PRE 2010 DOCSBalding
$
BUILDING
See Back Page for Fee Schedule
Permit No.: _-404-- l
Inspections
$
RESIDENTIAL APPLICATION
65% of Building Permit Fee
Received By:
763-572-3604
"7 &</
CITY OF FRIDLEY
Fire Surcharge
Date Rec'd:
a ✓�//
.001 x Permit Valuation (1/10%) q
DATE!
�I, /MATT ��Dq
SITE ADDRESS
� _
ZZ, i l_P ol�O C ! y'D
$
THIS APPLICANT IS:
JWOWNER ❑CONTRA TOR
Curb Cut Escrow
PROPERTY OWNER/
NAME:
ft + 6 ft = ft x $20 = $
TENANT
ADDRESS: CITY
STATO IP'
$450 Conservation Plan Review
PHONE:
$� �°
CONTRACTOR
NAME:
$
STATE LICENSE # EXP DATE
Agreement necessary ( ) Non Necessary ( )
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
.SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
TITTW❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: " '0Z4Xxofw ,5 f/
SIZE OF IMPROVEMENT LENGTH - <�J ✓ WIDTH
HEIGHT Sq. Ft.f
ROOFING
allOUSE ONLY
"
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT: 3 ��
1. Existing Floor Plan
GARAGES .s� /
❑ ATTACHED GARAGE
2•
Proposed floor plan
PROPOSED SIZE: /a/
PROPOSED HEIG_HT�-
❑ DETACHED GARAGE
3.
List of structural members to be used
SIDING /Yq
A j Ji
FOR NEW CONSTRUCTION INCLUDING DECKS,
R Vinyl Gam! 1
�—YC� �7- Ql _C 'Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
;0 Fascia
and proposed project
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS laYes ONo 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:
TOTAL JOB VALUATION (USING /� � , M3 E SCHEDULE)
OCCUPANCY TYPE
Permit Fee
$
23629,76
See Back Page for Fee Schedule
Plan Review
$
8
65% of Building Permit Fee
Surcharge
$
"7 &</
(.0005) times the total job valuation —Minimum $.50
Fire Surcharge
$
91 199
.001 x Permit Valuation (1/10%) q
License Surcharge
$
$5.00 (State Licensed Residet}tial Contractors)
SAC Charge
$
% S� , ®®
$1450 per SAC Unit (Plans to MWCC for determination) ` (5PL01
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$� �°
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due 5-183,
_ ®
Make checks Davable to: Citv of Fridlev 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 which requires review approval of plans. �A S ,
SIGNATURE OF APPLICANT PRINT NAME !'f%'U44&-/ �Aq� DATE
JUN -26-2005 08:27 AM
MNCheak COMPLIANCE REPORT
Minnesota Energy Code Permit I
MNoheck Software Version 3.0 ooei/
f Checked by/Daum
f 1
COUNTY: Anoka
STATE: MinnQsota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 6-2-2005
DATE OF PLANS: 2-2-05
TITLE: 05106
PROJECT INFORMATION:
model.
COMPANY INFORMATION:
JOHN STAHMM HOMES
COMPLIANCE: PASSES
Required UA - 363
Your Home - 279
Area or Cavity Cont. 41aaing/Door
Perimeter R -Value R -Value U -Value UA
------------..»,.------------------------------------------------------....,,-------
CEIL,INGS 1397 44.0 0.0 36
WALLS: wood framer 161, O.C. 1932 19.0 2.0 108
BSMT: Conc. 3.51 ht/2.81 bg/3.51 insul 353 11.0 0,0 40
GLAZING: Windows or Doors, Above Grade 242 0.350 85
DOOR; 36 0.120 5
FLOORS: Over Outside Air Be 30.0 0.0 3
HVAC EQUIPMENT: Furnace, 90.0 AFUE
-----------_...,--------------------------------------------..----...,--------. -----
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plana, specifications, and other aaloulations
submitted with the Permit application. The proposed building has been
designed to meet the requirements of he Minnesota Energy Code.
Builder/Designer �' Date t3'r
P.01
F FRIDLEY
1 University Avenue NE
Fridley, MN 55432
FAQ. it ANSM 11AL: SHE -ET::,
TO:
From:
FAX #:
67/
J
G
PHONE #:
PHONE #:
DATE:
SUBJECT
NUMBER OF PAGES (mciuding cover)
0 URGENT ❑ FOR REVIEW O FOR COMMENT 13 PLEASE REPLY
NOTES/COMMENTS:
/ C/e allo"oo'v 00�
a y
bta
Wei It
Lvpn
A/
Pe
iec S
7'
- /, � & r0A J
Y
City of Fridley Building Inspections Dept.
6431 University Ave NE
Fridley MN 55432
Mechanical
Ph: 763-572-3604 FAX: 763-571-1287
Residential Application
City of Fridley
See Back Side For Required Information
Permit #
Date -(,R -05- Site Address: I e- Vee_
The applicant is: (cirice one)
Owner Contractor
Property Owner.
Address: N,9 G{ -
R e �e
City: re ,`d 0 e s4
State: N4., , Zip: 5.s -q 3 9 -
Phone:
Cell: 7 4 3 - O Fax:
Contractor Information
Company Name: Si,
✓m - "Stle,,,-
Contact Person: &A,
Address: :5 d,%,
le d
City: eLde. P�kf
Phone: -
State: P.,,- , Trp:5s Y �-
Cell: 619 -34G- un ( Fax: 763- 7 9.5=Li 9 3 7
Email:
MN Bond# & Exp Date a -
Type of Work (circle one):
Ne Replacement Alteration/Remodel
Detailed Description of work:
U ® o�
Equipment Installed: MFG: Model: SizeBTU: 76,000
MFG:
I r Model:0-ki- 9,14-1—Size/BTU: av
MFG:
--- Model: Size/BTU:-----,
Please check all that apply:
_Fireplace (gas) $15.00 New Gas Grill $10.00
�C A/C $25.00
_Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Air to Air exchanger $15.00
Y Furnace $35.00 _Pool Heater $35.00
_Boiler $35.00
_Gas Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00
,Gas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $ . / J (Total from above -Minimum fee $35.00)
Surcharge $
0.50
Total Due $
95st Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical 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 startwithout a permit; that the work will be in accordance with the
approved pian in case of all work which requires review and approval of plans.
c
Signature of Applicant: Date: q
Approval Inspector Signature: Date:
Please Note: Separate permits are required for Building, Plumbing, and 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 Propan&UGC 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
HEAT LOSS CALCULATIONS
46823.64
FOR: MATT GRABAN
SEPT 26, 2005
1424 RICE CREEK ROAD, FRIDLEY, MN
FRONT ELEVATION - ABOVE GRADE
WALLS, WINDOWS AND DOORS
WALLS, WINDOWS AND DOORS
AREA
M.F.
AREA
M.F.
BTUH
GROSS WALL 616
-
28.16
GLASS 95.75
28.16
2696.32
DOORS 21
41.36
868.56
PATIO DOORS
88.00
0.00
NET WALL 499.25
3.52
1757.36
INFIL - DOORS 20
118.80
2376.00
INFIL - WINDOWS 111
47.52
5274.72
8162.00
TOTAL
12972.96
RIGHT ELEVATION - ABOVE GRADE
SPACE, CEILING, MISC.
WALLS, WINDOWS AND DOORS
AREA
M.F.
AREA
M.F.
BTUH
GROSS WALL 539
---
28.16
GLASS
28.16
0.00
DOORS
41.36
0.00
PATIO DOORS
88.00
0.00
NET WALL 539
3.52
1897.28
INFIL - DOORS
118.80
0.00
INFIL - WINDOWS
47.52
0.00
0.00
TOTAL
1897.28
REAR ELEVATION - ABOVE GRADE
WALLS, WINDOWS AND DOORS
AREA
M.F.
BTUH
GROSS WALL 616
---
GLASS 84.75
28.16
2386.56
DOORS
41.36
0.00
PATIO DOORS 42
88.00
3696.00
NET WALL 489.25
3.52
1722.16
INFIL - DOORS 26
118.80
3088.80
INFIL - WINDOWS 83
47.52
3944.16
TOTAL
14837.68
TOTAL BUTH
46823.64
DATE
SEPT 26, 2005
LEFT ELEVATION - ABOVE GRADE
WALLS, WINDOWS AND DOORS
AREA
M.F.
BTUH
GROSS WALL 513
-
GLASS 42.5
28.16
1196.80
DOORS 21
41.36
858.56
PATIO DOORS
88.00
0.00
NET WALL 449.50
3.52
1582.24
INFIL - DOORS 20
118.80
2376.00
INFIL - WINDOWS 45
47.52
2138.40
TOTAL
8162.00
BASEMENT WALLS AND FLOORS, CRAWL
SPACE, CEILING, MISC.
AREA
M.F.
BTUH
BELOW GRD WALL 708
-
BELOW GRD WIND.
28.16
0.00
NET WALL 708
3.00
2124.00
CEILING 1397
1.76
2458.72
BASEMENT FLOOR 1297
3.00
3891.00
EDGE LOSS 160
3.00
480.00
INFIL - WINDOWS
47.52
0.00
0.00
TOTAL
8953.72
Date: 9/26/2005 Revision Date: 9/26/2005
Site Information
Address 1: 1424 RICE CREEK ROAD
Address 2:
City: FRIDLEY, MN County: ANOKA
Application Infonnation
Business Name: MATT GRABAN
Contact Person:
Office Ph: Fax: Cell Ph:
Address 1:
City: State: Zip Code:
New Construction
Project #:
Lot: Block:
Subdivision:
MN Contractor License #:
House Details
Square Feet: 2694 sq. ft. Avg. Ceiling Ht: 8
ft. Number of Bedrooms: 3
Ventilation : Balanced
Total Ventilation Capacity: 94 cfm.
Minimum Continuous Ventilation :60cfm.
Balanced Ventilation: 94 cfm Exhaust Ventilation: 0 cfm
Combustion Appliance
Water Heater: Direct Vent/Sealed Combustion
Input BTUs: 40,000 Independently Vented
Furnace/Boiler: Direct Vent/Sealed Combustion
Input BTUs: 70,000 Independently Vented
Other Combustion Appliances
Gas Fired Direct Vent Fireplace(s): No
Gas Fired Power Vent Fireplace(s): No
Gas Fired Natural Draft Fireplace(s): No
Solid Fuel Appliance(s): No
Exhaust Eguipment
Exhaust Ventilation Capacity (cfm): 0
Clothes Dryer (cfm): 135
Exhaust Fan Rating (cfm): 135
Make -Up Air
No Make -Up Air Required by Code
Combustion Air
Minimum Combustion Air Requirements Have Been Met.
Applicant Name (print): Signature/Date:
Code Official (print): Signature/Date:
0 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines. Page 1
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
0,�= ® t
Permit Number
Received By
Date Received
NOTE: IF PROPERTY IS NOT OWNER(OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT -
DATE 'F L4 YOUR E-MAIL ADDpRESS
SITE ADDRESS % Li �� i C e- G e -e v--
THE APPLICANT IS: (CIRCLE ONE) OWNER O TRA
NAME
PROPERTY OWNER/
ADDRESS
TENANT
CITY STATE ZIP
PHONE #
NAME Q(%Ae- W J 4r— Plv w-6-^� ± q,--4;�; r10ENSE # 2PV7
ADDRESS S Oa !O 4/ ks Ad
CONTRACTOR
CITY Pr•'ge- @,61 STATE e!!!d✓ ZIP
PHONE # '?&3— a3a-100 - FAX#
PERMIT TYPE
X SINGLE FAMILY TWO FAMILY TOWNHOUSE
TYPE OF WORK
NEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED
FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
BATH SINK/LAV L FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35)
CLOTHES WASHER KITCHEN SINK > WATER CLOSET BACKFLOW PREY. ($15)
__L_DISHWASHER LAUNDRY _WATER H 5) FOR IRRIGATION
_
WATER MET OTHER
MU),L(
Permit Fee $ MINIMUM: $15.00 or 5% of cost of the Improvement -whichever is
Plan Review $ greater on work less than $300
Surcharge $ .50
TOTAL DUE $�® Make checks payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT — NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 plan's.
I
NAME OF APPLICANT � e 2°J \ DATE
leas or pri
SIGNATURE OF APPLICANT
4 _ � ._ . � _ 3 .. .r -.Y , .�. , . �.� +,_,' �3_ � . w _Y .. ..,.. .r. �' 6_..u.3"�... ...... e ' .u+�-.. v _ s`.'s_._ ...max=..-_ ..... ._....�• �....-.q`F... � .. .�. �-'�.r.. .. :�
CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT
6431 UNIVESITY AVENUE NE, FRIDLEY, MN 55432
(763)572-3604
i�—
City of Fridley � tee.. 6
6431 University Ave NE
Fridley MN 55432
(763) 572-3602 or Fax (763) 502-4977
Water and Sewer Permit Application
New Connection
❑ Existing
Date: 10– 3-0 S
❑Utility Line Repair/Relocation
❑Water and Sewer Connection
Job Address: I 2 yl ? 1 cc
Name of Applicant (Plumber):
Name of Property Owner: 4 G
Existing Structure Permit #
Permit Type: Sewer Fee: e16
Water Fee: )—
Meter Fee:
Repair Fee:
Relocation:
State Surcharge:
SAC Charge:
Special Assessment Fee:
o
Total: $ A!�-I-
el
Applicant Signature: z
Inspector approval:
Water Meter Repair – Weekend & Holidays
$125/hour
Water Connections Permit
$50
Sewer Connections Permit
$50
Inspection Fee for Water/Sewer Line Repair
$40
Special Assessments
See Engineering
Cost of Water Meter
See Utility Billing
SAC Charge
$1450
State Surcharge
$ .50
Water Tap
See Engineering
04/04/05
US—
Building
$
BUILDING
Permit No.:
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Fire Surcharge
CITY OF FRIDLEY
Date Rec'd:
DATE
YOUR E-MAIL ADDFASS
$5.00 (State Licensed Residential Contractors)
SITE ADDRESS
I
$14 0 per SAC Unit (Plans to MWCC for determination)
00
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
ft + 6 ft= ft x $20 = $
PROPERTY OWNER/
NAME: ., u d C,G
$450 Conservation Pan Review
n
ADDRESS: AL o CITY r� ', `��
STA _Z
TENANT
Sewer Main Charge
PHONE:
Z2 62177 -
Agreement necessary ( ) Non Necessary ( )
CONTRACTOR
NAME:
Make checks payable to: Ci of FridleyAttach Stipulations
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
PROPERTY TYPE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
I • Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WII',TDOW 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 $ OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
.001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$14 0 per SAC Unit (Plans to MWCC for determination)
00
Curb Cut Escrow
$
ft + 6 ft= ft x $20 = $
Erosion Control
$
$450 Conservation Pan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks payable to: Ci of FridleyAttach 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 mfl 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 r ' iew and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME /JJ L � � ' DATE_
Reference No. 601-05-
0656 Request For Service Report
-City of Fridley � a
Service Requested wateilsewer inspection "DAte lI/4/OS Time 8:45 `AM
Department Public Works
Division Water
Location of Service need 1424 Rice Creek Rd
Owner or Agent of Property Dustin Phone: (H) 612-328-530
Name of Citizen
Address
Phone: (H)
a
Details of Request New home water & sewer inspection needed. Appointment set for Friday,
November 4, 2005 @ 10:30 AM.
r S -e 1 "e, L.
Date Cleared / /f . 4/ 6 S—
Citizen notified es No -
Signature of person clearing request �`�'"
's
cmroF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432
(763) 571-3450 • FAX (763) 571-1287 • TTD/ITY (763) 572-3534
Single Family
February 17, 2006
Michael Sherman
1424 Rice Creek RD NE
Fridley, MN 55432
Re: Final Inspection 1424 Rice Creek RD NE
Dear Sir:
A final inspection was conducted on February 17, 2006 for the completion of the dwelling
at the above address. The inspection noted that the construction was completed
according to the approved plan but the following items need to be completed before the
building permit can be finaled out;
1. Provide sod in the front and side yards by June 15, 2006.
2. Install hard surface driveway by June 15, 2006.
3. Maintain silt fence per City Engineer until the sod is established
We will expect the above items to be completed by the scheduled dates and a
reinspection called for. The dwelling is approved for occupancy.
If you have any questions concerning this matter, please feel free to contact me at 763-
572-3603.
Building
See Back Page for Fee Schedule
BUILDING
Permit No.: L� C
Inspections
.001 times the total job valuation
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$5.00 (State Licensed Residential Contractors)
CITY OF FRIDLEY
Date Rec'd:
DATE
YO E-MAIL ADDRESS
$
SITE ADDRESS 1 q
9
Fee Determined by Engineering
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
$
PROPERTY OWNER/
NAME:
ADDRESS: t CITY
STATE ZIP
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
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:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE 3.
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit ADDITIONS & PORCHES SUBMIT:
❑ Ahuninum
❑ Trim 1. Site
Plan/Survey showing the existing structures
❑ Other
❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
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 OP' LABOR AND 1VJA 1 ai.a:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 1 114 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
$
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)
$
9 ft+ 6 ft =�. ft x $21= $ Clio
$
$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 cod 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 peand 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 ret,t' o review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME DATE
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