AF - 37010Date
Owner
Addr
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BUILDING PERMIT
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Fridley,
Builder
Address
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M�. N° 3oon
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L�OCATION OF BUILDING
No. � �� � . . . . Street . .� . . . . . . . . . . . . . fi%�,�,�, , : . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
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Loi . . .� �. . . . . . Block . : . .. .. . . . . . . . . . Addition or Sub-Divlsion . . . .��l�:���.�,� . . . . . . . . . . . . . .
Corner Lot ............ Inside Lot ...�� ., Setback ............ Sideyard ..........................
DES�CRIPTION OF' BUILD[NG
To be Used as:
[/'` . . . . . . . Front �. .�.�. . Depth �� . I3eight ��":"�": "`"' gq. F't. .��� Cu. Ft, . . . . . . . .
. .. . . .. . . . . .. .. .. . . . Front . .. . . .. . Depth . .. . . . . . Height . . . . . . . Sq. Ft. . . . . . . . . Cu. F't. . . . . . . . .
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Type of Construction ����;'�"ii Est, Cost , , , ��,�, . . . ,�, , To be Completed .� .�C`!2�6!�
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In consideration of the i�ssuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with ail provisions of
ordinances of the village of Fridley.
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In consideration of the payment of a fee of $. ..�, permit is hereby granted to ..... ....�
• • • • • • . . . . . . . . . . . . . . . . . to construct the building or ad dition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects ttf the ordinances oP
Fridley, Minnesota regarding loca,tion, construction, alteration, maintena�nce, repair and moving of buildings with-
in�the village limits and this permit may be revoked at any time upon vi�lation of any of the provisfons of said
ordinances. , _ r,
NOTICE:
Thts permit does not cover the construction, installation or alteration for wiring, plu . n gas heating, �
sewer or wate�. Be sure to aee the Bu7lding Inspeato� for separate pe�mits for these i .
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City of �ridley, inn . N° 8567
BUILDING PERMIT
Date: OCTOBER 27, 1965
Ovvner: CYR'd LIlaR �� SAME
Addresa 6800 Channel Road N. E. AddresB
Fridley 32, Minaesota
LOCATION OF BUILDING
No. 6800 s�t Channel Road 1Q. E. p� oP Lot
Lot — 23 – Block Addition or Sub-Divqeion Brookview Addition
Corner Lot _ Ins�tde Lot —. x Setback __._ Sideyard
Sewer E1eva13on — Foundatfon IIevaiion
DESCRIPTION OF BUILDING
To be Used as:
ROOF REPAIRS �t �.. Depth Height 5q. Ft Cu. Ft
Front Depth ITeight Sq. Ft C�. F't.
Type of Constructfon F�t. Cost _.--�.�.�.��_ To be Completed
Ia a:onsideration of the isauance to me of a permit to construct the bu9lding descri}xd above I agree to do
th� praposed work in accordance with the d�scription above set f � ffi c�pliq�yce wi� afl provlsions of
orr7inanc�a oP the dty oY Frldley. 1% Li�
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In co�sfderat[on oP the payment oP a Pee of R 4. 00 , permit ia hereby graated to � L�
to conatruct the buflding or add3tion as described above. This �rmit ia graated upon
the express condit[on that theperaon to whom ft is grented and his agents, employeee and worl�nen, 9n all work
done in, around end upon said build9ng, or anypar� thereoP, shall conform 9a all reapects to the or8inaacee of
FridleY� M3naesota locatton, constructton, alteration, maintenance, repeir aad moving of buildings
wlthin the dty limits� permft maq be revaked at any ti�ne upon violation of any of the Pr�vYaiona oP sa4d
ordlnane�ea.
AT•T•� G. JENSEft 8�� �
NOflC�
'Ihis �neb dea ao� eersr ths �on�leuaHoe, tnataDatiee Io� v►iriao. P�uml+feW o+� h�aHn�� a�w� er wm►. B� sun to a�
tM BotWioO Ie�tae tee ap�rtl� p�nNa he f6�p k�np.
APPLICATION FOS $UILDING PERI�T
CITY OF FRIDLEY, MINNESOTA
` // �tL c
OWl�R' S NAME
ADDRESS
M+��ZN�Y� ����t�) a��i� � � �� ��L�3
=-�� Stree� � part of I,ot
....__...._..
. � � � ��R ADDITION OR SUBDIVISION ��8�_�� _
...r.�.�
Corner Lot�_Inside LOT�Setb�ck Side-�Y�rd
. . SEWER EL�iATIDN FOUNDA'.['Yd1�T EtEVkTI�11i <
�.... � �.. �:. �.. _,. �.
Applicaat attach ta this form Two Certf#icates d� gti�vey of Lot and proposed
building location drawn on thes� Certifitt�tes.
used as;
DESCR3PTIOAT OF BUILDIlVG
Height
Sq. Ft. Cu. Ft.
Depth Height
� Sq. Ft. Cu. Ft.
Type of Co�ttstruction E�timaCed CDSt ���
To be campleted � �
�!'he undersigned hereby makes application for a permit for the r�rork herein specified,
agreeiag to do all work in strict accordance uriCh the City of Fridleq Ord�l.nances
and raling� of the Department of Buil8ings, and hereby declares that a11 the €acta
and repres�ntations stated in Chis applic�tion are true and correct.
a
(8chedule of Fee Costs can be found on the Itevex�e Side).
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BUILD3IIG PERN�T, FF,� , _SGHED�.E "
SECTION 2. The Inspector of Buildings sha].1, before issuiag any ��it for the
erection of any building or structure, or for any addition to any existing build-
ing or structure, or for any alterations or repairs to anq e.�cisting building or
structure, upon application thesefore, require the payment bq tbe applicant for
auch permit o� fees to tbe amount herein below set forth and in the..manner hareia_..
provided to-wit; •
2.1. For anq such permit for the erection of any �irewproof buildin�,
other than a garage, �varehouse, factory ar grain elevator, or for tlie erection
of any fire-proof addition, for similar occupancy, to any existing building,
shall 6e at the reCe of $1.40 for each one thousand cubic feetf os fraction
thereof, in euch cubical contents.
2.2. For aay such permit for the erection of any fire-proof garag�,
Werehouses factorq or_grain elevator, or for the erection of any fire-proof
addition, tor similer occupaacy, to any existing building shall be at the rate
of $1.25 fo� each ane thousand cubic feet, classified as "fireproof" by
3ection 542 of the Minaeapolis Building Code.
HOIISES , . _ .
2; 3. For any auc1Y permit for the erection of any noa-fireproof building,
otber than a garage, warehouee� factory or grain elevetor, or anq non-fireproof
addition, for eimilar oceupaacy, to any exi�ting building - germit $1.00 for each
one thousan.d cubic feet.
GARAGES
__._.._
2 4_ For any�auch perm3t for the erection of any aon-fireprvof garage,
warehou�e, factory or gisin elevator, or for the erection of any non-fireproof
addition, for similar occupancy,. to any exieting buildiug or for each auch.
buildiag or addition - ninety cent� ($0�.90) for each one thousand cubic feet
os fraction Chereof, 3n the cubical contertts t�ereof with the minimum of $4.00.
For the purpose of computing fees for building pesmits, the cubic�l contents
of aay building or addition to a uniform hei�ht throughout by multiplyin$ the
graund azea covered from a point six (6) inches below the floor line of the
basement or cellar to the average height of the upper aurface or to the average
height of the reof su,rfaee of the main gable of a pitched roof.
2.5. For repairs os alterationa to an existing ats�ucture, the fee ehall
be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or frection
thereof in the coat of all propoaed �ork.
2= In no case ahall the fe� charged for aay permit as set forth in
Section 2 be lesa than $4.00.
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SUBJECT
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 DEVEIOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� _ �
� �"'1 � CITY HALL FRIDLEY 55432 NUMBER REV.
�----� • •�� 612-571-3450 910-F15
JOB ADDRESS 6800 Ghannel Road N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 23 $Y'pp]CVl,2�n1 AdCl],'tyOII
2 PROPERTYOWNER MAILADDRESS
Jan Wright same
3 CONTRACTOR MAILADDRESS
.SdiYIE
4 ARCHITECTORDESI(iNER MAILADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDIN(i
Rssidential
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WORK
RP�'00� C�.U1e�.
9 CHANGE OF USE FROM
STIPULATIONS
DATE
9J10/87
ZIP
21P
ZiP
PAGE OF
/ /
PERMIT .
_ 19166
ECEIPT NO.
�G�-3�
APPROVED BY
SEE ATTACHED
SHEET
PHONE
572-0310
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
O ADDITION � ALTERATION O REPAIR 0 MOVE ❑ REMOVE
TO
Can be sec�nd layer.of shingles, but not third.
Install ridged. galvanized va,lleys.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATINC3, TYPE OF CONS
VENTILATING OR AIR CONDITIONING.
THtS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEF WORK IS COMMENCED. • NO. DWLG. U'�
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT ��-�OOO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANV OTHER STATE OR LOCA� LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $�.%.'rJO
SIGNA RE OF CONiRACTOR OR q RIZED AGENT �DATEI
��
� -il�-��'
ViG OF OWNE F OW R LDERI IDATEI
oGGUPANCY GROUP IOCCUPANCVLOAD
SQ. FT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$.50
SAC CHARGE
TOTALFEE
., _ A1 ��8.��
N� [] City of Fridley Effective �/1/86
ADDN. [ ] R-1 AIdD R-2
AI,TER. [ ] Building Permit Application
Construction Address: � �D '��.�nE'- �c�[�c� �C►� l�°�e � �S�3Z
Legal Description:
owner Name & Address: �Q'� l��r�� �c�,-�, - 5came c��.�eS� Tel. ��7Z-D3� L�
Contraetor: Tel. �
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to scale.
DESCRIPTIOA OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECH AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �,r�o -E� ZOOO �. .-�.-�
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback
Type of Construction: '�e ���i Estimated Cost: $
Approx. Completion Date: .� Z Q �� O
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Baek Page for Explanation
DATE : � / � � `��
Permit Fee
Plan Check
State Surchar�e
SAC Charge
Park Fee
Sewer Main Charge
TOTAI.
STIPULATIONS:
.
APPLICANT: Tel . � �7Z -�✓7 � O
ITY IISE ONLY
$ ��. �U Fee Schedule on Reverse Side
$ c 25� of Building Permit Fee
$ ° S� $.50/$1,000 Valuation
$ $525 Per SAC Unit
$ Fee Determined bq Engineerin�
$
�.� � Agreement Alecessary [ ] Not Necessary [ ]
$
�j�C�' 2 l b � � saG
�Q G
s���,�
— �U
� .J�
�'�. � `�
BIIII.DING PERMIT FEE SCHEDIILE
The Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for any addition to any existing building or structure, or
for any alteration or repair to any existing building or structure, upon application
therefore, require the payment by the applicant for sueh permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
Total 9aluation
$1.00 to $500.00
Feea
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and ineluding
$2,000.
$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
includ3ng $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
ineluding $50,000.
�50,001.00 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.
DRIVEiTAY DEPRESSION ESCR�i
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - Driveway Width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits for construction �ill be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
construetion site.
A Certificate of Survey of the lot, showing the loeation of the foundation onee it
has been constructed will be required before proceeding With the framing.
sue�ecT P N O.
City of Fridley o 19 8 9 4
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T R IPT
r
� 1 y_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ��� y,�
1 � ,
l---_ � /'�'1.� CITY HALL FRIDLE� $5432 NUMBER REV. DATE PAGE OF APPqOVED BY
L ��' � 612-571-3450 910-F15 5/12/89 � �
JOB ADDRESS 6800 Channel Road N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. P't. 23 ( arcel 1220) Brookvie�v Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Wright 6800 Channel Road N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Covenant Construction Co. 7904 - 73rd Avenue N., Brooklyn Park, MN 55428
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINO
Residential
7 CLASS OF WOFK
O NEW ❑ ADDITION C� ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WOFiK
Alterations in Basement
8 CHANOEOFUSEFROM TO
STIPULATIONS
See nota.tions on plan
SEPARAT� ��Rl�71TS REQUtRED F'-OR
IJV�RING, H`A�TIr��, FLUMBING AND �1GNS.
SEPARATE PERMITS ARE REQUIqED FOR ELECTRICAL, PLUMBING, HEATIN(3, TYPE OF CONS7'• OCCUPANCY GROUP OCCUPANCY �OAD
VENTILATING OR AIFi CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WOqK IS SUSPENDED OR ABANDONED FOR A PEHIOD OF 120 DAYS AT
ANY TIME AFTEFi WORK IS COMMENCED. • NO. DWLG. UNITS OFFSTREET PARKING
I HEFEBY 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 y�],3s2OO $C.GO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $153.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
$159.60
S�GNATUFiEOFCONTRACTORORAUTHORI2EDAGENT IDATEI s� WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
�. �
SiGNATUAE OF OWNEA IIF OWNER BUILDERi �DATE� � BLDG �NSP � �q%
� [ ]
� [ l
�� [ ]
cor,struction Adaress:
L�gal Description:
Effective 5/1/88 �
1�1 AND R-2
m,;�ding Permit Application
��''�J G/-�tJavn� ��, ��
�r a3 ( ���o ) �oo,�u��u� � /�• no �
owner Name & Address: lr� i2J�1 �1. #
Qontractor: �jv�2rA�i �'�rv���vc��-°�al.�� �-c� Te1. #
Addres.s : i� o � � 7 �� �' `� %��� • /l�U. L��/�vc✓n �,�/� , /Z�i,�a> S � �/� �'
Attach to this application, a Certificate of S�uYVey of the
lat, with the prapo�ed c�oa�structioai dr�wn on it to scale.
�RtIPl'I�T �' II�VHr1F�T1'
�' - rn o � ���' R�-� l�-�-�-� � ,.�..e.e��
LIVnVG ARE�,: LP�1 wicith xeic�t scl. Ft.
CA� AREA: Length Width Height Sq. Ft.
D�CK AREA: Length Width Hgt/Grotu�d Sq. Ft.
OR�It: '
Cbrner Lat [] Inside Ir�t [] Ft. Yd Setback Side Yaxd Setbacks
Zype of Doristruction: 12Q � t�•, v Q.tSZ Fstimated Cost: $ �-�, o�OD
Approx. Coanpletion Date:
Proposed D�iveway Width If New Opening Is Desired: Ft. S $
Width + 6' See Back Page
n�: 51r�1�9 �r�c�xr: �;�/ ��, � �. # '�93°3�oU
Permit Fee $ �,2�� 1�J
State Surchan�e $ r . (�n
SAC Ct�arge $
Driveway Fscrow $
Park Fee $
Sewer Main Criarge $
. v
sz'�ZZa�s:
$ /�g/O
�S•
/9y���
CITY �E �Y
Fee S�le an Reverse Side �.
$.50/$1,000 Valuation
$575 per' SAC Unit
Alt. nA° OY' Alt. „Bn AbOVe
Fee Detrermined bY �3�r�9
Ag�oertt Neoessary [ ] Not NeoessaYy [ ]
a
�
�
:�� � � � r • ��•. � � :�' _•�:i�� 1
Zl�e Chief Buildir�g Official shall, before issuir�g �r+++; ts for the erec.�tion of any
builciing or stnructure, or for ar►y �iditio� to any existing building or structure, or
for ariy alteration or r�air to any existirg buildirg or stn�cture, upon ap�lication
t��refore, require the payment by the applicant for s� �r++�;t of fee.s to the amaunt
herein belc�w set forth and in the manner i�erein pravided to-wit:
Z�OTAL VAIIJE
$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
��
$15 (Minim�� Fee is $15 plus surd�ar9e)
$15 for first $500 plus $2 for each additional $100 or
fractiaa� ttiereof, to at�d including $2, 000
$45 for first $2,000 plus $9 for each ac�Clitional $1,000
or frackioal thereof, to and including $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fractioaz thereof, to ancl iricluding $50, 000
$414.50 for first•$50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and iricluding $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and 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 th+er�of, to and includirig $1,000,000
$1,000,001 arid up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DItIVE�Y �3I�T �
(Ganc;rete Curb Str+eets On1Y)
Alternate "A" : R�moval ar�d replaoe�ment of curb ar� gutter oazly - Driveway width plus
6 feet times $13.50.
Alternate "B" : Remaval ar�d repla�ent of ca»rb artii gutter and in.stall a 3 foot wide
approach with 6 iTK� depth - Dtiveway width plus 6 feet times $15.75.
�/�; �a� �'; � •;� •l° ;��_�i�n � M �;�
P�ermits for oo�struction will be issued a m�*+��� of 24 hou�s fraan the time of
application to allcyw for praper review of th�e pro� st�c4ue and of the
co�truction site.
A Oextificate of Sluvey of th+e lvt, sh+owing the location of the fo�u�dation onoe it has
it has been constructsd will be required before pro�ding with the framir�g.
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SuBJECT
City of Fridley
AT THE TOP OF TNE TWINS g� I L D i N G P E R M I T
i�
� �
� ' COMMUNITY DEVELOPMENT OIV.
� •V °'��� �
r � � PROTECTIVE INSPECTION SEC.
i---.� �"' �'� CITY MALL FRIDLE� '.iS1�2 NUMBEF AEv
t 612-571-3450 910-F15
JOB ADDRESS 6800 Channel Road NE
1 LEGAL �OT NO. BLOCK TiiACT OR AODITION
DESCR. 23 Brookview Addition
2 PiiOPERTY OWNER MAIL AODRES$
David Blaido 6800 Channel Road NE
3 CONTqACTOR MAIL ADORESS
Aztec Roofing 11583 Rupp Dr, Burnsville, MN .
< ARCNITECT OR DESIGNER MAIL ADDRESS
5
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW
8 DESCRIBE WORK
Reroof House & Gar
9 CHANtiE OF USE FqOM
STIPULATIONS
MAII ADDFiESS
❑ ADDITION O ALTERATION
19 Sq) Tear-off
TO
DATE
3/23/99
21P
895
ZIP
ZIP
❑ REPAIR
R
vAGE OF
� �
'29051
RECEIPT NO.
/�1� /
APPqOVEO B�
SEE ATTACMED
SHEET
PMONE
PHONE LICENSE NO
•0040 20139140
PMONE LICENSE NO
PMpNE LICENSE NO
❑ MOVE O REMOVE
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK 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 REOUIRED FOFi EIECTFlICAL, PLUMBING, HEATING, "rc �r wi
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION zONING
AUTMOR12ED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OF ABANOONED FOR A PER100 OF 120 OAYS AT
ANV 71ME AFTER WORK IS COMMENCED. NO DWLG.
1 MEpEBY CERTIFV TNAT I HAVE fiEAD AND EXAMINED THIS APPLICATION 1
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp�UATION
ANO OROINANCES GOVERNING TMIS TYPE OF WORK WI�L 8E COMP�IEO
WITM WMETMER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A pERM1T �1 f 6Z8
DOES NOT PiiESUME TO GIVE AUTMORI7Y TO VIOIATE OR CANCEL TME pEqM1T FEE
PROVISIONS OF ANV OTMER STATE OR LOCAL LAW REGULATING CON-
STRUC710N OR 7ME PERfpRMANCE OF CONSTRUCTION �S�F.00
(� PLAN CNECI
, —Tl//lu/Il�f� 3%.3��f`( Licens
S�GNA URE OF CON'aACTO Oi1 n MOA4ED nGENT 1DATE�
4�uaE O� OwNEp��� OWNEpBU40EAi �O�iEi
SO.
S7ALlS
GROUP �OCCUPANCVLOAD
CU FT.
OFFSTREET PARKINC
IGARAGES
$.81
iAC C RGE
Fi e SC $1.63
'OT L FEE
$61.44
IT
�
JUN-c4-1998
�DDN [ ]
�LTER [ J
�onstructionAddn
L.egal Descripcion:
11�48 FROM CITY OF FRIDLEY TO �,`� 0 8959962 P.01iO4
Uu�aw��... .......��
CITY OF F�tIDLEY
SXNGLE FAMIiY AND DUPLEJCES R-1 AND R-�1TY OF FRIDLEY� ��'
BUILDING PERMTT APPLICATiON �� s�3� uNiv�RSi�r avE. N.E.
_fA0 ,n\ �Qini �v nnn� �Sd��-4384
Jwner Name & Address: �� (��(�l (� (11�(�C.� (XO.�,IiE l'1 � 1 +�1�' - I U. L' _ Tel. �l
�onaactor:� 1�'_ {�CX7�� G „ 1VXNL.ICENSEA� '��� ��/�C�
4ddress: 0 I�� ��� (�� �t� � YI'�i//,�,��:' 1'�! N Tel.1t ��� '��
�
Attach to this application, a Certificate of Survey of che .
loc, with the proposcd construction drawn on it to scaIe.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTYON OF IMPRO'VEMENT
I,et�gth ,_,_ Width .Hcight
I,ength � Width Height
Length Width �
'�...
� `� -
Sq. Ft.
Sq. Ft.
Sq. Ft.
T � � . ��,C
v G
:onsQUCtion Type: �1� Estimated Cost: � �Co��
(Fee Schedule on Back)
�riveway G�rb G�t Width Needed: Ft. + 6 Ft � Ft x$ _$
�ATE: � Gl APPLICANT: Tel. �Y D�J� -���U
'ermit Fee
� ire Surcharge
�tate Surcharge
�AC Charge
.icense Surcharge
)riveway Escrow
;rosion Control
'ark Fee
;ewer Main Charge
TOTAL
�'I�ULATIONS:
$ (� �
$__ �� �o
$ o
. <� �
$ .
$ �=d�
$ •
$
$
$
$ �
CITY USE ONLY
Fee Schedule on Rcvcrse Side
.001 of Pennit Valuadon (1110th°b)
$.50/$1.Q00 Valua�tion
$1000 per SAC Unit
$5.00 (State Licansed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.Q0 Conservation Plan Revicw
Fee Determined by F,ngineering
Agreement Neeessary ( � Not Necessary ( ]
a + _ '
V. Building
Inspections
763-572-3604
DATE �IUY�J�
SITE ADDRESS _�
THIS APPLICANI' IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.�
Received By:
Date Rec
YOUR E-MAIL ADDRESS I C�f�rU L�Ui // �'YI ��►^` G�'° KIT'/ /� °LYY1��I�//✓�✓f� aP
,P,�. ,� ,J � � �° �� . . w► .n a r'c-s_/ a � (/
❑ OWNER �CONTRACTOR
PROPERTY OWNER/ Nnn�; OHt�/� /�N� ��tJV�►4 ��/�
TENANT ADDRESS: � �� �� � �iAi900�?�� L ��.rir4t� CITY �i^lf�I �y STA
PHONE: ��.� ����' 02 y �a
CONTRACTOR N,a�: "�' d. ►"� �' -I�e,r- i,4•�5 ri�� m
SUBMIT A COPY OF STATE LICENSE # ��o o� y EXP DATE % �
YOURSTATELICENSE ADDRESS: .3�t� �.I °`VE���4W� f}-►d� .�, 4tI CITY �W �`� c
WITH APPLICATION PHONE ,�reSl ' ��.� ' fs'� � / FAX �SI - � � �- R � g %
TYPE
PERMIT TYPE
TYPE OF WORK:
FAMILY/NEW CONSTRUCTION
�'ADDITION ❑ GARAGFJSHED
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMMING PO�
� ❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: A�� I� /Q�/��v/ �0� �^
SIZE OF IMPROVEMENT � T� LENGTH f'�
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
SIZE
❑ WINDOWS
❑ DRAIN TILE
❑ OTHER
��,�PVd��"i�ne o,S �rv
� �� �� WIDTH
'�'.,�63oZ
ATF�i%`�P �/�Z
i�' HEIGHT .�
BASEMENT REMODELING SUBNIIT:
1. Exisdng Floor Plan
2. Proposed floor plan
3. List of structural membeis to be used
Ft.
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
� V'myl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum O Trim 1. Site Plan/Survey showing the existing structures
❑ Other � Fascia and pmposed project.
WINDOWS 2. Two sets of construction plans
IN EXIS1'ING OPENINGS �Yes ❑No LOCAITON OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE CO5T OF LABOR AND MATERIALS:
(iJSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ci 7'7CP 3� Cl� OCCUPANCY TYPE
Permit Fee $ ,�t 1,�j See Back Page for Fee Schedule '
Plan Review $ ,� 7�1.r ,�► ( 65% of Building Permit Fee
Fire Surcharge $ �.� ��(� .001 times the total job valuation
Surcharge $ �'� � � � .0005 x Permit Valuation Minimum $.50
License Surcharge $ � Q C�� $5.00 (State Licensed Residential Contractors)
SAC Chazge $ $1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ $450 Conservation Plan Review
Pazk Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due_ $ "(�� ,�� Make checks paysble to: City of Fridlev Attach Stiuulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the informarion 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 applicarion for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whic equires revie an approval of plans.
SIGNATURE OF APPLIC PRINT NAME�%p{telf � [�',�W( �j DATE �/� o D�
� �
0�/02/2097 16:20 �338859
TIMBERCRAF'T
Ju 1 02 2p07 8: 56AM E�tie�sh��!�C� i �e�er i�+S
�.. .._-.�..�-
� '1
PAGE 02
G51 -6:38-6867 P • 1
C
�STEPHAhI E1��1�����tING
1 2 Nor� r1, sw BriB n►, N 51 i, e,! �c i 1) 3 8B
'ra John Ludwj� �� �ro� HetUy Esbeph�r► „�_
�. gs��33-esse c� June 29� 2�7 � _
�.�.�-.�.
� 651�11 �'+�� 1 _
�—
n.� 9ledio Re�idencx� p�Jd� �tlon� � —�
p� �*er 1l�rMrM+ Q�NiuM. CannnM� x Foryarw� 0����'
..._.-- '
According tc your requast I rovie�weci tg ��h�� an�my�ly'�s� the fotl�wing rea mpV
jo3sts and trie he�r c�rer th ger�g
re�nmenda�ions: �
1. The 2x8 axisUng jo9s+s supporang tt�e �waN and �� roof of �e additi+an n�ed to �s
rainfioaaad, Ackling aru�h�r ?.x8 �red �o be adequ�. Hov��aver the cl�� m+9t�t
exceed wh�t is e1lo��ed tot ��aor d�n. By add�ng '/•' ph�d 91W��d and ne�ed
be�sn the new a►�i 1he �t�n9 jc�#s wi11 bring the de#�ion cl� t_o a�hle
jpy�l. The m�dmum deflecbion is the� �r�u� of fuU design liv� loe�d anc� fu�l �naw and
snaw drift lo�tl. Belov�� e�c�+ jarnb dF i�e 6'.0' and 5-�" openlri� add 7"/." Mipulam in
add�ion ba the (2) 2�c8. The ne�w joista �hail l�ear fuly on t�p of !he �eam and th�e
� �.
2.
3.
Tt�e ?�c8 fl�ar joi� a��p�er eclf�quate b�t tl�e floar de�tecfilan i:s hi�t�r th���n it is allow+e;d
�orfloo�r de�ipn. �y �kling'/" F�lywoad gl�! and ne�il�d to the e existing ja�ists will result
in em acoep�ie dafte►c�on.
T'he new header instaqed at tlx, bo�tonn of the additlon wa� o�er the �;�'�ttg g��a►�le
door shaq be 3 11 '1/8° P�altem PSL or equal. The ktieader ia �pabN� vf �upportu�g
ihc addi�ion end s eocisti�$ fl�r. Under this icading th+� header is reaching �'bs
n�2�xirntan �j►.
You ind�ted ttt�t tl�e �i► plywaai wit! !�e out from 4'-0" x8'-D" t►oards. Be�cause the joist
spar� �re longer than B'•0", plec�e �the �' PhJ�vood I�nB pi� (8'-�"i �nt�recl in tl�e span.
O��er conatruc�lor► �em� wero not pan ot' �1�is �cope af wvrk. H' you hav� any questio�re,
feet troe �o c�l me.
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06�/20/2007 15:39 6338859 TIMBERCRAFT PAGE 02
REScheck Compliance Cetrt�fic�te
ZOQO IECC
RE,Scheck5t�� Vension 3.b Releese 1
Dats 8fename: C:1Ptogreln File�lChecktRESc�:lBladio.rck
PROJECT T�E: 68Qa Chmmel Roa�, Fridlay. riN
CITY: Fridley
3TAT�: Mi�mesota
HDD: 7391
CON3TRUCTION TYFE: Single F�a Wy
wnvDOw / wnta. RaTto: o. i 7
DA7'E: Q61Z0l07
DA'T� OF PLANS: b/I 11�7
PROJECT DESCRIFTIQN:
24' x 14'-6" Additian ov�r tuck wider gar�ge.
D�,SIGN�R/CONTRAGTOR:
Timb�CraB En�erprises, �Inc.
COMPLIA�TC�:
Maxim� UA = 82
Your Hom� UA = 74
Gcili�g 1: Flat Ceiling or Scissor Trusa
Walt 1: Woad Frame, �b" O.c.
Wfndow 1: Metal Freme:Double Pane witb Low-F;
D�r t: GEass
Floar 1: All-Wood Jais�/Tivss:Over Unconditioned Space
Furaace l: Fcmced i%t Air, 78 AFI)E
Air Conditionar 1: Electric C�cal Ac:,10 SEER
.�_����1
" Pe:r�nit xun�ber —
�T[099
Area or Cavity
� R Value
0,
Checked By/Dete
Gla�c�g
Gmt, or l�ar
�Y� ��� �
348 38.0 0: D
SaQ 19.0 0:�
50
33
348 26.0 2E�.0
10
25
0.370 19
o.3su ��
7
COMP'LIANCE STATEMENf: The pmpc�s�l buildiag desip� described here is consistent with the bu.ilding plans,
speciScattons. ead olh�r celcnlations atibmittad with ti�a p��it a�Gcation. The propose.+i building hes, been designed to
meet the 2000 IECC r�airements in F:ES checkV��airnt 3.6 Rele�st 1{fo�mcrly MECchecJ� and to ccnnply with the
ms�dabry requiremeflts listec! in ti�e F�Sche kI��pepection Checkllst.
Aua�ae�ID�i�er k/, nate d 2 d 7
L�
FROM :City of Fridley
Building
�nspectyoXls
763�5'12-3604
DATE � � �
SIT� ADDRESS �
THIS APPLiCANT {S:
OWN�:R/
'1'1�NANT
gUg�utlT A COPY OF
Yovx s�rA�
LICENSB Vd17'L�
APPLICATInN
PERMIT TYPE
TYl'E OF WORIC:
pETAII,E� ]3ESCRxPT]
PER MS 16B.665 the pei
improvem�nt, inseallatx��
Labor cost urtder $300 =
FUR PRQIF�.`TS WHL�RE
�pR OF E:ACH B�aL
Ec�uipme��t In9lxillad
AJC $7.'4.00
A1R To A1R �XCHA1
,BOILdiR $35.00
► r��-ifIVATEY LRVER �l
�n��c�r woiuc sto.00
Permft Fee
Surchatge
TOTAL DUE
FAX N0. :7635711287
MECI�ANYCAL
RESIDE�TTI�L APPLYCA�ION
CITX OF FRIDLEY
E-MA1L
❑ pWPTER
ACT P�LLSONf:
P.TE I�ICENSE �!
iDRESS:� • � �
t)NE a' �, �' �!�..�
$�SCiLE FANIILY L'1 '1'WO FAMILY
�-
NEW I� REPLACEMENT �
OF VvORK
Aug. 01 2007 09:46AM P4
Perm�t No.;����i(�
Received B�►:
�
STA7'E ZIP_..._
EXl' DATC�,��
�CITY , �, STA� Z�,
:z _
❑ TOWNHUUSE
7`LiRATI ON/Ri'sMODbL
nit Pce is a minimum of $1�.00 or S% of the tot�l coat up to $500•00, whicliaver is geater, for tlae
or replflcement of a residential fixture, excludin� the fixtures. (This should raflect only ihe cost o¢ lebc►r )
5.00. Labor cost between $30Q to $5(lb � cost of labor _� x.OS =
l f?XCEEI)S $500, FEI'S ARE BASED ON �10.0o PrR FDCI'URE, NXCEAT W�1BaE NO'TED. FIXT1.][tBS: (INUICA'PF. TOTAI.
MFG: , — MODLI.: SIZB/BTU
��: MODPL= „_ S1ZL•'.B'fiJ,_„^�
MFC: _ MUnEL: SIZEJBTU
_FIkEPLACE (GAS) $15,QU �A5 �1G�/OVEN $1�.00
$1S �,FIRFPLACR (Vd�l)) $35.00 _NEW (iAS dRILL $IOAD
FIIRNACfi $35.tl0 _,,,^GA8 UNIT HTR $1�•OU
CiAS I�RYER $10.00 _PQOL HFATER �3iAU
�cas �pt►aa�in.ao _ vEN�rAx $is,� ,��
�,r� Numrober of f�xtures @ $10.00 x $10.00 = $�, _,_
$ ""�`� . 0 Nu�nber of �txture.S �, $15,00 �_ x $I5.00 � �
$ , ,� Number of '�ixtures � $25.00 � x $25.00 � $�,_,_
Number of fixtures �o. $35.00 ___ x $35_00 = $�,
5tato 5�vch�rge = $ •�o
Tot�.l � $�„_
i'HiS IS AN �PLICATION FOR A PERMIT-N1U'f VAL1D IlNTIL PROCF�SSEP
1 hereby apply for a b ilding permit and 1 acknowledga that rhe uo�ormation above is complete and accur�te;
thel the work wi11 be in
c�fiform��nce with tl�e ' anees and codes of the Ciiy of �ridley and with th� Minnesota Cons4vc�ion Codes; tihat I�mder�nd this is
not a petYnit but enlY application for a permit �nd work is not to start without a permic; thei the work will be in aceordanca with the
apprpyed pl� in the e of all wotk wltich requires raview a�r►d apprvval of plens. s �
3IGNATURE OF APP1.1C ���.�° PRIN'[' NAME ,�1 � ��� OATE
City of Fridley
Building Insp�ct�ons Aepa�rtment
6431 Univer'sity Avcnue N�, Fridley, MN SS�F32
763-572-3604
�AX; 763�502-�F977
Building
Inspections
763-572-3604
DATE��
S1TE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OR'NER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMI'T TYPE
�rYrE oF woxx:
MECHANICAL
RESIDENTIAL APPLICATION
CIT�' OF FRIDLEY
❑ OWNER
NAME:_�
ADDRESS:�
PHONE:
cot�.artY ru�;_
CONTACT PERSC;
STATE LICENSE #_
ADDRESS:
PHONE
YOUR
�. �
�SWGLE FAMII..Y ❑ TWO FANIII.Y
❑ r�w ��cE�rrr
DETAII..ED DESCRIPTION OF WORK
FAX
CITY� � 1 e
'�-69N9H'11
AKE STAF�T
{�, MN 55408
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
. ... ._. ... ... ._.. L ' '
Permit No
Received By: /�v
Da���'d�JpN �a
PER MS 16B.665 the permit fee is a minimam of $15.00 or 5% of ffie total eost np �to $SOO.00,.whichever is greater, fo� the
improvement, installation or replacement of a residentiai 5xh�re, excluc�ing.�te. �es•. .(Ti�is.sl.iouid reflect only.the cost of labor )
Labor cost under $300 = $15.00. I.alior cost between $300 to $500 = cost oflabor . _ . . . �c .OS ,- . ., � �: . .
FOR PROJECT'S WHFdtE LABOR EXCEEDS., SS00 .- AItE �AS ON 510.00 PER FIX1'URE..EXCEPT �VHERB NOTf�A. Fi7CTURES: (AIDI(;ATE TOTAL .
NUMBER OF EACH BELOWj � �. �. MODEL.�� � . SIZUBTU �� a�''
�1�PmentTtistalled . 1wIFG:
A+ffG: �, ' MODII.: � . �,T��. . �
NII'O: MODEL:
� ciAAS RANGFJOYEN S 0.00
� $25.�1 i ) �15.�
AIIL TO ATR fiXCHANGffit $15 CE (WOOD) $35.� NEW (iAS (iRII.L S10.�
FURI4ACE 535.00 (�AS UHIT H'�R 510.00
CfID�IIQEY LIIVER $10.� � AS DRYER SI0.00 P�OOL HFA1�t 535.�
DUCT WORK SL0.00 GAS PIPIN(i 510.00 VENI�.ATQR;IS.OQ
_ —= x� �a% ��i� �m , e � �a
Surcharge
TOTAL DUE
$� Number of �res @ $10.00 x �1o.ou = �
$ � .50 Number of fucd�r�s � $IS.QO x $15.00�= $
$ � Number of � @ $25.� x $25.00 a
� Number of fixtures @ $35.00 � x $35.00 = $
S�e Surcharge = $�-� S�-O
Tota1 ° $�;�,�
TfIIS LS AN APPLICATION FOR APEitNIIT�10T VALID UNTII. PROC�SS�
I hereby apply for a building penp�i�t and I aclmowledge that the information above is complete and axm�te; that tha work will be u
conformance with the ordinances and cod� City of FrlsIlay aad widi the A�itme.sota Constcuction Codes; that � uaders�nd this i:
not a permit but only an �'on for d work is not to statt wi�out a permi� ti�at the work will be in acc,ordaace with th�
approved plan ia ti�e cas of . _ review aad approval of�ansi ! � �/ /....,
SIQNAT'URE OF
" City of Fridleg
Building Inspections I?epartment
b431 iJniversity Avenue NF� Fridl�y,. MN 55432
- 763=572-36D4
FAX: 763-502-0�977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RES(DENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDI�IONS EXIST!(�G HOME ❑ MAKE-UP AIR
R.EQUIRED FflR NEW/EXIS.TIN��I�Qlu(�f�S ::+;:,:.:.: � :.� : . .:.
�� �Y.� � �A'•.',r� �
':,.1�73•: ".: _ y a.� . ,
'�t: 2 ;,:' ��ii�~'i.;•j:.+,�ji�: '
1. Combusta.on Air (See note belot�)� :; _ ' ' , ' . .
� �a
?:.�':'i" . .
a. Oil or solid fuel IMC Cha�ter 7 with MN Amendments
b. Nalural Gas or Propane/IFGC Chapter 3 with h�IN Am.endments
2. Make-up Air (See note below)
a. IMC Chapte� 5 with MN Amendments
3. Venting
a. Gas appliance.s 1FGC Chapter 5 with MN Amendments
b. Fuel other tlian gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW H�MES
4. Heat loss 8i rAOlin.g load per room �
a. Requir�d on new construdion lMC 1346.0312
5. Ventilation .
a. Per MN Energy Cc�de 7670 or 7672 � .. .
6. Duct Desi�n Per�IlViC 1346_ 060�:2 _ ' _ - - - - -_ �-�— - -
a. AOCA Manual D
NOTE: Centerpoint Energy Mechanical Code Gnidelines software may be as�l for
coambusfion and make np air calcnlati.ons .
Building
Inspections
i63-572-3604
srrE AnnxESS �
�us aPr�carrr �s:
PROPERTY
OWNER/
TENANT
CONTRACTOR
PLUMBING
RESIDEl�TTIAL APPI�ICATION
CI'I'Y OF FRIDLEY
❑ owivEx
ADDRES3:
PHONE:
�
%��''a\�
.. .
ADDRESS
Permit
Received By:
Date+�d�e�: �
,....�.�..� �
SUBNIIT A COPY OF STATE LICEAT3E #_��T ►� �,� w��_ E7� DATE ( Z'� �
YoUR STATE ADDRESS: 3670 �edd F�d #-100 C11Y STATE zIP
L�cIIVSE � rxorrE Eagan, MW 55123-1 �c
A.PPLICATION
PERAIIT TYPE
TYPE OF WORK: I � �R'
FAMII,Y O TRVO FAMILY 0 TOWNHOUSE
DETAILID DESCRIPTTON OF WORK
� �EPLACEMENT
,
PIIt MS 16B.665 tl�e permit fee is a mmimum of $15:00 or 5% of the total cost np to $500.00, wlrichever is greater, for
improveinent, installarion or replacemeirt of a reside�ial fixdue, excluding ttue fixtures. (This shonld reflect only the �st �
I,abor cost under $300 =$15.00. Labor cost between $300 to 5500 = cost of labor x.OS =
FOR PROJECTS WFIERE LABOR EXCEEDS $500, FEES ARE BASED OAT $10.00 PER FfXTiJRE, EXCEPT WFIERE NOTED. FIXT(JRES: (IIVDI
NUMBER OF EAC;H BELOVI�
BATfi SI1VK/I.AV FLOOR DRAINS 3HOWER WATER PIl'ING
BATHTUB GAS PIPING (n�D caPLx�vsP) SWIMNIINQ Pl)OL WATER SOF1N]
CL01�S WASHER KiTCHEN 3INI{ WATER CLOSET BACKFLOW PR
— D��'�� _ LAUNDRY TRAY �WATER HEATER ($3� FOR IRRIQATI(
_ WATER METER _ OTFIER
Pemut Fee $ �� , d� Number of fixdues @$10.00 x$10.00 =
$��e .50 Nnmber of fixdu�es @ $15.00 x $15.W = '
iTAL DUE $�. S�� Numher of fixdu�es @$35.00 x$35.00 =
State Suncharge =
Tota1=
1TT�SS I� AN APPLICA110N F0�3'i A PER1vITT IJOT VEILID UNRL PRO�ESSED
20
3
�Y'71 r` �1
($35)
. ($15)
I hereby applq for a building permit and I acknowledge tlr�t the iafomiarion above is complete and accivate; that the wo will be in
co�ormance with the ordimnces and codes of the City of Fridley and with the Minnesota Constivction Codes; that I this is
not a permit b� only an application for a permit aud work is not to start without a permit; tl�t the work will be in acco wirh the
approv� plan in the case of all work w�ich re�i� re_yiew and approval of glans.
sic�ra� oF arrrscarrr
City of Fridley
Bailding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
� 763-572-3604
� � v. •t« cn� nn^»
,\
�
I
3uilding
��.spections
763-572-3604
�ATE_ V / /
iTE ADDRESS _
^HIS APPLICANT IS
ly�
?Rt?Y'ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
�,IITH APPLICATION
PROPERTY TYP�
BTJILDI�TG
RESIDENTIAL APPLICATION
CITY OF FRII�LEY
RI
Permit No.:
Received By:
., ����-.g�.
�D�S i-od►'�p�.ldi�ionrs �o�
v�
❑ OWNER k�CONTRACTOR
(� U l` l� l� r o
Ess: L S d o ('hn n n i
E: ?L31SZ1-?443
N,�: rHD At- Home Services, Inc.
sTA� rac 2690 Cumberland Pkwy, Ste 300
,e,DDx�ss Cumberland Office Park
PHONE Atlanta, GA 30339-3913
Q sINGr� Lic# 20268257 Ph. 763/542-8826
PERMIT TYPE Q �DTfION
❑ BASEMENT FINISH
0 DECK
�E oF woiuc:
ESCRIBE WORK BEING
� OF IMPROVEMENT
_ ooFnvc
nv
���ER OF SQUARES
z.4RAGES
�OPOSED SIZE:
ROPOSED HEIGHT:
T.DING
� Vinyl
; Aluminucn
i Other
�P.VTDOWS
EXISTING OPET�TINGS C'�Yes ONo
: FOR NEW OP�TGS-DESCRIBE SIZE OF
'ENING CHANGES & " �A
o GaRaGFas�
❑ ROOF
❑ SIDING
❑ SWA�IIvIING POOL
❑ ADDITION
❑ REMODELING
TFi
❑ HOUSE ONLY
� HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
0 Fascia
LOCAT� ON OF WINDOWS
L./V)11a (�0�1/�')
ITY �il �/I ti STAT'E ZII' F'.a R/ 3 7
Jod� m F�d�r Jdn<5
c qSa (3Y5- (.�y7 �
CTTY STATE ZIP
rE
_ .'ORIES
r�wII•moevs
❑ DRAIN TILE
❑ OTFIER
►n �n .�Y� s �� a,oa�. nr
WIDTH HEIGHT S . F�
BASEMENT REMODELING�SUBMIT:
1. Existing Fioor Plan
2. Proposed 800r plan
3. List of structural members to be osed
�.
FOR NEW CpNSTRUCTION INCLUDING DECKS,
ADDITTONS. & P4RCHES SUBNIIT•
1. Site PIanlSurvey showing the existing structures
and proposed project
2. Two sets of coastructioi► ptans
3. Energy Calculations
_ PE OF WINDOW TO BE INSTALLED Y NUMBER OF WII�IDOWS � �
ALL FEES ARE BA5ED ON VALUATION, INCLUDING THE COST OF LABOR AND MA
(LTSING THE 1997 U.B.0 FEE SCI�DIJT:E)
TOTAL JOS VALUATION $ �{ , 0 C� O OCCUPANCY TYPE
erm.it Fee
Ian Review
srcharge
ire Surcharge
;cense Surcharge
.4C Charge
�.�rb Cut Escrow
� osion Control
�rk Fee
�wer Main Chatge
�tal Due
$
$ �. v n
� ti.oa
$ S. e�
$
$
$
$
$
See Back Page for Fee Schedule
6S% of Building Permit Fee
(.000� iimes the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (Staxe Licensed Residential Contractors}
$1450 per SAC Unit (Plans to MWCC for determi.nation)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATTON FOR A PERMIT-NOT VALID UNTII. PROCESSED
iereby apply for a building permit and I acknowle�ge that the information above is complete and accurate; that the work will be in
nformance with the ordinances and codes of the City of Fridley and with the Minnesota. Construction Codes; that I understand this is not a
�rmit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
an in the case of all work wIuch requires revi nd approval of plans.
GNA7'URE OF APPLIC '�' PRINT IQEIME l%� S� � ��i �C DATE f� / � S l�
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erectian of any building or
stru.ciure, or for any addition to a.ny e�isting buildi.ng or s#ructure, or for �axy a1�-eration or repair
to any e�.sting building or structure, upon application therefore, require the payment by the
applicani 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 min;mum of 24 hours from the ti.me of application to
allow for proper review of proposed structure and of the construction siie.
A Certificate of Survey of the lot, showin.g the locati.on of the existing foundation will be
required before proceedin.g with the framing. New Hou.ses Onlv
City of Fridley
Buildi.ng Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977