PRE 2010 DOCS'�Ie'3 -3.V
City ®f Fridley, Minn. N° 9569
BUILDING PERMIT
Date: Dec I -1967_
Owner: Clemron Inc. Builder Same��
Address 701 Columbia Blvd. Address Same
LOCATION OF BUILDING
No. 7300 Street Tempo Terrace part of Lot
Lot 13 Block 3 Addition or Sub -Division Melody Manor
Corner Lot _... X Inside Lot . Setback 35' Sideyard __. 10' & 17'
Sewer Elevation -- 861.53 _ 864.53
Top R of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front 24' Depth 44' Height 20' Sq. Ft 1236 Cu, Ft.
-Garage Front 20' Depth 21' Height ..._...10' Sq. Ft. 429 Cu. Ft.
Type of Construction Frame Est. Cost — 23 900 _. To be Completed
SEWER LOCATION - 49' Norhh of Manhole
WATER LOCATION - 10' North of Sewer
In consideration of the issuance to me of a permit to construct-j*e building described.,A ve, I agree to do
the proposed work in accordance with the description above set forth and compliance, tit all provisions of
ordinances of the city of Fridley.
-. $100-n(1 Cos—�(�r�axrt'gni-fi n !'ltarmw
In consideration of the payment of a fee of it 43.00 , permit'ls hereby granted to Clemron
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 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 time upo viola ono any of the provisions of said
ordinances. P 1
Official
Building)WW"
JAN
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to as
the Building Inspector for separate permits for these items.
. ..
APPLICATION FOR BUILDING PERMIT
CITY OF FRIMEYO MINNESOTA
OWNER'S NAME BUILDER
ADDRESS ADDRESS
LOCATION OF BUILDING
NO. STREET /e/ PART OF LOT
LOT__y BLOCK ADDITION OR SUBDIVISIONx
CORNER LOT INSIDE LOT SETBACK S La SIDE YARD /
SEWER ELEVATION S ,S FOUNDATION ELEVATION `1Se3
App a-ftach/to" tis fo Two Certificates of .Survey of Lot and proposed
building location drawn on
these Certificates.
DESCRIPTION OF BUILDING
To be used as;
Front�G Depth �iy��� Height`- 71
Sq. Ft. Cu. Ft.
Front Depth_2,/Height-
Sq. Ft. Cu. Ft.
Q
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 of
Fridley 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 Z SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
�. „
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing any permit for
the erection of any building or'structure, or for any addition to any existing
building or structure, or for any alterations or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for_such.permi.t of fees to the amount herein below set forth and in
the manner herein provided to -wit:
2.1., For any such permit for the erection of any fire -proof building,
other than a garage, warehouse, factory or grain elevator, or for the erection
of any fire -proof addition, for similar occupancy, to any existing building,
shall..be at the rate of $1.40 for each- one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2 For any such permit for the erection of any fire -proof garage,
warehouse, factory or'graiu elevator, or for the erection of any fireproof
addition, for similar occupancy, to any existing building shall be at the
rate of $1.25 for each one.thous.and cubic feet, classified as "fireproof"
by Section 502 of the Minneapolts��.;Building Code.
HOUSES
2.3. For any such permit.for the erection of any non -fireproof
building, other than a garage, warehouse, factory or grain elevator, or
any non -fireproof addition, for similar occupancy, to any existing building ..
permit $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non -fire -proof
addition, for similar occupancy, to any existing banding or for each such
building or.addition - ninety cents ($0.90) for each one thousand cubic feet
or fraction thereof; in the cubical contents thereof with the minimum of $4.00.
For the purpose of computing fees'for building permits, -the cubical contents
of,any building or addition to a uniform height throughout by multiplying the
ground area covered from a point six (6) inches below the floor line of the
basement or cellar to the average height of the upper surface or to the average
height of the roof surface of the main gable.of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee shall
be at the rate of $3.00 per each Five Hundred Dollars ($500,00) or fraction
thereof in the cost of all proposed work.
2.6. . In no case shall the fee charged for.any permit as set forth in
Section 2 be less than $4.00.
STORM REPAIR DAMAGE FEES:
Residential: Estimated Cost of work up to $500.00 - $5.110
Estimated Cost of work over `' :; .. °:ts h , , r�o
Commercial Estimated C, of canU. t c s 1-,0 • 0 -
Estimated C. of worts 6ver` U r.UJ - 420.°�L
t
Application for Power Plants and Heating, Cooling, Ventilation, ReFrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... $10.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 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 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 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 ...................... 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) ....................... 5.00 $ ..�
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAY�
1st 3 Fixtures ...................... x$ 2.00 $
Additional Fixtures ................. x .75 $
Gas Range to 199,000 ........... x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE
Dept. of Bldge. Phone 560-3450
City of Fridley:
The undersigned hereby makes application for a permit for the work hereir.
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,
i .. of Building.r
Used as
To be cc
Estimated Cost, $ 4 e
Old -;wilding Permit No. Permit No. ®a
HEATING or PO PLANTS—Steam, Hot Water, arm Air No
Trade Named Size No
Capacity. Sq. Ft. E.D.R Xt9 BTU H- P,
Total Connected Loa �d Kind of Fuel -
BURNER — Trade Nam "'� ,.Size No--
Capacity.
o Capacity Sq. Ft. E.D.R-- BTU H.P.
(REMARKS—OVER)
0
RAY N. WELTER H EATI N 13 Ca
4637 CHICAGO AVE.
B
COMIP0
az Business Phone No
kC--,-,,al Cogrl agle�nts o11®rta Public Service Co.,
lTy
T LOSS �`il�g.�`igT1�'i�` ONS DEPARTMENT OF BUILDINGS LI
I TOW
VILLAGE
Weatherstrips A.S.H.V.E. _. Construction No. Insulation
` Guide
Windows I Doors Reference Out. Wall jInt. Walll Ceiling I Roof I Floor Kind d I How Applied
Yes—No Yes—No-"
�T -
S FL Roam Length// Width ®� Height ' �� / FL I #_, l i� If400 'I Length// Width Height
Windows
an
Doors—Crackage
Crackage
and Area
/ 5z
v��
70
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
®
p a�
Coef.
l Btu
Infiltration
Glass
`" %�✓
_
S
Coef.
Btu
Infiltration
Glass
Exp. wall
/
3
Coef.
l Btu
Infiltration
Net exp. wall
I
5_0
-
Glass
0 0
'
V-155
Exp. wall
Net exp. wall
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
�-
Int. wall
Floor °1
Ceiling :2 ,y ®�®
��
J -d C. b
Floor
Total Btu. f /
' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. I AI Length J idth a
or Windows
and
Doors—Crackage
Crackage
and Area
/ 5z
v��
No..
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Gf 03
p a�
Coef.
l Btu
Infiltration
Glass
`" %�✓
_
S
Coef.
Btu
Infiltration
Glass
Exp. wall
/
3
Coef.
Btu
Infiltration
Net exp. wall
I
5_0
6
Glass
0 0
- J
V-155
Exp. wall 7: X
Net exp. wall
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Int. wall
Floor °1
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
+� Fl. j RW Room I Length , l Width / Height '
Windows
and
Door
Crackage
and Area
/ 5z
v��
No..
Width
of pane
Height
of pane
No. of
lights
Lineal ft. Area
of crack sq, ft.
—of 'pan�e-
AV
DA
Gf 03
p a�
Coef.
l Btu
Infiltration
Glass
`" %�✓
_
S
Coef.
Btu
Infiltration
Glass
Exp. wall
/
3
Exp. wall Zg
`°
�+
Net exp. wall
I
5_0
6
®
0 0
Int. wall
V-155
Ceiling
Ceiling
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Floor °1
Total Btu. -
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
® Fl. I At�� Room I Length /,.;S! Width
Windows and
Doors—Crackage and Area
No.
No.
Width
of pane
Height
of pane
No. ofi
lights
Lineal ft.
I of crack
Area
sq. ft.
—of 'pan�e-
AV
DA
Coef.
l Btu
Infiltration
Glass
`" %�✓
_
S
Exp, wall .�k
Coef.
Btu
Infiltration_.52W_/622—
3
Exp. wall Zg
`°
6 2—
Glass
Glass
Exp. wall
I
5_0
Int. wall
Net exp. wall
Int. wall
�®
V-155
Ceiling
Floor f `�
Total Btu. / `(
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
ieighgAl. I PA& Room I Length�i� Width 91 Height
Windows and
Doors—Crackage and Area
No.
No,
Width
of pano
Helght
No. of
lights
Lineal ft.
or crack
Area
sq,,,,
—of 'pan�e-
AV
DA
Coef.
l Btu
Infiltration
Glass
`" %�✓
_
S
Exp, wall .�k
Coef. Btu
Infiltration
Glass
3
Exp. wall Zg
Net exp. wall
Int. wall
Ceiling���
Ceiling lo�
Floor
V-155
Floor
Total Btu. � a�
lequirfl sq fi. l±;,l>.lt. Ili tiq. tris. W.A. J-a�tei r�tri ,,
Wi dows and Doors—Crackage and Area
No.
Width
of pane
Helght
of pano
No. of
]lghts
Lineal ft.
or crncic
Arca
sq. ft.
Coef.
l Btu
Infiltration
Glass
`" %�✓
_
S
Exp, wall .�k
Net exp. wall
<7
Int. wall
Ceiling���
QIP
Floor
Total Btu.
1%tsa11111-exlaiq, ft, or sin, lrit3. W,A. J wader aroM
OIL,
City of Fridley
Application for Plumbing and Sas Fitting Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK �w
Number, Kind and Location of Fixtures Loci
Mz
rn
OL
3t7
x $1.50
.�F�
x $3.25
?
;�
o��°d
zr/�{
C Z
Z
$
RATE TOTAL
W
�r'a
U'
?
�O
R
N
WATER HTR.
GAS
RIC
Base
Ist
-4
2
2nd
3rd
_
4th
° Future Connection Openings
New Fixture, Old Openings I
Connected with
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... I x $2.00 $ • G dj
Future Fixture Opening ................
New Fixture Old Opening ..............
Catch Basin ...... .....................
Water Heater (Up to 99,000 BTU) ..... .
New Ground Run Old Bldg. ............
Electric Water Heater
GAS FITTING FEES: NO.
1st 3 Fixtures ..........................
Additional Fixtures ....................
Gas Range to 199,000 BTU ..............
REPAIRS & ALTERATIONS --Refer to Code
x $1.50
s
$
x $1.50
$
x $3.25
$
x $3.00
x $3.25
$
$2.00
$
RATE TOTAL
x $2.00
G O
x $ .75
$
x $5.00
$
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 facl
and representations stated in this application are true a correct.
Fridley, Minn 1
Owner m 1?,o /i.% at
Kind of Building &j b
Used as a -
To be completed about A O U 14
Estimated Cost, $ 1 -L- 0 J
Old—New. Building Permit No Permit No. da
Business Phone
Description ................................................$
TOTAL FEE $ Q 3 -Oe) az
Application for Power Plants and Heating. Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of BlAgs. Phone SM -3450
GRAVITY WARM AIR:
RATE
TOTAL
Furnace Shell & Duct Work ..........................
8.00
$
Replacement of Furnace .............................
5.00
$
Repairs & Alterations—up to $500.00 ..................
5.00
$
Repairs & Alterations each add. $500.00 ...............
2.50
$
MECH. WARM AIR
Furnace Shell & Duct Work. to 120,000 BTU ............
8.00
$
each add. 60,000 BTU .......................
2.00
$
Replacement of Furnace .............................
5.00
$
Repairs & Alterations—up to $500.00 .................
5.00
$
Repairs & Alterations each add. $500.00 ..............
2.50
$
STEAM or HOT WATER SYSTEM
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 $ J7.60
Additional Fixtures x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING V,,60
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE $��=
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 applicatioq-are true and correct.
EkTim"WIMM90
Owner
Kind of Building
Used as
To be completed about C�
�
Estimated Cost,
Old- New. Building Permit No. Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No
Trade Name �t�/� e Size No A� -,10-36
Capacity
Total Connected Load Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Signe
-<�42 Business Phone No -
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1991
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES. NO. RATE TOTAL JOB AD
New Fixtures
Urinal
Old Opening, New Fixture
owe
:::..Tra
Wash
y
...rFloo
Drin
Auto
' Washer r
Catch Basin
Gas Water Heater
Gas EI
R n e
cStories
Rain Water Leader
ase m e
Sump/Rece'iving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas
$10.00
Gas Range
Floor 1
Gas Dryer
$10.00
Back Flow Preventer Required KYes
() No
Type
$5.00
i r
F o0 2
Floor 00 3
Floo r4
PLUMBING FIXTURE RATES. NO. RATE TOTAL JOB AD
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Rece'iving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas
$10.00
Gas Range
$10.00
Gas Dryer
$10.00
Back Flow Preventer Required KYes
() No
Type
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance _
State Surcharge $ .50
TOTAL FEE $��
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 correct.
Owne
Building Used As
Estimated Cost � C' " ®� PERM IT NO.
PLUMBI
SIGNED
TEL N0�0
Approved B Rough -in Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
1
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
Back Flow Preventer Required.
Type
NO.
RATE
TOTAL
m
5.00
$
>1
m
$
m
1.50
u
_ S
x
0
$
Water
d
_ $
1
$
_ $
5.00
W[GHm3
$
o
^ $
m w
$
14
aro
Heater
5.00
+�
$
10.00
m
~ $
10.00
$
N
q
aap,
w (n
.4
.4 .9
=
u
W
NU
14
�A
G%
I A
3
A W
G.
U
4 3
C7
O
as
lec
1st
2nd
3rd
4 th
(R) - Future Connection Opening
Connected with Sewer
(*) - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
Back Flow Preventer Required.
Type
NO.
RATE
TOTAL
_ $
5.00
$
S
3.50
$
_ S
1.50
$
_ S
4.00
$
$
5.00
$
_ $
5.00
$
_ $
5.00
$
$
5.00
$
^ $
5.00
$
$
7.00
$
$
5.00
$
$
10.00
$
~ $
10.00
$
Yes ( ) No ( )
$ 5.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
19 of Value of Fixture or Appliance
S
$ /15 .Cll
State Surcharge $ .50
Reinspection Fee $
5"
�/
($15.00) TOTAL FEE $ l
Effective Date May 1, 1988
Job Address /, '%✓ - ��� �� Jc-
Department of Buildings
City of Fridley
Tel. 0571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn.
OWNER
KIND OF
USED AS
TO BE COMPLETED ABOUT JL
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. ( / C129
Company
Signed By-32-6,4-alrte,
Tel. No.
ROUGH INSP. _
Date
w
P/P--
FINAL INSP.
Da
APPROVAL FOR PERMIT
HINIHUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
HOUS HEATING TEST RECORD
P.
ADDRESS APT.0.�. Y SUBURB
OCCUPANT OWN
E R.,�
HEAT LOSS DATE HTG. INST. GAS CO. METER BAD #00
SOLD BY INSTALLED BY 29
Electrical Work By Gas Line By.
TYPE OF HEAT GA FAHW STEAM SPACE HTR. UNIT HTR. OTHER
GASP"_ �
1�
MAKE .,("%+ yy _i��`��� li �,G- MA KE
Model Model
'17,'17,512t��'
Serial 'c��Max.
INPUT MAK
Model
E
CONTROLS
THERMOSTAT Heat Plug
Valve
Limit^
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model -
Pilot Timing S!!::F �g
CONVERSION
OF BURNER
BTU Rating
OF FURNACE
Vent Size
KIND OF LINER IZ NONE
Draft Hood. Regularor
Filters Size Number
Chimney Location Inside AP -!!T777' Outside
Chimney Construction
Smoke Bomb Wiring
Draft �- Test Tag"'
L.W. Cut OffDor Pressure Lighting Inst.
Pressure l�+ Peree C o���� � �ITate Tested it 9
Input CFH / PA 2 ��pany Testing Z 00
Stack Temp. Percent CO 9:2Name of Tester Coe
Form 235
SUBJECT
P 0•
City ®f Fridley
25916
AT THE TOP OF THE TWINS
BUILDING PERMIT
`
RECEIPT NO.
• _ COMMUNITY DEVELOPMENT DIV.
rr PROTECTIVE INSPECTION SEC.
J
NUMBER
REV
DAVE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
4/9/98
JOB ADDRESS 7300 Tempo Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
13
3
Melody Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Tom Stimart 7300 Tempo Terrace NE
330-5530
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Trendy Roofing 210 Zachary Ln, Plymouth, MN 55441
591-9433 20027543
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 O ALTERATION 0. REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (22 Sq) 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
1STALLS
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
$.91
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,834
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-
Fire SC $1.83
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$59.50
PLAN CHECK FEE
TOTAL F E
Licens $5.00
$6 .24
- SIGNATURE OF CO TRACTOR OR AUTHORIZED AGENT IOATEI
P OPER LIDATED T S IS YOU ERMIT
J
BLO INSP
riATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
0
01,
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION '
ConstructionAddress:
Legal Description:
Owner Name & Address: Tel.
Contractor:_MN LICENSE # QC�;��-� 3
Address: f b acs. c�c t ,; ����\e,►.®�_;-.��� SS`1�i1 Tel. # S G%'\ -0\ 3
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER:
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type Estimated Cost:
-=5;�(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: LJ - / APPLICANT: Tel. #'Sc
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ J
��
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
$1,00,001 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 $13.50.
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 $15.75.
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 MECHANICAL permit d B
Inspections RESIDENTIAL APPLICATION Received By:
D cT 0 20
763-572-3604 CITY OF FREDLEY
DATE Q' 3 D - d -r YOUR E-MAIL ADDRESS
SITE ADDRESS `73 6 0i dd �f C %t Q t tj E aee e a� 9 0
THIS APPLICANT IS: ❑ OWNER leONTRACTOR
PROPERTY NAMH:` 116rt L Sia `1 G'0-�
OWNER/ADDRESS: '7 (9 ii -row I1, -O -Aa-`.• N 1r -- CITY t 1 STATEMme+ZIP�5�i�,
TENANT PHONE: -1 -T Y `7
CONTRACTOR COMPANY NAME:
SUBMIT A COPY OF CONTACT PERSON: CLI r 3
YOUR STATE STATE LICENSE � EXP DATE
LICENSE WITH ADDRESS..FA 9 6 to e. a of r=. CITY a ao 1 ,, STATEti ZIP 'Cs
•
APPLICATION PHONE r7 6a 719 q j f r FAX
9
PER W TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ❑ NEW `RRREPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK _,h StA 11 f24` 1 Q %
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) MODEL: SIZEBTU
Equipment Installed MFG: SIZE/BTU
MFG: MODEL: SIZEBTU
MFG: MODEL:
A/C $25.00 _FIREPLACE (GAS) $15.00 . GAS RANGE/OVEN $10.00
_AIR TO AIR IXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 7,FURNACE $35.00 GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
_DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00
Is
V10
Permit Fee $ .:
Number of fixtures @ $10.00 x $10.00 = $
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 = $ U o c
State Surcharge = $ .50
Total = $ �� u
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. n
SIGNATURE OF APPLICANT C r� a '� -� _PRINT NAME C (S ►2t, z DATE
RX
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
1•
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. Naiural. Gas or PropaneUGC Chapter 3 with MN Amendments
2, Make-up Air (See note below)
a.. TMC 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
& 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