PRE 2010 DOCSNOTICE:
This permit does not cover
sewer or water. Be-sure to seel
construction, installation or alteration for 'wiring, p'lun►bing, ga '! heating,
uilding Inspector for separate permits fo e -Items.
4�
Date:
Owner
Address ..�
Village of Fridley, Minn.
BUILDING PERMIT
.. 1 37 ......
° 1821
Builder..............................................
Address.............................................
OCATION OF BUILDING
No. .. .�. .. Street ...7 .................... Part of of ...... ...... ......... .
Lot .� !• Bloc.....
Addition or Sub -Division . �}'.� . ��.. .
Corner Lot ........... side Lot ...4 ... Setback .. .... Sideyard .. A ...................
&-I qvv�- V�-
DESCRIPTION OF BUILDING
T be Used as:
...a Front .. Depth .2C(r.. Height.^? Sq./ Ft. ........ Cu. Ft. ........
......... Font ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction 11 ..... Est. Cost 1.7 . A. Y.. To be Completed ..................
r . In consideration of the issuance to me of a permit to construct the building described above, I agree to do
fie proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
;y.
. ....... .C6" -.
In consideration of the payment of a fee of $) Rt .®IPS .. , peJt it 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 with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
...... Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
*Air Conditioners can not be placed In a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CITY OF FRIDLEY INSPECTION DIV,
Effective On January 1;1993
6431 Unlversity Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3804 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
SCHEDULE
JOB ADDRESS
RATE
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 $ 20.00
$
representations stated in this application are true and correct,
,1993
Gas Piping (Needed with new furnace) $10,00
$
OWNER / r i .r <
Gas Range $10,00
$
BUILDING USED ASS`"'
Gas Dryer $10,00
$
ESTIMATED COST 3 �' PERMIT NO. I%
*Air Conditioning — Ali Sites $10,00
$
•
DES¢RIPTION QF FURNACE ANO OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
f
No, of Heating Units / Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
Commercial/industrial 6�0.
BTU HP EDR
1% of Value of Appliance or Work
$ 5 e
Fuel Total Connected Load
State Surcharge50
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
/$
HEATING COMPANY
MINIMUM FEE FOR ANY HEATING/COOLINGNENTIL.ATION
REFRIGERATION/AIR CONDITIONING
PERMIT IS $15.00
Signed By / /�� Tel No.
PLUS THE $,60 STATE SURCHARGE
REINSPECTION FEE $30,00
Approved Byca� Rough—In Date Final Date i3
*Air Conditioners can not be placed In a side yard without
written permission from adjoining property owner. 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
(
)
No
(
)
3.
,Has no foreign objects lodged within
Yes
(
)
No
(
)
4.
Is securely supported
Yes
(-)
No
(
)
S.
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
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT24812
BUILDING
PR EMI T
-
--
RECEIPT NO.
Ir
COMMUNITY DEVELOPMENT O
L
PROTECTIVE INSPECTION SEC..
CITY HALL FRIDLEY 55432
NUMBER
EV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
77
12/3/96
JOB ADDRESS 7190 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
I Pt 18,19
1
Oak Creek Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Robert/Betty Scott 7190 Riverview Terrace NE
571-3063
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
11
Citywide Home Improvement LimIroadwa M ls. MN 55411 529-2489 3013
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 0 ALTERATION REPAIR
❑ MOVE ❑ REMOVE
R❑
8 DESCRIBE WORK
Reroof House 25 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the 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
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
I 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
$2,062
$1.03
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 $2.06
PLAN CHECK F
TOTAL FEE
Licen SC
5.00
82.84
2
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
N P
RLY VA (DATED THIS YOUR PERMIT
U
Z6
llF
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI1--,,'gZDG
INSP
DATE
61
NEW
ADDN (] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address:
Effective 1/ 1/95
Legal Description: po
Owner Name &. Address: - Tel. #
Contractor: MN LICENSE # �% //
Address: 1i�!') % Tel. # 7
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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
Length Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ j Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ �`
Approx. Completion Date: ) J - S
(Cost on Back)
Driveway Curb Cut Width Needed: F + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #_Z, Z�X _
CITY USE ONLY
Permit Fee $ 7q, ` -S Fee Schedule on Reverse Side
Fire Surcharge $ Wit' - 06�, .001 of Permit Valuation (1 / 10th %)
State Surcharge $ o- $.50/$i,000 Valuation
SAC Charge $ $850 per SAC Unit
License Surcharge $ G-00 $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 $ 9;2
c
C,
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION. FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 11/
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (UST ON BACK)
1 % of Value of Appliance or Work
Commercial/industrial
1.25% of Value of liance
r A.V
Rate TOTAL
$ 30.00 $
$10.00 $
Effective On January 1, 1997
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and corm
sI /Q ,1998
OWNER_ (/
$10.00 $
BUILDING USED AS
$10.00 $
$ 25.00 $
State Surcharge $ 50
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
ESTIMATED COST // 00 PERMIT NO. 13 c Y,-),
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuels/el Total Connected Load
Burner Trade Name,
BTU
HEATING
Signed By
Size No.
HP
EDR
Approved ByRough—In Date
FILL OUT BACK SIDqFOSTACK VERIFICATION ON
REPLACEMENT FURNACE
Final Date
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
v
Yes
CHIlVINEY AND STACK VERIFICATION
Yes
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 ()
No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
4.
Is securely supported .
Yes ()
No < )
5.
Meets all current Code requirements for size
Yes ()
No ( )
and total BTU's connected
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
v
Yes
No
Yes
O No
( )
R 1
CITY OF FRIDLEY INSPECTION DIViSION (9, b Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, a�
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES V
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
AII'Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
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.
JOBADDRESS ?/�C Ql �C=��'�� %�PA-ee
OWNER
TOTAL
BUILDING USED AS
$ -0 /
ESTIMATED COST PERMIT NO. < -7
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_ Circle One (Steam) (Hot Water (Warm Ai
$ Trade Name R"0 Size No. U60A. ®'7
BTU 25,-000 HP EDR
Fuel A AT-- Total Connected Load
Burner Trade Name Size No.
$ SOD 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
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
SUPERIOR CONTRACTOR&W . �`i 7-®-
6121 42nd Avenue o.
Crystal, Mn 5;422
HEATING
Signed TEL #
Approved By IC4 Rough -In Date Final Date __�/_01
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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 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. YesNoiw
( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes No ( )
When installing a new venting system, 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( ) Nof
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( ) N� )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type RL) J rz> BTU Input 57080 a�ssis
r Nat
Appliance #2 Type BTU Input Far 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
ALTERATIONS: (Describe) I'��@I�✓A��� A�� �tr��Ai�-`�(l �d
957 6; ea -k ®N i c- A -/R- C.G.. LLAT .® t
E.WPERIOR COMTRACT0 3 @'<T
6121 42nd Avenue No.
HEATING CO: Grystel, Mn 65422
Signed By: Date: 0
CITY OF FRIDLEY INSPECTION DIV. �� <®� Effective On Jan 1, 2000
6431 University Ave NE doo
Fridley,. MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
JOB ADDRESS -11010 �� Cry a� �.i� � J�1 , � F_
New Fixtures
$ 7.00
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
m , 200
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Owner Vl®�i .
Water Heater -Electric
$ 7.00
Water Heater - Gas** �_
$10.00
Building Used As
Gas Range**
$10.00
7
Gas Dryer**
$10.00
Estimated Cost (vo • C-)0 PERMIT NO. -
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COM NY_L a. aj od � Uu= (NJ6 ray
Reinspection Fee $47.00/Hr
SIGNED / TEL N0.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved By Rough -In Date Final Date
State Surcharge
S .50
TOTAL FEE
$ 0 d 5b
MINIMU FEE OR ANY PLUMBING[GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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 O No
The venting system is; plastic/PVC and meets all current codes and manufacturer
specifications including'sizing, length, Number of elbows and termination. Yes O 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 existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No
When installing a new venting system, 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 Type and Size/Common Vent and Vent Connector Information
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
ALTERATIONS: (Describe)
f
HEATING CO:
Signed By: Date:
MINNESOTA DEPARTMENT OF HEALTH . BONDING AND INSURANCE CERTIFICATE
This is to certify that Leland G. Stull master plumber License No. PM002769
representing Lee Stull Plumbing has filed a $25.000 bond with the Secretary of
State on January 5, 2000; and provided evidence of Public Liability Insurance
with limits of at least $50.000 per person, $100,000 per occurrence, and
$10,000 property damage for the year 2000 in accordance with the provisions of
Minnesota Statutes, Section 326.40 (1978).
BOND NO. 55-159749
United Fire b Casualty Company
Cedar Rapids, Iowa
MR LELAND G STULL .
LEE STULL PLUMBING
15532 NOWTHEN BOULEVARD
RAMSEY MN 55303
Policy NO. BCN 0270491 01
West Bend Mutual
John F. Lund, Minnesota Agent
Wayzata, Minnesota
Patricia A. Bloomgren, Director
Division of Environmental Health
Jan K. Malcolm, Commissioner
tatc of ft"finnenta
Anntoota 30epartmtnt oftattb
PLtPr nM UNIT, BOX 64975
121 EAST SNVE'1'FI PLACE, ST. PAUL, MN 55164-0975
Master Plumber License
LIC== NO 002769PM
co:
Deland G. Stull
15332 Noarthen Boulevard
Awka, Mti 55303 -
EFFECTIVE DATE
EXPIRATION DATE
rAW
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
May 25, 2001
Mr. Robert Scott
7190 Riverview Terrace NE
Fridley, MN 55432
Re: Final Inspection at 7190 Riverview Terrace NE
Contractor: Superior Contractors Inc
Dear Mr. Scott:
A mechanical permit was issued on May 19, 2000 to install a furnace with air cleaner and air
conditioner at your address. According to section 305 (a) of the 1991 Uniform Mechanical
Code, a final inspection shall be conducted on the mechanical work authorized by this permit.
As of this date, no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Mechanical Code. 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 expire the permit and no
further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
'n ^ _ e/ P® ft e
r�
Building
$
BUILDING
Plan Review
PermitNo.:
Inspections
RESIDENTIAL APPLICATION
$
Received By:
763-572-3604
$
CITY OF FRIDLEY
License Surcharge
Date Rec'd:
DATE — =
YOUR E-MAIL ADDRESS
$
SITE ADDRESS 71-9Q X11t, eV- V,
°r,
$
THIS APPLICANT IS: OWNER
KONTRACTOR
$
PROPERTY OWNER/
NAME:
e
Fee Determined by Engineering
ADDRESS:
n CITY
STATE—ZIP
TENANT
- Make checks payable to: City of Fridley Attach Stipulations
PHONE:
CONTRACTOR
NAME:
I^C -e ci
STATE LICENSE #�
�. EXP DATE
%� n 40,zL
et— STATE�%�
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:_ ,
t- ITY
cSiS��
WITH APPLICATION
PHONE
FAX
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION
❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH P1 ROOF ❑ DRAIN TILE
❑DECK
13 IDING ®OTHER
� � /0Roa ✓ ei -
❑ S WIMMI ATG POOL
O
TYPE OF WORK:
❑ NEW
❑ ADDITION
❑ MAINTEN
PAIR ❑ REMO ELING
DESCRIBE WORK BEING DONE:
E lf�' e
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ 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
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 OF LABOR AND MATERIALS:
(USINGMI 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
$�";
,Q $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
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
$
- 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 w re ires iew approval of plans.
SIGNATURE OF APPLICAT��' ./ l s PRINT NAME J d6�/ �l . /� re6" l V06 -DATE ®e Z12 ,�2 S~—
Building
BUILDING
Permit Nis.: 2((' —6 -
LM?
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Datk 'd:
763-502-4977 FAX
EFFECTIVE 1-1-08
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DATE
YOUR E-MAIL ADDRESS
401
SITE ADDRESS -71 ' ®
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THIS APPLICANT IS: XOWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: &I -e" S�
TENANT
ADDRESS: l �I®I ✓t'� U I %V'/4 ee CITY r� /
,/ �^
STATri" ZIP
//� /`d�
PHONE: &/,A' 56 7 - 352 `%
NAME:
ADDRESS: CITY
STATE ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE FAX
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
PROPERTY TYPE
INGLE FAMILYINEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH❑ OOF ❑ DRAIN TILE
❑ DECK SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
�MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: 5;d;'Il4� �CD
/—�
poo
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT
SQ FT
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:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS,
&PORCHES SUBMIT:
❑ Vinyl
Vinyl
❑Soffit
1. Site Plan/Survey showing the existing structures
❑ u ❑ Trim
and proposed project.
OtherAlum Qc�P�
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS XYes
ON, LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &C�Gfpuf
TYPE OF WINDOW TO BE INSTALLE Its NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ qUy(, 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
$
$
$
id
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)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary
Make checks savable 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 codes
of the City of Fridley and with the Minnesota onstruction 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 accor ce 4' i e approved plan in the case of all work which require review and /ap�rovv� I of plans. G J
SIGNATURE OF APPLICAN PRINT NAMEd /I/LjjfS�Ii DAT&D �/
APPROVED BY / / DATE