PRE 2010 DOCSCITY OF FRIDLEY INSPECTION DIVISION `� � � -Q C ®o 1 ��
6431Ul ����
University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work,.Bumer —
Also Replacement Furnace
. (Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $
$10.00 $
$10.00 $
$10.00 $
$ 25.00 $
a
State Surcharge
TOTAL FEE
$ .50
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.5b STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effecti On Janr 9���
JOB ADDRESS� !Ea2.x " Al 4a
The undersigned hereby makes application for a permit for the :Work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
,1998
OWNER
BUILDING USED AS
ESTIMATED COST �� �y ��. PERMIT NO. 1
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPAN s/�
Signed By Tel No. �3� ��-✓
Approved By Rough—In Date Final Date t 4`"' C'J4""
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. . Has been carefully examined Yes (Vj No ( )
2. Is free from rust or deterioration Yes W No ( )
-3. Has no foreign objects lodged within Yes (a No ( }
4. Is securely supported • Yes (j/� No ( )
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of
All other BTU's .,
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
a
14
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes (V No ( )
Yes
No
Yes
No
SUBJECT
MIT NO.
City of Fridley
3 0138
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
PROTECTIVE
��r
E J
�
I .."'1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
". 612-571-3450
910415
8/30/99
!OB ADDRESS 5891 West Moore Lake Drive
K
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
IDonnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mr & Mrs David Pohl
571-1462
3. CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
N. Central B1drs. Inc. 7401 42nd Ave N
New Hoe 55427 533-6168 3763
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 0 ADDITION 0 ALTERATION TY REPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reside house and ara e• Soffit and fascia
9 CHANGE OF USE FROM
TO
STIPULATIONS
Call for building wrap inspection before
covering
Install soffit ventilation to meet the State Building Code.
Permit Inspection Cards
Will Be Wailed
To Homeowner To Post
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 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 1 HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
7000 $3.50
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-
$139.25
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
Fire SC $7.00
FEE
PLAN CHECK FEE;754.
Licens $5. 75
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
EN RD VALI D THIS IS OUPEFjIMI
X
Bl0 INSP OAtE
SIGNATURE OF OWNER OF OWNER BUILOERI IDATEI
NEW [ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER SINGLE FAME1,Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Vl
Construction Address: %q 6� v p sT Mooa I AI<F
Legal Description-
Owner
I
Owner Name & Address: M P• 4 M IZ� MV I D i �i Sg&, Tel. # G jj � I �1 b4Z
Contractor:,N. UNTVAI &ILDFLiN• MN LICENSE #�3 7
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DIESCR=1Ol°d OF IMPROVEAlENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: e P tnmted Cost: $ rib M, 00
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #°�'Ot
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ l3 - )s'
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th o)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ ILI %
STIPULATIONS:
v
/70i
ALL FEES
TOTAL
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
.SED ON VALUATION, INCLUDING THE COST Ur* LAISUK AIV iv IVIA i r,ccmi.a:
00 (USING THE 1997 .0 FEE SCHEDULE)
rALUATION $ O OCCUPANCY TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley 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 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 w ich requires7""—Q
w and approval of plans. l L
SIGNATURE OF APPLICANT PRINT NAME VFW V1 7 / ZfvU! _DATE /O"3L' (Q
BUILDING / I 7 4-Permlt
s
N o
Building
B
Received By:
Inspections
RESIDENTIAL APPLICATION
763-572-3604
CITY OF FRIDLEY
Date Rec'4 !�
DATE �3 - U �Q
YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS:
❑ OWNER ONTRACTOR
PROPERTY OWNER/
NAME: v
ADDRESS: 5 C) 1 y7 Y1'� g. CITY
TENANT
PHONE: % U-2
CONTRACTOR
NAME:
_
STATE LICENSE # �7 {D y EXP DATE -5 au
SUBMIT A COPY OF
LX n CITY IV? K) Synt/✓ STATE 1 L IP �i 2 it 9
YOUR STATE LICENSE
ADDRESS: -Q-`-
WITH APPLICATION
PHONE - - d FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH CMOOF ❑ DRAIN TILE
❑ DECK p SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
QVEW ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: a•9 ,-
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ((HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1.
Floor Plan
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 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 ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES
TOTAL
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
.SED ON VALUATION, INCLUDING THE COST Ur* LAISUK AIV iv IVIA i r,ccmi.a:
00 (USING THE 1997 .0 FEE SCHEDULE)
rALUATION $ O OCCUPANCY TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley 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 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 w ich requires7""—Q
w and approval of plans. l L
SIGNATURE OF APPLICANT PRINT NAME VFW V1 7 / ZfvU! _DATE /O"3L' (Q