PRE 2010 DOCSt "-
City of Fridley, Minna
BUILDING PERMIT N® 4134
Date: . --.. ...... //
Owner: -------- ------------ Builder
Address..... ....................... --_......._.__.._.._....._......._...._......_..._-•__........._.... Address............................................................. ..... .........................................
LOCATION OF B ILD!��G
No.Street _...- _ ....,�...� ....artof t ------ ---- --............
Lot ...........�................... Block ....._.........-..............._ Addition or Sub-Divisio � ...... G'-'_'...
Corner Lot ..........................------... Inside Lot ....._X .............. ......... Setback ..... .I.. 2............... Sid d .. ,/ L ._'...!................._............._.._.._..
Sewer Elevation ............ ....................... _............. _............................ __..................... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: .�
.._............ Front �,�(.....'...Depth .�f.....1..'�/ ._PHeight ...1.. -.'.'Sq. Ft.._.. Cu. Ft.
..._.............:_..................... Front ....................... Depth ...__......... .. Height ........................ Sq. Ft. ..... _........... .._.. Cu. Ft. .....................
Type of Construction ... ................................................. _..... Est. Car -12t. -W? To 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 sett 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 we
the Building Inspector for separate permits for these items.
r
APPLICATION. FOR BUILDING PERMIT
CITY OF F'RIDLEY, MINNESOTA
Owner`s Nanie ,� Builder
Addre5we-.0 :' r Q xAddress
LOCATION OF BUILDING
No. a ,(o_. S,tr� t' ® -Part of .Lot
Lot, Block a Addition or Sub.Div. -
Tr
71
Corner Lot Inside Lot I- Set Back
S Side -Yard 14__._Q (�
SEi "ELEVATION �',-FOUNDATION ELEVATION 44
,V cant: a tta ch to this form, = Certificate of Survey o La.t and' propos ui ding
locati�ii.
DESCRIPTION OF BUILDING
To '4e 'used ast.
cYr' Front Al .P �j P� Depth I
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft
Cu. Ft.
Type of Construction Estimated Cost_„�j'
To be completed `go
The un0ersigried''hereby" makes application for a permit for the work herein,specified,
agreeing' *toy do -,A-11 work in strict. accordance with the City 'Ordinances and 'ruling of
the De�ent•of`Buildirigs, and -hereby, declares that all the facts and'r'epresenta-
tions:sitated in this application are true and correct.
DATE r o SIGNATURE
Side.)
(A Sc edu]e of Fee costs can be found on the Reverse
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,,.r_ppair,,,_s to
Ir
�.tructure, upon application the�refon,'j To 'u
ag� - �,* A q,
g �uilding �qr
the payment , by the applicant for such permit of fee's to the amount
herein below set forth and in the manner herein provided to -wit:
pre
2.1 For any of any fireproof building.,
other than a g-aLr4ge.i.,,.yarqi�oT
fKrAb'_r;y, or grain elevator., or for - the
erection of any fireproof addition, for similajr'occupancy, to any
existing building shall be at the rate of $1.40 for each one thousand.
cubic feet, `or fra ction. they-eof in .such- cubical., -contents, -
2.2 For any such permit ...�qp�!,the erection of.-aTl-v.-.fir-epr-oof--W-age,
-6r grain.. elevator, . .. o . r _ for . . . the . . erection of any fireproof
addition for similar occupq�icy _-,3�y,.e61sting building shall be at the
rate of J1.25 for each 'O"n'e.".'t-ho"tc'a':t.d:dubi'b feet, classified as "fireproof"
by Section 502 of the Minneapolis Building Code.
— Hi
2.3 For any such. pea-,�it:*for- .�he!:*e*r-ectior-r--o-ff-7any-mcii;-PirePFoof-be ildng
n
otne__:Ei�a'a garage, warehouse, factory or grain ,elevator.,: or any,,
nonf13jeprOO_D_ARjdi1ion)-- -for similar'' occuPa=Y, to any existrQ-building.
$1.00 for each one.thousand cubic feet.
For any --such pei-mi:t f&the er'ec'tion of any non -fireproof ga:pa
warehouse, factory or grain elevator, or for the erection of any non -
fireproof addition..? _for simil.q;-.'-000,aP4ncyj 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 cont6fi-Es!th0reof-
with a minimum of U-00,
For-t�i`e' purpo s -s- of fees
for di permits the cubical
contents of any building or addition to a un fori__heilght..throughou by
multiplying the ground area'covered from a point six (6) indhes below
z.
the floor cline of the bappmqnt or cellar to tho-avarage_heigbt of. the
. t . of .
average t I he roof surface of the main,
gable of a pitched roof,
tions to an existing, s
2.5 For repair.� or. pl-ra
0-'':P' Hundred Dollar or
be--a--t--the .-rate of 43 00 -6, e s (6500-00),
fraction thereof in the cost of all proposed,
2.6 In no casep.hll
Qr,,_.arjy.:.--per�t dt'---Ibet far h iri
can
-Section 2'
q;
bel
T'.
!:T�
v,
SUBJECT
PERM
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
RECEIPT NO
COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
1 I
=
1 "1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/7/83
JOB ADDRESS 7630 Van Buren Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
2
Shaffer's Subdivision #1 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Richard Pouliot 7630 Van Buren Street N.E. 780-2533
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Fullerton Zumber Co. 5737 —37th Avenue South, MPLS. 727-2904
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
X
8 DESCRIBE WORK
Reroof Dwelling and Install Escape Window in Basement
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
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
$1l OO
$, 55
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
P OVIS NS OF ANY OTHER STATE OR LOCA AW REGULATING CON-
$19e OO
ST U ION OR THE PERFORMANCE OF CONS CTION.
PLAN CHECK FEE
TOTAL FEE
$19.55
SIGNATURE OF CONTRACTOR OR AUTHORED AGENT (DATE)
WHEN PROPERL VALIDAT D THIS IS YOUR PERMIT
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG INSP D E
Effective Aug. 1, 1981
CITY OF FRIDLEY
APPLICATIM FOR RESIOENTIAL BUILDING PER 141TS
(New, Alterations, Additions, or Repairs)
OtsrIER:
ADDRESS: S ri U,A A Ut �F"'j S %/; ADDRESS: S'7 S `2- 3 71' Vj MALS-;
TEL n0: '7 F- c,� ® 2- 3S TEL NO: 7 Z 7 -- L "� a'f
Construction Location
STRICT -NO: STREET:
LOT: BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback.: Sideyards:
`Applicant attach to this form two Certificates of Survey of lot and
':proposed building location drawn on certificates to scale.
F '
DESCRIPTION OF CONSTRUCTION
Front:
p4q_S t_AI t T Square Feet:
Front:
Square Feet:
Depth: Height:
Cubic Feet:
Depth: Height:
Cubic Feet:
Type of Construction-. O ui c k- ejt-*= 2A, `v_Estimated Cost: $ /Q C)
Rb Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE jEVF.RsE SIDE OF SHEET -
?Sie undersigned hereby makes application for a permit for the %:,ork herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correc .
DATE: �. � � '"� ,.� SIGN2ITUF.e^� :
v
Stipulations;
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 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:
$1.00 to $500.00
$10.00 (Minimum $15.00)
$501 to $29000.00
$10.00 for the first $500 plus $1.50
for each additional $100 or fraction
thereof, to and including $2,000
$2,001 to $25,000
$32.50 for the first $2,000 plus $6.00
for each additional $1,000 or fraction
thereof, to and including $25,000
$25,001 to $50,000
$170.50 for the first $25,000 plus
$4.50 for each additional $1,000 or
fraction thereof, to and including
$50,000
$50,001 to $100,000
$283.00 for the first $50,000 plus
$3.00 for each additional $1,000 or
fraction thereof, to and including
$100,000
$100,001 and up
$443.00 for the first $100,000 plus
$2.50 for each additional $1,000 or
fraction thereof
Plan Check: 25 percent of building permit fee.
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
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 been constructed will be required before proceeding with the
framing.
CITY OF FRIDLEY
APPLICATION FOR PWMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL_
New Fixtures g 5.00 g
Future Fixture* g 3.50 $
Old Opening. Now Fixture $ gam_
seer Dispenser $ 4.00 $
Blow Off Basin g 5.00 g
Catch Basin g 5.00 g
Rain Nater Leader $ 5.00 g
Hydraulic Valve $ 5.00 $
Sump or Receiving Tank 8 5.00 g
Nater Treating Appliance $- 7.00 $
Not Water Neater $ S.00 $�
Gas Range $ 10.00 g
Can Dryer $ 10.00 g
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
is of Value of Fixture or Appliance $
Reinspection Fes $ State Surcharge $ .50
($15.00) TOTAL FEE $
Krtectave Aug. 1, 1981
Job Address ® j� r-� 4
Department of Buildings
City of Fridley
Tel. 0571-3450
The undersigned hereby slakes application for a permit for the work herein
Specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Bu.1dings. and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley. Nn. el"q . l
OWNER zv�e " 116
KIND OF BUILDING
USED AS
ROUt.11 INSP.
Date
FINAL INSP. 6 -1 (I &
Date
APPROVAL FOR PERMIT 6
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
u
�i'
a
Mater
.ci a
a
G"
gg�
Heater
"
�
8m
a.
0'1
"
o
A
w
di
8
aim
g
e
too
a"
6
lot
2nd
RAN
3rd
NN
4th
(R) - Future Connection opening
Connected With Sewer
V) - New Fixture, Old Opening
Mater
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL_
New Fixtures g 5.00 g
Future Fixture* g 3.50 $
Old Opening. Now Fixture $ gam_
seer Dispenser $ 4.00 $
Blow Off Basin g 5.00 g
Catch Basin g 5.00 g
Rain Nater Leader $ 5.00 g
Hydraulic Valve $ 5.00 $
Sump or Receiving Tank 8 5.00 g
Nater Treating Appliance $- 7.00 $
Not Water Neater $ S.00 $�
Gas Range $ 10.00 g
Can Dryer $ 10.00 g
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
is of Value of Fixture or Appliance $
Reinspection Fes $ State Surcharge $ .50
($15.00) TOTAL FEE $
Krtectave Aug. 1, 1981
Job Address ® j� r-� 4
Department of Buildings
City of Fridley
Tel. 0571-3450
The undersigned hereby slakes application for a permit for the work herein
Specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Bu.1dings. and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley. Nn. el"q . l
OWNER zv�e " 116
KIND OF BUILDING
USED AS
ROUt.11 INSP.
Date
FINAL INSP. 6 -1 (I &
Date
APPROVAL FOR PERMIT 6
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
SUBJECT
City ®f Fridley
28649
T 664F THETWINS
E
BUILDINGPERMIT
R
`�,�
, i fr ��e�e _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC
/.,
E
NUMBER
HEY
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450 1
910-F15
11124198
JOB ADDRESS
7630 Van Buren St ret NE
1 LEGAL
LOT NO. BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6 2 IShaffer's.subdivision
#1SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ken Duba7,94-7199
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Top Gun Inc. 5014 Parris -428-4559
20128233
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
D NEW 0 ADDITION 0 ALTERATION Qx REPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof house and garage 12 SO 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
OCCUPANCYLOAD
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
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
1028
.51
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�QT.HE PERFOR IAN E OF CONSTRUCTION
$37.50
Fire SC $1.03
PLAN CHECK FEE
TOTALFEE
Sd
Liense SC $5,0Qj
1$44.04
SlNATURED ONTRACT OR OR AU7-Hbo4IZEq AGENT iDA
WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
S.GNATURE OF OWNER pF OWNER BUILDER, iDATE,
BL G NSR
BATE
NEW (' Effective 8/1/95
ADDN (( CITY OF FRIDLEY
ALTER () SINGLE FAMILY AND DUPLEXES R-1 AND R-2
1: --+,,
on
Building Pernut App
d s: ; IA)257,
ConstructionA dres 113
Legal Description:
Owner Name & Address:
-7(,0-3
Tel. #
Contractor: 7-C P 6 CMU - /l)C MN LICENSE # �%�� �l�_
Address: —�®/� ��/S1t lge7 Tel. # V2- 2
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. FL
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: —
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: �/!— 01 Estimated Cost: $C��•
ot
Approx. Completion Date:
(Cost -on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: / _APPLICANT: Tel. #���%(4&A A USE ONLY
Permit Fee $ /, ) " Fee Schedule on Reverse Side
Fire Surcharge $, t6 .001 of Permit Valuation (1/10th%)
State Surcharge $ p S� $.50/$1,000 Valuation
SAC Charge $ $850 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 $
STIPULATIONS:
Building
BUILDING
$ �C' I -;)"T
Permit No.: ':20 ow ,I
Inspections
RESIDENTIAL APPLICATION
Received By: ffy�b
763-572-3604
CITY OF FRIDLEY
.001 times the total job valuation
Dat 2011
763-502-4977 FAX-
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
EFFECTIVE 1-1-2010
$
$2100 per SAC Unit (Plans to MWCC for determination)
DATE ' t [ YOUR E-MAIL ADDRESS k d\-)t)a.\1
' . V\4 VyLAI ( �
TEC
SIADDRESS 7 Lo3 ti: oQ" t:S .�' -1k-I) , . E t S c '-A-0 P a
ti� w -3
THIS APPLICANT IS: V.OWNER ❑CONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME:
Fee Determined by Engineering
TENANT
ADDRESS: `"7Lra�b6= A !U ITY_ L s
� STATE &% ZIP
Total Due
PHONE:
Make checks savable to: Citv of Fridlev Attach Stiaulations
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE #
EXP DATE
AND CERTIFICATE OF
ADDRESS:
CITY STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
WSINGLE FAMILY/NEW CONSTRUCTION SIZE L-A • t A. 3 . t
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF IJ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: f
SIZE OF IMPROVEMENT LENGTH '74, IDTH
HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES 13 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES ° ❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE: %EOETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim
I. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes Olo LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF 4VO } Lk
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS Of)f-.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ -M OCCUPANCY TYPE
Permit Fee
$ �C' I -;)"T
See Back Page for Fee Schedule
Plan Review
$ QS 4 1
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$ g E} •
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $24 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary( )
Total Due
$ UFaiA 3Y
Make checks savable 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 application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of aU work which requires^ fevvNw d approval of plans.
SIGNATURE OF APPLICANT�� ��� i� L-)- d INT NAME �tAftA kk bQ1-i DATE la'
1z
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 1' $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for I" $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 1' $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 forthe 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
763-572-3604
Fax: 763-502-4977
Building
Permit Fee
BUILDING
��� See Back Page for Fee Schedule
Permit No.:SX16 0 10'
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By: 9?k
763-572-3604
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
763-502-4977 FAX
CITY OF FRIDLEY
ec'd: ,
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
�
Erosion Control
$
EFFECTIVE 1-1-2010
Park Fee
•
DATE
YOUR E-MAIL ADDRESS �
, vk&e�
SITE ADDRESS L46J l�C,-- r � c o J`Cr���
,� A� S� Z
THIS APPLICANT IS:
AWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: —T
TENANT
ADDRESS:`i to3 Z�, LSCS,y
CITY �f zi�g� STATEAAAZIP S L432-
.P 2PHONE:
PHONE:—IRS -14
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE #
EXP DATE
AND CERTIFICATE OF
ADDRESS:
CITY STATE ZIP
INSURANCE
PHONE
FAX
PROPERTY TYPE
J&SINGLE FAMILY/NEW CONSTRUCTION
SIZE Olt x `2.W
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCEIREPAIR PIZEMODELING
DESCRIBE WORK BEING DONE: Ra1i
u'l,
SIZE OF IMPROVEMENT
LENGTH L4� WIDTH ( HEIGHT , 5 SO FT
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
Floor1. Existing
GARAGES
❑ ATTACHED GARAGE
2.. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS_ & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
l . Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes f4No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
e S N�HE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
��� 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
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $24
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
5 1, ! Make checks savable to: Citv of Fridlev Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of 1 work which re ti es re ew and approval of plans. c� ,
SIGNATURE OF APPLICANT PRINT NAME -3 D ATE )b — PL� —10
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 1' $2,000 plus $14 for each additional $1,000 or fraction, 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 1" $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 1g $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 0 $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
1 l/1 A,,,66X
t i
i2
_ i r714/.i�
�24" Dia. base
Structural Details by
Becklin & Whitney
Consulting Engineers, Inc.
P.O. Box 471
Cambridge, MRI 55080
763-689-5631
0
I '
CC/'se-fes' O� ,
1 HVRERY CERTIFY TILAT THIS PLAN,
SPECIFICATION, OR REPORT WAS PREPARED BY ME
OR UNDER my DIRRC't SUPERYI.SION THAT
AND
AM A. DULY REGISTERED PROF MtONAL
ENGINEER
UNDER THE LAWS OF THE STATE OF
iENGREEN -
MINNESOTA.
�1
VYII:I wi A. IIF Kj, N, P:£.
DATE: June 25, 2010 REG. NO, IS494
Structural Details by
Becklin & Whitney
Consulting Engineers, Inc.
P.O. Box 471
Cambridge, MRI 55080
763-689-5631
0
I '
CC/'se-fes' O� ,
BC6 Post Cap
C'Oly 4'Ioly 2 y r 2x6 Brace
-
��' (2)1.75x9.5 LVL or (2)11.875 LVL
L90 both sides �.
24" '
2x6 SP #2 braces both directions
at each corner (8) locations
ABA66 Simpson or equal
-� /L 1, sR
2x6 SP #2
(3) 31/2" Ledgerl-ok
7 ft minimum
9
Structural Details by
Becklin & Whitney
Consulting Engineers, Inc.
P.O. Box 471
Cambridge, MN 55080
763-689-5631
�-- BC6 Post Cap
21_0"
6x6
SP #2 treated
ABA66 Simpson or equal
,1
42" Below
outside grade
24" l
1 IIERF.D\' CFRI IFY TIIAT THIS PIAN.
• i �,
SPECIFICATION. OR REPORT WAS PREPARED BY ME
UR INDFR MY UIRFLT SUPERVISION AND TIIAT 1
�•~��� •'•,�/2
����'r
AM A DULY REGISTERED PROFS ZONAL
ENGIYEERUYIIF.RTUE LAWSOFTIIESTATFOF
ENCiUVEER
mINNF.S(TI'A.
�N9. IH434 .�A4�
�iii144�it1, �
�'pF•••••�Nf9,•`
Fix
i,� MIN
WII.tJ.VAI A. BF.CI:I.IN. P.E.
i,.•
DATE. June 28, 2010 Rm No. 18494
9
Structural Details by
Becklin & Whitney
Consulting Engineers, Inc.
P.O. Box 471
Cambridge, MN 55080
763-689-5631
�-- BC6 Post Cap
21_0"
6x6
SP #2 treated
ABA66 Simpson or equal
,1
42" Below
outside grade
24" l
CITY OF FRIDLEY MOVING [ ] DEMO [ ] PERMIT APPLICATION
6431 University Ave NE
Fridley MN 55432
(763)572-3604 FAX (763)571-1287 ft 2016
Job"+'
Legal Description: J° 2
Owner & Address: Tel.
Contractor: Tel. #
Address: State License #
DESCRIPTION OF BUILDING
HOUSE: Length
Width
Height
Sq. Ft. Cu. Ft.
Cu. Ft.
GARAGE:Length
Z,21 Width ���
Height �\s
Sq. Ft.
OTHER: Length
Width
Height
Sq. Ft. Cu. Ft.
Estimated Cost
$ 9
Approx.
Completion Date c ?—R -l0
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL
UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE.
Moving Route:
APPROVALS) REQUIRED PRIOR TO ISSUANCE:
MPCA: NOTIFICATION OF INTENT -TO PERFORM A DEMOLITION ( ) YES ( ) NO
❑ Wat�Or %dill Paid: Yes[ ] or Collect [$
n
cial Condit
Engineering Conditions
Fire Marshal Conditions
]Signature
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict
accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the
property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application
are true and correct.
A7 7 TIVXXnT rrnN nFRRic- TNrT TTniNG FOIINDATION & SLAB, SHALL BE REMOVED FROM SITE.
(.0- ZE -l0
Date Signature
Moving Wrec '
Principle building into Fridley .... $300.00 For each 1,000 cubic feet or fraction ...... $1.25
Accessory building into Fridley ... $ 42.00 For structures which would be impractical to
Through or within the City ...... $ 20.00 cube, the fee shall be based on the total cost
Move a building out of City ...... $ 20.00 of wrecking at the rate of $6.00 for each $500.00
or fraction.
Effective 1/01/2010
MINIMUM $20.00 Office Use Only: SAC -D form completed
Building MECHANICAL Permit No I
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY McUp 0 "
763-502-4977 FAX I EFFECTIVE7-1-2010
DATE q " ,7- /I YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
t OWNER ❑CON77TRACTOR
NAME: v v iJG•�
ADDRESS: i, �Ct n Yl� Sri CITY F{ ' 4
PHONE: (q) 1 It, 7 1 i'7
ATE )ylla ZIP
COMPANY NAME:
CONTACT PERSON:
STATE LICENSE # EXP DATE
ADDRESS: CITY STATE ZIP
PHONE FAX
PERMIT TYPE OVSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: JQ NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORKS/"i
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALCIS PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG:
MODEL:
SIZE/BTU
MFG:
MODEL:
SIZEIBTU
MFG:
MODEL:
SIZE/BTU
$25.00
(GAS) $15.00
_,GAS RANGE/OVEN $10.00
_A/C
TO AIR EXCHANGEER $15
_FIREPLACE
(WOOD) $35.00
_NEW GAS GRILL $10.00
_AIR
$35.00
_FIREPLACE
_FURNACE $35.00
GAS UNIT HTR $10.00
_BOILER
LINER $10.00
DRYER $10.00
_POOL HEATER $35.00
_CHIMNEY
DUCT WORK $10.00
_GAS
TGAS PIPING $10.00
VENTILATOR $15.00
THIS IS AN APPLI ATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work -which requires review and approval of plans.
SIGNATURE OF APPLICANT �.;`� i:. t. G / �/ PRINT NAME T s / I /QL'/J1_=^DATE
INSPECTORS SIGNA'
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. NI 104.4.13
5. Ventilation
a. Per MN Rule Chapter 1322. Sec. 1104
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.