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' 2422 Enterprise Drive
� • M�dota Helghts, MN 55120 `
LAND SURVEYORS • c�va. a�aNmzs (612) 881-1914 FAX:681-9488
LAND PLANNERS . uNDSCApE aRaiITECTS fi25 Highway 10 N.E. s
Blaine, MN 55434
(612) 783-1880 FAX:783-1883
Certificate of Survey for:
House Address:
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House Model:
THE RO TTL UND COMPANY
156 Christianson Court
Benton
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x soo.o Denotes Extsttng E/ewotlon
"� Denotea Proposed EleMOtJon
----�- Denotea Dralnoqe Flow Directlon
� Denotes Drolnoge de Utillty Ease►nent
--o- Denotes Monument
--$- Denotes Offset Hub Bearings shobrn cre ossumed
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PItO.P�SED .BUILDING ELEVA?70NS
Gorcge Sfab Elevation: 8� �� 7 (at doar)
NOTE: Propoaed bupd�y stte grading ia in accordoncs with ths
grading plans approved by the ctty enqkmer,
NOTE: Contractor muat verHy atl dim�stona k driveway design.
LO T 2. BLOCK 1 CHRISTENS0.1oT CROSSING
ANOKA COUNTY, MINNESOTA
We hereby certify that this survey, plan or report was prepared by me or under my direct superviaion and that I a duly licensed
Land Surveyr�r under the lows of the State of Minnesotc. Dated this I� day of S�ep�p,,,,�e� A.D. 19 9�
Signed: PIONEER ENGI ERING, P.A.
1 ---
S�.'�1�. 1��= �Qfeet __ 6 BY �, _
Robert B. Sikich, L.S. Reg. No. 14891 or
� 16190.07 Terrence E. Rothenbacher, L.S. Reg. No. 20595
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* PIONEEA
* anp neer
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, 2422 Enterprise Drive
Mendoto Heighta, MN 58120
uwu simvEroxs • av� o�aNmts (612) 881-1914 FAX:881-9488
uND PIANNERS . LANDSCApE ARCHITECTS 625 Htghway�10 N.E.
Blatne, MN 55434
(612) 783-1880 FAX:783-1883
Certificate of Survey for:
House Address:
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House Model:
THE RO TTL UND �'OMPANY
156 Christianson Court
Benton
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x soo.o Dertotes ExtstJng ElevcUon
�oa'� Denotes Proposed Elev�otion
—�— Denotes Drafnoge Flow DJractlon
—� Denotes Drofnoqe k UtJpty Ecsement
-- Denotea Monument
— Denotas Offaet Hub Beorings shown ore assumed
Cy�.S�
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PRaPOSED BiTbDING ELEVA770NS
Gorage Slab Elevatfon: 857.77 (at door)
NOTE: Prnpopd buUding sita grading ts in aeoordanes with ths
qradlnq plana approved �y the city enpinee�.
NOTE: Conboctor muet wriy o4 dlman�tone & triveway dsa(gn.
LO T 2, BLOCK 1 CHRISTENSON CROSSING
ANOKA COUNTY, MINNESOTA
We hereby certify that this survey, plan or report was prepared by me or under my dtrect superviaton cnd that I o duly licensed
l.and Surveynr under the tows of the State of Minnesota. Dated this ��� day of s���� A.D. 19 9�.
p��{g�y �,�,5{ Q�p� jo-�-�O/6 Signed: PIONEER ENGINEERING, P.A.
Ke.y I�i��sP �e,� G�•i �
Scale: 1��h= 3Qfeet � , - BY ���s�, Q�.--
Robert B. Sikich, L.S. Reg. No. 14891 or
] 16190.07 Terrence E. Rothenbocher, L.S. Reg. No. 20595
SuBJECT .
c�ty of Fr�a�ey ? �. � � �
AT THE TOP OP THE TWINS g U I L D I N G � E R M I T
r
; � RECEIPT NO.
� ` _____ COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC. �J�/
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� � �"��1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED 8�
�""'�'� �'' 612-571-3450 910-F15 10/9/96 � �
108 ADDRESS 156 Christenson Court
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Christenson Crossing SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PFIONE
Rottlund Homes, 2681 Long Lake Road, Roseville, MN 55113 638-0500
3 CONTiiACTOR MAIL ADDRESS ZIP PHONE UCENSE NO
Rottlund Homes (same as above)
4 ARCHITECT OR DESIGNER MAIL ADDFESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
6 USE OF BUILDING
Residence
7 CLASSOFWORK � NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOiiK
Construction of a new home.
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plans.
� l���►�f� .P"ER4����CS 'R���1��� ��iD S1CN��.
_ ���, . - , l�E�i4 i �iV�� �'�lJ�ell{����
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• �, cat� for
Befiore a��g''�ocations
a�� ut454 0002
�'R�� B� �!�
REQ
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK Oft CONSTRUCTION ZONING SQ. FT. CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS APPL�CATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SUfiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED �]5,698.ZH State SC �37.SS
WITH WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE '
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $737 � 25 Fire SC �%S .%O
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
O O PLAN CHECK FEE T07AL F '
/`� /�� icense Fee $5.00 2 1 0.80
SIGNATUAE OF CON7RACTOA UTMOAIZED AGENT ionrE� ''�WHEN PFOPERL UDATED THIS IS VOUR PERMIT
a 4.!%� y
SiGNnTUAEOFOWNERUFOWNER8U4DER� IDATEI Bl �NSP qFTE
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
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ConstructionAddress: � J�� (' ]� � I �T I�I � �LJ�K.T
Legal Description: _ �p'f" �, �jj,,p� 1 �_('{��j<j-� �p 7� �D�1 N �
Owner Name & A ress: �'�-n � � �� �OmE� Tel. # j� �g—Q.��
Contractor: ~
�-�`r�v�+��, �io mF� ivnv �c�avsE # 1 �, ��
Address:�lo� l �.(�NC� L�-1K.0 ��Ai� �► � �; 1°�if� 5 I 1 Tel. #�`�j$---�
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
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DESCRIPTION OF IlVIPROVEMENT ��� r �,,,,�
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Length (�(�' " Width �`i � d�� Hei ht `" S. Ft. � I� J� 9 d�� ��
-b g � q
Length � -'(�'' Width j �'-(�" Height ��-�`� Sq. Ft. ��y =0u / � ��
Length — Width Hgt/Ground ° Sq. Ft. �32 "��$�°�
Corner Lot [Vr Inside Lot [] Ft. Yd Setback
Type of Construction: ��pp ��q��
Approx. Completion Date: ��q`�
(Cos t on
Side Yard Setbacks
Estimated. Cost: $ �`j �, %� , /,�
Back�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: q' S' � LP APPLICANT: �j(�,�� Q��� Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
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$ ,D�, �
$ '� �
$
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation �
$900 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Park Fee $ J��. � Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessar�.�
TOTAL $ � I �,
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STIPULATIONS:
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BUII.DING PERNIIT 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 permxt of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$1Q0,001 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 $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,l}00
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 plus $5.00 for each additional
$1;000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $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
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
Sheetl
Y �AREA (Sq Ft) �U-FACTOR �U-FACTOR X AREA
CEILING/ROOF
INSULATED AREA 1064.70 0.022 23.42
FRAMING AREA =(10% of ceiling azea) 118.30 0.027 3.19
SKYLIGHTS 0.00
OTHER 0.00
TOTALS A 1183.00 B 26.62
AVERAGE U-FACTOR: B / A = C C 0.023
REQUIRED U-FACTOR (from Energy Code) (U = 0.026) : D 0.026 �'
EXPnSFD WAT.T.
IIVSULATED AREA 1037.00 0.043 44.59
FRAMING AREA 211.20 0.089 18.80
WINDOWS 122.00 0.370 45.14
DOORS 37.80 0.067 2.53
RIM JOIST 0.00 0.035 0.00
FIREPLACE WALL 0.00 0.072 0.00
ABOVE GRADE FOUNDATION WALL 0.00 0.087 0.00
FOUNDATION WINDOWS 0.00 0.00
FLOOR OVER UNHEATED SPACES (U = 0.04) 0.00 0.00
OTHER 0.00 0.00
TOTALS E 1408.00 -: :: ; -:' F 111.06
AVERAGE U-FACTOR: F / E = G G 0.079 ;,,r ,'
REQUIRED U-FACTOR (from Energy Code) (U = 0.110) ' H 0.110
If C is greater than D, or G is greater than H, revise the design as necessary to meet the envelope criteria
of the Enerev Code.
1) U-Factor for skylights and windows must be dzcermined by the Nadonal Fenestration Radng Council Standard lOQ-91 or
ASHRAE 1993 Aandbook of Fundamentals, Chapter 27, table 5.
2) Thermal Transmittance of opaque components (including integrally insulated masonry and metal stud framing)
use part 7670.0450, subpart 4.
Page 1
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CHIlVIlVEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefiilly examine�d Yes (�) No i)
2. Is free from rust or deterioration
3.
4.
5.
6
Has no foreign objects lodged within
Is securely supported
Meets all cutrent Code requir�ffient.s for size
and total BTU's conne�ted
Has total heating BTIJ's of
All other BTLT's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air be�n provided for water hea.ter
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes()No()
Yes ( ) 1Vo ( )
Yes()No()
Yes()No()
Yes()No()
Yes()No()
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Client:
Address:
City:
Phone:
Fax:
Comment:
Rottlund Homes
2681 Long Lake Road
Roseviile, Minnesota 55113
638-0500
638-0501
YOUR BUILDER FOR LIFE
Company:
Representative:
Address:
Ciiy:
Phone:
Fax:
Comment:
Project Name:
Reference City: Minneapolis, Minnesota
Daily Temperature Range: Medium
Latitude: 44 Degrees
Elevation: 834 Feet
Outdoor Outdoor Indoor Indoor Grains
Dq/ Bulb Wet Bulb H�LHl�m. � Buib Differ�nc�
Winter: -20 N/A N/A 72 N/A
Summer: 95 75 50% 75 36
Total Building Suppiy CFM: 659
Square feet of room area: 1,186
Fiare Hea�ng & 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: 0.556
Square feet per ton: 817.931
Totai heating required with outside air: 50,755 Btuh 50.755 MBH
Total sensible gain: 13,050 Btuh 76 %
Total latent gain: 4,197 Btuh 24 %
Total cooling required with outside air: 17,247 Btuh 1.437 Tons (based on sensible + latent)
1.450 Tons (based on 75% sensible capacity)
Calcufations 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.
I -.
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Component Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
I4A Window Double Pane & Storm Clear Glass Wood Frame 138 4,328 0 3,448 3,44g
8M Glass Door poubie Clear Glass Wood Frame 40 2,028 0 1,200 1,200
I11 C Door Metal Polystyrene Core 38 1,643 0 422 422
121 Wall R-19 + 1/2" Asphlt Board(R-1.3) 1,192 6,032 0 1,547 1,54�7
� 16H Ceiling R-38 insulation 1,186 2,837 0 1,357 1,357
� 23C_ SIabNVarm Duct 11/2" Edqe Insulation(R-8) 176 16,192 0 0 0
Subtotals for structure: 2,770 33,060 0 7,974 7,974
Active People: 4 0 920 1,200 2,120
Inactive Peopie: 0 0 0 0 0
Appliances: 0 0 300 1,200 1,500
Lighting: 0 0 0
Ductwork: 0 3,786 0 0 0
Infiltration: Winter CFM: 47.4, Summer CFM: 31.6 216 4,801 774 696 1,470
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9.108 2,203 1,980 4,183
Sensible Gain Total: 13,050
Temperature Swing Multiplier: X1 00
Building Load Totais: 50,755 4,197 13,050 17,247 '�
�i otal Bui(ding Supply CFM: 659
Square feet of room area: 1,186
CFM per square foot: 0.556
Square feet per ton: 817.931
Total heating required with outside air: 50,755 Btuh 50.755 MBH
Total sensible gain: 13,050 Btuh 76 %
Total latent gain: 4,197 Btuh 24 %
Total cooling required with outside air: 17,247 Btuh 1.437 Tons (based on sensibie + latent)
1.450 Tons (based on 75% sensible capacity)
Calculations are based on 7th edition of ACCA Manual J.
All computed results are estimates as buiiding use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
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, e l HOUSE ��i'EATI G TEST RECORD 6 Gf�'�� �
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AODRESS � ��' "'' % V b � APT. FLOOR CITY �—.SUBURB
OC�JPANT � OWNER
HEAS LOSS _ _�.T_DATE HTG. INST. ° �'� °
�S�3LD $Y `✓��'�,�� � INSTALLED BY �1,�. �
Eleehicgl'�lork $y Gos Lins Br � !/
TYPE OF HEAT GA FA .�HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS QE IGN - CONVERSION
; MAKE �, MAKE OF BURNER
AAod.l �".-• > Modal �
�
Serioi Mo:. BTU Rating
INPUT � ^ - MAKE OF FURNACE
_ Model
CONTROLS � l%' ry
THERMOSTAT � "�'" Heq Ivg Vsnt Size ��'�
Volvs /' � KIND OF LINER SIZE NONE
Limit _� ��� , �� Draft Hood Rsgulotor .� ���� �� `�� '=��
���
Limif Ssttiny � i � Filtsrs Size Number
Fan Setti�g 4 �- Chimnsy Location Insids Outsids
Pilot Type `� Chimney Construction
Pilot Moke t ��c���'� �
Pilot Model � Smoks Bomb Wiring
Pilot Timing °'� /�•�. ��� � DraFt F Tsst Tag
L.W. Cut Off ""� Door Pressure Lightiny Inst. �°
Prossure_��� � Psresnt C0� � �'� Date Tested f
Input CFH Psreent 02 Company Testing
Staek Temp. �'� ^_ Percaet CO Name of Tsstsr �
'�
Form 235 " ?� �
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FRIDLEI' MUNICIP.�L CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, iv1N SS432 •(612) 571-3450 • FAX (61?) 571-1?87
January 2, 1997
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 156 Christenson Court NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on January 2, 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 572-3602.
Sincerely,
� ', , i �;
BARRY' RIESCH
Building Inspector
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SUBJECT Yt °^
c�ty of Fridley 2 6 6 7 0
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
RECEIPT NO.
; ; �ll
� ' COMMUNITY DEVELOPMENT DIV.
i Vy �"'.'�
r � � PROTECTIVE INSPECTION SEC. '
1 . ,
i---. ��"','� CITY NALL FRIDLEr $5432 NUMBER REV DATE PAGE OF APPROVEO BV
i �� 612-571-3450 9to-Ft5 7 16/98 � �
JOB ADDRESS
156 Christenson Ct.
1 LEGAL LOT NO. BLOCK TRACT OF ADOITION SEE ATTACNED
DESCR. 2 1 Christenson CrossinQ SNEET
2 PROPERTY OWNER MAIL ADDRES$ IIP PNONE
Ernest Garpiepy 574-7452
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Minnesota Exteriors 8600 Jefferson Hwy Osseo MN 55369 493-5500 0002877
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADOFESS 2�P PMONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE ❑ REMOVE
B DESCRIBE WORK
9 CHAN(iE OF USE FROM
STIPULATIONS
TO
TYPE OF COI
SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, PLUMBIN(i, HEATIN(i,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL APID VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OF ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG.
I HEREBY CERTIFY THAT I MAVE READ AND EXAMINEO THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �SOO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE
PROVIS NY O R STATE L LAW REGULATIN(3 CON-
ST TION OR THE PE STRUCTION. �21.00
PLAN CHEC
P Licens
— SIGNATURE OF C TOR OR AUTMORIZED AGENT IDATEI
C�f.NnT1IGF l]F 11WNFR �IF nWNER BUILDERI �DATEi - B�O
IST. OCCUPANCY dROUP OCCUPANCY LOAD
SO. FT. CU. FT.
UNITS OFFSTREET PARKING
STALLS GANAGES
SURTAX
$.50
SAC CHARGE
Fire SC $.50
�FEE TOTA EE
_����$5.00 $ .00
�AL�DA /,THIS IS��� �EJRM1��
/./ /
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE I %sI2 �
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
ow�vEii/
TENANT
CONTRACTOR
SUBMTf A COPY OF
YOURSTATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERNIIT TYPE
�rE oF wo�x:
PLUIV�BING
1tES�ENT�L APPI,ICATION
CITY OF FR�LEY
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS
❑ OWNER
NAME:_ V�{�Q SG�P��'iM SY
ADDRESS: I.sb ii� N�a"r'iM �4DY1 � l� ��
PHONE: �10 �J' " 7 t I — � %�7�I
STATE LICENSE #_
STATE BOND #
ADDRESS:�
PHONE �
�SINGLE FANIILY
❑ NEW
❑ TWO FAMILY
�LEPLACEMENT
, ..
FAX
❑ TOWNHOUSE
Permit No.:
EXP DATE
EXP DATE
�- -. :
�.�{._;,3, ,;�> �
��2
TE�ZIP ss���
DETAILED DESCRIPTION OF WORK �,S�r. �r.Efi'tj �i/l i� (�(J(�iC�'iWlGV�" �� �,t'��Y
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). NIINIMUM FEE
$35.50.
BATHSINK/LAV _FLOORDRAINS SHOWER WATERPIPING
BATHTUB GAS PIPING (NEED CITY LIC) SWIlVINIIIVG POOL WATER SOFfNER ($35)
CLOTHES WASHER KTl'CHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
_ DISHWASi�R _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
_ WATER METER _ OTI-IER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �/L��f'O/2 L�d'�iPiC- PRINT NAME� l G�— LGv`� �/'�1 DATE I Z�$
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
JUL-16-1996 11�08 FR�M CITY QF FRIDLEY TO
�DDN [ J . y,, - .: CITY, OF FRIDLEY . . . .
.�,..; : ::= � . . , . :
1LTER [% SYIITGLE FAMII;Y-AND�DUPLEXES R-1 AND R 2
. : ;,. . . . , . . . . BUII.DTNG PE�tMIT APPLICATION
.-,,. . , . . . .:-, . .
:���o���s: � i���;� ��.����Lt: � . � ��,�.
4933689 P.02i02
��1� �
�����3
� ���������
�egai Description: � ' � . . .
�wner Name & Address: �,��. �,�-� a� �+�,e�� Tel. # �'��q m.7���
��tarac'tor: �ti�,���,-�� �',�.I,��,,�r-c �� MN T:ICENS� # ��f� 7 �
.ddress:. �� �,�'�.�. ��cs �'°as� Gle� � �3�� Tel. # ��1�°�,�� "'
1vII�IG AR�A,:
ARAG� Ai�A:
ECS AREA:
TI�R:
�` `�' Attach to this application, a Certificat�e of Survey of the
lot, with the proposed construcaon dra.wn on it to scale.
�
. .. , . . ,. ,. DESCRIPTION OF IlVVIPRO'V�MENT
��; �._ �.::,;:� . . .. . . _ . . . � . . . ,
Len$th . Width � Height Sq. Ft.
� . : .. � . 'Length ... � . � . �� : � . Width � Height Sq. F� �
� Length � '� � � ' � Width � ' � Hgt/Crmund Sq. Ft.
. Ir
►�S$i1Ct10II �Qe: � FSiln18� COSL: $ � �1�
' .:`-=.:':��..: -- . � . ' � . ' `: . (Fee 5chedule on Back1 � �
iveway C�rb Cut Width Needed: � � �'�� � � Fc: � + 6 Fe = � Ft x � � � $ �
s—. � _
.�: �7 ����s '
�it Fe�
E Surchatge
te S�trcharge
.0 Charge
�ease Surcharge
:veway Escrow
,sion Conuol
�C Fee
ver Main Charge
TOTAL
�'U.LATIONS:
T�. � ��/ ���/�
. . . .. CITY USE ONLY
$ ��• �� Fee Schedule on Reverse Sids
$ � �� °� �.001 of Pennit� Vaivation (11�Erth°!o)
$ � $.50/$1,OOQ Valuation
$ $I.000 per SAC Unit "
$ �. U C� $5.00 (State Licensed Residernial Conuactors}
$ ' AIt. "A"� or AiL. "B" Above
$ $45Q.00 Conservation PIan Review
$ F� Determi�ned by Engin��ing -
$ Agreement N�+ressary [] Not Necessa.ry j}
$ °� ,(��
TOTAL P.02