AF - 45613�City of Fridley, Minn.
�
� BUILDING PERNIIT N° , 6621
��: _.�.-��� ���_ __ � /f� �
,
Owner: .._ . I�J� Builder ._.._ ._ .�... . :......__....._.._........_.._.._..._.._.__._..__
Addrem_—..__.._..---�...—..�..__..._.�.__...._�..._.._ Address __.....�---'--_.___.._............_......._.._._......_._....–�--
•
.
..w+. t.... .... .....
Na ���.� 3treet ,. _... ..... oP Lot ......._......._.._..._.. _._. ..
Lot _—�.---._._._ Block .—_. . Addition or Sub-Divisian .. .. ..__ ._ . . -.�
�--�----- -� � � � �
Corner I.ot _.__..—..._.._.._ Inside Lot _.._��_..._..._ Setback .�P z�.. ._�..... Sideyard _.._.. ��_ ._.___.�.__...__..�....
Sewer Elevatim ._._..----._.._._.._..._._._.._.._..---._._........_.._.._ Foundation Elevation ...._._._.�—....--.----.–.--.—.–..---
�, DESCRIPTION OF BUILDING
veoa
_....__.._ �t _s9._. �� �_ ���,t _.��1z�.. sq. �.1._/3�/��. �. ���
� _ ._ PYroat __.�.� DeSth _.� 8ei6ht _..�Jl�94. FL .�2.,R� O Cu. Ft. __.._.._� O
Type of ...etton _...: _ �._ Fst Cost��..._...._.. To be ComPleted .._._.__.:.—.�
In cooaideration of the 9ssuance to me of a permit to ca�ssUvct the building deacribed above, I agree W do
the propaed avork in acrnrdance wit6 the d�scription abwe set forth and in oompliance with all provisions � of
a�dimnces of the dty of FridleY. .
Ea co¢�sid�ati� d t6e P$Y�nt of a fee oi a..��.., permit ia herebY Brsated W...---._... _
W conshvet t6e bullding or
the exprese ecmditlon that the peraon to whom it fa gr
done in,- around and upon said building, or anypart
FridleY. Mfnnesota regaidUig location, conatructiam, :
within the dt,y limits aral this B�'�t may be revoked
ordinanoee.
� as descrfbed above. This permit is granted upon
:d his agenta, employees end workmen, in all work
shall conf�m in all respeeta W the ordinances a2
i, maintenance, rnPeu' and moving of buitdings
�me upaq,+�ielgtion of aztv of the proviaions of eatd
Buildin8 InaPector
NOTICE:
ThL yNnle dea na cswr rM w�eneNa. Ir�aIl�Nee fer of�iy, ptwn6iny, ps Mnino, aw�r er wabr. B� mr� ro a«
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t�AI LOSS GALCULATIONS DEPARTMENT OF BUILDINGS G/, /�-3 ' hIINNF.APOF.iS; MINN.
WeatheraErips �• "H'V' ' Conatruction No. Insulation
Guide
Window Doors Referena Out. Wall Int. Wall Ceding Roof Floor Kind How Applied
Yes ` I Ye � 19— �
FI.� `J � oom Length Width !3 Height FI.� / Room Length / Width ✓d Height
Windows and Doors—Crackage and Area Windows and Doora—Cracicage and Area
Infiltration
Glasa
Eap. wall
Net exp. w
Int. wap
Ceiling
Floor
Total Btu.
17g�
�eE Bm
!
ft. E.D.R. or aq. ina. W.A. L.eader area
/ m Length Width /
and Doora—Crackage and Area
Infiltntion � �,,,
C.laaa i
Exp. walt X
Net exp. wall
Int. wall
Ceiling
Flom �
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Lead�
F7.� / ; . Room CLength W
Windows and Doors—Crackaae and Area
EaP. wall
Net ezp. x
Int. wall
Ceiling `
Floor
'fotal Btu.
G� �'"
area
g' �
LOGE B[U
Glaaa
Eap. wall �
Ceilin
Floor
Total
Infiltration
Glau
Exp. wall
Net ezp. w
Int. wall
Ceiling
Floor /
Total Btu.
w�oao,�.
W,a�.
No. ot oan
Net ezp.
int. wall
�� �
oeE. Btu
h. E.D.R. or sq. ins. W.A. l.eader area � .
�i Room I ��sth idth /Q Height $
and Doore—Crackage and Area
He16�t No. ot Llneal tt. Area
a o[ pane 116�b of crack eQ. [t.
7� �l1 / rj (o
or sq. ins. W.A. Leader area
�m I Length Width f
—Crackaae and Area
�� �
�cef. Btu
ft. E.D.R. or aq. ina. W.A. Leader area � � II Required sq. ft. E.D.R. or sq. ins. WA. Leader arca
. pS6 ��?' — �. :w� : . � , r i . `/ � ��`
F�AT [.�S CALCULATIONS DEPARTMEN7' OF BUILDINCS MINNEAPOLIS, MINN.
�tat6ecttrips _IIA.S.H.V. . Conetruction No. Ineulation
Guide I I
•••. , � •, - a H A 1' d
Windows and
wia�n i
Na. o[ nane <
Reference Out. WaIl Int. Wall Cwlmg Roof Floor Km ow pp ie
19—
I.eng�h Q Width Q Height `� FI.) Room Length Width Height
�rackage d Area I Windowa and Doora—Crackage and Area
��� _,
Infiltration
Clasa / �
Exp. wall �' j( g'
Net exp. wall /
Int wall .
Ceiling _
Fioa� 3 �3�
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI•� % Room � Length Width g' Height
Windowa and Doon-Crackage and Area
WIdt4 � Nelsnt ��� No: of Lfveal [t. Aro� � �
No. of pnn � o[ wue �tlahta ot crack �C.. fA ���
�
�II�I�tiehOD
�86E
E7[P. WB��
Net eap. w
Int. wsll
Ceiling�
Floor
Total Btu.
ExP. wall
Net acp. waf
Int. wall
Ceiling
Floor
Totnl Btu.
Required sq.
.R. or nq. ins. W.A. Leadez area
Room � Length �� idth �
bra—Cracicage and Area
/���'
Coef. Btu
ot aq. ins. W.A. L.eader arc� ��
Infiltration
Glass
E:p. wall +
Net eap. wall
In� wall
Ceiling
Floor
Total Btu.
E.D.R. or aq. ina. W.A. Leader ana
Room � Length Width
IDoors—Crackage and Area
No.
IO�I��Ia�1011
�88E
Esp. wall
Net exp. wall
Int. wall
Ceiling
floor
Towl Btu.
Required nq. k. E.D.R. or sq. ins. W.A. Leader area
Fl.� Room I Length Width
Wiedowa aed Doora—Crackaae and Area
Glasa
Fap. wall
Net exp. wall
Int. wail
Ceiling
Floor
Total Btu.
or sq. ins. W.A. Leader arca
V ��
oef. Btu
Btu
� sue.iecr �� � � RE�RMIT . .��
� Gity of Fridley ° 3Q��
�
"Tt"ET°°°`T"�T""'"S gUILDING PERMfT
: i
� RECEIPT NO. �
� � �' � COMMUNITY f7EYELOPMEMT OIV.
. ; �.-- y
� �� � ""� PROTECTIYE INSPEGTION 9€C. � .. � � ��,�.
1
�� 4 �'°� �. Gtt HALL PRIDLE� 55a32 NuMSea PEV.� D�TE . PAGE Of . APPflOVED BV�
i••_-J`'' �•���.si2-55a-s�5o � �� 910.F75 � � � � . .
�os nooaess 1451 G1aCier Ldne
� t LEGAL� - �OTNO. � BLOCK � TRACTORADDiTION � SEE�ATTACMEO �
� OESCR: � � 1 .innsbruck Sub Plat. 4 . s„EET
�� 2 PRUPERTVOWNER� � MAILqDDRES3 ZIP PHONE .
Hugo 4�olf 1461 Glacier Lane
�.3 CONTRACTOR� � � � MAILA�URES& ��' Z�P PHONE LICENSENO.
PFflI.� LdY..$OA� � .
' 4 APiCN)TEGFORDE816NER - MAILADORE65 � � ZIP .. PMONE UCENSENO.
� 5-ENGINEER � - � MAt4ADDRESS . ZIP PHONE LICENSENO.
e U5E�6FBUfLD�NG � � � �
'residential
� 7 CLASSOF WORK - � � �
❑ �NEW .�� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
H � � 4ESCRIBE WO:iK � � � � � �
add 4 x l0 to kitchen and construct an 18 x 14 deck
A GHANGEOFUSEFqOM � �� TO - � .
. STIPULATIONS � ��� . . �� . .
SEP0.RATEPERMITBAREREOUIREDFORELECTRICAL,PLUMBING.NEATING, TM�EOFCONSL� OCCUPANGYGROUP OCCVPANCVLOAO
VENT�EATING OR-AIR CONDITIONING. �
TNIS-PERMR� BECOMES NUIL AND VOID IF..WORK��OR CONSTPUCTION ZONItyG . SQ.FT. -- CU.FT.
'. AUTHORFZED IS NOT COMMENCED WITHIN 60 pA.YS�; OR�Ii CONSTRUCTION �. . � �
OR WORK IS.SKISPENDED OR ABANOONED FOR A'.PEH(O� OF 120 DAYS AT � � �
.-ANY TIW1E AfTEP WQAK�IS COMMENCED. '� � , NO D1NL6= UNITS � OFFSTREET PARKING �
I MEREBV CERTIFV LNAT:I HAVE READ AND EXAMIN�O THIS APPLICATION � STALLS � GARAGES �
ANDKNOWTHESAMETOBETRUEANOCOflAECT.ALIPROVlSIONSOFLAWS yq�UATION � � SURTA%�� � � �
AND OR�INAMGES� GOVERNING THIS TYPE OF WORK WILL BE GOMPLIED � �� �� �� �
WITN WMETNER SPECIPIEO HEREIN:OR N�T:'LH��6RANTING OF A PERMIT ],.
WES�N6T�PRESUME TO GIVE AUTHORITY TO�VIOLltFE--0R CANCEL THE pERMITEEE`� ��. � SACCHARGE '.. .
PR¢pIS10N3 OF ANY OTHER STATE�OR LOCACLAW RECaULATING CON-. 1S::OO �
STRUCTIOW OR TME PERFORMANQE OP CON3TflUCFION. . � �
� - � � _ �� PLANCHEGN.FEE� . � TOTALFEE �
16.18
�siGH UREOFCONTR1Li0ROR1UTHONIZEDg� r� �� ioATE� N PPOPERL VALIDATED THIS 19�VQUR PEPMI �
c � - Cr�,e/ ) l
� /'l--%S �%/ 7�'
�SIGNA REOfOWNEPOROWNERBUIL 1 104TEI � gLOG.1NSO � � �PTE �
/
i
/
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
� r �'L"''u'` l
OWNER`S NAME; �_ L��: „ V(lJ[ .� BUILDER•
�,nrn�ss: /�fs ( �fc.���,, L�.,`_nnDxESS:_ (��.� i �^
NO:. STREET
�T� � BLOCK:_ 1 � ADDITION:___ ,�. ��1 S+� _D � t�
a�FO,�,
CORNER LOT: INSIDE LOT:�SETBACK: SIDEYARD:��
Applicant attach to this foxm ltao Certificates of Survev of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As:
��� �.e- Front: � Depth: ( U
Height: 1 �r�y
__'t�
Square Feet •_ �/(� Cubic Feet: �� F', O
��.� _Front: � � Depth;_ / �%
� ______�"_Height:
Square Feet;_ � �2 Cubic Feet•
�r°--
7jrpe of Construction: .�,�r,rn,-,� ��,,�.s,� Estimated Cost: $�' � 3SC+
To Be Completed: J t�-� � jf j
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and ntlings of the Department of Buildings, and hereby
declares that a11 the facts and representations stated in this application
are true and correct.
DATE: _(v. _ �j� - 7r SIGNATURE:
- ,6�-__�=_� �.�.
(See Reverse Side For Additional Information.)
�Y
��,d�e
�, i�� .c.�o�
/�- /�
_�.
,
A �
City of Fridley
•T TME TOP OF TME TWINS
.
„
� .
� � ��� _ COMMUNITY DEVELOPMENT DIV.
� v� � � CROTECTIYE INSPECTION SEC.
r ,
`.._.� � ' '�'� CITY HAII FRIOLEV SS/72
� 612-571-3450
lOB �DDRESS
1451 Glacier Lane NE
1 LEGAL �OTNO. BIOCK TNSCI
OESCR. 2 1 Inns
i FROGEATV OWNER MAIL AODRES$
5 ENGINEER MAIL
WOFK
ADDFESS
A�DRESS
SuB�EC�
BUILDING PERMIT
910-F15
o�GE Of
� /
30035
, _
RECEIPT NO.
��
♦I>qOVEC !r
SEEATTACMEO
SMEET
VXONE LICENSE NO
81-8232 42A9
PMONE LICENSE NO.
O NEW O ADDITION ❑ ALTERATION � REPA�H ❑ MOVE O REMOVE
Reroof house and garage (36
9 CHANGEOFUSEFROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
SEVqRAtE PERMIT5.4RE HEOUIREO FOR ELECTRIC�L, PIUMBING, MEATING.
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NUIL 4N0 V010 �F WORK OR CONSTRUCTION
AUTMORIZED IS NOT COMMENCED WITHIN 80 OAYS. OH IF CONSTPUCTION
OR WORN I$ SUSPENOEO OR ABANDONED FOA p PERIOD OF IZp DAYS AT
ANY TIME AFTER WORN IS COMMENCED.
I NEREBY CERTIfY iMAT 1 N�VE READ ANO E%AMINED TNIS APPLICATION
♦ND 1(NOW 7ME SAME TO BE TRUE �ND COAAECT. �LL PROVIS�ONS OF LAWS
ANO ORDIN�NLES GOYERNING TMIS TYPE OF WORK WILL BE COMPLIE�
WITN WHETHEN SPECIfIEO MEFEIN OR NOT. TNE CR4NTING OF q PERMIT
OOES NOT GRESUME TO GIVE AUTMOFITY TO VIOLnTE OF CANCEI TME
FROVISIONS OF ANY OTHER STA7E OR LOC4l lAW REGUL�TING CON�
STqUCTION OR THE PERFORMANC OF CONSTRVCTION
� .. /
S�G �IUaEO�C �, OR�U��Oa4ED�GENI �O��E�
$TAlLS
rr�v�t � '
ADDN
ALTER
Effective 5/10/99
( ] CITY OF FRIDLEY
[v]� SINGLE FA1bIILY AND DUPLEXES R-i AND R-2
BUILDING PERMIT APPLICATION
Construcuon Address:
Legal Description:
1�
Owner Name & Address:
�J'l�
�t � �a �
U���
�° ��
Tel. � 5 i 1 ''-+O6
Contractor: ��,J�,r� �C�.�¢n.ung MN LICENSE �i �► oi � q
Address: Q �O � �Qlwvt �e ..� , ��"�_,� 1 o h Tel. # �ci I•Ffo� ,3 �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTi�R:
Attach to this application, a Certificate of Survey of the
lot, with the pmposed construction drawn on it to scale.
I.ength
I,ength
I.ength
DESCRIPTION OF Il�iPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground _ Sq. Ft.
Construction Type: � _ Estimated Cost: $ � �O � �� 7 �
Driveway Gtiub Cut Width Needed: _Ft. + 6 Ft =_Ft x$ _$
DATE: �S '� 'g �I APPLICANT: ,� � ���hv�AX�iI� Tel. a 88' i-g a3�
Permit Fee
Fire S�ucharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 7. �S"
$ .lS
$ /. S7
$
.p LVV
$
$
$
$
$ 1a�.9�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pernut Valuadon (1/lOth%)
$.so/$1,000 valuation
$1050 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 [ ]
Building
Inspections
763-572-3604
�ATE 7- as-
SfTE.4DDRESS �y
TMS APPLICANT (S�.
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
YOUR E-MNL ADDRESS
Penr.it No.:
Received By:
Date Rec'd.
corrTxa.cTOx �oMP.wY N,�.� Anderson HCating and Air-Conditioning
5�rg��T A COPY OF CONTAC7 FERSON�. Q"��<<,__ l.___— A
YOUR STATE STATE UCENSE � N�A� Y3�� CeIItCa� AVe N'�.
LICENSE WITH ADDRESS: �7
APPLICATIO'� PHONE 7(1.�'%Kl- �iS// C��. [ItS� Mn 55421
PERMIT TYPE
TYPE OF WORK:
�[NGLE FAMILY ❑ TWO FAMILY
p��y �REPLACEMEN7
DETAILED DESCRIPT]ON OF WORK!1
❑ 70wNHOUSE
❑ AL7'ERATION/REMODEL
Q��
ATE ZiP
STATE_ZIP
PER MS 16B.665 the permit fee is a minimum of $15.D0 or 5% of the total cost up to SSOD.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures`. (This should reflect only the cost of labor j
Labor cost under $300 = S1S.00. Labor cost between S3D0 to i500 = cost of labor
x.05=
FOR PRO�CTS WHERE L.480R EXCEEDS 5500, FEES ARE BASED ON S10.D0 PER F1kTURE, EXCEPT WHERE NOTED. FTRTURES: (I1QDiCATE TGT.41.
\'l,'1.4BER OF EACH BELON� MODEL: SIZc/BTU
Equipmentlnstalicd ��� MODEL: SIZ&BTU
MFG�. SIZEBTU
�,.G. MODEL:
F[REPLACE (OAS) SI S.DO _GAS RANG&OVEN S1D.00
PJC 525.00 —FIREPLACE (WOOD) 535.00 NEW GAS GRILL Y10.00
.41R TO AIR EXCHANGcER S 15 —FU�pCE Y35.00 _GAS IIMT HTft 510.00
BOILER 535.00 GAS DRYER 510.00 _POOL HEATEA S3S.00
_CHIMNEY LINER 510.00 GAS PIPiNG YI D 00 VENTILATOR 415.00
niirrwowcsio.o0 — . v.....�... �_,,.,��:����a��.;;�,n�nr:xr:r`s�F„Fnu.PR"nlF.f:TS::O1'ER�S�O
Permit Fee
Surcharge
TOTAL DUE
IJNDY.ic:'a3uV_,h .�.r:.; ,..�. _,..,.. a...._.___
Number of fixtures @$10.00 x$1D.00 = 5
$��' � Number of fixtures @$ I5.00 _ x� 15.00 = S
$
$ �_ � Number of fixtures @ 525.00 _ x�$25.00 = $
Number of fixtures @ �35.00 x $35.00 = $ _
State Surcharge = $ �>Q
Tota1= �
� THIS IS AN APPLICATION FOR A PERMIT-NOT VALID lJN'I�IL PROCESSED
[ hereby apply for a building permit and I acknowledge 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 Mumesota Construction Codes, that I understand this is
not a permi[ but only an application for a permit and work is noi to start without a permit; that the work will be in accordanee H'ith the
approved plan in the case of all work Which requires review and approval of plans. �
/�9� r�TNnr�eC ����e/1.���'q�r" Da.ra aS�D(o
SIGN.4TLRE OF APPLICANT C u/�� �� -
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fr'rdley, MN 55432
763-572-3604
� AX: 763-502-4977