AF - 42881** �
* PIONE�A
* eng naer
'� * * *
24?2 Entarprlee Drive
M�dota Helghts, MN 55120
LAND SURVEYORS • avu. o�aem�s -- (812) 881-1914 FAX:881-9488
LAND PLANNERS • LANDSCME ARCHIlEC15
Certificate of Survey for:
House Address:
�-7
1' %
House Model:
825 Hiqhway��10 N.E.
Blaine, IdN 55434
(612) 783-1880 FAX:783-1883
THE RO T TL UND COMPANY
150 Christenson Court
Halston
CHRISTENSON CO URT
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vacant y � � os�°�;
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80 ,C� '"�0��
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x soo.o Denotes Ex►sting Elevatlon
� Denotes Proposed Elewtlon
—� Denotes Drafnage Flow Dlrectfon
—� Denotes Dra�nage dc Utllity Easement
-•a- Denot� Monument
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SATELLITE LANE �
• .;:. ,. _• �, : f, ► ►.._ �►... �i : i+ � .!-
lowest Floor Elevctlon: $53•S
Top of Block ElevctJon: 856.5
Garoge Slab Elevatlan: �56.1 (at door)
NOTE: Prapoaed buAdhg slt� qrading b in ac�►danu wtth the
9radtn9 Pbne approvsd by the elty anqinear.
.-+- Denotes Offset Iron BearTngs shown are assumed voh: Contraotor must varity a1 d4nendons k drlveway desiqn.
LOT , 5, BLOC.I� 1 CHRIST.LNSON CROSSING
ANOKA COUNTY. MINNESOTA
We h�eby certify that thts survey, plan or report was prepared by me or under my d(rect eupeMslon and that I a duly Iicensed
Land Surveynr under the laws of the State of Mlnnesota. Dcted this Z°1 *N day of J� A.D, 19�
Signed: PIONEER ENGINEERING P.A.
Scale: 1��h = 30feet a,. w BY �
y , Robert B. Sikich, L.S. Reg. No. 14891 or
� 1 F t ��. t n Tt�r� Terrence E. Rothenbaeher, L.S. Reg. No. 20595
sue�ecT P .
City of Fridley ` 2 5 4 41
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
�
� �
, � R N .
� • COMMUNITY DEVELOPMENT DIV. � ''`./ /
r � V � PROTECTIVE INSPECTION SEC. �,
i ` �
� /"'1 � CITY HALL FFi1DLE� 85432 NUMBER REV OATE PAGE OF APPROVED BY
�""� � �'' 612-571-3460 910-F15 8/28/97 / /
JOB ADDRESS 150 Christenson Court NE �
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. S 1 Christenson Crossing SHEET
2 PROPEFTY OWNER MAIL ADORES$ 21P PHONE
Rottlund Company Inc 2681 Long Lake Rd, Roseville MN 55113 638-0500 1335
3 CONTRACTOR MAIL AODRESS Z�P PHONE LICENSE NO.
Same
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK NEW � ADOITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
�
8 DESCRIBE WOFK
Construct a 42'6" x 25' Townhouse and a 22'6" x 20' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Paid Park Fee for lot of $375.00.
3EPARATE PERMITS REQUIRED FOR
1�IIR6i'�lG, H�hTING, PLUMBING AND �i��l�.
TYPE OF CONST. OCCUPANCY f3ii0UP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTHICAL, PLUMBING, HEATING,
VENTII.ATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED fOR A PERIOO OF /20 DAYS AT
ANY TIME AFTER WOFK 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 COQREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX Fire SC
AND ORDINANCES GOVERNING THIS TYPE O: WOf;K WILL BE COMPLIED lOH, 623 �54.31
WI7H WHETHER SPECIFIED HEfiE1N OR NOT. THE GRANTING OF A PERMIT � lOS.GL
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PEFFORMANCE OF CONSTRUCTION $932. LS �9 O.00
�i PLAN CHECK fEE T TAL FEE
SC .00 2,050.18 + PF
Si�E= f CO � nCi THOAi2EDaGENT IDATE� EN Y VALI D� HIS IS VOUR PERMIT
8
S�GNATUAE OF QWNEp ��F OWNER B ERi iDATE� � 8 G iNSP ��FTE
�. a
NEW
ADLN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLiCATION
Effective 1/1/97
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ConstructionAddress: _ /�(� ��,I -f Ew ��w ) � �LIZ.� �
Legal Description: ,�p j , �Lp 1
Owner Name & Address: � uE ��T�l c►�� (��, ��,, �L� I N�. Tel. # ln��pp
Contractor: S�mE �vnv �[.,icErtsE � I 3�5
Address: ,��0$1 ��� ��q.�� -��� �v t L�� ��551 ! Tel. # _!� �� -- O JUp
LIVING AREA: �
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the 4
lot, with the proposed construction drawn on it to scale. �7i��' �
� -;�3xU-5Y' 'I�/�
/ � 3, y /iv/
DESCRIP'I'ION OF IMPROVEMENT �� �
�,��u„L��.. ��.3�y/z,Uy ,31
qa3' y��'� sY
Length '`(� =(o" Width '-0"� Height �'-p" Sq. Ft. �:,� c�g3, Z'�
Length '- C�" Width �'-p" Height �'�°' Sq. Ft. �� yq� �
Length °—' Width Hgt/Ground --Sq. Ft. � ����
. r,! p��Z3, /3
�
Constniction Type:�[)p°�� �� --��, —���p� Q��� ��ated Cost: $ � (� j' LZ,� �
��--
(Fee Schedule on Back)
Driveway Curb C�t Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ��j9 �''� APPLICANT: ;
� Tel. # �p��—�� C�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
I�riveway Escrow
Erosion Control
$ 3�, 2�
$ (�� C�
� 5'� 3/
$ ,�
$ �` �
$
$
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
Park Fee $�rj,-�j _ p� Fee Determined by Engineering
Sewer Main Chazge $ �� ��'° Ag�gement �Tecessary [ ] Not Necessary [ ]
�
�.`��j�. �. 5 � ? (' � �� 7
TOTAL $ ZS% �
3TIPULATIONS:
_ , , ,.
e J s
I3UII,DING YEI�VI[T FEE SCHEDiJLE
1'ile Chief Bui(ding Of�cial shall, before issuing perniits for the erectio�t oC any building or struct+ure, or fi�r
an}� addition to any existing building or structure, or for any alteration or repair to any existing building �r
stivcture, 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
$�O1 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1Q0,000
$100,001 to $500,0{?0
�500,001 to $1,000,000
$1,000,001 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 $12.50 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 $1p0,000
$887.25 for first $100, 000 plus $5.00 for each additional
$1,OOO�or fraction thereof,.to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,OQ0 or fraction thereof, to and including $1,000,000 �
$5012.25 for the fust $1,000,000 plus $2.75 for each additional
$i,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROVV
(Concrete C�Zrb 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 �
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
.
P�t�nits for construction will be issued a minimum of 24 hours from the time of application to allow for pro�er
rc;��ie�ti• of the proposed structure and of the construction site.
A��'e�tiiicate of Survey of thc lot, showing the location �f the foundatio�l ��nce it has it has been constructe:±
"'�:: ��� rcquired hefore �r��cecdin� «�ith N1e fra�ning.
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CHIIVIl�TEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�) No ()
2. Is free from mst or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5. Meets all cutrerent Code requir�m�nts for size
and total BTU's connected Yes () No ()
6 Has total heating BTLT's of
All other BTiJ'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 ALTERATTONS Being Done:
HEATING CO:
Signed By:
Date:
0
0
�
Client:
Address:
Ciiy:
Phone:
Fax:
Comment:
Rottlund Homes
2681 Long Lake Road
Roseviile, Minnesota 55113
638-0500
638-0501
YOUR BUILDER FOR LIFE
Project Name:
Reference City:
Daily Temperature Range:
Latitude:
Eleva�on:
Winter:
Summer:
Outdoor
� Bulb
-20
95
Company:
Representative:
Address:
City:
Phone:
Fax:
Comment:
Halston �'
inneapolis, Minnesofa
Medium
44 Degrees
834 Feet
Outdoor Indoor indoor Grains
et Buib g�. � Bulb Difference
N/A N/A 72 N/A
75 50% 75 36
Total Building Supply CFM: 664
Square feet of room area: 2,054
�4�-�.���o ��!
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: U.323
Square feet per ton: 1,197.276
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)
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.
�
e
Component Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A wndow Double Pane 8� Storm Clear 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: 582 229 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
Buiidinq Load Totals� 41,498 5,147 14,608 19,755
��otal Buiiding 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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..............b:.�:?..;;•�� ••••X,�••�•.��,},••�••,�v,•,•;;.,...}.,.�y..:.�w.v:.�::•::: v\t•,•,y�lw�;..:.h...�:.+:::.�a\�.,v; r..:..}�\.. �.n..v... ......�...:t... �.... «....4....
Total heating required with outside air: 41,498 Btuh 41.498 MBH �
Total sensible gain: 14,608 Btuh 74 %
Total latent gain: 5,147 Biuh 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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... ... ...............,.......... .......... ... ..... .. ......,... .. .. ........ . .. .. . ..,....�, �� ..�::.:..:::...:;...,
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..'�....s.... t....;:.� �..,,...e.. .�.*....•:\t:•::::•�:^+• ::::,•::�:.::. .� �:.. \•::::::�. �
., . � . . ..::::•.a•::.c+.k .r.. .. . ...�r....w .. `5�...,.. ... .\r ��\ti... . .. ... ... •.•::...:..•,\.�'..;•;•:;•,.,:�:::.,...: . A.. �:.:fi:•::•::•:. .. .ti . �.
.. � . ..,..••..a. • k+..........\...... . •. r:.... . ..\... :..`� .. . .:.... .,,w...... . ;.s.t •.r...\ .. ,..•e�:.. ...'', s\....+. .. ..:�.`t..
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:� ......�...h...� ..� \...n�.. \\.,. ..:. \..\vi�.�.... ...� v.�:....��.. ...... £.•.•.•.• •:^::??. \.:��•ii.x�.... .v�. \�A•\•: •.•:.e3::•}iv:::x.•.•..•.•:
..��...v.. ...\..�... ...\ �.. ♦.4... �..\..... ♦.��.�::::4i::i{:;::.4�};•�'},;.���.;., M1�;•;•w��•%:i;:;:iL•.•.•Tn.�.•.
......................•::•:........t...•:�•:.\� �.. .. �::�.•.•i\::.•:............�. �:�...:..�..v.v:�°.•.•::.n...e:::kh^:::: � •.•nh�... .... v... .n..�... .:. . �\ �.\4 . ...'�
v::::.�:{4i::: nv� ;•r�,���.,.,:.�,:::ry;:.v::.«:•::.•.•.d\\�,y.E�...;.•�.4ry;.:{.:•`}:+.%� ��\'�... \\}.••..•.•. ... �...�.....�...::: ••: v. M•:::�. �.�::: •. • •: •��::. �1�.\+::.'�{ �.,v,u'•• :\::: x,.};.}}i::?i:=ii:i.li::::::.•%:'::•y••�•,•;;•
...... ..... . ...... . �� .� �.,•::.. .. .....�• :::........ ... .. . ...... � .. ...�v. . .:. �.....v . ..
Calculations are based on 7th edition of ACCA Manuai 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.
»
Component Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A Window Double Pane � Storm Clear Glass Wood Frame 189 5.929 0 5,389 5,389
11 C Door Metal Polystyrene Core 40 1,730 0 444 444
121 Waii R-19 + 1/2" Asphlt Board(R-1.3j 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: wnter 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: 684
Square feet of room area: 2,054
CFM per square foot: a 0.323
Square feet per ton: 1,197.276
Total heating required with outside air: 41,498 Btuh 41.498 MBH
Total sensible gain: 14,608 Btuh 74 %
Total latent gain: 5,147 8tuh 26 %
Total cooling required with outside air: 19,755 Btuh 1.646 Tons (based on sensible + latent)
1.716 Tons (based on 75% sensibte capacity)
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CI 1 I OF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • G.431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
z
November 6, 1997
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 150 Christenson Court NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on November 6, 1997 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 572-3602.
Sincerely,
RJ/mh
sue�ecr
c�ty of Fridley
AT THE TOP OF TFIE TWINS g � I L D I N G P E R M I T
i �
� � COMMUNITY DEVELOPMENT DIV.
i •
i Vy �"��'�
r � � PROTECTIVE INSPECTION SEC.
`-.--� ��"' �•� CITV NALI FRIDLEv 53432 NUMBER
t 612-571-3460 9�aF�s
10B ADDRESS
150 Christenson Ct.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 5 1 Christenson
2 PROPERTY OWNER MAIL ADORES$
Carol Sprin.ger
3 CONTRACTOR MAIL ADDRESS
Minnesota Exteriors 8600 .Teffercon Nwv n
4 ARCHITECT OR DESIGNER MAIL ADDRESS y
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDIN(i
RPCiriPntial
7 CLASS OF WORK
REV
7/16/98
ZIP
PAGE OF
/ /
PHONE
�.0
PNONE
PMONE
�1666
RECEIPT
��j/
APPROVEO BY
SEE ATTACHED
SMEET
LICENSE NO.
r7
LICENSE NO.
LICENSE NO.
❑ NEW � ADDITION ❑ ALTERATION � REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Storm Damage
8 CHANaEOFUSEFROM TO
STIPULATIONS
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBIN(i, HEATINO,
VENTILATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OFi ABANDONED FOF A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS
I HEREBY CERTIFV TNAT I HAVE FEAD AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yqLUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT SOO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISION HER STAT R CAL LAW REGULATIN(i CON-
ST N OR THE PER M NSTRUCTION. Z1.00
PLAN CNECK FEE
° License
S�GNATURE O � A TOp Op AUTMOfiIZED AGENT IDAT I �
i
SiGNATURE OF OWNEA i�F OWNER BUILDERI IDATE� BLD N Pz
S�.
STALLS
LOAD
CU. FT
GARAGES
)T L FEE
_7.00
THIS IS UR PERMIT
♦
- � i
1ADN
1L'TER
�.:
JUL-16-1996 11��8 FROM CITY QF FRIDLEY TO 4933669 P.02/02
[ I � ;,�, - .: CI'I'Y. OF i+ZtIDLEY . . . .
�...e:::� � - � •��
[ l SYIITGLE FANiII:Y-AND�DUPLEXES R�1 AND R-2
� . . , .: : _. BUILDING PE�tMIT APPLICATI�N
, . . . .:-, .
:onstivctionAadress: � � -
���
��%���
�����6��
egal Description: ' " � � � .
�wner Name & Address: � ����,� �_�.�. TeI. #
�� ���-� �� �
'ontz�actar: 4� �.@L � °�-�� �,������* � � .a MN T.rCENSE # ��p,�. �'�� ,
,ddress: . �%t�'2 ���� :��b,... � 4L_�-ar� F�'_�.�3� �,�1i.� a ��'�� Tel. # � � �-��� ..
ivII�IG AREA.:
ARA►G� AitEA:
ECS AREA:
��.
''�" Attach Lo this applic�tion, a Certificate of Survey of the
lot, with the propased construction drawn oa it to scale.
..,. DESCR�TION OF IlVVIPROV�MENT
�..�.�::�, ..:.:�._... �. ., ,
Len$th . Width � H�ight Sq. Ft.
� �� � � �Length ��� � � � � =� � Width � Height Sq. F� �
Length� �� � � � � Width � � � Hgt/Ground Sq. Ft.
Y
�'
►ns�ruction 1�►pe: � � � Esrimated Cost: $ �t .� C�?
'" ��`-=�•'`�•��' �- ' • � � • � ' `' . fFee Schedule on Back1 , . : �
iveway Curb C�t Width Needed: ��� Ft: �+ 6 Fc = F� x� � _$ �
►TE: °�� ��-�.� . � APPLICANf: � `� � Tel. # � ���%J�' � .
. .. CITY USE _ONLY
�nit F� $ �l, C�� Fee Schedule on Reverse Side
E S�rcha�ge $ �� �� �.00! of Pen�nit� Vaivation (1/1�Okh°1o}
te S�trc�atge $ �� $.50/$i,000 Va.�uation
C Cbarge
;ease Surcharge
:veway F.scraw
�sion Conuol
k Fee
ver Main Charge
Tora�.
[�'ULAITONS:
$ $i.000 per SAC Unit
$ ,�. C� � $5.00 (State Licensed Residenaal Contractors)
$ " AIt. "A". or Ait. "B" Above
$ $45p,00 Conservatian Plan Review
$ Fee Determined by Enginnee��ing ..
$ Agreement Necessary j� Not Necessary []
$ � . ('�
Y TOTAL P.02
°� � � �� ��
Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY ���N 1� 009
I)A'I C_�,� • 2'� YOUR E-MAIL ADDRESS
tirrr-. ���or.�ss i Sc3 C.1'l r���115�i 1 C`�1.�2-f"
I'I IIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY NAME: ��e � ���e �,y,�
OWNER/ ADDRESS: 1� r\�A�t�Y�i d.-1' CITY -1�ir►��'�� STATE�i�ZIP�
TENANT -
PHONE:
CONTRACTOR COMPANY NAME: . °�
tiUI3MIT A COPY OF CONTACT PERSON:
1'OUR STATE STATE LICENSE # EXP �D\ATE
I_ICCNSIi WITH ADDRESS:G�� '�S N• CITY (!� STATE�ZIP � 2�
;\PPLICATION PHONE�� • �i� ° II (� �j FAX �T
PERI�11T Tl'PE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
Tl'PE OF �VORK' � NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK '�_�j��(���if�� �1� �\� �q��.
�—.
PER I��iS 16B.GG5 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, e�duding the fixtures. (This should re�tlect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .OS —r�. ; � - , - �;� �
�„� `.��;-- �
Pc)R P�OJCCTS WHERE LABOR EXCEEDS $500. FEES ARE BASED ON $10.00 PER FIXTURE, ElCEPT WHERE NOT�Yh-�I`�TURES: (I�� �ATE TOTAL
NIi�IB�� OF GACH BELOW) -�
I:��ui�iment lnstalled MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
:VC'1+2�.ou F[REPLACE (GAS) $I5.00 GAS RANGE/OVEN $10.00
AII: TO AI� C�CHANGEER $I S FIREPLACE (WOOD) $3�.00 NEW GAS GRILL $10.00
RUILER $35.00 FURNACE $35.00 GAS L1NIT HTR $10.00
CI11�4NC1' LINER $10.00 GAS DRYER $10.00 POOL HEATER $3i.00
DUCT WORK $10.00 GAS P[PING $10.00 VENTILATOR $15.00
PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 �_ x $25.00 = $ • `>°L
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $c� •E7C�
THIS IS AN APPLICATION FOR A PERM[T-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowledge that the infomiation 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 Mimiesota 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; that the work will be in accordance with the
, approved plan in the case of 1 work w' h req '• s review and approval of plans.
� ti1GNATURF (>P APPLICANT � I PRINT NAME •�e �[ e���ATE •`' Q9
PLEASE NOTE: SEPARATE P MITS ARE REQUIRED FOR BU[LDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
643 ] University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977