AF - 46764Date:
Owner:
Addres
City of Fridley, Miun.
B�JILDING 1'ERN.�IT
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N° �04'7
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' ��,�= Builder _
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s ._ ---�--.._.. _._._ Address .�.._... �'.�! --•---- —_._
/ �,,Q�Q,TION �",' �111LDING
/ � �-� " ' d•
No. _...L._� ..z Street .._� _""_�;����;__s��_'���__ Part o t _
Lot ....._.�!.� __ $1� � : ddition or Sub-Di ' ' _'� 4,r�... .
vision ` i
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Corner Lot -____. � Inside Lot .�.. Setback _._..,�y"�.�r._ Sideyard .�.._.,�C..��____._..__ ____
Sewer IIevation �______�__....._, .A Foundation Elevation
DESCRIPTION OF �UILDfNG
T6�Used� ' f `
r ; � ,� ,'j
� �._._.L.,�.. d:;'_ Front . �� De th f ' ! � ` ''� , " ':<^
-�-�-�.�_.�. �'. ! � r� P _ � 6 :_ Height -'- l --_-- �9 � �- � r �-- Cu. Ft �_ 1.�. ! . ',,
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f .c. f------ Front '� ir.: Depth .�.__� ;Height � `-'�f�• Cu r t �`�t i�'�
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TYpe of onstructaon ..� .:._-:r.��:..::-..:.. ,. ,...- -�.__ E s t. C a s t -�--r��`,-•;'►.: -°'-----•--�....._ To be Comp le t e d --�------�--- -�--�-��------_
In consideration of the issuance to me of a pernut to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinancea of the city of FY�idley.
� •
In comsideration of the payment of a fee of �:� 1`� ., permit is hereby granted to_
to construct the buildiag or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worlrnien, in all work
done ui, around and upon said building, or a�y part thereof, shall ��o� �� respects to the ordinances of
Fridley, Minnesota regarding location, constrvction, alterahon, maintenance, repair and moving of buildings
�� a�3' 1�its and this Permit may be revoked a t any time upan violation of any of the provisians of said
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�-«..�—�s� �ir:�.c.�,�-�. B�ulding InSpeCtOT
NOTICE
T6is p�rmit doss not eov�r th� eonsfruetion, installation for wfring, plumbing, gas heating, sswe� or watea Be wn to s�
th� Buildin0 Intp�ctor for separats p��mits for thass ifsms.
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HEAT ,LOSS CALCULATIONS �����DE�RTME�EIT OF BUILDINGS PRIDLEY MINN.
Weatherstri A.S.H.V. , ,
� Guide Conatructan No. Inaulation
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No Yes—No 19_
Fl•� -Room ( Length �'�j Width U Height � Fl.�/Vjq Leagth Width /� Height
Windows and Doors—Crackage and Area Windows and D rackage and Area
�Vldth Helght No. o[ Llneal [t. Area Wldth Helsht No. ot Ltaeal tt Ara�
No. o[ vane o[ Dane lights of crack w• [t• No. o[ Dane ot pane 1166t� of crack p. tL
'' � `I � v i Fr
y& I G 7
Coef. Btu Cocf. Btu
Infiltration �(,� (o � � InGjtration � �� f � i2 d
Glaas 3 5 I � S� ��
Exp. wall � 4 ss �
Esp. wall O d
Net exp. wall `w l ' �3 1T� e�. w_t� O� I ��j �
t� au p J
Int. wall Iat. waU
Cei�ing �;j 0 j'; (� �
Floor � 3 (� Q
Total Btu. ' O
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area �
/ Fl.� � t Room � L.ength S`Width ( C', Height �
Windows and Doors-Craclwge and Area
Wld h Helsht No. ot Llneal tt. Area
No. of Dane ot pane 11�ht� o[ craelt p. tt
2. °,1D 315 I / h S7
Coef. &u
In6ltration � V � (� 0 Q
Glaas ss �
Exp. wall / 2 0
N�< <=P. ,va„ � �.1 �, � Z
Int. wall
Ceiling l S D f� �' � 0
Floor � �D I O O
Total Btu. � j`/ �
Required sq. ft. ED.R. or aq. ins. W.A. Leader area
FI. a q- Room � Length Width (o Height
Windows and Doors—Crackage and Area
Wldth Heliht No. ot Llneal tt. Area
No. ot Dans ot D�ne I16ht� ot crack p. It.
�a � 1 .S" U
Coef. Btu
Infiltration $—' L D 4 6
Glass z ;� O
Eup. wall Qd
Net e:p. wall � � 3�
Int. wall
Ceiling (o O J � 0
Floor i. O ;� 6
Tbtal Btu. � �/ (o
Required aq. ft. E.D.R. or sq. ins. W.A. Leader area
� Ceiling
IFloor
� Total &u.
s'�
s'�
Required sq. k. E.D.R. or aq. ina. R/A. I.eader area
� FI.I ' Room I L.ength � Width /� Height
Windows and Door:—Crackage and Area
Wldth Hel[ht No. o! Llneal tt. Area
No. ot pans of yane ll�hb ot crack �p• [G
2 3� � 6 � l y 1�/
In6ltratioa
Glass
�. w.0
N� �. ,�u
Int. wall
Ceiling
Floor
Total &u.
0
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� 70
J � 7
Required sq. k. E.D.R. or aq. ins. QIA Leader area
F1•� F Room I L.ength / Qlidth Height
Windowa and Doors—Crackage and Area
Width Hsisht Na o! Lln�al tt. Area
No. ot pae� of pan� Il�hb o[ oraelc q. tt
1 6 �D � �r la
.Infiltration
Glasa
Eip. wall
Net e:p. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. k. E.D.R. or �. ias. W.A. Leade� area
1
Btu
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HEAT LOSS CALCULATIONS DEPARTMENT, OF BUILDINGS FRIDLEY, MINN.
Weatherstcips A.S.H.V. , Construction No. Inaulation
Guide
Windows ( Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How
Yes—No Yes—No 19_
F7•� L/ V� Room Length Width � Height Fl.� Room Lengt6 Q/idth
� Windows an oors—Crackage and Area Windowa and Doora—Crackage and Area
� �Vidth Helsht No. o[ Ltneal ft. Area Wldth Hel�ht No. ot Lineal tt. Aeaa
No. ot pane ot Dane lishts o[ crack sq. ft. No. ot D=ne o[ pane tl6hts ot craclt p. tt
� e� � ' � 0
� d ��
Coef. Btu
Inhitratioa °oZ (i (� � / v�Tli Q In6ltration
Glaas �/ " ;2 o`�O Glau
e�p. Wau 3 0 � n
Nec exp. wall
Int. wall
Ceiling 3 3 8'
Floor
Total Btu.
Required sq. ft. E.D.R. or aq. ina. W.A. I.eader area
Fl.� Room � Length Width
Windows and Door�—Craclwge and Area
Wldth He16ht No. ot Lineal tt. Area
No. ot pane ot pane Il�ht� ot crack �a. tt.
p. wa
�� Net e:p. wall
toc..,�au
�� Ceiling
� Floor
� Total Btu.
� L� s �� �
Coef. Btu
In6ltration
Glaas
Exp. wall
Nec e:p. wal)
Int. waU
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
F7. Room � L.ength Width
Windows and Doors—Crackage and Area
Wldth Hel`ht No. oL Llneal tt. Area
No. ot pans ot Dane 11`ht� ot crack sa. tt.
�
lnhltration
Glau
Exp. wall
Net e:p. wall
lnt. wall
Cei�ing
Floor
Tbtal Btu.
Required aq. ft. E.D.R. or sq. ias. W.A. Leader arca
Btll
Beu I
Required sq. k. E.D.R. or sq. ina. WA. L.eader area
Fl.I Room I l.ength Width Height
l�/indows and Doors—Crackage and Area
No. ot naes otepam Il[hU ot c ack wr tt.
Infiltratioa
Glass
Fsp. wall
Net ezp. waU
Int. wall
Ceiling
Floor
Total Btu.
Requued p. k. E.D.R. or aq. ins. Q/A. L.eader area
F7.� R�oom I L.ength Width Height
Windown and Doors—Craclwge aad Area
Width Hel�ht No. ot Lineal tt. Area
No. ot pane ot pane Il�ht� of crack p. tt.
Infiltration
Glau
Esp. wall
Net ezp. waq
In� wall
Ceiling
Floor
Total &u.
Required sq. k. ED.R. or sq. ins. Q/.A. L.eader area
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c�ty of Fridl�y �- 16 4 7 3
AT THE TOP OF THE TWINS B U I L D I N G P E R M( T
r
; � RECEIPT NO.
� ' COMMUNITY DEVELOPMENT DIV.
' j L' -
r � • � PROTECT�VE INSPECTION SEC. �"'� ,�.t S
� . �
� � ��"1 � CITY HALL FHIDLE� SS432 NUMBER REV. DATE PAGE OF APPROVED BY
�'""'� � ��' 612-571-3450 910-F15 12/14/81 / /
108 ADDRESS 137 Hartman Circle N.E.
1 LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].O 2 S3I1CIII11rS't SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dr. Kenneth_Mi.11er 137 Hartman Circle N.E. 571-1824
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
ReS 1C�P.Tltld Z
� CLASSOFWORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Add wall in basement tA create a workshop area
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE
HE�1TlN�, ��� �Qt1lR� f0�
��� N��
S€PARATE PERMITS ARE REQUIRED FOR EIECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OH AIR CONDITIONWG.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
QR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORFiECT. ALL PROVISIONS OF LAWS yq�UATION SURTAX
AND ORDINANCES GOVEfiNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S27S $.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF GONSTRUCTION. S�.CJ. OO
� PLAN CHECKFEE TOTALFEE
$15.50
7uftEOCCON�RACTOfiORAUTH RIZEDAGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
, � 2- �L{ -�i / �. �
- SiGNATURE OF OWNER�IF OWNER BURDER� �DATEI HCDG iNS� n7
CITY �F FRIDLCY Effective Aug. i, i9si
APPLICIITI0:1 FO(t RCSIDL"i�TIA� QUILQIi1G PEFL'jITS
(Ne�•�, A1 terations, Acidi Lions, or Repa irs )
OIJNER: ��� ��er�e� '�,����..,— QUILDER: ��w�� ����`�,v—
ADDRESS: 1�1 �o.�-��o.� C.�� Y`c, t� ADDRESS: �,3% '-�o�•c��c�v� G� rC.��,.
TEL �IO: �� (— I�Z,� TEL t�0: S71—��7�'
Construction Location
• STTtI�T NO: � STItEET: __�G.c��mp�r G��G��_
LOT: . � � BLOQC : �_ ADDITION : � - jo�r� � v.� ��
Corner Lot: Insic3e Lot: �_ SetbacY.: Sid�yards:
Ap�licant attach to tliis form two Certificates of S�,irvey of lot and
proposed building locatiaa� drawn on certificates to scale.
DESCRIPTIOid OF COFlSTP.UCTIOPJ
Front: Depth : Height:
Square. r'eet: Qibic Feet:
_ Front: Depth: Height:
Squar.e� Feet: Wbic I'eet:
Type of Cor.struction :��r� �g� �'f--� a�-e,o� � Estimated Cost: $��� v
�s � ���
Zb Be Nr.�pleted:
Proposed Drivesaay Width If New Openinq Is Desired:
Alt. A Alt. B
$� S
. SE� RzVERSE SIDE OF SHEET
13ie undersianed hereby ma3:e� application for a permit fcr the �:vrk herein specified,
agreeinq to c3� ,all work iii strict accordance ��ith the City of I'ridley Ordinances and
rulings of tlie Delkzrtm�nt of Buildine�s, and hereby declares that all the facts and
representatiens stated :n this application are true and correct.
D.1TL�: l2"'�� �f SIGNAT[lI�:
Stipulations:
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� � SuBJECT . �
City of Fridley
AT THE TOP OP THE TWINS g � i L D I N G P E R M I T
r
� �
� �
� • COMMUiJITY OEVELOPMENT DIV.
� � L � PROTECTIVE INSPECTION SEC.
� �. �
� � i"'1 � CITY HAII FRIDLEY 55432 NUAIBER RE�
�""� � ,'� 612-571-3450 910-F15
JOB ADDRESS 137 Hartman Circle NE
t LEGAI �OT NO. BIOCK TRACT OR ADDITION
oesca. 10 2 Sanc3hurst Addition
2 PROPERTV OWNER MAII ADDRESS
Shawn Miller 137 Hartman Circle NE
3 CONTRACTOR MAIL ADOHESS
Richard Hastings Contr. 6331 Riverview Terr NE
4 ARCHITECT OR OESIGNER MAIL AOORESS
5 ENGINEER MAII ADDRESS
OATE
7/13/93
ZIP
PAGE O�
� �
PERMIT NQy
'�1970
�-3 � �
•nvaoveo er
SEE ATTACMED
SHEET
PHONE
PHONE LICENSE NO.
i74-9966 4051
PHONE LICENSE NO.
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
p NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O fiEMOVE
8 DESCRIBE WORK
Reroo� DHrelling (,25 Squares) 2nd Layer
9 CHANGEOFUSEFROM TO
STIPUTATIONS
Iristall smoke detectors as per UBC 121Q adjacent to all sleeping areas
and in basement, Ice and water protection at eaves and valleys. Provide adequate
attic ventilation. Roo�ing can be the 2nd layer but not the 3rd.
TYPE OF CONST. OGCUPAN
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDtTIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERfOD OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS
I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION �- STALIS
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2 r QQQ
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING coN- $45. f)Q
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK f EE
�-_ 7/3 j� License SC $5, 0
S�GNATUHE OF CONTRACTOp OA A HOA�ZED AGENT IDATEI WHE .� E ALI
-, r
c:rusriiacncnwucw�iinWNER8l11LOER1 �DATEI BLDG �NSP
GROUP OCCUPANCYIOAD
CU. FT.
OFFSTREET PARKING
$Z.Q�
SAC CHARGE
Fa.re SC $2.00
TOTALFEE
$53.00
D THIS IS vOUR PERMIT
�_ /���
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CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction A�: � 3 � J��4,�'r �,��v C���L �'
Effe�tive 5/26/93
. �
�
I,egal Description:
�arner Name 8t Address: �. l`( � �� �� Tei. #
Coubractor: i G( w R n �S �i i►' �' c o MN LICENSE ��i'�D 5/
Address: � 33 � �� �F� vi �� '�"� � Te1. # S 7�/-9p�.�
At�ach to this application, a Ceitificate of Smvey of the
lot, with die proposed aoa�tion drawn ai it to scaie.
DESCRIPTION OF II1�PRO�i�
LIVING AREA: L�tgth Width Height
GAR�GE AREA: Length W�h Height
DECK AREA: L�gth Widm HgtlCmwnd
� 'i '
�n
Sq. F�
Sq. Ft.
Sq. Ft.
Corner I.ot [] Inside �.ot {] Ft. Yd Sed�ck Side Yard Set�cks
1�pe of ConStcvc.Ki�t: ;�F',�oo� EsNmated Cost: � 2ar�o.�-
Approa. Compl�ion Date: 8/�,�93 Z. S S�.
�— {Cost � Back)
Driveway G�n�b C'ut Wic�6 Needed: Ft. + 6 Ft = Ft x$ _�
.
DATE: 7/ 3 � APPLICANT: Tel. #�S 7�-�1�6'
Pe�mit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Svrcharge
Driveway Escrvw
Erosion Conhol
Park Fee
Sewe,r Main Charge
TOTAL
s 45, v�
� 2. =—
S /. �"
S
S � �`
S
S
S
$
S �a��
...._.
��11 1 .!_
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
�.50/�i,000 Valuation
$75Q per SAC Unit
$5.00 (State Lic�sed Residential Contractors)
Alt. 'A" or Ah. "B" Above
Consetvation Plan Review S45U.00
Fee Det,ermined by Engineering
Agreement N�ry [ ] Not Necessary [ ]
STIPULATIONS:
i
SuBJECT PE
City of Fridley 2 2 2 5
' , AT THE TOP OF THE TWINS BU I L D I N G P E R M I T NO.
t
� t
COMMUNITY DEVELOPMENT DIV. t
r � y � PROTECTIVE tNSPEC710N SEC. ��J 3
� �
� � i'�'1 � CITY HALL FRIDLEr 55432 NUMBER REV DATE �AGE OF APPROVEO B�
�----'�'� �'' 612-571-3450 9t0-F15 12/3/93 / /
JOB ADOHESS 137 Hartman Circle NE
1 LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 10 i Sdri(�'1llXSt Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Dr. Kim Miller 137 Hartman Circle NE 571-1829
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO.
Cities Home Ilnprovement Co 6148 Olson Mem. , Golden Val 55422 571-0332 182
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE IICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE pF USE FROM TO
STIPULATIONS
Proyide sztlak.e detectors as per UBC 1210 adjacent to all sleeping areas
and in basement� Provide adequate attic ventilation�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTIIATING OH AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND YOID tF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 80 DAYS, Oq IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APP�ICATION 1. STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $t� � FjOA $2.. 3O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
�OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $'72,00 Fire SC $4.60
STRUCTION OR HE PERFORM E f CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
� " ���� � License SC $5.00 $83.�0
SIGNATUREOFCON' TOpO UTHORIZEDAGENT IDATE� WHEN PHO LY V ATED THIS IS VOUR PERMIT
� �'3 -�
SiGNATUAEOFOWNEAUFOWNENBU�LDEA� �OAtEi ,.�r ��DG � n�TE
xEw
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CTf Y QF FRtDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Build'wg Permit Application
Effective 5/26/93
���-Sr3
co�„�oz► Aaa�: 3 7 i!�-iv G� �-�� �-e Zr �
Legal Description:
Oamer Name & Address: � h_ l�� 0�-< </`t � C. c.-Q.w Tel. A� �/-,/�'�f
CoMractor; � MN LICENSE # / � �
Address• caCSd � �..,.. � ZZ. Tel_ ��'/-���L..
LIVING AREA: I�ength
GARAGE AREA: Leagth
DECK AREA: Length
OTHER:
Atxach t,o this application, a Certificate of S�vey of the
lot, with the proposed oa�c�ioa drawn on it to scale.
DESCRIPTION OF I11�RO�i►EMENT
VV'�th
w�n
Width
Height
xeigt�c
HgtlGroc�nd
Sq. F�
Sq. Ft.
Sq. Ft.
Corner I.ot [] Iaside Lot [) Ft. Yd Se�cic Side Yard Setb�acl�s
Type of ConstnuKion: 1Qrz 5�.�-p Esdmated east: S �ao�`�
Approa. Completion Date:
Driveway Ctirb Ctit Width Needed:
DATE: —
Petmit Fee
Fir� Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
(Cost on Bacic)
Ft. + 6 Ft = Ft a�
�I � M � �
� G�-- Fee Schedule on Reverse Side
$ 1/, L, �: .001 of Permit Valuation (1/ lOth%)
S $.50/SI,000 Valuadon
$ $750 per SAC Unit
S 5. � n �5.00 (State I.icea9ed Reside�rtial Conhactnts)
S Alt. "A" or Alt. "B" Above
$ Conservation Plan Review 5450.00 •
$ Fee Determined by Engineering
$ Agceement Neces.sary I) Not Neces.sary [ l
TUTAL $�, T "��_�C= STIPULATIONS:
� 3,� �
_�, �
=S
Tel. � f7.�
CITY OF FRIDLEY PERMIT NO.: 2oos-0002s
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: O1/06/2005
-r- (763) 572-3604 FAX: (763) 571-1287
ADDRESS . � �
PIN : 153024120047
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 0.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1
# GAS DRYERS 0 # GAS RANGES 0
# OF NEW FIXTURES 0 VALUE (FOR b�NIMUM CALC) 400
# WATER TRMT APPLIANCES 0
APPLICANT PLBG PERMIT bsINIMUM FEE 0.00
NORBLOM PLUMBING CO PLBG FIXTURES (NEW OPENINGS) 0.00
2905 GARFIELD AVE S PLBG FIXTURES (EXIST OPENII�iGS) 0.00
MINNEAPOLIS, MN 55408-2173 WATER TREATMENT APPLIANCE 0.00
(612) 827-4033 WAT'ER HEATER - ELEC 0.00
WATER HEATER - GAS 35.00
GAS RANGE FEE 0.00
OWNER GAS DRYER FEE 0.00
MILLER KENNETH M& SHIRLEY PLBG REPAIR/ALTERATIONS 0.00
137 HARTMAN CIR NE STATE SURCHARGE, PLBG FLAT 0.50
FRIDLEY, MN 55432 TOTAL 35.50
PAID WITH CHECK # 29772
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 time after work is commenced.
I hereby certify that I have read and examined this
application and know 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 pe rmanc of construction.
Applicant Date
Bldg Insp Dat � �
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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Building
Inspections
763-572-3604
DATE_2{ ' `�%
STI'E ADDRESS /3 7
THIS APPLICANT 1S:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
I_: � � 1 I �
�,.,�,..^
Pemut Nq..;
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR�F-MAIL ADDRESS
i■r. �.���
�wDxESS: ! 3 7 ��u
PHONE: !63 S%I—lQo2Q
STATE LICENSE # L�• O
,�D�S: �s�a
❑ SINGLE FAMILY/NEW CONSTRUCI"II
❑ TWO FAMII,Y/NEW CONSTRUCTION
£XP DATE �_ � � I �D %
s ��
'7� _3-q7 � - 7 '
❑ BASEMENT FWISH ❑ ROOF O DRAIN TILE
❑ DECK O SIDWG ❑ OTf�R
❑ SWIIvllvv�.TG POOL
o xEw
❑ MAINTENANCE/REPAIR
DESCRIBE WORK BEING DONE
SIZE OF IlvIPROVEMENT
ROOFIIVG
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
� Vinyl
❑ Aluminum
❑ Other
�]
LENGTH
❑ HOUSE ONLY
❑ HOUSE 8c GARAGE
❑ ATTACHID GARAGE
❑ DETACHED GARAGE
❑Soffit
O Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS Yes �No LOCATION OF WINDOWS
OR FOR NEW OPE1dING -DESCRIBE STZE OF
OPENING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED �"' L 2 NUMBER OF �
Received By:
Date Rec'd:
'A'
��Y3z
�� sya9
Ft.
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTTON INCLUDING DECKS,
ADDITIONS. & PORCF�S SUBNIIT:
1. Site Plan/Survey showing thc wtisting structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $(� � 6 t' °� U.B.0 FEE SCHEDULE)
OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ f 3g , d$' See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �/ (.0005) times the total job valuation — Minimum $.50
$ .001 x Permit Valuation (1/10%)
$ ,�� ��`� 55.00 (State Licensed Residential Contractors)
$ �� 51450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �•/O Make checks paYable to: City of Fridley Attach
THIS IS AN APPLICATTON FOR A PERMTf-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 Construcrion Codes; that I understand this is not a
permit but only an applicatio permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all wor hic uir s r ie an approval of plans.
SIGNATUREOFAPPLIC � pRINTNAIviE ��� E�� �� �� DATE� ��� O 7
Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09
�7 . __-
DATE �<�l �� � 9 YOUR E-MAIL ADDRESS
SITE ADDRESS !3' �}fti2f-/'i�is�/ C� i'�( C
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCR[BE WORK BEING
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED I-�IGHT:
❑ OWNER �CONTRACTOR
.: S��st1�J %j'1 s �/t /�
C CITY
H•,e � v('�S, ., L
Permit No.
Received By: f'�u'
Date �1�: � t �� � 1 �
ATE�W ZIP S� :t
STATE LICENSE #_�O 6 3�/ d� f EXP DATE
AnnxESS: l,�37SG,��'��l� /q�r/� cmr f��'�A` STATEi'hN`LIP 5.�2�
PHONE G'S/- %y3 ��b 3 v F,e,X GS/' 330 -�I/ G
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/I�fEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGFISHED '�WINDOWS
❑ BASEMENT FINISH ❑ ROOF O DRAIN TILE
❑ DECK ❑ SIDTNG ❑ OTHER
❑ SW[MMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITfON
�MAINTENANCE/REPAIR ❑ REMODELING
SIDING--- — -- - - — - -- -
❑ Vinyl
❑ Aluminum
❑ Other
l�
c. P
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
HEIGHT
FT'
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of swctural members to be used
__ _ _ _. __ _ _ . _ __ _ _ FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Trim 1. Siu Plan/Survey showing the existing structures
❑ Fascia and proposed project.
2. Two sets of conswction plans
WINDOWS 3. Energy Calculations
[N EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF n
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �, D Od °`� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ --
$ S�v
S
S
$
$
$
$
$
See Back Page for Fee Schedule
65% of Buiiding Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum �.50
�5.00 (State Licensed Residential Contractors)
52000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks aavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 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 Minnesota Construction Codes; that 1 understand this is not a
permit but only an applicarion for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of a ork which re uires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �� � (.t • /J%��� DATE � —�6 `— D /