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SUBJECT PE .
c�ty of Fridley . 12090
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� • COMMUNITY DEVELOPMENT DIV.
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r � � PROTECTIVE INSPECTION SEC. ����
1 = i
� /�"{ � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� � �'� si2-5so-3a5o 910-F15 4/11/73 � �
JOB ADDRESS g110 Fairmont Circle N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 1 Bourdeaux's Spring Brook Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerry Hodd
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Castle Homes Inc. 7613 Central Avenue N.E. 55432
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential Dwelling
7 CLASSOFWORK � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construction 26' x 41' Dwelling and 26' x 24' Garage
9 CHANOE OF USE FROM TO
STIPULATIONS provide a hard surface driveway. Provide a verifying survey before
capping. SAC charge of $275.00 paid.
SEWER L�ATION: 92' W. of Ma.nhole
WATER LOCATION: 10.1' East of Sewer Service
TYPE OF COPIST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCl ET3IIlC.'
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORRED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT jt-], 1066 27 352
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. 21 SI.S.00 y� �.p.7G
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTHOHITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF AIdY OTHER STATE OR LOCAL LAW REGULATING CON-. $Sl.00 $L7S.00
STRUCTI THE PERFORMANC F CONS . UCTION.
s'� . � PLAN CHECK FEE TOTAL FEE ^
� y l.��-' �/—/L - �3 $336 . 76
SI�3i EOFCONTRACTORORAUTHORR6'bAGENT (DATEI y�F{ PER Y VALIDATED THIS IS YOUR PERMIT -
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SIGNATUREOF OWNERIIF OWNER BUILDERI IDATEI BLDG IN5P �ATE
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OR �1TIAITT0�1 ��JILDZ�tG ��I�T�'
C�TY OF PRTTl�,�Ye M�NN�54T�1►
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BUI��TNG P�RMIT F�� ��H��U�E
S��Q� 2. Th� I�epecto� pf �u�ldinga s��l�, be�oxQ �asui�g germ�t� far �he
����t�on o� a�y bu�lding o� s�ructure, or for any addition to any �ist���
����d�� o� struC�ure, ox fv� any alteration ox xe�airs to a,ny ex���i�g
��s������ o� st�c�uxe, upou �ppX��ation theref�se, requ�re �he paymeat by �tie
����i��t fp� such per�n�,z o� �ees �o the a�tount herein below aet �ar�h �d �
���; �e� h�x�e�.� p�ov�ded � �v��wwi� z
U�9'dFORM �U�LDTNG COAE� 7.j'Pe �.e 2 bc 4-$2.15 �or each axae �t►ous�c� cubic
�e��, p� f�actipn th�fi�a�, in �uc�a cubical contents. �.`ype 3& 5-$�e85 �o�
�a�#kt o�s �%pc�usand �,b�.c ���t. .
��D � T ��O1�A,� � �iF1��aMAT � ON
Fp� �� �u�pQpe of ��apu�i�,g �ees for building perenits, the cubical contents
of atiy building or addition, i� det�traiined by mui��.ply$n� the �xound area
�ave��ci. f�'om � poi#�� s�x (6j inc�es below the flaor line Qf the basement
&►�,* fi.�e ����a� to �%e average he�ghts of the upper surface or to the avera��.�
��8t c�f �e �oo�E �a��'face o� �he uiaiA gable pf a, pi�ched xoo�,
.� ��i�rs o� al�,�����o�� �S aa� existin� s�su+�tta�e9 �a� f�� shall be �+� �h�
�r�.�� v� $3.00 �e�r e��h f�ve h�dsed dollars {$�OUof10) � f�,��ion tharsof �,�n
�il� ect�� a� a�.l p,�Qps9�ed wo�k„
?� � ca� sh��l t�� #e� fox at�r pexmit as se� fo�rt� �Ca 5���#.o� 2 ba
�.�s ��n $3. �.
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'�7�3�����TiQ�1 0� �C9�iNAA'iI(3N
Dipi�s ��s�.ts �Qx �cr�tst��t�oa� will be i�$ued a ���Cma�m of' �4 �c�urs ��a�m �i�►e
�Ma o� applicatia�, �o �l�oa� fox prv�e� review of �he �xapased ���usture �d
�� �e t�st�uation �si�e.
' � ��'��� Su�v�y o� �� �.�� ��in;� ti� �.oca��; c�� �h� �auuctatir�, o�ce �,�
�� �a� �.s�it�edm �riil � g�uir�d be€oze �roceedin� w�.�la �� fr�i�„
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CI�R�'�F��A'�� pF lJ��i��AN�CY
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�o�t i� • i��e Qz �ccu�a��r a� �ty �#'�.et�ure €�r whiah a bui.ldia$ pet�a%� ha� b�en
isstted3 �ud s�,��l a���u� �}�ai$ �ot be used a� occup�ed uzttil a Cc���ificate
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HEAT C�'SS C,4LC�'LATIONS HEATfiVG � AIR C�iVDIii0�91�G CO. MINNEAPOLIS, MINN.
Weatherstrips :,.S.H.V.E. Construction No. Insulation
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Weatherstrips A.S.H.V.E. Construction No.
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es No Yes-No �g
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MINNEAPOLIS, MINN.
Insulation
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HOUSE HEATING TEST RECORD D 20469
ADDRESS 8110 �airmont Cir� N.E� APT. FLOOR CITY SUBURB �'idle.y
OCCUPANT Gerald R� Hpdd OWNER YeQ
HEAT LOSS DATE HTG. INST. GAS C0. METER BADGE ed ck Ht
SOLD BY INSTALLED BY � g•
Eleetrical Work By Gas Line By n tt
TYPE OF HEAT GA FA � HW STEAAA SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE �'331iamson MAKE OF BURNER
Model 1117-10-•fi Modol
��a� 7316429 Max. BTU Rating
INPUT ZOO�OOOBtt1 � . MAKE OF FURNACE
Model
CONTROLS
THERMOSTATCm 260 Heat Plug Vent Size ��
Valvo M.H. V8UOG! KIND OF LINER �liffi. SIZE 6� NONE
Limit Robehaw RI�i, 750n Draft Hood VertiQal Regularor �itrol 325-3
Limit Setting ��� � Filters Size 16� 1! `�5n Number 1
Fan Setting 90°i & 120�i Chimney Loeation Inside Ye9 Outside
Pilot Type C+Q11�1e Chimney Construdion Metalbead��e
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilot Timing g8 �eeaonds Draft �� Test Tag YQ'8
L.W. Cut Off Door Pressure Lighting Inst. YQa
Pressure �- ���a�+' �—Percent CO2 gr-sa/� Date Tested 18�A8.�73
Input CFH �� Pereent OZ 7�� Company Testing
Stack Temp. ����� Percent CO �-� � Name of Tester
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SUBJECT
City of Fridley 2 6 3 3 9
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
�
� �
RECEIPT NO.
� ` _�_�_ COMMUNITY DEVELOPMENT DIV. �
r � L � PROTECTIVE INSPECTION SEC. ��� 9
� �
1 . �
<---. � � �",'� CITV HALL FRIDLEV 85432 NUMBER REV OATE PAGE OF AVPROVEO BY
�� �� 612-571-3460 910-F15 6/24/98 / /
J09 ADDRESS g110 Fairmont Circle NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNEO
DESCR. 3 1 Bourdeaux's Spring Brook Addn SNEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PFIONE
Fred Erickson 8110 Fairmont Circle
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Richard Hastings Contr 6331 Riverview Ter NE, Fridley, MN 55432 574-9966 4051
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PFIONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDIN(i
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOYE ❑ REMOVE
8 DESCRIBE WOi;K
Reroof flouse & Garage (22 Sq) Tear-off
9 CHANdE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY aROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHEFi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEFMIT �1,834 �.92
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �Sg.SO Fi e SC �1.53
�
PLAN CHECK FEE T � FEE
���= �� ° „ �. Z !� License C $5. 67.25
� SIGNATUf;E OF CONTFACIOR OR AUTHO ED AGENT IDA EI
EN FOP � VALID� �S VOUFi P RMIT
i
S�GNATUREOFpWNEA��FOWNERBUILDEAI �OATEI 8L G INSo DaTE
� � -
rrEw
�DDN
- ALTER /�
��- . . ��33�
- .�. - . � ���
ConstzuctionAddress: °� l%� �iq r� lu�� �,r`� c=r � o �
Legal Description: •
[] .
[ ] CITY OF FRIDLEY
[] _., ,� SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
' � � BUILDING PERNIIT APPLICATION
Effe.ctive 1/1/98
Owner Name & Address: t� t) ��, i��,��� Tel. #
Contractor: � � �i ,� e�. �� ����� �i � � MN LICENSE #�� -��L
Address: � 3 3 a � a �' .� � �i � � � �� � Tel. # ..S �y�-� ��'� �
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:
OTHER:
DESCRIPTION OF INIPROVEMENT
Length � Width Height Sq. Ft.
Length Width Height Sq. Ft. .
Length w�ar� Hgt/Ground Sq. Ft.
�� S
��
Construction Type: � � rZ � �_ �_ ,F �.� � �r � Bstimated Cost: $ , � � � . $ O
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � � APPLICANT: _ _ . � ��� Tel. # S�Z� - t ���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$��`�� S 0 Fee Schedule on Reverse Side
$ � . �' � .OQ1 of Permit Valuation (1/lOth%)
$ ,�� $.50/$1,000 Valuation
$ � $1000 per SAC Unit
$ ', O�' $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 $50,0(}0
$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 $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
� __ �-_
Buxlding PI�[rMBING P�'�i� N�.� �,
Inspec��ons R.]�SI��NN�'��.L .t�FP��CA.TIO� Rec�ived B .
' 763-572�3604 CITY OT�' F�DLE�" Da�'� U L 2 8 200 .
na� 07/25/08 Youx�-�x.���ss wnelson(cr�larsonplumbinq.com
, s�r�anDx�ss 811� Fairmont Circle NE
TH]S APPLICAA''C iS: ❑ OV�TIER f�GOIQTRAC1i0R
PROPERTY N,�,M�; Marilyn Erickson
��� a.nn�ss: 8110 Fairmont Circle NE crr�r_ Fridlev STATE,�VINZIP SS�Z
���' pxoNE: 763-780-4661
corrr�cTOR �: Larson Plumbinq, Inc.
StJ�M�T A COPY OF STATE LICENSE � 3341 PM � Daz� 12/31/2008
YOUR STATE Anv�ss: 3095 -162nd Lane NW Ci� Ando�er srarEll/IN z�P 55304
�,ic�rrs� wrrr� pxorr� 763/427-76H0 FAx 763/427-9448
A.PPLICATION
PERMTT TYl'E � S�GLE FAMILY � TWO FAMILY ❑ TOWNi�OUSE
TYPE OR WORK: d �E�'` � �PLACENI�Ti'P
' 17�?AILED DESCRiPTIOI� OF WO�tK Water Heater Replacement
PER MS I6B.665 the permit fee is a minimum of $15.04 or 5% of the toial cQSt up to SS00,00. whichever is greater, for ihe
improvement, installation or replacement of a residentia4 fixttue, excluding t�e fixtures. {This should reflect oaly the cost of labor )
Labor cost under �300 =�15,00. Labor cost beiween $300 to �500 = cosi oflabor x.OS =
FOR PROJECTS R'kiER� 1. ABOIt EXCEEDS $500, FEE$ A4tE SASED ON $10.fl0 PER FIXTURE, FJCCfiPT 1'df�RE 130TED. FIXTURES: ([NDICATfi 'fOTAL
NUMBER OF EAGH BELpV�
BATH SXNKILAV Fi.,00R DRAINS SHOWER WATER P1�ING
BATHTCi� GAS PIPINO �n cmticExs� SWIA�fMING POOL WA�'Elt SOFINER ($35)
_ CLOT[�S'VJASHER �"�KI'fCHEN SINl: WATEIt CLOSE7' BAGK�iAW PREV, ($15)
b3SHWASHER _ LAUNDRY'FRAY X WA'TEFt X�EA'CER ($35) FOR IRRIGATION .
_ WAT£R ME'fER `OTHER
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;'P£ � :,�E$`R'��E1?���'O�Z:: >'�:�'�{�b �x �'t � � > 5'.� �'a �, 1 ,� }.rs:..:c`�.�r:.... . ,� . s. . ._x:: ;+':
Tti!?�1`�'.. _ . �.: :(?� ...�. ..:,�.s $,.. _ �,;��x.�:.. .:��.�,:.�...r,�E�:�:E�;�O�;P�L�7�C'T'� O.`1�R:�,$:�0�:':
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Permit �ee . $ ��,�� Nuzn:ber of fixtures @ $10.00 x $l 0.0U = $
Surchar �e .SO Number of �'ixtures @ $iSAO x $I5.00 = $
TpTAL DUE $ 35 .� Number of faxtwres @$35.00 x 535.00 =�
State Surcharge = $ .SO
Total = $
TI-IIS 15 AN APPL4CATION FOR A PEitMIT NOT VALID UNTIL PROCESSED �
i hereby apply for a building permit and I acknawledge t�at 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 Minnesoia Cansiruction Codes; that I understand fihis is
not a permit but only an application for a permit and work is not to start witi�oat a perxx�it; that the work wil� be in accordance with the
approved plan in the case of all work which requires review and approval of pians.
sr A o� P�r � P NAME �.� ��a� !� 1�u1 / I+l9Q►�,DATE 07/25/08
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City of Fridtey
Bu�lding Lrispect�ons D�partment
6431 University Avenue NE, Fridley, MN 55432
763-572-36Q4
FAX: 763-502-4977