AF - 42958�* �
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2422 Enterprlse Drive
Mendota Holghte, MN 55120
LAND SURVEYORS • cvt� oraN�s (812) 681-1914 FAX:681-9488
LAND PLANNERS . uNDSCAPE ARCHI7ECT5 625 Hlyhwoy 10 N.E.
Blalne, MN 55434
(612) 783-1880 fAX:783-1883
Certificate of Survey for: THE ROTTLUND C�MPANY
House Address: 8461. 6483. 6465. & 6467 Christenson Couri
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House Model:
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x 900.o Denotes Exlstfig Elevotlon �
� Qenotes Proposed EleMatlon
— Denotea Drclnage �fow Dlrectlon �
—� Denotes DrcJnage dc UtIllty Ecsement
--0- Denotes Monument
-�- Denotes Off�et Iron Bearings show� are assumed
LOTS 8-11 , BLOCK . 2
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Garaga Slab Elevation: 861.0 (at door)
NOTE: Proposed buBdhg site g►ading b in accadancs ritM the
• 9��9 Pbns opproved br the clty angk�eer.
N07E: Contraotor must rxify aN dime^atona �C d�ivsway deal9^•
CHRISTEIeT50I1T CR.O5SING
ANOKA COUNTY. MINNESOTA
We hereby certify that this survey, plan or report was prepered by me or under my direct supervision and that I a duly licensed
Land Survey�or under the laws of the State of Minnesota: Dated this �_ day of A.D. 19�
Signed: PI R ENGINEERING, P.
t BY �
S c a le .��—� O�- Robd-t B. Sikich, L.S. Reg. No. 14891 or
3� 16190 60 TRB Terrence E. Rothenbacher, L.S. Reg. No. 20595
SuBJEC�
City of Fridley
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
r
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� • COMMUNITY DEVELOPMENT OIV
r � v � PROTECTIVE INSPECTION SEC
� '� �'-'1 � CITY HALL FRIDLE� 55032 NUMBER aEV DATE
�""� � �'' 612-571-3450 910-F15 6/5/97
JOB ADDRESS 6461 Chz�stenson Lane NE _�
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 8 2 Christenson Crossing
2 PfiOPERTY OWNER MAIL ADDRESS
Rottlund Co 2681 Long Lake Rd, Roseville MN
3 CONTRACTOR MAIIADDRESS
Same
A ARCHITECT OR DESIGNER MAIL ADDRESS
Timothy Johnson _
5 ENGINEER MAILAODRESS
ETS Inc 220 S Marion Rd, Sioux Falls, SD 57107
6 USE OF BUILDING
Residential
PAGE Of
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TCf�AII l I�IV. ��
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RECEIPT NO. `
��6�
APPFOVED BY
SEE ATTACHED
SHEET
113 638-0500
ZIP PHONE LICENSE NO
Zlp PHONE LICENSE NO.
22350
ZIP PHONE LICENSE NO.
19015
7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
�
8 DESCRIBE WORK
Construct a Townhouse & Garage
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan. Paid Park Fee of $1,500 for building.
Monies paid below are for all four units.
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIRED FOF ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZpNING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOfiK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $434,591
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �2,562.LS
� PLAN CHECK FEE
` � 5
. l)RE OF CON'AAC A OR THOAIZED AGENT IDA EI �y WHEN PFi
pF pWNEA��F OWNEA B ILDERi _ _ 10ATE�
s
OCCUPANCY GiiOUP IOCCUPANCYLOAD
FT. I CU. F
OFFSTHEET PARKING
STALLS GAFAGES
SURTAX Fire .5�,'
$217.50 434. 9
SAC CHARGE
$3,800 (4)
TOTALFEE
$7,014.34 + PF
:RLY�VA�LIDATED THIS IS VOyR PERMIT
�s� � � 0l /J
T
Fi�paid P1an Cl�ck $
Fstimated Cbst $
Receipt #
M � � ��
I' ! � I I �' �I • : I�I 1. .`� 1: :
S[JILIiINCr P�MIT APPIIC'AZIOIv
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• - �... - 1/; ` \.+lir .s i : �,�, : : __ , s;. �=1
CO�7I'RAC'POR & ADDRFSS
Architect & P�ddress
��� & Aaa�s _
Effective 3/1/96
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Zoning
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?�g.# 'L'L S�v
�.# 1Ra15
- 'S�10-1
TYPE OF WORIt � New ❑ Ar.3dition 0 A].teration -Describe �1�10b7� ED
L,IIJ o T (�ov�..a � 1 ��AJI-� �mE �•�i.��u�i cJC�
Applieant Signature �; j��i� 6,�1 e„� Tel # • G!'� Date � � q-q �
BDII,DIl�]G DIl��ISICS�TS �
�
Length o� —��� Width .�a° � Q" Height'���v f� Sq. Ft.� # of Stories �
OFC. AREA: Length Width Height Sq. Ft.
�E AREA: L�ength � Width Height Sq. Ft.
O�iER ARE�: Length Width Height Sq. Ft.
VALI]ATIC�T
sq. �. � X s 5y. �a c��sg. �. - v�,�t��. $�►z��o�o°�7
sq. Ft- ia2b0 X $ 1 A. �'oZ �/s�. Ft. = vatuation $ z1 °° ) _ $ yl3`�± �5.� . �
Sq. Ft . x$ Gost/Sq. Ft .= valuation $ ) 'ITO'I'AL VALTJE
Building Use i � l� Construction 'Type�� N� OccupancY GrouP �'3
Ais Conditioning �Yes L] No Fire Protection Prr�vided [l Yes �No �°wN�°��
Performance Band ,Arrou.nt $ See Reverse for Schedule i�ceived [] Yes [l No
�t F� $ �.S'�� .as
Plan Check $
� s���� . $ 3 -,�'
State St�rchan3e $ o7/7.SG�
sAC ct�arye � S ��, l�
Erosion Control $
�k F�gx��s S /Soo• ao
spec. Assessments $
nriveway Escrow $
m�L $ S . �
See Fee Schedute on Reverse Side
In E�ccess of Prepaid Amount - See Reverse Side
.00l x Perntit valuation cl/loth o)
$.5o/$i, o0o valUation (see �sched. for > $i r�llion)
$98b per SAC Unit (Plans to NdnTCC for determination)
$450.00 Cbnservation Plan Review
Fee Detezminea By Engineering
Agreement Necessary ❑ ,Not Necessary []
feet x $13.50/foot
. `%o�y� �, ��s � .
$1 to S00
501 to 2,000
2,001 to 25,000
25,001 to 50,000
50,001 to 100,000
1�0,001 to 500,000
500,001 to 1,000,000
1,000,001 and up
$1 to 2,OOp
2,001 to 25,000
25,001 to 50,000
SO,QO1 � to 100,000
100,001 to 356,000
O�er $356,000
"���u�� r�.KM1T �EE SCHEDULE
$21 (Minimum Fee is $21 plus surcharge) �
$21 for lst $S00 plus $2.75 for each addn'1 $100 or fraction, to and includ:
$2, 000
$62.25 for lst $2,000 plus $12.50 for each addn'1 $1,000 or fraction, to a
including $25,ppp
$349.75 far 1st $25,OOp plus.$g,00 for each addn'1 $1,000 or fraction, to a
including $50,000 � .
$574.75 for lst $50,000 plus $6.25 for each addn'1 $1,000 or firaction, to a
including $i0p,ppp
$887.25 for 1st $10U,0pp plus $5.00 for each add.n'1$1,000 or fraction, to a�
including $SOO,OOp _ . � .
$2887.25 for the lst $500,000 plus $q.,25 for each addn'1$1,000 or fraction,
and including $I,ppp,pOp
$5012.25 for the lst $1,0OO,Opp pl� $2,�5 for each addn'1$1,000 or fraction
PREPAID PLAN.CHECg FEE SCHEDULE
$29.25 .
$29.25 for lsfi $2,000 pIus $5.85 for each addn'1$1,000 or fracfiion, to �and
including $25,000 ,
$163.80 for lst $25,Opp pi� $9.,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 $1pp,000
$415.68 for lst $100,000 plus $2,2�5 for each addn'1$1,000 or fraction, to and
including $356,000
$1,040 (Balance due with issuance oi building permit)
PERFORMAIVCE BpND POLICIES
When a building permit is issued for a commercial, indusGrial or a multiple dwelling residential project which re uire
outside improvements,a Performance Bond or a Letter of Credit shall be submitted to the City. The bond willc ove
all outside improvements, including but not limited to landseaping, irrigation, curbing, blacktopping, screening fences
lighting, and storm drainage systems.
Calculation of bond amounts will be determined by the buildin
buiIding permit value up to a 2 million dollar project or a$60,Opp bo d Actual amounts will be rounded o�e of th
$100. The City reserves the ri ht to re neares
g Quire greater or lesser bond amounts based on unusual circumstances, Project.
with no outside improvements, generally will not require a band.
Bonds must remain open until the project is fuily completed. A� bonds will be held over one winter and throu h the
next growing season to insure the survivaI of all Iandscape installa�o� �e City will then inspect these ro ertie:
in August of the year following the initial planting. B�n� �y �en be released in October of that ear if al
improvements are sadsfactorily completed. y
.
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HEAT LOSS
SOLD BY
Elsetrfcoi Work Br
TYPE OF HEAT
MAKE
Mod•I
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�.APT. FLOOR CITY SUBURB
� OWNER
INSTALLED BY
Gas Lin� Br
_ SPACE HTR. UNIT HTR. ' OTHER
CON V E RSI ON
MAKE OF BURNER
Model
Mas. BTU Rating
MAKE OF FURNACE
Model
�" CONTROLS � �/�
THERMOSTAT � Hs t �� Vent Siss i -
Valrs KIND OF LINER SIZE NON
Limit D�aft Hood '� I � '
� �e9ularor
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Limit SsNi�y Fi Itsrs Sise�� G umbsr �
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Pitor Tr� "' Chim�ey Construetion
Pilot Maks �
Pilot Modsl Smoke Bomb
Pilot Timing 'f�" f'. ���- Draft
L.W. Cut Off Door Pressurs
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; Pressure � reent G02 �' Dote Tested �
Input CFH Peresnt OZ Company Testing
Staek Temp. f� Perc�ot CO Name of Tsstsr
235
_Wiring
_Tsst Tap
_ Lightin9 Inst.
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FRIDLEY
FRIDLEY MUN[CIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
October 29, 1997
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 6461 Christenson Lane NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on October 29, 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,
RON JU
Building
RJ/mh
.�.
suerecr "PER�MIT NO'
City of Fridley 25 7 81
AT THE TOP OF THE TWINS gU ILDING PERMIT ��\
r -�
� � 'iifCETP7�N0.
� • COMMUNITY DEVELOPMENT DIV. � / /
� LV ������� / �/[/
r � � PROTECTIVE INSPECTION SEC.
� �
� .1 �
� 1 �"'1 � CITY HALL FRIDLEV �03Z NUMBER REV OATE PAGE OF APPROVED BY
ti.__.11.' '•i 612-571-3460 et0-F15 2/3/98 / /
JOB ADDRESS 6461 Christenson Lane NE
LOT NO. BLOCK TRACT OR ADDITION
1 LEGAL SEEATTACHED
oesca. 8 2 Christenson Crossing SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PMONE
Mar% Foley 6461 Christenson Lane NE
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
A E Wallen Homes Inc 4571 North Rd, Ci�cle Pines, MN 55014 780-8812 1950
d ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADORESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential Townhouse
7 CLASS OF WORK
❑ NEW O ADDITION [� ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFK
Finish entertait�ment room on lower level
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
�A�ATE PEFt�AITS RE�UIRL-'D FOt�
1NIRIIVG, h1EATIN�, �'L�1�fEi�lG AND �iGltiS;o
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, NEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTfiUCT�ON ZONING SO. FT CU. FT
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 OAYS AT
ANY TIME AFTEH WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yALUATION SURTAX
ANO OHDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �/�, OOO �L.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PEFMIT �
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON- @
STRUCTION T ERFO, NCE OF CONSTRUCTION. � W87 • 25 Fire S�'i ��i. 0�
,/ �`� � PLAN CNECK FEE TOT FEE
Licens C $5.0 $98.25
iGNATUREO CON'RACTOAORAUTMOR12EDAGENT IDATEi EN ROP ALID T�IS IS YOUR PERMIT
J��, � �r
� �rI
S�GNATU�iEOFOWNEA�iFOWNERBUILDER� �DATEI .� Bl �NSP pFTE
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: � �� � ���� ��� ����
Legal Description:
Effective 1 / 1 /98
�� �����
�
Owner Name & Address: �i'�/�/� �� Tel. #
Contractor: � G , �it���� /��� �%�G MN LICENSE # ��,� -
�
Address: ��.S�r ��!� ��°'= �t�� �ii/� i���/.�� el. # �lz ����Z
� � Attach to this application, a Certificate of Survey of the 6l Z� 3��`�� �
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTI�R: �iuS� ��1/%��71��,v /�ac� /�ios�-- � G� �G��'`t
�
Construction Type: Estimated Cost: $ y/%�1��-
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT: Tel. #�
CITY USE ONLY
Permit Fee
Fire Surcharge
State 5urcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � Z�
$ �
$ 2. `,�
$
$ 5%�
$
$
$
$
$ �� 2�
Fee 5chedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUII�DING PERMIT 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 permit 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
$100,001 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 $1,000
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 $100, 000
$887.25 for first $100,OQ0 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,Q00 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.
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sue�ecr PE . i'
City of Fridley 2 8 854
AT THE TOP OF TNE TWINS g u I L D I N G P E R M I T
;,
� � COMMUMITY OEVELOP�MENT OIY. p�
� •
� `y � '
r � � PROTECTIVE INSPECTION SEC. 1�19�99 �� o
� _ �
� ��"1 � CITY MALL FRIOLE� S�132 NUM6EP REV DATfi VAGE OF APVROVED BY
�"'"�� �'� 612-571-345p 910-Ft5 � �
JOB AODRESS 6461 Christenson Lane NE
t LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
oescR. g 2 Christenson Crossin SNEET
2 PROPERTY OWNER MAIL ADQR�$$ ZIP PNONE
Christenson Crossing Townhomes
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
Town & Country 7910 12 Ave Bloomin ton -
4 AFCHITECT OR DESIGNER MAIL AODFiESS ZIP PNONE L E NO.
5 ENGINEER MAILAODRESS 21P PNONE IICENSENO
8 USE OF BUILDING
e i
7 CLASS OF WORK
❑ NEW ❑ AODITION O ALTERATION ❑ REPAIR O MOVE � O REMOVE
8 DESCRIBE WORK
Re a r s
9 CHANOE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
TYPB OF CONST. OCCUPANCV GROUP OCCUPANCV �OAO
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING. FIEATING.
VENTILATING OR AIR CONDITIONING
TMIS PEiiM1T BECOMES NULL ANO VOID IF WORK OR CONSTRUGTION ZONING SO. FT CU fT
AUTHORIZED IS NO7 COMMENCED V�1ITHIN 80 OAVS. OR IF CONSTHUCTION
017 WORK IS SUSPENDEO Oii ABANQONED fOR A PER100 OF 12p DAVS A7
ANV TIME AFTER WORK IS COMMENCED. ' NO DWLG- UNITS OFFSTAEET PARKING
I HEREBY CERTIFV TMAT I HAVE READ ANO EXAMINEO THIS APPLICA710N STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE AND CO�pECT. ALl PROVISIONS OF LAWS VA�UATION SURTAX
AND ORDINANCES GOVERNING TMIS TVPE OF WQRK WILI �E COMPUED
WITM WHETHER SPECIFIED MEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHOFi1TV TO VIOIATE OR CAMCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANV OTMER STATE Op LOCAL LAW REGULATING CON- @
STFUCTION OR TME PERfORMANCE OF CONSTRUCTION �p21.00 Fire SC �.SO
PIAN CMECK FEE TOTAI F
.�� � ��°ij License $5. $27 00
S�GNATUAE O� CON"Aa OA OA AUTNOp�ZED AGENT iO�TE� EN flOP VALIOATE T 1S IS�UF PERMIT
� '� /
S�GN4TUpE O� OWNEQ��� OWNEpBU�LOEA� IDATE� � ' G�NSp - O6Tt
� Il
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII.DING PERMIT APPLICATION �
a
.� �o�
constructionAadress: � �� �, C� ��G� j � �� � � C
Effective 1/1/99
�� p�
� �'
Legal Description: �
Owner Name & Address: Tel. #
Contractor: �c�• a��'�u •�'� ,� MN LICENSE �0?40 j/?8 Z
Address: '�y/0 /dZ � �c ����u, ��o�. %��1 .SSya7S Tel. # ✓�s�S - 5�z33
Attach to this apnlication, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECB AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
��--� � o
Construction Type: �'Y ���r S.r,P�,P'� Estimated Cost: $ ���
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �— / y- °i � APPLICANT: j ��ii� g .� �' � �/ Tel. � yo s -�io - � gi3
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAI:.
STIPULATIONS:
$ O?/ v �
$ �
$ S�
$
$ .� (� �
$
$
$
$
$� ��1�
CITY USE ONLY
Fee Schedule on Reverse Side
. QO l of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� Su6�ECT . � � P� --,_
City of Fridley 8 9 � �
AT TME TOP OF THE TWINS g � I L D I N G P E R M I T
r
; � RECEIPT NO.
� • COMMUNITV DEVELOPMENT DIV. �%
� j V �'��� , �(/ �
f � � PROTECTIVE INSPECTION SEC
L--_. �;/"','� CITY NALL FRIOLEr SS1�2 NUMBEII pEV DATB PAGE OF APPROVEO 6�
L J� 612-5��-3a5o 910-F15 3/5/99 / /
�oe aooaess �
6461, 6463, 6465, 6467 Christenson Lane NE
t LEGAL LOT NO. BLOCK TRACT OR AOOITION SEE ATTACMEO
oesca. 8 to 11 2 Christenson Crossing SHEET
2 PiiOPERTY OWNER MAIL ADpR�S$ ZIP PMONE
Rottlund Townhomes
3 CONTRACTOR MAII ADDRESS 21P PHONE LICENSE NO
Town & Countr Roofin 7910 12 Ave S Bloomin ton MN 55425 545-4233
4 ARCMITECT OR DESIGNEii MAIL AODRESS ZIP PMONE LICENSE NO.
545-4233
5 ENGINEER MAII ADORE$S ZIP PMONE LICENSE NO
8 USE OF BUILDING
Townhomes
7 CLASS OF WORK
0 NEW p ADDITION p ALTERATIpN xp REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Building (90 Sq ) Tear-off
9 CHANGE Of USE FROM TO
STIPULATIONS
Underlaym.ent must comply with the State Building Code.
TYPE OF CON T. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS AFiE REOUIREO fOfl ELECTRICAL. PLUMBING, MEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTfiUCT10N LONING SO. FT CU FT
AUTHORIZED IS NOT COMMENCED V�ITNIN 80 DAYS. OR IF CONSTHUCTION
Ofl WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS A7
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMIN�D TMIS APPLICATION S7A��5 GARAGES
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX
AND ORDINANCES GOVERNING TNIS TYPE OF WORK WILL QE COMPUED
WITH WHETMER SPECIFIEO HEREIN OR NOT. TME GRANTING OF A PERMIT �7 � 713 �3.86
DOES NOT PRESUME TO GIVE AUTMOiiITY TO VIOLATE OR CAMCEI TME pEqMIT FEE SAC CMAFGE
PqOVIS10NS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON• $13J.25 Fir C�7.71
STRUCTION OR TME PERFONMANCE OF CONSTRUCTION
PLAN CNECK FEE TOT EE
C� Liceens $5.0 3.82
S�GNATU Of ON'WACTOp RAUTNOR�ZED G� 1DAfEi EN P OP ALIOA F�IS IS V Up PEpM1T
L� �-�-°
S�GNOTUAE O� OWNEA��� OWNEA BU�LDEp� �D�rE� Bl0 NS� � ���T E
Mar-04-99 05s47P
NEW ' L l
AllDN [ ]
AI,T�R ( ]
ConscructionAddress:
Legal Description:
Owner N��Address:
Contract�c: /�7c)Y1 �i \
Address:
LIVI�iG AREA:
CITY OF FRIDLEY
SYNGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDINCr PERMiT APPLICATION
��
P_06
1,:��o�ura, ai ai�u
��
. �� Q�
� �D
� i'el. #
_ MN LICENSE ��U,j�'�% R
; Tel. � -
Attach to this application. a Cectificate of Survey of the
lot, with the proposed constniction drawn on ic to scale.
DESCRiPTION OF IMpROVEMENT
Length Width �, Heig6t Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
AECK AREA: Length Width HgdGround Sq. Ft.
OTNER: ����
---� ,,[�� % �
Coizscruction Type: � p� (� 1-T g►' �� ��'� Estimated Cost: $� i�� �r� %_
(Fee Schedule on Back)
Driveway Curb G�t Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT: Tel. �l,{S'y.S -�/� . 3 3
Permit Fee
Fire Surcharge
S[ate 5urcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ " 37,
$ `i ��
$ �. �'
$
S �� �'
$
$
$
$
� I��3j ��
CITY U5E ONLLt
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.SO!$1�000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
F�e Determined by Engineering
Agreement Necessary [] Not Necessary L 1
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CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
PERNIIT N .: 2004-0132�1
DATE ISSUED: 08/12/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 6461 CHRISTENSON LN NE
PIN : 143024320197
LEGAL DESC : UNAVAII.,ABLE
: LOT BLOCK �
PERMIT TYPE : PLUMBING
PROPERTY TYPE : TOWNHOUSES
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A WATER
SOFTENER.
# ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) 0
# GA5 DRYERS 0 # GAS RANGES 0
# OF NEW FIXTURES 0 VALUE (FOR NIINIMUM CALC) 300
# WATER TRMT APPLIANCES l
APPLICANT PLBG PERMIT 11�IINIMUM FEE 0.00
SHII.OAH WATER CO PLBG FIXTLTRES (NEW OPENIlVGS) 0.00
7319 166 AVE NW PLBG FIXTURES (EXIST OPENINGS) 0.00
RAMSEY, MN 55303- WAT'ER HEATER - ELEC 0.00
(763) 753-9244 GAS RANGE FEE 0.00
GAS DRYER FEE 0.00
WATER TREATMENT APPLIANCE 35.00
OWNER STATE SURCHARGE, PLBG FLAT 0.50
JOB LILLY TOTAL 35.50
6461 CHISTENSON LN NE PAID WITH CHECK # 10009
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
T'his permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the perfo ance construction.
Applicant Date
Bldg Ins D�
5EPARATE PERMITS Q D FOR WORK OTI�R THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
►63) 572-3604 FAX: (763) 571-1287
ADDRESS : 64G 1 CHRISTENSON LN NE
PIN : 143024320197
LEGAL DESC : UNAVAILABLE
: LOT 8 BLOCK 2
PERMIT NO.: 200402311
DATE ISSUED: 12/21/Z004
R6599
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : COMMCRCIAL
CONSTRUCTION TYPE : ADDiTION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMGS VOID 12 MONTHS AFTER PERMIT ISSUE DATE.PH :763-784-3729
1;1 # INSPECTIONS
# 0-100 AMP CIRCUITS 2 # 101+ AMp CIRCUITS
APPLICANT
LAZER ELECTRIC
8164 ARTHUR STREET N.E
SPRING LAKE PARK, MN 55432
(763)784-3729
OWNER
GITTLEMAN MANAGEMENT CORP.
6461 CHISTENSON LN NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any tiane after work is commenced.
I her�by certify that I have read and cxamined this
applicat�on and know the same to be truc and conect. All
provisions of laws and ordinances govcrning this type of wor�
will be complied with whether specified he�ein or not. The
granting of a permit does not presume to give authority to
violate ar cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant __Date
Bldg Insp __Date
ELEC PERMIT FEE - MIN (NON-RESI)
ELEC AMP SERVICE FEE
ELEC CIRCUIT FEE (0-100 AMPS)
ELEC CIRCUIT FEE (101+ AMPS)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 42761
SEPARATE PCI:MI'1'S REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0.00
30.00 u
1`ERQO \l� �
0.00
0.50
42.50
Building ,
Inspections
763-572-3604
DATE :� � e� � �7
SITE ADD S �
THIS APPLICANT iS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
12ESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL
�r,`s�-e�5o+� ��v►< �
❑ OWNER �1CONTRACTOR
�
e� o � �rv�DH��� �ti
ADDRESS: CITY
PHONE: GZ�J`�`- " a % � ` a � � � .
NAME: � e� v. ( e,s ,e o H s �
STATE LICENSE # e�- �a
f,.1 L
- 7�i S- S 35��
0 SINGLE FAMILYINEW CONSTRUGTI(
❑ TWO FAMILY/NEW CONSTRUCTION
EXP DATE
❑ BASEMENT FINISH ❑ ROOF
O DECK ❑ SIDING
❑ SWDvWIING POaL
TYPE OF WORK: � �
O
DESCRIBE WORK BEIN�i
SIZE OF INIPROVEMENT_
1VUMBER OF SQUARES
GARAGES
PROPOSID SIZE:
PROPOSID HEIGHT:
SIDIIVG
❑ Vinyl
❑ Alumimun
❑ OOdier
W1lVDOWS
IlV EXISTII�iG OPENINGS ❑Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPEMNG CHANGES &
TYPE OF WII�IDOW TO BE INSTALr _Fn
❑ HOUSE 8c GARAGE
❑ ATfACHED GARAGE
❑ DEfACHED GARAGE
OSoffrt
❑ Trim
❑ Fascia
LACATION OF WiNDOWS
Pemut No.:
Received By:.
Date �Lr'ti: °
CITY�I t ! 04'
IES
❑ WW�WS
❑ DRAIN TiLE
-�'OTE�R
�
'���� ` -��4ce
)TH HEIGHT
'ATE ZIP
a.r��� s,> l o Y
RASENIENT REMODELING SUBNAT:
1. Existing Floor Plan
2. Proposed floor pian
3. List of struciaual members to be used
Ft
, FOR AIEW CONSTRUCTION IAICLUDING DECKS,
f�DD1TIONS. & PORCHES StJBMIT:
1. Site PlanlSwvey showing the existing strucwres
� ProP� P�.l�
2. Two sets of construdion plans
3. Energy Calculations
�
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIA.LS:
(US �I-7-�E �� SCHEDULE)
TOTAL JOB VALUATION ''—°-�_ � OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
License Surcharge
SAC Charge
Curb G�t Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Tntal nnp
$.�(n3,,�J,j See Back Page for Fee Schedule
$ 65% of Building Permit Fee
���,.� �
$ �� 5� .0005 x Permit Valuation Minimum $.50
$ ,� U� $5.00 (Staxe Licensed Residential Contractors)
$ � $1675 per SAC Unit (Plans to MWCC for determinaxion)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$�i� �, i,� Make checks payable to: City of Fridley Aitach
� THIS IS AN APPLICATION FOR A PERMIT-N07 VALID UNTIL PROCESSED
I hereby apply for a building permit and I a.clrnowledge 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; thax I understa�d this is not a
permit but only an application for a p it and work is not to start without a ermit; that the work will be in accordance with the approved
plan in the case of all work w i�� �q es review'and approval of plans.
SIGNATURE OF APPLICANT � � PEtINT NAME . L���'1 �� t� (�► I t�' DATE I ���
P�.ge 2- Building Residential Application ,
BUII..DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing pemvts 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 struct�ue, 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 FEES
$1 to $500 $23.50 (Minimum Fes is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1� $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000 $69.25 for 1�$2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional$1,000 or fraction,
to and includin $50,000
$SO,QO 1 to $100,000 $643.75 for 1$SO,OQO plus $7 for each additional$1,000 or fraction to and
includin $100,Q00
$100,001 to $500,000 $993.75 for 1� $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000 $3,233.75 for the 1� $500,000 plus $4.75 for each additional $1,000 or
fiaction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each add.itional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Perm.its for conshuction will be issued a minimum 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, showi.ng the location of the existi.ng foundation will be
required before proceeding with the framing. New Houses Onlv
� City of Fridley �
. , Building Inspections Department
- - '�ersYrt-y�e
Fridley, MN 55432
763-572-3604
FaX: 763-502-4977
W
� ` �
Restoration Contractors, Inc. dba Clean Response
-
480 N. Prior Ave.
661-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
Client: Gittleman - Christenson Crossing
Property: 6461 Christianson Lane
Fridley, MN 55432
Operator Info:
Operator:
Estimator:
Type of Estimate:
Dates:
Date Entered:
ANDY
ANDREW BANAS
Water Damage
12/21/2007
Price List: MNMN4B7D
Restoration/Service/Remodel
Estimate: CHRISTENSON-CON
Business: (952) 277-2720
Business: (651) 755-0639
:q�
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i'
i`�.°'
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'i �
�
�
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
ss1-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
�@''--' Room: Office
T mr ."
tb : �
b � ±
��
1- �Q.
'��.. r
�r
�c
�
CHRISTENSON-CON
Basement
481.26 SF Walls
682.45 SF Walls & Ceiling
22.35 SY Flooring
60.16 LF Ceil. Perimeter
Ceiling Height: 8'
201.19 SF Ceiling
201.19 SF Floor
60.16 LF Floor Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Batt insulation -12" - R38 201.19 SF 0.00 1.34 269.59
Batt insulation - 6" - R21 240.63 SF 0.00 1.08 259.88
R&R Visqueen vapor barrier 240.63 SF 0.07 0.32 93.84
5/8" drywall- hung, taped, with smoath 562.14 SF 0.00 2.44 1,371.62
wall finish
1/2" drywall - hung, taped, with smaoth 120.32 SF 0.00 2.45 294.78
wall finish
SeaUprime the walls and ceiling - one coat 682.45 SF 0.00 038 259.33
Floor protection - self-adhesive plastic film 201.19 SF 0.00 0.49 98.58
Room Totals: Office 2,(4�,(2
I---S 91° �
°' s T
: I�
+�N m
� � � �
�� 1
�,� ��„�
s.
DESCRII'TION
Room: Utility Ceiling Height: 8'
237.69 SF Walls 55.73 SF Ceiling
293.42 SF Walls & Ceiling 55.73 SF Floor
6.19 SY Flooring 29.71 LF Floor Perimeter
29.71 LF Ceil. Perimeter
Batt insulation - 12" - R38
Batt insulation - 6" - R21
R&R Visqueen vapor barrier
5/8" drywall - hung & fire ta.ped only
Clean floor
CHRISTENSON-CON
QNTY
55.73 SF
118.84 SF
118.84 SF
174.57 SF
55.73 SF
REMOVE
0.00
0.00
0.07
0.00
0.00
REPLACE
134
1.08
TOTAL
74.68
12835
0.32 46.35
1.44 25138
0.34 18.95
12/28/2007 Page: 2
0
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
651-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
CONTINUED - Utility
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Room Totals: Utility 519.71
�-3' 11 ° -
�
a� �.
T'
•7 m k�a in
1 a � 4'5°�3'6°
�__:____:.�
Mhi Ra�
Room: Lanndry Ceiling Height: 8'
l183.30 SF Walls 44.21 SF Ceiling
m 227.52 SF Wa11s & Ceiling 44.21 SF Floor
�� 4.91 SY Flooring 22.18 LF Floor Perimeter
26.59 LF Ceil. Perimeter
Missing Wall: 1- 4'S" X 6'8"
DESCRIPTION
Opens into Mnd Room Goes to Floor
QNTY REMOVE REPLACE TOTAL
Batt insulation - 12" - R38 44.21 SF 0.00 1.34 59.24
Batt insulation - 6" - R2l 45.83 SF 0.00 1.08 49.50
R&R Visqueen vapor barrier 45.83 SF 0.07 0.32 17.88
5/8" drywall - htmg, taped, with smooth 135.87 SF 0.00 2.44 331.52
wall finish
1/2" drywall- hung, taped, with smooth 91.65 SF 0.00 2.45 224.54
wall finish
SeaUprime the walls and ceiling - one coat 227.52 SF 0.00 0.38 86.46
Floor protection - self-adhesive plastic film 44.21 SF 0.00 0.49 21.66
Clean floor 44.21 SF 0.00 0.34 15.03
Room Totals: Laundry 805.83
CHRISTEN50N-CON 12/28/2007 Page: 3
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
ss�-sas-saoa ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
�
4'3°+3'6°
^ - -=---=- T
�
� N Q
s°qt�4 4=� 1
�
Missing Wall:
Missfng Wall:
DESCRIYTION
Room: Mnd Room Ceiling Height: 8'
130.36 SF Walls 32.95 SF Ceiling
16331 SF Walls & Ceiling 32.95 SF Floor
3.66 SY Flooring 15.56 LF Floor Perimeter
19.98 LF Ceil. Perimeter
1- 4'4" X 8'0" Ogens into Stair 1
1- 4'S" X 6'8" Opena into Lanndry
QNTY REMOVE
Goes to Floor/Cefting
Goes to Floor
REPLACE TOTAL
Batt insulation -12" - R38 32.95 SF 0.00 1.34 44.15
Batt insulation - 6" - R2 ] 32.59 SF 0.00 1.08 35.20
R&R Visqueen vapor barrier 32.59 SF 0.07 0.32 12.71
5/8" drywall - hung, taped, with smooth 98.13 SF 0.00 2.44 239.44
wall finish
1/2" drywall - hung, ta.ped, with smooth 65.18 SF 0.00 2.45 159.69
wall finish
SeaUprime the wa11s and ceiling - one coat 163.31 SF 0.00 0.38 62.06
Floor pmtection - self-adhesive plastic film 32.95 SF 0.00 0.49 16.15
Clean floor 32.95 SF 0.00 0.34 11.20
Room Totals: Mud Room 580.60
e
DESCRIPTION
Room: Garage Ceiling Height: 8'
573.74 SF Wa11s 319.24 SF Ceiling
892.98 SF Wa11s & Ceiling 319.24 SF Floor
35.47 SY Flooring 71.72 LF Floor Perimeter
71.72 LF Ceil. Perimeter
QNTY
REMOVE
Batt insulation - 12" - R38 319.24 SF 0.00
Batt insulation - 6" - R21 573.74 SF 0.00
CHRISTENSON-CON
REPLACE
134
TOTAL
427.78
1.08 619.64
12/28/2007 Page: 4
Restoration Contractors, Inc. dba Clean Response
� ' 480 N. Prior Ave.
6b1-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
DESCRIPTION
CONTINiJED - Garage
QNTY REMOVE REPLACE TOTAL
R&R Visqueen vapor bazrier 573.74 SF 0.07 0.32 223.76
5/8" drywall - hung, taped, with smooth 892.98 SF 0.00 2.44 2,178.87
wall fuush
SeaUprime the walls and ceiling - one coat 892.98 SF 0.00 038 339.33
Overhead door repair - Minimum charge 1.00 EA 0.00 185.00 185.00
Remove Overhead door ttack 28.00 LF 1.04 0.00 29.12
(Install) Overhead door track 28.00 LF 0.00 4.22 118.16
Detach di Reset Overhead (garage) door 1.00 EA 0.00 0.00 162.25
��
Clean floor 319.24 SF 0.00 0.34 108.54
Room Totals: Gara.ge 4,392.45
+ :.. - -
� ■.�
.��
.��
��
�'��
�- -_ .�
�.�
.�
� �I
Room: Storage
272.93 SF Walls
312.19 SF Wa11s & Ceiling
4.36 SY Flooring
34.12 LF Ceil. Perimeter
Ceiling Hefght: 8'
39.26 SF Ceiling
39.26 SF Floor
34.12 LF Floor Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Batt insulation - 6" - R21 136.47 SF 0.00 1.08 147.39
R&R Visqueen vapor barrier 136.47 SF 0.07 0.32 53.22
5/8" drywall - hung, taped, with smooth 312.19 SF 0.00 2.44 761.74
wall finish
SeaUprime the walls and ceiling - one coat 312.19 SF 0.00 0.38 118.63
Clean floor 39.26 SF 0.00 0.34 13.35
Room Totals: Storage 1,094.33
CHRISTENSON-CON 12/28/2007 Page: 5
Restoration Contractors, Inc. dba Clean Response
' ' 480 N. Prior Ave.
661-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
� i��■
■��■
�s: �i
e�,_�.�
■�i
■�■
■��
Room: Stair 1 Ceiling Hefght: 17'
248.25 SF Walls 30.16 SF Ceiling
278.40 SF Walls & Ceiling 72.13 SF Floor
8.01 SY Flooring 23.07 LF Floor Perimeter
18.31 LF Ceil. Perimeter
Missing Wall: 1- 4'4" X 8'0"
DESCRIPTION
Opens into Mad Room
QNTY REMOVE
Goes to Floor/Ceiling
REPLACE TOTAL
Batt insulation - 6" - R21 124.12 SF 0.00 1.08 134.05
R&R Visqueen vapor barrier 124.12 SF 0.07 032 48.41
5/8" drywall - hung, taped, with smooth 124.12 SF 0.00 2.44 302.85
wall finish
SeaUprime the walls and ceiling - one coat 278.40 SF 0.00 038 105.79
Floor protection - self-adhesive plastic film 72.13 SF 0.00 0.49 35.34
Room Totals: Stair 1 626.44
Area Items Total: Basement 10,666.98
Hra
� '��' . -
� m.,m. -
1 _.______ _�___
Missing Wall:
Missing Wall:
Missing Wall:
Main Level
Room: Dining Room
221.79 SF Wa11s
358.86 SF Walls & Ceiling
15.23 SY Flooring
35.08 LF Ceil. Perimeter
1 _ 2�8�� X 6�8��
1- 6'2" X 6'8"
1- 11'll"X8'0"
Opens into Living
Opens into Living
Opens into Kftchen
Ceiling Height: 8'
137.08 SF Ceiling
137.08 SF Floor
26.25 LF Floor Perimeter
Goes to Floor
Goes to Floor
Goes to Floor/CeiLtng
CHRI5TEN50N-CON 12/28/2007 Page: 6
Restoration Contractors, Inc. dba Clean Response
' ' 480 N. Prior Ave.
681-s46-3408 ST. Paul, MN. 55104
Phone: 651-646-3408
Fax:651-917-2506
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Batt insularion - 12" - R38 (Insulate the rim 13.13 SF 0.00 1.34 17.59
joist around exterior)
Batt insulation - 6" - R21 110.89 SF 0.00 1.08 119.76
R&R Visqueen vapor barrier 110.89 SF 0.07 0.32 43.24
5/8" drywall - hung, taped, with smooth 247.97 SF 0.00 2.44 605.05
wall finish
1/2" drywall - hung, taped, with smooth 110.89 SF 0.00 2.45 271.68
wall fuush
SeaUprime the walls and ceiling - one coat 358.86 SF 0.00 0.38 136.37
Room Totals: Dining Room 1,193.69
i-3'4-�°'�'',°'+ Room: Kitchen Ce�iling Height: 8'
��
� 277.33 SF Walls 146.41 5F Ceiling
� '�' T 423.75 SF �Valls & Ceiling 146.41 SF Floor
�� 16.27 SY Flooring 34.67 LF Floor Perimeter
�. �.�,. �. 34.67 LF Ceil. Perimeter
n=_ .---- � 1
Missing Wall: 1- 3'S" X 8'0"
Mfssing Wall: 1- 11'll" X 8'0"
DESCRIPTION
Opena into Living
Opens into Dfning Room
QNTY REMOVE
Goes to Floor/Ceilfng
Goes to Floor/Ceiling
REPLACE TOTAL
Batt insulation -12" - R38 (Insulate the rim 17.33 SF 0.00 1.34 23.22
joist azound exterior)
Batt insulation - 6" - R21 138.67 SF 0.00 1.08 149.76
R&R Visqueen vagor barrier 138.67 SF 0.07 0.32 54.08
5/8" drywall - hung, taped, with smooth 285.08 SF 0.00 2.44 695.60
wall finish
1/2" drywall - hung, taped, with smooth 138.67 SF 0.00 2.45 339.74
wall finish
SeaUprime the walls and ceiling - one coat 423.75 SF 0.00 0.38 161.03
Room Totals: Kitchen 1,423.43
CHRISI'ENSON-CON 12/28/2007 Page: 7
Restoration Contractors, Inc. dba Clean Response
� ' 480 N. Prior Ave.
651-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
�-2� a° �
� �
a
� �- 1
� �z z•
Room: Closet Ceiling Height: 8'
89.33 SF Walls 6.88 SF Ceiling
96.21 SF Walls & Ceiling 6.88 SF Floor
0.76 SY Flooring 11.17 LF Floor Perimeter
11.17 LF Ceil. Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Batt insulation - 6" - R21 44.67 SF 0.00 1.08 48.24
RBcR Visqueen vapor barrier 44.67 SF 0.07 032 17.42
5/8" drywall - hung, taped, with smooth 51.54 SF 0.00 2.44 125.76
wall finish
1/2" drywall - hung, taped, with smooth 44.67 SF 0.00 2.45 109.44
wall finish
SeaUprime the walls and ceiling - one coat 96.21 SF 0.00 0.38 36.56
Room Totals: Closet 337.42
�7' 3°
�--4' 3° �
�
DESCRIPTION
Room: Bath Main
� 165.33 SF Wa11s
m 188.35 SF Walls & Ceiling
1 2.56 SY Flooring
20.67 LF Ceil. Perimeter
Batt insulation - 6" - R21
QNTY
4133 SF
1;7 �I'u Cili/ �
0.00
Ceiling Height: 8'
23.02 SF Ceiling
23.02 SF Floor
20.67 LF Floor Perimeter
REPLACE
1.08
TOTAL
44.64
R&R Visqueen vapor bazrier 41.33 SF 0.07 0.32 16.12
5/8" drywall- hung, taped, with smooth 6435 SF O.QO 2.44 157.01
wall finish
Drywall tape joint/repair - per LF I5.50 LF 0.0(1 7.75 120.13
Texture drywall - smooth / sldm coat 124.00 SF 0.00 0.96 119.04
(necessary where wallpaper was removed)
SeaUprime the walls and ceiling - one coat 188.35 SF 0.00 0.38 71.57
Room Totals: Bath Main 528.51
CHRI5TENSON-CON 12/28/2007 Page: 8
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
6s�-846-3408 ST. Paul, MN. 55104
Phone: 651-646-3408
Fax: 651-917-2506
Room: Pantry
���s°--i
_._'...P__
m �
i�
�
84.00 SF Walls
90.50 SF Walls & Ceiling
0.72 SY Flooring
10.50 LF Ceil. Perimeter
Ceiling Height: 8'
6.50 SF Ceiling
6.50 SF Floor
10.50 LF Floor Perimeter
. �
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Drywall tape joinbrepair - per LF 10.50 LF 0.00 7.75 81.38
SeaVprime the walls and ceiling - one coat 90.50 SF 0.00 0.38 3439
Floor protection - self-adhesive plastic film 6.50 SF 0.00 0.49 3.19
Room Totals: Pantry 118.96
b
�
�
- Room: Living
�� 439.80 SF Walls
�W 734.77 SF Wa11s & Ceiling
32.77 SY Flooring
I 6 62.34 LF Ceil. Perimeter
M➢seing Wall: 1- 3'S" X 8'0"
Missing Wall: 1- 2'8" X 6'8"
Missing Wall: 1- 6'2" X 6'8"
Missing Wall: 1- 3'll" X 8'0"
Opena into Kftchen
Opens into Dinfng Room
Opens into Dining Room
Opens into Hall Main
Ceiling Height: 8'
294.97 SF Ceiling
294.97 SF Floor
53.50 LF Floor Perimeter
Goes to Ftoor/Ceilfng
Goes to F7oor
Goes to Floor
Goes to FloorlCeiling
DE5CRIPTION QNTY REMOVE REPLACE TOTAL
Batt insulation -12" - R38 (Insulate the rim 26.75 SF 0.00 1.34 35.85
joist around extetior)
Batt insulation - 6" - R21 216.95 SF 0.00 1.08 234.31
R&R Visqueen vapor bazrier 109.95 SF 0.07 032 42.88
5/8" drywall - hung, taped, with smooth 511.92 SF 0.00 2.44 1,249.08
wall finish
CHRISTENSON-CON 12/28/2007 Page: 9
Restoration Contractors, Inc. dba Clean Response
' ' 480 N. Prior Ave.
ss�-846-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
CONTINUED - Living
DESCRIPTION QNTY REMOVE REPLACE TOTAL
1/2" drywall - hung, taped, with smooth 109.95 SF 0.00 2.45 269.38
wall finish
SeaUprime the walls and ceiling - one coat 734.77 SF 0.00 0.38 279.21
Floor protection - self-adhesive plastic film 294.97 SF 0.00 0.49 144.54
Room Totals: Living 2,255.25
}' Z'�4' 3' -� J
�.
�F--4' -I H3' 11 °"
I�� �
Mfasing Wall:
Misaing Wall:
Mfssing Wall:
DESCRIPTION
Room: Hall Main Ceilfing Height: 8'
T 98.68 SF Wa11s 32.97 SF Ceiling
131.64 SF Wa11s & Ceiling 32.97 SF Floor
1 3.66 SY Flooring 1233 LF Floor Perimeter
12.33 LF Ceil. Perimeter
1- 3'11" X 8'0"
1- 4'0" X 8'0"
1- 3'll" X 8'0"
Opens into Stair 3
Opens into Stair 2
Opens fnto Lfving
QNTY REMOVE
Goes to Floor/Ceiling
Goes to Floor/Ceiling
Goes to Floor/Cefling
REPLACE TOTAL
Batt insulation - 6" - R21 24.67 SF 0.00 1.08 26.64
R&R Visqueen vapor barrier 24.67 SF 0.07 0.32 9.62
5/8" drywall - hu1�g, taped, with smooth 24.67 SF 0.00 2.44 60.19
wall finish
SeaUprime the walls and ceiling - one coat 131.64 SF 0.00 038 50.02
Floor protection - self-adhesive plastic film 32.97 SF 0.00 0.49 16.16
Room Totals: Hall Main 162.63
CHRISTENSON-CON 12/28/2007 Page: 10
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
6s1-84s-34o8 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
,
■��i ■�
���7 �
�"--�� '".
�� � :.�
■��■ ■
Missing Wall:
M�tssing Wall:
Room: Sta�tr 2 Ceil�ing Height: 17'
177.67 SF Walls 22.67 SF Ceiling
200.34 SF Walls & Ceiling 60.97 SF Floor
6.77 SY Flooring 21.58 LF Floor Perimeter
15.33 LF Ceil. Perimeter
1- 4'0" X 8'0" Opens into Entry way Goes to Floor/Ceiling
1- 4'0" X 8'0" Opens into Hall Main Goes to Floor/Ceiling
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Drywall patch, ready for paint 1.00 EA 0.00 54.85 54.85
SeaUprime the walls and ceiling - one coat 200.34 SF 0.00 038 76.13
Floor protection - self-adhesive plastic film 60.97 SF 0.00 0.49 29.88
Room Totals: Stair 2 160.86
S �ii
e ��
_ . : • ��o
-��
�e �v
�■ ��
Missing Wall:
DESCRIPTION
Room: Stafr 3
204.09 SF Walls
225.63 SF Walls & Ceiling
6.56 SY Flooring
14.92 LF Ceil. Perimeter
1- 3'll" X 8'0"
Batt insulation - 6" - R21
RBcR Visqueen vapor bairier
5/8" drywall - hung, taped, with smooth
wall finish
SeaUprime the wa11s and ceiling - one coat
CHRISTENSON-CON
Opens into Hatl Main
QNTY
102.04 SF
102.04 SF
102.04 SF
225.63 SF
REMOVE
0.00
0.07
0.00
0.00
Ceiling Height: 17'
21.54 SF Ceiling
59.05 SF Floor
21.10 LF Floor Perimeter
Goes to Floor/Ceiling
REPLACE
1.08
0.32
2.44
TOTAL
110.20
39.79
248.98
038 85.74
12/28/2007 Page: I1
Restoration Contractors, Inc. dba Clean Response
� ' 480 N. Prior Ave.
681-646-s408 ST. Paul, MN. 55104
Phone: 651-646-3408
Fax:651-917-2506
CONTINUED - Stair 3
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Floor protection - self-adhesive plastic film 59.05 SF 0.00 0.49 28.93
Room Totals: Stair 3 S 13.64
�� -���:
To i°�i'3° m N
�,;o..
'• ' p±3'2� 1
1
�9' 6° -�
Miseing Wall:
Room: Entry way
160.02 SF Walls
190.95 SF Walls & Ceiling
3.44 5Y Flooring
20.00 LF Ceil. Perimeter
1- 4'0" X 8'0" Opens into Stair 2
Ceilfng Height: 8'
30.93 SF Ceiling
30.93 SF Floor
20.00 LF Floor Perimeter
Goes to Floor/Ceiling
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Batt insulation - 6" - R21 16.00 SF O.QO 1.08 17.28
R&R Visqueen vapor barrier 16.00 SF 0.07 0.32 6.24
Drywall patch, ready for paint 1.00 EA 0.00 54.85 54.85
Drywall replacement �r LF - up to 2' tall 8.00 LF 0.00 7.18 57.44
SeaUprime the walls and ceiling - one coat 190.95 SF 0.00 0.38 72.56
Floor protection - self-adhesive plastic film 30.93 5F 0.00 0.49 15.16
Room Totals: Entry way 223.53
Area Items Total: Main Level 6,917.92
2nd Floor
CHRISTEN50N-CON 12/28/2007 Page: 12
0
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
681-646-3408 ST. Paul, MN. 55104
Phone: 651-646-3408
Fax:651-917-2506
� �r e� ��
1
0
1
Room: Bed 2 Ceiling Height: 8'
392.01 SF Walls 130.23 SF Ceiling
522.24 SF Walls & Ceiling 130.23 SF Floor
14.47 SY Flooring 49.00 �,F Floor Perimeter
49.00 LF Ceil. Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Drywall patch, ready for paint 1.00 EA 0.00 54.85 54.85
SeaUprime the walls - one coat 392.01 SF 0.00 0.38 148.96
Floor protection - self-adhesive plastic film 130.23 SF 0.00 0.49 63.81
Room Totals: Bed 2 267.62
T O ►��3° m T
� �,
1 �' e 3° �' 1
- e'�°-�
Room: Landing 2nd
Missing Wall: 1- 4'0" X 8'0"
DESCRIPTION
160.03 SF Walls
190.96 SF Walls & Ceiling
3.44 SY Flooring
20.00 LF Ceil. Perimeter
Opens into 5tair 4
QNTY REMOVE
Ceiling Height: 8'
30.93 SF Ceiling
30.93 SF Floor
20.00 LF Floor Perimeter
Goes to Floor/Ceiling
REPLACE TOTAL
Batt insulation - 6" - R21 40.01 SF 0.00 1.08 43.21
R&R Visqueen va�r barrier 40.01 SF 0.07 0.32 15.60
5/8" drywall - hung, ta.ped, with smooth 40.01 SF 0.00 2.44 97.62
wall finish
SeaUprime the walls and ceiling - one coat 190.96 SF 0.00 0.38 72.56
Floor protection - self-adhesive plastic film 30.93 SF 0.00 0.49 15.16
Room Totals: Landing 2nd 244.15
CHRISTEN50N-CON 12/28/2007 Page: 13
_� c�-��;\
,\�p�PON�;
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
ST. Paul, MN. 55104
Phone: 651-646-3408
Fax:651-917-2506
��
,I �
�
�� ��
�
1 �
71°.�•q �°
�Q�
Room: MSTR CL Ceil�ing Hefght: 8'
240.59 SF Walls 47.51 SF Ceiling
288.10 SF Walls & Ceiling 47.51 SF Floor
5.28 SY Flooring 30.07 LF Floor Perimeter
30.07 LF Ceil. Perimeter
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Drywall patch, ready for paint 1.00 EA 0.00 54.85 54.85
SeaUprime the wa11s - one coat
240.59 SF
0.00
0.38 91.42
Floor protection - self-adhesive plastic film 47.51 SF 0.00 0.49 23.28
Room Totals: MSTR CL
169.55
Area Items Total: 2nd Floor 68132
Room: Plnmbing
_L
��
�%'
� ��
��
DESCRIPTION QNTY REMOVE REPLACE TOTAL
PLUMBING -(Bid by Seitz Bros Plumbing) 1.00 EA open item
Repair multiple frozen/broken pipes. Detach water heater, water softener, toilet, and pedestal sink to make repairs on structure.
Repair plumbing to water heater and water softener.
Room Tota.ls: Plumbing
0.00
CHRI5TENSON-CON 12/28/2007 Page: 14
� C•j,�-��
' �\SPO �
`x
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
ST. Paul, MN. 55104
Phone: 651-646-3408
Fax:651-917-2506
Room: ELECTRICAL
; i.
�� -
�::
� flam1lmgh
IIamV/1!h
DESCRII'TION QNTY REMOVE REPLACE TOTAL
ELECTRICAL -(Bid by Southside Electric) 1.00 EA open item
Check circuits for water damage, remove water damaged light fixtures, and setup tempoiary lighting.
Room Totals: ELECTRICAL
��
� . :-
����
DESCRIPTION
0.00
Room: Heat, Vent, & Cool
QNTY REMOVE REPLACE TOTAL
HEAT, VENT & AIR CONDITIOMNG - 1.00 EA ogen item
(Bid by Air Mechanical)
Replace water da.maged flexible ducts and clean remaining duct-work. Also, replace circuit boazd on furnace.
Room Totals: Heat, Vent, & Cool
Room: Egterior/General
�� %
�� ��
0.00
CHRISTENSON-CON 12/28/2007 Page: 15
. ,�
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
6a1-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
Fax:651-917-2506
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Siding Repairs -(Siding has visual waxer 1.00 EA open item
damage)
Room Totals: Exterior/General 0.00
Room: General
i
,��;„ .
� . :
�� � �
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Dumpster load - Approx. 40 yazds, 7-8 tons 1.00 EA 521.04 0.00 521.04
of debris
Cleaning Technician - per hour (post- 16.00 HR 0.00 28.31 452.96
construction cleaning)
Taxes, insurance, permits & fees (City of 1.00 EA open item
Fridley Building Permit)
Room Totals: General 974.00
Line Item Totals: CHRISTENSON-CON 19,240.22
Grand Total Areas:
6,64237 SF Walls
2,303.04 SF Floor
0.00 SF Long Wall
2,303.04 Floor Area
2,958.51 Exterior Wa11 Area
0.00 Surface Area
0.00 Total Ridge Length
2,146.95 SF Ceiling
255.89 SY Flooring
0.00 SF Short Wall
2,341.67 Tota1 Area
34928 Exterior Perimeter of
w�
0.00 Number of Squares
0.00 Tota1 Hip Length
8,789.33 SF Walls and Ceiling
812.70 LF Floor Perirneter
815.22 LF Ceil. Perimeter
7,017.80 Interior �Vall Area
0.00 Total Perimeter Length
CHRISTENSON-CON 12/28/2007 Page: 16
. , e
Restoration Contractors, Inc. dba Clean Response
480 N. Prior Ave.
661-646-3408 ST. Paul, MN. 55104
Phone:651-646-3408
F�: 651-917-2506
Line Item Total
Matl Sales Tax Reimb
Subtotal
Overhead
Profit
Replacement Cost Value
Net Claim
Summary for Water Damage
@ 6.500% x
@ 10.0% x
@ 10.0% x
ANDREW BANAS
19,240.22
4,222.04 274.43
19,514.65
19,514.65 1,951.47
19,514.65 1,951.47
23,417.59
23,417.59
CHRISTENSON-CON 12/28/2007 Page: 17
�
Building �/j�i Ci�NjCAj., Pemut No.: OD�'- D�
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 �Ty OF FRIDLEY D���'�:AI� ' 200
DATE �� - � YqO!UR E-MAII. ADDRESS
SITE ADDRESS l.Q� � � (�j „Q/�/i.�b�1 W�-�_
THIS APPLICANT IS: O OWNIIi �CONTRACTQR
PROPERTY x,�
OWNER/ annxFSS: crrx sTa� z�
TENANT
�o�:
CONTRACTOR co�axx Nn[v�:
SUBMIT A COPY OF corrracT r�xsoN: 16411 Aberdeert Str�t RIE
YOUR STATE STATE LICENTSE # Nam Lake, M�
LiCENSE WITH Ap��s: CTTy STATE ZIP
APPLICATION �O�-1 � 3���_ 7 7 y-� FAX
pERNIIT TYpE �SIN6LE FAMII.Y O T�VO FAA�tII,Y O iOWNEiOUSE
TYPE OF WORK: ❑ �w � �,ac�vT �n[.�r�anTTON�onEr,
DETAILED DESCRIPTION OF WORK C.�(;Q (�,� I�,( �#-
� V 2Z-S ir
PER MS 16B.665 the permit fee is a mmimum of $15.I10 or 5% of �e Mtal c�oat ap to 5500.00, whichever is greater, for the
improvement, installation or replacement of a residential Sxtuie, excludin� the fixUu�es. (This should refl�t onty the cost of labor )
Labor cost under $3Q0 =$15.00. Labor cost betweea $3Q0 to $SQO = cost of labor x.OS =
FOR PR0IECTS WHIIiE LABOR EXCFEDS $300, FEF.S ARE BASID ON $10.00 PER FIXTURE, EXCEPT WHEIiE NOTF�. FD�'1�JRFS: (INDICATE TOTAL
NUMBER OF EACH BII.OV1�
Eqaipment I�talled MFG: MODII.: STZFlBTU
MFG: MODII,: SIZFJBTIJ
MFG: MODII,- SIZFJBTU
_A/C $Z5.00 FIRF.PLACE (GAS) $15.00 GAS RANGF/OVEN $10.00
AIR TO AIR EXCIiANGF� $l5 FIItF�LACE (WOOD) $35.00 NEW GAS GRII.L $lO.OD
_BOI[.IIi $35.00 _FURNACE $35.00 GAS [JNIT HTR $10.00
CHIlVIl�Y LIlVIIL $10.00 _GAS DRYER $10.00 POOL IiEA1'II2 $35.011
DUCT WORK $10.00 (iAS PIPING $10.00 VENTII.ATOR $15.00
PERMIT F� PROJECTS F�R UNDFR $SOtI PERMIT FEE FOR �'ROJECTS OVER $500
Permit Fee $ Number of fixdues @$10.Q0 x$10.00 =$
Surcharge S _50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ ATumber of fixtures @$25.00 x$25.(� _$
Number of fixtures @ $35.� x $35.00 = $
State S�ucharge = $ .50
Tota1= $ 5,
THIS LS AN APPLICATION FOR A PEItMIT NOT VALID UNTII. PROCFSSID
I herehy apply for a buildin� permit and 1 aclmowledge Yhat the infarmation simve is cnmplete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the IvI'wnesota Construction Codes; that I understand this is
not a permit but only an application for a p�ermit a� work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work wluch requIIes ieview and approval of plans.
SIGNATURE OF APPLICANT _ y J^�Y `1 /� c(; l� PRINT NAME Ti`� a I1 /� ���ATE /'`� -V 1f
PLEASE NOTE: SEPARATE PERl��f S ARE RE UII2ED FOR BUtLDING, ELECTRICAL AND MEGHANICAL WORK
l;ity of l+'ridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�� �3����� � �
Building MCCHAIVICAL Permit No � -
Inspections RESIDENTIAL APPLICATION Received By:
763-s�2-3604 CITY OF FRIDLEY ��� 11
763-502-4977 FAX �c.l.� 1-1-0s
DATE ' � � YOUR E-MAIL ADDRESS
SITE ADDRESS Y� I�j 1 V�.
THIS APPLICANT IS: ❑ OWNIIi �JCONTRACfOR
PROPERTY NpME: ' l� 5
�W�� ADDRESS: CTPY STATE ZII'
TENANT
m�or�:
CONTRACTOR co�nivsr rrat�: 1 � G
NOTE:
L��� � c A� �# � 03 0 5 ,,r
EXP DATE
REQUIIiED FOR GAS r� n n �–�-(�{` � �,: LP STA'T�/�1 ZIP��
ANDHVAC. ADDRESS:� ��'1 �( tT�P_VI Li� �� I�.`� CTfY
SUBNIIT COPY OF BOND PHO� ���-- C�L3l.� '°7'� l-�, F�{
ANI�IlVSi►jtAN��__ _
PERNIIT TYPE �SIN(3LLE FAMII,Y ❑ TWO FAMII,Y 0 TOWNHOUSE
TYPE OF W ORK• ��w �xxEri.�c�rrr ❑ fu,�TTO�MOn�, �
DETAILED DESCRIPTION OF WORK � G� C� �'' - i.
PER MS 16B.665 the permit fee is a minimum of $13.00 or 5% of �e total cost np to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fit�tture, excluding the fixtures. (This should reflect only the cost of labor )
UR
Labor cost under $300 =$15.00. Labor cost between $300 to 5500 = cost of labor x.OS =
FOR PROJECT5 WfiERE LABOR EXCEED3 $SQO, FEES ARE BASED ON $10.00 PER FIX'I'URE, EXCEPT WHERE NOTID. FIXTUR�S: (INDICATE TOTAL
rr�m oF �c� s�,ow> MODEL: �(D(4�rU�'� 1.20 `� C7 s1zES�rv � G"U�
Equipmant lnstalled MFCr. � �' ilLi�
MFG: MQDEL• SIZF/BTU
MFG: MODII.: SIZE/BTU
A/C $Z4.00 FIRF1"LACE (GAS) $15.00 _GAS RANGF/OYEN $10.00
AIR TO AIlt EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS QRILL $10.00
BOILER $35.00 —�CFURNACE $35.00 (iA3 UNTI' iITR $10.00
CHIl�INEY LINER $10.W GAS DRYER $10.00 POOL HEA1'ER $35.00
DUCT WORK $10.0(1 GAS PIPING $10.00 VENTILATOR $15.00
PEI�.MI'C FEE �'RD.rECT� FQR tJR�DFR $S�0 PERMIT F.EE FOR PROJECTS OVER $500
Permit Fee $ Number of fixhues @$10.00 x$10.00 =$
Surcharge S . SQ Number of fixtures @$15.00 x$15.00 =$
TOTAL DiJE $ OR Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
NIINIMUM $1550 ' NIINIMUM 515.50 Tota1= $� 5.��
THIS IS AN APPLICATION FOR A PERNDT NOT VALID UNIII, PROCESSID
I heieby apply For e machanioal pa�mit aad I aoknowledge Wat U►e infoimation above is oomplete and aoou�ate; that the work will ba in aonformanae with fl►e ordinances
and oodes of tha City of Fridley end with tha N7innesota Coaettuation Cade�; that I nnderstand this ie not a pernut but only an applioation for a parmit snd work is not to
start without a peiwih that tha wotk will ba in acoordanae with fha ed plan in fhe oase of all work w6iaL requires review and apprwal of plana.
SIGNAT PLICANT 6/�f W `�`' — 1 W"— ��Gvv"" 'PRIN'P NAME ���i(,� �,Q �,�I���bAT��� � �
APPROVED B ` DA�I I
PLEASE�NOTE S ARAT'E I'ERMTl'S A�tE RE L7IRED �OR BUII,DING, ELECTRICAL AND MECHAMCAL WORK
Cit� of Fridley
Bnildimg Inspectfons Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX:763-502-4977