AF - 47323City of Fridley, Min,n.
BUILDING PERMIT
Date: � r�� ' 1 1�i 1971
��� %�
° 1097
OVVIIer: —_Tri -Cn Rni 1 tinr B��, S�me
Ad�Sg �„], S7an R»rt�n Stve�pf R F Address —�ame
LOCATION OF BUILDING
No. 37 80 s�t _ Jackson Street N.E.
Part oP Lot
�- �'6 - Bl� 4 Addition or Sub-Divisfan Melodq Ma,nor 3rd Addition
C°rner Z'°t - Inside Lot - x SEtback �_._ s;deyard 10 �& 10 �
�IIevatian r. $�3.b7 ��6.6.Z-�a�.r,az�..�_____
_Wve Tou of Footin�
DESCRIPTION OF BUILDING
To t� v�a �:
Dwe � i� Front ��' DePth 26 � Height 20 � gq, �-t, 1040 � Cu. F't
- �a''��� Front 20' DeP� 24 ��e�tght l�' Sq, Ft, 480' Cu. Ft 4, 800'
�►pe of Construction Frame ��_$24,000 To be Completed _ Sept. 1, 1971
Provide a verification survey before framing. Provide a hard surface drive.
WATER LOCATION: 105' S. of Ma,nhole, 10' N. of Sewer Service
SEWER LOCATION: 115' S. of Manhole
In cansideration oP the issuance to me of a germit to construct the building described above, I agree to do
the ProPcsed work in accordance with the description above set forth and in compliance with all proviaions oP
ordinaac�s of the dty of Fridley. � ,_
In consfderat4on of the payment of a fee of $�� 48 O�t is hereby granted to-��i-Co Builders
to canstruct the building or addition as described above. This �t is grantQd u�n
the euAress candition that the peraon to whom it is granted and his agents, employees an worl�en, in a]1 work
done in, around and ugon said building, or any part thereof, shali cbnporm in all re8pects to the orc�inances of
FridleY� Minnesota regardiag location, construction, alteration, maintenance, repair and mov3ng oP bufldings
�� �e �tY �i'ts end this permft may be revoked at aqy time u�n violation of any of the provlsions og said
oi'diaanc�.
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NOTIC�
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L�T ��Br.ocrc��M�s.00Y Ma�oa 3ao Auu�Y�oN
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APPLIC.�TION FOR BIIILDING PIIiMIT
CITY OF FRIDLEY, MINNESOTA
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OWNEFc'S NAME�/Z ( C� � %� P ��"� � � BIIILDPR �,�' l (' ca / � �z �'�[ Ci� a'z S
ADDRF�S �.� � I ��•, �e. tj � r� e r�,% AUDRF�S
LOCATION OF BIIILDING
N0. �%3 ��' S _����� .��°b
LOT BLOCK ADDITION OR SIIBDIVISION hr'r���' ����� 37.� �?�°'''
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CORNEft LOT INSIDE LOT�_SETBACK ��/ SIDEYARD O-� / D
SEWFR ELEYATION TOP OF FOOTING
Applicexit attach to this form Two Certificates of Survey of Lot and
propoaed building location drawn on these Certifiaates.
DF�CRIPTION OF BUII,DING
To Be IIsed As:
%�°'{- S e Front L� Depth ��_, Height f 5��,� �
a
, Square feet l��l v Cubic Feet
l� �.- ���, 2 Front a- � Depth �. c� Height � o �
Square feet `� �� Cubic Feet
Type of Conetruction �N � a� � 2 e'° �CJ Eatimated Coat J' �=° ;�� ������
To Be Completed ,� � 4J � % � %� ��
The underaigned hereby makee application for a permit for the work
herein specified, agreeing to do all work in etrict accordance with the
City of Fridley Ordinances and rulings of the Department of Buildings,
and hereby declarea that all the facts and repreaentations atated in
this application are true and correct e �1'� C� y' ��.� ,,�,��,
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D�TE %,� � SiGN9TURE �-d c
(Schedule of Fee Coats can be fourid on the Reverse Side.)
N0�'E: A Certified Survey of the lot, showing the location of the founda�ion9
once it has been constructed, will be required before proceeding with �e
framing.
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BIIILDING PERMIT FFE SCHEDIILE
SECTION 2. The Inepector of Buildix�s shall, before issuing permite .
for the erection of any building or structure, or for any addition to any
exiating structure or building,.or for any alteration or repeirs to any
existing building or structure, upon. application therefore, requixe the
payment by the applicant for such permit of fees to the amount herein
below set forth and in the ma..nner herein provided to-wit:
IIniform Buildin� Code: Type 1, 29 & 4-�1075 for each one thousand
cubic feet, or fraction thereof, in such cubical c.nn.tents. Type 3� 5-
$1e50 for each one thousand cubic feeto
For the purpoae of computitx� fees for buildi.ng permits, the cubical
contents of any 'builcii.ng �Y�'�addition to a uniform heigirt �thraughout 'by
multiplying the ground area covered from a point si.x (6) inches below
the floor line of the basement or the cellar to the average height.of
the upper surface or to the average hei�ht of the roof surface of the
ma,in gable of a pitched roof.
For rege.irs or alterationa to an existing atructure, the fee shall be
at the rate of �3.00 per each five hundred dollars (=500.00) or
fraction thereof in the coat of all proposed work.
In no case ehall the fee cha.r�ed for ar�.y permit as aet forth in Section
2 be lese than $5.00.
NSSSD Coxinection Chargea based on location - Area 1 or 2.
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Cirii EnOiereQring Telepka�a 784-6066
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This Fa o trve pnd correcf ►epreeentatioe o! o aurvey of the boundories of the lond dbove deacribed cu�d of tha
bantloa of atl buildings� i1 any� tfrereon� and all viaible encroachmeMs, if any� from er on said land. This wrvey Is
m�de only Fn eonneefion whh n mor►gage loon now being placed on the properey and no lio4ilitr is ose�med
exoepf to the halder ef sueh moHgnga or oer other ineeresf.aeqaiirad by fhe reason o� sueh mortgage. 11 is
understood smd agreed �q, n�anv+aents hare been placed for fhe purpose of asfobiithing lot lines or boundory
cortten. Date� tl�is `�.� �'�Ylar of 1�1l. D, 19,�
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;rataips A.S.H.V. Conatruction No. � -
Guide � nsulation
s Refereaee Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes o 19_ �
,�I/ Room Length Width t—ficigM c. �'1.� � Room l.�ngth —Wideh (' Height �
Wi�dows and rs—Crackage and Area \Nindows arsc$ �oors—Crac�age and Area
�VtUth Helg . o[ Llneal [t. Area Wldth Hefght No. of Llneal tt. Area
No. p o( a I te ot crack �p. tt. No. of Da ol p ne Ifghte ot crack ea. tt.
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lnbltration
Glaaa
Fap. wa{I
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lnt. wall
Ceiling
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7'o I Btu.
Required sq.
No.
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Net esp. wall
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oe sq. it�s. W.A. ader area
�m Length -�idth � �
—Crackage aad Area
.tlo.p! Llneal tt. Area
[nt. w u
Ceiling � ` �
Floor r- /
Tot Btu.
uired sq. ft. E.D.R. or aq. ins. W.A. Leader area
Iaapeotors notee:
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Int. wall
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To Btu. --"
Requir q. f,t. E.D . or sq. ins. W.A. L.eadee area
'< <. Fl.l Room I Length �� Width
Windows and Doora--Crac�age and Area
Wldth Hel�ht No. ot Llneai [t. Area
No. ot pan ot Da s ilghu at crac eq. ft '
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C% Glaas
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� Net exp. wal!
_ Int. w#Il --
Ceiling'
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� 7'o Btu.
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;�n���.w� 1 �:� -rs '' ��...:.r�c� � Out.'�a�! I Int. Wali T( e►ling --ino{ Floor---
, , Kind How pp �e
. � , --- . � i � , I _ _ t- � ' � .� e�- �,., �
vc: } . _ .�-_ 7
s '� � � ` � s �: _ ----- •
_
'_-�_;=� = - - - - � - , � � � �', oom � Len th Width �eight •
T} � . ; > !y'�.r., i � � Heipht _ '; � F�. . � / '� B
! i . y • �o<+�r. -^gt �
,e _. r�.. �. �: . •` - ;. __ � -= -
!�'induws and 1�: ��- ��t3� <<aPe and �rea ' i� __ Windows and Doors—Craekage nd Area
_.. ._ ._. .-.—.--_.-.- ...-� � Width eiBht No. o[ Llneal tt. Area
�!� iJnra. ft ! ���-a H
`---- --�ti�„iih T N�� K',• '�' tcr� K', tt '� Nn. Dg�e ofDane t hte otcrac eQ.t
•T� - �,tp��,,t._�T_-�- _ - � �—_ ' _- .� �
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._ � . --- - ` -- i_.�Et Eicu - ,�
--,- �-- ----L.. .-._ . ._ ..._ ,..—___ r ,._____q� . � __--_—
- t ' �� " (nliltration
1n61tratiop -- __ — -- -� - —� --__.. '—._ �--- � . --- _
�ass � -- —.T _— ��. _.-.-- �, (alass -
Exp. wall �' ' -- ------- __ ..� , f� _Exp�wall -- -
.r_ .�._..i. _ ...-�_--� ��
Net exp il � _ .. � `._ Net exp. wall
Iqt. wall _ -----.____ - _�I Int. w ll
Ce�lmg � � . r�a.._..._-�._y_ ;I Criling'• .� —
.�'—'�'7`��'�y' —1- •- � � ,} Floor — —
.�— � � 'I —
Floor , " __ �
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Tot� Btl �. - �--- - �-t-�- j
I
Kequir�� sq D.R. or sq. ins. W.A^lxd���r area _
. . ��. — -T- < - — — -��
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a.g
W►ndows and Doors� --Crac1cage and Area
�WI•tth IielBht Nu. ot Llneal tL Area
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lat. wall
Cei�i� - /',
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_� �.�._ , Required sq. ft. E.D.R. or eq. �ns. wA. L.eader area
t�eight �*r I F'�,� Room I L.ength Width Height
I Windows aad Doors—Crackage and Ana
I Wtacd elgbt No. ot L�neal tt. Area
No. ot yane ot pane 116hte ot craah ea. tt.
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sue�ecT PERMIT NO.
City of Fridley � 121 1
AT THE TOP OF THE TWINS g U I L D I N G P E R M I
r '
R IPT N
� � COMMUNITY DEVELOPMENT DIV.
, • ��/���
� Vy �����'�
r � � PROTECTIVE INSPECTION SEC.
1 = �
�l /"'� � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i--��� � ,'� 812-580-3450 910-F15 4/18�73 � �
JOB ADDRESS �380 Jackson Street N:E:
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 16 4 Melody Manor 3rd Addition SHEET
2 PflOPERTYOWNER MAILADDRESS ZIP PHONE
Gerald L. Olson 7380 Jackson Street N:E; 786-0334
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
S ame
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Dwelling
7 CLASSOFWORK � NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a deck 13' 6" x 12 '
9 CHANCiE QF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, WOOCI
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TFiUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $'ZOO. •SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLA K FEE TOTAL PEE
$5 .50
e
SIGNATU EOFG�N?RACTORORAUTHOFIZEDAGENT IDATEI WH N PROP LY AL TE HIS IS YOUR PERMIT
���,� � � 4/18/73
I NATUREOFOWNERIIF WNEHBUILDEHI ; IDATEI DA7E
�
AP.�����TT�� F�A RE�IA������. ALT��ATIA�,
OR� ��IATTiaN �l1�LDI�IG P�RMiT
G�TX AF �RITI���`, MINN��QT�►
%�� �3��
,F �
� , J{: , ti � - j � " 1 � + fii�%!?�� f�r�l/i%� � � �
� ��L;«. � i ��/.i/ • --- �
1 ���� /�� � �:s� �l—L� .� "1 l:' _��i/i,L� �
�t�3,� � 3 d�O �'�T� �
, .�
� x � �LOCK ��� e�����1 a � .�
� LOT: �� LOT:� , SETBACK� SIDEY�RD:�
�►�.i� �#.�dq �a ��� iv Certificates of Suxvey of Lak a�ad prop���d
�1�.�� l�aeati,orl �� � �#esae Ce�tif�.ca�es,
�
��se���T�q� OF �UILDING
-� � ii� �s :
° �..�,�.,, ; �,� � ,�eight :
�IC� ■ r ie i � � . .
S�axe F���,� cS �� Cabi� J�'�e�� .
�'r,aa� t Dep�h ; Hei.ght g
$qy�a��a �'eet; Cubic Feet t
�►{a� o� �aastruc�ki.a�� , l�stis�ai:ed Cost: ,�0���
,...�. . �
�� � t�����cta
���ig�►�d hereby �e� $�rpli.ca�t.iv� �or, $ pe�aLt fa� tl�e wa��k b�ereir�
#�f�gi$d�, ag�eei�a� tc� da a�� �Q� i.0 att;Lc� accordaace witt► �he �i,�r of
�.tdi.� i��d�a�ce�e �d aCO��� aP� �e DeFas�te�� qf Bu��di�a� s� �teseby
�,sla�� � all �� �acts �d ��resenta�ione s�ated i� ti'►ia ��►3i,�atiom
a� � �d aprrec� .
,� �� � � �
� / /�r i � �Ii� -, f f 1 ��/
� � - —
�� _
�� 1t�i►�ee l�f�t� T'a� �d�t�o�a1 Info�atioa.)
��l� v �/
` � � � '��h%�
� �,' �r�
.
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0
BUT�ATN� PERMIT F�� S�H�DU�E
�F�+C�?l��T 2. 'i'he IAepecto� pf �u�,ldings sk�a11, befa�e i.esuiag permit� for �he
������.on o� a,�y bu�lding �x etructure, ox for aay addition to any �ist�.�
t�a���d� ox stxuG�ure, or fv�c any alteration or �epairs to any ex�.��ing
��.a�,���.sa� ox st�a.ctuxe, uperc� �ppli,�ation theuef�se, xequire the pa�A� by �he
�.�p�.i��t €px such per�,j,t o!; ��es to the amount herein below set for�h �.�d �
t�� ��x hesx�#.n p��vided � �a4wi� s
U111�FORM BU�LDTNG �OAE; �pe �.� 2& 4-$2.15 �or each �cae t,Y►ouss�d cubi.c
�e��A ,p� f�a�tian th�7cec��, in ��� cubical con��nts . 3�rpe 3& g-$�. s 8,5 fox
eaeb or�s �ousand �ai+�c �set, .
A�DiTIflI�1A�, �NFa#iMAT�ON
Fp� �� puxpp�e of �aanput��.n� #eea for building pexmits, the cubical contents
oi any building or addition, i� det�rmined by mul�iplyln� �he g;round area
��►�9C�d #�c�an a poi�� ��c (f } in�hes below the f�.00x l.ine Q� the basement
� t�e +C���a� �o the average heights of the upper surface or tp the avera��.�
�t �� �kae �oc�� �.�x'face v� Xhe main gab�e Qf a pitched xoo�,
��i7cs a� at1�����.ot�$ � aa existing �tz�t�ep �a� f�e sha��. be �t� �h�
�c�,�� o� $�.OU �►ex' ��h f�ve h�dsed dollaxs ($sUQo00) � f�t���.� thex'sof �.n
�h�: cw�� o� a11 g�ca�sect wo�kP
%�r+► ca�e ak�a�� I�be �es fo� a�ty pe��.� as se� �oz� �.a Se���ar� 2 be
�t �au $3.1�Q.
�
������ATiQN 0� ��iJNA�'�ION
��� P�7nn�ts �vx ��st:���.oa wi17� be i��ued a��u� a� Z4 i�cxtrs ��am ttee
�a a� �,p�2icat#,o�, �v �t��aw �ax prapex review ot tita p�rapos�d s��u&tt�re aad
�� �e �tru��ion �i�e.
' � C��l�i� Sux�v�y c�� �� 1�� �a�i:+� t�+� �c�ca�i�a ca� t.li� �aunc�tir�, o�c� �t
�� �� �ts��d� wiil � gequised befe��e tsroceed�in��, w��hh � fr�f�.
,
C�RTT���Ai� QF Q��PAN�Y
��ir,�,�tia�a €Qx ����i�3,aa�aa a� Qacupa�cg shal�. bs made tea (1Q) t#�r�s pxior
�o fih� cx�se ox �oc�up�y o� �tay �ic�etre far whiah a bu�.ld,�.�$ petzai� haa b�sn
issue+�; .�tuc� ��id stxt�ckv,lre� �ha}.� �ot b� used c�� occup�ed until a Cexti.ficate
af 9a�upa�y l�s beeR �seus�.
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� SUBJECT PE NO.
City of Fridley o 17827
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� � •
� `L _ COMMUNITY DEVELOPMENT DIV. /��� �
r i � PROTECTIVE INSPECTION SEC.
1 = i
� �"�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�'"'"� � ,'� 612-571-3450 910-F15 12/4/84 / /
JOB ADDRESS �380 Jackson Street N. E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCH. ZG 4 Melody Manor 3rd Addition SHEET
2 PROPERTYOWNER MAILADDRESS Z�P PHONE
Gerald L. Olson 7380 Jackson Street N.Ea 786�0334
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Same
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ HEMOVE
8 DESCRIBE WORK
Construct a 16' x 20' Li:ving Area 1�1,dditi,on a,nd mave- an existing deck
9 CHANOE QF USE FROM TO
STIPULATIONS
r
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 6Q DAYS, OR IF CONSTRUCTION .
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICAT�ON �' STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $12 950 $6�4H
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFMIT FEE SAC CHARGE
•PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �+�8� 5O � None
STRUCTION OR THE PERFOBMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$24.63 $129,61
IGN TUREOFCONTRACTORO�TNORI DAGENT IDATEI �' � hEN PROPERLV V ATED THIS IS YOUR PERMIT
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SiGNATURE O WNER�IF OWNER BUILDER� IDATEI BLDG iNSP F7E
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Cit of Fridle �/ 1��.
Y Y C.,�" �
R-1 AAD R-2 ��
Building Permit Applieation �
Effective 4/1/84
Constructioa Address: �� 8 d �_��'�l �'�' OvI�
Legal Description: � � � / � � � � y � �I � � w
Owner Name & Address :� ��- M r s �9-� L-� �/�a"`� Tel .
Contractor: � �'�'� Tel .
Address•
# -
# —
Attach to this applieation, a Certifieate of Survey of the
lot, With the proposed eonstruction drawn on it to scale.
DESCRIPTION OF IMP80YEMENT
L
IVING ARE�• Length � �Tidth ' zU Height �� S9. Ft. J
� � AREA: Length ________— Width Height Sq. Ft. _
DECH AREA: Length �Tidth _ Hgt/Ground Sq. Ft.
�R: �Qu�� �'������ � �
� ° _ - ""�� �
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek _ Side Yard Se aoc
Type of Construction:
� CJz�-z� ���rv.-�__ Estimated Cost. $ % 2
Approx. Completion Date:
Alt. A Alt B
progosed DriveWay Width If New Openin� Is Desired: See Back Page for Explanation
� �i�J
• � Z �_ APPLICANT: V � �'°'�'�" Tel. 4��� �33y
DATE: � �
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sever Main Charge
TOTAL
STIPULATIONS:
CITY IISE ONLY
� ��� Fee Sehedule on Reverse Side
$ �� 25� of Building Permit Fee
� $.50/�1,000 Valuation
� _.,•-� $u25 per SAC Unit
� � Fee Determined by Engineering
_�
.--�
��` ,� � Agreement Necessary [ ] Not Necessary [ ]
�" I ro
� _ - �
BIIILDING PERMIT FEE SCHBDULE
The Chief Building Official shall, before issuing permits for the erection of any
br�ilding 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 applicant 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
Fees
#10.00 (Minimum Fee is $15.00) ,
�501.00 to �2,000.00 $10.00 for the first $500 plus $1.50 for each
additional �100 or fraetion thereof, to and ineluding
�2,000.
�2�001.00 to $25,000.00
$25,001.00 to $50,000.00
$50,001.00 to $100,000.00
$100,001.00 and up
$32•50 for the first $2,000 plus $6.00 for each
additional �1,000 or fraetion thereof, to and
in�luding $25,000.
$170.50 for the first $25,000 plus $u.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
$283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
5433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEi1AY DEPRESSION ESCRO�i
(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 replacement of curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - Driveway Width plus 6 feet times $15.75
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 atrueture and of the
coastruetion site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been c�onstructed will be required before proceeding with the framing.
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CHIM��EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (� No ()
2. Is free from rust or deterioration Yes (� No ()
3. Has no foreign objects lodged within Yes� No ()
4. Is securely supported Yes � No ()
5. Meets all current Code requirements for size and
total BTU connected . Yes �j No (}
6. Has Total heating BTU's of �p� �C�
Al l other BTU's �� � D��
TOTAL a l�� �%Q(�
Rema rk s
Com pa ny _ ��s�%��r' ��;:��� ��� ��"�
Signed By ,�,�-� m ,1 —
Da te � "— �� ���
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n
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TO WHOM IT MAY CONCERPd:
I will allow Jerry & Ginny Olson to install an_.aTr
conditioner unit on the south side of their house
at 7380 Jackson Street, Fridley, MN.
�
, � ,�� �,�, !
/ /
sue�ecr P .
City of Fridley � 2 0 9 8
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � R T NO.
� ' COMMUNITY DEVELOPMENT DIV. � I� I
� j V �����'�
r � � PROTECTIVE INSPECTION SEC.
1 = �
� /�"1 � CITY HALL FFiIDLEv 55432 NUMBER REV. DATE PAGE OF AP�ROVED BY
�""'� � �'� 612-571-3450 910-F15 9/1Q/93 / /
JOB ADORESS �380. JACKSQN STREET NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1-6 4 Nielody Manor 3rd Addition SHEET
2 PROPERTYOWNER MAILADORESS ZIP PHONE
J'erry Olson 7380 Jackson Street NE 786-0334
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D& D Home Ztnproveznent 7401 Central Ave NE, Fridley 55432 784-7543 4840
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 2�P PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof Iiouse (22 Sc�uares ) 2nd LaXex
9 CHANGE OF USE FROM TO
STI PU LATIONS
R,00�inc� ca,n be the 2nd layer but not th� 3rd. Install adequate attic
venti�.ation, �xoyide �moke detectors. as pex U&C 121Q adjacent to all sleeping areas
and in basement,
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINCi,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOFK OR CONSTRUCTION ZONINt3 SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OFi ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE fiEAD AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED $1�158 $.59
WITH WHETHER SPECIFIED HEREIN OH NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEHM1T FEE SAC CHARGE
PROVISI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29.. QO k'ire SC $�.. �.9
STRUC ON R THE PERFO NCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
� Ll.�.'P.I1S@ ..�C �5 e 0� $35 a %8
• S�GNATUREOFCONTRACT0170RAUTNORIZEDAGENT IDATEI WHE ROP VALIDATED THIS IS YOqUR PERMIT
' %a �-� / /D ` L �
SiGNATURE OF OWNER UF OWNER BUILDER� IDATEi — DG P nATE�
� �� ��
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ADDN [ )
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CITY OF FRiDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R 2
Building Permit A�lication
Effe�tive 5/26/93
�1�1
C,onsbntction A�: 7��0 �A��/ld ��
--.��--
Lega1 Description:
Oavner Name & Address: �� I� �%S�� Tel. �%� y
Co�►tractor: D& D Home Improvement, Inc. MN LICF.NSE # 4840
p��; 7401 Central Avenue N.E., Fridley, MN 55432 Tel. # 4840
IdVIAIG .AREA: Ixatgth
Attach to this application, a Certificate of Survey of the
lot, with die propa►sed constivction drawu on it to sc�ie.
DESCRIPTION OF IIMPROVEMENT
Width Height S9- Ft
GARt�GE AREA: Length Ri'�h H�aght �. Ft.
° DECK ��REA: i.�gth Width HgtlCrouad �. Ft.
OTAER:
Corner Lar [ I L�icie L� �] Fk Yd Setback Side Y�d S�tbacks
Type of co�vetioa: � ��i�� � ���L � G�r�stimated Ca�c: S /� � �
Approx. Completion l�ate: ..�, f �9.� � ��
(Cost � Back)
Driveway Gurb Cut Widd� Neectal: F�. + 6 Ft = Ft x$
_$
DATE: � j� l� APPLICANT: Tel. #�$��— � �
Permit F�
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Drive�vay Escrow
Erosia►n Conirol
Park Fee
Sewer Main Charge
TUTAL
$ �9 D��
$ %. � �
� ��
�
$ .�. D ��
S
!�. _l1. ' � .�I_ .
Fce Schedule on Reverse Si�
.Otll of Permit Valuation (1/lOt1►'�)
$.50/$1,000 Valuatioa
$750 �r SAC Unit
$5.00 (State Lacensed Residential Contracw�°s)
Alt. "A" or Alt. "B° Above
$ Conservation Plan Review $450.00
$ Fee DeLermined by Engi�inS
$ �►�� N�+ I l Not Ne�c��sary I I
� �� � �� STIPULATIONS:
�;:.:; _
BUII,DIN(� PERMIT FEE SCHEDULE
The Chief Building Official sha11, before iscuing pe,rmits for the erection of any building or structure,
or for any addition to any existing bnildiag or strucha�e, or for any alterarion or repair to any existing
building or suuqure, upon applicatioa therefore, require the pay�nent by the applicant for such permit
of fees to the amount herein below set forth and ia die manner herein provided to-wit:
TOTAL VALUE
$1 to $500 �
$501 to �$Z,OOU
$2,001 to $25,OQ0
$25;001 to $50,000
$50,001 to $100,0(10
$100,001 to $500,�
$500,001 to $1,000,�
$1,000,001 and up
FEES
$15 (Minimum Fee is $15 plus sarcharge)
$15 for first $500 pins $2 for e,ach additional $100 or
fraction thereof, to and including $2,000
.$45 for first $2,000 plus $9 for �ch additional $1;000
or fracrion thereof, to and including $25,000
$252 �for f�rst� $25,000 p1�s $6.50 for each additional $1,000
or fraction thereof, �o. and including $50,000 -
$414.50 for first $50,0� plus $4.50 for �ch additional
$1,000 or fraction thereof, to aad incloding $100,0(�0
$639.50 for first $100,0U0 plus $3.50 . for each additional
$1,000 or fraction thereof, to and including �$SOO,OQO
$2Q39.50 for the first $500,000 plas $3 for each addit[onal
$i,000 or frdcbion thereof, to and including $1,OOO,WO
$3539.SU for t8e fust $1,000,000 p2us $Z for e�ch addifional
$1,000 or fraction �thereof -
DRIVEWAY DEPRESSION ESCROW
(Concrete C1�rb. Streets Only)
Alternaie "A": Removal and repla.cemem of ani� and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B": Removal and replacement of curb and gutter aad install a 3 foot wide.
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the pro�sed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�ation of the foundation once it has it has been
constructed will be required before proceeding with the framing.
-� - �.,
sue�ecr RMIT NO.
City of Fridley 2 5 3 31
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
�
� � RECEI NO.
COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC. L���
� � �
1 . i
� � /"'1 � CITY HALL FRIDLE� 85432 NUb1BER NEV DATE PAGE OF APPROVEO BY
�----� � �`' 612-571-3460 910-F15 7/30/97 � �
J08 AODRESS 7380 Jackson Street NE
t LEGAL LOT NO. BLOCK TFACT OF ADDITION SEE ATTACMED
DESCR. I.G 4 Melody Ma.nor 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PNONE
Gerald Olson 7380 Jackson Street NE 786-0334
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Rite Way Waterproofing 448 Li1ac St, Lino Lakes Mn 55014 786-0550
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �7 ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Install interior basement drain tile
9 CHANOE OF USE FROM TO
STIPULATIONS Electrical extension cords can not be used as part of the power
source to the pump. Drain tile can not be emptied into the sanitary sewer.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPARATE PEHMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING,
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORFiEC7. ALL PROVISIONS OF LAWS yq�UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �� 875 �.94
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING coN- �59.SO Fire SC �Z.BS
ST UCT ON OR THE PERFORMA E OF CONSTRUCTION.
� � PLAN CHECK FEE TOTAL FEE
� �� � $62.32
SIGNAIUFEOiCON'RACTOAORAUTMOFI EDA T ��Dn E� WHEN PROPERLY ALIDATED THIS IS Y UR PERM�T
� �� p
SiGNATUREOFOWNERiiiOWNERBUiLDERi IDATEI � g� IN57 � ppTE
NEW [ ]
ADDN [ ]
ALTER � [ �
CITY OF F,iZIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/97
,�� �� ���1
ConstructionAddress: � � � � �i4 0�� � �T' � �
Legal Description:
Owner Name & Address: ��,� ("� L�p�j Tel. #_ 4-1> �� -- ��� c.�
Contractor: S _ ' ���o � � MN LICENSE # /
Address: _ � L� f � (,1(�}� �T • � I.k� �S , � Il� 5501 � Tel. # �"jg(c� - �
Attach to this applicarion, a Certificate of Survey of the ( M I Li4 H-
lot, with the proposed construction drawn on it to scale.
LIVIVa�G AREA:
GARAGE AREA�
DECK AREA:
OTI�R:
DESCRII'TION OF Il1�IPROVEMENT
I,ength Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
5q. Ft.
Sq. Ft.
g�l� .°o
Constcuction Type: ��T. #����yy��� �q-��� Estimated Costr $ �, --
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. -i--fi: Ft-=---- �t.�x -$ - =$
DATE: �-Z j--� f i APPLICANT: Tel. #�( g(o -� SSZ)
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULnT(ONS:
�
$ ��
$ �
$ � �
$
$ EX�YVi PT
$
$
$
$
� �Z �
Fee Schedule on Reverse Side
001 of Permit Valuation (1/lUth%)
$.50/$1,000 Valuation
$950 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 [ ]
�..-.
� .a
[3U[LDING PERMiT FEE SCHEDULt:
`I'lic Chief Building Official sliall, before issuing permits for the erection of any building or stcucture, or fc�r
any addition to any exiscing building or structure, or for any alteration or repair to any existing buildinv or
st�ucture, upon application therefare, require the payment by tl�e applicant for such permit of fees to the amoiint
herein below set forth and in the manner herein provided to-wit:
TOTAL YALUE
$1 to $50{?
$501 t0 $2,000
$2,001 to $25,000
$2�,001 to $50,000
$50, 001. to $100, 000
$100,001 to $500,000
$SOO,OOl to $1,000,(�0
$1, 000, 001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
Y
$21 for first $500 plus $2.75 for each additional $1� or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,(H?0 plus $9.OU for each additional $1,000
or fraction thereof, to and including $50,000
$574..75 for fust $SO,Opp plus ${> 25 for each additional
$i,(i� or fracdon thereof, to and including $1(�;OOD
� . _.
$887.25 for first $1(?O,OQO plus $5.(}U for each additional
��:
$1,D� or fraction therea��to and including $5�,�0
$2887.25 for the fust $S�,OOp plus $q..?S for each additional -
$1,000 or fraction thereof, to and including $1,�;OQU
$5012.25 for the fust $1,�O,Ot?0 plus $2,75 for. each additional
$1,OW or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete G�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.�0_
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway.width pius 6 feet times $15.75.
VERIF[CATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 t�ours from the time of application to allo:w �or pm�::r
review of the proposed struclure and of the construction site.
�� Cer�iticate of Survey of tlie lot, showing the location of ihe foundation �mce it hafi it i�as hecri cc�nstruc°_- :
',�'i`? I�� ►-eyuircd t�efc,r.-e ��rucccdit3� ���ith [he framin<_i.
� • a
`�h�� t� �
sue�etT � PEFiMIT
City of Fridley 2 8 5 8 �
�� 5 7������ THE �,�NS g U I L D I N G P E R M I T` RE�E�PT N
• COMMUMITY OEVELOPM�NT pIV. � ���
r � v � � PROTECTIVE INSPECTION SEC.
i . •
� _ /°'1 � GTY MALL fFIOLE� SS��2 NUMBER NEV OATE PAGE Of APVItOVED Bv
�"°�' �'� 612-571-345p 910-F15 11/16%98 � �
JOB ADDRESS
7380 Jackson Street NE
t LEGAI �OT NO. 6LOCK TRACT OR AODITION SEE ATTACHED
DESCR. 1( 4 Melod Manor 3rd Addition SHEET
2 PAOPEiiTY OWNEH MAIL AOORE$$ ZIP PMONE
Jerr Olson 786-0334
3 CONTRACTOR MAIL ADDRESS 416-4804 Z�P PNONE LICENSE NO
Midwest Roofin & Sidin 18 Glad ne
4 ARCHITECT OR OESIGNER MAIL AOORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW O ADDITION � ALTERATION � REPAIR O MOVE � O REMOVE
8 DESCRIBE WORK
Reroof house and ara e(28 S Tear-off
9 CHANf3E OF USE FFOM T�
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PEFiM17S ARE REOUIRED FOR EIECTRICAL. PLUMBING, NEATING, TYP� OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIF CONOITIONING
THIS PERMIT BECOMES NULL ANO VOID If WORK OR CONSTRUCTION 20NING SO. FT CU fT.
AUTMORIZED IS NOT COMMENCED V�!ITMIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANQONED FOR A PERIOD OF 1�p DAYS A7 �
ANY TIME AfTER WORK IS COMMENCED ' NO DWLG. UNI7S OFFSTFEET PARKING
I HEREBY CERTIFV TMAT I MAVE READ ANO E%AMIN�O TNIS APP�ICA710N STALLS GARAGES
AND KNOW TME SAME TO 8E TRUE ANO CO�iRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WpRK WILL QE COMPUEO
WITM WNETMER SPECIF�ED MEREIN OR NOT. TME GRANTING OF A PERMIT 23 1.20
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CAMCEI TNE pEqMIT FEE SAC CMARGE
PiiOVIS10NS OF ANY OTHER STATE Ofi LOCAL LAW REGUTATING CON-
STRUCTION OR THE PERFORMANCE Of CONSTRUCTION F re 2. O
PLAN CNECK fEE TOTAL E
S�GN4TUFlE O� CON"AACtOA Op AUTMON�2E0 AGENT IDAiE� EN OP Y A IS IS YOU PERMIT
!
. !
S�GNniuAEO�OWNEAi��OWNEp8U4DEp� �OATE� . ' � INS�' � O�TE
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3uilding
nspections
763-572-3�.04
�
iITE ADDRESS _
i HIS APPLICANT IS:
PROPERTY OWNER/
T'EN�1NT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
0 OWNER �L`�NTRACTOR
PHONE:
STATE LICENSE #
� PROPERTY TYPE ��GL
� T9d01
PERMTT TYPE �DT�
ASEI
O DECK
•rYrE oF woRx: o �+
O MAIN
DESCRIBE �ORK BEING DONE
SIZE OF IlMPROVEMENT_�,c
AIiJA�ER OF SQUARES
GARAGES
PROPOSID SIZE:
PROPOSED HEIGHT:
SIDING
❑ Viayl
O Alaminum
� Od�er
�L���
i �
u1�
FINISH 0 ROOF
❑ SIDDdG
� SWA9vi
Permit No.:
R����a By:
Date Rec' d: � l � �
EXP DATE �/�f�/� �
��-- CITY_��i/E'iY'
F� �Q�- ���-�s� 3
SIZE
STORIES
�SHED ❑ WR�IDOWS
❑ DRAIN TILE
O OTi�R
�G POOL
�N
7.WG
�, ��l.t�/� Gr�Lr �'l ��? ! �S �
WIDTH HEIGHT
� HOUSE & GARAGE
� ATTACI�D GARAGE
0 DEfACI-�D GARAGE
OSoffrt
❑ Tria►
❑ Fascia
wnvnows
IN pQSTIIdG OPENINGS ❑Yes �Ido IACATION OF WINDOWS
OR FOR NEW OPEMNGS-DESCRIBE S1ZE OF
OPENING CHANGES &
r %i� � i•
.'I"EE�IP �53�(,�
Ft�
$}iSAMFNT RFMODELiNG SUBMIT:
I. Existing Fl�r Plan
2. Proposed floor plan
3. List of str�ctural members to be osed
FOR NEW CONSTRUCTION INCLUDII�IG DECKS,
qr�nTT70NS_ & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing swcwres
and P�Pos� P%1�
2. Two seta of constr�ction plans
3. Energy Caleulations
TYPE OF WW�W TO BE WSTALLED MJIvIBER OF WII�iDOWS I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS.
TOTAL
Permit Fee
Plan Review
Fire Stu�charge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
(USING THE 1997 U.B.0 FEE SCHEDULE)
�TION S / I,11�U OCCUPANCY TYPE
$ �a-1 �_
$
$ . a
$ . S�
$ S. ��
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 tunes the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Detertnined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make c6ecks payable to: City of Fridley Attach
TI-IIS 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 accwate; 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 which q' es review an ap val of plans.
SIGNATURE OF APPLICANT - PRIN'f NAME_���'t"�".� �dII�ATE O'— Z��
Page 2- Building Residential Applica.tion
BUII..DING PERMIT FEE SCHEDULE �
The Chief Builda.ng 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 buildi.ng or structure, upon applica.tion 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:
VERIFICATION OF FOUNDATIOIV
Perm.its 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 constru.ction site.
A Certificate of Survey of the lot, showi.ng the loca.tion of the existing foundation will be
required before proceeding with the $aming, New Houses Onlv
City of Fridley
$uilding Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
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City of Fridley Building Inspections Dep� Ph: 763-572-3604 FAX: 76 571-1287
6431 University Ave NE
Fridley MN 55432
MechanYCal Pe�,�# '�`���`����I
� . � ,_
. Residential Application � ��°
Gity of Fridley
See Back Side For Required Information
G
The apaficant is:
Property Owner.
Address:�
City: //�
Site Address: %�$� - � %(Lt�S�'Jf� c�t!'�P-P� �
; onel Owner Contractor
�
Phone: Ce��: rax:
Coritractor Information �
Company Name: S� A��Y� � �� � ���� � �
Contact Person:
Address:. � � �
��� h State: �I nl Trp: SS �3 a
Phon�:'7l0 -7��f— �a�l Cell:ro%?—��fe—�fn� Fax: �1�:�`7g�� �937
�,,,.,,�. a c.n �.�, ��� P.v� �1������ MN Bond# & Exp Date L �lo
of Work
New
Detailed Descripiion of work: , ,
Equipment Instailed: MFG: Model: 5¢eit� i u:
MFG: Model: Size/BTU:
MFG: Model: : Size/BTU:
Piease check all that apply: _Fireplace (gas) $15.00 _New Gas. Grill $10.00
A/C $25.00 Firepiace (wood) $35.00 _Gas Unit HTR $10:00
Air to Air exchanger $15.00 Fumace $35.00 ,_Pool Heater $35.00
Boiler $35.00 Gas Dryer $10.00 Ventilator $15.00
Chimney Liner $10.00 Gas Piping $10.00 �
i�Duct Work �10.00 _.,_,Gas Range/Oven $10.00 �
Permit Fee
Surcharge
Total Due
$ , �rj (Total from above-Minimum fee $35.00)
� 0.50
$ �S • 5 C� Make check payable
This is an application for a permit- not valid
I hereby apply for a mechanical permit and I acknowledge that the
accurate; that the work wfll be in conformance with tha ordinances �
with tha Minnesota Construction Codes; that I understand thfs is n
for a permit and work Is not to stert without a perml� that tha woi
approved plan in casa of all work which requlres review
Signature of
Approval Inspector Sig
Please Note: Separate permits are required for Building, Plumbing,
I� �. .S� � J n/A A l�1AAG
to C of
mtil proc
formatlon above (s complete and
d codas of the Ctty of Fridley and
a permit but onty an applicaUon
will ba In accordance with the
nd approval of plans.
Date: � ��
Date: U 6 �
Electrical work
;,�1�v I. �O�
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
�. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amend.�ents` - �"� -- -- ��
b. Natural Gas or Propane!lIFGC 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 Cha.pter 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 767U or 7672
6. 'Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations