PRE 2010 DOCSCJ
City of Fridley, Minn.
BUILDING PERMIT
Date: June 18 1968
Owner: Dalberg Blders . Builder
Address 1121 80th Ave. N. E. _ Address
Same
Same
LOCATION OF BUILDING
N� 9797
Ll,?Aee2
yz��
No. 1640 Street — 75 th Ave. N. E .-----Part of Lot
Lot ._-_ 3 -_ Block 1 Addition or Sub -Division .� Dalberg Terrace
Corner Lot _ x Inside Lot --- Setback 351 —_ Sideyard ._ 10' -29'
Sewer Mevation --Sq! Q9 ASA _ n (e n„roY _ 1
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front _ _42' Depth 24' Height 20' — Sq. F't. 1008 CU. Ft. 20,160
Garage Front ?91fif Depth 22' Height 12' Sq. Ft. 451 Cu, Ft, 5412
Type of Construction Frame Est. Cost — $14,800 _ _ To be Completed —
SEWER LOCATION - 84,51 W. of'M.H.
WATER LOCATION - 18.21 W. of Sewer
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 t If and in compli with all provisions of
ordinances of the city of Fridley. _
.00 Sewer Connection
In consideration of the payment of a fee of $ 38.00 , permit is hereby granted to Dalborg Blders .
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, is all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinaaces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permft may be revoked at any time upon violation of any of the provisions of said
ordinances.
Official`
Building SaVOM
Jqhn Breher
NOTICE:
This Permit dose not cover the construction, instatlatlon for wiring, plumbing, gas heating, sewer or water. Be are to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY • OF . FRTDLEY-, M UMSOTA
tAJ
R'S, NAME
ADDRESS - ..:: ADDRESS.,zzz�
LdCATIOX dF BUILDING
N0. �(o 10 STREET ` n
LOT 4 BUCK ;J ADDITION OR SUBDIVx6-I0NZAL. aF-P—g a�W4 CF
CORI ER LOT i/ INSIDE LOT SE SIDEYaRD 2`9
SEWER ELEVATION TOP OF FOOTING
•Applicant attAch.:to-this form.TWp Certificates of Survey:of Lot and proposed
building location drawn on tbese Certificates.
..`: �;... DESCRIPTION OF BUILDING,
To Be Used As:
44'e ��
, �., ... ,Front Z Depth�'" . Height Z e
Square feet r00 Cubic Feet .2 v A,0
y .Front 20 Depth 1-'Z- .Height
l�
Square feet- ,'/ ( Cubic Feet -S
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 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
(Schedule of Fee Costs can be found on the Reverse Side).
#0�z X13 ®=
•
Application for Power Flees and Ma gi Cading. Veanj Q%*0me Rei rigamMon and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE
TOTAL
3000 Owner
Furnace Shell & Duct Work ..........................
6.00 Kind of
$
$10.00
Replacement of Furnace .............................
stft
$
6900
Repairs & Alterations—up to $500.00 ..................
k.,46C
$
6000
Repairs & Alterations each add. $500.00
............... E
a$
3-00
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 ..............
STEAM or HOT WATER SYSTEM
Dept. of Bldgs. Phone 5560-3450` �
.ocation / �! ` S� ���( � U z -
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to d� 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.
$.
$10.00
3000 Owner
$
6.00 Kind of
$
6.00
$
Used as
3®00
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... f4ft $ $10.00
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... $ 1.0000
Each add. 200 sq. ft. EDR Steam ...................... 3 $ 3-00
Each add. 320 sq. ft. EDR Hot Water .................. 39da $ 3000
OIL BURNER—to 3 gal. per hour k9a$ 6000
over 3 gal. per hour—Fee Fee Schedule
i99 000 l
GAS BURNER (up to 9&BTU) ..... 5.00 $
GAS FITTING g: 1999 000 BTU NO RATE TOTAL
1st 3 Fixtures .......Q.((�..j.............. x $ $ $2.00
Additional Fixtures .. x $ 75
Gas Range to x 2.00 $i5o00
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE $ G�
To be completed about
EsnNew.
st, $
OluildingPermit No. gig /1 Permit No. A j 1.9
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Nam Size No
Capacity Sq. Ft. E.D.R._ - BTU H.P.
Total Connected Load V.I. Kind of Fue
BURNER — Trade Name Size No
Capacity Sq. FL E.D.R — BTU H.P.
(REMARKS—OVER)
NBURBAN AIR DONDIMM- ° .
Signet W 9 CENTER DRIVE
By MINNEAPOLIS, MINNESOT913432
�e ,E Business Phone No
City ®$ Fridley
ApplicaFlan C -w Plumbing cand Gas Feieing Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK ��
Number, Kind and Location of Fixtures Location
41
tU
m
Su,
',�
S}
fLC
I
n�
1A
Uz
W
Ox
W
0
a
z
e
e
WATER HTR.
GAS
ELEC.
f�
z
sip
Qz
8�
��
a7i
z
F
N
n2
ro
3
(�g
C7
UO
Base
r
1st
%
2nd
3rd
4th
' Future Connection Openings
Connected with
Sewer
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... —� x M $ $2'. GO
Future Fixture Opening ................ x• M,lo
$ 50
New Fixture Old Opening ............... x i&x$ $1050
Catch Basin ... ..................... — x 3.25 $
Water Heater (Up to &A' aTU) ...... x $ ` $3-00
New Ground Run Old Bldg. .......... x 3.25 $
City of Fridley:
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, Minn
Owner
Kind of Building—
.4B .
Used as
To be completed about
Estimated Cost, $
Old -- *e Building Permit No Permit No.
Signe °L
.By-�
Business Phone No'2`
ROUGH
Electric Water Heater $2e00 SAI,
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ..........................Z x $1 $-) $2,00
Additional Fixtures x $
-75
Gas Range to • 6 .............. x $ $5e00
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE $ djj 3, ® d
048
r/
SUBJECT
NO.
City of Fridley
23936
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT
Ir
�
COMMUNITY DEVELOPMENT DIV.
i ~ PROTECTIVE INSPECTION SEC
�ljy
� � r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
12/27/95
JOB ADDRESS
1640 75 Avenue NE
t LEGAL
LOT NO. BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3 1
Dalber Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Tom Gallus
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Century Roofing & Construction 6336 Lyndale
Ame S, Richfield,
MN 55423869-2767
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20034174
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Rer of House 21 S Tear-off valley and
install ice and water, other area is a
second layer
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
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
@ 84
$
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,680
•
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
Fire SC $1.68
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$54.00
PLAN CHECK FEE
TOTALFEE
License X $5.00
$61.52
SIGNATURE OFC .RACTOROR AUTH RIZED AGENT IDATEI
WI PROP
LY VALID THIS IS YOUR PERMIT
rNSP
PATE
SrGNATURE OF OWNER IIF OWNER BUILOERI rDATEI,ALOG
r/
NEW [ ] Effective 8/1/95
ADDN [ ] CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: _� f '75 �h Jyt errr _
Legal Description:
Owner Name & Address: 'To Al C
h1j jA 5 Tel.
Contractor: CiCh kA✓ Qj5k;f4,k)yV_ MN LICENSE # a /
Address: 6 d&- Sq Tel. # 36 % %��_
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT k
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: 19-C900F
05A -S- 3
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback ide Yard Setbacks
Type of Construction: Estimated Cost: $ — gO /6�)®
Approx. Completion Date: / a . 31- ?t'
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 F = Ft x $ _ $
DATE: la���-pr _ APPLICANT: Tel. # 27�_�
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ ` _ $.50/$1,000 Valuation
SAC Charge $ $850 per SAC Unit
License Surcharge $. C $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
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00 $
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00 $
Gas Dryer $10.00 $
*Air Conditioning - All Sizes $ 25.00 $ 'qS-' Od
All Others/Repairs & Alterations (LIST ON BACK)
11% of Value of Appliance or Work $
Commercial/industrial
1.25% of Value of Appliance or Work
Effective On January 1, 1997
/ bi r. I_.
JOB ADDRESS
�/440 �s �
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in, strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
.2,4 - 1997
OWNER. % / Q(
BUILDING USED AS Asx.
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units
Trade Name
VA •°V
S-5 - A036
Circle One (Steam) (Hot Water) (Warm Air)
Size No.
BTU HP EDR
$ Fuel Total Connected Load
State Surcharge $ .50 Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $4200/Hr
*Air Conditioners can not be placed in a side yard. without
written permission from adjoining property owner.
HEATING COMPANY
Signed BY -LZ Tel No. %? % - (-loo
Approved By Rough -In Date Final Date
FILLOUT BACK SIDE R STACK VERIFICATION ON
REPL,AYEMENT FURNAc
---a•�.
P P
CEMMY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes
O No ( )
2. Is free from rust or deterioration Yes ()
No ( )
3. Has no foreign objects lodged within Yes ()
No ( )
4. Is securely supported Yes ()
No ( )
5. Meets all current Code requirements for size
and total BTU's connected Yes () No ( )
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIVISION
Effective On May 10, 1999
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION
AND AIR CONDITIONING
SYSTEMS AND DEVICES
JOB ADDRESS 4, R 2411,e
RATE SCHEDULE
OWNER " r7- r
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner -
$ 30.00
$_22
BUILDING USED AS �- a
Also Replacement Furnace
-ZZ)
COST PERMIT NO.
(Side Vent - Fill Out Back)
ESTIMATED
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units % Circle One (Steam) (Hot Water arm Air
Gas Dryer $ 10.00
$
Trade Name Size No. o
BTU 70, c)=Po HP EDR
*Air Conditioning - All Sizes $ 25.00
$
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
1% of Value ofAppliance or Work
$
BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work
$
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are*true and correct.
TOTAL FEE
MINIMUM FEE FOR ANY-HEATING/COOLING/VENTILATION
HEATING CO
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
Signed DATE /-,!% -w
REINSPECTI.ON FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
Approved ByI4 Rough -In Date Final Date --r
written permission from adjoining property owner.
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date: — /G _ CJ/
CHIlVI URY AND STACK VERMCATION
The
undersigned hereby verifies that the existing chimney
or stack:
1.
Has been carefully examined
Yes ()
No
( )
2.
Is free from rust or deterioration
Yes
O No
( )
3.
Has no foreign objects lodged within
Yes ()
No
( )
4.
Is securely supported
Yes (
). No
( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No
( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date: — /G _ CJ/
CITY OF FRIDLEY PERMIT NO.: 2004-007 0�?
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 05/18/2004
571-36U4 YA21: (763) 571-1257
ADDRESS : 1640 75TH AVE NE
PIN : 123024140031
LEGAL DESC : DALBERG TERRACE
: LOT 3 BLOCK 1
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 500.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER 8317 OF THE
2000 INTERNATIONAL RESIDENTIAL CODE. SCREEN EXISTING PATIO (20'X 8')
APPLICANT
BUILDING PERMIT FEE 23.50
FIRE SURCHARGE 0.50
HUBER ANGELA M & MATTHEW A
1640 75TH AVE NE
STATE SURCHARGE, VALUE 0.50
FRIDLEY, MN 55432
TOTAL 24.50
PAID WITH CHECK # 7399
OWNER
HUBER ANGELA M & MATTHEW A
1640 75TH AVE NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of aqy other state or local law
regulating co P do r th a ce of construction.
Appli Date
Bldg Insp Da1916)
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
9, -2 -75 -5 -
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION�I1
Construction Address: qQ vT 5'—L X IJ , �_-
Legal Description: (_mt 3 8 1
Owner Name & Address: Tel. #
Contractor. Lx V\e)'r MN LICENSE# —
Address: r75tNA,, ✓0E Tel.# 7&1 2Ss-&L3 -
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: SiAN.a e X�s�,� p0 2—c' x
Construction Type: _) �NML -�, Si nn. ty,,`i o Estimated Cost: $ 5 GD
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: APPLICANT: AVU Q A CL AV -6X Tel. #. -70 i� '(-e03 (�
Call (763) 572-3604 for Permit Fees If mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
TOTAL $ QJ1 • -S 0 STIPULATIONS:
r
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,• t.11l✓I�IibNrdl,f ( � L` ��' �� .Y �•1 � � Ica"rl i�l`+�f1fl;, �j I'C
l✓J 4i,it 1'vf'I/ '�y ` VV l•�tL•:•k V/ l)�:.
kill. ;e,�lra E N G H NI E E R i N V' INC.
S!,,,•� � ,.,
U.II �� lIW/n ��:� ��Afk � 6f Va•�•'u
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tllJrlk:•-•l� ��1c1i»�����•.� � ,Su; �t�t�c c�r•.y—..•-�. .
cew ar�I ,fid,c[.l It e olr. 'Dal� nLlildOrS Inc.
N0R-'N
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CITY OF FRIDLEY BUILDING INSPECTIld
6431 University Ave NE
Fridley, MN 55432
763572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work. Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
0
~ Gas Dryer
*Air Conditioning - All Sizes
J
A_
All Other Repairs or Alterations (List on Back)
196 of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater on work less than I
LL Commercial/Industrial/Institutional
>. 1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Ir
U
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
State Surcharge
TOTAL FEE
m
v
;o REINSPECTION FEE $50.00/HOUR
CS) *Air Conditioners can not be placed in sideyard withc
R from adjoining property owner - copy to City
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
$ and rulings of the Building Division, and hereby declares that all the facts
and. representations stated in this application are true and correct.
HEATING COT01-At
�IeI%LI-0?1r pp��oo��
$ZS. SignePAA] fa Tel f I�i'_ L,
FAX #t3- 3 O � - as.no_ Date �s � 0.05
approval
U)
FILL OUT BACKSIDE FOR STACK VERIFICATION REPLACEMENT FURNACE Approved
Rough4n Date Final. Date__
JOBADDRESS )k9Q :)�h AAK o
Fee
Tota
Owner P � a iAher
$35.00
$
Building Used
$10.00
;
ESTIMATED COST 11A22 ®® PERMIT NO
$10.00
$
DESCRIPTION OF FURNACE AND BURNER
$10.00
$
# of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No
$25.00
SIE -100
BTU HP EDR
Fuel Total Connected Load
$
Burner Trade Name Size No.
BTU HP EDR
State Surcharge
TOTAL FEE
m
v
;o REINSPECTION FEE $50.00/HOUR
CS) *Air Conditioners can not be placed in sideyard withc
R from adjoining property owner - copy to City
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
$ and rulings of the Building Division, and hereby declares that all the facts
and. representations stated in this application are true and correct.
HEATING COT01-At
�IeI%LI-0?1r pp��oo��
$ZS. SignePAA] fa Tel f I�i'_ L,
FAX #t3- 3 O � - as.no_ Date �s � 0.05
approval
U)
FILL OUT BACKSIDE FOR STACK VERIFICATION REPLACEMENT FURNACE Approved
Rough4n Date Final. Date__
Building BUILDING
Permit No�r�
Inspections
RESIDENTIAL -APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
I
Date Rec'd:
DA
A I Y -MAI ADD S
SITE ADDRESS
C
1
THIS APPLICANT IS:
❑ OWNER *ONTRACTOR
PROPERTY OWNER/
NAME: ✓ el 44
TENANT
ADDRESS: S CITY Tf
STATE_ZIP
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
STATE LICENSE # EXP DATE 3 –
W2
YOUR STATE LICENSE
ADDRESSCITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
INGLISFAMIIYINEWCONST CTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITIONO GOMAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑NEW ADDITION
❑ MAINTENANCE/REPAIR ODE ING
DESCRIBE WORK BEING DONE: ' D
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING❑
HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2•
Existing Floor Plan
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 PlawStuvey showing the a lsting structures
❑ Other
❑ Fascia
and proposed project
2.
Two sets of construction plans
WIND W
IN EXISTING OPENINGS ❑Yes
ONo LOCATION OF WINDOWS
3.
Epergy Calculations
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 TtIKIV7 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $
TYPE
Permit Fee $ [ ,'o�� See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Surcharge $ (.0005) times the total job valuation — Minimum $.50
Fire Surcharge $ .001 x Permit Valuation (I/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 $ ® C)
— 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 l 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 pe and work ' Wfo start %vitlrout a permit; that the work will be in accordance with the approved
plan in the case of all work w ' h req` ' vi an r plans,
SIGNATURE OF APPLICANT r►i%TNT NAMr: W f �f Lie �► ��/ �nTE a .' 191