PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N° :5:6DI
Date: "Woo,
Owner: Builder <f—
Address Address
,�//��' C ION Uz
UILDING
No. LS.z! Street I _ __— P
r
Lot _ _._ ]Block __ _ __ Addition or Sub -Division -Ot
Corner Lot __ Inside Lot Setback .r Sideyard --
Sewer Elevation ___ — Foundation Elevation
DESCRIPTION OF BUILDING
To Used IrA� Z49 1,
�.. �+t
Front Depth ght �� Sq. Ft..do Cu. Ft..
f ro
-6 t Sq. Ft. Cu. Ft.O
ype of Construction Est, __ 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 compliance with aft provisions of
ordinances of the city of Fridley.
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 maybe revoked at anytime upon '� viola of the provisions of said
'ordinances. ���
C'= 7yr;.K
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 Renu.
It
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name... Builder,
.. ..._.
Address -e Address
LOCATION OF BUILDING
NO. - Street -0. Part of Lot
Lot Block Z Addition or Subdivision d�
Corner Lot Inside LotSetbackZL_Side-Y&�
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:
Frontes 4 Depth ��3eight
sq. Ft. /® „ - cu. r<t.
- Front 2 o„Depth Z jHeight
Sq. Ft. C; " --- Cu. Ft.
Type of Construction�� Estimated Cost/4 CI
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 of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correct.
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for Plumbing and Gas Fitting Perndt
Dept. of Bldgs. Phone SU 4„7
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
�j
3
f7
m
VI
3 F
p
0 LL
Q� w
a
w
Z
O
•
•
WATER HTR.
Base
1st
2nd
_
3rd
—
4th
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.
Owner
Kind of
• Future Connection, Oponings . wrua� wu+a Sewer
New Fixture. Old openings Cesspool O Used as
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heata-(Up to 200,000 BTU) ...... x 2.00
New Ground Run Old Bldg . ............ x 3.25 $
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 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE
To be completed about
Estimated Cost, $ ,f -op ® Q
Old ew. ' ding Permit No Z Permit No.
FINAL
az 2M 7-59
e
r
Appfication for Power Plants and. Heating, Cooling, Ventilation, .Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $ —
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam ......
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
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
.......................
$�
GAS FITTING FEES:
NO RATE TOT
1st 3 Fixtures ......................
x $1.50
$
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
$ _
'
]ALTERATIONS & REPAIRS
TOTAL FEE
$
F'OUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470
. 7. i�.n — ' /'n -Ad
1.2
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.
4g P
su�1� C
Fr'� , )Fridley, 19inn —
Owner .Z7� J CQ22
Kind of Building
Used as
To be completed about
5-1962
Estimated Cost, $ � "6 .f�
wilding Permit No. '5-0114 Permit No. C
DESCRIPTION OF WORK
HEATING eat vt r , Warm Air—No�
Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P,
Total Connected Load Kind of Fuel
BURNER — Trade Nam Size No �'�a
Capacity Sq. Ft. E D. GCO. SEDC IC HG. & AIR-COND. CO
1001 Xenia Av. S.
!Minneapolis 16, Minn.
ed 1611
By
,w 42 2M 7-59 Business Phone
(REMARKS—OVER)
Db rv
�
8-M
L
47
6.Ae4 � rAFNnVF7W
3v
HEAT LOSS CALCULATIONS
DEPARTMENT OF BUILDINGS
MINNEAPOLIS, MINN.
Weatherstrips
A.S.H.V'.E,
Guide
Construction No.
Coef. Btu
Btu
Insulation
\YiBjlo ors
I
Reference
Out. Wall Int. Wall Ceiling Roof
Floor
Glass
Kind How. Applied
Le. No es No
19.__,_
-2-11 1419
Exp. wall
/40
1
Fl.I oom
1 Length Width Height
F1.I
oom I Length Width Height
Windows and Doors—Crackage and Area
I
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
�®
BI j, q 20
�-�fall ! R t
Coef.1 Btu
Infiltration
Coef. Btu
Infiltration
Glass
Exp. wall -3
Net exp. --wall - y
Int. wall
Ceiling 14
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.I 1 Dilikoom I Lenffth� iiidth 4
Windows and Doors—Crackage and Area
I
Width Height No. of Lineal ft. Area
No. of pane of pane llghta of crack sq. ft.
Width Height I No. ofLineal ft. Area
No. of pane of pane lights of crack sq. ft.
-7- 8, l
�-�fall ! R t
Coef.1 Btu
Infiltration
Coef.
Btu
Infiltration
SO VZYQ
-:N19
O.
Glass
Net exp. wall
'-2,S'
S`V
7 O
Exp. wall
/40
Ceiling
a-ILI
3
Net exp. wall
Net exp. wall
11/40
Int. wall
/7
1151
Int. wall
Ceiling /7—)(/j
/
P-/ J�
Floor >0
'-
16
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Height I Fs.l MRoom 1 Length 1,t- Width 1/ Heiaht
Windows and Doors—Crackage and Area
I
Width Height No. of Lineal ft. Area
No. of pane of pane llghta of crack sq. ft.
p
-7- 8, l
�-�fall ! R t
Coef.1 Btu
Infiltration
(®
31
Glass
SO VZYQ
Exp. wall
O.
Infiltration
Net exp. wall
t
Int. wall
Floor
/40
Ceiling
a-ILI
3
Floor
Total Btu.
I- Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
-1 12Moom I ength Width
Height
Windows and Doors—Crackage and Area
%/
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of,pane llghts of crack sq. ft
Coef.1 Btu
Infiltration
371 667
Glass
Exp. wall 14
Coef.
Net exp. wall — - 3
Infiltration
Int. wall
Ceiling
(� .
Floor
/40
� Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I -'
Windows and Doors—Crackage and Area
�D Room I Length / J)
Width Height No. of Lineal ft. Area
No of pane of pane lights of crack sq. ft.
%/
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of,pane llghts of crack sq. ft
v 1 f
Coef.
Btu
Infiltration
Coef.
U
Infiltration
Glass
1 -my
24
.S70
/40
Exp. wall
S7)(
2-100
Net exp. wall
Net exp. wall
/7
1151
Int. wall
Int. wall
Ceiling
'-
16
2 -
moi../ 12 -
Floor
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1r
Fl.j
�D Room I Length / J)
Width
%/
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of,pane llghts of crack sq. ft
v 1 f
Coef.
Btu
Infiltration
1 -my
Glass
MI
Exp. wall
Net exp. wall
Int. wall
Ceiling
/
Floor
Total tu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
Original•
PERMIT for Power lants and Heating, Cool-
ing, Ventilation, Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of Heating Plants `�Z-�-� L , to be insta ltered—repaired
�/1 _ G -r%
Make -�� ,Size ;
Oil fired—,- Coal fired ; Gas, fsred_7,,,_; Gas Authorization No.
Remarks
W
Approved by
Final Inspection Date , 19_
Inspector
p 4�"2 SaZ
Permit N° 4547
Fee
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn.-
Owner
inn. Owner a - 44=j
Location a 1 y
Kind of Building
How Occupied �v
Work to be Commenced / - —,31,19-61
To be Completed t 15, ,19
Estimated Cost, $ / 9 '5-' �
Old -New, Building Permit No.
Permission is hereby granted to - 4 to install—erect—use the material and devices described in the
above statement. This permit is granted upon We express condition that the persor0to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein na d, and to the specific ns set forth in the approved application for this
permit on file in the office of the Inspector of Buildings.
Inspector of Buildings
az 2M11 -67V
SUBJECT
City of Fridley
4
AT THE TOP OF THE TWINS
BUILDING PERMIT(
r
COMMUNITY DEVELOPMENT DIV
~ PROTECTIVE INSPECTION SEC
r � ,
�'�'1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OFJAPPROV613
By
�""� 612-571-3450
910-F15
6/9/97
JOB ADDRESS 210 69 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
Rice Creek Plaza North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
John Nelson 210 69 Avenue NE
571-3476
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
B & B Roofing 6760 Madison St NE, Fridley, MN 55432
571-0248 9042
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 ❑ ADDITION ❑ ALTERATION j1 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage
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 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
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
@
$2,062
$1.03
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIO19S OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$74.75
Fire S�'i $2.06
STRU=CT PERFORM CE OF ONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
C
License SC $5.00
$82.84
` $IGNATUREOFCONTRA TOR OR AUTMORIZEDAGENT (DATE)
WHEN PROPERLY IDATED
i
BLDG SP
THIS IS YOUR PERMIT
DATE
SIGNATURE OF OWNERoF OWNER BUILDERI (DATE)
SPIA
ADDN [ J CITY OF FRIDLEY
ALTER [ l SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDDING PERMIT APPLICATION
ConstructionAddress z�� 4- � P
Effective 1/1/97
Legal Description: L� j / A w 1 j—
Owner Name & Address: ��/�
/1/L`.Z S��I Tel. # -5-7
Z 7z�
Contractor:
MN LICENSE #
Address: _%z �'� ��� 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:
/oma y� o? S S CP v/l L S
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Estimated Cost: $
(Fee Schedule on Back)
Ft x $ = $
C'?o 6 —),
M r
DATE: % ✓� �I g �j" APPLICANT: ��j AUT i� (� Tel. # _� 71— 7/-/
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ 11S Fee Schedule on Reverse Side
$ o C) .001 of Permit Valuation (1 / 10th %)
$ A &_J $.50/$1,000 Valuation
$ _ $950 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 [ ]
✓a %W3
Building
BUILDING
Permit No.:-�007
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
DT6R J0 L - 2007
CITY OF FRIDLEY
DATE V" -k vi YOUR E-MAIL ADDRESS Lex
C • C.onI
SITE ADDRESS
,
THIS APPLICANT IS:
❑ OWNER
PROPERTY OWNER/
c^ ,,CONTRACTOR
NAME: -C, E: 1
TENANT
ADDRESS: I CITY
STATE_ZIP
PHONE: 1 +4-I -Co
�?7
NAME:
Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113 t
TATEZIPWITH
WITHAPPLICATION
PHONE
[3 SINGLE SINGLE FAMILY/NLicense #20130983
—STATE—ZIP—
PROPERTY TYPE
❑ TWO FAMILY/NEW G 651-264-4777
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF 13 DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW 13ADDITION
C3MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �ei1 j
�s' i5• '
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT t.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGE
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
❑ Vinyl
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit
ADDITIONS.
& PORCHES SUBMIT:
❑ Aluminum
❑ Other
❑ Trim
1.
Site Plan/Survey showing the existing structure
❑ Fascia
andP*oPo sed ro'ect.
P J
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION O WINDOW
OR FOR NEW OPENINGS -DESCRIBE SIZE OF 1\ LA h �! OWE r ®Cr(
3.
Energy Calculations
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL r LES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
AL -
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
ATION S
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 Fridlev 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 iI
conformance with the ordina s and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not.
permit but only an applicati' for a permit d work is not to start without a permit; that the work will be in accordance with the approves
plan in the case of all work vbich requires iew and approval of plans.
SIGNATURE OF APPLICANT INT NAME ta_(nLkjDSC>JN DATE Q%:SUt,-0 6 /
Building
BUILDING
Permit No.
Inspections
RESIDENTIAL APPLICATION
Received By.,
763-572-3604
CITY OF FRIDLEY
D.W',EC ®1 2008
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE l d dd — of YOUR E-MAIL ADDRESS
/7 a'�� 9/� A G o,y7
SITE ADDRESS fd
�% /9!/ L iL) E
THIS APPLICANT IS: ❑ OWNER 'CONTRACTOR
PROPERTY OWNER/
NAME: SclS, ,J 4, £GS 01 J
ADDRESS: �.'o ""q4 'A4 /J L
CITY STATE_ 14/ZIP
TENANT
PHONE: ���_,721— 3 2l
NAME: d e- C a'J V-4
ADDRESS: 7YO% ✓U S'.ve z-C'✓6 .4-L�
CITY 47- STATE OVLIP 2F16
CONTRACTOR
SUBMIT A COPY OF
PHONE ::L- / - /_-ZL 7/G /
FAX '.f1- �y6 ' ysU5
YOUR STATE LICENSE
STATE LICENSE #
EXP DATE oz�DP
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILYINEW 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
19 MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:% Pg.- e t 1Vc - ew
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES JB 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:
13 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 $ ?6-7�.tri ?�1� �" OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
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)
$1825 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 Davable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
lations
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 des; 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 accord with th proved plan in the case of all work which requires review and approval of plans. ��
SIGNATURE OF APPLICANT PRINT NAME 41(e- *NO end °� DATE AWOVA'
APPROVED BY DATE
Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY arc - 4 007
DATE /,;2 3 -o-7 YOUR E-MAIL ADDRESS
�
SITE ADDRESS ,-21 � V e- /v �_-'
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: Sv.'i
OWNETENANT
ADDRESS-,-,2)C2 &2� A v N -'V F CITY_r i' 1e_ STATF/�ZII'
PHONE-%7& e3--S7/-.34f 7L-
CONTRACTOR
COMPANY NAME: S 4 e r yn S 74e rs
SUBMIT A COPY OF
CONTACT PERSON r► (a r - '0? //.'
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRE/SS.� ` 9 c enema ea; 4L.ri e/ C1TY�yt4b .S'-. L'?q ,c I sTATIII) ZIPJeSJU'/
APPLICATION
_
PHONE(GX5/-7sVe z�f Z) 7 FAX (!1� J-� �7� &P %-'
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK-
(ATEW O REPLACEMENT ❑ ALTERATiON/REMODEL
DETAILED DESCRIPTION OF WORK n S> ! 0
,:,as
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 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)
EquijHWm Installed MFG: / 6CL V S M0DEL0 V i-_:7,�S,e + SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
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
FILER $35.00 $35.00 GAS UNIT HTR $10.00
—FURNACE
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR $15.00
PERMIT FEE PROJECTS FOR UNDER $500
PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $ Number of fixtures @ $10.00 1 x $10.00 = $ 4b-,v v
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 = $
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 o all work which re review and approval of plans.
/
SIGNATURE OF APPLIC PRINT NAME �Q. / IM f-�► DATE 42 3 -0
PLEAS 'NOTE: SEPA:DATEPERMITS ARE RE UIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
Building
❑}VEW HOME CONSTRUCTION ❑ ADDMON
BUILDING
Inspections
DESCRIBE WORK BEING DONE; _
RESIDENTIAL APPLICATION.
763-572-3604
13 HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
CITY OF FRIDLEY
763-502-4977 FAX
PROPOSED SIZE:
❑ DETACHED GARAGE
PROPOSED HEIGHT:
EFFECTIVE 1-1-08
DATE • //
• 1/6 YOUR &MAL DRESS
SITE ADDRESS �% %
. `A
THIS APPLICANT IS:
❑ OWNER *P&NTRACTOR
PROPERTY OWNER/
NA1V1E:
TENANT
ADDRESS:i;_%
CITY
PHONE: 1748557I—Z
CONTRACTOR
NAME:
ADDRESS -1
SUBMIT A COPY OF
YOUR STATE LICENSE
pHOL� FAX �o st 1
STATE LICENSE # EXP DATE
PROPERTY TYPE
&SINGLE FAMILY N SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE(SHEDWS
❑ BASEMENT FINISH ❑ ROOF DRAW TILE
❑ DECK O SIDING
❑ OTHER
TYPE OF WORK:
❑}VEW HOME CONSTRUCTION ❑ ADDMON
A?A>IVTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE; _
SIZE OF IMPROVEMENT
LENGTH WIDTH
13 HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
GARAGES
❑ ATTACHED GARAGE
PROPOSED SIZE:
❑ DETACHED GARAGE
PROPOSED HEIGHT:
SIDING
13 Vinyl
OSoffit
E3Aluminum
❑Trim
❑ Other
❑ Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes Flo LOCATION OWS
OR FOR NEW OPENINGS.DESCRIBE SMS OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE IN3TAT r Fm) t rrnrtnvo AD asn.,.r.....,
ALL FEES ARE BASED ON
TOTAL JOB VALi
Perm it Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
1aL.LYYI Ulfl:IT'IS.5URLDUL
� 1
I N
PermitNo.•
Received By:e1 ��_
Ri
ODEUNG SUBMTr;
1. Existing Floor Plan
.2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. &PORCHES SUBMIT,
I. Site Plan/Survey showing the existing structures
and proposed prgJwL
2. Two sets of construction plans
3. Energy Calculations
OF LABOR AND
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minim= $.50
$5.00 (State Licensed Residential Conttactors)
$1825 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 uayableto: 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 d this is not a permit but only an app 'on for a permit and work is not to start without a
permit on site; that the work will be in acco with the p the terse of all work which ' rm and of plans.
SIGNATURE OF APP/LIC PRINT NAME DATI • I• I • I• I
APPROVED BYI /,/.ems —. Z /, .