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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N?'I���� Date: Owner: Builder _..._....._. Address _. _. �? ..� Address ._..... a, '® LOCATION OF BUILDING No..:. --. .. .._.._.... Street t �3`rs. _!si"" ,e._....__.__ Part of t Lot .-...__ - Block ................ ..._ ..................Addition or Sub -Division .... :. �.:YJ ........... 3, Corner Lot ..... . ................... _........ Inside Lot ..... _..... L+."' ........... Setback ._.._...., ............ Sideyard .................. _............. _............. - ..... -.... Sewer Elevation ................................... ........ _.... _...................... _.... _....... _.... .......... Foundation Elevation DESCRIPTION OF BUILDING To be Used as: � -- --- Height --.----�- -- r I Depth g Sq. Ft. I S Cu. F't. _.......- - /� Front ..... .............. ............. ....... ron Depth ................ .., Height ............. Sq. Ft. ...................... Cu. Ft. ..... _................. Type of Construction ...:.....orf.. est. cost ...,�"_..�-�{'�r.'......�.�_'.".'1.Co be Completed ..... ........ _._.._........ ........... THIS PERMIT, DOES -CAUTION UTHORIZE VIOLAT. ION OF ANY PRIVATE LAND COVENANTS AND MLDING RESTRICTIONS, !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 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, re - d moving of buildings within the city limits and this permit may be revoked at anytime, upon vio tion of an of the provisions of said OTdiIIatice3. �`' r _._. ....._ ding Inspector NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name .% Builder Address Addresa� .. LOCATION OF BUILDING No. Street F, "�f" �8' 1k J _ Part of Lot Lot 4 Block 15- Addition or Sub,Div. Corner Lot_ Inside Lot set Back = c) - !' Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front o Height Sq. Ft.1 �4 ems_ Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft, Type of Construction Estimated Cost .�:�= ) •. -� To be completed 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 representa- tions stated in this application are true and. -correct. - DATE � 4_ w SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) City of Fridley Application faw Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4.7470 DESCRIPTION OF WORK � A ® 7 die% //yy � Number. Kind and Location of Fixtures Location E ` PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: �QQ Number Fixtures ...................... 12Zi Future Fixture Opening ................ x 1.20 New Fixture Old Opening .............. SH Catch Basin ............................ Om R J wU 0U' 0 z �U' • • N WATER HTR. GAS ELEC. az (09 ° a4 O R Base / 1st 1 1 1 1 1 2nd _ 3rd 4th • Future Connection Openings Connected with Sewer New Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures ...................... x $1.50 Future Fixture Opening ................ x 1.20 New Fixture Old Opening .............. x 1.00 Catch Basin ............................ x 3.25 Water Heater (Up to 200,000 BTU) ...... x 2.00 New Ground Run Old Bldg. ............ - -- x 3.25 TO/TAL $/6.'. 0 $© $ $ , a 0 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 $ oZ , a U REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ /-9.tK/ ej 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, Owner (9. Kind of Building &e14 e n nr) . Used as To be completed about Estimated Cost, $ Old—New. Building Permit No PeMit oZ C' Signe ROUGH FINAL - -9M042 42 2M 7-59 Business Phone No 19(—.O City of Fridley, Minn. 9790 • BUILDING PERMIT Date: June 10, 1968 i Owners _ Thomas Weinhandl Builder — Same Address 380 67th Ave. N. E. _ Address Same LOCATION OF BUILDING No. — 380_ Street _ _ 6 7 th Ave . N. E . Part of Lot Lot ____ 4 __ Block 5 _..._.._ Addition or Sub.Division . Rice Creek Terrace Plat: 3 Corner Lot --- Inside Lot Sewer Elevation �— Setback — _ _ Sideyard __ Foundation Elevation _.. DESCRIPTION OF BUILDING To be Used as: Garage Front ___Z4' Depth 24' Height �12' Sq. Ft. 600 Cu. Ft 4200 Front Depth _ _ Height Sq. Ft. _ __ Cu. Ft. Type of Construction game Fst. Cost A1,000-00 --- 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 set forth and in mpliance withone of ordinances of the city of Fridley. u7-0yd In consideration of the payment of a fee of $ 11.00 .,permit is hereby granted to— Thomas Weinhandl 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 ordineaces 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 ea�d ordinances. Official Building RXIMMOr ohn Breher • NOTICE: This permit does not cover the comstruction, huhgation for wiring, plumbing, gn heating, oewer or water. Be sun to see the Building Inspector for separate permits for these Nems• APPLICATION FOR BUILDING.PERMIT. . CITY OF FBIMZYO MINNESOTA OW1+�R'.S DAME /�i: ���,(7td�!.� Jul .. ; ....:._� LWDB:LSS V �fGE !r .�,�ADDREAS' j, T� •ti fir LOCATI014 OF 'kTiLDING NO. �U STREET - z aetJ`�,pa LOT:_•BLOCRJr- ADDiiIO�T Og SDDI�SIC�Nf 3 CORDER LOT INSIDE LOTY SETBACK SIDEYAR SEWER ELEVATION TOP ;OF„ �POTING Applicant attach to this form Two Certificates of,Survey of Lot and.progosed building location drawn on these Certificates. DESCRIPTION -OF BUILDING To Be Used As: + Frontl�_ Depth Height'', _ Square feet 6.0-0 Cubic Feet Front Depth Height Square feet ` Cubic Feet Type of Construction, Estimated Cost dz' To Be Completed w The undersigned hereby makes application for a permit for the work 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 correct. LW DATE (Schedule of Fee Costs can be found on the Reverse Side. P'� 1r .. � . . 0 0 City of Fridley Application for Plumbing and Gas RMng Permit 0 Dept. of Bldgs. Phone 5M-3450 DESCRIPTION OF WORK2 Location Number. Kind and Location of Fix�}tes A PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ` x $2.00 $ G d Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening ............. Catch Basin ...... .................... Water Heater (Up to 99,000 BTU) . New Ground Run Old Bldg. ........... Electric Water Heater GAS FITTING FEES: x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ s $2.00 $ NO. RATE TOTAL 1st 3 Fixtures ...... ................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................. ..............................$ TOTAL FEE $ City of Fridley: 40 The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Mnn C Owner Kind of Building Used ash To be completed about Estimated Cost, $ '..!*—New. Building Permit No Permit No. Signe /y �, o p Business Phone No. ROUGH FINAL _3 - I L ` Z Z l7 n F N WATER HTR. GAS ELEc O Base 1st 2nd 3rd 4th _ • Future Connection Openings Connected with New Fixture, Old Openings I Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ` x $2.00 $ G d Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening ............. Catch Basin ...... .................... Water Heater (Up to 99,000 BTU) . New Ground Run Old Bldg. ........... Electric Water Heater GAS FITTING FEES: x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ s $2.00 $ NO. RATE TOTAL 1st 3 Fixtures ...... ................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................. ..............................$ TOTAL FEE $ City of Fridley: 40 The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Mnn C Owner Kind of Building Used ash To be completed about Estimated Cost, $ '..!*—New. Building Permit No Permit No. Signe /y �, o p Business Phone No. ROUGH FINAL _3 - I L ` City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PERM13091 r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 . i CITY HALL FRIDLEY 55432 812-580-3450 RECEIPT NO. NUMBER 910-F15 REV. DATE 7-16-75 PAGE OF APPROVED BY JOB ADDRESS 380 — 67Th AVENUE N.E., FRIDLEY, MINNESOTA 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 1 RICE CREEK 'jTERRACE, PLAT 3 SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE LYLE LARSON, 380 — 67TH AVENUE N.E., FRIDLEY, MINNESOTA 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. JAMES JABLONSKI 5610 MATTERHORN DRIVE N.E. FRIDLEY 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING RESIDENCE 7 CLASS OF WORK ❑ NEW Jk ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK INSTALL PATIO & DECK 9 CHANGE OF USE FROM TO STIPULATIONS WARNING REQUIRED FOR WIRING, digging call local utilities SEpERATE PERMITS REQ TELEPHONE - ELECTRIC - GAS Etc. tjEAITING, PEU M91NG AND SIGNS. REQUIRED BY LANV 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 AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION ZONING SO. FT. CU. FT. 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED, VALUATION SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- PER IT FEE SAC CHARGE ST�UCTIONTHE PE O ANCE OF CONSTRUCTION. a 6 —7s PLAN CHECK FEE TOTALFEE SIGNAT06F CONTRACTOR OR AUTHORIZED AGENT (DATE)46 WHEN PROPERL ALIDATED THIS IS YOUR PERMIT rriT.Y 16. 1975 BLDG. )NSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) •APPLICATION FOR RESI•DENTIAL., ALTERATION, OR ADDITION.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NM11E ; � BUILDER: - • - �� ADDRESS:__'k S 61 �► ADDRESS: -- NO:. STREET: 7" BLOCK:ADDITION: LOT:. CORNER LOT: ddac— INSIDE LOT: SETBACK: SIDE -YARD: Applicant attach to this form 1%.7o Certificates.. -if Survey -of Lot and.proposed building location drawn on these Certificates. DESCRIPTION'OF BUILDING To Be Used As: ont: Depth: Height: .- Square Feet: Cubic.Feet: • Front:' Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: A btoz)`"'_ To Be Completed: ter_ The undersigned hereby makes application- for a permit for the work 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 correct. • DATE: SIGNATURE: (See verse Side For Additional Informat on.)' U' e SUBJE& O. City of Fridley fl;�21;27 AT THE TOP OF THE TWINS BUILDING PERMIT r F RE • ____ COMMUNITY DEVELOPMENT DIV. 3604 , PROTECTIVE INSPECTION SEC. L 572 i A �.� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED 8r ��"' ---_ „ L 612-571-3450 910415 9/4/01 JOB ADDRESS 380 67 Avenue NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Howard Strand 380 67 Avenue NE 763-502-8728 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 ❑ NEW O ADDITION O ALTERATION C REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (21 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 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 $2 251 $1.13 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE T ALFEE $86.63 17 SIGNATURE OF CON' CTOROR AUTHORIZED AGENT iDATEi EN PROP ALIDAT THIS IS YOUR P MIT 4e - 81OtrNSo qA iE S-GNATURE OF OWNEAoF OWNER BUWLOE Ri IDATE- NEW [ l Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: L Lee 6 -7 Legal Description: Owner Name & Address: J�S"� o /A�Vv� Tel. # 763 �'��- 0 2 2R Contractor: MN LICENSE # Tel. # 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. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �u1'l dv Construction Type: %1-2_ /`� Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: f— '(--o ( APPLICANT:y Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ !63-s5' Fee Schedule on Reverse Side - $ ;.1- .001 of Permit Valuation (1/10th%) $ l3 $.50/$1,000 Valuation $ $1150 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 [ ] T, ' , SUBJECT City of Fridley 33046 AT THE TOP OF THE TWINS BUILDING PERMIT r E , hnzIPT N COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. r 1 E NUMBER NEV GATE PAGE OF APPROVED BY I = �"'1 CITY HALL FRIOLEY 55432 763-571-3450 910-F15 9/5/02 JOB ADDRESS 380 67 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 1 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Howard Strand 380 67 Avenue NE 763-502-8778 J CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. S ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION j] REPAIR O MOVE O REMOVE B DESCRIBE WORK Repair garage roof trusses 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, 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 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 $1,600 $.80 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL F E $5y.45 SIGNATURE OF CON'RACTO 'O/P AUTHOR EO AGENT IDATE- HEN OPE ALIDATPO T IS IS YOUR PERMIT VL BLDG INSP OATE FI &GNATURE OF OWNEA,IF OWNER BUILD RI IDATEI NEW (] CITY OF FRIDLEY Effective 1/1/2002 ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: ��' -2-4;9- Legal Legal Description: Owner Name & Address: Tel. # 76 3 &v I N? )r,9 Contractor. ��`/��TL _ _ MN LICENSE # Address: Tel. # 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. Ft. GARAGE AREA: Length Width Height =� — Sq. Ft DECK AREA: Length OTHER: Width Hgt/Ground Sq. Ft Construction Type: Estimated Cost: 0,4 t C'a Driveway Curb Cut Width Needed: Ft + 6 Ft = �'Ft x $ _ $ DATE: F` J - 0 2— APPLICANT: OS -_;C�- _ _ Tel. # 76 3 SGA S%IR Call (763) 572-3604 for Permit Fees if mailing In application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ ._S7.oS- $ 1,60 $ •moo - $ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 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 [ ] STIPULATIONS: F1 Building Inspections 7.63-572-3604 DATE �fK1 SITE ADDRESS — THIS APPLICANT IS: PROPERTY OWNER/ TENANT MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL -1W 4OWNER OCONTRACTOR ADDRESS: PHONE: CONTRACTOR I COMPANY SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: CONTACT PERSON: Permit No.; CITY STATE ZIP, STATE LICENSE # EXP DATE CITY STATE ZIP ADDRESS: PHONE ASI SINGLE FAMILY 0 TWO FAMILY 0 NEW 92 REPLACEMENT DETAILED DESCRIPTION OF WORK FAX 0 TOWNHOUSE 0 ALTERATIONIREMODEL. PER MS 16B.665 the permit fee is a minimum of $15.60 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 WHERENOTED. FIXTURES: (WDICATE TOTAL NUMBER OF EACH BELOW) G SIZEBTU Equipment Installed MFG: MODEL: a� MODEL: SIZEBTU MFG: SIZEBTU MFG: MODEL: A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 —_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 _FURNACE $35.00 GAS UNIT HTR $10.00 CHHANEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER 535.00 DUC WORK $10.00 GAS PIPING $10.00 _VENTII-ATOR 515.00 ._ - m e - �..'� ...i77,t[�`F�4,_'L:l, WSvl�y;sw,lo!.t�k*:s .Ff'^.• .'. .=...we:. ... � ..r,. +.... -... �,.-r .... _ _ Permit Fee $ Number of fixtures @ $10.00 x$10.00=$ 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 T� 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 Wmnesota -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 r ires revie and approval of plans. SIGNATURE OF APPLICANT � PRINT NAME DATE 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 HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEWIEXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel ]MC Chapter 7 with MN Amendments b. Natural Gas or PropanelIFGC 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 air calculations Building $ 651!10 BUILDING Permit NO.: 90610 l Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY Date:C p (1 � 70� 763-502-4977 FAX $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) EFFECTIVE 1-1-08 $ DATE F-5' - U 4P' YOUR E-MAIL ADDRESS $ SITE ADDRESS 3 YO C; ? ea -`L 1% c $ Fee Determined by Engineering Sewer Main Charge $ THIS APPLICANT IS: 1P OWNER ❑CONTRACTOR Total Due PROPERTY OWNER/ NAME: �L°J ADDRESS: >'T C� P L��Li/�� CITY � e STATE ZIP TENANT PHONE: NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE 11 SINGLE FAMILYNEW 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: ❑ 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: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used, PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. ❑ Other ❑Fascia 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 THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ ;c P 3a r X-0 OCCUPANCY TYPE Permit Fee $ 651!10 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ & 13 .001 times the total job valuation Surcharge $ ,,a-2 .0005 x Permit Valuation Minimum $.50 License Surcharge $ $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 $ 61, 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 on site; that the work will be in accor ce with the appy ved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT 7-&, PRINT NAME LfOW'f&© 5MA&e DATE fVP APPROVED BY DATE