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PRE 2010 DOCSCity of Fridley, Minn, BUILDING PERMIT Date: Owner: We--Iz?,._...,_'? a pt , - --. Builder Address '~`'.ftCl __ ._. Address . LOCfIO F BUILDING No. /'_.._.._ Street _� :f Part ofum Lot °.�_..:..*�... Block _--_,:-.._._........... Addition or Sub -Divi ion ... Corner Lot ............ - .Inside Lots .............. Setback ........_..:.......... _........ Sideyard .....2-.7:..._Q....... -- ......... .y� o Sewer Elevation ....._._ _..,._.f.' ........... _. __...._......- Foundation Elevation .......... ...................... _. DESCRIPTION OF BUILDING To Used as• ... Front ..Ls�_'... .._.. Depth ...: Height .� '�= .. Sq. Ft. �[.* Cu. Ft.02- ...._.. .... _...........-_.. Depth ...............�,> ght ...ez+ ... Sq. Ft. ..... ................. Cu. Ft. ................. ..... Type of Construction ......... A._ ' 1 ... Est. Cost ...... loe on .. _........ To be Completed .............. ............................. _.... _-'-_ THPS F E P MIT DOES �,kl% �01'J OF I PJY P r �'W, i 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 all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $.—_.---_._.._, permit is hereby granted to..... ......... ....... .............. ------__—_ 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 workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violatign of any of the provisions of said ordinances. /7 ....�...L_ Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. , 4 Owners Name Address APPLICATION FOR BUILDING PERMIT , CITY OF FRIDLEY, MINNESOTA ilder d 00 Or T�I�G�_C�o 'LOCATION OFBUILDING No. ZZ—e Street Part of Lot t�LotHlocltAddition or Sub,Div. Corner Lot 1 ---Inside Lot___._ Set Backer SEWER ELEVATION 'IP4'7° % 3 FOUNDATION ELEVATION_, (firs Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft, Type of To be Cost � �� The undersigned herby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the fact and representa- tions stated in this application are true and c rrect. DATE ��SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) BUILDING PERMIT 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 therefor, 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 fireproof 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 fireproof garage, ware- house, factory or grain elevator, or for the erection of any fireproof 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 - fireproof addition, for similar occupancy, to any existing building or for each such building or addition. Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a 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 for each Five Hundred Dollars ($540.00), 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. City of Fridley, Minn. BUILDING PERMIT N° 5 3 7 Date: ____+_`r""-��+� J'S Owner: Builder �r Address Address i No. -fir Street Lot -Block addition or Corner Lot Inside Lot aitback Sewer Elevation Part of, Lot Sidevard Y_ Elevation DESCRIPTION OF BUILDING - __N To Uqf . Front Depth ,, Height Sq. Ft: Cu. Ft +p" Front 0 Depth ght Sq. Ft. Cu. Ft. Type of Construction Est _ 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 21 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of permit is hereby granted to— 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 workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance and moving of buildings within the city limits and this permit may be revoked at any time upon vi tion of any of the provisions of said ordinances. 1___\ ,r' Building Inspector NOTICE: This permit does not cover the construction, installation for whine, "plumbing, gag heating, sewer or water. Be sure to see the Buildh►g htspector for separate permits for these Qems. _ 4 • APPLICATION FOR BU 1DING PERMIT CITY OF FRIDLEY, MINNESOTA , Owner's Name Builder Address Address No. of Lot Lot Block V Addition or Corner Lot ✓/ Inside Lot Setback_e -jD 1 ELEVATION a. Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To bw)used, as Sq. Ft. "�T Cu. Ft. Front_ Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated CosT..�� 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the factseand representat stated in this application are true and correct. DATE 4 SIGNATURE � (A Schedule of Fee Costs can be found on the Reverse Side.) BUILDING PERMIT 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 build- ing or structure, or for any alterations or repairs to any existing building or structure, upon application therefor, 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 fireproof garage, warehouse, factory or gain elevator, or for the erection of any fireproof addition, for similar occupancy,,to any existing building shall be at the rate of 61.25., 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 01.00 for each one thousand cubic feet.. 'tfii�# 2.1+. For any such permit for the erection of any non -fireproof garage, warehouse, factory or grain elevator, or for the erection of any non -fireproof -addition, for. similar occupancy, to any existing building or for each such building or addition. Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $/..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-srea 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 for each Five Hundred Dollars ($500.00), or fraction thereof in the cost of all propos6d work. 2.6. In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. City of Fridley ApplicaMon for Pionbbg and Gas Filihtndt Dept. of Bldgs. Phone 980-3490 . DESCRIPTION OF WORK Number. Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL ip i/NELEC. $ Future Fixture Opening ............ x $1.50 $ New Fixture Old Opening .......... x $1.50 $ 1 Catch Basin .................... x $3.25 $ HWATERa759 Base x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water Heater .............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1 1st 1st 3 Fixtures ............ • • • x $2.00 :2.00 Additional Fixtures .................. x $ .76 $ Gas Range to 199.000 BTU ............... x $5.00 $ install (1) gas grill 3.00 REPAIRS & ALTERATIONS—Roger to Code 2nd 3rd 4th • future Connection Openings * Now Fixture, Old Openings Connected with Sewer CassPOW El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $100 $ Future Fixture Opening ............ x $1.50 $ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater (Up to 99,000 BTU) . • • • x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water Heater .............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1 1st 3 Fixtures ............ • • • x $2.00 :2.00 Additional Fixtures .................. x $ .76 $ Gas Range to 199.000 BTU ............... x $5.00 $ install (1) gas grill 3.00 REPAIRS & ALTERATIONS—Roger to Code 52-84-915.51 Location 190 NE. Liberty St. City of Fridley: The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that an the fact and representations stated in this application are true and correct Fridley, Minn Jules 1971 , 19, Owner William Super Kind of Building frame Used as residecne To be completed about July 16, 1971 Estimated Cost, $ 10.00 Older New. Building Permit No. Permit No. O� i By - Business Phune No MINNEAPOLIS GAS QQv ROUGH Description ......................................« ..... •$ .A® Surcharge .50$ TOTAL FEE $ 5.00 City of Fridley Application for Plumbing and Gas Fitting Permit DepL of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. .. TOTAL gJ1=Q1, Z $1.50 $ Future Fixture Opening ................ IA Z 4j `a6 W 0 Z • • WATER HTR. 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 €� New Ground Run Old Bldg . ............ x �5,, zip 8� NO. S G °d �Z (94a �n (70 F N GAS ELEC. $ Gas Range to 200,000 BTU .............. x 2.00 $ Base 1st 2nd _ 3rd _ 4th • Future Connection Openings I Connected with Sewer El � New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................ $ TOTAL FEE $ ` City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do 411 work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn., _l4— Owner 66 - Kind of Building Used as To be completed about Estimated Cost, $ _ % �j Old—New. Building Permit No / 'S Permit No. Idr 0 Signe By Business Phone No ROUGH FINAL - 'A" as 2M 7-39 1911 City of Fridley Application for Plumbing and Gas Fitting Perm* DepL of Bldgs. Phone SII 4-7470 s DESCRIPTION OF WORK /�� Number, Kind and Location of Fixtures Location '� AGS//Gy�� PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... /a - x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. H N Catch Basin ............................ x 3.25 W Z , ` WATER HTR. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ ,%s Range to 200,000 BTU .............. x 2.00 $ ai Base 1st 2nd _ 3rd _ 4th _ • Future Connection Openings Connected with Sewer � New Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... /a - x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ......—�— x 2.00 $ dis0t New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ ,%s Range to 200,000 BTU .............. x 2.00 $ TERATIONS—Refer to Code TOTAL FEE City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Kind of Used as To be completed about Estimated Cost, $ Old—New. Building Permit Permit No. � Signe By Business Phone No ROUGH m —� FINAL 11K DDS a 2 2M 7-$9 3uilding BUILDING Permit No.: nspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: )ATE O co YOUR E-MAIL ADDRESS V -Q -V Q, Eu mire1D1Y1�O�1 i ;ITE ADDRESS 11M APPLICANT IS: )�OAER ❑CONTRACTOR PROPERTY OWNER/ NAME; ADDRESS: CITY STATFI�OIP TENANT PHONE: CONTRACTOR NAME: STATE LICENSE tl EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE '9 SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYMEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH 'OROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES 'P HOUSE & GARAGE BASEMENT REMODELING SUBMIT_: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SEDING 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 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ Q'S -)61 OCCUPANCY TYPE Permit Fee $ ,�� See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ (. .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 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 payable to: City of Fridley 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 Construction Codes; that I understand this is not a permit but only an application r 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 is requir �.reviewnd approval of plans. SIGNATURE OF APPLICANT PRINT NAME 4� lD1 VV� 1� G� C Ire DATE - l FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER 1, understand that the State of Minnesota requir that all resid ntial building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exetion from the licensing requirements. As the owner of the property at () m , Fridley, I am exempt from the state licensing requirement 6nly if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 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 construction or improvement of this house and I understand that some of these 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. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date q1 114 Building MECHANICAL Permit No.: "X Inspections RESIDENTIAL APPLICATION Received By: //�70 763-572-3604 CITY OF FRIDLEY Date Rec'd�� 763-502-4977 FAX EFFECTIVE 1-1-08 DATE YOUR E-MAIL ADDRESS SITE ADDRESS RQ) t THIS APPLICANT IS: Ba OWNER ❑CONTRACTOR PROPERTY NAME: -AJ i-9- OWNER/ ADDRESS: lqO t' L,_ S- �1 c_ CITY (\ C �) STATE ZIP�� 13�. TENANT ,i PHONE: �� ,--le o0a0 CONTRACTOR COMPANY NAME: 1 NOTE: SEPARATE CITY CONTACT PERSON: LICENSES ARE STATE LICENSE # EXP DATE REQUIRED FOR GAS AND HVAC. ADDRESS: COY STATE ZIP SUBMIT COPY OF BOND PHONE FAX ANDINSURANCE PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK' ($(NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK Aaccpq, � tai oW PER MS 1613.665 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 should reflect only the cost of labor ) OR between $300 to $500 = cost of labor 4 a x = -25 Labor cost under $300 = $15.00. Labor cost .05 FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU A/C $25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00 ,FIREPLACE TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR _FIREPLACE $35.00 $35.00 _GAS UNIT HTR $10.00 _BOILER _FURNACE LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00 _CHIMNEY DUCT WORK $10.00 YGAS PIPING $10.00 _VENTILATOR $15.00 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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 wi a approved Ian in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME !/s UXDATE APPROVED BY DATE 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 0 NEW HOMES/ADDITIONS a EXISTING HOME 0 MAKE-UP AIR REQUIRED 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 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 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. Building BUILDING Permit No.: Mb�-t Inspections $ RESIDENTIAL APPLICATION Received By: -- 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 1-1-08 DATE YOUR E-MAIL ADDRESS SITE ADDRESS /f �� � 1J bu`�7// �f AIG / THIS APPLICANT IS: [OWNER OCONTRACTOR l PROPERTY OWNER/ NAME: TENANT ADDRESS: /lam✓ L��Ei��i CITY �mC/ � STATE,&AZIP-5�r-/3 PHONE: 7� 3 —79 -it 00 o NAME: 75 ",T ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE -FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/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 ❑ MAINTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: '� i �lY'2V�%C. 611 L� IA, 1" _ SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE I. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures 11 Aluminum 13 Trim t. and proposed project ❑ Other El Fascia 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 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $a.(9� $ $ 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 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 on site; that the work will be in accordance with the approve plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME %JAG z � DATE APPROVED BY DATE