PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 7027
"/v/
Date: Date:
Owner: _ _ Builder f
Address Address
LCA ON O j BUI-LNG
No. Street -Li- lL Part f t
Lot__ Block c2 Addition or Sub -Division
Corner Lot._ Inside Lot Setback _ Sideyard
Sewer Elevation ____ ____ Foundation Elevation
DESCRIPTION OF BUILDING
T Used sa: _
Front Depth Z 3_ Height Z Sq. Ft Cu. Ft f -,
Front Depth HeightSq. Ft Cu. Ft
Type of Construction w Es t 4 __ 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 for�a�d in complia7,.- i all Provisions of
ordinances of the city of Fridley. (( it f 1
In consideration of the payment of a fee of $ = , permit is hereby granted
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
VVI dty ]units and this permit may be revoked at any time upon violat3�{} of any of the provisions of said
Building Inspector
NOTICE:
" permB don not cover the construction, hmaWen for wiring, plumbing, gas heating, saner or water. Be amre to $ee
the Bonding Inspector for sapartle permhs for these items.
No. Street part ,of Lot
Lot Block Addition or Subdivision X41 U A d 14, _q
Corner Lot inside Lot Setback,Side,Yard
SEWER ELEVATION FOUNDATION ELEVATION
A
pplicant attach to..this,-form Two.Certificates of :Survey of Lot and proposed build-
ing location drawn on these Certificates
DESCRIPTION OF BUILDING
To be used as:
P® V, Front Depth Ja Height
Sq.. Ft. Cu.- Ft..
Front Dmpth Height
Sq. Ft. Cu. Ft
Type of Construction. � k`,C), yj'e Estimated: Coat _
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,..ef,the.: Department, of, ,Buildings, and -hereby ,declares that all the facts and
representati.ons stated in this application are true and: correct.
,(Schedule of Fee Costs can be found on the Reverse Side).
City ®f Fria�ey
suB�Ecr
2 5 99
`J
AT THE TOP OF THE TWINS
BUILDING
PERMIT
P
i t
COMMUNITY DEVELOPMENT DIV.
r I PROTECTIVE INSPECTION SEC.
NUMBERREV
DATE
4/27/98
PAGE OF
APPROVED BY
CITY HALL FR16LEY 55432
612-571-3450
910-F15
JOB ADDRESS 6181 Rainbow Drive
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
2
Sylvan Hills
SHEET
2 PROPERTY OWNER MAIL
David Chizek, 6181
ADDRESS
Rainbow Drive, Fridley 55432
ZIP PHONE
571-4449
3 CONTRACTOR M IL ADDRESS
ZIP PHONE LICENSE NO
David Chizek (same as above)
4 ARCHITECT OR DESIGNER M IL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Cp
ADDITION ❑ ALTERATION [X REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof (tear-off)I'
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must meet 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
MOT.
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
.66
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-
$45.75
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
Af
$47.74
Si ATu E OF CONTR TOR THORIZ AGENT �DATEi
WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
r 27
�
�, RLAG iNSP
QATE
S+G OF OWNEROFO ERBUi ERI IDATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress :
t
Legal Description:
Owner Name & Address:
Contractor:
Address:
Effective l/ 1/98
Tel. # 5,71-
MN
71-MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
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: le Estimated Co $
(Fee Schedule on Back) 43
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE:
APPLICANT:
CITY USE ONLY
T
Tel. #
Permit Fee ✓`✓ �$ a Fee Schedule on Reverse Side
Fire Surcharge l33$ .001 of Permit Valuation (1/10th%)
State Surcharge .4C$ $.50/$1,000 Valuation v '
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:
g ` cello
?�7
SUBJECT
AMR MIT
City of Fridley
2 6 2 714
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
N
RECEIPT O.
�• ___ _ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
PROTECTIVE
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
6/12/98
JOB ADDRESS 6181 Rainbow Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
2
Sylvan Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
David Chizek 6181 Rainbow Drive NE 571-4449
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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 ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace 18 sq of siding on house & garage; Reroof House & Garage ( 24 Sq)
Tear -off; Add closet in bedroom - extending out under eave; Replace window
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
AAA"M PERMITS REQUWD FOR
WIRING, HEATING, PLUMBING AND SIGM.:
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. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1 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
$2,771
$1.38
WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT
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-
$74.75
Fire C $2.77
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALfjfE
$7 90
SIG ATUR OFCONTRAC OR �i THOM DAGENT IDATEI
NPR P R LIDATE I$ IS Y UR PERMIT
_
gp DATE
SIG U EOF OWN' pF OWNE ILDERI IDATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
11"'Afl41;ConstructionAddress:
Legal Description:
Owner Na® & Address: . �0ym C-4
Contractor:
Address:
Effectiv 1/1/98
�S
s57
Tel. # 6/2- s 7®- 4-eoee�
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: 1�tr L -V W1A00 / (ybxV3) ((P/4Z. IY S4eV /V YL 511014 (ROU a4 f a ."t
3) '0 - x ffvvsF f' 0 l aye r) P, S i' 0 hbb CZ OS rr %V ARP JC C9 ' �
Construction Type: Estimated Cost: $ ®ate Cyd A`l row
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
(Fee Schedule on Back)
Ft x $ _ $
DATE: 6 — r 2- " V APPLICANT: DAL',"Oe Tel. #boz 9'71 jq 4 41
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY
20.®�
Fee Schedule on Reverse Side (3 1
.001 of Permit Valuation (1/10th%)
$.50/$1,000. Valuation 771.
$1000 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 [ ]
STIPULATIONS: 9 q vF H
41d
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
June 1, 1999
Dave Chizek
6181 Rainbow Drive NE
Fridley, MN 55432
Re: Final inspection at 6181 Rainbow Drive NE
Contractor: Action Heating & AC, Inc.
Dear Mr. Chizek:
A mechanical permit was issued on June 24, 1998 for the property located at 6181
Rainbow Drive NE for a new furnace and air conditioner. According to Section 305(a)
of the 1991 Uniform Mechanical Code a final inspection shall be performed on the
mechanical permit: As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do not
hear from you, we will expire the permit and any inspections on this installation will
require a new permit.
Any questions can be addressed to myself at (612) 572-3603.
Sincerely,
Barry Riesch
Building Inspector
JLIN-24-1999 09:15 r7POM :'-`1T'T' CIF FRIDLEY
� >
Tj
1-0 Z I
44
m
0 D
TICI 5712547 P.03/04
cn -21CP 0
4 - & —
_71
0
tl
CO
0
0
z
C)
}ate Zvi'
0
D
:yp (r)
>
O A7
4L -
_TI_I -1-'2, —1' S.1 I G19 '1 (. FRI-ill i=: T T'i' OF FF r DLEY TO I c f 1'254 P. 04/04 e
h
Ob AD
40)ND
/00)Dob
TOTAL P.04
SUBJECT
PERMIT NO.
City of Fridley
33615
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
_
I PROTECTIVE INSPECTION SEC.
rl
E
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
763-571-3450
910-F15
6/16/03
JOB ADDRESS 6181 Rainbow Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
2
Sylvan Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
David & Marsha Chizek 6181 Rainbow Drive NE 763-571-4449
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
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
Construct a 24' x 1516" Addition to Dwelling
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan.
WARMIN
MOM digging call foir
811 utility location
SEPARATE PERMITS
40002
REQUIRED FOR:REQUIRED'
Y LAW
A18
TYPE OF CONST
OCCUPANCY GROUP
OCCUPANCYLOAD
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
1
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
$15.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$30900
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
PLAN CHECK FEE
TOTALFEE
$486.75
SIGN UR ONTR ,TO OR AUT RW1'_ IOATEI
HENPROPERLY VALIDATED THIS IS YOUR P RMIT
S -GNAT RE T O RalfOWNERIDATEI
BLW INSP GATE
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description: I–®T z lwa - 2" 0 5 Y1-wd Was
Owner Name & Address: Tel. # 63 SW yk!42
Contractor. - 0 MN LICENSE #
Address: Tel. # 7b 571
N LIVING AREA:
GARAGE AREA:
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 4Sq. Ft.
DECK AREA: Length Width 1 Hgt/Ground Sq. Ft.
OTHER:01jJ)= Wacw1�
7 f�
Construction Type: ����` Estimated Cost: $ k --
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: G I� 03 APPLICANT: Tel. I/I %� C.�/"//��— Tel. # 143 5-7/
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee $ / ` , ° 7-5�- Fee Schedule on Reverse Side
Fire Surcharge $ ®00 .001 of Permit Valuation (1/10th%
State Surcharge $ / S'': 0o $.50/$1,000 Valuation
SAC Charge $ $1275 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Curb Cut 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 $
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. .
$ .50
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE
HEATING CO
ILZ�(O 3
Signed la� , TEL # 7613
FAX #
e -
Approved Byek Rough -In Date Final Date
liitective January 1, 2603
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND
HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
JOB ADDRESS
RATE SCHEDULE
C"'
OWNER
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner •
BUILDING USED AS w
Also Replacement Furnace $ 30.00
(Side Vent Fill Out Back)
10,60
ESTIMATED COST PERMIT N0.®�`
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement) Col k
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Gas Dryer $ 10.00
$
Trade Name Size No.
BTU HP EDR
*Air Conditioning - All Sizes $ 25.00
$
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name 4#r �) � (6 Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. .
$ .50
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE
HEATING CO
ILZ�(O 3
Signed la� , TEL # 7613
FAX #
e -
Approved Byek Rough -In Date Final Date
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
C`OM6"nN <FNT Vr=NT CONNECTQR AND r.QMBI IRTIM AIR VFRIFICATION
When ranlsii an _Anhag fliranna, 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 (1 No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
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 iayinfing r_nme 1ctinn air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes( No ( )
When required t0 inefall a new cnmbuc_t_inn air i# will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes( No( )
When Ingfaffinn a now venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
spedfications. This does include AGA -LAMA Category I Central Furnace
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.
TW+p and Si7P/Cnmmnn Vent and Vent Connect-nr
Yes()No( )
Infnrmatifln
Air nliannp
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
Al T RATIONS- (Dane -Aha)
in Type M
HEATING CO:
Signed By: Date
nspections RESIDENTIAL APPLICATION
163-572-3604 CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
XM ADDRESS [I
'HIS APPLICANT IS: O OWNER .CONTRACTOR
RIk
Received By �-0 Mo
Date Rec' d:
PROPERTY OWNER/
NAME:(� 0, 1i 't'C Ch
I'rle k
Plan Review
TENANT
ADDRESS: ( 9 I 11Z IP cx i n
bo tk) St
j
.001 times the total job valuation
PHONE: `I LV 5 %
L{ LI 9
.0005 x Permit Valuation Minimum $.50
CONTRACTOR
NAME:
$5.00 (State Licensed Residential Contractors)
SAC Charge
SUBMIT A COPY OF
STATE LICEN # aQ Li `-I'
3 -31, °'C-
EXP DATE -3 - 0 -7
YOUR STATE LICENSE
ADDRESS:
$
_ CITY 6-5q 3a
WITH APPLICATION
PHONE 'l LR
3 C FAX
-1 IV 3 - -
PROPERTY TYPE
QSINGLE FAMILY/NEW CONSTRUCTION
SIZE
$ C� _ `��
0 TWO FAMILYAMW CONSTRUCTION
STORIES
PERMIT TYPE
0 ADDITION
0 GARAGEISHED
0 WINDOWS
0 BASEMENT FINISH
(ROOF
0 DRAIN TILE
0 DECK
0 SIDING
0 OTHER
0 SWIMMING POOL
TYPE OF WORK:
0 NEW
0 ADDITION
0 MAINTENANCE/REPAIR
0 REMODELING
DESCRIBE WORK BEING DONE: - "�0, P L-44-, - J - f _ r O
312E OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft.
1OOFING
QUIvBER OF SQUARES a
SARA ES
'ROPOSED SIZE:
?ROPOSED HEIGHT:
"JNG
7 Vicryl
Aluminum
Other
WINDOWS
N EXIST NG OPENINGS OYes ONo
JR FOR NEW OPENINGS -DESCRIBE SIZE OF
JPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
0 HOUSE & GARAGE
0 ATTACHED GARAGE
0 DETACHED GARAGE
OSoffit
0 Trim
0 Fascia
LOCATION OF WINDOWS
NUMBER OF WINL
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:
I . Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TAT A i TAT! V A i TT A TT^W @ -72,r) I . fW! d TTTl A Xd1V TV1±1G'
Permit Fee
$ ®ice .� �'
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ 3,01 01
.001 times the total job valuation
Surcharge
$ I . S�A
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ F�' P120
$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
$ C� _ `��
Make checks payable to: City of Fridley 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 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 Xvhich requires review and approval of plans. /� P (�
SIGNATURE OF APPLICANT K0i PRINT NAME i K • W pb,p DATE '"I I 1
Building
Inspections
763-572-3604
DATE C/ C': -r
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
PLUMBING Permit No.: Y-1
RESIDENTIAL APPLICATION Received By:
CITY OF FRIDLEY/ Date Recd4.,9/_/1
Z aO i0 YOUR E-MAIL ADDRESS G� i Z� K-1zi� /'?P • G o
❑ OWNER ❑CONTRACTOR
1 1 C'
G1
NAME:
STATE LICENSE #
EXP DATE
,TE,&WZIP
ADDRESS: CITY STATE ZIP
PHONE
® NEW
FAX
FAMILY ❑ TWO FAMILY
CEMENT
❑ TOWNHOUSE
DETAILED DESCRIPTION OF WORK C' -!n— p to e-,--- W -4-4e r G! e- -L*.e e—
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;J'ROJECTS WHERE LABOR EXCEEDS -$500; -FEES ARE BASED ON $10.00 PER FIXTURE,EXCEPTS MRENDT:ED::FIXTURES ..(INDICATE TOTAL
NUMBER OF EACH BELOW)
_ BATH SINKA AV _FLOOR DRAINS _ SHOWER _ WATER PIPING
—BATHTUB GAS PIPING MFED cmucmz) _ SWIMMING POOL _ WATER SOFTNER ($35)
_ CLOTHES WASHER —KITCHEN SINK —WATER CLOSET _ BACKFLOW PREV. ($15)
—DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_ WATER METER —OTHER
Permit Fee $ Number of fixtures @ $10.00 1 X$10.00=$ 10, bb
Surcharge .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 o es of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applicati f a perm' and w rk is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all or hich uires r pproval of plans.
SIGNATURE OF APPLICANT L PRINT NAME DATE
City of Fridley - -
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977