PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn.
N° 2219:
Date i ... .
Owner............................. Builder ..
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Address f... .. .. .. .... Address ...........
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LOCATION OF BUILDING
No. , Street. -a ...
.................... Part of Lot .
T f Dl....l.. - ♦ a�e�.`_ _�1' _ � :dF'.. s,*.'i� ./* �.�Jf.i7`
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Corner Lot ......
... Inside Lot' .. Setback^. Sideyard a?a"g+'. .... . .
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DESCRIPTION OF BUILDING
To be Used as:
r� �
a Front •. ' /16%.
. » Depth ... ;Height .. Sq. 1;'t, ...... Cu. 'Ft. ....... ,
II
m
.... i Front ... Depth ..... Height... qS. Ft...... Cu. Ft........ .
Type of Construed `" , i;a , Est Cost r• f ,
.. ...... To be Complet ..� c
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In considerationijof the issuance to me of a permit to construct the building described above, Iagree to do
the proposed work accordance with the description above set forth and in compliance with all provisions of
ordinances of the vll age - of Fridley.
'F
I consideration
. l
of the payment of a fee ofAl- �" , permit is hereby granted to , , ", / ......
... to construct the building or addition as described above. This is granted
o%e express eonditio
done in,around and I
permit upon
that the person to whom it is granted and his agents, employees and workmen, in all work
pon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding
in, the village limits Ind
location,,alteration,, maintenance, repair and moving of buildings with.
this permit may be revoked at any time;; upon violation of any, of the provisions of said
ordinances.
j
.,. ;. ... Building Inspector
NOTICS:
This permit does
not cover the construction, installation or alteration for wiring, plumbing, gas heating;
sewer or water.
a sure to see the Building Inspector for separate permits for these items.
J
CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2001
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
�
JOB ADDRESS J c�r
RATE SCHEDULE �))
OWNER
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 1 &L -
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
Rate
TOTAL
n�
BUILDING USED AS
$ 30.00
$
j'
A/I
ESTIMATED COST
PERMIT NO.
$10.00
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00
$
No. of Heating Units
Circle One (Steam) (Hot Water) (Warm Air)
$ 10.00
$
Trade Name ALOs
a moi. Size No.
BTUc&
HP EDR
$ 25.00
$
Fuel
Total Connected Load
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.
Burner Trade Name Size No.
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE ��1
TEL #�
Date 9—d� V
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 manufacturers 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)
HEATING CO:
Signed By: Date :
3uilding
$ V3 as
BUILDING
Permit No.: K
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Surcharge
CITY OF FRIDLEY
Date Recd: ' 1
)ATEP_`�
YOUR E-MAIL ADDRESS
$5.00 (State Licensed Residential Contractors)
;ITE ADDRESS (OL4 t l
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21= $
CHIS APPLICANT IS:
❑ 0 `CONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME:
Fee Determined by Engineering
ADDRESS: Lk iaxA4 I It l S CITY_ ' C� STATE T S 5! 3 2
TENANT
Agreement necessary ( ) Non Necessary ( )
PHONE:
$
CONTRACTOR
NAME: v C', �1 O a -,kc C -1, �
STATE LICENSE # L 1 I EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: �C g� t \A �1 3"�- FIN -Q— CITY R
STATEN E V- 91
WITH APPLICATION
PHONE CD I ' 3 ?'3 b FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH PROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
WMAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: TX- C,. y O -U, 4- �� 'g a"-�
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES INHOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGESATTACHED
GARAGE
I. Existing Floor Plan
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
❑Soffrt
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I . 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 BASED�1 ALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
__I ( �' SING THE 1997 U.B. FEE SCHEDULE)
TOTAL JO $ OCCUPANCY TYPE
Permit Fee
$ V3 as
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ 1
.001 times the total job valuation
Surcharge
$ (. J
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ 500
$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
$
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 or is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whi h e uir revi d approval of plans. �'+1 J % /
SIGNATURE OF APPLICANT PRINT NAME J 'T,ey't / V/ ��P DATE r
Page 2 - Building Residential Application
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
$23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000
$23,50 for 1 $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
$391.25 for 10 $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 IR $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 $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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: 763-5024977