AF - 45680�
Date
Owner
Addres
�,
BUII�DING PERMIT
�,
Villa.ge of Fridley, Minn, No 2? 7�
/f,�.:--. a.�:6--: � :� ....................
��•� .. . .................. Builder ............................................
s !!C•A.��... .. . l��j%.••'�•••.. Address .........................................
LOCATION OF BUILDWG
e
No. ��"?�% . . . . . . . . Street . �4���. . . ��% . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . .
Loic . . . . a�.9 . . . . . . . Block . . / . . . . . . . . . . . . . Addition or Sub-Division . . . . . . . . . .5�.� . . . . . . . . . . .
�
.
Corner Lot . . . . . . . . . . . . Inside Lot . '.I�. . . . . . . . . Setback f�. . . %��. Sideyard / �. ��� . . . . . . . . . . . . . .
DES�CR[PT[Ol�f OF' BUILDING
To be Used as:
� ���
'����5����� . . Front !��. . . Depth �� �.�'�(Height f �f . . ..
a!Lll�'� . . . . . Front � . . . Depth .'��. �.°. . Height . . . . . . . . .
Type of Construction ,/�6Y�7� .. Est Cost j�.l.�o .�. .... .. ...
�
sq. � t. �3�� cu. �. . . . . . . . .
Sq. Ft. . �:T.�. Cu. Ft. . . . . . . . .
To be Completed /�.�'�r�.�P�
�
�
In coiisideratibn di the i�ssuance to me oP a permit 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
�rdinance� of the village of F'ridley. ;+
• ''' _ �� � I �
Yn consideration of the payment of a fee of $�� -.°. , permit is hereby granted to ..�. �. .. .
....
............ to eonstruct the building or ad dition as described �bove. This permit ig grant upon
the eaep s condition thst the person to whom it is granted and his agents, employees and worl�nen, in all work
done '' arotlnd and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnes6t�, regarding locat3on, construction, alteration, maintenance, repair and moving of buildings with-
in the village limi4s �nd this p�rmit may be revoked at any time upon viola�iqn of any of the provisions of said
ordinances. i`'/ p / � p� �
0
`�".°.! �: . . . Building Inspector
NOTICE:
This permlt does not cover the construction. insta Ilation or alteration for wiring, plumbing, gas heating,
sewer or wate�. Be sure to see the Building Inspe�tor for separate permlts for 4hese items.
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� CITY OF FRIDLEY �-F�'" ��� /o��� n�
APPLICATION FOR HEATING REPLACEMENT �
CHIMNEY AND STACK VERIFICATION
THIS FORNi MUST ACC0�IPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION � _ DATE � %/ 7%
OWNER �- � % �� ADDRESS
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are lodaed within
4. That it is securely supported
5. That it meets all current Code requir�nents
f�r size and total BTU connected
6. Total Heating BTU ��� �
Al l Other BTU �� � �-� �
• TOTAL l C� � ;�`
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REMARKS J
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HEATING PERMIT �
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SIGNED ��
Lice ee
l�m�c�sa�•�.,,�.c.�c,�— •
by
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Address �l ?� a—•�.�"� � �
Tel ephone 5��-�—'�0.�.� �
Fridley City License �
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sue�ecr PERMIT NO.
City of Fr,idley � 2�. 3 5�
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� � .
� �` COMMUNITY DEVELOPMENT DIV. p
r � y � PROTECTIVE INSPECTION SEC. ��"�� p�
i �
� S �
� �'�'1 � CITY HALL FRIOLEr 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�"°� � �'� 612-571-3450 910-F15 5/27/92 / /
JOB ADDRESS 6917 H:i.ckory Dxiv� NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCF. 2� 1 OS'tIIl8S1 � S 3rd Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
AI Soderquist 6917 Hickory Drive NE 574-1091
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIIADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION �] REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WOHK
Reroof D�?elling (�30 �quaresl Tea�-�p,f�
9 CHANGE OF USE FROM TO
STIPULATIONS
Underla�zrient mus.t coznply v�rith State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS AHE REOUIRED FOR EIECTRICAL, PLUMBING, HEATIN(3,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZONINO SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTHEET PARKING
I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GARAGES
AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,590 $. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEF;MITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $`3']QOO Fire SC $1.. S9
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$39.3�
SiGNaiu��J££ OF„ N`i57/ CTO pRAUTHORIZEDAGE 7 iDaTEi WHFiN P/p�/y/�PE LY ALI ATED THIS IS YOUR PERMIT
� ��'� °, / / � �!'iiC.��uG�� � V �O'S � � � � � LK / ' �^� � � / �
C J
SiGNATURE OF OWNER�iF OW BUILDER� iDATEi BLDG �NSP r�qTE
�� .. ::::� '.�. ,`...;. . .�,..i,.,:.,... .:i :ci>:. ..�;..'�: .'.�: ...�.�.�. .�. , ...�. :..:�.c ::c,...�.:; .,�:�: .... . . . . . . .. . . . .. . . ,. ,�, . . .. .. .. .. . . .. . . .. ....... . . .., . .. , .,. . . . . . .. ... . .. ....
NEW [ l
ADDN [ ] CITY OF FRIDLEY
ALTER [ j SINGLE FAMII,Y AAiD DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/92
Construction Addr�: � 9l � �� G � m/� ,� �/`'��ti �
Legal Description: c� %,� �j � L. I (�S i �i {��' S � Q 4 �L.�-
Owner Name & Addr�s: ,L smo ��� v� S T Tel. �174 /0 9�
Contractor: S� � F MN LICFNSE 1�
Address: � Tel. �
Attach to this application, a C,eitificate of Survey of the
lot, with the proposed consh�uction drawn on it to scale.
LI�ING AREA:
GARAGE AREA:
DECg AREA:
� ,
I.ength
Length
i i �'
DESCRIPTION OF IIVIPROVEMENT
�dth Height
Width � Height
Widt6 HgtlGround
: � �d ��iZ � / Y_ a�i� -O�
Corner Lot [] inside Lot� ] Ft Yd Setback _
Type of Constivction: �—� v� ��-�L��S=S �
Approx. Completion Date:
Driveway, Curb Cut Width Needed: Ft. + 6 Ft =
Sq. T�t.
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Est�rmat�ed cost: S /S �p `-°
(Cost on Backj
Ft x $ _ $
�
DATE: � � �s =%�APPLICANT: - � TeI. # S� � �� p�
Permit Fee $ �'7, G�-C�
Fire Surcharge $ %. �
State Surcharge $ � dC�
SAC Charge $
License Surcharge $ `—
Driveway Escrow $
Park Fe� $ --
Sewer Main Charge $ "—
TOTAL $ �����
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00. (State Licensed Residential Contractors)
Alt. "A" or Alt. °B" Above
Fee Determined by Engineering
Agreement N�essary [ ] Not Necessaty [ ]
�� s_
BUII,DING PERMIT FEE SCHEDULE
The Ghief Buildiag Official sha11, before issuing permits for the er�tion of aity building or stNCture, .
or for any addition to any existing bnilding or structare, or far any alteration or repair to any existing
bailding or strucd�e, upon aPPlication therefore, rec�uire the PaYmem bY the applicant for such permit
of fees to the amount herein below set forth and in the manner herein provided- to-wit:
TOTAL VALUE
$1 to $50i1
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,0�
$100,001 to $500,000
$500,001 to �1,000,0�
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $S00 plas $2 for �ch additioaal $1(� or
fraction thereof, to and including $2,000 �
$45 for 5rst $2,000 plus $9 for �ch additionat $1,000
or fraction, thereof, to and including $'ZS,000
$252 for first $25,000 pins �.50 for each additional $1;000
or fraction thereof, tu and including $50,000
$414.50 for first $50,0� plus $4.50 for each additional
$1,000 or fraction thereof, to and including $1�,000
$639.50 for 5rst $1�,000 plus $3.50 for each additional
$1,000 or fiaction thereof, to aad including �$500,000
$2039.50 for the first $500,000 pins $3 for each additional
$1,000 or fraction thereof, to and including $1,�0,000
$1,(�0,001 and up �-ap-- $'�S�:S�D�-€or-t�e fiist �1,000,000 plus $2 for �ch additional
$1,000 or fraction �thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Gtirb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times
$13.50. �
Alterna.te "B" : Removal and replacement of curb and gutter and install a 3 foot wide �
approach with 6 inch depth - Driveway width plus 6 f�t times $15.75.
VERIFICATION OF FOUNDATION
Permits for construcbion will be i�ued a minimum of 24 hours from the time of application to allow
for proper review of the proposed structure and of the coa�truction site.
A Cefi�ficate af Survey of the lot, showing the location of the foundation once it has it has be,en
consbructed will l� required l�fore proce�ding with the fiaming.
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CpMMON VENT. VFNT CONNECTOR AND COMBIJSTiON AQR VER F1�ATIOM
When e�tacirt� an eYistirwoi fu,�an� the undersigned hereby ve�ifies ti�at the
ven�ng has been examined and Is free fran rust, detetioration, obstructions.
and Is securety supported and firestppAed where requfred. Yes () No ()
7tte venting System is plastN;/pVC and cneefs aRl curretrt c�ies arx4 man�facttsrer
speclfications ficluding sizing. length, number of elbows and te�mminatiar�. Yes (} Np ()
The understgned also verifies titiat the replacement unii is a listed assembPy
and meets the a�rrent c�odes and ��rr�,fac�a�re�s spec.hficatlons, This does
include ApA-CAMA Categary f Centrai Fumace Venting Tab�es for fan
ass�ted and naturat draft appii�nces.
The exisbn+� combastio� air i•s sized anai installed to meet tlie currer�t C�c1es
and manufacturer's s�s�ations.
VYhen reguired to inst�li a�ew combustion airait wil! be sized anal instaBled
To meet the qarrent codes and �r►�nufacturer's specifica�ons.
Yes()No()
Yes()No()
Yes ( ) No ( )
When in�tallfna a new ventinc� system, the underslgned heceby verifies that
it is a Ilsted assemb� and m�ets the curre►rt codes and man��acturers
speciflcaitions. This daes ir�c�d� A�1-GAMq Cagego►yr i Cen�a� Fumac�
Vendng Tables for fan assisted and natural draft appfiances. Yes () No ()
Is the c�mmo� verrt and v�nt co�r�dors sized art� inst'dAed caorr�ctiy af�er
an aPpliance has been� rerr�oved from the ;.�mmon vent arid ventQd
separately as per cuRern cades. Yes () No ()
A�aliance Tvr� and Sizc�lCammo� Ven,� and Vent Ce�ne�ator Infarrrwatioe
Appllance #1 Type A ���,�w gTU �nput�� Fan Assisted or Nat �
Applianc� #2 Type L�TU lnput F'an A�sisted or Nat
APplfahce �3 Type �� BTU Input Fan �4sted o� Nat —��
Totaf Appliances � TotaE �ttu 4nput
Common Ver94 Tyape
Ver►i Height Dismeter �� �n��
Applian� #1 Vent Connec4or Hc;ight ft Lertgth ft Diameter �_____�n 1'yAe �
Apptiance #2 Vent Connector HeigM ft Le�gth ft Diameter in Type
Appliance #3 Vent Cortnector Height flt l.ength ft Diameter in Type
A�1'�RATIOAIS• lDesc�ib�+)
HEATlNG
Sig�ed By:
ze�ze�d s0�ez,
� '
Ol ,13�I?J� � �U.I� W0�1� SS:�Z 0Q�-1Z-f10N
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CIIYOF
FIt[DL�Y
FRIDLEY MLTNICIPAL CENTER • 6431 LJNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 1, 2002
Ms. Jane Barness
6917. Hickory Drive NE
Fridley, MN 55432
R�: Final Inspecrion at 6917 Hickory Drive NE
Contractor: Dave's Appliance Heating & Air
Dear Ms. Bamess:
A mechanical permit was issued on January 3, 2001 to install a furnace at your
address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date, no inspection has
been called for.
The permit 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" and no further action will be taken.
To set up the inspection or to have any questions answered, please contact the
Building Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE ���c:, Cp YOURE-MAILADDRESS 1�1esWei� MS✓l. c� ✓�
SITE ADDFESS �v�1 � 7 %�� c�i(o/'..� ��• l�� r�' q
THIS APPLICANT IS: �J OWNER ❑CONTR.ACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
�� � 5.,.�� a s r� �v
Permit No.:
Received Bv`
Date Rec'd:
ADDRESS: CQ`� �'7 N. ��o�y .i�r_ fV� CI'I'Y -�.�.� � STATE I'1�TP �`13 �—
PHONE:�c_3 � �( 73 � 3 — c�,.-fz� + w�_c,l� —�i z ti�� `13b'i
STATE LICENSE
EXP DATE
ADDRESS: CITl'.
,� SINGLE FAMILY/NF
❑ TWO FAMILY/NEW
❑ BASEMENT FINISH
❑ DECK
❑ NEW
❑ MAINTENANCE/REPAIR
FAX
KUCTION SIZE
CTION STOI
❑ GAR.AGF/SHED
❑ ROOF
❑ SIDING
❑ SWIMMING POOL
.�
2
❑ DRAIN TILE .
�OTHER.- p''�fc I•�.,—
TB ZIP
DESCRIBE WORK BEING DONE: 4��^-� �-Q lr.��-- � fu�v-� r� �,-.� -:�,, i� �Y �;,N9 �� � 4�-..�"� c4.o� r'
SIZE OF IMPROVEMENT S � ^�g-
NUMBER OF SQUARES
GARAGES
PROPOSED S1ZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
LENGTH
❑ HOUSE ONLY
O HOUSE & GAR.AGE
� ATTACHED GARAGE
❑ DETACHED GARAGE
�Soffit
0 Trim
❑ Fascia
HEIGHT
Ft.
BASEMENT REMODELING SUBMTf:
1. Existing F7oor Plan
2. Proposed floor plan
3. List of shvctural members to be us�
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADD7TIONS. & PORCHES SUBMIT:
1. Site P1anJSurvey showing the existing swcwres
and proposed projec�
2. Two sets of constrvction plans
WIl\DOWS 3. Energy Calculations
IN EXISTING OPENINGS �'Yes ONo IACATION-OF WINDOWS
OR FOR NEW OPENINGS-DESCRiBE SIZE OF L• d•— ��'� �
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLEDW'�^ Ik�'""' • c I"� NiJMBER OF WINDOWS -5
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIA.LS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 2Q � � �, OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb G�t Escrow
Erosion ConUrol
Park Fee
Sewer Main Charge
Total Due
$ `��� ���
g �� , oc�
$ . �J
$ �!� s O �
$
$
$
$
$
$
$ v
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 (Sta.te Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w ch requires review and approval of plans. �
SIGNATUREOFAPPLICANT �u-- ��V PRINTNAME ��"' S'"���$�""�`/ DATE 3� � I°�°
�. � �
Building PLUMBING Pemut No.:_
Inspections R�SIDEN�I�L APPLICAT][ON Received By�
763-572-3604 CITY OF FRIDLE�X Date Rec'a:
DATE � �S �� YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: �O �CONTR.ACTOR
PROPERTY Nq�: �
owlvEit/ ���s: G r ccrrY �� STATE�z��
TENANT PHONE: 7 G� —, I^7`3
CONTRACTOR NpME;
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE ADDRESS: CITY STATE ZIP
LICENSE VJITH pHONE FAX •
APPLICATION
PERNIIT TYPE �GLE FANIILY ❑ TWO FAMII,Y O TOWNHOUSE
TYPE OF WORK: O NEw �:BEPLACEMENT
DETAILED DESCRIPTION OF WORK ' ��' �,cu� (h �,�. /1 ��-/ t� vt c,< < c t�
PER MS 16B.665 the permit fee is a minimum of 515.00 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 )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor /�.5�: Obx .OS =��,�sU
FOR PROJECTS WI�RE LABOR EXCEEDS $SQO, FEES ARE BASID ON $10.00 PER FIXTURE, EXCEPT WI-�RE NOTED. FlXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVi�
BATH SWKILAV FLOORDRAINS SHOWER WATERPIPING
BATHTUB GAS PIPING (n� cnrtrc�vsEj SWIIvARNG POOL WATER SOFTNER ($35)
CLOTf�S WASHER KTTCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER ME!'ER OTFIER
��� � � ��y�j x�'$� s� ��- �� � �� � �'. � �
as�"��.' .,'� � � .'�i .-� � .:v�.,�,_ ',s�''��aa�,%w,:4,., F�r�.S,a4� ��.., �'q ,�� .���-.� .n.. �;..-
Permit�Fee $ �. o d Number of fixtures @�$10.00 x$10.00 =$
Surchaz e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ / ,S .�Q Number of fixtures @ $35.00 x $35.00 = $
State Surchazge = $ .50
Tota1= $
THIS IS AN APPLICATION FOR A PERMIT-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 Consh�uction 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 all work which requir� review and approval of plans.
� � % c (� �
SIGNATUREOFAPPLICANT C� Av%"�S pRINTNAME �ic- c.JvJZ itiJ� S f� DATE 3��% I° �°
� . P F t ti v� } �� �u ; 4 � 4 { b �;M1'� '� .{
_ ,,, y�'.. .. _ _ .
, , „ . . . �u , .
.
..-
� � ' m�...w� e . . . ' C ,�:: 4'.c'�.b,.�
Q�� �. 'x� � u
City of Fridley
]Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977