AF - 35356City of Fridley, inn
6431 University Ave. N. E., Miinneapolis, Minn. 56432
BiTILDIl�TG PE�MIT
�: � - - „ . - . .j►j►
pw�er; _ Ri��ha�d Miller Homes B�d�. SAME
Aaaress 1600 Rice Creek Road � Ad� SAME
-��193 -.
6131 LOCATIOiV OF BUILDING
No. .����� street Ben'�amin Street par� of �,t
Lot ._..__ 2 2 ._..__ Block _..� 3._...,_....__ Acldition or sub-niv�ton .�.._ B r i a r da 1 e
Corner Lot .....___.._.____ Inside Lot X Setback 3 5� .�. s�deyard 5� and 10'
�@� IIevation _.�_- 921.05 �(a�[��IIevation 9 � G..O 5 Md n i rm im
�rvP Tov af Footin� y
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To be vsed as:
DESCRIPTION O� BUIL�ING
Dwellin� ___` �.o�t39' 8" �p�, 34' Height 20' Sq. � 1072 �� 21,440
Garag.e �nt 20' �p� 22' H���t 10' �� 440 �� ���� 4,400
Type oi Construction �.0�� F rame �, �� .,� 3 0. 0 4 6 To be Completed June 19 7 3
STIPULATIONS: Provide a hard surface driveway. Provide a verifying survey
before ��pping. Stqxm s_� ��r�r � �-� ��7�� ca���a.tEr-�� �taken�ut.
�= � ';�' ° /� � -'� � f� �` ,� ' K '�. �' y° � - ,� �'� ���� � " � ''' - ,.
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SEPERATE PERMfi'S REQUif�D FOR �Af1RfiVG,
I�ATING, PLU�1BiiVC� ANQ SlGIVS
WATER LOCATION: Stopbox 10.5 Sou of Sewer. SEWER LOCATION: "Y" 3' North of Manhole
In considera,tion of the issuance to me of a pexznii to consi�uct the building described abov� I agree to do
'�he 1�posed work in accordance with the description above set forth and in compliance with all provisions o#
Ordinances of the city of Fridley. � °
_ ��� � c �
- ��.5..1�St2i�° 4�irrharQ�_ ..
In consideration of the payment of a fee oiF �• � 0 , permit is hereby granted to Ri chard Mi l ler Home
to construct the building or additi.on as described above. This perm3t is granted upGri
_ the express condition that the person to whom it is granted and his agents, empIoyees attd worl�en, ia all work
done ui, around and upon said building, or any part thereof, shall conform. in all respects •to ihe ort�in$nCes oi
I�'ridley, Minnesota regarding location, construction, alteration, maintena.nce, repair and moving of bwll��
�� city limits and this permit may be revoked at any time upon violation oE an� of the prov35�tona oi Said
ARREL CLAR ��
NOTICE:
Thts permY! does no4 cover the eona4rucfion, installaHon ior wirin8. Pw�b�B► 8� h��►9. ��' or water. Be wro to ses
fho Building Inspeeta� fa� separate permiis fo� fheae hems, i
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560-3�50
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ANOKA COUNTY
6431 UNIVERSITY AYENUE NE December �q, I972 FRIDLEY, MINNESOTA 55421
TO WHOM IT�MAY CONCERN:
Whereas the City o Fridley has is ued a building permit to construct a
structure at �/,3 � ,� ,,
Whereas the permit is dated prior to January 1, 1973 and the City of
Fridley did not collect or receive any "Service Availability Charge".
Therefore if for any reason the Metropolitan Cauncil and or the rtetropolitan
Sewer Board assess or bill the City of Fridley a Servica Availability Char�e for
this structure or sewer hook up, we the undersigned agree to and will pay the
City of Fridley for said chargas. �;_.' n ^^ .�
Witness �
5igna
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lond 0lon�i+►g �f�r�� 1���� � 6815 Migl�wa�r Na. 6S N. E
lond Svrv����� • � ( MinneopoHti,
s���L ��s1i�g (� !'l /1�l��'i�t►'i1 � ' %��• Minn. SSi71
t�vil Eng�neer�rsg
� � 1el�phone 78�-60��
Mun+crpal ErFgineerin0 En�inee�r� Bt SiU,iV��t)t'� A•ea �odo bli
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���,�� ��� �, ����i„o, Certificates of SuYVe�„r of Lpt aad proppsed
�mt�.�.�$ ls�cati,� d� � #�s� Caxtifi.c��ess
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�������TI�N OF �UII���AiG
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$�uax� �'get; ¢4(� Cubic ��eti '��� � ... . .
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��+e� #� al.l �h� ��s �d ���esentatio�s �t.ated i� t��s sp$►I�,catia�
a�� � a�$� narrect� .
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t��t �tl�ve�a� ia�s�r TO$ A�a�:�O�ai IItfO,�Sti�n►.?
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-�U�LATN� P�IZMIT F�� ��H�DUI�E
S��Q�T �. �'h� TAepecto� pf �ui,ldings sk�al�, be�azQ iasuia� perm�.t� for �he
��;��t�on o� a,ny build�ng o� s�ructure, ox fox any addition to any �ae�.st�.x�g
���.�dis� ox stz�Gture, o�e fo� any alter$�ion o�c �epai,rs �o �y ex��tir�g
���,��� o� stxucl��are, upon �ppli.�ation theref�re, requ�.re the pa�►me�� by �iis
a��1,i��� fvx' su�h per�.t af �ees �o the a$tount herein balow seC f�ar�h ��d �
�i�� ��x h�ax�#.� p�swided � �o¢wiX a
UNT�4RM �i,1T�LDT.�TG CODE � 7.`YPe $� 2� 4-; 2. I5 �ar each �rae t.hous�d cultic
�e�fi� g� f�ac�3.on Ch�7�ea�. i,n ��� cubical c�at�nts. �YPe �& 5= 5�.85 �o�
�a�$ r�r�s �ousand �b�.G fseC, ,
��D � T �fl1�1Ai, � NF�AT � ON
FA� ��e �►uxgla�e g� �oanpu�:�ii� �ees for building permitsy the cubical cantents
Q� �y building a�r addition, i+� determined by muitiply�.n� �he �ound area
�ay+�� �Ant � 8oi�a� �� �f ) ine,�,es below �he fl�o�x line o� the b�.sement
� i�i� C���a� �a �F�e average #�eights of the uppeT surface or to the avera�� r
��� �e �oc�� �face v� �he uiain �ah�e vf� a pi�ched xao�.
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� �c�i� o� al�e�at�om$ �o 'ax� existin� �t�tu�ceg �e f�e shal�. b��e �� �he
��,�� o� $���+D {�r +�,�, ��,ve ��qtc�red dollar� �$�U@.Ut3) aa� f�a�ti�. �h��ao� i,r�
�� c+��� �� ,�1�. �rrs�aed wQ�kA
%�a c�e ai�a�l ��+�s fo�c �Y Pe�i� a� se� #�� �.0 S���ian 2 b�
i�a �a� $�.tNi.
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V������Ti�N 0� ���TNUA�I(3N
�tp�� ��its ��x ��#.�utr,�.o� w�.l�. be �.��ued a ���m v� �4 ��trs ��� CYts
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' � ��'�.�i�d i5usv�y v� �h� �.�� �a$ ti� �ocat�; �� �h� �auAdati�„ o�� ��
�� ��.s�i��sda wiii �+ a�qu3red before Froceedin� w�l� ��r�i�,
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Qf t��ugax��y i� bse� �stes�.
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City of Fridley
4T TME TOP 0� TME TiMIN�
rti.---~--� COMMUNITY DEV[LO�MIENT piv.
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Job Address
b131 NE Benj�,min St.
Richard Nfiller Const.
Contractor
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i1��ECT
PLUM�I��r, PERf9IT APPLICATI��J
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Aaaress one
1600 Rice Creetc Rd. 781 1600
ress P one
733 Marquette �ve l�pls.
Use
R�s.
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Plumbin Fixture Rates; Np, gATE TOTAL
Number F u�tures x $2.00 �_
Future Fixtures '_� X $1.50
New Fixture-Old Open. x $1.50
Catch Bsstn x $3.25
Water Heater-99,000 BTU x $3.00
Ground Run Old Bldg. x$3.25
Elec. Water Heater x $2.00 �
Gas Fitting Fees:
lst 3 Fixtures 1 X$2,00 2.00
Additional Fix tures
X $ .75
Gas Ra,nge-199, 000 BT[T x$5.00 !
���� �� 1
II� � Repairs & Alterations
� See
I Description; Inst. (1) Gas Ra,nge Code 3.00
� ----
I � State Surchar�e Class "A'� Surcharge .50� .50
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i � � � TOTAZ FEE $ 5.50
���
� !The undersigned hereby makea application for a permit
for �he wox�k herein apecified� agreeing to do all work .
� in atrict accordance w ith the City Ordiaances and rulingj
of the De�axtment of �uildinge, and hereby declare that �
,� a11'the facta and repxeeentatione stated in this
al����� �n a carrect.
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HEAT LOS3 CALCULAilON9 � �� �1 �' �� � Jr� ,;�� ��� !�i',�-��� ��5�t���
Weath�ra�rips G�i� ' C01l�iNt�IOA NO.
WirtdQws I Doon Referenee Out. Wali Int. Qlall Ceiling Roof Floor ' Kind
Yea— o ea— 0 19_
`� Fl.� a.�i /,�.. Room l.ength ,� Width Height "� � Fl.� �`';��,,;..�. •Room�l
Windows and Dooro—Crackage and Area Windowa a� Doore—Cr
tVldth Helght No. ot Llneal tt. Are� � Width Helaht Na
No. ot pana ot p�ne It�ht• ot crack �q. tt. :; ��, No. ot Da�s ot Dsne lfs
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1n61cracion , � �;�" ; �,
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F�ep. wall / � e
Net exp. waU f .rir �� � 'I
Int. wal)
Ceiling . l U �. '�
Floor
TotalBtu. � � � y,.�
Required aq. k. E.D.R. or aq, in�, RJ.A. L.eader area
"� Fl. '" Raom� Len�th � Width O,. Height ` Gi '�
Wiedows snd Doors—�racke`e and Area
tdtA Hal�ht No, 0 Llneal tt. Area
No, ot D�n• ot �ns IIt11t� ot crack q. 1t.
G� .� ���_ � a�. � r� �
Coef. Btu
1a61trahop G -r .�
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Glaas �� c �. , A ,
Exp. wall ,� � ' / p
Net exp, wall � ;7 ,��,', �� �
Int. wa()
�'� Ceiling � � ;+ . .� f' �. , � � ..
Floor -
Total Btu. a
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Required sq, ft. E.D.R. or s. ins. W.A. Leader area
Fl. -�- <�� Room ngth i; Width ,.�' Height ���'�.,. �
Windows �nd Door�---Gsckage aad Area I
WE t He1�At p, ot Lleaal Lt. Area
No. ot pan� o! Daes Il�b�� ot crack �a. tt.
Btu
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Infiltration
Glaaa
Fap. wall f � �
Net exp. wall
Int. •vall
Ce��ing
Floor
� How �
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and Area
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Total Btu. � R;
Required aq. ft. E.D.R. or aq. ina. W.A. Leader ares /
FI.1 ' e•, ti Room I Length �g Width � eig t
Window and Doors—Cracicage and Area
W1dth Hel�ht No. ot L1nea1 (t. Are�
� No. o[ pans ot Dane U�ht� ot cruk �. [t. �
� � � °' }'; , �;s. "' , `' i',, � � ` .5 ��,�' °
3 � �, �
Infiltration "
Glasa. _ .
Exp. wall ' �'' m
Net exp. wall
Int. wal! } <..- _
Ceiling ,�. �`�
Floor
Total Btu.
�
�
Y�
�r "��.
�, ' °� ,� ��,,E�
r /G-�.- ca
.� ,��,_
�' � e
Required aq. ft. E.D.R. or sq. uia. WA. [.eader ares /
F7•� �-,,.� Room I Lengtb /U Width � U Height G;
Windowa and Doon--Craekage and Aroa �
Wtdth Hel�ht No. of Llneal tt. Aee�
No. oL pane ot pane tl�ht� ot rack p. tt.
� - ` ``,% �:r ..� � _` e , �'4
/ �� jr%1- P
Infiltratioa ` � - � �f. Btn
�',�-��.-„ . In6ltration ,� � �,� ��,
Glas� Glaes ' P; �
Eup. w�ll ,� � Exp. wall s, S• � s
Net exp, wal) �r,�'�t --� �� ,�- • Net eap. wall � �
Iat. w�!! ' �
� ` Int. wall
Ceilin �" �
S -� �a` . = s��." jr �� Ceiling a;' ,� �---`'
I��oor ,.,.----- ._" Floor � -°
�i � � ,� l �,a
Total Btu�. �'
� . ; �.. Total Btu. ; �, -� � �
Requiret� sq. ft. E.D.R. o� e. ine. W.A. Leader area � Required aq. ft. E.D.R. or sq. ins. WA. l.eader area /
Fl. , � Room Length ' !.; Width �' / Height '� � �. F'J.I ' ,6,-6-,_�;�,, ,Rooml Length / 'i W;dch / �' Height ^'
Wiadowa^and Doors—Crackage and Area ,, Windowa and Doon—�rac�age and Area
IdBh H��tbt g..gt Llnul tt. Area - Wldth He4Qht No. ot Llneal tt. Aro�
� No. o! p�n• at pans 1� At� ot cnck �p. tt. � No. of pane ot pane Il�hb ot enck p. !t.
6 ^ ✓ .«� Fi �- f 'y ..� -! e� � �.. ���%
1n61tration
Glae�
Eup. wall ,� � �
Net esp. wall
Int. wsU
_Ceiling -¢. .� ��
F loor
Total Btu.
Required aq N�, �.��
Coef. Btu Coef. 8tu
� �'�`� - - �: , � In6ltration - � �, ! �' : %' ;,
� �`� i',.� e�"-., 2 , Glaes ,�.- " �~ p� „•
�>.� F. ,�-e�--�
�' '�"' Exp. wall ` ' . < <
,�° �% Nec exp. waU e, �•
Ynt. wall '
�.°.� r"•� `` `�' Ceiling
Floor �
" `" °'��° ,�"r Total Btu.
or p. ina. W.A. Le�der area . Required aq. ft. E.D.R. or aq. ins. WA. Leader arca
c .
,r
��
�
:
'' �r .
HEAT i.0�►4 CALCULA�ION9
• Weath�roiripa G�e • COpl�NClIOA NO. ��a�
�'p Windowa I Doora Refereace Out. Wall 1nt. Q/all Ceiling Roof F7oor ° Kind H�y
Yea— o Ye�— 0 19
�•� "f -• ?�,.� u#Zoom l.ength i Width �' % Height �.� �m �pg�, Q/idth
Windov►� and Doors—Crackage and Area Windowa and Doors--Crachage aad Area
No. t D e ot Dane Iltht■ ot crack ,p =t. �1dtA Hel�ht No. ot Lineat !� Ana
No. of pane ot pane Utht� ot enck ra. [t.
�� �� '� �_ J �' �- ,
°�; ,. o:� ..� � . -
Coef. Btu �
In6ltration �� _ � ,, �
�ass , _ Inhltration
• F.xp. wall ' �
`� � `� Glasa
� Net eap. wall _ Exp. wall
lnt, wall
%' N�� ��p. ,,,eu
Ceilin , ,
1nt. �vall
8
Floor � � � Ce.�ing
Tota! Btu. Fdoor
'� �`�' Total Btu. �
Required eq. k. E.D.R. or aq. ina. W.A. l.eader area Required sq. ft. E.D.R. or sq. ina. W.A. L,eadtr aree
F1•� �.12.,^, • Room � Length � Width �% Height� � j,�_° F1,1 Room I l.ength Width
Wiadow� and Doors-...Crackage and Area Windows and Doors—Cracicage and Area
dth He1�At No. ot Llaeal tt. Are�
No. ot ean� et n.... u�w.' -' ----'- -- -
Wfdeh Hetght No. o[ L1nea1 [t. Area
No. ot yans o[ pane IIgAb ot cneh �. tt.
f. Btu .
In6ltratiop � � Infiltration '
Glaa� � *; � •�,� _ _ . ,
Glass.
Esp. wall ��j ° ° �g� ) Exp. wall
Net e:p, wall o�.� " ° Net esp. wall
Int. wall Int. wall
Ceiling `- �?' , � �' � Ceiling
Floor
�' � Floor
, Total Btu. ` Tota1 Btu.
: Required aq, ft. E.D.R. or aq. ina. W.A.1,eader area /'
I F7• �°� • Room l,ength r,. Width/ �. Height f�=; � p.�
Window� aad Doors—Crackage and Area
W{ H�I�At No. oI Llneal tt Are
I'
Coef.� Btu
Required aq. ft. ED.R, or aq. iaa. W.A. I,eadtr area
� Fl•� Room I I�ngth Width Height
I Windowa and Doors—Cracleage and Area �
No. ot pt�• ot psne II�At� ot ar�ck �c. tt. -- WI<
Coef.. Bcu
Inbliratlpp � ,.�!�. � ,
Glaas
Exp. w�U =�� .� ' r� � , >
Net esp, waU ,� � ,
int. w�11 • '
Ceiling � �� ,,,, : �
Floor .4
Total Btu, � r�.�
Required aq. ft. E.D.R. or sq. iae. RI.A, Leader ares
;�.= Fl. �, , �;%.'_:�- Room � Length ,� ,'{ -- Width ,`� - Height `' X =
Windaws aad `boors--Crackage aad Area �
- -- dth _ _H�ltt �to,_ut_ _Liqeal tt. �rea
No. q( �n• ot Dans Nsbt� o�crack eq. tt. ` ` ^--
J :.' "' ,• `J� '�' � �
- � �"�' %�' � �� �'�
z �d���l���
�r ��
Coef. Btu
Infiltration � � _ �,�>� �. � ��
Cla�s �`n. . '� ,.
� J � � .! ;° , t�... � � '
F�cp. wall � �--�-
.�_�
Net e:p. waU I,'� , ��, - ��
lnt. wsll �r,,r � � � �
Ceiling
Floor ��.! � ,m . � � � "' ; �� �
� ��
Total Btu. ��
Required sq. ft. E.D.R, or sq. ina. W.A. Leader area '
�
Infiltration
I Glaas
Ezp. wall
Net exp. waq
Int. wall
I Ceiling
� Btu
a V{QO Y{Ye
Required sq. ft. E.D.R. or aq. ins. WA. L.eader uea
�• Fl.� Room I Length ----- Width Height --
Windows and Doora—Crackage a�d Aeea
_ Wtdeh Hnl�ht Hv of Lineal [t. Arer
No. ot yAne ot Dt�e Ilshts ot erack sQ, tt.
,
Coef. Btu
Infiltration
I Glass
I E�cp. wall
I Net ezp. wail
Int. wall
ICeilin
Floor
` --�-•--� -�. •.•.•....... v� aq. ins. w.li. Ll�dt� iRi
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HOUSE HEATING TEST RECORD
���I'�� - a da , ; ; _ .;v >�� `� —APT. FLOOR �'�—CITY F_SUB11R8.—_--
ADDRESS ` "
OCCUPANT ,�' ,: `�, _ OYiMER
HEAT LO55 D�TE HTG„ INST. GAS C0. METER BADGE j.;-.: -, ,�il ,•, ;
,� � _' �'f`�"� INSTALLED BY
SOLD BY ` y ` � � a `' °
Eleetrical Work By Gas Line By
TYPE OF HEAT GA FA �"i`'r HW STEAM SPACE HTR. UNIT HTR. OTMER
CONVERSION
�, GA� DESIGN
MAKE �`f ' ' � MAKE OF BURNER
,:.:H` `s �' �° _"a � �` � , Modei s�
Model - "<
Serial Max. BTU Rating
��y� r•' ��' ,� MAKE OF FURNACE �� �'
t- �-
INPUT Model
CONTROLS �' �;.
.�- Yent Size ;' a
THERMOStAT ,' ��.—.—='--� — Heat Plug KIND OF LINER '�b ' SIZE "`--..=�-NONE
d M J
9 ��i _'�, �� �
Valve ` _ ,�'`F�` � � Re ularor
'�;,a { ,, .. �;, � ,';. Drah Hood
L imit Number
Limtt Setting P� ` Filters Size ,
� Outside
Chimney Loeation �^$�e{-�--�----
PilotSTYpe ""� `��,� Chimney Construction �
Pilot Make " - �'
Smoke Bomb ° Wi�1°9
Pilot Model `�" �:`r.�' Test Tag �`��
� '�.-� v � ��;., Draft
Pilot Timin9 Lighting (nst. '"� �
L.W. Cut Off Door Pressure �
,� �, >
,�` ^' '�' � Date Tested " `' �
Prossure '� ° �, Percent CO2 �,,� � � �� `� i� �`3 `
In ut CFH '� �� Pereent 02 �° � Company Test�ng ;
P .�`�; '� �>' � '":�° Name of Tester
Stack Temp. ��- Percent CO I
Form 235
SUBJECT �- � 5 8 9 4
City of Fridley � N°.
AT THE TOP OF THE TWINS g U I L D I N G P E R I T �
i �
' � RECEIPT NO.
' ' COMMUNITY DEVELOPMENT DIV.
' j L ____�_ �
r � � PROTECTIVE INSPECTION SEC.
� ,
i
, � r'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�'���� � ,�� 612-571-3450
910-F15 8/22/80 � �
JOB ADDRESS 6131 Benjamin Street N.Ee
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 22 3 Briarda.le SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dennis Behemer 6131 Benjami.n Street N.E. 571-9304
3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO.
Poo1 Insta.11ation Experts 2231 Cardina.l Place St. Paul, N¢�T 55119 738-2997
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
X NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install an above round ool 16' x 40'
8 CHANGEQFUSEFROM TO
STIPULATIONS
See stipulations in letter dated August 22, 1980 by Environmenta.l Officer
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
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 . $r.JsQ00 $2�5Q
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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- $`30.00
STRUCTION OR THE PE ORMANCE OF I N.
PLAN CHECK FEE TOTAL FEE
"�� - �� $32.50
SIGNATURE CONTRACTOROFAUTHORI2EDAGEN (DATEI � _ , WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
_ w.
p Q�l-- �� ��rr�a �� �
SIGNATUREOF OWNERIIF OWNER BUILOERI IDATEI BLDG �NSP � TE �
CITY OF FRIDLEY -
ARPLICATiON FOR RESIDENTIAL QUILQIPJG PERMITS
(.Cdew, Alterations, Additions,.or Repairs)
' _ _.a4�f���• ` �-� !111 S d���.�_ BUI LDCR : -Y��L /�%��gL�Tiv� �u �° �� � �
ADDr�ESS: �`�` /°3 �NJ��//� ADDRESS: �a% ��C.I�iN�9�- f"�
TFL N0: � — ��G �{ TEL N0: %.�� �°'�i1
. Construction Location
• ST�T NO: ���/ STREET: ���� ��l.I��M-(f� _ _�_
LOT: �� BLOCK: � ADDITION: ��/�( ��C /.,/9L L .
Corner Lot: Insicle Lot: ' Setbac}:: Sideyards:
Apnlicant attach to this form two Certificates of Survey of lot and
proposed.buildi.ng location drawn on certificates to scale.
� DESCRIPTIOtd OF COfVSTRUCTION �
�t.8o�� �,���tip
� �
`f'dl�L, Front: f(� ` DeAth: �� r Height: a�
Square.Feet: Cubic Feet:
Front: Depfih: Height: �
Square• Feet: Cubic Feet:
Type of Construction : V/ N �i�
7.b Be Cbmpleted: � C���S
� Ga'
Estimated Cost: $ '��%��
• Alt. A Att. B
P�oposed Driveway Width If New Opening Is Desixed: $� $
� . , SEE REVERSE SIDE OF SHEET _
The undersigned hereby makes appla.catian for a permit for i:he �aork herein specified,
agreei.ng ta do all work in strict accordance with the City of �'ridley Ordinances and
rulings of the De,partsnen� of &uildings, and hereby declares that all the facts and
representafions stated in this applica+���ri ar� true and correct_
DATE: - ao�, I�/� SIGNATL1FiE:
Stipulations :
� l�-J
� 2�
�%ti-�-�-� •�` Z_ Jf�'"".�'`�
� � �
�
3 �-�
3��
�
�° . �� e,.���, ,
�_ .
.
� - . ,
• BUILDI(�G P�Rf�1IT FE� SCHCDULE� . � �
S�CTION 2. T}�e Zn:,pector aL ]3otild3.ncJ� :;f���:�., n�r-or� i_;suing pexlniL-� tor Lhe erc:ct3.Un
oi any buylcl:ing or :.;truct:ure, or i'or anX addi.ti.on t•o any cr.i�ting building or s�nicL-w;e,.
. cir for. any all:cration� or re�,��ir.s L-o •any cr.i,��ng buiXciing _or structure, upon app�,�ic:ation
�L-hc�eio�^e, require the paymen�. by t2ic a}?�l.icant• ior. such pex�mi.t of fees i:o. the amount -
herein be.law set forf:h an� in the manner herein pzovicled L-o-wiL: � •
N��7 CO�ISTRUCxIOD] : Single rami]_y IIames and Garaqes : $4 . 0�/J., 00� cubic ie.et. • .
PL11N CiiECK: 25 percent•of bua.lcling }�e�rmi� t'ee.
DRIV�i7AY DEPRLSSIO1rT: (Concrete, Curb 5treets Only) �'
' Alternat:e T�: Rcemoval and replac�ment of concxete cuxb and �
gui:L-er anly; Driveway width plus 6 Eeet x YXa�ID?5
Alternate B: �moval and replac:�ment o� concrete curb and
. . ' . • gutter and instal]. a 3 fooL- wide apnroach with �'
� . . 6 inch deptli; Drivcway width plus 6 feet X$17.85 �
• • . �DDITIQN/�L Ii1F0E��11�TI0N
rar ths purpose of`computing iees foar building �rmits, th� cubical conten�s of any
buildzng or addi�ion, is dctermined by multiplyiny the ground area covered i'rom a
poa.t�t sir. {�j i.nches beloc,r thc= floor line of the basement or th� cellar to the
a,verage heights of the upper surface or to the average heigh� of the roof surface
of the main gable o� a pitched rooi. � �
For repairs or alterations to an exis�ing structure, the fee shaZl be a� the rate
o£ $3.00 per each �ive hundred dollars-($5d0.00) or fraction thereoi' a.n fihe cost
of all pxoposecl wcrk. _ �
Tn •no case sha]1 the fee charged for any permit as s�t forth in Sec�:ion 2 be l.ess= �
than $7.50 plus $.50 sta�e surcharge. •
� � VERTFICA�"I0� OF FOUND�jTIOfV
NOTE: Perr,iits �oz construction will be issued a minimum of 24 houzs from the time
ot �ppli.cata.on to al.low for pxoper review of the praposed structure and of the
cons�ruction sa.te.
A C�e�-ti�icaLe ef Su�vey of the lot, shoH�ing the location of the foundation once it
has Ueen coFistxticted will be required before pxoceeding with the framing.
. CkRTIFICATE QF OCCl1PANCY
APp].ication ior a Cer�tificate of Oceupancy shall be made ten (10} days prior to the
use or occup3ncy of any structure ior which a buildiiig permit has been issued; and
said structure shai.l no� be used o1- accupied until a Certificate ot Occupancy has
been. �ssued. P .
r
0
• � . • , �
�
P�: �,� - . �--
�
kuncf Plaoning
I,antt Sv►veying
Soits fe�t.ing`
�;ril En�ineerir+g
M�nitipal Ersgittesring
MQr�tQage
C� 13 I
������"•1,��'�� 687S Nighway No.65 M.E.
�� � • � Mianaapolis�
�l��'`t1�('t���1��� ��llf'. +a��n. �soa�
Telephona �eo-eoea
�i,'`��r��@��65 � i�7'"��.q@�d�.8 4r�o Codr 612
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'. 8431 UNIVERSI'TY YA�lENUE P1.E.� FRIDLBY, R�IINMESOT� 65432
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�� _ r TELEPIiONE ( 812)571-3450
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6 � = August 22, 1980 . .
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f � Pool Installation Experts ,
' �` 2231 Cardinal Place - ' � -
�' St. Paul, MN 55119 --.,. 4_
��.�`,�- � � - .
� Res Swim�ting Pool Construction at 6131 Benjamin Street N.E.
; . -
Daar Si�rs: . . � . _
� This letter is to make clear this department's requirements for the _'_
•, swimming pool construction at the abov� address. � '�
,� l.� As indicated, two (2) skinuners approved. by the National.Sanitation �` .
Foundation will be provided.
` 2. As indicated, two (2) inlets of approved design for fresh and/or '� .
� repurified water will be provided. .
, 3. The filter and pwmp sha1.1 be ap�raved by the N.S.F. and be of �
sufficient capacity to provide a minimiun turnover of at least two (2� -
times in 24 hours. This depari�nent recommends a turnover ra.te of .
6 - 8 hours.
i � 4. A deck of at least three (3) feet wide; measurecl from the pool waters ,-
( edge, shall be provided which extends completely around all private
residential pools. Above ground private residential pools may be = �..
provided with decking of a minimwn size of 4 feet by 4 feet at pool .
- entYy points and provided that such decking has the app�oval of the �
i � City. - � �
:.4.
i� 5. Eencing or other effective means including but not lirsited to walls
i , or buildings, aceeptable to the City, shal]. be provided to positively
� � " control all access fio public and private residential swi.mming paols. .,,
� Fencing shall meet the followirig criteria: . ': •
t - .Ca) The fencing shall grevent the entrance of children and be without ;
' �• hand or foot holds that would enable a person to climb over it. �
; � (b) The fencing shall be at least 6 feet high and entrances shall be '
' equipped with self-closing and self-latching gates capable of �
� being locked. ,.. .
� ;(c) Self-closing and self-latching devices shaZl be placed at the top
!i of the gate or otherwise inaccessible to small children.
" (d� The opening beL�aeen.the �ttom of the fence and the graund or -
other sur,face shall be not more than four inches. �
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Pool Installation Experts -
August 22, 1980 e _-_
Rec 6131 Benjamin Street N.E. . Page 2.
6. An automatic chlorfnator should be provided with a suitable test kit. ,
7. All e].ectrical and plumbing installatians shall be inspected and
approved by the Cii.y Inspection Department.
8. A11 overhead electrical lines must be greater than 15 feet away from
the pool surface. An alte�na.tive is to bury said li.nes.
9. The pool fill spout must be protected by a vacutmi breaker or air-gapped.
10. Suitable safety equipment to include but not limited to a ring buoy
and rope that is l� tiunes the pool diamet�er, and shepherds crook pole
must�be provided and mainta.ined with the pooZ at all times.
Furthermare, these and any other requirements must meet the provisions of
the Fridley City Code, Section 115, Swimming Pools. The builciing pexmit is
�.approved cbntingent on f3.na1 inspections and approval by the City.
If any questions or problems arise fran this letter, please feel free to
contact me at 571-3450. .
Sincerely, _ .
- — _
S 1 J; p p ,_ R.S. . ° - .. _, .. „ ,-
_- -
-- - .. . � .
Envirormiental Off icer - _ = � " - = ; •
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, _ ,., �. .. . _
S�TO/mh _ :_ _ .� _ _ .. . _ . _ _ - - �- - : __ _- . - _ . . : ,
CC: Mr. Dennis Behemer -: -__ --__ - - "_ . _ _. ..
6131 Benjamin Street id.E. '
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_._.._.
THE MINUTES OF THE REGULAR MEETING OF THE FRIDLEY CITY COUNCIL OF MAY 5, 1975
- � --- �- - -
123
The Regular Meeting of the Fridley City Council of May 5, 1975 was called to.order at
7:30 P.M. by Mayor Nee.
PLEDGE OF ALLEGIANCE: '
Mayor Nee welcomed those present at tbe meeting and invited them to join the Council in
saying the Pledge of Allegiartce to the Flag.
ROLL CALL:
MEMBERS PRESENT:
MEMBERS ABSENT:
APPROVAL OF MINUTES:
Councilwoman'Kukowski, Councilman Breider, Councilman Starwalt,
Councilman Fitapatrick, and Mayor Nee.
None.
REGULAR MEETING OF APRIL 7, 1975:
MOfiION by Councilman Starwalt to adopt the Minut:s of the Regular Meeting of the Fridley
City Council of April 7, 1975. Seconded by Counci}woman Kukowski. Upon a voice vote,
all voting aye, Mayor Nee declared the motion carried unanimously.
ADQPTION OF AGENDA:
Mayor Nee said the City Manager had advised'him there was an agreement with the
Telephone Company that should be added and considered at the present meeting.
Councilman Breider indicated he wou'�d like to set the date and time for the Board of
Equalization meeting on May 8, 1975.
MOTION by Councilman Starwalt to adopt the agenda as amended with the previously mentioned
additions. Seconded by Councilman Fitzpatrick. Upon a voice vote, all voting aye, Mayor
Nee declared the motion carried unanimously.
OPEN FORUM, VISITORS:
May.or. Nee explained to those present thdt the Council works from an agenda aook during
the meeting and ihere is one available at the podium at the back o; the r.00m for those
interested in the agenda. He said there is a great deal of documentation involved
and if anyone would want to address th ncil, they should do so.
MRS KATHY MALONE, 61�BENJAMIN STREET N.� E., REQUEST FOR ADDITIONAL STOP SIGN
�. .
Mrs. Malone addressed the Council and explained that she had thought that there had been
approval for installtion of two stop si•gns in the area at the previous meeting of the
Council. She further explained that signs had been installed at one intersection and not the
other. Mrs. Malone said she had talked to Councilman Star.walt concerning the confusivn
and he had indicated he would listen to the tapes of the meeting. The motion made at
that time had been.to call for a study at both locations and after this a motion to
install the signs had been made without definite specifiaations on location.
Councilman Starwalt said he planned to listen to the tapes, but had not been able to do
so. He affirmed the statements made by Mrs. Malone in that he had called for a study
� on the installation at both locations.
�. i .
� Councilman St�:vt�1t said he felt the installation of the first signs should be considered
for their effectiveness and if it is necessary, the additional signs could be installed
in the future. Councilman Starwalt explained that he intended the signs to be some-
' what temporary until the area is further developed.
�
Mrs. Malone said she did not feel that the problem is being solved by the installation of
59gns at only one intersect.ion. The traffic still travels at a high speed in this area.
Mayor Nee said he thought the Council had settled the problem on the s9gns on Briardale
Road. Councilman Starwalt explained that this_was on one corner, and the property owners
had requested that this be done at 61st and Benjamin also. He felt this may be a process
for the interi•m period while there is a great deal of constructior�in the area. There
will be a road cut to the west into the park property and this wijl provide a break in
the traffic. Councilman Starwalt said stop signs should not be used for relief of speeding.
J
•
' ° � 124
r
REGULAR COUNCIL MEETING OF MAY 5, 1975
PAGE 2
Ne said he had asked that the property owners try to work with the action that had been
taken and not take any further action until it is needed.
Mr. Robert Erickson, 5950 Benjamin St., said he did not.feel the action of the present
installation was at all sufficient. He indicated his home was only a half a block from
the area and he thought the additional stop sign was definit�,y needed.
Mrs. Malone said something should be done before there is a tragedy in the area.
Mr. Joe Peterson, 1565 Gardena Avenue, addressed the Council and explained the traffic
feeding into the area all comes from a straight shoot and it is very fast. He explained
that there was a recent accident in the area and if there were youngsters outside,
there would have been someone hurt.
Mayor Nee asked if this is a County Road and the City Manager said it is a City road.
�
MOTION by Councilman Starwalt to install a stop sign on 61st Avenue and Benjamin Street.
S�conded by Councilwoman Kukowski. Upon a voice vote, all voting aye, Mayor Nee deciared
the motion carried unanimously. ` ,.
Councilman Starwalt said this would put two stop signs between Grace High School and `.`ce
Creek Road. He added, there may be a need for more, 6ut he felt this should be limited
at the present time.
OLD BUSINESS:
RESOLUTION N0. 70-1975 - REQUESTING METROPOLITAN TRANSIT COMMISSION TO INSTALL BUS
SHEL ERS FROM MEETING 0 APRIL 21, 1975 : .
The Public Works Director, Mr. Richard Sobiech, explained to the Council the three
different types of requests noted on the map on the agenda and requested in the proposed
resolution. He said one would be where residents of the City had reauested installation
of shelterS, another where City people had seen a.number of people waiting at a bus
stop, and thirdly, where there is a potential for substantial-ridership. He said there
are eleven suggested locations that might warrant a bus shelter. He explained that those
proposed would be contingent upon the MTC reviewing the locations for proper number of
residents and people using the location. ' '
MOTION by Counciiman Fitzpatrick to adopt Resolution No. 70-1975 requesting Metropolitan
Transit Cortartission to install Bus Shelters. Seconded by Councilman Breider. Upon a
voice vote, all voting aye, Mayor Nee declared the motion carried unanimously.
The Public Works Director explained that if the people of the area had requested the shelter
and the suggestion had come from MTC, they had already conducted a study on the need and
determined the need does exist.
Mayor Nee questioned the placement of a shelter on the north side of the Fridiey Market.
The Public Works Director indicated thislocation was in the area of Fiarmont and Glencoe.
Mayor Nee asked if this is on the residential side of the street. The Public Works Director
said it is felt that the shelter will attract the residents of the area. •
Mayor Nee asked if there would be a problem fram the owner of the residential property
adjacent•to the proposed shelter. The Public Works Director said there is enought right
of way and the shelter is attractive, not unsightly. Mayor Nee as{�ed who lives on the
northeast corner of Hugo and East River Road. A member of the audience said he thought this
is Georgia and Albert Kellner's home or 8182 East River Road. Mayor Nee asked if they had
� a fence and the man said yes. He believed the fence isset back about six feet from the
\ road and there would be ample area for the bus shelter.
Councilwoman Kukowski said it had bee� brought ta her attention that the shelter on 57th
and University creates a traffic hazard. She explained that the bus moves in front of the
existing traffic. The Public Works Director said thisis a problem that the City would
have to put up with for the time being. He further pointed out that the plans are
for the installation of a park and ride stop in that location.
The City Manager reiterated that if the MI'C appwves the additional locations for the
bus shelters, the City would have to appropriate money from unappropriated funds to
install the slabs. He pointed out that this would be about $350 per shelter.
NEW BUSINESS:
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CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5.
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Meets all current Code requirements for size
and total BTTJ's connected
Has tota.l heating BTLT's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
�
8. Has combustion air been provided for water heater
Remarks:
LisT t AI,- TE�A�i�� Bemg Done: — --
HEATING CO:
Signed By:
Date:
�.'es � ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
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CIIYOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 12, 2001
Doris Rolek
6131 Benjamin St NE
Fridley, MN 55432
Re: Final Inspection at 6131 Benjamin Street NE
Contractor: A-Abc Appliance & Heating
Dear Ms. Rolek:
A mechanical permit was issued on August 30, 1999 for the installation of an air
conditioner at your address. According to Section 305(a) of the 1991 Uniform
Mechanical Code, a final inspection shali be performed on the work. As of this date no
inspection has been called for.
The permit fees that were paid covers the inspector's time to check to make sure the
appliance was installed correctly. We also check to make sure all wall penetrations
have been caulked.
You will be given thirly (30) days from receipt of this notice to respond. If we do not
hear from you, your permit will expire and any inspections on this installation will require
a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DAV��SEN
Buildi nspector
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existins� 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 required. Yes () No ()
The venting; system is plastic/PVC and meets all current codes and manufacturer `
specifications .including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and naturai draft appliances.
The existing combustion air is sized and installed to meet the cuRent 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 manufacture�'s specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installin�a a new ventinst svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance;has been removed from the common vent and vented
separately as:per current codes. Yes O No O
Appliance Type and Size/Common Vent and Vent Connector Informa#ion
Apptiance #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
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describel
HEATING CO:
Signed By: � Date :
Building
Inspections
763-572=3604
4'
DATE L� " � �
STI'E ADDRESS ��
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATTON
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLE
� YOUR E-MAI DRESS �� �D
��? � ��/�� �` /' / �
O OWNER I�ONTRACTOR
NAME: �J`' / d
ADDRESS: La �� /.� 1%/ i�/�i'% CITY .�/,
PHONE:
uen,rF• //�/9 6'Ol., i//'G' iA. s F�1' 1 i7/' .
STATE LICENSE
PHONE 74 3 .0 U�l' '
❑ SINGL FAMILY/NEW CI
� TWO FAMILYMEW CON'
� BASEMENT FINISH
❑ DECK
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
� Vinyl
❑ Aluminum
❑ Other
WIIVDOWS
IN EXISTING OPENINGS ❑Yes �No
OR FOR NEW OPEI�TINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WW�W TO BE INSTALLED
PermitNo.: ,�°�"�f �-'
Received By:
Date Rec'd: �P� z�'' 'i�a'
.i% �J�� �°��s, l�os�!
Jr EXP DATE O:Z '.5 �` d�
� CITY Z: � �� STA��r��� ��y
FAX . `�D —
tUCTION SIZE
CTION STORIES
O GARAGE/SHED O WINDOWS
❑ ROOF ❑ D TILE �v
❑ SID1NG OTI�R�/1S�//l��i J t�� Z/'�Dv D� %
❑ SWIMIVIII�IG POOL _ �
�,
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
� ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF
� WIDTH
� HEIGHT �� �f Sq. Ft.
BASEMENT REMODELING SUBIVIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBNIIT:
1. Site PIan/Survey showing the existing strucwres
and proposed project
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND MATERIALS:
(USIN THE 1997 U.$.0 FEE SCHEDULE)
TOTAL JOB VALUATION $� � DO �.�� OCCUPANCY TYPE _
Permit Fee $ �„?� _ a. �°" See Back Page for Fee Schedule
Plan Review $ — 65% of Building Permit Fee
Fire Surchazge $ �.� .001 times the total job valuation
Surcharge $ � e.i�— .0005 x Permit Valuation Minimum $.50
License Surchazge $ � a $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
I Erosion Control $ $450 Conservation Plan Review
' Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary O Non Necessary O
Total Due $ • 02 Make checks a able to: Ci of Fridle Attach Sti ulations
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 in
conformance with the ordinances and cades of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a it 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 work which , quires revie . d a proval of plans. �
j SIGNATURE OF APPLICANT l�'� . PRINT NAME ��� h--4� �� DATE ���� �
I __
Page 2- Building Residential Application
BUILDING PERNIIT 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 building or structure, or for any alteration or repair
to any elcisting 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:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fa�c: 763-502-4977
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�-----�
Building BUILDING Permit rTo.� `�� �� O p
Inspections RESIDENTIAL APPLICATION Received By:
763-s�2-3604 CITY OF FRIDLEY �'�
763-502-4977 FAX EFFEC'ITVE 1-1-2010
DATE lY � r� —��/ � YOUR E-MAIL ADDRESS
SIT'E ADDRESS ��3 1 1 Je,v� i 4w. � r� �'j
THIS APPLICANT IS: 0 OWNER �,CONfRACTOR
PROPERTY OWNER/ N�: � � � I[
TENAN'I' ADDRESS: ��� � (�r < n... c� a CITY � oC � STATE ZIP
PHONE:
CONTRACTOR NpME: ,,�,,,,� o�. �,.,�,�, �; �.�
SUBMIT A COPY OF STATE LICENSE # 2�(0 3� 5 L�o EXP DATE �� 3 l- Z a 1 Z
YOUR STATE LICENSE
ANDCERTIFICATEOF �D�S� 1�� �—�^� �� CITY�"}'�� �� STATEl�ZIP SS°30
INSURANCE pHONE �3- YK3- l�� � FAX
PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE
� ❑ TWO FAMILY/NEW CONSTRUCTION STORiES
PERMIT TYPE ❑ �DITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FIIVISH �tOOF ❑ DRAIN TILE
❑ DECK O SIDING ❑ �'��
❑ SWIMINIIIQG POOL
TYPE OF WORK: O NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENAIdCF/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: —
SIZE OF IMPROVEMENT LINGTH WIDTH HEIGHT S Ff
�pp�G ❑ HOUSE ONLY �ASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES � ❑ HOUSE & GARAGE t. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of strucbual members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCT[ON INCLUDING DECKS,
SIDING ADDITlONS. 8c PORCHES SLJBMIT:
O Vitryl ❑Soffit 1. Site Plan/Survey showing the existing structures
❑ Aluminum ❑ Trim and proposed project.
❑ p�� � Fascia 2. Two sets of construction plans
WIIVDOWS 3. Energy Calculations
IN E7QSTING OPENINGS DYes �No LOCATION OF WINDOVJS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL NLL�iS AKr. �AAtiL:U U1V VALUA1�1V1V� 11Vl.LUl111V1� 1�liL� l.V.)1 Vl� LAaVl( A1�IL 1rlAlL' 1(1A1..7:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �Zf%0 OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �`� �`9 See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �a .001 times the total job valuation
$ F� .0005 x Permit Valuation Minimum $.50
$����� $5.00 (State Licensed Residential Contractors)
$ $2100 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$24=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ ' I Make checks uavable to: City of �ridley Attach
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accuraxe; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a rt and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all w ich r�quires re�view and approval of plans.
SIGNATURE OF APPLICANI' ,� ]�� I�iC �I � PRINT NAME DATE
Page 2- Building Residential Application
BUILDING PERNIIT 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 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:
VERIFICATION OF FOUNDATION
Permits 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 Departrnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977