AF - 46187^
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Village of Fridley, Minn.
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BUILDING PERMI�
N� 8�� O�fice of INSPEG°rOR OF BUII.DINGS
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Owner -
�-_.� , +-,, 's"'� �'"w�
Architect Fridley� Minn., ,;� f ~ �' ".� • :"� � , 18��..
Builder
r LOCATION OF SiTII.DING
No. ` r� "� � Street ��'� i��� '� '�° - f'�� Part of Lot
Lot Blocic Addition or Sub-Divieion
,, DESCRIi'TION OF BLTILDING
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Front '�' Depth � Height Storiea Manner of Conetruc�n �'% �""� s= �• �,,��
To be used ae � �'�c i � �' L,a°� , `'#- To be completed �� .�• '' — � +4'" Estfmated Cost =-��� ��
Permit ie herebq granted
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the building �� descrlbed in the above statement. This permit is g'ranted
upon the exprese condition that the person to whom it ia granted, and his agente, employees and worlmaen, in all
the work done in, arouad e.nd upon said building, or any part thereof, sha11 conform ffi all respecta to the ordi-
nances oP Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving oP buildinga
within the city limite, and thfs permit may be revoked at any time upon vtolation of any of the provisions of said
ordinances.
.� �,�
°�°� `� � y�ll�'-°� i_n�az�ector of Buildings.
AGREEMENT AND SWOi�.N STATEMENT
In consideration of the issue and delivery to me by the Inwpector of Buildings of Fridley of
the above germit, I hereby agree to do the proposed work in accordance with the description
above set forth and accordi.ng to the provissions of the ordinances of Fridley, and, bein� first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true a� therein atated.
Subscrik�ed and sworn to before me at Fridley,
;. . %.�
day o� �"�� � �� �, .� F _ � .:r,<,: A.D. 19 ..,.�..�_
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City of Fridley 19 2 6 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� `L _ __ COMMUNITY DEVELOPMENT DIV. � / ���
r � � PROTECTIVE INSPECTION SEC. ��
I = �
� �"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'"'"� � ��� 612-571-3450 910-Ft 5 11/6/87 / /
JOB ADDRESS 1359 Hillcxes.t D�ive N. E.
1 IEGAL LOT NO. BLOCK TRACT OF; ADDITION SEE ATTACHED
DESCR. '] 4 Moore Lake Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Brian Bohne 1359 Hillcrest Drive N.E. 574-9023
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS Z�P PHONE LICENSE NO.
8 USE OF BUILDINO
Residential
7 CLASS OF WOFK
❑ NEW � ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20� x 15� 6!' addition to Dsaelling
9 CHANaEOFUSEFROM TO
STIPULATIONS
See notations on plan. Addition must be 10 feet from side lot line.
� � , � "' / F �'2, � � N
�'� rs�4��d��Li;w�.:,°�
SEPARAI'� PER Before �'r�T;i;;g �^�3f"J�cR�� t��:,�y'��:.>
9/U/IRB�V�, Fi�A�I �IT LRF�UI��'p TELEPHd�.��G7��C-G�S�t�..
������� ��� ��I , � RE�urR�� �� �,�
��s. ���
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE FiE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED $]_S �.00 S7• S5
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �
DO�S NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OFi THE PEFFORMANCE OF CONSTRUCTION. 5�-�-6. SO N/A
PLAN CHECKFEE TOTALFEE
$ 29.13 $153.18
. SIGNATU EOFCONTRACTORORAUTFiOR12EDAGENT IDATEI WHEN PROPERLY V IDATED T IS IS YOUR PERMIT
. "r ,ye�l ll �
d GNnT RE OWNER UF OWNER BUILDERi �DATEi BLDG �NSP � �O.T
N� [] City of Fridley Effective 4/1/86
ADDN. ,Q�] �R-1 AND R-2 �
AI,TER. [ ] Building Permit Application
Construetion Addre
Legal Description:
Owner Name & Address : � r� a'� ��� h I 3 SQ FJ,'I I c r esfi .{�r _ Tel . 4� C� 7 L/- 90,2 3
Contractor • �� Tel .���� a I i U
Address: ��� �
LIVING AREA:
GARAGE AREA:
DEC� AREA:
OTHER:
Corner Lot [ ]
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to seale.
DESCRIPTION OF IMPROVEMENT
Length � 0� Width /� �� Height Sq. Ft. 3� % sa �''�.
Length
Length
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft. __
��UK N ' � ��a�����
Inside Lot j�] Ft. Yd. Setback Side Yard Setbaek
Type of Construction: �� �0� ��� �'�� �
Approx. Completion Date: ��Y�� �
Estimated Cost: $ '� U
I�',/Dv
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: s^ B ek Page for Explanation
DATE: ll- 3- F3� APPLICANT: �/L�� �%��- Tel. � S�y� %a 3
Permit Fee
Plan Cheek
State Surcharge
SAC Charge
Park Fee
SeWer Main Charge
TOTAL
STIPULATIONS:
�t �
CITY IISE ONLY
� �1�,�� Fee Schedule on Reverse Side
$ �Q,f� 25� of Building Permit Fee
� �%��� $.50/$1,000 Valuation
$ '� $ 525 per SAC Unit
$ °� Fee Determined by Engineerin�
`$ Agreement Neeessary [ ] Not Necessary [ ]
I �'�,�
��` I DU
j�)o �4--,�70 �� � G� � �c-,4��
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Z,ouu— �s§�
1 ��� ��,DO
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BUILDING 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 strueture, or
for any alteration or repair to any existing building or structure, upon applicatio n
therefore, require the payment by the applieant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
Total Valuation
$1.00 to $500.00
Feea
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for eaeh
additional $100 or fraetion thereof, to and ineluding
$2,000.
$2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00 �170.50 for the first $25,000 plus $4.50 for eaeh
additional $1,000 or fraction thereof, to and
-. ineluding $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for eaeh
additional $1,000 or fractio_n thereof, to and
including $100,000. °
$100,001.'00 and up
$433•00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraetion thereof.
DRIYEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Removal and replaeemd�t of curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - Driveway°width plus 6 feet times $15.75
9ERIFICATION OF FOIINDATION
Permits for construction will be issued a minimum of 2u hours from the time of
application to allow for.proper review of the proposed strueture and of the
construetion site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been constructed will be required before proeeeding with the framing.
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Building
Inspections
763-S72-3604
763-502-4977 FAX
DATC �' 1 D
SI1'E ADDRBSS �
TH1S Al'PLICANT IS;
OWNER/
TEIYANT
PLUMBING
RESIDENTIAL APPLICATIUN
CITY UF FRIDLEY
E�FECTIVE 2-19-49
Permit No.�`7'- � �
Received By: V
Date Rec'd: ��' �
YOUIt E-iV1AlL ADDRESS �1Bt1 �P1�1/�S � L Wl IA 1^ a �--� v✓1
'�S'�" �r -N� �
t70WNER 6�GONTRACTOR
� ..
°1 Oh
g• ('?i u�l�G✓GS'{" l�,r IJ � CITY ��'� c V STAT��ZIP�tf�Z
i � � _ tictq ... �'4f R/
CONTRACTOR r�AME: De�.n s 1�ra-�'ess Pa H� I Niv w� IQ;1, c, ___
SUBMII' A COPY OC S'PA7'B LICENSB N ��"' P EXP DATE
YouR srATc
L[CENSE, BOND AND STA'fE BOND � Z � �P '�M d Os� ��% EXP bA'I'E
CERTIf 1CATE OF App�ss: Zt�ti y��a 8 CITY �oae.rs s�rATE N1N ziPS'"S37i/
INSURANCC p�_�ONE %I93 ��i ZA� L3Z ( FAX
PERMIT TYI'E
TYPE O�' WORK:
(i].SINOLC FAMILY
O NGW
DETAILED DESCR1PT10N OF WURK
❑ TWO FAMILY O TOWNIIOUSE
� REPLACEML'NT
FEBS AR8 f3ASED ON $10.40 P�R FIX'I'URE, EXCEI''1' WNER6 NOTED. F1X'!'URL'S: (INDICATE TOTAL NUMHER OF BAGH BELOW} MINIiVIUM FBE
$35.50.
BATH 311VK/LAV fLOOR DRAINS S�IOWER _ WATER PIPINC3
BATHTUB GAS PIPiWG (NBF.DCITY LiC) iSWIA9MING 1'OOL _ WATERSOfTNCR(S35)
� CLOTI�IES WASHER ^ KITCHEN SINK � WATGR CLUS�'f _ BACKFLOW PRLV. ($I S)
i DISI�lWA5HBR � LAUNDRY 1'RAY �.WATER 1iEATC[i ($3S) pOR IRRIdA'C101Y
-" — � WATER MF'l'E?It "OTHER
N umber of fixtures (u7, $l OAO � x $ I 0.00 = $__ _ . .. _ _ ._
Numbcr of fixtures (a� $ I 5.00 _____ x � I 5.00 -- $, . _, _ , ... _.
Number of fixtures �a, $35.Od ..1_._ x$35.00 = S_°�.� o 0
State 5urcharge
$,�50
Total = $ �'�•,�O
1'I�IIS IS AN APPLICATION POR A PERMIT-NOT VALIb UN'I'IL PROCESSED
I hereby apply for e plumbing permit and 1 acknowledge that the information above is complete and accurate; d�at the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Consuuction Codes; that i understand this is
not a permit but only an spplicacion for a permit and work is not ro 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.
SIOfVATURfi dF APPLICAi�lT
NAME DAT6
TE PERMITS Altki KH(�UIR�D HOR
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, NIN 55432
763-572-3604
FAX; 763-502-4977
AND
, _ . . . . ... ,.,., Wt/ b L �Zfi�B 600ZlS/£ :a;ea " Z% L :a�ed ... ,_S£68-8Zb-£9L :uaa� .,., .. .�,.. . . .. , . �� ......,, .. , ,. 4 .
Building MECHANICAL Permit Ivo.:- c�
Inspections RESIDENTIAL APPLICATION Received By:_ �
763-572-3604 CITY OF FRIDLEY D��'�'
763-502-4977 FAX EFFECTIVE 1-1-2010
DATE ��� Z�� � YOUR E-MAIL ADDRESS
SITE ADDRESS O�J � � � � ��
THIS APPLICANT IS: ❑ OWNER [YCONTRACTOR
PROPERTY NAME: �t-Y �' �'�1 �+�,.,, •`
TNANT ADDRESS� c3S����� �C Y''eS� T�� • IV� CITY 1�f G.1C� I�,U STATE YI�f�LIP��'u
PHONE: � �a'-%�� -Se-I��(O
CONTRACTOR COMPANY NAME: �`.� f �� � � � �
SUBMIT A COPY OF CONTACT PERSON: �1(� °t- L.� �A
YOUR STATE STATE LICENSE # Z� - YYl EXP DATE �Z` Zv �� ZC�` �
LICENSE WITH ADDRESS�I�JiS � C�. �-(�.� �� CITY O' I�S STATE�YiP�IP�7
APPLICATION pHONE� �3'�-l26 • 1 32 I FAX7 LO?J' •� Z$' • 3�_
PERMIT TYPE � S[NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ��w y.�PLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK 1
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
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 UNIT HTR $10.00
�CHIMNEY LINER $10.00 _GAS DRYER $]0.00 _POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of fixtures @ $10.00 _L x $10.00 = $
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number o€fixtures @_$3.S.U0 . x $35A0 = $--' - - --°, -; - - -_ �:._� :. : � --- - __
State Surcharge = $ .50
(MINIMUM FEE $35.50) Total = $ �✓' � ° S �
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 understa.nd this is
not a permit but only an applicatio 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 r' which require review and approval of plans.
SIGNATURE OF APPLICA '� ' \ PRINT NAM�� C I YI��DATE � 2,�j I��
APPROVAL INSPECTORS SIGNATURE DATE �
PLEASE NOTE: SEPARATE PE TS , REQUIRED FOR BUILDING, ELECTRICAL AND MECHA1vICAL WORK
Citv of Fridlev
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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