AF - 47028_ _ .._ .. . ,
._� . ; ._ ..
sus�ecr RMIT NO.
City of Fridley � 16 5 5 4
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
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� • COMMUNITY DEVELOPMENT DIV. /_ / v 7
r � y '� PROTEC7IVE tNSPEC710N SEC. �� / O�
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� '� /•"1 �. � CITY HALL PRIDLEV SS432 NUMBER REV. DATE PAGE OF APPHOVED BV
ti----�' '•' 5/3J82
612-571-3450 910-F15 / /
10B ADDRESS 6175 Heathe r Place
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 1 Heather Hi 11 s WeSt sHeer
2 PROPERTYOWNER MAIIADDRESS ZIP PHONE
Mr. & Mrs. Thomas Elwell Hackman Drive Fridley
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Brickner Builders, Inc. 6249 Ben More Drive N.E. 574-9871
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
SAme
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
residential
7 CLASS OF WORK
p NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
1l
a oescR�BEwnew house and garage (approx. 45' x so� )
9 CHANGE OF USE FROM TO
^
- STIPULATIONS p�d $1, 000 park fee. ��` �; ,
1. Provide a hard surface driveway �QV�R�
2. Provide a verification survey ��� ��r $��
3. Provide sod in the front d�e�� �""
�tA� Y _ . c
WATER LOCATION: 28' 5outh� S�n,`Manho�e.
SEWER LOCATION: (9' Deep Iri' �� � ater Service. Expose
, -��
service to est. tAp o£ foo ''
DRIVEWAY DEPRESSION COST: N/
. �
Park Fee $1,000.00
TYPE OF C NST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED fOR ELECTRICAL, PLUMBING, HEATING, W�� fra
YENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 3167 �' E)%2
ANY TIME AFTER WORK IS COMMENCE0. NO. DWLG. UNITS OFfSTHEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WQRK _WILL BE COMPUED 236 � 300. �O � � H. ��J
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRAWT�NG OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIQLATE OR CANCEL THE pER 1TFEE SACCHARGE
PROVIStONS OF ANY OTHER STATE LOCAL LAW pEGUTATING CON- �8�j,�Q 4Z5.00
STRUCTION E PERFORMA OF ONSTRUCTION.
� PLAN CHECK FEE T T F E
,�( 8 � �`z�. os
IGNATUREOFCON7RAC ORIZEDAGENT IDATEI WHE PROP RL A D T HIS IS YOUR� PERMIT
�,3���
SiGNATURE OF OWNER��F OWNER BU�IDERI IDATEI�_ INSP, DFTE
.
.�. °`.�'-- .
.E: .
CITY Of FRIDLCY Effective Auq. 1, 1981
Ai'PLIG117I��i f0f; RESIDLi�TI11� IIUILpIitG PL(L'�ITS
(Ne►•r, Alterations, AddiLions, or Repairs)
��`^ /p► �'
ONINER: � / r/� ��
ADDRESS: �2 � �����
7EL N0:
I3 E -e��� � JCc'�� .
UI LD R : C��
ADDRCSS: CG�S ���— � ��
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Construction Location
- STRI�TsT NO: �� � � STItF.ET: /
LOT: � BLOCZC: _� ADAITION: ��
Corner I,ot: Inside Lot: v SetbacY.: ✓�
�
Sideyards : � d �/�
Ap�licant attach to tliis form two Certificates of Slirvey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOid OF COt1STRUCTIO��
Front: Depth:
Square Feet: Ctibic Feet:
Height:
. Front: Depth: Height:
Squar.e FePt: (l�bic Feet:
� a'3�, 3��.
Estimated Cost: $
Zype of Cor,structian:
Rb Be Q�r.�pleted: � // v �/
proposed Driveway kidth If New Opening Is Desired:
Alt. A Alt. B
$ $
, SE� Re.VERSE SIDE OF SHEET �
�iie undexsigned hereby mal:es application for a permit fcr the �:vrk herein specified,
agreeing to do ,all Work i.r, strict accordance with the City of I'ridley Ordinances and
ruli»gs of tl�e Delhzrtm�nt. of Builc3in�s, and here*�y declares that all tl�e facts and
repres�ntatiens stated in this application are e and correc .
C- � /�
D.3TL: ,r �� � ' � � SIGNATUI�.: ��i���7 � C�"Y—^
Stipulations:
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�_ - - ' r � RONALD F. MEYER � � . �' � � T � -
_ _ = I.A��TD SIIRQEYOR , _ -- - _ _
�e suwve�r�na SU�DIVI�ION Dp+av "
rnrr.+oN� �zi.aaes
aes �sss�� sT.. aT. �,w�, �wrv. ss�o� �
I he�eby certify fhat this survey was prepared by me ond tha# 1 am a duly
Registered Land Surveyor urtder the laws of the State of Minnesota. �
/' Reg. No..9051 Date: ri1 f �_
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o Denotss iron monument plac�d.
Scale: 1" = 30'
.S'd�./iy Er.e� f �
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Lot 9• Block l, HEAT� HILLS WEST, Anoka County. Minaeaota. �
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<- � .- EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
� OWNER %lX � iil/Q S��0 yYl�{ � E G(N E L L _
SITE ADDRESS � � % � �F� �� « P��� E _
� 7 � 3^�L PHONE ��I �' �0 7%
CONTRACTOR �/I / G XI1J ErC /J �O�C°S j��� ��
� Determine working square footage of each.
l. Total exposed wall area ....3 g� sq. �ft. x'�7 = 6�b -� 3`
2. �otal roof/ceiling area ....37 S�O sq. ft. x-�s/ _ �.�� V`
r
a.
b.
c.
e.
f.
5•
Total exposed wa 11 area above f loor =
Total wall window area ..........................
y�.�• �3
Tctal _ cloor area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7 � 6�
Total sliding g�.ass door area . . . . . . . . . . . . . . . . . .. s133 • /
Total fireplace wall area..� .....................
Total wall framing area (average 1096) . . . . . . . . .. •� 7`t- �s�
Total net wall area above floor . . . . . . . . . . . . . . . . ., a � / g• 6 3
Total rim joist area. ........................... 3��
Total exposed foundation area = % �-�7
h. Total foundation window area .................... �'�
i. Total net foundation a�ea above grade........... '70•1�1
Determine "U" value of each wall segment.
a. yL6- �3 X��U�� - 3 Q =
b 3�- 6q � .,U„ . �� _
.
�. L33 - w X„U„ . 3� _
a x °v"
.
e. � ` 7• �� X nUu
f . � ��� i� � • � � X ��U ��
g � �a � g ��U ��
.
h. � - � X "U"
�.
� � • ?� X ��U"
.�g
• �
. {�
.3$
� '�7
3. ..............................Total
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e
/.�9- 83
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1�.3
- �l_.�_
= i •�v
_ �. �.2r
= 3 3. L�
_ yy s� �
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,` • _ 2 _
If item #3 on previous page is the same as, or less than item #1, .
you have met the intent of SBC 6006(c)2.
Total exposed roof/ceiling area = � I Sp
,
j. Total skylight area .......................... /� —
n�� k. Total roof/ceiling framing area (aver ) 6l.
����p�7 1. Total net insulated roof/ceiling area........ 173
-1. Determine "U" value for each roof/ceiling segment.
� q� X „Uu .s�s �'L-�
;. _
/I��f' . k . � L � X ��U„ � `U t = � 1- • '��i
- `�-� 1 t 13 G X�.,Un� . o-L = S`�• � v
. -
' 4 ..................................Tota1 = / L � �
' If total of #4 above is the same as, or less than #2, you have met
the intent of SBC 6006 (c) 1. �
A lternate BuildinQ Envelope Desicln
To utilize the total envelope system method, the values established
by the sum of items #3 and #4 shall not be greater than the sum
of items #1 and #2.
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sue�ecr P MIT NO
city of Frialey � 9 0 2 s
, AT THE TOP OF THE TWINS gU I L D I� G P E R M I T
f
S � RE .
COMMUNITY DEVELOPMENT �IV. `�` ��
L PROTECTIVE INSPECTION SEC. �
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' � �'��1 � CITY HALL FRIOLE� 55432 NUMBER REV. DATE PAGE OF APPROVEO BV
�•."�''' : �.' 612-571-3450 9� 0-Ft 5 / /
6 24 87
�os no�aess 6175 Heather Place N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 1 Heather H1.11S Ttd2S.'t SHEET
- 2 PAOPERTV OWNER MAIL ADDRESS ZIP PHONE
Tom Elwell 6175 Heather Place N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE _ LICENSE NO.
Jansick Construction 6480 Squire Drive N.E., Fridley 574-9679
d ARCWI7�ET OR DESIGNEH MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGIN�ER MAIL ADDFESS ZIP PHONE LICENSE NO.
' 8` USE OF BUILDINO
l�es identi al
7 CLAS$ OF WORK
� NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a gZ 21� x 12' Deck and a 14= Octagon Porch.-- Remove existing deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations an plan. Variance on rear yard approved by Appeals
Cawmission on June 23, 1987 clown to 16 feet.
WARNiN�
6etore digging call local u�'h'ti�
SEPARATE pERM1TS RE TEIEPNONE - ELECTRIC • G�S �t�.
WtRtNG, HEqTING, p�� Q�� � F�R REQUIRED 8Y =
�6 AND SIGNS.
��►�
F •',.
SEPARATE PERMITS ARE HEQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR �F CONSTRUCT�ON
OR WORK IS SUSPENDED OR ABANDONED FOR A fERl00 OF 120 DAYS AT
ANV TIME AFTEH WORK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION �. STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPUED
W�TH WHETHEA SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT SS � OOO S2 . 5O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
T �TION OR THE PERFORMANCE OF CONSTRUCTION. $SO. SO
PLAN CHECK fEE TOTAI. FEE
�D �� J',Z $12 . Fi3 $ 65 . 63
si ATUREOFCON�Aa UTMOAIZEDAGENT IDATE� �" WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�
SiGNATUREOFOWNERUFOWNfABU�IDEAi IOAtE1 BLDG �NSP Da
G�eSA�-:�. . .
NEW [ ]
ADDN. .��
pLT ER . [ �
Construetion Add
City of Fridley Effeetive 4/1/86
R-1 AND R-2
Building Permit Application
Lega1 Description: � "'
Owner Name & Address: q
Tpm �I r.c�e/I Tel. #
� Tel. # ,,��%/
Contraetor:
Address• �D��'D ��/,[ /�/' e � � ic��-¢••+ -
Attach to this application, a Certificate of Survey of the
lot, �ith the proposed construction dratan on it to scale.
DESCRIPTIOA OF IMPROYEMENT
�-t Yx. B-vt. I Z Y o`L l $q . Ft .
LIVING AREA: Length __ Width Height
GARAGE AREA: Length __ Width Height Sq. Ft. _
Dg�g y�gA: Length 2�� �Tidth / Z. Hgt/Ground Sq. Ft.
_ i � (�, .� v
OTFiER :
I�� x i3,S� -� � 3�. �� a- a��,a� =�I��� �� y
Corner Lot [] Inside Lot [�] Ft. Yd. Setback __
Side Yard Setback
Type of Construction: Estimated Cost: $ --
Approx. Completion Date: �u�u !-
�`. /9�7 5�,00 �
(�6C �2X�► � 2�Z +1��7Z�-/� z 3Z x(,.�t� '���'�.a�� Ait. n ait s
proposed DriveWay Width If New Opening Is Desired: See Back Page for Explanation
DATE: o ` �—d � APPLICANT: �'- , Tel . # S7 -Q�7
CITY IISE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
C�/1 q�
$ .�✓, V� Fee Schedule on Reverse Side
$ � a��3 25i of Building Permit Fee
$ o�.�d �.50/$1,000 Valuation
� �525 per SAC Unit
$ Fee Determined by Engineering
$ ,�^ Agreement Necessary [ 7 tiot Necessary [ 7
TOTAL $ J � ��
� �^ �
STIPULATIONS: �q-,2,. (�µ2di (iA�A-UC�., �R.o(YZ �_ i� �� �
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-c�osauu�W }o alo�s ay� �o sMO� ay� �apun �o�(an�ns puo� pa�a�s�6aa
�t�np � wo ��oy� pu� aw �q pa�oda�d s�M �(a��r�s s�yl �oy� �(�il�a� �(qa�ay 1
�o«s •wN�w •�rnd •�� •i� a�ssar zes
�� .
8 � �� �6Gf-ILL !NO►w=171
��� NpIpQ NOIi1/�10�11Q ONIA71WAS ONY7
xoa3exns ahTv-t
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ADDRESS
PIN
LEGAL DESC
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
E•7►�►�11�L !�l►.�;F
: 6175 HEATHER PL NE
: 133024430082
: HEATHER HILLS WEST
: LOT 9 BLOCK 1
571-llIf%
PERMIT NO.: 2004-00360 �� -
DATE ISSUED: 03/18/200 D ����
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE.
RECONNECT FURNACE AND AIR CONDITIONER
# INSPECTIONS
APPLICANT
DEPENDABLE ELECTRIC INC
2619 COON RAPIDS BLV
COON RAPIDS, MN 55433
(763)757-5090
� ./►I :
ANDERSEN DALE C& PATRICIA L
6175 HEATI�R PL NE
FRIDLEY, MN 55432
1
STATE SURCHARGE, ELEC FLAT
ELEC PERNIIT FEE - NIIN (RESn
TOTAL
PAID WITH CHECK # 28305
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 lrnow the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
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 performance of construction.
Applicant Date
Bldg Insp
Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
(t- '
0.50
20.00
20.50
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY PERMIT N0.�04-00397 `
6431 UNIVERSITY AVENUE NE y-�---
FRIDLEY, MN 55432 DATE ISSUED: 03/29/2004
163) 572-3604 FAX: (763) 571-1287
: 6175 HEATf�R PL NE
: 133024430082
: HEATI�R HILLS WEST
: LOT 9 BLOCK 1
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
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 6-A
REPLACE FURNACE (WARM AIR, BRYANT, 110,000 BTU'S) AND AIR CONDITIONER
# A/C iJNITS 1 VALUE OF APPL OR WORK
# FURNACES 1 # GAS DRYERS
# GAS RANGES 0
APPLICANT
RIVER CITY SHEET METAL INC
9928 BLLJEBIRD ST NW
COON RAPIDS, MN 55433
(763)754-2199
OWNER
ANDERSEN DALE C& PATRICIA L
6175 HEATI�R PL NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or const�vction
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 ihat I have read and examined this
application and lrnow the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a pernut does not presume to give authority to
violate or cance the provisions of any other state or local law
reguta �' cons ction or the performance of construction.
Annlicati� t \ Date .
Bldg Insp
HEATING PERNIIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WIT'H CHECK # 12675
ARATE PERMITS REOUIItED FOR WORK OTI�R THAN DESCRIBED ABOVE.
0
0
0.00
30.00
0.00
0.00
25.00
0.00
0.50
55.50
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-..t--,--_
MAR-25-2004 12�03 FROM CITY � FRIDLEY TO
7542906 P.03iO3
THE BELOW MUST BE F�LED !N WHEN REPLAClNG FUEL BURNiNG APPI�WCES OR THE
APPL1CA71�N W1�1. 8E RETURNED
,•, ��,� i ►� •� � •: s, � •, t�. � � ���
When �epl�taa a� eY��^� b�r.e, the undersigned hereby verfies that the
ve� has been exemined and is fr+ee from n�si, detenoratian, obsbvctions, /
ar�d is securely supported and flrestopped where required. Yes (�S No (
The venting system is ptastidPVC and meets all cuRent codes and manufadurer
specificabons indudir�g sizi�g, IengU�, number of elbows and termirsation. Yes () No �
The u�tdersigned also vetifies that the �eplacement unit is a lissted assembty
and meets the wtret�t codes and manufar�urers specifications. This does
include AGA-GAMA Category I Cerrtral Furnace Vendng Tables for fan
assisted and rk3tura! drait appiiances.
'T'� oY_ i`�� cen�e�+�+�en ��r � S�ed and insialled tn meet the wirent codes
_ ar�manufadure�s specfications. _
VNhert neqt�ed to " ' w� be si�ed a�d insf�ed
to meet the cume�t codes and manufaettxe�s speaficatiorts. ,
VVhen ' the undersigned hereby ve '�fies fhat
it is a 6sbed assembly and meets the cun�ent codes and manufachuers
s��tio�s. Thls d0es indude AGA-GAMA Category I Central Furnace
Ventir�g Tables for fen assisted and natuta! dratt appfiaances.
(s the comrt�on vent and vent c�nnectars saed and instaNed comedly after
an appNanoe has been rernoved from the common vent and vented
separately as per curreM codes.
Yes (� No (
Yes (�o { )
Yes (�J No ( )
Yes (.� No ( )
Yes (�) No ( )
�.�
..« i.._ . .. .:.� . �� �� . . :,. . � . :.n .,� �._.«�.. .� . .�� . � . ,
Ap�iance #1 Type BTU Input //6 Oy'v � Fan Assisted or Nat ���
Appliar�ce #2 7ype BTU Input �, Fan Assisted or Nat
Appflar�ce #3 Type � _ STU Input Fan Assisted or N�t
Total Appiiances Total Btu Input ��
GaTUnon Vent Type J`�� Vent Height � �iameter % r inches
Appliance #1 Vent Connedor Height ,�„�ft Length ,�ft Diameter in 7ype
Appfiance #2 Vent Con�ector Neight �,�ft �ength ,�ft Diarneter in Type
App{i�anc�e #3 V�nt Connedor Height w�ft Length �R Diameter in 7ype �
� ' � � � �.- . .,�
HEATING CO:
S+9rx'd BY: Date : 3l � S`
TOTAL P.03
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE '�(� U 2
SITE ADDRESS �
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
� OWNER jd'CONTRACTOR
PROPERTY OWNER/ N,4,�,E: A,�dersoh
TENANT �pRESS: 6 � 7S /-/�a-itier �i CITY
PHONE:
Permit N
• - - - • : ,, /�.
�. ����-,�. ► � . � i;
ATE %%%/iirZlP
NAME: /'10o e j1 ! n (' ' rf
CONTRACTOR ,�D�SS:6ay� ✓Jeca�ur Ave l�/ _CITY oo�� TATE�IPSS
SUBMIT A COPY OF pHONE 76 �' 36 6-� O I O F1�X
YOUR STATE LICENSE
STATE LICENSE # a d 6�� 4 a F EXP DATE �Z,� - O�T
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
-BSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDIT[ON ❑ GARAGFJSHED ❑ WINDOWS
O BASEMENT FINISH jd ROOF ❑ DRAM TILE
❑ DECK ❑ SIDiNG ❑ OTHER
� SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR � REMODELING
ROOFING
NUMBER OF SQUARES �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
� Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
0 DETACHED GARAGE
HEIGHT
�
BASEMENT REMODEL(NG SUBMIT:
I . Exisiing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Fascia and proposed project.
2. Two seu of consuuction pians
3. Energy Calculations
LOCATION OF WINDOWS
NUNIBER OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LA$OR AND MATERIALS:
` SING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ J�� � OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ,�,�•as See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ a .001 times the total job vafuation
$ .0005 x Permit Valuation Minimum $.50
$ S'"� $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 checks payable to: City of Fridley Attach
THIS IS AN APPLICAT[ON FOR A PERMIT-NOT YAL1D UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge thaY 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 permit and work is not to start without a
pertnit on site; that the work will be in accordan 'th proved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �%, n� Q� O�'lf DATE
APPROVED BY DATE
;uildin�v
L�s�e�zions
%6�-=7=-�60�
76�-��0�--!!�; � r_a��
SIT'L ADDRL•SS
T'HIS:�.PPLlC.�NT is:
PROP�'tT':
oyviv�v
T�N��(T
CONTR�iCTOR
SUBMIT A COPY OF
YOUR S'I'ATE
LICEtiiSL. DOND AND
CERTIFICATE OF
INSi7RANCL
_' ? s1� M�'
Q OWNEP.
��; � 1 �' ! -1 �i ;
� � �� �.-�� ('T'�,_�; ,� �����..; � �����I
�..�,�, :� � _ -,-�-„ �- -�.�
, ;� � � , � �
�.. � �� r�::���. _�
LrF�:c:rv� ;-?-as
`!QU[t L--�V1Ali. .�DDRESS
N �
NAML•: I�QiTYCU � nI�I�Lt-S'(YI
ADDRL•SS: �I � i'���'i� �I i�,�
PHONG: �D�L � RI "I' OS�
ST.4TE LIC -�i ISE m
STATE BOND �
ADDR.ESS: �?�ID MM�
PHONE ��/3� 7'%�`f�
TYPE OF WORK: I� N�
n°nnit No.:
i'�ec�ived Bt�' •
�a�9� �? � T � 20�
STA
�4' DATE
_w..........•�,-~"'
L":CP DATL
F�.x ��'t,.�' �,r
FAMILY ❑ TWO FAMILY � TOWNHOUSE
DETAILED DESCRIPTION OF WORK
. • �� M� �a
�� ' �
PER MS 168.665 the permit fee is a minimum of �15.D0 or 5'/0 of the totai cost np to ��00.04, whichever is �eater, for thc
improvement„mstallation or replacement of a residential fr�e, excludin; the fixt�res. �(This should reflect only the cost of labor )
Labor cnst undsr $300 =�15.00. Labor cost between �300 to �500 = cos# of labor x,OS = plus .50 s�ch��e
� OR `�
FOR PROIECTS yVF�RE LABOR EXC�DS �500, FEES ARE BASED ON � 10.00 PER FIXT'iJRE, EXCEPT Wi�RE N1]TED. FIXT'URES: (Il�iDIC�1TE TO'15AL
NTJIvSSE�t OF EACH BEL01�. MII�tIIvfIJM FEE S 15.50.
BATIi SINKIiAV ' FLOORDRAINS SFlOWER WATERPIPING ;
BATHTUB GAS PIPING (NEED QTY LIG� SVVIbIIvIIl�TG POOL WATER SO FTNER (53�
CLOTI�S WASHER KITCf�N SINK WATIIt CLOSET _BACI�'LOW PREV. ($1�
_ DISHWASHER _ LAUNDRY TRAY " 1WATERHEATER (S3� FOR IRItIGATION
_ WATER METER ,_ OTFIER
Permit Fee � Number of fixsures (cr� �10.00 x� 10.00 =�
SurcharQe .i0 Number of fixiures cr � 15.00 x$15.00 =�
TOTAL DUE $ OR Number af fi.�ctures ��35.00 � s 535.00 =$ �0�
� • State Surc��ge = $ 50
fMUM �i5S0) ' � � � (MINIMLJM �1550) Total = � �
THIS I5 AN rLPPLICATION FOR A PERMIT-NO'C VALID UNTII. PROCESSED
l l�ereby apply for a plumbin� permit and I acicnowledge that the information above is compiete and accurate; that the wor!c will be in �-
con%rmance with the ordinances and codes ofthe rity of Fridley and ,vith the Niinnesota Consmaction Codes: that L understand this is '; -_
� not a permit but oniy an appficarion t'or a permit and wori: is not to start without a permiC on site: that the worl: �,vill `be in accordance i--
�I �.:vith the aoproved plan in the case of all �,vorlc �.vhich requires revietiv and approval ofplans.
li •� . •. '
'� :iIGi•1ATZJPS l)f r'�I'PL:C."�NT !'P.1rIT7lAML''. ,�/l/i"� ��� _-17ATL /ti � ��
i �� :I
�' :i�rPOVr:� i3v o,n�rr:'
i
;�r��:��_Si,:',I •�T?j: '''-�;� �r�:IviIT'S.,_P..E'?'r'i�i"IF�.r =�7P. �.1�( " 1.l�ICi: — ..,...,.Pic, ,1„ ;, vT, r;,� �r. - ,
C' ,r_�. R:-TL':�� � � .: ? L✓ ..�i.;y::; � : � i � G'� r� i�I iC,"�.L.. .�/i�RL;:
_.�� �)J[ .,� :'i��8'�r
jiflllQlzl.`� �ST•.28�:�:UI1.5' .::'f'.T).:1�'":::1F�*,1' �
?1= , _ ::lve:"�IL�,� . leilu� � �. '..ic11�:" ::�i l .i : � -- —
-'i� _ --_-: �1�1'1 - .
. _;'� ; : i �-. _ J,-.
,---
Building MECHANICAL Permit No.. t V�
Inspections RESIDENTIAL APPLICATION Received By��
763-572-3604 CITY OF FRIDLEY D��
763-502-4977 FAX ��
EFFECTIVE 1-1-08
DATE � � IO YOUR E-MAIL ADDRESS
SITE ADDRESS � I JS � L"`�
THIS APPLICANT IS: ❑ OWNER I�CONTRACTOR
PROPERTY NAME: P� R� C j� A� �� se�
OWNER/ ADDRESS: �i7S H��� PL�1"�E Cp['y �I{ IG/ STATE/H�ZIP SSy3
TENANT pHONE: 7b3— �N�P� �g0�
CONTRACTOR COMPANY NAME: MARS%I HE'+'ff/�1 /W� ,/Q'rK C� oN0 i'��Ni'^�
NOTE: /
SEPARATE CITY CONTACT PERSON: , P I`�1 �MA��N -
LICENSES ARE STATE L[CENSE # EXP DATE //� ,/
REQUIRED FOR GAS ADDRESS: (pLNg LA���L9� .%i�'; � CITY [3/�+�+I�� � STATF/ "�'�ZIP �SS7 �
AND HVAC.
SUBMIT COPY OF BOND pHONE �63- 5 36 -obb� FAX 76 3'�i .'fb ^ 02� Z(o
ANDINSURANCE
PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW � REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK I<�� C�o��^�_�1Z ��� �� � L�^�°�� t D�us*+
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
OR
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON S]0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
Equipment Installed MFG: ��"�� MODEL: ��y' � Z`i SIZEBTU Lyaou
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
�A/C $25.00 FIREPLACE (GAS) 515.00 _GAS RANGFIOVEN $]0.0(1
AIR TO AIR EXCHANGEER S 15 FIREPLACE (WOOD) 535.00 NEW GAS GRILL � 10.00
�BOILER $35.00 "��'URNACE 535.00 GAS UNIT HTR S 10.00
JCHIMNEY LINER $10.00 �`��GAS DRYER S 10.00 POOL HEATER $35.00
�DUCT WORK 510.00 GAS PIPING 510.00 VENTILATOR $15.00
P�RI�I�' F�� P'�(i7ECTS FpR UNL?ER`$SQQ PERMIT FEE FOR PR03EGTS OVER $504:
Permit Fee $ . Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @� 15.00 x$15.00 =$
TOTAL DUE $ OR Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
MINIMUM $15.SQ MINIMU�QTotal = $ f�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical 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 permit and work is not to
start without a permit; that the work will be in accord nce with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT i�y"" %� PRINT NAME I��y Oy�s� DATE ��b�to
APPROVED BY DATE
�� �'. ; A�� N : �k�, �'4�1RA�'� I'�1�11�I� 1�RE RE [:TIl��T� Ft�� ��I�I�T�y� ..` . , �AI, AND�;,11� ,�`,�,���T�G'.r�i.L ����,p'.„. :
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977