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PRE 2010 DOCS789.01 a. Ci#y Of Fridley App9cation Dept. of Bldgs. Phone 580-3450 DESCRIPTION OF WORK 6621 Lucia Lane Number. Kind and Location of Fixtures Location PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ..... x $2.00 $ �p tNo Naa New Fixture Old Opening ....... x $1.50 $ yl x $3.25 $ Water Heater (Up to 99,000 BTU) ...... �7 ® New Ground Run Old Bldg. . ... .... WATER HTR. $ Electric Water Heater t r8 $ GAS FITTING FEESs NO. RATE TOTAL N OU<; N GAS ELEC. Base 1t Re la e 1 tad - 3rd -- 4th - -- ° Futuro Connection Openings Connected with e Now Fixtnrs, Old OpeningsI Sewer El Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ..... x $2.00 $ 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 $8.00 $ New Ground Run Old Bldg. . ... .... x $3.25 $ Electric Water Heater x $2.00 $ GAS FITTING FEESs NO. RATE TOTAL lot 3 Fixtures .......................... x $2.00 $ Additional Fixtures . .................. x $ .75 $ Gas Range to 199,000 TU .............. x $5.00 Replace AJ.) range $— REPAIRS & ALTERATIONS—Refer to Code Description ............................. TOTAL FEE $ 3.00 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 all the fact and representations stated in this application are true and correct Fridley, Minn- Nov. 4, 1969 19, _ < Owner R. Connolly Kind of Building frame Used as residence To be completed about Nov. 74 1969 Estimated Cost, #10.00 Old-XNew. Building Permit No. Permit edo._ Signe e " Rusin one No ,,,,,upou as ROUGH FINAL I-?— / (-) APPLICATION FOR RESI'DE'NTIAL., ALTERATION, - OR ADDITION.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAI-LE :_ BUILDER: A5 • ;L ADDRESS : G� c �z L-2 - ADDRESS :.1:1.'1' NO:. STREET: LOT: BLOCK: ADDITION: CORAYER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attacr. to this foray Two. Certificates. -if. Survey .of Lot and.proposed building location di.--a-in on these Certificates. DESCRIPTION•OF BUILDING • a , To Be Used As: Front: / Depth: ©� Height :'' Square Feet: ;g $'o Cubic.Feet: 42 a Front Depth: height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ 13c--r) To-Be Completed: ' . , The undersigned hereby makes application -for a permit for the workherein specified, agreeing to do all work in sttict 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. • .� - j 9 — �% SIGNATURE:- (Se. IGNATURE. - DATE: - ' (SeeReverse Side For Additional Information.)* ' �1 3c 7c • tj C) t+ 5�• ¢oR PJ(rs N �� ta4c" t � P�� A�� � eo` to uP TVAIS pLA NED A p N� pl 1131 -ETON S E. CON� QRS° ng call local uti files Before d+„ Etc. _d . f,�o(s -1 �' •:ray TEtCPHON -ELECTRIC - L W. 130 N 4qL '� Illi • c 8 r .q /V -- w ale R1 A4 s SUBJECT 1p City of Fridley 3452 rErp AT THE TOP OF THE TWINS BUILDING PERM I T RECEIPT NO. `L ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-1715 4/13/76 JOB ADDRESS 6621 Lucia Lane N. E. 1 LEGAL LOT NO. BLOCK TRA CT OR ADDITION SEE ATTACHED DESCR. 5 l Alice Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Connally 6621 Lucia Lane N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Westphal Roofing 3039 Fillmore Street N.E. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION [I ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re -roof dwelling 9 CHANGE OF USE FROM TO STIPULATIONS PERMITS REQUIRED FOR WIRING, SEPERATE HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 1 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, $1,530 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .76 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $12.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 1.7-7& $12.76 1 SIGNATURE OF CONT TOR ORAUTHORI DAGENT (DATE) WHENpQPROPERLY THIS IS YOUR PERMIT I //VALIDATED iQA .Q - l X ��:r - f IBLDG. INSP DATE SIGNATU E OF OWNEROF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY) MINNESOTA OWNER'S NAME :�T "w BUILDER • ADDRESS: Q/ (� ��s i� ADDRESS: -�,�. NO:. STREET : 4 / � a & g—j � 4 LOT: �'° BLOC.: ADDITION: CORNER LOT: INSIDE LOT:_ SETBACK: SIDEYARD:. Applicant attach to this form Two Certificates of Survey. of. Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front: Depth: Height: Square Feet:. Cubic Feet: Front: Depth:_ Height: Square Feet; Cubic Feet: Type of Construction: �, �;_��� Estimated Cost: $ 14-4'.3a 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 Dc;partmenL of Buildings, and hereby declares that all the facts and representations stated.in this application are true and correct. DATE: 1_3- 7 to SIGNATURE : (See Reverse Side For Additional Information.) �17 560-3450 Cit ® �` d �e Cycy ANOKA COUNTY 6431 UNIVERSITY AVENUE NE December 13, 1976 FRIDLEY, MINNESOTA 55432 Mr. Robert Connelly 254 - 105th Avenue N.W. Coon Rapids, Mn. 55433 Re: Required Repairs of 6621 Lucia Lane N.E. Dear Bob: As you requested, I am sending you this letter to verify the requirements which you complied with in regard to your repairs of 6621 Lucia Lane. As a condition of your building permit to re -roof the house and improve the garage, we required that a firedoor and closer between the house and attached garage be installed. We also required proper amounts of fire code sheetrock (5/8 inch thick) be installed for the one hour separation between the house and garage. Our records show that these items were complied with on the final inspection of the repairs. I hope this is sufficient information for your records; if not, please contact me at 571-3450. z y, RONALD E. HOLDEN Building Inspection Officer REH/mh CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE m PLUMBING FIXTURE RATES: NO. ?1 m New Fixtures 0 $ 5.00 o Future Fixtures X N $ Water $ 1.50 4 Beer Dispenser $ 4.00 P Blow Off Basin $ 5.00 W m Wv ' oul wUN Rain Water Leader Heater $ 5.00 $ Hydraulic Valve M m Sump or Receiving Tank $ 5.00 W C 0 U x a $ Hot Water Heater $ 5.00 $ Gas Range O] +C Gas Dryer _ $ 10.00 $ Back Flow Preventer Required. . . yes ( ) No S V N ALL OTHERS AND/OR REPAIRS AND ALTERATIONS m 1% of Value of Fixture or Appliance ` $ cwrA $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $(> u 3amO A 14 U w 3 o as lec 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater _ $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer _ $ 10.00 $ Back Flow Preventer Required. . . yes ( ) No ( ) Type $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $(> Effective Date May 1, 1988 Job Address / /6' t7,1,4 /,0 Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this app i�caat on are true and Yr t Fridley, Mn. Lt 3 19 OWNER _ e/'— KIND OF BUILDING r,4 77 ,e-- USED AS I/.,$, TO BE COMPLETED ABOUT��%`jJ ESTIMATED COST lfU .00 q / OLD - NEW BUILDING PERMIT NO. PERMIT NO. / Company ! l Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE City of Fridley SuBjECTPER AT THE TOP OF THE TWINS BUILDING PERMIT .3274 r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF AP ROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 4/7/95 JOB ADDRESS 6621 Lucia Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 1 Alice Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Clinton Steele 6621 Lucia Lane NE 571-7571 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Paul Davis Systems 3065 Spruce St St Paul MN 5 117 490-3204 8535 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Repair wind damaged roof (6 Squares) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $450 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO S OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTI OR THE PERFOR NC OF CONSTRUCTION. $15.00 Fire SC $.45 PLAN CHECK FEE TOTAL FEE License SC $5.00 $20.95 SI NATURE OF CONTRACTOR R UTNORIZEDAGENT IDATEI WHEN PROPER VALIDATED THIS IS V UR PERMIT BL09f INSP DATE SIGNATURE OF OWNER of OWNER BUILDERI IDATEI NEW ADDN CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: Contract Address: c Effective 1/ 1/95 Tel. # �; % 1 --;!57( 'ENSE Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: _ Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ �.�2 Driveway Curb Cut Width Needed: DATE: APPLICA (Cost on Back) +6Ft= �Ftx $ _ Tel. # -32© STIPULATIONS: ' CITY USE ONLY Permit Fee $ UU Fee Schedule on Reverse Side Fire Surcharge $ ��� .001 of Permit Valuation (1 / 10th %) State Surcharge $ S� $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ ' STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave -NE " Fridley, MN 55432"'1" . 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On January 1, 1997 PLUMBING FIXTURE RATES: NO. MATE TOTAL MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR $ 4.00 Beer Dispenser $ 5.00 •:�?` z. :ysf9Yovx- YQJh_<4 .. Ffoor• xAuto. cX-�ra�v... La� ''.••...o- Nater He aterUrfnal Yater Treating Appliance $10.00 Shower $ 7,00 Tray Drain Washer 9z�. Ran GBasement $10.00 Back Flow Preventer Required )Yes (j No Type $15.00 ...4� Elec Floor 1 • "_If:<« a •, i u -day'3�:_s- y.. M gg K..... 3tiX?�y:�b%3Y ox 3; r s.:' oxx 3s I:. > 4:Z u .: � }�'.. }� /� Floor 2 w•`'' wx •it.•.•Y}i _�{^'X� v�9A{ ' :�i34N :1 i3iv��� 1- = - �Y..y(y(.;<n Jk�4n>Xrk ; .}h•S•Yw� :.. p - O x-0i��rn.-4b�i.:•' �Xyd.4.l'.i%aP fix: ..: v 6X4: �;[y'y$j���i.�SY i� XCK!x .:i:- -7k ��i'�.� 'y,''}'ti-+i�X�:f' i} _. q.� Ftoor $ �.. :.X�' v +f - ffl9S 6 9%wn, :�•�..: 3ibxt :.::Xti :_l• h��[. q.%$� .d;4 Sxv. n �.R• 3Xrxt^%�'_x �; �'s/ �<�����x� ���;:«FY hF. � =:::.Ki''• Floor 4- -y3c_,.... >.i:.::as. :.r.' 'sS..- . -_ $• - `_ .v�.'.`�-ko' x•O•g�"r. .;ni»-:�: X c�}'.i��s�„ :7p+iy.;•'..Y:t;X :-i�X£' , a y .a..6. -_-r ,Y?�)r >�:�� {}���•.TS: T- {4. 39 sz',c�>�rhs-°? iitv:_4XXyX:. PLUMBING FIXTURE RATES: NO. MATE TOTAL New Fixtures $ 7.00 Old Opening, -Now Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7,00 Yater Treating Appliance $10.00 Water Heater —Electric $ 7,00 Water Neater — Gas** _� $10.00 10,00 Gas Range— $10.00 Gas Dryer** $10.00 Back Flow Preventer Required )Yes (j No Type $15.00 JOB ADDRESS` 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 BuUding Division, and hereby declares that all the facts and representations stated In this application are true and correct. C� /49 , 1997 Owner s�T6eZ �l/�i�TON 5'21 - % Sr 71 Building Used As I . Estimated Cost PERMIT No. /)(5-10 %0 PLUMBING COMPANY Reinspection Fee $42.00}Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE Approved By TEL N D. ,'?/ .� Rough—In Date- Final Date 40, ® PLUS THE $.5o STATE SURCHARGE **COMBUSTON AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES. m Cc 0 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 MECHANICAL Permit No.: Building Inspections RESIDENTIAL APPLICATION Received By - 763 -572-3604 CITY OF FRIDLEY D A9P X00 X 763-502-49c7p7 FAX EFFECTIVE 1-1-08 DATE / "- / " ®� YOUR E-MAIL ADDRESS SITE ADDRESS & c. / LuG 7t 4_gi no_ M AJ THIS APPLICANT IS: WNER ❑CONTRACTOR PROPERTY NAME: P n► �, P j P 0 L -� n �� J [1t�CITY F /' J P�STATF ZIP OWNER/ADDRESS:��(�Z TENANT PHONE: I e— S i l— 7S-7J— j C7CONTRACTOR CONTRACTOR COMPANY NAME: CONTACT PERSON: NOTE: SEPARATE CITY LICENSES ARE STATE LICENSE # EXP DATE REQUIRED FOR GAS AND HVAC. ADDRESS: CITY STATE ZIP SUBMIT COPY OF BOND PHONE FAX AND INSURANCE PERMIT TYPE ?IIINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ❑ REPLACEMENT Ml:'ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK njA A1C I" o � a 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 Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .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 _CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00 VENTILATOR $15.00 WORK $10.00 _GAS PIPING $10.00 _DUCT z. Permit Fee $ Number of fixtures @ $10.00 x $10.00 Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ t' 9- .'5�'D 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 with the approved plan in the case of all work which requires review and approvalof plans. Al 4z `I� P S lei C DATe' SIGNATURE OF APPLICANT ,6294ta PRINT NAME e t 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 0 EXISTING HOME ❑ 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 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. Building $ BUILDING Plan Review Permit No.: '2bJ,() H3 Inspections Fire Surcharge RESIDENTIAL APPLICATION Surcharge Received By: 763-572-3604 License Surcharge $ sou SAC Charge $ CITY OF FRIDLEY $ Da APIGEI-A 763-502-4977 FAX $ 62-0 $ EFFECTIVE 1-1-09 $ (�, `�. " OfA $ DATE - YOUR E-MAIL ADDRESS ,�0 SITE ADDRESS iv "� �1 Q U"F_ THIS APPLICANT IS: ❑ OWNER ;(CONTRACTOR PROPERTY OWNER/ NAME: Q'P iJ t! UAA— TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: A�12-�yS ZC�Wt 2SSE 'K 21rtOtr Uc— SUBMIT A COPY OF STATE LICENSE # � �� 1 EXP DATE 03 • ` sl .10' YOUR STATE LICENSE AND CERTIFICATE OF N-3,13[� c ADDRESS: 06M 1J'\Q AN11 'J �� CITY ` UaAtx-V1 STATEW(J ZIP'SS%l`1 INSURANCE PHONE 1a. �'�o`i FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK R SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 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 1 Soffit ADDITIONS. & PORCHES SUBMIT: E3 Aluminum � Crim I . Site Plan/Survey showing the existing structures \ L Other ZAA (. �ascia 2. and proposed project. 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: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �� O _ OCCUPANCY TYPE Permit Fee $ A 2 3 4S Plan Review $ Fire Surcharge $ �Z,y 3 Surcharge $ � S License Surcharge $ sou SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park 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 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$22=$ $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 c des of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for p it and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all ork w h requires review and approval of plans. -n -�' `,,, \ SIGNATURE OF APPLICANT PRINT NAME �W _ �Z_ " t1 OJ DATE