PRE 2010 DOCSCity of Fridley, Alinn.
BUILDING PERMIT
Date: --• 4 '"'"'61 00-
Address
Builder
Address
N°
LOC TION F BUILDING
No. {�, � Street _ _ l X—.—Part o Lot _
Lot _ _ �__ Block �,, Addition or Sub -Division ' R
Corner Lot _ Inside Lot Setback * � -..r' SideyardQ001
Sewer Elevation `_ Foundation Elevation
DESCRIPTION OF BUILDING
Toe Used- as
f, 40'' Aoed4 Front ~ Depth Meight Sq. FL Cu. Ft0A2L/"' 0
Front Depth Height Sq. Ft. _ Cu. Ft.
Type of Construction `` _Est. Cos �'a a 47U 2 0.�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 all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ It ,permit is hereby granted to—.
PC
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 violation of any of the provisions of said
ordinances.
} �► 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
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Builder ''tL"
Address Address Y N
LOCATION OF BUILDING
No. I o o z StreeD�t�" Part of Lot
-,,,,,c� �- (,
Lot Block . � Addition or Sub.Div.(Lai____„,,..,
Corner Lot�side Lot Set Baa____3.Side-Yard -D -
SEM ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUIMING
ems— -/r-
To be used as:
Front Depth Height
Sq. Ft. 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 facts and representa-
tions stated in this application are true andcorrect*
DATE _ I/ fi,/ /� D 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 permitforthe erection of any fire -proof building,.other
than a garage, warehouse, factory or grain elevator, or for the ereotion-,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 41.25 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 peridt 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 ($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' less than $4.00.
r' .
Application for Power Plants and: Healing. Cooling, Ventilation. ,Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace 5.00 $
Repairs & Alterations --up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECIL WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ �`
each add. 60,000 'BTU ... — .................. 2.00 $ _
Replacement of Furnace ............................. .§.00 $
Repairs & Alterations—up to $500.00 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam.......
8.00
$
Furnace Shell & Line --to 640 sq. ft. EDR Hot Water
... 8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
OIL BURNER—to 3 gal. per hour ........................
5.00
$
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) .......................
5.00
GAS FITTING FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
Dept. of Bldgs. Phone SU, 4-7470
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.
/J/% I
Fridley, Minn_ 9-31 19 `
Owner � H/ 6 y' /
Kind of BuildingY L1 Wl t_
Used as RAS
To be completed about
Estimated Cost, $
Old—New. Building Permit No. ®� Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water,a*i"—No ON
Trade Name /UrGK&1AjAOjjAk Size No-
Capacity.
o Capacity Sq. Ft. E.D.R An4'2 6eD BTU /-+ H.P.
6 7
Total Connected Load Kind of Fuel —s
BURNER — Trade Name Size No
Capacity. Sq. Ft. E.D.R BTU H.P.
See Fee Schedule
-212
TOTAL $ '7- Signe
By
42 4M 7-59 Business Phone No- a (S'�) 21
(REMARKS -OVER)
HEAT LOSS CALCULATION!Y344..,,,. DEPARTMENT OF BUILDINGS MINNEAPO MINN.
WeatherstripsA.S.H.V.E. Construction No. Insulation
Guide
vikows I ors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
e o 0 19— .? " y N
/ F1 ' — Room I Lenath..7/ Width Ake' H---- t ' II / Fl. • Room I Length Width/1 ! Height 4P'
Win ows a
Doors—Crackage and Area
Zo
4a
Required . E.D.R. or sq. ins. W.A. Leader area
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
/ 3 *- 1 .o
-0 deo
/ i �O 4 /S. /O.
Exp. wall
Coef.
/7d'
/f
Coef.
Btu
Infiltration
Glass
Coef.
Btu
Infiltration
&/f.9
Glassly
Glass
9
S o
3?:S'G
Exp. wall
Int. wall
Q py
Net exp. wall
Net exp. wall
/0
70.0
Int. wall
,,O
/JvQ
Int. wall
Ceiling
a
Ott
Floor
Ceiling
z
lv*
py
/
Jo O
Floor
F1.1 Room I Length Jrx
30
Height
voseq
Total Btu.
Fl oomjLengthojq Width o f Height
Zo
4a
Required . E.D.R. or sq. ins. W.A. Leader area
Width Height No. of Lineal Lt. Area
No. of pane of pane lights of crack sq. ft.
Fl. 4v Room I Length /719
Width ,o� Height ,
Windows and Doors—Crackage and Area
Exp. wall
Coef.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
/ W ! g A07 /?.'8
Glass /9
a A
P. wall CAF p
Glass
Coef.
Btu
Infiltration
Exp. wall ei6
Ar
Glass
Net exp. wall
S20
R3:
Exp. wall J/2
Int. wall
Net exp. wall
peQ
/0
70.0
Int. wall
Floor
S
Ceiling
a
Ott
Floor
wcoe,
z
lv*
Total Btu.
.fr
Required 1q. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Jrx
Width
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Btu
Infiltration I /p 'Ar
Glass
Exp. wall 9 l xjP
Net exp. wall G /O li 40
Int. wall
Ceiling / rQ
Floor ------ /9 7 All
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Fl oomjLengthojq Width o f Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No. of Lineal Lt. Area
No. of pane of pane lights of crack sq. ft.
G M. tea. G
Glass
Exp. wall
Coef.
Btu
Infiltration
Glass /9
a A
P. wall CAF p
Glass
Net exp. wall
o
9s -o
Exp. wall ei6
3
Net exp. wall
O
/
Int. wall
Ceiling
Floor
S
S
Total Btu. O'
Required q. ft. E. .R. or sq. ins. W.A. Leader area
Fl oomjLengthojq Width o f Height
Windows and Doors—Crackage and Area
Btu
Width Height No. of Lineal Lt. Area
No. of pane of pane lights of crack sq. ft.
G M. tea. G
Glass
Exp. wall
Coef. B
Infiltration .'1/
J00 //
Glass /9
a A
P. wall CAF p
sTO
Net exp. wall
S
Int. wall
Ceiling
Floor
Total Btu.
of Fl.j Room I Length ? Width " Height
Windows and Doors—Crackage and Area
Width Height No. oL Lineal ft. Area
No. of pane of.pane lights of crack sq. ft -
/r I
AC I ale /x,? I Ar
Coef.
Btu
Infiltration /j , P
T,�
Glass
Exp. wall
Net exp. wall /p
fre
Int, wall
Ceiling
sTO
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
S
5
City of Fridley
Application for Plumbing and Gas F'*ting Porn*
Dept. of Bldgs. Phone SII 4-1
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
y
NO. RATE
TOTAL
Number Fixtures ......................
x $1.50
$-�
Future Fixture Opening ................
x 1.20
$
y. N
N
u�i
Catch Basin ...... .....................
w
Z
�0
•
•
WATER HTR.
GAS
EIEC
$
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
$
Base
t
%
1st
1
2nd
3rd
4th
• Future Connection Openings
Connected with
I
Sewer El
New Fixture, Old Openings
Cesspool El
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 $Z�a
City of Fridley:
U
The undersigned hereby makes application for a permit for the work herein
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 facl
and representations stated in this application are true and correct.
To be completed about
Estimated Cost,
Old—New. Building Permit
ROUGH – % 7 –
FINAL
42 gni
Business Phone
J
7t -
City of Fridley, Mm. T 9886
BUILDING PERMIT
Date: August 13, 1968
owner: — John Holmberg Builder Same
Address 1000 )KTX Lynde Drive Address
A&Same
LOCATION OF BUILDING
No. 1000 Street — Lynde Drive ____ part of Lot
Lot 8 __ Block 3 Addition or Sub -Division ._._.._ Lyndale Blders . 6th
Corner Lot —_ Inside Lot r Setback --- Sideyard —
Sewer Elevation —_-- Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: '20, �q
Garage Front Depth Height —1—OL 10 t Sq. Ft. Cu. Ft.
Front _ __ Depth Height Sq. Ft. Cu. Ft.
Type of Construction _.._ FrgMe Est. Cost` -ne-0 __ 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 a'll provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ ' 00 v , permit is hereby granted to John Holmberg
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 violation of any of the provisions of said
ordinances.
Building Inspector
Clarence Belisle 6,1r✓
NOTICE:
This permit does not cover the construction, installation for wiring, phunhing, gas heating, sewer or water. Be sun to see
the Building Inspector for separate permits for these items.
5-71 -1-
City of Fridley, Minn. 1141.
6431 University Ave. N.E., Minneapolis, Minn. 55432
BUILDING PERMIT
�M
Owner: __—John Holmberg Builder. SSP -
Address ._..__1Q00 Lynne Drive N.E. Address
LOCATION OF BUILDING
No. _1001— Street ._ Lynde Drive N.E. part of Lot
Lot ._._.._...$.._. Block I ..___ _. __ Addition or Sub -Division T Vn da 18 Au it rl er4 Arl do
Corner Lot Inside Lot __ _ Setback Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: Finish Rec Room and Den
Front Depth Height - Sq. Ft. Cu. Ft.
_..__._ Front . _ Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost — $1,000.00 To be Completed Iyear
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 firth and in complfince with all provisions a
ordinances of the city of Fridley. // ,I I / "� //
In consideration of. the payment of a fee of $_6_- 00 _ V , permit is hereby granted to John Ho1mber
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordinitnces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
.Wix in n� city limits and this permit may be revoked at any time upon violation of any of the provisions of Said
Inspector
CLARENCE SS BELISLE
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to ss
the Building Inspector for separate permits for these items.
Q
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: k),& , IV, Z WZ? 6�f 6 BUILDER: 66,1Wr)0-
ADDREU : L- YA/ 9 F '0/2 ADDRESS : F
NO:. STREET:
LOT: BLOCK: ADDITION: Z_
CORNER LOT: v INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this fora: Two Certificates of Surv9X of Lot and proposed
'wilding location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: //v/5 r/ Rz- c Roo -i o ---Iv
Fronts Depth: Height:
Square Feet: Cubic Feet:
Fronts Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: , Estimated Cost: '$ /000
e s
To Be Completed= .
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all Mock 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.
DATE: �� /� , /F 7 / SIGNATURB
U
(See Reverse Side For Additional Inform
B
•
eJ
01
SUBJECT
P
City of Fridley
33084
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
NO.
`V _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
572®36®4
rDI �
E _
I 1 � CITY HALL FRIOLEY 55132
".j
NUMBER
t1Ev
DATE
PAGE OF
APPROVED By
763-571-3450
910-F15
9/13/02
JOB ADDRESS 1000 Lynde Drive NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
g
3
Lyndale Builders 6th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Florence Wells 1000 Lynde Drive NE 763-571-7272
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Rite Way Waterproofing 448 Lilac St, Lino Lakes, MN 55014 651-786-0550
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 C. ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install interior basement drain tile system
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code.
Brit lnsactin Cards
Will Be Mailed
TO ®eoW nr To p -t
rus
SEPARATE PERMITS ARE REQUIRED 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
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 OWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$1.63
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,255
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-
$97.25
Fire SC $3.26
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
City L se
SIGNATURE OF CON'RACTOR OA AUTHORIZED AGENT IDATEI
P PER T IS YOUR PERMIT
/^ /A_T`ED
S,GNATURE OF OWNER,IF OWNER BUILDERI IDATEI
BL NSP ,'/f/Y� IATE
01
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572.3604 Bid Insp
ALTER ]" SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION 3
Construction Addre
Legal Description:
Owner Name & Address: E'71®/ 2Anc_eW eA Ls Tel. # (IG3 •- 5-7 r - f7a 17a
Contractor. Rite -Way Waternroofing MN LICENSE#
Address: 448 Lilac Street, Lino Lakes MN 55014 Tel.# 651-786-0550
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: Inti-rinr Ba4nmant brain Tilp Syatr-m
Construction Type: Estimated Cost: $ 3a55 00
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: 9' / APPLICANT: in� Tel #
Call (763) 572-3604 for Permit Fees if mailing In application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee $ �'+? as Fee Schedule on Reverse Side
Fire Surcharge $ 3-co'(P .001 of Permit Valuation (1/10th%)
State Surcharge $ U3 $.50/$1,000 Valuation
SAC Charge $ $1200 per SAC Unit
License Surcharge $ V AW $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- $ ( ' 1 STIPULATIONS:
NEW [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: i
Legal Description:
Owner Name°& Address:
Contractor.
LIVING AREA:
GARAGE AREA:
DECK AREA:
geeIi . - '
?005--001aO
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
`� << Tel.#���
MN LICENSE #
�S) 19Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
aV
Construction Type: Estimated Cost: $ D ,
Driveway Curb Cut Width Neede . + 6 Ft Ft x $ _ $
4L,� #DATE:
Call (763) 572-3604 for Permft Fees if mailing
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
763-571-1287 i'f using credit card and we will call
USE ONLY -
$'77,.? -S' Fee Schedule on Reverse Side
$ -- e:5;1� 65% of Permit Fee
$ 3. !o .001 of Permit Valuation (1/10th%)
$ /, SS' $.50/$1,000 Valuation
$ — $1350 per SAC Unit
$ : o v $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ /!34-T'0— STIPULATIONS:
Building MECHANICAL Permit No. 0`7
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 W,Q%We0PT - 4 2�
CITY OF FRIDLEY
DATE
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERIVIIT TYPE
TYPE OF WORK:
❑ OWNER
COMPANY NAME:___ _
CONTACT PERS( %� �; LE
410 WEST LAKE STRM:il
STATE LICENSE!{
Pk
A, MN 55408
22,- STATE ZIP
ADDRESS:
PHONE
`SINGLE FAMILY I7 TWO FAMILY
❑ NEW X_EPLACEMENT
DETAILED DESCRIPTION OF WORK
FAX
❑ TOWNHOUSE
[3 ALTERATION/REMODEL
PER MS 16B.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 )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor _x.05
FOR PROJECTS WHERE LABOR EXCEEDS $i , FEES ARE B ED ON $10.00 PER FDCI UItE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) /.[ 1 o SaFRTU�
Equipment Installed MF GVY� MODEL:
MFG: MODEL: SIZ9g 1 U
MFG: MODEL: SIZEBTU
00
YA/C$25.00 CE (GAS) $15.00 GAS RANGE/OVEN $10.
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
BOILER $35.00 5CFURNACE $35.00 POOL HEATER $35.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 VENTILATOR $15.00
DUCT WORK $10.00 GAS PIPING $10.00 —
Permit Fee $ Number of fixtures @ $10.00 x $10.00 =
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00= $
TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 =
Number of fixtures @ $35.00 x $35.00 = $ ;S<
Stde Surcharge = $ 50
Total = $ L,6 w Q
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 1 understand this is
not a permit but only an tin or a d work is not to start without a permit; that the work will be in accordance with the
approved plan in the of 4v ch s review and approval of yuan � ` l"\ , /,n
SIGNATURE OF
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTINQ_ HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or PropanevUGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
& 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 ]MC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER 'S NAME /C /Y & h—/® e 41 '6 E.Q 6 BUILDER - 40 1V e k
ADDRESS f® o ® 4 Yy 9j &- e2 R ADDRESS
LOCATION OF BUILDINC
NO. M W SIREE'I' Z- )" 1Pd
LOT g BLOCK 3 ADDITION OR SUBDIVISION
COR-NER LOT v INSIDE LOT SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this forte. TY7o G'artifioates of Survey of Lot and
proposed buildirZ location drawn on these Certificates
DESCRIPTION OF BUIId)TNG
To Be Used As:
C t,' Front Depth Height
Square feet Cubic Fent
Front
Depth Height
Square feet Cubic Feet
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 of Fridley Ordinances and rulings of the Department of Buildings,
and hereby declares that all the facts and representations stated in '4
this application are true and correct.
DATE SIGNATURE
(Schedule of Fee Costs can be foutzd on Reverse Side
. it A %"
a:. 1 • f $3 00 for of ul, r j v o ::-:.sa..a,+. v» •- _ _. ...
h,! ; ate of proposed work.
the cost of all
a
OF fee charged for any permit
set forth�ir�
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