AF - 47629nBarinon� �u. �coRu
1. LOG►TIOM Of �Ell �� �� � MlliaEi blant N fQUE M�E�LL^� NO. �
County Na�t d�� �j 1!
// /� r!
Tamship Nur Ta�+nshlp NunDer Rany� NuNe� Sectioa No. Frycti;nof y 1• YELL OEPTII (co�pl�Ud) Oat� s�aled
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Nwertc�l Stn�t Addnss �nA tity of N�ll Loeallon or 0lstaact fro� Rad S. DRIIIlN6 NETH00 (if knorn)
Int�rs�ctton 1(] Gbl• tool 1� 14wn� 1� Ortw� 1� Duq
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sna� *xacc {oc.slon or wlt 3Q Rotary 60 J�st�d 9j� Paw� Auge�
(in s�ttloe yrid r1tA •X•) � Sk�teh yy of wll loutlon 6. OiSTN11tTi011S
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t. PIWYERTY OYNER'S NI111E q�iltay Addrt=t tf diffennt tMs 8. CASIN6(S)
�� proptrty addnss 1ndlutW �bow 1J� Bluk I�TAnadW 7(�
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7. . FONMIlTION L06 COLOR fOpINTION fROM TO
If nut knmm, tndteat� foew�tta� to9 fro� nw wll or ia�rby wil. 1e. W ft.
:Si1�D rcµ.v S'�ff> O o 9' ���,�� rro. �✓Y ic. c� � r�.
(it knornl
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�' /� s� o'.+�/ fiLt �j 30. STATIC YATER IEYEI
.°t� rs. (�'e.�ou p.eow
i..a s�.�. aa w.:�r.a
u. ��u�rw car�or
. 1� Pitl�s: Ad�yt�r {� Fow4 wri�d
2� B�sp�nt offs�t �
3� INl l P1t
16. REl111RK5. ELEVATION. SOUNCE OF pATA - CASIN65 RENOYEO. CASIN6S PEIIFORATED. ETC.
12. GIWIITIN4 [IIFONIMTIGN
I� N�at CaNnt 7� l�ntonlL� �
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�'� :�� `j �'F �r.� �f"� f� 13. NtAaEST SOURGES Of tONTAMIII�TI�I
'��'� �' _ fNt dlnttton typs
' INIi disisf�ct�d bNow se�itnyt � Y�s
, �, �y��d-� �rt�cs r;��% ����'r�
i�. vww p w.owa � woc vr.s.as
Type: ip w0�n101• �J 1,5. Turbia� 50 Reciprocatlnq
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� 15. EIIISTi116 I�LLS (Yl�as� sktttA lotatia�s of a0axdoaed �ad
actiw �+elis /� rsarkt sattoa o� on b�et.)
OtM� unuHd wri l(:) a orop�rtyt � Y��
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17. WTER t�Ll CONTRAC?ORS CEBTIFICATION
TMs wU w3 �i�d und�r �y �uHsdictioa and th13 nport
is trw W tM b�st ot iqr tnwl� ind btii�f.
f d111 •t .S�r�✓ lfr�2C l0 ��:�0 3
llansN Bu�ln�ss Nw Utente No,
. Addrfis �I. tiG✓ iLQL•l�'f' �
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FfICIAI ABAMDONED YEL� NECORO (May ba uf�A for Proqarty Transter) Nar ot Dr/ll�r
I�:aISt lZli Ml?e DCaD
sue�ecT PERMIT
City of Fridley 2 0 7 2 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i � RECEIPT NO.
� �
• COMMUNITV DEVEIOPMENT DIV. `
1 � L � PROTECTIVE INSPECTION SEC. - �� C' �'�
� �
� . �
� � /"�1 � CITY HALL fRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""�" ,'� 612-571-3450 910-F15 3/8/91 � �
JOB ADDRESS 5730 Jefferson Street NE
� LEGAI LOT NO. BLOCK TRACi OR ADDITION SEE ATTACHED
oescR. S 13.33' o Lot 2, Al of 3, & all of Lot 4 l in N of th SHEET
2 PFOPERTV OWNER MAIL ADDRESS . O �4 � B4 � Adams StiiP Addn PHONE
Ideal Homes Inc. 591 - 108th Ave NinT, Coon Rapids 55433 755-2652
3 CONTqACTOR MAIL ADORESS Z�F PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MA�L ADORESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
�] NEW ❑ ADDITION ❑ ALTERATION � AEPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a, 40 � x 26' DHtelling and a 2Q � x 22 � Gara e
9 CHANGE OF USE FROM TO
STIPULATIONS �ee notations: on �lan. Proyide sod in the front a,nd Side yards. Provide
a hard sur�ace_ dx�iye�uay. Qrovide City with.veri�'ying survey Tae�ore capping. Old well
was capped and £�,lled Fax licensed contractor on 3/4/91. Paid $750.00 Park Fee.
SEf�IER LOCATTQN: 8" VCP 1Q � E: of E property line (Approx. 11 � Deep in Street)
WATER LOCATION: 6'� CIP 2Q� E o� E property line.
DRIVEWAY CUT ; N/A Bituminous wA��HG
-Be#o�e digBing call tot
alf utiaty locations
SEPARATE PERMITS REQUIRED FOR a�-o�oz
WtRtNC, HEATiN�, PLUMBfNG �IND SIGNS. REQUIRED BY L.AW
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING,
VENTILATING OR AIR CONDITIONtNG.
7HtS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GAHAGES
AND K,NQW ThIE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATiON SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL 8E COMPLIED $�6,050 $3HeQ3
WITH WHETHER SPECIFIED HEREIN Ofi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $S�G.00 $650.00
TRUCTION OR THE PERFORMANC OF CONSTRUCTION.
pjpy,G}i6�',K..F[-6- 70TAL FEE
.
�re $76 $1,300.08 + Park F e
SI AT E. CONTRACTORORAUTMORIZEDAGENT IDATEI WH N PRO EFi D THIS IS VO� PE�
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� SiGNniURE OF OWNER iiF OWNEF BUiIDERi IDATEI L INSP f)FTE
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� EBTE&IOR ENVELOPE AVEE9GE "Q" COMPQTATION
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°S ITE :�ADDRESS : S7 3 � � ��'So �J �, t1� . � .
2.
2.
-3.
9Tl{AC;TOR• `- 1 ' r.sA�3 DA'j'L: FHON�' —aZ S�
- DETERMI?�Tr' WORKING SQQanE F04TAG�' GF Ea��H:
TOTAL E�OSED WdLL AREA. ... 7�L �� =q ft x"II" � � = 2b,•
TOTAi1 ROOF `CE IL TNG AREI�-. .. _ b`[ 4� s� s' � x.. s.' y�' •� = Z� �
TOi�: E�O�EI� WE�:L• ARE2 CA���GT.A`�' T()I�T^ :
. � Tot3? ex�esed aall .
� area abovz f? ��r. . . . Zoo �, 3 _,� � �
: (+�
a) Tota? Rall windo� 2?"E.'3:
� - '�LLF F132@C�. .. ii��� cn_ I':, X"i:` r q8 = S�.S^
�IM�e3... Q� f� Y ..v:. _
` � b) Tetal door �re�. . . 'a 3'1.9 �q f � Y "�" , �S' = 9 �48
- c) Teta? slid�r-g g?a�� eo�r �===:
��,��'?az�d. .. �3.5 Q� ft � ..G.. �-- 4S = 1 ,4
' �*1 �cZt�. . . v5Q f't :C �u� _
- d) Tota? firegiac:� wal? �re� ^°^ sq r ��••Q�-; n� _ _�--
- e) TQta? rra? Z fraw=� Z?'P�
_ (avA � A lo� � 3 � -
f)
g)
h)
1)
_ .,2�g.. a� . . . . . . . . . . . � .ta SQ ii. X ���� � = i''���
Total net Rall are� zbove
floor (.ir��Iate•�; . . . . . . . �Q�Z3 �L �T Y ..II.. +�43 = �3 3
,
Total rim joist 2'_"@Z. .:.. 1�3 �3 sq ft x"II" �t� = 4,°t
Total foundation
area (exposed), . . . . . . . . . 14 �.:� i�
Totzl foundation raindow
$y'@^c . ......... .......... '^° SQ f% L� ..�.. _ �o.�.
Total. ne � founda ��or_
ar�� zbove grade. . . . . . . . __�? � __s� f z Y ..0.. ± L _ ,,� ��
; .%
TuT9� 2 } t:+ru 1) _ ,j���
If � �e L K� i= the ;�me aG , cr ? a�= t�-n ;��:� �'
in:,z:�� e' 2 l�CA3 1. Ih00a�A f_`. " -= Y���: i72ve s�� t: �
anc,. � .
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4. TOTBI, E%POSED &aQF\CETi�ING C�i,GIILgTI4NS:
Tatal e :pos�3
ro�f�cei�ing ar�a...... lo�t,. sq ft
,i ) Total sLyZig�at are=- . . " '� �q =t x ° �., - „' �
�} Tota! rao� c�il.i�+�
f rzmi� are�
{avera�� 10�} . . . . . . . . . . l .to �c f � s 'R' a Z = 2•3
I j Tozal n�t is� sj a ��c
rOCr �C�1.j ? � �.°�. . . . . SSI. �4 g,> r � � ..r��. .aZ.� - 2Q �
,
TOT�L• j; tiyu 1} _ �_
I� t�0 JG' C� �� l. tL ° rt:.w'+� ,� ��� =°: � t.ZI2I? Sf �: 90i,: :?=°�_ .::C ��!-_
l��cil.. �J_T C. �t.c_� i. 15t�i}L'` � a_^_'�•i�.
�,_�.==t�: "_' = �': --- -�i�� E�3'% �LCP� I��:, =��w
T�.7 utit j 1�C I+r.� Y� L1G� G��'TS���TJ �jj� l��i�i �:�:ra�S�:1 = �r�`. +7c:�.�w' '
estsb�ls::e� b� �:�e sum c; ? �em: ~ R:; a„c� �� s�ali r_c � e= g_ _a��_
t�'1�:1 t'±Z SL•^..7 oT l:.t'�.° #_ ��G ,'+.L.
1 �. �� r `'i -� `Z , Z. � � � = G.� �� r `
3. ��4-,1 -, a 23 •O ' te1,1
C�'�"-�'ICPT �ON
T i+.`r�'-L,J C°:t1= ti'_"+c:. ! ln� � • �� ..�,. fcCL-`►_'•= .
Y �!�cVE C2 .1.+.2 �,C�Q �,. .. �n,_
•.R.. vaj ues he_e_� aad that the bu? lei e h�re ce�cri�ac n:?a�_ c�
excee.�� ; t�e �ta�e ef Lir_r_s_ota Er.er�Y�C4nservzz�on Act.
t.: igr_� :,ure }
�•
��z �c'�
:t ;1�_ I�Z' � *.( •�y'•� j�,I:J
' �:A:..:U_ -
- _ �
_ �_ _
4
�1
3
CITY OF FRIDLEY
Effective Date January 1, 1991
aPPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
QESIDEI�TIIIL
Purnace Shell and Duct Work,
Burner (1►lso zeplacaunt furnsce)
Gas Pipinq
(pipinq r�ded rith nw furmce)
Gas Range
Gaa Dryer
• Air Conditioning (all sizea)
1111 Othera/Repairs and Alterations
1• of Value of Appliance or work
COMMEACIALjINDUSTAIAL
1 1 of Value oi Appliance or Work
REINSPECTION FEE $30.00:
RATE TOTAL
s 20. oo S �U,�
S 10.00 S IQ. Uv
$ 10.00 S
$ 10,00 S
$ 10.00 S
State Surcharge
TO't�L ?LE
Roaqh Insp.
Date
Final Insp. !O `���` G /
Date � ,
x„ . �
Approval for Permit ���
i�
S
S .50
S
S,�
MINIMUM FEE FOR ANY NEATING/COOLING/VENTING PERNIT
IS 515.00 PLU9 T1iE 5.50 STATE SURCNARGE
•Air Conditioners can not be plsced in side yaxd without
writtan pes�ission fzta adjoining neiqhbor.
Job Address v + � O v � �I � - " "� � i `�-'�
Building Inspection Div. 6431 University Ave NE Fridley MN 55432
Tel. No. 572-3b0A
The unfersigned hereby makes aQplication Eor a pecmit for tM wrk fiereis�
specified agreeing to do all work in strict accordance with th� City Codes
and rulings of the Department of Buildings, and hereby declarer that all the
facts and representations stated in this application ara tcve and cosrect.
3-- S , �9 9 �
OWNER � � Cx.�-� --�( "r ''`�+," _�
KItiD OF HUILDING ��'� � �'�'�1 K^�"'� �1
USED 11S Zi l�1JC.r
e �
TO BE COMYLETED ABOUT � �� (
ESTIMATED COST � � ��v�
OLD - NEW BUILDING PERMIT NO. PERMIT NO. �(, ��( J
DESCRIPTION OF FURNACE/BURNER
HFATING ot POWER PLANTS� Steam. Not WateT,� Wsr� 8i.�' Nc•
Trade Name �-�' "" 1 � size No. 'J ��/� C�J � �� �.2�� / �
CapaGity ��� Uv� Sq. Ft. EDR " B'N�� � ilp
1bta1 Connected Inad `i�� �`Y/ lCind of Fuel hCl7f Wl�--`�-��'"—
SURNER - Trade Name Site No.
Capacity Sq. Ft. EDR BTU HP
coo,pr�y 4� C �u�v �,k,
Signed By
Tel. No. �" �-- �
Fill out back side for stack verification on replacement furnaces
. , , . ..- .. . _y. . . ,-:
c t� w,(a..- ,
. ��/%y` ' ' CZTY OF � INSPECTION DEPARTMENT��rv ��a/ � �� 3��
HEA�x;'IA7SS �.+"ALC'ULATIONB DEPARTMENT OF BUILDIIVGS Y�vLAGE !
Weatherstrlp� A.S.H.V.E. Construction No. Insulation
Guid� — -
Window� Doors Referenoe Out. Wall IInt. Wa114 Ceiltng I Roo1 � Floor Kind ( How Applieci
� Yes—No Yes—No 19. I �
� .......
�
F'1, i[;v,'h Room � Length /� Width /,j Height $ Fl. I�j.� Room I Length � j Width (� Height <:
<
Window and Doors--Crackage and Area Windows and Doors--Crackage and Area
Width Helght No, ot Llneai Lt. Areo Width ilelgrit No, of Llneel It. Aren
No, of ane oi pane 11 hta ot crack sq. ft. No. ot pane o! pane llghts oi crack s9. ft.
l s 8 a6 Ya / /
cc�ei. stu
; ' In8ltration 2 b {�o /v y0
�
I G1ass �{0 5� oZ O OD
i Exp. wall
: Net exp. wall ` ` /0.7 7 !
; In� wall
c�ii�ng � � i y � �'{
i Floor
i Total stu. S%63
' Required sq, it. E.D.R. or sq. ins. W.A. Leader area
Fl. ,ga�' K�k�w° oom I Length ,2 � Width // Height �'
Windows and Doors--Cracka.ge and Area
Width elght No. 01 Llneallt. Area
No. 01 ane ot ane 11 hts ol crack sq. it.
/ 2 . �3 !v 6
26 Y�
_ coet. Bcu
Yn8ltration - .3 ,6 �10 / y y v
G� 8 5 �yo�
' Exp. wall , . _
�"' Net exp• wau ,� 16 i 5 I.Z,
In�.'wall
cet�ng ` .2 �{ � y 9 6 �
Floor
Total Btu. b 3� �
Require�d sq. it. E.D.R, or sq. ins. W.A. Leader area
F'1, Room Length ( 3 Widtli (� Height
Windows and Doors--Crackage and Area
Wldth :f Helghc No. ofI lne 1G Area �
rio: 02 qatie_ I ot pane�lights I oi crack sq. fE.
t
�� Coel. Btu
Lzflltration / �{O 6 Y o
' G1ass /6 So Do
_^Exp. wall •
' rret exp. w�au 200 ! ym o
Int. wall ' `
; Ceiling � /8 � �,? 8
> ` Floor ' `
` To� s�u. : 3s 6 8
; ELequired �q. it. E.D.R. or sq. ins. W.A. Leader area �J
Infll'tration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Q
�
�
�
�
_- - -- -
Required sq. Pt. E.D.R. or sq. ins. W.A. Leader arna �
Fl., Er,,� r Room' Length ( S Width S
Windows an Doors--Crackage and Area
No. Width � Helght I No. of � Llneal 1t. � Area �
oi pane oi pane _1lghts •oi crack s4• ft.
� 3 7 `�� � 2
I
Infiltration
Glass
Exp. wall
Net exp, wa11
Tnt. wall
Btu
6 �Ev
�'c� C�
ii � .�
S ZfO
313b
Height �r��
ccet. stu
�?l /6D0
Y.� Sv � �mo
/k'Z 7 /� 7S�
c��� o Y � o
Floor
Tota1 stu. 53.3
Regezirecl sq. it. E.D.R, or sq. ins. W.A. I.eader area
Fl. � t3��„�f'f�.00m � Length 3 S Width 2'/ Height �
Windowa and Doors--Crackage and Area
Wldth Fielght No. of Llneal tt. AreR
No. ot ane ot pane llghts ot crack sq. tt.
3 �f Y�' '�b'
� � /e� b
i 6 .�b y.z
Ccef. Btu
insl�tration $ �J �fo 33 Io G.
G1asa
Exp. Wall
Net exp. wa11 �'y B
Int. wall
Ceiling
Floor $ � a
T�tal Bcu.
so y Oo
�S i.��zo
Required sq. i� E.D.R, or aq. ins. W.A. Leader arEa
25��
z3y oc.�
� ����=
. .
, , . . .�
, MOUSE NEATING TcST RECORD �
. �: '���o J�FFF So.,v S � � .
AODRESS �PT. RLOOR CITY SUBURB
OCCIJPANT ,�/ OwN6 R
': HEAT I.OSS �,3�DATE MTQ INST� �� ��— �� CAS CO3 METE4 S�OCE ' �
SOLD BY /`�ATi�J�" � Cod/iti c✓t� INSTAILED 6Y -
,: El.ehleol we�M 8r ' Co. Lt�. 9r
T'f P E OR HEAT CA .._,� FA H'� STE/�1r► SPIICE NTR. UNIT NTR. OTHER
GAS OESIGN � • CONVEaS10N �
� MAKE, �r,�A'�� W►KE OF BURNER
Mod.l Mod.l
� S«iel � M�a. BTU Ratin�
; INPUT M�KE OF RURNACE
1Aod.1 '
�-�,,,�r CONTROLS S�/
THERMOSTAT .1�3_L.L� H�at P1u9 w.nr Sis•
ye�Y� G%li �TE �'o� t! I' KIND OR l.INER ��''�"` SIZ �� NONE,�_
i.imit 700 dr�Ft Heed 'L R�g�le»r �--3.'ZS/�%A�0/
l.imit S�Hiny /��'C Fi it�s Sia�.L� X�X / �'!umb�� � �
P�n S�MIny �%t�"r•'�� Q�Imn�r Leaetien Inri/d. O�Hid•
; P�io�.TrP. C7►imn�Y Construdien �lA�S
, '. Pll�t Mekr A'`rr .
� Pilet biod�) ' Sino4� 8emb � �Miri�y �
Pllo� Timin9 Oro/t �`T�st Teo
L.W. Cyt Oii [?�or Pr�ssw• '/✓ l.fqhH�q Ins1.
0
�: ': Pr��aw�' '' �' i� � P�re��t CA� i 06 � WM T��1� ' � '
' Itiput CFH �.� PNe�nt Q •� 9�._ Companr T�stinq T'v �'' / `✓
o i . d c70 ° `
Smelt 7�mp: 27s PKCtat CQ ��� Nom� ei T�st�r
� Paw� 1�3 , ,
ZZ
1
, ,..
'
' 1
1
1
j
� � A
' • , .
1
� �
�
: � �
� . � 1
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1991
APPLICATION FOR PLUMBING AND GAS FIITING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EAGH FLOOR
PLUMBING FIXTURE RATES:
New Fixtures
Ofd Opening, New Fixture
Beer Dispenser
Biow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas
Gas Range
NO. RATE TOTAI
KJ $ 7.00 ��,00
��
Gas Dryer
Back Fiow Preventer Required ()Yes () No
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $5.00
Reinspection Fee $30.00
ALI.OTHERS ANDlOR REPAIRS AND ALTERATIONS
1 R�o of Vatue of Fixture or Appliance
State Surcharge
0, ao
.50
JOB ADDRESS S 7?J' G �P��e�s�.i v� Sf lUc°
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do ali work in st�ict accordance with the city codes
and rulings of the Building Division, and hereby declares that afl the facts
and representations stated in this application are true and correct.
�� �� ,1991
Owner _ ��� � �awie S
Building Used As `'� �� �i`J� �'—
Estimated Cost �� U�', vU pERMIT NO. � � lo``� �
PLUMBING COMPANY ��''�Ha�`df �'lu �%h I3����
F
SIGNED BY TEL N0. �� G�G �
Approved By Rough-1n Date •3 ` j�,'��inal Date ��Z -��
MINIMUM FEE FOR ANY PLUMBtNGlGAS PERMIT IS $15.00
TOTAL FEE $�a �Sd PLUS THE 5.50 STATE SURCHARGE
_
_
CITYOF
FRtDLEY
FR[DLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
May 10, 1991
Ideal Homes Inc.
591 - 108th Ave NW
Coon Rapids, MN 55433
Re: Final Inspection at 5730 Jefferson Street NE, Fridley
Dear Sirss
A final inspection was conducted on May 10, 1991 of the above
address and the following items mt�st be completed before the
structure can be finaled:
1. Frovide sod in the front and side yards by June 30, 1991.
2. Provide vacuum breaker and sillcock on back of structure by
June 30, 1991.
3. Provide 6 inches of earth & wood separation on dwelling
foundation by May 20, 1991.
4. Complete gas hookup and inspection by May 20, 1991.
We will expect these items to be completed by the scheduled dates
and reinspections called for. Occupancy of the structure is
approved.
If you have any questions on this matter, please feel free to
contact me at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
�
_. ..
� SuBJECT . � P,E � . ���
c;ty of Fr�a�ey 3 0427
A7 THE TOP Of TME TWINS g � I L D I�1 C P E R M I T
r
' ' NO.
� �; y � COMMUNITY OEVEIOPMENT OIY. /
f � + �� PROTEC7IVE INSPECTION SEC. �� �(� J
, ,
, ; ,__. ;
l__-•�; ;•� CITY MAII FRIDLE� SS�.�I2 NUMBEN REV OATE PAGE O� AFF110VED BY
i 612-571-3450 910-F15 10/21/99 / /
lOB ADORESS 5730 Jefferson Street NE
1 LEGAL �OT NO.All 3 BLOCK TfiACT OR ADD1TfON SEE ATTACHED
DESCR. Pt.2 & 4 �+ A a SNEET
2 Pf10PERTY OWNER MAtL AODR�S$ ZIP PMONE
Dan & Paula Babor 572-0037
3 CON7HACTOR MAIL AODRESS Z�P PMONE LICENSE NO
Window Lite Home Im rov. 8400 89th Ave N Br n P -2 2 2
a ARCMITECT OR DESIGNER MAIt, ADORESS 21P PMONE LICENSE NO.
5 ENGINEER MAII ADORESS tIP PMONE LICENSE NO
6 USE OF BUILDING
Residential
7 CIASS Of WORK
O NEW O AD�ITION ❑ ALTERATIQN � REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Install new picture window (cut new o enin
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the house.
Permit tnspection Cards
Wi11 Be Mailed
To Nomeo�►ner To Post
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO
SEPARA7E PERMITS ARE FiEOUIqEO POR EIECTNICAL, PLUMBING. HEATING,
VENTILA7ING OR AIR CON01710NING.
THIS PERMIT BECOMES NUIL AND VOIO If WORK OR CONSTRUCTION ZONiNG SO. FT CU FT.
AUTMORIZED IS NOT COMMENCED V�117HIN 60 OAYS, OR If CONS7RUCTION
OR WORK IS SUSPENOED OR ABANOONEO FOR A PERI00 Of 120 DAYS A7
ANY TIME AFTER WpqK IS COMMENCED. NO DWLG. UNI7S OFFSTREET PARKING
I MEfiEBY CERTIFV 7HAT I MAVE READ ANO �XAMIN�O THIS APPlICA710N STA�LS GARAGES
AND KNOW TME SAME TO 8E TRUE ANO COARECT. ALL PROVISIONS Of LAWS yA�UA710N SURTAX
AND OROINANCES GOVERNING TMIS TYPE OF WpRK WILL BE COMPlIEO
WITH WHETHER SPECIfIEO HEREIN Op NOT. TME GRANTING Of A PERMIT �3120 �I.SG
OOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEI TNE pERMiT FEE SAC C RGE
PROVISIONS OF ANY OTHEp STA7E OR LOCAL LAW REGULATING CON- @
STqUCTION OR 1HE PERfORMANCE Of CONSTRUCTION $9I a ZS Fl SC y�3 .�.2
PLAN CNECK FEE T FEE
Lice SC 06.93
S�GNatuAEO�CON7RA(;tOpOp�UTHONIZEO�GENt iOATE� p �Y VALID O TMIS IS�Fi P M
i �
i! S�GNniuAE O� OwaEQ ��F OWNEA BU4DEii� ��rE� � � B G�h5 ptrf
r �_ ,
NEW [ )
ADDN
ALTER
Effective 5/10l99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII.DING PERMIT APPLICATION
Construction Address: �'��% �� —�
��
_< .,_ . _
. U l/U (/
Legal Description:
Owner Name & Address: ��Qr� d.- �(�.,..� ��,L. L�j/.�,,�j n� Tel. ��.5��'-- da3'%
Contractor: i` � ` MN LICENSE # �OD�3g�s"�
_._. .. _ .
Address: V �� � i3 C�l �.� / V /� � ��DD L�i „ /' �/7t� %1�l/� Tel. 1t " (Cr�J "do�t �
LIVING AREA:
GARAGE AREA:
DECK AREA:
O'THER:
Attach to this applicadon; a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
. - DESCRII'TION OF IlVIPROVEMEIVT
Length Width Height
Length Width Height
Length Width HgtlGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: � n , Estimated Cost: $ ;J, /�, �� `
' �(,t,t� fl¢cv' t�`ir� > :
Driveway Curb Cut Width Need�d. . -. Ft. -F � Ft = Ft �x $� _ $ -
DATE: �� APPLICANT: ��in �� �i� `tNl1v2. q�yt,�i�y�1.¢ /)c��Tel. �! , � ? 2
Permit Fee $ -/ �� � J�
Fire Surcharge $ � _
State Surcharge $ /. J`��,v
SAC Charge $
License Surcharge $ �, Ot�
Driveway Escrow $
Erosion Control $
Park Fee $
Sewer 1Viain Eharge � �$ : .
, TOTAL
STIPULATIONS:
$ ��
CITY USE ONLY
Fee Schedule on Reverse Side
: .QOI of Pertnit Valuation (1/14ch%)
$.50/$1,000 Valuation :
$1050 per SAC Unit
$5.04 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
: . ... ,._.
Agteement Necessary [ l Not` i�lecessary [ � ] � � ° -� . � ' . , � . , .
sue�eci P N
City of Fridley 3 21 10�
AT THE TOP OF TME TWINS g � I L D I�1 G P E R M i T
� . E p�e
. � �p�0
� ' COMMUNITY D£VELOP�ENT D1V.
� � V � PROTECTIVE INSPECT{ON SEC. ��Z-3�04
, . ,
� � /"'1 � CI7Y HALL FRID�E� SSIJZ NUMBER pEV O�TE PAGE OF APVqOYEO 9r
������'� �'' 612-57�-3450 9�aF�5 8128/O1 � �
JOB AODRESS 5730 Jefferson Street �
t LEGA� �OT O. BLOCK TRACT OR ADOITION SEE ATTACMED
oescA. t.�, All 4 Adams Street Addition SMEET
2 PROPERTY O NER MAIL ADORES$ ZIP PHONE
Daniel Babor, 5730 Jefferson St, Fridley MN 55432 763-572-0037
3 CONTRACTOR MAII. AODRESS ZIP PHONE IICENSE NO
Renewal by Andersen, 350 73rd Ave, Fridley, MN 55432 763-502-4777 20130983
� ARCMITECT OR OESIGNER MAII. AOOfiESS ZIP PMONE LICENSE NO.
5 ENGINEER MAtI ADOFIESS 21P PNONE LICENSE NO
8 USE OF BUILOING
Residential �
7 CLASS OF WORK
�1 NEW ❑ AODITfON O ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
New windows (5� bay window; patio door
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.4.1.2 of the 1997 Uniform Building Code. Caulking
& flashing for all exterior openings.
' TYP OfCONST. OCCUPANCYGROUP OCCUPANCVIOAD
SEPARA7E PERMITS ARE REOUIRED fOR ELECTFi1CAL, PIUMBING, HEATING.
YENTILATING OQ Alp CONDITIONING
TMIS PERM1� BECOMES NULI AN� VOIU 1F WONK Oii CONSTpUCT10N ZpNING SO. F7 CU fT.
AUTMORIZED IS N07 COMMENCED N(ITHIN 60 OAYS. OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIQO OF 12p DAY$ A7 `
ANV TIME AFTER WORK IS COMMENCED. ° NO. DWIG. UNITS OffSTREET PARKING
I HEAEBY CERTIfY THAT 1 HAVE REAO AND ExAMIN�D TMIS APPIICATION S7A�LS GARAGES
ANO KNOW TME SAME Tp BE TRUE ANpCOPAECT. ALL PRpWS{ONS Of LAWS VALUATION SURTA%
AND ORDINANCES GOVERNING 7HIS TYPE OF WOAK Wll� 8E CfJMP41E0 $1S��iOO.00 �7•70
WITM WHETMER SPECIFIED HEREIN OR N07. TME GRANTING Of A PERMIT
OOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE OR CANCEL THE pEqM17FEE SACCMARGE
PROVISIONS OF ANV OTMER STATE OR LOCA� LAW REGUTATING cow- $265.LS Fire SC �LS.�FO
STRUCTION OR TME PEAfOpMANCE Of CONSTRUCTION
PLAN CNECKFEE TOiALFEE
nse $ .00 $293.25
SiGNATUpE O� CON'FACTOA OA AUTHOp�ZED AGENT IOATE� yy Pf10PERLY VAUOATEO TNIS IS Y UQ FlMIT
�
S�GN41U�7E O� OWNEp��F pWNEABU�IDEA� � iDATE� � � � BLOG �NS� � � � � pa�E
�wt �
ADDN
ALT�R
Effecrive 5I10%99
L ] Cr�'� aF ���
[ ] S�NNGI.E FANIILY �YD �UPLE�S R-i AN� �t-�
BUII.DING PERNII'T APPLICA�'ION
�onsrruction Address: �j � 3p J-�,�..� �c �o n �J� 1'V . �L.. •
Legal Description: �
Owner Name & Address: ��r;,�� �j��� . Tel. #�3•5�'a• 003�'
COIItraCtor: , Renewal By Andersen MN j;jCENSE �#
350-73rd Ave. NE —
Ad�ss: F'ridley, MN 55432 Tel. #
763-502-4777
Attach t< #MN201309R3 )f the �
lot, with _..._ r-_r _ scale.
LNING AREA:
GA�2AGE AREA:
DECK AREA:
OTTHER:
Construction Type:
DESCIRIF'�IflN UF �MP�4�EM�'�:NT _ � �
Length Wi3th Height Sq. Ft.
Length Width Height Sq. Ft.
Length Vi�idth Hgt/Ground Sq. Ft.
��
Driveway C�rb Cut Width Needed: Ft. + 6 Ft =
:�v� �l114 S�'iV� c3
Estimated Cost: $
Ft x $
0
�
�
.�•
DA1'E: o1a •'�v • � j APPLIeANT: �p,��� Tel. # � ol • ��{S • (Q 0 �{ �'
Permit Fee
Fire Surcliarge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Chazge
TOTAL
STIPULATIONS:
� at�5. as
� � S.�10
$_ �' .�'�
$
$ �Ov
$
$
$
$
.
� . _'.,.
����.a5
CITY USE ONLY
Fee Schedule on Reverse 5ide
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC ITnit
$5.00 (State Licens�d Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determi.ned by Engineeri.ng
Agreement Necessary [ ] Not Necessary [ ]
. �
SuBJECT
City of Fridley 3 8 7 3
AT THE TOP OF THE TWINS gU I L D I N G P E R M I T
r
� ` RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. ' /
' j V �"�� ' 1 ��` �
r � �� PROTECTIVE INSPECTION SEC. C f
i . �
� � �"'1 � CITY HALL FRIOLE� SS��2 NUMBER AEV O�TE v�GE O� •nvnOVEO 9r
�"'"'�� ��� 763-571-3450 9t 0-Ft 5 9/ 11 / 03 � �
IOB ADORESS 5730 Jefferson Street NE
t LEGAL ��T NO. BLOCK TRACT Ofi ADDITION SEE ATTACMEO
oesca. Pt 2,3,4 4 Adams Street Addition s►+EET
2 PFOPERTY OWNER MAIL ADDFESS 21P PMONE
Don Babor 5730 Jefferson Street NE
3 CONTRACTOR MAIL AOORESS ZIP PMONE LICENSE NO
Paul Klingbeil Construction Inc 6161 Trinity Dr NE, Fridley, MN 55432 612-804-0908
l ARCHITECT QR OESIGNER MAIL AO�RESS ZIP PHONE UCENSE NO.
20382513
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WOFK
O NEW C� AD�ITION O ALTERATION O REPAIR p MOVE O REMOVE
B �ESCRIBE WORK
Construct a 14' x 23' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
iNARN1�G
Before digging cali for
a�� utility locations
454-0002
REQUIRED BY LAVY
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRiCAL. PLUMBING. NEATING.
VENTI�ATING OR AIR CONp{TIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. fT CU FT
AUTNORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR If CONSTRUCTION
OR WOFK IS SUSPENDED OR ABANDONEO FOR A PER100 Of 120 OAYS AT
ANY TIME AFlER WOf;K IS COMMENCED NO DWLG. UNITS OFFSTREET PARKING
I HEAEBY CERTIfY THAT I MAVE REAO AND EXAMINEO THI$ APPIICATION 1 STA�LS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVIS�ONS OF LAWS VAIUATION SURTAX
AND OAOINANCES GOVERNING THIS TYPE OF WOfiK WI�� 8E COMPlIEO
W11M WNETMER SPECIFIEO MEREIN OA NOT TME GRANTING OF A PERMIT �3�H7S �1.94
DOES NOT PRESUME TO GtVE AUTMORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STA7E OR LOCAI LAW REGULATING GON-
STRUCTiO TME PERFORMANCE OF CONSTRUCTION �9%.ZS Fire SC �3.HH
� /� �� P�AN CHECK EE TOTA� PEE
�s^'`��/ ens SC $5.00 $108.07
S�GN4TUQE O� CON'R1�TQR OA 0 OA�ZED 4GENT �O�TE� PROPERLY VA�IOATED 1M15 IS YOUR PERMIT/�•�+.��
- ' �' �' 1 �V _
S�GtiatuaE O� OwNEQ��� OwHEQ Bu��OEA� �O�iE� tOG NS ����E
s �
NEW
ADON
ALTER
[}
[I
[l
Construction Address:
legaf Description:
Owner Name 8s,Ac
Contractor.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRlDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
S7 3 � �.����so,� S� -i�
Q/V Bo��o'�
iN '�
� Nr �
�
Effective 1/1/20Q3
(763) 572-3604 Bidg insp
(763) 571-1287 Fax ��
` �� �('
� , � jI� -
����
��
��
Tel. #
MN LICENSE # �� ��3 �a�'3
Tel.#�/2--�Dy �d�1��
2.���c/ v
/Atta h to his application, a CeRificate of Survey of the
lot, with the proposed construction drawn on it to sca ie.
DESCRIPTION OF IMPROVEMENT
Length Width Height __ Sq. Ft.
Length Width Height _ Sq. Ft.
Length �� Width � HgUGround b%� �� Sq. Ft. �
'on T e: tl 6 � ,� °"'^t-- Estimated Cost: $ .�. % d � � � `� � S . �f
C�nstructi yr
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
•� 2 _
DATE: � 5� d _ APPLICANT: � Tel. # � � �� `� ^�y �
Cali (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. `� .
' CITY USE ONLY -
Pennit Fee
Fire Surcharge
State Surcharge
SAC Charge
: License Surcharge
Curb Cut Escrow
- Erosion Control
Park Fee
Sewer Main Charge
` TOTAL
$ 7. S
$ �.
$ �, , �'( �I
$
$ ��
$
$
$
$
r� �
Fee Schedule on Reverse Side �
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contraetors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
.,
�:. �
� i
i I � i i I i
, j j �
j ; F I '
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_ �_ �, ___
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, _ __ ; ___ � _ .
____. ___..�__ _�_
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:� -_-�_�_:;_....
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-- , __. _ ___I.._..
. i . _.
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�631572-3604 FAX: (7631571-1287
PRINTED WITHOUT ISSUING 1/12/2004
: 5730 JEFFERSON ST NE
: 233024130134
: UNAVAILABLE
: LOT BLOCK
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
�� ��o
PERMIT NO.: 2004-00029 �
DATE ISSUED: O 1/ 12 / 2004
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
GAS PIPING FOR RANGE; VENT SYSTEM OVER RANGE MICROWAVE
# A/C UNITS 0 VALUE OF APPL OR WORK
# FURNACES 0 # GAS DRYERS
# GAS RANGES 0
APPLICANT
WHITE BEAR MECHANICAL INC
2379 LEIBEL ST STE 600
WHITE BEAR LAKE, MN 55110
OWNER
BABOR DANIEL L& PAULA J
5730 JEFFERSON ST 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 local law
regulating construction or the erfo ce of construction.
Applicant � � Date
. � : • /L�%���lr�
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
STATE SURCHARGE, MECH FLAT
HEATING REPAIRS/ALTERATIONS
GAS PIPING FEE
TOTAL
PAID WITH CHECK # 3009
SEPARATE PERMITS REOUIRE� FOR WORK OTHER THAN DESCRIBED ABOVE.
1500
0
0.00
0.00
0.00
0.00
0.00
0.50
15.00
10.00
25.50
OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 - APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
,
. - JOB AI
Residential Rate
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace, , $ 10.00
but not replacement)
Gas Range �$ 10.00
Gas Dryer $ 10.00
*Air Conditioning - All Sizes : $ 25.00
All Others/Repairs & Alterations (LIST ON gCK)
1 jo of Value of Appliance or Work , �'�
C mmer`�dustfial� � v ����{�
1.25 Jo of Value of Appliance or Work .
State Surcharge
TOTA� FEE
REINSPECTION FEE $47.00fHr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property�owner.
TOTAL
�
$ � � C�
$�
$
$
$�
$
$ .50
$
n V
d
�
�
01NNE
Effective On January 1, 2002
BUILDING USED AS
ESTIMATED COST ��DO PERMIT N0. rO�'� � C '�';;'
E
DESCRIPTION OF FURNACE AND OR BURNER
No. of Hea#ing Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size Na
BTU . HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specifi�d agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
+ DATE �� - D �`
a' . A �I
�
�..
Approved By Rough•In Date Final Date
FILL OUT BACK SIDE FOR S�'iIACK VERIFICATION ON REPLACEMENT FUR�IACE
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
i , / —
Pe er
ec ' e By
e eceiv
NOTE: IF PROPERTY IS NOT OWNERlOCCUPtED- A LICEIVSED CONTRACTOR MUST OBTAIN THE PERMlT.
DATE �I d�� D�o YOUR E-MAIL ADDRESS �
SITE ADDRESS
THE APPLICANT IS: (CIRCLE ONE) OWNER ONTRACTO
NAME � a.r, �bo r
PROPERTY OWNER! ppDRESS
TENANT
CITY ( �i STATE ZIP 5���
PHONE # ��D�'— S 1 �. �vU!�
NAME \'� O LICENSE # �' M
CONTRACTOR �DRES�%S � �IO �b
CIN r STATE Yh I�I ZIP SS ( a 3
PHONE # I'3�" `��-i O FAX#
PERMiT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE
TYPE OF WORK ❑ NEW `6� REPLACEMENT
DETAILED DESCRIPTION OF WORK �O1 CPi���_�L��
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED
FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
BATH SINKlLAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER (=35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. (S15)
DISHWASHER LAUNDRY TRAY �_WATER HTR ($35) FOR IRRICaATION
WATER METER O7tiER
Permit Fee $ �� b MINIMUM: $15:00 or 5% of cost of the improvement whichever is
Plan Review $ greater on work tess than $300
Surcharge $ .50
TOTAL DUE $ +GJI� Make checks payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT — NOT VALID UNTIL 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; that the work will be in accordance with the approved plan in the case of all work which
requires review and approval of plans.
NAME OF APPLICANT f.� � � d \ �l DATE � �lr �o '
Piease type or print
SIGNATURE OF APPLICANT � �- h
t.�,. . : ., ; � �r '- �.. ,�z�r �< fda s� s' �.t1 r., �� °" ��r�t-��'•c; k ��''� �� � 4'�k� '� �t"` 3k i x � `F:'�� '�`�„a4 �: i n .
PLEi�SE.NOTE �£pARAi�rP.ERMITS A�E��QI�IE�E� �t�R'� ��F:��1*IG �:��"`f�TG�t.;�������tll��;���� �+,,� ���k � � ��'
CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT
6431 UNIVESITY AVENUE NE, FRIDLEY, MN 55432
(763) 572-3604 ��� �
Building
Inspections
763-572-3604
DATE Q �
SITE ADDRESS �
TH1S APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS I�+ � ���
❑ OWNER �ONTRACTOR
ADDRESS: CITY
PHONE:
NAME:�([.($��
STATE LICENSE #
� ��� 7���
SINGLE FAMILY/NEW
TWO FAMILY/NEW CC
❑ BASEMENT FINISH
❑ DECK
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT_
ROOFING
N[3MBBR OF SQUARES �v
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
Received By: l
Date Rec'd:� %D__ DL
TE_ZIP,
EXP DATE • �
CI u L STATF.�IP ���'�
�E % � t� v � 7.3
�ROOF
❑ SIDING
❑ SWIMMING POOL
O ADDITION
[pAIR �REMODELING
� l`i� i i �s�►� S �'
_LENGTH
❑ HOUSE ONLY
�HOUSE & GARAGE
❑ ATTACHED GAR.AGE
❑ DETACHED GARAGE
OSo�t
❑ Trim
❑ Fascia
❑ DRAIN TILE
❑ OTf�R
WIDTH
HEIGHT
Ft.
BASEMENT REMODELTNG SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of strucwral members to be used
FOR NEW CONSTRUC'fION INCLUDYNG DECKS,
ADDTfIONS 8c PORCHES SUBMTT•
1. Site Pian/Survey showing the existing structures
and proposed project
2. Two sets of cons�'uction plans
WINDOWS 3. Encrgy Calculations
IN EXISTING OPENINGS �Yes �No IACATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING T E 1 97�B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $��.�� � OCCUPANCY TYPE
Pemut Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �5.�. �.SY
$
$
$ ..
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Pernut Valuation Minimum $.50
$5.00 (Staxe Licensed Residcntial Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pemut and I aclaiowledge 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 Cons�uetion Codes; that I understand this is not a
permit but only an application for a pemvt and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w' h re u' review and approval of plans.
SIGNATURE OF APPLICAN • �_ PRINT NAME��� 1�1�DATE