PRE 2010 DOCSBuilding
$
BUILDING
See Back Page for Fee Schedule
Permit No.
Inspections
-YG9 `I. %
RESIDENTIAL APPLICATION
Received By:/
763-572-3664,Date
Ll s _ 4- L
OF FRIDLEY
Date Recd:
DATE '5o
YOUR E-MAIL ADDRESS
.0005 x Permit Valuation Minimum $.50
SITE ADDRESS 2
'a rJ s . 1C� MN
-5.L� 0
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
$
PROPERTY OWNER/
NAME:
Curb Cut Escrow
TENANT
ADDRESS: CITY STATE ZIP
ft + 6 ft = ft x $21 =$
PHONE:
$
CONTRACTOR
NAME: 91veHo-"e5 /inc
Park Fee
STATE LICENSE # Z® 71-0) 3 X131 EXP DATE MW -ryq j
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDREs : Z Z fi /� 1 Tel
CITY 6 011 ✓r t STATE ZIP
WITH APPLICATION
PHONE6 3 74r7' ZZ FAXC63
Z v
PROPERTY TYPE
JXSINGEE FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:'
❑ ADDITION
TENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: N ew t°�-" S (:-
SIZE OF IMPROVEMENT LENGTH
WIDTH HEIGHT 13 V t7 Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
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 ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING 1' 27 i1.CE SCHEDULE)
TYPE
p�PE
TOTAL JOB VALUATION $ /% �'OCCUPANC
Permit Fee
$
d i ° a5. ;j
See Back Page for Fee Schedule
Plan Review
$
-YG9 `I. %
65% of Building Permit Fee
Fire Surcharge
$
Ll s _ 4- L
.001 times the total job valuation
Surcharge
$
-7:2,3
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
-5.L� 0
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
175-5—C -77-c-7
$1550 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
$
Si �. �,�
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 acknowled a that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ci hdley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an app 'cation a o not to start without a permit; that the work will be in accordance with the approved
plan in the case of all ork whic ires re approval of plans.
j SIGNATURE OF APPLIC PRINT NAME /��/)//� DATE �� ��
Permit #
Permit Date
tzlREScheck Software Version 3.7 Release 1 b
Compliance Certificate
Project Title: JAKE MAGDIK RESIDENCE
Report Date: 06/07/06
Energy Code: 2000 Minnesota Energy Code
Location: Anoka County, Minnesota
Construction Type: Single Family
Glazing Area Percentage: 11%
Construction Site: Owner/Agent: Designer/Contractor:
FRIDLEY, MN JEFF
BLUEPRINT HOMES
MN
e e 1 . o , • •
Cont. -Glazing
Cavity
Assembly R -Value R -Value or
D..
Ceiling 1: Flat Ceiling or Scissor Truss: 1276 44.0 0.7 34
Wall 1: Wood Frame, 16" o.c.: 2024 19.0 0.7 103
Window 1: Above-Grade:Vinyl Frame:Double Pane with Low -E: 234 0.350 82
Door 1: Solid: 38 0.070 3
Wall 2: Wood Frame, 24" o .c.: 280 10.0 0.7 24
Basement Wall 1: Masonry Block with Empty Cells: 848 10.0 0.0 49
Window 2: Basement > 5.6 ft2:Wood Frame:Double Pane with 18 0.350 6
Low -E:
Floor 1: All -Wood Joist/Truss:Over Unconditioned Space: 312 30.0 0.7 10
Floor 2: All -Wood Joist/Truss:Over Outside Air: 12 30.0 0.7 0
Furnace 1: Forced Hot Air: 90 AFUE
Air Conditioner 1: Electric Central Air: 10 SEER
Compliance Statement: Statement of Compliance: The proposed building design described here is consistent with the building
plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet
the 2000 Minnesota Energy Code requirements In REScheck Version 3.7 Release 1 b and to comply with the mandatory
requirements listed in the REScheck Inspection Checklist.
Builder/Designer Company Name
Project Notes:
CROIX #06233....6/7/06
Date
JAKE MAGDIK RESIDENCE Page 1 or i
Permit #
Permit Date
0 REScheck Software Version 3.7 Release 1 b
N/"' Compliance Certificate
Project Title: JAKE MAGDIK RESIDENCE
Report Date: 06/07/06
Energy Code: 2000 Minnesota Energy Code
Location: Anoka County, Minnesota
Construction Type: Single Family
Glazing Area Percentage: 11%
Construction Site: Owner/Agent: Designer/Contractor:
FRIDLEY, MN JEFF
BLUEPRINT HOMES
MN
Compliance: Passes °3t�i�,o;P°",MaximumUA 410;; rs"Your Horne lJA 311 -> 24.1°lo Better Than Code (UA)
Ceiling 1: Flat Ceiling or Scissor Truss:
1276
44.0
0.7
34
Wall 1: Wood Frame, 16" o.c.:
2024
19.0
0.7
103
Window 1: Above-Grade:Vinyl Frame:Double Pane with Low -E:
234
0.350
82
Door 1: Solid:
38
0.070
3
Wall 2: Wood Frame, 24" o .c.:
280
10.0
0.7
24
Basement Wall 1: Masonry Block with Empty Cells:
848
10.0
0.0
49
Window 2: Basement > 5.6 ft2:Wood Frame:Double Pane with
18
0.350
6
Low -E:
Floor 1: All -Wood Joist/Truss:Over Unconditioned Space:
312
30.0
0.7
10
Floor 2: All -Wood Joist/Truss:Over Outside Air:
12
30.0
0.7
0
Furnace 1: Forced Hot Air: 90 AFUE
Air Conditioner 1: Electric Central Air: 10 SEER
Compliance Statement: Statement of Compliance: The proposed building design described here is consistent with the building
plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet
the 2000 Minnesota Energy Code requirements in REScheck Version 3.7 Release 1 b and to comply with the mandatory
requirements listed in the REScheck Inspection Checklist.
Builder/Designer Company Name Date
Project Notes:
CROIX #06233....6/7/06
JAKE MAGDIK RESIDENCE Page 1 of 1
City of Fridley
6431 University Ave NE
Fridley MN 55432 e
(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: !A k_1 I O kP
Job Address: MIA " Z t d Si_ ° N1�7
Name of Applicant (Plumber): Mi VI 8 . h L °
Name of Property Owner: �jY1 hfiD� C °
Existing Structure Permit #
Permit Type: Sewer Fee:CjQ .°')
Water Fee: 5 0.00
Meter Fee:
Repair Fee:
Relocation:
State Surcharge: . ro D
SAC Charge:
Special Assessment Fee:
Total: $ 100.roO
Applicant Signature: CIUro0
Inspector approval:
Water Meter Repair — Weekend & Holidays
$125/hour
Water Connections Permit
$50
Sewer Connections Permit
$50
Inspection Fee for Water/Sewer Line R air
$40
Special Assessments
See Engineering
Cost of Water Meter
See Utility Billing
SAC Charge
$1550
State Surcharge
$ .50
Water Ta
See En 'neerin
04/04/05
r_�
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604CITY
OF FRIDLEY
Date Rec'd:
DATE-,/ � - 4a b YOUR E-MAIL ADDRESS
SITE ADDRESS 2.;t / � !C Tr
THIS APPLICANT IS: O OWNER *ONTRACTOR
PROPERTY
NAME: %-
ADDRESS: CITY STATE ZIP
OWNER/
TENANT
PHONE:
CONTRACTOR
��
NAME: /�'I�C IVO IAS J)Z C
STATE LICENSE # ? fl LAS EXP DATE / a - 3
SUBMIT A COPY OF
YOUR STATE
ADDRESS: ,!� 5f -a Ulf hR II1a lid CITY eLDA/ STATE n,,, ZIP _rSd //
LICENSE WITH
PHONE 9
tz.3 1V11- /flS(j FAX 9d2_
APPLICATION
PERMIT TYPE
06INGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
0 REPLACEMENT
DETAILED DESCRIPTION OF WORK 7yiL„✓y Di Alt ,n/ A14k %C
PER MS 1613.665 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..shouldreflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 =
FOREROJECTS WHERE LABOR EXCEEDS1500,71TEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT.Wi ERE'NOTED .F.DCrA-MS:-.(INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV _FLOOR DRAINS SHOWER _ WATER PIPING
BATHTUB / GAS PIPING (ArEw crryLicEmsk) _ SWIMMING POOL _ WATER SOFTNER ($35)
CLOTHES WASHER / KITCHEN SINK/ WATER CLOSET _ BACKFLOW PREV. ($15)
L DISHWASHER LAUNDRY TRAY ,LWATER HEATER ($35) FOR IRRIGATION
WATER METER —OTHER
NAMMmu
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $ WO - CRS
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $ -W
TOTAL DUE $
State Surcharge = $ .50
Total = $ lS .
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 worl 1 'c r tures review and approval of plans.
SIGNATURE OF APPLICANT it PRINT NAME
f
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
IN
Building
MECHANICAL
Permit No. -
Inspections
RESIDENTIAL APPLICATION
Received By:
f �'
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATE C7 6 YOUR E-MAIL ADDRESS
A
SITE ADDRESS ZW 1 3 64
THIS APPLICANT IS: ❑ OWNER PCONTRACTOR
PROPERTY
NAME:
ADDRESS: CITY STATE ZIP
OWNER/
TENANT
PHONE:
CONTRACTOR
COMPANY NAME:
SUBMIT ACOPY OF
CONTACT PERSON:
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRES/S� 3 g CITY STATE 2Z&zIP 72_dJ_
APPLICATION
PHONE �) av-qu G FAX f — 7K
PERMIT TYPE
Ej SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
RNEW ❑ REPLACEMENT ❑ 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) / I /
Equipmentlnstalled MFG: 'Gta did MODEL: HEX �6� SIZE/BTU 60000
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00C�FURNACE $35.00 GAS UNIT HTR $10.00
CHIIVINEY LINER $10.00 DRYER $10.00 POOL HEATER $35.00
_GAS
DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00
�y f
>.a.^�i
i- T Y'F,. Nf `�v,-. _�n-'. £�. 'T"...�. .... .. x.51:
Permit Fee $
Number of fixtures @ $10 00 1 x $10.00 = $k0. QW
Surcharge $ .50
Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $
Number of fixtures @ $25.00 �— x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $_,Sc
State Surcharge = $ 50
Total = $ "1-0
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 DATE 8 2
-
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 0 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
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REOUIRED 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 air calculations.
���
'Building
AHCHANICAL
P��nitrro.:
InspectionsRESIDENTYAY,
APPLICATION
Received By: //Q
763-572-360
CITY OF F LEY
DateRee`d: %
DATE _ _- I YOUR E-MAIL ADDUSS
SITE ADDRLSS' %
THIS APPLICANT IS: O OWNER -PC'.ONTRACTOR
PROPERTY
NAME;
Oi1VNER/
TENANT
ADDRESS: CITY STATE ZIP
PHONE:
CONTRACTOR
COMPANY NAME;
SUBMIT A COPY OF
CONTACT PMWN'
YOUR STATE
STATE LICENSE Y N t — 719 51) EXP DATE
LICENSE WITH
ADDRESS; � `�1i�......_ "1'1 r`i ITY STATE /�wGIP J� i3
APPLICATION
PHONE FAX
PERMIT TYPE
,161NGLE FAMILY O TWO FAMILY O TOWNI•IOUSE
.j
TYPE OF WORK:
D REPLACEMENT C ALTERATION/REMODEL
DETAILED DESCRIPTION OF "WORK
PER MS I6B.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 WHEU LABOR EXCEEDS $500 FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment InstalIC4 MFG: 5�D MODEL: SIZE/BTU
MFG; MODEL.: SIZMTU
_
MFG: MODEL: SIZEISTU
_A/C $25.00 >CFIRMPLACE. (GAS) $15.00 GAS IAwGE(OVE a$10.00
AIR TO AIR UCHANGEM S 15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOU,ER 535.00 _FURNACE $35.00 -GAS UNIT HTR $10.00
CfiIIv�TEY LINERS 10.00 ,_GAS DRYER Sl D.00 HEATER $35.00
_POOL
DUCT WOPIX $10.00 GAS PIPING $10.00 YENrILATOR $15.00
Permit Fee $
Number of fixtures $10.00_x$10.00 = $
Surcharge SSD
Number of fixtures @ $I5.00 x $15.00;-- $
TOTAL DUE $ IS.
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = S
State Surcharge $� ..- .50
'Total c $. _..._
THIS 1S AN APPLICATION POR 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 tate Minnesota Construction Codes; that I understand this is
not a permit but only an appli t far a permit and work is not to start without a permit; that tho work will be in accordance with the
approved plan in the case .a w k whi es ravie and approval of plans.
SIGNATURE OF APPLICANT PR11dT NAME L! DATE
City of Fridley
Building Inspections Department .
6431 University Avenue NB, Fridley, MN 55432
763-5723604
FAX: 763-502-4977
Td WULE :ZO 9002 zZ 'daS 4eeTT4SR9Z: 'ON Xbd
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