AF - 42927sue�ec. RMIT NO.
City of Fridley 2 6 0 4 3
AT THE TOP Of THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
. ; � ----- . �� 9 �
r � '� PROTECTIVE INSPECTION SEC.
1 . �
i•.-- � �'��1,; CITY HALL FRIOLE� 55A32 NUMBER REV DATE PAGE OF APPROVED BY
L ��' ' 612-571-34b0 910-F15 5/13/98 / /
JOB ADDRESS 6418 Christenson Lane NE
1 LECaAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. 3() 1 Christenson Crossing SHEET
2 PROPERTY OWNER MAIL ADDRES$ IIP PNONE
The Rottlund Company Inc 2681 Long Lake Rd, ROseville MN 55113 638-0500
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same 1335
4 ARCHITECT OR DESIGNER MAIL AOORESS ZIP PNONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO.
8 USE OF BUILDINO
Residential
7 CLASS OF WORK
ClX NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 42' x 25' Townhouse and a 22' x 20' Garage
9 CHAN(iE OF USE FROM TO
STIPULATIONS
Paid Park Fee of $375.00. See notations on plan.
�� ������
Betors d�gg�ng call fot
a�ti , �t��;�y Iocations $�PARAt� PERIV9CTS REQ�IIRED �OR
�� 434-OQ�2 � 1NIRING� H�Ti�VG, PLUMBINt� AND SiGMS'.
REQUIRE'D B� �
SEPARATE PERMITS ARE REQUIRED FOR EIECTRICAL, PLUMBING, HEATIN(;, TYPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING Sa. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOH 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 EXAMINEO THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PHOVISIONS OF LAWS VALUATION SURTAX Fire SC
AND OFiDINANCES GOVEfiNING THIS TYPE OF WORK WILL BE COMPLIED 129 � FjOO �C�F. 8O
WITH WHETHER SPECIFIED HEREIN Oi; NOT. THE GF;ANTING OF A PERMIT � 129. EjO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL THE pEfiM1T FEE SAC CHARGE
PROVtSIONS OF ANY OTHER STATE OR IOCAI LAW REGULATING CON- � 1� O3J . LS � 1� OOO
STRUCTION OR THf PERFORMANCE OF CONSTRUCTION.
---� �_�3_c)� PLAN CHECK FEE T07AL FEE
�� �_ License $5. $2, 236. 65 + PF
SiGNATURE OF �� AUTHORiZED AGENT �DATE� N ROP VALIDA D THIS IS VOUR PERMI
� ' ,�/3-
S�GNATURE OF OWNEA �iF OWNEA BU�LDERI �DATEi � �ysp ��pTE
NEW
ADL'N
ALTER
�
[l
I' )
constructionAadress:
Legal Description: ��
Owner Name & Address •
y
CITY OF FRIDLEY '
SINGLE FAMILy A,ND DUPLEXES R-I AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/97
,� 3
��� ���
. �'
�, GOT ��
• _ � ��. ,Y� i � �u ►.S� � � �,. � ��► ��i I N C�. Tel. # /n _ - �O
Contractor: S� m�. � MN LICENSE # 1?�?�
A d dress:_.7�i��1 L��l ��LG `Rr�il i�c�v�L�E . Nli�i 5511 Tel.#!¢3$"O�
LTVING AREA: '
GARAGE AREA:
D�Cg AREA:
OTHER:
Attach to this application, a Certificate of Survey of the `i�,,,,� �,�. /� ys �.
lot, with the proposed construction drawn on it to scale. X�� �/
=���Css�
_ __ _ DESCRIP'I'ION OF IlVIPRO�'EMENT ���� �G �� �x � Sy
,
��,�f - 7�D��o, ; y- Gy�3Y s ?
Length - ' � � ` Width �2._ Height .�' Sq. Ft. 17�. � ,
Length a� � " Width �! � Height =p `� Sq. Ft. ' � �
Length � Width H Gro � y�rl�, �,
gt/ . und Sq. Ft. b', /35 ,�
. �
Constniction Type:���� ��at� Cost: $
� � (Fee Schedule on Back) l�C� � ��
Driveway Ci�rb C�t 'Width Needed: Ft. + 6 Ft = Ft x$ _$�
DAZ'E: - APPLICANT: � �� �—_--`-��� Tel. # �.�� � /�
Permit Fee
Fire Surcharge
�tate Surcharge
SAC Charge
License Surcharge
Driveway Escrow
?rosion Control
?ark Fee
>ewer Main Charge
TOTAL
TIPULATIONS:
$ � CJ Z�
$ / c�
$ G��
$ /, � cv
$_ - i�, °'�
$ �
$
$ �7�co�
$ �
$ �f � oc�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
�.soi$i,000 v�u�tion
$950 per SAC Unit �
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
•$450.00 Conservation Plan Review
Fee Deternuned by Engineering �.�
Agreement Necessary [ ) Not Necessary [ ]
�
BUII,DI\'G I'ERiVi[T FEE SCHEDU[,E:
1'he Chief Building Official shall, before issuing perniits for the erection oC any building or structure, or fi�r
an}• addition to any existing building or structure,� or for any alteration or repair to any existmg buildin� or
s�ructure, 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 �
��01 to $2,000
�2,001 to $25,000
525,001 to $50,000
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each addi�ional $100 or
fraction thereof, to and ancluding $2,000
$62.25 for first $2,000 plus $12.5� �'or each additionaI $1,000
or fraction thereof, to and including $25,000 • - ..:L.
$349.75 for first $25,000 plus $9.00 for each additional $1,00�0-
or fraction thereof, to and including $50,000 �
S50,001 to $100,000 $574.75 for. first $50,000 plus $6.25 for each additional
. $1,000 or fraction thereof, to.and includiug $1Q0,000
� 100,001 to $500,000 °
�500,001 to $1,000,000
�1,004,001 and up
$887.25 for first $100,000 plus $5.00 for each additionaI
$1,OOO�or fraction thereof,.to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each �addidonal
$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
llRIVEWAY DEPRESSION ESCROSV
(Concrete Gtizrb Streets Only)
�
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
�lternate "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 FOUNDATIO`T
.
'�rnii�s for construction will be issued a minimum of 24 hours from the time of application to allow for prop�r
.:�•ie��• of the proposed stnicture and of the construction site.
��:;c�tit7cate of Survey of tlie lot, showing the location of the foundatio�� ��nce it has it has been constructe:!
•i.: ;�: r�quir�d h�fore �rc�cce�iin� u�ith the framing.
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Client:
Address:
Ciiy:
Phone:
Fax:
Gomment:
Rottlund Homes
2681 Long Lake Road
RosevNle, Minnesota 55113
638-05Q0
638-0501
YOUR BUILDER FOR LIFE
Project I�ame:
Refe�ence City:
Daily Temperature Range:
Latitude:
Elevation:
Winte�:
Summer.
4�4
834
Outdoor Outdoor
�,@� Wet Bulb
-20 N/A
95 75
total Bullding Supply CFM: 878
Square feet of room area: 2,085
Company:
Representative:
Address:
City:
Phone:
Fax:
Comment:
� F�[1to slab on grade)
mneapolis. Minnesota
Medium
Degrees
Feet
Indoor Indoor Grains
$�. � Difference
N/A 72 N/A
50% 75 36
�v
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: 4.421
Square feet per ton: 971.676
Total heafing required with outside air: 59�658 Btuh 59.658 MBH
Total sensible gain: 19,312 Btuh 77 %
Tota1 latent gain: 5�812 Btuh 23 %
Total cooling requfred with outside air: 25.124 Btuh 2.094 Tons (based on sensible + latent)
2.146 Tons (based on 75% sensible capaci�r)
Ca�ulations 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.
,+ ,�.�'� %�' . . .p ..;. . .� �: �� ���' � � ; " . c u" ,� ,�.� �d. : �� �' '
� ' ; ������' ,. . ,�, � �
�;�C�'t`�.":��^.�:,�"c.�"; .�;lv�:>..a,.,"�`."x+a�",,.v�.' .�.' � a. �a' 'a' ,,. T.. \�'r*.. � '.4;L„\?.' �?.?., �
Ln` '� 1k � ����� Q.�o'o (a:.�aQt � � �3Y'�+
�r ^c�\�� . �' V �� ' �.w' . .��'�`����.\ ��: ;� • ` , .
Component Area Sen. Lat. Sen. Tota!
Descripfion Quan Loss Gain Gain Gain
4A �ndow Double Pane & Storm Clear Glass Wood Frame 202 6,336 0 7.110 7.110
8M Qlass Door pouble Clear Glass Wood Frame 40 2.026 0 1,200 1.200
11 C Daor Metal Polystyrene Core 38 1,643 0 422 422
121 Wail R-19 + 1/2" Asphlt Board(R-1.3) 1,858 9�402 0 2�412 2,412
131 Part R-19 + 1/2" Asphlt Board(R-1.3) 162 410 0 134 134
161 Ceiling R-441nsulation 1,114 2.357 0 1.127 1.127
2QJ Floor Over Open Crawl Carpet + R-3Q 14 45 0 7 7
23C SIab/Warm Duct 11/2" Edge Insulation(R-8) 26 2�392 0 0 0
23D SIabNVarm Duct 2" Edge Insulation(R-11) 13Q 11 �123 0 0 0
Subtotals for structure: 3,584 35,736 0 12,412 12,412
Active People: 8 0 1.840 2,400 4.240
Inactive People: 0 0 0 0 0
APR��a�eS� 0 0 300 1,200 1,500
Ughting: 0 0 0
Ductarork: 0 2,666 0 0 0
Infiltration: Winter CFM: 120.0, Summer CFM: 60.0 280 12,148 1,469 1.320 2.789
Ventila�on: Winter CFM: 90.0, Summer CFM: 90.0 0 9108 2,203 1,960 4,t83
Sensible Gain Total: 19�312
Temperature Swing Mul�plier: X1 00
guilding Load Totals: 59,658 5,812 19�312 25,124
,,`�:'�: �� � �. ;�; �:e�i:� � �� v, �-,��.-• ,. �
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�a\'`.a.?:�: �:fi��". a��.�a:� �� �\ Za, � h U�... �.�'.. ������i.�i*;:�.�.c�.�.. ,���'i. .`.�,"��'�,..§. : ..��.. .i'� �v �1��.. .
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�omponent Area Sen. Lat. Sen. Total
Description �uan Loss Gain Gain Gain
4A wndow Double Pane $ Storm Clear Glass Wood Frame 202 6.336 0 7�110 7,110
8M Glass Door poubte 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�858 9�4Q2 0 2�412 2�412
13f Part R-19 + 1/2" Asphit Baard(R-1.3� 162 41Q 0 134 134
161 Ceiling R-44 InsulaUon 1,114 2,357 0 1.127 1,127
20J Floor Over Open Crawi Carpet + R-30 14 45 0 7 7
� 23C Slab/Warm Duct 11/2° Edge Insulation(R-8) 26 2,392 0 0 0
23D Slab/Warm Duct 2" Edqe InsulationtR-11} 130 11.123 Q 0 0
Subtotals f�r stsucture: 3,584 35.736 0 i 2,4t 2 12,412
Active People: 8 0 1.840 2,400 4,240
Inactive People: 0 0 0 0 0
Appliances: 0 0 300 1,200 1.500
Lighting: 0 0 0
Ductwork: 0 2.666 0 0 0
Infiltration: Wtnter CFM: 120.0. Summer CFM: 60.0 280 12,148 1,469 1.320 2�789
Ventilatlon: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2.203 1,980 4,183
Sensible Gafn Total: �g�3�2
Temperature Swln Multiplier: X1 00
?one Load Totais: 59.656 5.812 19,312 25,124
Supply CFM: 87B
Square feet of room area 2.085
CFM per square foot: 0.421
Square feet per ton: 971.676
Total heating required with outside air: 59.658 Btuh 59.658 MBH
Total sensibfe gain: 19.312 Btuh 77 %
Total latent gafn: 5,812 Btuh 23 %
Total cooling required with outside air: 25,124 Btuh 2.094 Tons (based on sensible + latent)
2.146 Tons (based on 75% sensible capacity}
,.i s, .,;�r a._. _ a ..-� � ..... . _ _ -•'°_-,,.- - a.—., � F _s- �. --�.R;..,a,,.—��.-a:.•�.�.-,..+ _ . . .,a .._...,�
�
` ' A HOUSE HEAT,:{t�G TEST RECORD y ���G����°'
A`�� � � � ,�� , P ,�"�',,:) :
ADDRESS s� � > �° APT. FLOOR C1TY �SU9UR8
OCCUPANT ,� _` ' OWNER
HEAT LOSS _ f .�DATE-�iTG. INST.�' �
SOLD BY `'°" ��.�"��� INSTALLED BY d,� 9 �.
� �'t �� �
Electricol Work Br Ges Lins Br r...,,P
TYPE OF HEAT GA ' FA �HYI STEAM SPACE HTR. UNIT HTR. OTHER
` GAS DESIGN CONVERSION
NtAKE �-�"� -°'°�A MAKE OF BURNER
Mod.) :f T ` I�Aodel
Se.iol �� r "� Mo:. BTU Ratinq '�
U1�U7 ����"-�a�`�� MAKE OF FURNACE
Mndel
1 `�^.� -*"'�.°,�.° '"��,.,,,. � CONTROLS _ . , _ --- - �� �
�'R':9�RMOS7A���.� Heot Plug ��i Vsnt Si:e ,,_��i,r�`
r'� �' * .,
Valvs �_� �`" KIND OF LINER SIZ + d NON�
Limit 6 �.� Droft Hood Reguloror � °'
,_ , _,, ;,°
Limit Ssfting �'�� ✓ Filter; Size� ,� � � umber
Fon SeHing � ' .�1� . � ��
�� � �_ Ckime+sy Location fnside ' Outsids
Pilot Type �`� Chimner Construetion
Pilot :Moke ��� ��' � "°°
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CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
March 24, 1999
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 6418 Christenson Lane NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on March 23, 1999 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,
- �t.u� � �
BARR RIESCH
Building Inspector
:'7�ii
d•
Buildin; � �
Inspections
763-572-3604
BUII�DI�TG
RESIDENTIAL APPLICATION
CITY OF FRII�LEY
� �, �.�
Pernut No.:
Received By: " `} �"
Date Rec'd: ���' ° ��
DATE Ib � 1 Z I ��o YOUR E-MAiL ADDRESS 't'vM S a" P.� °l_'C �OY�L S• GDYY►
SITE ADDRESS �4l � C]nY'i 5E�Y1S0Yl I�Y�P_ �
THIS APPLICANT IS: � OWNER
ERTY O'WNER/ u�: tZaSeYYb�v':2 �aC�O�d.
�N� a,DDxFSS:� � C1nt1 S�'e�nSatn �e. Cm_�id\ � U STAT�II'�Z
PHONE: �l03 I S7 �i' �[ 4 � y
colvTx�,c�roR �:_ g��W�, BY ANDERSEN
SUBMIT A COPY OF STATE LICE j92O COITNTY RD. '�C�� WEST
YotrR sTA� Llc�rsE aDDxESS:_ ROSEVII.,LE, MN 55113 CI"TY STATE z�.
WITH APPLICATION pgp� 651-264-4777
P�9P�R=rv �rvv� _ u
❑
PERMIT TYPE Q
❑ BASEMENT FINISH
❑ DECK
�rE oF woux:
DESCRIBE WORK BEING DONE:
SIZE OF II��PROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPC?SED SIZE:
PROPOSID HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
� Other
vwnvnows
IN EXLSTING OPENINGS �Yes �No
OR W OP�I�IINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIIJDOW TO BE INSTALLED
� #�9139g83 --
❑ GARAGE/SI�D
❑ ROOF
0 SIDING
0 SWIlvIlvIDJG POOL
❑ ADDTI'ION
�PAIIt ❑ REMODELING
? � s W�YY1� s
LENGTH
❑ HOUSE ONLY
O HOUSE 8c GARAGE
� ATTACHED GARAGE
0 DETACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
i •�� � • � i �•��
/iLLl' � (�l r. , JL �
r�
Q DRAII�1 TILE
� OTI�R
HEIGHT Sa. F�
BASBMENT REMODELING SUBIvIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of shvcwral members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
,ADDITTONS_ & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing strucivres
and proposed project
2. Two sets of conshuction plans
3. Energy CalcuIations
ALL FEE5 ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA'
(USING,� 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ `T� �,S � OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb G�.t Escrow
Erosion Control
Park Fee
Sewer Main �
Total Due
�$
.., $ � , e �
$ ��►�
�. $ �. � n
$
$
$
�$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valua.tion — Minunum $.50
.001 x Permit Valuation (1/14%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Canservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City oi Fridley Attach
IS AN APPLICATION FOR A PERMIT-NOT VALID UIVTIL PROCESSED
I hereby apply for a ui ding permit and I aclmowledge 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 applicaiion for a permit d work is not to start without a permit; that the work will be in accordance with the approved
plan ' the case of all work wlu'ch req�ires r' andapproval o€plans.
GNATURE OF APPLICANT � PRINT NAME �► YY1 SCV1P�1� DATE �O ( J Z j � Co
Page 2- Building Residential Application ��
BUII.DING PERMIT FEE�CHEDULE
The C]uef Bu�.l di.ng 'Official 'sh�l.]., before � issuing permits for the erection of any bu3ldang � or
structure, or for any ad.d.ition to any e�isting building or shucture, or for �aary a1#�ra.tion or -repair
to any existing building or structure, upon application therefore, require the paym.ent by the
applicant for such permit of fees to the amount hereip. below: set farth, and in the ma.nner herein
provided to-wit: . • .
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.5.0 gl�s surchazgej-
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additi�nal $100 or fractian, to and
includi.n $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includi.n $$25,000
$25,001 to $50,000 $39125 for 1�` $25,000 plus $10.10 for ea.ch additional $1,000 or fraction,
to and including $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional$1,000 or fraction to and
including $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for ea.ch additional$1,000 or fraction to
and including $500,040
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,OOU or
fra.ction to and including $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a m;n;mum 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 existin.g foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
�
� �
Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE - � V '
SITE ADDRESS � r ��
THIS APPLICANT I5: ❑ OWNER �
PROPERTY OWNER/ NpME: �
TENANT . ______ / �
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
�rrrE oF wo�:
1'lilil3
I
ADDRESS
PHONE _ o�- -D
STATE LICENSE # K� �P � S �
❑ SINGLE FAMII,Y/NEW CONSTRUCTION
O TWO FAMII.Y/NEW CONSTRUCTION
❑ BASEMIIVT FINISH �F
❑ DECK ❑ SIDINCi
O NEW HOME CONSTRUCITON
O MAINTENANCFJREPAIR
Permit No.:a
��
Received By: ViL
n��a�EP 3 20C
���CITY � � ( (� �I � STAT
%
- r
F,vc Z� 3-� _p � Z`�os
EXP DATE '� - �
SIZE
STORIES
:ls�v o Wn�moWs
O DRAIN TILE
❑ 01'f�R
NG POOL
O ADDTfION
O REMODELING
� z�r.
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S Ff
ROOFING � C/ ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
N[JNIBER OF SQUARES �� 0 HOUSE & GARAGE 1. E3tisting Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: 0 DETACHED GARAGE 3. List of structural members w be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCfION INCLUDING DECKS,
0 Vi�l �Soffn ADDTfIONS, 8c PORCHES SUBNIIT:
O Aluminum ❑ T� 1. Site Plao/Survey showing the existing strucdues
� Other � Fascia a"d pr°p°sed pr°��.
2. Two se�c of conshaction plans
WINDOWS 3. Energy Calculadons
IN EXISTING OPENINGS ❑Yes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF �
OPENING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
TOTAL JOB VALi
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
�SED ON VALUATION, INCLUDING THE COST OF LABOR AND MA'�'RiAi c;
(USING THE 1997 UBC FEE 3CHEDULE)
���� e OCCUPANCY TYPE
$ ���, �� 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)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21 =$ ,
$ $450 Conservation P.lan Review
$ ' Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �`'�„ Make checks payable to: Ciity of Fridley Attach
THIS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
[ hereby apply for a building pemiit and I aclmow edge that the info ve is complete and accurate; that the work will be in confom�ance with the ordinances and codes
of the City of Fridley and with the Minnesota ction Codes I d this is not a permit but o y an applicadon for a pemut and work is not�p without a
permit on site; that the work will be in acco ,the plan ' e c�se of ap work which requ' review and approval of pl �J�
SIGNATURE OF APPLICANT ( RINT NAIvIE +(� ( n GZ- �DATE 6����
APPROVED BY
DATE
���