PRE 2010 DOCSi
City of Fridley, Minn.
BUH DING PERMIT N® 3466
Date: .. ,�. .. .: .......
Owner ....................................... Builder .... ... ... J ... .........
Address...................................... Address .............................................
LOCATION OF BUILDING
No: ........... Street ..... ....... ... ...... .<.... Part of Lot ..
�/fLot/011 ! /Kock ............... Addition or Sub -Division
.. Inside Lot .. %�.. a
Corner Lot ......... ..... Setback —�. 5ideyard
DESCRIPTION OF BUILDING
To be Us as: .,
a � �P �
..... rout , y.. �.. Height �f~ ��. y Sq. Ft. -3..3I7 Cu. Ft~T.f?. 7#6
.................... Front ........ Depth ........ Heightt........ Sq. Ft......... Ca Ft.........
101.0
Type of Construction ................... Mat. Cost... /I XQ ..'.'To be Completed
...................
- / r /fes
In consideration of the issuance to me of a permit to construct the building desribed 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 f .�q, 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 with-
in the city limits and this permit may be revoked at any jitimeon violation of any of the provisions of said
ordinances.
..... ..... Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
1_
0
Application for Porter Pius and Heating. Cooling. Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
RATE TOTAL
8.00
5.00
5.00 $
2.50 $
8.00
$
2.00
¢
5.00
$
5.00
$
2.50
$
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ 16. 0
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ _
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ 2°
OIL BURNER—to 3 gal, per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ 62
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $_%
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $ /
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
REMARKS: 1/411,
FAIVE
See Fee Schedule
�-/ TOTAL FEE $
% 1
Loc on so 2 . �-' `; �/�/G _ ` , i�—;"
City of Fridley:
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.
Fridley, Minn -
195 -2
195-2
Owner /_ 195—
Kind of Building- C2 195—
Used as
To be completed about
Estimated Cost, $ 3
Old New. Building Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—St Hot Wa , Warm Air—No
• Cr '20 J
Trade Name R % Size No 6-/ S ---CT
Capacity /l f 6 Sq. Ft. EM.R BTU H.P.
Total Connected Load/ 9!2 f 7,9 Kind of rue]
BURNER — Trade Name b.�/_�/%' Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Signed C �✓ e� ✓ S=Fr
11 POST 1 M -t 2-58 Business Phone No-
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3602 or Fax (763) 502-4977
-Water and Sewer Permit Application
❑ New Connection ❑Utility Line Repair/Relocation
Existing ❑Water and Sewer Connection
Date:,?—
Job Address: Sig c-�— 3 V -a
Name of Applicant (Plumber): /1 , C, _/—D/77,®lC� �rS
Name of Property Owner: h'e -a—
Existing Structure Permit #
Permit Type: Sewer Fee:
Water Fee:
Meter Fee:
Repair Fee: X
Relocation:
State Surcharge:
SAC Charge:
Special Assessment Fee:
Applicant Signat
Inspector appro,
Total: $
Water Meter Repair — W d & Holidays
$125/hour
Water Connections Permit
$50
Sewer Connections Permit
$50
Inspection Fee for Water/Sewer Line Re air
$40
Special Assessments
See Engineering
Cost of Water Meter
See Utility Billing
SAC Charge
$1550
State Surcharge
$ .50
Water Tap
See En 'neerin
04/04/05
Building
AKE IJAS>L;D ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
BUILDING
Permit No.- 667'X -I
Inspections
ZBC
®D 21 OCCUPANCY TYPE
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
CITY OF FRIDLEY
Fire Surcharge
Date Rec'd: 1361
1763-502-4977 FAX
Surcharge
$
5V .0005 x Permit Valuation Minimum $.50
License Surcharge
$
EFFECTIVE 1-1-08
SAC Charge
$
O
G�
DATE_aryI
YOUR E-MAIL ADDRESS (�' QS`7
L" i� ��Y "6s' CAM
SITE ADDRESS �L2.h
$450 Conservation Plan Review
Park Fee
_
THIS APPLICANT IS:
❑ OWNER *ONTRACTOR
Sewer Main Charge
PROPERTY OWNER/
NAME: i nl 16hLL.
Total Due
TENANT
ADDRESS: S r NAEr- CITY FP D �a
STATEA4hLZIPtZ3-)/ 2—I
PHONE: /103 !3q— 204
I hereby apply for a building
d I acknowledge that the information above is complete and accurate; that the work w�71 be in conformance with the ordinances and codes
44"
NAME:
the to 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
CONTRACTOR
ADDRESS: It ,Q) OW17EZS G90fe- A -Y&-- 'SU.IT -) ITYk-
STA ZIP'
SUBMIT A COPY OF
PHONE &3 7-2-5`033 FAX
P NAME JR I'�/ v DATE 5- �M
YOUR STATE LICENSE
�/^
STATE LICENSE # AQ2& ' 5
G�
31
s EXP DATE
PROPERTY TYPE
qlNGLE FAMILY/NEW CONSTRUCTION SIZE
❑ Two FAMILY/NEW CONSTRUCTION STORIES
PERIVIIT TYPE
GE/SHED ❑ WINDOWS
❑ ADDITIONPSIDING
13BASEMENT FINISHC❑ DRAIN TILE
❑ DECK ❑OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:1.
NUMBER OF SQUARES
❑ HOUSE & GARAGE
Existing 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
1.
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 r'Z;Eb
AKE IJAS>L;D ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1"jFEE SCHEDULE)
'OTAL JOB VALUATION S
ZBC
®D 21 OCCUPANCY TYPE
Permit Fee
cl ; S7- See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
RIP .001 times the total job valuation
Surcharge
$
5V .0005 x Permit Valuation Minimum $.50
License Surcharge
$
-00 $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 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
$
o40 Make checks payable to: City of Fridley AttachStipalatious
e
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building
d I acknowledge that the information above is complete and accurate; that the work w�71 be in conformance with the ordinances and codes
44"
of the City of Fridley and
the to 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
be in acco
with the approved plan in the case of all work which requires review and approval of plans. /
SIGNATURE OF APPLI
P NAME JR I'�/ v DATE 5- �M
APPROVF.T) RV
0
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