AF - 44163SUBJECT ,
City of Fridley � 15 3 3'��
AT THE TOP OF THE TWINS g U I L D I N G P E R M �
r
; � REC IPT NO.
� ; y ______ COMMUNITY DEVELOPMENT DIV. � �
r � � PROTECTIVE INSPECTION SEC. � � ,3 �
� �
i__-- A����,•� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i �� 612-571-3450 910-F15 7/13/79 � �
JOB ADDRESS 5855 Arthur Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3S A11C1. Sl]U. #9Z SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Dan Echols 5885 Arthur 5treet N.Ee 571-6146
3 CONTRACTOR MAICADDRESS Z�P PHONE LICENSENO.
Custom Homes Inc. 6141 Highway #10 N.W., Anoka, ND.�T 427-8871
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRES c R����� ���NE _�� L�: E NO.
� a�
6 USE OF BUILDING
Re51C�PT1'tl�.�. •
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 31'8" x 28' Dwelling and a 25'4" x 22' Garage
9 CHANGE QF USE FROM TO
STIPULATIONS provide a hard surface driveway. Provide sod in the front and side
yards. Provide City with copy of verifying survey before capping.
SEWER LOCATION: (Approx. 11' Deep In Street) 25° S. of Manhole (Invo 963088)
WYE ELEV: 963.12 �P OF FOOTING: 966.62 Minim�
�1TER LOCATION: A,pprox. 10' N. of Sewer Service. 28.5' S.Ea of Manhole
DRIVEWAY DEPRESSION CO5T: 16' + 6' x$15.75 =$346.50
WARNtN�
CcU ��� D06S ►� p,��� ettore d%inr All lOG1 U�ilitie�
TAIS �AtA 1S /1�3R ���� � E�tbATl�l� ��d�lF • E(,E�IC • �� �f�,
���s � a �n°� � o�v�r �wo R�Ql1IRED 8X ��V�
wFO�,r�o
TYPE OP CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCI Fl^dIIle
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONED FOR A PERIOD OF 120 DAYS AT 1294 + 557 39, 426 7bta
ANY TIME AFTER WORK IS COMMENCED. N0. 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 OR NOT. THE GRANTING OF A PERMIT �`%Z�OOO $36.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CNARGE
PROVIStONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �^
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ].�j%� %O y-x2S. OO
PLAN CHECK FEE TOTAL FEE
3 _ e 43 $658.13
SIGNATURE CorvTRACTORORAUTHORIZEDAGENT �DnrEi - WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
� l3 �
SIGNATUREOFOWNERIIFOWNERBUIIDERi IDATEI BL�G INSP �AT
.�
CITY OF FRIDLEY -
AP-PLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: ,�'�6�/j� �f��G'�s«
ADDRESS : �3`�'���,�'��,� �'%� ��'
TEL N0: e5'�7% �- �v/�-�
BUILDER:
ADDRESS:
TEL N0: �,� .�° fi��/
Construction Location
ST13�T NO : ��,S�J STREET: ��✓�/�G� a�� /'r� G�
�' ,
I,p7.': s�D %�y BLOQC: ADDITION: ��,� o���� �'�
Corner Lot: Insicle Lot: Setback: ,3$- Sideyards: S' =/� �
Apnlicant attach to this form two Certificates of Survey of lot and
proposed building locatian drawn on certificates to scale.
DESCRIPTIO�d OF CONSTRUCTION �
� c�� �' ,
P
Front: �d � Depth: � � Height: �l� �'� t`�.�iv.eD�
Squa�e Feete %�� ���;,Cubic Feet: �C �%z�� �•�'�� /d9Z
�L�����
n � �� �
C�- .-� �- Front: �� � Depth: ��° � Height: °,
. -� ���a�s
Square� Feet: ��Q� �,ro`,,�, Cubic Feet: ,�'i��(�
Type of Construction : �%'�.f�
7.b Be O�mplet�d: � . /l�
Estimated Cost: $ O�
' ��flod
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: �� $ �� $
5EE REVERSE SIDE OF SHEET
'I'he undersigned hereby ma.kes application for a permit for the work herein specified,
agreeing to ds� all work in strict accordance with the City of Fridley Ordinances and
rulings of the Departinent of Buildings, and hereby declares that all the facts and
representations stated in this applic
DATE: � � ' �� �'' � � SIGNATURE :
Stipulations:
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S�c. 42 S. o v
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BUILDIf�G PERt�IIT FEE SCNEDULE� °�'
S�CTION 2. The Inspector of IIuildings shall, before issuing permits for the erec�ion
of any building or struc�ure, or for any addition to any exis�ing building or structure,
. or for any alteration or repairs to•any existing building or structure, upan application
�thereforer require t.he payment by the applicant for such permit of fees to,the amoun�
herein below set torth and in the manner herein provided to-wit: •
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSYON: (ConcreteeC�rb Streets Only) �
' Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x�15.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; •Driveway width �plus 6 feet x$17.85
�; 1 1 �:L. 1 �' � � l�
For the purpose of computing fees for building per�its, the cubical contents 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
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee sha11 be at the rate
of $3.00 Yier each five hundred dol].ars �� ($500.00) or fraction thereof in the cost
of al.l proposed work.
In�no case shall the fee charged for any permi� as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge. �
VERIFICATIO� OF FOUNDATIQN �
NOTE: Permits for cons truction will be issued a miniminn of 24 hours from the time
of epplication to allow for proper review of the proposed structure and of L-he
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
� ; ; � � ':►
' Application for a Certificate of Oceupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building pexmit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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GER4tF�CA'TE UF �l3RVEY
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�•N does Aot pw+pari tb show improvementa or encroachmer�ts, if any. Aa surveyed by me this,._._�__ �?_. _.._.-�L� cf
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H� T LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
W�TM�R�� �•��•� ME OF CONSTRUCTION INSULATION
L 6uid�
�adow� Doen �n� OuF. W�q Is1. Wap Cdd Reef Reer Kiad I Giling I Wall
Y�s — Ne Ya — Ne 19
/ p. I �` Rooru l.�no4h Wtdfh N�i961 I� q, I�I�.v�DQ /R�m ( L�nqfh �i Width � H�iyh1 �
6�=
WINDOWS and DOORS — CRACKA6@ �ed ARW � �A/INDOWS and ORS — CRACKAGE end AREA �
Infllh�Ho�
W�p
61�a
R�y�h�d sq. !t. E. D. R or . im. W. A. lud�r �n�
� R( �/NiNL Roaa I.�aq1h /3 Wtdih �%� HdqM
WINDOWS •nd DOORS — CRACKA6E �nd AR@/►
Widfh N�ta f No. o uM R ArN
__N_e._�_ e_f �p�n� I ot'�n� Il�hh I ei puk� ��. f,f.
� I f�'D �'a� D,a 3 I S�
�
�__,
Ce�f. � Bfu. _
I�ilfr�Hen p
6p. Wdt
61aa
N�f 6ro. W�II
t�qaind �q. k. E D. R. or sq. ina. W. A. Ls�d�r ena �
' FL I ���� Room � l�nqfh �3 Wtd4h�d ��p H�igh1
WINDOW3 �nd DOORS — CRACKAGE �nd AREA I
No. �WtMh H�IqM No. ef Lin�al it. 11n�
o} wn� OI pOA� + Itahf� I of aaek I �a. A.
I Co•f.l Btu.
leflllrafion D�n Iafllh�Hon Doon "�"� ""'��
6p. W�q W:q
61�u 61�a
Nd W�II ZS N�! 6p. Wdl Z
I�. '�Ndl Isi. W.II
—a,n�.o ioo ZP 3 . oo� 3 3 ,
Total Btw '7 Tofd 61u. :
R�quirod sq. H. E D. R. or t. teu. W. A. L��d�r �n� • R�quind iq. H. E. D. R or sq. in�. W. A. L��d�r ens
� R „�%j�V/NG Room L�eqfb 3 Wtdth �� �,3 Hdqht � �I• � L�N/NG Room L�nqth 7'� Width � 5 Hdght
WINDOWS and OOORS — CRACKA6@ and AREA ' WINDOWS �nd DOORS — CRACKA6E �nd AREA
WIdfA MdqM Ne. nwl ArN NdaM e. L m�i An�
Na of n� ef n� II hk el aack . N. No. of oan� ef n� UahM e} erack �q. A•
i ;� y s� 3 �9 �� .�- z �� �� z
In$IhaHos
ti�1 6p.
'hif.lA/ap
R�qwl�d �q. H. E. D. R. m �q. Is�. W.
AT•SOOei.!!
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lufiltration 'y",
6p. Wa11
61w
Nd 6a. Wdl
dtu.
nd �a. H. E. D.
e+�.
. A. L��d�r �n� �
Q�RMID TOTAL �� 9��
�/�
a�-1�� S" 'SS= �.,.��1, � a
.
HEA�' LOSS CALCUTATIONS DEPARTMENT OF BUILDINGS
yy�TM���� A.S.H.V.E. MB OF CONSTRUCTION INSULATION
6uid�
I'�I Wiadow� I Doee �n� OuF. W�p lef. W�R G1dn Reof Floer Ipnd Gtling W�II
Ya—Ne Yu—No N
p I I
r I Itoom L.��th Wldih �6 �` H�tqM I//i,�y, Reem I L�nqth Width �' H�TgM �
WINDOWS an DOORS — CRACKA6@ �ud AREA WINDOWS and DOORS — CRACKA6E end AREA
V✓idtb Hdp No. uw Aru Idth HdpM No. of Lin�al H. Ane
No. of p�n� oi in� I hb o/ v�eli W. /f. No. of paa� of p�n� Uqhh oi veek �q. N.
I'� / � �� a- � � / / � <C � 3 ��G I z3
I�ilhaHo� p�M -
W.p
�� 61a�
Nd6.W.11
1u1. Wdl
I Tetal !1w
R..,�ind w. N. E D. R. er �q. Im. W. A. L��d�r m�
NdFL ( Roas I.�e4tb � Width
WINDOWS and DOORS — CRACKA6E �nd /oREA
Wldfh I H�ta f No. e I Linw 6 Ana
Ne. o} p�n� 01 p�a� Uahh e1 a�ek ���q. A.
� � ��r�p � 3 z
Ie►fllMaHon
60. W.II
61�a
N�f .
IM. '�Mdl
HdoM
�p' � �A���G,LRean � I.�aq16 !�!'(oWfdlh H�iqht
WINDOWS and DOORS — CMCKA6E �nd AREA �
IA�IM�NOII
e •'
6ba
'N�! 6p. Wdl
Mt. Mhll
R�qwlyd �q. A E. D. R. or �q. lu�. W. A. I.�ad�r �n�
RT.sao=�.�e
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Co�f.l Btu.
. (r�filtr�fion Doon � � �'�'
. Wdl ]
� 61aa Z3
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I� W.0
Cwtltn o► Fleer ,�
� Tefd Na. s�
R�quind . N. E D. R or ss�. ies. W. A. L�ad�r are�
E.p Room I L�nqfh Z/� �d4h /�� Hsight
WINDOW3 �nd DOORS — CRACKAGE �nd AREA I
�
InRMr�Hon adorn
Doon
1Mall /
61�a
i 3 N�4 6p. Wdl
lat. Wdl
� � GiUn or Hoor
To#al B4u.
R�quind sq. H. E. D. R. or �q. tn�. W. A. L��d�r ane
�FI. B� Reom I.�nq16 Width
WINDOWS �nd DOORS — CRACKA6E ��d AREA
d1b Hdqht Ne. Llnw k. An�
No. ei s�n� e� e�a� IIahM � ef u�ck � �a. A.
� ���
I�'ilhation po;�
W�u
61�a
a
N�t W�II
Inf. Wdl
Gldo •Hae► �IT '
Tefd Nu.
RpWnd tq. H. E. D. R. or �q. im. W. A. I.��der �n�
G�MID
O
H•iqht
C.G-
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� � � � January 3, 1980
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8431 ' Uf�IVERSITY AVENUE id.E.. FRIDLEY, MIPdNESOTA 56432
= " �`� 1�4r. Jim Gilbertson
'`"� Custom Homes Inc.
; „�;,
,r�' 6141 Highway #10 N.W.
,�''
' Anoka, N�1 55303
Re: Final Inspection at 5855 Arther Street N.E.
Dear Mr. Gilbertson:
TELEPHONE ( (312}571-3450
A final inspection was made on January 2, 1980 of the above address and
the following items were noted which must be c�pleted before the structure
can be finaled out;
1.
2.
3.
9.
5.
6.
7.
Insta.11 nuts and washers o�n anchor bolts by January 15, 1980.
Insta.11 joist hanger on outside of deck joist by January 15,
Post house numbers on structure by January 15, 1980.
Install vapor barrier on framed basement walls by January 15,
Complete exterior surfaces by January 15, 1980.
Pick up all construction debris on site by January 15, 1980.
Provide sod in the front and side yards by June 15, 1980.
1980.
1980.
We will expect the above items to be completed by the scheduled da.t�s
when reinspections will be made to deteriaine compliance. If you have any
questions on these items, please contact me at 571-3450.
Sincerely,
_ �.
DARREL G. CI.�1RK
Chief Building Oi'ficial
DGC/mh
CC: Mr. Dan Echols
5855 Arthur Street N.E.
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6431 UNIVERSITY AVENUE N.E., FR�DLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
'� January 17, 198�
Mt.. Ji.m Gilbertson
Cust�m Homes Inc.
6141 Highway #10 N .6d.
Anoka, I+�I 55303
Re: Final Inspection at 5855 Arthtzr Street 2J.E. (5ECO1�iD NOTICE)
Dear Mr. Gilbertson:
A final rei.nspec�ion was. made on January 15, 1980 of the above address
and the tollowing items were again noted which must be campleted before
- the structure can be finaled out;
l. Post house ninnbers on structure by Februa.ry 1, 1980.
2. Complete exterior surfaces by February 1,,1980.
3. Pick up all construction debri.s on site by February l, 1980. �
4.� Provide sod in the front and side yards by June 15, 1980.
We will expect the above items to be completed by the scheduled dates
when reinspections will again be made to determine compliance. If you
have any questions on.these items, please contact me at 571-3450.
5incerely,
L1A . CLARK ' � .
Chief Building Official
DGC/mh
CC: Mr. Dan Echols
5855 Arthur Street N.E.
�Y� /��f/�� �
nes-27a2 (9-8�
PZ-02722-02
1(� s%� '��
STATE OF MINNESOTA
DtrARTMENT O� NUMAN dBRVICEB
444 LA!►AYtTTE ROAO
ST. rANL. MINNBSOTA ds101
��8-86
Date
Cit of Fridle '
oning'Authority
6431 University AVe. N.E.
Street Address
Fridlev, L�IN 55432
City State Zip Code
RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE
Subject: ����� ������ _
Name of Day Care Home Applicant
�ss .�� ���J � �C- �
Street Address
�� ��'.�c/ :� �3 �
City AState Zip Code
Type of License:
Family Day Care �
Group Family Day Care
Licensed Capacity r�C)
Phone No. � °7/�-- � � ���_
This is to inform you that we are in receipt
licensure under Minnesota Rules� parts 9502.0300
Rule 2)� Family Day Care and Group Family Day Care
this license is subject to compliance with the
Statutes� Sections 245.781 to 245.812 and 252.28�
the Public Welfare Licensing Act and the rnles of
Services.
of an application for
to 9502.0445 (formerly
Standards. Issuance of
provisions of Minnesota
subdivision 2� known as
the Department of Human
You should note that under Minnesota Statutes, Section
3, a licensed day care facility serving 12 or fewer
considered a permitted single family residential use o
purposes of zoning. Subdivision 4 of the same section
licensed day care facility serving from 13 through 16
considered a permitted multi-family residential use
purposes of zoning.
If we do not hear from you within
will consider the above-mentioned
your local zoning code.
Sincerely,
Lice sing W rker �
Street Address
245.812, Subvision
persons shall be
f property for the
indicates that a
persons shall be
of property for
30 days after receipt of this letter, we
day care home to be in compliance with
COMMUNITY HEALTFi & S�JCIAL
SERVICES DEPARTl47ENT
COUNTY OF ANOKA
COURTHOUSE, FOURTH FLOOR
Name o ency Organization
City State Zip Code
AN E�UAL OPPORTUNITY EMPLOYER
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CHIMNEY AND STACR VERIFICATION
The undersigne�T hereby verifies that the existing chimney or stack:
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1. Has bee�� -carefully examined Yes () No ()
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2. Is free��om rust or deterioration Yes ( j No ( j
3. Has no �o���.yyri obj ects lodged within Yes O No O
4. Is securei.y, j supported Yes O No ( j
5. Meets al�, ci�rrent Code requirements for
size and�to�al BTU's connected Yes O No O
6. Has tatal_1;eating BTiJ's of ---
All other BTLT � s
TOTAL BTII's
Remarks
List Alterations Beinq Done�
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HEATING COMPANY
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacins� an existina furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where requir�d. Yes () No ()
The veritiing system is plastic/PVC and meets all current codes and manufacturer
spec�c�tions including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the repiacsment unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft applianc�s.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air. it will be sized and installed
To meet the current codes and manufacturer's specfications. ____
Yes()No()
Yes( ) No( )
Yes ( _) No_�_ _
When instaliina a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does indude AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliaruces. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
AaAliance Tvpe and Size/Common Vent and Vent Conne�tor Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height _ Diameter inches
��ct, Ve��' �a�e I.�ee�v . 80, �c�+ gru �vr���low»6P�u
Appliance #1 Vent Connector Height ft Length ft Diameter in Type C� �� •
-- p►RA�� ���f�onaeci�r Hei�h.t___ _ ft_ (�n_gth, ��t_ Diam�t�r i_n T e
Applcance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describel
HEATING CO:
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C[IYOF
FR[DLE,Y
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
August 23, 2002
Mr. Pat Echols
5855 Arthur St NE
Fridley, MN 55432
Re: Fina1 Inspection at 5855 Arthur Street NE
Contractor: Walter Mechanical
Dear Mr. Echols:
A mechanical pernut was issued on November 15, 2001 to install a gas fireplace at your
address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this pernut. As of this date the inspection has not
been requested.
'The pemut fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your pemut open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the pernut "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspecdon or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
Building
Inspections
763-572-3604
DATE I — CJ�T � � C
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 APPLICATION
55 �(
❑ OWNER
NAMF• 7A.�'
CITY OF FRIDLEY
Permit No..
Received By:-' L" � � J�1 p
Da a d�°"$�� „ 4�
E-MArIL ADDRESS t�5c�,,rdd@ a ep� oc • C.vY1rl
�L •
OCONTRACTOR
G1� 1 S
ADDRESS: � CITY 5TATE ZIP,
PHONE: �" �0 aJ � S� I'° �D I� CD
NAME:
STATE LICENSE #_
ADDRESS:
PHONE
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #20130983
651-264-4777
❑ BASEMENT FINISH ❑ ROOF
� DECK ❑ SIDING
❑ NEW
O MAINTENANCE/REPAIR
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
NUMB£R OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
0 Other _
G1i1]�II (il.l
L�
LENGTH
❑ HOUSE ONLY
❑ HOUSE 8c GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
0 Trim
❑ Fascia
WINDOWS
IN EXISTING OPEMNGS DYes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
f STATE ZIP,
❑ DRAIN TILE
❑ OTHER
HEIGHT
@ASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS_ & PORCHES SUBMIT:
1. Site Plan/Survey showin� the existing strucdm
and ProPo�a P�.lect.
2. Two sets of construction plans
3. Energy Calcnlations
� WINDOW TO BE INSTALLED NUMBER OF WINDOWS I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�, ��) D�° OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Cutb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ S. �y
$ �. � a
$ S.DU
$
$
$
$
See Back Page for Fee Schedule
65% of Building Pertnit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$I550 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 checic4 payable to: City of Fridley Attac
THIS IS AN APPLICATION FOR A PERM[T-NOT VALID 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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
pern�it but only an application for a permit and work is not to stact without a permit; that the work will be in accordance with the approvE
plan in the case of all work whi requ'ves re 'ew and approval of plans.
SIGNATURE OF APPLICANT A/P� ��t n_l�[ a'-/�`� PRINT NAMEOI 1Q�(�� � e y��e!� �'� DATE !� O GT ��D
/ 1�
bl
yf f'i' f_ r'� "y j'I! `""',1
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k������..� 1�..-, r.1 �Jii � l Ib N��!.:�� 1;�i=E'�� .� �:�_ 1�� i�_�11 ��i5 I��i���1I T r
�e ;�V i_. Y"!i s �`� t... �!.. ��. C'�. ( 1 1,.� :� J,a I�: ��•' !., 1�� n L.i I Y.J � C� i'�, B\� 1, f, 1�\ J 4
. . . � ��� �
.�- -
e �� / -
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1�cli;.z.'e�: o " __... _�,____ ilc'!ti 1"C'y., .��OJ 0� C o-��.� J UP . ._
�'ei. .io� _� y,�/- � �g ,.
IYoe e.��,,'�J� S9_� crrt: P!� v r ��". _,__, �
�'r'�t ° ___���_�_ 337T�::Y : �____._._ �rD7TI7:; . _�� f �, � �{ � �
�O ✓,f
C�}:cL�:i; ���7: ------ ;€IJS:t?�T' T,Oi: � SL'.!'T;T�C;•'; ��!� SIUL171P.D.S: /0� G�...a0 ,r �
��;'y�S1i.e�iiaL- ai: i:uc;, 9:c� this ic,:c�n °i�oo �'r.d �.:17_ 1!'�i{=!_; oF Survey af Lat and proposed
�`Li]..X.U?:''!'.,f' .ifJCua:1C�11 C�Y'�::�:i1 Ol� 't�YE'.Si: (�G2LiL1C�i_C_'S. •
1) c S�: f: ] P T I ie f'd 0 F� IJ i l_!:J I�� G
To k�c� :l�c.d Tss e
...._.��' �d c ���' Fr�i? ;.. _ S � � ?��ptl? e �a � � He;..�h_t . ,� 6 '
�Squ�re F'eez: � �ubi.� FE:c�t: �� ���
. �A'!r�T� � ._____ I'rcn � : .? �2, 2 S� t.`� . .2 J�, � _ He � c� h+, o ! � _.�
. �
Sqi�are i�eet: � l �`ubi:: Feet: �V� �
`f.Vpe o�' �C�rS�a'L'I:LLL�1071: `�(f�_�rG,,�o� Estimated Cost: $ �,
� S' �/�O. -°-o
7'0 �3e Coir.y�lei:e�: !�� v�, f ____ AlL-. A ��lt�e R_
--�- _
�'roFos�cl Drive�aa� j4idtl� If hew c��eni.n, Is Desir�d �p ° _ $ � $ _ •
`S�; I`c�\'��'.SE STD : OF SHEE'�)
�`h� undr�r�it?�:c:d �ic:.'ei�;� ni�l:c�s aFrlication fo1. a pe:��r,if� for the �•:ork lierein
s�ec:a.i::i.r��i, ; g�x��eing �ro do all c.c�rk in �tiict acco�_c!ance with the City af
��x�i.ct.lc;r C7r.;�i:��,r�c.r_:� ar,c? r_u1Jli�:• of th� Dc_�a.L't:r.�ent oi )'uildings, a�nd }�creby
�€:c:1.a�-�, ±�iist a}_1 t:l,� faci:s �iaid re�?�.��^�en��t.i��ns st�ated �..� i:liis ap�licaL•ion
are ¢.:zc..�=: ;�rc� coy-yrct. �c:c r^ver�e �ic3e ior a:lciition�l iiifo>n�at�.�n„
z��.T�o y. z� ✓xr:� ,°r���.r-.. -- —
S�.i.pulai:ioiis: °7 /�' ,,��
G� ` /%�J�� �
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'���G2� �� �� a �� ��� �� � ��
, �;, � . �i — (� �- �� . ��s a � �
v
� �2G�>�P � �%CG �� � i6 � p �� .
S7Lc05 c,=, �:P� �s l�uc. ar,��
��o
. c.��_,4,�, .
. ��. �fc � �<�/. �9
� �' 3 � 7 . ��'
4, �/w '- ao+ 6 x i�,s� =
�,� � � 9�, �y
BIiIL�Tf�JG PEK(�IIT FEr, 4C';�GL�ULE
SEC`I'IOrI 2. The .i:iZS�?ector oL Bui_ldings Gh.all, beft�re issuiny permir_s ror- i�i�4� ��ect:i��n
ot any bL�ilding ��r strw�iure, or fo� any additi_c�n t� any existinc7 buil�:.�.ra:� or stzu:.t��rc;
or for any ai��sation or r`.�pairs �o any e-r.ist�_ng building or structure�; u�?on applica�i�n
th�r.eforey require the pa�ment by the applicai;.t f'.�r such g�eL-mit of fees t�� the amvunt
herein below set forth and in i:l�e manner lierein �Yovic�ed ta-wit:
IdFG•7 COi�StRUCTION: Single Fumily Homes ana G�rages: $4.00/Z,000 cubic feet�.
PLAr1 CFiLCIt: 25 percent of building p�rmit fee.
liRIVEln7ESY Di�PRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: �moval and replacement of concrete curb anci
gutter and insta.11 a 3 fcot wide approaeh with
6 inch depth; Dr`i�eway width plus 6 feet Y�l�•20
ADDITIONAL INt=OR�ti+A ION _
For the purgose of compu�ting fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the grou�zd area covered from a
poi_nt six (6) inches below the floor line of the basement or the cellar to the
avzrage heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to an e�isting structure, the fee sliall be at the rate
of $3.00 �er each five hundred dollars ($500.00) or fraction thereof in the cost.
of all proposed work.
In no case shall the fee charged for any �emtit �s set forth in 5eetior. 2 be less
than $7.50 plus $.50 state surcharge.
�(ERIFICATIO� OF FOUNDATION
NOTE: Permits �or construction will be issued a minimum of 24 hours from the tiTne
of appli�ation to allow fo.r proper review of the proposed structvre and of the.
construction site.
A Certificate of Suzvey of the lot, showing the location of the foundation once it
has been constructed will be required before �roceeding with the framing.
CCRT�FICATE OF OC�UPANCY
Applicati�n �or a Certificate of.Occupancy shall be made.ten (10) days prior to the
use or occupancy of any structure for which a building pe nnit has been issued; and
said structure shall not be used or occupied until a Certificate of �ccupancy has
been issued. , °
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�YtLdsl!
�orham Builders, Zizc. #'�**
Gary M. Gorham
9050 COLLINS ORIVE, ANOKA, MfNNESOTA 55303 / PHONE (612) 421-0998
July 11, 1978
Inspections Department
C ity of Fridl ey
6431 Unieersity Avenue
Fi3:dfiey, Minnesota
Dear Ron,
As per our phone conversation on July 11, I will not be aUIDe
to proceed with the building on 5855 Arthur St. On May 5
I took out a building permit at a cost of $991.99. Can I
get back any or all money on this permit at this time4 I
have no intention of building on this lot this year.
Sincerely,
�� ����
Gary M. Gorham
President
7 r�y"
� �3 �
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�jb �
°� `�
,�1
' ATTENTION OF: -
i
�
4 -ro �arb R3.a'l�ut . _ �
¢. _ ,� -
� - �
. : - . . .... � . . .. F� � _
suB,l�cT a�fnad oi swl:l�ng Pesmit for �a�-�ae ;
� . :-�
P1ea�e ref�d $955.53 t�o� �rham dess 98`�0 +��L�s
Th3s afmouut is £or ihe fo27.o $i 5.83 �� ';
� $t32.7fl Fot 81�8f� 9��q@r �?7.00 folc �
_ �
xeta9.a�9 �36,�t� wi�$ah w31i 3.r�olu�e t�►e �7.5�� �� s
CfTY Of fRIDLEY �
643� University N. f.
Minneapolis Minn:- _ 554�1.
. b12-560-34SQ
" �
�!�'. 1i k, .
`� de].� 13� 1978 � :,�` �
�fe q �
�ve, �k8. �'�T 5�fi30�: - I
� � �"
,(1t1.�}.�oz 8gC cla�ge, _.
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ag :-�ff�.� `i�te �ftmd is. �
_ ,�= ' -� :
fs�r 9wt.lc�i.ng Pesm3.t 8Z4:67a, iss�ed' S. 1978, for �55 �Ar�Jtvr Et�i�t N.E«, wli��h
� - - t-
* at� �t � be �uilt. .
F
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SIGNATURE ` �=•T "."�
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Clindows ( Doors Refermee Ou� Wall Inw Q/a� Ce�ing Roof Fl�r Kiad How �
Ya—No Yea--l�io 19
/ F1•� �/'/'� %�a Room Length a9m VP'idch 2 He;$ht � � Fi•I y�' Room Lengch / h+ Widdi
Winc�ows an Doors—Gackage and Ana Windows a�1 poors.�Crackage and Area
W1dtH Hefght No. of L1nea! LL 6na Width Setght ,Na o[ Ltneal ft Area
No. ot pano oL yane IlvBte oL oraet sa. f!. No. ot �ne ot yane lfaLb o! eraol� ed: IL
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Glass �
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Ea�'• "'a11 � � F�. wall 61,e� �
IVet exp. wall p�� 1Vet eap. wall �
Int. wall �� �,�,�
�,00: /� ? e � F�oor
ceil. �. �
Total Btu. � Total Btu.
lZequired . ft. E.D.R. or sq. ins. W:A. Leader area Required�sq. #w E.D.R. or sq. ias. W.A. l.eader area
F7.� a�$� Room � Len�h /�'� Widch Hei�ht �° / � F7.1 � Room I l.engt6 Width /e
Windows and Doors—�rackage and Area Windows and Doors--Crackage and Area
Wfdth Height No. of Lineal it Ares Wldth Helght Na'o! L1nea1 tG Area
Na o! Dane of pane 1f;hLa of orack q, ft,
No. of Daee ot pana 116LLe ot oraok ea. tt
o� � �. � e �' � � � � .� � ��
. Coef. Btu C
Infiltratioa � � a� � �' L�filtration e
Glasa ,��' � � �°� Glass � �
Eap. wall Eap. waU %
Net eap. wall Net eap. wall ��
In� wall Ia� wail
Floor , Floor
Ceil. �� � Ceil. �
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Total Btu. . � 7'otai Btu. �
Required sq. fG E.D.R. or aq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
2 F7- ��? ,�TE� Room � Length °`Widt6 °� He�ht � Fl.� � Room I I.ength A Width ��'� eight �� �
Windows and Doors—Craekage and Area Windows and Doors—Crackage and Area
Wldth Flelght No. oL Llneal ft Area Wfdth Helght Na ot Llneal tt Area
No. ot aane ot pane llBhts ot asack ed. [t Na ot pane ot,pane IlBhte ot crack nQ. ft
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Glaas� �� 'd�, A�' Glass � � � � �'�� �
Exp. wall � ?, Eap. wall -
Net exp. wall ��' � Net eap. Wall *'a P,,,� '�" j' �' ,'
Int. wall ' Int. wall �
F7oor Floor
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Total Btu. � .�� ` � 1'otal Btu. � �
Required s:�. ft. �.D.R. or sq. ins. W.�i. Leac�r are�s F�eqi:liCC� 5C}. �t. E.DmR.,oa sq. ins. W.A. l.eader area
Wcathcrstrips �� Conetrnction Na. Insolation
CJindo� Doors Reference OuG Wall ' In� Wa8 Ce�1ing Roof Floor Kind How Applicd
Y �
es—No Y o 19.._.
e �•I � � �m �„� 4 w� � , � x�;� �: Fl., �m � �° � W� D� � t���� ��
QVindowa an Doora—�rackage and Arw �/indows a�l Doora—Crackage and Area
Width Hetght No. o! LlneRl ft Arta Wldth HelgLt �ia ot Idneal fL Aras
No. of Dano ot pane i(vhta ot crack sq. LG No. of pane ot yane 1lgLts oL cnek e�: [G
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In6ltratioa � --
Glasa
ExP• wal� �� � �
Net eap. Wau � 3 �
Int. wall
Floor � , �
Ceil. � �
Total Btu. �
Required sq. ft. E.D.R. or sq. ins. W:A. L.eader area
l. F7.� � U Room � Length �' ��/idth �'6 ° Hei
Windows an oors—�rackage and Area
wfach eight xo. ot Ltneal tb wres
Na o! pane ot pane Ifahte of cracB q, tG
' �� �� '� ��A ��
In6ltratioa O � �
Glasa
Eap. wall
Net esp. wall �
Ia� waU
�pOi
Ceil.
Total Btu. .
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
� Fl• � ;�p .,,�� Room � Length �� °� Widt6 �
Windows and Doors—Crackage and Area
Wl�lth He�ght No. oL Llneal fL Araa
No. ot pane o[ pane Ilghts ot crack eq. [t,
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(
Yn6ltratioa � � N
G�ass � �
Exp. wall Q
Net exp. wal] �
Int. wall
F7uor
Ceil.
Total Btu.
Requued s:�. ft. E.D.R. or sq. ina. W.A. Leac�r ae+e�
: .
1,;:
B� i
Btu
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Btu
In5ltration
Glaas
F�cp. wall
Net eap. wall
I�I In� wall
Floor
� Ce�7.
�', Total &u.
� Requ�ed sq. #L E.D.R. or sq. ms. W.A. Leader area
�•I A G�'(��OOID � L.CD$Lll I A+d� 1C�[{l I E
Windows and Doors—Crackage and Area
Wldth Helght Na'ot L1nea1 tt Area
No. ot pane ol pane I1sLLe ot araok aa. tt
� �� �� �
c
Infiltratioa � '
I' Glass a
Eup. wall �
Net ezp. wall �,
Ia� waIl
�oot / � �
Ceil.
7'otai �tu. � �
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
i�•� �. I/� 1 Room I Length Width ��' Height �=
�Yindows and Doors—�Crackage and Area
Wldth Height Na of Lineal tG Area
Na ot pane ot,pane IlBhte ot crack eQ. !t
� � �� � � � ��
�
Coef. Bcu
Infiltration ` �
�� � �
_ Glau — .� � �a�� G� �°J �
� Eap. wall
�
Net esp. wall j' ,�,
InG wall ;' �
I
Floor r�'j _ �'.� : ;� �'!.+`�'
i:eil:
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Total Btu. ,,�z "; �
w
Req�ired sy. ft. E.D.R.,os sq. ins. �i.A. �ader area;�;;�� _
Weathcrstrips Guide Conatrnctioo T
C/indow: I Doora Reference Ou� Wall Int. Wa� Ce�1ing
Yes— o Yea�'-1Vo 19_
Fl.� 7' Room Length 6�° Width �"� �B Height e
�TVinclows and Doors—�rackage aad Area
Width Height No. 01 LlneRl iL I,t�a
No. ot Dano ot pane tivhte ot crack �. Lt
Cocf. Bta
Infiltration
Glass
ESP• wal�
Net exp. wall
Int. wall
F7oor
Ceil. ��' � � ,� �"
Total Btu. � �
l�equired sq. #t. E.D.R. or sq. ins. W:A. Leacler area
F7.� Room � Length � g' ' P✓idth �!��°� Height ��; °
Windows and Doors—Crackage and Area
Wldtb Helght No. oL Ltnea! ft. Aroa
Na of Dane ot pane liQhte of Craok aQ. tt.
� � �� � ��
Coef. Bta
In6ltration � �, �� �
Glasa �, a'� �
Esp. wall ,
Net esp. wall , � �
Ia� wall
Floor � �
(:eil.
Total Btu. . ��° �',
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
F1. 'Zl i 19 � Room � Length p��' Widt6 � E�ht ����n
Windows and oors—Crackage and Area
Wldtd Helght No. of Lineat fL Area
No. ot Dane ot pane Ifghts ot ceaCk aq, tG
� � � `c�a �� �_ �
a � �e � c,j �
f.�
� �� ��
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B
Ynfiliration �
Glass - - S� � �.4 � � � a �,
Exp. wall
Net exp. wall
Int. wall
Floor
Ceil.
Total Biu.
fit. E.D.R. or sq. ins. WA. I.ea�r asea
!a. � i�alation
Roof Floor Kind How Applied
Fl.� Room Length Width Height
Windows a� Qoore—Crackage and Area
Wldth HefBht iVa of Ltaeal it Area
Na of pane ot paae llghts ot craolc eQ: tG
Coef. Btu
In5ltration
Glaas
F�p. wall
Net esp. wall
InG wall
Floor
Ce�.
Total Bta.
RequQed sq. #L E.D.R. or sq. ins. W.A. Leader area
F1.I Room ( Leagt6 Width Height
Windows and Doors--Crackage and A,rea
Wldth Height Na oi Llneat tG Ares
No. ot Dane ot pane I1sLLs ot eraok sq. t�.
Coef. $tn
Infiltration
Glass
Eap. wall
Net ezp. wall
Ia� waD
Floor
Ceil.
Totai �tu,
Required sq. k. E.D.R. or aq. ins. W.A. Leader area
Fl.� Room I I.enBth Width Height
Windows and Doora—Craekage and Area
Wldth Helght Na of Lineal tt Area
Na of pane of,peae Ilghte ot crack eQ. tt.
Coef. Btu
Infiltration
C.lass
Exp. wall
Net exp. Wau
Int. wall
Floor
� �e�.
1'otal Btu.
_P�eq�irecl sc�. $t. E.D.R., o� sq. ins. �/.A. L.eader area
� SUBJECT � � • ' P
City of Fridley 3110
AT THE TOP OF THE TW�NS � � I L D I N� P E R M I T
r
� ► RECEIPT NO.
� `v __���_ COMMUNITY DEVELOPMENT D1Y. / _�
f � � PROTECTIVE INSPECTIQN SEC. � 4�
1 . .
i--_-� �'�' �.� CITY MALL FRIDLEV !{,f' �32 NUMBER REV O�TE v�GE Os �PVROVED Br
L 612-571-3450 g�ap�g 6/26/00 � �
JOB ADpRESS 5855 Arthur Street NE
t LEGAL �OT NO. BLOCK TfiACT OR ADDITION SEE ATTACMED
DESCR. 38 Aud. Sub 4�92 SNEET
2 PROPERTY OWNER MAIL AODRES$ 21P PMONE
Daniel Echols 5855 Arthur Street NE 5 1-6146
3 CONTRACTOR MAIL AODIiESS 21P PMONE LICENSE NO
American Building Contractors 12247 Nicollet e �
4 ARCMITECT OR DESIGNER MAIL ADDqESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PNONE IICENSE NO
8 USE OF BUILOING
Residential
7 CLASS OF WOFiK
O NEW ❑ ADOITION � ALTERATION �] REPAIR ❑ MOVE O REMOVE
B DESCRIBE WOqK
Reroof - Tear OFF House/Gara e 26 s uares
9 CHANOE OF USE FROM TO
STIPUTATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMI7S AqE REOUIREO FOR ELECTRICAL. PIUMBING, HEATING,
VENTI�ATING OR AIR CONOITIONING.
THIS PEFMIT BECOMES NULL AND VOIO IF WORK OFl CpNSTRUCTION IONING S�. FT CU fT.
AUTHORIZED IS NOT COMMENCED V�IITHIN 80 DAVS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 1� OAYS AT
ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UNITS OfFSTREET PARKING
1 HEREBV CERTIFV 7NAT I HAVE READ ANO EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PqOVISIONS OF LAW$ VAIUATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED �2 2'�2 a OO � 1. I�F
WITM WMETHER SPECIFIED HEREIN OR NOT. TNE GRANTING OF A pERM1T s
OOES N07 PRESUME TO GIVE AUTHOiiITV TO VIOLATE OR CANCEL THE pERMIT fEE SAC CMARGE
PROVISIONS OF ANV OTHER STATE OR LOCAI LAW REGULATING CON- $83.25 Fire SC
STRUCTION O TNE PERfORMANCE Of CONSTRUCTION �2.27
P�AN GNECK f EE TOTAL F
� 6'° Z'6'(�PD License C$5 .00 $91 6
S�GNATUAEOFCON'AACTOAOAOUTMOA�ZE0IGENT iDaTE� NE PROPE ALIDATED IS IS VOUR PERMITt�
��•I /V 'i/�
S�GNOTUAEO�OWNEA��FOWNENBWLDEA� �DAiE� Bl �NS� � qpfE
NEW [ l
ADDN
ALTER
��og�
Effective 5/10/99
L] CITY OF FRIDLEY � P�/r oy
I l SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2
BUII..DING PERMIT APPLICATION � , � � . � , .; : , , :
Construction Address:
Legal Description:
Owner Name & Address: ��1��� ��� AyZ�h�� , Tel. #��(��)���'�p f�(P
Contractor: �� � � I� �����(`, LVIN LICENSE # � I �Q–(�
Address: � �ay� �� �l �°� � �j(.1.�2hSUl I l� Tel. # _ q�oi–�0�– �0��7
,, . — ,
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: I,ength Width Height- � Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
`Z�' s� _
.
Construction Type: �.�, �' �� �u,i Q� Estimated Cost: $ .5 (
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ .
DATE: � = ZZ. APPLICANT: Tel. �{ �.Sa �' �D� � �0 ��
Pemut Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��
$ �_ 0'1 �
$ / . / `l'
$
W r r
$
$
$
$
- ,
�,_ 9���'�-_r
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pernut Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 ger SAC Unit �
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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Cf[YOF
FRtDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 23, 2004
Mr. Dan Echols
5855 Arthur St NE
Fridley, MN 55432
Re: Final Inspection at 5855 Arthur Street NE
Contractor: Residential Heating & Air
Dear Mr. Echols:
A mechanical pemut was issued on November 12, 2003 to install a fi�mace at your
address. According to the 1991 Uniform Mechanical Code, a final inspection shall be
conducted on the work authorized by this permit. As of this date the final inspection has
not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your pemut open for another 30 da.ys and if we do
not hear from you within this time to set up the inspection, the permit will be marked "no
inspection called for by homeowner after notification" and expire the permit.
To set up the inspection or to have any questions answered, please contact the Buildi�zg
Inspection Division at (763) 572-3604.
CinrPrPlv
DJ/mh
Building
Inspections
763-572-3604
DATE �`11V()l;
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:
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MA
�L�v�r S�-. N. �
❑ OWNER �CONTRACTOR
L ADDRESS
ADDRESS: � � CITY
PHONE��j � ,,�j�" �- �
NAME:
STATE LICENSE #
ADDRESS:
PHONE
❑ SINGLE FAMILY/NE�
❑ TWO FAMILY/NEW [
Renewal By Andersen
1920 County Road "C' West
Roseville, MN 55113
License #20130983
651-264-4777
❑ BASEMENT FINISH ❑ ROOF
� DECK O SIDING
NE W
WIN �
!N EXISTING OPENINGS OYes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS �
p►LL r G�� wx� BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USI1�jG THE 1997 U.B.0 FEE SCHEDULE)
_ TOTAL JOB VALUATic�lv e l.Q ► U l nl — ...,�.m.,..,.�. .�.,��
❑ HOUSE ONLY
❑ HOUSE & GARAGE
0 ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
��
J
Permit No..
ived By:
�OV �
Rec' d:
ATE ZIP
ATE_ZIP
❑ DRAIN TILE
❑ OTHER
HEIGHT
BA EMENT FMODE� 1N(' S1IRMIT�
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONC .� PORC F ci IBMIT•
1. Site Plan/Survey showing the existing structure
and proposed project.
2. Two sets of construction plans
3. Energy Calculadons
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ��.as -
$
$
$ �.a3
$ �, C1C?
$
$
$
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)
$ I550 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 Fridlev Attn�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID 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 i�
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not ;
petmit but only an application or a permit and work is not to start without a permit; that the work will be in accordance with the approvec
plan in the case of all work wh h requires iew and approval of plans.
SIGNATURE OF APPLICANT RINT NAME ('Q�� j/1 DATE J`'[ �U�"