PRE 2010 DOCSCity of Fridley, Minn. N° 8652
BUILDING PERMIT
Date:
Owner: Z'� - - - -- Buil
Address Address
LOCAT N � F 1 ING
No. �� / a Street Part of Lot
Lot Block Addition or Sub -Division
Corner Lot Inside Lot Setback _ Sideyard f
Sewer Elevation .9 o :S- Wpevation Fr
DESCRIPTION OF BUILDING
To Used _
Front .� Depth -,h Height Sq. rL � � Cu. Ft.
Front .� Depth Height Sq. Ft. Cu. Ft.
Type oP nstructioa Est. % t—' -`To be Completed
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with ;h provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of V W-) , permit is hereby granted to-
the
othe express
to construct the building or addition as described above. This permit is granted upon
condition that the person to whom it is granted and his agents, employees and workmen, 9n ail work
:Ly
, Minnesota regar�n� location, construction, alteration, maintenance, repair and moving of buildinea
� city limits and this permit may be revoked at aqv �pVon vle�ion oY any of the provisions oY said
NOTICE
rob permit den not emu the emoructlon, habWas hr whing, plumbing, gas hWA* ower er weer. Be sun to ae
the Building loweder hr operate pamib hr thea Nems,
APPLICATION FOR BUILDING PERMIT
CITY AF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER f1f OW 6 -
ADDRESS r YZ ADDRESS -�-�
LOCATION OF BUILDING
NO. 7 STREET /-,f4 c r /c/ � !� 1� G?/� PART OF LOT 0 P
LOT 3 BLOCK ADDITION OR SUBDIVISION 2 -
CORNER
CORNER LOT INSIDE LOT_ySMACK SIDE YARD
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction 17 ro M t:--- Estimated Cost /'!-.0 o o
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 Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct,
DATE .3 I G SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
BUILDING- TEN FEE SCHEDULE
SECTION 2, The Inspector of Buildings shall, before issuing any permit for
the erection of any building or structure, or for any addition to any existing
building or structure, or for any alterations or repairs 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:
2.1.. For any such permit for the erection of any fire -proof building,
other than a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof.addition,,for similar occupancy, to any existing building,
shall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2 For any such'permit for the erection of any fire -proof garage,
warehouse, factory or.grain elevator, or for the erection of any fire -proof
addition, for similar occupancy, to any existing building shall be at the
rate of $1.25 for each one thousand cubic feet, classified as "fireproof"
by Section 502 of the Minneapolis Building Code.
HOUSES
2.3. For any such permit for .the erection of any non -fireproof
building, other than a garage, warehouse, factory or grain elevator, or
any non -fireproof addition, for similar occupancy, to any existing building -
permit $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such,permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevator., or for the erection of any non -fire -proof
addition, for similar occupancy, to any existing building or for each such
building or addition - ninety cents ($0.90) for each one thous.and.cubic feet
or fraction thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of computing fees for building permits, the cubical contents
of any building or addition to a uniform height throughout by multiplying the
ground area covered from a point six (6) inches below the floor line of the
basement or cellar to the average height of the upper surface or to the average
height of the roof surface of the main gable of a.pitched roof.
2.5. For repairs or alterations to an existing structure., the fee.shall
be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in the cost of all proposed work.
2.6. In no case shall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
STORM REPAIR DAMAGE FEES:
Residential: Estimated
Cost
of
work
up to 5500.00
- $5.00
Esti,rnted
Cost
of
work
over
- $10.00
Commercial; Estlmate
lost
of
work
up tb 'Y_'0,,L 00
- $1'' 110
,, �.'tiniate.
, ost
of
work
over $500.00
- $� 0
w , y
City of Fridley
AT THE TOP Of THE TWINY
tw------- GOMMVNITY DEVELOPMENT DIV,
m PROTECTIVR 1NOftCTNNI 111M.
CITY HALL :RIDLRY 1111102....1`.� :j 1111102 W-sYo-sgsO
53-84-s-915.51
PLUMBING PERMIT APPLICATION
Job Address
910-FIBA 1 0 12115/73 1 1
1 1 800
7b30 N.
E. Lakeside Road
owner
Address
Phone
Robert
0. Persgard
Contractor
Address
Phone
M1NNF_GA_1;r0a
,AARQUE;'TE AVENUE
Kind of Building
Use Mepsk •" M'NN.
Frame
Completion Dates
.mate ost
5-10-7410.00
I
Plumbing Fixture Rates: N0.
RATE- TOTAL
Ci_—
W
- !
Number Fixtures x
`2.00
°I
i
11 Future Fixtures x
$1.50
aoNra
ere
� I
I I I i
�
•�
New Fixture -Old Open. x
$1.50
'iddV
I
i
O
Catch Bastn x
$3.25.
ors
I
;
—I
Water Heater -99,000 BTU x
$3.00
i
li
Ground Run Old Bldg. x
$3.25
Baas
'MNIVaI
f
Elec. Water Heater x
$2.00
s"ravel
N
�
I
� I
I w
Gas Fitting Fees:
,O c
•Nlvaa
1st 3 Fixtures x
$2.00
O
f
I
!'Z4
O b
...Moms
I (
I
I (
c7
i Additional Fixtures x
$ .75
!b
'1Nf10d
I
I
I
HNIaa
Gas Range -199,000 BTU x
$5.00
t/1 p�
•AYtll
NSVMI
I
I
..m
Repairs & Alterations
iWWq
See
••"�8I
I
I
I I
Description: Install Gas Grill Code
5.00
.Nl.rnl
I
1
I
I
I
State Surcharge ;s 'A = Surc_hargi� 50� .50
TOTAL FEE
$ 5.50
I I
I
Ntr•
I
I
I
!The undersigned hereby makes application
for a permit
•,rNltlol
I
I
I
I
for the work herein specified, agreeing
to do all work
uas°-n
in strict accordance with the City Ordinances and rulin
tlairM
I
I
of the Department of Buildings, and hereby declare that
all'the facts and representations stated
in this
application—AM,.true and correc .
Signature_ "
Date
CITY OF-FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK Ni1MRFR OF FIXTI IRFC Tn RF IAIRTeI I Rn nki cer+u ci nno
Effective On Jan 1, 2000
7 ®R --
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 3!¢1'11✓ ts 6610i✓ IZ
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas*"_
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% 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 fjuilding Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
2062
Owner
Building Used As F)Sa1D4VJ CIC,
00
Estimated Cost PERMIT NO.A3 4�n�
PLUMBING COMPANY A/0,=M PLQ9j&AJr, C4
SIGNED BY
Approved By
TEL N0.
Rough -In Date Final
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
N•
S.te
•. ��Men
- -. -
Lam:
7 ®R --
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 3!¢1'11✓ ts 6610i✓ IZ
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas*"_
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% 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 fjuilding Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
2062
Owner
Building Used As F)Sa1D4VJ CIC,
00
Estimated Cost PERMIT NO.A3 4�n�
PLUMBING COMPANY A/0,=M PLQ9j&AJr, C4
SIGNED BY
Approved By
TEL N0.
Rough -In Date Final
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
N•
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes O No ( )
The venting:; system is, plastic/PVC and meets all current codes and manufacturer
specifications :including sizing, length, number of elbows and termination. Yes( No {= )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA -LAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes (
) No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes (
) No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes (
) No ( )
When instailina a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
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 ()
No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance#2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS. (Describe)
HEATING Cb:
Signed By: Date :
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
MARK NLIURFR OF FIXTURES TO BE INSTALLED ON EACH FLOOR
O _ 06Sgfffective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS
New Fixtures
Urinal
-------------------
..
$10.00
--
- ---- -----
Wash
Tray
- -
:: �I€
Floorgo
Drain
�.......
Auto
Washer
....
Gas
Range
Sump/Receiving Tank
$10.00
Water Heater
$35.00
:
Gas Ele c
Water Heater - Gas**
$35.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required M'�es () No
Type WVI" -W
$15.00
Floo r1
Floor 2
Floor 3
I
F o0 r4
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS
New Fixtures
$10.00
Old Opening, New Fixture
$10.00
Beer Dispenser
$10.00
Blow Off Basin
$10.00
Catch Basin
$10.00
Rain Water Leader
$10.00
Sump/Receiving Tank
$10.00
Water Treating Appliance
$35.00
Water Heater -Electric
$35.00
Water Heater - Gas**
$35.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required M'�es () No
Type WVI" -W
$15.00
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $LE__V
L/ E-, ...
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
and representations stated in this application are true and correct.
DATE: , 20
OWNER r Lj c, r,9 --t he C.5 J n y—
BUILDING USED AS
ESTIMATED COST,
PERMIT NO.
PLUMBING COMPANY
SIGNED BSS^'�'�' TEL N0.
Approved Bye Rough -In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE
t
FILL IN COMPLETELY FOR REPLACEMENT FUEL BUMING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No( )
The venting system is plastic/PVC and meets all current codes and mAnufacturer
specifications including sizing, length, number of elbows and terminatidn. Yes () No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
Tfie existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes (} No( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's;
specifications. This does include AGA-GAMA Category I Central Fumace
V6nting 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 () No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input Fan Assisted or Nat
Appliance #2 Type
BTU Input Fan Assisted or Nat
Appliance #3 Type
BTU Input Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter. in Type
Appliance #2 Vent Connector Height ft Length ft Diameter. in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
Building
$ t1,,�
BUILDING
Plan Review
Permit No
Inspections
RESIDENTIAL APPLICATION
$
Received By
763-572-3604
$
1.19.0005 x Permit Valuation Minimum $.50
License Surcharge
$
p $5.00 (State Licensed Residential Contractors)
SAC Charge
CITY OF FRIDLEY
$1825 per SAC Unit (Plans to MWCC for determination)
Dat 'd:
763-502-4977 FAX
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
EFFECTIVE 1-I-08
Sewer Main Charge
$
DATE
YOUR E-MAIL ADDRESS
o
Make checks savable to: Citv of Fridlev Attach Stipulations
SITE ADDRES
THIS APPLICANT IS: ❑ OWNER
6�ONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS:
i JJ CITY
STATE ZIPb�
PHONE:
NAME: `
ADDRESS:
` Ajc,. CITY
STATEtN ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE
e6 FAX IP6-
- t�
YOUR STATE LICENSE
STATE LICENSE # (�� ( (� EXP DATE
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMFLY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION
❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT
FINISH ROOF ❑ DRAIN TILE
❑ DECK
❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:C001-
G'
SIZE
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING}❑�
NUMBER OF SQUARES n
HOUSE ONLY
LY HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:DETACHED
GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS, & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I .
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No
LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(� -, ((USING THE 1297 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ -1 CiL$Q - 0(—, 55�,4- OCCUPANCY TYPE
Permit Fee
$ t1,,�
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
'2 -'55 .001 times the total job valuation
Surcharge
$
1.19.0005 x Permit Valuation Minimum $.50
License Surcharge
$
p $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary( ) Non Necessary ( )
Total Due
$
Make checks savable to: Citv of Fridlev Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the Minnesota Construct' n 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 actor ith a approved an in the case of all work which requires review and ap oval of plans.
SIGNATURE OF APPLI PRINT NAME DATE
APPROVED BY /l-1 / DA'
AND MECHANICAL