AF - 34873,�,..
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r"'�1 (�1
��ity of Fridley, Minn..
BUILDING PERMIT
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N° 6488
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No. ������ Sts�et �����S..�A �
Lot �_ Block � Additl� or
Corner Lot Inaide Lot � �tback
3ewer Elevatlam
IIevation
DESCRIPTION OP BUILDING
To �� Jr �, �pth a� i%ight �... Sc1• F't��L�-_ Cu. Ft��
^ bnt ____ �pth � � Sq. Ft Cu. Ft
Type oE Camstructt _ �Est. � �o be Campleted
Ia �deration oP the isauanc+e to me of a permit to constcuct the building described above I agree to do
��dinanaea� th�e ctt�y ��y with the d�scrlption above set fQrth,Bati in c�mpliance with,�l provlsfona of
/� �"� J //
Ia cromdderatlon of the paymeat of a fee of
perrmit is hereby gianted t�
to c�onstruct the builain� or addition as described above. This �ermit is gianted upa�n
�he egpre� c�taition tvat the to whom it ia graated and hia agents, employe� and worl�sea, in all work
re pers�
do�e in, aswand and upoa said building, or an,q thereo� ahall coffiorm fn sII r�pects' to the orclinaac� of
Fi�idley, M�ta locatia�►, aaao��tru� alteration, mainteaance aad moving of buildin�
wI� dty ]imitsn�� permit may be revoked at aTMy 13�upa�n� aay of the prav9sions oY Beid
/ 1
i�,r;.""'_.,"?T
�"'� NOTIC&
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CSIMN�Y AND BTACx VSRIFICATIOW
The undersigned �ereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes �) No ()
2. Is free from rust or deterioration Yes jj� No ()
3. Has no .foreign obj ects lodged within Yes () No (�(j ,l'�
4. Is securely supported Yes-(� No ()
5. Me�ts all current Code requirements for
size and totai BTU's connected
- -- 6 . - Ha� �tal �ieating BTU's of `�u � � fl -
Al l other BTU' s �� Q� a
TOTAL BTU' s '� � ��
Remarks
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Yes ( "'�No ( )
List Aiteratians Beinq Done:
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.. _ �,. . ..::
ROYALTON HEATING & C�UNG
HEATING COMPANY - 8 TH AVENUE N.
Signed By BROOKLYN PARK, MN 55443
_ — _ _.e _ � . wwwa�
Date ' " ' — - - i
�
�581 al��� �w4
HEAT L06S CAI�CULATIONS DEPART NT
Weathentrips G�� C�n r
Windows Doors Refereate Ou� Qlall In� Wap Ce�id�
�o e�o 19_
Fl.� Room Leagth Width Height
Wiadowa and Dbo�s—Craekage aad Area
�YIAth H•i�e� No. o[ Lla�al tt. �na
Na ot paae et paa� II�Aq et eraelt q, tt.
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2� � �! � Z- �,� ,
�
S 2�� / % 1 ' m�s
�-- �� a i/ � `� �7 Coef. Btu
1n61tration
Class .
F.up, waQ
Net e.:p. w+�U ' .
lnt wall
Ceiling
Floo�
To�al &u.
Required aq. ft. ED.R. or �q. in�. WA. L.eader area
Fl.) Raom l.engch Widch Heigl�t -
Wiadows and Doors—�Crackage aad Area �
Wldlb HN�pI Na ot Lln�al tt. As�a �
Na et pan� ot yaa� Il�bt� ot anak �p. ft
%/ ��=� � Q �
� 'i`t 7?t ( % 1 �.-�/!
Coef. Ben
In6laatioo '; � �/ ,, f �y ?Z.
Glasr �
E:p, wal! �i
Net e�. wall `� c�'
�.�. ` `L G BG?
Ia� wal!
c�a�g (� � ` I �C�n
��� Inil l � Z,Q
Total &u.
Required aq. f� ED.R. o� sq. in�. WA l.eader area "``//
Fl. Room � Leageh qlidth Hei�ht •�
Wwdowa a� Doon--Cracka�e and Aroa
w�ata xd�et tva et lrn.s� r� wn• i
Na et wa� et oaa� Ilelt� et e..et .e_ t�
�
1n61tratioa
Glaa
Exp. waU
Nct exp. wall
�In� wall
Ceiliag
��
Floor
Tota! &w
�
f� ED.R m p. ia�. W.A. Leader area
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OF INSPECTIUN 1Y11N�FAp'pLLS. (Y@gY.
� - Iaadaaon _
Roof Floor Kind � ,
Fl:� Room I.sagth QI'edeh
Windows and Doors--Craekage and Area
w�a�e x.i�n� ro. oc �s..� s, nn.
Na ot y�s� ot oan� II�AU et anck p. R.
�
In6ltntioa
Claa
E:p, wall
Alet e:p. verall
Iat. wall
Ceiling
Floo�
Total Btu. �
Required sq. Ft. E.DR or �q. ins. R/A Leader area
Fl.I R�oom I Leagth W�lth
Wiadows aad Doon--Crukage and Area
WtdtR Rsl��t Na ot L1n��t tt. Arn
No. et yaa� ot oaa� II�AL ot enel� p. t�
In6ltratioa
C,tw
�sp. w.0
Net ezp. wall
In� waU
ceiliag
Floor
Toeal Ben.
Required p. h. E.�.R. or w. ids. WA. I.eader area
Fl. Room I i.en�eh Wideh
Windows aod Doon—Craeka`e aad Area
WtA �At Na ot aal t4 Ae�a
Na et vas� Ot �s� II�S4 ot onel[ q, tR
Iablr..eioa
Glaw
��
Net e�. wall
Io� wall
Ceiling
Flaor
Toc.l Ben.
ReQuind q. h. E.D.R. ar p. ia�. WA. Leader uea
Bto
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Building
Inspections
763-572-3604
DATE I ' �, —d�
SITE ADDRESS ��
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL A►PPLICATION
CITY OF FRIDLEY
' - � � ,... _, � �!�
' - � � i . 1�
�:!�! � " � i I �
• ' ��' S� ♦�. � ��A:/ .`' � �i
O OWNER �(C;ONTI
NAME: O A �I
ADDRESS: " �
PHONE: ��Q� • S TI —"
NAME:
STATE LICENSE #
ADDRESS:
PHONE
❑ SINGLE FAMILY/NEt
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #20130983
651-264-4777
O BASEMENT FINISH ❑ ROOF
O DECK ❑ SIDING
IO
DESCRIBE WORK BEING I
SIZE OF IMPROVEIV�NT
OFSQUARES
�.�RSGES
PRUPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vuryl
O Aluminum
� Other
i�i�:T]
ADDITION
�
o HOUSE ONLY
� HOUSE 8t GARAGE
0 ATTACHED GARAGE
D DETACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
wnvnc�$
IN EJQSTING OPEMNGS �Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
5TATE ZIP
t STATE ZIP,
❑ DRAIN TILE
O OTHER
F�
BASEMFNT RFMODELING SU9NLr7':
1. Existin� Floor Plaa
2. Prop�sed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS_ & PORCHFS SLIBMIT:
1. Site Plan/Survey showing the existing structur
and P�P�d P�.1�
2. Two sets of canstructioe plaas
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
_ (USING THF 1997 U.B.0 FEE SCHEDULE)
y
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchatge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
JOB VALUATION S�� S 3--
$
$
$
e
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.� (State Licensed R�sidential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination}
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement ne�;.essaiy ( ) Non Necessai7+ ( )
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID iJNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I under�and this is not
permit but only an applicati for a permit and work is not to start without a�it; that the work will be in accordance with the approve
plan in the case of all work 'ch requ' review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME 1 �lfl� �o_��j�/�„ DATE��
Building
Inspections
763'-572-3604
763-502-4977 FAX
S1TE ADDRESS �
THIS APPLICANT IS:
0 OWNER
BIJII�DING
RESIDENTIAL APPLICA'I'ION
CITY OF FRIDLEY �
EFFECTIVE 1-1-08
YOUR E-MA1L ADDRESS
Permit No.;
� - - - . : .;I%r`i:�,
�
-
�'� �u� i � L �
�, ;�r: . �, � � �.
PROPERTY OWNER/ N,an�: Le ��� d�v so�
TENANT �D�S. CITY STATE zIP,
PHONE•^I�o3 S`�� /3��
CONTRACTOR ADDRBSS:3�3 Ji �r,aey, NaYv C1TY C�re� ��+ STA'cE ZIP SS3/6
SUBMIT A COPY OF Pxor� 7b3 ya7 �6 �6 FAX 7�.� y'7 ��e.�
YOUR STATE LICENSE STATE LICENSE # a OOIO�i ?� � EXP DATE ��3/��
PROPERTY TYPE I � SINGLE FAMILY/WEW CONSTRUCTION
❑ TWO FAMILYMEW CONSTRUCI'JON
PERMIT TYPE ��DITION � GARAGFJSHED O W1NDUw5
❑ BASEMENT FMISH O R�F ❑ DRAIN TILE
❑ DECK �'SID1NG � � OTHER
TYPE OF WORK:
DESCRIBE WORK BEING
ROOF'ING
NUMBER OF SQUARES _
GARAGES
PROPOSED S12E:
PROPOSED HEIGHT:
�
myl
Aluminum
� Other
❑ NEW HOME CONSTRUCTION ❑ ADDI7'ION
�MAINTEIdp1VCE/REpAIR ❑ REMODELING
. �- - • - l- � - -- -- - .�. //_ �_
WINDOWS
IN EXiSTMG OPENINGS OYes DIdo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
� DEfACHED GARAGE
FT
BASEMENT REMODELING SUBMIT•
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
��� ADDITIOATS. & PORCHES SUBMIT:
❑ Trim 1. Site PlanlSurvey showing the existing structures
❑ Fascia az►d Proposed project
2. Two set� of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
�}li�T� �i:i�7 �
ALL FEES ARE BASED ON VALUATION, INCLUIfING THE COST OF LAB(3R AND MATERIALS:
(USING THE 1997 UBC FEE SCAEDULE)
TOTAL JOB VALUATION S�, o� 0 S% ° 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 .d
$
$
$
$
$ . ,. � _ �
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 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 c�mplete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and. wid� the Miraiesota Construction Codes; that I understand ifiis is not a permit but only an application for a permit and work is not to start without a
�it on site; that the work will be in accorda withththe approved plan in the case of all work which requires review and approvaF of plans.
SIGNATURE OF APPLICANT PRINT NAME��h� C� L- •�IccIC DATE 6 a 0
APPROVED BY DATE
Page 2- Buildi.ng Residential Application
��'� �-; BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any altera.tion or repair
to any existing building or structure, upon applica.tion therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 W$2,000 $23,50 for 1�` $500 plus $3.05 for each a.dditionai $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,OOO.plus $14 for each additional$1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` �25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,�0 or
� fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the I�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applicaxion to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 '
763-572-3604
Faz: 763-502-4977
Buildin.g
Inspections
763-572-3604
763-502-4977 FAX
DATE e 7 - � � � �
STi'E ADDRESS ����%
THIS APPLICANT IS: � OWNER
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERIVIIT TYPE
TYPE OF WORK:
DETAII.ED
PHONE:
PLU1ViBING
RESID]EIoTTIAL� APPLICATIOl`T
CITY OF FRIDLE�
YOUR E-MAIL ADDRESS
Permit
Received By;
� , :��; <;�
ATE ZtP
STATE LICENSE #,�, ,� �O �R��/v/ EXP DATE � �2 ° � U � [:l S�'
STATE BOND # � d O�' �� 7� EXP DATE
ADDRESS: / 4/90 �4"� '- r� 8'3 �i✓ CITY,`%9 �.�r � P.�,�..2.P � STATEa���ZIP_��
PHONE � / � �2��a� o O �_ FAX ; j�_ �=� /.L� � � �
.I���
OF WORK
❑ TWO FAMILY O TOWMiOUSE
❑ REPLACEMENT
PER MS 16B.66S the permit fee is a minimum of 515.00 or 5% of the total cost up to 5500.00, whichever is greater, for the
improvement, insta.11ation or replacement of a residential fixture, excluding the fixtwes. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. I.abor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge
OR
FOR PROJECTS ViI�IERE LABOR EXCEEDS $5�, FEES ARE BASED ON $10.00 PER FIXTURE. EXCEPT WH£RE NOTED. FIXTURES: (INDiCATE TOTAL
NUMBER OF EACH BELAVi�. MINIMUM FEL S I5.50. - - �
BATH SINK/LAY FLOOR DRATAiS SHOWER � WATER PIPING
— gp�B GAS PIPIAIG (NEED C1TY LIC) SVI�MMiNG POQL WATER SOF'CNER ($35)
CLOTH�S WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
'—' '— WATER ME'fER _ OTHER
Permit Fee
TOTAL DUE
$1
$ • Number of fixtures @ $10.00 � x $10.00 = $ �-�'
.50 Number of fixtwes @ S 15.00 x$15.00 =$�f�
$ OR Nutnber of fixtures @$35.00 x$35.00 =$
� State Sui�harge = $ .50
(MIMMUM $15.50 Tota1= $ .
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete a.nd accuraxe; 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 appGcation for a permit and work is not to start without a permit on site; that the work will be in accordance
with the anvroved plan in the case of all wg�vhich requires review and approval of plans.
SIGNATURE OF
APPROVED BY
City of Fridley
JBuilding Inspections Department
6431 Uzuversity Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
DATE � O� I � D�
DATE
���
( i
Caity of Fridley, Minn.
BZJII,DING PER1iZIT N° 3� 66
nate: . . �.'. ./a�.-.� `.`�j�. . . . .. . . . . .
. .
Oyva�r ....................................... Builder ..... ..... .../:�/.. . . ... .. .........
� �G/�'.�-r�
aadar� ...................................... aaa�s .............................................
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LQCATI�1[ OF BUILDINCa
No. . �l ��� 8tr�et . .��r��.�°�� . . �� . . . . . . . . . . . . . . . . Part of . . . . . . . . . . . . . . .
Lot . ..�. . Biock . ... � .. .. .. . . Addil3�or Sub-DI�v3sion .�/I�I.�.�"..�. :���y:�:'; �
Corner I.at . . Iaside Lot J1. Setback �� . .`�. . 3ideyartl �;� .�. � . . . . . . . . . . . . . . .
� DESCRI�PTION OF' BUILDING
To Used
` ,��: t�k � �%'�"_ � `8� /� :� `�. �.%.�° �. �/.9!'.��.�'
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� ... . . . .. � ... .. ��t � . .. . �,. �. . . . .. .. . � �. . . . . . ..
Zj►pe of Construd3on . . . . . . . . . . . . . . . . . . . F�st. Caet. ��� �.�.�"°. . . To be Completed . . . . . . . . . . . . . . . . . . .
In conaideratlon of iS�e is�ance to me of a pernnit to coastruuct the buil8fng desrlbed above, I a� to do
the propaaed Work in accordance with the descrlpttoa above aet forth and ffi camplisnce with all prov3sions oY
ordinancea oP the dty oP F'rldley.
.� ..................... .... ...................
In conslderation of the payment of a fee bf $�'• -�' •�.� Permft is hereby �atrted to ... .. ...... .. . -:
. . . .. . . .. . . .. . . .. . . . . . .. . to cbnstract the bttl�ing or additian as described above. T6is pernnit is granted upnn
the espress eonditian tbat tbe person :t� whom ft i� �ranted aad 1�is age�, emPlos'ees aud worlQnea� fa all wark
done in, aroand and u�n safd bu3lciing, or aay part thereof. shall csonform in all respects to the o�dinnanc�a of
Fr1d1eY. BBi�esota regaraing la�tion� con�truction, alteration, mafntenance� repatr and moving of buildings with
in the city limit� and this permit may be r�vok�d at any time upon violation of any of the provisiona oF seid
ordinanc�. „ . l
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NOTICE:
This permit do� not covar the aonstMta�tllon, irre�tallatio'n or alteratlon to� wi�ing, plumbieg, gas heating, � _
sewa� or wate� Be aure to see tha Bullding I�p�to� ior separate perosdia for these item� �
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SUB URBAN ENG/NEER/NG , INC. .
Fn9ineers Fr Sur✓eyors �
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