AF - 43989City of Fridley, Minn.
BUILDING PERMIT N� � g 4 z
Date: ....._--�.'_`.=--�---� �_.'.:'u.�..._�..�......---.....--•-•-------.._......
Owner: .......................---��---��----......--�----......._.....................-----•-----•---....................... Builder .� .�. .�. ���.....�:._
Address
Address
-LO. .M. TION. OF B DING
No. :�..:��_... �Street . ....... . . ... *.'�''-'!!�i�....��ri'!.=�...t... Part of Lot •--------
.._.._._.._. _.__...�_ .____._
................... Block ...._........ ....... Additioan or Sub-Divisi� ... - -. . _......� _... �
Lot ........�� ...� .....
Corner Lot ..........._ .................._... Inside Lot .._.�.r.�".�-.--............ Setback .._��. �......---._• Sideyard ----..�-�r.--._./�.� ............._. _....
Sewer Elevation ........---�--�-� ........................•--•----�--•--........._........-•---....................---... Foundation Elevation .........--�---...---�
DESCRIPTION OF BUILDING
To Used as: f �
�,/� / � :
.... .
Front "�... .._� �epth ..�-.�i�I Height ._..�.. Scl. Ft. : _ Cu. F't. �
.. . .. . ..�-�......... Front .��•� �Depth ......�,.. e� t .........��-. S9. F't. . : .. ..... Cu. FL _.. ,. �
�pe o truction ..."',,,�.��...- --. .. . ' ... Est. Cosi�r. .. �--_-i�_�To be Compieted ................._._..._..._:....:_..._........
����'���� - E VIOLAT.
��� ,._._ TH�R�Z D
PER�,,n.,': i Dt��`�- `ANp Cp�ENPNTS AN
TH�S O� A�,� puN,CTIONS'
�pN RESTR
gU1�D�NG
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed woa�k in accordarice with the descrlption above set forth and in compliance wlt6 all pro�vieioas of
ordinances of the city of Fridley. .
---�..----.....-•--�-----------•--_.._.._............_..........___..._._..___._..__...._..._....._.._...._..._..
In consideration of the payment of a fee of $.. ..............-.--., Pernut is hereby grantRd to...-•----------__...-----._.._...._...__.:.._.__
•--.--.._.....-•-•---._.........._--------------......._...._........ ta construct the building or addition as described above. Thia permit is granted uiwn
the express condition that the person to whom it is granted and his agents, employees and workmen, in all worlc
done in, around and upon said building, or any part thereof, shall c�foam in all respects to the or�linanoes of
Fridley, Minnesota regarding lceation, construction, alteration, maintenance, re�ir and moving of bt�di�ngs
within the city limits and this permit may be revoked at any time upon viol of any of the pravisions o! eaid
ordinances. .s'""'1 �/i �
N4�ICE:
: '
This p�rmif �tfs,,,�
� ; _,.
1h� Building In��"eetki�, fi
�� �
�. ,
�'eov�� 1h� wn�eueNon, inslallafion for wirrnn�g, pl4mbiny, qa h�atiny, aw�r or waN►. d� wr� la sM
ssparst� p�rmits for fhss� ifems.
� i
:._;__,_�,
a�u4 �
- �.�.�
.,
APPLICATION FOR BUILDIldG �T
CITY OF FRIDLEY, MINNESOTA�
`' _ �'
Owners Name Builder --y�
Address Address
IACATION OF BUILDING
; � ��
`�''�•..
No. '�� >'�� Street �-�'��--r-���� ��2 Psrt of Lot
Lat � c3 Block . � Addition or S�b.Div. �� --z= =� � , .
_�
Gorner Lot Inside Lot�� uet Ba.ek 3 s� Side-Yard ��
SE`WE'R. ELEVATION FOUNDATIiON ELEVATION
Applican� attach to this form Certificate of Survey of Lot and proposed building
loca.tion.
DESCRIPTIOIv OF BUILDIAiG
To be used as: ! �
��° . '' �v
:-Cl'_,�. �-__z..���_, �- Front Depth l H�eight, �� ....�...�
Sq. Ft. G`u. Ft.
-r_� � Front �� �� �/ Depth � .� Iieight � �
Sq. Ft. Gu. Ft.
Type of Constructio�� 7�,^ ��'� � �` - Estimated Cost
To be completed.
The undersigned hereby makes application for a permit £or the work herein apecified,
agreeing to do a11 work in strict accordance with the City Ordinances and ruling of �
the Department of Buildings, and hereby declaxes that all the facts and representa-
tions stated in this applica.tion axe true and cor ect. ,
DATE � .�- G o SIGNATURE �'�`'' _�°—�- '
(A 5chedule of Fee costs can be found on the iteverse 5ide.)
J � � . n
• � _
T. . . . ..
v�
� Appticai�io� fo� Pawer Rlants and He�nting� Coo�ing. Ventilatio�, Refrigerc�tion and
fo
,�' Air Canditianing Syste�s and Devices
,
' PARTIAL RATE SCHEDULE Depi. of Bldgs. Phoae 3U 4-7470
GRAVIiY WARM AIR: RATE TOTAL Locatio*+ (�L� As ��/1-G�'
Furnace Shell & Duct Work .......................... 8.00
Replacement of Furnaee ............................. 5.00
R.epairs & Alterations—up to $50Q.00 . . . . . . . . . . . . . . . . . . 5.00
Repairs & Alterations each add. $500.00 : . . . . . . . . . . . . . . 2.50
MECH. WARM AIR
Furnace Shell & Duct Work to 1?A,000 BTLT . . . . . . . . . . . . 8.00
each add. 60,000 BTU ............ ......... .. 2.00
Replacement of Furnace ............................. 5.00
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . 5.00
Repairs & Alterations each add. $500.00 .. . . . . . . . . . . . . 2.50
STEAM or HOT WATEA SY$TEM
Furnace Shell & Lines—to 400 sq. tt. EDR Steam ...... 8.00
Furnace Shell & Line—to 640 sq, ft. EDR Hot Water ... 8.00
Each add. 200 sq. it. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50
$
�
$
�
� ✓
�
$
�
$
$
$
�
$
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 �
over 8 gal. per hour-See Fee Schedule
GAS BURNER <up to 400,OOQ BTfJ) . . . . . . . . . . . . . . . . . . . . . . . 5.00 v
GAS PIPING (Up to 3 Fixtures) . . . . . . . . . . . . . . . . . . . . . . . . . . 1.50 $ "
(Add SOc each over 3>
AIR CONDITIOIQING
FAN HEATING SYSTE�d
�/ENTILATIMG $YSTEM
.�1LTERATIOMB & REPAIAS
�+�tEMaiRSB:
�
3ee Fee Schedule
TOTAL FEE �$�/;'Zx—
City of Fiidley:
i%4 I�
,,i,`a�
+1�"
�
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings,' and hereby declares that all the facts
and representations stated in this application are true and correct.
, _ �y, �` SEP 2 8 1960 _ _ is5—
�i��1/ir���//J/i///�/_ �✓
Kind of Building
Used as
195—
To be completed about
�.- �
Estimated Cost, $ ►I.�,��
New. uilding Permit No. � � ��-
DEBCRIPTION OF WORK
H�ATING - - ter, Warm Air—No. �
, . .t�
Trade Nam Size No^�S� %- G'�
�
Capacity Sq. Ft. E.D.R�r�L_�= BTTJ H.P.
Total Connected Loa �� a Kind oi Fue
.
. �
SiTftNER — Trade Nam Siz No �� ` ��%
Capacity Sq. Ft. E.D. S� TU H.P.
/ GEO. SED ICK HTG. & AIR-COND. CO
�-- ���0 1001 Xenia Av. S.
Minneapolis 16, Minn,
Sign
By
11 POST t M-8-58 Business Phone
._. , ��;a, S: .�,`l�. ��s,� -� '��'i .�1 7►
'�. :�>.� � �
1%J6 a�O�s . ' .. .. � . �/,.1�� �_ ,•.� . ��i 7 .3 /"i.
HEAT LOSS CALCULATIONS �� DEPARTMENT OF BUlLDINGS
Weatherstrips A.S.H.V.E. Construction No.
Guide
Windows `( Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor Kiad
Yes—No Yes—No 19—
Fl Room � Length �' Width �(} Height � Fl.�'.9/ ���,�/,,�,,j Room � 1
indows and Doors—Crackage and Area Windows and oora--Cr
Nidth Aetght. � No. o[ Lineai ft. Area Wldth Height No
Na, of Dane of Dane - tights of crack aq. �tt. � ' No. ot yane ot pane 11g
� �
y
� � � i�
Coef. Btu � �_ jef ,�!
Inhltration
Glass
Exp. wall �'
Net exp. wall
Int. wall
Ceilin t
Floor
Total tu.
Required sq. ft. E.D.R. or sq. ias. W.A. Leader area
Fl.� / Room ( Length Width Height
Windows and Doors—Crackage and Area
Width Hetght No. of Ltaeal tt. Area
No. of pane ot pane lighta ot crack eq. tt.
� G s.�
Coef. Btu
In6ltration �j'
. f�aaa �
Exp. wall �
Nec exp. wall �"'
Int. wall
Ceiling ' /(�
F�oor
'Total $tu.
, Requirecl sq. ft. E:D.R. or sq. ins. W.A. Leader area
FI. Room � Length Width Height
Windows an Doors—Crackage and Area
�� Wldth �Helght � �No. ot Lineal tt. Area
' N0. �of pane ot pane tlBhta ot crack ea. tt.
- Coef. Btu
' Infiltration
Cslass
Exp. wali -?
Net exp. wall � � j �"J ,t,, �,
Int. wall }9
Ceiling �
� F,1oor '
?ota) tu:
Required sq. ft. E.D.R. or aq, ins. VN:A. Leader area �
In&Itration
Glaaa
Exp. wall :
l�let esp. wall
Int. wall
Cetling
Floor
Total Btu.
�ri.��.
.4 :,.F+� i�' ,
MININ�APO[.iS. NQMV.
Insulstion
How.
�W'ulch /1-
�nd Area
eal tt. Areit
crack eq. tt.
�
% .
�- s..
/..�
Required sq. ft. E.D.R. or aq. iaa. WA. Leackr ates j'
Fl. �,.,� Room I Length / Width H
Windows and Doora—Crackage and Area
Wldth Height No. ot Lineal ft. Aroa
No. oi psne of pans !lghts o1 crack p. ft.
/�
�
In6ltration
Glaaa
Exp. wall �
Net exp. wall
Int. wall
Ceiling
Floor
'I'— E
''`� /�/- � �
F7.� Room l Length �/ Width Height .
Windows and Doors—Crackage and Ana
Wtdth Height No. of Lineal ft. Ates
� No. of pane � ot.Dane � lighte ot crac& p. tQ � �� �
Infiltration
Glass
Exp. wall
Net exp. �
Int. wafl
_
Ceilin
Floor
1'otal
DCY .,
i� .
Sr�tg ;
� �':
u. ' ;
� sq. ft. E.D.R. or aq. ins. WA. I.�ader irea 1
sue�ecT N O.
City of Fridley 216 5 3
' , AT THE TOP OF THE TWINS g � I L D I N G P E R M I T R IPT NO.
r
� �
.
COMMUNITY DEVEIOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC. O��
i �
� � /'��1 � CITY H ALL � FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�""�' �'' 612-571-3450 9�0-F15 11/12/9 / /
108 ADDRESS 6820 Brookview Drive NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ]_� 2 Brookview Terrace 2nd Addition SHEET
2 PROPERTY OWNEF
MAIL ADDRESS ZIP PHONE
Char Patton 6820 Brookview Drive Fridley 55432
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Moberg Construction 7610 - 16S Lane NW �3����i Anoka 55303 753-4427 0004127
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAI� ADDRESS Z�P PHONE IICENSE NO.
6 USE OF BUILDING
]?aelling
7 CLASS OF WOHK
❑ NEW � ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Add beam £or garage so�fit
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE FEQUIRED FOR ELECTRICAL, PLUMB�NG, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAVS, 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 CEiiTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TfiUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT $435,00 •5O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANV 07HER STATE OR LOCAL LAW REGULATING CON- $l,�j � OO Fire SC ^. 44
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$5..00 $20.94
S�GNATUAEOFCON'RACTO�:OA�+UTHORIZEDAGENT IDATE� - 'yy EN P PE Y VALID TED HIS IS VOUR PERMIT
1/ /� -' �'
5'�GNATUREOFOWNERiIFpWNEABUI�pER1 I�ATEI G iN P �1aTE
NEW [ J
ADDN [ J
ALTER�
�
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: �2C> ��6e �/ ,�v ��_� ��
Legal Description:
Ettective 3/1/92
Owner Name & Address: e � ��t..-�ex� �o �"2a��fr�1 Tel. #
Contractor: �/�j2,�_���- MN LICENSE #
Address: ��10 �%�� � �?l i1.� �1 r ��{l�_/�4 Tel. # ����;Z
Attach to this application, a Certificate of Survey of the
lot, with the proposed construcdon drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: LenQth
OTHER:
�
Corner Lot ( ] Inside Lot [ )
Type of Construction:
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Widtti Hgt/Ground
� �_ ,� .,,. � . ., /1n. �
Ft. Yd Setback
Approx. Completion Date: //= / � �' Z
Driveway Curb Cut Width Needed: Ft. + b Ft =
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Sefibacks
Estimated Cost: $ ��� °'� _
(Cost on Back)
Ft x $ _ $
DATE: -/Z � APPLICANT: Tei. # ��'�� y�/z7
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Park Fee
Sewer Main Charge
TOTAL
$ /SOD
$ ���
$ , �"D
$ �-z��--►
$ �,DG
$ —�__
$ �
$ `F3
� ��� 1
C T� USE ONLY
Fee 5chedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors�
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ J Not l�tecessary []
STIPULATIONS: - - �
sue�ecT RMIT NO. .
City of Fridley 2 94 76
AT TME TOP OF THE TWINS g U I L D I N G P E R M I T
f
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
' j v _-_._ , ����
r � � PqOTECTIVE INSPECTION SEC.
1 . �
l_--- A,�����;', CITY NALI FRIOLE� SS�32 NUMBER pEV OATE PAGE O� ACPAOVEO BY
t �� 612-571-3450 9t0-Ft5 5/17/99 / /
JOB ADDRESS 6820 Brookvi ew Dri ve NE
1 IEGAI LOT NO. BLOCK TRACT OR AODITION SEE ATTACNEO
oesca. 10 2 Brookvi ew Terrace 2nd Addi ti on s►+eer
2 PROPEfiTY OWNER MAIL ADDRESS 21P PMONE
Lonnie Hellerud 571-4305
3 CONTRACTOR MAIL AODRESS ZIP PMONE LICENSE NO
Renewal by Andersen 350 73rd Ave NE #8 Fridle 55432 502-4777
� AiiCHITECT OR OESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAtI ADDRESS ZtV PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION � ALTERATION O REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Replace one bay window in home
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2, 1997 U.B.C.
?YPEOFCONST OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PEfiMITS ARE REOUIRED fOF EIECTRtCAL, PLUMBING, HEATING.
VENTII.ATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOIO IF WORK Op CONSTRUCTION ZONING SO. FT CU FT
AUTHOAIZEO IS NOT COMMENCED WITHIN 60 DAVS. OR IF CON57qUCT10N
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCEO. NO OWLG. UNITS OFfSTHEET PARKING
1 MEREBY CERTIFV THAT 1 HAVE REAO AND EXAMINED THIS APPLICATION STALLS GAiiAGES
ANO KNOW TME SAME TO BE TRUE AND COFRECT. A�� PqOVIS10NS OF LAWS yq�VATION SURTAX
AND ORDINANCES GOVERNING 7HIS TVPE Of WORK WI�� BE COMPLIED
WiTH WMETMER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT �3 �GZH �l .8�.
DOES NOT PRESUME TO GIVE AUThiOR17Y TO VIOLATE OR CANCEI THE PEqMIT FEE SAC CHA GE
PROVISIONS OF ANV OTHEq STATE Op IOCAL LAW REGULATING CON- 7 G
STqUCTION OR THE PERfOfiMANCE OF CONSTRUCTION �8/ . 2'rJ Fi r C$3. V3
PLAN CNECK F TOTA F E
Lic SC 5. .69
S�GNATUREOFCON'FA(;TQFOAAUTMQRIZED�GEN1 �OATEi HEN ii A O T HIS IS� PEji
�/ /
-- S�GHatUQE O� OwtiEQ ��F OwHEQ 8uil0EQ� iD�iE� ,.�g� �ro5o q�rE
Prepaid Plan Check $ Effective 1/1/99
Estimated Cost $ CITY OF FRIDLEY
Receipt #
�
BUII.DING PERMIT APPLICATION
Construction Address �P �S a � ��,jJ�lp.C�� �),�,il-�
T rxra 1
�� �
�� ��
� 4�
Z�TLnS
owrier & Address L6—YL.YU_6 i�-P /,� 0,� ,J J� ���v �i.( � �1.- Tel# 5% I- � QS
• - • •- • ��- j ! � 1 . . >
. -
.�
�� -� vtl ' Tel# ,� -�l "77i
Erlgineer Reg. #
BUII.DING CONSTRUCTION
TYPE OF WURK [] New Ll Addition � Alteration -Describe
. , � ��
OFC. AREA: Length Width Height Sq. Ft.
WHSE ARF�A: TE'�h Width Height Sq. F't-
OTF�R ARF�A: T P*� h Width Height Sq. F't .
�r�� '
APPLICANT Tel # Date .����'-/
_ VALUATION
sq. Ft. x$ Cost/sq. Ft. = valuation S ) � J^�� �
Sq. Ft. x $ Cost/Sq. Ft. = Ualuation $ ) _ $ / u� � .
Sq. Ft . x$ Cost/Sq. Ft .= Ualuation $ ) 'IC7.CAL VALUE
Building Use Construction T�pe Occupancy Gn�up
Air Conditioning [] Yes Ll No Fire Protection Pravided ❑ Yes [] No
Perforn�nce Bond Amount $ See Reverse for Schedule Received [] Yes ❑ No
�e�mit Fee $ � 1 � 'o? 5
Plan Check $
Fire surchaz�e $ 3. l0 3
State S� $ � • �C'
SAC Ct�azge $ j ' `�
Erosion Control $
Park Fee $
S�ec . Assessmerits $
Driveway Escraw $
z+o►rAr., $ `� 1, Le q
See Fee Schedule on Revexse Side
In Excess of Prepaid Amount - See Reverse Side
.00l x Pezmit valuation (1/loth s)
$.50/$1,000 Ualuation (See Sched. for > $1 Million)
$1050 per SAC Unit (Plans to MWCC for detezmi.nation)
$450.00 Conservation Plan Review
Fee Detezmined By Engineering
AgreemPnt Necessazy [J Not Necessazy [l
feet x $13.50/foot
ATT CH STIPULATIONS
/c�� v/�� G�nzatcC �E7`���� l�v /�L� G��/-��— �
�<�v �/ /�GG ,��Y�� �ie' 7'"��' J/•zl�=L��e�— ���-- �"e„
��o.�����` ���� �� � � �