AF - 47815City of Fridley, M��
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� BUILDING PERMIT N� 7os�
Date: ""'' �cS � . _ _
Oovner: � Su9lder ���_C��.
'�a� Address
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-�-��j ��TI F �ILDING
No. ��'--rL-e.--.- Street --,e...-y6 _._._ Part Lot
� ��E� Slock _ � Addition or Sub-Divlaion � « �
Corner Lot _ Insfde Lot �� Setback .�.�_ �___ Sideyard �� � E
Sewer Elevation `S° IIeval3on �J� � �4
e 6F o�^'
' DESCRIPTION
T U .
Front -�.�____. Depth �
I�`roII
OP BUILDING
= ' ��� � j� ; /�' • .,,' I ;`:J'�
�tA �Pth I� t Sq. F� Cu. F't
��'Pe oP Constructton �� B� -� ��_�� � To be Completed
� � work in accordance with the d+escriA�to�n above�s�et fo and liance with � I a
g gree to do
o�sciinances of the dty of Fridley. P pruvlsions og
����
In consideration of the Pa3ra►ent oP a fee oP
Permiit is hereby �raated to
to construct the bufldin,g or addition as d�cribed above. Thiapermi t is graated upon
�e �A�s �ondition that the person to whom it is granted and h�is a en em lo ees an�i Wor
done iq around and� �nsaid��g, �`:onatructt ��0�' ahall o�ffior�'an 3n all �� in all work
FridleY� M�n�esota g on, alteration, ma3ntenaace. rePeir a�nd mov ng o��g �ces of
within the d]iaoits and this permit may be revoked at any t�� uP� viol�n oP any of the provisiona of�eaid
ordinanc�s.
Building' Inspector
('� NOflCEs
� Re� does eof een� t6s eonstwc�i�, irt�alinioe �or �GIeO. piumbtea, e� 6uHa� mr�� or wafsr. e� suro te sss
��i��8 �sr fo� pparat� wr�hs 16er fkps h�mt.
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: APPLICATION FOR BULLDING PERMIT •
CITS( OF FRIDLEY, MtNNESOTA �
LOCATION OF�BuILDING ,.,. . ,
. � � a . , . , . .
No. � ' Streat��p��� part of Lot�_
Lot�l� 'd`Z Block��^ Addition or Subdiuiaion „� '�
� , ..
Corner Lot`�Iaside Lot �fSeCback �,�i� . S.ide-Yard . �� / �- � - •
SEWER ELEVATTON FOUNDATION ELEVATION
� �
Applieant attach.to this form Two,�ert.ifiaates.of Surveq,of Lot and propos�d build-
ing location drawn on these Ce�Gificates. ,. � ,,
DESCRIPTIOAI OF BUTLDIAIG
To be ueed ae:
. � � - o
� �P %/ os� 9' i�rant ��. Depth ��,� Seighfi��. /`�
.�'— .
, - S q. �'t . ;� C� /�?: Cu . . Ft .; .
FronC Depth Height
: , � SQ. Ft. Cu. „�Ft: �
. � r�
Type of Coastruction� ��?.� , . � � Eeti,mated Cost� e .��s � �
To be Completed��s�,/ , l��' <�_, _ .
,
The uadersigned hereby malte's application for a permit for the work herein epecified,
agreeir�g eo do all work ia etrict accordaace with the CiEy of Fridley Ordinances and
rulings �f the.Department of Bufldings, and hereby declares that all ehe facts and
representatious stated in'this applicatioa are true a�nd.correcC. �
na� � f� � % �� s�c� �
�(Schedule of Fee Costs caa be found on the Reverae Side).
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BUILDING PEn.t9IT FEE SCBEDULE
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SecCfon 2. The Inspector of Buildin�s sh�ll, before iseuing any permit for
the erection of any building or structure, or for any addition to any exist-
ing building or structure, or for any alteraCions or repairs to any es3stin�
building or structure, upon application therefor, require the paymeat by the
applicant for such permit of fees tv the amount herein below set forth and
in the mannes hereia provided Co-wit:
2.1, For any such permit for �he erection o.i eny fire-proof building, other
than a garage� warehouse, factory.or graia elevator, or for the erection of
any fire-proof addition, for similar occupaacy, to any existing building
shall be et the rate of $i.40 for each one thousand cubic feet, or fraction
thereof, in such cubical`coatents.
2.2. For any �uch permit for Che erection of any fire-proof garage, warehouse,�
factory or grain elevator, or for tbe erection of any fire-prcof �dditinn,
for similar occupancy, to anq exieting buildiag shall be at the rate of $1.25
for each one thousand.cubic feet, cla�aified as "fireproof" by Section 502 of
the Minneapolis Building Gode..
HOUSES
2.3. For sny such permit for the erection of aay non-Hreproof buildiag cther
than a garage, warehouse, factory or grain elev8tor, or aay noa-fireproo€
additi0n, for similar occupancq, to any euistiag buildiag - permit $1.00 for
each oae thousand cubic feet.
GARAGES
2.4. For anq such permit for the erectioa of any non-fireproof garage, -
warehouse, factory or_grain elevator, or for the erection of any non-fireproaf
addit3.on,�€or-s-imilar occupancy, to any existing buildiag or for each such
_�,_..--building or addition - nineCy cents ($0.90) for each one thousaad cubic feet
or fraetfou thereof, in the cubical contents thereof with a minimum of $4.OQ.-
For the purpose of computiag fees for building permits, the cebical coater�ts
of any buildiag or addition Co a uniform height throughout by multiplying the
ground area covered from a point si� (6) iache� below the floor line of t.he
basement or cellar to the average height of the upper surface or to the
average he3ght of the r�of surface of the mafn gable of a pitched roof.
2.5. For repaira or alteratioas to an exiatin� structu�e, the fee ahall be
at the rate of $3.00 per each Five Hundred Doliara ($500.00) or fraction
thereof in the cost of all propoeed work:
2.6. In no case sha11 the fe�.char�ed..for.�any-germi�-as set forth in
Sectioa 2 be lesa thaa $4.D0.
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LAIVD SURVEYORS
Anokn, Minnesota
CERT6FIC/�.TE AP SURVEY: � ,�-```
R,►�PH Lun�o
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K►MBALL Sr�EET
L01`S �.�ltL���2� BLdCK D� RfYERVt�W HEfGHT�3
ARiOKA COUNTY� hliNNESaTA
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1 HEREBY CERIIFY THAT TH1S 15 A TRUE AND CORRECT REFRES�PI'ATiON OP . A SURVEY _ OR TH6 BOUNDARIES OP THF A80VE
DESCRlBfD LAND, AIVD THE LOCATiOW OF ALL BUILDIAIGS, THEREON, AND Alt Y151BkE BdtROACHMENTS, IP MiT, F&Oh1 OR QN SAID
LAND.
AS SURHE1fEC BY MF TF�S ,..',�„� .rH.. DAY OF ...A+iAY............K ..............�».......�.��...��.... RD. 19v,;,T,,...
N. C. HOIUM AND q�5SOC1�S, 1 C�-� WND SURVEYORS
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SUBJECT
City of Fridley ° 16111
, ` AT THE TOP OF THE TWINS gU I L D I N G P E R M I E�PT .
r
� 1 v_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � 7�/
1 . �
(•--_ � ��'��,'� CITY HALL FRIDLEY SS4$2 NUMBER REV. DATE PAGE OF APPROVED BY
i �� 612-571-3450 910-F15 4/8/81 / /
JOB ADDRESS 517 Kimba.11 Stre�.t N. Ee
LOT NO. BLOCK TRACT OR ADDITION
1 LEGAL SEE ATTACHED
DESCR. I.O��.�.� 2 I► Ri�rerviewc Heights SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
wiilard Bergeron 517 Kimb:all Street N.E. 786-2843
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
��.
4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
R@S 1C12ri'tl�.
7 CLASS OF WORK
� NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK a
Construct a 14' x 22' Detached Garage
9 CHANGE QF USE FROM TO
STIPULATIONS provide a ha.rd �urfaae. driZre�a. OHmer a rees that
y. g gaxage is not to
he attached to the h�us�e until frost .�ootings axe insta.11ed under garage.
S�PERAT� 1NARHIHG
H�'ATIN�, P � R"��rs
�g�N� REQU��� F� gefote �ggin� call local utilitiea
ANp ��S. R�'����8 T�LEPNONE - ELECTRIC - GAS Etce
REC�UIREC� �� ��'�
SEPARATE PERMITS ARE FiE�UIRED 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 S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 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 ,' 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 $2, 713 �`I...3G
WITH WHETHEH SPECIFIED HEREIN OR NOT. THE GFANTING OF A PERMIT
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- $12.32
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
, $13. 68
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT iDa7E� f'- WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
,��('�l � ' � - � � c� o�
SIGNATUNEOFO ERIIFOWNER ILDERI T IDATEI ea • BLDG iNSP � E
CITY OF FRIDLCY •
, APPl.ICI1TIO:�d FOC; P,CSI[)E(dTI/ti_ QUILDILIG PEFU�II7S � .
(We�•r, Al l:er��Lions, Additions, or Repairs) .
O1JtdER: � CUI LDER : . . ��1 r9'/i► � .
I1DDR�SS: ,�'/'��.,G�-L/�,�?�. �i%� ADDRCSS: • .
TEL N0: ��'�' -° c� i�,"�,� `� 7EL IJ.O: '
� Construction Location `
STRL�T AIO: y��� STRE�T: � .
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L07.': 4� / � � � o� BLOCK : �� ADDITION :
,
Corner Lot: Inside Lot: Setback: Sideyards:
Ap�licant attach to this form two Certificates of Survey of lot and
. proposed building location dracan on certificates to sca].e. �
. • DESCRIPTIOid OF COF�STRUCTIOPd -
Front: � Depth; o� o� Iieight: ,�Q .
Squane. Feet: �� (kibic Feet: ��
, � Front: Depth: Heightz
. Square- Fe�t: � Cubic Teet: �
Type of Consi�ruction :�� ��,�A Esiimated Cost: $ p� �ec,� c r�
Zta Be Oo��pl.eted: � .��i�,�� • .
` . _ � Alt. A A1t. 8
Proposed Driveway Width If New Opening Is Desired: $' $
, . .. SE� R,�VERSE SIDE OF SHEET
�iie undersigned hereby ma�:es application for a permit £or the �:�ork' herein specified,
agreeing to c�o ,all work in s��rict accardance �•�ith the City of I'ridley Ordiiiances aiid
rulijig� of i:he Depari-ment of Buildings, and hereby declares th�zt all the iacts and
represenE.�tions stated �i this applicatian are true and correct.
D.iTF::: ��� --�W SIGI�TIITUF.E : �/�JJ �C
utlj�ullt,].ol�s :
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:;I::C`.Ci01�� 2. �'i'I�L 7n�.:��cci:�r. of 13uS.lc:in��:: ::liril.l., befar.r. i.; :uii��J pc�znit;; tor lhe crcc�i.on
vf: t�ny l�ui.l.c3.ir��� ar :�t:ruct:urc, or. �a�: an�► adQi.l:.i.��n +�a aily cr,i�L-i.i�� Ltiildi.ncJ or :,tzucL•w:e,
. cir. t:ar t,i,y ciJ.i:crltiou or. r.cl��►ir.s Lo -any c::S.::t:in�,� l�ui.).di.n-j or �L�.uctt�rc, u��w� ar�J�li.c:ata.o�i
�thcl:utor.c, r.cqu3.r.c lhc Paymc��t: }�y t]ic ar�p].i.canl: foz- such per.m�.L• or tee, to tlie arnounL•
hczcin bcl.o�•r sr.i: tor.tli �u�d i.» �hc manricr. h�rc�.n ��rova.dacl L•�-��:a.L•: •
t�7);1•I COtJ�`!'I:UC'.Clat�: Si�zc�l.c 1'amil.y tlome:� and Gar.ac{es: ;�4.00/).�0�0 cub5.c fect.. .
1'7..Ai2 Clt}:G;: 25 i��r.cc►►t: oS hui.lclincJ J�ci7nii: tc:e.
U1tl:VEIdA1' llL•'PP.i:55I0i•;: (Cancrctc, G1.ixU Si:rceL-s Only) � �"
• R].ternat:e A: itc:inoval and rep].accment of concre�e cuxb and
c�uL-L•er only; llriveway �aidtli p].us 6 ieet x$13. �0
1�,].ternate B: Removal and replacem�•nt of concrete curb and
.� guL•ter and install a 3 fooL- ���ide aPproach ceiFh ='
' .• 6�nch depth; Drive��ay �•�i4th �plus G feet x.$15..7�
• . ADDI i I O�/�L I �tiFOR��9�1T I 0� �
Tar the �surpase of co�puta.nc� tees far. building permits,. L-he cul�ical. contents of any
bua.l.d�.ng or addition, 5.s dctcrmi.ned by rnultip.lying ihe ground area cavcred from a
point siY (G} inches belo�,�� ihe �J.00r 3.ine oi tlZe basement or th� cellar to tiie .
�verage heights of the •u�per surface or to ihe average height of the roof surf�cce
oi i:he raain gable of a pa.tched roof. • �,
Fox re�zi.rs or al.terations to an existang structure, the fee shall be at the xate
.. of $3.00 per cacli five hundred dollars '� ($500.00) or fraction tlzereaf a.n the CQSt
oi all propos�d wox.k. . _ '
In •no case sha�.l the fce ciiargeci for any ppx►nit as set �orth i.n Sectiun 2 be less �
than $?.50 Plus $.50 sta�e swrcharge. � - �
_ VERT F I CATI 0� OF FOUF�[n111 I Otd
NOTE: Pexmits �or construcLi.on will be issued a minimum ai 24 hours fr.om U�e time
oi a�plication to a]_l.o�+� for proper re�►iew of the proposed structtare and oi ihe ,
construction site. �
�
1� Certificate � of Survey o€ the lo�, sho�,Ting the location of 1:he foundation once i.t
has been cons�nrcted �.�a.11 k�e required bef.ore pr.oceeding with the iraming.
..�rj�T I F.�GATE OF ���UP/1I��C1' � � '
' T,pp�.icati.c�n ior � Cer�ificate oi' Occuk�ancy shall. L�e madz� ten (IO) c3ays prior to the
use ox OCCLl}?311Cjr oi any sti-ucture for �aiiicli a L�uilcli�ig perr,iit Izas heen issued; and
s.iict structuze siial�. iiot be used or. oecu��ied i:iitil a CertS.ia.c���e ot Occui�ancy has
been xssued. �
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: LAI�iD SURVEY�RS
Anoka, Minnesotp . - " �
C�itT1�IC.�Tf aF SURV�Y: ,•= �
RALPH L.t1►Vf3
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LOTS 'I.O-'I I°�2 � BLOCK D� R 1 VERV 1 EW HE 1 GHTS
APlOKA COUtdTY� h�iNNESOTA
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{ HEREBY CERTIFY THA7 SHIS IS A TRUE AND CORRECT REPRESENTAP.ON OF A SURVEY OF THE BOUNDAP3ES .OF iHE ABOVE
DESCRI6ED LAiJD, AND THE LOCATION OF ALL BUILDInGS, THEREON, AND ALL VISISLE ENCROACHMEN7S, IF ANY, FROM OR ON SAID
LAN0.
AS SURVEYED BY ME THIS 2� � H DAY OF .,, �;� a Y,,,,,, A.D. 19 ��,...•
................. ................,..................................
N. C. HOIU,N AND. A�SOCI�S, I C� — LAND SURYEYORS
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CHIM�dEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes J�'f No ()
2. Is free from rust or deterioration Yes {� No ()
3. Has no foreign objects lodged within Yes � No ()
4. Is securely supported Yes � No ()
5. Meets all current Code requirements for size and
total BTU connected ites � No ( j�
6. Has Total hea ti ng BTU' s of p���
All other BTU's ��, �
TOTAL �� —J
Rema rk s
Com pa ny
�— �
Signed By
_____ _ __ __ ---
Date �e— 9���'
d
�"�/�- /�����.�� .,�.
I Gerald Zambrecht do agree to my nei�hbor
t�illard Ber�eron ha.ving th� �,ir Conditionin�
�unit installeci an.d located on the ��st end
of his hausP.
Signed -=��--
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CHIM��EY ANJ STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes ()
,
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for 5ize and
total BTU ccnnected
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
CITY OF FRIDLEY
6431 iJNIVERSITY AVENUE NE
FRIDLEY, NIN 55432
57"L-36U4 N'AX:
: 517 KIlVIBALL ST NE
: 033024220086
d
d
A
PROPERTY TYPE .
CONSTRUCTION TYPE .
RNERVIEW HEIGHTS
LOT 10 BLOCK D
BUII.,DING
RESIDENTIAL
WIl�TDOW/DOOR REPL
571-1287
_ �-_ �-_�
.
PE 0.:2004-009�;
DATE IS5UED: 06/17/2004
VALUATION : $ 7,000.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENII�TGS.
REPLACE 12 WINDOWS & WRAPS WITHIN EXISTING OPENIATGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
CUSTOM REMODELERS INC (1748)
474 APOLLO DR
LINO LAKES, MN 55014
OWNER
EDWARD & VICTORIA, TENGBEN
517 KIlVIBALL 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
application and lmow 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 does not presume to give authority to
violate or cancel the provisions of any other state or local law
re ' g cons�uction or the performance of construction.
A��1.__� r . 1 �
► � _ 1 ../%���� I,•' � ' ��_�1
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 46049
Petttlif In��r��r�� �
Wiil �� � �'��'�S
��
Ta Mo �ailed
�neo�ner To Posi
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
139.25
7.00
3.50
5.00
154.75
NEW
ADDN
ALTER
� � CITY OF FRIDLEY
I I 6431 University Ave NE, Fridley, MN 55432
I l SINGLE FAMILY AIVD DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name 8 Address:
Contractor. f D � /1.C�1,�
� �-b� 3 � 3 �
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763) 571-1287 Fa�c
` oo� -o��as�
�
S 17 '` Tei # -�r� � -� �b- d�o ,F�
MN LICENSE #��_
Tel. # �,�_S/ — % ��'� 1f�K�
Attach to this application, a Certificate of Survey of the
lot, with the proposed aonstruction drav�rn on it to scale.
DESCRIPTION OF IMPROVEMENT
L�/IPIG AREA: Length Width Height S. Ft.
q
GARAGf AREA: Length Width Height S. Ft
q
DECK AREA: Length Width
OTHER: Hgt/Ground Sq. Ft.
Construction Type: � 4✓ ^ mated Cost: $ �(��(,� � ���-���j��`�,�
`��h� _
Driveway Curb Cut Width Needed: F+ 6 Ft = Ft x$ �
e
D/1TE: �Q`' — � �4ppLICANT: "�/� /�
1'�I. # � ` `d f� � t�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
yoa�.forcard number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main �h�ge
TOTAL
CITY USE ONLY -
$ ���o� � Fee Schedule on Reverse Side
� 65% of Permit Fee
� '� - � � .001 of Permit Valuation (1/10th%)
�— %� - S d $.50/$1,000 Valuation
� $1350 per SAC Unit
� �o� $5.00 (State Licensed Residential Contractors)
� Alt. "A" or Alt. "B" Above
� $450.00 Conservation Plan Review
� Fee Determined by Engineerin�
� - - - - - - Agr�emenf I�cessary [ ] Not Necessary [ ]
� � �' � STIPULATIONS• '
Building
Inspections
763-572=3604
�r�^—
SITE ADDRESS �,
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
BUILDING
RESIDENTIAL A.P'PLICATION
CITY OF FRIDLEY
YOUR E-MAII. ADDRESS
�� � /�/�
❑ OWNER �CONTRACTOR
:�ss: �i����
�. �7G' ? a °� n .... °7� -��
SUBMIT A COPY OF STATE LICENSE #�o�,�i a�
YOUR STATE LICENSE ADDRESS:���/�
WITH APPLICATION pHONE G� S�� G1�_S %-
PROPERTY TYPE
PERNIIT TYPE
�rE oF wox�c:
Y/NEW
Permit No.:
,� - :. : -s�
' 11 1 � ,
�.-�--�
' ��'`��° e. STATE�IP.
EXF' DATE -.� '� S � °- (��
� CITY,� Do,�� �r 6 i,/ STATE�IP�Jf''
FAX �i�i� —��% �� ��
O BASEN�IT FINISH J81 ROOF O DRA1N TILE
❑ DECK ❑ SIDING ❑ OTF�R
❑ SWARMIlJG POOL
�
DESCRIBE VdORK BEING DONE:
SIZE OF IMPROVEMENT
�cvvruvv
NUMBER OF SQUARES �_
GA1tAGES
PROPOSED SIZE:
PROPOSED HEIGH'f:
SmING
❑ Vmyl
❑ Aluminum '
❑ Odter .
❑ REMODEL.AIG
9dID7'H
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACf�D GARAGE
❑ DEfACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
WWDOWS
IN E7QSTWG OPENII�iGS OYes ONo LACATION OF 9�WD09JS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
I�TUIvIBER
F�
�.ASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed fl�r plan
3. List of struct�ual members to be used
FOR NEW CONSTRUCCION fIdCLUDWG DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing strucbues
and proposed proje�t.
2. Two set� of construction plans
3. Energy Calculationc
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
�, (USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�� J�(.�i OCCUPANCY T�PE
Permit Fee
Plan Review
Fffe Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
� ^
$ �,�
$
$ C
$
$
$
$
� _ �
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)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$2l =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THLS 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; thax I understand this is not a
permit but only an applicaxion 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 whicl� requires review and approval of plans.
SIGNATURE OF APPLICANT _�/�.__�_` C� �� d��pRINT NAME .J �e ``//p p�DATE�� ��
%%� -
Page 2- Build.ing Residentia.l Applica.�ion
BUII.DING PERNIIT FEE SCHEDULE
The Cluef Buildi.ng Official sha11, before issuing permits for the erection of any buildi.ng or
structure, or for any addition to any existing building or stru.cture, or for any alteration or repair
to any existing building or siructure, upon application therefore, require the payment by the
applicant for such permit of fees to the amoun.t herein below set forth and in the manner herein
provided iawit: '
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 Certifica.te of Survey of t�ie 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 Deparhnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
Ins�ections
763-572-3604
763-50�-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-08
ADDRESS
� � � '� ItIII�/:w'Iii,//,%`�►L-"'7
■ � ■ • •�
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
�
ADDRESS: .J �% 1Ciry� b�� S T
PHONE: 7G � �� � �S � �Z_
0
Received By:
STATE �/ lµ%ZIP S �3
ADDRESS: CITY STATE ZIP
PHONE
STATE LICENSE #
FAX
PROPER7'Y TYPE I�NGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ BASEMENT FINISH
❑ DECK
TYPE OF WORK: 0 NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
DESCRIBE WORK BE1NG
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes �IVo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIAIDOW TO BE INSTALLED
EXP DATE
❑ GARAGE/SHED GY1#iNDOWS
❑ ROOF ❑ DRARV TILE
O SIDING ❑ OTHER
0 SWIMMING P(mL
❑ ADDITION
p�EMODELING
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
FT
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 ADDTTIONS. & PORCHES SUBMIT:
❑ Trim 1• Site P1an/Survey showing the existing sUuctures
❑ Fascia and proposed project.
2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
�
ALL FEES ARE BASED O1V VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
� THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY_ TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Swcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Ma.in Charge
Total Due
$ v2 � � :�-.�
$ , ��D
$ ��
$
$
$
$
$
$
$ �� e I'I
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 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 checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a build' permit and I acknowledge thai the information above is complete and accurate; that the work will be in confortnance with the ordinances and codes
of the City of Fridley and wi the Minnesota Construction Codes; that [ 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 w 1 be in accor th the app ved plan in the case of all work which requir view aad appro I of plans.
SIGNATURE OF APPLI�ANT,�������'� ° PRINT NAME ilC� �GllP1 �%,/ DATE D 3 �0 0
� . . . • � : /1_I!�'���/n/�//1 �/ , .
Page 2- Building Residential Application
� ";� , , BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, before issuing pernuts 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 applica,tion 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 stxucture and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 '
763-572-3604
Fax: 763-502-4977
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATE �D l8 (O
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER _ OCONTRACTOR
Permit No.
Received By:
ADDRESS: CITY STATE ZIP
PHONE:
CoMPANY
SUBMIT A COPY OF CONTACT PERSON: �.,,ap1�NNL �/U (j1�,��" "'
YOUR STATE STATE LICENSE # EL� ¢'+�r��iD�
LICENSE WITH pDDRES���i'�,r'EJ4�� PX' C Z ST �
APPLICATION pHONEiL� ��'�� FAX
PERMTT TYPE
TYPE OF WORK:
�SINGLE FAMILY ❑ TWO FAMILY
❑ NEW ❑ REPLACEMENT
❑ TOWNHOUSE
IJALTERATION/REMODEL
i
FEES ARE BASED ON S10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J Z006 ASHRAE HANDBOOK.
Equiptt�nt Installed MFG: MODEL: SIZEBTU
1VIFG: MODEL: SIZFlBTU
MFG: MODEL: SIZFJBN
_A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGFJOVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 _FURNACE $35.00 _GAS LJNIT HTR $10.00
CHIMNEY LINER $] 0.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
THiS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PR�ESSED
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 applicaxion 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 whic re' e view and approval of plans.
SIGNATUREOFAPPLICANT � PRINTNAII�./r �N `I�.cI� DATE �8 D
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 NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME 0 MAKE-UP AIR
REOUIRED FOR NEW/EXISTING IiOMES
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. N1104.4.13
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 Guidelines software may be used for
combustion and make-up air calculallons.