AF - 45621City of Fridley, Minn.
BUILDING PERIYIIT
Date: _.i�_"':.'..I�+�-��.� __._�_____
Owner: _._(�4!"3�__�.: -�`�'�`�'� Builder
Address ___.—_.........--.--..�._..._......._._.._.....__..._.._. Address
N° ' 5120 \
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No. < �41..... 5 �".r...�. � � �� �� �-'--- Pay�b�pJP Iat _ _.._. _...._._..._._
Lot _. � ._...._. Bloek — `T_._ . .__ A dition or Sub-Division ..I{��+L��/a�Gr�._..�+
Corner Lot _......_� Inside Lot ._.._.._�.-�._.._ Setbaek �-f--.... Side3'ard ._...,t�...!'��.-t.�....._� _......_..—._
Sewer Elevation
Foundati� Elevation
DESCR9PTION OF BUILDlNG
F
� a f � � �
To j% �� ��y �_''` Front ��.�� Depth .�,�. '�.. Fieight ¢�,-_...� .. Sq. Ft E�4 F
! ,t ,��
�:-
.t.w�� .'�"L'�� Front � �}.. Depth _..��.['"� Height ���. Sq. Ft �`�°'s_�r
� . .�--.�° i•o • 6;"G'."
Type of Gbnstruchon __..... ."'�� F�.Y�.'� .. Est. Cost eL.t.'__��� ..."'".E. To be Completed ....
�' '_
Cu.
Ch:A
f'r ,� �' ,f
FY.6'� a1 1'"-f��tl�
Ft. .�. 4 i �
� In rnnaideration of the issuance to me of a permit to construct the building descrihed above, I agree to do
the proposed work in accordanee with the description ahove set fort.h and in compliance with all provisions oY
ordinances of the city of Fridley. _
In consideration of the paymeat oE a fee of $s:L.C--_., permit is hereby granted to_�.__—
to construct the building or addition as described above. This pernvt is granted upon
. the express condition that the persoa to whom it is granted and his agenta, employees and worlmien, in all work
done in, around and upon said building, or any part thereof, shall coffiorm in all respects W the onlinances of
Fridley, bIinnesota rngarding location, construction, alteration, maintenance, repair and moving of buildinKs
within the dty limits and khis pernut may be revoked at any time upon violation of aay of the provisions of said
oPdia8SlC28. A) w n " i
BUS1dID6 IIlSpCCi01'
NOTICE:
Thb pamil daas no! eovar IMa eon�IrueNon, insfalklion foe wiring, plumbing, gas heafing, uwer or waNr. Bs sun b sae
fM Buiiding Inspetlor for sepanh permin for fham ilams. � . '
a�o4
�
�/
a�xax�ox Fox $uxr.nnac �ax
CITY OF FRIDLEY, MIN��40Tt
Ovc�era 2�aas
IFKJ
aaareaa eaargsa 3�-3� A�•rv�
IACATION OF BUILDING
po. �o street, �,�o/%���Z,H-v Part of Lot --
Lot �^Hlock„_%,,,,�,__Addition or Sub.Div � ��-�:=z � � �
Corner Lot Inside Lot Set Hack Side-Yard _`'��
� ELEI/ATION FOUNDAT7DN ELEVATION
Applicant attach to this form.Certificate of Survey of Lot and propoaed bvilding
location.
D$3CRIPTIOIv OF BUIIDING
� � �
Type of Consfiruction Ssti�ted Coat
To be comp].eted -
The underaigned hereby makos application for a permit for tha work herein epecifiAd,
agreeing to do all work in striot accordance with the City Ordinances and ruling of
tha Depart�airt of Buildings, and hereby decleres that all the facts and repreaenta-
tions stated in this epplication are true and ect.
DATE �-�G1.i /3 /9G ° STGNATt1RE G�/ ,
(A Sohedule of Fee coeta can be found on the Reverae Side.) �
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HEAT LOSS CALCUTATIONS DEPARTMENT OF BUIIDAVGS MINNEAPOLIS, lbIIlal.
Weachen�rips A•S• •v • Conatmction No. Insulation
l Guide l
Window�a I Doorso II R, E9etenee � Out. Wall Int. Wall Ceiling Roof Floor I Kind How Applied
FLj "' �EA Room Length Width Height eZ FI.� �`'a ffEO Room Lengt6 /J� Width Height
Windowa and Doors—Crackage and Area Windows and Doora—Crackage and Area
Wtdtfi Helg�t No.ot Ltneelft. Axes WItltL He1gLt No.o1 Lfnealtt. Atef
No. ot D>ne o[ Dane Ilg�b of en<k s0. [t. No. of pane o[ pane tlghb ot crack W� «�
L 3 3 �� � Z� y/
�
C«f. Bm Coef. Btu
Infiltratioa Z �' In6ltration � k� /S
Glaas 3.3 O �o.S
, wall 08
N Nwa�l , _ _ S : S _.�
Int. wall
Ceilin8 S�X/ �r �
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area
�FI•� ,qr�f Room Length �' Width Height Q
Window: and Doore—Cracka¢e and Area
a� � / �s
Caef. Btu
In6ltration L
Glaas p — —p
Ezp. wall � m'l.
Net ezp. wall p/ O
►m. wall
Ceiling ' �` 3 Z
Floor
Total Btu. d 7�.�
Required sq. &. E.D.R. or sq. ins. W.A. Leader area
FI." .E Room �l.ength Width / Height
Windows and Doora—Crackage and Area
Wldth Helg�t No. ot Llneal tt Area
No. o[ D�n� ot D�ve 11{hb of craek p. tt. �
z� a� aa �
Coef. Btu
In6ltration aj �'% �
G1a+* � SO OQ
Fap. wall $�
Net exp. wa (� (� ,�
-Iat.svaU
Ceiling Q 9 fQ
Floor
Total Btu. ,3
Required aq. ft. E.D.R. or aq. ina. W.A. Leadtr arca
Glaaa .3 O .�0
Esp. wall (o D �
_ Nettxp. wall 3 ' ��
Int. wall - p
Cei�in8 /J �O / �i��-�
Floor
Total Btu. �
Required aq. ft. E.D.R. or aq. ina. W.A. Leader area
F7.1/) G Room � I.ength (] Width Height
Windows and Doors—Crackagc and Area
Wldth Re1B�t No. of Llneel [t. Area
No. ot Wne ot pans Itahtt o[ crack q. [t.
y a a� ..5�
Coef. tu
Infiltration a � ,�� o G
Glaaa a � .i � / DO
Fap. wall �j'�j' c�
Net eap. wall 33 —
Int. wall
Ceiling
Floor p !� 3�
Total Bm. D
Required tq. ft. ED.R. or sq. ins. W.A. l.eader erea
F7.� i e/f,t�/ Room I Length / Width � Height
Windowa and Doon--Crackage and Area
Wldth HBl6�t No. of Llnea] [G Atea
No. o[ pane ot pane IlShte ot crack w. tt.
z- a� �_; � a � �D
�. a 8 y
Coef. Btu
Infil[ration �t..
Glaaa �D DO
e=P. Wen y
Net exp. wall _ , '" 6�
Int. wai!
Ceiling
Floor � /p 5/e� o
Total Btu. a2,
Requ'ved aq. ft. E.D.R. or sq. ins. WA. I.eader arca
a ` �
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HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
A.S. V.
Weatherotrips Conatruction No.
Guide
Win�do_wa I Doors I Reference I Out. Wall Int. Wall Ceiling Root Floor
�yws�–�Na o 19_
FI. Room Lengt6 Width Height FI.� ,�yj�
Windows and Doora—Crackaae and Area Windows a�
Nltlth Helght
No. af Dane of Dan!
� �� ��
x� �,.Y.0 , : .
Int. wall
Ceiling
Floor 3X
Towl Btu.
Requiced sq. ft. E.D.R. or sq. ias.
f Fl•� .6 td' }' Room Length
Windowa and Doon---Craekage
w�a�e xeie�� ++o. oa i
No. ot Dane of pana IffCta
/ � � � 8 %��
In6ltration
Glau
Exp. wall Q ,�'
--�–
Net exp. wal)
Int. wall `
Ceiling
Floor �,3 J( '
Total &u.
�.R. or aq. ina.
Room �Lenstl
In6ltration � ,S (o
Glas�
Exp. wall � �X�
Net e:p. wall
. �et_ w� _ _ .. . _— ---"_ -.._ .. _ ..
Total Btu.
or aq. ins.
L.eader area
Width
Ana
saer area
WWidtA /.
�
. eri
�/
� .� �--
Btu
area �
z �6
Infiltration
��
exP. Weu
Net e�D• w
Int. wall
4POLiS. MIAiNi.
Insulation
How
Area
a�
Coef. Btu
�8 1'1 O
O 50
13
equired sq. ft. E.D.R. or sq. ina. W.A. i.eader a*ea
FI,� Room I L.ength P/idth
Windows and Doora-�rackage and Area
Exp. wall
Net eap. v
Int. wall
Ceiling
Floor
Total &u.
.R. or �q. ins. W.A. Leader area
Room I Lenech Width
ora—Crackaae and Area
Infiltration
Glasa
Exp. wall
Net exp. wa� _
int. wall
Cei�ing
Floor
7ota1 Btu.
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GEO. SEDGWICK HTG. & AIR COND. CO. p#k Z 2 9� 6
HOUSE HEATING 7EST RECORD
ADORESS t�4 � p c �. � c�€R t A�u E CITY FR 1 D 1 F„_ f1
OCCUPAFVT OWNER �O � v kJ D E' � N
HEAT COSS DATE HTG. INST.
SQLD BY INSFALLED BY �'r�C? SG'OGW�C K
Etecteical Work By ��Eo 5'En 61�[rC K Gas Line By ��'n Sfi�G WL C K
TYPE�OF HEAT-� ��GA_ FA� HW_ STEAM_ SPACE HTR._UNIT HTR.�OTHER
GAS DESIGN CONVERSION
MAKE r�+�Y-� �� fi'nf�1 MAKE OF BURNER
Model C �%5 " �,3 Model
SeriaP �� ��,�-C1 � � � 2 � " Max. BTU Rating � �
INFUT �� �f �a MAKE OP FURNACE
Model
. ..., --
� #�gpt Plwg
� �lw+�i c
Lit++it Setting
Fan Setting _
�lot Type L � ti-- .
Pitot Make �
Pilot Model . �
Pilot Timiog �[� 5 E' C
L.W. Cut dff � �►��
Pressure ? • S `� Percent COz �"��
Input CFH ��� � 0 Fercent OZ -J�2�
Stack Temp. - 3�J<a� Percent W�
�!
Vent Size - b' �
KIND OF LINER � SIZE NONE �
DreftHood (;f&g7YC�� Regulator
Filters Size � Number
Chimney Location Mside� . � Outside .
Chimney Construc6ort � � � �
Smoke Bomb - � Wiring OK
Draft _-L' L— Test Tag
Door Pressure Lighting Inst.
Date Tested •�— .�� ` 7 !� � _
Company Testing � OG W(CK 1�F147`1NG CO
Name of Tester- FNT C!C h�- ��
Form 235 � . �
Su6JEt1
c�cy of Fridley 21559
ATTNETOPOFTHETWINS gUIIDING�PERMIT
; �. iiECEIPT NO
� �` _ COMMUNITY DEVELOPMENT DIV. �� �
� Y PROTECTIVE INSPECTION SEC.
r . ,
, � ,
� /"'\ • CITV HALL FRIDLE� 55�32 NUMBER REV DATE PAGE OF nVCROVEO BY
4"'-'� • •'� 612-571-3450 910-Ft5 9/21/92 / �
JpB ADDRESS 1480 Glacier Iane NE
1 LEGAL �O�NO. BLOCK TRAGTORADOITION
DESCR. 1 4 Innsbruck 2nd Addition
2� PROPERTY OWNEF � MAIL ADORES$
Craig Wadzink 1480 Glacier Lane NE
3 CONTRACTOR � MAILADDRESS .
Same
5 ENGINEER
OF WORK
ZIP
MAIL ADDRESS
SEEAT7ACMED
SHEET
PMONE
571-2541
PHONE LICENSE NO.
PHONE LICENSE NO.
LICENSE NO.
❑ NEW � ADDITION ❑ ALTEHATION � REPAIR ❑ MOVE ❑ REMOVE
DESCRIBE WORK
Construct a 24' x 18' Garage Addition
9 CHANGEOFUSE
STIPULA710NS See notations on plan, Provide a hard sur£ace driveway. Add smoke
detectoxs in dwelling unless already installed. I£ roo£ is hand f[ramed� we will need
detailed drawings.
SE7ARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUM8ING, HEATING,
VENTILATING OR AIP CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR GONSTRUCTION ZONING
AUTHORIZED iS NOT COMMENCED WITMIN 80 OAYS, OR IF GONSiRUC�ION
OR WORX 15 SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT �
ANY TIME AFTER WORK IS COMMENCED. � NO. DWLG. UI
I IIEREBY CERTIFY TMAi I HAVE REAO AND EXAMINED THIS A7PLICATION 1
AND KNOW TNE SAME TO BE TRUE AND CORFECT. ALL PROVISIONS OF LAWS yq�UATION
ANO ORDINANCES GOVERNING THIS�TVPE O: WORK WILL 8E COMPLIED $�j�HQO
WITH WHETHER SPECIFIE� HEREIN Ofi NOT. THE GRANTING OF A PERMIT
DOES NOT PNESUME TO GIVE AUTMOFITY TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF ANV OTHER $TATE OR LOCAL LAW REGUTATING CON- � $lOS.00
STRUCTION OR THE PERFORMANCE OF CONSTRULTION.
swwn�e or co�ac�o�+�f�+ �� �
STALIS
CLL FT.
$3,40
SACCMARGE
Fire SC $6.80
707ALFEE
$118,2�
���
NEW [ )
ADDN �
ALTER [ )
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/92
Construction Address: /� SO C�-LR.�.� e... L.iv ��' F�'.f[� hiv ��'s't�,� �
t,egat Descriptioa: Lo� � 8�,I4.�- �' =w� �l.t i� r w c k :2 N i� � rQ � i� i e su
Owner Name & Address: G'r�:i� L.�a.eQ.�...rIL �s..�.�..rw.�w�'el. #57/—S;SS%I
Contractor; /? r s� L�'-- MN LICENSE N ""—
--�
TeL #
Attach to this application, a Certificate of Sucvey of the
tot, with the proposed const�uction drawn on it to scale.
DfiSCRIPTION OF IMPROVEMENT
LIVINCs AREA: Width Heigt►t
GARAGE A1tE��� Width / 8, Height l0 �
DBCR AREA: Length Width Hgt/Ground _
OTHER:
Sq. Ft.
Sq. Ft. �oI �,T7:
Sq. Ft.
Corner Lot �Inside Lot [) Ft. Yd Setback Side Yard Setbacks
Type of ConstruCtioII: 1,aieo � Fr.,.+.�C ��� C�� $�'d''����
Approx. Completion Date: �y I�+�rT" �'3 5�,,:, .,J r.� loow.sr �"7'�+�+ F�GC ?,
(Cost on Back)
Driveway Curb Cut Width Needed: � Ft. + 6 Ft =_Ft x$ _$
DATE: �—/L -� 9�1 APPLICANT: � �,� .,.�1 � �' Tel. #S7/-��.T S'�/
�,
Pemut Fee $ ���.�� Fee Schedule on Reverse Side
Fire Surcharge $ , gd .001 of Permit Vaivation (1/lOth9b)
State Surcharge $ �, �� $.SQ/$1,000 Vatuadon
SAC Chatge $ $700 per SAC Unit
License Surcharge $ 55.00 (State Licensed Residential Contractors)
Driveway Escrow $
Park Fee $ �
Sewer Main Charge $ --��
TOTAL $ �o� �
Alt. "A" or Alt. "B" Above
Fee Deternuned by Engineering
Agreement Necessary [ l I�fot Necessary t l
. � �,! .. � , , � r ,: , i i
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S7/– �S y'-/
r IISt �tY
Title
PLAT DRAWING
Tl File NO. �s� D � � �
Legai �� �% � .�.crLra�,�
o'�' �..� °�i.� -
/L�wo (< s. c•.
Prop 'rt Address:
l� �o � 1�'�,. ��.tic '—
.�iY'i� ��-�/ � Lw-H.
� /
` Th�s Plat Drawing is not Intended to be used as a survey and shouid not be relled upon as sueh. The Ict dsmen-
slons are taken irom the reca'ded P�at cr the county recards and are assumed to be correet. The locatlon of the
improvements shown on this drawing are approximate and are based upon a visual tnspec8on ot the premises.
A licensed surveyor should be contaeted itan accarate survey is desired. This plat drawing does not constttute
a Itablllty of the comQany and Is fntended for use by the campany onty. SG� �� p�.o
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�' GBORGB E. HOPKINS � Regis�ore�l.Laad'Siirveyor a�d..Civil Bngiaeer r3'am`°
� Phode SO. 1-8856 ' 1070t�iKicollet Avenue:South 4
- ; . btianehpolia 20, Mino. -: ; :
,._ _ PLAT OF SURVEY :
�.
. y . . � Scqk � 1. inch - �'. ¢ D •':'leet �:
. ... , ' .' : 46.�
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PAOPmR'X'S� Or' +-r� Aa���v �Tl/��� 1.�e ' �" i z �
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� This *ikrv� we`made,and aert,iticate drevm for.the parpose o! showing the
bo�ntdd�r�,8a ot-the lot aAd the.essement of reeord. 'fhere ara no enoroach�erits.
Sv111die6 atake8 xere twt est by the sxrveyor. f. ' ,
CERTIF[CATE OF SURVEY ,
I hereby cerWly that on � DeC. � 19_LQ I sunpyed the properFp� depaUbed above and that the above plat 1a a correet
r.m•..nt.NOn ot tsld surveY. � � . � .. , � � . , . . .
� . /��'9�._ �- � . . �
uF i[aso3 �es ea '}T�,zed �SUB SO_I Aeg.mrr� .,,.����' �k� sseT eq .z-tt6ilosa'_
� sue�et+ � � . � � � PER
City of Fridley 3 0 5 71
,� �TTMETOPOFTMETWINS gUILDING PERMIT
� . RECEIPT NO.
� :�V��_���_ GOMMUNITY DE�ELOPMENT DIV. �� /�
f � PR07ECTIVE INSPEC710N SEC. . �
�
� � /"9 � CITY NAII FRIDLE� 55�02 xuM�EA MEV O�TE vAGE Of ,1NROVED B�
�.._.�' '•� 612-571-3450 9fo•Fi5 12/7/99 / /
lOB ADDRESS 1480 Glacier Lane NE �
1 LEGAL �OTNO. BIOCK TNACTOPADDITION $EEATTACXED
oescn. 1 4 Innsbruck 2nd Addition SHEET
2 PFiOPERTY OWNER � MAIL �DDA(5$ 21P iMONE
Tim McCaule Sr 1480 Glacier Lane NE 574-1178
J CONTRACTOp MAILADDRESS ZIP GMONE LICENSENO
Same
� ,4RCNITECTOROESIGNER MAILAOORE55 21P GXONE LICENSENO.
5 ENGINEER MAILADORESS . Z�V PMONE LICENSENO
6 USE OF BUILOING
Residential
7 CLASS OF WONK
❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
X
8 DESCPIBE WORK
Reside House & Gara e
9 CNANGEOFUSEFROM TO
Si1PULATIONS
Call for building wrap inspection before covering or take pictures
of wrap.
� � � TVPEOFCONSi. OCCUPANCYGROUP OCCUPANCYIOAD
SEPAR4TE PERMfTS APE AEOUIRED fOR ELECTRICAL, PLUMBING. NEATING,
VENTILATING OR AIR CpNDITIONING. -
THIS PERMIT BECOMES NUIL �NO VOI� IF WORK OR CONSTRUCTION IONING 50. FT CU. FT.
AUTHORIZED IS NOT COMMENCED �j7THIN 60 DAVS, Ofi IF CONSTRUCTION .
ON WORI( IS SUSPENDEO OH ABANDONED FOA A PER100 OF 120 DAYS AT
ANY TIME AFTER WORN IS COMMENCED. NO. DWLG. UNITS OFFSTREET P�RKING
I HEPEBY CERTIFY TMAT 1 H11VE REpD AND E%AMINED TNIS APPLICATIpN 1 STAlLS G�RAGES
AND NNOW TME $AME TO BE TRUE AND CORRECT. R�� PqOV1510N5 Of �AWS yALUATION � $URTA%
ANO ORDINANCES GOVERNING TMIS TYPE OF WpRK WI�� BE COMP�IEO @
WITN WMETMER SPEpF1ED MEpEIN OR N07. THE GRANTING OF A GERMIT �.3�000 � WL.SO
DOES NOT 7RESUME Tp GIVE �UTHORITY TO VIOL�TE OA CANCEI THE pENMITFEE SACCMARGE
PROVISIONS OF ANV OTNER $TATE OA LOCAI LAW FEGULAiING CON� Q83.25 . Fire SC. .y3.�0
STFUCTION OR TME PERFOFMANCE OF LONSTRUCTION p
P�ANCHEGNFEE . TpTAIFEE �
W$%.7
S�GH �uAEO�tOrv'neClpaOA�u��0A2ED�GEni �O�VE� N P PEAI� •TED T YOUR PEQMIT
S�GN<i Nf O� OwNEA � OW f ��IOERi �� !��t� Bl �NS� � ���� �
.
NEW[]
ADDN [j
ALTER f l
>( Construcdon Address
Legal Description: _
Effective 5/10/99
C1TY OF FRIDLEY "�
SL�iGLE F.AivIII.Y A��1D DUPLEXES R-1 AND R-2 I,��
BUII.DING PERMIT APPLICATION �� / n\
l�ffso Gc�u�z- r,�►�,� J `)
)( Owner Name & Address: `% r-� Nj`�AucE Y S2 Tel. #_
Contractor: Or�„��/2 MN LICENSE �t
Addresx � n.� � Tel. 1!
LIVING AREA:
GARAGE AREA:
DECK AREA:
x OTI�R:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
L.ength
Length
ll ' � • Ibl' ' 1 ; bl \�y
_ Width
_ Width
Width
l�0 ✓SS d-r
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground _ Sq. Ft.
Construc6on T e: pov
yp Fstimated Cost: $ 3,
Driveway C�rb C�t Width Needed: Ft. + 6 Ft = Ft x$ _$
�( DAT'E: / Z'7- �f 1 APPLICA��IT: �.c L _ Tel. /t (, /z �%y //%
'�� �j�
CITY USE ONLY
Permit Fee
Fire S�.:rcl�rge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Conh�ol
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 83� ��"
$�.Q
$ /, S�
$
$
$
$
$
$ �% '�
Fee Schedule on Reverse Side
.001 cf Pe:mit Valeia!ioa {1!iQth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservadon Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
PERMIT .. -0042 �
1
DAT'E ISSUED: 04/02/2004
(763) 572-3604 FAX: 763 571-1287
ADDRESS : 1480 GLACIER LN NE
PIN : 253024120048
LEGAL DESC : INNSBRUCK 2ND ADD
: LOT 1 BLOCK 4
PERMIT 1'YPE : BLTILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING
VALUATION : $ 2,894.00
NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE.
INSTALL DIFFUSERS FOR NEW LAY-IN CEILING
STATE LICENSED CONTRACTOR 1
APPLICANT BUILDING PERMIT FEE 83.25
FIRST CHOICE CONTRACTING INC FIRE SURCHARGE 2.89
I 1020 KUMQUAT ST NR' STATE SURCHARGE, VALUE 1.45
COON RAPIDS, MN 55433 LICENSE SURCHARGE 5.00
TOTAL 92.59
OWNER
MCCAULEY TIMOTHY J& MARY JO
1480 GLACIER LN NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if conslruction
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
applicadon and lmow the same to be true a�d cocrect. All
provisions of laws and ordinances goveming 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 co tructio le p ormance of construc wn.
`Appli t Date `� 2 D�
-BldgInsp Daie ��
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW
ADDN
ALTER
[1
�
Construction Address: � g6
Legal Description:
Owner Name & Address: � �'�"
Contractor. r +ST �u r C
Address� U �LD kr�mG�it
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
.ST .
C
l� !l S�
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763) 577-1287 Fax ��(�
�O, f , wz I
f��
Tel. #
MN LICENSE # Zo/S p��
Tel.# ?L} 2� �/3y -_-
Attach to this application, a Certficate of Survey of the
bt, with the proposed construction drawn on it to scafe.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Sq. Ft.
Sq. Ft.
S�,Ft.
Construction Type: � Estimated Cost: $ �-�� �CJ ��
Driveway Curb Cut Width Needed: _Ft + 6 Ft =_Ft x$ _
DATE: �- �� APPLICANT: /�'� d��[�7 Tel. # 7� � y�� y���
Call (763) 572�604 for Permit Fees if mailing in application. Fax to 763-577-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
�
a,
c,
� rI
r
�, — • �
CITY USE ONLY
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
PERMIT NO.: 200402296
DATE ISSUED: 12/17/2004
(763)572-3604 FAX: (763)571-1287
ADDRESS : 1480 GLACIER LN NE
PIN : 253024120048
LEGAL DESC : IIdNSBRUCK 2ND ADD
: LOT 1 BLOCK 4
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 0.00
NOTE: COMBUSTION AIIL SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A PH:763-753-9246
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXT[JRES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0
# GAS DRYERS 0 # GAS RANGES 0
# OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 200
# WATER TRMT APPLIANCES 1
APPLICANT PLBG PERMIT MINIMUM FEE 0.00
SHII.OAH WATER CO PLBG FIXTURES (NEW OPENINGS) 0.00
7319 166 AVE NW PLBG FIXTURES (EXIST OPENRIGS) 0.00
RAMSEY, MN 55303- WATER TREATMENT APPLIANCE 35.00
(763) 753-9244 WATER HEATER - ELEC 0.00
WATER HEATER - GAS 0.00
GAS RANGE FEE 0.00
OWNER GAS DRYER FEE 0.00
MCCAULEY TIMOTHY J& MARY JO PLBG REPAIR/ALTERATIONS 0.00
1480 GLACIER LN NE STATE SURCHARGE, PLBG FLAT 0.50
FRIDLEY, MN 55421 TOTAL 35.50
PAID WITH CHECK # 10264
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if conshvction
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 }a�ow the same to be true and correct. All
provisions of laws and ordinances goveming 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
regulaf constru tion or the performance of construction
Ap �cant Date
Bldg Insp Date ° C
SEPARATE PEItMITS RE RED FOR WORK OTF�R THAN DESCRIBED ABOVE.
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Building PLUMBING z�ermit tso.:� -o
Ii�spections RESIDEl�ITIAL APPLICATION Received By:
'163-572-3604 CITY OF FR][DLEY pa��� �7
nAr� May4,2007 YOUR&MAILADDRESS wnelsontcDiarsonplambing_com
s��nnoxsss 1480 Glacier Lane NE
� THISAPPLiCA1�T15: ❑OWNER WCONTRACTOR
PROPERTY N,�� Mary Joe McCauley
owtvE�v ,wDxsss: 1480 Glacier Lane NE crrr Fridlev STATEMNZIP SrJ4Z�
'r�NANT ryo*�e: 763/5741178
co�xac'rox N„r,�: Larson Plumbinq, Ina
SUBNf17' A COPY OF STATE LICENSE 0 3341 PM EXP DATE 12l31 /2006
YOt3R STATE �Da�.ss: 3095 -162nd Lane NW cirv Andover srnrEMN zie 55304
LICENSE WiTF7 rxoxe 763/427-7680 Fnx 7631427-9448
APPLICATION
p�,RMFT..fI,PE W SPI(?LE FM41LY ❑ TWO FAMILY ❑ TOVt73H0USE
TYPE OF WORK: ❑ NEW � REPU+CE1.gNT
DETAILED DESCRIPTION OF WORK Water Heater Replacement
PER MS 16B.665 the permit fee is a m[nimum of 515.00 or 5% of the tofal cost up to $500.00, whichever is greafer, for the
improvement, installation or replacement of a residentiat fixwre, excluding the fixtwes. (7'his should reflect only the cost of labor )
Labor cost under �300 = S15.00. Labor cost between 5300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE IABOR EXCEEIIS 5500, FEES ARE BASED ON $1 DAU PER FIX7'URE, bXCEPT WI'.ERE NOTED. FIJC'i'URES: (lNDICATE TOTAL
NUMBER OF EACH BELON�
BATH S1NKIl.AY _FIAOADRAINS SHOWER WATER PIPING
BATHTUB GAS PIPA]G �o cmuc�) SWIMM1Na POOL WATER SOF"I'NER (S35)
CLOTFffi5 WASHEft KiTCHEN SINK WATER CLOSET BACKFLOW PREV, ($IS)
D15NWASHER _ LAUNDRY TRAY WA7ER HEATER (S35) FOR fRRIGATtON �
_WATERME'FER _OTHER
T"��I�31'�,i?i'.��' Y7.di'£T�f`(5,kt�,$54(f,`,.,s" ��` v�';, �;r;` ��,,.,;:.e`��°xs�?�i�fvTiT`FEE^FOYf",AliOJEi,?1'S<OVER$5Q0': '
�.,,.
Permit Fee $ 35 .�Q Number of fixtures (�a $10.p0 x 510.00 =$
Sarch e .50 Number of fixtures (a� $ I5.00 x$15.00 =$
TOTAL DUE $_�_.�Q Number of fixtures Q$35.00 _ x$35.00 =$
State Surchazge = $ .50
Total = $
THIS 15 AN APPLIGTION FOA A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work wifl be in
conforniance with the ordinances and codes of the City of Fridley and with the Minnesota Conshvction Codes; that I understand this is
not a permit but only an application £or a permit and work is not to start without a permit; that the work will be in accordance with the
approvcd p(an in the case of all rk which r' es view and approval of plans.
SfONATUREOFAPPUCAN'C PRININAME Wendy Nelson onre 5/4/07
, � i's�;AS� . . �.,°�S' ��3',.: 3'�`' ;R�'T1�lJ`�($R?�!LjTLbIi3�"�� •�.f'i't,ijL�'NI�;IvTECHA1�T�rfiL W��fiC';., at
. ,�
�lij' Of �F'1f710�'
Bvilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-5723604
FAX: 763-502-4977