AF - 35662r.:�, Yi� � .s "F
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,R� . - BIT�LDING PEI��MI� - �
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�� �ill e of Fridle , Minn. �� � 0 9�
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s�.te . �',����'���"
� �:��(33wner` . , ,�,�,��` Builrler
; i dc7ress � �,�.g�: t • �'��. f � �ddre�ss
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!�� , L�?G,�,TI1�N 4F B�J�LDING .: -
Na. .� �:�� Street � .. �°�.� . . Part of L�t .
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' Y ,/��. Blflek ,� . . . Addition ar� ub-Division °� +� ,�, ,�, ,�,
'��- °- er� I�t ..�. ..� � �� � . ,
. . . inside I.o� . .. . . . . . �. . . Seti�.Ck
: C ��'�:'�%i� Sideyard .'�+� ��:�"'` . . . . . . . .. :
�I ;
r��. � DESCR�PTI�N E3F BUILDIN�S
" �ITa 6e IJsec� as:
: �._ ;� °, .
� � � � �, �� � _ � � � �
` . , ` . . Froat . �.�±.. . T?epih .�.�. . . Height � �,�. . F`i. . Cu. FE. .
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, y�:. . D th �?". . He3 ht Sc�. Ft. ... . . . . . . . . . . . : „
,��� _ _
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of Construd;fon, .�„����`: Est. Cost . : .�,�`�1�!� . r: "'� . . : To be Gomple�ed �. /�."���
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£: _ - .
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I� � Yzi considerai3on of the ,fssuanee to 3ne of a Per�� � to coz�struct tk�e : building .descriibed above, 2 agree to da �-'
; ��he Px'oPosed'.work in �ccordance with tYae •�Tes�arip�ion �bove set fortht. a�d in compliance �vith all provisio�as of
; ' ��rdinanc,�s of : the v3llage af �'rid�ey..
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� - . .. �. . , � � -. ...,_ - . •_ • • � � � _ • • .�� • � •. • � � � �f. _
I Tn c�tderaiion o� the pa3�t of a Pee of $. .�� ~.;: Permitris hereby gz�anted.to. . ,
° ' • �,�`�� . e
. . ...: : , . . . , . . . : . . �o lsons4�uet'the . b'uilrling_ 4r additior� �s deserit�d above. This permii is granted upon
.,
� .:� e�express c:ondition;ihat YhQ Persan ic� whom it is
' ••
-,, grauted 8,nd �� his agents, em�Ioyees � an& warl�net�; iri� a�l �wosk
one in, arou�d and upon said buitding, csr anY pa,rt thereof, �lia'll confo�m, �in ,
i al� 3�espect.s t�.`t)ie, o�8inancea of ,
, , diey, Minneso�a regarding l�ation, construc�ion, al�eration, maintenance, repair ancl moVing of buildin�s with-
the village lirntt� and tliis':permit,may be revvke�Y at any� t�e upon viola���;�o� ariy' of �th�- Provisioi�s oi said <
° _ � � rdi�at�tces. ,
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- . � MtlT'ICE: . °
This pe�mit does nqt cover 3he cpnstruation, ir�siatt�tion ar aiteratfc�r for wl,ringf pturntting� gas h�ating, a� °":'
� a..sewer or wat�ar. Be sure fo see the Bu[Idtn� InspeGtor for separate permtts for these it+ar�s.,;_
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Job Address
� l 7o Cr.��-P �n �,.
Con
Bil ].1� illg
P
��.�d�cr
Pexmit No.
v,
HEATING PERP�IT APPLICATIOi'J
910-FI7A Q , 2/15173
�a ��SS
�l 7� �
— A ress _
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Pae� 6F at��toJE�
1 ' 1 800
� P one
/� P o
°W Ls,
S;omptetion Date -- timate ost
/��, �
���'�� �P����� �Y�' �`� ����° Heating/Power P1an�s �r
�ace �hell � ]�,rct �.'�ar1� ......... ....... ..gi0.�0 � Steam Ho�t Water Warm Air
�tepl�crrn�n# oi �cmac°� . . �.� � �o �
Repairs ac Al4erations—up to �340.00 . s� s__ __ Trade Name
�iepairs �s �,18�rations �ach add. �500.Q� , g.� $___ Size Nos l� �� !/ ��C% ,
��� � � � Capacity Sq, r^t.
�ce Shell & %hact Work to I�,�UO B'I'�J . . . . . . . . .$10.� �_ EDR BT`U �����`v Ton a
�ch �dd. 6t1F1�fl0 �`I°BJ .. ...... .. 3.17v $
� ' ' ' ' � ' � ' � To tal Connected Load
Replac�°m��Y ot F°urnace .. . . . 6.� $ Kind of Fuel ,.,1�j,�
It�snrs �s A14.erations--vp to $SQ0.0°a . 6.� g
R��irs & A14erations each add. ��{D0.00 . 3.� � $LZrnex
s�� os r�o°r ���� ���'�� Txade 1Vame
Furr.ace She�3 3e Lines—to 400 sq. 44. F.DR S4eam �10.00 v.—�____
S1ZE. Z10.
F't.unace Shetl & Line—to 640 sq. it. EDR Ho2 �a4er 10.�D $_ �
jEach add. 20�J sq. 4t. €DR Steam �.(x1 �___ _._ - Capacity Sq.Ft
EaeD� �c�d. 320 sq. f4. EDR Hot V�'ater 3•� S �DR $Z+�J �on e
�II. �YJ�3�i1ER-4o 3 gal, p�r hour 6.� � �
over 3 gal, p�s hour—�See �'ee Schedule -dG�%^O`�„�7� .2. ��C,.�,I
l.
G3�S �LTR�J�&t tup to 1���,� F;Ti7) �.0� 5 i
over lS9,Oi'� �i`LI S�e F� �eh�u2a I
G1��> F'%'1TIPaG 4'ir,S: YJO Pl�,.'F� Z'OT�aL
lst 3 Fix4eares . .. .. x� 2C� $
�ddit3anal F3x4t�res x ,'g �
Gas Ran�e to ISa3,t� . . �� �.f�} �
50 State Surcharge
1 IA �Oh�Y a E� �EY�d� a�D
F�Tt �2��1. a i?�6� E`J��T.�'�:� �a� 7�� �eY�� �
dL.F3�ILlA�'IR7G $7f�� �t
1�LTEfd0Y20Pd� � �iEFcmiY�� '1POY�`�ag,... i� �1�
�0�1�
�aa�I,_ r� S �G�
5uburban Air '
t=onditi��g � �
841� Center L)rive
• Minneappl� M;
Signature �
a�---� — l° — 7 `
SUBJECT P
City of Fridley . 125'73
ATTHETOPOFTHETWINS gUILDING PERMIT
;,
,�
COMMUNITY DEVELOPMENT DIV. -^ /� ��
' � ti: - �/
r � � PROTECTIVE INSPECTION SEC. (
1 . �
�� ` /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,'� 612-580-3450
910-F15 6 3 74 � �
JOB ADDRESS 6170 Caxol Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].l 2 Shorewood Addt: SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Roland Zeller 6170 Carol Drive N.E.
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 CLASSOFWORK
❑ NEW 0 ADDITION ❑ ALTERATION L� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK Reroof dwelling
8 CHANGE OF USE FROM TO
STIPULATIONS
SEP�RATE PERMITS REQUIRED FOR UVIRING,
HEATING, PLIJ�IBING AtiD SI��VS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENFILATING OH AIR CONDITIONING. S�11I1 ZES
THIS PERMIT BECOMES NULL AND VOID IP WORK OR CONSTRUCTION ZONING Sa. 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 $468.QO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE aRANTING OF A PERMIT • 5Q
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. � �`S.00
�� PLAN CHECK FEE TOTAL FEE
' ;�� $5. 5Q
si �Cro AUTH DAGENT IDATEI WHEN PROPER VALID� IS IS YQU�ERMIT ,,
3 y ��
SIGNATUREOFOWNERIIF W RBUILDERI IDATEI BLDG.INSP ATE
aPPI,I:;pTION FOR RLSIllENTIAL, ALTEItaTI���,
OR f'1i)llI�'I�l�` l3�1II�DING PERMIT
C I'1'�' C1F 1-1:1 llL�:X ,�11 �tiNESO'T�1
OW1�T�"S NAME : � ��.� ��'�i��� BUILDER: ��/°%�
,ADDRESS : _ (� r�� ��L DBP. �,C� ADDRESS :
4�� s s f /`� T eJ �.�' 1'�i 1� ��" �� � f�L.a JG �L� �
T,Q�' : l � BLOCK ; �_ ADDITION : �J'7��',xC fil/GPl� �,Qf ��GC
CQRIY�R. LOT: INSIpE 1,OT: SETBACK: SIDEYARD;
Ap��.ican� attach to this Loxm 1�ao Certificates of Survey O� I,p�. and proposed
bu�ild�.xi� ].ocatian drawn on �hese Certifi.cates. T
�ESGRIPTIUN OF BUILDING
To �� Ussd As;
�� ' ,�,�/ �P� Front : Depth : Height :
Square Feet: Cubic F�et:
Front: Depth: Height:
Square Feet; Cubic Feet:
�
�'ype� o� Co�.stxuction: f/��'N��Cf Eatimated Cost: $� �� DG'
�4 $� e����.���a: � G✓'�'�°
1'hes uadexsigned hexeby ma.kes applicativn fox a permit for the work hexei�a
sp�ei.fied, agxeeing to do all woxk in st�ic� accoxdance with �he City of
Fxi.dley �rdinances and rulings o� thc> Uepartment ot Buildings, and herel�y
d�aclaxes that .�11 the facts and representations stated in this application
a�e true and currc•ct.
UATE : �_�� _ S IC;�AT{JRE :
(Se� Reverse Side For Additiona.l Tnforma
� . (�'�
� � r�2����
��Y
� �
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BUILDING k'�IL�TI'I' l��:F. SCIIEllUI_�:
$��T�pN 2. The lnspect�,r �sf Btti.ld�n,�s sl�all, befor� issuing permits f.or the
�7;Qetion of any 6uilding ox' strurt��r�•, c,r �ox� an�- addition to any exist�ng
�6uilding oz structurc�, or tor ..�riy .� i turati.on or r�:pairs to any c�;isting
b�uildin� ar structuxe, iipon app�icati�n t.kierelnrc:, r`q�.irc the paytnent by the
�.�pliGanz fox such permit of fees. to th�� amount herein n�low set forth and in
the manner hexe.i.n provided to-�-lit:
[JN��QRM BU�LDIN(; COAE; Type 1, 2& 4-- $2.15 for each onc: thousand cubic
�eet� ax �raction thezc:of, in such cubical contents. T}'pe 3& 5-$1.85 for
��akt Qne thousand cubic �eet.
AUI)ITIONAL L�I=ORhiATION
�'or the purpose of computing tees f�x building permits, the cubical coiitents
of any buildin� nr �ddition, is determined by multiplying �he ground area
aA��x'�d fxom a point six (6) inches below the floox li�ne of the basement
ca� the, �e11ar ta th�� average hcights ,>f the upper surface or to the average �
h�i�ht �� �he roof surface of tlie main gahle of a pitched roof.
Fox x�pairs ox al.texations to an existing structure, the fee sha1J. be at the
7Cat� o� $�.00 pex each five hundred dollara ($500.00) ox fraction thereof in
the �oa� of all pxoposed work.
�rt nc� �ase shall, the fee chaxged for any permit as set forth in Sect�.on 2 be
lees tYaan $S.OQ.
VERIFICATION OI' FOUNDATION
�1Q1�g p�sxmits far canstruction will be issued a minimum of 24 hours fxom th�
tiute o� app�ieati.on, to allow for proper review of ths proposed structure and
�$ t�he const7cuction site.
1� �srtified Survey of the lot, showing the location of the foundation, once �,�
has been eonstructed, will be xequired before proceedin� with the framing.
�" 1:RT I F I CATE Ui' qGCUPANCY
Application fc�r a Certiiicate o� Uccupancy shall be made ten (10) days prio�
fip �he use or occupaiicy of any structure for which a building permit has beetl
�.��tt�d; �nd s,iid structure sha11 not be used or occupied until a Certi�icate
�f pacup��y has been isaued.
.
SUBJECT
City of Fridley I� 15 61
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � ECEIPT NO.
� ` ____ COMMUNITY DEVELOPMENT DIV. � � �
� v � PROTECTIVE INSPECTION SEC.
r � ,
� . ,
� � /'�"1 � CITY HALL FRIOLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'""� � ��� 612-571-3450 910-F15 / /
2/15/80
JOB ADDRESS 6170 Carol Drive N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 11 2 Shorewood Adda.tion SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
la 6170 arol ive N.E. 571-8624
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
7 CLASS OF WORK
❑ NEW � ADOITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Construct a 16' x 20' Addition
9 CHANGE pF USE FROM TO
STIPULATIONS
��P���iE PE�:MiT� R��lll��� ��R �VlR6�iG, .
. _, �-. � r a ��:� �, � �ti, -� F, � � �-� a-� �
��o_a`��.�cf`.k�, ,r��,..� f aa 9.,�- ,t�"ay'.°r ������-.
� �
gpfi�,�e ��R�ang call IocaB utiliii��
� �`�f �s�►s� � �LE�.;TP�C - ��!S �'k�
�E��I��� �'� �.��
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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 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 $g' 750 S4. HS
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO YIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERF MANCE OF CONSTRUCTION yti`GO.00 NONE
PLAN CHECK FEE TOTAL FEE
�e . ��� �' �S ' �� $15.00 $79.88
SiGNarURE0FC0 � a TORORAUTHORIZEDAGENT �onTE� WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
��_ � � � � ��' ������
F.�.
SIGNATUREOFOWNERtIFOWNERBUILDERI IDATEI BLDG INSP nA E
�
CIT� OF' FRIDLEY
APPLICATTON FOR RESIDENTIAL l3UIl.DIPJG PERMITS
(fdew, Alter��tions, Addil:ions, or Repairs)
OWPdER: �e��AN� ��11�2
ADDRESS : � P � O �' � �CR.� (
TEL iV4: �'?( — �(���
STREET NO:
LOT:
Gorner Lo't:
BUILDER: �e�7'�te�F�a„� ��.��edtR�ec� ���vs� r
A D DR E S S: 'l5g5a `-( `� �¢r t� a2.� �'� ,�t9 �,
TEL (d0: ��5� �7�'� �o
Construction Location
s���T: � r "7a e �a�a� !
BLOCK:
✓ Insa.c7e Lot:
ADDITION:
Setback: Sideyards:
Appl9,cant a�tach to this form �ro Certificates of Survey of lot and
pro,posed buildi.ng location drawn on certificates to sca].e.
QESCRIPTIG�� OF CONSTRUCTTON �
�d�� Front: � W Depth: °�J Height: � ���
Squa�e. Feet: � Q C1a.bic Feet:
Fron�: Depth: Height:
Square• Feet: Cubic Feet:
T,�'Pe ot Constructian : /� x Z C> i,� ��
7.b Be Cbznpleted: '� 'a <[ — �d
Estimated Cost: $ �a
• � � � � 7�
_ A3.t. A Alt. B
Proposed Driveway 6didth If New �peninq Is Des�seds $� '"`— $
SEE REVERSE SIDF, OF SHEET
7'he undersigned hereby makes application for a permit for the work herein specified,
aqreeing to do all work i.n strict accorclance with the Ci'�y of �'ridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in thi� application are true and correct.
DATE; �-/�°- �� SI�TATURE:
S�ipulatiorss :
3�� � a�. 3y
. 3 �.v � �; �li► .
,� 3 v y � X �-�
,���� ���
P�n� �s
P ' ' `A
�
JU X t� = G4. a0
P. c� .. / ,,''.�v
t-� �1.8l1-
f � �O
Y
J �
' � ��, s�
BUILDIIJG ('�Rt�i1T Fr� SCHCDULE� .
5�CTiON 2. The Jn�>l�ectar_ o� lluilQi.ngs ::ha]_l, beforc i.:.•suing pea.�niL-a �01: the err_cL-ion
oi any buiJ.ding ar :�L-ruct:ure, or far any aaai�.�.ori L•n ariy cr.isi�ing building or stxucture,
vr. for any a�.L•cration or re�;�airs L•o •any er.a.�t-ing S�u:i.1c3S.r�g or st-xucturc, up�n application
therefor.e, require the paymenti hy tlie aP�la.canL- for. :;ucla s�ermit of fees to the amoun�
herein bel.ow set fori:h a.iid in i:he manner herein provided to-wiL•: �
NI,W CONSTRUCTION: Single �'ami7.y IIames and Gara.ges : $4 . OU/l, 000 cubic teet.
PLAN Cfi1:CY.: 25 pe�-cent of hu�_].ding permiL- fee. .
ARIVEt�JAY DEPRLSSIOt1: (Concre'te, Cur_b StLeets Only) �
• Alternate A: Itemoval and replacement of concrete curb and
gutLer only; �riveway wicli.h plus 6 ieet x Y��,�75
AlternaL-e B: Removal and replacement of concrete cuzb and
. ' gui:ter and instal7. a 3 foat wide approach with ��
' 6 inch depth; Driveway width plus 6 feet x$17.85 �
. DDITI�NIIL INF'OR�IATIO�!
I'or the purpose of computa.ng fees for building per�na.ts, the cubical contents oi any
bui.lding or addition, is determined by xnuli:iplying i-he ground area covered from a
, pa5.nt sir. (6) inches below the floor ].ine of the basement or th� cellar to the
average iieights of the upper surface or i:o the average height o£ the roof suriace
oi the riain gab�.e of a pitched roof .
For repairs or alterations i.o an existing str�zcture, the fee shall. be at the r�te
of $3.00 �er each five hundred dollars-($500.00) or fraction thereof an the COSt
of all proposed work. . �
Tn •no case shal.l the fee charged for any permit as set forth zn Section 2 be �.ess �
tnari $7.50 plus $.50 state surchargee '
V�RTFICATIOV OF FOt1NDI�TIOt�
N�TE: P�rmits �or construci�ion will be issued a minimtun of 24 hours fxom the time
of applica�ion to allow for pxoper review of the proposed structure and of the
construction sitee
�. Certificate of Survey o� the lot, showing the loca-�ion of the foundation once it
2aas been constnicted will be requi.red before pr.oceeding with�the fiaming.
kRTIFICAT� QF O�.C�jPANGY
X�pp�ication for a Certifica�e af Oceupancy shall be made L-en (10) days prior to the
use or occupancy o� any structure for which a buildiiig permit has been issued; and
said sti ucture shall not be used or occupied uni:il a Certificate of Occupancy has
been i.ssued.
.�
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�TERGY CONSERVATION SUPPLEMENT TO BUILDING PERMIT APPLICATION
pI,ANIJING AND IAiSPECTION DEPARTMENT
CITY OF FRIDLEY, MINNESOTA
This supplement is provided to assist the applicant i.n computing EXTERIOR ENVELOPE
AVERAGE "U" FACTOR INFORMATION. Thi.s information is required so the BUILDING
OFF'ICIAL can determine that submitted plans co�nply with the ENERGY CONSERVATION
DESIQV CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S
respc�nsibility to accurately compute the dat�; reflect the proper DESIGN CRI.�ERTA
in the plans; submit product specifications, if needed to suppor� the "R" and "U"
factors used; and to assure construction is per approved pJ.ans.
JOB LOCATION:
OWNER,/COAiTRACTOR :
ADDRESS : PH�� °
Ao Determine the Total E�cposed Wall Area as follaws:
l.
2.
3.
4.
5.
60
7.
8.
9.
Tota1 wall w3.n.dow area � �
Total door area
Total slicling glass door area �°C�
7.btal fixeplace wall area.
Tata1 wall framing area. (average _10 0) `f �ea
Total nat wall area above floor(average 90%) �O �
Total rim joist area � �_
Subtotal: Total exposed wall area above floor
Zb tal foundation window area ' -�
Z+otal net foundation area above grade �
Subtotal: Tatal exposed founda.tion area
GRAND TOTAL EXPOSED WALL AREA S� �--�
B. Multiply the GRAND TOTAL EXPOSED WALL AREA X.17 =
C.- Determine the Total Exposed Roof/Ceiling Area as follows:
10. Total skylight area
11:. Tota1 roof/ceiling framing area (10�)
12. Total net insulated roof/ceiling area
GRAND TOTAL EXPOSED ROOF/CEILING AREA
; .
�
r
D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X.05 =
P�
� ^�
�-��
Item I � , � �
Item II � �
�r
�'
E. Determine the "U" value of each segment (1-9) and multiply by the area as
follows :
1. ' % � X ��U�� s � � _ `�b. S �,
2. g oU° —
3 . � � g ��U�� � � = Z I � Z �
►
4. X "U" _
5 - � � X ��U�� ► � � � ° �7
6. �� O X "U" ^ D 5'� = 1 7,`'� O
7. '�� X "Un eOSi�° _ '�•�� ,
8. X uUn =
9. g ��U�� _
ADD 1- 9 FOR TOTAL WALT, 5EGMENTS = ITEM I II � b.(a �
�. Determine the "U" value of each segment (10-12) and multiply by the area as
follows: �
10. X "U"
11� � a x /�i711
V
1G• p� () $ A �1T711
�,
� I � �
, D � ��
H
��
. .
.
ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS = ITEM IV I II
G. If Item III is the same as, or less than Ite�n I, you have met the intent
� of State Building Code 6006 (c) 2. '
H. It Iteqn IV is the same as, or less than Item II, you have met the intent
of State Building Code 6006 (c) 1. �
I. Ada Item I a S�`� `�" + Itea► II �!o = l B �,�`i°°
J. Add Item III � l� , � � + Item IV 1 °+°, 1 1 . _ � � � , �f 4 � �
K. If the sum of Items III and IV are less than Items I and II, you have met the
intent of the Code for total envelope system.
The undersigned, as applica.nt for a building permit, hereby affirms the above
information has been prepared and submitted by himself or under his direction,
hereby acknowledges the information to be correct and accurate; and hereby
presents the information with required plans in support of the building permit
application.
9
BY =
0
DATE:
✓;,. � s
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C.'e��.11l .� ..r fi��`��, .�_. �;.
� ��
sus�ecr MIT
City of Fridley � 79
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
� � REC
� �L __�_�_ COMMUNITY DEVELOPMENT DIV. �
r j � PROTECTIVE INSPECTION SEC. ��^���
, i ; « ��
� /'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE � PAGE OF APPROVEO BY
�'"""� � ,�� 612-571--3450 910-Ft5 4/16/85
� �
JOB ADDRESS 6170 Carol Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �.�. 2 Shorerntood SHEET
2 PROPERTYOWNER MAILADORESS 21P PHONE
R. Zeller 6170 Caxol Drive N,E.
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Perfection.Pre�ex'red Const. 8824 Baltimore Street N.E., Blaine 55434
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE ' LICENSE NO.
786-7716
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDIIdG •
Residential
7 CLASS OF WORK
O NEW CXl ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOHK
Construct a 16' x 14t Deck
9 CHANOEQFUSEFROM TO
STIPULATIONS
���-� 1������"���
��;� �- �efore da•? � .� � � � `�
����i��� �������`?.���� � �ELEr��,'��r`.�.r�CE�s�1'�'`a� r 9t ��
4 a ��r;, �� �
I Y��, P� �� ��r���' �0 i ��'� �d ��� � ° �a�v �r��
����' � ��� ��i � � �� �
da ��.
SEPARATE PERMITS AFE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTII.ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED 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 COMPUED $]_ i 40Q �.�..uA $� 70
WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT aY15Y4YL
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- �23 . rJO
R CTION OR THE PERFORMANCE OF CONSTRUCTION.
PPLAN CHECK FEE TOTAL FEE
. $5.88 $30.08
SIGNATURE CO RACTORORAUTHORIZEDAGENT �oarEi __ y_ WHEN PROPERLY V ATED THIS IS YOUR P RMIT
C�� � � 1� �_
- � �o
SiGNATURE OF OWNEF�IF OWNER BUILDEPI IDATEI BLDG INSP nATE
�
NEMf []/ City oP Fridleq Effective �i/1/84 .
ADDN. [ �i}� R-1 ABD R-2
pLTER. [ ] Building Permit Appliaation
� �
Construction Address: � ��%l� (�/�UL K12rv�
Legal Description: // C--. � �f-�F�t�GUla
owner Name 6 Address : ' � � � �b �/��L � Tel . �
Contractor: Tel. �
Address:
LIVIBG AREA:
GARAGE AaEA:
DECB AAEA:
OTHER:
Corner Lot [ ]
Attach to this applieation, a Certificate of Survey of the
lot� rith the proposed construction draxn on it to scale.
DESCRIPTIOB OF II�IPBOYEHENT
Length Yidth Height Sq. Ft.
Length Yidth Height Sq. Ft.
Length -� b�' Width � Hgt/Ground Sq. Ft �Z�
�,-L� � ��� , ��
Inside Lot [] Ft. Yd. Setbaek Side Yard Setback
Type of Construetion: ��C� � Estimated Cost: � I� V o���
Approx. Completion Date: �'°� �`�
Alt. A Alt B
Proposed DriveWay Width If NeW Opening Is Desired: � �
See Back Page for Explanation
DATE: ' a` ,_
Permit Fee
P�an Check
State Surcharge
SAC Charge
Park Fee
SEwer Nain Charge
TOTIIL
STIPULATIONS:
��
\�
a
APPLICANT: . rer. � �? ���� ��
f`
CITY OSE O1�LY
��3� Fee Schedule on Reverse Side
� �d� � 25� of Building Permit Fee
� c� o �.�0/�1,000 Valuation
� ° a425 per SAC Unit
� - Fee �termined by Engineering
�
� � Agreement Necessary [] 8ot Necessary [ j
���, ��
�S
���� �����
BII�.DIAG PERMIT FEE SCHBDIILE
The Chief Building Official ahall� before issuing permits for the erection�of aay
building or structure, or for any addition to any existing building or structure, or
for aay alteration or repair to any euisting building or structure, upon applicatio n
therefore, require the payment by the applicant for such permit of fees to the amount
her�in beloW set forth and in the manner herein provided to-xit:
?otal Yaluation
a,.00 to �500.00
Feea
�10.00 (Minimum Fee is �15.00)
�501.00 to �2�000.00 �10.00 for the first a500 plus �1.50 for each
additional �100 or fraction thereof� to and including
a2,000.
�2,001.00 to �25�000.00 �32•50 for the first �2,000 plus �6.00 for each
additional �1,000 or fraction thereof, to and
including �25,000.
�25�001.00 to �50,000.00 �170.50 for the first �25�000 plus �4.50 for each
additional �1,000 or fraction thereof, to and
including �50,000.
ffi50,001.00 to �100,000.00 �283•00 for the firat �50,000 plus �3.00 for each
additional �1,000 or fraction thereof, to and
including �100,000.
�100,001.00 and up
�433.00 for the first �100,000 plus �2.50 for each
additional �1,000 or fraction thereof.
DRIYEiIAY DEPRESSION ESCRON
(Concrete Curb Streets Onlq)
. Alternate "A": Removal and replaeement of curb and gutter only - Driveraay Width plus
6 feet times a13.50 -
Alternate "B": Removal and replacement of eurb and gutter and install a 3 foot wide
approach With 6 inch depth - DriveWay Width plus 6 feet times a15.75
VERIFICATION OF FOIINDATION
Permits for construction Will be issued a minimum of 24 hours from the time of�
application to a11oW for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, shoWing the location of the foundation onee it
has been aonstrueted Will be required before proceeding With the framing.
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CHIMtJEY AN� STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,�)
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
- _ ---- -
5. Meets all current Code requirements for size and
total BiU connected
6. Has To ta 1 hea ti ng BTU' s of
All other BTU's
TOTAL
Rema rk s
�,
, _
No ( )
No ( )
No ( )
No ( )
Yes ( ) No ( )
Com pa ny
S.igned By _
Da te
sus�ecr PER
City of Fridley _ 20201
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � R TN
COMMUNITY DEVELOPMENT DIV.
r � L � PROTECTIVE INSPECTION SEC.
� ����
ii � �
-_--� ��'��,`� CITY HALL FRIDLEY 55432 NUMBER REV. bATE PAGE OP APPROVEU BY
i 612-571-3450 910-F15 11/16/89 � �
JOB ADDRESS 6170 Carol Drive N.E.
1 LEGAL LOT NO. BLOCK THACT OR ADDITION SEE ATTACHEO
oesca. 11 2 Shorewood Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Roland Zeller 6170 Ca.rol Dx�iSre N.E. 571--8624
3 CONTHACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDIIdG �
Residential
7 CLASS OF WORK
�7 NEW � ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10� x 12� Storage Shed to Rear Xard
9 CHANOEQFUSEFROM TO
STIPULATIONS
Shed must �e at lea,st 3�eet ��om side or back lot line or o�f from
any ea,sement. Shed must T2e securely anchored to ground hy a, slab or tie-downs,
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 GAAAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND.ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1-� OAQ S z SQ.
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $2 'rJ e OO
PLAN CHECK FEE TOTAL FEE
$25.5Q.
SIGNATUREOFCONTPACTOF70RAUTHORIZEDAGENT IDATEI WHE PROPE Y D THIS IS YpUR PERMIT
r
• J /
SIGNATUFE OF OWNER tIF OWNER BUILDERi iDATEi LD SP D!•TE
rnw {�
�� [ ]
ALTIIt � ]
R-1 AND R-2
�,; � ding Parn�it Application
Effective 5/1/88
� % �' �"',�-6�,� � �_� ,�" �
Construction Address: --
7�ega1 Description: g ����¢- ��C J ` � _ -
owner Na� & Address: � � ���'d� �,�=�,�.� Tel. # � > � ��s
Contractor: ,�I- ,�"',�,�' �( �- �y� �.�'� � � ?��' � � Te]. . #
A�3aress: � � � i� � ,�.� ���� �f.��
, ,
Attach to this appiication, a Certificate of Survey of the
lot, with the propo�,�ed con��tnzction drawn on it to scale.
� ;,�: �• w� •� • � � i• •,• � :� �a+
I�IZTil� ARE�i: I�rlgth W'ld'th H21C,�t1't SCj. F't.
GARAGE �fREA: Le�gth Width Heic�it Sq. Ft.
nEQt A�A: r�ength width xgt/Gr�und sq. Ft.
OTl�R: S'i13� �.� � �`►� I O �!'� � 1 �.� � _
Corner L�t [] In.side L�ot [ a Ft. Yd Setback Side Yaxd Setbacl�s
Type of Construction: '1��� �t�� � Estimated Cost: $ � �� �
Approx. Cc�mpletion Date: (�a
Proposed Driveway Width If New Opening Is Desired; Ft, $ S
DATF:: � �.16- �cArrr:
Wi 6' See Back Page
` Tel. #
CITY ��Y
Pennit Fee $ � 5, �� Fee Schedule aa'1 Rev�rse Side
state surcharge S a� $.50/$l,00o valuation
SAC Qzarge $ $575 per SAC Unit
Driveway Escraw $ Alt. nAu or Alt. ngn �bave
Park Fee $ Fee Dete�mined by E�ngineerin!
Sewer Main Charge $ Agreement N�essarY L l Not Necessa�y
: v�
STIP[JLATIONS :
$ � S.�(�
�
[]
��� �
�vp . � � .O�
S � �- -==
��eo�
f:?I�� � t�: 9�i.���Y 51�i' _ w:i5a. u�
-?�e Chief Building Official shall, before issuing pernuts for the erection of any
buildirig or structu�se, or for any add.ition to any existing building or structure, or �_
for ariy alteration ,or repair to any ex�stinq bi�i 1 dir�g or Structure� u�n applicatior�
therefore, require the pa�t by the applic�nt for such ��;t of fees to the amount
herein below� set forth and in the manner herein provided to wit:
210TAL VAI�JE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
i��
$15 (Minim�nn Fee is $15 plus surch�rge)
$15 for first $500 plus $2 for each additional $100 or
fraction there�f, to arid includirig $2, 000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to arxi including $25,000
$252 for first $25,000 plus $6.50 for each add.itional $1,000
or fraction thereof, to arid including $50,000
$414.50 for first $50,000 plus $4.50 for each adcTitional
$1,000 or fraction thereof, to arid includirig $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or frac�ion thereo€, to arxl including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to ar�l including $1,000,000
$1, 000, 001 arul up $3539. 50 for the first $1, 000, 000 plus $2 for each additioria].
$1,000 or fraction thereof �
URIVEWAY► DEP�BSI�+1 ESC[�W
(Concrete Curb Streets OnlY)
Alt�rnate ��A�r; Removal and replacement of curb arid gutter only - Driveway width plus
6 feet times $13.50.
Alternate ng��; Removal and replacement of curb ar�d gutter and instalZ a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VELiIF'ItaiTIO�T OF EtOD1�ID►ATI�T
Permits for construction wi1Z be issued a m;n;�n++ of 24 hours froaa the time of
application to allvw for proppx review of the praposed structure anci of the
co�struction site.
A Cextificate of SuYVey of the lot, shawing the location of the fowzdation once it has
it has beeri constructed will be required before proceeding with the framing.
SuBJECT . _ �
City of Fridley 2 2 2 0 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I
r
; � ECEIP - .
� `y _ _ COMMUNITY pEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTION SEC.
1 i �
� �'�'1 � CITY HALL FRIDLE� 55432 NUAABER REV. DATE PAGE OF APPROVEO BY
�.---� • •`� 612-571-3450 910-F15 1Q/26/93 / /
J08 ADDRESS Fjl']O Caxol Drive NE
� LEGA� LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 11. 2 SY1OY'E,'WOO$ SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Roland Zeller 6170 Carvl Dri.ve NE 571-8624
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
5ame
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION C� REPAIR D MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo� Hou�e �Tear-p��)
9 CHANGE OF USE FROM TO
STIPULATIONS
Unde�layzqent zqust cozttply .w.ith th.e State Building Code. �rovide adequate
a,ttic venti.lation, Px'cayide �m,ok.e detectors as pe� UBC 1210 adjacent to all sleeping
areas a,nd i,n b,asement,
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCY�OAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OFi 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 yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO $2 5QO. $1� 25
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHAFiGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S7RUCTION OR THE PERFORMANCE OF CONSTRUCTION. S4G�� �a k'a:re SC $2 ��JO. .
PLAN CHECK FEE TOTAL FEE
$49, 75
nTU oFCONT aCrOaORaurHO EDnGEN IOATEI yyH O VALIDATED THIS IS YOUR PERMIT
/� ��
SiGNATURE OF OW R iIF OWNER B I IDATEI �°BLDG �N P qAT
rt�vv
ADDN
��
[l
Il
��
crr�r oF ��tn�Y
SINGLE FAMII.Y AND�DUPLEXES R-1 AND R-2
Building Permit Application
Ef%cbive S/26/93
�7��
Consltuction Address: � � �f �i�J��„� �},� ./v l�
Legal Descrip6on:
Uwner Name & Address: ���� ����������� Tel. y�a�`
com��: L� � �'�� �",a��,e � � �,�, !�%'%�.1�� LICENSE #
, �>d�"�
� �f ^
Attach to this applicatioa, a Certificate of Suivey of the
1�, with the proposed coa�truction dt�wtt on it tp s�ale.
DESCRIPTIOAT OF IIVII�ROVEMENT
Tel. �`
LIVIPiG AREA: Length Width Height Sq. Ft
GiARAGE AREA: Length Widttt HeiBht Sc!- Ft.
DECK AREA: Length Width Hgt/Grovmd Sq. Ft.
oTHEx: �— �i�r� `�.� ,��C � ��i',e°'� �-��� � �
Corner Lot [ J Inside Lot [] Ft. Yd Se�iback Side Yazd l�ks
'Type o€ Constivction: Fstimated Cast: $ ���'� p�
Agprox, Completion Date:
Driveway Curb Cut Widt� Needed:
DATE: �� � APPLICANT:
Petmit Fee
Fire Sarcharge
Sta.te Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TUTAL
s y� c�
$ � �r
,
�_ _ � o
Z5�
$
$
$
$
$
�
�
$� #��
(Cost � Back)
F� + 6 Ft = Ft x$ _$
' � .�L
Fee Schedule on Reverse Side
.QD1 of Permit Yaluation (111(�h�)
$.SU/$i,000 Valuation
$750 per SAC Unit
$5.00 (State Licensed Residetrtial Contiractors)
Al�. "A" or Alt. "B ° Above
Conservatian Plan Review $450.00
Fee Determined by Engineering
Agreement Necessary { ] Not Necessary { ]
STIPULATIONS:
Tel. # aI � �/ � ,��v o�' �
�
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts for the erection of any building or structure,
or for any addition to any existing building or st[uchire, or for auy alteration or repair to any existing
building or sbrucdire, upon application therefore, require the pay�nent by the applicant for such permit
of fees to the amount herein below set foith and in the manner herein provided to-wit
TOTAL VALUE
$1 to $500
$501 to $Z,U00
$2,001 to $25,0�
$25;001 to $50,000
$50,001 to $100,00Q
$100,001 to $500,000
$500,001 to $1,000,000
$I,UOU,001 and up
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $SUO plus $2 for each additional $100 or
fraction thereof, to and including $2,OOU
$45 for first $2,000 plus $9 for each additional $1;000
or fraction thereof, to and including $ZS,Q00
$252 �for first� $25,000 p�es $6.50 �a�r each additional $1,000
or fraction thereof, to. and including $50,000
$414.50 for first $50,0� plus $4.50 for each additional
$1,000 or fractii� th�eof, to aad including $100,000
$639.50 for fir� $i�,OQO plus $3.50 for each additional
$1,(�0 or fraction th�reof, to and including $500,000
$2039.50 for the fust $500,000 plus $3 for each additional
$i3OIX1 or fra.ction #hereof, to and including $1,000,000
$3539.50 for the first $1,OOQ,000 plus $2 for each additional
$1,000 or fraction �thereof �
DRIVEWAY DEPRESSION ESCROW
{Concrete G�rb Sireets On1Y)
Altemafe "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B": Removal and replacement of curb aud gutter aad install a 3 faot wide.
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum af 24 hours from the time of application to allow
for proper review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been
con�tructed will be r�uired before proceeding with the framing.
_ � � -�
Sua�ecT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i�
� �
' ' COMMUNITY DEVELOPMENT DIV.
� ♦V ��'�� �
r � � PROTECTIVE INSPECTION SEC
�
i.__-� �"' �•� CITY HALL FRIOLE� SSIJ2 NU48Ei1
i 612-571-34b0 910-F15
JOB ADDRESS
6170 Carol Drive NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
oesca. 11 2 Shorewood
2 PROPERTY OWNEF MAIL ADDRES$
Roland Zeller 6170 Carol Drive NE
3 CONTRACTOR MAIL ADDRESS
Same
4 ARCNITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAIL AODRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
D NEW
B DESCRIBE WOFiK
Reroof House & (
9 CHAN(3E OF USE FROM
STIPULATIONS
NEV OATE P�GE Os
4/30/99 / /
21P
'29365
_/
RECEIPT N 5
��"���L
APPROVED BY
SEE ATTACMED
SHEET
PMONE
571-8624
PMONE LICENSE NO
PMONE LICENSE NO.
PMONE LICENSE NO
O AODITION O ALTEiiATION � REPAIR O MOVE O REMOVE
e (21 Sq) 2nd
TO
Roofing can be the 2nd layer but not the 3rd.
CONSTRUCTION WORR HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS ARE HEOUIRED FOR ELECTRICAL, PLUMBING, NEATIN(3, TYPE OF CONST
VENTII.ATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTFiUCTION IONING
AUTHOR�ZEO IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANOONED FOR A PERIOO OF 120 DAYS AT
ANY 71ME AFTER WORK IS COMMENCED NO. DWLG. UNITS
1 HEREBY CERTIFY THAT I MAVE READ AND EXAMINED THIS APP�ICA710N �
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION
AND OqOINANCES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED 1 799
WITH WHE7HER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT � s
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OF CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATING CON•
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION ��C).JS
S�GNAT CO � ACTOA UT EO A �OAfE�
�T E � OWNEAdi NEA IOATE�
� �
OCCUPANCY
STA�LS
OCCUPANCVLOAO
CU fT.
REET PARKING
IGARAGES
$.90
4C ^�,MARGE
i `�e SC $1.80
TA� FEE
$59.45 /
�
rrEw
ADDN
AL1'ER
[l
Il
[]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ���i4-%' � � �/(��� ,
Legal Description:
Effective 1/1/99
��
a3 �
� ��
�
Owner Name & Address: n � aC�i�/ �l � �� ,C ,c'�,�r Tel. #����Cr�'
Contractor: ��j(� MN LICEN5E �`
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed constxuction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
1 X �o ���
Lengt� Width Height
Length Width Height
Length Width Hgt/Ground
� �f�' Y/' . YZ ! / /Y el I� / � � /�\ A /� /�/L
5q. Ft. � / �� °`
U
Sq. Ft.
Sq. Ft. _
�(' O�
.�/� ��iPi�� � f=� � `�`-�u �`-
.
construction Type: �--- � sc: $ �' �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$,
DATE• �� `� APPLICANT:
��, � S� CITY USE O Y
Permit Fee $ ` Fee Schedule on Reve e Side
�
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ /��� .001 of Permit Valuation (1/lOth%)
$_ $.50/$1,000 Valuation
$ $1050 per SAC Unit
—� �
1'�l�
Tel. #
$ $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 [ ]
1
BUII.DING PERMIT FEE SCHEDULE
The Cluef Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure; upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,0�
$25,�1 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,�1 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.SO for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional$1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
pltemate "B°: Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minnnum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
_
_
UIYOF
FRtDLEY
FRIDLEY MUIYICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-345U • FAX (612) 571-1287
June 25� 1999
Mr. Duane Knealing
Frtdley Middle School
6000 W. Moore Lake Drtve
Frldley MN 55432
Subject: Sewer Backup
Deaz Mr. Knealing:
PW99-083
On May 2], 1999 there was a backup at the residence �17Q Carol Dr-ive. The Clty was called and
inspected the problem. It appeared the cause of the backup was the result of the Frtdley Mlddle
School swimming pool disposal. When the middle school swtmming pool water Is pumped out, the
pressure of the pump and the tIming of the day can result in a full flow condition of the sanitary
system resulting in a surcharge and a backup In the residences immediately downstream from �the
school.
Mr. Roland Zeller of 6170 Carol Drive apparently made a claim for compensatton of lost materlal and
effort In cleanIng up the effects of the backup to the school's lnsurance company and was denled.
(Copy attached)
I would suggest that the school either contact their Insurance company to reconsider the position
taken in regard to this event as it relates to good public policy.
If you need any additional information in this regard, please contact me at 572-3550.
Sincerely,
����,��
John G. Flora
Director of Public Works
JGF:cz
�oF F�
� ` �
PUBLIC WORKS
MEMORANDUM
TO: John Flora, Director of Public Works
FROM: Jim Brindley, Sewer Supervisor
DATE: June 24, 1999
SUBJECT: Fridley Middle School Swimming Pool
On May 21, 1999, there was a sewer backup at 6170 Carol Drive N.E. Phil Penon, the on-call
person, was called at 4:00 p.m. He inspected the up and downstream manholes on Carol Drive
and found the line was clear and flowing normally. He inspected the basement at 6170 and it
was obvious that the sewer had been backed up. Phil noticed that the water on the floor was very
clean and there was no odor that is usually associated with a sewer backup.
The homeowners expla.ined to Phil that the sewer had backed up in the same ma.nner several
years before, and that they had confumed that it was caused by the Fridley Middle School
pumping down their swimming pool. Because of the time of day and because the sewer line was
down and flowing normally, the school was not contacted at that time.
On Monday May 24, 1999, I went to the home at 6170 and inspected the basement. I then went
to the Fridley Middle School at 9:00 a.m. and met with the school's head custodian. I believe his
name is Duane Murphy.
He told me that the swimming pool had been pumped down on Friday May 21, 1999, because it
was necessary to do some repair work on the walls of the pool. He escorted me to the pool and I
observed that the pool was down approximately 4 to 6 feet below its normal level. He also told
me that the pump that is used to empty the pool is rated at 400 to 600 gallons per minute. I
explained to him that a pump of that size could very easily over capacitate the 8 inch diameter
sanitary sewer line that it is connected to. I explained the situation with the home on Cazol Drive
to him. I gave him my business card with the City of Fridley Public Works numbers on it and
told him it was important that they notify us if they are going to empty their swimming pool
again. He appeared to be very cooperative and said that he was going to post the City's number
and a message on the wall next to the swimming pool pump.
� 06/16/1999 11:51 6125719178 CITY OF FRIDLEY „� PAG-Ey� 02
CIl'Y OF FRIDLEY l/�' r... %, i±� _''/`S,'cF y �.
. , SEINER STOPPAGE
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CREW �pCAT10N WHETI NOTIFlED ��Y 7�1� �'�EL�I �-~�
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EQUIPMENT T/� TO SITE . � u _ � .
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ICAUSE OF STOPPAGE �,I
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Custom Solutions. Proven Results."
June 10, 1999
Roland Zeller
6170 Carol Drive, N.E.
Fridley, MN 55432
Re: Plan Participant: ISD #14-Fridley
Claimant: Roland Zeller
Claim No: 20-227-24469
Deaz Mr. Zeller:
3441 Wayzata 80
Minneapolis, Minnesota 554=
Telephone 6iz.5..
Facsimile 6iz.5�
www.insur�nc
We are the third-pariy administrator for the Minnesota School Boards Association Insurance Trust
Group Self-insured Property and Casualty Plan ofwhich the Fridley District is a Plan Participant.
This letter will serve as a follow-up of our phone conversation of June 8, 1999, at which time I advised
you that we must respectfully deny liability for any damage sustained by you on or about OS/24/99
when water entered your basement. The school district must he legally responsible before payment can
be made. The school district, in the process of draining your pool, did act properly and no negligence
would be imposed on the school district for your loss.
You may wish to contact the City who, you indicated in your note of June 2, 1999, initially made an
ofFer to call Service Masters to come out and clean your basement. I believe this acknowledgement of
responsibility by the City would be sufficient for them to honor your claim.
Based on the facts as presented to us, the school district must at this time respectfully deny your claim.
Should you have any questions regarding this letter, please do not hesitate to contact me.
Sincerely,
��� i�� �
William A. Ko es �
PP
Senior Claim Representative
(612)591-7426
WK:bba
Equal OpporWnity Emc��
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Building °
In�pertions
763-572-3604
763-502-4977 FAX
srrE ,e,DD�ss �.�
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING D(
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SiZE:
PROPOSED HEIGHT:
��JIL�ING
Permit No.:
RESIDENTIAL APPLICATION Received By:
CITY OF FRIDLEY vate �� I
EFFECTIVE 1-1-08
�_ YOUR E-MAIL ADDRESS� O� �-
�C � �/t' [ �� � J �
❑CONTRACTOR
���-- �- ��-�C.�i°
- 6� ` � /�' ��� F��-��'°-� ,�Y� /��-�31r�,��'—STATE�
ADDRESS: CITY,
PHONE
FAX
STA ICENSE # EXP DATE
SINGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILYiNEW CONSTRUCTION STORIES
❑ BASEMENT FINISH
❑ DECK
❑ NEW HOME CONSTRUCTION
❑ MAINTENANCFJREPAIR
0 GARAGE/SHED
❑ ROOF ,
❑ SIDING
❑ SWIlvIlVIING POOL
❑ ADDITION
C�EfvIODELiNG
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
� C /d 1
SIDING
� Vinyl �Soffit
❑ Aluminum ❑ Trim
❑ Other ❑ Fascia �
WINDOWS �� ��9�(�- � �
IN EXISTMG OPENINGS QYes ONo P/'x'� ► L�A�'I'ION OF WMDOWS� �
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES 8e
TYPE OF WINDOW TO BE INSTALLED. �� ER OF WINDOWS_
��
'ATE ZIP
❑ DRAIN TILE �.�.��
❑ OTHER
n�1 ��C P�y ,C�'�e C� � ,�t�' �t'J �'�
- � �� � `� �l/ �% 4,
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BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
�
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS_ & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed pmject
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LTSING THE 1997 UBC FE� SCHEDULE)
TOTAL JOB VALUATION $��j 'J��' OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
� ���
$
$
$
$
$
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)
$1825 per SAC Unit (Plans to MWCC for determination,
ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$. . Agreement necessary ( ) Non Necessary (
��T ��— Make checks payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID iJNTIL PROCESSED
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ly�'%f� �,&d
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I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a
pern►it on site; that the work will be in accordance with the approved plan in case I work which requires eview and approval of plans.
SIGNATURE �Fz4 'LI�ANT �__��� \ T NAME���C�� � �i�,(,�TE � 1
APPROVED BY � /�N" ___ _ _ _ 4 ,/ DA
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, 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 o�- 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 Department
6431 University Avenue NE
Fridley, MN 55432 '
763-572-3604
Faz: 763-502-4977
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Cl i 1 �F
FR[DL�,Y
FRIDLEY MUNICIPAL CENTER • 6431 iJrTIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
�� � � understand that the State of Minnesota
require that ali residential ' ing contr ctors, remodelers and roofers obtain a state
license unless they qualify f r s,ec' ic exem tion from h licen ing requirements. As
the owner of the property at °� �0 ,�� , Fridley, I
am exempt from the state lic sing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forFeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.0?.
Furthermore, I acknowledge that I may be hiring independent contractors to pertorm
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
pecFormed on this property.
Nam
Date
Inspeciions
�16�-�7� -36d �
��7�:l�.Y��.�! 3�� 1"'i.i ���i.�t�.����
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t�cLCi v cu �
�A,I,E y_ 1_ b� YOUR E-MAIL ADDRESS
SITE ADDRESS � I%� �,OL �2,D ( Dr t v t, �✓z. � p 1 c.
THIS APPLICANT I5: ❑ OWNER �ONTRACTOR '
PROPERTY
OWNER/
TENANT'
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WI'TH
APPLICATION
PERMIT TYPE
z�rE oF woRx:
1�IAIv�: ✓ZU �. ev a'� '��.� i� 0�' ' STATE�ZIP J��r3�"
a.DD�sS: �(� o �a.. �e. o( D�� • crrY F�. �� 1 t a
PHOTiE: `7 b.3 -- S� r- 8��'�
co�.�rnr Na�: �2 t �� � �a v G� �.�.� �-1�� �
CONTACT PERSON: C' � =
STATE LICENSE # EXl' DATE
Q]a� �-i O�l�t c�l` D�1 � CITY� �� r[1P �,�, STATE D�-i�ZIP �rS�3 �.-
ADDRESS• � —
PHONE "% b 3. S'7 f- �' 6 a- � FA:{
l� SINGLE FAMILY � TWO FAMILY
❑ NEW �'P�EP1-ACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAII.ED DESCRTPTION OF WORK -� S�a l( 2c, I e-e.�.�-t �� ��.�. k, ��°� �' /J � Q- C a� c� [�'t 6v�t ✓
PER MS 16B.665 the permit fee is a minimnm of 515.00 or 5% of the totai cost up to ��00.00, whichever is greater, for the
improvement, installation or replaeement of a residential �e, excluding the f�tures. ii�is should reflect only the cost of labor )
Labor cost under �$300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJEC7S iidHERE I1�80R EXCEIDS $500, FEFS ARE BASED ON � 10.40 PER FD�TtJR�, �C�T � N�T�• F�' �ICATE TOTAL
NUMBER OF EACH BII.OV+� �u- �- �, i S�,q �./ d3 b b�o SIZElBTU •� 6 � v �
Equipment Installed _ MFG: � ��t � �°�� MODEL: ; J � �� o SI�] � - '_�
�o � MFG: fb�-�c �.^ � MODEL: I�. `�''� - SIZFIBTU
�G; . MODEL: _G� �,�O,VEN $10.00
%� A!C S25A0 FIREPLACE (GAS) �15.00 . �vd GAS GRILL $1Q.00 '
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _Gp� �T HTR $10.00
BOILER 535.00 �F(JRI`IACE �35.00 p{���, �� $35.00
—C�� �� � �.Op _GAS DRYER $10.00 �p,TOR 515.00
DUCT WORK $10.00 ,_GAS PIPING $10.00 — , ,._
�_ _
..�.,.. . _....,,..., �:��:-.,-���r��,r��e�e�"'cra"a�ti:d�ir��s�fA'i�1:F�� : (
• ° . ...:�,. .. ._.... .... �. _.. .......-..
. , �:i:t:nxr.n�k�.�r•n�.,o,..p.,.�..;....: �_,:..._,..--„--.,. �_..—..... . .
' . � � . '. Number of fixiures @ �10.00 x $10.00 =
Permit Fee $ Number of fixtures @$15.00 x$15.00 =$
5urcharge $ .50
TOT�I. DUE � Number of f�xtures @�25.00 � x 925.00 =� 5• �'�
Number of fixtures @ �35.00 d x $35.00 = � 35 � � �
State Surcharge = $ -��
Total = � � � � � °-
THI51S AN APPLIC.aTION FOR .� PERMIT-iaOT VALID UNTIL PROCESSED
I hereby anpiy for a b�iilding permit and I aci�owled�e that �he information above is complete and accurate; that the �,�ork �,vill be in
coniormance with the �rdinances and codes oT the �':ty oz "��dley and �.viih the l�linnesota•��onstrucrion C�des; that I understand this is
zot a permit but oniy 1n a�plicazion for a permit and -.vort: :� aot �o �tart •vithout a oermit; that �.iie �•rori� 'viil be in accordance 'virh the
�pproved nian in the case or' all ,,�oric'.vnicn reauires revie�.� -;nd ��provai oi pians. � G
� r. � ,� 1��a-,�s�, .,p�t�' �:IAiv1E�� : J `a- I,O t'J 7AT'E ` �" � \
�IGiaA'N� ^P .�PPLiC.'�i�Ti' C � - --- --. .
— �:e`°T '3I � �':��8'`r
�hII�CP&h'�` _a15�J�'�-:�flS :'���&`.";,fll��l�
�u= - :niverc:ri, .;z,e:�ue :`�iL. ^ricile��. :viZ•1 .�4�--
";� _ ; ; � = �Q�-
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�uilding
Inspections
763-572-3604
763-502-4977 �'AX
T A.,� I C7 --� ��� C�
SITE ADDRESS !
THIS APPLICANT IS:
PgtOPER'H'Y
OVV1vEYt/
'I'ENANT
CO1V'I'II�C'I'Ogt
SUBMIT A COPY OF
YOUR STATE
LICENSE, BQND AND
CERTIFICATE OF
INSURANCE
p'E�I'Y' 'I'YPE
'�'I'E OI+' VVOkt%:
4�? ? � �s, � �j3 ¢ � al 3
k � ,
�g � 9 n'i ,'1 Y� � S l'a � 1\ �- j�7 @ �, � ♦' � i 5,�
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; ; �, ��, �. ; a�. � �
, �
ti ri �� _
YOUR E-MAIL ADDRESS
❑ OWNER [iiCONTRACTOR
CITY
TE LICENSE #
Permit No
Received By:
D����c
EXP DATE
STA
STATE BOND # EXP DATE
nvDxESS: �670 nnricl Rd c�rY
PHONE Eagan, MN 55123 Fnx
�INGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
p TWO FAMILY � TOWNHOUSE
�REPLACEMENT
ATE ZIP,
p'['E ZIP
gEES ARE BASED ON $10.00 PER FIXNRE> EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50. SHOWER _ WATER PIPING
BA.I'H SINKR,pV _FLOORDRAINS — WATER SOFTNER ($35)
BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL — gACKFLOW PREV. ($IS)
CLOTHES WASHER _ KITCHEN SINK ,_ WATER CLOSET —
— LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ DISHWASHER -- V,rATER METER � OTHER
.�,�...�»,.,� ,.�. ._:. -- _ _
THIS IS AN APPLICATION FOR P. PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit 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�work w�h�ch r quires review and approval of plans f^ ��� ' o� �
\ ,, _ _ ,. .,�
SIGNATURE OF APPLICANT
Cfl$3' Of �+ rfldlej'
�u�fl�di�a� �ffisp�ctfl��as �epa�men�
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
' FAX: 763-502-4977
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