AF - 38348sue�ecr , PERMIT NO.�
City of Fridley :` 25 � 6 8-\�
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
! � RECEIPT NO.
� `y__ COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTtON SEC. ,�p?��
i �
� �
( � ��'�� � CITY HALL FRIDLE� 55�32 NUMBER REV DATE CAGE Of APPROVED 8V
�'"""�'� �'� 612-571-3450 910-F15 10 / 6/ 9 7 � �
J08 ADDRESS 126 Christenson Court NE
1 LEGAL �OT NO. BIOCK TRACT OR ADOITION SEE ATTACHED
oESCR. 1 17 Christenson Crossing SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PMONE
The Rottlund Co Inc 2681 Long Lake Rd, Roseville MN 55113 638-0500 1335
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAI�ADDRESS ZIP PHONE UCENSENO
6 USE OF BUILDING
Residential Townhouse
7 CLASS OF WORK
xO NEW ❑ ADDITION O ALTERATION � REPAIR p MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 28' x 24' Townhouse and a 22' x 20' Garage
9 CHANGEOFUSEfROM TO
STIPULATIONS
See notations on plan. Paid Park Fee of $375.00.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OA CONSTRUCTION ZONING SO. FT CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WOfiK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFiTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT `P89 � 592 ��F�F. HO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEfiM1T FEE SAC CHAfiGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION �824. 7S Fire SC �H9. S9
/ / PLAN CHECKFEE TOTALFEE
� � 7 License SC $5.00 $1,914.14 + PF
S�GNATUAEOFCON"P- CTOQ AUTHOFli2EDAGENT iOA7E� WHEN PqOPERLV ALIDATED THIS IS VOUR PERMIT
\ li%'� , \a:�'J U ' �J^ , �
S�GNATURE O� OWNEp'��F OWNEA BUILDE�7� iD�TEi "^Y g� iNS� f�q7E
NEW jj�
A�31::� "� [ l
ALTER , [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1 / 1 /97
��g
�� �a38
ConstructionAddress: I Z �G G�{%�/s%�N�(�N �%�%
Legal Description: �JLL?��( f , � % /% �j�/S%��l�/(` G�iQS S /�%Lj
Owner Name & Address: ��� �p-�j j,(//1//J L� /i(/G . Tel. # d,3� �SI L�
Contractor: �j �r1%� MN LICENSE # l ��.5
Address: �pg % LO�U(sj �KE �% � �OSEVILL�,1�N 53%/3 Tei. # �o� �D�O
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. ����^- ���� X�" SY
- yu� 773-G9
DESCRIPTION OF IlVIPROVEMENT a'�,�.c ���Z Y� � f y� y�i G�2 �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
�$'�Q�,
22=C�u
Width Z1� O�� Height �9 �!o �� Sq. Ft. /Z 7D
Width ��Op Height I8'8%`r Sq. Ft. �'�}'O�C ��%eJ
Width �— Hgt/Ground — Sq. Ft. -- ��35'�
_ � � �z iq
Construction Type: �E5/1�EiV TI,Air- Estimated Cost: $ �p 7, �1' g/ ' �d
�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ��-lg� ( 7 APPLICANT: �G�l� L�E Tel. #�� 0���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� � �`7'• ��
$ ,S
� �Y, �
� 9�0, `�
� � ��
$
$
� .� 7 S� �
$ -�_.
� �0��9� /
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering �"` � -�'�- ��
Agreement Necessary [ ] Not Necessary [ ]
SU[LDING PERMIT I�CE SCHEDUE�[±, �'
"I'hc Chief Building Official shall, before issuing permits for the erection of any building or strueture, or for
any addition to any existing building or structure, or for any alteration or repair to any existing buildin� or
scructure, 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
$�Ol to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $S00 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,D00
$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 $1Q0,000
$887.25 for first $100,000 plus $5.00 for each addirional
$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)
A(ternate "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
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Yeemits for construction will be issued a minimum of 24 hours from the time of application to allow for pro�°r
review of the proposed structure and of the construction site.
A Certiticate ot Survey ofi the lot, showin� the location of the foundation �>nce it has it has been construc�:.: :
«��'i ��� r��uire�i i��l�ore �roceedin� �vith the framinR-
�,��/�?1���
CITY QF FRIDLEY INSPECTION QIV.
6431 Unlversity Ave NE
Fridley, MN 55432
572-3604
�:r • . . r
r�����` -
���'� ,,,� � °--�- .
,� -��-
�� _ � -
_�
�ffective On �larch 1,1996
APPLICATION FOF{ POWER PLANTS AND HE:ATING, COOLI�JG, �►EN7ILATION,
REFRIGERATION AND AIR CONDITIONING S`rSTEMS A'N� UEVICES
J�B ADDFIES� I � � � �� �-�I J � �'� � ��t� �� (,��—�
Rosidential
Furnace 5hell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new turnace}
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appiiance or Work
Commorcial/I ndustrial
1.25% of Value of Appliance or Work
Rate
$ 30,00
$ 10,00
The undersign�d hereby makes applicatfan tor a permit for the work herein
TOTAL specified agr��in;� to cIo all work in strict �ccordance with the City Codes and
� � rulings of the Building Division, and hereb declares that all the facts and
$.� ��• G�' representation� stat�d in thls application are true and correct. ,� ��r/
� I� (,."�---r ��i C��� C1� --t�
u� �f� ��I - � ,���.
OWNEFI J ' Q �' I�.�� ��!��
$ 10.00 $
BUILqIPJG UaED A
$ 10,00 $
� ESTIMATED C�ST �l (�,%��� � �.��� PERMIT N0. �-x � �'�
$ 2s.00 $ �-� �• G �� f
State Surcharge
70TAL FEE
1?FSCRIPTION OF FURNACE AND �OR BU�,NE9
$ No, of I-leating Units 1 Circle Ono (Steam) (Hot Water)" ��a�rm Air .
Tr�d�► Namec=//L!/ V l�� j� Size No, i.��%'�fiii 4�� %t7/ /,?`
gTU �VruVU HP EDR
$ Fuel 1/1` Total Connected Load
,50 Burner'frade Name Size Nn.
� �� � �'1
BTU HP EDR
�_?
MINIMUM FEE FOR ANY HE�►TING�CnOLIWG 1L/ENTILATION
REFRIGERATION/AIR CONDITIONIIVG PERMIT IS 25.00
PI�US THE $,50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
�Air Conditioners can not be piaced in a�ide yard without
�vritten permission from adjoining property owner.
� �
HEATING CCIMPANY ���� �.� �� �G ��;�� �
Signed 8
- - ��c�rl 1 � �
Tel No.° ,
Approved 8y �j✓J Rough—In Date Final Date ���—
�---�—
FILL OUT E3ACK SIDE FO STACK VERIFICATION ON
REPLACEMENT FURNA E
CHININEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from nist or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5. Meets all current Code requirements for size
and total BTU's connected Yes () No ()
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been grovided for water heater Yes () No ()
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
�
�----,
Client:
Address:
Ciiy:
Phone:
Fax:
Comment:
Rottlund Homes
2681 Long Lake Road
Roseville, Minnesota 55113
638-0500
638-0501
YOUR BUILDER FOR LIFE
Project Name:
Reference City:
Daily Temperature Range:
Latitude:
Elevation:
Winter:
Summer:
Outdoor
� Bulb
-20
95
Company:
Representative:
Address:
City:
Phone:
Fax:
Comment:
Dalton
Minneapolis, Minnesota
Medium
44 Degrees
834 Feet
Outdoor Indoor Indoor Grains
7CY�L.Bl1112 S�ID.� D.q�B�11h Difference
N/A N/A 72 N/A
75 50% 75 36
Total Building Supply CFM: 684
Square feet of room area: 1,349
Flare Heating & Air conditioning, Inc.
Randy
9303 Plymouth Ave. N.
Golden Valley, Minnesota 55427
542-1166
542-3101
YOU CAN FEEL THE DIFFERENCE
CFM per square foot: 0.507 �
Square feet per ton: 807.086
Total heating required with outside air: 41,850 Btuh 41.850 MBH
Total sensible gain: 15,043 Btuh 76 %
Total latent gain: 4,817 Btuh 24 %
Total cooling required with outside air: � 8,860 Btuh 1.655 Tons (based on sensible + latent)
1.671 Tons (based on 75% sensible capacity)
Calculations are based on 7th edition of ACCA Manual J.
All computed resutts are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
*,,s:.�
� ��z
� ���
Component Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A Window Double Pane & Storm Clear Glass Wood Frame 181 5,678 0 4,986 4,986
8M Glass Door pouble Clear Glass Wood Frame 40 2,028 0 1,200 1,200
11 C Door Metal Polystyrene Core 38 1,643 0 422 422
, 121 Wall R-19 + 1/2" Asphit Board(R-1.3) 1,396 7,064 0 1,814 1,814
131 Part R-19 + 1/2" Asphlt Board(R-1.3) 127 321 0 105 105
161 Ceiling R-44 Insulation 681 1,441 0 689 689
20J Floor Over Open Crawl Carpet + R-30 13 42 0 7 7
23D Slab/Warm Duct 2" Edqe Insulation(R-11) 102 8,727 0 0 0
Subtotals for structure: 2,578 26,944 0 9,223 9,223
Active People: 6 0 1,380 1,800 3,180
Inactive People: 0 0 0 0 0
Appliances: 0 0 300 1,200 1,500
Lighting: � � �
Ductwork: 0 0 0 0 0
Infittration: Winter CFM: 57.3, Summer CFM: 38.2 259 5,798 934 840 1,774
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: 15,043
Temperature Swinq Multiplier: X1 00
�
Building Load Totals: 41,850 4,817 15,043 19,860
f_ .z;�;:;;:t:�;i;:;c.:�:t:;::::<�::�::::>::r:.---.... �::. .;._:: . . .... . -._. �'�,
Total Building Supply CFM: 684
Square feet of room area: 1,349
CFM per square foot: 0.507
Square feet per ton: 807.086
Total heating required with outside air: 41,850 Btuh 41.850 MBH
Total sensible gain: 15,043 Btuh 76 %
Total latent gain: 4,817 Btuh 24 %
Total cooling required with outside air: 19,860 Btuh 1.655 Tons (based on sensible + latent)
1.671 Tons (based on 75% sensible capacity)
Calculations are based on 7th edition of ACCA Manual J.
All computed results are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
�
�1
�
. _ �
- �i;}
.::.»::;;;::::..-.;.-:--:-.-,;..�.::. ,;,� . .._ ..:: :.:.::: :::::.:::.::::«»»;�:
.. .. ... .... ... . .
.......:::..............:. :: ..:::::::: :..... _ .:.:. .
.. .........: ......:: .....
. . :::,.,�:<,';, �':�..�---:<:z:l�:�:<i':z:::::�<�'i>if?>�'::;:;>.:i::;:=::::;:�;;;:;:;�::?::i;::i:�: �`;'•i;:: �::;:ti?:�:;:;:i'.•
Component
Descri tion
4A Window Double Pane & Storm Clear Glass Wood Frame
8M Glass Door pouble Clear Glass Wood Frame
11 C Door Metal Polystyrene Core
12� Wall R-19 + 1/2" Asphlt Board(R-1.3)
131 Part R-19 + 1/2" Asphit Board(R-1.3)
161 Ceiling R-44 Insulation
20J Fioor Over Open Crawl Carpet + R-30
23D Slab/Warm Duct 2" Ed e Insulation R-11
Subtotals for structure:
�' Active Peopie:
Inactive People:
Appliances:
Lighting:
Ductwork:
Infiltration: Winter CFM: 57.3, Summer CFM: 38.2
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0
Sensible Gain Total:
Temperature Swinq
Zone Load Totals:
lier:
Supply CFM: 684
3quare feet of room area: 1,349
-otal heating required with outside air: 41,850 Btuh
'otal sensible gain:
otal latent gain: 15,043 Btuh
otal cooling required with outside air: 19,gsp gtuh
u
�
Area Sen.
Quan Loss
181 5,678
40 2,028
38 1,643
1,396 7,064
127 321
681 1,441
13 42.
102 8,727
2,578 26,944
6 p
0 p
0 p
0 p
0 p
259 5,798
� 9,108
�
�
CFM per square foot:
Square feet per ton:
Lat.
Gain
0
0
0
0
0
0
1,380
0
300
0
934
Sen.
-ain
4,986
1,200
422
1,814
105
689
0
9 22 3
1,800
0
1,200
0
840
1,980
15, �
To1
Ga
4,9�
1,20
42
1.81
10:
68;
_ �
9,22�
3,18G
0
1,500
0
1,774
4,183
� � .vu
4,817 15,043 19
0.507
807.086
....._.::.
41.850 MBH
76 %
24 %
1.655 Tons (based on sensible + latent)
1.671 Tons (based on 75% sensible capacity)
0
al
in
0
?
i
�
�
; � -�.,�,,�.� , , ..
HOUSE HEATING TEST RECORD � ��/� �
�' � �
AD[?RESS"_ � �� � '� �---' /' `/ -�= ' � APT. FLOOR CITY �.�L_SUBURB
OCCUPANT ' " OWNER
HEAT LOSS DATE HTG. �NST. 1)- •�'�� `"�
T—�- � � � � - - - - –
SOLD BY -L� �'=� - INSTALLED BY °'''� �
El�chicol Work Br Gas l.i�• By • "
TYPE OF HEAT GA FA - HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE � f'` "��`�� MAKE OF BURNER
C_ 6' .� ,�-'� .�
Mod�l `� � Model
Serial � % =� Max. BTU Roting --
� INPUT MAKE OF FURNACE
� Model
__T--- �ONTROLS ��/ ' `;' "�,--'
THERMOSTAT� �� Heqt. Ivq Vsnt Size /, .� �
Volra �'� KIND OF LINER � $IZE�� fJONE
Limit � ; �� Draft Hood R�yularor ////// -� ' � `' 'j,- �� `
';:i?, 1 — F. �`��.�l�?'�-. Numb�r � .
Limit S�ttiny ; ilters Size T�_, -
� �. ; r
Fan Settiny ''� -- Chimnsy Location Insid� Outsid•
Pilot Typs ���� Chimney Construction
Pilot Maks �.�/`j.�`�j �
Pilot Model `� Smoke Bomb M�iring
Pilot Timing � f�`�1 �� DraFt y.::j Test Tap
L.W. Cut Off � - Door Pressuro �� ` Lightiny Inst.
_ ! ; - -�'
Prossure �%.°'� �� '`_� Psrcent COZ Dote Tested ��
Input CFH �jyi��_ Peresnt 02 ��'� Company Testing � 'i . —
Stack Temp. .-�'v';e� Perc�nt CO �-� Name of Tester
Form 235
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Water �
Stories Closet i Urinal
Basement
Floor 1 ( -�--
Floor 2 _�
Floor 3
Floor 4
Effective On January 1, 1997
APPLICATION FOR PLUMBING f�ND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
�ath < Wash Drink. Floor Catch ' Auto. Gas Gas Mi:
Tub Shower Sink ' Tray Fount Drain Basin ' Washer Appl: Range Fix1
l l � !
�`
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures ! $ 7.00 �D3
Old Opening, New Fixture $ 4.00
Beer Dispenser $ 5.00
Blow Off Basin $ 7.00
Catch Basin $ 7.00
Rain Water Leader $ 7.00
Sump/Receiving Tank $ 7.00
Water Treating Appliance __ $10.00 __
Water Heater -Electric $ 7,00
Water Heater - Gas** � $10.00 /D
Gas Range** ( $10.00 i �
Gas Dryer** __ $10.00
Back Flow Preventer Required ()Yes () No
Ty p e------ — --- $15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance �3
State Surcharge
TOTAL FEE
JOB ADDRESS__ ��t (o ���-�i 'J-l�� SU� ��'
Water Heater
Gas Elec
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
_ �O� /� ,1997
Owner /� �!�-"'���i� r°c7
Building Used As ��`�
� � i . ��
Estimated Cost _ PERMIT NO, � °`�' � �
PLUMBING COMPANY I����C �lu�i ���^ll'
—�--
SIGNED BY �'/�G���%�� TEL N0. y�o� -v`�/�/
Approved By ��L.� Rough-In Date
$ .50 � �
MI NI MU M FEE F R ANY PLU
���.5 � PLU S TH E$.50 STATE SU RC
N
Final Date �'��
1AIT IS $20.00 �7�`
**COMBUSIION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SG1 INCHES.
�
_
C�TY OF
FRI DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55�32 •(612) 571-3450 • FAX (612) 571-12H7
January 7, 1998
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 126 Christenson Court NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on January 7, 1998 for the above noted townhouse. We found
that the construction of the building complies, to the best of our knowledge and belief, with all
the requirements of the building codes of the City and the State of Minnesota relating thereto,
and permission is hereby given for the occupancy of said building.
If you have any questions on this matter, please feel free to contact me at 572-3603.
Sincerely,
�
RRY ESCH
Building Inspector
..
Building BUILDING Permit No.:�� �Z�L rI S�
Inspections RESIDENTIAL APPLICATION Received By:��
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX �;�eC� ' �-
EFFEC7IVE 1-1-2010
DATE �� oL �� YOUR E-MAIL ADDRESS d� r r� � l( �� v i-�-ti ���r� Cvn f/^xC 1`/H�.
SITE ADDRESS 7. C t T �
THIS APPLICANT IS: ❑ OWNER i�CONTRACTOR
PROPERTY OWNER/ NAME:_ �� `G( fj1/�%1 h(�
TENANT pDDRESS:� a. G GLiv�i S t�n s�� CITY � �
� r��t� STATE �I/�'GIP SS� 3
PHONE: � /� ! ��' � - �� /
CONTRACTOR NAME:�(� ✓' �-l� �, a.Gt� C o�J �v�o� c�-i h 9
SUBMIT A COPY OF STATE LICENSE # aZ- M(� 'Q 3 O(o EXP DATE
YOUR STATE LICENSE 3 �/J/j�
AND CERTIFICATE OF ADDRESS: �' �- � � 7�1 CITY ST, P� ! STATF%; ,,. `IP�SSI�
INSURANCE pHONE � S�— 7� ^ 0 �!� O FAX S- �d - qS
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STOWES
PERMIT TYPE O ADDITION � GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH O ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING � OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEw HOtvtE CoNS'['[tUCTION ❑ ADDIT'ION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING � ❑ HOUSE ONLY
� `y i BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES �� �HOUSE & GARAGE 1. Existing Floor Plan
GARAGES � �ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGH7':
SIDING \ �1 � FOR NEW CONSTRUCTION INCLUDING DECKS,
Vinyl ❑Soffit �\\� ADDITIONS. & PORCHES SUBMIT:
Aluminum � Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
a1.L r��:�s AK�: BA��ll UIV vALUA"TION, INCLUDING THE COST OF LABOR AND MATERIALS:
USING THE 1 97 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �; (�O - .�.�o OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ 1<< /�-S
$
$ `, -+ /
$ 4- J (,�
$ 5°j��
$
$
$
$
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)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
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 permit on site; that the work will be in accordance with the
approved plan in the case of all work which r uires revi and approval of plans.
c--
SIGNATURE OF APPUCANT PRINT NAME �GLr� �- �( Q'/�Gc ./ DATE -S ��/IO
�
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
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 such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$] to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for ls` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for I S` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 151$25,000 plus $ I 0.10 for each additional $ I,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for IS` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for ]�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the IS` $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 forthe ls` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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
Fax: 763-502-4977