PRE 2010 DOCSDate:
8/15/67
City ®f Fridley, Minn. N9 9396
BUILDING PERMIT
owner: HOMEDALE BUILDERS Builder
SAME
Address 27 Wayzata Blvd. Address SAME
'75/9 LOCATION OF BUILDING
No. Street Tempo Terrace part of Lot
Lot __ _ 13- Block _ _ Addition or Sub -Division ____ Melly Manor 4t -h AdAi toren
Corner Lot - Inside Lot — R Setback ___ 15 ' ...._._.. - Sideyard 5 -10'
Sewer Elevation 880.20 1 99MOR RGORM $83 20
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front �46' Depth 24-28' Height 20 ' Sq. Ft, 1152' Cu. Ft. 23,648
Garage Front 20' Depth 24'480'Height _____ID Sq. Ft. Cu. Ft. 4800'
Type of Construction Frame Est. Cost ^W5Q0.00 _ To be Completed NQV• 15 1967
SEWER LOCATION - 36.5' West of Manhole
WATER LOCATION - 26.5' West of Manhole
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%aboveed and in compliance with 21 provisions of
ordinances of the city of Fridley.
100.00 Sewer Connection Charge
In consideration of the payment of a fee of $ X42.00 , permit is hereby granted to Homedale Blders
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 ssaa3id
ordinances.
CLARENCE BELISLE Building inspector
NOTICE
This permit does not cover the construction, kotelletion for wiring, plumbing, gee beetles, sewer or water. Be ams to we
the Building Inspector for separate " for these items.
M.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
BUILDER X-
ADDRESS
LOCATION OF BUILDING
N0. STREET PART OF LOT _
LOT :— BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDE -YARD
SEWER ELEVATION �� TOP OF FOOTING
4licant attar to this Torm two certificates of survey of lot and proposed
b ilding location rawn on, hese two certificates.
DESCRIPTION OF BUILDING
To be Used as:
-- Front Depth XHeight ��
Sq. Ft. %4f Cu. Ft.
Front Depth !2-q Height
E
Sq. Ft. Cu. Ft.
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 ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE 141�11 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side). i
I a
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building of structure, or for any addition to any existing
buildi.ng:or structure, or for any alteration 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 provid.ed to -wit:
Uniform Building Code: Type 1,2, & 4- $1.75 for each one thousand_ cubic feet, or
fraction thereof, in such cubical contents. Type 3 & 5 - $1.50 for.`each
one thousand cubic feet.
For the purpose of computing fees ,for building permits,, the cubical contents of
any building or addition to a uniform height throughout by multipluing 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 &t -to the average{ height of the
roof surface of the main gable of,,,a pitched.roof.
For repairs or alterations to,an existing structure, the fee shall be at the
rate of $3.00 per each Five 1Wridred Dollars -($500.00) or,'fraction thereof
in the cost of'all proposed work.
In no case shall the fee charged for any-permi.t as set forth in Section 2 be
less than $5.00.
NSSSD Connection Charges based on location- Area tor 2.
Ci- �
%AF
, '_..
M
� K
r® City of Fridley
O
Application for Plumbing and Cas Fitting Permit
R
Dept. of Bldgs. Phone 860-3450
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
i
iz
Number Fixtures ....... ..............
—— x $200
$
i
x $1.50
Z
nzr�:
Z
SaU
tQj Z
O
6
J
C
WU
OZ
Z
•
•
N
WATER HTR.
GAS
ELEG
Base
z $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$
Additional Fixtures ..... ..............
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
1st
2nd
3rd
4th
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,
Owner
Kind of Building
° Future Connection OpeningsI t,onneczea wun Sewer
New Fixture, Old Openings E]FiCesspool Used as
�
PLUMBING FIXTURE RATES:
NO. RATE TOTAL.
Number Fixtures ....... ..............
—— x $200
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ...... .....................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg. ............
x $3.25
$
Electric Water Heater
z $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$
Additional Fixtures ..... ..............
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE e
1
1
To be completed nl—lt
Estimated Cost,
Old—New. Build
ROUGH
FINAL
19_
Business Phone No
SUBJECTN
City of Fridley
26759
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
/ 9
1 �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
= S CITY HALL FRIDLEY 55432
"'j 612-571-3450
910-F15
7/22/98
JOB ADDRESS
7519 Tem o Terrace
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DescR.
13
4
MelodyManor
4th Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Sheila Mensching
784-4360
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Four Seasons Roofing & Remodeling
-9410
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP HONE LICENSE NO.
20138780
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION N REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (24 S) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS Aasr
Underlayment m&ut comply with 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 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
1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER S CIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2001
1.00
DOES NOT PRE E TO ITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS O N,Y OTH ST TE A LOCAL LAW REGUL TING .CON-
STRUCTIO O HE PERF M OF CONSTRUCTION.
$74. ]5
ire SC $2.00
PLAN CHECK FEE
TOTAL FEE
License SC $5�61.00
82.75
S NATURE OFCONTRACTOR O AUTHORIZED AGENT (DAT I
WHEN PROPERLY V ATED THIS IS YOUR PERMIT
�4,^ "2,Y^
r BLD -NSP DATE
S,GNATURE OF OWNER - IF OWNER BUILDERI IDATEI
NEW [ ]
ADDN [ ]
ALTER [ ]
ConstructionAddress:
Effective 1/1/98
CI*,,OF FRIDLEY .
SINGLE FAMILY ; -AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION 1 �.
Legal Description:
Owner Name & Address:la M_ e y7S0_A tna Tel. #_ x3460
Contractor: LO U r s fJ Yi S o d j�a
–0- l c' MN LICENSE # 2
Address: IN 3 U n d U Tel. #
Attach to this application, a Certificate of Survey of the f
lot, with the"' proposed. construction drawn on it,to scale.
DESCRIPTION, OF UYIPROVEMENT
LIVING AREA:Length
Width Height
Sq. Ft.
GARAGE AREA:
Length Width . Height
Sq. Ft.
DECD AREA:
Length Width Hgt/Ground Sq. Ft.
OTHER:
i"�Q�YI 0 v 2.. cL 11 e-zx, az, e� oxf-
5 h i r1 q l eS
Construction Type:
n ed.� ovt Estimated Cost: $
00 l
..... (Fee Schedule
on Back).
Driveway Curb Cut Width Needed: Ft.'' + 6 Ft = Ft x $
_ $
DATE:. /7— I
APPLICANT:'_(:�2
TeL
!CITX- USE ONLY
Permit Fee
$ Fee Schedule on Reverse Side
Fire Surcharge$
�00'` 001 of PermitValuation (1/10th%)
State Surcharge
$ /- (_0 $.50/$1`,000'Valuation
SAC Charge ,
$ $1000, per SAC Unit
License Surcharge
$F $5:00 (State Licensed Residential Contractors)
7 rti.;t
Driveway EscrowAlt,
' "A" or Alt. "B" Above
Erosion Control
$ :`$_450-.00 Con�erv4tion Plan Review
Park Fee
$ Fee Determined by Engineering
Sewer Main Charge,;
$ ' . , Agreement Necessary [. ] . Not, Necessary [ ] zfx gl , .,; ti� ,.: � •:;
TOTAL.:;.,.
STIPULATIONS:
.BUILDING PERMITTEE SCHEDULE,
The Chief Building Official shall,: before issuing permits for the ere1.ctioti'of any building or structure, or for
11
any addition to any existing building or structure, or for any alteration or repair to any. existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to -wit:
TOTAL VALUE
FEES
$1 to $500
$21 (Minimum Fee.is $21 plus surcharge)'
$501 to $2,000
$21 for first $500 plus $2.75 for each additional'$100 or ,
fraction thereof, to and including $2,000.
$2,001 to $25,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000
$349.75 for first $25,000 plus $9.00 for each. additional $1,000_
or fraction thereof, to and including $50,000. .
$50,001 to•$100,000 $574.75 for"first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012:25 for the fust $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 an&reolacenment of curb and gutter and install a 3 foot wide d: .
approach with 6 inch -depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION ........ �-#-
Permits for, construction will be issued. Am hi 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.
SUBJECT
P
City of Fridley
_
13-1-3-4-3)
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
L COMMUNITY DEVELOPMENT DIV.
l-e�
r ; PROTECTIVE INSPECTION SEC.
`
�� ",'� CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
Ai+PROVED BY
_-_-
L612-571-3450
910-F15
8/25/00
=GE
JOB ADDRESS 7519 Tempo Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
13
4
Melody Manor 4th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Brian/Sheila Mensching 7519 Tempo Terrace NE 763-784-4360
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Cj REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering.
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
SQ. 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
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
r
$3,300
$1.65
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 CHEC E
EE
'41TOTAL
$1.2.20
SIGNATUQE O"TAUTHORQEDAGEN T IDATEr
E RWVL EDHIS I$ � UR PRM
of
BL G rNSP - PATE
STUAE OF OwNEQ iF WILDER, rDATEi
ADDN [ ] CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 7-5 / q 0 �„s✓�d^G� r.� _ /�,
Legal Description:
Effective 1/1/2000
(763) 572-3604 Bldg Insp
Owner Name & Address: / al Tel. # 72'-��
Contractor: MN LICENSE #
Address:-�/
Tel. # �f o
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 HgtfGr()iind Sq. Ft.
OTHER: S�Ereczse, &,/?�M
Construction Type: lj.4utl L Estimated Cost: $ 3 3�/J
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: 4q'�V &&APPLICANT: ` ` y/ - Tel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ , aS� Fee Schedule on Reverse Side
Fire Surcharge .001 of Permit Valuation (1/10th%)
State Surcharge Owl $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ s ��
STIPULATIONS:
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to -wit:
TOTAL VALUE
$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 $1,000,000
$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
W . .
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit # ®��• ®c2�°�
Residential Application
City of Fridley
See Back Side For Required Information
Date —_R -Q6 Site Address:'' 619 TernQD MY CC
The applicant is: (cirlce one)
Owner ontractor
Property Owner: tar %O►r T%A
C hkt)p�
Address: 75la TICM
TffraCh
City: Fria Iew
State: MN Zip:55 3�..
Phone: `i IS- I J4 -43(00
Cell: Fax:
Contractor Information
Company Name:S
& 6\r CGt1C�\�h�il\
Contact Person: ICP V t "Cu--l'soci
Address:'1921 Qnivtrslit
-04
MC N>✓
1--
City.
State: t`AN Zip: 515
Phone: 71o3- 5 Z - b46q
Cell: Col Z.- 7A13 - 9143 Fax: 'I LOS 5'12 01 (D
Email: Q (e?
rACACLLCALA5. jnC* MN Bond# & Exp Date
Type of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work: -f
UrVJklSh GYAC1 infAC,At
Equipment Installed: MFG:C-rood man Model:&MSf070 a/BTU: 93%
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas Grill $10.00
AJC $25.00
Fireplace (wood) $35.00 _Gas Unit HTR $10.00
_Air to Air exchanger $15.00
7Fumace $35.00 _Pool Heater $35.00
_Boiler $35.00
_Gas Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00
_Gas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $
35 • (Total from above -Minimum fee $35.00)
Surcharge 60.50
Total Due $JS
.s-- Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical 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 case of all work which requires review and approval of plans.
Signature of Applicant: Vi ` Date:" r0�
Approval Inspector Signature: Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Revised 6/14/2005
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT-
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
`) _ ; � ,f _
REQUIRED FOR NEW/EXISTING HOMES ` �''
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances 1FGC 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
Building
PLUMBING
Permit No.: e
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FR MLEY
Date Rec'd: (In Lip
DATE �f ! l ) ICS YOUR E-MAIL ADDRESS
SITE ADDRESS e-,, ME
THIS APPLICANT IS: ❑ OWNER MONTRACTOR
PROPERTY
NAME:,%,L 14 Men Whtn Cf
OWNER/
ADDRESS: 1j CITY 1 r4 Ie, STATEALNLIP 55'43
TENANT
PHONE: ' i WI - 77r?-(- Ll ?)L,
CONTRACTOR
NAM
SUBMIT A COPY OF
STAT L C� SSE m i EXP DATE / a-� .
YOUR STATE
ADD dvI ITY STATE ZIP
LICENSE WITH
PHONE
APPLICATION
j
❑ TOWNHOUSE
PERMIT TYPE
I7SINGLE FAMILY ❑ TWO FAMILY
❑ NEW REPLACEMENT
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK (A)Cd-P— r
f
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 FD{TURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING
_ _FLOOR
PIPING (NEW Ct7rticEhao _ SWIMMING POOL —WATER SOFTNER ($35)
—BATHTUB —GAS
CLOTHES WASHER KITCHEN SINK WATER CLOSET _BACKFLOW PREV. ($15)
_ _
DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_
WATER METER —OTHER
y, A
".e,°...
Number of fixtures @ $10.00 x $10.00 = $
Permit Fee $ �3. C) 0
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $. CX-)
State Surcharge = $ .50
Total = $
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 ancodes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applicatio 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 hick review and approval of plans.
PRINT NAME DATE 6/®
SIGNATURE OF APPLICANT
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
3 5 -Sr"
fm 1',) f'
Building
MECHANICAL
Permit NO.: �e
Inspections
RESIDENTIAL APPLICATION
Received By
763-5ic
72-3604
CITY OF FRIDLEY
Date Recd: '
DATE — YOUR E-MAIL ADDRESS
_IqL
SITE ADDRESS ..00
CONTRACTOR
THIS APPLICANT IS: ❑ owkER
PROPERTY
NAME; � SC ,
5J�
OWNER/
ADDRESS: �1 CITY
STATE,ALZIP
TENANT
A2
PHONE:
CONTRACTOR
COMPANY NAME: S d <
SU13M1T A COPY OF
CONTACT PERSON:
YOUR STATE
STATE LICENSE # EXP DATEC
LICENSE WITH
ADDRESS: (�-
STATE 6 `/� ZIP`f�Z
APPLICATION
PHONE_.W S FAX
TYPE
�INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
PERNIIT
TYPE OF WORK:
❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK 1=
PER MS 1613.665 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) A F�C
SIZEBTU
Equipment Installed MFG: MODEL: ls*��I
MFG: MODEL:
SIZE/BTU
MFG: MODEL:
SIZE/BTU
�A/C $25.00 FIREPLACE (GAS) $15.00
GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
_BOILER $35.00 FURNACE $35.00
LINER $10.00 DRYER $10.00 _POOL
HEATER $35.00
_CHIMNEY _GAS
DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR
$15.00
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 _L x $25.00 = $-197W
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $.
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 of to start without a permit; that the work will be in accordance with the
approved plan in the case of work w h re . es review d approval of p1w.
SIGNATURE OF APPLICANT PRINT NAmEL 1 E,1i id 19 " DATE
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 HOMESIADDITIONS EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel 1MC Chapter 7 with MN Amendments
b. Natural Gas or.Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per 1MC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
3uilding
Inspections
763-572-3604
BUILDING aao�
RESIDENTIAL APPLICATI®N
CITY OF FRIDLEY
YOUR E-MAIL
;ITE ADDRESS 75- 1 c -7,--*6'3'1 Ao 7--ee - ae e
HIS APPLICANT IS: O OWNER CONTRACTOR
Permit No.:
Received By:
Date Rec'd:
PROPERTY OWNER/
NAME: ri sahi
I GL n
S 0,
TENANT
ADDRESS: -7 5-19
1
E crrY Erl Q STATE SS' 2_
/�� . �J' See Back Page for Fee Schedule
Plan Review
$ .
65% of Building Permit Fee
CONTRACTOR
NAME: tk)FL_iJAJ&17DhJ
0JW b6
W mp&r y
SUBMIT A COPY OF
STATE LICENSE 4 �X�6i'I
fes' �''S `� s✓' d L
D i Gi (� e�
YOUR STATE LICENSE
ADDRESS:
OW82bo
CITYST. Louis P,l�STATE
WITH APPLICATION
PHONE S 2
3,3- FAX
q-52- — L
PROPERTY TYPE
0 SINGLE FAMIL /NEW CONSTRUCTION
SIZE
$
O TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
0 ADDITION
O GARAGE/SHED
O WINDOWS
0 BASEMENT FINISH
0 ROOF
O DRAIN TILE
0 DECK
0 SIDING
OTHER (2. V --T L A G E_
0 SWIMMING ING POOL
TYPE OF WORK:
0 NEW
0 ADDITION
0 MAINTENANCE/REPAIR 0 REMODELING
DESCRIBE WORK BEING DONE: 'ReD I a. zmua _� ®-V w i n d nw �s 4 ?b
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
LENGTH WIDTH
0 HOUSE ONLY
0 HOUSE & GARAGE
GARAGES 0 ATTACHED GARAGE
PROPOSED SIZE: 0 DETACHED GARAGE
PROPOSED HEIGHT:
SIDING
0 Vinyl OSoffit .
0 Aluminum - 0 Trim
O Other 0 Fascia
wlNDows
IN EXISTING OPENINGS.dYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES & dd
TYPE OF WINDOW TO BE INSTALLED NUMSER OF WINDOWS__�P
HEIGHT
Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
F6R'NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the.existipg structures
and proposed project..
2. Two sets of construction pians
3: Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR
AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ /0 OCCUPANCY TYPE
Permit Fee
$
/�� . �J' See Back Page for Fee Schedule
Plan Review
$ .
65% of Building Permit Fee
Fire Surcharge
$
/ .001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$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
$ / o Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
T hereby apply for a building permit and I acknowledge that the information above is complete and accurate; `tliaf 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 a d approval of plans. �ry
SIGNATURE OF APPLICANT' PRINT NAME ALL I SOt3 1 1:a EoueA E � o� D� 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 inihe rnazutef herein
provided to -wit:
TOTAL VALUE
FEES
$1 to $300
$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 inaction, to and
including $$25,000
$25,001 to $50,000
$391.25 for 1s' $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 l- $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 10 $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for cozisiruction will be= issued a ininirrium 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 Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977