PRE 2010 DOCSCary of Fridley,
BUHDING PERMIT N? 6543
Date: .+ _ iilll rI ! y
• ,dl%./i.d yr „y%/,.` ,i/,'B.1lder
Address Address
ri
LO F BUILDING
No. Street Ppt of Lot
Lot — _ Block Addition or Sub -Division 4t&44
Corner Lot . _ Inside Lot _ _ Setback ._ Sideyard
Sewer Elevation — Foundation Elevation
In consideration of the issuance to me of a permit to construct the building de5�/?
bove I agree to do
the proposed work In accordance with the description above and in compth 1 provisions of
ordinanesa of the city of Fridley. - j e
In consideration of the payment of a fee of $ ®" permit 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, fn all work
done in, around and upon said building, or any ppart thereof, shall conform in all respects to the ordinances of
7W,
inances
Building Inspector
NOTICE:
This perp* does not corer the construcdon, instaMen for whing, phnabing, gas heating, sewer or water. Be sure to we
the Building Ietp•ctor for soperat• permits for these iternw
APPLICATION FOR BUILDING PERMIT
CITY OF-FRIDLEY, MINNESOTA
OWNER'S NAME
ADDRESS ADDRESS ,z / / I -
LOCATION OF BUILDING
No. --fStreet�" €e��i�'��Part of Lot
Lot+� Block Addition or Subdivision,____/%��
Corner Lot Inside Lot-4—Setbaek ?j �� Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DEa DESCRIPTION OF BUILDING
T b u as • -S A � -7 3� I � &Irv%
a
o
Front Depth �- Height
01
Sq. Ft. // �� Cu. Ft.
Front Z4 _Depth 9_g.,4_Height
Sq. Ft Ft.
Type of Construction Estimated Cost
To be Completed /' I ,, � 13
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 ar%Arue and correct.
S IGNATtiRE
(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 exist-
ing building or structure, or for any Alterations or repairs to any existing
building or structure, upon application.therefor, 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:
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 grain elevator, or for the erection of any fire -proof addition,
for similar occupancy,'to any existing building shall be at the rate of $1.25
for each one thousand cubic feet, classified as "fireproof" by Section 502 of
the VAnneapolis Building Code.
HOUSES
2,3. For any such permit for the erection of any.nod-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 -fireproof
addition, €or similar occupancy, to any existing building 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 a 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 fo ebargAd for any perwit as set forth in
Section 2 be less than $4.00.
City of Fridley
Application for Plumbing and Gas Fitting Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
Gi
I
3
3�
ou
e; Z
as
Z
3
-jz
U°d
w
t�
7Z
GSa
z
�i
Uo
•
F
t
N
WATER HTR.
GAS
ELEC.
Base
Water Heater (Up to 200,000 BTU) ......
x 2.00
/
New Ground Run Old Bldg. ............
x 3.25
$
GAS FITTING FEES:
NO. RATE TOTAL_
1st 3 Fixtures ..........................
x $1.50
$ ,
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
1st
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old ��9s
Connected with
Sewer
Cesspool El
PARTIAL RATE SCHEDULE
Dept. of Bldgs. Phone SU 4-7470
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.
Owne
Kind of Building
'f Used as x �✓
PLUMBING FIXTURE RATES:
NO. RATE T�TAL
Number Fixtures. ..............
x $1.50
Future Fixture Opening .......
x 1.20
O
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ...... .....................
x 3.25
$
` O
Water Heater (Up to 200,000 BTU) ......
x 2.00
$
New Ground Run Old Bldg. ............
x 3.25
$
GAS FITTING FEES:
NO. RATE TOTAL_
1st 3 Fixtures ..........................
x $1.50
$ ,
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE -
A
To be completed about
Estimated Cost,
Old—New. Building Permit
ROUGH
FINAL
.QQW42 2M
Business Phone
4
Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
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 L/
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 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE $ �L
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470
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 application Me true and correct.
Owner
Kind of I�ding
Used as
To be completed about
Estimated Cost, $ `17�
ew. Building Permit No.
s
Permit N
19Z_"3
DESCRIPTION OF WORK
HEATING or P WER PLANTS—Ste Hot Wa �WarmAir---J_o
/°
��/I �r�/���
Trade Name �'�'� " Size No
Capacity Sq. Ft. E.D.R. � �`� B. H.P.
Total Connected Load - � °r 2 Rind of Fuel
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
S RAY N. WELTEFZ HEATING C®.
4637 CHICAGO AVE.
By—NjNWF. eP®&.1.9 .27
4 z 2M Business Phone No v/
SUBJECT
PERM
City of Fridley
219 91
AT THE TOP OF THE TWINS
BUILDING PERMIT
RE
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
)3L/ S
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
7/22/93
JOB ADDRESS 7340 Tempo Terrace NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
3
Melody Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jim Lawrence 7340 Tempo Terrace NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Top Gun Roofing 9644 Xim,ines in, Maple Grove MN 425-1455 3388
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 ❑ ALTERATION [2 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroot Dwelling (24 Squares) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with.the State Building Code, Provide adequate
attic ventilation, Install smoke detectors as. per UBC 1210 adjacent to all sleeping
areas and in basement.
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 GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2,000
$1.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$45.00
Fire SC $2.00.
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
License SC $5,00
$53.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
WHEN P O ERLY VALIDATED THIS IS YOUR PERMIT
7,
BLD IN SATE
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATEI
NEW [ ] Effective 1 / 1 /93
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�
Building Permit Application
Construction Address: 2�� ��7 /��
Legal Description:
Owner Name & Address: Tel. #-)W-03 2
Contractor: MN LICENSE # 33 69
Address:q6--Ay'Vl1W X� �� Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width
Height
Width
Height
Width
Hgt/Ground
Corner Lot [ j Inside Lot [ j Ft. Yd Setback
Type of Construction:
Approx. Completion Date:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimated Cost: $ MR
(Cost on Back)
Ft x $ = $
DATE: `7� l APPLICANT: Tel. #—
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
CITY USE , ONLY
'j o Fee Schedule on Reverse Side
$ c,2. .001 of Permit Valuation (1/10th%)
$ ' $.50/$1,000 Valuation
$ $750 per SAC Unit
$ 5—r 0 U $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt_ "B" Above
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
Fee Determined by Engineering
Agreement Necessary [ j 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 $15 (Minimum Fee is $15 plus surcharge)
$501 to $2,000 $15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1;000
or fraction thereof, to and including $25,000
$25;001 to $50,000 $252 for first* $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional
.$1,000 or fraction thereof, to .and including $100,000
$100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 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.
CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS, AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
HEATING COMPANY
MINIMUM FEE FOR ANY HEkTING/CQOLIN9NENTILAiION
REFRIGERATION/AIR COt,1DITIONIIVGPERMIT IS 25.00 Signed ByJ&1 Tel No. 4
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By Rough -In Date Final Date
"Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE OR STACK VERIFICATION ON
written permission from adjoining property owner, REPLACEMENT FURNACE
JOB ADDRESS q ca'tC3
RATE SCHEDULE
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
$ 30.00 $ __6
representations stated In this ,application are true and correct.
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
$ 10.00 $
���� ,1996
Gas Range
$ 10.00 $
OWNER
BUILDING USED AS
Gas Dryer
$ 10.00 $
*Air
ESTIMATED COST. E� . �� PERMIT N0.
Conditioning - All Sizes
$ 25.00 $
All Others/Repairs &Alterations (LIST ON BACK)
DESCRIPTION OF FURNACE AND OR BURNER
1% of Value of Appliance or Work
$
No. of Heating Units f Circle One (Steam) (Hot Water) rmAir.
Commercial/Industrial
Trade Name Cct r v-- o- - Size No.
BTU_' HP
1.25% of Value of Appliance or Work
$'
EDR
Fuel �0 ; c Total Connected Load c�Ea
State Surcharge 50
Burner Trade Name Size No.
TOTAL FEES
BTU HP EDR
HEATING COMPANY
MINIMUM FEE FOR ANY HEkTING/CQOLIN9NENTILAiION
REFRIGERATION/AIR COt,1DITIONIIVGPERMIT IS 25.00 Signed ByJ&1 Tel No. 4
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By Rough -In Date Final Date
"Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE OR STACK VERIFICATION ON
written permission from adjoining property owner, REPLACEMENT FURNACE
8.- Inas combustion air been provided for. water heater Yes (-I NQ ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
/0-az-�C
CI DIM NEY 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 (4 No
( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes (X No
( )
6
Has total heating BTU's of { 000
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes () No
( )
8.- Inas combustion air been provided for. water heater Yes (-I NQ ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
/0-az-�C
HOUSE HF,ATING TEST RECORD
ADDRESS -7'' C--��j t�v�i� APT FLOOR_ CITY SUBURB
v�,�.vY'tllvl -�
vwlvri�a Grt -�
HFAT T.01SR DATE HTG INST
/moi
solo- ri Y �`
II TSTALLED BY
ELECTRICAL WORK BY
GAS LINE BY
TYPE OF HEAT GA FA HW
STEAM SPACE HTR UNIT HTR OTHER
GAS DESIGN
CONVERSION
MAKE 5r ryA 09®/ i
MAKE OF BURNER.-
URNERMODEL
MODELN
MODEL
SERIALS f pq 6AO7 909
MAX. BTU RATING
INPUT Xo_ ao,>elf a �r�
MAKE OF FURNAC
MODEL
CONTROLS
THERMOSTAT ( ( HEAT PLUG VENT SIZE
VALVE
KIND OF LINER 4,'0 SIZE NONE
LIMIT
DRAFT HOOD AI& REGULATOR 0
LIMIT SETTING 11967 -FILTERS
NUMBER J
SIZ&TWINSIDE
FAN SETTING , ,
CHIMNEY LOC ®OUTSIDE
PILOT TYPE �� ® d oe
CHIMNEY CONSTRUCTION
PILOT MAKE
PILOT MODEL
SMOKE BOMB WIRING
PILOT TIMING /�
DRAFT TEST TAG
L.W. CUT OFF d-
DOOR PRESSURE LIGHTING INST
PRESSURE PERCENT CO2
UCS ' DATE TESTED
INPUT CFH _PERCENT W
09e-3 COMPANY TESTING
STACK TEIVIP_3_g�f5_PERCENT CO
C, NAME OF TESTER ? ��
sue iEtr
Rl�i°F �V
City of Fridley
3 092
AT THE TOP OF THE TWINS
?
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC
��
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
5/2/00
JOB ADDRESS 7340 Tempo Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
3
Melody Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
James Lawrence 7340 Tempo Terrace NE
784-0379
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Eagleview Construction Inc 2937 174 Lane NW, Andover,
MN 55304 753-5469
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
20067043
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW O ADDITION O ALTERATION j] REPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof House & Garage (24 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
1 ISTALLS
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
$2'098
$1.OS
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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
PLAN CHECK FEET
AL FEE
Licen$5.0
se
$91.40
GNAT FIE OF CONTRACTOR OR AUTHORIZED AGENT IDAfTE.
HE PROPIMLOF
VALI D THIS IS V R PERMIT
BL G INSP
-3--3 p
rIAtE
S-GNATUREOFOWNEAoFOWNER BUILDERI IDATEi
NEW I l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION ��
Construction Address: 3� l_/,o� /eWW, kc
Legal Description:
Owner Name & Address: _jp4af,&S 1G� Tel. # 79y G3
Contractor. ��'"'� (Uz l o
9�t-- MN LICENSE # '2c'6Co70 Y3
Address: Tel. #
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 Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �<
Construction Type: VV Estimated Cost: $ 6
90
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: APPLICANT: Tel.
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ 40Y $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$Q/' Lo
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
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,00,000
$5,608.75 for the first $1,000,000 plus $3.15 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. New Houses Only
Building
MECHANICAL
Permit No.:�
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604CITY
OF FRIDLEY
mate Recd:
DATE V D YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER NTRACTOR
PROPERTY
NAME: lAn
ADDRESS: Lt 0 CITY STA IP
OWNER/
TENANT
PHONE:
CONTRACTOR
COMPANY NAME:
SUBMIT A COPY OF
CONTAC
YOUR STATE
STATELICENSEA10 WEST LAKE STREET EXP DATE
LICENSE WITH
ADDRESS: WINNEAPOLIO�55409 CITY STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE
)441 OGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
OF WORK:
❑ NEW )(REPLACEMENT ❑ ALTERATION/REMODEL
TYPE
DETAILED DESCRIPTION OF WORK
the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
rPERMS.665
installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of laborder
$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) ��'y SIZEBTU �^
MODEL:
Equipment Installed MFG:
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
LA/C $25.00FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
UNIT HTR $10.00
-BOILER
$35.00 _FURNACE $35.00 _GAS
CHIMNEY LINER $10.00 DRYER $10.00 POOL HEATER $35.00
_GAS
^ PIPING _DUCT WORK $1000 GAS PIP G $10 0 gyp' TOR $15.00
M
H:a`,- �`..r .
�, "• 3,., �� Vis'
r 3 �,Id+.
Number of fixtures $1�.__.
Permit Fee $ @ x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
t $25.00 = $�
TOTAL DUE $ Number of fixtures @ $25.00 x
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $. Sal
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 pe it ork is pot to start without a permit; that the work will be in accordance with the
approved plan in the case o k ich req r iew and approval of pl
SIGNATURE OF APPLIC
i
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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 ]MC Chapter 7 with MN Amendments
b. Natural Gas or Propane/MGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. 1MC 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 INSPECTION DIV.
3431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURFR TO RF INSTAI I Fn nN FA(:I-I P1 nnR
Effective On Jan 1, 2000
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range"*
Gas Dryer**
Back Flow Preventer Required ( )Yes O Nc
Tyles
NO. RATE TOTAL JOB ADDRESS l'1E it', 61ZOIE12-
-_j_
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $ X -
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 Puilding Division, and hereby declares that all the facts
and rPnrPsentatinns stated in this ann ication are true and correct.
LAWRENCE, JAMES A , 2V97
7340 TEMPO TERRACE
FRIDLEY, MN 55432
(763)784-0379 7
Building Used As i7�r�t1lY C,�t.,
Estimated Cost PERMIT NO.
PLUMBING COMPANY 01S=M )OLU Aj C, CZ
SIGNED BY
Approved By
Rough -In Date Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
��Jffl
Eva
Even. man M M -
MM
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range"*
Gas Dryer**
Back Flow Preventer Required ( )Yes O Nc
Tyles
NO. RATE TOTAL JOB ADDRESS l'1E it', 61ZOIE12-
-_j_
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $ X -
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 Puilding Division, and hereby declares that all the facts
and rPnrPsentatinns stated in this ann ication are true and correct.
LAWRENCE, JAMES A , 2V97
7340 TEMPO TERRACE
FRIDLEY, MN 55432
(763)784-0379 7
Building Used As i7�r�t1lY C,�t.,
Estimated Cost PERMIT NO.
PLUMBING COMPANY 01S=M )OLU Aj C, CZ
SIGNED BY
Approved By
Rough -In Date Final Date
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 () 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 -LAMA Category 1 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 asper .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 :