PRE 2010 DOCSCity of Fridley, Mm.
BUILDING PERMIT N? 5 4 0 3
Date:
Owner: Builder "c
Address Address
Jf LOCTIOI OPS DING
No. * Street .- fife... ._ Part of
Lot - _____ Block ___ ' Addition or Sub -Division
_ Or
Corner Lot _ _ Inside Lot _ _ aback �5_--...._... Sf 4iey d
Sewer Elevation — ___ _ Foundation Elevation
DESCRIPTION OF BUILDING
Toff as:
Front Depth Height Sq. Ft. _ Cu. Ft.=-.
nt
Depth A -.Height _ Sq. Ft. _ Cu. Ft.. _
Type of Construction '''AeEst. Cost :2M '_—_- Co 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
ordinances 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 so
the Building Inspector for separate permits for these Nems
4
Owner 1 s
Address
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Builder
LOCATION,OF BUILDING
No. /. / Stree Part of Lot
LotBloek �- Addition or Subdivisio
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
ont �—� Depth ---2— c> ----Height Q
Sq. Ft. Cu. Ft.
ct� Front`Depth SC / eight
Sq. Ft. Cu. Ft.
Type of Construction \� Estimated Cost�—;Xd v d
To be Completed / `- 6
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.
DATE 7-1& SIGNATURE
(A Schedule of.Fee Costs can be found on the Reverse Side.)
BUILDING PERMIT FEE SCHEDUIE
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 build-
ing 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 meaner 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 fireproof 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 $1.25.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./+. For any such permit for the erection of any nor -fireproof garage, warehouse,
factory or grain elevator, or for the erection of any non -fireproof addition, fnr
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 $1.00.
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 for 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.
CITY OF FRIDLEY
APPLICATION FOR.POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTEM:
RATE TOTAL
$12.00 $
7.00 $ s
7.00 $
4.00 $
Job Address
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
$12.00 $ specified agreeing to do all work in strict accordance with the City Codes
4.00 $ and rulings of the Department of Buildings, and hereby declares that all the
7.00 S facts and representations stated in this application are true and correct.
7.00 $
4.00 $ Fr ey, Minn. AD— 19--47
OWNER
Boiler & Lines up to 100,000 BTU
$12.00
$
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
each addn. 50,000 BTU
6.00
$
OIL BURNER- to 3 gal. per hour
$10.00
$
each add. 3 gal. per hour
10.00
$
GAS BURNER- from 100,000 BTU to 199#999 BTU
$10.00
$ %iJ• i�
(over 199,999 BTU see Fee Schedule)
S
GAS FITTING FEES:
1st 3 Fixtures x
$ 3.00
$
Additional Fixtures x
$ 1.00
$
Gas Range to 199,000 BTU x
$10.00•
$
AIR CONDITIONING
$
FAN HEATING SYSTEMS See Fee schedule
$
VENTILATING SYSTEMS
$
ALTERATIONS & REPAIRS
$
State Surcharge
$ ..750
TOTAL FEE
$ % / , SZ
ROUGH INSP.
Dace
FINAL INSP.
Date
APPROVAL FOR PERMIT s
REINSPECTION FEE
($10.00)
MINIMUM FEE FOR ANr HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT b"`7Z
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER.
HEATING or POWER PLANTS, Stoam, Hot Wate Warm AiY No.
Trade NameSize No.
Capacity ffff Sq. Ft. EDRBTU BP
Total Connected Load _Ae_ Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU®® HP
Company
Signed By
Tel. No.�
SUBJECT
�
City of Fridley
26944'
AT THE TOP OF THE TWINS
BUILDING
E lollIT
r
RECEIPT NO.
' • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
H�J
NUMBER
REV
DATE
PAGE OF
APPROVED BY
I "S CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/31/98
f'
JOB ADDRESS
6131 Tr nity Dr
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
10
1 1
1 Sylvan Hills Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Richard D.& Cynthia D.Baker 6131 Trinity Dr.
586-0177
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Owner
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 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
R roof house and garage 0 S Teax-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
S0. 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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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 SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
1668
.83
DOES NOT PRESU,%NE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF,'ANY OTHER TATE OR LOCAL LAW REGULA ING CON-
STRUCTION }THE P FO A C O C STRUCTION.
54,QQ
Fire SC $1.66
�y
PLAN CHECK FEE
TOT FEE
..
56.49
ATURE FCOAC AU D GENT I ATEI
EN ROP
B G It S
ALIDA THIS IS YOUR PER
r
qA E
SIGNATURE OF OWNER OF OWNER BUILDERi MATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Effective 1/1/98 `
as ��
Owner Name & Address:
Contractor:
�b�tel. # (� '/& zz—
MN
LICENSE #
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: S"1--
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: _ Ft. + 6 Ft%= Ft x $ _ $
DATE: �31119 APPLICAP
CITY USE ONLY
Tel. # J ��
TOTAL 4
STIPULATIONS:
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 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 4
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 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 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
PLUMBING
Permit No.:��
Inspections
RESIDENTIAL* APPLICATION
Received By: Abb
763-572-3604
CITY OF FRIDLEY
Doe'&'MAY 15 200
763-502-4977 FAX
EFFECTIVE 1-1-08
j L
DATE YOUR E-MAIL ADDRESS . %6G'�C/'/f.L
SITE ADDRESS r
THIS APPLICANT IS: ❑ OWNER AlC6NTRACTOR
PROPERTY
NAME:
ADDRESS: CITY STATE IP
OWNER/
TENANT
"
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
STATE LICENSE # EXP trATE
YOUR STATE
LICENSE, BOND AND
STATE BOND #DD EXP DATE
CERTIFICATE OF
ADDRESS;./%JyZ '5 . 'tal %t h ®C /V,6" G-" CITY ( e TATE ZIP
INSURANCE
PHONE 7,/,-3 75" FAX
PERMIT TYPE
;4INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW PLACEMENT
DETAILED DESCRIPTION OF WORK
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 = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW). MINIMUM FEE $15.50.
SHOWER %� WATER PIPING
—BATH SINKILAV _FLOOR DRAINS _
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL _WATER SOFTNER ($35)
_ _ _
WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
—CLOTHES _ _
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER —OTHER
MRamM El 1_11a
Permit Fee " $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
OR Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
State Surcharge = $ 50
(MINIMUM $15.50)
(MINIMUM $15.50) Total = $—
THIS 1S AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 on site; that the work will be in accordance
with the approve an in the case o all w requires review and approval of plans.
SIGNATURE OFAPPLI ANT PRINT NAME / �� �3 J �C�G��`�— DATE
APPROVED BY DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977