PRE 2010 DOCSDate:
Owner:
Address
City of Fridley, Minns
BUILDING PERMIT
N® 1-586
,t
Builder.................. .. _.__.._.._._........ ... _........ .............. _......
Address......... ...........:.::.�-�;.�........._ ��':_._.,�'...................... _..__..._...
LOCATION SOF BUILDING
NO. ..... � ..... Street `.. ....W.: ,_._ .. ,.t ..R...... Part of _..............
Ilk
Block t� ..............---- Addition or Sub -Division .... - ...._. g4 +� � ` �►
Lot ....._.. ._... .._ .....- v`
Corner Lot ..... -.........
............. Inside Lot ............... .............. _........ Setback :': ....... Sideyard ....._ _.�'............. ............. _.........
..
SewerElevation ..... ............................. _......._..._.....__...._......._..................._........ Foundation Elevation ................................... .............. _........................... ..................
DESCRIPTION OF BUILDING
To be Used asp f
71
�._.,Front Depth ..._.." ,rte
` '.rte.
p Height _.: Sq. Ft. Cu. Ft..
L.I.°�fconstruction
V.d..._.:........... Frnni.a.. °Depth ......... -height _€+" Sq. Ft.....,[, "
/ate
Type . :�E,� .. Est. Cost ... .... .... ..�+ ..::.....:.. To be Completed ................. __............._..._.._........
• � s yam} �.' .1
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 all provisions of
ordinances of the city of Fridley.
.tr" .......... _.__. _ ___ _... .___...._...._......._....
In consideration of the payment of a fee of $.; " Ir ................. permit is hereby granted to ..................................... .........._......._..
_._.....___.._..._..... .............. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen,, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation_ of any of the provisions of said
ordinances. e"�4 Al
wilding Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing,, gas heating, sower or water. Be sure to see
the Building Inspector for separate permits for these items.
4
i
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Builders -
Address
LOCATION OF BUILDING
No. Street Part, of Lot_,
a
Lot Block `�- Addition or Sub,Div. �
Corner Lot ' Inside Lot______Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Height
Sq. Ft. Cu. Ft,
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in'this.application are true and correct.
DATE SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
I
City pf Fridley
Application for Plumbing and Gas Fitting Pennit
-- Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK Ic�
Number, Kind and Location of Fixtures Location
47
NO.
RATE
TOTAL
N
x
$1.50
$
Future Fixture Opening ................
w
�QjZF
w
ta�3Z
Gw
.I
C7
�U'
Z
z
�U'
®
`
N
WATER HTR.
GAS
ELEC
Water Heater (Up to 200,000 BTU) ......
�+
2.00
Q
?
3
o
$
LL
u
<
U�' nd
a4
O
$1.50
$ ® 6
Additional Fixtures ....................
x
.50
$
.�7
x
2.00
$
Base
I
�'
1st.
�-
2nd
_
3rd
4th
Future Connection Openings
Connected withI
Sewer
New Fixture, Old Openings
Cesspool �]
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$
Future Fixture Opening ................
cP, x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
Z x
2.00
$ "
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ...........................
x
$1.50
$ ® 6
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ......... .......................................$
TOTAL FEE 41
City of Fridley:
The undersigned hereby .makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Adi 19 6
e
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old e uilding Permit
ROUGH W , '� ? C/, —
FINAL .
a 2 2MI 7-59
By v v r
Business Phone No. �—
A
CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 190
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00 $ 3& representations stated in this application are true and correct.
(Side Vent — Fill Out Back) ;U. ,1996
Gas Piping (Needed with new furnace) $10.00 $ OWNER — %�;
I(YiGt,� �
Gas Range $10.00 $
BUILDING USED AS
Gas Dryer $10.00 $
ESTIMATED COST aV101 PERMIT NO.
*Air Conditioning — All Sizes $ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water)arm Air}
Trade Name ftmLj�ca+irlLbir Size No. &UK --►S
Commercial/Industrial BTU —ISr HP EDR
1.25% of Value of Appliance or Work $ Fuel fN&1noroJ CxLv-S Total Connected Load
State Surcharge $.50 Burner Trade Name Size No.
60 BTU HP EDR
TOTAL FEE DEPENDABLE INDOOR AIR QUALITY. INC.
HEATING COMPANY 2619 COON RAPIDS BOULEVARD
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION COON RAPIDS. MN 66433
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed B vyz� (I t,+ 1 nTeel No. 5Q40
PLUS THE $.50 STATE SURCHARGE. _ l
REINSPECTION FEE $42.00/Hr Approved ByRough—In Date Final Date
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE OR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (9 --No ( )
2. Is free from rust or deterioration Yes (—)-No ( )
3. Has no foreign objects lodged within Yes() No (ra-
4. Is securely supported Yes (-)-,"No ( )
5. Meets all current Code requirements for size
and total BTU's connected Yes (,-)) No ( )
6 Has total heating BTU's of �-
All other BTU's
TOTAL BTU's
44o. o
7. Has a liner been provided for water heater Yes () No (�
8. Has combustion air been provided for water heater Yes No ( )
Remarks:
List ALTERATIONS Being Done.
6agaaffillat- Zeta q�?
HEATING CO:
Signed By:
Date:
DEPENDABLE INDOOR AIR QUALITY, INC.
2619 COON RAPIDS BOULEVARD
�nnni PAPinG um rr%,aR."4
CITY OF FRIDLEY INSPECTION DIV.
,6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On May 10, 1999
MARK NUMBER OF
FIXTURES
TO BE INSTALLED
ON EACH FLOOR
Shower r
Wash
.:.fit.... -
�..
Floor
n
:. .....:.:.......:....:........
Auto.
�: Washer `: :Ran
'ft:::::::::. .>:..>�:`..::..
Gas
e
Water
Heater:
Stories
QUrinal
.�:..
..r.::
,...
Elec
Basement
t
Floor 1
E
Floor 2
............
Floor 3
Floor 4
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOBADDRESS-HO RICE ifgEEK 74rif,
New Fixtures .,. $ 7.00 •04 The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin $ 7.00 and representations stated in this application are true and correct.
Catch Basin $ 7.00
Rain Water Leader $ 7.00 ,1999
Sump/Receiving Tank $ 7.00
Water Treating Appliance $10.00 Owner
Water Heater -Electric $ 7.00
Water Heater - Gas** $10.00 Building Used As IiPd/ %D
Gas Range** $10.00 n� /
Gas Dryer** $10.00 Estimated Cost 3087®. 0 0 PERMIT NO. 979 / c�
Back Flow Preventer Required ( )Yes () No g^
Type $15.00 PLUMBING COMPANYz�t/
Reinspection Fee $47.00/Hr SIGNED BY ' i TEL NO.-�!�
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved B Rough -In Date Final Date
State Surcharge $ .50
MINIMU FEE ZFR ANY PLUMBINGIGAS PERMIT IS $20.00
TOTAL FEE $a,50 PLUS THE 5.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
Building
Inspections
7.63-572-3604
DATE
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
ca
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
B YOUR E-MAIL ADDRESS
O OWNER ®GONTRACTOR
TADDNAS:E:
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
DETAILED
COMPANY NAME:_
CONTACT PERSON:
Permit No.:
Received By:—
DateRec'd: �'1' jL0
A
STATE LICEN # EXP DATE
ADDRESS: 1` ��l t ®�^� STAT1 ZIP�`�
PHONE -1& 3 � _ FAX
WGLE FAMILY ❑ TWO FAMILY
.W a REPLACEMENT
)WORK
0 TOWNHOUSE
❑ ALTBRATIONMEMODEL
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) MODEL: SIZE/BTU
Equipment Installed MFG: SIZEBTU
MFG: MODEL: SIZEBTU
MFG: MODEL:
AJC $25.00 E LACE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL 0.0.00
_BOILER $35.00 _FURNACE $35.00 GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 PONT. HEATER $35.00
VENTILATOR $15.00
DUCT WORK $10.00 PIPING $10.00
$ Number of fixtures @ $10.00 x$10.00=$
Permit Fee
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $ O
TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota -Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of irk which requir eview and approval of plans.
X $�2
SIGNATURE OF APPLICANT PRINT NAME �� -��,411 -
DATE
City of Fridley
Building Inspections Department .
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
3uildin9
$
BUILDING
See Back Page for Fee Schedule
Permit No.:
nspections
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604
.001 times the total job valuation
CITY OF FRIDLEY
$
Date Rec'd: — 1 6�
.0005 x Permit Valuation Minimum $.50
)ATE /
YOUR E-MAIL ADDRESS
$5.00 (State Licensed Residential Contractors)
;ITE ADDRESS 1'7c>
rC e C�ce fc
i HIS APPLICANT IS:
❑ OWNER IRCONTRACTOR
$
PROPERTY OWNER/
NAME: P'o,6 -C 14 L K
Erosion Control
ADDRESS:c? Rk-e Cp': CITY
STATF0411P sS`P 3S`
TENANT
Park Fee
PHONE:
CONTRACTOR
NAME:
$
STATE LICENSE # 2,c>S i a 9 EXP DATE
Agreement necessary ( ) Non Necessary ( )
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: 9/-"4 01-V CITY "&q--
STATI ZIP SS�t3`r
WITH APPLICATION
PHONE i L- Z 5(- - -S `76$7 FAX `7 (= 3- ?6S--'7(35-3
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 P OT,IiiER ;
❑ SWIMMING POOL /=� dam",
—
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ODELING
DESCRIBE WORK BEING DONE: �� -; -L� ZE L' A r e P J A t. --4Z-
SIZE OF IMPROVEMENT Z LENGTH WIDTH
HEIGHT / Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
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
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes
OND LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ IL/ a S> --1?OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
®
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$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
$
. L! 0
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 which requires review and approyl of plans. c�
SIGNATURE OF APPLICANT PRINT NAME !: I2— DATE (� �'
Building
AND MATERIALS:
BUILDING
Permit No. ' �
InspectionsRESIDENTIAT,
TOTAL JOB VALUATION
APPLICATION
Received By
763-572-3604
'r ��
CI'T'Y OF Phi L,EY
Dat d:
p r� ,i� ,/
DATE -1 ., 8 1 o Y UR E-MAIL D U f S 6D Q I f r j 0 i Q S. C 0
ADDRESS rh
g
SITE ADDRESS 1U 1.� 1 7-u f
/, 03
THIS APPLICANT IS:
❑OWNER CONTRACTOR
$
PROPERTY OWNER/
NAME:P> Q / Q a
License Surcharge
TENANT
ADDRESS: 190 1 u. C r ~�:
CITY i t (r 1t I� -STATE—ZIP—'!5'19 N 3
SAC Charge
PHONE: 763(,562 - 07-77
CONTRACTOR
NAME: FHD At- Home Services, Inc.
Jodi t b <
STATE LIC 2690 Cumberland Pkwy, Ste 300
TEA t 3 Y - G 0 y'7
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS Cumberland Office Park
CITY STATE ZIP
WITH APPLICATION
PHONE Atlanta, GA 30339-3913
D SINGLE Lie# 20268257 Ph. 763/542-8826
=E
PROPERTY TYPE
fewer Main Charge
O TWO FA
.ORMS
PERMIT TYPE
QADDITION D GARAGE/SHED
OVINDOWS
t 10 7, 7
D BASEMENT FINISH D ROOF
D DRAW TILE
D DECK D SIDING
0 OTHER
17 SWIMMING POOL
TYPE OF WORK:
D NEW D ADDITION
OVAINTENANCE/REPAIR D REMODELING
DESCRIBE WORK BEING DONE: W I 11(,(v tJ PA .A
19 //I
SIZE OF IMPROVEMENT LENGTH
WIDTH TA.TGHT . Ft.
ROOFING
D HOUSE ONLY
NUMBER OF SQUARES
D HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
D ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
D DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
D Vinyl
13soffit
ADDITIONS. & PORCHES SUBMIT:
D Aluminum
D Trim
1. Site Plan/Survey showing the existing structures
D Other
D Fascia
and proposed project
VW'MOWS
2. Two sets of construction plans
IN EXISTING OPENINGS Nes []No LOCATIQQN OF WINDOWS
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF [.1
DPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
NUMBER OF WINDOWS
ALL FEES ARE ]BASED ON VALUATION, INCLUDING THE COST OF LABOR
AND MATERIALS:
(USING $
[•
99 U.B.0 FEE SCHEDULE)OOCCUPANCY
TOTAL JOB VALUATION
TYPE
Permit Fee
$
'r ��
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
surcharge
$
/, 03
(.0005) times the total job valuation — Minimum $.50
Eire Surcharge
$
G 1.
.001 x Permit Valuation (1/10%)
License Surcharge
$
-6.60
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
:�urb Cut Escrow
$
ft + 6 ft = ft x $20 = $
erosion Control
$
$450 Conservation Plan Review
?ark Fee
$
Fee Determined by Engineering
fewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Fatal Due
$
t 10 7, 7
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
:onformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
)ermit 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
)Ian in the case of all work which re uires re 'wand. approval of plans.
:IGNATURE OF APPLICANN , f PRINT NAME ` ! e �� l� DATE