PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT k? (:5:5:0 8
Date: ..�.
saw:
Omer: M `'... All, Builder
Address Address
40CATIO UI DING
No. Street _C�-_ P of Lot
Lot __ Block Addition or Sub -Di
Corner Lot Inside Lot _ ` Setback d�— Sideyard
Sewer Elevation ___ — Foundation Elevation
DESCRIPTION OF BUILDING
To Used
�X�
Depth Height Sq. Ft.;Cu,
Front _'"`�.SI Depth ' Height Sq. Ft.' Cu. Ft.
4 d .•0A•
Type of nstruction Fit. To be Completed
In consideration of the issuance tome 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
prdin esu of the city of Fridley.
In consideration of the payment of a fee of , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part, thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration; maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
t
Building Inspector
NOTICE
This permit does not corer the construction, Installation for wiring, plumbing, gas heatb& Sewer or water. Be sure to we
the Building Inspector for separate permits for these boom
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Ownbrs Name Builder �•.�-��-�-�+cr
Address _ Address .,6� 1*
LOCATION OF BUILDING
No. Street. '_ Part of Lot _-- -
Lot Block _ /• Addition or Sub. Div.
Corner Lot Inside Lot .._ Set Back b�
A,plfcant'attach io this form Certificate of Survey of Lot and proposed
l*iilding .lgcation.
DESCRIPTION OF BUILDING
To be u$ed as
Front Depth,_______Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Fti, Cu. Ft..�_
Type of Construction Estimated Cod
To be completed .�..�
daege-
The undersigned hereby makes application for a permit for the work
herein specified, agreeing -to do all work in strict accordanee with the
City Ordinances acid ruling of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true •and.' correct. S°,I/V�a�v� �-D �,.•-e,
Date ���� .�----- Signature ZZe
(A Schedule of Fee Costs can be found on the Reverse Side)
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept, of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK �'�/ �' •�` �`
Number. Kind and Location of Fixtures Location 4�
PARTIAL RATE SCHEDULE
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.
p Fridley,_Vlinn / >- 5 19-41/
Owner
Kind of
/ Used as
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures x $1.50 $—�/ d d
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 $ =2 - d
New Ground Run Old Bldg . ............ x 3.25 $
To be completed about �� /
Estimated Cost, $ en
as
Old New Building Permit No PermitAo.,
Signe
By -LI-)
Business Phone No /s: a
ROUGH /6 - ;Z - 10
FINAL
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .........-•..............
x $1.50 `U
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FSE $ � oZ' °z
J
°don
WU'
Z
a
(7O
•
R
•
N
WATER HTR.
GAS
ELEC.
Base
1st
q
2nd
3rd
4th.
• Future Connection Openings
e New Fixture, Old Openings
Connected with
sewer E]
Cesspool
PARTIAL RATE SCHEDULE
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.
p Fridley,_Vlinn / >- 5 19-41/
Owner
Kind of
/ Used as
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures x $1.50 $—�/ d d
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 $ =2 - d
New Ground Run Old Bldg . ............ x 3.25 $
To be completed about �� /
Estimated Cost, $ en
as
Old New Building Permit No PermitAo.,
Signe
By -LI-)
Business Phone No /s: a
ROUGH /6 - ;Z - 10
FINAL
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .........-•..............
x $1.50 `U
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FSE $ � oZ' °z
Application for Power Plants and Heating, 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 c+
Furnace Shell & Duct Work to 170,000 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 $ r ��
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE $ +�
ROUGH
FINAL
Dept. of Bldgs. Phone SII 4-7470
C
City of Fridley:
a
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 �e' ������.
Fridley, Minn 1,r 1963 --
Owner 3 --
Owner
Kind of Building � ""-
et
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No. 4r Permit No. d
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No ee ,4
Trade Name Size No.Z®® OQ 0
Capacity dv Sq. Ft. AM- BTU H.P.
Total Connected Load Kind of Fuel
Capacity �® ` �• Sq. Ft. E.D.R r BTU A.P.
(REMARKS -OVER)
r
Signe
(Z
Byf
42 2M Business
Building
Inspections
763-572-3604
DATE��-A;
SITt ADDRESS �7 ee
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
0 OWNER CONTRACTOR
Permit No.: GO'",
Received By:
C% p 1 W
COMPNY NAME: Anderson Heating and Air -Conditioning
SUB1`�iIT .A COPY OF CONTACT PERSON: 0411czj —
YOUR STATE STATE LICENSE # N/s0 4347 Central Ave N.E.
LICENSE WITH ADDRESS: ft"_STATE ZIP
APPLICATION PHONE Z&__9- 4 - �5 / COI. HtS, Mn 55421
A
PERMIT TYPE 19LSINGLE FAMILY O TWO FAMILY O TOWNHOUSE
TYPE OF WORK:0 NEW XREPLACEMENT O ALTERATjyN/REMODEL
/ / 11
DETAILED DESCRIPTION OF WORKCf"
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 $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHE
RENOTED. FIXTURES: (INDICATE TOTAL
btn
','111vIBER OF EACH BELOW) MODEL: " V 3J1 `-'' SIZEBTU /V
Equipment Installed MFG SIZEBTU
MFG: MODEL:
MODEL: SIZE/BTU
MFG: GAS RANGE/OVEN $10.00
_YA/C $25.00 FIREPLACE (GAS) $15.00 _NEW GAS GRILL $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 GAS UNIT HTR $10.00
^BOILER $35.00 FURNACE $35.00 —POOL HEATER $35.00
_
CHIMNEY LINER $10.00 _GAS DRYER $10.00 '—VENTILATOR $15.00
—nUCT WORT: $10.00 _GAS PIPING $10.00
T}15 %.-moi;na , . 2�_q�jn
II% �]✓'. 'KU91~;_l rVx uI- ._._ m
Permit Fee $ � Numberof fixtures @ $10.00 x $10.00 =
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ �j _.� Number of fixtures @ $25.00 x $25:00 = $
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 all work which requires review and approval of plans.
�L ) /
> ATURE OF APPLICANT L ��%Gt�Le�✓r • PRINT NAME d�'ll T t e1� 47�C ��� !A' DATE
SIG.
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 AEXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a- Oil or solid fuel TMC Chapter 7 with MN Amendments
b. Natural Gas or Propana.UGC Chapter 3 with NLNAmendments
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
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $-a I�fC� . da OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge .
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ % /, J)
$ 3,
$ /, 7 7
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21 =$-
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will be in accord a with the proved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPL \ PRINT NAMEf 4/ %4ek DATE�O 08
APPROVED BY ""'\ 0 � v DATZ
BUILDING
Permit
Building
Inspections
RESIDENTIAL APPLICATION
Received By: /2
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE l �i/D S
YOUR E-MAIL ADDRESS
5'
SITE ADDRESS ACoJ
�f
t0ferfe 51J . /
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: 5-htth /~ r
—
ADDRESS: CITY
STATE—ZIP—
TATEZIPPHONE:
TENANT
PHONE:- 3 5-71 6 Y%3
NAME: ` d- W '
ADDRESS: 313 LTt 14►�'e�o,� is<wv CITY CI/h
STATE zIP�s`S316
CONTRACTOR
SUBMIT A COPY OF
PHONE ?43 1-/.27 96% FAX
YOUR STATE LICENSE
STATE LICENSE # a Ori/Oa EXP DATE
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑WINDOWS
❑ BASEMENT FINISH J1rROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
DCMAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: `i�D P re. rC house 4m• �
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES 50 XHOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
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:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS & PORCHES SUBMIT:
❑ Vinyl
❑Soffit
I. Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
M EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $-a I�fC� . da OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge .
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ % /, J)
$ 3,
$ /, 7 7
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21 =$-
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will be in accord a with the proved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPL \ PRINT NAMEf 4/ %4ek DATE�O 08
APPROVED BY ""'\ 0 � v DATZ