$ : ��, /� �g �, f sicru►�a�a: �
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(Sea Revsr�e Side For Additianal Iaformation.i S`" � S��� ��� � 6
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City of Fridley 3 0419.
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T � -" �
f
; � RECEIPT NO.
� ; y__ COMMUNITY OEVELOPMENT DIV.
f � � PROTEC7IVE INSPECTION SEC. �� 7�
i � ,
� � �"'1 � CITY NAIL FRIOIE� SS�32 NUMBEP pEV D�TE P�GE Oi �nvnOVEO Bv
�'""�" �'' 612-571-3450 9t0-Ft5 10/19/99 / /
JOB ADDRESS 557 Janesville Street NE
1 LEGAL �OT NO. BLOCK TRACT OR Ap01710N SEE ATTACMEO
DESCR. 20,21,.22 E Riverview Hei hts SNEET
2 PROPERTY OWNER MAIL AODR�S$ Z�P FMONE
Steve � Liz Hamre 786-0530
3 CONTRACTOR MAIL AODRESS ZIP PMCNE UCENSE NO
a ARCHITECT OR OESIGNER MAIL AODFiESS IIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDiiESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WOFK
O NEW � ADDITION O ALTERATION ❑ REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Construct a 12' x 18' sh
9 CHANGE Of USE FROM TO
STIPULATIONS
See stipulations on plan.
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIREO FOFi EIECTRtCAL, PIUMBING, NEATING.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU fT.
AUTHORIZED IS NOT COMMENCEO V�IITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR A@ANOONED FOR A PERIOD OF 120 DAVS A7
ANV TIME AfTER WORK IS COMMENCEO. NO DWLG. UNITS O�fSTREE7 PARKING
1 HEREBY CERTIFV THAT I HAVE READ ANO EXAMIN�O THIS APPIICATION STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SUR7A%
AND ORDINANCES GOVERNING TNIS 7YPE OF WpRK WILL 8E COMPUED
WITM WHETMER SPEC�fIE� MEREIN OR NOT. TME GRANTING Of A PERMIT �ZSOU �.. ZS
DOES NOT PiiESUME TO GIVE AUTMORITY TO VIOIATE Oii CANCEI THE pEqMIT FEE SAC CNARGE
PROVISIONS OF ANV OTMER STA7E OR IOCAL LAW REGULATtNG CON•
STqUCTION OA THE PERFOFMANCE Of CONSTRUCTION �83. 25 Fire SC 2. rJ�
PLAN CNECK fEE TOiAL FEE
Si ♦TyFEO�CON"P�(TOAOp�UT O�ZEO�GEht �o�tE, EH R P ALIOA MIS IOSYOUp PEpMIT
/ � ���
�GN4T q p pWNEA� O�N F il Epi �DAfE� � �
Bl �HSo � qatE
NEW [ ] .
ADDN [ ]
ALTER [ )
Construction Addre;
Legal Description:
�1�
Effective 5/10/99 � �
CITY OF FRIDLEY
SINGLE FAN�.Y AND DUPLEXES R-1 AND R-2
BUII,DING PERMIT APPLICATION
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„n� .�1�.
Owner Name & Address:
Contractor:
Address:
MN LICENSE # . .
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DE.SCRIPTION OF IlVIPROVEMENT
Tel. #
: ��
.,
.. ;
'���r�
LNING AREA: Length Width Height Sq. Ft.
�:ARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft. '
OTI�R: `o� X �� •N�1�Q�
Construction Type: �Q�Qi Estimated Cost: $ ca�, S�e ��
Driveway Curb..Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ -
DATE: $� 9� APPLICANT: �iyi� Tel. # 2,�,�-�U,$'.�v
Pernut Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ .3. � �Fee Schedule on Reverse Side
$ . s� .001 of Permit Valuation (1/lOth%)
$ $.50/$1,000 Valuation
$ $1050 per SAC Unit
$ $5.00 (State Licensed Fesidential Contractors) -:-� . .
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering �
$_ _ Agreement Necessary [ ] Not Necessary [ ]
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;ITY OF FRIDLEY INSPECTION DIV.
431 University Ave NE
'ridley, MN 55432
763) 572-3604, FAX (763) 571-1287
D� ' 6� Q a p' Effective Apri11, 2004
-f b
APPLICATION FOR PLUAABING AND GAS FfTTtNG PERM{T
MARK NUMSER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
'LUMBING FIXTURE RATES:
�ew Fixtures
)Id Opening, New Fixture
9eer Dispenser
31ow Off Basin
NO. RATE TOTAL JOB ADDRESS_ �t�nnn:¢. • a.S o'W Y1�n�
;atch Basin
iain Water Leader
�ump/Receiving Tank
Vater Treating Appliance
Vater Heater -Electric
Vate� Heater - Gas'* 1
�as Range**
3as Dryer`:
3ack Flow Preventer Required OYes O No
TYpe
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.Q0
$10.00
$10:00
$15.00
� teinspection Fee $50.00/Hr
'�LL OTHERS AND/OR REPAIRS AND ALTERATIONS
� 1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
atld 1'ep�eSentations stated in this annlicatien are tn�g a�d COffeCt.
HAMRE, UZ
557 JANESVILLE STR�ET N.�..
FRIDLEY, MN 55432
OWNER ��63) 786-0530
� BUILDlNG USED AS �S! �+e.✓1�
ESTIMATED COST �f%'O � PERMITNO.
" ! 20 � S
PLUMBING COMPANY O��` 0'v►� r
SIGNED BY • TEL N0. ii�o12�1�Z%-5�033
.�
Approved By
$ •�
Rough-In Date Final Date
-------------- - -- - --- ----- - -------•--•----- -----... .— ------. .. _ .
$�S � OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
�OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. '"�PROVIDE COMMON VENT INFO ON BACK SIDE
Building
Inspections
763-�72-3604
JAT� " 1 >� I —
�I!'E .4DDRESS 7
T';-ilS APPLICANT IS:
PROPERTY �,��
OWNER/ �DRE;
TENA.�'T pHONE:
0
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
0
E-MAIL ADDRESS
CI
Pennit No.:
Received By:
CONTR4CTOR COMPa.1�Y N�: '
CONTACT PERSON: O�LI-����— Anderson Heating and Air-Conditiomng
sLa�.ur .4 coP�• oF N/p 4341 Central Ave N.E.
�'OUR STATE STATE LICENSE �
LICENSE �'tTH ,qDDRESS: '�' u
.�PPLIC.ATION pH�� �7���_�/_ �S// _ C��. Ilt$, Mn SS421 a'��..
1
PERNIIT TYPE I�MGLE FAMILY ❑ TWO FAMILY D TOWNHOUSE
TYPE OF WORK: � �W ��PLACEMENT
DETAILED DESCRIPTION OF WORK �
❑ ALTERATION/REMODEL
A
_STATE ZIP
PER MS 16B.665 the permit fee is e�entlof a[re� den5 o fixture� xcluding the fixtue so �TOO.Ohould�reflect ongy the cos�trof labor )
improvement, installauon or replac
Labor cost under $300 =�1 �.00. Labor cost between $300 to $500 = cost of labor
x.05=
rOR PROJECTS �`}-IERE 1-4BOR E7:CEEDS SS , FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT �'�'HERE NOTED. FIXTURES: (INDICATE TOTAL
'�ti'�3ER Of EACH BELO�� MOD X� SIZEBTU�?��
Equipment Installcd 1"�G 5���
�� MODE g�E/gTU �_
�� MODEL: �._
FIREPLACE (GAS) $I5.00 _GAS R.ANGE/OVEN $10.00
�`�`�� �`� �� FIREPLACE (WOOD) $35.00 _T�iEW GAS GRtLL $10.00
_P1R TO AIR E?�CH.4NGEER $15 • �FURNACE $35.00 _GAS UNtT HTR $10.00
BOILER 535.00 POOL HEATER 535.00
CHIT�L'�'E�' LINER $]0.00 GAS DRYER $10.00 —�N7'ILATOR 515.00
DUCT WORK �10.00 GAS PIPING $10.00 — _ . .. •
_ — ,,.,, ., ... �.. k� ���t.., �..,� ��:�,.:.,,,�n,;�r�,�����nuF:p�in�rTS:QV�R`�50
�I3' FEE PRO' , , :- . , .. ..;. ., , :..„ tr.w., ,..w -.... ,. , . ._ ... _ ._ .
Permit Fee $ .Q� Number of fixtures @$10.00 x$10.00 =$
Surcharge � . 0 Number of fixtures @$15.00 x$15.00 =$
TOTAL DLJE � Number of fixtures @$25.00 x$25.00 =�
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
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 Mir►nesota 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 the case of all work which requires review and appro��al of plans. �
SIGNATURE OF APPLICAM
C G�i`Z��� �----PRINT NAMEC ��i TT e/� ��L `'�I L/J DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
��
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC „
�
�IE1RV HOMESIADDITIONS EXISTlMG HOME ❑ MAKE-UP AlR
REQUIRED FOR NEW/EXISTING HOMES '
1. Combustion Air (See note below) .
a. Oil or solid fuel IMC Chapter 7 with MN Asnendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amen�nents •
2, 1vlake-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venti.ng
a. Gas appliances IFCrC Chapter 5 with MN Amendments
b. Fuel other than gas TMC Chapter 8 with MN A.mendments
REQUIRED FOR NEW HOMES
4. Heai loss & cooli.ng 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
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Building � BUILDING Perrnit No.: ��- �'i
Inspections RESIDENTIAL APPLICATION d B�-�-
763-572-3604 �� �' `�
763-502-4977 FAX CITY OF FRIDLEY vate xec'd: J ��-�
EFFECTIVE 1-1-2010
DATE �' ���� V ^ YOUR E.-MAIL ADD SS '� �� �_ t� V� 1 �� �-ini'✓' f.� C f C� ✓� {'�1 I1 � %�
SITEADDRESS SS 1 Gc��1QSlf1 � L )1'i1�Q�C��
THIS APPL[CANT IS: ❑ OWNER �ONTRACTOR
PROPERTY OWNER/ NAME:
TENANT ADDRESS: �S\ 7 �� Vt ��G S CITY � STATE,�IP S SN��
PHONE: 7�0 3— 7� tO '� C� � O
CONTRACTOR NAME: i, S � e.-
SUBMIT A COPY OF STATE LICENSE #% b�D � O � 0 EXP DATE ��/�—� Z-
YOUR STATE LICENSE � _
AND CERTIFICATE OF ADDRESS: �i ?�'/? S�.-�y,q /J�iw-�n CITY� n�[�.ar- STATE/�3P ��30
INSURANCE pHONE ' FAX � 6 - %�v '
PROPERTY TYPE `�SINGLE FAMILY/NEW CONSTRUCTlON SIZE
❑ TWO FAMILY/NEW CONSTRUC7ION STORIES
PERMIT TYPE ❑ ADDITION O GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FIMSH �tOOF ❑ DRAIN TILE
❑ DECK d'SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDiTIOAI
�MAINTENANCEJREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: J�. ✓'b t!
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING �1 HOUSE ONLY BASEMENT REMODELING SC�MIT•
NUMBER OF SQUARES 2 I� �HOUSE & GARAGE 1, Existing Floor Plan
GARAGES ❑ TTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: �'bETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl �Soffit ADDI1'IONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1• Site Plan/Survey showing the existing structurcs
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS OYes ONo LOCATIOrf OF W[NDOWS FOR W[NDOWS - PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACNRE S7'iCKER ON WINDOW.
OPEIIING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES AKE BASED UN VALUA"1'1V1V, iNCLUlliNG "1'HL�' CU,"1" VF LAISVK A1vL MA1LKiAw:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ _ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$ �?� �� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ .0005 x Permit Valuation Minimum $.50
$ ' 4� $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 ( )
$ (a J, r Make checks uavable to: Citv of Fridley Attach
THIS IS ,4N APPL�CATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
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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 applicatio r a permit and work is not to start without a permit on site; that the work will be in accordance with the
appmved plan in the case of I ork which equ' es review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME `� �� �'a Z� k DATE f��� T % D