AF - 46797i
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City of Fridley, Minn.
BUILDING PERMIT
Date: _April 18, 1967 __.__.._...__._
3��y �
�T� 9190
pa,�r: _ R. Frazier . BWder �arvey Peterson
Add�ss ...._._6333_ Ryan Ave . South �,d� 151 Glen Creek__Road .�,. _. ��_�
No.
Lot
181
21
LOCATION OF BUILDING
Hartman Circle N.E.
Street �----__.__..___ _.._..____...., —_ Part of Lot _— ___.�_
. Block _.___......2_..___�.._� Addition or Sub-Division _...._..._..Sandhurst Addition
�
Corner Lot �_.`� Inside Lot ---� X•_m---. Setback 112 -•- —.--`_ Sideyard ._..._.�..._..__
Sewer II�atioa —829�.5----...._._.__..__ ----.----- __..._.__832_.5
Top of Footing
DESCRIPTION OF BUILDING
To be Used as: 44 Ft .
Dwelling �t _�� �p� 22 Ft . Height 18 Ft . gq, F�, 1032 �, r-t, 19 , 903
Garap�e __�._ �nt 2�...4 Depth 23� 4.._. Height _.._10 _�_ �, 496 �, �, 4960
Type of Construction _Frame.__......_._.._..�.._ Es� Cast �$22.x_000------- To be Completed �
SEWER LOCATIOft 150 Ft. West of Manhole
WATER LOCATION 132 Ft. West of Manhole
In consideration of the issuanoe to me of a permit to cons e building be'l above, I agree to do
the P�P� work in acoorciance with the description above set and in co li c� with all provisions of
aa�linances of the city of Fridley.
Ea cor�sideratfon of the payment of a fee of � 37 .50 �� � hereby granted to �rsze�� �.—
Peterson . to construct the building or addition as described above. This permit is grauted upo�
._.__.,........_.._.._._.._-- -�...._.._._..__
the expres�s condition that the person to whom it is granted and his agents, employees and worl�en, in all work
done in, around and upou said building, or any part thereof, shall conform in all respects to the ordir►ances of
Fridley, Miiuiesota regarding location, construction, alterahon, maintenance, repair and maving of buildings
within the city limits and this permrt may be revoked at aRy tune upo� violation of aRy of the provisiona of said
ordinancea
CLARENCE BELISLE B�� ���
NOTICE:
Thb p�emit do�s aot eowr flw eosshveHoe. ia�hll�Ha� fer wirino. P�ab�W O+s M�tiSY. »wK or wahr. M� to s»
th� Buildin� In�p�eror for »p�raN p�esih for 1h� i1Nns. ',
"� _,, _ - r
APPLICATIO:Y FOR BUILDING i°BItMIT
CI3'Y OF ritillLEY, I�IINVESOTA
OWAEB'S NAMS
So
i
ADDRESS 6�3 3 3 �i/� it/���„�S ADBP.ESS�S"/ ��l'' J,/ CR�F� f�I��,
�.�
, LOCATION OF BUILDING �
NO . ��� � STREET��f R�MA N G/ 7t e�/-" PART OF LOrT
LOT °o� � BLOCK „L ADDITION OB SUBDIVISION �i4�,UD �{vR �T /�d°�/T/0,�'/
!
CORHSB �^IN$IDE LOT_,_,�_SETBACR II �" SIDE•YARD
SEWER 8L8VATION FOUNDsATIOP ELEVATION
Appiicant attach to this form Two Certificates of Survey of Lot sad proposed
building location drawn on these Certificates.
n$sctu�riort oF su�.nu�c � o/ � Y��
To Be Used A�: ��s'/ b� rC! �,,e �Q �� 5 ��c �,� � r� .
yg /x � -z z, Y �
Fro�t �i � Depth_ _ .y fleight
0
Sq. Ft . l d 3� . Cu . Ft .��r'�"'�- �
� ��. _.�
�� "l�ront„`_;� Depth �` Height � � _,
sQ.Ft. 4S=.Ft.y.�Go
��
Type of Coastruction �� �C �l f_ 8stimated Cost � 2, �a D �
To Be Co�opleted
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance w�.f�i;_the City of Fridley Ordinances
and rulings of the Department of Buildings, a�i[[d hereby declares that all the facts
and repreaentations atated in this application ar true and corr t.
DATI3 � �� � � SI(�IATURE
(Schedule of Fee C ts can be f nd oa the verse e).
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CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
X�. .,....__ __ �
PERMIT O.: 2004-00205
DATE ISSUED: 02/13/2004
(?63) 572-3604 FAX: (763) 571-1287
ADDRESS : 181 HARTMAN CIR NE
PIN : 153024120059 �' � �' ��
LEGAL DESC : SANDHURST ADD � '
: LOT 21 BLOCK 2
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION(ALTERATION
VALUATION : $ 25,000.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER SECTION
310.9.1.2 OF TI� 1997 UNIFORM BUILDING CODE WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF
$1,000 ARE MADE TO RESIDENTIAL DWELLINGS. CONVERT DECK TO 4 SEASON PORCH
IS APPLICANT A CONTRACTOR? 1
APPLICANT BUILDING PERMIT FEE 391.25
WINDSOR COMPANIES FIRE SURCHARGE 25.00
1175 E HWY 36 STATE SURCHARGE, VALUE 12.50
MAPLEWOOD, MN 55109 LICEN5E SURCHARGE 5.00
TOTAL 433.75
PAID WITH CHECK # 22370
OWNER
GUDDING ROBERT & JOYCE
181 HARTMAN CIR NE
FRIDLEY, MN 55432 SEPARATE PERM�TS
REQUiRED FOR:
AGREEMENT AND SWORN STATEMENT WIRING HEATIN6
This permit becomes null and void if work or consbruction PlUMBING AND SIG�IS
authorized is not commenced witin 60 days or if construcrion
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
regulatin constructio� r e o of constructi . �
Applic C�- �
Bldg Ins D / .
SEPARATE PERMITS REQU D FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW
ADDN
ALTER
I)
[l
P
, ac�`�
CITY OF FRIDLEY v� E�Fective 1/1/2004
6431 University Ave NE, Fridley, MN 55432 �(763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION �
�
��
Construction Address: �� � �f ��
Legal Description: I S1-�
Owner Name & Address: °4- Ltl�l Tel. #
Contractor: �lV � ��Z � MN LICENSE # �>� �7
Address: ��/ � �� Tel. # (� 1- � - ���
(�i.iS �,
Attach to this application, a Cert�cate of Survey of the«l� �F �`�'� `,� l �� � �3
bt, with the proposed construction drawn on it to scale.
LIVING AREA: Length Width
GARAGE AREA:
DECK AREA:
OTHER:
���
Length
Length � ��
DESCRIPTION OF IMPROVEMENT
Height .
Width
�
Width �
�
Height
HgUGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: � �� �� � Estimated Cost: $ ::� �� � ��.=�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � � APPLICA • — Tel. # �� I � . �-CJ��- ' V
Call (763) 572�604 for Permit Fees if mailing in application. Fax to 763-571-1 87 if using credit card and we will call
you for card numbe�.
Permit Fee $ ��J� , a5
Fire Surcharge � �
State Surcharge�a S�
SAC Charge $
License Surcharge $ , 4f�
Curb Cut Escrow $
Erosion Control $
Park Fee $
Sewer Main Charge $
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th°lo)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "6" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ )
TOTAL $ STIPULATIONS:
�.�� �Sf
�
�.
� :
Larson 6gineedng of Minnesota
3524 LaboPe Road -
White Bear Lake, Minnesota 55110-5100
651.481.9120 Fax: 651.481.92Q1
www.larsonengr.com
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P4RCH DESIGN FOR GUDDING RESIDENCE
Located in Fridley, MN
December 30, 2003
LEM #20031262
1 h�eirb!► oeA�Y tt�t thisPler►. a�oa�� °f
�t �,,,M prepared by rtw or t� m�l ��d
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P�ofe�sionai F�e� � tlte law� d�e
8tate d Mimesota.
P�int Name: ..��d
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pM1 r '63 l.ioerre �
PREPARED FOR
WINDSOR COMPAlVIES
ST. PAUL, MN
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" Larson Engineering of Minnesota SUSJECr �X,y�,��� ���[`� SHEET NO. OF
3524 Labore Road '
White Bear Lake, MN 55110-5100 PROJECT NO.
651.481.912Q' Fax: 657.481.9201 BY DATE
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'35241abore Road
White Bear Lake, MN 55110-5100
551.481.9120 Fax: 651:481.9201
www.{arsonengccom
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Larson Engineering of Minnesota Su6.1EC �-t4����l��.}�— SHEET NO. OF
: 352d Labore Road
White Bear Lake, MN 55110�100 PROJEC7 NO.
654:481.9120 Fax: 651.481.9201 - - BY DATE .
www.larsonengr.com
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RES�check Compliance Certificate
2000 Minnesota Energy Code
REScheckSoftware Version 3.5 Release le
Data filename: C:�Program Files\Check�REScheck\Gudding.rck
PROJECT TITLE: Gudding Project
COUNTY: Hennepin
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: O 1 /06/04
DATE OF PLANS: December 17, 2003
PROJECT DESCRIPTION:
conversion of deck to 4-season porch
DESIGNER/CONTRACTOR:
Windsor Companies, Inc.
COMPLIANCE: Passes
Maximum UA = 347
Your Home UA = 347
0.0% Better Than Code (LJA)
Permit Number
Checked By/Date
Gross Glazing
Area or Cavity Cont. or poor
Perimeter R-Value R-Value U-Factor UA
Ceiling 1: Flat Ceiling or Scissor Truss 1216 38.0 0.7 35
Wall 1: Wood Frame, 16" o.c. 1414 19.0 0,0 70
Window 1: Above-Grade:Wood Frame:Double Pane 200 0.320 64
Door 1: 5olid 26 0.350 9
Wa112: Wood Frame, 16" o.c. 720 19.0 0.0 37
Window 2: Above-Grade:Wood Frame:Double Pane with Low-E 98 0.320 31
Wa113: Solid Concrete or Masonry:Exterior Insularion 224 32.0 0.0 7
Window 3: Above-Grade:Wood Frame:Double Pane 100 0.320 32
Basement Wall 1: Solid Concrete or Masonry S00 32.0 0.0 57
Wall height: 8.0'
Depth below grade: 7.0'
Insularion depth: 3.5'
Floor 1: All-Wood Joist/Truss:Over Outside Air 255 38.0 10.8
Proposed and Mazimum U-Factor Averages
Proposed
Average U-Factor
Maximum
Allowed U-Factor
Above-Grade Windows and Glass Doors 0.320 0.370
Includes Foundarion Windows > 5.6 ft2
S
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specificarions,
and other calculations submitted with the pemut application. The proposed building has been designed to meet the 2000 Minnesota
Energy Code requirements in REScheckVersion 3.5 Release le (formerly MECchecl� and to comply with the mandatory
requirements listed in the RES checkInspecrion Checklist.
Builder/Designer Date
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UTYOF
FRfDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
January 31, 2003
Mr. Robert Gudding
181 Hart�nan Circle NE
Fridley, MN 55432
Re: Final Inspection at 181 Harhnan Circle NE
Contractor: Blaine Heating AC Electric Inc
Dear Mr. Gudding:
A mechanical permit was issued on September 26, 2001 to install a furnace at your address.
According to the 1991 Uniform Mechanical Code a final inspecdon shall be conducted on
the work authorized by this pernut. As of this date the inspection has not been requested.
The pemlit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notificadon" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerelv.
DJ/mh
SuB�ECr
City of Fridley
AT TNE TOP OF TME TWINS g � I L D I N G P E R M i T
r
� �
� ; y ����� COMMUNITY DEVEIOPMENT DIV.
r � � PR07EC7tVE INSPECTION SEC.
i = �
� �"'1 � C17Y HA�� FRI�LE� SS�J2 NUMBEN pEv
�""��� ��� 763-571-3450 910-F15
J08 ADDRESS 181 Hartman Circie NE
1 IEGAL ��T NO. BLOCK TflACT OR AOOITION
OATE P�GE OF
7/17/03 / /
�ESCp. LI 2 Sandhurst Addition
2 PROPEiiTY OWNER MAIL ADDRESS ZIP PMONE
Bob Guddiag 181 Hartman Circle NE
3 CONTRACTOR MAIL ADORESS ZIP PMONE
Heritage Remodeling 7768 N Shore Circ�e, Forest ?.ake, MN 55025 612-
4 ARCMITECT OR OESIGNER MAIL AOORESS ZIP PHONE
5 ENGINEER
MAIL ADDRESS
�3712
RECEIPT NO.
� �
•vnnpvED s•
SEE ATTACHED
SHEET
IICENSE NO
701-6524
LICENSE NO.
20172084
tIP PHONE IICENSE NO
6 USE OF BUILDING
Residentia�
7 CLASS OF WORK
O NEW O ADOITION O ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 OESCRIBE WORK
Remove gravei from roof of house & ga�age; insta?1 z Durolast rubbe��zed membrar.e
9 CNANGE OF USE FROM
TO
STIPUTATIONS
�nstali pe: manuf�cturer's spec�f�cat�oa. Submit to City a copy of
the iast�l?at�on specs.
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIRED fOF EIECTFICAI. PIUMBING. MEATING,
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NUII AND VOIO If WOpK Op CONSTRUCTION 20NING
AUTHpRIZEO 4S NOT COMMENCEO WITHIN 60 OAYS. OR 1F CONSTRUCTION
OA WORK IS SUSPENOED OR ABANOONEO FOp A PERIOD OF 120 OAYS AT
ANV 71ME AFTER WORK IS COMMENCEO- NO OWLG. UNITS
I MEREBV CERTIFV THAT 1 HAVE REAO ANO EXAMINED 7H1S APPIICATION 1
ANO KNOW TME SAME TO BE TRUE AND CORRECT ALL PROVISIONS Of �AWS VAlUAT10N
AND OROINANCES GOVERNING 7HIS TVPE Of WORK WILI BE COMPLIEO
WITM WMETHER SPECIFIEO MEREIN OR NOT TME GpANTING Of A PERMIT �S �OOO
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE Oii CANCEI TME pEpM1T fEE
PROVISIONS OF ANY OTHER STA7E OR LOCA� LAW REGULATING CON- @
STRUCTION OR TME PERFORMANCE.Of CONSTRUCTION y+111.25
, / PLAN CHECK FEE
�� :.icer.s
S�GNA1UaEO�CONCFACiOAOAAJT�OA�ZED�GENT IDATE� FN p�
iDaiE� � .
OCCUPANCYGqOUP IOCCUPANCY�OAD
7
STA��S
$5
V
OfFSTRfET PARKING
IGARAGES
$2.50
AC CMARGE
Fire SC $5.00
Dr�� cEE
$123.75
THIS IS YOU� ERMIT
NEW [ j CITY OF FRIDLEY Effective 1!1/2003
ADDN [ J 6431 University Ave NE� Fridley, MN 55432 (763) 57z-3604 Bldg {nsp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPUCATION
Constcuction Address: ��� � ���-� � �` �C�'� �l. C - _
Legal Descriptiom '
Owner Name & Address: �o � � � � �%Nq Tet. #
Contractor. C�2�` ���''�dh���`K ' MN LICENSE# �� �172bby
Address: �� to� N- ��mcze C�'��cf� ��PST Lk_ S'SbZ el. #��7"�al --�s2�
Attach to this application, a Certificate of Survey of the
lat, with the proposed construction drawn on it to scale.
DESCRIPT{ON OF {MPROVEMENT
WING AREA: Length VVidth Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width HgUGround Sq. Ft. �
OTHER• P-� �� -�►�r � nS G�vs� � G x-lzgGE �SS °�/,�j�
� ,�,/ .." /Z�-f� R��� (t' rCf�
?� sc � �� f� ,
Construction Type:, � 1�0 �` Estimated Cost: 3 S� °° °
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x a =$
DATE• 7��+a� APPUCANT: Jb�� �v�����,Z Tel.# C� 2-70l— �SZ��
Call (T63) 572-3604 for Permit Fees if mailing in application. Fax to 763�71-1287 if using credit ca�d and we will
call you fo� card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ �1�. as
$ . D t�
$
$
$ �D
$
$
$
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th°�)
$.50/$1,000 Valuation
$1275 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 [ ]
TOTAL $ �� • l � STIPULATI�NS:
ADDRESS
PIN
LEGAL DESC
'� PERMIT TYPE
� PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
�umi,F.Y_ MN SSd�2
572-3604 FAX:
: 181 HARTMAN CIR NE
: 153024120059
: SANDHURST ADD
: LOT 21 BLOCK 2
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
PERMIT NO.: 200400392 �j3�
��
DATE ISSUED: 03/29/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
WIRE ADDITION
# INSPECTIONS
APPLICANT
I ACE ELECTRICAL
5465 HIGHWAY 169 N
II PLYMOUTH, MN 55442-
OWNER
I GUDDING ROBERT & JOYCE
I 181 HARTMAN CIR NE
� FRIDLEY, MN 55432
7
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 goveming this type of wor�
will be complied with whether specified herein or not. 'Ft�e
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 performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERNIIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 026768
SEPARATE PERMITS REQUIRED FOR WORK OTFIER THAN DESCRIBED ABOVE.
39.50
0.50
40.00
�
ADDRESS
PIN
, LEGAL DESC
�
CITY OF FRIDLEY
6431 UNiVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-36v4 r�ax:
: 181 HARTMAN CIR NE
: 153024120059
: SANDHURST ADD
: LOT 21 BLOCK 2
s�i-iz��
PERMIT O.: 2004-00387 �
DATE ISSUED: 03/25/2004 �
I PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITIONIALTERATION
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE b-A
ADDITIONAL DUCTWORK FOR ADDITION
# A/C iJNITS 0 VALUE OF APPL OR WORK
# FURNACES 0 # GAS DRYERS
I # GAS RANGES
APPLICANT
WINDSOR COMPANIES
1175 E HWY 36
ST PAUL, MN 55109-
OWNER
� GUDDING ROBERT 8c JOYCE
' 181 HARTMAN CIR NE
�, FRIDLEY, MN 55432
0
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construcrion
authorized is not commenced witin 60 days or if construcrion
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 laiow the same to be true and correct. All
provssions of laws and ordinances goveming this type of worl
will be complied with whether specified herein or not. The
grauting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construcrion or the performance of construcrion.
Bldg
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS PIPING FEE
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIOMNG FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 22596
CFPAR ATF PRRMiTC RR(1TiTRRiI F(1R W(1RK (1TF�TRR TNAN iIRCC RTRF.T� AR(lVF_
......_.�..__....__._�.�_.._......�..____..� _ ___ ..,..___...___...__ __��. ��___�__ _�_ ._.
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NEW
ADDN
ALTER
.. _. . __ . _ . _ . . . �. . _ . . . v. . . . . ✓._� � 1 U
[ 1 CITY OF FRIDLEY
I) 6431 University Ave NE, Fridley, MN 55432
I 1 SINGI,F FAMILY AND DUPLEXES R-1 AI� R-2
BUILDING PERMIT APPLICATION
Constru�tion Address:
Legal Description:
Owner Name & Address
(:olltfdCtOf: �
Address: _ _C�:Jt'J �
G.i1C7GC1JC1.� I'. t1G� ICl.!
��' � �� �y �
Eff ctive 1/1/2003 �
(�63) b72-3604 Bldg Insp �"Q�
(T63j 571-128TFax
,. �
Tei. #�
i�
.
• MN LICENSE # `
���)c��� � 7e1.� � ��� � 3�3 l
Attnch to this appiication, a Certificate of Survey of the
lot, with �he proposed c�onsVu�tion dtawn on it to scsle.
DESCRIPTIQN O� IMPROVEMENT
,
LIVING AREA: Length Width Height Sq. Ft. �
GARASoE AREA: Lengih Width �� Height Sq. Ft.
DECK ARFA: Length Width HgtlGround Sq. Ft.
orHER:
�. �
Construction
,•
�,�_� � _.�r •
Drivevyay Curb Cut Width Needed: Ft. + B Ft = Ft x = y
DAT�: APPLICAN ' Tel. � V ( � �O
Call (763� 572�644 for Pcrmit Fees if maitin9 in application. Fax to 763�6Tf-1287 if asing crectit cant artd we vriil
call you for card number.
Permit Fee
Fire Surctta�ge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Esc:row
Erosion Cor�troi
Pa�k Fee
Sewer Main Charge
T07AL
CITY ySE ONLY -
�
$ 3a �. a S Fee Schedule on Reverse Side
� 3-�• .001 of Permit Va)uation (1110thqb)
� � O• � $_50/�1,�0 Valuation
$ $1275 per SAC Unit
$�� $5.00 (State Licensed Reside�tial Contradors)
$ _ Alt. "A�� or A1t. "B�� Above
$ _ �450.00 CoRServation Plan Review
$ _ Fee Det�mine�d by Engineering
$ Agreerr�ent Neoessa�}r I l Not NecessarY [)
S �� `+�• �� STIPIII AT{�NQ•
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE "l'2�—
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
-Bi�ILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-I-08
Permit No.:
Received By:
• . , ..,
���
YOUR E-MAIL ADDRESS ����,5 � 1 Vl L��+�i S/Y`/k �� << �"�
KtV�i—Ma" V YY ��
❑ OWNER �ONTRACTOR
NAME� �%\/r�P l]'1
CONTRACTOR aDDx�s�
SUBMIT A COPY OF pHONE
YOUR STATE LICENSE �
STATE LICENSE #
PROPERTY TYPE I� SINGLE FAM[LY/NEW CONSTRUCTION
0 TWO FAMILY/NEW CONS'fRUCTION
PERMIT TYPE ❑ �DITION ❑ GARAG
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIlvIM
� °'� �-f� STA
_F� ���
EXP DATE
SIZE
STORfES
� W[NDOWS
O DRAlN TILE
❑ OTHER
TYPE OF WORK: I❑ NEW HOME CONSTRUCTION O ADDIT'ION
❑ MAINTENANCE/REPAIR $REMODEL[NG
DESCRIBE WORK BETNG DONE:
R FING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
N �+►7 /=�( �COkJ
� HOUSE ONLY
❑ HOUSE & GARAGE
0 ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWS
�EXISTING OPENINGS �1Ges ONo LOCATtON OF WINDOWS
OR FOR NEW OPENMGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE MSTALLED Ab�� S( k�— NUIviBER OF �
�i_STATE M
'3 �Sy6
— /.- 7�0 �l
��K cJle�.�J �p�C
Fi'
BASEM�NT REMODELfNG SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of strucmral members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site PIazJSUrvey showing the existing 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:
(US NG THE 1997 UBC FEE SCHEAULE)
TOTAL JOB VALUATION $ '�, �S O� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surchazge
License Swcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$ ��(� (7 See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ 'j'SQ .001 times the total job valuation
$ S .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �. Make c6ecks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pertnit 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 Minnesota onstruction Codes; at und rstand this is not a pem►it but only an application for a permit and work is not to start without a
permit on site; that the work will be in accord with the approv 1 case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT - PRINT NAME LJ Ci WLQi c� l�t�N�DATE �'Z`'��
APPROVED BY DATE �
Building .7(Q �
Inspections
763-572-3604
763-502-4977 FAX
DATE�� Z
SiTE ADDRESS _y
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
� MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS
-�i�t�! C i 2
0 OWNER �ONTRACTOR
a ce �UDO� N
;: Rrrvt � c ��TY
(_'�� u''�-7 -,�.rl�--,
, � .I:I � ��� �
,- ,
. _ _ , ; ��
,
�.,�' � � : - �
ATE��ZIP ��E3�-
CONTRACTOR COMPANY NAME: ��/J C� �p C-� S��- S
SUBMIT A COPY OF CONTACT PERSON: � R�II"N /v C�t-Sc`�N
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH pDDRESS:�2 `� E �t I/�G--IL �i CITY d l�"- STAT� N ZIP
APPLICATION pHONE �e��i -�� � g7(p� FAX 7�3 -�-f 22 -�''6�9'
PERMIT TYPE I� SINGLE FAMILY ❑ TWO FAMILY
TYPE OF WORK' ,� NEW REPLACEMEI3T
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
�
FEES ARE BASED ON S10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: ([TIDICATE TOTAL NUMBER OF EACH BELOW)
Equipmentlnstalled MFG��[�f.t'� � MODEL: �T�O(LF�--�(�g'Q7Q SIZE/BTU �{Dd�
MFG:� MODEL: C� ' �� Z3� SIZE/BTU Z�{� C�
!� A!C 525.00
_AIR TO AIR EXCHANGEER S 15
_BOILER 535.00
CHIMNEY LINER 510.00
_DUCT WORK SI0.00
MFG: MODEL:
FIREPLACE (GAS) 515.00
^FIREPLACE (WOOD) 535.00
�URNACE 535.00
GAS DRYER 510.00
GAS PIPING S 10.00
S►ZFJBTU
_GAS RANGE/OVEN $10.00
NEW GAS GRILL S10.00
GAS IJNIT HTR S 10.00
�POOL HEATBR 535.00
VENTILATOR 515.00
TH[S IS AN APPLICATION FOR A PERM(T-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 will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a pernnit and work is not to start without a permit; that the work wi11 be in accordance with the
approved plan in the case of all Yr whi�h-rcc�s �view and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME_���A-I1i �SQ fv DATE ����� /
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977