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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® _ Date: ... .......... ........... ......... Owner ....................................... Address ...................................... 3229 Builder ...... i� e�........... . Address............................................. LOCATION OF BUILDING No. Street . �'` : a............................... Par$ of Lot .... .. . Lot ........ Block .................. Addition or Sub -Division Corner Lot ............ Inside Lot ............ Setback ....:f.±. Sideyard' ...ra .:. a ........ t DESCRIPTION OF BUILDING To be Used as: A ... ... Depth ..... Height .. .... Sq. Ft... l .. . Cu. ....... Front Ft -:: � . ...�......... .................... Front .... Depth ........ Height ..... Sq. Ft........ Cu. Ft ........ Type of Construction �. '��. �... :':...... ls`st. cost. .,t ..'......... To be Completed .:) . I..... a ....... In consideration of the issuance to me of a permit to construct the building desribed 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. 1 .............................. �!�',�O,O,Q ;�?/L✓t!C, 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. _ .. . c, Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. .i DESIGN DEVELOP BUILD THOMAS S. SILVIS 210elNDIAIA AVE. NORTH • MINNEAPOLIS 22, MINN. . 8-7666 i Ap O 0 f �)o,���T i City of Fridley, Minn. BU11DING PERMIT NO 6669 i° Date:CWwr: Builder D`6 IrI Ie Address•d � LOCATIO MNG No. Street _1_ ye_ P of Lot Lot __ Block r Addition or Sub- on Corner Lot _ Inside Lot -Setback Sideyard Sewer Elevation _ _ _ ._._ Fo dation Elevation DESCRIPTION OF BUILDING � Front � Depth Q Height L Sq. Ft cu. Ft. Fro Depth eight __ Sq. Ft. cu. Ft. Type of Construction "VV— Est. �-� `�"�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 oY the city of Fridley. A? A U - 1z - - 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 it► all respects to the ordinances of Fridley, Mismesota regardixg location, construction, alteration, maintenance, repair and moving of buildings within the ty cilimits and this permit may be revoked at anyuvioletie�.of any of the provisions of said ordinan//�� 11 Building Inipector NOTICE: l This peneh does not cover the constwation, lmft Hon for WhIs . plumbing, gas hoa&& sewor or water. Be are to no the Building hapector for separaN permih for those hems. ATTENTION OF: CITY OF FRIDLEY I To 6431 University N. E. Minneapolis Minn. 55421 612-560-3450 SUBJECT "J DATE z L%�-✓/ / c-C� i SIGNATURE REPLY: _ n i DATE, SIGNATURE REPLJER°Si COPY ® RETAIN_ FOR YOUR FILES 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 'HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $3 200 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $19.20 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE CONTRACTOR OR R1 A�g SIG�A/f SNT EN PROP 1 OFFSTREET PARKING STALLS GARAGES SURTAX .90 SAC CHARGE TOTALFEE 20.10 RLY VALIDly;ED THIS IS YOURePJ-rRMIT 1 APPLICATION FOR RLSIMNTIAL, ALTERATION, OR DDITION BUILDING PERMIT CI'T'Y OF 1-1:1 DL1:Y , SII NNESOTA OWNER'S NAME: / 4a BUILDER: ) "4sell_� ADDRESS: 3 3 ADDRESS:�- NO.--. STREET: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed buildixig location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front • S U Depth: g e7 Height • � �c Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: RrL.Qgia Estimated Cost: $ 3 2 ep o , e, To Be Completed: 2y 0,4 V $ The undersigned hereby makes applicatilon for a permit for the work herein specified, agreeing to do all work in stiict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that ill the facts and representations stated in this application are true and cirrt-ct. / DATE: =%� �� / 9 % S I(; NATURE : C `, (See Reverse Side For Additional Information.) P. 31. -�. x rcf. 2, a s�j V'_ -N-1A)e q 2 � r i 20, SUBJECT PER NO. of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT T NO. Ir?City _______ COMMUNITY DEVELOPMENT DIV. v ^fig_ r I PROTECTIVE INSPECTION SEC. �J i \ CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 8/1/95 JOB ADDRESS 6336 Pierce Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 Moore Lake Highlands 1st SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sharon Hughs 6336 Pierce Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Greg Wills Exteriors 4246 Royce St NE, Columbia Heights MN 55421 788-0529 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION C. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install vinyl siding/aluminum trim 9 CHANGE OF USE FROM TO STIPULATIONS 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 ] 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 $5,830 $2.92 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $112.25 Fire SCC $5.83 PLAN CHECK FEE TOTAL FEE / /� F Gc lLG $121.00 /11 SIGNATURE CON7RACTORORALITHORIZEDAGENT IDATEI WHEN PRR�O�PERLLY/AALI/DAAJED THIS IS YOUR PERMIT WB _ SIGNATURE OF OWNER iiF OWNER BUILDERI IDATEI BLDG NSP DATE fzFoln ADDN ] CITY OF FRIDLEY ALTER ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: �'���/� r' ! r%ZC S% /("/z—� Legal Description: Effective 8/l/95 Owner Name & Address: .S K(� h S r–� Tel. # Contractor: ( �/ ` �K 7'-�`-r� l ' d le --S: _ MN LICENSE # Address: /</-570 C5S �7– ���� Tel. # 7eja - oZ 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: Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: a':4 St �9 j Estimated Cost: $�� �O _ Approx. Completion Date: lZ m 7�2t-vj (Cost on Back) Driveway Curb Cu Width Needed: Ft. + 6 Ft Ft x $ _ $ DATE: l g� APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge Q� STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $850 per SAC Unit $5.00 (State Licensed Residential Contractors) Aft. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ I Not Necessary [ ] NEW [] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address:- Legal Description: Owner Name & Address: Contractor: Effective 1/1/2000 (763) 572-3604 Bldg Insp Tel.# 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 IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: Estimated Cost: $ \, � X Driveway Curb Cut Width Needed: I/)//' . +�Ft �F $ _ $� ®n DATE: �— APPLICANTel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1100 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: PCS / 1 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 E MP IM11112 ■ w4v;l� ADDRESS 6336 PIERCE ST NE PIN 133024310048 LEGAL DESC MOORE LAKE HIGHLANDS 1 ST LOT 13 BLOCK PERMIT TYPE BUILDING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,547.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (22 SQ) TEAR -OFF APPLICANT JOHNSON RANDOLPH E 6336 PIERCE ST NE FRIDLEY, MN 55432 OWNER JOHNSON RANDOLPH E 6336 PIERCE ST NE FRIDLEY, MN 55432 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 presume to give authority to violate or el e p visi s of any other state or local law regulating o i n or p ormance of conshWtii n. Apel' an Date q- 5 71-1L57 PERMITO.: 2004 6 DATE ISSUED: 04/19/2004 BUILDING PERMIT FEE 83.25 FIRE SURCHARGE 2.55 STATE SURCHARGE, VALUE 1.27 TOTAL 87.07 PAID WITH CHECK # 7639 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. & �z /( NEW [ ] CITY OF FRIDLEY Effective 41/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION �LI Construction Address: --Fac L Et. - 4, F— Legal Description: Owner Name & Address: Contractor. 5E l f Tel. # 7&3—,59&-"7�/8� MN LICENSE # Address: (,a Z06P t� QLD S'�'' Tel. # 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 1 �Widlth Hgt/Ground Sq. Ft. `...OTHER: ?O ' + Construction Type: Estimated Cost: $�� Driveway Curb Cut Width Needed: Ft. + 6 Ft = F $ _ $ DATE: q" Pt ' APPLICANT: Tel. # Z(o,-3 _b 9 & _7 UD Call (763) 572-3604 for Permit Fees if mailing in ap3ticefion. Fax to 763-571-1287 If using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ O3 _c s4 Fee Schedule on Reverse Side $ 65% of Permit Fee .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1350 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. T" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ .�� STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6336 PIERCE ST NE PIN 133024310048 LEGAL DESC MOORE LAKE HIGHLANDS 1 ST LOT 13 BLOCK PERMIT TYPE BUILDING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE GARAGE, DETACHED PERMIT.:2004-01118 DATE ISSUED: 07/14/2004 VALUATION : $ 7,428.00 NOTE: CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE HARD SURFACE DRIVEWAY. SEE NOTATIONS ON PLAN. CONSTRUCT A 14'X 24' GARAGE ADDITION. STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE 153.25 DURABILT ASSOCIATES INC (3004) PLAN CHECK FEE 99.61 6318 CAMBRIDGE ST FIRE SURCHARGE 7.43 ST LOUIS PARK, MN 55416 STATE SURCHARGE, VALUE 3.71 LICENSE SURCHARGE 5.00 TOTAL 269.00 PAID WITH CHECK # 41680 OWNER JOHNSON RANDOLPH E 6336 PIERCE ST NE FRIDLEY, MN 55432 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 c& t4e pe,Iformance of construction. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW CITY OF FRIDLEY/Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # 763 _S"�G -'77 o'O MN LICENSE # 8 C – 3O D `/ Tel. # 9 -3 9 –?3 37D ©FFIlz— 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 t. 'y1 Height Sq. F Length ��_ Width �.. / Height, Sq. F Length Width Hgt/Ground Sq. Ft F %r�l�� Construction Type: � Wm Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $C-e y DATE: Gla APPLICANT: Tel # %3 �'" /i �i P Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit cans and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $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 [ ] r.. TOTAL $ Q ®® STIPULATIONS: 3uildhfg BUILDING Permit No -:0(0 — CC) TYA pectlOnS Received By: LA ns RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY Dat eRec'd: 5� a� )ATE YOUR E-MAIL ADDRESS ;ITE ADDRESS A J 'HIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: 9hn&11 an - $ 6if. . i( 65% of Building Permit Fee ADDRESS: n Stt CITY $ STATE10)&P �S�c TENANT $ PHONE: 74.3 it $ $1550 per SAC Unit (Plans CONTRACTOR NAME: S £. ft+6ft= $ $450 Conservation Plan Re, STATE LICENSE # ^ EXP DATE Fee Determined by Enginee $ SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS (p ?l Make checks payable to: CITY STATE---ZIP- TATEZipWITH WITHAPPLICATION PHONE FAX PROPERTY TYPE INGLE FAMILYiNEW CONSTRUCTION SIZE E3TWO FAMILY/NEW CONSTRUCTION S'T'ORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOFD X' = ❑ DECK ❑ SIDING THER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION / ❑ MAINTENANCEIREPAIR ❑ REMODELING Oki 1J i P'2 DESCRIBE WORK BEING DONE: L SIZE OF IMPROVEMENT NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other LENGTHSLau ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia wmnowS 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 L (US 1997 U.B.0 FEE SCHEDULE) TnTAL TnR VALUATION S 8 5O OCCUPANCY Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ 83 ,a5 See Back Page for Fee Sche $ 6if. . i( 65% of Building Permit Fee $ a.. $ j .001 times the total job valtu $ �{ .0005 x Permit Valuation N. $ $5.00 (State Licensed Resid $ $1550 per SAC Unit (Plans $ ft+6ft= $ $450 Conservation Plan Re, $ Fee Determined by Enginee $ Agreement necessary ( ) t $ (p ?l Make checks payable to: THIS IS AN APPLICATION FOR A PERMIT -NOT VALID I hereby apply for a building permit and I acknowledge that the information above conformance with the ordinances and codes of the City of Fridley and with the Minnes permit but only an applica for a permit and work is not to start without a permit; t] plan in the case of all worf wh o r es T ' w and approval of plans. 1 SIGNATURE OF nkc� 5 ''W HEIGHT Ft. BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations AND MATERIALS: dmum $.50 tial Contractors) MWCC for determination) x$20=$ Necessary ( ) V of Fridley Attach PROCESSED L 1i complete and accurate; that the work will be in Construction Codes; that I understand this is not a the work will be in accordance with the approved (TD DATE Building Inspectifns 763-572-3604 DATE 5_ g D SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: DET MECHANICAL RESIDENTIAL APPLICA CITY OF FRIDLEY YOUR E-MAIL ADDRESS ❑CONTRACTOR ADDRESS: (e 1p �i s P P 9 + Alp— CITY PHONE: '%'5 COMPANY NAME:_ CONTACT PERSON: STATE LICENSE #_ EXP DATE ADDRESS: CITY PHONE FAX &:SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNI ❑ REPLACEMENT OF WORK fJ Permit No.: 0-L°U"<< ON Received By: Date Rec'd: X N ATE nµ.21P Sss 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. I (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, NUMBER OF EACH BELOW) MODEL: Equipment Installed MFG: MFG: MODEL: MFG: MODEL: A/C $25.00 _FIREPLACE (GAS) $15.00 . AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 BOILER $35.00 FURNACE $35.00 —CHIMNEY LINER $10.00 _GAS DRYER $10.00 DUCT WORK $10.00 GAS PIPING $10.00 Permit Fee $ Surcharge $ .50 TOTAL DUE $ x.05= WHERE NOTED. FIXTURES: (INDICATE TOTAL SIZEBTU SIZE/BTU SIZEBTU GAS RANGE/OVEN $10.00 NEW GAS GRILL $10.00 —GAS UNIT HTR $10.00 POOL HEATER $35.00 VENTILATOR $15.00 Number of fixtures @ $10.00 x $10.00 = $ Number of fixtures @ $15.00 x $15.00 = $16 Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $-/ q, S> THIS IS AN APPLICATION FOR A PERMIT NOT VALID I hereby apply for a building permit and I acknowledge that the information above is conformance with the ordinances and codes of the City of Fridley and with the Minne: not a permit but only an a tion it and work is not to start without a per approved plan in the cas of a tKrk whic) regAires review and approval of plans. 1 SIGNATURE OF City of Fridley PROCESSED nplete and accurate; that the work will be in -Construction Codes; that I understand this is that the work will be in accordance with the V ArArj DATE Building Inspections Departm nt 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 NEWIEXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or PropaneUGC 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 ki I y UF- r rZIULt:y INSFLL,111)N DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Lllvt,ttvc; .),1it t, —JU- MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR 1lVdtt3t• Urinal C3�ti? Shower :..:.:::::::.:::::: r Wash W h Tray tH° '<<.> �1�, Floor Drain a `' "a<` G:.: k�tt�<.:::..<. Auto. Washer .t�..� Gas Mise<>:»>: Ran e x,...Ga w t r a e Heater s EI ecStories Basement / :ii:::�}:��iJ. :S:'�R:::::::•r. Floor 1 iir•.; Floor 2 I 3 For o ?iid:•:::t: Floor 4 PLUMBING FIXTURE RATES: NO. RATE New Fixtures �3 Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank r Water Treating Appliance Water Heater -Electric Water Heater - Gas`" Gas Range" - Gas Dryer" Back Flow Preventer Required ( )Yes M No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 TOTAL JOB ADDRESS W1 r ��'�C�?, /K, If7- 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. (�' Y 9 , 2006 Owner t` r4 xl D y �(� JS/S®� 74 J -,!596 "7 ?-Y6 Building Used As Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance .tt� Stale Surcharge .50 Estimated Cost &- ,0000� PERMIT NO PLUMBING COMPANY SIGNED BY � TEL N0. 9. 2 -,9W -70/Z) Approved By TOTAL FEE PLUS COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTI N 04(A) AND ABLE 6-A. Rough4n Date Final Date COMMON VENT INFO ON BACK SIDE