AF - 44513SUBJECT P ,
City of Fridley ° 14230
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M • EIPT
r
� i y�_���_ COMMUtJITY DEVELOPMENT DIV. /� _
r � PROTECTIVE INSPECTION SEC. �"`���I ^ J
1 � � (/ �/�.i .v
1 �
�4 � /'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE � PAGE OF APPROVED BV �
""'� � ,�� 6t2-560-3450
910-F15 7/20/77 � �
JOB ADDRESS 60 6� Alden Circle N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. rJ 1 Henriksen Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Leif Henriksen 6434 Riverview Terrace N.E., Fridley 560-4560
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 AACHITEC7 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
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 35' x 26' Dwelling and a 20' x 24' Garage
SEPERATE P'ERM1�S
9 CHANGE QF USE FROM M�. A�(�(�, p���NG AND T���
•�\i
STIPULATIONS Provide a hard surface driveway. Provide sod in the fmnt and side
yards. Provide a verifying survey before capping. Provide 2 x 8" rafters and/or
proper bracing for rafter design shown on plans. Provide vapor barrier in
ceiling.
SEWER LOCATION: (Approx. 9.5' Deep) 51' East of Manhole (Inv. 952.05
WYE ELEV: 953.43 TOP OF FOOTING: 956.03 Minimum
WATER LOCATION: 38' N.E, of Hydrant
DRIVEWAY DEPRESSION COST: N/A Existing depression �����
SAME PLAN AS 81 ALDEN CIRCLE N. E. $g(p� �p� ��p�j �tIIIt1ES
1'!�!� L1:i QF FIMptEY CO�S NO? C�tlARAFIiEC iH�i T��LE�E • Fi�ECTRIC • GAS EtC.
�ccu�ucr of v�mr �o�,�nc�s ,�+,o ElEVA�iG'r.,�,, ��(�UtRED 8Y LA�W
TMIS DATA � 1`OR �lFORMAiION PIJRPOSES ONtY AN�
�soNs usu�c rr sHOU�o v��Flr� nii� �oaw�►no�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CON,�T. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. Wp d Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R"1 9�.0 t 4$O 23 OO TO't3
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 VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT S29 � 39S ��.4 .%O
DOES NOT PR SUME TO GIVE HORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS ANY OTHER TE OF LOCAL LAW REGUTATING CON-
STRUCTIO R T P FO IVCE OF ONSTRUCTION. S92.00 $375.00
PLAN CHECKFEE TOTALFEE
s �� $23.00 $504.70
SiG� RE F ONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROP lY VALIDATED THIS IS YOUR PERMIT
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SiGNATUfiE OF OWNEfi IIF OWNEF BUIlDER1 IDATEI � BLDG.INSP DATE
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July 22, 1977
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6d31 Uf�IVERSITY AV'�PIUE N.S., FRIDLEY, iVlINNESOTA 55432
TELEPHON� ( 6y2}577-3450
Mr. Lei:f Henriksen
6434 Riverview Terrace N.E..
Fridley, Mn. 55432
Re: Addresses For Lots 4& 5, Block I, Henriksen Addition
Dear Mr. Henrik.sen:
�n1e have changed all the records in City Hall to show the following:
Lot 4, Block l, Henriksen Addition - 61 Alden Circle N.E.
Lot 5, Block l, Henriksen Addition - 60 Alden Circle N.E.
6de would appreciate it if you would change your records to show th.e
above addresses for the above legal descriptions.
If you have any questions on this matter, please contact me at
571-3450.
Sincer ,
RON HOLDEN
F3uilding Tnspector
RH/mh
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E. iX�t:t�rm�r�� the °t)" value of eacl� sc�c3men*,. (1-9) and multiF,ly hy the area a;
+:�,.i . .. . .
%Ct.il�� r
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2 - _.__ _--��'--��-' -- }� ,. �, „ , 3$ = 3 �• � G' �'a-�-� t�1 �-�
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� . 2 � ., U ,. , �.. �,.. _ �, 2 $ � ! �1. �. �L A E.�.
5 - � 4�''�.,.- x �� � � �� _�`�..._ _ j �, D S'rt,t ta ��. �-
6. �.Z.!> � ;� „��, r C��__ _ _,.s�'��---��s .LtJ'.�c�.t��t'f"�.N �.t�''�c't�,
7 . /� � k „U., � c8 ,�. _ � . S � � � �"1 J� � � T � �,.4-
a . f, „� „ , .�s�` _ �t, a D ewS t,K ��o+���
,�. ��. x ��L�� � �/i�+
ADD 1-9 :."OR TOTAL td��LL SEG�SE�ITS
- .�3?, �-� �-� s '�' ° `' � ��
.,+�r. _ ,u_ _ �rmrn� T7# �L� �� ��
F. i�etezmine the "U" value of ea�h segment (10-12} and multiply by the area �.s
foZlows: , - �
10.
11. !
12. , /G/
1�' �'/xa7 ��
X �� fd x = r � �
X „u„ , o _ � 3 7 �,�- � �
X a�u `v j� _ � f z4 . �� ��'jG "�
✓ /F
ADD 10-].2 FOR TOTAL ROOFJCEII,ING SEGMENTS '� � � � � �"�"'�"Z'*'t!i!�i�• . �J�� � �
G. If Item ITI is tl�e sai!?e as, o.r less than It��n I, you have :net the intent
of State Building Cade 6006 (c) ?..
H. If Item IV is ttie sar.ie as, or less than Iten II, you have met the intent
of State Builaing Code 6006 (c} 1.
I. Add T tem I
J. Add Item III
+ Item II
+ ztem Iv
a
a
K. If the si:m of Items III and IV are less than Itens I and II, you have met t�e
a.nt�nt of the Code for �ot.a1 e*ivelope systerav
The unclersi�ned, �s applicdnt for a building ���rmit, hereby affirms the above
in�ozmation has been ��repared a�d ;�u�mi�ted by himself or under his direction,
hereby acknocoledges the information to Y�� cozrect and accurate; and hereby
presents t13e i>>fo�-matien wi�.-h,,,�c�ui.red plans in support of ti�e huilding permit
�PP�.ication. r+� �� .�
BY=
� .
DATE : �� ^/` f ��/
i
0
F
I;�:] t?GY � C�';:;�;I '%,;'_'• G;7 �UI'F'7 Et�SL:Fd7' TO L'�JI:LI�I iIG F'I,itMIT IIPPLICI►1'IUfJ
i'i.J1i:':i1lf�; 11^1C) II:S1'i'.�"I'I��f! t�Il�'i;t,�["�I;,,17,
CIi'Y Oi' r:'i;ILLI:Y, fil;i;�I::;`i`i`!�
'?'1� .:upt Ic�;:i��nL is �,rc�vici{•ci to a:�si�st th� a�;�;licant in comr�uta.ng EKTI:i?IOR FII`iELC>I� ;
AVi. AGE "t7" 1�'T�C'i'�It INI'C.iii7i�T?ON. This inform,�tion is rcyuired so the FiUILUING
U'r'i'lC1I�L �ati c:et��rr:u:ie �;��+,:. .,ui�mi+_ficc� plan:, comp�_� wi_th the L•:t1ERG�' CGNS;�it','�:TION
D�SIGii C?:IZ'EI�II: o� t}Ze Sfi�'�T�� L'U7LDING CODE (Sectir.;n 6U00) . It is the J�PPLICAidT' S
res�x>nsibi_lity to accuratei� compute the data; reflect the proper DTSIGid CP,ITrnIA
in ttie ��l�:�s; sui;mit F;rociuct sZ>ecificatzons, if needed to suprort the "R" and "L"
factors u�cd; a.nc3 to assure cor.strucL-ion is per approved plans.
JOB LOCATIG^3:
OWPdEF�,/CONTR�CT
ADDRESS:
A. Determine the Total Exposeci ZJall Area as follows:
B.
C.
PHONE:
1. Total walZ window area r
2. Total door area `
3. �btal sliding g;:ass �oor area .
4. To tal f ireplace wa11 area `�
5, �'o.tal wall framing ar�a (average 10%)
6. 'i°otal net wall area above floor(average 900)
7. Total rim joist area �py tt �,��i J�
SuL-tc��aJ_: Total exposed wall area above floor
�
��
�
8. Tc�tal foun�ation ��:indow area ��� �g
9. Tc>tal net foundation area above grade �X �'�Z��•w►
5ubtotal: Total exl.�o.sed foundation area
GRAND TOTAL EXPOSED 6aALL AREA $��
�
--...,....�
Dlultiply the GRAND TOTAL E�POSED WALL AIZEA X.17 fs�'.�d 11�; ,.`�.,.�em I
Determine the Total Exposed �oof/Ceiling Area as follows:
,
�
� x g� i�x /� %Gi��'
Ii�'"� � —
: ���. �, � ,�,��
:
10. Total skylight area
11. Tot�l roo� %cPilir.g £ra*ning area {10 �)
12. Totai net insul�ted roof/ceiling area
G�ND TOTAL EXPOSED i2UOF/C�II,IIQG ARE1�
•
_ . �y
,
,�
/
�
�% .�
f'� �:�� 3
� .i�'
D. Multiply the GRAND TO"'AL EXPOSED ROOF; CEILIIJG AREA X�05 = em II ��►� (;�
�1e x �— ---�
� Y
CITY OF FRIDLEY � .
. ,
APPLICATION F0� RESIDENTI�L BU�LDING PERMITS
(NEW, ALTERATION5, ADDI1"IONS, OR REPAIFtS�
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OWNE12: �� j�� ��/ �}� /^��=�-�¢ . BUILDER: � P� l I�V�'ll Y i,�SC �
��
Address : � 7 �� v� t� i 1 � Address : f Lf ,�� ` ��'- Yy�
1� t �7 � !!iF? 1'° C e- i_i'�i d!' �� LUP Y� y �° �.% !
Te 1. No . � -� j � — [< <= � �
No. :��` Street: ��/�E' /ii � i Yc ` �
LOT: � BLOCK: �_ ADDITION: ���� r+ J�,s',v y�_��l ,
CORNER LOT: INSIDE LOT: .� SLTBACK: SIDEYARDS:
Applicant att�ch to this form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING :�
To Be Used As: �� - � � /
ft � �r S �? _ Front: � , Depth: e�'�r Height: l � _ '
Square Feet: ��� Cubic Feet: j 8, Z° ��
� � J �
_c '� �"cz c; Front: Depth: v�� Heic�ht: � �
���
Square Feet. �t �d CubiC Feet. ��
Type of Construction: �.;(�i ��r! � Estimated Cost: $ l
/ �/ p� c�'�3 i 00
To Be Completed: `�Z�;� �;�� �zZ `�p �,. Alt: A J Alt. B
a� rPa�i
Proposeci Driveway Width If New Opening Is Desired �y�� $ $
- (SEE REVERSE SIDE OF SHEET)
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 Buildinqs, and hereby
�declares that all the facts and representations stated in this application
� re true and correct. See reverse side for additional information.
� �
DATE: _���7 � SIGNATURE:
P�_�
p � • ��T � � `�Z t �'�'
Sti ulations : ��_ � � �. � / � ��,�y�wl
a��e.. ��w '
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BUILDItJG PER��IIT FEt SCiiEDULE
SECTION 2. The Inspector of Buildings shall, before issuing peYmits for the erection
of any building or structure, or for any addition to any existing builciing or structure,
or for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the applicant for s�;cY, permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
NEW CONSTRtiCTION: Si:�gle Family Homes anct Garages: $4.00/1,D00 cubic feet.
PLAN CHECK: 25 percent of building permit fee,
DR.IVEWAY nEYRESSION: (Concrete Curb Streets Only) .
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$11.75
Al.ternate B: Removal and replacement of concrete curb and
gutter and instalZ a 3 foot wide approach with .
6 inch depth; Driveway width plus 6 feet x$15.4�
AD�I T IONAL I t�FOR"IAT I ON
For the purpose of computing fees for building permits, the cubical cantents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roof surface p
of the r�ain gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In na case shall the fee charged for any permit as set forth in Section 2 be less
than $7.5� plus $.50 state sur_charge. .
.yERIFICATIO�V OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
of application to allow for proper review of the proposed ,tructure and of the
cot�struction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed wil]. be required before proceedii:g with the framing.
�� : ����i�� ' ' ►�
Application for a Certificate of Occupancy shall be made ten (1G) days prior to the
use or occupancy of any structure for which a builcli ng permit has been issued; anc�
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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�ypTA��,qG MINNESOTA VALLEY
�`„t SURVEYQRS $� ENGINEERS CORP.
G �
� � . ��� I71P0 RiVERr06D DRtVf S�RNSVtLGE. MINNBSOTA 55377 � � � `
�`y�RS E� P►.�,. aamo
Cer�ificate of Survey for; Iaef HetZricksen
THE C11Y QF fRIDL�I( DOES NOT GUARArtTEE THE
ACCURACY OF UTILITY LOCATIONS AND ELEVATtONS,
TiiiS DATA IS FQR INFORAAATION PUf;P�SES ONLY AN7
PERSONS tJSING R SF10UtD VERIFl( I�iE pVFpKI�►qTION
4N 7He
r9L ��N 1/1�AY ,�° �''.�' 8° °�
�
WARHING
Before diggi�g call local�s �tc. ���
TELEphpNE - ELECTR AW 5
��QUtRED e� . ;o
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Lot 5, I�lock 1, Henricksen's Addition, according to the plat
on fil� in the register of deeds, Anoka County� MinneBota.
!V
_
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� '_ ,30'
I her�by c�rlify fhot this is a hva ond tsrrect rtp"r�f�wMRfiM► Mia�e.s�ta Ystltr S�rreyers �(
of a sur�cy oi tl�e 6eLedorias of 1b�.�ob�ve d�asribsr-Iw.nd, ��=�R�lil. ��' ��y-
end of ibe Ioco�ioo�ol all 6uildings� /h�r�sn� �pd o�l rjsibl� ,� �`��l ! y/� N ._.
sntroochm�nls� ef ony� from o� on said� loed. � . � `�'��'���'• ` --. � •—_ ` ��-� '�y��.ea�:�+• � 1. .�l..
As� surveyed by me tbis2� duy o/ � ri� .�Arp. 19�. �pA. Rl=. �:VO, ag
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CITY OF FRIBLEY
�iPPLICaTION �OR PUIMBING AND GAS FITTING PERMI7
N �. �nl M u . x c� Water
�' �� '^ � � [ � �n Q � w w c Heater
� � .-i cn F�.� r3 S� m�C 1+ q, r�
•�-1 fa 'v �'J C N �C � I d 1, .� C E CJ �S • LG
1� '.' „ .0 •.i .X .r C � f�
p • +� �� � N'� O O N N O In N � N N .0
� �'°+, ( N r � •.+ a�+ o I r. .-+ ro�s a ro ro .� ro +�
co v � � a m �n s o�w, cn ., u a a 3 c� � c� o�as lec
��� �� l 1
�s: �► � �. � —
��3 I
�-'t I
(n) _._�u:e Connection Openirtg Counected with Sewer
i*) = tic:w Fixture, pld Opeiting Water
PARTIAL RATE SCNEDULE
PLU'�:3ISG FISTU1:Ii fU\TES: �N�
t�Cs.;.:�er Fix �ures X
FUt.�re Fixture Opening �� X
Ne•a r ixture, Old Openirig X
Catch >asin X
wa�er Hester - to 99,0�0 BTU � x
li:;�, J2D IITU to 199, 000 BTU x
Wa�er So:teaer X
tiew �rou:i3 Ran Old Building X
Electric ;�ater Y.eater X
c.as ��TTri�� r�.:s:
lst 3 fixtures
Ad.a.i �ic :al Fix tures
Gas :<a:�:ye to 199,000 BTU
RATE
S3.00
s2.00
$2. 00 �
$5.00
$5.00
$10.00
$7. 00
$5.00
$5.00
TOTAL
1`�
S
S G. OD
$
$
$ s�2S�_
S
$
$
.�.. x S3 . 00 $ . (� (�
x $1.00 $
x $10.00 $
REPAI::S £, ALTLRITIOVS
I rirsc ;`0�.00 $5.00 $
each a��. $:00.00 or fraction 52.00 $
State Surcharge $ .50
, TOTAL FEE g ��,��
RF.INSPECTION FEE
ts�o_nn�
�% � -
Job Address C,�`� �
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Bui2dings, and hezeby declazes t!:at all
the facts and representations stated in application are true and correct '
4 _ Fridley, �V i, 19��
OWNER /� r_ /
�__�C C ��
KIND OF BUILDING �( �6 � a ��2'(� VK �
USED AS f l tdJ Q_ � 1, y�,iA
TO BE COMPLETED AIIOUT �¢'j,� . ,
ESTIMATED COST / �� _�j (� �# Q (�
OLD - NEW -BUILDING PERMIT NO. PERMIT NO. ��Z�'�
Company �
/'
Signed By
�
Tel. No, _�� 3
ROUGH IfJSP.
Date
FINAL INSP. � .Z - j'��' 7 �
' Ddte
APPROVAL FOR PERMIT � �
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SURCHARGE
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION� REFRIGERATION AND
.AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL �ATE SCNEDULE
GRAV3TY WARM AIR: RATE TOTAL Job Address (/� ;" �X, n (:�2C_�
Furnace Shell & Duct Work $12.00 $ .
Replacement of Furnace 7.00 $
Repairs & Alterations-up to $500.00 �•00 S Department of Buildings
Repairs & Alterations each add. $500.00 4.00 $ City of Fridley
Tel. #571-3450
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations-up to $500.00
Repairs & A}.terations each add. $500.00
STFAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3,ga1. per hour
each add. 3 gal. per hour
GAS BURNER- from l00,000 sTU to 199,999 BTU
(over 199,999 BTU see Fee Scliedule)
$12. 00
4.00
7.00
7.00
4.00
$12.00
4.00
7.00
6.00
$�o. o0
10.00
$10.00
GAS FITTING FEES:
lst 3 Fixtures x$ 3.00
Additional Fixtures x $ 1.00
Gas Range to 199,000 STU x$10.00
AIR CONDITIONING �1
FAN HEATING SYSTEMS 1 See Fee Schedule
VENTILATING SYSTEMS —�
ALTERATIONS F, REPAIRS
State Surcharge
TOTAL FEE
ROUGH INSP.
Date
FINAL INSP. � � � 3 ^ � 0
Date
APPRpVAL FOR PERMIT i �
RE2NSPECTION FEE
(.$10.00)
The undersigned hereby makes application for a permit for the w�rk herein
S �c'�(J specified agreeing to do all work in strict accordance with the City Codes �-
$�f-,��) and rulings of the Department of Buildings, and hereby declares that all the
$ facts and representations stated in this appli.cation are true and correct.
$ Fridley, Minn. _�2�_ , 19 7 �
OWNER � e /�t'iy1/t��-��� .
$ KIND OF BUILDING �/u�.r�+�S/�
$ ,% /
$ USED AS /T fl/'...��,(s—�e�
$
TO BE COMPT,ETED ABOUT ?D
� �f�$ ESTIMATED COST
$%6•OU' OLD -�UILDING PERMIT NO. PERMIT NO, ______���_'
$ -
S 3; n Q.
S
$ '
S
S
S
S
$ .50
sa . v
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, 5team, Hot Water, Warm bir- No. �Ojo� �a� �/_Q —
Trade Name �,Q Y� f1U�1L Size No. ��d dUO
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name� �� Size No. �
Capacity Sq. Ft. EDR BTO FiP
Company /�ZL�.c(/ t/C'�
Signed By
Tel. No. ��b — Z �S�
_
_
C�TYOF
FRtDLEY
FRfDLEY h1UtilCIPAL CENTER • 6-331 UNIVERSITI' AVE. N.E. FRIDLEY, IviN SS�132 •(61?) 571-345p • FAX (61?) 571-1?K7
April 12, 1996
Mr. Keith Wood
D & B Roofing
65111 83 Ct
Brooklyn Park, MN 55443
Re: Reroofing Without Obtaining a Building Permit at 60 Alden
Circle NE, Fridley, MN
Dear Mr. Wood:
On March 21, 1996, you were informed by the City of Fridley
Building Division that a building permit needed to be obtained for
the reroofing that you were performing at the above noted address.
As of this date, you have failed to apply and obtain a building
permit for this work.
We will expect you to correct this violation on or before April 30,
1996 and a special investigation fee will be added equal to the
permit fee. If the permit is not obtained by April 30, 1996, this
matter will be turned over to the City Prosecutor for his legal
consideration.
Please contact me at 572-3603 if you have any questions on this
matter.
Sincerely,
,�
.�� ", i �
3 lr,; , ( ���,1'
BARRY IESCH
Building Inspector
BR/mh
_ _ _ ]i�
io�7.lss
. r
��1G,�� 1(.��i 1,N(�fi��-��:!f�� � C�� � C� � dF �� �Z��
Building
Inspections
763-572-3604
'63-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECI'IVE 1-I
DATE� I I I�� YOUR E-MAIL ADDRESS
S[TE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SU$MIT A COPY OF
YOUI2 STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
❑ OWNER �CONTRACTOR
NAME: �;� �,�{ a �� t� n
ADDRESS: 6O �� C. ? rLl� CITY_
PHONE: ( Io �-- S�% �- h� D�`
NAME: v �! � � O� S
' ADDRESS: 7 a,i �j� � GV� �/+i t'n • I� n'VQ
PHONE � S j��-{ b Q— (p (� � FAX
�� a
�
Permit No.� —bl°1 � �
Received By:
Date Rec'd:_t � — l a.�
STATE�ZIP .SS1-(3 �
CITY F4rm ir�%r STATE:?NZ[p ��Q��-1
STATE LICENSE # a� 3 I Q S I I EXP DATE � 3� 3� ��(7U °�
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYMEW CONSTRUCTION STOF
❑ ADDITION
❑ BASEMENT FINISH
❑ DECK
❑ NEW HOME CONSTRUCTION
fj� MAINTENANCE/REPAIR
❑ GARAGE/SHED ❑ WINDOWS
�Q' ROOF ❑ DRAIN TILE
❑ SIDING ❑ OTHER
O SWIMMING POOL
❑ ADDITION
❑ REMODELING
DESCRIBE WORK BEING DONE: �! e�p D�
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES ��_ ❑ HOUSE & GARAGE �, Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Ptoposed floor plan
�ROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
:OPOSED HEIGHT:
S[DING
❑ Vinyl
❑ Aluminum
❑ Other
W[NDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPG OF WINDOW TO BE 1NSTALLED
❑Soffit
❑ Trim
❑ Fascia
LOCAT[ON OF WINDOWS
NUMBER OF
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS_ & PORCHES SUBMIT�
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
ALL P'EES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
� ( ING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ {a � 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
$ �"� �'�S See Back Page for Fee Schedule
$ `� 65% of Building Permit Fee
$ .001 times the total job valuation
$ .0005 x Permit Valuation Minimum $.50
$ � D $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 payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D 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 confortnance 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
�ermit on site; that the work will be in accordance with the a proved plan in the case of all work which requires review and approval of plans.
GNATURE OF APPLICANT PRINTNAME J� �� DATE II�/�
APPROVED BY
DATE
.
< � �_ � ,�_ �.n��c�.r.n�a
• . ;... , ,.,, ,.
Address: �2382 CHlF
: FARMINGT�
1
0
0
I.BOWLING .
'3 jl2Q09
From: 7637537540 Page: 5/7 Date: 10/8/20101:01:13 PM
Building MEC�A�,�ZC,A.�
Inspectiaz�s RESIDENTIAL APPLICATI�ON
�b3-s�2-��04 CITY OF F.RIDLEX
763�502-4977 F.AX ° ,��rt�,r.,,� , , ,�. �
AA.�b 4�
S�'b A,AA�SS _
�S .Al'kx.�Ce#N'I' IS
OVV1�JEli/
°I'�+ �iA�1H�'
CONTRACTdR
susNn-r a cu� v�
YOUR STATE
�.ICE�tS� u'R�
A,�P�.ZCA,�ON
���'x' '�'X�E
7YPE OF WORK:
itOiJ[t E-MAIL ADDRESS
❑ OVV�TER �CObTTRACTOR
0
+ ' � �• !�1�i�/f�7�►'L�%I"���:1�%.[1�:��i�L�]l�fT
. . .. .t� ��i ,�
. ■.
�to�r� f�g�y i��`-�,�D I�
�ZNG�.E F��,X ❑ TwA PAMii.Y
�'
q N�VV �tEPLACEMENT
DETAILEU DESCRIPTION OF WORI�
O r�wxuc�US�.
Q AiTERAT10N/RE�140DEL
Pezmat No.:
Recei�ved
onn
FEES AR� �1f UN 5�000 �E�t k'�Ai7xtE, E�C�P'x' WHE� NOTED. FIXTURES: (iA'i1lCATE TdTAL Nl �MB�Et P� �.A,C� $�x.Ua�
�tQYIDE ��AT LOSS CALC'S �E�t 1xA,NU J Z006 A.S�#E �Al�'DBOdK
£q� pzr�ent Instailed MFQ: �'�'�i. �OA�I.: `��'�"� S1ZElBTU � �� B�,
MFG: if'7�I./L@ MOAk�.: � S[ZEJBTU�+ 1_
11�G: MODEL:
c E2s.00 _Fixsar.ncE �c.as) $as.00
AIR TO AIR F.�CCiiANGEER St5 FIRSpLpCk, (wppp) $35.pp
_i30�.fs�R 535,d0 �URNACE $35.00
_C��N£X L11dE.R $10.00 QAS T�RYER S10.00
AUG'�' WO� $10.00 GAS PIFIIVG 310.00
SIZk/�/97U
_c,�s �xcrrov�x sio.00
_NEW GAS GRILL SIO.t10
GAS t7N�]' t�t St0.00
POOL HEATETt 535.00
VE.N'1'ILA't'C1K E 13.W
�5 x5 A,N A,PPLICt#TTON �Oli A PERMIT-NOT vALID L7NTii PROCESSED
Z�;exeby a��p�y �'oz a bu��diwg �e�ait arAd I acknowledge that the informatio� above is connpiete and accurate; that tht work w�ill be iuo
conformance with the ordinances and codes of the City �o�` Fn'�idXey s;�d wi.tix tl�e Minnesota Construction Codes; LtzExt Z u�de�d this is
nat a pernut but only an application for a pe�t aud wo�r�C �s mot #o start without a permit; that ci►e work wi�� be iva accordar►ce with ttie
apProved p�aoi ua tb�e case o£ alz wox�C w�,�cb� �r�u�res �revxew and approval of plans.
s�c�rr,�� o�e .n,�,zcnrnr
APPROVAL
V City of Fridlcy
Building Inspectiions Depa�rtme�a.t
643I U�ive�sxty .A,ve�ue �TF, �xadley, MN SS432
763-572-3504 FAX: 763-502-4977
�A��..o a
( (�