AF - 46082• . . . •
City of Fridley, Minn.
BUILDING PERMIT NA 6 6 2 2
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Date: _.._...,��.-.,� '!.-- � � � .___.___.._.. 2
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Owner: .._._.�Cx��-: _. ..._ _����G�� .� Builder _.. .�c ._ . �-fifi��.:......----- .............-
Address....._.._.._...._.._..._.___..__.._..._._._..__...___._.._.._.._._.._...._..._...._.._.._ Address _..___.._..._.._......._.._......__._.._..----....._.._..._..._.--•._._._..__.__.__._.
� CA , F UILDING
, ,
No. .._`�..,.��...��� Street .._. . ...._. ...,.- .. j.. . . ._�r .................•-----•. P of Lot •------.......... ___._...... .__._ ._......._ ....._..._
Lot .___..�....._.___ Block .___._....._� ............._._.._.._. Addition or Sub-Division ..... ._.. . __. .._ ..:._ ._..._ .. .... ..._.._..__.._... ._...._
�.�} `'/ �r1 /
Corner Lot _-----......_..._._..._ Inside Lot ....._....._�.. Setback ....._.lvl_...� .............._ Sideyard ............,�4.�.._..._..._........___..._....__..._..
Sewer Elevatiart _._.._.._.__....._..---_..__...--•...._.._..__.__.._.._.._.._---...._ Foundation Elevation
DESCRIPTION OF BUILDING
J����J /fT Used : %
/ � ! 1!
: �� , ....._�y�/ Front _.�._ . Depth ....�...�...�.P_.. Height _...G.--Q.'.... Sq. Ft. �..T�.�l...? Cu. Ft � •- d �
. . /
._ .....__._...._._._.._..�._. Front ____.........__ Depth _..___.....,. Height ..._-........� Sq. Ft. _..--_.___.._. Cu. F� _._..___._
Type of Constxuction ���1.�,,����:��. .,,,�,,,.�.. Est. Cosi �rC�,L..�..�e..---_.:." ."To be Completed ..._:_.......__._.._:._.._.__._—_
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•
In consideration of the issuance to me of a pernut to construct the building described
th� proposed work in accordance with the description above set fo and ' complianc
ordinances of the city of Fridley.
�i �
I agree to do
orovisinns of
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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 o�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked a t any� ugo� vioi ' any of the provisions of said
ordinancea ////
Building InspeCtor
NOTICE:
iMs p�nnit doa not cover th� construeHay insfallNien for vri�iny. plumbin0. 0as h�aNn�. »w�� or wabr. B� wn to sN
th� Bvildia8 Intp�eror for s�p�n» p�rmhs Por fh�a ibms.
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APPLICATION FOR BUILDING PERMIT
CITY OF F�tIDLEY, MINNESOTA
OWNEIt' S NAME BUILDBR
ADDRESS ADDRL$S
LOCATION OF BU�I,DII�
No. ��s��_ Street��� Part of Lot
Lot � Block � Additic►a o�t Subdivision
Corner Lot Inside Lot Setback Side Yard
SEWER ELEVATION FOUNDATION ELBVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing iocation drawn on these Certificates.
To be used as:
DESCRIPTION OF BUILDING
Front Depth Height
, Sq. Ft. Cu. Ft.
Froat 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 of Fridley Ordinancea and
rulings of the Department of Buildings, and hereby declares that a1Z the facte a�d
r�presentations atated in this application are true and correct.
I3ATE �
(Schedule of Fee CoSt3 C8II be ivuuu vn �a� tc�vesr�e aiu��.
/
.. . . _ � t . .. � z , :, .
City of Fridley
Application for P'lumbing and Gas Fitfing Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
C� � �1 N Y F c� Z�n w Z
F �n Z I�n Z � _> Z Z �i Z�1 Z p S � U' Z
;� � �� � � 3� o° � g�O S� <3 c`�� �� �o
c : - ...�� ��
�■��� ■�■
. .� �� . .
3rd
4th �L_ I � � � :;'z •�._��_
• Future Coanection Opeaiag's� .
* New Fixture, Old O�esiiaas�a
WATER HTR.
• •
F N GAS ELEC.
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PAI����AL RATE SCHEDULE
, ,
PLIIMBING FIXTURE RAT`ES: NO. RA7
Number Fixtures ..:. : . . . . . . . . . . . . . . . . . _..� x $1.50
,
,_: _
Future FYxture Operiing . . . . . . . . . . . . . . . . x 1.20
New Fixture Old Opezung . . . . . . . . . . . . . x 1.00
Catch Basin .,.. ' .............. x 3.25
Water Iieater (Up to 200,000 BTU) ......�_ x 2.OU
New Ground Run Old Bldg. . . . . . . . . . . . . x 3.25
� = •_ . .
Sewer �.:
Cesspool . _ _ :;
: �:
TOTAL g -
� .00:.
$— -
$ � S .
� �� °y ,.. t
$
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures ..........................� x$1.5U $ �• 5�
Additional Fixtures . . ... ............. . . x .50 $
Gas ftange to 200,000 BTiJ .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
Torar..r�E $ 3-��
Depl. of Bldgs. Phone SU 4-7470
LoCStion ! �� �----��L— � �� / � � ` �
City of Fridley:
.
r
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 facl
and representations stated in this application are true and correct.
Fridley, Minn.��� �� , 19�_�
awner �� �/�2- 5'
Kind of Building ��/1� �
Used as �Gi/� L L r w°�
To be completed about
Estimated Cost, $
Old-1\Tew. Building Perxnit No. ��` Permit No.
s;�, a �c,�. �4i �h 2�ru �'��, (£ /����if�
By
Business Phun o. `/� 5� a ��O �
ROUGH
FINAL
sz 4M
�
Application for Power Plants and Heerting. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems ond 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 12U,000 BTIT . . . . . . . . . . . .
each add. 60,000 BTLT .......................
Repiacement o4 F�irnace .............................
Repairs & Alterations—up to $500.00 . .. . . . . . . . . . . . . . .
Repairs & Alterations each add. $500.00 . .... . . . . . . . . .
8.00 $
2.00 �
5.00 $
5.00 $
2.50 $
$TEAM or HOT WATER SYSTEM
Furnace Shell & Lines—ta 400 sq. ft. EDR 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 BURIvER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal, per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . 5.00 $�p , p �
GAS FITTING FEES: NO RATE TOTAL
lst 3 Fixtures ..................... x $1.50 $
Additional Fixtures . ............... x .50 $
Gas Range to 200,000 BTU . . . . . . . . . . . x 2.00 $
AIR CONDITIONING �
FAN HEATING 3YSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE ���—
ROUGH
FINAL
Depf. of Bldgs. Phoae SU 4-7470
� `� �i� LL �T - lU - �
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do ail 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.
F�idley, 1Vlinn.�q � � , 19` ='S
Owner � � ��Y ��'+ �R'S
Kind of Building
Used as � w� LL� �v�
To be completed about
Estimated Cost, $
Old—New. Building Permit No. Permit No.
..�—
DESCRIPTION OF WORK
HEATING or POWER PI.AN15�team, Hot Water, Warm Air—No.
Trade N ame Size No.
Capacity
Sq. Ft. E.D.R. BTU H.P.
Total Connected Load Kind of Fue1
BURNER — Trade Name Size No.
Capacity Sq. F`t. E.D.R. BTiJ H.P.
(REMARKS—OVER)
��e a z 2M
signe � + 7�� �.1� � �
By
Business Phon o' ►►� J'� '�-- l� Z
Applica�ion for Power P{ants and Heating. Cooling, Yentilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAI.
' ' G, 'G
Furnace Shell & Duct Work . . . . . .. .. . . . . .. . . . . .. .2�c8.00 ��
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Aiterations each add. �500.00 . . . . . . . . . . . . . . . 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 1?A,000 BTIT . . . . . . . . . . . .
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
8.00 $
2.00 �
5.00 $
5.00 $
2.50 $
STEAM or HOT WATER $YSTEM .
Furnace Shell & Lines—to 400 sq. ft. EDR 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. Pt. EDft Hot Water . . . . . . . . . . . . . . . . . . 2.5Q $
OIL BURIVER—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 TOTAL
lst 3 F'ixtures .. ... . .. .............. x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU . . . . . . . . . . . x 2.00 $
AIR CONDITIONING �
FAN HEATING 3YSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRB TOTAL FEE �
��
ROUGIi
FINAL
Depi. of Bldgs. Phone 3U l-7470
�
Loc83ion � � � � � � b 16 ��i l�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.
F`ridley, Minn.7n� �'. � 2- � , 19 �
Owner ����L-s, ,,, �Q � .
Kind of Building
Used as
U
To be completed about ---� • 3 6
Estimated Cost, $ � �'
Old—New. Building Permit No.
� v � °�"� Peim�t
DESCRIPTION OF WORK
HEATING or POWER, i'L.ANTS�team, Hot Water, Warm Air—No.
Trade Name Size No.
Capacity Sq. F't. E.D.R. �U��a 6iG BTLT H.P.
Total Connected Load�� „d„ �r„�7 3 3� Kind of Fuet /v , G:
BURNER — Trade Name Size No.
Capacity Sq. Ft. E.D.R BT[J H.P.
{REMARKS-OVER)
��<Z sM
Sfgne �
By - � . �
Business Phone No. (� - y�(����
�".: ": E!.. .� . . . b!� � � vi i i�a�.�.r�
q7_ga ���,.�pr�l �° APPLICATION FOR PUlMBING ANfl 6AS FITTING PERMIT
�} . ,
� � j� p � � . � o Water
r a a Ap w�� � ; �• w G Hcatar
w 1 A . C H •� x� �C C G 3 � �� O.�C � V 0.
O O ••� � 111. �C N�•1 a 0 S �•v1 i� In (I! N M •y3C 88 ' 12C
w u � m ci v"�i 3 A w v'�i w c� ��� u � � o
t'
lst co ne t r,y
2ad
� 3rC .
a ch ' . .
(A) � Futuse Connection Openinq Connected with Sewer
t•) • New Fixture, Old Opening warer
PARTIAL RATE SCHEDULE
PLU�IBII�G FIXTURE RATES: N0.
hlz.5ar Fixtuxas . x S3.Q0
fliture�FL�cturo Opening •� x $2.00
Aew Fixture, Old Openi�g x 52.00
Catch Sasin �. x 55.00
i, Hater Heater • to 99,000 B�T7, x S5.00
� 100+000 BTU to 199,000 HTtJ x$10.00
Water Sotteaer ' x s7.Q0
t�e.r Grour.d Iau� Old Buildinq �_ x� 55.00
Elecuic Wa�er Heatar � x $5.00
RATE
G,1S FITTI\C FBfiS, , ' ,
lst 3 Lixtures '
J.3ditioaal Fixtur�s • �-
.W: Range to 199,000 STO
REPAIRS $ ALTERATIONS
Pirst 5100.00
each add. 5100.00 or lsactton
TOTAL
$
S i_
S ^�
S „_�.
S i_
S �_
S ,_._
$ _,�_„r�.
x $3.00 S
�,� X $1•00 $ .��.._�
x 510.00, S �_
State Surcharqa
$ 5. 00 $ ,_,!__
5�.00 $ ,__
S ,_SG
'� 00
0
Job Addresa •7539 ABLE STRF��, �
,�� Dapartment ot Suildings
' City of Fridley �
Tel. �571-3450
The underaigned hereby makes application !or a permit Los the work heze!
apecitied aqreoing•to do all work in strict accordnnca with the City Code
and rulinqs oE tha Dapart�ent o! Buildiaga, and hereby declarea that all
the facts and representations stated in this application are true ar.d coz;
3-23-'l7
Fridley, M.�. � 19
��R JANICE .AIVDERSON •
f rame
1CIND OF BUILDING '
USED AS re S.
TO 8E COMPLETED ABOUT 3-3�-77 • �
ESTIMATED COST lO�OO
OLD - NEW BOILDING PERMIT N0. PER+lIT N. °'`-'�
c��� �
' �@�ny
. Signed Sy `
Tal. No.
ROUGH INSP.
Data �
FIN�L INSP.
DAtQ
APPROVAL TOR PGRMIT _�L�.—� _� ,
MINIMUM FEE FOR ANY PLUMSING PERNIT IS $7.50
TOTnL FEE g . "'ass "A'-' Surcharge .50'
REINSPBCTION FEE .
(S]0.00) � • •
_.��.� � ..-�.�.... .....� ��.�.. �. ....�
0
0
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sue�ecr R
City of Fridley 25 30 8
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
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COMMUNITY DEVELOPMENT DIV. � � ��
V PROTECTIVE INSPECTION SEC.
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� � /'��1 � CITY NALL FRIDLE� 55132 NUMBER REV DATE PAGE OF APPROVED BV
�"""�� ,�' 612-571-3450 9t0-F15
7/24/97 / /
J08 ADDRESS 7539-41 Able Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. S 2 Nagel's Woodlands SHEET
2 PROPERTV OWNER MAIL AODRESS 21P PMONE
ABLE PROPERTY MANAGEMENT 9920 Zilla St NW, Coon Ra ids Mn 55433 754-0743
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Kozitza Construction 9175 Isanti St, Blaine MN 55449 786-3625 2650
4 ARCHITECT OR DESIGNER MAIL ADDiiESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADORESS Z�P PHONE LICENSE NO.
6 USE OF BUILDING
Duplex
7 CLASS OF WOFK
� NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22' x 22' Detached Gara e
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Provide a hard surface driveway.
Variance on rear yard setback approved by Appeals Commission on 8/14/96.
11�AR���if
Before digging cpll to�
all utility iocations
SEPARATE PERMITS REQUtREQ FOR E UIRED �BY LAW
WIRING, HEATING, P�UMBING ,qNp S� � �
GNS, �
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS AFE REOUIRED FOR ELECTRICAL, PlUM81NG, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERI00 OF 120 DAVS AT
ANV TIME AFTER WOFK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 2 STAILS GAHAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX
AND OROINANCES GOVERNING THtS TYPE OF WOfiK WIL� BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �8 � 949 ��F. �F7
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTIO OR THE PERfORMANCE Of CONSTRUCTION. �1�F9.75 Fire SC �H.9S
2`� PLAN CHECK FEE TOTAL FEE
License SC $5.00 $168.17
5iG UAEOF Orv�RACTOAOAAUTH o.nGENr �DATE� WHEN PROPERLV IDATED THIS IS VOUR PERMIT
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S�GNATUFlE OF OWNE:7 i�F OWNEA BUiLDEAi IDATEI ' BLO INSP �1iTE
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ConstructionAddress:
Le�al Description
CI'fY OF NRIDLEY
SINGLL FAMii,Y AND DUPLEXES R-1 AhTD R-2
BUILllING PLRMIT APPLICA'I'ION
i 3 �' - �{ i
/ � . .1�.�
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`S L_'�r'-z�� L��s
E1�(=ective 1/1/97
�� �5���
Owner Name & Address: �'l,l� ��.�,,�� ���,�y�f� � Tel. # 7 5Y- � ? �[3
Contractor: _I� ->
� � �'S C� zi % Z �- �6t1 �` ; MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
`��� lSii��)i � �,
..c ..,, ,
Attach to this application, a Certificate of Survey of th�
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. # 7�`7'��i'7�(3
Length Width Height Sq. Ft.
L,ength �2 � Width bt a, Height Sq. Ft. �
�ng� Width Hgt/Ground Sq. Ft.
Construction Type:_ �; ���Q, ���,,,,� Estimated Cost: $ �, LDc� ���� ,_s�c�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft �x $ —�
DATE: Z - � Y
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcllarge
Driveway I:scrow
�Erosion Control
I'ark 1=ee
Sewei- Main Char-ge
�I�U"l�nl.
S"I�[1't Ii.;A�l�i( )\�ti:
APPLICAN'T: ,�� ';�� ,__ Tel. #�7;� Y� 61 Y 3
,1/ ` "
CITY USE ONLY
$ /�� � Fee Schedule on Reverse Side
� �q'� .001 of Permit Valuation (1/lOth%)
�_ �i `/% $.50/$1,000 Valuation
$ $950 per SAC Unit
�_ ��� $5.00 (State Licensed Residential Contractorsl
`�__ Alt. "A" or Alt. "I3" Above
� $450.00 Conservation Plan Review
� I�ee Detennined by Fngineering
� __ Agreement Necessary [ ] Not Necessary [ ]
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SUBJECT
C�ty of Fridley 6 7 9 9
AT THE TOP OF THE TWINS g � I L D I N G P E R M i T
r
� ` IPT NO.
� ; y _.�__ COMMUNITY DEYELOPMENT DIV. � /����
r � PROTECTIVE INSPECTION SEC. ��y
i �. �
i.--- A;/"';'j CITV HALL FRIDIE� � 55432 NUMBER AEV OATE VAGE Oi AV�ROVEO BY
Z '� 612-571-3450 9t0-Ft5 7/23/98 / /
JOB ADDRESS
7539-41 Able St NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. r) 2 Na el's Woodlands SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Able Pro ert Mana ement 2 Zilla n -
3 GONTRACTOR MAII ADDRESS 21P PMONE LICENSE NO.
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS I�P PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZiP PHONE LICENSE NO.
6 USE OF BUI�DING �
n'
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof 22 S Tear-off
9 CHANGE Of USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
SEPARATE PERMITS ARE REOUIqED FOR ELECTRICAL, PLUMBING, NEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOEO Ofi ABANOONED FOR A PERI00 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
l HEREBY CERTIFY THAT I HAYE READ ANO EXAMINED THIS APPLICATION 2 STALIS GAAAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS Of LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED MEREIN OR NOT. THE GAANTING OF A PERMIT $1834.80 �.92
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pERMITfEE SACCHARGE
PROVISIONS Of ANV OTHER STATE OR LOCAL LAW REGULATING CON- _
STRUCTION OR THE PEAFO F CON TRU �or,. $59.50 Fire SC �Z . H�
PLAN CHECKFEE TOTALFEE
- License SC 5.00 $67.25
S�GNATUAEOFCON'RACTOAOFAUTHOA�IEDAGENT IDATE� WHEN PROPER VALI ATED THIS IS YOUR PERMIT
.�v- � -z --�
SiGNATUREOfOWNER�IFOWNERBUILOER� iD�TEi �' IF�SD �IiTE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �� ���
/ ��
ConstructionAddress: �,�-� �S -��'-- �/ ,�%✓����%- /�� '
Legal Description:
Owner Name & Address: ����D'����=' //'ll���� Tel. #
Contractor: j'�/d��% �- MN LICENSE #
Address: � �� C`i �/ �j'�'% ��D���`r'/�% �J�� � Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. �
LIVING AREA:
GARAGE �AREA:
DECK AREA:
�� I '
Construction Type:
Length
Length
DESCRIPTION OF Il1�IPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
/� --�, o � -
Estimated Cost: $ ,� � / c�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
DATE: APPLICANT:
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
$ 7/i)`"
$�
$ ��'�
$
$ �i L�
$
$
$
$
$ ����
Fee Schedule on Reverse Side
001 of Permit Valuation (1 / l Oth %)
_$
Tel. #
$.50/$1,000 Valuation
$1000 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 [ ]
��
0
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
5/L-36U4 N'AX:
: 7541 ABLE 5T NE
: 123024220022
: NAGELS WOODLANDS
: LOT 5 BLOCK 2
: BUILDING
: DUPLEXES
: WINDOW/DOOR REPL
571-1LtS7
PERMTT .: 2004-01271
DATE ISS . 004
VALUATION : $ 1,500.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DUPLEX PER R317 OF
THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
INSTALL AN EGRESS WINDOW. PERMITS REQUIRED FOR BASEMENTBEDROOM FINISH.
STATE LICENSED CONTRACTOR 1
APPLICANT
TRENDY ROOFING SONS INC (20027543)
210 ZACHARY LANE
PLYMOUTH, MN 55441-
OWNER
ASHRAF LLC
2947 BENT TREE HILL RD
NEW BRIGHTON, MN 55112
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 worl�
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 any other state or local law
re _ ' n or the performance of construction.
Bldg
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
SEPARATE PERMITS REQUIRED FOl� WORK OTHER THAN DESCRIBED ABOVE.
54.00
1.50
0.75
5.00
61.25
NEW
ADDN
ALTER
�� CI7Y OF FRIDLEY Effective 4/1/2004
�� 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg Insp
�� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMITAPPLICATION � �,� j �/��/
(
Construction Address: �
Legal Description:
Owner Name & Address:
Contractor. � < � �
. � 1 —� ...� 5 ,-
� r
�
L
�C ,
s-� v,�. � �:�5�
Tel:
MN LICENS #
Tel.� � � � �
� � � �l � �3
Attach to this application, a Certificate of Survey of the
bt, 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 HgUGround Sq. Ft.
QTHER:
SU� G'.� �
Construction Type:
`-.� � ��� Estimated Cost: $ - �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 1 � �� APPUCANT: � �^���3
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
TOTAL
�
$ .���C�C� Fee Schedule on Reverse Side
$ r' 65% of Permit Fee
$ , � (� .001 of Permit Valuation (1/10th%)
$ '�S ' $.50/$1,000 Valuation
$ $1350 per SAC Unit
$ � , �`'Q $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 [ ]
$ ,� S~ STIPULATIONS:
V
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6431.UniversityAveNE,.'v. �v..v,. y.�. n��j.G' '�'� �c�-�
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT �'�' 'i��' ��� �
(763) 572-3604, FAX (763) 571-1287 -
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR �'G� �5 �JI�S�,
...:..:::.:::::::::. .....,..........
. .. .. ., . ...... . ..:: .: ;::::. :.,,;::.: � >;:>:.;::.;: .....:: :..;: :<::.::.>;:.:>:
........: ....:..r ..
:�<,:;: :.>..<:::;:;::;;;:.:.:; ;<:.:<�,: :;:::,.;
�t':::�:>:::: : .::: :. ..::
��?i.:�:.. Wash :p � t�;:{:::::::;: Floor ��>::::r;: Auto. ::: Gas .>: w
...� .....:.::... .. ��::s�::>:��:;:. ��'�z•<.::>•.. ater Heater
:��..�::::�::
Storie
s :: ri
��>:<` U nal :
:: Show r
:�.'�::<»:;:_::� e
�.... Tra
':T.#��<'>::;�. ?�� D ain
:���#'`��:>;>�::: r
:::.,...�::.:..:.:.. ...::::.........:....
:....., ::::: :.:. :.:::
. .:.:.:::::...:::::. .............
. . ....... ,.
.. ....
:.:.::.. ....... ;:::.::<:::..::._:...<..:..�. :.::::::::.:::::�.�
.. .............. ..... . ...: . ......,�;;:.�.�. Y :�.�.1�#:1�:<;:�~:.. :�T�:::::::;':>: Washer �i�l. ::: Ranqe ���::::>::>�:;� Gas Elec
FEoor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ ���1 �.�� �'�. �� In�
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin .
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas""
. Gas Range'"`
Gas Dryer**
Back Flow Preventer Required ()Yes () No
Type
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.00
$15.00
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
�t� C.�
$ � `..J�
� , �-�- .��
_c�
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.
OWNER T��
BUILDING USED A
ESTIMATED COST
PLUMBING CO
SIGNED BY �
Approved By �
DATE: C� � �� � � �-p , 20 ��
�''�� � 1 C� � ` ��l �� r j �,��r, . \,
PERMIT NO.
Rough-In Date
��� �t � ���
_ Final Date
OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
. ' .
COMB�ISTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE
�
Building BUILDING Permit�
Inspections RESIDENTIAL APPLICATION Received By:.
763-572-3604 CITY OF FRIDLEY Date Rec'd,�'�
DATE
SITE ADDRESS `
THIS APPLICANT IS:
YOUR E-MAIL ADDRESS
❑ OWNER ❑CONTRACTOR
PROPERTY OWNER/ Nq�: f ��
TEN.ANT wrr�nnnn.
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
�-f� �:�-�S � �
_/-,� /' A� I,� s! �r�rv f��. `i� r
AT���IP�y�
PHONE:
NAME• ( F,�"YL �CY� �! i� r`S � re .L �✓L-
STATE L[CENSE # EXP DATE
ADDRESS: r� �.3 P v1�d� � � � �� CiTY E° � �l�� STA'I'��P .%���� /
PHONE
❑ SINGLE FAMILY/NEW
�'TWO FAMILY/NEW C(
❑ ADDITION
❑ BASEMENT FINISH
❑ DECK
DESCRIBE VJORK BEING DONE:_
SIZE OF IMPROVEMENT � 5
ROOFING �,�.`
NUMBER OF SQUARES �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
� ���
FAX
❑ GARAGE/SI-
�'ROOF
❑ SIDMG
❑ SWIMMING
18sHOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
WINDOWS
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 �
SIZE
0 DRAIN TILE
❑ OTHER
WIDTH HEIGHT
Ft.
BASEMENT REMODELING SUBIvIIT:
1. Existing Floor Pian
2. Proposed floor plan
3. List of structura! members to be used
FOR NEW CONSTRUC7'ION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of conswction plans
3. Energy CalculaLions
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USINC„� THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�O"Z /_ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Sarcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ��7� ��
$
$ ' O%
$ �_ ��_
$
$
$
$
$
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= 8x$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 eview and approval of plans. �"
SIGNATURE OF APPLICANT _'�' � � � _PRINT NAME A /'/� �'�'l4 �P DATE ID °`c3 '' � Ip