PRE 2010 DOCSI
40-1
pity of Fridley, Minn. 11.373
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMU
Date:. April 11, 1972
owner: _Amber Construction, Inc. Bider Same
Address 6070 Stinson Blvd, N.E.Address Same
No. _020. Street _ S t• i n c nn$1,ud, . W. V. Part of Lot
Lot _ _ _. 1. __ Block _._.._ _ Addition or Sub -Division
Corner Lot __ __. __ Inside Lot _ _ X Setback 35' Sideyard 10' & M=
Sewer Elevation _ _ Foundation Elevation _.._
TUTERIM
To be Used as:
House �.� Front 401 Depth 26' Height 20 t Sq. Ft. 1, 040 Cu..,Ft. 201, RQQ.
Garage Front 22 _ Depth __9-6 Height _141 _ Sq. Ft. 72 Cu. Ft M9, 7 2g
Type of Construction — Frame Est. Cost $26, 00.0. Q0_ -- To be Completed August 1 72
(20,323.00)
Provide verification survey and hard surface drive.
Sewer & Water Contractor will come in and get locations.
In consideration of the issuance to me of a permit to co the building described above I agree t4 do
the proposed work in accordance with the description abov f and in compliance / pons of
ordinances of the city of Fridley. , v
+v.+V Ya. G. 4.G YlAi 6u1141r.G
In consideration of the payment of a fee of S 50100' permit is hereby granted to " Amber
Construction, Inc. 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 ordinknces 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 anyeof the provisions of said
ordinances.
ag;��g
or
Clarence Belis e y
NOTICE:
This permit does not cover the construction, installation for whine, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
A
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM BUILDER: Ayr_m'erx- 11'5-7.
ADDRESS: ADDRESS: -
0
NO:. STREET: 57 o,,
LOT: BLOCK: ADDITION: Z- *-Z
CORNER LOT: INSIDE LOT: L-� SETBACK: 5 SIDEYARD: z-
7--77
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Aat4� Front: Depth: 2 Ce Height:
Square Feet: . zo 47 0 Cubic Feet: "'I?
LL-- Front: 2— Depth: Height:
Square Feet;_ _5;ZX Cubic Feet:
Type of Construction: Estimated Cost: $ ;2(,. U00
I o'
To Be Completed: 7 z--
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fr ' idley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: L SIGNATURE:
(See Reverse Side For Additional Information.)
1%
City of Fred!®y
mdSm
Dept. of Eldon Phone 560-34W
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures Location -
WATER
ocatio
g-gawa commmaon openingsI ware
Now Fizftn, Old Openings
Sewer
Ceaspool
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures
9 x $2.00
$ CC)
Future Fixture Opening ..
x $1.50
$
New Fixture Old Opening ....
��
¢
Catch Basin ..
`Q
7
7a
O O
d
P1
WATER MTB.
GAS
ELEC.
Base
= $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...... .. . .... .........
4
$ • �?
Additional Fixtures ..... ..............
x $ .,M
$
Gaa Range to 199,000 BTU ...............
x $5.00
$
Ise,
-
2nd
—_
3rd
-
—
4th
-
g-gawa commmaon openingsI ware
Now Fizftn, Old Openings
Sewer
Ceaspool
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures
9 x $2.00
$ CC)
Future Fixture Opening ..
x $1.50
$
New Fixture Old Opening ....
x $1.50
$
Catch Basin ..
x $3.25
$
Water Beater (Up to 99,000 BTU) .... _�_
x $3.00
$ 3"00
New Ground Run Old Bldg.
x $325
$
Electric Water Heater
= $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...... .. . .... .........
�— x $2.00
$ • �?
Additional Fixtures ..... ..............
x $ .,M
$
Gaa Range to 199,000 BTU ...............
x $5.00
$
REPAIRS R ALTERATIONS—Refer to Code
Description .................................. .............$
TOTAL FEE ta
s
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
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 fact
and representations stated in this application are true and correct -
Fridley, Minn_ 5' ® / F 192-1--
Owner
9ZOwner 1)g
Kind of Building IY
Used as l') �_. L
T
To be completed about %
Estimated Cost, $_
Old ff uilding Permit No.-- _ _. __Permit No. $�
Signed _
Business Phone No_
ROUGH
FIND .
� Pewee PI=ft mW H
S klieg® YeetilotiOeR Reft elive and
Air Ceesl Onieg Systemn and Devices
PARTIAL RATE SCHEDULE
GRAVTI TY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work $10.00
Replacement of Furnace . .. . ..... .. 6.00 IL -
Repairs & Alterations—up to $300.00 6.00 $
Repairs & Alterations each add. $500.00 3.00 $—_- _-
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ........
.. $10.00 $
each add. 60,000 BTU ....................
.. 3.00 i
Replacement of Furnace
.... 6.00
Repairs & Alterations --up to $500.00
6.00 $
Repairs & Alterations each add. $300.00 .... ..
3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. _
Furnace Shell & Line,—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam So)
Each add. 320 sq, ft. EDR Hot Water 3.00 $—
OIL BURNER—to 3 gal. per hour 6.Q0 $
over 3 gal. per hour --See Fee Schedule
GASB (up to 199,000 BTU)
8.00 $
over 199,000 BTU See Fes e
GAS FITTING .
NO RATE TOTAL
1st 3 Fixtures .. ....
x$ 100 $
Additional Fixtures
x .75 $
Gas Range to 199,000
a$ 8.00 $
AIR CONDMONWO
a
FAN HEATING SYSTEM Sae FES Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
TOTAL FEE
ROUGH (SURCHIARGE _.50)
FIIQAL
Dept. of Milos. Phor►e W -M
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 Ordit►ance:
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
r
f
��
�l Aidley, Minn_ G, ®r
Owner
Kind of Building .
Used as _-___---_-- To be completed abou
Estimated Cost,
Old—New. Building Permit No. Permit No. 3 6
DEdCRIPTIOX OF WORK
HEATING or POWER team, Hot Water, Wam Air—Nom
Trade Name � Size Ne_ Z,
Capacity— Sq. Ft. E.D.R BTU H.P.
Total Connected L.oadXW of
BURNER — Trade Name Size No
Capacity Sq. Ft. ED 1a- BTU .
(REMARKS -OVER)
S1` tU
Si N AIR CONDI?I®NI
"IMEAPPOW, MINNfS( T13 r
Business Dhow No -
��
Building
$
BUILDING 5v ;K5
See Back Page for Fee Schedule
Permit No. -
Inspcctions
e
RESIDENTIAL APPLICATION
Fire Surcharge
Received E,
763-572=3604
.001 times the total job valuation
CITY OF FRIDLEY
$e',
Date Recd: "
Z 170
Lr) 0— C- C�-S C�k
/401, A(
DATE
YOUR E-MAIL ADDRESS
- f0
j
SITE ADDRESS d0 ZO —C tll Hyl Vil
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
$
PROPERTY OWNER/
NAME: oil � L 5'C,
Erosion Control
TENANT
ADDRESS: 02- 0/,d CITY ! J-
STATI? A&��
Park Fee
PHONE:
CONTRACTOR
NAME: L-0 ' rs aa -y 0�3
$
STATE LICENSE # 2039'3?re '� EXP DATE 3
Total Due
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: �? 3 3 G e"I dy$ /Q °K CITY -S Y A STATFOWP=/O R
WITH APPLICATION
PHONE 16-9-/ — 29° 5-33-L FAX �S— ~ Z`T I —2.3I
PROPERTY TYPE
AS SINGLE FAMILY/NEW CONSTRUCTION SIZE 11
I
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT j' TYPIi
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
BASEMENT FINISH 13 ROOF 13 DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR AWREMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
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 ❑Yes [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 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 1rj®00 OCCUPANCY TYPE
Permit Fee
$
;F r
See Back Page for Fee Schedule
Plan Review
$
e
65% of Building Permit Fee
Fire Surcharge
$
.0
.001 times the total job valuation
Surcharge
$e',
_ & v
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
S Z5y
$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
$
Make checks pavable 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 foraermit and work ' not to start without a permit; that the work will be in accordance with the approved
plan in the case of all wor c require
treview an approval of plans.
SIGNATURE OF APPLIC PRINT NAME '7 DATE Z
Ve,, } O L4 - I& re • -e -
jor y &A -)G:.11 ._
ga-74 " c N S l om
6KTS;aP- Pi.? )/5
-S1iamer d �41 :7y l %+�p,.s / J `' e 7"
l
�019,�j &/�011cl k
ec, c) s00--,
; °� �r �N ,rl- 5-
w:/% cy
j�ase r �► �
e
DQ
ci Pi
r
Building
MECHANICAL
Permit No.7— Qd-_)7 9
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: J/ 7
DATE YOUR E-MAIL ADDRESS O G 4 L 9 A C 14 C U S G O. IE r
SITE ADDRESS CQ ® q® S l' 1 N cS 0 n/ a L V O
THIS APPLICANT IS: VOWNER ❑CONTRACTOR
PROPERTY
NAME: 0 O M Q (+L G A C I-1
ADDRESS: & 0a O S T/ rV S ®n/ CITY P R l J L l:. a/ STATE M N ZIP S- S Y 3 DL
OWNER/
TENANT
PHONE: Q&''i• S?_Q�• '3'7SF�
CONTRACTOR
COMPANY NAME:
CONTACT PERSON:
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE
&SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
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 $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZEIBTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR
$35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
_BOILER
LINER $10.00 EGAS DRYER $10.00 _,POOL HEATER $35.00
_CHIMNEY
DUCT WORK $10.00 PIPING $10.00 ,��VENTILATOR $15.00
_GAS
tib
4 ..
RE
Permit Fee $
Number of fixtures $10 00 x $10 00
Num
@ _ $
Surcharge $ .50
Number of fixtures @ $15.00 x $15.00 = $
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#t-a ork which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME g�ydL�J a•I DATE �'
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-5024977
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
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.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Permit No.6-7- t0090
Building
PLUMBING
Inspections
RESIDENTIAL APPLICATION
Received By: DK
763-572-3604
CITY OF FRIDLEY
Date Recd: C7
DATE YOUR E-MAIL ADDRESS Q c3 G1, L 4 QCl-4 P O S &C) . NET
SITE ADDRESS C® C?.°Z C? S j-1 N S a1V 1 i1_148 N L
THIS APPLICANT IS: DOWNER ❑CONTRACTOR
PROPERTY
NAME: Off" G4LaQC14
OWNER/
ADDRESS: 60 S?I1VSQr4 (.31v.6 n/v CITY l L L \ STATE f11F'&1PS_S 3g_
TENANT
PHONE: `�� 3 S ?� • 3 s
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE ZIP
LICENSE WITH
PHONE FAX
APPLICATION
PERMIT TYPE
SINGLE FAMILY O TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
0 NEW 0 REPLACEMENT
DETAILED DESCRIPTION OF WORK
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
NVMBER OF EACH BELOW)
0 BATH SINK/LAV DRAINS / SHOWER _ WATER PIPING
_FLOOR
_BATHTUB _ GAS PIPING ax.Dctrt uCENsE) SWIMMING POOL _ WATER SOFTNER ($35)
SINK ]E WATER CLOSET BACKFLOW PREY. ($15)
_ CLOTHES WASHER _ KITCHEN _
DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER —OTHER
Permit Fee $
Number of fixtures @ $10.00 x $10.00
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
= $ 50
TOTAL DUE $
State Surcharge
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 oaii-v rk which requires review and approval of plans.
SIGNATURE OF APPLICANT �� PRINT NAME do 4 4� DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
t•
MECHANICAL PermitNo.:,�
Building Received By:
Inspections RESIDENTIAL APPLICATION Date AUX
7.63-572-3604 CITY OF FRIDLEY
YOUR E-MAIL ADDRESS Q QP, U 5
DATE
SITE ADDRESS Co U A ri
THIS APPLICANT IS: OWNER DCOI.ITRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
NAME: tl
ADDRESS: ® ® SS o ry�yeme' CITY_STATE IfGIB�ZIP
COMPANY NAME.
CONTACT PERSON:
STATE LICENSE W EXP DATE
Com, STATE ZIP
ADDRESS:
PHONE
FAX
SINGLE FAMILY D TWO FAMILY ❑ TOWNHOUSE
D NEw KREPLACEMENT ❑ ALTERATION/REMODEI.
DETAILED DESCRIPTION OF WORK E
PER MS 16B.665 the permit fee is a minimum of5.0 r 5°eo X u� total cost tures. $�� �hou d reflect only the0, whichever is r, for the
co t of labor )
improvement, installation or replacement of a residential
=
Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor x.05I, TOTAL
FOR PROJECTS WHERE LABOR EXCEEDS 5540' FEES ARE BASED ON $10.00 PER FIXTURE,
EXCEPT WHERE NOTED. FIXTURES: (IND
NUMBER OF EACH BELOW) MODEL: 2ftp*1 U C9 0 SIZEBTU O D o O T O
Equipment Installed MFG: (� R --T � MODEL: N d4 tea A PQ STZFJBTU
': Z .f _ MODEL: SMEBTU
MFG: FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
,A/C $25.00 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL 0.0.00
AIR TO AIR EXCHANGEER $15 RFURNACE $35.00 _GAS HENIT HTR $10.00
BOILER $35.00 GAS DRYER $10.00 _POOL HEATER 15.DD
_CHIMNEY LINER $10.00
GAS PIPING $10.00 VENTILATOR $15 00
si bi3CT WORK $10.00— H _
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
t I
conformance with the ordinances and codes of the City of
kFridle is not a d with
rt without Minnesota perm; th t the work Coll be in accordanced this is
not a permit but only an application for a permit and Coo
approved plan in the case o all Coo hich req ' es review and approval of plans. DA S- y -v7
SIGNATURE OF APPLICANT
PRINT NAME � =''0 (?
City of Fridley
Building Inspections Department .
6431 University Avenue NE, Fridley, NIN 55432
763-572-3604
FAX: 763-502-4977
Number of fixtures @ $1Q.00
x $10.00 = $
Permit Fee$r.50Number
of fixtures @ $15.00
x $15.00 = $Surcharge
$Number
$
of fixtures @ $25.00
x $25.00 = $TOTAL
x $35.00 = $
DUE
Number of fixtures @ $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
t I
conformance with the ordinances and codes of the City of
kFridle is not a d with
rt without Minnesota perm; th t the work Coll be in accordanced this is
not a permit but only an application for a permit and Coo
approved plan in the case o all Coo hich req ' es review and approval of plans. DA S- y -v7
SIGNATURE OF APPLICANT
PRINT NAME � =''0 (?
City of Fridley
Building Inspections Department .
6431 University Avenue NE, Fridley, NIN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEWIEXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel TMC Chapter 7 with MN Amendments
b. Natural Gas or propane;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 TMC 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 TMC 1346:0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be n$ed for
combustion and make up awi . calculations
BUildmi g
$
BI 110I)ING
Permit No.:,!2CD-170�
Inspections
$
RESIDENTIAL APPL1 ATION
Received BiU
763-572=3604
$
CITY OF FRIDLEY I �
Date 01: L 0 200
DATE
YOUR E-MAIL ADDRESS
ig 'D -
SITE ADDRESS
N ALVP
$
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
SAC Charge
PROPERTY OWNER/
NAME: O V4
$1675 per SAC Unit (Plans to MWCC for determination)
TENANT
ADDRESS: tp O O S T 1 rnr.Son! CITY FVZ O,L Ems/
STAT0t%cziP SJ,/3;Z
ft + 6 ft = ft x $21 =$
PHONE: 9 (9 3 — .S -D a — 31) „55*
$
CONTRACTOR
NAME: doyAC t4ovn - +nro-iL7"-I I
Park Fee
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE S ( FAX
$
PROPERTY TYPE
MSINGLE F Y/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
AADDITION ❑ GARAGE/SHEDWINDOWS
❑ BASEMENT FINISH E3 ROOF RAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ WMMIING POOL
TYPE OF WORK:
❑ NEW MADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: ALtlZ W n� a&4� j94 f
3 ` 0 Ret -1 /M-0/701
SIZE OF IMPROVEMENT 3 POPS I/ ENGT i _ 'Wiii -I HEIGHT8' Fr
ROOFING
Y _
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑So$t ����5 L
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Other
❑ Trim`
❑ Fascia RJ i�
1. Site Plan/Survey showing the existing structures
and proposed project
\P2����
WINDOWS
L10 13 OC4 CAU
2. Two sets of construction plans
IN EXISTING OPENINGS XYes ❑No LOCATIOIJCIF 0 ® f_
`
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF �
W 1 A)V S6 (,J "
OPENING CHANGES &GF,�t/j?'�MI,
TYPE OF WINDOW TO BE INSTALL.
�� 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
Penaut Fee
$
4__'5
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
'50,60
.001 times the total job valuation
Surcharge
$
ig 'D -
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$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
$
- , 75-
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 reqwes review and approval of plans.
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Building
$
BUILDING
See Back Page for Fee Schedule
Permit No.:
InSp C ianS
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604
.001 times the total job valuation
CITY OF FRIDLEY
$
Date a: 07
DATE7 ®
YOUR E-MAIL ADDRESS be. asc-4(0
mi y4po .
SITE ADDRESS D / O Z.®
S'Dr "-Ceaij gi-'(-4
SAC Charge
THIS APPLICANT IS:
❑ OWNER I CONTRACTOR
$1675 per SAC Unit (Plans to MWCC for determination)
PROPERTY OWNER/
NAME: 00k7 1= LA)z YEA
TENANT
ADDRESS:_ 60 CITY 141;-.41t >,,
STATFI,al ` ` Z
PHONE: 70— _57 ?Z— 3 7S�
Park Fee
CONTRACTOR
NAME: I q ,
Fee Determined by Engineering
STATE LICENSE # Z®3 S—� EXP DATE o
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: 333 /®-? CITY ,V
X STATE�hfiXIP
WITH APPLICATION
PHONE ga-l- '/Z r -S"32 / FAX
Make checks payable to: City of Fridley Attach Stipulations
PROPERTY TYPE
OSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
)RADDIfION ❑ GARAGEISHED ❑ WINDOWS
0 BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW 0 ADDITION
❑ MAINTENANCOREPAIR 131 REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH % WIDTH
HEIGHT a Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
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 ❑Yes OND 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 THE ®U�.B�C E OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
/0 O
.001 times the total job valuation
Surcharge
$
5 -,OD
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
rj UD
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 fi = ft x $21 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( }
Total Due
$
3/9.6&
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'4ftchlre uir s r vie d approval f plans.
SIGNATURE OF APPLICANT PRINT NAME DATE 6r®
Page 2 - Building Residential Application
BUILDING PERNIIT FEE SCHEDULE"
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to -wit -
TOTAL VALUE
FEES
$1 to $500
$23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000
$23,50 for 1s` $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000
$69.25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$39125 for 1" $25,000 plus $10.10 for each additional $1,000 or fraction,
to and including $50,000
$50,001 to $100,000
$643.75 for V $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for 1- $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000
$3,233.75 for the V $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up
$5,608.75 for the 1' $1,000,000 plus $3.15 for each additional $1,000 or
Tfraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
V7
LIP
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