PRE 2010 DOCSN® 7396
Builder --
® LO TI OF BUILDING
No. Street �--_ . P t
Lot Block Addition or 0-1u. on
Corner Lot , Inside Lot -- Setback S
Sewer Elevation ...... Fo dation Elevation
DESCRIPTION OF BUILDING
TO Oe i
Depth Height Sq. Ft. CU. Ft 214(e
Front Depth Height Sq. Ft. Cu. FL
7�?pe Of on 4.0 Est. 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 a'll provisions of
ordinances of the city of Fridley. dj 10 /--) I /J
In consideration of the payment of a fee of $ 1—> , 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. — - ®,
NOTICE:
This permit does not cover the cand, ctian, installation for wiring, phnnbing, gas heating, ewer or water. Be sure to see
the Building inspector for separate permits for thea items.
APPLICATION. FOR BUILDING PERMIT
CITY , OF FRIDLEY, • MINNESOTA73
OWNER'S NAME �� BUILDER _
ADDRESS` �?e --. J Q ADDRESS 19, t
LOCATION OF BUILDING
No. ..Street dart of Lot
Lot Block_Addition or Subdivision
Corner.ot Ins ide Lots Setback , : Side : Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of.Lot and proposed build-
irig location drawn on these Certificates..
DESCRIPTION OF BUILDING
Front. Depth. Height
,a
Sq. Ft. Cu. It
,Front Depth Height
Sq. Ft . Cu Ft.
Type of Construction Estimated Cost
To be Completed
The undersigned hereby makes application fora permit for the work herein specified,
agreeing to do all work in strict ace ordance 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 correct.
DATE
j Schedule of Fee Costs can be found on -the Reverse Side).
A � �
.. '�+�
j�
_. �
�Q t
�`� _. I I
zl��. �. �' - _.
1:
rj
___ � � �.
SUBJECT
P
City of Fraley
3000 6
AT THE TOP OF THE TWINS
BUILDING
PERMIT
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
f PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE /�n
7
PAGE OF
APPROVED BY
L , ` 612-571-3450
910-F15
10B ADDRESS 4780 2 1/2 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1, 2
6
Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mary Zylka
572-8966
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
RNR Construction 12049 Oregon Cir. Champlin 55316 422-2010 6644
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION ) REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage 22 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
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 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
1923
.96
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S N OR THE PERFORMANCE OF CONSTRUCTION
$69.25
A
Fire SC $1.92
e
PLAN CHECK FEETOTALF
LiactC S
5.
7 13
IGNATURE OFC TRACTOR COR AUTHORIZEO AGENT ATEi
EN ROP
ALIDATE IS IS Y PER
S-GNA URE OF OWNER�1F OWNER BW�DERI - IDATE.
Bl G iNSF'
MATE
NEW[ j
ADDN
ALTER
Construction Address:
Legal Description:
Effective 5/10/99
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Z/,790 2%5/ /C/t--
°3 p �"
130®21 1e�'
Owner Name & Address:
INJO
Z z.Z 4
V7 a6 Z ''� j
�` Tel. #
Contractor: ZA) e
r3
�K ck T a—
.001 of Permit Valuation (1/10th%)
MN LICENSE
Address: ✓ � �% V �
Ole L (0 ca - C1 I �
� r�
(�
�,��0( Tel. # &
Attach to this application, a Certificate of Survey, of the
lot, with the proposed construction drawn: on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height Sq. Ft.
Height Sq. Ft.
HgyGround Sq. Ft.
_If
Construction Type: / CAs" 0, ,� i�c-�`` J� ` Estimated Cost:
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = 'Ft x $
INI
69 APPLICANT:2� DATE: . ^�
:STIPULATIONS:
USE ONLY
Permit Fee
�aCITY
$ / s 12 S
Fee Schedule on Reverse Side
Fire Surcharge
$ 0 ,;
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC.LTpat
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
$ 3
:STIPULATIONS:
Building
$
BUILDING
Plan Review
Permit No.: '
Inspections
Surcharge
RESIDENTIAL APPLICATION
/20 (.0005) times the total job valuation — Minimum $.50
Received By:
763-572-3604
C77 .001 x Permit Valuation (1/10%)
CITY OF FRIDLEY
$
Date Rec'd:
DATE /� NO V d S YOUR E-MAIL ADDRESS
$
SITE ADDRESS �i SO NL-'
Curb Cut Escrow
THIS APPLICANT IS:
O OWNER (!°CONTRACTOR
Erosion Control
PROPERTY OWNER/
NAME: /%Z&7. /Gt4
Park Fee
TENANT
ADDRESS: V7 86 '7- 11Z S f , A1& CITY /.OL -e 4
STATFIUI eIP
$
7�3 - g 9 6
Total Due
$
PHONE:
CONTRACTOR
NAME: kA-11C 0�n/
//
STATE LICENSE # (P 6 </y EXP DATE `/;-7 /9 °e
e Ce
SUBMIT A COPY OF
/-� a-vq alfe6 0�` C "'C CITY 0 STA ZEN�0
YOUR STATE LICENSE
ADDRESS:
WITH APPLICATION
pg NE '20 - Z12 2 • 21 / c) FAX
p%NGLF, FAMILY/NEW CONSTRUCTION SIZE
PROPERTY TYPE
O TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
O ADDITION O GARAGE/SHED O WINDOWS
O BASEMENT FINISH GOOF O DRAIN TILE
O DECK O SIDING 0 OTHER
O SWIMMING POOL
TYPE OF WORK:
O NEW O ADDITION
CE/REPAIR O REMODELING
DESCRIBE WORK BEING DONE: I%b kf if4a f— LsHApe iyIA1 Si oe �1r�� •c
/�sc �� P P/� , K
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
NUMBER OF SQUARES -
--Et"OUSE ONLY
O HOUSE & GARAGE
BASEMENT REMODELING SUBI Tf:
1.
Existing Floor Plan
GARAGES
O 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
❑Soffit
ADDITIONS_ & PORCHES SUBMIT:
O Aluminum
O Trim
1.
Site Plan/Survey showing the existing structures
O Other
—B-Fmia
and proposed project
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS OYes ONO 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 MA'FERIALS:
(USING -THE SP7 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ O OCCUPANCY TYPE
Permit Fee
$
9&. /oO See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
/20 (.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
C77 .001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks payable to: City of Fridley 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; that the work will be in accordance with the approved
plan in the case of all w w 'c eie and approval of plans. _
SIGNATURE OF APPLIC ���'��,t PRINT NAME f IO aN& y � y.5/ -i &I I Z- C- DATE �S/1/� d
Building
Inspections
7.63-572-3604
DATE
SITE ADDRESS —
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIODLEY
YOUR E-MAIL ADDRESS
!g
❑ OWNER iNTRACTOR
Permit No.:
Received By: Q-1
Date Rec' d:'l' .,?i -0 �O
ADDRESS: a < CI Y - STATS/l/ ZIP,
PHONE: r763,"?.5V?o
COMPANY NAME: etal Inc.
CONTACT PERSON: •E Suite 39 e7hWIS
STATE LICENSE # ''
ho-
ADDRESS:1 ,)QnR STATE ZIP,
�
�Trv41
PHONE _ FAX
TYPE OF WORK: 113 NEW
FAMILY 0 TWO FAMILY
[J'REPLACEMENi'
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
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 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) MODEL: I !d 3` y SIZEBTU
Equipment Installed MFG: SIZEIgTU
MFC,: MODEL:
MFG: MODEL: STZEBTU
E
A/C $25.00 _FIREPLACE (GAS) $15.00 . _GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL 0.0$10 00
BOILER $35.00 _FURNACE $35.00 _,GAS HHTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 00
POOL HE$15ATER $35.00
DUCT WORK $10.00 _GAS PIPING $10.00 VEIQTTLATOR .
_ atiii:!w-.2/si�»iYti"vA3?.iiZri'�W1"i
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 / x $25.00 = $
TOTAL DUE $
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 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 PRINT NAME �f f k l' �RJ2 -DATE Z 5
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 NEWIEXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or PropaneUGC 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 IMC 1346:0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up airy calculations