PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N 61 o 5
Date:
Owner:.„ ��t'�' `��.+'.T�t Builder
Address Address
Lot _ _ Block C ddition or Sub-Divisio
s
Corner Lot — Inside Lot , Setback . Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth s Nelgbt Sq. Ft Cu. li`t
Fron ., `Depth TTeight Sq. Ft. _jW Cu. Ft. — &V
Type of ction . Est Cost To be Completed T
In consideration of the issuance to me of a permit td `construct the building described above I agree to do
the proposed work in accordance with the description above set forth Ind onanpliance with afl 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 pelt is grantedupon
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, Bffinnesota location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and permit may be revoked 'a t. any time upon violation of any of the provisions of said
ordinances. w. ,�,.
Building Inspector
NOTICE:
%b permit dos not eswr the eommeden, Inds len for wkk& pNosbing, ga hating, aver er gates. Bo sm to sm
the Bulidhng Inventor for aparaM penolfs for thea hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builder
Address
ress
F BUIL I
o. Street Part of Lot
Lot BlockAddition or Subdivision /J
Corner Lot I Inside Lot Setback 5J / 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 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 this application
are true and correct. /�� �; /1 r,
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for Plumbing and Gas Fitting Penna
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK ��
Number, Kind and Location of Fixtures Location
07
C
3
• TOTAL
?�
Number Fixtures ....... ..............
ti
o�
u'S
C Z
��
`fin
�ai
5 u�i
<3
(�7°d
w
(�'10�
Z
�O
•
F
•
N
WATER HTR.
GAS
ELEC.
Base
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
RATE TOTAL 0
1st 3 Fixtures ..........................
x $1.50
$T
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
1st
2nd
3rd
4th
• Future Connection Openings
e New .Fixture, Old Openings I
Connected with
Sewer
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
$ C G
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
RATE TOTAL 0
1st 3 Fixtures ..........................
x $1.50
$T
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$ _
TOTAL FEE $ �� P
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 feel
and representations stated in this application are true and correct.
e—,FridlM Minn�'Z" fn 19
Owner OL/
Kind of Building
Used as
To be completed about
Estimated Cost, $
Olduilding Permit No
—
By L---= t' i
Business Phone
ROUGH V— -1 is o ( i—
FINAL
.QW42 21A
Application for Power Plants and Hearing. 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 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
PTEAM 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 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
FINAL
See Fee Schedule
TOTAL FEE -4 ° d
Dept. of Bldgs. Phone SU 4.7470
el
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 tfue and correct.
_�
Owner Z
Kind of Building
Used as
To be completed about
Estimated Cost, $
016". Iding Permit No. �� Permit No. v `L
DESCRIPTION OF WORK
19 �Z
HEATING or R`te Hot Water, Warm Air—No
Trade Nam 1-�`f�- Size No °?
Capacity12 ®- Sq. Ft. E.D.R q ' r BTU ®® H.P.
Total Connected Load �� �. b Kind of Fue 7j
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
v
42 2M
(REMARKS—OVER)
City of Fridley
Application for Plumbing and Gas F'itti'ng Permit
Dept. of Bldgs. Phone 560-3480
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
p�
G7
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
�in
U
°C
<3
d �U' Sa
6
z
�p
•
F
•
N
WATER HTR.
GAS
ELEC.
Base
x $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...... ...................
x $2.00
$ 2.00
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
2 x $5.00
$ 6.ot
1st
Ingtallt
2nd
3rd
4th
• Future Coanectioa Openings
New Fixture, Old Openings I
Connected with
Sewer ❑
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 $3.00
$
New Ground Run Old Bldg. ............
x $3.25
$
Electric Water Heater
x $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...... ...................
x $2.00
$ 2.00
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
2 x $5.00
$ 6.ot
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ 8.00
Location 6561 NE. monni ey
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. MAY 19 1969 19—
Owner Vernon B. Nyberg
Kind of Building
Used as Residenoe
To be completed about MAY 2 4 1969
Estimated Cost, $ 10,00
OldX' New. Building Permit No Permit No.
signe MINNEAPOLIS GA CO.
Business Phone N
90,
ROUGH
FINAL—L-7-
l
SUBJECT
-
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT(""'RECEIPT
r
I ,
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
71-1
r I
�5
I
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
L 612-571-3450
910-F15
9/3/98
JOB ADDRESS 6561 McKinlev Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
3
1
Clark's Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Vernon B. Nyberg
571-8096
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 27 S ear -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 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2313
$1.16
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$74.75
Fire SC $2.31
PLAN CHECK FEE
TOTAL FEE
1$78.22
TU OFCON�RACT, AUTHORI2EDAGENT �DATEi
HEN PROPERLY DATED HIS IS YOUR PERMIT
YNA
1!kz-�
SLOG NSP
A!�11 -
- BATE
S,GNATUR O U OWN UILDERi iDATE�
l
NEW [ ]
$ S�
Effective 1/1/98
ADDN [ ]
CITY OF FRIDLEY
.001 of Permit Valuation (1/10th%)
ALTER [ ]
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
ConstructionAddress:
Driveway Escrow
$
Legal Description:
Erosion Control
$
X Owner Name & Address:
PZ WAJOA)
Tel. # 76_
Fee Determined by Engineering
Sewer Main Charge
$
X Contractor: oGUNIx MN LICENSE #
Address:
$ ! ��
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BiPROVEMENT
LIVING AREA:
Length Width Height
Sq. Ft.
GARAGE AREA:
Length Width Height
Sq. Ft.
DECK AREA:
LenA Width Hgt/Ground
Sq. Ft.
x OTHER:
_
Construction Type:
Estimated Cost: $-�
(Fee Schedule on
Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
_ $
ATE: - -! APPLICANT: _
Tel. #
CITY USE ONLY
Permit Fee
$ S�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /, /
$.50/$1,000 Valuation
SAC Charge
$
$1000 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:
- 1.
Building
BUILDING
Permit Fee
Permit No. o , 11 ?,q
Inspections P
Plan Review
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
CITY OF FRIDLEY
n��°� � '�� P
763-502-4977 FAX
0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
EFFECTIVE 1-1-2010
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
DATE 9 12_� 110
YOUR E-MAIL ADDRESS` �t
i nas m k c I U o �-e Q mss n, C n w
SITE ADDRESS
m C fc ( e � e
Park Fee
THIS APPLICANT IS:
❑ OWNER CTOR
Sewer Main Charge
PROPERTY OWNER/
NAME:
Total Due
TENANT
�
ADDRESS: C r7r
CITY �-,,A ( e C.1 STATE V�vgIP3�—
PHONE:
CONTRACTOR
NAME: C t I r= Sr O► r V G
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # 02 0 7oZ Co FS'—/
EXP DATE 3 I3/ rZU l I
AND CERTIFICATE OF
ADDRESS: (0 3 C/ / /YJO "ROE S NE
CITY 1-12 STATEMIUZIP573-L:j—
INSURANCE
PHONE 76 2 —3?(o7
FAX
PROPERTY TYPE
I—N FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGFJSHED
❑ WINDOWS
❑ BASEMENT FINISH S IZOOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: C O e 1 GLC e e— eL{ a ca e! 96t ra
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING OHOUSE ONLY
NUMBER OF SQUARES_ ❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
d q
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
13 Other
❑Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
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)
1U1ALJUIS VALUA11UN 1i
uuuuYANUY "1YYLe
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
,4-1 .001 times the total job valuation
Surcharge
$
0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $24 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
l L 7 < !T Make checks savable to: Citv of Fridlev Attach Stiaulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby appl r a buil ' etmtt owledge that the information above is complete and accurate; that the work will be in
conforman with th rdinances and codes th City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only application for a permit d rk is not to start without a permit on site; that the work will be in accordance with the
approved pl in th ase of all work which s review and approval of plans. n
SIGNATURE OF AP PRINT NAME lSf N A:+ r LGo CL DATE