AF - 42864�* �
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2422 Enterprise Drive
Mendota Halghts, MN 55120
LAND SURVEYqtS • c�H� ataN�s (612) 881-1914 FAX: 681-9488
LAND PUINNERS . LANDSCAPE ARCHITECTS 625 Highwoy 10 N.E
Blatne, MN 55434
(612) 783-1880 FAX:783-1883
Certifica te of Survey for:
House Address:
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T�I� RO TTL U1YD C�1�IP�NY
141 Christenson Court
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CHRISTE�TSON CO idRT
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x eoo.o Denotes Existing Elevation
�� Uenotes Proposed Elevatlon - P .� ���� ���
—�-- Denotes Drainage Flow DirectJon
� Denotes Drainage & Utillty Easement Garogs Slab Ereviolion: �(at daor'�
—o— Denotes Monument N07E: Propoa�d buUding dte grodu,q ta tn aaardoncs with ths
�adiny plana approved by the city enqh►eer.
t Denotes Offset Iron Bearings shown are assumed NOTE: Contrcotor must ver(ty ap dbnenafona k drivewoy design.
L�1 T 50 , BL�CK 1 CI�RdSTE1V'SON CROSSIIITG
ANOKA COUNTY, MINIVE50TA
We hereby certify tfiat this survey. plan or report was prepared by me or under my direct supeMsion and that I a duly Iicensed
Lond Surveyor under the laws of the Stote of Minnesota. Dated thfs, I�,.�._ day of ��'c.� A.D. 19�.
Signed: PIONEER ENGINEERING, P.A.
Scale: ���h = � BY 1 �,.� �. �-����,
1 �O � Robert B. Sikich, LS. Reg. No. 14891 or
923 16190.55 Terrence E. Rothenbacher. L.S. Reg. No. 20595
SuBJECT .
City of Fridley �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �� ��
r
; � RECEIPT NO.
� i y_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ��� %
� . � �
� � /"�1 � CITY HALL FRIDLE� SS4$2 NUMBER REV DATE PAGE OF APPROVED B�
�'"'"� � ,�� 612-571-3450 910-F15 4/1/97 � �
JOB ADDRESS 141 Christenson Court NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. SO 1 Christenson Crossing SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
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 ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW O ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 42'6" x 25' Townhouse & a 22' x 20' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Paid Park Fee of $350.00. Paid Additional
$25.00 Park Fee on 9/18/97.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE FiEQUIRED POR EIECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT.
AUTHOHIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WOiiK 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 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUR@TAX Fire SC
AND ORDINANCES GOVERNING THIS TYPE OF WOtiK WILL BE COMPLIED �lO],531 WS3.77 @
WITH WHETHEF SPECIFIED HEREIN Ofi NOT. THE GRANTING OF A PERMIT y�lO�I.S3
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE Ofi CANCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $92� � 2S �9SO.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
j PLAN CHECK FEE TOTAL FEE
�/1 4� License SC $5.00 $2,043.55 + PF
� E OF CONTRA,CTOR AUTHOA�ZE�AGENT 1�ATE� WHEN PiiOPERLY^�TED THIS IS VOUR PERMI
SiGNATUAE OF OWNEQ �iF OWNER BU�LDEA1 �DATEi B G iN� ��
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
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ConstructionAddress: I y � LNI�ST�ISow1 (�� �-r %`l - 3 0-� y- 3 a- -� 3 lC�
Legal Description: ('p-r �j0 g�,ot,� I GHR�S7�ISa�1 G�nSsi� IG
Owner Name & Address: T�' �°�-�L, ���_�I�� Tel. #�p'�-o�c�
Contractor: y�}vv�,8: MN LICENSE #_ 13�5
Address• Z�gl (.�,1�.J�� (,�IG, �a,. ����--� �,�. Tel.# [o�h-p�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length y 2,�-(0; Width 25 :O �� Height
GARAGE AREA: Length �2 =o Width 7,0 -p Height
DECK AREA: Length — Width — HgtlGround —
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C� �'a� � �'- 31,�9iG. z�
s's� .�3x rz.�7= y3�y. z9
sq. Ft. �3, i'L� ��y� ; Zs
Sq. Ft. y�f0 �! �� ..
Sq. Ft. — � 4�G, kb
__ __.---
� �G - �,�1, l3
Corner Lot (�J Inside Lot [] Ft. Yd Setback �� � Side Yard Setb�cks ZO.S'
Tyge of Construction: � Estimated Cost. $(o Z, ,% ql -/G75�1.�3
Approx. Completion Date: 3 9$ . �.
(Cost on Back) �
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: , APPLICANT: _ i3Y; �,;,,.,,• Tel. # 63d -o Sao _
Permit Fee
Fire Surcharge
State Surcharge �
�AC Charge
�icense Surcharge
�riveway Escrow
� 927.2 �
$ /�7. S3
$ s3, � �
$ �1�1, u'
� 7, �"
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation �
$9�0 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
�rosion Control $ $450.00 Conservation Plan Review
'ark Fee $ ��'OO Fee Determined by Engineering
�ewer Main Chaxge $ --��-- Agreement Necessary [] Not Necessary� ��
TOTAL
�TIPULATIONS:
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CHIlVIIVEY AND STACK VERIFICATION
The u�ersigned hereby verifies that the exisCing chimney or stack:
1. Has been carefiilly examined Yes (�) No O
2. Is fre� from n�st or deterioration Yes () No ()
�3. Has no foreiga objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5. Meets all current Code requiremcnts for size
anci total BTU's cc�nn� Xes ( j No- O ——
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been pmvided for water heater Yes () No ()
8. Has combustion air i�en gmvided for water heater Yes () No ()
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
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�_ �, � o y �� a I���-� �o ��(
Client:
Address:
City:
Phone:
Fax:
Comment:
Rottlund Homes
2681 Long Lake Road
Roseville, Minnesota 55113
638-0500
638-0501
YOUR BUILDER FOR LIFE
Project Name:
Reference Ci1y:
Daily Temperature Range:
Latitude:
Elevafion:
Winter:
Summer:
Medium
44 Degrees
834 Feet
Outdoor Outdoor Indoor
� �L�L.@� H81.HU!]].
-20 N/A N/A
95 75 50°Io
Total Building Supply CFM: 664
Square feet of room area: 2,054
Company:
Representative:
Address:
Ciiy:
Phone:
Fax:
Comment:
is, Minnesota
Indoor Grains
� Bulb Difference
72 N/A
75 36
Fiare 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: 0.323
Square feet per ton: 1.197.276
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Total heating required with outside air: 41,498 Btuh 41.498 MBH
Total sensibie gain: � 14,608 Btuh 74 %
Total latent gain: 5,147 Btuh 26 %
Total cooling required with outside air: 19.755 Btuh 1.646 Tons (based on sensible + latent)
• � 1.716 Tons (based on 75% sensible capacity)
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Calculations are based on 7th edition of ACCA Manual J.
All computed resuits are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
�
Component Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A �ndow Double Pane & Storm Clear Glass Wood Frame 189 5,929 0 5.389 5,389
11 C Door Metal Polysiyrene Core 40 1,730 0 444 444
121 Wall R-19 + 1/2" Asphlt Board(R-1.3) 1,495 7,564 0 1,940 1,940
15B Wall 2-5' Below Grade 8/12" BIk+R-5 530 3,608 0 0 0
16H Ceiling R-38 Insulation 1,027 2,457 0 1,175 1,175
21 A Basemt Floor 2' or More Below Grade 1,027 2,268 0 0 0
Subtotals for structure: 4,308 23,556 0 8,948 8,948
Active People: 4 0 920 1,200 2,120
Inactive People: 0 0 0 0 0
Appliances: 0 0 600 1,200 1,800
Lighting: 0 0 0
Ductwork: 0 0 0 0 0
Infiltration: Winter CFM: 87.3, Summer CFM: 58.2 229 8,834 1,424 1,280 2,704
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: 14,608
Temperature Swinq Multiplier: X1.00
Building Load Totals: 41,498 5.147 14,608 19,755
total Building Supply CFM: 664 CFM per square foot: 0.323
Square feet of room area: 2,054 Square feet per ton: 1,197276
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Total heating required with outside air: 41.498 Btuh 41.498 MBH
Total sensible gain: 14,608 Btuh 74 %
Total latent gain: 5,147 Btuh 26 %
Total cooling required with outside air: 19,755 Btuh 1.646 Tons (based on sensible + latent)
1.716 Tons (based on 75% sensible capacity)
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Caiculations are based on 7th edition of ACCA Manual J.
All computed results are esKimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
ti
Component Area Sen. Lat. Sen. Total
Descripfion Quan Loss Gain Gain Gain
4A wndow Double Pane & Storm Ctear Glass Wood Frame 189 5,929 0 5,389 5.389
11 C Door Metal Polystyrene Core 40 1,730 0 444 444
121 Wall R-19 + 1/2" Asphlt Board(R-1.3) 1,495 7,564 0 1.940 1,940
15B Wall 2-5' Below Grade 8/12° BIk+R-5 530 3,608 0 0 0
16H Ceiling R-38 Insulation 1,027 2,457 0 1,175 1,175
21 A Basemt �Floor 2' or More Below Grade 1,027 2,268 0 0 0
Subtotals for structure: 4,308 23.556 0 8.948 8,948
Active People: 4 0 920 1,200 2,120
Inactive People: 0 0 0 0 0
Appliances: 0 0 600 1,200 1,800
Lighting: 0 0 0
Ductwork: 0 0 0 0 0
Infiltration: �nter CFM: 87.3, Summer CFM: 58.2 229 8.834 1,424 1,280 2,704
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: 14.608
Temperature Swing Multiplier: X1.00
Zone Load Totals: 41,498 5,147 14,608 19,755
Supply CFM: 664 CFM per square foot: 0.323
Square feet of room area: 2,054 Square feet per ton: 1,197.276
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Total heating required with outside air: 41,498 Btuh
Total sensible gain: 14,608 Btuh
Totai latent gain: 5,147 Btuh
Total cooling required with outside air. 19,755 Btuh
41.498 MBH
74 %
26 %
1.646 Tons (based on sensible + latent)
1.716 Tons (based on 75% sensible capacity)
L�.� :. ' r i i. . . ,t. . . . . . 3 .. .. � : . . ����� y u. .
� .� �; � V.� _ HOUSE HEATING TEST. RECORD , ��
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- A�D�RE;�S. APT. FLOOR GTY SUBURB
OCCUPANT OWNER
HEAT LOSS—� DAT HTG. INST. "�'' �'
SOLD BY r�"' 4 � INSTALLED BY -�
Elsehical Work� Gus Line Br �s
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
�15 DESIGN CONVER510N
MAKE MAKE OF BURNER
AAod�l Modal
Seriol � Max. BTU Rofing —
1NPUT ' MAKE OF FURNACE
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CONTROLS �', � . _ �� . �.9� '. r
THERMOSTAT�� He t �f , �8nt Sise u ____, �-
Valve K1ND OF LINER SIZE NONE
Limft � Droit Hood d Rspulotor �%/��`�; � a�� ���
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Fan Setting Chfmnsy Loeation Insidd Outsids
Pilot Typs Chimoey Construdion
Pilot Make
Pilot Model -� Smoks Bomb Wiring
Pilot Timing "'� DraFt Tsst Tap
L.W. Cut Off / `' Door Presauro Lightinp Inst. `
Pressure °'"�� srcent CO2 � Dote Tsatsd '`�
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Inpuf CFH—' Ps►eent OZ Company Testing
Stoek Tsmp. Percent CO Name of 7sate�
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CITY OF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 •(6l2) 571-3450 • FAX (61?J 571-12K7
June 27, 1997
Rottl�nd Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 141 Christenson Court NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on June 27, 1997 for the above noted townhouse. We found
that the construction of the building unit 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 unit. �
If you have any questions on this matter, please feel free to contact me at �72-3603.
Sincerely,
./ �/ l�
L(J i i �.s::v.N�-
BARRY ESCH
Building Inspector
..
_
CITY OF
FRIDLEY
FR[DLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN i5=432 •(61?1571-3=i50 • FAX (612) 571-1287
July 30, 1997
Rottlund Company Inc
2681 Long Lake Rd
Roseville, MN 55113
Re: Park Fee Shortages for Issued Building Permits
Dear Sirs:
In checking our files we discovered that on 10 building permits
issued in Christenson Crossing, you were charged a$350.00 park fee
instead of the required $37:5.00 park fee which was a stipulation of
the plat approval, resulting in a total amount due of $250.00.
The addresses involved are: 121 Christenson Court NE, 128
Christenson Court NE, 130 Christenson Court NE, 133 Christenson
Court NE, 135 Christenson Court NE, 137 Christenson Court NE, 140
Christenson Court NE, 141 Christenson Court NE, 145 Christenson
Court NE, and 147 Christenson Court NE. Each building permit has
the park fee paid noted in the stipulation section.
We apologize for any inconvenience this error might cause and if
you have any questions concerning this matter, please feel free to
contact me at 572-3602.
Thank you for your prompt attention to this request.
Sincerely,
RON JULKOW�I
Building fficial
RJ/mh
' SuB�EtT - .
City of Fridley 2 8 9 0 8
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� � E .
v _ COMMUNITY DEVEIOPMHNT DIV.
f � � PAOTECTIVE INSPECTION SEC. � � �
�
� . ,
� _ �'�'1 � CITY MALL FF110LEV Sj1a2 NUMBEN NEV O�Tfi PAGE O� APVqOVEO B�
�----�: �.� 612-571-3450 910-F15 2/10/99 / /
10B ADORESS 141 Christenson Court NE
t LEGAL ��T N0. BLOCK TRACT OF ADDITION SEE ATTACHED
DESCR. SO 1 Christenson Crossing SFIEET
2 PROPERTY OWNER MAIL ADpR�S$ 21P PNONE
Duane Vogel 141 Christenson Ct NE 574-2120
J CONTRACTOR MAIL ADORESS ZIP PNONE LICENSE NO
Minnesota Exteriors Inc 8600 Jefferson Hwy, Osseo, MN 55369 391-5519 2877
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OK WORK
� NEW ❑ ADDITION ❑ ALTERATIpN �] REPAIR p MOVE � REMOVE
8 DESCRIBE WORK
Reside West Side of Townhouse - storm repair
9 CHANOE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
TYPE OF CONST OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS AqE REOUIRED FOR ELECT:iICAI, PLUMBING, FIEATING,
VENTILATING OR Alq CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOIO If WOiiK OR CONSTpUCT10N 20NING SO. fT CU fT.
AUTHOfi12ED IS NOT COMMENCED V+!ITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 OAYS A7
ANY TIME AFTER WORK IS COMMENCED NO DWIG. UNITS OFfSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE fiEAO AND EXAMIN�D THIS APPLICATION I. STALLS GAFAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. A�L PqOVISIONS OF LAW$ yp�VATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WpFK WILL QE COMP�IE�
WITH WMETMER SPECIFIED MEREIN OFi NOT. THE GRANTING OF A PERMIT �SOO �.SO
DOES NOT PRESUME TO GIVE AUTNORI7Y TO VIOLATE OR CANCEL TME pEqMtT FEE SAC CMARGE
PROVISIONS OF ANY OTMER STA7E OR IOCAL LAW REGULATING CON-
STRUC710 OR TNE PERFORMANCE OF CONSTRUCTION �ZI . OO Fire SC �. SO
P�AN GNECK FEE TOTAL FEE
Z /� �� License SC $5. $27.00
S�GNATU o�CO OC10AOpAUTt10p�LE0AGENT io�rEi W1�EN PFOPER ALIOATED TMIS IS V UR PE�RMIT
��e U�71
S�GN47UAE O� OWNEA��� OWNEii BUiIDER� iO�fE� � 8L0 �hSo � � O�iE
JUL-16-1996 11�06 FROM CITY �F FRIDLEY TO
)DN [ J . �,, - . .. : : CITY, OF FRIDLEY . : . . .
.TER [] SYNGLE �FAMII:Y `-AND � DUPLEXES R-1 AND R 2
�: � . _ . , . . _ . BUILDING PERMIT APPI.ICATION .
�
� � � . ~� .
nst�uctionAddtess: � �, �
4933689 P.02i02
��
: � ��� �
� �
;al Description: � � � - � � � .
�ner Name & Address: �r..�.,.�� �`.� . TeI. � �°°�� �1� .
�tzactor: ' � �� �°�.� ��..���..� � , M1V' Y.TCENSE # � � 7'
, :.- .
3ress:�� ���-„�� ,j�t..�w � � a ���Tel. � _ �,/ �
� ''`' ` Attach to this application, a Certificate of Surv�y of the ���° �
lot, with the propased construction drawn on it to scale.
. . . . . .., DESGRIPTION OF IIVIPROV�MENT
��: .. _ . . . . .. . . _ . . . � . . . ,
�ING 1�R��A,: Length . Width • H�ight Sq. Ft.
RA►G� Ait�A: � . , � � . �Length .. � . � . . . W idth � Height Sq. FL ' .
CB AREA: � Length.:. .,� � Width ��� gt/G�roun�'� Sq. F�.
E�R: . �� 1��,�' l� 2G�1 °1C �' /J�r� /�.
�
.. S��w� � o0
�tru�tion 1�►pe: � - ated Cost: $ .�D
+ � • • . . (Fee 5chedule on Back) . . . . �
� .:�:.::� ..:: .. � � � .
eway C�rb C�t Width Needed: ���� � Fc:��+ 6 Fc = Fc x$ � _$ .
s x,
t
ut Fee
S�tcha�ge
S�rcharge
Charge
Lse Surcharge
:way Escrow
.on Con�rol
Fee
.r Main Charge
or�,�.
ULA?IONS:
TP.I. # °° '�
. , _ .. CITY USE ONLY
$ �� � v Fee ScheduJe oa Reverse Side
$ � v .::: �.00i of Perinit� Valuation (1/IOth!)
$ .. $�v $.SU/$i,000 Valuatien
$ $1000 per SAC Unit -
� .S O Q $5.00 {State Licensed Residenual Contractors)
$ � AIt. "A". or Alt. "B" Above
$ $450.00 Conservatian Plan Review
$ Fee Determined by Engineering _
$ Agreement Necessary [ j Not Necessary j)
$ � . Ol�
�
' ' ' - TOTAI. P . 02
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE �� I � ��
SITE ADDRESS / -F � L.
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTf A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
�rrE oF woxic:
BUILDING
Permit No.:
RESIDENTIAL APPLICATION Received By�'�`� �
CITY OF FRIDLEY vat��'D: AU G 2C
�c� i-i-os
ADDRESS
■ • u�
PHONE %%y�� �0�7 —�
STATE LICENSE # �P �
O SINGLE FAMII.Y/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
0 ADDITION O GARAG
❑ BASEMIIVT FINISH ❑ ROOF
O DECK ❑ SIDING
O SWA�IIvI
� NEW HOME CONSTRUCTION
❑ MAINTINANCFJREPAIR
DESCRIBE WORK BEING �NE:
SIZE OF IMPROVEM�I*t7'
G
N�U�MB�ER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
�iny� ` �
O Aluminum '
❑ Other
f , �/
CITY STATE ZIP,
FAX � � '" G
EXP DATE '� — �
SIZE
STORIES
'ISHED 0 WIN�WS
o nx�n�r �rn,E
❑ OTf�R
NG POOL
O ADDITION
O REMODII.ING _
- ❑ HOUSE ONLY
° ❑ HOUSE & GARAGE
1 � � ATTACI-IED GARAGE
� DETACHED GARAGE
0
❑Sotirt
❑ Trim
❑ Fascia
wnvnows
IN EXISTING OPENINGS OYes ONo LOCA110N OF WINDOWS
OR FOR NEW OPEIVINGS-DESCRIBE SIZE OF
OPENING CHANGES Bc
TYPE OF WIN�W TO BE INSTALLED NUMBER OF �
BASEMENT REMODELING SUBNIIT:
1. Existing Fl�r Plan
2. Pcoposed floor plan
3. List of strucNral members W be used
FOR NEW CONSTRUCfION INCLUDING DECKS,
ADDITIQNS 8c PORCHES SUBNIIT:
1. Site Plan/Survey showing the existing structures
and ProPo� P%leit.
2. Two sels of construction plans
3. Energy Calwlations
ALL FEES ARE BASEB-OA1 YALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
'OTAL JOB VALU
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dae
(USING THE 1997 UBC FEE SCHEDULE)
TION �`C" ��c= ��� OCCUPANCY TYPE
--'$ See Back Page for Fee Schedule
$ 65% of Building Petmit Fee
$ �.d� .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 Elan Review
$ Fe,e Determined by Engineering .
$ Agreement necessary ( ) Non Necessary ( )
� � Make ch�ks payable to: City of Fridley . Attac
I hereby apply for a building permit and I
of the City of Fridley and with the M' �
pem►it on site; d�at th v�nll be i
SIGNATURE OF APPL _
APPROVED BY
IS AN APPLICAITON FOR A PERNIIT-NOT VALID UNTIL PROCESSED
ige that the ' 'on above is complete aad accurate; that the work will be in confomiance with �e ordinances end codes
Rruction undeStand this is not a permit but o y an applicadon for a permit and work is not W wi out a
ith thg � pi in Ute case of all work which requ' review and appmval pl �,�,/'� - / r
� PRINT NAME � l ! G� C� DATE � 4
f� �e� DATE � I I
osrvsr2o�o 13:16 FAH
r�oo2tvv�
Building � �'LUIVIBIN� perm�t rto-:�'l,� (
Inspections �tESIDENT�AL Al'►pl,iCt�►TIt�N R���,� sy:
763-572-3604 ��� ��, F��L�.� ����(� 1 0 ���
763-502-4977 �.A� �t�riv� �-� zoio
DAT� �'� �/ L� YAUR E.MA1L ADDIiL'5S � I� �� r(,� /N7
SITE ADDlL�SS l�f / t�%�� ra 7�1V�/J' G�T • I'�• ��; --
THIS APPLICANT 1S: � 01ti'IV�ft i�ON71tA�TQK .�
UWN�RI
TENANT
cv�•rnP,c:ruR
SUBMIT A CUPY C1F
YpUit STATE
LICENSE. 80N17 ANI�
c�,���r►r•�caTE oF
[NSU��aNCF.
PERMlT TXPF
TYPF. U�' WC1RK:
NAM�: Ll�L• ✓�/1�/'CI
nuu�rss: / �/ �!S
PHON�: �%��75F""
NAMt: D��%�!
STArk �.ic�tVSE it�
szAS� �nn�u � �3�'00.� �
PHpN� ���� � /+�L/�'
5�i1NCiLFi NAMILY
r�
❑ N �14'
L��TAILED DESCRIP'['[ON OF Wt7RK
O'fWA 1+AMILY
--.� G
0
�R�PLAC�M�Nti
. / ' ������
�xr t�nr�/oZ-�%��_
� 1�AT�
CY.�%�L�I�.�✓ • 5TATt��//Jr 'LiPcJ ��j %
uAx !� .f� �'!-�U c � „
� Tt7WNHQUS�
Ftt! AIL�.I3ASY.11 QN $10.�0 F�R NIXTUR�r rx�:�1�'i WHF.'1tIL' iV(5TL•1]. NIXTUR�S: (31V�ICATE TOTAL 1VUMkt�R ()1�' tiAL:H B�LCaVJ). MiNIMUM F'�E
335.50.
HATM SIiVKiLaV YLQAR 17RA1N3 SHOW��t WqTEtt RiP'INti
BATNTUH GAS PlP1NG (NE�U C1TY UC' �SWIMMINt7 ?bOL � WATh:It 5AhTNF�t ($35}
C'I:Q7'Ht5 WA�NtR _1tlTCti�N SIiVK \4ATBRCLLlS�'T klACKl+LQW i�It�V. ($15)
_ UESHWA9H�lt _ LAIiN[]RY TitAY �AT}sR NfATrlt (�3$) i'CI1t IRIt1GATiON
_ WAT�R MhTksK _ OTtiER
�
.::�>; •
_ . _ _ ;': �t� s�. _.......
TFUS iS AN APPLICATION f�'(!R A PF:1tMiT•NAT VAI.1D UNTI(. PR,AC�,SS�l�
1 herc;by apply fur a plurnbin� permit and I acknowlcdgc th�t thc infarm�,tion �vc is camplcte and accuraic; that thc work wili bc in
conform:�nco with thr. ordinans�vc and cod� of thc Cety of FYidlcy end with thc Minncsots Con.�uction Cod�;; that t undcr:atand th�x i.ti
not a rermit but only an applitation far a pcnnit end work is noi to Rtart without a pc�mit bn sitG; that thc wark will bc in accardancc
wirh th� approvc�d plan in ti�c �%a.sc of sll wurk whicfi �quirGS r�•viaw and approveI of plan.s.
51GNATUIt� OF APRLIL'ANT /�/'LLl���% �Z�� �� PRIN7 NAM� �� ��%/�'�. UATk IP r�'��C�
�ity of �rid�ey
�witdt�n.g inspectio�as Depurtment
643 � TJniversity Avenue NE, Fridley, A�lN SS4��
T63-S72-�6�}4
FA�: `76�-502-4977