AF - 44069•
•
City of Fridley, Minn.
.�" s`.� 7�
BUILDING PERMIT No 71s3
Date: _'-.f•_._..� ..� ..[G�.. �.._ .._._ _
_..�_
`;
Owner: ._.. ... _ _.. .�__.. . Bu3lder ._... ._ _ ............._....................._....._......._....__...__..._..___.._......
Address_..._.._.._...._.... ..___..__......_._..._..._._...__._....._.....•-•..._...._.._......._.._ Address _..�__.._......._......_..__....___._.._..._......__......__._.._._._._.._..._.____.�...
� CATION O BUILDING
No. �../......��. Street ._ . . _.. -�'�-dl.'t •...��,�r.•.�••... .�i...� Part of Lot ....�.�.�'�..�.. ._ _ __.__._
Lot ....._...._._...._......._...._ Block •---_._..._......,�..........._....._.._. Addition or Sub-Division �� �i���Ll!- ..�; f..._. - a---_...__
Corner Lot ....._.....�...... Inside Lot ----._ ........:....._..._._..._..... Setback ._..,,�.,�.�...�.�--•----.. Sideyard ..��..._.._.....�...!......_..._..__.__.._..
._ G� � y�-
Sewer Elevatiam .....='� s.../...a�._._.._...._._.._...--•............_..._._'��j��'''��''"{' on Elev t�on .---._�'�...�_..�c�...� ....�. S__.___.._...._._
�/ A_ � i �
DESCRIPTION OF �UILDING
`v :
_ . ........ _ Front�~� . Depth �.�•— Height .�� -. Sq. F� �.c.l.�.�.L� Cu. FL ���
.. .
._ . . _:�... Fro t ��.__ Depth _...:� I�eight _.,�..�.�.�._�,� Sq. Ft. .�Ae2 � Cu. F� _'�'�..�!�
of txuction. ��p� ���
TYPe `���""v�P�..__. Es� Cos �LL�_..��r.v..�...._........ To be Completed _..:_._.__._...:._._.._.__—....
7
In consideration of the issuance to me of a pernut to construct the building described above, I agree to do
th� proposed work in accordance with the description above set forth and in comp ' ce with provisions of
ordi�►ances of the city of Frfdley.
�
--- -�� —
.���
In cansfderation of the payment of a fee of �..+c�....�.._._......_.., permit is hereby grauted to._.._..._
.____,........_......._._.._..._.:.__._..._._.._ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, ernployees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city liinits and this permit may be revoked a t any time upon,}�olation of any of the provisions of said
ordinances. /'1 fl // _
Building Inspector
• NOTICE:
ihis p�emit doa not eowr du eonstrueiioe, inshllallon fer wirino. Plumbina. �u 6�atiny, swr�e or wat�r. 8� wn to sN
�h� suildins In��etor for ppuaN p�rmils fo� fha� iNna.
r�
APPLICAT�ON FOR BUILDING PERMIT
CI�Y OF F�tIDLEY, MINNESO'�A :.",
OWNER' S NAME�///li'/`�,/, /� � �/ `"e�/`J BUiLDER�/)�/yj�f'�/ � %c,�Sost
T
Ann�.ss y�o,�' ,�',�. /� .� T ADDRESS ��0�l�,��%% � 7�
. LOCATION OF BUILDING
No. .�L�G� Street 1,.3 irc` Jt�t tit� � ,�Part ;of Lot
Lot� $��d;2,� : BlQCk �/ _ Addition,or Subdivisi�on,�'�//'i4 �t �,�.//c;
Corner Lot � Inside Lot Setback Side-Yard .
�_�
SEWER ELEVATION FOUNDATION ELSVATION
Applicant attach to thia �orm.Tato Certificates af.Survey of Lot and proposed build-
ing.location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as;
�.y . . . , �
/�`0/�2 .-� , �, ,_,_ . Front� ��6_ � Aepth 2 ( Height : -. � �� .
, ... _ . Sq. Ft.. , Cu.•: Ft.: . .
. . , � ,.
: . :.:
,° �/'r�9-�[ � Front � / Depth 2 � Height (�
--.r
•. � � Cu ., , Ft, .
, Sqr. Ft, , .
Type af Constructian ��''� /rt- ,, ; 'Estimated Cost�l�v—a
y-
To be Completed / ,2 -= / �-- �( �
,
_ .. . : ; � .
The undersigned hereby makes�application for.a peraait for the�-wo�ck �erein specified,
agreeing to do a11 work in strict accordance with the City of Fridley Ordinances and
rulings �f the Department. of Buildin,gs, and t�ereby declares that �1�1 the £�ts and
represeatations stated in this application are Cxue aad cor.r�ct.;
�
nA�_ ��► /.5 f 9/� s��ru,sux� .� �--
�
�
�(Schedule of Fee Costs can be fouad on the Reverse Side).
. + ,' � '
•
�..� . �
� sas-eaaa
TWIN CITY TESTING AND �NGINEERING LABORATORY. INC.
ENGINEERS AND CHEMIST$
�� i
��' ' 2440 Fronk{in Avenue - St. Paul 14, Min�. :�' �
� � , s
REPp�T oR: DEI+'��T3t TESTS OF COI�k'ACTED FTLL s
RESI]�E�TGE LOT �
PROJECT: i��.�� ��i��iN,N�E. pATE: September 3 r �-9�'
C�T�IA AE�gHTS, MTNIJ�SflTA
REPORTED TO: Ac�vanced Heatirig ar�d A3.r oflditi4�3..ng ������ TQ �
�'�09 N.E. Main Str�e� �� � d �I �
Minneapc>lis , Min�es o�a �/'� ' � I
Attention: Mr. klayriax�d Edson
�..�.-� as�s�
LABORATORY No. 1.1-42�.
TEST NUMBER:
DATE TAKEN:
TYPE SOIL:
LOCATION:
1
Aug.31., 1964
Brown medium
sand with
a little
gravel (li
At S,S'.
corner of
buil.ding
I�EPTH BELOW FINAL ELEVA'�'ION: 2'
�
Aug. 31, 19f�4
Brown meditzm
�and with
a 1itt1E
gravel (1)
At S.W.
corner of
building
2'
3
Aug, 31,1964
Brown medium
�and w�.th
a little
gravel (�.)
At N,W.
corner o�
bu3,].ding
2'
4
Aug . 31, i964�
Brown mediUm
sarxi wi'th
a little
�ravel (1)
At N.�.
corner of
bu�].ding
2�
FIELD DENSITY DETERMINATION:
Method Der,�ity in Place $� Sand-Cone Method. ASTM:Dl�S6-58T t-�`� �gis)
Dry Density (pcf) 111 106.5 10A 106.5 .
Maisture Content (%) 6.'�
Plus #4 Macerial (%) 2
�.8
�
?.2
6
8.7
8
LABO�ATORY 1�OISTURE — DENSITY ,�EL ATION OF SUIL:
Mechod Standard Proctor, ASTM•D698-,�ST, Method "A��, (.-�4 8asis)
Maximum Dry Density (pc� IIO.s 110.5 110.5 11Q.5
Optimum Moisture (%) 1Q.6 1Q.6 I�.6 10.6
COMPACTION TEST RESULTS:
Relative Proctor De�sity (%) lpp.5 9�.�
RecominendQdMinimumDensityi�) 9S 95
90.5
9,5
96.�
95
REMARKS: The above te�t loeations were selected by Twin Ci�y Test�.ng and Engirieering
Labaratory, Inc. Compact,�.on meets the reco�nmended minimum �pecifications in
the ar�a of tests �'1, �2, and �4, init is balow �pecif�.eations in the othex
tes�t area.
A� A MUTUAL PRQTLCTION TO--C,LICNTA. TN[ ►U�I.IG ANO OVR�[LV[t. ALL R[rORTS A11! RU/MITT[p A� TNL CONFIDtNTiAL rROrlRTY Or CLI[NTi. AND AUTNOII•
IZATION /OR IWlLIC;ATION Ol fTAT[M[NT�. CONC�Uf10N• OR [%TAACT� iROM OR R�6ARDIN6 OUR IICPpRTO If 11[�i11V[D P[NDING OUR WRITTF.N A�►ROVAt
' ''� • Twin City Testi nd Engineering Labor tory, Inc.
By �
- sss-s�e
TWIN CITY TESTING � ENGINEERING LABORATORY. INC.
EMGINEERS AND CMEMI$TS
d��'• 24�0 Franklin Avenus - St. Pov) 14, Minn.
�
�1 T�
: � !
� REPORT OF: DENSTTY TES'�S OF CpMPACTLD F�,
RESTAENGE LaT
PROJECT; �1.9� �L"�.�iN � N.�' • DATE: September 3 s �.9�'
COLIIN�IA HEI(3HTS, MINN�'SOTA copi�s To
REPORTED TO: ����� �ea,tj.Ti�, and Air Cond�.t�on�.ng, ZT3C,
�709 N.�, r�in stree�
Minneapolis, M3.nnesota
At�enti nn• NLr NGZVn=�,� �''� � �
4 �4� ��'
I.ABOftATORY No. �1,.��1
TEST NUMBER:
DATE TAKEN:
' � 1�
LOCATION:
DEPTH BEI.QW FINAL ELEVA'�'IQN:
�
Augus�t �],, 1964
Br cywn m ed�.um
aand with
a li�tle
g�ae�l (1)
��� N. o�
S.E. Qorner
o� b�t�.lding
At g�ad�
�
August 31, 196w
Brcywn medi�.u�¢
s�a�r3. w�.th
a littlm
gravel (1)
z5' N. oF
S.W, corner
of building
At �ade
�IELD DENSITY DETERMINATION:
Mechod e���-�� � F��Q B9 SaMd-Cone �tethod, A.STM:D1��6-S8T (-� Ba��.$)
Dry Density (pcf) ll�t 114
Moisture Content (%) 5.5 5.3
Plus #4 Material (%) � �
,
LAB,QRATQRY MOISTURE - DENSITY R�I�A',�ON FO SOII.:
Mechod S'�andard Proc�pr, AS�M:D6g8-58T, Method "A", (�4 Hasia)
Maximum Dry Density (pct� 114,,,� 11�.�
Optimum Moisture (%) 1Q.6 �4.f
COMPAC�ION TEST RESULTS:
Relative Proctor Density (,`�. ) �-�
Recarnnended Miisitnum D�nsi,ty f'�i 95
95
REMARKS; The �bove teat locati,on� w�re �eleateci b� �win Gity Testing and Tnig�ne�ering
Laborat4ry, Inc, Campactian m�et� the ret�omm�nded mit�i�;um �Pe�i�'iaat�.ons
�.n �ha abpve t�st axeaa.
AS A MYTYAL PROT�STION TO—C�LIRM9�. TML rY�IIC ANp pVRRIV[�� A{.L IIRr011T� A11[ •NAMITTLD AS TM[ CONIIpSNT1AL IiROD�IITY 0/ C61RNTt. ANp AyTM011•
IiATION IQR ►Y�FICATION 0• �TATiN�MT�. GQMCLUSION� p1! faC{'RACT{ FIIOM O� 11t1iAf1q1N6 OUR R!►pRTf 1� RR1L1tV[D 1KMDINp OUA WIII�TRM AT►ROVAI.
. .> �', ` Twin City Testin nd Engine�riny Lobor tory, Inc.
By , _ �
� • ss�•a4as
TWIN CITIf TESTING � ENGINE�RING LABORATQt�Y. INC.
.d•�"�y ENGINE�RF,► ANq GHEMISTS y�t T
�O
' �A40 Franklin Ave�ue - St. Pa41 14, Mi��. �� �
REPORT pF: DENSITY �FjS� OF CC�'ACTET? FILL
RFSIDEIJCE LOT
PROJECT: Jr'1.90 BITC�ANAN� N.L''� DATE: �Oj�@Tribf9l' 3� �.9�'
COL�IA HE�GAT5 i MINNE50TA
REPORT�D TO: Advanced Heat�ng and� Ai.r CQndition3.�ng ,�I�i�:�$ TO
4709 N.E, l�iain S�treet
Minneapoli,s M�.nMeso'ta
Atten�ion:• Mr. Maynard Ed�on 3
LABORATORY No.l],,-4��.
TEST NUMBER:
DATE TAKEN:
��..�
LOCATION:
DEPTH BELOW FINAL ELEVATION:
F�
September 2, 19��
Brcawn medium sand
w3,th a l�.ttle gravel (1�
A{, N.W, coxner of Build�.ng
(Re�teat of �3 )
2�
FIELD DENSITY DETER J�.N..�ATION:
Method Densi,ty in Place By Sand-Gane Method� �.STM :D15,�6-58T ��4 Ba�is�
Dry Density (pcf) 112
Moisture Content (%)
Plus #4 Material (%)
9.�
4
�ABORATORY MOISTURE — DENSITY �ELATION 4F SOIL:
Mechod Standa�d Pxocs�oar� A�TMsD698:..�8T, M�hod "A". (.�4 Ba�is)
Maximum Dry Density (pct� ]„],0•5
Optimum Moisture (%) 10.6
COMPACTION TEST RESULTS:
Relacive Proetor Density (%)
Recs c�nme nde d M ini.mwcnD e n� i ty( q)
101
9S
REMARKS: 'The above te�t lcacat�.on was seleeted by T�.n City Te�t3.ng and Bng�,ne�ring
Laboratory. �r'ic. Compaat�on x�ow m�et� �he re,commended m�.nicnum apea�.f�.aation�
�,n the alaove te�t ar�a.
M A MIJTUAL PRO7LCTION TO-GLI[NT{, TMt rU�LIC AMD OU11/eLVL�. A44 11�POI�Tf AR4 W*MITTRO M TMR CON/ID[NTIAL PRO►LIITY O► GLILNTS. ANO AYTMOII•
IZATION /OR 1W�LICATIOM 0/ �TAT[MLMT�. CONGWSION• OR LXTIIACT; /ROM OR R[6ARDING QUR RCI�ORT� �� 11Rt[RVLO r�N01N0 OUA WAITTLN A/IROVAL
� ,� Twin City Testin and Engineerin labo� tory, Inc.
• o . , ,� �
By ''' �
. 645.6446
TWIN CITY TESTII�G ANp EN�GINEERING LABORATORY. MNC. -
ENGINEERS AND CHEMISTS
'O�H�� 1440 Fro�k{in Av��v� • St. Po�) 14, Minn. : � s
., � �
MOIv�URE - DEN�'vl't'Y CURVE SAMP�E Na �.
RES mENC� L0�
PF�OJECT: 5190 BUCHA1vAN N,�' , DATE: !�BPt�1bCY' � w �-%�7�7'
COLIIMBIA :HE�GHTS MINNESOTA coPi�e �ro:
REPORTED O� ""' �"'-�
�3� Advan�ed Hoati� & Air Condition�g,Ir�a.
. LABORATORY NO. �.�.�-�21
111
w
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C�i
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t■� ��+7
0
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METHOD OF TEST: Standard Proctor, ASTI�I:D698-.�$T, Method "A"
TYPE OF MATE141AL: Brown med3,um sar�d (1)
MAXIMUM DENSITY: 110.� ib. /C11. ft.
4PTIMUM MOISTYR� � 1.p.�i %O
M018TUFt� CON'T�NT'--�-°�� � ' ' ~
sus�ecr PERMI . _,
City of Fridley . 14694
A7 THE TOP OF THE TWINS g U I L D i N G P E R M i T
r
� � ECEIPT NO.
� `L �_���_ COMMUNITY DEVELOPMENT OIV. '
r � � PROTECTIVE INSPECTION SEC.
1 �
i
14 � /'��1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""'� � ,'� 612-560-3450
910-F15 5/12/7$ � �
JOB ADDRESS 5190 Buchanan Street N. E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2$� 29 1 Marion Hills Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Maynard Edson 5190 Buchanan Street N.E. 571-1225
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Addition
7 CLASS OF WORK
❑ NEW G� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 21.5' x 26' Addition to Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS protect garage ceiling and frame walls with 5/8" Type X sheetrock.
pTE. pERMITS REQUtRED Ft7R V�'t��StsG,
SEPER iNC AND SI�tWS. W�RN�
t{�A�1�', P��B Before diggin� caN locat utilities
iELEPHONE - EtECfiRIC - GAS Etc.
REQUIRED 8Y LA�N
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOF ELECTRICAL, PLUMBING, HEATING,
VENTILA7ING OR AIR CONDITIONING. WOOC� FY'3IIl@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. 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. DWIG. 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 ���$1.4 � 26S �•7, 13
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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 CONSTfiUCT10N. yS 2( .$3
PLAN CHECK FEE TOTAL FEE
$40. 67
SIGNATUREOFCONTRACTO ORAUT IZEDAGENT (DATEI WHEN P OPERLY VALI qATED THIS IS YOUR PERMIT
�— I cQ�,.�J c-S —► ( - � �
G REOFOWNERNfOWNERBUILDERI ATEI BLDG INSP � DATE
5 `
• CITY or- r-�zi»�cY
' APPLICP,TIUf� ("0(t R�SII)I�fJTI/iL BUILDIC�G f'�IZI�IITS .
' ( f'�EW, �LTL= ftf1T I UI'd S, {'illll I T 1 Ul��, OfZ RL• ('/1I IZ S)
OWt7�R: //� ���"w� , �l1���`" I3UILllJ.l2: ''' �
���J.��JJ � � / �a ��k�o-�rc.�v naar�JJ � • � '
• Tel. I�o. ..� %/ " /�� � •'
No. �/ i0 5treet: ,B .
7..OT : T3I�OCY.: 11DDITIOt� :
CO1tl1ER LO�': IIdSID� LOT: S;:`�L'T�CY.: SIUL•'Y7�RDS:
Ap�.�licant attach �L-o �his fonn �ao Cert.ificate�; of Survey of LoL- and proposed
bui.lding a.ocatiaii draYm on these Certi�icates. �
DESCRT PTIO('J OF BUI LDI I�G
xo I3e Used 1�s:
c " /
�t/ti+ Front: 2,� Depth: Z� � Height: / Z ,
Square Feet: ,35 Cubie Feet: �o�_ _
rront: � Depth: � Height:
' Square reet: Cubic Feet:
�'yp� of Ccuzstruction: ��"�'��` Es�:imai�ed Cast: �$ . . � �
xb }3�: Com.pleted: s� �� ��1� Alt. A Alt. B
Prvposed Driveway tti'a.dtli If 2.ew Openinq Is Desired $ $
(sLr: I'.�VERSE SIDE OF SHELTI
The undersigned heT'eby makes application for a permit for the work ]ierein
s�ecifa.ec3, agreeing to do all e<<ork in strict accorciance �aith the City of
Fxi.dley Ordinances at�d ruli,igs of. the De??ari�r,tent oi l�uildings� n»d heleby
declarrs t:hat all tl:e faci�s anci representatioi:s �t-ated i�1 this apulicai��oi1
axe true �-ind carxect. See reverse sie3e foi aclditio�ial 111�0:711c1L:101.
��../�% "� � '� '�'
DAT�: �7 SIGNItTU):E: �-� ?it-�� %' � � .
S�1�111�i:lOI1S: � G jo � •
� a.�"•�' � C'.�/�s.�/g a�, ��'�G s�s' X�Z =
� �'�� uv�.t'i /`�,,,,�,.�,r �# RG, 83
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CQNSULTl�JG ENGINEERS
t104 CURRIE AYENUE, MlNNEAPOLIS 3, MltdNESOi/4
S�t ��-__.___ .__ ._ 52N0 AVENUE N. E.
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i HER£$Y CERTIFY THAT THIS IS A TRU£ AND CORREC? PLAT OF A SURVEY OF
�.aT 2gi AND LOT 2�� BLOCK �� MARIAN HlLLS ADDITION� C17Y OF FRIDLEY�
PjENNEPIN COUNTY� MINNESOTA� EXCEPT T1iAT PART TMEREOF LYING SOUTHERIY
OF TliE CE�iTERt I NE OF 52NO AYENUE id , C., EXTENOEp {AS C�NTA 1 NEO 1 N AND
',FliOWr�l CN TNE PLAT OF MARIAW HillS 2Nt7 ADDITIGN� AND SUBJECT TC SAID
3TREET RIGHT-OF-WAY OVER THOSE PARTS OF SAIO LOTS IOCATED 4/1THIN THE
i'IO�TTH ONE-MAIF OF 3AtD STREET RIGHT-OF-WAY AS EXTENOEO� AS SURVEYED
8Y ME THIS �zTH DAY OF MaY, �964� A,D.
S t GNEn ��i''r�'�-�
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St �EE
4'00'*!$ ��I� . ssat aq Z uo���aS .
u� u�so; �as se -���-�us-�o; �pa8.z8�,'aa; aq� ITg�lg esaa ou uI ' g
� �x.zoM pasodozd �'�a 30 �so� aq� n�-;oaxay�,_
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PLANNING & DESIGN
: � � i�-�M. {<:i�. Ac,GiT�,:�� r;�JF� c-��q�;::
7101HiOHwAVl6w.l. PLAN SHi.'OF &l1TL� b`
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Page 1 of 4
EXTERIOR ENVELOPE AV�i27',G�: "U" CGMPUTATION
, ,
OWNFR: � tpt�}�'�'r� L.� ���0 �J DATE I� �(J " S 7 1L L...
SITE ADDRESS :'rj I�� (� 1� ST �� PiiUNE : S^� �" I Z Z S
CONTRACTOR: �v /.��CiG� �T ( i�G�
,
Determine warking square footage of each ,'
� x��� +��r.c±i�
1. Total exposed wall area...... (0 3 sq. ft. x .17 = � d �
�� X,21�". Q�
2. 'Poal roaf/ceiling area ...... S� sq. ft. x .05 = �- U
Total exposed wall area above floor = �O �9
a. Total wall window area ................................. t 0 O
b. Total door area ....................................... � O
c. Tota1 sliding glass door area ......................... t{.Q
d. Total fireplace wall area ............................. _L..f.�Q.
e. Total wall framing area (average 10°s) .................. __�'Z
f. Total rim joist area ................................ . 7/
g. L� wall area above floor. . ......
h. --�1 area above floor �P.���:!`!�vc.�. . W����. '
i. wall area above floor .......................... O
j. wa11 ar_ea above floor .......................... O�
Total exposed foundation area = �
k. Total foundation window area ........................... �
l. Total iiet foundation area abave grade ................. Q
Determine "U" value of each wall segment
(e.g. window, door, each separate wall section)
a . � (� O X �� U,� _.. ' � .� . - 3 _�_ �'!� EtLM o P R-+� E `�`/ ��,q^oQ-M j .
b . G7 g „U„ -- _ . .._
�. 4 o X,�U« .�, _= a�s
d. t.�,A , X ��U�� — _ —
e. �D Z X
f. . , � X
�. � � � X
h. X
i. � X
"U" t� �
.
�,U�� � ��_ �
��U�� C7�p _
.
��U�� �O =
.
.�.
�� U �� �
� . Q X ��U�� -�' _
k. C% X "U" -
1. � g ��U�� "'_ _
3 . .................... ........ Total -
�
. 3
�
��
�
�
_ l_?Z .�
If item #3 is the same_as,
or l�ss than item #1, you
have met the intent of
SBC 6006 (c) 2.
0
IYxterior Envelope Average "U" Computation
" Total exposed roof/ceiling area = 5 S
m. Total skylight area ............................ Q
n. Total roof/ceiling framing area (average 10'�)... �
o. Total net insulated roof/ceiling area........... �'O 3
Determine "U" value for each roof/ceiling segment
m. � X "U" � _
n. 'J��o X ��U�� 0 � _
�
o. S� � x„U„ . O 2� _
4 ........................... Total =
Z
t3
�S
Page 2 of 4
�
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006 (c) 1.
n
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the sum of
items #3 and #4 shall not be greater than the sum of �items #1 and #2.
�. t o� -� 2. �- 8' = l 3�
3. �[i2 + 4. �� _ � r L^
f
WALL SECTZONS
NOTE:.Use 10� of opaque wall area for
fram� construction
�
WALL
FIG. #kl
i ` �- � • �,
�. , �,
� f�
F'S G. �# 3
FRAiiE i?ALL .
� ' i0
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, - � - . � � �.` •
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Page 3 of 4
Construction " R-Value
1. Interior air film 0.68
2.. L'GYP. �.
�.
s.�..,�e �.� D- y. 3 5
4. s k��-M � �" ei ���' ��
S. s1��oJ�- I�s�ccD p.2b
6. Exteri�r air film . 0.17
(�( -. l2L c� Total �, al I
1. Interior air film 0.68
2. ��G�l� t�J� O.�S
3. 3�u � �S, i2-t3 �3,00
4. �1�y �(J 1 L�"R � Q� � Z O Cv
5- I� STuCC..-o 0.20
6. Exterior air film 0.17
u�,�60� Total ,�(d�$'to
l, Interior ai-r film 0.68
2. I��i.�� g(,,`i uJ � 4.� $'
3. �1'' � w,sv c.. � 2 tZ ZL.00
4. � S E���►.1C. 2. 0(o
5. i�` SQ`tl C�- � � ��
6. Exterior air film 0.17
(� _ � b 38 `� Total , 'i/
�
1. Interior air film 0.68
2.
. 3.
4.
5.
6. Exterior air film 0.17
To ta 1
. � I o � r '� � 4
..��(��T�f"�"� • ' � , ' �� . �
.:- �r� � �
�` � • .s : �
�( ( .:=== , � : ' ` . �
/<( � . . • . �
� ' _ .
. b `, � 11f � �
�. .
(�1 , . ��� � _ �� � /(l^ r �� �' �
FIG.. �t4 �rc � ,� ` . .=� i�r
. � p ,..
• �« 1 x X � i`/�!/
. � // ( _ !t � _ �i� f
NOT1:.c Indicate type, "R" value, depth and �
placeri�nt of insulation.
. ,�
.
ROOF/C�ILING
• V"�,IZT
ifei�ted
Page 4 of 4
Construction R-Value
1. Interior air film 0.61
2. L��G`�� ��_ . �•�
3. 1'L4 I r.►S R-3g 3�.��.
4. Exterior air film (still) • 0.61 •
(,,` _, Ej'y:Sv Total 3 7 iG7
� :-� /Ja 2$.�t'� {. 1. S. A-t fZ T� 1 �. n/�
�� � ���� Z. v k G� j�
Heat flow 3 , ,��
up . 1 � �,n � n� S i2 -Z7
.
• - . � . A-t 2_ w^-t l� �
r zc. �'s � ' . (,l = . 0 3
?A��j:r_t•"��._._�'�'c�'�i�����:c'Li:fi'4?°-n�`�SG'.IC�-.L��Gft ..
�- _ _ ' _ _�
�__ _..._.._. i'/.3`�� .
}?eat floca up . , ;•ven[ed
_ ,PTr. ��6 � . .. . . �' .
. 3 r� : � 5 :
. � �'
. c-S..n�'�4
� t,�l S.'� �-,-fr.°,.3:. _.�._�-� „�
� cMR.;3`,�.:;_... ;0. • .. :... .i�
. _ c 4 . �': f : _'t � y - - ' . - - - . �•-l'"�' / . F � / iQ
. ;
• N0.?-VP.��'TE17 . ' .
.., �. � Hent � �, � _
, .� � f low ap . .
� _ .; • ..
r.r.c;. �� . .
O � �o �
m,�r
�. 3s
�i . O O
d,` �
� 3 3, o '2,.�
1. Interior air film 0.61
2.
3.
4. Exter.ior air film (stili) 0.61
Total
1. Inside air film 0.61
2.
3.
4.
5. Outside air film _ 0.17
Total •
Note: Use additional sheets if more space is
needed for details and calculations
,
....� �
� CITY QF FRIDLEY � � .
APPLICdTION FOR PL.UMBING AND �AS FI�TING P�RMIt
m � m ' u k� d Water
� u� ��� w r�, a m q u p, w � Heater
v u rl m N•'1 +7 ba m rJ s+ s1,
..� .. � .s c m x y v u .0 c� c� 4 �+
u � n c .e -+ .c e a 3 0' V•.� O.c u v
i .-°+ w � `� � ��� o.°c .-°r ro ro y ro a N N r�
c� u � w c� y 3 o w y w u m d r e� � v� O as lec
� .
zs� 1
�ng �
3 z.'. �
a ��
1{R) � fliture Connectioa Opening Connected witY�. 5ewer
i
{•} x Naw Fixture, Old Opening Water
PARTIAL RATE SCHEDULE . '
FiUaflING FIXTURE RATrS: N0. RATE TOTAL
!�.n:zber Fixtuxes
Ftature F±xture Opening
New °ixture, 02d Opening
Catch Basin •
Water Heater - to 99,000 &2'U
100, 000 BTtl to 199, 000 BTSS
Kat�r Softener
t:ew Grour.d I�n Old Euilding
Eleatric Water Heater
GAS FiTTI:r'C FEES:
lst 3 fixtures
Additior.al Fixturea
Gas Range to 199,000 BTU
�� x S3.00
x S2.o0
X $2.00 �
x 55.00
x 55.00
x $10.0U
.t S7. OG
x $5.00
X SS.00
x 'S3.00
x $1.00
x 510.00
S
S
$
S
S
S
5
S
S
S
S
S
REPAIRS F, ALTERATIONS
First �100.00 $5.0a $
e:.ch add. 5100.00 or fraction S2.00 S��
Sta�e Surcharge $ .50
_ TOTAL FEL' $ � .�
REINSPECTION FEE
(510.00)
Job Addresa �190 Buchanan Street P� . E. � � � � � � � �
Department aE Buildings
City of Friciley •�
Tel. #571-3450
0
The undersigned hereby makea applicetion !or a permit !or the vork hereia
specified agreeinq to do all work in strict eccozdance with ths City Codes
and rulings of the Department of Buildinqa, and hereby declares �hat all
the iacts and representations stated in thia application are true and oorreat
Fridley, Mn. December 1� , 19 �8
ow�R Mayna�rd A. Fdson
Frame
ICIND OF BUILDING �
vsED ns Dwelling •
To s� cor�r.� Gn asonT P'iaY 15, 1979 .
'� � ESTIMATED COST W3OO.�0 .
OLD - NEW SUILDING PSRMIT NO. PERMIT NO. /���/-�
d�1�X 0•,�mer - N:aynard A. Edson
Siqned By`�� '
Tel. rto. 571-1�881-+� j 1 s. �—
ROUGii ZNSP.
Date
FINAL ZNSP.
� Date
APPROVAL FOA PERMIT ��iG�`S..L.
MZNIMUM FEE FOR ANY PLUMSSNG pE IS a7•SO pyvg a.SO ST71TE 80AQQ1I�.S
�_
-_..-_ --__._:_:_, _.
�
�
0
�
�
' � - � SUBJECT . � � ' ��. � � P E .
c;ty of Fria��y 32021
A7 THE TOP OF THE TWINS ��� L D 1�� P E R M I T
r
; � - RECEIPT NO.
� ; ��__��� COMMUNITY DEVEIOP��NT OIV.
r � � PqOTECTIVE INSPECTION SEC. � �'� j�
� � w
' � �'��� � C�TV NALL FR10lEY SS�32 NUMBEN NEV DATE PAGE O� AVPROYEO B'1
�----�•� �'' 612--571-3450 9t0-F15 7/23/O1 / /
JOB AODRESS 5190 Buchanan Street NE >
1 IEGAL lOT NO. BLOCK THACT Oii AOOITION SEE ATTACHED
oescR. 28,29 1 Marian Hills Addition s►+eeT
2 PROPERTY OWNER MAI� AOORESS ZIP PHONE
Maynard/Patricia Edson 5190 Buchanan Street NE 763-571-1225
3 CONTRACTOR MAILADORESS ZIP PMONE LICENSENO
Same
� ARCHITECT OR DESIGNEfi MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADORE$S ZIP PHONE UCENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
C� NEW O ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
S DESCRIBE WORK
Remove existing Deck; Construct a 21' x 12' Deck
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan.
�
SEPARATE PERMITS AqE REOUIqED FOF ELECTRICAL, PLUMBING. MEATING, TVPE OF CONST. OCCUPANCY GROUP OCCUPANCV �pAO
vENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WQRK OR CONSTRUCTION 20NING SO. fT CU FT.
AUTHOqIZED IS NOT COMMENCED W�THIN 60 DAVS. OR IF CONS7RUCTION
OR WORK IS SUSPENOEO OR ABANOONEO FOR A PERIOD OF 120 OAY$ A7 �
ANV TIME AFTEF WORK IS COMMENCED. '' NO: DWLG. UNITS OffSTREET PARKING
1 HEREBY CERTIFV THAT I MAVE REAO AND EXAMINED THIS APP�ICA710N 1 $TA�L$ GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORNEC�. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO OROINANCES GOVEFNING THIS TVPE OF WORK WI�� BE CpMPUED @
WITH WHETMER SPECIFIEO MEREIN OR NOT. THE GRANTING Of A PERMIT �2 � 772 W 1.39
OOES NOT PRESUME TO GIVE AUTHOAITY TO VIOLATE OA CANCEL THE pEqM1T FEE $AC CHARGE
PROViSIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON•
STRUCTION OR TME PERFORMANCE OF CONSTRUCTION �H.3.25 Fire SC �Z.77
PLAN CMECK fE TOiA EE
�' 7.41
S�GNATUAE CON7PA(;TOQ0�7 ai ENi � iO�iEi MEN R P ALIOA THIS IS V=� P�RMI��
�' ��� /
L r
N O�OWNEQi��OWNEQBU�LOEF�i �D�iE� � Bl ��NS� � � � ����E
N� [ l Effective 1/1/2001
ADDN [] ', CITY OF FRIDLEY (763) 572-3604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BU�LDING PERMIT APPLICATION
Construction Address: 5190 BUCHANAN ST. N E
Legal Description: LoT 28 , 29 BLOCK 1 MARION HII�LS AD�7ITION
Owner Name & Address: MAYNARD A& PATRICIA L EDSON Tel. # i 763 ) 571-1225
Contractor: OWNER MN LICENSE #
Address: SAME Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
�THER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
�-_..
Length � 1 Width 12 Hgt/Ground �� Sq. Ft.; '
l __._ -
Construction Type: GREEN TREATED LUMBER Estimated Cost: $ .-�-+-��� ����
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 7/20/O1 APPLICANT: MAYNARD A EDSON Tel.# (?�63)571-1225
CITY USE ONLY -
- --Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STI PULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in apptication
$ 8�-aS Fee Schedule on Reverse Side
$ o� • %% .001 of Permit Valuation (1/10th%)
$ �/,,� $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Pfan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ C�%- y�
�►�►�,i�,��►��-� ar�r�itect�ral � ,str�ctural pr��Cast c�e��r��� �r�ducts
I��ti►W��iT C�t� � ___._.�... �.___ __ _._
. Praj. �C�,:�+��'�.'..%'� _�!a.,,.��..�....`�..�._ �h. Na. _ . . !�s°r� ..
.'S"`t �r.c9 "'�sac.t� a�,a�,�w�a � w' td»�
£�ax2C��9 • :7st►ec�,Mtin��esata ► 65?b3-t3aGf� '�'"`+�.�-cx.�. � �M�.�,..ae-�,.
phOn�: i�?2^425-5;'��S Subj.'3G.�::T,���...�5�.�."�..__"'Ca_�..r�.iS:..._... E3 _......,._......�__... �lob No. _.__._
_.._...,.a..�.�._..�..� __............,._._._..._.._.. ���.�
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CONSULTlNG ENGlNEERS
1104 CURRIE AVENUE, M1NNE^POLIS 3, MIMNES07N
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( HER�pY CERTIFY THAT THIS IS A TRU£ ANO CORRECT PLAT OF A SURVEY OF
LaT Z�u AND LOT 2�� BLGCK I� MARIAN I-{lltS AOD{TIGN� C{TY OF F�RIOIEY�
N£NN�PiN C'JUNTY� MINNE507A� EXCEPT THAT PART THEREOF LYING SOUTHERLY
OF TMi CENTERLINE OF 52N0 AVENUE N.L. EXTENOEO �AS CONTAINE� IN AND
'5�101,fr'1 ON TNE PLAT OF MARIAN NILLS 2Np AOOtT1CN� AND SUBJECS TC SAID
STREE7 R1GhiT-OF-WAY OVER THOSE PARTS �F SA10 L07S LOCATED WITHIN THE
NOitTK OME-MALF OF SA10 STREET RIGHT-OF-WAY AS EY.TENDEO� AS SURVEYED
8Y ME THIS IZTH DAY OF MAY� �964� A,D.
�� u��o; �as .se ���cad
S i GNEn �i�/����
y
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(`
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5,� �' '�,E,9
- _ _a�y ..9_�_�aSC
� � ' � � Sue�ECT - � . . ' �. . •
c;ty of Fr�a��y 3� 96 �
AT THE TOP OF TNE TWINS g�� L D 1 N� P E R�II I T
r
� � RECEIPT NO.
� ` � � COMMUNITY DEVELOP��N? DIV. �J /�_3604
r � v � PftOTECTIVE INSPECTtON SEC. 5/ G ���
� � �"'1 � CITY NA�L FRIOIE� 55�32 NUMBEA i1EV D�TE P�GE 0� APnROVEO Br
�""'�"� �'� 612-571-3450 9t0-F�5 7/10/Ol � /
JOB AODRESS 5190 Buchanan Street NE .
t LEGAL �OT NO. BLOCK TiiACT OF ADOITION SEE ATTACHEO
DESCR. ZH,29 1 Marian Hills Addition s►+EeT
2 PFOPERTY OWNEF MAIL ADORESS ��P PHONE
Maynard Edson 5190 Buchanan Street NE 763-571-1225
3 CONTRACTOF MAIL ADORESS ZIP PHONE �ICENSE NO
Norling Exteriors Inc 341 79 Way NE, Fridley, MN 55432 518-2399 20098700
a ARCNITECT OR OESIGNER MAII, AODRESS ZIP PMONE UCENSE NO
5 ENGINEER MAtL AOORESS ZIP PNONE UCENSE Np
6 USE OF BUILDING '
Residential
7 CIASS OF WORK
❑ NEW O AODITION � ALTERATION C.� REPAIR O MOVE - O REMOVE
8 DESCRIBE WORK
Soffit/Fascia
9 CHANGEOfUSEFROM TO
STIPULATIONS
Install soffit ventilation to meet the State Building Code.
7YPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAO
SEPARATE PERMIlS ARE REOU4RED POR EIECTRtCAL, PIUMBING, NEATING.
VENTILATING OR AIR CONDITIONING.
TMIS PERMIT BECOMES NUII AND VOIO IF WORK OR CONS7RUGTION ZONING SO. FT CU FT
AUTHOiiIZED IS NOT COMMENCED WITMIN 60 DAYS. OR IF CONSTRUCTION <,
OR WORK IS SUSPENOED OFi ABANDONEO fOR A PERIOD Of 120 DAYS A7 �
ANV TIME AFTER WOfiK IS COMMENCED. ` NO DWLG. UNITS OfFSTREET PARKING
I MEREBY CERTIfV THAT 1 HAVE AEAO ANp EXAMIN�O TMIS APPUCATION 1 STALI$ GARAGES
AND KNOW THE SAME TO 8E TRUE ANO CORR�Ci. ALL PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS 7VPE Of WORK WILL 8� CAMP4IED @ @
WITH WHETMER SPECIfIED HEiiEIN OA NOT. THE GRANTING OF A PERMIT y�is9OO �p.9S
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAI LAW REGUTATING CON-
STRUCTION OR THE PERfOFiMANCE OF CONSTRUCTION �6;6.20 Fire SC �1.90
\�� P�AN CNECK fEE TOTAL EE
cx�--�.� � � ,�� , Ib'►� 01 License $5.00 4.05
S�GN�iUpEO�CONCRA(;iOQOp�UTMOQ�2E0AGENT iD�iE� EN OPE V IOATE MISJ$..Y�OUR PERMIi
� �• �
S�GaaiuAE O� OwNEA��v OwrvEQ BW�DEQ� iD��E� � � iq$v � � r�ntF
NEw [ l
ADDN [ ]
ALTER [�-J—�
Effective 1/1/2001
CITY OF FRIDLEY (763) 572�604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �� ci' 1�1 tJ� C�1 �.7p ,(7� 1rl -�a2�cS. ��.Lt 1�1 k� •�ri 5 L/oZ I
Legal Description:
Owner Name & Address: (�1!l��.v NG.K'G� �� S?m Tel_ #(�7l�� �Z �- 12Z5
Contractor: �� ��., ._L- �� i b �,S �-�17C. - MN LICENSE # 2G ���7�� 2 °0�8��
Address: �-1 •"7 t c„ �c��� fN E•�"'�� .�-e ��(1 � , SSL{ � Tel. # S!�' �3�7 C71�3
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width
Length Width
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Construction Type: fi c�.�c:�., SO i� �'-�,�r�C e�s Estimated Cost: � �
� 900 �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �1 APPLlCANT: a ' �7��
� ��---� � • Tel. # 5��-a3`�S
CIIY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
S7IPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ (� -�(� Fee Schedule on Reverse Side
$ 1, �(� .001 of Permit Valuation (1/10th%)
$ , 4.5+ $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ s. DC� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Aft. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ `7�- .D�
..
3uilding
nspections
�63-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
>p'I'E , ' ^ �a � ��' YOUR E-MAIL ADDRESS
ITEADDRE3S G,f G����I�/� PU6
'HIS APPLICANT IS: ❑ OWNER
Permit No.:
Received By�y �'
Date Rec'd: � ' ���'
PROPERTY OWNER/ Np�; ►�A Y�t.p � D S��/
TENANT ,e,DDRESS: �1 �. ?U17�li�d��/ CITY ��2"��L�i'� STATl�iu✓'LIP S
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PHONE:
STATE LICENSE # 02 d 0�1 �X 7 �� EXP DATE
ADDRESS: ��) ?q � �� �'-��"� CtTY �2=p STA'i'�?�ZIP
PHONE 76 7�� �'� 3� FAX
�SINGLE FAMILY/NEW CONSTRUCTION SIZE
TWO FAMILY/NEW CONSTRUCTiON STORIES
PERMTT TYPE � �DITION ❑ GARAG
� BASEMENT FMiSH IS�ROOF
❑ DECK f] SIDING
TYPE OF WORK:
ADDITION
����
o Dx�n� �nt,�
❑ OTHER
DESCRIBE VJORK BEING DONE: � oo� �N �LL��
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. F�
NUMBER OF SQUARES �_ ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT•
GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan
PROPOSED SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan
3. List of swctural members w be used
PROPOSED HEIGHT:
SIDING FOR NEW CANSTRUCTION MCLUDING DECKS,
❑ y�y( �Soffit ADDITIONS & PORCHES SUBMIT
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing struc�res
p p�� ❑ Fascia and proposed project
2. Two sets of consdvction plans
WINDOWS 3. Energy Caiculations
IN EXISTING OPENINGS OYes ONo IACATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE WSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LJSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $���a o 3q 30 ^ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �-, .a s
$
$ 3
$ I :9 �
$ S' _ cs�
$
$
$
$
$
$ �O�:i
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)
$1550 per SAC Unit (Plans to MVJCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks aavable to: City of Fridley Attach
THIS IS AN APPLtCAT10N FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclaiowledge 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 I understand this is not a
permit but only an applicati 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 work 'ch requir eview and approval of plans.
SIGNATURE OF APPLICANT �� PR1NT NAME j�2 V� C'�L�t� DATE �� 3���o