AF - 38000Rec # 44698 P 44697 NssD
City of Fridley, Minn. 1�T° 9 9 9 4
BUILDING PERMIT
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Owner:
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Add1e88 AddTeyg � 17 �aTa.v�a.ta. $l V..a,
LOCATION OF BUILDING
No. `�420 Street .�roncer� CZa,r�.� ._._ —_ Part of Lot
Lot _.._.._��__ Block .�. Addition or Sub-Division _
Corner Lot � Inaide Lot �X Setback �..—.��r._ Sideyard ��9._
Sewer IIevataton ��6.29 ._ .�,�.��nx. 87�.29
Top of Footing
DESCRIPTION OP BUILDING
To be Used as:
.�ktel 7 j�,g Front —.�2 Depth ..._2¢.._ Height --?8— Scl• F't. ��8— C�. FL —�1'3'384
Ga-�^a e Front __2L1—_ Depth _.22..� �Teight _1.p.— Sq• Ft -,�,9— �• '� —�89—
Type of Construction Frame ��, �_ 21 QQ,Q_ __ To be Completed F� P�b ; �-�9
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SE�rTER LOCATION: 86t South of Maxx�.hole
WATIl� LOC�TION: 76' South of Manhole
In consideration of the issuance to me of a permit to construct the building descrl�d above, I agi�ee to do
th� proposed work in acc�rdance with the description above set forth and in compliance with all proviaions of
ordinancea of the dty oE Fridley. // /% „ �, d e
In consideration of the payment oY a fee oP $���._-, permit fs hereby granted to�omPr7 a.l l r7 rg ,
to construct the building or additfon as described above. Thispe rmit 3a granted upon
the express condition that the person to whom it ia granted and hia agenta, employees and worlmaen, in all work
done in, around and upon said building, or any part thereof, shall conform in all reapects to the ordtnances of
Fridley, �f3nnespta location, conatruction, altera.tion, maintenance, repair and movin� of buildiugs
within the dty ]imits� pernnit may be revoked at any time upon violation of.aa3��f the P��� of seid
ordinances. ' �
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CL�RIIVCE BEI,ISI�E °
NOflCE:
This psrm(t d� not eovsr �hs aoeslrueHoe, InshllaHoa fer wtrtne. Plumbine, eu 6sattne, iew�� er wdsr. B� wn fo �
flro Bu(WieB le�p�sta� fer aparat� p�rmhs fee fhas thna.
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APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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OWNER' S NAME BUILDER e����",� �_��� iJ/ -
ADDRE S S � ADDRE S S� ��f� ���� ��_
I,OCATION OF BUILDING
N0. �� STREET_���P��,� �_PART OF LOT _
LOT �� BLOCK � ADDITION OR SUBDIVISION�� � �p��-s,���_
CORNER LOT INSIDE LOT � SETBACK �,� SIDE-YARD �� � _
SEWER ELEVATION TOP OF FOOTING
Apglicant attach to this form two certificates of survey of lot and proposed
building location drawn on these two certificates.
DES�RIPTION OF BUTLDING
To be Used as:
������� -= Front .�� Depth -�- Height � � _
Sq. Ft �C� � Cu. Ft. � � �� � / _
���f���� _, . Front '�-�• Depth � �. Height_ ,� � _
,��-
Sq. Ft. ��� Cu. Ft. t-i � C� � -
�/ �/ � .°f_
Type of Construction ��..t��/r't C�� Estimated Cost _
To Be Completed � /���% � _
The undersigned hereby makes application for.a permit for the work herein speci£ied,
agreeing to do all work in strict accordance with the City of Eridley Qrdinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE � SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
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BUILDING PEItMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building of structure, or for any addition to any existing
buildf.ng:or structure, or for any alteration or repairs 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: .
Ur..iform Building Code: Type 1,2, & 4- $1.75 for each one thousand cubic feet, or
fraction thereof, in such cubical contents. Type 3& 5-$1.50 for ea�h
one thousand cubic feet.
0
For the purpose of computing fees��for building permits, the cubical contents of
any building or addition to a uniform height throughout by multipluing the ground
area covered from a point six (6) inches below the floor line of the basement or
cellar to the average height of the upper surface or to the average height of the
roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
, rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction thereof
in the cost of all proposed work,
In no case shall the fee charged for any�permit as set forth in Section 2 be
less than $5.00.
NSSSD Connection Charges based on location- Area 1 or 20
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HOUSE HEATING TEST RECORD
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ADDRESS �/ °� � � APT. OOR ITY , B -- �
OCCI�PANT OWNER � -
HEAT LOSS DATE HTG. INST. GAS CO. METER BADG
SOLD BY INSTALLED BY � � �s
Eisehical Work By Gaa Lfna By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. _
GAS SIG
MAKE � �'—�- MAKE OF BURNER _
Mods l �— Model
Sxial �� ��— �� Max. BTU Rating—
INPUT ������ MAKE OF FURNACE
Model
.�.,�� �CONTROLS
THERMOSTAT F �Heat Plug
Valve
Limit ��' � ��.��
Limit Setting ��
Fan Setting �-� � f� - �`
Pilot Type
Pilot Make
Pilot Model �—���
Pilot Timing ���'�
UNIT HTR. OTHER
CONVERSION
Vent Size � �
KIND OF LINER �9'1E�NONE
Drok Hood ��� Regularor
Filters Size Num r
Chimney Loeation (nside Outaide
Chtmney Construetion
Smoke Bomb Wiring .� !�
Draft � Test Tag ��
L.W, Cut Off Do r Pressure_ Lightiny Inst.
< e — c ��— c �' �
Prossuro �H Pereent CO2 qte� sted '-�"' ��"� �
Irtput CFH �� Peµ��'���°� ��i�any Testi�g �
Sfaek Temp. Pereent CO � �� � Name of Tester
Form 235
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CHIMr�EY AND STACK VER�FICATION
The undersigned hereby verifies that the existing chimney or stack;
�.
1. Has been carefully examined Yes �
2. Is free from rust or deterioration Yes �
3. Has no foreign objects lodged within Yes �
4. Is securely supported Yes �
5. Meets all current Code requirements for size and
total BTU conr�ected
6. Has Total heating BTU�s of `%�,Ca� �
. �e
All other BTU's � 3 � °
TOTAL � Z � c� �
Rema rk s
No ( )
No ( )
No ( )
No ( )
. Yes �� No ( )
Company �C.. JG' s�l—d �C%7%-�011 .��°�-.
Signed By
Da te � '� �:S — � G1
SUBJECT .
City of Fridley 2 6 0 6 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
; � T NO.
� ' COMMUNITY DEVELOPMENT DIV.
� ; V �.����� `/ l V
r � � PFOTECTIVE INSPECTION SEC.
1 i r
� /"'1 � CITY HALL FRIOLE� SS432 NUMBER REV DATE PAGE Of APPHOVED BV
�----�' �•' 612-571-3450 910-F15 5/20j98 / /
J08 ADDRESS 7420 CONCERTO CURVE NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 12 2 Melody Manor 3rd SHEET
2 PiiOPEIiTY OWNER MAIL ADORES$ ZIP PNONE
Dougherty 7420 Concerto Curve NE 785-2543
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Renewal By Andersen 350 73 Avenue NE, Fridley, MN 55432 502-4777
4 ARCHITECT OR DESIGNER MAIL ADORESS IIP PMONE LICENSE NO.
20040630
5 ENGINEER MAII ADORESS ZIP PHONE LICENSE NO.
6 USE OF BUILDIN(i
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �7 ALTERATION O REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Replace 14 windows in home with pocket insert windows
9 CHAN(iE OF USE FROM TO
STIPULATIONS
Install smoke detectors to meet the State Building Code - in each
sleeping room and on each level of the dwelling.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIH CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OF CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITMIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKlNG
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALl PROVISIONS OF LAWS yp�UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �12 s 198 �C7. I.O
DOES NOT PRESUME TO GIVE AUTHOfiITV TO VIOLATE Oq CANCEL THE' pERMIT fEE SAC CHARGE
PROVISIONS Of ANY OTNER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �LJ9.7S Fire SC �iL.LO
PLAN CHECK FEE TOTAL FEE
License SC $5.00 $223.05
SIGNATUREOFCONTRAC70ROAAUTMOA�ZEDAGENT IDATEi NEN PROPERLY V DA7FD THIS IS VOUR PERMIT
�Il' � � �L
S�GNATUREOFpWNERi�iOWNERBUiLDERi IDATE� w BLDG NSP f�pTE
�
�w � � Effective 1/1/98
ADDN [] CITY � OF FRIDLEY rn
ALTER [�.}� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �p ��
BUILDING PERMIT APPLICATION - : ��� ;_�n
G�� � . . _, . _ . � -�
ConstructionAddress: � �-2,� �-�v � V l�1/�
Legal Description:
Owner Name & Address: �1��'(11(�.5����`t . Tel. # !1`��� •25�i-3 ,
�4Z� C w �.�v cv2�r�
Contractor: �,J�/a,� �.{ ,q,,� p�g� MN LICENSE #_Z�k1�0 G3c�
Address:"� SO �3 � f.��C /�E t 2►OLt.� %1?n� SS�/3 2 Tel. #� Z- �771
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
DES�YtYPTI�N OF �'ItOi����T'I'
Length Width Height �^ Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
�
/
h�inr Gbi-fJ /� %�0lYiL N i i/� � C.�C' i�vScX�'
rVirv pclr-�f S
Construction Type: Estimated Cost: $_ � 2��, Q, �j _
(Fee Schedu.Ze on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ � _$
DATE: � � c1 •� U APPLICANT: � Tel. # b� Z' Z�S-7 •
Permit Fee
Fue Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main- Charge
TOTAL
CITY USE ONLY
�_����, %S Fee Schedule on Reverse Side
� /.�.-020 .001 of Permit Valuation (1/lOth%)
$��, � $.50/$1,000 Valuation
$ � $1000 per SAC Unit
$ , a0 $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 [ ]
$ ��3.aS`'
STIPULATIONS : �/yj�+ :��r G7�� � � �► �� �����es �S
�•�.� o.,s �'"�4G'i5� �+�'�'EL a /_ %�� .�G�/��Li.�/cc�
� ,. -
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 $25,0(10
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $SQ0,000
$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 fust $2,000 p�us $12.50 for each ad�itionai $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 $100,000 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 $1,0(}0,000 plus $2.75 for each addirional
$1,000 or fraction thereof
DRIVEWAY DEPRE�SION ESCItOW
(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 minirnum 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.
sue�ecr PE .
c�ty of Fridley 2 9 2 6�`
AT TNE TOP OF TME TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� `v __�___ COMMUNITY OEVELOPMENT DIV. ��� P
f � � PROTECTIVE INSPECTION SEC. �
�
1 i �
� �'�'� � CITY NALL iRIDLE� 35192 NUMBER pEV O�TE v�GE Oi �vvaOVED Br
�""� � �'' 612-571-3450 9t0-F15 4/21/99 / �
10B ADDRESS 7420 Concerto Curve NE
1 LEGAL LOT NO. BLOCK TfiACT OR ADOITION SEE ATTACMED
DESCR. IZ 2 Melody Manor 3rd SNEET
2 PROPERTV OWNER MAIL AODRESS ZIP PNONE
3 CONTFACTOR MAII ADORESS ZIP PMONE LICENSE NO
Dahl Builders & Remodelers 451 Maple St, Spring Lake Park, MN 55432
4 ARCHITECT OR DESIGNEF MAIL ADDRESS ZIP PMONE LICENSE NO.
784-4830 20050777
5 ENGINEER MAII ADDFiES3 ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �} ALTERATION �J REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (21 Sq) Tear-off; Reside House & Garage; Bathroom Alteratio
9 CHAN(3E OF USE FROM TO
STIPULATIONS
See notations on permit. Call for building wrap inspection before
covering. Underlayment must comply with the State Building Code. Provide
smoke detectors in all sleeping rooms and on all levels of the dwelling per
Section 310.9:1.2 of the 1994 Uniform Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYPE OF CONST OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ApE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NUII AND VOID IF WORK Oii CONSTRUCTION ZONING SO. fT CU fT.
AUTHORIZED IS NOT COMMENCE� WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOR A PER100 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED NO. DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFY THAT I MAVE READ ANO EXAMINED TNIS APPLICA710N 1 STAILS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yp�UATION SUR7AX
ANU OqDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED @
WITM WMETMER SPECIFIED HEREIN Ofi NOT. TME GRANTING OF A pERMIT W12,799 �6.�FO
DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL TME pEqMIT FEE SAC C RGE
PROVISIONS OF ANV 07NER STATE OR LOCAL lAW REGULATING coN- $199.75 Fi SC �IZ.SO
S RUCTION ME PERfOAMANCE OF CONSTRUCTION
/r����� PLAN CMECK fEE TO AL FEE
1
L se SC 5. 0 $223.95
S��N4TUAEOFCO �pACTOAOp4UT110p�2ED4GENT IO�TE� ME �T�HIS IS Uii PERM'!i/7/�
�J' V �;
S�GN4TUAEO�OWNEadFOWNEA8UIL0EA� iDATE� .PBI G �NS� '�r�atf �
Effective 1/1/99
NEW [ ] CITY OF FRIDLEY
ADDN [ ]
pi,�g [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 a��Q �
� � BUILDING PERMIT APPLICATION � ��
� 7; . � r-� �T �t�, �
COAStrl1Ct10IlAddTCSS' • � �� v (,�L�i`� �- f �4�
Legal Description: .
Owner Name & Address: Tel. #
Contractor: l�,L � �G%✓1� `� �r��✓`'`�=�'��"� MN LICENSE # �?� �� ��7
Address: ��l ��iC'�� S�� Tel. # 2��/- ��' � G
• ° Attach to this application, a Certificate of Survey of the
lot, with the proposed construcdon drawn on it to scale.
LIVING AREA: ,
,;��>.
GARAGE AREA:
DECK AREA:
OTHER: �
DESCRIPTION OF �MPROVEMENT
J,eng� Width Height Sq. Ft.
Length� Width Height _ Sq. Ft.
Lengdr��% Width Hgt/Ground Sq. Ft: d� ��
I- � � �-- -- � �-.-,/.,�___��,,,6hnit�` � ��vr�,ar��% � /%10�� ��L�
�. �r� � � i �_ � � � �:
' �' ��� Estimated Cost: $
Constcuction Type: � l� �� �
��i,�, �,�99
�=�°` '� (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �-�°- ��J APPLICANT: �J ��� Tel.
a. ��.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge '
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee _ ,
Sewer Main Charge
'`TOTAL ' �
STIPULATIONS:
$ ���?��
$' l��C�
$ �. ��
$
$ � -�U
$
$
$
$
$ �°�-�� %�
. /�/1.O�e�a
J T� ��
�
�,� �-/�
�����
�
CITY USE ONLY �
Fee Schedule on Reverse Side j 2� �
�
.001 of Permit Valuadon (1/lOth%) In ��,2,
.50/ 1 000 Valuation ��
$ $,
$1050 per SAC Unit , '
$5.00 (State Licensed Residential Contractors) , ���,�r. n���%�,
i�
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review •�3 G��C 3j�J ,�
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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BUILDING PERMIT FEE SCHEDULE
'fhe Cluef Building O�cial shall, before issuing permits for � lter tioln or re na rt 1 any xist gc Uuild ngf or
any addition to any existing building or structure, or for any a P
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
$i to $500
$501 to $2,�4U
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
FEES
$21 (Minimum Fcc is $21 plus surcharge}
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000 0
$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 $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$5�,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up
$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)
plternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
piternate "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 $23.25.
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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