AF - 46184,.+c;
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Village of Fridley, Minn.
BUILDING PE�!'II�
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N� . � i� Office of INSPEGTOR OF BUILDINGiS
Oavner "--•�'* .�,�- �,�,�1 = .
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Architect Fridley, Minn. �' -� �'^ � , 19<���:,..
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Builder � '
LOCATION OF BUILDING
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No. � �� �� Street � �F'� ��t ,�'_�ar--.-��
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Lot �'-�� . Block �`" Addition or Bub-Division
of Lot
� �s DESCRIPTIQN OF BLT�DING
€� ,» s..�
Front �' °�' Deptl�--��-�-� Height ``�; 8torles `�'��"`°" Manner oP Conetruct3oa �°♦''�"� �.'J��'�'�$�---x
To be uaed as �'� ��'� � ;='�-� � � To be compieted�;:.��� °� � `� -"��' �' Eetimated Coet�r� � � "'`�,
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{ y V/ � �p Y�.� �....d::..s2.-8 ��¢ ��. �rr.. (p, !t_ 9 �$
!'�Aar'4.s--�.� .. 4. �&�-4C='d i�:�M��°7-'"i_>-"°.�.%iL ..r:-�'�y-'4��.:.f,.:.-_�.g�.'v.� '-���;��.�.. !
Permit is hereby granted
�p �^'�a j `�,Af �.,,� �, � .
the buflding ��"'�" describe�d in the above atatement. Thie _permYt ia graatecl
upon the egpreae condil3on that the person to whom it is granted, and hie agente, employees aad avori�nen, in a1l
the work done in, araund and upon said building, or any part thereoP, ehall conform in alI respecte to the ordi-
nances oP k`ridley, Minn., regardfng the conetruction, alteratfon, maiatenance, repafr and moving of buildinge
within the city Iimita�, and tl�is permit raay be revoked at anq time upon vlolation oP anq of the provisions of safd
ordinance�..
AGR�rr �vn swoRN s�ra�rrr
In consideration of the iasue and delivexy to me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
swora, I hereby atate and say that the facts sta�ed by me and contained in the above permit are
true as therein state.d. ' �
Subscribed and sworn to before me at Fridley,
day o�_.��� ��T-�=..-�:..�:=�- D. 19 ���'
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City of Fridley, Minn.
BUILDIliTG PERMIT
Da�; June 23. 196�
,,� �
N°
p�. �aridolpjD G. Larson B,� Eandalnh a. Larsun
� 1 7 Hill Crest l3rive A� 1357 Silcrest Dri�e
�9 � ��
'7996
LOCATION OF BUILDING
No �� SLseet ��- CT'es'� Drive Part of Lot
Lot 6 Block -�a' Addition or Sub-Diviad� ��7x�ke�.Ei]18
Corner Lot _ In�de Lot � 3etback 5ldeyard
3ewer IIevatioa - - - -------- Foimdati� IIevatlon
DESCRIPTION OP BUILDING
To be Uaed ea:
�i n 8;_ T�'ami l� POOffi
-� FYnnt Depth Height Sq. Ft Cu. Ft
Ga2�8ge Front Depth fTeight $q. Ft Cu. Ft
Type of Construction �e F�t. Cost ��6a K� To be Completed
Dining & Fam�.ly Aoom , GSrage
Ia consideratton oP the issuance to me of a permit to construct the bwlf�ing descrlbed ab�ve I agree to do
th� ProPosed arork in acoordanc� with the d�scription above set forth aad in compliance wi a�l ons of
ozdinaat�s oP the dty of �Yidley. �-�, f:-" �° �
f�,%/� � '�/°
Ia camalderatloa oP the pa3►ment oY a fee o! y�.sQ��, P�t fs herebY granted to Randol (',_ TaTSOri
to construct the buffding or addition as de�Ibed abave. This t is granted u�n
the egpress c�ortdition that thepe�on to whom it is gcanted eacl his ab�eate. emP1oye� an worl�nen, in all work
done in, around and upon said building, or anYpart thereof. ahall conform in aII reapects to the ordinaac� oE
Fridley� Minnesota regarrling lo�ation, aomstruct�on, alteration, mainteneace. rePafr and mwiag oE bufldings
wittiin the dty ]iffits and thia permit ma�► be revoked at aay tlme upo� vlolation of enY oE the P�viaiona oF safd
or�aana�.
�llen Jensen g,��,g �r
NOTIC�
YW p�emk dea aw eewu Na �mnn�ae, �� vrie�Y. P1�6mo. Ya 6�aN�, awa � wahr. 6� sun to aM
tta gutldi� I�elo� ter apual� p�rm8s im fMp N�ns.
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AI'PLICATION F0� rt I,IT�GG PERMIT , ,
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. CITY OF F`RTDL�Yy , ldlV�90TA
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Oi�R' S NAME ��}i��i� �'�?'_ .��, � ���BUlT�DER �.�-,.s��� .: ia� � �.4� � �%
� e . . � , .. . wr"'� -
ADDRESaS � • ��. c,. ! � � % ��dQe �
__�,�_.��"7 /`t« � � �g't�" �ADDI�ESS ii � S� ,e� � �
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LOC�Z`TON OF SU`�DING
No. d � �� �=� :� �,�,�,-;�.; �•_Ser`�et �lLc, ��g�r- ��p Patt of Lot_,�=
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Lot_ � Block � � Additio�r or Suhd�vi�3on �� o�� °�-!z � ��',!,! _L���
Corner Lot Inside.�ot P� .__;a�e��k�. Side-Yard .4 �
SEW'ER E�.E�VATIQN FOUNDATION . EL�Vi�I`PTiT�I �
... • � . . �. .
Appi�e�nt attach to tl�i9 form, T�ro Certificatee et, Seirqey of Lo� aisd � fsro�Crsed `h�i.d•�ti4
ing locatic►n rl��wa bri these (;ef�tificate� . - .
DESC&II�iON OF BiIII�DING
J1b be used �s: ,
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���� � �s� ��, i° ��`roaC o��. �, DePth �� ��° H�F�t� '� ?'
9q. Ft . `�b f Cu . Ft . ��,_: ,� f? �/` �
_� �-��-�� ,�Front ��, Dmpth �,S Aeight t� �� _
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� �q. Ft, �� Cu.� Ft. �
. �
Type of ConsCructioq---�'�� Estimated Cost�� �"� �
��+�d��fi ��o � �i� �o � �'� �
The undersigned hereby makes application for a permit for the work herein apecifi�d,
agreeigg tio �o al,l raork ii� str�ct accvrdance with the City of Pridle� Ordin�ances aud:
�ulings i� e�e Departm�at��nf Buildiags, and fiereby declares Ch.at all the f�cts and
repre.segt8tians stated ia this application are true, and correct.
����_
,�e.ef Fee CQSts can be fouad on the Reverse Side). �,
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BUII.DING PERMIT F8E S�FJ4E
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Seetion 2. The Inepector bf Buildin�s �s�alt,-�be�or� iagu,�,�g sny permit for
, Ei�e erecCion of any buildin� or etru�tyure�, �or � for any add�Et3� ts any exiet-
_ iag buil.ding or etructure, or for, anp $�teT'st�sgis,•`or'.:repattb t� any e�isting
�uildi�g or atructure, upoa applicat�"c�i. �er,e or, ���re the �tp��t by �'�a
applicant for suah permit cf fee� �{� �he amouat •her�iu��•below set �forth._a�d
: � ia the manoe= herein provided to-ta�t:� �� •
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•---- 2.1. F�r aay �uch permit �or the �za��.��.ori Tc��� any fire�p�� bu 1di ,%.
� Q$� athe�
..,�,� � a �ar�e� war•ehous�, factory pr.'�g�►�'r ��ev�C�c;, ,� �or. tLe et�Li�ra ��� �'•
q�fire-�r.�of addi�3on.. fo�. aim�L�;ar'�°oir�;�p3�ayr �o: a�ty esis�i�g btr�.i-d� `}•:;� -
�ahelt be at the rate s# $1.4Q for e�cit., pt� t�o�e�td ,Rtib�d feet, os � fra�� .. w
, �r- .. : t�iiereuf, in auch cubic�l c�ontgn�s . • • :• � ' �'. ` ;.. °,,- � �' . .
.� n. . . . , • ,
� Z�a. For any such. permit fc�:.,��e erection o� any #irerpraQi g�raae__.��--�-��,,,
.a�Ctory �r grain elevator, or f,�►•�he c:�e�tian af ett�� �� � ..�
. for aimilar occupaacq, to an�r e�ciet�in� �tldfmg st���,� •be _�t `e �'
�. ...'�.:fO{ •��h ot►e� .tht�nsend cubic .feefi;�.,c��a.esiii�d �,,�firepta►a�" hy� .Si
t11�.�tinacapaL•,tt,�-gu,g}� C��i�y, . ' '
� `'�_ flOUSES . � . � ,_ :
�-� � 2•��. Fc�r anq sush permi.� fo= �he- er.ectioa of en non-f�tr� :•.. .... .
�'� � han 'a gaigge, 'warehonse, �acto y P��. ��ildia� -
additioa, for aimf��r ocCu �' or, graia elevator, or �aisy �sa�•-fit+�p�b�` �'
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each �ane thou� P�:�y� to eYey e#igtixKg tiuildin�g - pe�i,t $E.� fQr -- .
� �c�bi� fe�@..
GiARAGES � . . • • � . ,
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2--•�+• Far 8ny auch pernuLt f�r the e=ection of aay non-fireproof a
warehouse, factory or grain elevator, o� for th� erection of any non��pt�'y'���
��a�rri,.:, � � 'Zar•' occupancq, Cv aay as�tet
-_,..- � n8 or addition - niaetq cents � build3ng $r for esr�r 8uch ,•
or �f�r�,t,�� �areof.. . i�a� tbe cubical� contents f tbereof c�f thta �� � fc feet
� ��.Qp,,,,_
For �he puri�g nf� acm .
cf e, n y b u i l d i �'� fees for baildin g permits, t h�' c u b i c� 1 c� t t e�-` `
n g o r s d d t ioa Co a unifcrm heighC throug�ol�t� �
gro�nd aaea aove�ed .ftom a point siu (6) isuh�� beld�w the ��r 1�����
basement or cellar to tlie average hei�ht of tha �upger su�fnce -or �to-'tbe'
� ��.
average he3ght ag the r@oi �urface of the mai� gable of a.�itch�d roof. �
. ��.5,��. For rapairs or alteratioas to �n exist � ..�. - . . , + .
.�at Che rate of $3.00 pe�r egch Five I���ed u�8� �: `��g E�e al�!►1 ����: ;' .
.;. therebf in �he cos�� 'bf �1 p�� p� ..,..,.k - ,- — ($�)F a►= �s�etfaa'_ '_ �
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STATE OF MINNESOTA DEPARTMENT OF HEALTH C���� �� �`'`�
._
`' • ABANDONED iiELL RECORD U �
i. �aurtan av wet,�. MINNESOTA UNIQUE WELL N0. H
(leave blaak if not kno►m)
County Name
To►mship Name Township N Range Number Section No. Fraction 4. WELL OEPTH (eompleEed) .Oate seeled
FRIDLEY � E k kof k
30 5� 23 w 24 NWSWNE 105 tt. .TUN _ 23 � 199
Numerical Street Address and City of Well Lacation or Distance from Road 5. DRILLING IIETHOD (1f knmm)
(ntersectlon 1�Cable tool 4� Revene 7[j Urtven 1� Dug
1357 HILLCREST DRIVE NE �
2� Hollow Rod 5[] Air 8� Bored 11[]
3� Rotary 60 dette4 9� Power Auger
Show exact location of rell
(in sectian grid rith 'X•) N Sketch map ot well lotatton 6. OBSTRUCTIOMS
N Mell obstrueted Q Yes No
_ �___ ._ _,, Obstruetions recwvad fes � No If obstructions cannot be
' ' i removed. tantact MOH
W _ : _ _ � _ ' _ before sealtng.
, , -�- ` E �0� �
` ; • _ T I• 1" 1. USE
- - y,�. �DOmestic 4� MoMto�ing 80 Neat Loop
_'
_�_ __� _� __: I 2� Irrigation 50 Publie 9� IndusL�y
I
' ' ' j ��� � 3Q Test liell 60 Municipal 1� Comaercial
r-- 1 SL — " J� Alr Cond9tioning lIj]
2. PR�PER7Y OYNER'S NAXE Mailing Address if ditferent than 8. CASING(5)
RANDY property address indicated above � Black 4�Threaded 1[]
1357 HILLCREST DR. NE ��
LARSON FRIDLEY � NN . 5 5432 ZO Galv. sp we�dee
30 Plastic 6[j Statnless Steel
HARDNESS OF 3 �n, co 1 00 re,
3. FORMATION LOG COLOR FORM0.TION FROM TO
If not known, indicate fortnation lag from new we11 0� nearDy well. in, to ft.
SAND BROW . 0 20 9. scae�
�screenea Mett rroa�00 rt. w1-05 fc.
CLAY BROW 20 60 (If known)
� Open Hole from _ ft, to _ ft.
FINE SAND GRAY 60 190 10. STArdc�r,�ER LEYEL '
SHAKOPEE DOLOM. PINK 190 22 tt.�ee�or ❑ above
�ane u ace oate Meesured 6— 2 3— 9 2
11. 41ELLHFAD CONPlETION
1� Pltless Adapter 4� Found Buried
� �Basement otfset 50 .
Wel l Pft
16. REMARKS, ELfVATIDN, SOURCE OF OATA - CASINGS REMOVED. CASINGS PERFORATED, ETC.
12. GROUTING INiORNATION �j BAGS
GEOLOGY WAS TAKEN FROM THE WELL AT : �Heat tement sentonite
6 537 CENTRAL AVE .� FRIDLEY � HN . erout matertNP��II�rom� to_ t cu. yes
W A T E R L E V E L I N T H E A B O V E W E L L: 4 5' __
DATE WATi�'i'1Z �EVI�daL �1T�iS gAKEPi: i-2�-4E 13. NEAREST SOURCES OF CONTUMINATION
80 teet W d��eetton CITY SEWER �y�
Well dlsinfected beforo sesiing7 �Yes
14. PUMP �Removed � Not Present
Type: 1[I Submersible 3� L.S. Turbine 5� Reciprocating
�Jet � Centrifugal 6[]
15. EXISTING i1ELL5 (Please sketch loeatlons of abandoned and
n��1 �'� � activa �11� 1n remn�ks seetian or on back,)
JV�� Other unused wlt(s) on propa�ty7 � Yes /��/► No
Abandoeed: j] Permanent � Temporary � Kot sealed
� 17. HATER NELL CONTRACTORS CERTIFICATIOM
�.' I,,;:� This well was sealed under my jurisdlction aad thls report
�\Y : ;� is true ta the best of my knowledge and belief.
According to MN St�te Regulations E.H. RENNER & SONS INC. 71015
Ltcensee Buslness Name Llcense No.
1
aea 0 427-6100
Signed � - - � Oate
u�5 STEVE N oa� 6-23-92
iFICIAL ABANOONED MELL RECORO (May b� used fOr o�operty Transfer) Name ot riller
z�arraxr: PILS WITH D�D K E V I N H 0 P P E
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �• COMMUNITY DEVELOPMENT DIV.
i tV �������
r � � PROTECTIVE INSPECTION SEC.
1 ; �
� � i"'1 � CITY NALL FRIOLE� SS432 NunaBER r+EV OATE
�°"� � ,'� 612-571-3450 910-F15 9/1/98
JOB ADDRESS 1357 Hillcrest Drive NE
1 LEGAL ��T NO. BLOCK TRACT OR ADDITION
DESCR. 6 4 Moore Lake Hills
2 PROPERTY OWNER MAIL ADDRES$ Z�P
Revin Lin er
3 CONTRACTOF MAIL ADDRESS Z�P
Town & Country Roofi� 9403 Minnesota Ln N Ma�IP ove 55�
A ARCHITECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGINEER MAII ADDRESS Z�P
8 USE OF BUILDIN(3
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION C� REPAIR
8 DESCRIBE WORK
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlaymen¢t must comply with the State Building Code.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBIN(3, HEATING,
VENTILATING OR Alii CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OF CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG.
I HEREBY CERTIFV TNAT 1 HAVE FiEAD AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE THUE AND CORRECT. L PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TVPE OF W RK WILL BE COMPLIED
WITN WHETHER SPECIFIEO HEREIN OR NO_. TNE�RANTING OF A PERMIT 2056
DOES NOT PRESUME TO GIVE AUTHORI TO I LATE OR CANCEL TNE pEf;MITfEE
PROVISIONS OF ANY OTHER STATE OR CAL AW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF C ST CTION 74 75
PLAN CNEC
�
� ce
SiGNATU CONiRAC OR AU OR AGEf T IDA I
- s�rtuaTiiaF nF nwNFP iiF OWNER BUILDEAI iDAT6
27508
� � /
PAGE OF APPHOVED 8Y
� �
SEE ATTACHED
SHEET
PHONE
574-9290
PHONE LICENSE NO.
545-49�� 70091�R�
PFIONE LICENSE NO.
PMONE IICENSE NO.
O MOVE O REMOVE
OCCUPANCY GROUP OCCUPANCV LOAD
SO. FT. CU. fT.
OFFSTREET PARKING
STAIIS GAFiAGES
SURTAX
. 1.03
SAC CHARGE
Fire SC 2.06
TOTAL E
i.0 8 84 �
�L A110A HIS IS PERMIT
� � G
��iTE
AIIG-13-1998 08�42 FROM CITY QF FRIDLEY --- - T� 8589320 P.01i02
� �y f � � � t'diCt3UVC 1J 1JJb
ADDN j l CITY OF FRIDLEY
�-T� � l SINGLE FAMYY,Y AND DUpLEXES R 1 AND R 2 .�
BUTLriYNG PERNIIT ApPLICA?ION �� � \
1
ConsmictionAddress: ��J� � � J`
Legal Description:
Owner Name & Address_ � ��f �v� ��h(t��' `�� \-� � \1@.v` � � r Tel. � � � —1, "` al 2�
Connactor: � NIN LICENSE ��-o t�°t 1 Z� a
Address: q � �`e,�P�-�-� � j1� TcI. �� 4�—L[ 2���
Attach to this application, a Certificate of Survey of the
lot, with the propos�d construction drawn on it to scale.
DESC�'fYON OF IDv�ROVEMENT
LIVING AREA: Leasgth Width iieight
GARAGE AREA: Leugth . Width Height
nECg AREA: Length Width HgVGrouad
Sq. Ft.
Sq. Ft.
Sq. Ft.
OTEER:
2 y s�.
Consaucdon Type•� Fscimat� Cost: $ � b S-� oc
�
(Fee Schedule on Back)
Driveway G�rb Giu Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �' I- l''! 15 APPLICANT: Tel. �f �y� -�..�
v
Permit Fee
Fire Suncharge
State Seucharge
SAC Cbarge
Licease Surcharge
Driveway F.sGroa
Erosion Control
$ 7N� 7s'
$ 1.oG
$ 1• � �
$
$ S�, O �
$
E�
k�l.M 7 � U_ 1
Foe Schedulc on Revetse Side
.001 of Permit Valuation (1/lOch%)
$.50/$1,000 Valuation
$1�0 �r SAC Uait
$s.� (state Licensed Rcsidcntial conuacwrs)
A1G 'A" c�r Al� "B" Above
$450.00 Conservadoa Plan Review
Park Fee $ Fee I?etermi�ed bY Engin�ring
Sewer Main Charge $ Agr�ement Necessary [] Not Necessary []
TOTAL
. S'TiP'LTLATIONS:
$ �2. �
� � SuBJECT � � P N�=o
Clty Of FC1(�Ie�' 3 2 2°I 8
AT THE TOP OF THE TWINS g � I L D I N G P E R M i T
� ` RECEIPT NO.
� •
COMMUNITY OEVELOPMENT DIV. ���m���� �/ / �
r � V � � PROTECTIVE INSPECTIQN SEC. 1eJ�V
� . �
� � /"9 � CITY HALI fR10LE� SS1�P NUM�EiI REV OATE PAGE Of AbPROVED BY
�""'�' �'� 612-571-3450 et0-F1S 10/4/O1 / /
J08 AODRESS 1357 Hillcrest Dr NE
1 LEGAL ��T NO. BLOCK TRACT OR AODITION SEE ATTACMEO
oesca. 6 4 Moore Lake Hills SNEET
2 PROPERTV OWNER MAIL ADDRES$ ZIP PMONE
Mark Fa ah 1357 Hillcrest Drive 763-572-9806
J CONTRACTOH MAIL ADDRESS 21P PMONE LICENSE NO
Renewal By Andersen 350 73 Avenue NE, Fridle , MN 55432 763-502-4777 20i30983
4 AiiCHITECT OR DESIGNER MAI ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADORESS tIP PHONE LICENSE NO
8 USE OF BUILDIN(3
Residential
7 CLASS OF WORK
p NEyy ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Replace 2 Windows Within Existing Openings
9 CHANOE OF USE FROM TO
STI PU LATI ON S
Provide smoke detectors in all sleeping rooms and or, all levels of the
dwelbing per Section 310.9.1.2 of the 1997 Uniform 3uilding Code. Caulk
and flash all exterior openings.
Permit Inspection Cards
Wili Be Mailed
To r�T� Po��
����
T�PE OF GONST. OCCUPANCY GROUP OCCUPANCV �OAD
SEPARATE PERMITS ARE REOUIREO FOR EIECTFiICAL. PLUMBING, HEATING.
VENTII.ATING OR AIF CONDITIONING.
THIS PEFMIT BECOMES NULI ANO VOID IF WORK OR CONSTRUCTION 20NING S�. fT CU FT
AUTHOR12ED IS NOT COMMENCED V�1ITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AfTER WORK IS COMMENCEO. NO DWLG. UNITS OFFSTREET PARKING
I MEREBY CEFiTIfV THAT I MAVE READ ANO EXAMINED TMIS APPLICA710N 1 S7A�L5 GAAAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SUiiTAX
AN� OROINANCES GOVERNING THIS TVPE OF WORK Wlll BE COMPLIED �1 425 $.71
WITH WHETNER SPECIFIED MEiiEIN OR NOT. THE GRANTING Of A PERMIT �
DOES NOT PRESUME TO GIVE AUTMOiiITY TO VIOIATE OR CANCEL THE pEqM1T FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN• 54.00 Fire SC �1.43
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION �
PIAN CNECK fEE TOTAL FEE
License SC $5.00 $61. 4
S�GNGTUAEO�CON•AACTOpOpOUTMOA�2EDOGENT iD�TEi ROPERLY LIDATED TH IS VOUp PEpMIT
!'O-S =�!
S�GNOTUAEO�OWNEA���OWNEpBU40@p� ibATE� BL �NSo - ����E
A"�
�[ ]
ADDN
AI.TER
Effective 5/10/99
� l CI'I'Y OF F��
[ l �G��'�..���������2
BUII.DING PERI�IIT APPLICl�TION
�onstruction Address: �135�- la:�\C.t�s� �t��. iV.�...
Legal Description: '
Owner Name � Address: �,� �, ���r�, '�- Tel. # �(0 3 •��'a 9 �OCv
CoIItractoi:; Renewal By Andersen MN I:ICENSE #�
Address:
Att�
lot,
I.iVING A�t�:
GA1tAG� �A:
DEC� Alt�A:
`� �, •�'� :�
•
350-73rd Ave. NE
Fridley, MN 55432
763-502-4777
#MN20130983
vey. of the
it to scale.
DESC�I�N �F ���'.�14�1� ..
I.ength Width F�ieight
Length Width �Height
I.ength Vdidtli Hgt/Ground
� . _ w �� e� L�
Tel. #
Sq. �t.
�q. �t.
Sq. Ft.
/1�n hn : n r'r!'� .
co���on �r�: ��.�a co�: � l, y as°°s
Driveway Curb Cut �`idth Needed: Ft. + 6�t =_ Ft x$
_$ -
�r��: 3 �Oc,� •0� ���e�: a� �ei. #_9�a•3�1s• (004 �
Permit Fee
Fire Surcliarge
State Surcharge
SAC Charge
Lic�nse �rchazge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge�
$ Sy.00
$ �•
$ .���-
$ �
$ S: �a
$
$
$
$
c� vs� �rr�.�
Fee Schedule on Reverse 5ide
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
��.QO (Staxe Liicensed Residential Coniractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservadon Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not IVecessary [ ]
To'�A�. $ � � `y�
�,� ��'7�-,��'C. �14. �• � � .
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
spec�cations including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existins� combustion air is sized and installed to meet the current codes
and manufacture�'s specifications.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturers specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installinct a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and rnanufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input ' Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
�
_
C[IYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 7, 2003
Mark & Debra Fagan
1357 Hillcrest Dr NE
Fridley, MN 55432
Re: Fina1 Inspection at 1357 Hillcrest Dr NE
Contractor: Homeowner
Dear Mark & Debra Fagan:
A plumabing permit was issued on November 13, 2001 to install a water heater at your
address. According to Section 4715.2800 of the State Plumbing Code, a final inspection
shall be conducted on the work authorized by this permit. As of this date the inspection has
not been requested.
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 by homeowner after notification" 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.
Cir�rPra�lv
DJ/mh
:,
- sue�etT PERMIT NO.
City of Fridle�► 32317
AT THE TOP OF TME TWINS g u I L D i N� P E R M I T
r
� ` RECEIPT NO.
' COMMUNITY DEVELOPNI�NT OIV. ` ��
� j V �'��� � L
r � � PROTECTIVE INSPECTION SEC.
� _ �'�'1 � CITY MALL FRIOIEr SS�32 NUMBEp REV O�TE P�GE O: APPi10vE0 Bv
�"'"�' �'' 612-571-3450 9t0-F15 11/13/O1 / /
JOB AODRESS 1357 Hillcrest DR NE �
t LEGAI LOT NO. BLOCK TFACT OR ADDITION SEE ATTACNED
DESCfi. 6 4 Moore Lake Hills SHEET
2 PROPEfiTY OWNER
MAIL AOOR�S$ ZIP PHONE
Mark & Debra Fagan, 1357 Hillcrest Dr, Fridley, MN 55432 763-572-9806
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO
Mark Fagan (same address)
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL AGORESS ZIP PNONE IICENSE NO
8 USE OF BUILDING
Dwelling
7 CLASS OF WOFiK
�1 NEyV � ADOITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
6 DESCRIBE WORK
Window replacement in 2 bedrooms
9 CHANOEOfUSEFROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms & on all levels of the dwel.ling
per Section %X 310.9.1.2 of the 1997 Uniform Building Code. Caulking & flashing
for all exterior openings.
" TYP� OF CONST. OCCUPANC� GfiOUP OCCUPANCr �OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTILATING OR AIR CONOITIONiNG.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING Sa. FT CU FT
AUTMOi;IZEO IS NOT COMMENCEO VyITHIN 80 OAYS. Oii IF CONStRUCTION {
OR WORK IS SUSPENOED OR ABANQON�p POR A PERIOD OF 120 DAYS A7
ANV TIME AFTER WORK IS COMMENCED. ` NO OWIG. UNITS OiFSTREET PARKING
1 MEFEBY CERTIFY THAT I HAVE READ AND ExAMIN�O THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TF1UE AND COQRECT. ALL PROVISION$ OF LAWS yp�VATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE Of WpfiK WILI �E CpMP41E0
WITH WHETMER SPECIFIED HEiiEIN Ofi NOT. TME GRANTING OF A PERMIT �SOO.00 �.SO
DOES N07 PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEI THE pEqMIT FEE SAC CMARGE
PROVISIONS Of ANV OTNER STATE OR LOCAI LAW REGULA7ING coN• Fire SC �. SO
STRUCTION OR 7ME PERFOiiMANCE OF CONSTNUCTION �L3.SO
PLAN CNEGK F TOTA FEE
$ .50
S�GNG7UAE OF CON'AACtOp OA AUTMOp�ZEO OGENT IDAfE� ME PROP V A�I� TMI$ I$,Y �ER �
l' I �
$�GNATUAE O� OWNEA��F OWNEpBUI�DEp� I�ATEI ' � IN P' f�6fE
NEw [ J
ADDN (]
ALTER [ J
Construction Address: �3
Effecave 1/1/2001
CITY OF FRIDLEY ,(763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Legal Description:
�
Owner Name 8 Address: ��t' � � �� Y� �a�r� _ Tel. # ''�,3 —����1 g� �
Contractor. �dr�tt�° l�nS�0.1( ��"1� MN LICENSE #
Address: Tei. #
LMNG AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft. �
OTHER: W 1�r1(�J 'C'�P �0.C�.°V�' �� r� �� r�6m S� �3' %� 1 l�� � 1 � x ��1
�W jp��.e+. �� �� �
Construction Type:�� ��'�Jl�i �'��$ Estimated Cost: $ � •
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �` I3 � APPLICANT: -�V a Tel. #��3 ���—�o�
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Call (763) 572-3604 for Pemnit Fees if mailing in application
$ v�,3• �� Fee Schedule on Reverse Side
$ S?� .001 of Permit Valuation (1/10th%)
$ �7� $.50/$1,000 Valuation
$ $1150 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 [ ]
� ��5�
STIPUTATIONS: �
i'��
��_l3 �a/
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing percnits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment 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 $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each aclditional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,Q00
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before praceeding with the framing. New Houses Onlv
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'�HE BEL.OW MUS � FlLLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE
APPUCATIOIV WI� 8E RETURNED
•: ��t •��_ 1•► � : �l : ' �►
.��t,•� � �r �j �r •L� -
�e� , fhe undersigned hereby verifies that �e
venting has been examined and is free from n.is�, deterioration, abstrudions, Y�s (�No ()
and is secure{y supported and firestapped where requir�:d.
The venting system is plastiGPVC and meets all current codes and manufacturer Yes
s�fica�ans induding sizing, Iength, number of elbaws and tertnination. (� No {)
The undecsi9ned also verifes that the replacement uni# is a fisted assembly
and meets the curren� �d�►g �nd manufadure�s specfica�ons. This daes
indude AGA-GAMA Categary l Central Fumace Venting Tables for fan
assisted and na�aral draft appliances.
The is sized and instaNed to meet the current codes
and manufac�urers sPeafications.
When required to ' wili be s�ed and instalied
to meet the cx�rre►�t codes and manufadurer`s speciftcations.
When , the undersigned hereby ve�ifies that
it is a�sted assembly o� i clude AGA-GAM�A CategorY I C ntral�Fumace
spedfica�ons. This d liances.
Venting Tables for fan assisted and natural draft app
Is the common vente nremov d fromthe commonv ent alnd v n� y after
a n a p p� a n c e h a s b e n
separately as per cwrrent codes.
Yes (� No ( �
Yes (�No ( )
Yes {� No ( �
Yes (� No ( )
Yes ��No ( )
��, � ' �'-�a/[`emmen �l�±n an Vent e
� � Fan Assisted ar Nat —� �
A liarice #1 Type � �-- BT� �nR�
RP g� j�p�; �_ Fan Assisted or Nat
App�ance #2 Type BTU Input Fan Assisted ar Nat
Ap��� � T�� Tn#al 8tu fnput
To�al Appii�nces ,�_
Cornmon Vent Type �°' '' ; Vent Height _____._.�..__... �iameter �n��s
Appliancs #'i Vent Connector Height !
Apptiance #2 Ver�t Connec� Height _. ft
,►....r..,.,,,e �� ��onf [:nnnednr Heiaht _ ft
Len9� �
Length _ �
Length ____ �
Diameter ____.�in Type �
Diameter in Type'______
Diameter in Type �
V Q-✓�'
y r, rt _ �. .� �. r�, ► i.� � r r� i 9 a n� rr�� w � � .
HEATING CO:
Sign�l By:
L�3'i�i�
. - � ar
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
�� ���
CITY OF FRIDLEY PERMIT NO. 2004-00835 ,�, '.
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE IS5UED: 06/03/2004 '
57"L-36U4 l+'AX:
: 1357 HII,LCREST DR NE
: 243024120061
: MOORE LAKE HILLS
: LOT 6 BLOCK 4
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1LS"/
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 AND AIlZ CONDITIONER
# A/C UTTITS
#FURNACES
# GAS RANGES
APPLICANT
DAVES APPLIANCE HEATING & AIlZ INC
1601 37 AVE NE
COLUMBIA HEIGHTS, MN 55421
(763) 781-6901
OWNER
MARK & DEBRA FAGAN
1357 HILLCREST DR NE
FRIDLEY, MN 55432
1 VALUE OF APPL OR WORK
1 # GAS DRYERS
0
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
applicarion and know 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 c ttuction or the performance of construction.
e,,,,t� Date _ _
,j�-� '� �. .,� � ,
: �_ � � _
HEATING PERNIIT 11�INIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 34486
� SEPARATE PERMITS REQLIIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
0
0
0.00
35.00
0.00
0.00
25.00
0.00
0.50
60.50
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 r'AX:
1357 HII,LCREST DR NE
243024120061
MOORE LAKE HII.,LS
LOT 6 BLOCK 4
BUII.,DING
RESIDENTIAL
ADDITION/ALTERATION
571-1"Lif7
��►�,�����---�.
PERNIIT 2004-00802
DATE ISSUED: OS/28/2004
VALUATION : $ 3,150.00
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 R317 OF TII�
2000 INTERNATIONAL RESIDENTIAL CODE. INSTALL SOFFIT & FASCIA. SOFFIT VENTILATION TO MEET THE STATE
BUII.DING CODE.
STATE LICENSED CONTRACTOR 1
Contractor 2nd address: 2915 Roosevelt Rd, St Cloud, NIN 56301 (Jack Kluempke)
APPLICANT
iJNITED BUII..DING CENTERS
125WSST
WINONA, MN 55987-
OWNER
MARK & DEBRA FAGAN
1357 HILLCREST DR NE
FRIDLEY, MN 55432
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 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
rPm�latinv cn��ttirntihr tble ��3IIC6 Of COD�.�UFt1Q;t.
BUII.DING PERNIIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
Bldg Insp � � Uate �._ L
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
97.25
3.15
1.57
5.00
106.97
NEW []
ADDN []
ALTER [ ]
Construction Address: �
Legal Description:
Owner Name & Address:
Contractor. �,
�ririrpcc• O�l� �
CITY OF FRIDLEY Effective 4/1/2004
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 �
� ���
P e �
I�l��c�reJS� �1V2, �
►
I E� ,
�'1 Tel. #��'����0
MN LICENSE# �- a�a�a�s�
��Tel. #�" �� t '- ���
e�"'�'�'° �� Attach to this application, a Certificate of Survey of the
I��,��,� bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
' -� Sc�i �
QTHER: '1 Y� S-i o.�� S�� i�' �
Construction Type:
Estimated Cost: $ � � �� ��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
�/ �� Tel. #�n3�'�'� ���
DATE: � t� APPLICANT:
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number. �ITy USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� ���
$ ',
$ �
$ . /�
$ �
$
.$ �- 1l�
$
$
$
$
$ �� ,
Fee Schedule on Reverse Side
65% of Permit Fee ( ) � �
.001 of Permit Valuation 1/10th%
$.50/$1,000 Valuation
$1350 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 [ ]
. - > .,
STIPULATIONS:
BUII.DING PERMIT TvEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addidon to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment 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 $500
$501 to $2,0�
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,0�
$100,001 to $500,0�
$500,001 to $1,0OO,OQO
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fracdon thereof, to and including $50,000
$643.75 for first $50,0� plus $7.00 for each additional
$1,000 or fracdon thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,�0
$3,233.75 for the first $SQO,Q00 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1, 000,000
$5,608.75 for the first $1,000,�0 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construcdon site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the e�sting foundadon will be required before
proceeding with the framing. New Houses Onlv
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-36u4 r°ax:
: 1357 HILLCREST DR NE
: 243024120061
: MOORE LAKE HILLS
A
e
PROPERTY TYPE .
CONSTRUCTION TYPE .
LOT 6 BLOCK 4
ELECTRICAL
RESIDENTIAL
ADDITION/ALTERATION
571-12ti7
PERMIT NO.: 2004-01093 �, ,���
DATE ISSUED: 07/13/2004
VALUATION .
! NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL AIlt CONDITIONER.
# INSPECTIONS 1
APPLICANT
HARO ELECTRIC SOLUTIONS
415 DECATUR AVE N
GOLDEN VALLEY, MN 55427
OWNER
MARK & DEBRA FAGAN
1357 HII,LCREST DR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This pemut 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 work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIN (RESI)
STATE 5URCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 1399
�r
SEPARATE PERMI"1'S K�(2U llt�ll N VK W Vtc1i v 1 t�tc � t�� L���.�c�nnL r�nv v�.
20.00
0.50
20.50
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�a-36ua r aa�:
: 1357 HII,LCREST DR NE
: 243024120061
: MOORE LAKE HII.,LS
: LOT 6 BLOCK 4
: BUII.,DING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : RESIDING
VALUATION : $ 7,145.00
571-1Z87
PER IT N _O.: 2004-01945
DATE ISSUED: 10/21/2004
NOTE: PER R703, 2000 INTERNATIONAL RESIDENTIAL CODE, REQUIRES THAT A WEATI�R RESISTIVE BARRIER BE
PLACED OVER EXTERIOR SHEATHING TO PROTECT THE INTERIOR WALL COVERING. EXCEPTIONS FOR THIS
PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATI�RPROOF PANEL OR WHEN TI-�E SIDING IS AN
APPROVED WEATI�R BARRIER VINYL SIDING IS NOT A WEATI�RPROOF COVERING UNLESS TI-iE
MANUFACTURER STATES THIS IN TI�IR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE
COVERING OR TAKE PICTURES. RESIDE HOUSE; REPLACE TWO WINDOWS WITHIN EXISTIl�TG OPENINGS AND
PATIO DOOR
APPLICANT
MARK & DEBRA FAGAN
1357 HII,LCREST DR NE
FRIDLEY, MN 55432
OWNER
MARK & DEBRA FAGAN
1357 HII.,LCREST DR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of 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 locallaw
regulatin crio�t o�the.�g�ce of construction.
Annlirant ih ,.x�l � �� Datel�I�lllo°°�•1
Bldg Insp
BUII,DING PERNIIT FEE
FIltE SURCHARGE
STATESURCHARGE,VALUE
TOTAL
PAID WITH CHECK # 3772
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
153.25
7.15
3.57
163.97
NEVV [] CITY OF FRIDLEY Effective 4/1/2004
ADDN (] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER ,�J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPUCATION � �.�� � c�
/
Construction Address: � � �� �o ��r�. �-l- '�� .1� `�l �`�' � , � � i ` �P
Legal Description:
Owner Name & Address: '�ii�r l�. �- . ��� Tel. #�°�3—��� - ��v
Contractqr. �I�C.,_,-- S�r � �t� MN LICENSE #
Address:�°I l �' '� ��.���° �, ; � �l� �� 5�3�1°- 1.! �.O Tel. # ��°-�5 � --��� �
LMNG AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
DECK AREA: Length Width HgUGround Sq. Ft
OTHER: �.I .��dl � ��' o -� � r����-� �; otd�wws ;1 �.-hr4 d��- ; I ,��o ���r
Construction Type: Estimated Cost: $�� I�i �
Drnreway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x$ _$ '
� ��� Tel. #�"� �'-�1� Chr�rk)
DATE: 0�� APPLICANT: - 3�' � 1—
Call (763j 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ��A -�� ��,�, �,
$ �
� ° �� � �_
$ � .�
$
.$
$
$ �
$
$
$ �
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
STIPULATIONS:
,.-
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon applicadon therefore, require the payment by the applicant for such pernvt of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each addidonal $1,000
or fraction thereof, to and including $25,000
$391.25 for fust $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100, 000
$993.75 for first $1�,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,�0 plus $4.75 for each addidonal
$1,000 or fraction thereof, to and including $1,(?00,000
$5,608.75 for the fust $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
praceec�iag ��t �h€ ���ing. New Houses Onlv
- _�
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE TI�4� l. �
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMTT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING D
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
0 Vinyl
❑ Aluminum
O Other
�',OWNER
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-08
YOUR E-MAIL ADDRESS
�CONTRACTOR
Permit No
�- - -. :
�. ►� �.L ' �� !'!;
�,� ��� � �C -'i�,. U►,+..-v� : �
�
CITY �'�P' 1 ��� STA
ADDR�SS: C1TY STATE ZIP.
PHONE
STATE LICENSE #
0 SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
0 BASEMENT FINI$H
❑ DECK
O NEW HOME CONSTRUCTION
❑ �ns�a,�vc�pa,m
WINDOWS
IN EXISTING OPENINGS ❑Yes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINI30W TO BE INSTALLED
❑ ROOF ,
❑ SIDING
❑ SWIMIvvIII•1G POOL
❑ ADDITION
FAX
EXP DATE
❑ DRAiN TILE
�OTHER ���0�°Vl �@ Y►n OC�P�
�'I P WIDTH �°
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�
�
Fr �� �
BASEMENT REMODELiNG SUBIvIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. Lis[ of structural members to be used
FOR NEW CONSTftUCTION INCLUDING DECKS,
❑Soffit �DDITIONS & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
� Trim and proposed project
❑ Fascia 2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 UBC FEE SCAEDULE)
TOTAL JOB VALUAT'niv e OCCUPANCY �PE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Cwb Cut Escrow
� Erosion Control
Park Fee
Sewer Main Charge
Total Due
:i`i � ... �,'��
i
;�,��{���
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)
$1825 per SAC Unit (Plans to MWCC for determinatiori)
ft+�6flt= 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 APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge t}►at 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 pertnit but only an application for a permit and work is not to staR without a
permit on site; that the work will be in accordan wi e proved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME ��iC, �- '� O� DAT ��
APPROVED BY DATE '
Page 2- Building Residential Application
a BUILDING PERMIT FEE SCHEDULE
The Chief Building O�cial shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment 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 FEES '
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for ls` $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $ I 0.10 for each additional $1,000 or fra.ction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each.additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
� fraction to and including $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applicati.on to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
°� , b�
�
�—�
l � � a' b
�--� ' 'S
� ��
�
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 �
763-572-3604
Faz: 763-502-4977
Building PLUMBING Permit rlo.� � � ' �'o �
Inspections RESIDENTIAL APPLICATION xeceived By:
763-572-3604 �
CITY OF FRIDLEY n °
763-502-4977 FAX EFFECTIVE 1-1-OS ��
DATE O�( � YOUR E-MAIL ADDRESS TC� �Cw� SC � TC� .�.� . K�t,�
s� .�D�ss 3�� ;11 ��, . t�-�, ' • �, "
THIS APPLICANT IS: �OWNER ❑CONTRACTOR
PROPERTY N�: ��, k �' •
OWNER/ pDDRESS: �rt- � �/'� C1TY STATE ZIP
TENANT °
PHONE:
CONTRACTOR N�:
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE
LICENSE, BOND AND STATE BOND # EXP DATE
CERTIFICATE OF pDDRESS: CITY STATE ZIP
INSURANCE
PHONE FAX
PERMIT TYPE � SINGLE FAMII.Y ❑ TWO FAMII.Y ❑ TOWNHOUSE
TYPE OF WORK: � NEW �'REPLACEMENT
DETAILED DESCRIPTION OF WORK �-ii�foOr+^ �+�rvi0e'� •
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 residenrial 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 x.OS = plus .50 surchazge
OR
FOR PROJECTS Wi�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXT'URE, EXCEPT WHERE NOTED. FIX'T[JRES: (INDICATE TOTAL
NUMBER OF EACH BELOV+�. MINIMUM FEE $ I5.50.
%i BATH SINK/LAV FLOOR DRAINS � SHOWER WATER PIPING
BATHTUB GAS PIPING (NEID CITY LIC) SWIA9�IING POOL WATER SOFTNER ($35)
CLOTf�S WASHER KTTCHEN SINK � WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IIiRIGATION
WATER METER OTHER
�' . %��i; PR4�C�'S Fij�:.�I�'DE�`i`��{i� ,�z . ;..; � ;. " ;'�'�:i�'��:�'�`£�l� i�'��3��: �"��: $Si�U ;:
�..�.�
Permit Fee $ �. �� Number of fixtures @ $10.00 x $10.00 = $
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DiTE $ OR Number of fixtures @$35.00 x$35.00 =$
�/� State Surchazge = $ .50
$15.50 ."�C� 1� $15.50 Tota1= $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID iJN'TIL PROCESSED
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 application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �-+'��C'°` PRINT NAME I/' CC�� �T'. � DATE � J�O�
APPROVED BY DATE
. �� ��►�� �.���:���u�r� � � � ° �v i�� �'i��: ���`��i��. +���r��.;:�� ����e��� ��a� , ., :
�� ;
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building PLUMBING Permit Na.: �' � ���
Inspections R�+ SIDEloTTIAL APPLICATIOl`T Received By:�,�
763-572-3604 CITY OF FRIDLEY Date Rec'a.:
763-502-4977 FAX EFFECTiVE i-1-OS �
DATE �� � YOUR E-MAIL ADDRESS � � ` v • •
srrE,a�Dxsss Q°��°� � i 1 s�'� �� ,c< �-� �
THIS APPLICAATT IS: �'OWNER OCONTRACTOR ,
PROPERTY NpME;
O�VNER/ ADDRESS: ��. �. �. CITY �Q'� STA? ZTP��
TENANT PHONE• �� °� �� �l � � %
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STA"I'E
LICENSE, BOND AND STATE BOND # EXP DATE
CERTIFICATE OF qDD�g; CITY STATE ZIP
INSURANCE . PHONE F�
PERMIT TYPE �'�GLE FAMILY ❑ TWO FAMILY � TOWNHOUSE
TYPE OF WORK: ❑ �w �REPLACEMENT
DETAILED DESCRIPTION OF WORK �� �AV � '+'� � � �� �� `� �
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, insta.11ation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. La.bor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $] 000 PER FIXTURE. EXCEPT WHERE NOTED. FiX7'URES: (MDICATE TOTAL
NUMBER OF EACH BELOV�. MINIMU1vl FE� $15.50. WATER PIPTNG
BATH SINK/LAV _FLOOR DRAINS _ SHOWER _
-gp�g GAS PIPiNG (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINiC WATER CLOSET - B O IRRIGA7'ION ($, 5)
_ DISHWASHER _ LP'UNDRY TRp'Y WA R ME'fER ($35, _ OTHER
-.y: _ _.._ �.;,,, . . �- � �� z �� .y; _� �.-�, � �,-.�"T ,, „ ;`- � ' . , . � .tt�:¢ '.. � � ; : '�. �;. ,
� 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 @$35.00 x$35.00 =$
Sta.te Suzcharge = $ .50
(MININNM $15.50 (MtNIMLJM $I5.50 Total = $
THiS IS AN APPLICATlON FOR A PERMIT-NOT VALID UNTIL PROCESSED
I he�'eby apply for a plumbing permit and I acknowledge that the information above is complete and accuraxe; 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 on site; that the work will be in accordance
with the approved plan in the case of 1 work which requires review and approval of plans.
SIGNATURE OF APPUCANT PRINT NAME Y i 1� +C °' `�� DATE ��I�
APPROVED BY DATE
�� F� �.; °F;` � �� � � ��
City of Fridley
]Building Inspections Department
6431 University Avenue NE, Fzidley, MN 55432
� 763-572-3604
FAX: 763-502-4977
Building MECHANICAL Permit lvo:� �-�il���
Inspections RESIDENTIA�, APPLYCATION Received B.
r.,
763-572-3604 CITY OF FRIDLEY Da'���
763-502-4977 FAX EFFECTIVE 1-1-08
Dp'pE � b ('�� YOUR E-MAIL ADDRESS ���•lA�✓Y�� .�
SITE ADDRESS ��S-�' ? 1 C�i1� � P
� THIS APPLICANT IS: �OWNER ❑CONTRACTOR
PROPERTY NAME:
OWNER/ pDDRESS:�sv1/M�Q. 0.S �� CITY ^� STAT ZIP��� �
TENANT PHONE���J�a�i°�Ig�
CONTRACTOR COMPANY NAME:
NOTE:
SEPARATE CITY CONTACT PERSON:
LICENSES ARE STATE LICENSE # EXP DATE
REQUIRED FOR GAS
AND HVAC. /1�DRESS: ' CITY STATE ZIP
SUBMIT COPY OF BOND pHONE FAX
AND INSURANCE
PERMIT TYPE ��GLE FAMILY ❑ TWO FAMILY O TOWNHOUSE
TYPE OF WORK: 0 NEW �REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK ���e. ���
PER MS 16�.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 $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVI�
Equipment Installed MFG: MODEL: SIZFJBTU
MFG: MODEL: SIZEBTU
MFG; ° MODEL: SIZEBTU
_A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIItEPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 _GAS DRYER $] 0.00 POOL HEATER $35.00
DUCT WORK $10 00 GAS PIPING $LO 00 N TOR $ 0
� _. � �' ��� �.��r'� ���'°�" �� ���'����'�� --
VE TILA 1
� Permit Fee $ �� Number of fixtures @ $10.00� x $10.00 = $����
Surcharge $ . 0 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
MIN�MUM $15.50 MINIMUM $15.50 Total = $
THIS [S AN APPLICATION FOR A PERMIT-NOT VAL[D 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 he in accordance with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT � PRINT NA � �T • DATE� �S�
APPROVED BY DATE
;� � �' � � � f� °�. .a '�; _ y' '� � ,� �?
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
;
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
� RESIDENTIAL PERMIT APPLICATION HVAG, �
o, � � . .
� N�W HOMES/ADDITiONS ❑ EXISTING Hq1VIE ❑�VIAKE-LTP AIR
REQUIRED FOR NEW/EXISTING HOMES
l. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments ,
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Pez IMC 1346.0603.2
a. ACCA Manua1 D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
Building BUILDING Permit rTo.: ��� �1>
Inspections RESIDENTIAL APPLICATION Received By: ,
763-572-3604 CITY OF FRIDLEY n����� �
763-502-4977 FAX ��c� i-i-oa '
DATE 4� YOUR E-MAIL ADDRESS o
STIB ADDRESS -- — - _ � '�9� �� � ���� . \ �, +
THIS APPLICANT IS: �OWNER ❑CONTRACTOR
PROPERTY OWNER/ NpME:
TENANT ADDRESS: �'��, ��f��� ,� CTI'Y � STATE ZIP,
PHONE: , ^ c
NAME:
CONTRACTOR ADDRESS: CITY STATE ZIP
SUBMIT A COPY OF pHONE FAX
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
PROPERTY TYPE �,SINGLE FAMII,Y/NEW CONSTRUCTION STZE
❑ TWO FAMII.Y/NEW CONSTRUCTION STORIES
PERMIT T'YPE ❑�DTI'ION O GARAGE/SHED � wn�lnows
❑ BASEMENT FINISH ❑ ROOF � DRAIN TII,E
❑ DECK O SIDING °BQTHER
❑ SWIA�IlVIING POOL
TYPE OF WORK: 0 NEW HOME CONSTRUCI'ION ❑ ADDTIION
❑ MAIlVTENANCE/RII'AIR REMODII.ING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEbIIIVT LENGTH WIDTH HEIGHT S FT ��
ROOFING 0 HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES ❑ HOUSE 8c GARAGE 1. Existing Floor Plan
GARAGES ❑ ATTACFIED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACI�D GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCfION INCLUDING DECKS,
❑ Vinyl ❑Soffit
ADDITIONS. & PORCi�S SUBMTf:
❑ Aluminum ❑ Trim 1. Site Plan/Siuvey showing the existing s7ucdues
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FbR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL NEP:J Al(l: SAJl�:li ViV VALUA1lU1V� llV(;LUDllVCi �l�Hl; (;U��l UP' LASUK ANll MATERIALS:
`(USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION
Permit Fee
Plan Reviev�
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$� d���_� See Back Page for Fee Schedule
$ �s0� ^f Building Permit Fee
$ ,� <�� .001 times the total job valuaxion
$ �, �� .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 Necessaty ( )
$ .� %` �` 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 pemut and I aclrnowledge that the information above is complete and accuiate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the Minneso� 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 on site; that the work will be in accor c 'th e a� royve 1 m the case of all work which requires review and approv I of plans.
SIGNATURE OF APPLICANT t� .,� PRINT NAME te� DATE� �p .
APPROVED BY DATE
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surchazge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each addirional$1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each addirional $1,000 or fracrion to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each addirional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional$1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certifieate of Survey of the lot, showing the location of the existing founda.tion will be
required before proceeding with the framing. New Houses Onlv
11
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City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Faz: 763-502-4977
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