PRE 2010 DOCSSUBJECT
PERMIT NO.
City of Fridley
28436
®TSE ° THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
`
r I PROTECTIVE INSPECTION SEC.
16
NUMBER
REV
DATE
PAGE OF
F/
APPROVED BY
CITY HALL FRIDLEY 55132
'•�
L____�%
612-571-3450
910-F15
10/27/98
JOB ADDRESS
1601 Rice Creek Road
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
Auditor's Subdivision #22
SHEET
2 PROPERTY OWNER MAIL ADORES$ ZIP
PHONE
Judith Hartman571-3095
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Owner
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LI I EENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof house and garage 31 SO Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCU ANCY 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
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
2656
$1.33
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
$74.75
Fire SC $2t66
PLAN CHECK FEE
TOTAL FEE
78.74
SiGNATu EO CONTRACTOR OR iDATEi a
WHEN PROPERLY LI DATED THIS IS YOUR PERMIT
ii
e $ NA R OF OWNE .� OW B LO iOAT i
BLD 11
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION \�
ConstructionAddress: 14701
Legal Description:
Owner Name & Address: -7T� LAS) Tel. #
Contractor: MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
PP Y
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
Height S
GARAGE AREA: Length Width Hei g q. Ft.
DECK AREA: Length Width Hgt/Ground Sq.
OTHER: 1
Construction Type: �00 �/ Estimated Cost: $ , �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
/j/2,7 7/ ---3 F.S�
DATE: � �
APPLICANT: � �L,A
Tel. #
. STIPULATIONS:
CITY USE ONLY
Permit Fee
$ / �% %3l
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
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
$ �7
. STIPULATIONS:
SUBJECT
.
City of Fridley
874
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
NO.
EE7I
COMMUNITY DEVELOPMENT DIV.
-____ PROTECTIVE INSPECTION SEC.
u'_
jPT
r 1
1 . e
e®
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
763-571-3450
910415
9/11/03
JOB ADDRESS 1601 Rice Creek Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Pt 5
Auditor's Subdivision #22 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mike Corbett 1601 Rice Creek Road NE
763-502-1018
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
First Landmark Builders 255 Roselawn Ave
E STE 48, Ma lewood, MN 55117 1992
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
651-699-3135
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK p
P X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 24' x 23' 2nd Garage
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Special Use Permit #03-11 approved
for second accessory building. Permit
issued subject to special use permit stipulations
and stipulations on plan.
WAR111pi(i
3ef0re digging call f®r
all utility 10cetions
oo�
ff EUI By A
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
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
$12,207
$6.10
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
PROVI NS OF ANY OTHER ST4E OR LOCAL LAW REGULATING CON-
@223.25
W
Fire SC $12.20
STR TION R TH P E CONSTRUCTION
t
PLAN ECK FEE
TOTALFEE
#,-Inse SC $5.00
$246.55
SIGNATURE OF CONTR TOR AUTHORIZED AGENT tDATE,
WHEN PROPERLY VALIDATED THIS IS UR PERMIT
G ,N pA TE
S,GNATURE OF OWNERof OWNER BUiLDERi iDATEi
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (76 ) 572-3604 Bldg t sp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 (76 } TVr12 7`'
BUILDING PERMIT APPLICATION.
Construction Address: I c `%r Oa
Legal Description:'
Owner Name & Address: I Tel.
Contractor. � J�(R eMN LICENSE #
Tel. #
Address:�S
M�-r 1wook
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LNING AREA: Length Width Height _ Sq. Ft.
GARAGE AREA: Length Width — Height _ Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: OP Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE Tel. # .�_ APPLICANT:
pk4 r�-
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to Q3-571-1287 if using credit card and we will b
call you for card number.
CITY USE ONLY-
NLY-Permit
PermitFee
$ 3e ;;6
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ .10
$.50/$1,000 Valuation
SAC Charge
$.
$1275 per SAC Unit
License Surcharge
$ 5 00
$5.00 (State Licensed Residential Contractors)
Curb Cut Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$ 1
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ )
a"I (00 55 STIPULATIONS-
TOTAL
$
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 Rice
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1%0 of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $ _CD —IM
$ 10.00 $�
$ 10.00 $
$ 10.00 $
$ 25.00 $
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATIO
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.
Effective
OWNER MI L-- (26
c--
L�1 0
BUILDING USED AS S�G���-
ESTIMATED COST A ZD PERMIT NO. 6/2W
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units I Circle One (Steam) (Hot Water' A'
Trade Na a a Size No.
BTU 006 HP EDR
Fuel NK Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
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 CWNe-
Signed _�tTEL # -76 3 -56-3,
FAX #
F L
' Final Date 3
Approved By Rough -In Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When rye la _finnan axistin0 ftiranra, 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 (i No ( )
The venting system is plastidPVC 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 manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes( ) No( )
The pY_ intina r nmhuS inn alr is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to ina+ali a naw rnmhnnfinn air.,it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When installing a new ventingcpm, 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 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. Yes( )No(
)
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 M
HEATING CO:
Signed By. Date
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
June 15, 2004
Mr. Michael Corbett
1601 Rice Creek Road NE
Fridley, MN 55432
Re: Final Inspection at 1601 Rice Creek Road NE
Contractor: Homeowner
Dear Mr. Corbett:
A mechanical permit was issued on September 30, 2003 to install a furnace in your
garage. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date the inspection has not
been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and the permit will be expired.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
CinrerPly
DJ/mh
Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd: to—
CITY
_ YOUR E-MAIL ADDRESS
p
SITEADDRESS k DOI 1Ce, Q(te Y, YQ1A C l V'V" t dkey W
M F)51A�)'L
THIS APPLICANT IS: 0 OWNER CONTRACTOR
PROPERTY
NAME:
OWNER/
TENANT
ADDRESS: ��R-O O �,�_ C,1� _� CITY V 0 _®j STATAgZIP �
PHONE: -y645CONTRACTOR
COMPANY COMPANY NAME:
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
STATE LICENSE #_C,k0111y �p EXR DATE
LICENSE WITH
-
ADDRESS: Wyk c1lad d Lin WE CITY blainL STATKWz P�b_44
APPLICATION
PHONE --IU?) — 1 %') - IT5 Q !) FAX ILL?) - -1 %?) - Li b U W
PERMIT TYPE
X SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORT` •
0 NEW ;REPLACEMENT 0 ALTERATION(REMODEL
DETAILED DESCRIPTION OF WORK� ( _k l 0j Qtk 1 G Q n(i j t ®_ 1 n Q p
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the t-tal cost up to $500.00, whichever is greater, for the
improvement, installation or *:placement of a residential fixture, cxcludir.; the fixtures. (This should reflect only the (ost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 =. cost of labor x.05 =
FOR PRO.IECTS WHERE LABOR EXCEEDS 5500. FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL- S"EBTU
NIFG: ___ —. MODEL: S! 7E,3TU
_
MFG: _ MODEL: SI"LE'BTU _ _ �~-
)(A.0 525.00 _FIREPLACE (c?.;S);15.00 RANG:,OVEN SIU `iO
_GAS
-AIR TO AIR EXCHANGEER S15 _FIREPLACE (WOOD) $35.00 GAS GRILL S10.00
_NEW
_BOILER 535.00 FURNACE $35.00 UNIT IiTR 510.00
_GAS
CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
XDUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR 515.00
PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL. DUE $ Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures a, $ 35.00 x $35.00 = $
State Surcharge = $ .50
Total =
THIS IS AN APPLICATION FORA PERMIT-NOT VALID UNTIL PROCESSED �
I hereby apply for a building and I that information is
permit acknowledge the above complete and accurate: that the N ork will be in
conformance with the ordinances and codes of the City of Fridley and %ith the Minnesota Construction Codes; that I understand this is
not a permit hilt Only an application for a rmit and work is not to start without a permit; that the v ork will he in accordance with the
approved plan in the case «ork wh h requires eview and approval of ans.
Sly NArLREc�rrAPPLI( :�N " NTN:��1L•' DA'I J70 _
PLEASE NOTE: SEPA RATR,LiITS ARE REQUIRED FOR BUILDING, EL ,CTRICAL AND)`IECHANICA L WORK
Cite of Fridley
Buildin(y hispections Department
6-131 University Avenge NE, Fridley, MN 53432
763-572-3604
FAX: 763 -30? -4977
0
Building
$
BUILDING
See Back Page for Fee Schedule
Permit NoQ-66 i -603.a4
Inspections
&S';o
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572=3604
1 times the total job valuation
CITY OF FRIDLEY
$
Date Recd: 3h S-7
®
License Surcharge
$
DATE — �'p
YOUR E -MAI DRESS
SAC Charge
SITE ADDRESS
$1675 per SAC Unit (Plans to MWCC for determination)
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
Nom:
$
TENANT
$450 Conservation Plan Review
Park Fee
$
ADDRESS: CITY
STATE ZIP
Sewer Main Charge
PHONE:
CONTRACTOR
NAME:
$
STATE LICENSE # EXP DATE 0 -,q
00 7 -
SUBMIT A COPY OF
YOUR
YOUR STATE LICENSE
ADDRESS: d '� dt r7Ce e5®ice `/� _ CITY
STA IP
WITH APPLICATION
PONE Z16 -21 FAX -
PROPERTY TYPEINGLE
FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING 'MOTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ,!REMODELING
DESCRIBE WORK BEING DONE: / -142MV E�%�
SIZE OF IMPROVEMENT °rv'° LENGTH WIDTH
J HEIGHTSq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE -y rc
C
I •
2.
Existing Floor Plan
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
1.
Site Plan/Survey showing the existing structures
❑ Other .
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS�;&s ❑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 9
TOTAL JOB VALUATION $ 9 7!2Q FEE OCCUPANCY TYPE
Permit Fee
$
3-1, Q5
See Back Page for Fee Schedule
Plan Review
$
&S';o
65% of Building Permit Fee
Fire Surcharge
$
1 times the total job valuation
Surcharge
$
—.00
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
1:5®6
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 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
$
1-1(.44
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 whic)ftAuires revue ;ppoval of plans. .--,
SIGNATURE OF APPLICANT
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
ULZO
763-572-3604
CITY F FRIDI,EY
..eTeCc�d:_
DATE ' T "%0 Y� E-MAIL Affs
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY
Nom:
OWNER/
ADDRESS: Mot FA CITY WOLUM STA Z
TENANT
PHONE:
CONTRACTOR
NAME: 41� ilel
STATE LICENSE # i i `C t !1✓ f E DATE
-—�-'�---- / %
SUBMIT A COPY OF
YOUR STATE
ADDRESS ,� /1, C /'L %�� i�� t5� , CITY ✓ �� �' ��JG `��"i �Gf! STATT&; ZIP
LICENSE WITH
PHONE ' FAX
APPLICATION
"
PERMIT TYPE
SINGLE FAMILY I] TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
)(NEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK )I VIA
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$300 -FEES ARE BASED ON $10.00 PER FDCTURE, EXCEPT WHERE NOTED :FI)CRJRES;. INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV _FLOOR DRAINS _ SHOWER WATER PIPING
_
—BATHTUB ,� GAS PIPING (VEw crirucEaE) _ SWIMMING POOL _ WATER SOFTNER ($35)
CLOTHES WASHER .KITCHEN SINK_ WATER CLOSET _ BACKFLOW PREY. ($15)
DISHWASHER AUNDRY TRAY :WATER HEATER ($35) FOR IRRIGATION
,�
WATER METER _ OTHER
R Yn [' T
t }3` � � :;iA' �.�� g�av n+3a'i�yd',c ��• A ;h�:�"� .�.. _ y.
Number of fixtures @ $10.0010 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 all r h re s re w and approval of plans.
v DATE
SIGNATURE OF APPLICANT PRINT NAME
MINOR' 2, ullpfflga=1101 A
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
W
Building
PLUMBING
Permit No.:(�
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date
763-502-4977 FAX
EFFECTIVE I-1-2010
M c
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: OWNER ❑CONtTRACTOR
PROPERTY
NAME: A t
OWNER/
ADDRESS: I CITY C11 e LA STA ZIP
TENANT
PHONE:�LP
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
ADDRESS: CITY STATE ZIP
INSURANCE
PHONE FAX
SINGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE
PERMIT TYPE
.
11 NEW ARFPLACEMENT
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK e kaCa
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
L BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING
_FLOOR
BATHTUB —GAS PIPING (NEED CITY LIC) _ 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
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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 on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
- pn� �
tf
�^+�-► ` , PRINT NAME ` p', (WW DATE
SIGNATURE OF APPLICA �?
@Wl5e-
a
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
E
Building
MECHANICAL
Permit No.:, (A'
Received B: '
Inspections
RESIDENTIAL APPLICATION
763-572-3604
CITY OF FRIDLEY
A
763-502-4977 FAX
EFFECTIVE 1-1-2010
//��
DATE YOUR E-MAIL ADDRESS 0 MC -S-56 &MCAM, N er
SITE ADDRESS lbol Rice— c&_,W RA
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY
NAME: M ICfiNWL -4 WN de–
OWNER/
,ICOR n
ADDRESS: Itao I Q (� �etL CITY ti'=M D[.e�( STATEjNAjZIP U
TENANT
263 -- 5601 —16 l8"
PHONE:
CONTRACTOR
COMPANY NAME:
CONTACT PERSON:
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
SINGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE
PERMIT TYPE
TYPE OF WORK:
0 NEW 0 REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK ill XL- A-' I�'TfMQdOM_ lie: "B (NReIQp
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
' lid MODEL: sizvBTU C
Equipment Installed MFG:
6 NK QN�Tr1N
MFG: MODEL: SIZEIBTU
MFG: MODEL: SIZEBTU
$25.00 FIREPLACE (GAS) $15.00 _GAS RANGEtOVEN $10.00
_A/C
TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR _FIREPLACE
$35.00 $35.00 _GAS UNIT HTR $10.00
_BOILER _FURNACE
LINER $10.00 DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY _GAS
DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00
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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.
SIGNATURE OF APPLICANT'-) "— PRINT NAME L C4 DA
�
I
APPROVAL INSPECTORS SIGNATURE ' DATE
ty of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
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 MN Rule 1346 Sec. 501
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. N 1104.4.13
5. Ventilation
a. Per MN Rule Chapter 1322. Sec. 1104
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 No..20lD - C35�
Inspections
RESIDENTIAL APPLICATION
Received By: 1
763-572-3604
CITY OF FRIDLEY
DaAD 9"'
763-502-4977 FAX
EFFECTIVE 1-1-2010
/0
DATE
YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: Q WaCZr Z?'
TENANT
ADDRESS: % &` '
ITY�®�' STATEIP
PHONE: 7,o
CONTRACTOR
NAME: 0 a- x -e .
SUBMIT A COPY OF
YOUR STATE LICENSE
®pad
STATE LICENSE #ter i"`1�� , �I -
EXP DATE
AND CERTIFICATE OF
ADDRESS:_ m _?"�:,�`; ).
g v &rte _CITY'4;'2 PPJTATE IP
INSURANCE
PHONE �-"
FAX —
PROPERTY TYPE
PAINGLE FAMILY/NEW dONSTRUCTION
SIZE
/13 TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED
❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF
0 DRAIN TILE
❑ DECK ❑ SIDINGOTHER.
/',/
❑ SWIMMING POOL
/ /VA_rt1
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR AREMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH O 9 WIDTH ® HEIGHT J SQ FT 27
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
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:
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
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USIN Rp 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ J OCCUPANCY TYPE
Permit Fee $ d 5. :; L5 See Back Page for Fee Schedule
Plan Review $ 2 1. 41 65% of Building Permit Fee
Fire Surcharge $ 3 AQ.001 times the total job valuation
Surcharge $ 2. ` .0005 x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $22 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due _214 $ Make checks payable to: Citv 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 on site; that the work will be in accordance with the
approved plan in the case of all wor /which rs}uir s review and approval of plans. 00,
SIGNATURE OF APPLICANT PRINT NAME��� DATE ��
_4�
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