PRE 2010 DOCSBUILDING
PERMIT
N° 2217
Village of Fri.
leY , Minn. ,
Date,
.... ........ .
Owner
Builder
...........................
Address ..........
..........Address..................
ddress..................
..
...... ........... ...
LOCATION OF i BUILDING
No. ... I
StreetOr .. .. .. Part of Lot
Lot -.
�
.V�l
lock .. _ l
� ..... Addition •r S�b Division ... � ................... ,
—'eve...
Corner Lot .....
Inside Lot ... Setback °` ' Sideyard , '``................
f
DESCRIPTION O BUILDING
To be Used as:
..
Front . ,.. Depth Height _........ Sq. Fi........... Cu. Ft.. .......
.. f.
.. Front ......... Depth ........ Height . >........ Sq. Ft......... Cu. Ft, ........
Type of Censtructioa
41140YAVAVLEst Cost . 10ASO V . .... To be Completed
it
In consideratia
I
i
i.
n
i of the issuance to me of a permit to construct the building ;,described above, I agree to do
the proposed work .
accordance with the description above set forth and in compliance with all provisions of
ordinances of . the 'age
of',Fridley.
it.......................
In ideration,'of
the payment of a fee of $..140, permit is hereby granted to .......
"construct
;,-�,,�
the express'eoriditia
done in, around and
to the building or addition as described above. This permit is granted upon
that the person to wholn� t'f is granted and his agents, employees and workmen, in all work
upon said building, or any pari thereof,"'shall. conform' in all respects to the ordinances of
Fridley, Minnesota
in the village limits
garding location, construction, alteration, maintenance, repair and moving of buildings with-
and this permit may be revolted at any time uon violation of any of the provisions of said
ordinances. ".
`ice
o . Building Inspector
Ur V
NOTICE:
l
This permit
oes not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water.
le sure to see the Building Inspector for separate permits for these Items.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
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 (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective On August 1, 1995
JOB ADDRESS ( YID / cSy sJ
State Surcharge
TOTAL FEE
s36? �
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.
Burner Trade Name
BTU
HP
Size No.
HEATING COMPANY &-d4l-j AZ
EDR
C Signed f2 G' W-4�.� Tel No. 4-/J�- C%PY.,3
Approved By Rough -In Date Final Date
FILL OUT BACK SID OR STACK VERIFICATION ON
REPLACEMENT FURNACE
� ,� 6U
The undersigned hereby makes application for a permit for the work herein
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
30.00
rulings of the Building Division, and hereby declares that all the facts and
$
$ -38
rue and correct.
representations stated in this application aJ,-,
,199
$ 10.00
$
OWNER /aZcs 1 n est L�
$ 10.00
$
BUILDING USED AS . [r
$10.00
$
s
ESTIMATED COST �'f u c� PERMIT NO.
$ 25.00
$
QESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm A'
Trade Name �A�Z&x .. Size No. LIC, 7A -
BTU i1 HP EDR
$
Fuel IU d4--ITotal Connected Load
State Surcharge
TOTAL FEE
s36? �
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.
Burner Trade Name
BTU
HP
Size No.
HEATING COMPANY &-d4l-j AZ
EDR
C Signed f2 G' W-4�.� Tel No. 4-/J�- C%PY.,3
Approved By Rough -In Date Final Date
FILL OUT BACK SID OR STACK VERIFICATION ON
REPLACEMENT FURNACE
� ,� 6U
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (°°15'No ( )
2. Is free from rust or deterioration Yes (V No ( )
3. Has no foreign objects lodged within Yes ("'I'No ( )
4. Is securely supported Yes (P-,:f"No ( )
5. Meets all current Code requirements for size
and total BTU's connected Yes (/-f 'No ( )
6 Has total heating BTU's of ,
All other BTU's
TOTAL BTU's -7
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
Listt ALTERATIONS Being Done: /
�/`�-�✓�'.�r ��J' `7�i�,�r�-cam
HEATING CO:,��
Signed By:
Date: % —��
SUBJECT
'
City of Fridley
2 9361 361
WI
AT THE TOP OF THE TNS
BUILDING
P E R
M I T
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
� PROTECTIVE INSPECTION SEC.
r �
1
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
5/3/99
JOB ADDRESS 6401 Taylor Street
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
N 701 of 3
2
Sub. 88
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Ray Breffle, 6401 Taylor Street, Fridley,
MN 55432
571-4461
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Twin City Roofing, 8605 Dunkirk, Maple Grove, MN 55311
420-4601 201-321-6
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION [ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
REroof House & Garage (20 sq.) tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with State Building
Code.
CONSTRUCTION HOURS: 7:00 a.m, to 9:00
p.m. Monday through Friday;
9:00 a.m. to 9:00 p.m. on Saturday; no
work on Sunday
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 80 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
$1,714.00
$.86
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 PERFORM A CE OF CONSTRUCTION
$56.75 $56.75IF
Fore SC $1.71
PLAN CHECK FEE
TOTAL F E
e�
License $5.00
121.07
URE OFC 'RACTOR OR AUTHOR AGENT ,DATE,
EN AL OAT IS IS YOUR PERMIT
001,ROP
BL ,NSP
DATE
S,GNATURE OF OWNERJF OWNER BUILDER, ,DATE,
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:®�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
I
Effective 1/1/99
ffAVU'Vlf'
,
yo � MN LICENSE# �-��
V, IUW
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width
Sq. Ft.
4-,-t orr-
Construction Type: Estimated Cost: ${
(Fee Schedule on Back)
.Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE:. APPLICANT:LTel. # 1,70 -?L7
�
STIPULATIONS:
/ C l r— CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ /, /
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$ (o
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ C) 0
$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 [ ]
f o2C 6
TOTAL
$
,
STIPULATIONS:
BUILDING PERMIT 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 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate B Removal and replacement of curb and gutter and install a 3 foot wide
" approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
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 the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
Building Ck
Inspections
7.63-572-3604
DATE C OO o
SITE ADDRESS t'
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
r�
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
.11-4- ME
❑ OWNER 11CONTRACTOR
I
CONTRACTOR I COMPANY
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
CONTACT PERSON:
ICENSE #
STATE L EXP DATE
ADDRESS: 13562 CENTRAL AVE NE CITY ANOKA STATE >�zrn 55304
PHONE 763-757-6202 FAX 763-757-6701
Permit No.:
Received By:
Date Rec'd:
ATEYh�zIP,
SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE
❑ NEW REPLACEMENT 0 ALTERAnON/REMODEL
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
NUMBER OF EACH BELOW)lSIZE/BTUTU W1.9- �O'I
Equipment Installed MFG: Q'_)MODEL: V 'C�3 ®TLI
MFG: MODEL: SIZESIZEBBTU
MFG: MODEL: GAS RANGE/OVEN $10.00
LAIC $25.00 _FIREPLACE (GAS) $15.00 �y GAS GRILL $10.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 GASUNIq HTR $10.00
_LIBOILER $35.00 _FURNACE $35.00
_CHIMNEY NER $10.00 —GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
—25
TOTAL DUE $ Number of fixtures @ $25.00 x$25.00 = $6
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $ S, <�O
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 APPLIC ° PRINT NAME R®GER 1T(iFF ETN DATE
eA (0 1 2
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
'7ti1_r.'77_';6n4
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEWIEXISTING 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 UNT Energy Code 7670 or 7672
6. Duct Design Per IMC 1346. 0603.2
.a. RCCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations