PRE 2010 DOCSCity of Fridley, Mim.
BUILDING PERMIT N?C5 3'7 4
Date: -- -- --- --
Owner: Builder
Address _ _ __ _ _ Address
® TIO OF
No. i_ Street _ Part of
Lot ` _ ._ Block _ Addition or Sub -duds - •----
Comer Lot _ Inside Lot _ _ Setback's —_' Sideyard _—
Sewer Elevation _ _ Foundation Elevation
DESCRIPTION OF BUILDING'
_�
40( Frond J4'Depth ? He1004 ight _ Sq. Ft. Cu.' Ft'
o Depth Height Sq. Ft. Cu. Ft.
t
Type of nstruction ' ti Oo y --- 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 all provisions of
ordinances of . the city of Fridley.
In consideration of the payment of,a,fee of $.""r , permit is hereby granted to.._._.
to c0=4 the building or addition as described above. This permit is granted upon
the express condition that the 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 violatro any of the provisions of said
ordinances. +'
T , , ding Inspector
NOTICE:
W
This pomlt does not cover the construction, installation ico�rlringj plutebfng, eas'heatin®, sewer or water. Be sure to sea
the Building Inspector for separate permits for these Items.
Address
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY.. MINNESOTA
LOCATION OF BUILDING
No. Street 10 ¢ Fart of Lot
Lot -4 Block / Addition or Subdivision_.
Corner Lot Inside Lot V' Setback_ 0 67 Side -Yard,
SEWER. ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To bused as - A
Sq. Ft. / Cu. Ft.� n ��
el `
Front Depth j Height��,
Sq. Ft. l Gu. 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 representations
stated in this application are true and correct.
DA � � SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
-.I V �,.A
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-1
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
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1st
2nd
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3rd
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4th
° Future Connection Openings
Connected with
Sewer �
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $ b t%
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ...... x 3.25 $
Water Heater (Up to 200,000 BTL) ...... x 2.00 $�a'� New Ground Run Old Bldg. x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... \ x $1.50 $ t� 5
Additional Fixtures x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FETE
4
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,
Owner
Kind of Building
Used as ✓�
To be completed about
Estimated Cost, $
mew. Building Permit No
Permit No.
zS
ROUGH I I
FINAL
a z 2M 7-59
By L -e
Business
19-6C
la
Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE- SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ................. .
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
STEAM or HOT WATER SYSTEM
RATE
TOTAL
8.00
$
5.00
$
5.00
$
2.50
$
8.00 $-
2.00
$
5.00
$
5.00
$
2.50
$
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gaL per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $�
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures x $1.50 $
Additional Fixtures x .50 $
Gas Range to 200,000 BTU ........... x 2.04 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $�
REMARKS:
Dept. of Bldgs. Phone
IC
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to-do all work instrictaccordance 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, 19�
Owner 195_
Kind of Buildix
Used as
To be completed abo
195—
Estimated Cost, $
Old= ew uilding Permit No.
DESCRIPTION OF WORK
BEATING or PO R PLANTS team, Hot Water, —No
Trade Nam Size No_ fK'2/ 6
Capacity Sq. Ft. E.D.R 4 BTU H.P.
Total Connected Loa Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
11 POST IM -12-58
AppRessfen !' Power Pkaft and H leg, �'e i1 ®e Re�ge
Air Condoning Stem -and Devices
GRAVITY WARM AIR:
RATE TOTAL
Furnace Shell & Duct Work ...........................$10.00
$
Replacement of Furnace .............................
6.00 $
Repairs & Alterations—tap to $500.00 .................
6.00 $
Repairs & Alterations each add. $500.00 ...............
3.00 $
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00
each add. 60,000 BTU ....................... 3.00
Replacement of Furnace ............................. 6.00
Repairs & Alterations—up to $500.00 ................ 6.00
Repairs & Alterations each add. $500:00 .............. $.00
STEAM or HOT WATER SYSTEM
Dept. of Bldae. Phone SW -3480
City of Fridley:
The undersigned hereby makes application . for a permit for the work hereit:
specified, agreeing to do all work in strict accordance with the City Ordinance:
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, MJnn
$
$ Owner rrl— t!
$ Kind of Building
$ Used as rj /yez ip
$
To be completed about 171
Furnace Shell & Lines—to 400 sq. ft. EaDR Steam .... . $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 10.00 $
Each add. 200 sq. ft. EDR Steam 3.00 $
Each add. 320 sq. ft. EDR. Hot Water . ... ............ 3.00 $
OIL BURNER—to 3 gal. per hour ................ ..... 6.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) ..... ..................
over 199,000 BTU See Fee Schedule :
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x$ 2.00 $
Additional Fixtures ............. x .78 $
Gas Range to 199,000+ ........... s$ &W $
4- i y S' a r. i10,
FAN DATING SYSTEM See Fee Schedaie
VENTILATING SYSTEM / % / 34- 3 3 4 -
ALTERATIONS
ALTERATIONS & REPAIRS TOTAL FM $
a
Estimated Cost, $ 5-00 - Od
jil New. Building Permit No. Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Stearn, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Bind of Fuel
BURNER — Trade Name Size No
Capadty _Sq. Ft E.D R BTU Hip
(REMARKS -OYER'
Z7
Signed
By
Business Phone
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTIUTION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
Rate TOTAL
$ 20.00 $ x®10 e
$ 10.00 $
$ 10.00 $
$ 10.00 $
*Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE $ .2®' S�
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB
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 ruling of the Building Division, and hereby declares
that all the facts and representations stated in this application are
true and correct. CSR -- 5 M ,1991
OWNE
BUILDI
ESTIMATED COST PERMIT NO. MOO
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units—L— Circle One (Steam) (Hot Water) arm Air)
Trade Name Size No.
BTU .57, ®D® HP_ t..3 EDR
ll 9
Fuel ^ T al Connected Load
61
Burner Trade Name Size No.
BTU HP. EDR
HEATING COMPANY jf; nc Sons Elec., Inc. dh
i..,..e .Ir .(i
iP VVesi BF(I'dw✓ay
Signed B `rysrz�, �� 55.1701 No.
Approved By Rough -In Date Final Date'
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes �No ( )
2. Is free from rust or deterioration Yes fro ( )
3. Has no foreign objects lodged within Yes o ( )
4. Is securely supported Yes ✓) No ( )
5. Meets all current Code requirements for
size and total BTU's connected
6. Has total heating BTU's c
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
Yes ( No ( )
Richmond & Sons ElElm,, Inc.
HEATING COMPANY Golden Valley tltpr �.+r Cc'.
dv,V,r
Crys4sl, P,h{�l 55429
Signed By
Date
MAR - 5
R :'
® unum9AN
NpINEE RINp
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rnoff,cr 571 GU66
fA75 Hhway No 65 NE
I MmnrafxtLt,
INC .-_.-____._.,___..—.
!I M,nnru+te 55431
-
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Tern r•ry tiyd 7* -1-, e l.e�d .Sr.rrn me � l and !`,noun
-9906510
I( ir101 t,id1 ft' -f
IO,n nh dlP, Rlpv,ex,te 55337
Certificate of
Survey
for OH,I
MCCAULEY
75.00
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75.00 ---''
Rickard Roo,&
Scale I = 30
• Denotes iron
monument folAnd
o Denotes iron
monument Se't'
Lot 1 , Block
Elwells Riverside Heights Plat 2
Anoka County Subject To easements jf any
1 hereby certify that this Is a true and correct representation of a survey of the boundaries of the above
described land, and of the location of a,L buildinysl thereen, and all vlslo.1f, encroachments, if any, from or on
sold land. As surveyed by me thisy of it f A.O. 19�
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75.00 ---''
Rickard Roo,&
Scale I = 30
• Denotes iron
monument folAnd
o Denotes iron
monument Se't'
Lot 1 , Block
Elwells Riverside Heights Plat 2
Anoka County Subject To easements jf any
1 hereby certify that this Is a true and correct representation of a survey of the boundaries of the above
described land, and of the location of a,L buildinysl thereen, and all vlslo.1f, encroachments, if any, from or on
sold land. As surveyed by me thisy of it f A.O. 19�
Building
Permit Fee
BUILDING
See Back Page for Fee Schedule
Permit No.: ` �0
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
763-502-4977
CITY OF FRIDLEY
$
Date A �., A
FAX
$
Q U $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
EFFECTIVE 1-1-2010
ft + 6 ft = ft x $24 = $
Erosion Control
DATE r a —w/o
YOU E-MAIL ADDRESS
Park Fee
SITE ADDRESS I
°C G�
Sewer Main Charge
THIS APPLICANT IS:
❑ OWNER I koNTR&CTOR
Total Due
PROPERTY OWNER/
NAME: 13ngi?. �Qr�n.sr
TENANT
ADDRESS:_ rzbd' CITY
STATE_aZIP
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # '2 0S VCS'% 7 �_ EXP DATE ` s
AND CERTIFICATE OF
ADDRESS: -8b 6< G r -H& CeCP/7 Cr
CITY STATE ZIP /i
INSURANCE
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONS TR CTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH DRAINTILE
I,ROOF
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION
❑ ADDITION
MAINTENANCE/REPAIR
❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
U LENGTH WIDTH
HEIGHT SQ FT
ROOFING O HOUSE ONLY
NUMBER OF SQUARES 13 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
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
❑ Feria !I
and proposed project
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF DOWS
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 ER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
2 L gg SING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ; 1 U OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
TIC .001 times the total job valuation
Surcharge
$
t"1 .0005 x Permit Valuation Minimum $.50
License Surcharge
$
Q U $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 $24 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
' Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks Davable to: Citv of Fridlev Attach Stioulations
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 ordinanc d es of City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicatio fo pe t d ork is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of w whi r res review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME. 0Du� -1(�AA71r;n DATE �� /� ��