AF - 47143�
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�'"`" `� Vill"age of Fridley, Minn.
BUILDING PERMIT �°• 18 6 3 �
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Date : . � "Y.'� :� �. � . :'j . :� � . . . . . . . .
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Owner ....... ................................ Builder .....i/.V.. ... . '�.� ..����'!�..,t;. E����'?�
L�')H��� /
Address...................................... Address .............................................
L CAT[ON OF UILDING
No. . . �! . 6. �. . . Street . . ..�/•�'E`��iw�. . . .✓ -. • . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . .
.�.
Lot ... ✓ .�. ..... Block ... .. �.......... Addition or Sub-Division .�:".�... . .. .............�:..�'��
r `f r��yl� '
Corner Lot . � . . Tnside Lot . . .�. . . . . . . . Setback .�. `? . . . . . Sideyard . . � d . . . . . . . . . . . . . . . . . . .
DESCRIPTION OF BUILDING
To be tised
.�/. . :�✓ . . . . . . . . . . . Front . . .`� �! . Depth ."� S' �.— Heightl"� 'S . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
..................... Front ........ Depth . .. Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction . . ;,�i.-�!'��-. . . . . Est. Cos' t .� `� � �. �'� . . . . . . . . To be Completed . . . . . . . . . . . . . . . . . .
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
proposed work in accordance with the description above set forth and in compliance with all provisions oP
nances of the village of Fridley.
.....................................................
:� ,f} �
In consideration of the payment of a fee of $..�:'� .'. .. ., permit is hereby granted to/t,i!GrY�'. ����" �
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the builciing or addition as described above. This permit is granted upon
the e�cpress condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
�.►���_ ' �G����. . . . . . . Buildin ector
. . . . . . . . . . . . . . . � �P
NOTICE:
This permit does not cov e construction, instatlation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate Aermits for these items.
�
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City of Fridley, Minn.
BUILDING PERMIT
Date: _..__..�.. �Pril 22�1969____.__.. ...._..w._.
�� 713
N° 10195
Owner: __,�:a,��..�,,...,�,e�.r.�..._.._.._..,�..._.._._......._..._ Builder __..._Fred Yesnes_�Co .�,Inc .._..__�
Address _...�681_...._Helene_Place _ _, _.__ ____ _ _ Ad� � 8841 31st Ave. North
LOCATION OF BUILDING
No. _._...__�?.�.�,_..._.. Street ._.__...__.Helene _Place_.._.___. _._. _. _._---.._. Part oP Lot _...�.__.
14 7 • • Lakeview Manor
Lot _.__......_..__.__..._ Block _._.._..._.__._..__---._...._...._. Addit�on or Sub-Divis�on ....._..._..�...____�._.__..__
Corner Lot ..M_--�.--._...__ Inside Lot ._.._...._....._...._._...------. Setback .----•--._.._..._._.._....._ Sideyard __._w�.._
Sewer Elevatian .._.._.._._.._._..__._._._._.�.._.....__._...----•-----...._ Founda.tion IIevation ...._...__ __.....Y
DESCRIPTION OF BUILDING
To be Used as:
____aaa�t�on._.....___ �,t _.26_'_.__ nepr� _24'.__ xe�ght ._. ��_'..._. sq. Ft. _624
_.__.._._______.�..._._._.__.__ Front _...____..__ Depth _.._.._�._.. Height ._.._....__.� Sq. F't. _...__.._...
Type of Construction _.._Frame__._.._...__.__ Est. Cost _...._$8.a.000.00._.._.._ To be Coaipleted
� � 12,480
Cu. Ft
0
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
th� proposed work in accordance with the description above t rth and ce wI all provisions of
ordinances of the city of FridleY• � � �o r� �,t �� -
In co�afderation of the payment of a fee of �.....__L4..Q�....._.., permit�is hereby granted to_.._.. Fred Yesnes3 Inc .
to construct the building or addition as described above. This permit is granted upo�
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinaaces o�
Fridley, Minnesota regardfng location, construction, alteration, maintenance, repa.ir and moving of buildiags
within the city limits and this permit may be revoked at any time upon violation oY aqy of the provisians of said
ordinancea
Official`
�� ����� � � Building �€ �
Muhich
NOTICE:
ihis p�emif doa aof eowr ths eonslrveNon. ia�al�on fo� wtrin�. PIum6L�W Ya hNNno, swwr er wab►. d� svn te a�
th� Buildiag In�p�ero� for s�p�rat� p�nnits for fha� h�ms.
a. `.
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APP�ICATION FOR BUILDING PERMIT
CzTY OF FRIDLEY, MINNESOTA
OWNF� ' � NAME ? � BUI LDEft � . ��� ,
'...
ADDRESS (p DRESS �— � �
LOCATION OF BUILDING
. n
NO . � STREET „T���V !/ `J
-,
LOT BLOCK �� ADDITIQN OR SUBDIVISION
CORNER L�T��INSIDE LOT SETBACK BIDEXARD��.,
SEWEft EL�.,,VATTON TOP OF FOOTING
Applicara,t attach to this form Two Certificates of SurvEy of Lot and
propased build,iz�g ].acation drawn on these Certificates.
AESCRIPTION OF BUILDING
To $e Used As:
�:,��4:�� Front Z(„ Depth Z Height Z�
,.,_,--
Square feet Cubic Feet
Fron� �epth Height
Squa�e feet Cubic Feet
Type of Constructio. Es�imated Cost� d 0 �
n , �
To Be Completed
The undexsi�ned h��y makc�s application for a permit for the work
herein spec�ii,ed, agreeix� to do all work in strict accordane�e with the
City o� F�idley Ordina�ces and rulings of thc Department of Buildings,
a.nd hereby �ec]:ares t�.at all the £ac�s and representations stated ixi
tY�is app�.�,oation ar� true a.nd correct.
�
DATE r � SiGNATURE
(Schedule of Fe� Costs qan be faurid on th verse Side.)
,z � �. 2 y � � =- j� � m,� �` j� P
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560-34SU
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C�fo Y���e
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ANOKA COUNTY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MINNESOTA 55421
The sole purpose of the addition at 681 Helene Place ,
is the lodging of another member of the immediate family.
I agree to maintain this as such and to stipulate these
conditions in case of any future transfer of ownership
of property at the above address.
�(�Z�/
�--� 3-�i
S
zr: � aate
��2���
�,
Cify o� Friclley ��'��
�,�p������ $oa� P'9�ra��3ng �e�d �� �i�ing �'er�aaa� ��
Dept. of $ldgs. Phone 5fi0-3450
DESCRIPTION OF WOitK / J ,(�� � ,/� l'
Numb�r, Kind and Location of Fixiures Location ll �/ �C� � /" /'/ �- .
� � �
� ru t Z v� = in i f'
r- m � ;
� 3c"�. � .�o�F � �n 3� c0 N
� - _
Base � �
Ist
2nd
3rd
4th
Fuiure Coaaection Openin3s
New FixYure, Old Openings
u
Z = tn w Z
�? O x N� r z i
oIS��'<3 �g �`r� �o
with
PARTfAL RATE SCHEDULE
P"a.IIMBING FIXTiJRE RATES:
Number �ixtures ......................
Future Fixture Opening ................
New Fixture Old Opening .....:........
Catch Basin .... . ....................
Water Eieater (Up to �l�i�BT'tn . . . . . .
New Ground Run �ld Bldg. . . . . . . . . . . . .
Electric Water Heater
G.�.S FITTING FEES:
1 WATER HTR.
f I N� GAS ELEC.
�ewer �
Cesspool n
1!TO. RATE TOTAL
`3 X �4 � G `''� �2'.00
-- X � � $1.50
X � � �1.50
—_ x 3.25 �
X � � #3.00
x 3.25 $
.9`g2.00
NiO. RATE TOTAL
ist 3 Fixtures . . . . . . . . . . . . . . . . . : . . . . . . . . x $�C $ �2.00
Additional Fixtures . . . . . . . . . . . . . . . . . . . . x � $ � 75
Gas Range to ����TU . . . . . . . . . . . . . . x � � �5.00
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
'I'OTAL E'EE $ � • b 0
City of Fridtey:
Tye undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with tt:e City O: dinance
and ruling oP the Departmsnt of Buildings, and hereby declares that ali the fact
and representations stated in this application are true and co:rect.
Fridiey,
Ow�ner
.�� /S�_ , I�J� J
Kind of Building .�ti � __
Used as �w-C–C�t--�--� _ �
To be completed about — s�� �"�G �j __
Estimated Cost, $ � � �
Old—New. Building Permit No. Permit No. 'T %��
signed LONDv�I PtUMBING CO. _
$Y `� G�C�'�''�
Business Phone No � a�'3`ys! 3 _
ROUGH
FINAL
�u�a
��� Permit for UMB{NG AND GAS FITTING
N.B. When work covered by this permit is ready, the Piumbing Ordinance requirea that requeat for
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit.,
W j . ...,.._a,.,a�
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's{'AT108 4 O Z t=- m
3 c''i � m �'-
Basement
lst �
2nd
3rd
4th
DESCRIPTION OF WORg
Number, Hind and Location of Fixtures
m I Z 3 �a"' I�� I N I O � I t<j 4N I Q O I i It I aU' ¢ I U' a` GASE � ELEC.
Connected with Sewer-Cesspool Gas Piping for Openings
Permission is hereby granted •�--U � to do the plumbing and
gas fitting in t�e building described in the stateme hereto attached, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building stuzll conform in all respects io ordinances of the City of Fridley, and
this permit may be revoked at any time upon the uiolation ot any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Finallnspection Date
Inspector.
4z IM-6-65-V
N° 4940
�I7 l �
�Permit / � �
Fee $ (c�
City of Fridley � � � �° ,19 ±�9
Owner
Location ��,/ % � ._��2��.
Kind of Building ��'�2-?�
Used as_
To be Completed �' � , 19 � g
Estimated Cost � �
Old-New. Building Permat No. 7"a`'� •°`'�
�-t..�.Q.c._ . � .
or ��
Inspector of Buildings.
V
Appliccit%n � Powtr �a�ts Qnd Ntal�g. Coofi�, Yen�r't�t�e, Refeiq�r�rtio� e�nd
Air Conditioning S� �d De�ric�s :
PAR�'t�tl RATE SCHEDULE n��. o� s�a�. � seo-saso ^
GRAVITY WARM AIR: !tA'P& ?OTIIL
Furnace ShelI dc Dt:ct Work . . . . . . . : . . . . . . . . . . . . . . . . . $10.00 �
' Replacement of Pt�rnaee . . . . . . . . . . . . . . . . . . . . . . . . ._ . . . G.00 :
Repairs & Alteraiions—up to a500.00 '. . . . . . . . . . . .' . . . . 6.00 � ---
Repairs dc Alterations each add. $500.00 . . . . . . . . . . . . . . . 3.00 #
1rtECH. WARM AIR � �
Furnace Shell & Duct Work to 1'0,000 BTIT . . . . . . . . . . . . $10.00 ��—
each add 8f1,000 STU .. .............. .... . . .
Repiacement oi E�rnace .. .....................:.....
Repairs & Alterations--ug to 5500.00 . . . . . . . . . . . . . . . . .
Repairs & Alterations each add. ;500.OQ ..............
3.00 ;
6.00 �
6.00 �
3:00 S
STEAM or HOT WXTEA SYSTEM
Furnace She�l & I�ines--to 400 sq. It. EbR Steam ... $1Q.00 $
�rnace Shell & Lin�to 64Q sq. ft. EDR Hot Water .. 20.00 $
Each add. 240 sq, ft. EDR Steam . . . . . . . . . . . . . : . . . . . . 3.00 $
Each add. 320 sq. ft. EDft Hot Water . . . . . . . . . . . : . . . 3.00 �
OIL BIIRNER—to 3 gal. per hour . . . : ' . . . . . . . . . . . . 6.00 $
over 3 gal, per hour�ee Fee Schedule
_ B�
GAS BURl�iER (up to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . : . . S.Oa a�
over 199,000 BZ'EJ Sea Fs� Seludulo
GAS FITTING FEES: NG Al►TE TOTAL
lst 3 FSxtures . . . . . . . .—�. xa 200 S `2�
Additional Fixttues . ............... x .76 #
Gas Range to 199,OOd . . . . : . . . . . x; 80� a
ua coanrrro�a �
FAN HEATIliG SY�TEliE � SM �P� Sch�dob
VEltTILA'rlliG BYSTEI�f
1►LTERAYIONB i� REPAIAS TOTA% PEB
Rovvx
�rtu, /1 - i z - % �
�%
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City o! Fridtey:
�
ti
The undersigned hereby makes appIication Sor a permit for the work hereir.
specified, agreeing to do all wvrk in strict secordance with the City fhdinance:
and ruling oF the Department of Buifdings, anct hereby declares that aIl the facts
and representations stated in this application true and correct.
F�ic�le Mian 7—G , 19 ,�
Owner ,���-� �.�2:��
Kind o!
Use� as
�'
7`o be completed about �� .�`
�
Estimated Cost, $ - �, � d
Oi New. Suilding Permit I�io. Permit No. "�`� ��
DFSCRIPTION OF WOAg
HEATI1�iG oz FOWER PL.AN15—Steam, Flot Wa . Warm Air Na.
TY�ade Name Size No. �/�S �'-� o
4��q�SEy '� ScI. Ft. E.D.R BTIJ H.P.
Total Connected Loa�c ��C� �� Rind o! FueL�� �-c-.�"
BUR.NER — Trade Name Size No
(REMARKS—OVER)
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HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTION MINNEAPOLIS. MINN.
Weatherstrips A.S.H.V.E, Conatruction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof F1oor Kind How Appli
Yes— ` Yes o 19_ � Cr,Q �Q , • �t , j''i
` Fl.� �r/i/v G. Room � Length 2, ' Width /3' Height ff ' FI.� � Room Length Z� Width Q
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area
Nfdth Height No. of Lineal ft. Area Wldth Height No. o[ Llneal tt. Area
No. o[ pane o[ Pane lighta of crack � eq. ft. No. of Dane o[ pane lighta � ot crack eQ. tt.
2a 2 : / $ /,3 �. � L �
2 Z Z �- 2�
r , s� ��
Coef. Btu Coef..
Inhltration ��• % In6ltration ,37.�
Glass o Z S � Glasa 1�, t, A
Exp. wall ;Z Q
Net exp. waU �
Int. wall
Ceiling Z, p /d 2
Floor � �p
Total Btu.
Required sq. fc. E.D.R. or sq. ins. W.A. Leader area
Fl.� � Room ( Length �� Width / 2� Height
Windows and Doors—Crackage and Area
Wtdth Helght No. ot Lineal tt. Area
No. ot pane ot Dane lighb ot crack eq. tt. ,
Coef. Btu
Infiltration � 3 � � S x,,,
c�ass z� so �� o 0
Exp. wall -
Net exp. wall �
Int. wall '
Ceiling Q S p�
Floor O '► f A� G
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. Room � Length Width
Windows and Doora—Cractiage and Area
Wldth Helght No. ot Llneal t[. Area
No. of Dane o[ pane Ifghts o[ crack sa. tt.
Coef. Btu
Infiltration
Glaaa
? Exp. wall
Net exp. wall
Int. wall
Ceiling
1� loor
Total Btu.
Required aq. ft. E.D.R. or aq. ins. W.A. l.eader area
Exp.�v�ll �,
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Btu
7
OI/31O
Fl.l Room � Length "� Width ' tieight
Windows and Doors—Crackage and Area
Wldth Height No. ot Lineal tt. Area
No. o[ pane ot Dane lights ot cracic aq. [t.
In6ltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
7ota1 Btu.
231 /ol 23�
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.� Room I L.ength Width
Windows and Doora—Crackage and Area
� W[dth Height No. of Lineal ft. Ares
No. ot pane of pane lights ot crack sa. tt.
Coef.l Btu
In6ltration
Glass
Exp. wail
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
sq. ft. E.D.R. or sq. ins. W.A. Leader area
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CITY OF FRIDLEY INSPECTION DIV,
fi431 University Ave NE
Fridley, MN 55432
572-3604
Stories Closel
Basement
Fioor 1
Floor 2
Ffoor 3
Fioor 4
. � Effective On�January 1;'1995
APPLICATION FOR PLUMBING AND GAS FITTING PERMit
MARK NUMBER OF FIXTURES TO BE INST,
Bath ;'; Wash annk ' �, . Floor
Urinal Tub , Shower Smk ' Tray Fourtt;...,. : Drain
PLUMBING FIXTURE RATES: N0. RATE TOTAL
New Fixtures � $ 7.00
Old Opening, New Fixture $ 4.00
Beer Dispenser $ 5.00
Blow Off Basin $ 7.00
Catch Basin $ 7,00
Rain Water Leader $ 7.00
Sump/Receiving Tank $ 7.00
Water Treating Appliance $10.00
Water Heater —Electric $ 7.00
Water Heater — Gas $10.00
Gas Range $10.00
Gas Dryer $10.00
Back Flow Preventer Required ()Yes () No
Type $5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
.50
$��
ON EACH FLOOR
h `; Auto. Gas
��.. :: Washer Appl
�as Misc: �' Water Heater'.
an e� Fixt.,� �! Gas Elec
I �':i�i,ay:il �.�:.�1'��I����'i�,.:�. I ���' :�I �:�. `��� �1: .
JOB ADDRESS�g' ��� I�tP {��G�C e N� . ,
The undersigned hereby makes application for a,permit forthe work•lierein�
spec'�'ied agreeing to do all work in strict accord�nce with the city codes :� ..
and rulings of the Buiiding Division, and hereby declare's. that ait the facts `� `
and representations;stated in this aPpiication are true and correct. . �
' . : , � ��� 1995 .
Owner �(�� �J i � � � . �
r ( �.�
Building Used As ��-� I ��,LC,�� .
� , �� .: � /�Q'�,,
Estimated Cost � PERMIT NO.� . � � < �J
PLUMBING COMPANY� ' �: t�
SIGNED BY � ` �T�L N0: �� � � � � t�.
Approved B • Rough—ln Date � • � Finaf• Date � � . .
MINIMUM . FEE FOR ANY PLUMBING/GAS� PEI�MIT �iS�� �15.�0
PLUS THE $.50 � STATE SURCHARGE � . � �
sue�ecr �fiMIT NO. �
City of Fridley 30729
�
AT THE TOP OF TNE TWINS g � � L D I N� P E R M I T
; � RECEIPT NO.
� •
COMMUNITY OEVELOPMENT DIV. /���
r� � y � PROTECTIVE INSPECTION SEC.
, ,
� ; .
l___. �,�����;'� CITY MALI FRIOLE� SS�.�IZ NUM�ER REV OATE PAGE Of ♦bPROVEO BY
L l\ 612_571-3450 9�Q-Ft5 3/16/00 / /
JOB ADDFESS 681 Helene Place NE
1 LEGAL ��T NO. BLOCK TAACT Oii ADDITION SEE ATTACMEO
oescR. 14 7 Donnay's Lakeview Manor s►+eer
2 PROPER7Y OWNER MAtL AQDRES$ 21G PMONE
Susan Dingmann 681 Helene Place NE 586-9717
3 CON7RACTOR MAIL ADORESS 21P pMONE LICENSE NO
American Building Contractors 12247 Nicollet Ave S, Burnsville, MN 55337
a ARCMITECT OR OESIGNER MAIL ADORESS ZIP PMONE UCENSE NO.
707-6959 20169383
5 ENGINEER MAII AD�RESS 21P PMONE LICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW
O ADDITION O ALTERATION F�] REPAIR O MOVE O REMOVE
8 DESCRIBE WOi;K
Reroof House & Garage (26 Sq) Tear-off
9 CHANGE Of USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
rrPe or c;or
SEPARATE PERMITS ARE FiEOUIREO FOR ELECTqICA�, PLUMBING, HEATING,
VENTILATING OF AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONS7RUCTION ZONING
AUTMORIZED IS NOT COMMENCED V�!ITHIN 60 DAYS. Ofi If CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 12Q OAYS AT
ANY TIME AFTER WOFK IS COMMENCEO. NO. DWLG.
I HEREBY CERTIfV THAT I MAVE REAO ANO EXAM�NED TNIS APPLICATION 1
ANO KNOW THE SAME Tp BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION
AND ORDINANCES GOVEqNING THIS TYPE OF WORK WI�I, BE CQMP�IED 2� 272
WITH WHETMER SPECIFIEO MEREIN Oii NOT. TME GRANTING OF A PERMIT �
OOES NOT P ESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL THE pERM1T FEE
PROVISIO F ANY OTHER STATE OF: LOCAI LAW REGU�ATING CON- �83 � 2S
TRUCTI N F THE PERFORMANCE OF CONSTFiUCTION
� � ////1 PLAN CMECM
I WI ! /l .( D�.( �/ Licen,a
S�GNA�D'�+E o� CoN-Anttoa�bQ �uT»oAi2EO aGENt
ATURE O� OWNEA��� OWNEp BUI�DEAi � �DATE�
SO.FT
UNI7S
STA��S
r
f E
2 $C .� . �� /
UPANCV�OAD
CU FT
ifFSTREET PARKING
IGARAGES
�UR7AX
$1.14
AC CMARGE
Fire SC $2.27
OTA� FEE
$91.66
� THIS�V/O.U��M1� \
U
qatE
N�w [ l
E1DDN
ALTER
� J� � Effective 5l1�9 la.� �
[ l S CITY OI�' FRIDLEY q� ��
[ J SINGL� FAMILY AND DUPLEXES R-1 AND R-2 ,�� �\
IIUILDING PERMIT APPLICATION � ' /1
b �
� � �1 � l �1 � �
Construction Address: � �,/�JrCJ �� �
Legal Description:
Owner Name & Address: �f � Tel. # ���� �%/�
Contractor: �tC.a� ;� i o MN LICENSE #��j� 3�`3
Address:1��G�� Nr rd %`Ei �U'� �� � /�f — Tel. !� i�o I� - %7 ��J�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AI2�A:
GARA.GE AIZ�A:
DECK AR�A:
OTH�R:
D�SCRIPTION Or IMPROV�NIENT
I.cngtii Widtlt I-Icight-
L.engtll Wid[h I-Ieight
ngth � Width Hgt/Ground
Sq. Ft.
Sq. Ft. �
Sq. Ft.
�
�_ � �
Construction Type: ��,�}(� p}-�-- �Q���j Estimated Cost: $, � ���
Driveway Gurb Cut Width Needed: Ft. + 6 Ft =__Ft x$ _$ �
DATE: I o� a� Q� APPLICANT: Tel. !{ �� � 67J��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
Liccnse Surchargc
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ �' Fee Schedule on Rcverse Side
$a� .001 of Permit Valuation (1/lOth°!o)
$ ��' $.50/$1,000 Valuation
$ $1050 per SAC Unit �
�.
$ `�'j $5.00 (Sta?c Liccnscd Rcsidcntial Contractors)
$ Alt. "A" or Alt. "II" Abovc
$ $450.00 Conscrvation Plan Review
$ Fee Determined by Engineering
$ Agreemcnt Necessary [ ] No[ Necessary [ ]
��� �
n
, ., ,
, ,: , ,
, ;,
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE Ip^ 11
SITE ADDRESS _J
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
e
❑ OWNER �CONTRACTOR
Permit No.: �,Z,����� � � �
Received By: �/'l��
���
ADDRESS: CITY STATE ZIP
PHONE:
STATE LICENSE #
EXP DATE
STATE BOND # EXP DATE
ADDRESS: �.D• .DVX IO � CITY CE�� STATEIV ZIP�SoII
PHONE %6,3 - yyyc- oa9a FAX
FAMILY ❑ TWO FAMILY O TOWNHOUSE
DETAILED DESCRIPTION OF WORK
O REPLACEMENT
FEES ARE BASED ON E 10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER�OF EACH BELOW). MINIMUM FEE
S3 .50.
BATH SINK/LAV FLOOR DRAINS ' SHOWER
BATHTUB � GAS PIPING (NEED CITY LIC) SWIMMING POOL
_ CLOTHES WASHER KlTCHEN SINK .� WATER CLOSET
_ DISHWASHER _ LAUNDRY TRAY WATER HEATER (S35)
WATER METER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
WATER PIPING
_ WATER SOFTNER (S
BACKFLOW PREV. SI )
� FOR IRRIGATION
_ OTHER
I hereby apply for a plumbing 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 appl�tior� fo� p�and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the se�f al or �ch requires review and approval of plans. , �
StGNATURE OF APPLICANT
NAME V'� I�/� �. � W 1�/� DA
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building MECHANICAL Permit No.: � � '
Inspections RESIDENTIAL APPLICATION Received By: �'' �`�
763-572-3604 CITY OF FRIDLEY Da�' '?' ' 2� 2��
763-502-4977 FAX EFFECTNE 2-19-09
DATE � � O YOUR E-MAIL ADDRESS
SITE ADDRESS �� I � QQ'Z,� �1 C�J
THIS APPLICANT IS: ❑ OWNER �CONT'RACTOR
PROPERTY NAME: �
OWNER/ ADDRESS: CITY STATE ZIP
TENANT
PHONE:
CONTRACTOR COMPANY NAME ` `
SUBMIT A COPY OF CONTACT PERSON: ���• _
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS:`�Q,4�,������) Q� �'i' • I L� CITY �0'YYZ (1'.e�{l �,STATE�ZIP���(�
APPLICATION l/
PHONE'7(��j-?(F(Q �75 a FAX 7(p�`t�C�-I �p, �_�
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK• � �W � �PLACEMENT �ALTERATION/REMODEL
�ETa,�ED DESCRIPTION OF WORK ` - - 1� �
` H���- � �n p���ror�rn �
FEE5 ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
Equipment Installed MFG: MODEL: SIZFJBN
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBN
_A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 FURNACE $35.00 GAS iJNIT H1R $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $ I5.00
� ��
t_ a.. .+`�. t .1 i�: � � ct� �� �n'�*`�5 w}F �. y,�'E %# t'ik� e�..� 5 .f �'_ �r�
` #"1�iJG�'�ii #����������'!'� :.��� s, � +•r� k�e' 7.�� 4;�" ,�� Y t �` k� Y.�`^r�`srt.,��� ��/ y�� :^��«.�_;,,„} �� �' � � ° � '� yz ��£ � e � � �` �"
1� +t 1 v " i £s ° J'� � kt Y "�z�'^�,:. '�� ?. , � n, � �'
lvantbeFOff7XtUreS Q� $1$.OQ__�__X.$25:00 r $_�,
�"
Number af fiactures-@ S25.Of? x$25.OU =$ �
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
MINIMUM FEE $35.50 Tota1= $ V �' ✓�
THIS IS AN APPLICATION FOR 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 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 accordance with the
approved plan in the case of a work which requires review and approval of plans.
SIGNATURE OF APPLI PRINT NAME /����i��,�p � DATE /���—��
�<<
PLEASE N4TE: SEPARATE ARE UIitED F�R BUI�,DII3G' E3:F,CTI�,ICAL A�ND CAL �URK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
Building BUILDING Permit No.• � ' ��% �
Irispeciions RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd: �v d�
763-502-4977 FAX EFFECTIVE 8-19-09
DATE !� I I°1 1 O 1 YOUR E-MAIL ADDRESS S�ea'� �+��� ���'J�e���s 1'/� C-. � L� '�`"l
SITE ADDRESS (�tSC 1 ���e.v� ��, IJ tr
THIS APPLICANT IS: ❑ OWNER f�CONTRACTOR
PROPERTY OWNER/ NAME: e \ n '
TENANT ADDRESS: �- CtTY ,
��—b' �� STATE �IP��
PHONE: � Lu3 - 5�$ l p—� I�
CONTRACTOR NAME: �.�� b � ' ` ' �'
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE LICENSE 1�
AND CERTIFICATE OF ADDRESS:�,`� (R� C-l�sS'iza ,.� �(..� � w CITY 7-inda�-'�'' STATE�ZIP S��
R�iSURANCE PHONE ^Zfl � FAX ^ 20 �1Q
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYf1VEW CONSTRL)CTION STOR[ES
PERMIT TYPE ❑ ADD�T7oN ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT F[NISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING �9THER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUC7'ION ❑ ADDITTON
❑ MAINTENANCFJREPAIR �REMODELING
DESCRIBE WORK BEING DONE: ' n �l e.r+ �
SIZE OF iMPROVEMENT LENGTH WlDTH HEIGHT S FT
ROOFING O HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE 8c GARAGE BASEMENT REMODELING SUBMIT:
l. Existing Fioor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structura! members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDI110NS. & PORCHES SU$MIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
fN EXISTING OPENINGS �Yes ONo LOCATiON OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FELS AKI; BASEll UN VALUA"1'lUN, INCLUll1NG "1'HL CUS"1' Ur' LAKUK A1Vll MA1 L;KIAL�:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALL
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Contro(
Park Fee
Sewer Main Charge
Total Due
$ -
$
$
$
..--
TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 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 uavable to: Citv of Fridlev Attach
THIS 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 Ci f Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application fo a rmi d rk is n t to start without a permit on site; that the work wi11 be in accordance with the
approved plan in the case a w � re ' r' and approval of plans.
SIGNATURE OF APPLICAN PRINT NAME ��� DATE � �� ��
f I I
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