AF - 38054SUBJECT �����
City of Fridley 2 5 412 '
AT THE TOP OF THE TWINS g � I L D i N G P E R M I T
r
� � R
� �` _��� COMMUNITY DEVEIOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC.
� �
� . �
� � /"'1 � CITY HALL FRIOLEV 55132 NUMBER REV DATE PAGE Of APPNOVEO 8Y
�._..�: '-� 612-571-3450 910-F15 8/25/�7 / /
JOB AODRESS 183 Christenson Court NE
t LEGAL �OT NO. BLOCIE TRACT OF; AODITION SEE ATTACHED
DESCR. 32 2 Christenson Crossing s►+eer
2 PROPERTY OWNEF MAIL ADORESS ZIP PMONE
The Rottlund Co 2681 Long Lake Rd, Roseville MN 55113 638-0500 �
3 CONTRACTOR MAII ADORESS ZIP PHOME LICENSE NO.
Same �
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Townhouse & Garage
7 CLASS OF WORK
I� NEW O ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE
8 UESCRIBE WORK
Construct a 26.33` x 30.33' Townhouse & a Garage
9 CHANGE OF USE FROM TO
STIPULATIONS See notations on plan. Paid $375.00 Park Fee.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OFi AIH CONOITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING Sa. FT. CU. FT.
AUTHORQED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CEFTIfV THAT I HAVE REAO AND EXAMINED THIS APPLICA710N 1 STALLS GAAAGES
ANO KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yq�UAT10N SURTAX
ANO ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIEO ���
WITH WNETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERM►T
DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THH pEfiMITFEE SACCMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- see 179 Christenson COUY't for Monies$
STqUC710N OR THE PERFORMANCE OF CONS7RUC710N.
PLAN CHECK FEE TOTAL FEE
!`��
1GNATUREOFCO � OiiAUTMORIZEDAGENT IDATE� WHEN PROPERLV LIDATEO THIS IS VOUR PERMIT
'
SiGNnTURE OF OWN NER BU40ERi �OATEi p µ$p� qa7E
I�repaid Plan Cher.:k $
Estimated Cost $ ,
Receipt #
CITY OF FRIDIEY
r •� � ��!� � • : � �� . � .
sLnr�ING r�r �rr�aCA'nOr1
Etfective 3/1j96
Construction Address ) � � 'LNR1�'« 1`1 `X�tv �flt�FZT ��g
Legal Description �T Jo�, `�ICC�LL_Y: 2,; ���T��-.�C� CF�� ti:�C�
owner & �aress'��� �w �p ..T'Zlo�� I.a.�cs 1�E �. . �E v�u.E - �113 Tel . # 1� �$-D500
CJ�N'TRAC'POR & ADDRESS s�1 m E ✓�5 14 i3Q�0� Tel .#
Architect & Address grqrpE A5 'C�/E 1 i vT�-f U��NnJ�x�,1 �5. #�� �S 5�
�igineer & Address �'f �j�'�/C. Z 20 lJO. ..�tAR+c�N �2D ., �► ouR -�FAl1,� 5D �1. # 1 q O 1 �
5'710'�
TYPE OF W�RK � New [] Addition [] Alteration -Describe y1i0�7l.'7 ��/Vlp.!�
�l uu�-r �,,r.� �„��mE� `��,� ���
Applicant Signature ` � Tel # - � Date � � � 5 ���
8[J.II�Il�G DIl�NSICS�TS
Length C%Z �-Q" Width �Z�-Q" Height �y�, Sq. Ft. "'%�� # of Stories�
OFC. AR�',A: Length Width Height Sq. Ft.
i�II3SE ARF,A: Length Width Height Sq. Ft .
0� ARF1�: Length Width Height Sq. Ft.
VALI�TIO�
sq. Ft. ��� x� 5�1.5� cbst/sq, Ft. = valuation $/,J-I►2�..1ad`7.�i
Sq. Ft. ZOD �$ /A.3� Cost/Sq. Ft. = Valuation $ ZI q �') = S 1`�
Sq. F't . x$ Cost/Sq. Ft ._. Valuation $ ) 'IC7I'�I, VALUE
Build.i.ng Use E�jl i���AL Cbnstruction �pe� (�_ OccupancY �uP �'�J
Air Conditioning �Yes [] No Fire Protection P�7vided ❑ Yes �To "fA+�dH�ES
Perfomance Bc�nd Amount $ {�{ � See Reverse for Schedule Received [] Yes I] No
Pernti.t Fee $
P1ari Check $
Fire Starcharge $
State Surcharge� $
SAC Cl�an�e $
Erosion Control $
Park Fee $
Spec. Assessments $
Dri.veway Escn�uv $
'POr�L $
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Pezmit Valuation (1/10th o)
$. 50/$1, 000 Valuation (See Sched.. for >- $1 Million)
$900 per SAC Unit (Plans to NdnICC for determir�ation)
$450.00 Cbnservation Plan Review
Fee Deternu.ned By Ehgineering
Agreemsnt Necessazy ❑ Not Necessazy []
feet x $13.50/foot
$1 to 500
SO1 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
$1 to 2,000
2,001 to 25,000
25,001 to 50,000
50,001 to 100,000
100,001 to 356,000
Over $356,000
�3U1Lll1�V(T Yr;KMIT FL� SCHEDULE
$21 (Minimum Fee is $21 plus surcharge)
$21 for lst $500 plus $2.75 for each addn'1 $100 or fraction, to and including
$2,000
$62.25 for lst $2,000 plus $12.50 for each addn'1 $1,000 or fraction, to and
including $25,000
$349.75 for lst $25,000 plus $9.00 for each addn'1 $1,000 or fraction, to and
including $50,000
$574.75 for lst $50,000 plus $6.25 for each addn'1 $1,000 or fraction, to and
including $100,000 . •
$887.25 for lst $100,000 plus $5.00 for each addn'1 $1,000 or fraction, to and
including $500,000
$2887.25 for the lst $500,000 plus $4.25 for each addn'1$1,000 or fraction, to
and including $1, 000, 000
$5012.25 for the lst $1,000,000 plus $2.75 for each addn'1$1,000 or fraction
PREPAID PLAN CHECK FEE SCHEDULE
$29.25
$29.25 for lst $2,000 plus $5.85 for each addn'1$1,000 or fraction, to and
including $25,000 •
$163.80 for lst $25,000 plus $4.225 for each addn'1$1,000 or fraction, to and
including $50,000 .
$269.43 for lst�$50,000 plus $2.925 for each addn'1$1,000 or fraction, to and
including $100,000
$415.68 for lst $100,000 plus $2.275 for each addn'1$1,000 or fraction, to and
including $356,000
$�1,000 (Balance due with issuance of building permit)
PERFORMANCE. BOND POLICIES
When a building permit is issued for a commercial, industrial or a multiple dwelling residential project which requires
outside improvements,a Performance Bond or a Letter of Credit shall be submitted to the City. The bond will cover
all outside improvements, including but not limited to landscaping, irrigation, curbing, blacktopping, screening fences,
lighting, and storm drainage systems.
ralculation of bond amounts will be determined by the building permit values. The bond amount will be 3% of the
i�uilding permit value up to a 2 million dollar project or a$60,000 bond. Actual amounts will be rounded to the nearest
$100. The City reserves the right to require greater or lesser bond amounts based on unusual circumstances. Projects.
with no outside improvements, generally will not require a bond.
Bonds must remain open until the project is fully completed. All bonds will be held over one winter and through the
next growing season to insure the survival of all landscape installations. The City will then inspect these properties
in August of the year following the uutial planting. Bonds may then be released in October of that year if all
improvements are satisfactorily completed.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridiey, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effedive On January 1, 1998
PLUMBING FIXTURE RATES
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Wate� Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas**
NO. RATE
�
�
** ���,e /'�4G-e` �[.�
Gas Dryer**
Back Flow Preventer Required ()Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$, o.00
$10.00
$15.00
TOTAL
�v
�
�v
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.596 of Value of Fixture or Appliance �• �
Siate Surcharge
TOTAL FEE
$ .50
$ p,,sv
JOB ADDRESS / �� L ���5 ��
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 ihis application are true and correct.
Owner
Building Used As
��/���p
�� /� , 1998
Estimated Cost PERMIT NO. ���
PLUMBINGCOMPANY �/� /��.�J%�
SIGNED BY � TEL N0. �7�'�
f �
Approved By Rough—In Date Final Date G �
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS �20.00
PLUS THE 5.50 STATE SURCHARGE
�*COMBUS110N AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 S� INCHES.
�, ,,�.�
HOUSE HEA��G TEST RECORD
, �,. - : r _ ,� .n.
APT. FLOOR
OWNER
�';��.%° `��'°� .� :
CITY �SUBURB
HEAT LOSS � ATE tj,TG. INST.� ..-�.--'
--�--
.�,SOLD BY %�- '-'/ ��''�-'� INSTALLED BY � %'
EI Wo By Gas Lins By fr' �
T, E OF' EAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
''::y .
�A E IGN CONVERSION
MAKE MAKE OF BURNER
Mod.l Modsl
Ssrial Mox. $TU Rating —
INPUT MAKE OF FURNACE
. Modsl
CONTROLS �� -
THERMOSTAT�,� ., t Pluy� . � V�nt Size ,
Volve ': KIND OF LINER t ` 'SIZE NO E��
,
Limit Droft Hood epvloror
Limit Ssttiny Filfers Size umbsr f
Fon Settiny '�� Chimnsy Location Insid� Outside
Pilot Typa Chimney Construction
Pilot Maks
Pilot Model ' Smoke Bomb ` Wiring —
Piiot Timing Draft _ Tesf Tay-
L.W. Cut Off '�"`" " Door Pressuro Liyhtinq l
y Preasuro �� --"'Psresnf CO2 Date Tested �'y �
Input CF _ Percent OZ Company Testing
Stock Temp. _��Percent CO Nome of Tes►sr
r
Form 235 �
�
. .
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�'" �in �F �Aio��riNSpECt�oN oiv.
64� f University Ave NE �
Fr.idley, MN 554�'2° "
572-3604
RATE SCHEOUIE
Restdential
�,
. EIf ivo On January I, I 997
ApPLICATION FOR F'OWER PUINTS AND FiEATING, COOLING, VEN7ILATION,
REFAIGERATION ANO AIR CONOITIONING SYSTEMS ANO OEVICES
Fumace Shell and Ouct Work, 8urner -
Also Heplacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new turnace)
Gas Range
Gas Dryer
"Air Conditioning - All Sizes
All OlherslAepairs 8 Afteralions (LIST ON BACf�
1% ot Value ot Appliance or Work
Commercial�lndustrial
1.25°,6 0l Value o( Appliance or Work
Rale
$ 30.00
$ 10.00
$10.00
$ f0.00
� 25.00
State Surcharge
TOTAI FEE
TUTAL
$ � ���
.
���l�
�
$
$�/��
$
,, : 1�, .,
Y►_� ��
�
�
MINIMUM FEE FOR ANY HEATING(COOLINGNENTIIATION
REFRIGERATIONIAIR CONDITIONING PERMIT IS $25 00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.001Hr
�Air Cond�ioners can not be placed in a side yarci wilhout
written permission lrom adjoining property o�vner.
�
JOBADDRESS � � $3�� � i`��/l�j� �-
, , --,-
71�e undersiflned hereby makes applicalion tor a permit for Ihe work herein
specilied agreeing to do all wotk IR slrict accordance wilh lhe City Codes and
rulings ol the 8ullding Oivislon, and hereby declares Ihat all Ihe facts and
representations stated in Ih(s application are Irue and correcL ' g
I °J �I'-�- _,,�,�
OWNER� �� �` (,�,�
BUIIDING USED AS
ESTINiATE� COST � PERMIT NO.,� �/ S�
DESCRIPTION OF FURNACE AND OH BURNER
No. of Heating Un�s � Circle One (Sleam) (Hot Wale� (Wa►m Air
Trade ame �C31�V j��1/ Size No. �$1� � 11) �
BTU �p�Q HP EDR
F�� �"71J1/ Total Connecled Load
Bumer 7rade Nam"e Size No,
8TU HP EDr�
HEATING OOMPMIY r r Q,� � ��j( �
Signed 8 el No. ��� I( Ipl�
Approved By Rough-in Dale Final Oale �(a�i
FIL� OUT BACK SIDE FOR StACK VERIFICATION O�V ��%
aEPLACEMENT FURNACE
�iTY OF FRIDLEY INSPECTION DIV._ Effective Apri11, 2004 �
�431 University Ave NE I�}�a 5
�ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT `, ��
763) 572-3604, FAX (763) 571-1287 �
MARK NUMBER OF FIXTURES TO BE INSTALLED �N EACH FI_nc�R
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'LUMBING FIXTURE RATES: NO, RATE TOTAL JOB ADDRESS_ �jcvvv�.¢. • o�S o'W yV�n�
Jew Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein
)Id Opening, New Fixture $10.00 , specified agreeing to do all work in strict acxordance with the city codes
3eer Dispenser $10.00 and rulings of. the Building Division, and hereby declares that all the fads
31ow Off Basin $10.00 and repre�,,.,�.,.:,,.,� �...,+� ;,, +ti.� �.,..��..�t�.,,, ��o +
rue and correct.
;8tCI1 B8S111 $10.00 PESTELLO, SUE O �7 O V O�
Z8111 Wat@� L@BdeC $10.00 183 CHRISTENSON COURT N.E. 20
iUlYlp/RECEIVI�g,T8t1k - $10.OQ FRIDLEY, MN 55432
Nater Treating Appliance . $35.00 OWNER , (��� 5��-0�33
1later Heater -Electric $35.00
'Vater Heater - Gas" �_ $35.00 BUILDING USED AS ��SI � e�c�
�as Range"" $10.00
� .
�as Dryer"' $10.00 ESTIMATED COST �� �^� PERMIT NO.
3ack flow Preventer Required OYes O No
Type $15.00 PLUMBING COMPANY O� K�` a� t '
teinspection Fee $50.00/Hr SIGNED BY TEL N0. �fol2� i�27-S�033
�LL OTHERS AND/OR REPAIRS AND Al.TERATlONS
1.25% of Value of Fixture or Appliance
APproved By . Rough-In Date Final Date
State Surcharge $ . 5�
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS 515.00 or 5% OF COST
, TOTAL FEE $�S � OF THE IMPROVEMENT WHICHEVER IS GREATER PI.US THE SURCHARGE.
.OMBUSTtON AiR SHALL BE PROVtDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT iNFO ON BACK SIDE
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS `
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION `
When replacina an existin� furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
, and is securely supported and firestopped where required. Yes O No O,
The venting system is plastic/PVC and meets all current codes and manufacturer `
specifications including sizing, Jength, number of elbows and termination: ' Yes O No O
The undersigned also ver�es that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does :
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. ' Yes O No O
The existina combustion air is sized and instaDed to mee� the currenf codes
and manufacturer's specifications. Yes O No O
When required to install a new combustion air, it will be sized and installed `
to meet the current codes and manufacturer's specifications. Yes O No O
When instaNinst a new ver�tinst svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting� Tables for fan assisted and natural draft appliances. Yes O No O
Is the common vent and vent connectors sized and installed correctly after
an appliance has been remaved from the common vent.and vented
separately as per current codes. Yes O No O
Apaliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU•Input Fan Assisted or Nat
Appli�nce #3 Type - BTU Input Fan Assisted or Nat �
Total Appliances Tatal Btu Input
Common Vent Type Vent Height : Diameter inches �
Appliance #1 Vent Connector Height ft Length ft Diameter ' in Type
Appfiance #2 Vent Connector Hefght ft Length ft Diameter - in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describel
HEATING CO:
Signed By: Date :