AF - 44165SUBJECT PERMI
City of Fridley . 14841
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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, /"'1 � CITY HALL PRIDLEr 55432 NUMBER REV. DATE PAGE OF APPROVED BV
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----�• � si2-5so-3a5o 910-F15 8/S/78� � /
10B ADDRESS 5885 Arthur S'r1^�t N.E.
1 LEGAL LOT N0. BLOCK �� � TRACT OR ADDITION SEE ATTACHED
DESCR. pt. 2$ (P rcel �) A11t�.. Sl]b. �92 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Uaniel Echols
3 CONTRACTOR ° MAILADDRESS ZIP PHONE LICENSENO.
Gorham Builders 9050 Collins Drive, Anoka, 1�T 421-0998
4 ARCHITECT OR DESIGNER MAIL ADDRESS jj� ZIP PHONE LICENSE NO.
A�� � QF qi�p�j, DO
5 ENGINEER MAIL ADDRESS j'��� O�=A ��IF�� P CF�LSg NO.
(tll�'
� �a �rvFO�r, "S �ro �EV� �
8 USE OF BUILDING c� �y� �r� . uw v��+�y � ��,�L1' ! r.:.,,
Resiaenti.a7. t��' �NF�;;;«,:„,; .
7 CLASS OF WORK
X IdEW O ADDITION ❑ ALTERATION ❑ HEPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 42' x 26' D�,tellin and a 23' x 24' Ga.rage
9 CHANOE QF USE FROM TO •
STIPULATIONS pmvide a��t haxd surface driveway. Provide sod in the front and side
yarci�s. Provide truss design and verifying survey by September 15, 1978.
Provide trea.ted floor plates in basement. Provide comb«usti.on air to furnace.
WATER LOCATiON: 40.7' N.E. of Ptoperty Li.ne, 53.6' E. of Hydrant.
.
SEWER LOCATION: 11' South of Water Service
DRIVEWAY DEPRESSION COST: 16' + 6' x$14.50 =$319.00
�����5� �
Befare digging call Iocai u�tiliiies
SEP�tAT'E pERM�Tg RE�I��R�� �R iVtRe R LEPHONE - ELECTR(C - GAS E�c.
� E� 4 T���, P E. U� l����� ,�tv� S►��S. �. E C� U I R��? B Y I A� N
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCI FT3II1@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION R 1 1536 '�" rJ�.2 34,944 To �.
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 1. 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 $52, 345 $26.�.%
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � $I.39. %S yS4OO. OO
PLAN CHECK FEE TOTAL FEE
�� �-�°��' $ 34.94 $600.89
SIGNATU OFCONTRACTORORAUTHORIZEDAGENT IDnTEi '� WHEN PRO ERLY VALIDATED THIS IS YOUR PERMIT
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SIGNATUREOFOWNERIIPOWNERBUILDERI IDATEI � BLDG.INSP pATE
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PARCEL I
The Sout°i'�T�feet of Lot 28 as measured at right an�les to tt�e South l ine
thereof, in A!,ditor's Subdivision No. 92, Anoka County, Minnesota, subiect
to the rights of the City of Fridle,y in Arthur Street ��ortheast.
� � .
PARr,EL II
. �
The "lorth 72 Feet of the South 144 feet of Lot 28 as rneasure�l at riqht
angles to the South line thereof, Auditor's Subdivision No. �Z, Anoka
County, Minnesota, subject to the riqhts of the City of Fridley in
Arthur Street iVortheast. �
PARCEL III . �
��
•That part of Lot 2�, Auditor's Subdivision Mo. 92, Anoka County, Minnesota,
lying North of the South 144 feet as measured at right anqles to the South -
line thereof, togetFer with that part of Gardena Avenue vacated, also subject '
�to the �ights of the City of Fridley in Arthur Street Northeast and in Gardena
Avenue.� � •.
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CITY or-
FI��ULCY .
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' f��'t L�CATXOiJ f'CiR f2L"�IUf=fJTIJ�L BUILDIPIG PER��IITS ,
' (�1�.��V�, �L'iL'R/1TI0(dS, II�►llITIOtaS, OR REPAIRS)
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owca�rt: _ �__ )c�� , e i � c!t � %s � 13UZLU%32: �;'�_; � � �., ��.1� � � �
Adclzess : ' . naaress : �} �.,�c� ��'� j�� �s � r � � �� �.. �
Tel . I�o . : �� / -c�,� 9 Fl � .
rao. S�g:;
LOT: 1°avee / �
SPxeet: �'f�i u v � . .
}3LOCY.: ADDITIOP7 :
COI2NER L�JT: I2�SIDE IAT: �� SLTBAC}:: ��' SID�YARDS: /e./ �
I�ppliea'r,t attach to this fonn �ao Certiiicates of Survey of Lot and proposed
bui_ldinc� locatian drawn on these Cextiiicates. �.
DESCRI PTI01�d OF BUI LDI �G
To Be Used As: '
s'�v,�,/e -�v�.,. �•��� Front: °f� Depth: '��G Iieight: -2y
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Square Feet: Cu�ic Feet: �� �2
�I'ront: �Z 3 Depth: G'Y� Iieight: / �
� 5quare I'eet: ��� Cubic Feet: S/� Q
Type of �'onstruction: ____,��� Estimated Cost: $ �j� ��
7.b Be Completed: Alt. A Alt. B
Proposed Driveway t�Tidt-h If Ne�,� Opening Is Desired � $� $
(SIT� 12�VERSE SIDE OF SHEET)
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a
The undersigned hereby makes ap�lication for a permit for the work herein
s�ci�iecl, agreeing to do a11 �cork in strict accardance with the City of
Fxidle�� Ordinances and.rulings of the Deoartment oi buildings, and hcreby
declares L-hat all the facts and re�resentations st-ated in i:his application
are ta:ue and correct. See reverse si.de i'ar acldition�l inio:.�nation.
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BUILDifdG F�R��iIT FEt SCN�DULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection
of any building or structure, or for any addition to any existing bui]_dir�g cr strucL-ure,
or for any alteration or repairs to any e�tisting buildiiig or structure, upon applicatian
therefore, require the payment by the applicant for such permit of fees �o the amount
herein below set forth•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 permi� fee.
DRIVEWAY DEPRESSION: (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: 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 Sl�•20
�II _�\-�_ 1 �' Y �\
For the purpose of computing fees for building permits, 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 shall be at the rate
of $3.00 per each five hundred dollars ($500.00) o-r fraction thereof in �the cost
of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $?.50 plus $.50 state surcharge.
� : � � � � 1. � j
NOTE: Permits for construction will be issued a minimtun of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction.site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
� + � 1 ':\
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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NOTE: USE .I22 OF OPAQUE WMLL AREA ROI� � .��> �
F�tAME �ONSTRUCTION � � GONSTRi1CTIQN (Rj VAi,tJE
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WALL SECTION -`��'"E'T<//�Tl.if/�'�'� �..t�.�'r�!/� �G'%,�ig' ,f`,�E'�c'� � •,�7NJS� PAGE
NOTE: USE 12% OF OPAQUE WALL AREA FOR
FRAME CONSTRUCTION CONSTRUCTION (R) VALUE
FIG. !I1 b PLAN VIEW
FIG. �il� SECTION
FIG. /l�`h SECTION
FIG. #l3 SECTION
1. Interior air film
2 • ��'"G:'r� ��•
3.G „�T�ia
4 .'S z' c �o°P :-fi'.Tr�
5.3d�'• GY� 13'�.
b. Exterior air film
TOTAL ( R)
��Ui�= I�R= , r) �� �
1. Interiar air film
2 . ��= "G °i.� ���8
3. ,'''sa'° GC. Fii� i..a,.
4 ...°� 3� "' �'UfE-�6i ���E'
5, �,�°, >��✓� �j�,
r.l r..J
6. Exterior air film
TOTAL (R)
��U��=1/R= . o���f_�
FIG. �E1
C014B. "U"=( . 12
0.68
4��
e� . u
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. 5!e
0.17
/�.�°v
0.68
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X . �>F � )-F( .88 X • A6��G ) _ . �`�`7'�
. oii - , o$�?�
�r.�r . 4 ��
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1. Interior air film
2. 5�°''r %.�'�5 f°ri3 /'�iy
3 . ' "!-"I k' /"i iri -�'a i �?�
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5 . � :`' �¢ �,�,>'. l�.�f
6. Exterior air film
TOTAL (R)
������= I /R= . n � /
�r yf
1• Interior air film
�
3., `
4 . " ��� �
° � � n, •
5.
6. �vo„z�=°-�� air il m �
TOTAL (R)
"U"=1 R=
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/ , e� a
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y� � �
r:/ i ��' . °� ,
1. Interior air film 0.68
2. '
3• Exterior air film 0.17
TOTAL (R)
"U" =1/R=
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Weathcrstrjps Guide Coartractioa No. Insulation
�lindo�n � Doors Referenee Ou� Wa12 ' In� Wa� Ce�ing Roof Floor Kind How
� Y�o 19_
I�•� 1� Room Length /� Width /�'�" Height �� Fl.l �pp�o �,�'� Room 1.ength? 6� W�dth �'
V'Vindows and Daors—�rachage aad Ana Winr]ows aad poors--Crackage and Area
Width Helght No. of Llnetl it Ana Wldth Helg4t i�ia ot Ltneal tt. Ares
No. ot Daao ot Dane Iivhte ot aract �. it No, ot �ne of paee Ii�hls ot araek eQ: 1t
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Infiltration 2 � �� �i Lv6ltratioa ��
L61
Glaaa A 9 S'� ��a Glaae
F�cn• wa►11 '�'� Ea�,, waU �
Net exp. wall �� $e� ��� `;� Net esp, w�all
Int. wall �,�, �
Floor ,� � Floor � �
Ceil. D Ce7. �> �� �,�
Total Btu. Total &u.
Required sq. ft. E.D.R. or sq. ins. W:A. L�eac�er area Requ�ed sq. #� E.D.R. or sq. ms. W.A. Leader are
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Fl.� � �a� � Room � Leagth �, ° Width l F� ° Height � ° � Fl.) �'6 ��1�°�y R� I �nsa, �a � � Width �° ° Hei$ht � °
Windows and Doors—Crackage and Area Windows and Doors�—�Crackagt and Area
Width Helght No. oL Llneal ft Aras Wldth HelBht Na'oL L1nea1 fc. Area
Na of paee ot pane llahta ot orao$ q. tt. ND. of pane ot paae 116Lte ot craak sV. tt
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Fl. �. 9�� �Room � Let�t6 /�� Widt6 /,' HeiS6t n. e p Fl.� �;? � Room I Lengt6 �' � Width ' Height �'
Windows aad Doora—Crackage and Area Windows and Doors—rCrackage and Area
Wldth Helght No. ot Llneal tt Aros Width Hefght Na ot Llnea! tt Area
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Weatherst�ips Guide Constrndion No. Inaolation
Cdindows � Doora Reference Ou� Waq ' Int Wa$ Ce�mg Roof Fl�r Kind How Applied
Yes— o X�o 19_ �
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1TVindows and Doors—Crackage and Ana Windows and Doore--Crackage and Area
W1dth Selght No. of Llneal it, At�s Wldth 8efght Na oL L1uea1 !t Area
Na ot Dano of psas Iivfite ot cract �q. fR Na of pane o[ �,ee ll�ht� o! cne@ eQ: [b
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F�p, wa1� �' . �
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F1oor � °-i �%' p! � _
Ceil. ��� Q �
Total Btu. �
Required sq. ft. E.D.R. oz sq. ins. W:A. l.eader area
Fl.� /�� ���oom ( Length , ��� ° Width G',�' ,�' Eleig�t <
Windows and Doora--Crackage and Area
wlath xefght xo. oL Lineal !A eres
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Tota� Btu. .
Requued sq. $. E.D.R. or sq. ins. W.A. Leader area
� F'1. ih"�� Room � Lengt6 �`�, ° p Width � °
Windowa and Doors—Crackage and Area
widc6 xelgbc xo. ot Llnaa� it Area
Na ot nane ot psne I1eht� ot crack eQ. tL
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Net eap. wa11
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Total Btu.
Requued s�. k. E.D.R. or aq. ina. WA Leader aren
�tf817011
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Net esp. w+all
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'fotal Btu.
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Wldth Helght Na'oL Lineal f�. Area
Ne. at naY6 Ot DSII! 1lRLia OL OtiCk [a. iL.
Infiltratioa
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Windows and D�ra—Crackas�e and Area
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8431 UNIVERSITY AVENUE N.E... FRIDLEY, MINNESOTA 56432
TELEPHONE ( 812)671•3450
` � -� �; December 27, 1978
�;: ,'
Mr. Gary Gorham
Gorham Builders Inc.
9050 Collins Drive
Anoka, N�1 55303
Re: Final Inspection at 5885 Arthur Street N.E.
Dear Mr. Gorham:
A final inspection was made on December 27, 1978 of the above structure
and the following items were noted which must be completed before the
building can be finaled out;
1. Provide combustion air to furnace area by January 19, 1979.
2. Provide sod in the front and side yards by June 1, 1979.
3. Call for a plumbing final inspection by Januazy 19, 1979.
We'will e�cpect the abave items to be completed by the scheduled dates
when reinspections will be made to determine compliance. If you have
any questions on these items, please contact me at 571-3450.
Sincerely,
DARREL G. CIARK
Qommunity Development Adm.
DGC/mh
a •
SuBJECT ,
c�ty of Fridley ' 2 9 5 41�`
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
r
S � RECEIPT NO.
� `y �����_ COMMUNITY OEVELOPMENT DIV.
r � � PAOTECTIVE INSPECTION SEC. ����
� �
� � ,
� � �'�'1 � CITY HALL fRIOLEY BS132 NUMBHN REV OATE PAGE Oi AVpNOVED BY
�'----�= �•' 612-571-3450 910-F15 5/24/99 / /
JOB ADDRESS 5885 Arthur Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACFIEO
oesca. pt 2g Auditor's Subdivision ��92 SFIEET
2 PROPERTY OWNER MAIL ADDRES$ 21p PMONE
Mark/Rathy Griebe 5885 Arthur Street NE 574-7019
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Same
4 AFiCHITECT pR DESIGNEF MAIL ADDRESS ZIP PMONE LICENSE NO.
S ENGINEER MAII ADORESS ZIP PHONE LICENSE NO
8 USE Of BUIl01NG
Residential
7 CLASS OF WpqK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof House & Garage (28 Sq) Tear-off; Install 3 skylights
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code. Install R-19
insulation around side of skylight framing.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYPEOFCONST OCCUPANCYGROUP OCCUPANCVLOAD
SEPARA7E PEFMI7S ARE FEGUIREO FOR ELECTfiICAL, PLUMBING. MEATING.
VENTILATING OR AIR CONOITIONING.
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. fT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOF A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOIiK IS COMMENCED NO. DWLG. UNI7S OffSTREET PARKING
I HEiiEBV CERTIFV THAT I HAVE REAO ANO EXAMINED THIS APPIICATION 1 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORREC7. ALL PROVISIONS Of LAWS yq�VAT10N SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @ @
WI7H WHE7MEii SPECIFIED MEpEIN OR NOT. TME GRANTING OF A PEFiMIT W2,899 y�1.�F�F
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE Oii CANCEL TME pEFMl7 fEE SAC CMARGE
PROVISIONS OF ANY OTNER STATE OR LOCAL lAW REGUTATING CON- $83 . 2S Fir SC �L . S9
STRUC710N OR 7NE PERFORMANCE OF CONSTRUC710N
PLAN CMECK fEE TOT EE
7.58
� TUAE Oi ON' Oa OA AUTMOA�2ED sGENI ATE� MEN R P VALID MIS IS VQUq�R��
/���
t 1
- G�/
S�GNGT E O� OWNEAi�� OWNEABWLDEp� IOAf i G�NS� q6TE,
► v -
r�w � �
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII,DING PERMIT APPLICATION
/� P
Constcuction Address: "7 �v
Legal Description:
Owner Nam
Contractor:
Address:
n
�� � ���1
�
Tel.# ��-S%��d/�
MN LICENSE # �
_ _ r' Tel. # �
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTI�R:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width HgtlGround Sq. �t
J (�
Construction Type: Estimated Cost: $ ��
�
Driveway Curb C�t Width Needed:
DATE: � 9 APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ 3, a5'
$ .
$ ,.
$
$
$
$
$
$
� �
fI
�
CITY USE ONLY
Tel. #
�� ��
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,Ot� Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. °B" Above
$450.00 Conservarion Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�
�s i�
R /—� �N M� {rCC i
►
:h
%�j� �
�� � .
' ,, ..
%� , � � i
STIPULATIONS: /� �/Jr%�''' // /� j�yf �,�j�
1 � V V - � ���/" " " i///,�
L�
i� �� �� �
BUII..DING PERMIT FEE SCHEDULE
Tiie Chief Building Official shall, 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, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,0�
$2,�1 to $25,000
$25,001 to $50,000
$50,001 to $10U,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
M���.�
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional$1,0(10
or fraction 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
$1,0(� or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $SOO,OOQ
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Sireets On1y)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alterna.te "B": Removal 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 FO�JNDATION
Permits for construction will 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 S�uvey of the lot, showing the location of the foundation once it has it has been constru��d �vill
be required before proceeding with the framing.
� _� _ ,,,
Building
Inspections
7. 63-572-3604
SITE ADDR�S ,��
'I'I-IIS APPLICANT IS:
PROPERTY
OWNER�
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
....
1VIECT�iANICAL
RESIDENTIAL APPLICATIC�N
CITY l�F FRIDLEY
❑ OWI�iER
a�nDt�ss: 5 �8�
YOUR E-MAIL ADDRESS
�ONTRACTOR
Permit No.: ,�. ��� – ���
Received By:
�/ � �
Date Rec'd: ' —
CITY I� Yl Gt �.P n ST
PHONE: `� 10.�j ' ?✓-�9 — Z 87/
COMPANY NAME:
IN�a �1C.
CONTACT PERSON:
STATE LICENSE # EXP DATE
ADDRESS:��� �� 1» C1(Z L�Y Crrv (�� CL-��P t, l STA'I��ZIPc�„��
PHONE��(,�3Zaa `1S�i�i FAX �IO� �Z3�S�S
TYPE OF WORK: I � �W
FAMILY ❑ TWO FAMILY
�PLACEMENT
❑ TOWNHOUSE
❑ pLTERATION/REMODEL
DETAILED DESCRIPTION OF VJORK e, C�L �V� ��' �-'�
PER MS 16B.665 the permit fee is a minim ameofa n�� ��e� exc uding thefixtures $Crhs Oho Id reflect o y there st of labor )
unprovement, installation or replacement of
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor __
x.05=
FOR PROJECTS VJI�RE LABOR EXCEEDS $SOQ, FEES ARE BASfiD ON $10.00 PER FLXTURE, EXCEPT W1�K� N�Tm' �TURFS' (1NDICATE TOTAL
1.1i.J]VBER OF EACH BELOV� ��I)� MODEL: Vu � L �� S�z�rsTU d 1 �, uu
EquipmentInstalled . , M�C'' � MODEL: 5��� • -
Iv�G: ,__--- SIZFJBTU
MFG: MODII.:
gIREpLACE (GAS) $15.00 GAS RANGFJOYEN $10.00
,_,A/C 525.00 —�pL,pCE (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR TO AIR EXCHANGEER $15 �F�ACE $35.00 _GAS UNTP HTR $10.00
BOII.ER $35.00 � _Gpg DRYER $10.00 POOL HFATER �'35.00
CHIMNEy LINER $10.00 GAS PIPING $10.00 VENI�ATOR $15.00
DUCT WORK $10.00 — �.�.. - - _ .: � � � . � ' ����
. � .. _.. ���a " ��� _ .._ _
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DLTE $ Number of ftxtures @$25.00 x$25.00 =$
� Number of fixtures @ $35.00 1 x $35.00 = $ ° -U l7
State Surcharge = $ .50
Tota1= $ � �J17
TF�.S 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 in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota �Construction Codes; that F understand this is
not a permit but only an applicarion for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all rk which requires review and approt�al of plans. _ l
SIGNATURE OF APPLICANT ,
`� Pxrrrr x.a� ' ' �_DATE
_,r _
City of Fri ey
jZS'�� Building Inspections Department .
� 6431 University Avenue NE, Fridley, MN 55432
763-572-3604
� n v• ���_Sm_4477
�
��
REQUIRED INFORMATI�N NEEDED TO PROCESS PERIVIIT
RESIDENTIAL PERMIT A.PPLICATION HVAC
0 NEW HOMESIADDITIONS ❑ EXISTlNG HONIE ❑ MAKE-UP a4IR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below) .
�. Oi.l or solid fuel ]MC Chapter 7 with MN Amen�.ents
b. 1�aii�ra�L'ras-or-Prngan-�GC C��ter 3 with MN Amendments _ ,
2, ��ake_up Ait (See note below)
a. TMC Chapter 5 with MN Am.endments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel oth.er tha.n gas IlViC Cha-pter 8 with MN Amen.dments
REQUIRED FOR NEW HOMES
4. Hea� loss & cooling load per room
a. Required on new covsfruction 1MC 1346.0312
� 5. Veniilation . �
a. Per MN Energy Co3e 7670 or 7672
6. Duct Design Per IMC 1346.0603.2 -
a. ACCA Manual D _
NOTE: Centerpoint Energ� Mechanical Code Guidelines sofiware may be used for �
camliv.siion and make up ai.� calculations .
' .
/
Building
°Iraspectiions
763-572-3604
763-542-4977 FAX
nA� /d- �
SITE ADDRESS
TH1S APPL[CANT IS:
PROPERTY OWNER/
TENANT
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERT1FtCATE OF
�►S��
1'ROPER'[Y TYPE
TYPE
TYPE OF WQItK:
DESCRIBE WORK BfiOUG
SIZE OF IMPROVRMFNT
From: 763 586 7954 Page: 2/4 Date: 12l4/200912:57:59 PM
BUILDING
R.�SIDENTIAL APPLICATION
CITY QF FRIDLEY
YOUR E-MAIL ADDRES$
T.
OWNER CONTRAC'I'OR
�ME� G G1 N_�
nnax,ESS:__ S��D-- �J r"� �u-e
PHO�: G�l�--d'( D-3 �.3
xan�t�:_ .�iOB.r �� 14
STATE LICETlSE #
.4DDRFSS: �p
'HONE - — �—j
D SlidCiLE FAMILY/NEW CONSTRUC'fION
i� TWO FANIILY/NfEW CONSTRUCTlON
❑ ADD1TlON E] GARAGE
❑ BASEMENTFINISH �,ROOF
0 DECK O S1DlT1G
❑ SWIMMIT
❑ NEW HOME CONS'i'RUC170N �
0 MAINTENANCFJREPAIR
�� � ��, � � � �
R ' � /
N[FMBER OF S�ARES /
S�ARAGGS
PROAOSED SIZE:
PROPOSED HBiGMC
�IDIItiG
t] �nyl
O Alummum
❑ Other
WINDORS
It� EXtS71TfG OP�IVINGS pYes ❑Nc
OR FOR NEW OP�VINGS-D$SCF.ISE SIZE pF
OAFNRVG CNANGES 8c
TOTdL JOB'VALI
Permit Fee
Plan Review
Fire Surchargc
Suroharge
License Siucharge
SAC Charge
C�ub Cut Escrow
Erosion Canirol
Patk Fee
Sewer Main Charge
IJQ HOUSE ONLY
�ti HOUSE 8c GARAGE
❑ ATTAC[iHD GARAGE
O DE'fACk� GARAGE
OSnffit
❑ Trim
O Fascia
LOCATfON QF W(NbOWS
Permit No.
Received By:
Date Rec'd: �
-iw�. ciTV !" STA
—Fx 76� - s'�b - ,
� �
EXP DA7E ,3
a'� �t� � �
FAX
SfZE
sroxlss
HED ❑ Wft�iDOWS
O DR.AIN 'f7LE
Q pTHER
iP00L
ADDI'iiON
�
�.
_ HEtGHT SQ FT �i U '
�ASEMENT RE4(ODE .ihlC S, fR�,trr
i. Existing Fl�r Pian
2. Proposedfloorplem
3. List. of suucnu�al :nemyers m be used
FOR NEW COIVSTRUCCION INCLUDI1dG DDCKS,
ADD]770NC .e � RCi�S UBMIT
!. Si6e PIaNSurvey sfrowing the existing shvcuaes
a� proposed project,
2• 7'wo ses of constr�tion pians
3. Energy Calculattona
FOR W[N�WS — PROVIDE U-VALUE AND
MANIfFACTl1RE STICKER ON 4V1VpOl1'.
uu a�w a e4.�,GY NuMSER OF W[Np0 WS
ARE BASED ON VALUATION, iNCLUDING THE COST OF LABOR AND MA'
� ����' � C�THE 1997 U.B.0 F�E SCHEDULE)
� See Back Page for Fee Schedule
$ � 65% of Huilding Permit Fee
� Q01 times the toal job valuation
�. `5�` .00OS x Permit Vatuarion Minimurn $.50
$ 55.00 (State Licensad Residentiat Contractors)
$ $20d0 per SAC Unit (Plans to MWCC for determination)
� ft+6�= fix$22=$
� $4Sfl Conservation Plan Review
� Fee Det�mined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ r�' Make checks payable to: Citv of Fridlev e rr�..
TFRS IS AN APPLlCATfON FOR A PERMiT-N07 V.AL1D UNTIL PROCESS6D
I hereby apply for a building permit and I acknowledge that the information abave is complete and accnrate; that th� work will be in
conformance with tEte ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applica6on for a permit and work is not to start without a permit on site; that the work will be in accordaace with the
apgroved plan in the case of aIl wor which requires revi and approva! of plans.
SIGNATUREQF APPLICAt�1T � v. PRINT NAME J GcJ7f .,( , Gr/1�ilO DATE Y d� U
� � > �
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Building
Inspections
763-572-3604
763-502-�9?7 FAX
DATE �
S['CE ADDRESS
TEDS APPLICAVT IS:
O�'VNERJ
TEVAfYT
From: 7633555266 Page: 1/3 Date: 1/1 3/201 0 1:39:14 PM
PLUMBING
RESIDENTLA.L APPLICATIDN
CITY UF FRLDLEY
, tO YOUR FrMAfL ADI3RES5
�� 5 � r� �,�y CJ'�`
D O�YN ER j�I' CONTRACTOR
Permit No.:281U �b�'
Received By:
NAME: SCe�T� 1.�.O.V� M����
ADDRESS: � Y�O • io� A�� CiCY �Y ���2.� STATE�"�1P
PI{OIV$' ��Z." O�� - 3a3sr
•\C0.� �w�-.
SUBMITA COPY QF STATELICENSE � C? S�$Z;P � p M EXP DATB t2 �'3\ Z.Q\ °V
LIC NSE, BOND AND STA'IE SOND � o� �^7 8 CD CI EXP DA7E� 3 � �J � O
CERTIFICATE OF ADDRESS: �qZO �,�V �� ��CITY �`C+�w. �-�.�'� STATE �1�LIP 5 S 3�'�
INSURA.NCE pHOIVL ��a3- 3S S` SZ�o�P Fp}� ��03' 3S�" j9i'�LS`
PERMIT TYPE
Tvr� o� wo�:
T�IIVGLE FAMILY
❑ NEW
DETAILED DESCRIPTIO�I OF WORK
p 7'WO FA.vIILY ❑ 70WNHOUSE
�REPLACEMENT
�.�:`
S�.tswe��
FEES ARE BASED Ol� $! D.00 PER F[XTURfi, EXCEPT WHERE NOl'ED. FIXTURFS: {IND[CATE TOTAL NUMBER OF fiACH BELOV�. 11IN1MU�i FEE
$35.50.
�,BATH SINIULAY FLdOR DItA1NS Sii�WER aWATER ('[P[I�G
� BATHTUB GAS PIPING (NE6D C(7Y LlC� _ SW[M[vllt'G POOL _V{iATER SOFfNEIt (S35)
CLOTHES WASl�ER 3 KITCHEN SlNK WATGRCLOSET HACKFLOW PRfi�'. (SIS)
= DISEiWASHER ._ LAUKDRY TRAY _WATER HEATER (�i5) � FOR iRRiGATION
_ WATER METER _ OTHER
Number of f�xtures C$ I0.00 � x$ i 0.00 =$�d•
Number of f�xtures C$ f S.OQ � x$15.04 =$
Nurnber of fixtures @ $35.OQ
State Surcharge
x $35,� _ $
$ � .50
THIS IS AlY APPLICATION FOR A PBRMIT-NOT VALID UNTLL PR(7C�SSEO
I hereby apply fur a plumbing permit and I scknowledge that the infortnation above is complete and accvrate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and witli the Minnesota Construdion Codes; that I uaderstand ihis is
not a permit but only an application for a permit and work is r�ot to start without a permit on site; that the work will be in accordance
with the approvc�l plan in the of all wor w tch requires review end appraval of plans.
SEGNATJRE OF APPLICAKl' �����°�-'�^ PRN'f NAME ti lE.v r..� C"1�vc.✓O. DATE `Z �� 3 L\ C7
PLEASE NOTE: SEPA1tATE PEAMITS ARE REOUIRED FOR BUiLDING_ F7_FC�trc�Ar. at�m �r�ra anrrr.ar. �arnuu
City of Fridley
Bailding Inspections Depax�trnent
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX; 763-502-4977