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City of Fridley, Minn.
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BUTLDING PERMIT N° 3 S 08
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Addr�s �; ,`�.� �d.. ���A� • �� Address . . . .. .. . . . . . . .. .... . . . . . . .. .. .. .. .. .. . . ... . . .
LO�GATION OF BUILDINC�
No. ��� � . Street . . �f. . . . . ..11. ��l.�., . . . . . . . . . Patt of Lot . . . . . . .
LOt � Q.. .. . B�a'1[ . . . . JFl.. .. .. . . . . A[1�lOII S b-D4V38fOIl �eC�%�� . .. . . .. . . . . . . ..���. y ��,
Coraer Lot ............ 7nside Lot ..�....... Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
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� . � . .. . .. .. . �ra�t . . . �,rb . �... . H�t � � . . . sQ. �t.�°� . . . cw. Fr. ���
.................... P'ram, ........ Depth ........ xeight ... SA. Ft. ........ c�. F't. ........
7�►pe of Constrlictton . . . . . . . . . . . . . . . . . . . EsL Ca�st. . . � �. .� � . . . To be Completed . . . . . . . . . . . . . . . . . . .
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In oonsideration of ihe isuance to me of a permit to construct uilding desribed above� I a�ee. to do
the psopo�ed work in ac�rordanc�e wlti� the desccigtlon above set and in campliance wYth a11 provlaions of
o�rdinanc�s of the dty af Fridley.
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In wnsideration of the payment oE a f� of $. . /.. .. .. .-� Pera�it is hereby graated tfl . .. .. .. .. . . .. .. .. ..
. . . .. . . .. .. . . . . . . . . . . . . . . to constcuct tlie building or addition es described abode. This permit is granted upoa
the express condition tvat the person �o whom it is �rantefl and his agen'ts� ea►Ploye� and worI�ea, in all work
done fn, around and upon said buflding, or a�► part ther�f, shall �nform in all respects to the ordi�ancaes of
Fridley. Miunesota regar8ing location� con�ticttan, alteral3on, maiutenance, repafr and moving oP buildiags with-
in the dty limits an�i tbis permit may be z,evoked at any 13me upan violaf3on of atry of the provisiona oP said
ordinances. . — .
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NOTICE:
This permit d�s not cover fJ�e conai�vatton� installation o� alteratton fo� wl�ing, plumbing, g� heating,
�wer o� water. Be sure io see the Buliding Inspeator fo� separete parnnita for thess Ibema
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flPPLICATION F�OR Bt1IL�IAiG PERMIT
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Ciii1 �F i'`iLiLLFii� Ci�`�a`��►7v1�
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Owners �� . C°�'' d de�c �-.,,�(1 �� ������.%/� . .
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�ctdress �3 3�'-�,.� TI�„�,� � � . �idarese s��� ��_,� ,,
. � • � Lt�A`�IOA1 F BIIILDING
No.�3 �� 'Stree.t :.`�Z:r�4T� � � P�rt of. Lot �.� __._,.. : .
Lo�� Bloccsk :�:=��d'dition.�or� Sub. Div. :��"�'�1012...� . -
C�rne� Lot ... . I�s�de Lot 3et Back . p
1pp13ca�t s.ttach :to. this fdrm' Certificate of Survey of I�et ead propo�ed .
build�i�:;lt�c��tfaa.: � . . � .
.� . ��, . � . .
..:: . r• • : < • • DF�RIPTION AF :HIIILD�IJG
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To be ueQd .as _ � � � / .
=�ont • � �pth��eight -'
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Front _____._....Depth ._._._. uAight
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3q. Ft. � _ . 'Ca. F�. � _._.�.�
T�rpe of .Construct�.nia - �� s�.�....:�,,...'
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Te be aomple�ed•: .. �� � . ' �_--------
F�ti�ted• Cost � � �
'Z`he unders3�ned�hereby �kes application far. a pe�mit for the work
herein t��ecifier�� a�rea�.ng to dn t�37.' wark in stsic�t accorde�aes w9.th the
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City �rdi�ric�s and'ru3.�ng: of .f;h�`'�epartment ef Buildings� and hereby
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deatares that all the facts and repreaentations stated irr thia appl3cat3on
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are true aud �orrect. ' � �
Date � - .� �` %�.�-�-- . . � ' 9igna.tur ' .
(A .Schedu7.e� 'Q€. Fee Costs can be found on the Reverse Side ). '
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� BUILDING PERMI� F�E' SCi�DUT,E . . `-. u
Sec�ion 2� The Inapector of Buildings shall, before iseuing as� pex�m3.t
for the erection of any build3ng or atructure, or for any addition to
any existing build3.ng or stxucture, or for any alterations or regairs to
an�r existing building or structure� upon applica.tion therefor� require
tbe pa3rment by the applica�t for such permit of fees to the amount .�
herein below set forth and iia the manner herein provided to-wit:
2,1 For any �uch pera�3.t for the erection of ariy fireproof build�.iig�
ather than a garage, warehouse, factorg or grain elevator, or_fox the
erectivn of any fireproof addition9 for sim3.lar occupancy� to aziy
exis£irig building shall be �.t the rate of �1,/�0 for each one thousand
cub3c feet, or fra ction thereof, in such cubicai� contentao •��
2�2..:For any su�h permit for the erection of any fireproof gara�e, ware-
house9 fac�t;ory or grain elevator, or for the erection of ariy fireproof
addi�ion for sixnilar occupancg, to any existing building sh�.11. be at the
rate of �7.�25 for each one �housand cubic feet, classified as "f3reproof"
by Sec-tian 502 of the Minneapolis Building Code,
HOIISES . -� � �
20 3 For , an;� auch pe�m%t f°or the erection of any, non-fireprvof bui5.ding
o�her��than a garage, warehouse9 factory'dr�g'rain elevator, or any
non-firepr�of addition; for ��m�1ar occupancy,•to•any existing building.
Permit "�1�00 for each one thousand cubic feete ,�
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G.�RAGES .. . ' .
2,4 For an� such permit for +�he erection of any non-fireproof �ara�e�
w�.rehou�e, �actory or �ain ele,�ato�; or for the erection of any non- '.
f�re�..Yoo.�" addition, for sim3.lr.�r occupancy, to any existing building or
for eacn succ'�rr° buiiding or additiona- Ninetg Ceats fbr each:oae
thou;and �ubic feet or fraccion thereof, in the cubical contents thereof
wi�h a �i.x�a.im.ua of �dF,00 - . .. • � �
F�x° the �ux°pose of comnut�.,ng fees for �bui7:ding permits the cub3cal •' �'
contexr�a 'of �:ny "builciing or addition to a uniform h+ei ht throughout by
mul-�?p1��n� the gra��d � rsa c�vered from a point aix �6) in�'hes below �
the floor •1 °�r,:� c+f tlle b�ae.r.,e:��c or cellar to the average $eight of the
urpar surfa�o or to v?��; aaer. �oe hei�ht of the: roof surface of the. �.in
g�,k�le . oi: a:pi �ch�d rooi � •�
205 For ragaisa or alter�.t.�on� to an exis�ing structure, the fee shall
be at �11e ra�e of �3.00 for each Five Hundred I�olla,rs (�$OOe00-)� q� •
fraction...thereot in� tha co3t of all propo��d, workn
2�6 in no cas� � sha.11 tr.s iee c���.rged for any perni.t as aet forth in
Sectio:� 2 3e less than �,00�,
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Caty of �Fridley, Minn.
BUILDING PERMIT
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4913
,� � L CATIO _ O BUILDING
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No. �..,.��,� st�t :'`.... __«� __.__._.__._ �t � __._..._._..._._.,�.�_ _._____..
Lot .....�..�..._......;. Block �..__ _._�Q_...�--•-•---._.... Additioa or Sub-Divisioa ...__. _ . .. ._ �'� _ s
... Corner I.flt .....__._�..._....___. Inside I.ot ....._.._..._..�___.._......_ Setback ---_.._.__._......_.__.._�.. Sideyard .....___......----..__.._....___._..._..._.�..�
Sewer IIevation
Foundation IIevaf3on
DESCRIPTION OF BUILDING
To be Used as:
_._....__.._.._.._...____..____r_. Front ......._____.. Depih ...._......__...__ Height ....._......_..-----. Sq. Fk _...._.___..__ Cu. Ft ....._..___._.
---_._._..__._..........___._..._.._.:_ Front __.__:_.._.. Depth ------.....__...._.. Heigh �---.-- 3q. Ft _.__._...__._.. Cu. Ft .�.._.,;.__._
Tyne of Construction ---_-----.._..._..._.__ ...............-------. Fst. Cost.-- �_ _�. .�... ._.._............__.. To 1� Completed .:..._..__._._..___._.._.._.__...
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In conaideral3on 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 descrlption above set forth and ffi compliance with all praviaions of
ordinances of the dty of Frldley.
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Ea consideration of the payment of a fee of $...�,�..__'�"."..:, permit fs hereby.g�anted to..._.._.._.._.�_....._.___..._..
to conatruct the building or addition ss described almve, This permit fs granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen; in all work
done �tn, arwmd and upon satd building, or any part thereof, shall conform in all respects to the ordivances of
F'ridley, Minnesota �egerding location, construction, alteration, maintenance, repafr and moving of buildings
within the dty Ii�nit8 and this permit may be revolced at any time upon violati of any of the provisions oP said
ordinancea . ��� �
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NOTICE:
This permtt doea eot cove� the eonshvcfion, instaqeHoe for wir(ne. plumb(ng, .@ab heaHng, sewer er water. Be �re te see I
1he BniWing Inspeetor for separate parmits tor thase Items. �/h� l�°'�°'���
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4: TH PERhJIIT D�JES,�`��-T AUTHORIZE VIOLAT-
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��� -- � 10�1r AP'�lY �'rci ' -=°�i� COVEPv�'�I�ITS AND
r _ BUILD{, :u t:'��'�i�I:,TIONS.
Ourner t �
�cldress
iPPt,IC,�TIO�T k� HIIILDIi�G PF�MIT
CITY OF FRIAI�Y, M�g
^ � L�AT�O1d�OF BIIILDI�G .
�ao. �3 �„� s-r��t,.��_� /��/ ��- re�t of �ot
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Lot_____�_�______Block Pi ",Addition or Suixiieisioa-�C1�1 t tT ��l�
copner Lot rasi.ae r,ot . .✓ satback - s3ae�.r�sra
SF�JER ELEVl�ION �' � � FOUNDAT�ON EL�iT�TION
�pplica,nt attaah to t�is form Certificate of Survey of I,ot aad pro�sed- buia.d3ng
location.
To e e ass
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DF�SCRIPTIQN (�' BUILDING.
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sq. Ft. �� D cu. Ft. ����
' Front� ptn Hei�ht
Sq. �1't. Cu. Ft.
Type of Conatruetion ��/�'�i � Eatima'tecl Coet
To be Compl.eted �
The u�deraign�l herebq� makes applicetion� for a perm�.t for "the work herein spee3f3ec1,
agreein� to do all work in s�t,rict accorclance w3.th the City Ordineacea and' ra�.ing of
the D��rt�nen�t p� d3.u�s, and hereby declares that�ll the facta� d r� esen�ti
stated _ in, tiiis a 3cat3on are 'true ` and eorrect. �,1
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(A Schedule oP Fee Cos'te c�,n be foiu�d oa the Reverse Side. )
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S�at�,gn 2r The Ine�ctor of �iil.din�a e}�all, l�for� 3ssufn� s�► perm�.� for t�e
erectiaa of ar�r �.iilding or struatur�, or f� aa�► add3tion to aas+ euiating build-
9;ag or �i�ucture, or �'or atqr e�],tera#,�ons . or repair� to sa� �itis� bui].di»g or .
structure, upon applics�3on the�cefor, require t�ii� ��n�C 'i�jr th� gppl3�nt. far
such perm�.t o� fe�a� to- the a�+ount hereia, belo�a set forth and in t�e �ner her�in
_..
provided to-a3t= . _ ._.. . _. , . _ . ., . : _ ..
z.l . For e�p► �uch germ�.t �or . thg = ersction c� a�► tyre-proof �i].asag, ot�er t�han
a ge�a�e, wareho�ise, f�ect�ory or �sin elevator� ar for ti� ereat3.on of aay fire-
proo� add9.tion, for s3�milar oe�panos►', to a�r es3at�r►g building . sbal7. i� at th�
�ate of �t..ltA for eaah one tliausend cubio f�t, �o�c f'raat�to� tl�ereof� fa �h
cubic87. �nteats. �
2.2. Far aay►� �h �t for th� e�ectioa o! any tireprooP. �eti'e�: wsretiouee,
factcry or grain el�vstor� or for tY� ereot3oa of ai� tirep�oof e�ddition, For
ait�lea ,occ�eacY� ta 8ag exi�'t►�ag buf.ld9,ag � sball i�e at t►he rats of �1.25 Por
each on� th�d cntbio feet, alae�i�ied as �f3rep�roo�� b� Seotion 502 of t�e
l�n�goli�. �Zd3�tg C�e. � � ,
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2.3. l�or aqq such paradt for t�e
t�naa a gera�e� wsrehousey fa�t�ory
additioYi, �er e3milar occuPaaa,�►s
�cii one thoueaad cnbSo feet.
� _
eree�i.on oP a�pr aoa•f'irepreo� b�31d9x�g other
or gza�.n elevator� or aqy no�•PireprooP
to any exieting buildi�tg. Permit �l.,� tor
2.4. � For ax�r euch permi.t for �e erect3oa ef ea�y nor�i�3repro�t ga�rege, trarebouse,
fact.ory or gra3n e3evat�r� or far the �rection ot sny. ae�iYrep�ao� aactitioa, faT
e9�.i.].ar occupanoF, to aay eRiat�n� buildi.ag or for eeoh �ttoh bt�3lding or additiol�.
Ninety Cents far eac� one thou�and aubic feet or f�a�tion ther�P, in the aubiaal
eori�ente � thereof with a minimt� of �d�..00. � �
For the purpoae of aompu�ing fees for building permite the cubie�al aoatenta oP �r
bu3ldin� or addit�.on to a un3�orm hei�at ti�roughout by multiplying the greund ,�ree
coesred f'rom a point e9x (6) 3nai�es below ihe f�oar lin� of t�ie besemeat or �el�er
to t,l�a average hei�h� of �he uppea, surfiaQe. or �t�o t�e -aver�,ge b,gight oP the rooP
�uurface oF the main gsble of,s p9.tched_rooP. ..
2.5. For repa3rs or altere.tioaa to ati ex'1.eting s�ruotuxe� the. .fee shall be et t$e
rate of �3.� for eaeh Five �aClred Dollera (��.00�, or Pt�atiou thereog in the
co�t of a�.l psapos�d work. .: , .
2.6. Tn uo case sheiZ �he fee � char$ed for an�► . permi�t a.� �t �orth iss SeotiQn 2�
].ess th,�n �..�.
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City of Fridley, Minn.
BUILDING PERMIT NA 7227
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No. street
I.ot __�� Slock
corn� r.ot r�ae r.ot � �t� .�,�4? sia�a :
sewer �levatlaai Founaati� Elevat3on
DESCRIPTION OF BUILDING
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in ca�sideration of the fesuance to me of a pernlit to cwmstruct the buildiug descrlbed above I agree to do
tbe P�P� work in acc:ordance wlth the d�ecrlptian above set Porth and in complfance wlth a�l provistons of
oi'dinanc�es oP the ctty of Fridley. �� �?, ff
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Ia considerat[aa� of the pa�►meat oP a fee of �.�� , Permit is her8lry �aated to
to c�omstruct the building or addition as d�scribed above. Thisp�rmi t is �ranted upon
the e� c�dittan that theperson to whom it is graated and his agettts, employe� aac� worl�nen, ffi all work.
doae in, ero�md and upon said bWldin�, or a�► thereo� shall oonform in all r�pecta to the ordinaace� of
� the�]imfts��a�ttifs pernni�'t � ��st aq�► timem�upo���� � o�t � � oF esid
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NOflt�
l� 11d� pe� do� uet �wr Nro �, i� ��. P�, �as M�. snra� er � 8� ans to as
Na B�g le�der ter p� Pam� �er tMa B�.
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, - - . _ , . � .. . , �'FLIC.l�1'ION .FQB � BUII.DII�jG >,PE� ,f _;, , ., „,.. ,
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..: � -CI',�Y �,0� F�IDTr�Y, ,MII��4'�A . - .. ._ __ a. ei l � ��
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._, .. .. ' .. - ... : , �� _ . . .d.. ... . ..,.,� , : .. . , . . s .�i. _.�. 'vuJ :I!_.,`?.T.'�� :l(�
VAilRiA,� i�lfCLi � - � �.. �.''.Fi.._.7:� _:PIj-� ..i.4
L� � �,r����r-�� ' BUII�DER
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AY�}+uW� � � � ., `ii�xi��=v `�����r��: S'�, � . , " n�- . e�.��.. -�-- �L�-
:_ �l � � ,��� }w .� . �.AnnaESS ,
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: � , � � ,. . , LOCATION OF ;BVxLDIA� ., 1: :� � f �
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Na« . s��.� . - . � S�re�e,t. -�: �.��:�.k.��;- �%�����=,�f �ot�
-. . ' �. - , l+.ris.�. rM w ' ' rirlt�.i.` �'�"rr+ _ .. .�.�i�.+. 1— '" < _ � ��
LoC . �.r � � � � .�
.s�'�I , , sl,ocl.s � ,�'.' �o �' �►da�.x ion� . � ,,Subdiyisi ion�,�,,�.: . ���n-�A�G�v�
Corner Lot �� � Ins3.de Lot jj , Setback � �,��id�e;r►�! +_ard r
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SETi�R E'�,EVATION FOj1pDATION L�LE9ATION �. � �� ,
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, Ap�liea,nt,. att�ch �p thie �orpn Twq Cert�£icatea; of, �Sur�►e� ;�oE; Lp� ;and p�go�ed, build-
i�,g ,];ocati�� drawn o#i �l�eas �CerGificatee .. , < . _ ,,;, , ;t. :
. � � . � . , � � .. : . . .. . _ �: �.r: _ . . . _ ` .
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DESCRIPTION OF BIIILDI�G
To be u�ed as:
� . � , r . , : .. � Froat � . �y �!� nem�
,,, ; F.�,�� �
. . � . � � . Height� . „�.�% °'�
� ._ _ , � . . - - �. '� - � � : .
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, .. .. . ' .. . . ��.:� . .. � � ., _ . �7�1 �� :� �� �. �. . .� �" v`4'r � �� °i� r:: _�. J�. �
. . _ �, � , . 1�: . "i � . � � ;±.� „ . ...,�. .;.�_ , , `i r
` � , J . Fiont � �pth � ; Height
,. _ _ , � ,' . Sq,,.Ft. . '..', - ',�Cu.��,�,Ft. , .
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Type of Coas�ruction;,�,,_�,G����c.�.�.�'�: � t _ y Lstimat�c� Go�t r �� .�
To be �le�e� . .. _ , . . ... .,�D ~ C.�.�� . � _ _ _ , _ ,
. . . : '�+ _ _ . .' _. . • . . , ,. . -. - , . `' =; , �'; a .. '
, .. �•- ,, , s �� : a , � , a ��,
The uadeisi�ned"hereby m�kes 'ePPlicat�,on ..fox a,.�p�esm�t� fQ�r �h��wa�k+�re�fa ,�gecif3ed,
agreeirig to do all work ia strict accvrdaaca✓witb`the Citq�of Fridiey Ordinances and
rulin�s.. �f,;the De�ar�memt, of Bu�:�ld�t.uge#_. and;:�er,�by,<:�ci;e�re�l tha�, al;l r�he ��Ce and
representatiaae atated ia tii�.s epplication are tr�e. ,aad �o�:.r��t. , „�.' -'-
�Schedule of Fee Ccats cea be found oa the Severse Side).
( ,
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4
BUILDIIIT� PEItMIT FEE S(�EDULE
e ,
Sectiaon 2. The inspectos of Builcli:nge sh�ll, before iasning any pes�it for
, th� erectioa of anq building or etructure, or for aay addiCfon to anq eafet-
iag building or structnre, or for aay alteratiaas or repai=e to aay esistin�
.building or structure, upon application therefor, require the payment by the
applicant fos such permit of fees Lo the amouat hereia below set forth and
ia the mannes hereia prov3ded to-wit; .
�_L� -2.1. �For aay euah permit for the erection o�C any fire-proof bailding, other
_.than_-a gara,�e: warehauas,-factorq`or grain elevator, oF for the erection of
any fire-proof addition, for similar occupaacq, to any existing building
ehall be at th� rate of $1.40 for each,one thca�saad cubic feet, or fraction
thereof. in such cubical ccsnt"en�s.
.. 2.2`. �'For `eay -e�uc� _p_e�rm�Lt- for �he eractioa of �-sng fi.re-proof gar-age, warehouse.,...
facCory or graia elevator, or for the erection of aay fire-proof �eddition,
fs����im�.laa oc.c�pancyr, to any' existitig� �buildin,� shall b� at the rate of- $1.25
for each ane thousand cubic feet, claeaified as "fireproof" bq Sectioa 502 of
� _ <<�_,.:Lh�. _M9.=�t3�polis �&iil�in,g CaIe, . . .
_ --. -:�S - _ �_� �,P, . . , ,. ..:
'° 2.3::'; For �y such pe=mit' for tiie 'erection of `any non-tiregroof buildiag athe=
than a gara�e, warehouse, factory or grain elevator,� or`aa� aois-firegroof
additiea, for aimilar occupancy, to aay exiatiag buiiding - permit $1.00 for
each oae thousand cubic feet.
GABAGES
_—
2, 4� For any auch permit for the erection of any noa-fir�proaf gara�e,
wa�e�use, fac.torg-- or :grain `elevater, or fcr the erectiog �o€- any nr�a�€�is�eps+oaf
additi�s�€as`-s3milar occupancy, ts soq existia� building or for esch such �
__� .:,. -building__9r.. _�ddit�,on `-_niaety ceat� ($0.90) for each oae thauaand cubic feet
or fra�tion thereof, in the cubical cantents th�reof with a minimimn of $4.04,•
For Che purpase of camput�ia� feea for buildin� pesmits, the ciabical cante�ts
_.__ of an�y bt�.ilding or additica Co a uniform height throughout by a�ltipZying the
ground area covered from a poiut si� (6) iaches below the floor line o�.the
„ . , _:
basement os ���ier to-`th� aver8ge-heighC o# the upger s��ce or to tbe
average height of the r�of �urface of the mai� �able of a p8,tched roof.
2.5. P'or repairs or alteratiane to an existin� structu�e, the fee shall be
at the rate of $3.,OQ per each Five B�dred 1�11ars ($500.00� or fraction_
ther�of 't� tfie 'cost dP ali propoaed work.
_ _ t. , ; _ . _
' 2'.�6�: "Zn 'no e�ee s�talr the ;Eee�:.�hat�e,d.#o=_�y-permd�k.-e� 8et forth ia
� �ectiaa 2 be 1esm: t�iaa . $t�.0a,= � � .
0
�
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•. � �`- ,.s
G
sus�ecr PER NO.
City of Fridley ,` 1615 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
� � EC
COMMUNITY DEVELOPMENT DIV. � � � (',
� �,. ------, w
r � � PROTECTIVE INSPECTION SEC.
�
� ` �
' r���� � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'""'� � ,�� 612-571-3450 910-F15
5/5/81 / /
10B ADDRESS 5336 Altura lmad N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADQITION SEE ATTACHED
DESCR. 3O 6 Carls��n°s S�ummit Manor North SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
R3ymond Ra�nussen 5336 Altura Roa,d N.E. 566-7702
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
imckford Roofing & Constrnction Oo. 10212 Taylor Street N.E. 780-1304
4 ARCHITECTORDESIONER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINO
Rp�ci C12i1't18�.
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Raroof cl�relling
9 CHAN(iE QF USE FROM TO
STIPULATIONS
lmo� can b�e Znd but not 3rd roof. Install ridged galvar�Yi.zed valle�s.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY CiROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING 30. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOV11yTHE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUAT QN SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED y�l� 50Q $. %rj
WITH WHETHER SPECIFIED HEREIN OR NOT. THE (3RANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T EE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ��. QO
STRUCTION-OR THE PERFORM OF CONSTRUCTION.
�_ � —— _ PLAN CHECK FEE TOTAL FEE
�` � _ �l D4 � � � � �,� .22¢(L�s� S� S -�s / $9. 75
SIGNATUREOFCO TRACTORORAUTNORI2EDA6ENT IDATEI ,:,_ - WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
� �� �
SiGNATUREOFOWNERIIFOWNER8UIL0ERi IDATEI � BLDG INSP npTE
�J
� GIT:Y (l� FitIDLCY • •
� '
,� A{'PLICII'fIO;J f0it f'.E;STUE'itlTI/ii_ B:U1Lt)It1G PCftt�1IT5
(tJG�•�, A1 Ler•�Liuns, liclditi�ns, or Rcpairs)
� 0.1�i1�ER: ��.A���.G`���. GUI LQE:f;: -�L�,�Fa-�1J ���.��� �1�:�
flDDRESS: �° S'�i-,� �:p;��� e `�11, /1DDRCSS: 1� tZ ���,� ��' !(�
t
TGL t�0: � S�� ' ��7�� TEL Id4: _ 7�b '1 .� � �L
� Cansi:ruction l.oca�ion ' �
. sTZ�T rio : � � STREI:T: A �.rZ-� r2 A �a �--� �U • � - .
, �
LoT: . � C� sLOCxc: � nn�iTZOx; . �i9-,�LL.S��J`s �.�n m � r �j�l-,�j,�
Corner �,ot: Insicle I,ot: SefbacY.: Sideyards: ��n�
Ap�lican4 at�ach to L-his form two Certificates of Survey of lot and
proposed building location drawn on c.erti.fi.cates to scale. � .
. � DESCRIPTIOi� OF CQF�STP,UCTION - �
�E �tg�+,�. Front: � D�pths Height:
. . . .
Squa�e. k'eet: Cubi.c Feet:.
. ' k'ront: Depth: � Height:
Square• Fept: - Cubic I'eet: .
�.'ype of Consicructian :�_ �e���{W t i EstimaL•ed Cost: $� $°� ��
�_
2to Be Cbr,�pleted: S� l Ch $ 1 �
` , . � A3.t. A Alt. B
Proposed.Drive��ay Width If New apeninq zs Desxsed: $' $.
, ., S�� Re.VERSE SiD� OF SiIEE� ,
7.iie undexsigned hereby makea applic�tian �or a permit ior the ti:�ark� h�xein sgeci�ied,
agreein� to c� ,all work ir� strict accdrdance �rith the Ci�y o£ I'ridley Ordinances and •
xul'xxig� o� tlte Departnten� af Buildings, and hezeby declares that all tlie iact� and
xcpresent�itions stated ;n �his zpplicatian are.true correc�. �
' �� ��� �
Da�Tf:: �`• �" �' ( SxG1�IA'!'UF�r:: 1/-���c.� .�Ld: �r
4
Sti�,�ul�tions :
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• �u��l_J)Ihic�s>r�i,r�'t�r r-c:�_ :>t:��r:.r.�ut_�� �.. . .
S,I::C`.t'x01�7 2. �'1'l�L ]:�r.;��ec�c�r. of: 13u�.1c?i>>�J:, :;hr�l.�., r��r:o�:r, i.:;s,i�i.r�cJ- pcnnzL•3 far t:t�c: crr.ci:ion
Gf uiiy l�u:i.l.�].i.n�i <�x :�1::.'UC:i:iIYL'� o�: Zv�' t,n�� cxc]Qi.i:a<�n !_� aisy cr,S.:;Ci.»cJ l�uilcli.r►g ��: esL•xucL•ur.r_.
.��Y. f:a�� z,�,y �iT.t�cr..-�t:ic,�i or. r.cl,��ir.:; �o •c117Y cxi: .1,lJl�J I)ll).�.C�J.IY•l or. sLr.ucturc, u�,�c.n ar>��].i.c:atS:on
'i:licr.:f.ar.c, �r:cqu.ia-c t�Ji� ��u}►mc��i. }�y t1�c �-�r�pl,i.c:anl: f.'c��- :,ucl� ��ar.mS.L• of £c:c: ta L•}ie arnatanL-.
hex�.irY br_J.oa� aaC rorL��� �u�a a.n t.hc ihanricl_ hc�:ca.n Z��:ovxc3c:c1 L•a-�::i.t: � • .
I�J1,L•] CU1J�'1'3:UC�.'xOtJ: uing7.e l.�amil.y lloiae:� and Ga�'��.cjC,: y�.00/).,O�Q cul�a.c �eet:. •
l?LA::2 C1Il:�t:: ?..5 I?er.cei�t: �L hui.7.cli:ug j�el-miL- fee.
U1tI:��Et:11Y llLI'P3.:5S�OI•:: (Cpncrctc, C1i�i� yL-rcets Onl.��� � '
' Al.t-cr-l�at:e A: ltc:�naval ax�d re���l,accment of concrete cuxb and
gui:ter only; l�riveF�ay S�S.c2th p].us 6 f:eet r. $13. �0
Jili:ernaL•e I3: }2emoval and rep�.acem�•nt of concrete curb and
.• � gut-ter and inst�-i].1 a 3[oot e�ide approach �.�it:h -'
, .• 6�nch depth; Driveway �•�idth �p�.us G feet x$1a.75
• � • �D�I � I OI�/�L,�f: ��o ���ntl bAl
�`or the pur}:�se of compuL-ing �ees for. building permits, L-he cubi.cal. contents of any
build5.nc�{ or addition, a.s dci:cr.mi.ned by inu].L-ipl.yirig the c�raund area ce�verea Lro:u a
. p��.n�. sis: (G} i.nches belaf� thc f].00r ].a.ne oi t-]ie basement or the ce].lar to tize
average heic�hts oi ihc •upper surface ar to f:he average lzeiyht of the roof. surt�cce
ot- the r►azn gabJ.� af a pitched roof. '
Eox xepai.rs or a].terations ta an existing structure, the fee sha11 be �t the xate
o.i $3 . QO �ier. each �ivc hundred do�.lars °(; �00. 00) or �raci:ion Uier�o£ in t13e eost
oi a].l pronosed wor.k. � .
xn •no c.ase sl3a�.l the fee cliarged far any pennit as set ioxth i.n Sect.ian 2 be �ess •
ti�n $7.50 p].us $.50 state swrchaxge. � . •
� . T F I Ct�T I Q�I QF FOUr�[n111' I ON
' NOTE: PermS.ts ; or construction wil�. be i.ssued a minim� oi 29 hours from ilie t,ime
oi aYk?Iication to a�.l.ow for proper review of ilie proposed si.ructur.e and oi ihe
constructa.on site. � •
�
A Certi�'icate � of Survey af th� lo�, shoc,=3.ng the location oi-' tlie �oundation onc� it
has been coiis�nicted t�*a.11 k�e zequzred bef.�re pr.oceedinq with the f:ramin�.
.�RTIFI('1�TE QF O��UPA[`Cl' ' '
' Arpli.catic�n �or a Certificate oi' Occupancy sh�ll k�e mac��� ten (10) d��x►$ prior t.o the
use ox accuF�iicy ai' any St:2.�1,CtllZ'C.' for �aliicli � a k�u ild•i_ng pcxr,iit Izas becn 15SUt?C�; and
s.iicl struct:u�-e :hal]. ziot i�e used o2- a�cu�,�i.ed L;i�ti�, a Ccxi:aiicate af Occul�zncy has �
ueen xssuec�.
0
_ . . . ... . . i . . � ..
'1. -`- .p q► .
. •
� • . •
� �
sus�ecr PERMIT NO.
�ity of Fridley � 9 6 681
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��
� � RECEIPT NO.
� `L �_��� COMMUNITY DEVELOPMENT DIV. �
f j � PROTECTIVE INSPECTION SEC. j
� `
t = �
� /���1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE aAGE OF APPROVED BV
�----� • •`� 612-571-3450 910-F15 5/13/82
� �
JOB ADDRESS 5336 Altura F�d(� N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. $O 6 �,r�.3021� 8 SLl�7.'� Mc7IlOr North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHQNE
lidymond R. Ras�ssen 5336 Altura Rpad N.E. 579-9626
3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO.
.SF1IDe
4 ARCHITECT OR DESIONER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENOINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDINO
R83].C�EII�I...a.�. '
7 CLASS OF WORK
0 NEW � ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Oonstruct a 15' x 7' Base�nt Addition
9 CHANaE OF USE FROM TO
STtPULATIONS
S�PERAT� PERMITS REQUIRED F�R ii��R�itlC,
r._
HEATi�NC, PLU1�f811VG AND �SI�N�.
������
6efore digging call loca! �a�tilaties
Tf�EPHONE - ELECiRiC - 6AS E�,
REQU�RED BY LAW
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY (3ROUP OCCUPkNCY LOAD
VENTIIATING OR AIR CONDITIONING. �'AnCr@te .
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S0. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION lO5
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
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 $775 yS. SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTINO OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTFFER STATE OR LOCAL LAW REGULATING CON- ],S.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECK FEE TOTAL FEE
$3.75 $19.25
�SIGNATUREOFCONTPACTORORAUTHORI2EDA6ENT IDATEt WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
gf��%,s, o . ,,�, a �� o��
s° 9GLP"' A URE F OWNER F WN R BUILOERI ID "1' BLDG INSP DAT �
� • Effective Aug. 1, 1981 •
• . CITY OF FRIpLCY
. AAPLICATI��! F01; RCSIDCA1TIlti. BUILpIIiG PL•itNiI7S .
- (Nc�rr. Alterations. Additions, or Repairs)
O�1NER: _��%�/�7oai,I�' �, ���tSSEl1�� BUILDER: � '. .
AODRESS: ` �33� �LT�lDP� �dQ, 4y� - ADD1tCSS:
TEL N0: _�% 9 96'� �' TEL fi0: �
. Construction Location
- STRI�T NO r Sr�� � STItEET: 6�I L T�1 �� .�. ��,
� • —,._..._.
7�Ta 3O BLOCKa � ADAITION: _��x�, . � %�Jyj,�� �-
Corner Lot: Insicle Lot: � Setback: «______ Sid�yards:
Ap�2icant attach to tliis form two Certificates af Sltrvey of Iot and
proposed buildinq locatio� c2rawn on certificates to scale.
DESCRIPTIOtd OF COtJSTRUCiI0�1
r�1'�' J�'ly,�A` �/l��, Front: /S'� Deptha '7 Heiqhta �
� Square. Feets �� Gtiibic Feeta
. Front: Depth: Heights
Squa�• Fest: � GZibic Teet: ,.,�[
7r.��
lc�s�`�3.� ? ��J �� �oy���T�- ��a�� �
Rype of Cor,structiaa�: _
. Rb $e Ob��pleted: __ �vt L�/' �� f q�2.
� . '7 ?�.00
Estimated Cost: $ �
Alt. A Alt. B
Proposed Drivc�iay kiclth If New Opening Is Des3reda �" $
_ . , . . . SE� RiVER�E SIDE OF SHEET �
�iie undexsi ned hereb ma�;e� a 2ication for a • •
3 Y Pp pezmit for the work� hexeiri specified,
. ac�reeinq to cta ,all wor3: u, etrict accordanee ��ith the City of Tridley Orc7inances raicl
zuliug� of the Delk�rtm�t of IIuilciinc�s, and hereby declares that all the facts and
repr�s�tation� statec] 3n this �pplicatien are true and cosroct.
._
D.1TEs �j ^ / '�'' (�� � SIGNATIIF�: _ 1.°�P�/1�-n� '�(, ���-i-r���
Stfpulations:t � •
��.,r..,� t �^► �. �
p.C, � , ,:
. �.�
� ��
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BUILDING PERMIT FEE SCHEDULE
The Inspector of buil�inqs sha11, before issuing permits for t�e
erect3on of aay builBiAg or structnre, oz for any addit3on to any �
bxisting bniiding or strs�cture, or �or any alteration or''repairs
to any exist3nq buile�inq or stsucture, upon application therefcre,
requise the payment by tbe applicar�t for such permit of iees to the
amount be�eia below set forth and ia the manner bereia psovided to-wit:
TOTAL VAi.IIATI�J
81.00 m 8500.00
�501 t+o $2, 000
52,001 � $25,000
�
¢25,001 to 550,000
Fi�S
510.00 �linim� Fee 515.00 plus surcharge
�10.00 for the first 550� plus 51.50 for each
additional 5100 or fraction thereof, to aad
iacluding $2,000
$32.50 for the first 52,000 pius $6.00 for each
additional $�,000 or fraction thereof, to and
inciuding �25,000
$170.50 for the first $25,000 pius 54.50 for
each additional $1,000 or fraction thereof, t�
an8 including $50,000 -.
550,001 to �100,000 $283.00 for tbe first 550,000 pius $3.00 for
each ac3ditional $1,000 or fraction thezeof, to
and including 5100,000
¢100.001 and up $443.00 for the first $100,000 plus 52.50 for
each adc]itional $1,000 or fraction thereof
PLAN t�IECKa 25 percesit of buildinq pe:mit fee
DRIVIIn1AY DEPRESSION ESQtOW: Concrete G1irb Streets Qnly
Alternate "A": Removeal and replaceioent of curb and gntter only
Driveway width plus 6 feet x$13.50 •
Alternate "8"= Reooval �d replacement of curb and qutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNDATION
Penaits for construction wiil be issued a minimwn cf 24 hours froaa the ti.me of
applicat3on to aliow for proper review of the propcsed structure and of the
construction site.
A Certificate of Sunrey of the lot, showinq the ixation of the foundation once it
has been constructed will be required before procee8i� with the framing.
j 7.�
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4�
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g
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,r�-,,p.t, �'x`"�`+.,� *�,' Ss* 6&> $ .:'� s"'4 -- ::� ` .*' a > y� � .t- �. � . .,�
� � 3��'"r^" �".r.,� Z .�'pE-� :. � � ` x.m.���� :; � . � _ -
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SUBJECT P . - ' �
City of Fridley � � 4 �-
� � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��
r
� � RE -.
� • COMMUNITY DEVELOPMENT DIV.
, ��______, �a,.���
r j � PROTECTIVE INSPECTION SEC.
�
l! � �
---•� r'�'1', CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF � APPROVED BV
i � � 612-571-3450 910-F15 4/25/84 � �
JOB ADORESS 5336 Altura Rd. N.E.
1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. 3Q K Carlsons .Sll�ll.'t N!c'1Y101^ 1�. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Raymond R. Ra�mussen 5336 Altura Rd. N.E. Fridley 55432 572-9626
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. `
�WIlliL'
4 ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINO
Residentiai
7 CLASS OF WORK
❑ NEW l� ADOITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE
S DESCRIBE WOHK
Construct a 16' X 14".addi_tian.
8 CHANOEOFUSEFROM TO
STIPULATIONS
���EKAi �. NEKi�ii� ��.t�Ui�EiS �OR YIIIRING9
a--;F;qTING. PLt_fl+�'�34Nr �N[� �IGNS.
SEPARATE(PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATI G OR AIR CONDITIONINO. WOOCI k'i�@
THIS PER�IT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZ�D IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R].
ANY TIME RFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT IS OOO. OO yS`T. SO
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �.�.0. �JO
PLAN CHECKFEE TOTALFEE
145. 3
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT (DATEI W EN PR PER A D TE THIS IS�YOUR PERMIT
�o�►.�nt�� '�f .�.2'�°'!�� �'Z-�T'�'
-SIGI�TUREO OWN Rtl OWNERBUILDERI IDATEI s_ . BLDG INSP DATE
NEw L l
w
Annx. [vt'
�,Tat: I ] �
City oP Fridley
R-1 AMD R-2
Building Permit Applioation
Effective 4/1/8�
Construction Address: �/ 3�� �G%�dpi� �' %�� •
Legal Description: �OT 3� ,,,�1Loc°� �k' C�,� O�n� ��
Property Owner/Address: ����av� /.�, /���/�1'S�"iv 5'IJ�.9G7�irfJ9•A�P.N�el. # %� 9�'�'6�
Contractor: ��d� S ,�'�o.C� . Tel . #
Address:
Attach to this application, a Certifieate of Survey oP the
lot, with the proposed construction draWn on it to scale.
DESCRIPTIOA OF II�IPR09EME1QT � c�-
LIVING AREA: Length �`l� Width .�,�_ Height �_ Sq. Ft.
GARA6E AaEA: Leagth '-' Width Height Sq. Ft.
DECR AREA: Length ` Width Iigt/Ground Sq. Ft.
_—
OTHER:
Corner Lot [] Inside Lot [� Ft. Yd. Setback Side Yard Setback
Type of Construction: � � � � 2 ���
Approu. Completion Date: ��'h'�--..,� �
Estimated Cost: $ ^/g oe�
Alt. A Alt B
Pro�sed Drivexay Width If New Opening Is Desired: � �
See Baak Page for Explanation
DATE: y^ 2 y^ � y APPLICANT: ���'�� �' ��dzr�� Tel . 4 i^�iz ��'2 �
• CIT7f IISE ONLY
�-
Permit Fee $� �� J� Fee Schedule on Reverse Side
Plan Check $ a�o �e� _ 25$ of Building Permit Fee
State Surcharge $ ��� $.50/$1,000 Yaluation
SAC Charge $ �� $425 Per SAC Unit
p�.g Fee $ � Fee Determined by Engineering
Se�er Main Charge $ '�—
�� � Agreement Necessary L] Not Neoessary []
TOTAL $
STIPULATIONS:
� S � �
sIIII.n� p��rr �E sc�snu�
The Chief Buildiag Official shall, before issuing permits for the erection of anjr
building or structure, or for any addition to any euisting building or structure, or
for aay alteration or repair to �nny;euiating building or stru+�ture, upon applicatio n
therePore, require the payment by the appliaant for sueh permit of fees to the amount
herein below set Porth snd in the mantter hereia provided to-wit: '
Tota1 Ysivation
�1.00 to a500.00
' Fess
$10.00 (Minimum Fee is`��15.00)
a
�501.00 to �2,000.00 $10.00 For the first $500 plus $1.50 for each
additional �100 or Praction thereof, to and including
�2�000.
$2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraetion thereof, to and
includiag �25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $�1.50 for eaah
additional $1,000 or fraetion thereof, to and
ineluding $50,000.
�50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1 , 000 or fra�e�tion thereof, to and
ineluding $100,000. •
$100,001.00 and up $433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or Praetion thereof.
DRIYEWAY DEPRBSSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of eurb and gutter only - Driveway width plus
6 feet t3mes $13.50 .
Alternate "B": Removal and replacement of curb and gutter and install a 3 Poot wide
approach With 6 ineh depth - Drivevay Width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits for constructioa Will be issued a minimum of 24 hours from the time of
application to allow for proper reviex of the proposed structure and aP the
Qonstruction site. �
A CertiPicate oF Survey oP the lot, shoWing the loeation of the foundation onee it
has been eoastructed will be required before proceeding with the framing.
�'���U�
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CITY QF FRIDLEY
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612 571 128? P.@1i01
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TOTAL P.01 ,
� c�ty of Fr�at�y S�g,E�T . P
AT TME TOP OF TME TWINS � U I L D 1 N� � E R M I T 2 913 3
r
; � RECEIPT
� `L ����� � COMMUNITY DEVELOPM�NT OIX.
r � � PRqTECTIVE INSPECTION SEC. ?D�
�
� s ,
� ��"1 � CITY MALL FRIOLEV j�1�� MUNBE, pEV DATB VAGE Oi APPNOYED BY
�.---� • •,, 612—s»-3aso e�aFts 4/6/99 / /
J08 AODRESS 5336 Altura Road NE
1 IEGAL ��T N0. BLOCK '�IiACT OR ADDITION SEE ATTACMEO
OESCR. 3O 6 Carlson's Summit Manor North Addn SMEET
2 PROPERTY OWNEFi MAIL ADpRF�3$ ZIP PMONE
Joe Paavola 5336 Altura Road NE 571-7048
3 CONTqACTOR MAIL AOORESS 21P PMONE LICENSE NO
Panelcraft of MN 3118 Snellin Ave S, M ls., MN 55406 721-6628 2179
d ARCNITECT OR DESIGNER MAI AODRESS ZIP PMONE LICENSE N0.
S ENGINEER MAIL AODpE$S 21P PMONE LICENSE NO
8 USE OF BUILDINCi
Residential
7 CLASS OF WORK �
O NEW � ADDITION O ALTERATIpN �7 REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Reside; soffit & fascia; reroof House & Garage (20 Sq) Tear-off
9 CHAN�iE Of USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code. Call for
building wrap inspection before covering.
COIVSTRUCTION WORR HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
Permtt inspection Cards
� 1Ni11 B8 Mailed.
To Homeoauner To Posf
SEPARATE PERMITS ApE REOUIREO FOF ELECTfi1CAl, PLUM9ING. MEATIN(i, �P� �F CON T. OCCUPANCY (iROUP OCGUPANCY LOAO
VENTILATING Oq AIR CONOITIONING.
THIS PERMiT BECOMES NULL AND VOIO If WQRK OR CQNSTIiUCT10M ZONING SQ. fT CU, FT.
AUTHORIZEO IS NOT COMMENCED V�1ITHIN 80 DAY$, Oii IF CONSTRUCTION
OR WOfiK IS SUSPENDED OR ABANOONED FOR A PERIQO OF 12Q DAYS A7
ANY TIME AFTEF WORK IS COMMENCED NO. 01NLG. UNITS OfFSTREET PARKING
I NEREBV CERTIFY TNAT 1 MAVE REAO ANO �XAM�INEO THIS APPLICATIQN ], STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIQN$ OF LAW$ yp�UAT10N SURTAX
AND OROINANCES GOVERNING TMIS TYPE OF WQRK WILL �E COMP�IEO
WITM WMETHER SPECIFIED MEFEIN OR NOT. THE GRANTING OF A PEFMIT �LL�71�F �C).36
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TMH pEAMITfEE SACCMARGE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGULATIN(i CON-
STRUC710N OR TME PERFORMANCE Of CONSTRUCTION $199.75 Fi SC �12.71
PLAN CFJECK FEE TOT l, FEE
Lic $5 0 $223.8
S�GNATUpE OF CON'AACTOA Op AU�MOp�ZEO pGEN♦ IDAtE� M N ROP ALIOA I�S IS �IT
� v,
S�GN4TURE O� OWNEA��f QWNEpBWl0E�1i �OATfft � �% � �NSP ' � f�b}E
I�IL'�V � � L'11CCUVC l/t/`)�F
liDDN � � . CI'I'Y OP E�2IDL�Y
AI:Ci:R �' � � S1NGLr rAMiL.Y ANll llUPI.CX�S R-I AND R-2 �
Builciin�; Pcrmit APplication
o � � 3 3�� ���J ��O
_ � �. ��
' �istruction Acl�ress: � 3 3 � � � ���'� /��_ _ .
Lcbal l�c;uri�tic�n:
O�vncr Nainc & Aciclress:
i_. �GP r' ✓D � UL
Tel. �{�7/°' 70�{8
Ccmtrac:lc�r: �-�l� C'�''c!`f a� !�'�•� MN L1CLN.SC �l �/ 79
---- - . L�`'_'_�. _... __---- - ----�---
Aciclress: �3//� ..�i�e /�--3 � /�-° � -. ��%� ���✓ �SS�1� � T�;1. /{ i� � - �o <v ��
LIVING ARClt:
GARAG� ARCA:
ll�CK ARrA:
OTI-ICIt:
Attach to this a�plicalion, a Cec-tificate of Survey of die
lot, �vith the Propc�sed cons�-uc;tion drawn on it lo scale.
Lengd�
Length
Length
D�SCRIPTION OF IMPROV�M�NT
WiQth I ieight
Wictth I�eight
Width HgdGround
s�. rc.
s�. rc:
s�. rc.
f(��� i � � �
Corner Lot ( j Insicle Lot ( � rt. Yd Setback Side Y etbac
'C e oi' Cc�nstructi�n: S.d:, .���1 �sc.� Oa , ao� Cstimated Cost: $ d �
�! Y- 7r
� . ,,rox. ComPlclic�n Datc;: � •� /� `%/�
r 1
(Cost on I3ack J /
I)rivc�v<<y Curb Cul Wiclth Nccdcd: rl. -{- G Fl = 1�1 x$ �_$ V��' _
llAT�: � � �' `�` � � APPLICANT: �_ �a.� Tel. �� 7oZ / � %(p ��'l
Pcrmit Pee
l�ire Surc:har�;e
�t�ric Curchar�;e
SAC: t:iiara;e
Liccns� Surchar�e
Qriveway Csa•aw
�rosion Cc�ntrol
Park Pec�
Sc;wcr Main Char�;c.
�I'OTAL
.STIPULATIONS:
CI7'Y iJS�: QI�jLY
$ 1�� �ee Schcdule c�n Reverse Sidc `
$�%/ .001 of' Permit Valuation (1/101h l )
$ (, 3� _� $.50/$1,000 Valuation
$ ^__ � $8Q0 ��cr SAC Unit
$ _ o�s0� $5.00 (Statc: Licensed Rc:siclential Contractors}
$ Alt. "A" or Alt. "I3" Above
$ $450.Q0 Conservation Plan Revie�v
$_ ____ ___ ___ l�ee Determinecl l�y �ngineering
`�.._..._.._.__.___------ A�;rccmcnl Neccssary I I Not Nccc:ssa�y I 1
� a � � . ��--
t , °`
,
- sue�etT • , IT NO.
city of Fridlt�� 32472
AT THE TOP OF THE TWINS g u �� Q ��� P E R M I T
r
' � � RECEIPT NO.
�
� �� �����_� COMMUdITY OEYELQRM�NT OIV.
r � � PROTECTIVE INSPECTION SEC. ��� �
�
1 = � '
� r'��1 � CITY MAL,L FRIOLEY SS�3i NUM9EN Btl DAT6 PAGE OF AMROVEO Bt
�---•� ' �•' 612-571-34sp 81 aFt g 3 J25 /02 / /
J
!OB ADDiiESS 5336 Altura Road NE
t LEGAL ��T NO. BLOCK 1RACT OR ADDITION SEE ATTACMED
DESCR. 3O 6 Carlson's Summit Manor North Addition SFIEET
2 PROPERT.Y OWNER. , MAIL A1QpR� . 21P PMONE
Joseph Paavola 5336 Altura Road NE 763-571-7048
3 CONTRACTOR AAAIL ADDRESS ' ZIP PNONE UCENSE NO
Midwest Restoration 6319 H 65 NE Fri 1 763-502-1082
4 ARCNITECT OR DESIdNEii MAI AODRE88 IIP PMONE LICENSE NO
5267
S ENGINEER k1AiL ApDRE$S � 21P PMONE LICENSE NO
8 USE Of BUILDIN(i
Residential
7 CLASS OF WOFiK ,
� NEW � ADDITION � ALTERATIpN [� REPAIR p MOVE � O REMOVE
B DESCRIBE WOfiK '
Repair wall and replace overhead and se.rv.ice doors damaged by vehicle
9 CHANf3E OF USE FROM TO
STIPULATIONS � See notations on p�an.
SEPARATE PEpMITS ARE RECUIRED FOH El.ECTNICAL. PLUMBING, HEATINd, �P� �� T� �CUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANQ VOIO IF WQRK OR C�pNS7RUCrT�O{�1 PONINCi SO. FT CU FT
AUTMORIZEO IS NOT COMMENCED V�{ITHIN 80 OAYB. OR IF CON�TRUCTION �
OR WORK IS SUSPENDEO OR ABANQONED FpR A P�RIOO OF 120 DAYS A�
ANY TIME AFTER WOiiK IS COMMENCED. ' NO, �I11LG. UNITS OFfSTREET PARKING
I HEREBY CERTIFY TMAT I MAVE REAO ANO EXAMIN�O TNIS APP�,IGArI(1N 1 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND C04ipECT. ALL PRpVI310N9 �F L'AW$ 'VALUATf0�1 SUqTAX
ANO OROINANCES GOVEpNINa THIS TYPE OF WQRK WI�L, E{E QpMPlIEO
WITH WMETMER SPECIFIEO HEREIN OR NOT. TME GRANTING OF A PERMIT � 1 s�OO � �. C7O
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CAMCEL TME pEqM1T FEE SAC CMARGE
PAOVISIONS OF ANY OTMER STATE OR LOCAL LAW RECIULATINii CON-
STRUCTION OR TNE P UCTION $44 . 8S Fire SC � L. LO
PLAN CN�CK fEE TQTAL FEE
Licens C $5.00 $ 1.65
S�GN4TUpEOFCON• ACT puTMOpi2E0aGENT •TEi � EN OPER LIDATEO NIS IS VpUp PEFiMIT
1i'��
� �
S�GNATU�iE O� OWNEp��f OWNEN BU�LOE�1t � � 1 AT �. '' � B� �pgO , q�TE
NEV11 [] CITY OF FRIDLEY Effec�ve 1/1/2002
ADDN [] 6431 Universi�y Ave NE� Fridley, MN 55432 (763) b72�604 Bldg Insp
ALTER `] SINGLE FAMILY AND DUPLEXES R 1 AND R 2
- BUILDING PERMIT APPLICATION
Construcaon Address: ���'� �� �v'•� dG��� /l/ ..� .
Legal Description:
Owner Name 8� Address: ..._1 ms�la�d ��+ vo�r Tei. #?"6� �'i� ���'
Contractor. /,�/,D ��� i ,�� ��i MN LICENSE # .�> � 7
Address: �%S� , /q��i5� s� �� ��60 �'fl �-- Tel. #�'�`�' .So 2 � t� �
LMNG AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Lertgth Widtl� Height Sq. Ft
Length Width Height Sq. Ft
DECK AREA: Length � Width Hgt/Ground Sq. Ft
on��: ��,o��.� �.��� � ,�/��c� �'���� ��
� ,,s''�.�c��� ��� �.�
Construdion Type: Estimated Cost: $ �20v "
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: �- APPLICA . Tel. # `�,��� `" ��S �-
Call (7 572 G04 for Permit Fees if mailing in application or Fax to 763-571-1287 if using c�sedit card and we will
call you for ca� number.
CfTY USE ONLY -
PeRnit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Drnreway Escrow
Erosion Control
Park Fee �
Sewer Main Charge
TOTAL
� ��� SS`
$ �
� . 0
$
$ .`� -00
$
$
$
$
$ �� �s�
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit
$5:00 (State Licensed Residential Contcactors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering �
Agreement Necessary [] Not Necessary I J
STIPULATIONS:
�"...--
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing baildin8 or stivcture, or for any alteration or repair to any existing bu�lding a�r structure,
upon application 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 tawit:
TOTAL VALUE
$1 to $500 .
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$1�,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEFS
$23.50
$23.50 for first $500 plus $3.05 for each additi�nal $100 or
fraction thereof, to and including $2,000
$69.25 for fust $2,000 plus $14.00 for each additional $1,000
or fiaction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to �nd including $100,000
$993.75 for first $100,000 plus $S.C� for each add.itional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,0�,000
$5,608.75 for the first $1,000,000 plus $3.15 fur each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate °g"; Resmoval and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction vvill be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has l�en constructed will
be required before proceeding with the framin8 • New Houses Onlv
�
�.:
Midwest Restor°a�an � Construation, ina
6319 H�twray 65 NE
, Frldley, MN 55432
' Phone(763)502-1082
Insur�ed Informat�on
Ir�ured Corrtact
P�vaola, Joseph P�wla, Jo�ph
5336 ALtura Rd Ne 5336 ALtura Rd Ne
Fr��y, MN 55421-1143 Fridley, MN 55421-1143
Home Phone (763) 571-7048 Home Phone (763) 571-70A8
Busi�s Phone (�i2) 935-9777 B�Ir�s Phone (952) 935-9777
Contact Information
ir�surea co�racaa �✓� s�zooz s:so a�n scnedu�ea stte v�tc �� srzooa s:so Ann
Estlmated Duratlon 45 Day(s) Initlal Slbe Vlsit 3J19/2002 8:30 AM
Garag�
Dimensions
Type Exterior� �rg�, Flat Perimeter o.00 ft.
HNgM/ p� 0" Wall Ar�a 0.00 �. ft
�YU� V Op
Tasks
Descrlption
Derno/R�laoe Steel Sectional Gara� Door - Woodgrain, Ra�ed Panels, Vlfhite Fin�h, 9'-0" x T-0"
.� � a�d support c�rage
Resquare Garage
DemolR�slace Misc. Freming AAember - Pine 1�c6
D�na�R�laoe Studs - 2"x4" x 8'
Demo/Replaoe Header - 2ea Zx8's w/Plywood
DemolR�lace Head� - 2ea ac12's wlPlywood
N6nimum Charge - E�Ctricel
De�ru�/Replaoe M�c. Framing IU�mber - Pine 1x6
DemalRepleae 1"n3" MisaeAeneo� Framing Nbmber
DemdReplaoe 1 "x12" - pine
V1hsp F�cterior Garage �tvice �ar
RspF�alt Roofing Fett �i0
N6nirrwm Charge - ExDerior S�iing
Derno✓R�laae Wrap Garage Door
D�nadReplaoe Exterior Hollaa Me�l �or - 20 Gauge, Flush, Full Panel,l-3/4" Thick, 2'�" x 6'-8"
M(nimum Charge - Pairrting
Remove/Reset Handb Lodcset, Single Cyhr�der, PoGahed Bress Fin�h, H�h Gr�ie
NBsa Framirq M�nber - Pressure Treated Zx4
Labor
Dimensions
7ype �r�ior, t2ectang�. Flat
YYldth � �'
Length a 0"
He1gF� � 0"
page 1 of 2
Perimeter 0.00 R
Floor Ar� 0.� sq. R
Wall Area U.00 sq. ft
Ceiltng Ar� 0.� sq. it
Miscellan�us
�
4uanttty
1.00 EA
1.00 EA
1.� EA
27.00 LF
64.� LF
3.00 LF
10.� LF
1.� EA
2T.00 LF
27.� SF
55.� LF
1.00 EA
3.� SA
1.� EA
1.00 EA
1.� EA
1.00 EA
1.00 EA
8.� LF
1.00 HR
�e
Tasks
Descriptlon
Flnal Construdion CJeanup
Haul to Qis'posel Si6e & Empty 1/2 to 3/4 Ton Pidcup Lo�i of D�bris, Indudes Dump Fees
RemovelReset Dow�pout - Aluminum 4"Dia., .25" Enemeled
Note - Estimate includes applicable sales tau except where prohibited by state law.
page 2 of 2
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Building
Inspections
763-572-3604 •
763-502-4977 FAX
DATE�
SITE ADDRESS _
TI-IIS APPLICANT IS:
PROPERTY OWNER/
TENANT
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECI'IVE ]-1-08
YOTJR E-MAIL ADDRESS
� l���� � �� ���r
0 OWNER �1CONTRACTOR
NAME: tt- w e �
ADDRESS: JF3 3 L, C�11'f�w`GzG� n� c�
PHONE:
Permit No.� -Lid lv
Received By: %
Date Rec'd: !
� 4`�' W �S�eS�, �o �n
.5 S"c,lZl
CONTRACTOR AnDltESS: < '�- �/ � crrYU�c�rv�-e �c�-Q s rA rrv � v�c,u��.s 3 ��
SUBMIT A COPY OF pHONE �/2 —��— 3 3.�' F�
YOUR STATE LICENSE STATE LICENSE # 2 0� a.S'S' ]� EXP DATE '��% ��
PROPERTY TYPE
PERMIT TYPE
� SINGLE FAMILYMEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUC['ION
0 BASEMENT FINISH
❑ DECK
TYPE OF WORK: O NEW HOME CONSTRUCITON
� MAMTENANCFJREPAIR
DESCRIBE WORK BE1NG
SIZE OF IMPROVEMENT
R�OFING
NUMBER OF SQUARES �
t
�ARAGES
PROPOSED SIZE:
PROPOSED HEIGH'f:
SID1NG
❑ Vinyl
� Aluminum
❑ 4ther
❑ GARAGE/SHED ❑ WINDOWS
j8{ ROOF ❑ DRAIN TILE
❑ SIDMG � ❑ OTHER
❑ SWIMMIIQG P�L . �
0 ADDITION
❑ REMODELING
/ 1 ❑ HOUSE ONLY
�D �PS/ �HOUSE 8c GARAGE
%U
WINDOWS
M EXISTING OPENiNGS ❑Yes DI�To
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES Bc
TYPE OF WIlVDOW TO BE INSTALLED
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
r1
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of strucwral members to be used,
FOR NEW CONSTRUCTION INCLUDING DECKS,
OSofflt A!�n�TTnNS & PORCHES SUBMIT'
❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Fascia at►d proposed project
2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
NUNBER OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(US�TG THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $�'�%D�'�� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ �_ 4 U
$
$
$
$
$
$ , a
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 Atta�
THIS IS AN APPLICATTON FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that d�e informa6on 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 nstruction Codes; az I understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will be in acco ce with ap r�v an in the case of all work which require • review and approval of plans. -���`*—'—
SIGNATURE� OF APPLICANT PRINT NAME ahd l�� rl �� DATE D�
_ � / _
: . . . • � : �—/��,J'�% l!!J�i � .
. .�
�� Page 2- Building Residential Application
o..
BUILDING PERNIIT 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 alteration or repair
to any existing building or structure, upon application therefore, requue 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:
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to
allow 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: 763-502-497? •
�
Building
Inspections
763-572-3604
763-542-4977 FAX
DATE � — � �
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
�i[�
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
MECHANICAL
RESIDENTIA.L APPLICATION
CITY OF FRIDLEY
YOUQR� E-MAIL ADDRESS
• /y�
� OWNER ¢CONTRACTOR
Permit No:
, _ . ► ��.
-.. �
� . �; �-� =
�, �; �0 , i
o w•
NAME�°�_ �y. l�bl� 67^�tSG/w�' � /�fC'K I
ADDRESS: CITY STATE �ZIP,
PHONE: %E�S ZI3 5���
COMPANY NAME:_
CONTACT.PERSON:
STATE LICENSE #_
0
EXP DATE
G
' .�5�� STATE �IP .ffOY�
�.SINGLE FAMILY O TWO FAMILY � TOWNHOUSE
TYPE OF WORK: � � ��CEMENT
DETAILED DESCRIPTION OF WORK ��n� `�'
❑ ALTERATION/REMODEL
�
FEES ARE BASED ON $10.� PER FIXTURE, EXCEPT Wi�1tE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUA J� 2006 ASHRAE HANDBOOK. O�
Equipment Installed MFG: �y12� MODEL: P� ��1 �O�D siz�s�cv
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZFlBN
�C $�.pp _FIREPLACE (GAS) $15.� GAS RANGEJOVEN $10.00
pIR Tp pIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.�
BOILER $35.� �,E.FURNACE $35.� GAS UNIT H77t $10.00
CHIlVIIJEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERAAIT-NOT YALID UNT1L PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; thaz the work will be in
conformance with the ord ance d codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an pli 'o for a rmit and work is not to start without a permi� that the work will be in accordance with the
approved plan in the case f a11 whi uues review and approval of pl s. /.
SIGNATURE OF APPLICANT PRINT NAME �'� ���� DATE �/ 't �/�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 � FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS 0 EXISTING HOME 0 MA.KE-UP AIR
REOUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below) .
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. N 1104.4.13
5. Ventilation
a. Per MN Rule Chapter 1322. Sec. 1104
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Center�int Energ,y Mechanical Cade Guidelines software may be used for
combnstion and mak�up air calculations.