PRE 2010 DOCSCity of Fridley, Mien..
BUILDING PERMIT N° Q5:7:3
8
Date:
Owner: •4r1_Ltf:e_41X;,�.4_2a Builder _
Address
Address
` LOCATION O B41LM
No. _,_ _street _� '_':''Oart t
Lot Block ddition or Sub-Division)M� ,
Corner Lot Inside Lot Setback l Y` _
Sewer Elevation _ __ Foundation Elevation
DESCRIPTION OF BUILDING
To Used
1' ��,! ,� �, fi ,bra► ,/ d , %�
Front - Depth i Height Sq. Ft C - + Cu. Ft.;
From Depth eaght Sq. Ft. Cu. Ft
Type of Construction' Est. Cost J' V � _ 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 $ _ _ r, permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
F
express condition that the person to whom it is granted and his agents, employees and workmen, in all work
e indley,hin inances.
NOTICE:
Tits permh doe: not cover the construction, hntallation for wiring, plumbing, gad heattn8, sewer or water. Be sure to we
the BuNing lespeder for separate permits for these hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner.'s Name /k Builder
Address D -)led . Address •t
LOCATION OF BUILDING
No. _ 3 2 Street Part of of
Lotl�C �onor?Bloc]cA ddivision
Corner Lot Inside Lot Setback` S Side -Yard 10 7` -
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
DESCRIPTION OF BUILDING
To be used a r
- Front Depth Heigh,
r� L ` f
sq. Ft. �� Z _ cu. Ft, J )may
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 ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correc .
DATE L SIGNATURE
(Schedule'of Pee Costs can be found on the Reverse side).
ft . . .
j Application for Power Plants and Heating, Cooling. Ventilation. ReMgeration and
}( Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470
� c
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
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 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
REMARKS:
$
See Fee Schedule
TOTAL FEE
IN
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.
` Mi
Fridleynn- "io'4"'"rup`
Owner �E�/ /�%�/L�S 195—
Kind of Building � 195—
Used as 6.* -,.e
To be completed about j O 6 Z
Estimated Cost,
Ol Xew Building Permit No.�
DESCRIPTION OF WORK
HEATING or POWER PLANTS—,Steam, Hot Water, Warm Air—No-
Trade Name Size No -6 S ev
Capacity l6?-- Sq. Ft. E.D.R- �// H.P.
Total Connected Load % V .3 9 Kind of Fuel Z& �/y
BURNER — Trade Name Size No-
Capacity / e, Sq. Ft. E.D.R BTU H.P.
Sign
11 POST inn -12-56 Business Phone No
City of Frill®y. .
Applicaflan f®r Plumbing and Gam F11-kig PO it
Dept. of Bldgs. Phone 860-3950
DESCRIPTION OF WORM
Number, Kind and Loceflon of Fixtures
• Futuro Con action Opmnings
$ New Fixture. Old Openings
..onnvs:cya rra�
Sewer
Ccsspool
0
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 ! 192
Owner
Kind of Building ® Oa v
Used as
To be completed about
PARTIAL. RATE SCHEDULE
Estimated Cost, $
_
O
Old—New. Building Permit No.
Permit No.
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
�7
Number Fixtures . ..............
x $2.00 $
•
Signed �����
e•� �-�_,_��
—
.
Future Fixture Opening ...........
x $1.50 S—_.
By
-' -
New Fixture Old Opening .....:....
x $1.50
Business Phune No
Catch Basin ....................
x $3.25 $
Water Heater '.Up to 99,000 BTU) • . • •
x $3.00 $
ROUGH
,
New Ground Run Old Bldg.........
x $3.25 $
Electric Water Heater...........
s $2.00 $
i'INAL v Z �1
33AS FITTING FEES:
NO. RATE
TOTAL
Ist 3 Fixtures ............ • • •
x $2.00 $
Additional Fixtures ................
x $ .75 $
Gas Range to 199.000 BTU ...........
x $5.00 $
REPAIRS h ALTERATIONS—Refer to Code
.50 State
Surcharge
'
Description ........................................
d.
TOTAL FEE $
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
Effective On January 1, 1993
State Surcharge
TOTAL FEE
$.60
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $L3.00
PLUS THE 5.50 STATE SURCHARGE
Burner Trade Name Size No.
BTU HP EDR
�ro 0"Ff —Or WE WS7 .r
.` �
REINSPECTION FEE $30.00 Approved By &! Rough–In Date Final Date
*Air Conditioners can not be placed In a side yard without
written permission from adjoining property owner.
FILL OUT BACK SIbE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
.._; .The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work In strict accordance with the City Codes arld
Furnace Shell and Duct Work, Burner --
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$30.00
$
representations stated in this application are true and correct. 100
(Side Vent – Fill Out Back)
-1 L ID
Gas Piping (Needed with new furnace)
$10.00
$
hCjmi�
S 7®7 - 3 $ I I
OWNER ::E Q
Gas Range
$10.00
$
BUILDING USED AS
Gas Dryer
$10.00
$PERMIT
/
ESTIMATED COST � ���� NO. ! ��
*Air Conditioning – All Sizes
$3f.00
$
D OF FURN&CE Atil) OR QURbjEA
All Others/Repairs & Alterations (LIST ON BACK
„SCRIPTION
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) arm All,
Trade Name, Size No. s
Commercial/Industrial
BTU '7 o Ofy-) HP EDR
1% of Value of Appliance or Work
$
Fuel n at Total Connected Load
State Surcharge
TOTAL FEE
$.60
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $L3.00
PLUS THE 5.50 STATE SURCHARGE
Burner Trade Name Size No.
BTU HP EDR
�ro 0"Ff —Or WE WS7 .r
.` �
REINSPECTION FEE $30.00 Approved By &! Rough–In Date Final Date
*Air Conditioners can not be placed In a side yard without
written permission from adjoining property owner.
FILL OUT BACK SIbE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
I
NOTE: #1 through #8 required when using a side vent furnace.
The undersigned hereby verdies that the existirig chmmey or stack:
1.
Has been carefully examined
Yes {)
No
{ )
2.
Is free from rust or deterioration
Yes ()
No
( )
3.
Has no foreign objects lodged within
Yes ()
No
{ )
4.
Is securely supported
Yes ()
No
( )
S.
Meets all current Code requirements for size
and total BTU's conned
Yes ()
No
( )
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes (
) No
( }
8.
Has combustion air been provided for water heater
Yes (
) No
( )
Remarks:
HEATING CO:
Signed By:
Date:
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Zone:
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P&Ltout certified by ACOA to meet ell regtlirOMMAa of Manual 3 FOM
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX: ( 763) 571-1257
ADDRESS
231 MERCURY DR NE
PIN
143024320023
LEGAL DESC
SYLVAN HILLS PLAT 4
WATER TREATMENT APPLIANCE
LOT 7 BLOCK 1
PERMIT TYPE
PLUMBING
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: ADDITION/ALTERATION
PERMIT N .. 200401049
DATE ISSUED: 07/07/2004
VALUATION : $ 0.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL FEBCO BACK FLOW
PREVENTER FOR IRRIGATION SYSTEM.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS)
# GAS DRYERS
# OF NEW FIXTURES
# WATER TRMT APPLIANCES
APPLICANT
JERRYS PLUMBING INC
13416 HANSON BLVD
ANDOVER, MN 55304
(763)755-4268
OWNER
COOK ROBERT JR
231 MERCURY DR NE
FRIDLEY, MN 55432
0 # GAS WATER HEATERS 0
0 # GAS RANGES 0
0 VALUE (FOR MINIMUM CALC) 0
0
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating constru ion or the performance of construction.
An is n Date
Bldg Insp ` —,� Date' --I 1 "a
PLBG PERMIT MINIMUM FEE
15.00
PLBG FIXTURES (NEW OPENINGS)
0.00
PLBG FIXTURES (EXIST OPENINGS)
0.00
WATER TREATMENT APPLIANCE
0.00
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
0.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
PLBG REPAIR/ALTERATIONS
0.00
STATE SURCHARGE, PLBG FLAT
0.50
TOTAL
15.50
PAID WITH CHECK # 22096
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT P 0,2
�7
(763) 572-3604, FAX (763) 571-1287 1�
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS J,
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 (a)Yes () No
Type, -0
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.00
$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 $
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.
OWNER
BUILDING USED AS
ESTIMATED COST
PLUMBING COMPANY -J
DATE: , 20-lT—
PERMIT NO.
SIGNED BY ® i1-��L!®1�6 TEL N0.
b�
�7
Approved By Rough -In Date Final Date l loL/
MINIMUM FEE FOR NY PLUMBING/GAS PERMIT IS $16.00 or 5% OF COST
OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE
i
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATION .
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and terminatidn. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes ( ) No ( )
When required to install a new combustion air, it will be sized and in$talled
to meet the current codes and manufacturer's specifications. Yes ( ) No ( )
When installing a new ventina 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 Fum4ce
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 CO:
Signed By: Date :
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Me hanical Permit#
Residenti 31 Application
City f Fridley
See Back Side F r Required Information
Date Site Address:
The applicant is: (cirlce one)
, Ownerontractor
Property Owner:
bL
Address:
City:
ate: Zip.--G
Phone:
Cell:
Fax:
Contractor Information
Company Name:
Contact Person, !
Address:
City:
State:—AkZ ZIP:
Phone: -7& ?1 'c/
Cell:
ax:
Email:
MN Bo
d# & Exp Date
Type of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work:
�J
45
SI
Equipment Installed: MFG:Model:
Size/BTU:
MFG:Model:
Size/BTU:
MFG:Model:
Size/BTU:
Please check all that apply:
—Fireplace (gas) $15.00
New Gas Grill $10.00
_A/C $25.00
_Fireplace (wood) $35.00
_Gas Unit HTR $10.00
_Air to Air exchanger $15.00 _Fumace $35.00
_Pool Heater $35.00
_Boiler $35.00
_Gas Dryer $10.00
_Ventilator $15.00
_Chimney Liner $10.00
_Gas Piping $JD -O — 35;,
_Duct Work $10.00
_Gas Range/Oven $10.00
Permit Fee $(Total
from above-
Minimum fee $35.00)
Surcharge $
Total Due $
0.50
J�5 ake check payat
le to City of Fridle
This is an application for
I hereby apply for a mechanical permit ar
accurate; that the work will be in conform,
with the Minnesota Construction Codes;
for a permit and work is not to start will
approved plan in case of all w
Signature of Applicant:,
Approval Inspector Sig
Please Note: Separate permits are required for Bui
Revised 6/14/2005
permit- not valid until processed
I acknowledge that the information above is complete and
:e with the ordinance 3 and codes of the City of Fridley and
at I understand this i not a permit but only an application
ut a permit; that the work will be in accordance with the
c which requires review and approval of plans.
Date: !�tIL�
Date:
, Plumbing, ad Electrical work
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ 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
$
Permit Nom! - 00
Inspections
Surcharge
RESIDENTIAL APPLICATION
License Surcharge
Received By:
763-572-3604
$
CITY OF FRIDLEY
$
Date Rec'd:=_>N (3-1
DATE O
YOUR E-MAIL ADDRESS Lz
e. . C
SITE ADDRESS
C ` \ \..La �� ° e
Total Due
THIS APPLICANT IS:
❑ OWNER NTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: W1's, w �c
STATE_ZIP
PHONE: Ro sb D– Log DaL
NAME: Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113
WITH APPLICATION
PHONE
13 SINGLE FAMILY/NFLicense #20130983
—STATE—ZIP
PROPERTY TYPE
❑ TWO FAMILY/NEW G 651-264-4777
❑ ADDITION ❑ GARAGE/SHED IN OOWS
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
W"MAMTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: `C&1.
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT S . Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING Si TBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS.
& PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I.
Site Plan/survey showing the existing structure
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS []Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
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 $ . b ® OCCUPANCY TYPE
Permit Fee
$
Plan Review
$
Fire Surcharge
$ . ?�
Surcharge
$ (o $
License Surcharge
$ 5,00
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$ S 7-. CIA
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)
$1550 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 bei
conformance with the ordinan and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not.
permit but only an applicati n or a permit rk is not to start without a permit; that the work will be in accordance with the approve(
plan in the case of all work ich uires e ' and approval of plans.
SIGNATURE OF APPLICANT �� ATE
Building
PLUMBING.
Permit No.• 7
Inspections
RESIDENTL&L APPLICATION
Received By:
763-572-3604D
763-572-3604CITY
OF FRIDLEY
RM'
DATE / (� D� YOUR E-MAIL ADDRESS 4?-gnI k-A-d e— C� S enP S_& - "YL-'%
SITE ADDRESS 2�!> r /?70V�-
THIS APPLICANT IS: bkWNER ❑CONTRACTOR
PROPERTY
NAME: 0t4M//_/) G GL"-DE"
OWNER/
-\
ADDRESS: G` 3 I (NV.i-c---l-Q-1 l E CITY F;/Z- O STATEZ?ZLJZIP SS
TENANT
PHONE:-7(,3 S-0--L 4,929
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE—ZIP-
TATEZIPLICENSE
LICENSEWITH
PHONE FAX
APPLICATION
PERMIT TYPE
GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW �fiPLACEMENT
DETAILED DESCRIPTION OF WORK A-CPZ-,9 w o 0 f4a'T yQ ND Ca L o
G�-A zFA-- SLAT otY VAUVEs
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 )
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)
BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING
_ _FLOOR
—BATHTUB —GAS PIPING (NEo crrrucmm) _ SWIMMING POOL _ WATER SOFTNER ($35)
CLOTHES WASHER91-IQTCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15)
_
_ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
—DISHWASHER
WATER METER OTHER
Permit Fee $ Number of fixtures @$10.00 x $10.00 = $
Surchar a .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $___,50
Total = $
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; that the work will be in accordance with the
approved plan in the case of,41 work w h q ' es review and approval of plans. l
d C d
SIGNATURE OF APPLICANT PRINT NAME ���''� `�� 4g&
�� DATE 7 / 3 I D011
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
PLUMBING
Permit No.: 3
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
D U'd.111- 2 6 200
CITY OF FRIDLEY
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS 3 1 MEA-c-K c" ,)a-I %JC WC
THIS APPLICANT IS: 0 DOWNER ❑CONTRACTOR
PROPERTY
NAME:-50"M -4 C ef —®E
OWNER/
ADDRESS:931 1n Ek . A-1. 1 DI �£ CITY Fo2.,OL E y STATE R,#/ZIPS 13 �
TENANT
PHONE: -7&3 5-00 4,92°�
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE—ZIP-
TATEZIPLICENSE
LICENSEWITH
PHONE FAX
APPLICATION
PERMIT TYPE
GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK Zf P L-A CZ 51-ivA—F Fy A d'y� S G`'�'�' ^' i ^iT"° o uS E
je lei!;- ygev0 /,!'1117�0/fiT�Luj 1QF /!_ 1.j>J F eL
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 )
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)
SINK/LAV DRAINS SHOWER _ WATER PIPING
—BATH _FLOOR _
_ GAS PIPING (NEw crrrircEysk) _ SWIMMING POOL _ WATER SOFTNER ($35)
—BATHTUB
CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15)
_ _
DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_
WATER METER OTHER
a,-
si
Number of fixtures @ $10.00 x $10.00 = $
Permit Fee $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
State Surcharge = $ .50
Total = $
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; that the work will be in accordance with the
approved plan in the case of work w re es review and approval of plans.
'
SIGNATURE OF APPLICANT PRINT NAME C 6 A-,9 E� DATE4Z&-_/�
TKI
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
BUILDING
Permit No.:11B T -
Inspections
RESIDENTIAL APPLICATION
Received By:1
763-572-3604
$
Date='id: 'y 4 ��I
Surcharge
CITY OF FRIDLEY
.0005 x Permit Valuation Minimum $.50
DATE a Lo n� 01
1Q5<XrAad6;)
$5.00 (State Licensed Residential Contractors)
SAC Charge
YOUR E-MAIL ADDRESS ? ep(2If—JC
� C.CJYY1
SITE ADDRESS 9-61
t U C l� j� t ►l -Q r (�Il
ft + 6 ft = ft x $21 =$
THIS APPLICANT IS:
❑ OWNER ACONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME:
Fee Determined by Engineering
TENANT
ADDRESS: n CITY
—
Total Due
STATE -ZIP -PHONE: 7 (D 3'5 c� - (9 / �R 7
NAME: Renewal By Andersen
Make checks payable to: City of Fiidley Attach Stipulations
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113 t
STATE ZIP
WITH APPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/NEI
PROPERTY TYPE
❑ TWO FAMILY/NEW C 651-264"4.777
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW 13 ADDITION
E3MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:�n�l�
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Scl. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
❑ Vinyl
❑Soffit
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Aluminum
❑ Other
❑ Trim
ADDITIONS
1.
& PORCHES SUBMIT:
Site PhWSurvey showing the existing structure
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS []Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL r L&zi ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USINGHE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S 5.-::539 — (1rV1IVA1%h!`V TVPV
Permit Fee
$ , a�5_
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
$ 00
$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 Fiidley 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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not.
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 approve[
plan in the case of all work which equires re .ew and appp^ro__vaal�l of plans. }� /n
SIGNATURE OF APPLICANT r�y PRINT NAME/{ l t].Cc' ]r+Z 1I�Gn �') DATE4& �
19
Building
BUILDING
Permit No.abl
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Dao%'8EP 0
DATE 50 F\U5 10
YOUR E-MAIL ADDRESS
o?, S$" .0005 x Permit Valuation Minimum $.50
SITE ADDRESS
$
5,00 $5.00 (State Licensed Residential Contractors)
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
$1550 per SAC Unit (Plans to MWCC for determination)
PROPERTY OWNER/
r
NAME: cd G u 'L n
ft + 6 ft = ft x $21 =$
ADDRESS: n CITY
STATE ZIP
TENANT
Park Fee
PHONE: : ' (0 3 " 500 _ (Pycyy
NAME: Renewal By Andersen
Fee Determined by Engineering
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
Total Due
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113
STATE—ZIP-
TATEZIPWITH
WITHAPPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/NEI
651-264=4777
PROPERTY TYPE
❑ TWO FAMILYINEW G
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: WrOSW1
I ricio
SIZE OF IMPROVEMENT LENGTH WIDTH
HEItFdT Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
3.
Proposed floor plan
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS_
& PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structure
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
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 $ S, 10 0 — OCCUPANCY TYPE
Permit Fee
$
IRS, 015' See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
S, f O .001 times the total job valuation
Surcharge
$
o?, S$" .0005 x Permit Valuation Minimum $.50
License Surcharge
$
5,00 $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
—T-371-0—
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 .
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an application a permit and w is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work w ' eq ' es revie d approval of plans.
SIGNATURE OF APPLICANT A Ri�AME/► lAfr. DATE 4/'