AF - 43741SUBJECT
City of Fridley ° 138
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
r �
; � ECEIPT NO.
� i L___��_ COMMUNITY DEVELOPMENT DIV. /y
r � � PROTECTIVE INSPECTION SEC. 7
� �
'4 � /���1 % CITY HALL FRIDLEV SS43Z NUMBER REV. DATE PAGE OF APPROVED BV
"'-'� � ,'� 612-560-3450
910-F15 10/8/76 � �
JOB ADDRESS 1550 Camelot Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 3 Harris Ld�tE.' Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Brickner Builders, Inc. 6245 Ben More Drive N.E., Fridley 574-9877
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
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 44' x 36' Dwelling and a 22' x 22' Garage
. . I �S
ATE P'ERMITS REQUtR�D � W�RtN�, �EtE�HONF - ELECTRIC - GAS Etc.
9 CHANGE QF USE FROM ���T�N�� P����NG ArID StGIV3• REQUtRED BY w
STIPULATIONS provide City with copy of truss design. Provide vapor barrier in the
ceiling. Soil borings and/or compaction tests may be required. Call for excavation
inspection. Provide a verifying survey before capping. Provide a hard surface
driveway. Provide sod in the front and side yards.
SEWER LOCATION: (Approx. 12' Deep) 63' East of Manhole (Inv. 876.43)
WYE ELEVATION: 876.68
TOP OF FOOTING: 879.68 Minimum
WATER LOCATION: 10' East of sewer service
--IMPORTANT—
TNE p1Y pf fR�p� ppEg NOT G�IARANTE; TNE
AC�tN1A�C"r pF t►��y MpTIFY THE FRtDLEY ENGR.
� OiATA IS /Qii p�p� �� ���At�� DIVISION REGARDtNG CURB
�� � Q diIOWD�V�i �j� ��Y� REMOVAI. aNO REP�aCEMENT
ON 1Ni �IR AT DRIVEWAY OPfiNiNGS.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCI FY'aMe
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 R_1 1404+484 Z8i1H4 TO't11
OH WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TtME AFTER WOFiK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $L�O�OZO $ZO.OZ
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 NY OTHER STA OR LOCAL LAW REGULATING CON- $112.74 $350.00
STRUCTION E PERFORM CE F CONSTRUCTION.
l PLAN CHECK FEE TOTAL PEE
/ �' �` �� $28.18 $510.93
SIGNATUREOFCONTRACTOFl UTHORIZE a�eNr IDATEI WHEN PFOP RLY VALIDATED THIS IS YOUR PERMIT
� � / /4 '� •
SiGNATUREOFOWNEPIIFOWNERBUILDER� IDATEI BLDG iNSP D 7E
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C 1�I�`r oF r-;Z I lil__EY
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AP P L I C/', r r c ra F � I? l��: S I DE t�! �1� 1/', �. �u r i_ n i r,r F L Rt�1 I TS �� � J�
� N G I� 1, R L. T E F t F, T I U( �S, A 1 7 U IT I � �� S, O R R E P A I R S)
;
oc�N�zz's nn�u.: 13lII:LD]:Tc:_' ,�' /� �� �� - " ;�/,�'.'" /��
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/iT)Dl{L:SS :_ _ ____ LIDDRL•'SS : `' �- 5�1�� ��"` ��; %J Ji� r ��,�'-
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TEL. IdO.: `"
A\\I . /� "r li STRrI�rJ. : � ��' i / < �' `" / G- /..� A✓'"
LOT: ° BI�GCK: ` ADllITIOi�. %'�,: 'r %"';; /,���'
C012I�FR L07': IhSTD]'s LO'i': '� SETBL.CI`: .: -��/ SIllLYAfili: �'��
APplicanL attach to this form ltao Gertiiicates oi' Survey of Lot and proposed
buildii�g location dr�:t�n on these CerL-i�icaLcs.
llLSCRIPTIO:� OF I3UII,llI\G
i , y �,;,,
To B Used �s: , .
' �/ .� �
k��Z�'1'�'�- Fxoill-. : � 7 Depth :_
� Squa.re Feet: / yG y Cubic Feet;
Height: 110 ��
-� 1, 3 �`y
.
� Front: .� 2 Depth : z �- Hei�ht � � �
Square Feet; ��� Cubic I'eet: ��Y'�
c� ,a
�pe o� Consi�ruction: �c.J`+�� �''��-�' Est3_mated Cost: $ '��i Q �-� "
,�To Be Complet.ed: _��
Tlie undersisned hereUy makes appl.icatian for a pez-�nit fo.r the work herein
specified, agreei.n� to do all worlc in st�ic.t accordance t��ith ttie City oi
Fxidley Ordinanccs and ru7.ings of the Departme.nt of BuildinRs, and hercby
declares Lliat all tlie i�zcl.s ar.d rePresentatioiis stated in this applicati:>ti
are true and correct. ��,���
�
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DATE : � � '� / `_ • SIUI�A'i'Ur.E : � l.�i� j��z . � _: �� , ..— -
(See Feverse Sicie For Additionll ]:n�oi-mation.)
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Page 1 of 4
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
/�'�-7�
OWNER: DATE
SITE ADDRESS : � -S/�� ��%Ij`�� L � � LAN"t PHONE : --� �� � / � �/
CONTRACTOR: �pC�/. G I�' N�I�C /�L��' .S ��"`l��
Determine working squaze foota3e of each �
1. Total exposed wall area. . . . ; . � 8 � b sq. ft. x .17 = � � �"` � � r'
� /�
, .. .... � b 7 . S� � -
2. Toal roof/ceilinq area ...... �� S�'s sq. ft. x .05 =
Total exposed wall area above floor =
a. Total wall window area .................................
b. Total door area .......................................
c. Zb tal sliding glass door area .........................
d. To=a1 fireplace wall area .............................
e. Total wall framing area (average 10$) ..................
f. Total rim joist area ..................................
g. wall area above floor ..........................
h. wall area above floor ..........................
i. wall area above floor ..........................
�j. wall area above floor... _......o ..............
Total exposed foundation area = b v
6�
3�.6g
3 �l • 9-b
1
� S •�3
�a�
r3,a.-,v
k. Total foundation window area ........................... �%���'
1. motal net foundation area above grade ...........:..... 6 v �
Determine "L*" value of each wa11 segment
(e.g. window, door, each separate wall section)
� '
a. b � g ��U�� . S � _
b. 37.G�j X „U�� � , ��� _ °�-I•��
c. � %' �� g ��U�� • . S�S� _ � � ' � �
d. % � X ��U�� • • � ti = � I • i � .
� . / � S�• � 3 X „U„ _ � ► 3 = � g , �j 3
f. 1 �,�% X��U�� �. 0� _ 7.
�.�o� �v . �
g. X ,�U„ . O% _ �'�.�5
h.
X "U"
e
i. X "U" _
� . X ��U�� _
' k. X "U" _
l. b't/ X nUn ' �I � _
3 . ............................. Total =
d��•�
__�g? • 3�
,
11
� �
�
l�
If item #3 is the same as,
or less than item #1, you'
have met the inten't of
SBC 6006 (c) 2.
�---' `
y�'
� Exterior Envelope Average "U" Computation
Total exposed roof/ceiling area = I3 ��•�
m. Total skylight area ............................
n. Total roof/ceiling framing area .(average 10$).,.
o. Total net insulated roof/ceilinq area........... �3 �1•s
Determine "U" value for each roof/ceiling segment
m. X nU° -
Page 2 of 4
n. X "U" _
o. 13S'1•� X„U„ . ��� _ �'�, o
4 ........................... Total = �/�L%`� �
� .
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006 (c) 1.
Alternate Building Envelope Design .
To utilize the total envelope system method, the values established by the sur.i of
items #3 and #4 shall not be greater than the sum of items #1 and #2.
1. + 2. _
3. + 4. _
0
WALL SECTIONS
NOTEi Use 10� of opaque wall area for
frame construction
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_:1G. #3
FR11t'�.� � 7ALL
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Page 3 of 4.
Construction R-Value
1. Interior air film 0.68
2• '/v �' S c ct R.o c L' � N�
3. "3 ��y STV� �•�S'
4. '�ti �1A�i (3/ks-� �, r�l
5. ��jL I�, �S�n) ��"'� o- C�
6. Fxterior air film 0.17
Total �. ,/ �
7
1. Interior air film 0.68
2. 'ti" St��c-(12o�.1t� (�'`��
3. ��L= INS�� II
4 . ' �� - nl /� / � (� Q s -c- 1 ►
s. ''1� ml�S� N► r�, 0• � �
6. Exterior air film 0.17
Total 1 �, �� _ . 01
.�-
1_ Interior air film 0.68
a. 314'a 1NS�L ��
3 . � ��ti ' � / ►'� ► � � 9
4. �'�L %� �[lL � 1'� S<" �' � 1
s. �'�(, Yh �¢ Sa j�l � r-c- 0. G 7
6. Exterior air film O.Z7
Total , . -
IS-SS -,°
�
1. Interior air film 0.68
2.
3. 'ti'' /3da�/t �, z S
4.
5.
6. Exterior air film 0.17 �
��� 2 . , s = • y�
. ., .
. , o . � . . ` u
� � �
..�.lz,T'�f.�� �� • . � �..� . ` .
-/�i :; � � _ -'� : •
/l ( :=� , , . ` .
/( ( " , ' . � � -
b ' � 111 -
. � �c� .. •', . , - • ' �, ` �' � _
i�i
FIG. #4 "'" � ' � � �- /�/
�. � � � is � . � p r .
. � ` • ��ii � .
� .
. � . �t� �� � � � r x r�� - `- ��� .
NOTr'.: Indicate type, "R"'value, depth and
placer.ient of instilation. '
ROOF/CEILING
.-- �
�' �i jZ J ) �:
�. �
>�-%,�:-. � -- �
�' �' � � .', � �
,� j ,�., ��t �irn'�"`;
i �
. ,. �; �.�.�- ��1- ;�� �I��; �
Yr1tT � •. . �= '�:—�-� .�..�-J
� �\\\ r
, :%� -��i f---� .
� , �leat flow
up . .
FIG. #�5 '
t�ented
i/a.tr,�.�!u� :;lt�_T1-�_�'� i'O,f•S+^,r.Cn<C✓'n_�-.G�7[el
- - - — �- — ---=.t
Page 4 of 4 R
Construction R-Value
1. Interior air film 0.61
a. '�i'' S/f'�cT ��.K o• NS'
3. ►�" ttvsv L � ig.�� ���ss Lv .
4. Eacterior air film (still) 0.61
Total �� 6 �^ �ti�
� , .,.�.
1. Interior air film 0.61
2.
3.
4. Exterior air film (still) 0.61
Total
! Neat floc�r up . ;�venCed•
_ ,FI�G. #6 � . _.. . • � ` . ' ' . 1. Inside air film
- -- 3 ----- - � ' : 5-- . z .
� .,' �+ 3 .
A �`� Se,S � �!�.. :.� 4 .
01�0.11.�.- ° -
' _ _ _.....�,at�`..:�-=-��?"• . .. ... __ -� 5. Outside air film
�
• rcu.�—vL'lV1rU . .
. • •� ,
� • F{L�ili ' �. ' . �
, � • £lOw up . • ' � ,
. .; . . . .. •
IAT.r. N7 . , . . .
0.61
0.17
Total
Note: Use additional sheets if more space is
needed for details and calculations
-,�,�,�"-�',
� us�RB�►H -
�� NQINEERINQ
1 NC.
� � ' Ciuil, Municipal & Environmental Engineering
� Land Surueying • Land Planning • Soil Testing
Mr. Dave Harris
6279 University Avenue NE
Fridley, Minnesota 55432
Re: Lot 2 Block 3
Harris Lake Estates
Dear Dave:
Main Office 571•6066
6875 Highway No. 65 N. E.
Minneapolis, Minnesota 55432
South Office 890-6510
1101 Cliff Road
Burnsville, Minnesota 55337
�ctober 15, 1976
n�` �,e'"
•,.
C�`� _�
� �
l' � �<�' ) �-� i � � �jU.,�
� ���
At the request of Jerry Belair, on October 11, 1976,
we examined the excavation on the above subject lot. Several
hand auger holes were drilled to a depth of 3 feet. Natural
sand and clay materials were encountered below the fill �
placed by Jerry Belair.
We took two density tests in the fill material at footing
grade on October 12, 1976. Both tests passed, one at 99% and
the other 102°6 with 90� of modified Proctor density being the
minimum acceptable.
Based on the above, it is our opinion that the foundation
material is satisfactory for a single family framed dwelling.
If you should have any questions, please call at your
convenience.
PJM/ j P
cc: City of Fridley (Darrel Clark)
Jerry Belair
Sincerely,
SUBURBAN ENGINEERING, INC.
� • %Z .
Peter J. Mol�naro
Project Engineer
Ruhcrl :Y/indcr. KrK. F,ng. F,. A Hath6urt, Reg. Suru. Wm. E. Price, Reg. Eng.
Wm !i. �lenren. lirg h'ng. Wm. K. Meyer, Keg. Eng. H. William Rogere. Lieg. Swu.
Gary R. Harris, Reg. Suro.
C1TY UF F�tIDLEl'�
aPPLICATION FOR �J1,';3;�iG AfvD �AS �ITTIt�6 P�R`^,1T
Pn?i?AL RATE SCHCDu�E �
P:,.,�.?i:tG F�XTJRE R�.T�S: \0. R!1"fE
_,..-�_- =?•r.:t:.`es �� x 53.00
_.._.._t __.,,__e c��...::� �_ x s2.00
::_•.: :ixt.._e, QI� C:en_^g __r. S2.00
:,.:tc:z �..._.a � x S=.CO
:;�--= .._4--- - to 95.Gv0 E::; l - 55.00
-C^.. G�� �.., to �59.000 3?C r, S'-C. �0
i:��eS S�_,._-.__ '/. S7.G0
.._•.+ ..ro�_._ ?_:.. C'_c ��_1'cy�:.g x $5.00
E�C��__C �•.._G� �Cu�Ci ' '/, a5.0�
G.�S r'�?:::�G F��S:
___ 3 :_.:.._�� l � s�.00
:,.:'_':,._..-.:;1 F�. �::res _ r 51. UO
G,s .�r.ge _o _93,OOQ PTU x S10.OG
?Z:?::?=S �i .ti;.Ti ��iTO`�S
---..t S:C�.�� S�.00
eac:� ..��. $_G�.�O o_ `rac`ion a"7..00
S::�e Surc :��gc
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:L-....__..._,,.� __�
• (`v.��.v�:l
ToTnL
S 3. 00
S �.UO
s
S S, U O
S
$
Y
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Job Acdress �� �,����� �Ix2E' -��
;e.�nrt^��:it o_° :•.iildin,s
Cit� or --:.c=cy
.�i. ,.G71-��;,
��
�;`> �
The unde=si,:ic� : e�eby :na�es p�licatio❑ _°or a?e:.^_:t _°or the �.ror;c he:e.:.:.
�:cc_fied ar,rec.r,g to co ..11 ror.. ia ��_ic� accoz�aace �.+:th t::_ Ci:y Cc.�.es
�nd ru!.ir.g� of th� Dcp3=t-1c::t o: ���ild? :as, ar.c ::crcby dec?arc^s tSat a:_
tne facts and reore�c%tatio^s .,tatec :� this a��.icatio^ are t::e a-:d c�zrec:
°�_d=cy. `=-�. - 7 "_ �� I°�
I �
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KI.ID Or IIJII,DZ:�G
US�D 11S
TO 3? CO?'�i��.:::D � :Oli�
ESTZ:�li1TED COST
CLD - N?'W °L'IiDING P�Rv_T \0.
ROUG:? INSP.
L'ate
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Co^:�a.^.y � � � � `� %�t�,
s, �-:�4 sy � � �z � "�
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FIN:�I, I\�n. �—l� � � �
Datc
F1PP:?OV11L I'GR ?I: u:IT���
: I\IXC:4 FE: ?OR A:.Y PL:;:!D.Z..., ?:R'�ZT ZS $7. SO
97-�� -879001 APPLfCATlON FOk PWMBING AND GAS FITTING PERMIT
M � q p � . � u Watdx
� .. u � � c M h s�c � aNi � .e c p u a w � N Ho4tor
,y� b C� � �� � �
�. :J Jf .�' � �UI C N �.[I � � O �+ VI i.� VI y N YI
�� � u' a m c� ai x a� vxi a �i �.'¢ x ii � u� o ne � lec
1st o,•n c� dr� er
2�d .
J rC ,
< ch • �
(R) � fV ture Connectlon Opening Connected aith Sawor
(•) � l�nv Fixtvre, Old Opening Watar
PARTIAL RATE SCHEDULE �
PLU�LBII�G FIXTURE RATES: N0, RATE TOTAL
2.U:Ser Fixture• �
Fti�ure F!xture Opening �
Acw Fixture, Old Opcning
Cacch Sanin •
� Nater Heater - to 99,000 STZ1
� 100;C00 �TV to 199,000 BTU
Hater Softnner
Ttev Grour.d iain Old Huildinq
Electric Nater Heater '
G�S FITTI\C FEES: �.
lst ] iixturea '
x.iditio�al Fixturai
.W■ Aangn to 199,000 HTU
REP�IIRS d ALTERATIONS
Pirst 5100.00
each add. 5100.00 or iraction
x 53.00
� x $Z.00
� x 52.00
x 55.00
� x S5.00
x 510.00
• x 57.p0
�^ x 55.00
x S5.00
x 53.00
� x 51.00
X 510.00
State Surcharga
TOTAL FEE
R�:t�JSPFr'Tfn�] 'c^c
55.00
S�.00
S
S
S
S
S
S
S
S
S
S
$
S
$
S .50
' 8.00
Job Addraee l��ip � f^�Al nt T�nP
,� Depnrtment o! Buildingn ' •
` City o! Fridley I
Tol. M571-]450
The undcraigned hereby make� application !or d pernit tor the rrork he
epecilied agreoing to do all work in atrict accordance vith the Cicy Cc
nnd rulings ot the Oapartraont of Huildinge, nnd heraby dcclare� that a�
the fncts and repreeentationi atated in thio applicntion are true ar.d c
Fridley� M.i. • 7" � 2'77 � 19_
owNER JO?-ItJSON
KIND OF BUILD2NG frame -
USED AS r°S. __
TO H£ COhII'L£TED A90UT 7-2�-7? � �
ESTIMATED COST 10 nn •
� �
OLD - NEW BUILDING PERMIT N0. E ZT N0. �:
G�!►�t�`�' �
' Com� .
� MINM�I�EQASCO
•, Signed By
� Tel. No.
ROUGH 2NSP.
� Date �
FINJ�L INSP. % -/V � % O .
Datu � '
7�PPROV7IL TOA PGRMIT ��3� , � .
MINIMUM FEE FOA �tdY PLUMSING PERMIT IS 37.50
�
_ �
i _
� �' ��� F ..
�� � .�` _:..,.����:
.�
�' ,,�`-�-;� �- �
� �' �
. `,,
� July 22, 1977
,��
�.'.
... f ,
�
�.
�ITi( O� ��Ii�L.EY
8431 UNIVERSITY AVENU� N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 812)571-3450
Mr. Tom Brickner
Brickner Builders, Inc.
6245 Ben N�re Drive N.E.
Fridley, Mn. 55432
Re: Final Inspection at 1550 Camelot Lane N.E.
Dear Mr. Brickner:
A final inspection was made on July 18, 1977 of the above address and the
following items were noted which must be corrected before the structure
can be finaled out:
l. Plug hele at southeast corner of basement fireplace damper with
mortar by July 29, 1977.
2. Submit to this office a copy of the verifying survey by July 29, 1977.
We will expect the above items to be completed by July 29, 1977 when a
reinspection will be conducted to determine compliance. If you have any
questions on these items, please feel free to contact me at 571-3450.
Sincerely,
RON HOLDEN
Building Inspector
RH/mh
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL �TE SCHEDULE '
GRAVITY WARM AIR: RATE TOTAL Job Address J-5 ��� L� ��'Yz':-e*C�
Furnace Shell & Duct Work $12.00 $
Replacement of F�rnace 7.00 $
Repairs & Alterations-up to 5500.00 7•00 $
Repairs & Alterations each add. $500.00 4.00 $
MECHANICAL WARM AIR:
EUrnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repai.rs & Alterations-up to $500.00
Repairs & Alterations each add. $500.00
STFAM OR EiOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNER- from 100,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES:
lst 3 Fixtures
Additional Fixtures
Gas Range to 199,000 BTU
AIR CONDITIONING �
FAN HEATING SYSTEMS see Fee schedule
VHNTILATING SYSTEMS �
ALTERATIONS F, REPAIRS
$12. 00 $,' ' . ��:,'
4.00 $
7.00 $
7.00 $
4.00 $
$12.00 $
4.00 $
7.00 $
6.00 $
510.00 $
10.00 $
$10.00 $
S
x $ :i.00 S .� � �
X $ 1.00 $
x $1U.00� $
� f, .- �.�- ,;- - State Surcharge
; � r �:; ' TOTAL FEE
ROUGH INSP. REINSPECTION FEE
Date (.$10.00)
FINAL INSP..` - !��- �
Da te
APPROVAL FOR PERMIT
S �/
S
S
$ .50
$��
MINZMUM FEE FOR ANY HEATING PERMIT IS $7.50 pLUS $.50 STATE SURCHARGE
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Nlinn. / , 19 '_7
OWLIER _r'�'�� �C �,''C % ��' /C % �-�I�S
KIND OF BUILDZNG -' (� //c i i'`7/l �"
USBD .�,s ,.�;1{; `" L C /-c�C
TO BE COMPLETED ABOUT � l, `��
� �
ESTIMATED COST ! "
OLD - NEW BUILDING PERMIT NO. PERMIT NO. '
� DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Aot Water, Warni Aii- No.
Trade Name !-;`�� �/// Size No. ,f �-, ��/�� ���� ��
Capacity _ ` Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel µ. ,, ;'
BURNER - Trade Name Size No. •
Capacity Sq. Ft. EI)R BTU HP
, � i
Campany ��-„ LiJ%��°��
Signed By � _ � � z' �
Tel . No. �-� %- �� Y �
sue�ecT PE
City of Fridley _ 16 2 7 3
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r �
� � •
� 1 y_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �� � �
i �
i
� � �'��1 � CITY HALL FRIDLE� 55432 NUMBER iiEV. DATE PAGE OF APPROVED BY
� ----�•' '•� 7/ 1 / 81
612-571-3450 910-F15 / /
JOB ADDRESS 1550 Camelot Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 3 Harris Lake Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Frank C. Masserano, Jr. 1550 Camelot Lane N.E. 571-6687
3 CONTRACTOR MAIL ADDRESS Z�P 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
storage
7 CLASSOF WORK
O NEW ('1� ADDITION ❑ ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
new 14 by 17 storage shed
9 CHANGE QF USE FROM TO
STIPULATIONS
1. Must be located 10' from side property line
and 10' from back line.
2. Must be tied down permantly with ties or on a foundation
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCY�OAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAI, PLUMBING, HEATING,
VENTILATING OF AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. 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 STAL�S 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 COMP IE� ��ZOO . VO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PE�hf
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 9.00
PLAN CHECKFEE TOTALFEE
9.60
SiGNntUAEOFCON�RACTOPORAUTHORIZEDAGENT IDATEI HEN PROPERLY A IDATED THIS IS VOUR P RMIT
, � �. ' J ' �:�-�'- .�t�..v � J
S�iGNATUFEOFOWNERiI OWNERBUILDERi �DATEI BLDG INSP �FTE
cirY or r-«ia�_cv •
Af'f'(_IC/1'(IU;d F'UR RESIUi:i�1TIl',i_ QU1LOItlG f'EfL'�I7S � .
� (tdeti•r, All:er��tions, /ldditions, or Rc�airs)
Ot�JI�JER: ��}NK C _ /� /�S S t K�ic.j J � �UI LDE�R : - SA�i11 -� � •
� .
ADDRESS : /� � v G�f�-�t � (�j� L.s�-�L�/`_ ADDRESS: . ` �
1'CL �VO : S'? /—�' � Sr7 TEL td0: '• I
� Construction Location '
sT�� rio : �/a c�� s2���:T: S,b► �'� -�
Lo��: �_ BLOac : 3 �nnz�zov : ��l'�'I S � � %F �C' S ��9-�C'
Corner Lot: � Insic3e Lot: SetbacY.: Sideyards s
Ap�licant attach to tliis form t�ti�o Certificates of Survey of lot and
proposed building 1ocaL-ion drawn on certificates to scale.
DESCRIPTIOi� OF C0�•!Si'RUCTIOPd • , �
�o��c �P�X I'ront: /�I � Depth: / 7 �' Height: %� I
�
Square. Feet: ��iS Clibic Feet:
Front: Depth: Height:
Square Feet: C�zbic Peet:
, � o_
Type of Construction : � c�� EstimaL-ed Cost: $,��o o,
7b Be Cbr,�pleted:
` _ � Alt. A Alt. B
Proposed Drive�•ray Lvidth If New Opening Is Desixed: $� $
, , SEL RF,VERSE SIDE OF SiIEET .
�.'iie undersigned lleLeby ma};e� applic�ticn for a pernlit fcr the �:�or3: herein specified,
agreeing to do _all work in strzct accordance �•�ith tlie City of Pridley Ordiiiances aiZd
rulii�7s of the DeZ�art-me��t. of Buildin<�s, and hez:eby declares that all the facts and
rcprescnt�iti.ens stated :si this applicatian are true and correct.
D.'�TE: �� / �, �j� SIGNl1TUF�'r:: , �
StiF�ulations : , --
.�
� /J �--r � � � � �, � , �;� �
. C� ����
, C� c%
._ �; ��
. i.
i
� �
� ` > � '
�� r �� C��r, t _� .�r±� �� � . �� >
- �.
x . w
,� '
►
CITY Of' ('ItIUI..CY •
Af'f'L1C/1�l'IU'd F�Of; (,l=SIUI:iITI%1_ [3UI1_DIiIG ('f{viITS , � � .c�,,-1�.�
(tdet•r, /�l Ler�ations, �tcldiLions, or Rc�nairs) �� j�'�,�.,
�'-� J
� O1•�11f:R: ���N�<. C _ ►�'l/�SS �l'��l/C� 7/� [3UILUER: S/� %1`�, .
ADbf;fSS: _ /S S ��-�Lv�` �,9/lJ� lIUI)f2f:SS:
�1.� �O: �--� l - �G �`-t c.�•,j(r �LL f\O.
-���//- ��S�S-S �',�r�,c� .
Cons�;ruction Location
d
s�rri��z� , r:o : 5i� �'1--� s�:�Rr}:�r: 5i4 �1--e �
z�o7�: �.rz� � �LO�:: .�_ �nz�rza�� : r�/�i �� � �a�`
�
Corne�_ i,ot: Inside Lot: Seiback: Sideyards:
n
Ap�licant at�ach to i.}iis f.orm t;ti�o Certi�icates oS: Survey oi lot and
prop�sed building .location drawn on cei-tificates to scale.
DFSCRIPTIOiv OF C�FISTRUCI-IOfd •
' . �
- . _��� � <�� j I'ront: � ,�� D�pth: �, � � Iieight: ���--�--
.
Squa�e Fee �_ _�� v _ Clzbic Fcet: '
0
r ront :
Depth:
Iieight:
Squai-e I'eet: Cubic I'eet:
�.ype of Co?�sLruction : ��-�. �-N � � ��,.,--< Esi.imated Cos �: $ � � � v c�
. . � ��,� . . . �-
7b Be Cbr,�pl.eted:
. _ Alt. A Alt. B
Proposed Drive�•Jay Stiidth If New Opening Is Des:i�red: $� $
, , 5�1: RF.i�F:R:�E SID � OF SiIEET
7.iie unc�er_sianed her.eby nia};e� applic�-?ta.cn for a pernlit fcr_ the �:nrk heYein speciiied,
ac�reeing to �o ,�i11 wor}; in s�t�rict accordince ���ith tlze Cit}� of I'ridley Ordiiiances �nd
rulings of Lhe Del�artmei�i. of I3uil.dings, anci hereby decl�res t.hat all the iacts and
repzesent-<lti.ens stated zn this auplication Zre true aiicl correct�.
D�:TF; S/ Cz �/
r�� _
St:i��ulations :
P�� �Q � ,� .� � � c� �� �°
� _,, � J- _ �p
' � �� o�,Q„� ,i �'.�..< �` �dW"� �""' �P
/V--o� Ca-.-.tis, � l� J�o-�` . � . �`.`�.,� ,�'�--+� �-�
� �,, ,�...,�.�, c-e-.�,,.Q.,9 ,�i,-� r+_,_,,r... ..� ;� ,`�.o
�i �! � � ;
r"_ c�-:_.D.«�a..,� G...r.. . F � l CS! .Q..r►_..,t' . �_ � �
57GN71`.CUI:r; :
C�' , S!�"1 ir�r� --
0
.-�
, J , L� L�
� / � S --
� �, . ,�5,
� . � . ��y�,.�--
�`��- i�__._�:�
.�
I
r
/.SSC) ��'.�,�� �f,--���
lnnd vionn�nq ^,�,r�'�'�'�i! 63)5 HigF+wayNo.65N.F.
lond Su'vcyi��g • • � �Minne�.Nolit�
so�i, r..1��„�� ' JI�IJ/f'('I!I/�� •�11('. Minn. 55432
Civ�l En nr�:.in /
g� y �rlephone Jd4-6066
�4uni��put F�.y�r,rrr�„9 �-En�;:ili'@1'S !sc Surve�-ors A�eu Codr. b1T
_. 1 �
Mortg�.ge Lo�,n Survey for__ "� ���
__ ��1�c�k��� _ Dt� �.
,
CAMELOT L�NE
c9
�9
M
<7'
750
�.�.
_ �;
" �._._ ____ � ____ +;
I , VN
M
I � 2 0 `'�
,,, , � -
�` .:;� --IS.s----
�;,I � ;,, o . ,,. 1�.5-
�+ . ,:,., �
I, %.
l : ', �=puuLVaTioN '�'
� /
� y (�AJI.`( � �
m
IN � M
t;.. ��..i,��i i, . �!{ ��
I 44.0
�
�
� � �� �- 7
I
t�, � i c.
10 L-- ----
o .o
75.D
- - �: � r
- `- � ,r�.+,;:i,i`.�
��
�G
-�
�� ,
3_
�"���
-� .
Lo-r 2, ��o� r� 3,
�AQrZlS �C./�I�E ��TATFS . _
Rna�O �'a•n�y ' -
ihit i} c� ��ue ond corrcct reprasrnta�ron o! o s�rvey of +Ar boundor�es o! the lond abovr dstvibed ond o/ fh• �
lo<atwn of all bu�lA�ngs� i( uny� thercon� a�d olf v�sible en[roochnieM+, i/ unr� }rom or on sa�d la�d. This w�vey N
mude unly in connetlion w�th o mortguyr lou� nOw bei�y pluced or. rhn propr.Ir ond no l�ab:{ity is osa�m�d �
r,wcrp� fo thr holder o/ such .»ortynyx or ony orh�r �ntere�� acqu�red by �hr reason of su[h mor�goge. It is � � �
( � undrrtitood und ayrre-d7 nR monumcn[Z have besn �lo<ed ior �hr. p�rpose O� estab��shi�ig lol I�nes or bou�dorY� -
L,�aS tornert Dated th�� /Y"" day oF��C, A �. 10�/ '
� SUBURBAN ENGINEERING, INC. C�� �� /� '
� Engine�5 j►ll 9 .ri.11'Q.' � =Y�
---(hrw�¢S c�ra�.�a�e E u�ili�y easemrcnfs br�y__� T` L� J�.` - Y
ti:
�;-
:�
�. ; . �: -
1.� . .__. , . _ . ..
..
_ -
_
C�� OF
FRI DLEY
FR[DLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FR[DLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
November 18, 1994
Owner/Occupant
1550 Camelot Lane N.E.
Fridley, MN 55432
RE: Home Occupations
Dear Owner/Occupant:
In the zoning district where you live, home occupations are
permitted as an accessory use, provided that certain criteria are
met. I have enclosed a copy of this City Code section for your
review.
Recently we received information suggesting that you may be
operating a business out of your residence which is not in
conformance with the restrictions. Specifically, the complaint
states that you use a shed as your office for this business. If
this is correct, please comply with the City Code by discontinuing
this activity immediately.
Feel free to call me at 572-3595 if you have questions or wish to
discuss this further. Thanks for your cooperation!
Sincerely,
Steven Barg
Planning Assistant
SB:da
Enc.
CE-94-557
sue�ecT PERMIT NO.
City of Fridley � 2 5 F� 9 6
AT THE TOP OP THE TWINS g U I L D I N G P E R M I T
r
; � RECE�PT NO.
� ` _��� COMMUNITY DEVELOPMENT �IV. �
r � L � PROTECTIVE INSPECTION SEC. F' �?� �
� �
� �
l_--_�,�/'�'\,'� CITY HALL FRIDLE� 55132 NUMBER REV DATE PAGE Of APPROVEO 8V
L 612-571-3450 910-F15 11/19/97 � �
J08 ADDRESS 1550 Camelot Lane NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 3 Harris Lake Estates SHEET
2 PROPERTY OWNER MAIL ADORESS ZIP PHONE
Frank Masserano 1550 Camelot Lane NE 574-7411
3 CONTAACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Same
4 AFiCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW O AODITION ❑ ALTERATION �] REPAIR D MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (30 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TVPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE FEOUIRED fOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIF CONDIT�ONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIfV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2 � SO2. � Z. Z5
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS Of ANY OTHER STATE OR LOCAI LAW REGULATING CON- @74.75 1L'e SC �Z.SO
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION y�
PLAN CHECK FEE TA� FEE
$78.50
SiG REO 7FACTOAOAAUtMOAl2EDAGENT IOATE� HE P LV VA TE� THIS IS YOUR PERMIT
�
! �
NATUAEOFpVyN �iFOWNERBU�LDEAi iOATEi B G�N ���rE
NEW
ADDN
ALTER
�)
[l
L]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1 / 1 /97
��/�� ��
� ' ��•
; ,��
ConstructionAddress: fj�'S � �i��'1 ��vrt L.�n�-P
Legal Description: �- o� � +'��, o � C� ,j �� ��. L�P ���
Owner Name & Address: Fo2A� �vl °� f'�/� S s��c �9- lY v Tel. # S7 `f • 7 �( / i
Contractor: i"l� �--�-P MN LICENSE #
Address: S� �'1 C
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certiiicate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
L.ength
Length
DESCRIPTION OF INIPROVEMENT
Width
Width
W idth
Height
Height
Hgt/Ground
Tel.# S��-��/
Sq. Ft.
Sq. Ft.
Sq. Ft.
���
Construction Type: Estimated Cost: $ c��, �°'�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 1 I • ! °l - � -1 APPLICANT: � �� � ,,¢ Tel. # 51� '� •7 4 I /
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ ��,��� � Fee Schedule on Reverse Side
$ �.� C . 001 of Permit Valuation (1 / l Oth %)
$ �� �S� $.50/$1,000 Valuation
$ $950 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ '')�.�C
c;ITY OF FRIDLEY INSPECTION DIViSION �(�-• ��U � Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572•3604 REFRIGERATION AND AIR GONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS f.s.'�' C�Nc�� •��- ��
RATE SCHEDULE /,�
OWNER ,�/a.,.-/� /%?t..�.��T-Gc.�,.�
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
Rate TOTAL
$ 30.00
$ 10.00
$ 10.00
$ 10.00
*Air Conditio�ing - All Siz $ 25.00
�� �� «� � c���
All Others/Repairs & Alterations (LIST ON BACK)
l�o of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
BUILDING USED AS I��z-9-�
$ i � .
ESTIMATED COST ��'�Ta.� PERMIT N0. �'� % �
$
DESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating its Circte One (St m) (Hot Water) (Warm Air)
$ Trade Name . — -' - a �ze No.
BTU HP FDR._
$�' Fuel Total Connected Load_.
$
$
$ .50
$ �� ,' O
�� � �: /c � � G�'� ��►'Yac'�1'
�
�� � �, ��✓ � �
C�SS��, /'�'��v' �"�'�=l`�
Burner Trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE f``' '�"``.'f°
� /
HEATING CO ����,� %���.C��
Signed
Approved
' :l/ TEL # G.�%/�-Gi3,3 �a�: - �
Rough•In Date Final Da e �Z
� �j�K� ��z� ��� ��G�� ��C��'�s��d��
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l��%/oU
_
_
U�iYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 11, 2002
Frank Masserano
1550 Camelot Lane NE
Fridley, MN 55432
Re: Final Inspection at 1550 Camelot Lane NE
Contractor: Allied Fireside
Dear Mr. Masserano:
A mechanical permit was issued on October 5, 2000, to install a gas fireplace at your address.
According to the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the
work authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Code. We will keep your permit open for another 30 days and if we do not hear
from you within this time to set up the inspection, we will mark the permit "no inspection called
for" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
�incerelv_
DJ/ls
�ITi' OF FRIDLEY INSPEC�I �UN DIV.
i431 University Ave NE
Fridley, MN 55432
763-572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2001
PIUMBING FIXTURE RATES
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas'•
Gas Range"
NO. RATE
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
TOTAL JOB ADDRESS �SSv
Gas Dryer•• $10.00
Back Flow Preventer equired�Yes () No
Type $15.00 i ��)
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTALFEE
�
a,��
0
$
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
. 20�
Owner `-'° L% - (-�-f iJ1�'���
Building Used As G���, -
l, or f /�
Estimated Cost �T'�� ` PERMIT NO. l��V
PLUMBING
SIGNED BY '"�- `-J TEL N0._
Approved By Rough-In Date Final Date J
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
►631572-3604 FAX: (7631571-1287
ADDRESS : 1550 CAMELOT LN NE
PIN : 133024410047
LEGAL DESC : HARRIS LAKE ESTATES
: LOT 2 BLOCK 3
PERMTT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOW/DOOR REPL
_ - _._ - -`_
PERMIT NO.: 2004-01655
��
DATE ISSUED: 09/22/2604
VALUATION : $ 16,824.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
REPLACE WINDOWS WITHIN EXISTING OPENINGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
RENEWAL BY ANDERSEN (20130983)
1920 W CO RD C
ROSEVILLE, MN 55113-
(763)502-4777
OWNER
MASSERANO FRANK C JR & C J
1550 CAMELOT LN NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
reg ' cons . ction or the performance of constructio .
Applicant Date��
Bldg Insp �l�(-,��j�_�-.-� Date
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 37213
279.25
16.82
8.41
5.00
309.48
��r��� �����,��;�i
VVI���� �� °n �ards
�� Ha���� �ailed
°�'��� ro Posf
SEPARATE PERMITS REQUIRED FOR WORi� OTHER THAN DESCRIBED ABOVE.
04/02/2004 FRI 13:21 FAX 3�� ELDER JONES 1�001/001
. . • .. . . . . • . .. ' . ' ' • . • • � . • •�•• � • . •• ..
N� [] CITY OF FRIDLEY Effective 4I1I2004
ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ j SINGL.E FAMfLY AND DUPLEXES R-1 AND R-2 (763) 571-7287 Fax
BU{�D1NG PERMIT APPLICATION
Construction Address: � `���L� �� ��� '���,��__^ ;�'_ ���� � (� �- �'ti--=-
Legal Description_ �
Owner Name 8� Address:-��� �-'�-�� �K�- � 1 1cti aS: -i� C'� ��,
Contractor.
Tet.# l�..o?,��-;-1�l -- l�
MN LlCENS� #
Address: ��W� BI' ANDERSEN Tel. #�pS I�� �V `[ "'
1920 COUNTY ROAD "C" WEST
ROSEVII.LE, MN 55113 icate Of SUrvey Of the
� drawn on it to scale: P
DESCRIPTION OF IMPROV�M�N7
LNING AREA: Length Width Height Syq, F� `�`�
GARAGE AREA: LengEh Wdth H2ight Sq. F��°` �'
DECK AREA: Length Width
,�, �r:��;�
HgtlGround Sq. Ft.
� • .,
., � ,
Construction Type: Estimated Cost: $ ��' � u l-�� .-
prNeway Curb Cut Width NEeded; Ft. + 6 Ft = Ft x$ _$
DATE: 1� PPLICANT: r Tel.# ���-?J��' �U"'��
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-577-1287 if using credit card and we will call
you fo� card number. ' i
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TO7AL
� a , as
$
$ 2
$
$
$ � 7
$
$
$
$ -
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Pemiit Valuation (1/10ih%)
$.50/$1,000 Valuation �
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
$ �y�
i
STIPUTATIpN��
0
NEW
ADDN
ALTER
�0�5- �o���
[ ] CITY OF FRIDLEY
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description: `^
Owner Name & Address:
Contractor: �� 'C i '�
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
t� � � � - — , � ,
� � � �G i� �� i�' /�'�C� � � � �1 � C= ��� �
! �� �; � %/ c ;
;�� � - � �
� S � C ✓� � � Tel. # �'��-�`' -� / � � i
MN LICENSE #_
Tel. #
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
,
Construction Type: `- � t �� � � � ` Estimated Cost: $� ��:�
�
��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _�
, ,
T�
DATE: `�7 I I � - � \- APPLICANT: '% � , �-7e1. #
Call (763) 572-3604 for Permit Fees if mailing in application. x to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee $��/,�� Fee Schedule on Reverse Side
z.
Plan Review $ f 0 65% of Permit Fee
Fire Surcharge $ . fjb .001 of Permit Valuation (1/10th%)
State Surcharge $ � bU $.50/$1,000 Valuation
�
SAC Charge $—� � $1450 per SAC Unit
License Surcharge $-� �� $5.00 (State Licensed Residential Contractors)
Curb Cut Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
�
TOTAL $ c�_�• � STIPULATIONS:
�