COS (2)City of Fridley, Mixm
BUILDING PERMIT No 5 6 8 3
Date: .J`
Owner: ' Builder -'• -,-- -- ---
r'
Address ..._.. _ _ Address _ — ---.-- —. --
�, 9> L® TION . OF BUILDING
No. _s SPart of Lot
Lot _ _ _ _Block _� _ :-__. Addition or Sub-DivisWn . • - • =-
Comer Lot ___ Inside Lot _ Setback _Awf-d... _ _ Sideyard _ e -
Sewer Elevation _ _ ___ Foundation Elevation
DESCRIPTION OF BUILDING
Te
U Front ° Depth J Height Sq. Ft. Cu. Ft.'
_ Front `� Depth ° :Height _ _ Sq. Ft. CFt.
u.
LZd
Type of Fit. Cost �o be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set. forth and in compliance with all provisions of
prdinanc:ea of the city of Fridley.
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, 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 any time upon violation of any of the provisions of said
ordinances.
-Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring; plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEYO MINNESOTA
P�owner's Name Builder I I , m
Address Address _-711 z - ����- ��� •�
LOCATION OF BUILDING
No. 290�street r%. Part of Lot
Lot 4— Block Addition or Subdivision
Corner Lot Inside Lot,Setback3r—iSide-Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
S�14rh-r- DESCRIPTION OF BUILDING
To be 'used as: / d -
Depth Height �
Sq. Ft. /�- / ® Cu. Ft.
C4�AT Frontepth &j L height
Sq. Ft. 7` Cu. Ft.
Type of Construction Estimated Cos ,1 6 ,9�
To be Completed i�e�r / Y-
The undersigned hereby makes application for
herein specified, agreeing to do all work in
the City of Fridley Ordinances and ruling of
ings, and hereby declares that all the facts
stated in this application are true and corrZ
DATE SIGNATURE
(Schedule of Fee Costs can be found on the
a permit for the work
strict accordance with
the Department of Builda-
representations
ct . ,•^�,
se Side) .
Y
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 fox 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 fireproof 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 Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any non -fireproof build-
ing 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, for similar occupancy, to any existing
building or for each such building or addition. Ninety Cents 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 con-
tents 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.
2.51 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 tr 1 $4.00.
City of Fridley
Application for Plumbing and Cas Fitting Perinit
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
�i
NO.
RATE TOTAL
Number Fixtures ......................
_
zZ
$
�Z
.Q
��
S�
y
o=
a3
end
Z.
�U 4c
NU'
00
s
R
s
N
WATER HTR.
GAS
ELEC
Base
Water Heater (Up to 200,000 BTU) ......
x
2.00
yy
$ oC
New Ground Run Old Bldg. .......
.... x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.5o
$�/ C/
1st
!
.50
l
Gas Range to 200,000 BTU ..............
x
2.00
$
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings
Connected with
Sewer �
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures ......................
c® x
$1.50
$
Future Fixture Opening ................
x
1.20
$ "
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
yy
$ oC
New Ground Run Old Bldg. .......
.... x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.5o
$�/ C/
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE $�O
L
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
Owner —, -
Kind of Building
Used as
To be completed about
d
Estimated Cost, $
New Permit Non— Permit No. 6 �
uilding
Signe
By-
y
Business
Business Phone No
ROUGH ! :2 - &/
FINAL
d2 2M
Application for Power Plants and. Heating. Cooling. Ventilation, .ReMpralion 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
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU .... . .................. 2.00 $ _
Replacement of Furnace ............................. 1.00 $
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
$ f
7
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 are true and correct.
P14ley, Minn (:�/' ' 19
Owner � �ya�
Kind of ading pp//
Used as
To be completed about
0
� r
Estimated Cast, $ ` _
Old New. Building Permit No. Permit No,
DESCRIPTION OF WORK
HEATING or P PLANTS—Steam, Hot Wa (W�arm: Air No
00%
Trade Name' Size No
Capacity Sq. Ft. E.D.R `�" BTU H.P.
Total Connected Load 4�lt 4-0 Kind of Fuel (-",
47
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Signs R A A 1. W E TER H A T 1 6 7E C C
By 4637 CHICAGO AVE.;
MINNEAFs LIS 7. MINNESOTA
42 2M 7-59 Business Phone No r' i-17
City of Fridley, NUnn. No 8751
BUILDING PERMIT
Date: APRIL 5, 1966
Owner: _ J. P. (LICK Builder INTER CITY BUILDERS
Address 7390 Tempo Terrace N. E. Address 35 Highway #10-
FRIDLEY, MINNESOTA 55432 Minneapolis 33, Minnesota
LOCATION OF BUILDING
No. 7390 Street TEMPO TERRACE N. E . __ Part Of Lot
Lot_ 4 _ Block 3 Addition or Sub -Division MELODY MANOR
Corner Lot ._— Inside Lot — Setback -_ _ _ Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
BEDROOM ADDN. Front -24 Depth 4 Height 10 Sq. Ft. 96 Cu. Ft. 960
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction FRAME Est. Cost To be Completed
In consideration of the Issuance to me of a permit to construct the building describedfth
Bove I agree to do
the proposed work in accordance with the description above set forth and in compliant 21 provisions Of
ordinances of the city of Fridley. J A �,
In consideration of the payment of a fee of $ 4.00 , permit is hereby granted to INTER CITY
13-9%kDERS t 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 location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
ALLEN G. JENSEN
NOTIC h
Thb pwO don not cower the eonatraeffen, leakWon for wkb, plumbia& ea hentb & awes or water. Be an to as
the BWMIIM Mqm for for apmft permift for thea Neva.
APPLICATION FOR BIDING PERMIT
CITY OF FRIDLEYs MINNESOTA
OWNER'S NAME ria ��At BUILDER . //���� [. r`TY �o2 //-Je�,y
ADDRESS 73 91) m 1) ew*
it a e e ADDRESSr9a /0 NO Zs 33
LOCATION OF BUILDING
N0, STREET M 0,9 1'e if,, PART OF LOT
LOT BLOCK. ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDE -YARD
SEWER ELEVATION FOUNDATION ELEVATION
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;
_�e--d /1 J4a tridt Front DepthHeight 451
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction..Estimated Cost dv �
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 theCity 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,//� 'SIGNATURE 40� Pou,
(Schedule of Fee Costs can be found on4he 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 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 Minneapolis 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 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 .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
- $5.00
Estimated
Cost
of work over
Commercial; Estimate%
`ost
of work V
Estimate.
,ost
of woa?c ovcr clot'.Uul
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1997
6431 University Ave NE
Fridley, MN 55432. APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 0 f�Mft TER Plqe1
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 $®° a�
representations stated in this application are truend correct.
Side Vent — Fill Out Back)
' 1997.
Gas Piping (Needed with new furnace) $10.00 $
J®H4J C4
OWNER.
Gas Range $10.00 $
BUILDING USED AS �2�iNe
Gas Dryer $10.00 $
°
ESTIMATED COST PERMIT NO. /-
*Air Conditioning. — All Sizes $ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
° of Value of Appliance or Work $ _
1 /o PP
No. of Heating Units Circle One (Steam) (Hot Wate (Warm Air
Trade Name Size No ac 0"-62
Commercial industrial
BTU ?,::Loo -D HP EDR
1.25% of Value of Appliance or Work $
Fuel /-rA-T-- Total Connected Load
State Surcharge .50
Burner Trade Name Size No.
BTU HP EDA .
TOTAL FEE 01 -so
SUPERIOR CONTRACTORS W!f,'
6121 42nd Avenue NO.
Crifstall' Mn 55422
HEATING COMPANY
MINIMUM FEE FOR ANY HEATING/COO LING/VENTILATION
�:Tel No. ��
CONDITIONING PERMIT IS $25.00
Signed By •
_REFRIGERATION/AIR
PLUS THE $.50 STATE SURCHARGE
Approved By Rough—In Date Final Date
REINSPECTION FEE $42.00/Hr
* placed in a side and without
Air Conditioners can not be pla Y
FILL OUT BACK SIDE F R STACK VERIFICATION ON
written permission from adjoining property owner.
REPLACEMENT FURNACE
CHIMNEY 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 No ( }
5. Meets ajUcurrent Code requirements for size
and totalPTU's connected Yes No ( }
6 Has total heating BTU's of `7J, 19-`f
All other BTU's oy
TOTAL BTU's
r ®moi W
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 YAX: ( 763) t071-1257
ADDRESS : 7390 TEMPO TER NE
PIN : 113024240024
LEGAL DESC : MELODY MANOR
: LOT 4 BLOCK 3
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-01438 ook
DATE ISSUED: 09/01/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. REPLACE 100 AMP FUSE
PANEL WITH 100 AMP BREAK SERVICE PANEL; INSTALL NEW ELECTRIC DRYER RECEPTACLE AND WASHER
RECEPTACLE BELOW ELECTRIC PANEL.
1;1 # 0-100 AMP CIRCUITS 2
APPLICANT
SUPER ELECTRIC INC
333 COLBORNE ST
ST PAUL, MN 55102
OWNER
GLICK JOHN P & DOROTHY P
7390 TEMPO TER NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date.
ELEC AMP SERVICE FEE
30.00
ELEC CIRCUIT FEE (0-100 AMPS)
12.00
STATE SURCHARGE, ELEC FLAT
0.50
TOTAL
42.50
PAID WITH CHECK # 6076
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763)571-1287
ADDRESS : 7390 TEMPO TER NE
PIN : 113024240024
LEGAL DESC : MELODY MANOR
: LOT 4 BLOCK 3
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-017261��
DATE ISSUED: 10/05/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114 -
OWNER
GLICK JOHN P & DOROTHY P
7390 TEMPO TER NE
FRIDLEY, MN 55432
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 118132
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp
Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Building
$
BUILDING
See Back Page for Fee Schedule
Permit No.:R
Inspections
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604
.001 times the total job valuation
Surcharge
$
°7, ot
.0005 x Permit Valuation Minimum $.50
License Surcharge
CITY OF FRIDLEY
no
Date Rec'd: w
763-502-4977 FAX
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
EFFECTIVE 1-1-09
ft + 6 ft = ft x $21 =$
Erosion Control
DATE ° ��
YOUR E-MAIL ADDRESS 0(!J a
. 7
SITE ADDRESS
$
THIS APPLICANT IS:
O OWNER .RCONTRACTOR
Sewer Main Charge
PROPERTY OWNER/
NAM B t�1�
Agreement necessary ( ) Non Necessary ( )
TENANT
ADDRESS:!2!-Za �7 c �a e - e -CITY d-1 -
STATEj% ZIP
Make checks Pavable to: Citv of Fridlev Attach Stiaulations
PHONE:
CONTRACTOR
NAME: `' _0L
L
SUBMIT A COPY OF
YOUR STATE LICENSESTATE
LICE,,,,NIlSE # EXP DATE
'
AND CERTIFICATE OF
ADDRESS: (a j 1� 1-t 5 ITY
� , rl STAT9�&IP
INSURANCE
PHONE - e -OL - Co - FAX —
PROPERTY TYPE
O SINGLE FAMILYNEW CONSTRUCTION SIZE
O TWO FAMILYNEW CONSTRUCTION STORIES
PERMIT TYPE
0 ADDITION O GARAGE/SHEDWINDOWS
O BASEMENT FINISH .5 ROOF O DRAIN TILE
0 DECK 0 SIDING 0 OTHER
0 SWIMMING POOL
TYPE OF WORK:
0 NEW HOME CONSTRUCTION O ADDITION
O MAINTENANCE/REPAIR 'REMODELING
DESCRIBE WORK BEING DONE: e rnffln 0
SIZE OF IMPROVEMENT
LNG~ WIDTH HEIGHT SQ FT
ROOFING 0 HOUSE ONLY
NUMBER OF SQUARES RHOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES
2 ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
O DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
O Vinyl
OSoffit
ADDITIONS. & PORCHES SUBMIT:
O Aluminum
0 Trim
I.
Site Plan/Survey showing the existing structures
O Other
0 Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS AYes ONo LgCA ION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF%� Li
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED I e NUMBER OF WINDOWS
ALL FEES ARE BASED ON
TOTAL JOB VALUATION $
ATION, INCLUDING THE COST OF LABOR AND MATERIALS:
HE 1997 U.B.0 FEE SCHEDULE)
OCCUPANCY TYPE
Permit Fee
$
Q15_/. Q5_
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
It -1,03
.001 times the total job valuation
Surcharge
$
°7, ot
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
no
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 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
$
C9171dq
Make checks Pavable to: Citv of Fridlev Attach Stiaulations
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 applicationfor a permit and work is pppt to start without a permit on site; that the work will be in accordance with the
approved plan intcase of all v�ork whic chi fires re ' �v and approval of plans.
SIGNATURE OF APCA - I �— PRINT NAM4� /(% i� N /,� L✓C'C&e_DATE 4
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 1st $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for 15` $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 1' $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for I" $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 151$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 15` $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: 763-502-4977
Building
OCCUPANCY TYPE
BUILDING
See Back Page for Fee Schedule
Permit Ivo.. ,9 ' 6
Inspections
$
RESIDENTIAL APPLICATION
$ Slou
Received By:
763-572-3604
$5.00 (State Licensed Residential Contractors)
CITY OF FRIDLEY
$2000 per SAC Unit (Plans to MWCC for determination)
Dat MAY 2009
763-502-4977pp--FAX
$
-ft
$450 Conservation Plan Review
$
Fee Determined by Engineering
$
EFFECTIVE 1-I-09
$ ) I
Make checks Davable to: Citv of Fridlev Attach
DATE 5 — 0 ''/ c2
YOUR E-MAIL ADDRESS %C r— ( C&223
SITE ADDRESS
THIS APPLICANT IS:
❑ OWNE 'CONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: e,y� P ,CITY !��
STAT ZIPSS
PHONE: -
CONTRACTOR
NAME: -
SUBMIT A COPY OF
Izzi
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS-- - CITY'
STA�ZIP �d
INSURANCE
PHONE7u Lo FAX
%
PROPERTY TYPE-1SINGLE
FAMILY/NEW CONSTRUCTION SIZE
E3 TWOFAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION O GARAGE/SHED 0 WINDOWS
❑ BASEMENT FINISH 0 ROOF 0 DRAIN TILE
0 DECK 11 -SIDING ROTHER
❑ SWIMMING POOL of
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION O ADDITION
❑ MAINTENANCE/REPAIR t' -REM DELING
DESCRIBE WORK BEING DONE: 16G C] C-' v, CJ
S
SIZE OF IMPROVEMENT
C6NGTH WI HEIGHT SQ FT
ROOFING
0 HOUSE ONLY
NUMBER OF SQUARES
0 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
0 DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
®Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum
Q Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
RFascia
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 ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
l4G THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $
Permit Fee
Plan Review
Fire Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
/v v
OCCUPANCY TYPE
$
See Back Page for Fee Schedule
$
65% of Building Permit Fee
$
.001 times the total job valuation
$ Slou
.0005 x Permit Valuation Minimum $.50
$
$5.00 (State Licensed Residential Contractors)
$
$2000 per SAC Unit (Plans to MWCC for determination)
$
+6 ft= ftx$22=$
$
-ft
$450 Conservation Plan Review
$
Fee Determined by Engineering
$
Agreement necessary ( ) Non Necessary ( )
$ ) I
Make checks Davable to: Citv of Fridlev Attach
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 appli for a permit and work is not to start without a permit on site; that th work will be in accordance with the
approved plan in th � Qrk which req revie d approval of s.
SIGNATURE OF APPL' I, /C jam' RINT NAM e N DATE_5 — / � ' 7
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 1s` $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for Is` $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 1" $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for I "' $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 1" $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
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
Fax: 763-502-4977