PRE 2010 DOCSVillage of Fridley, M=.
-BUILBUM PERMIT
N 8 8 i
Office of INSPECTOR OF BUMDINGS
Owner
Architect Fridley, Minn., 19
Builder
LOCATION OF BUILDING
No. '� street" -H A� , Part of Lot
Lot --L- Block Ad'"on or sub -Division
DESCRIPTION OF BUILDING
Front a ' '' Depth --' Height stories r ""Manner of Construction
To be used as
To be completed Estimated Cost
Permit is hereby granted to
the building described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
" ra ^~nsp�ctor of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery 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
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
Subscribed and sworn to before me at Fridley,
day of A -D. 19
Minnesota, this
J
SUBJECT
City of Fridley
®12218
AT THE TOP OF THE TWINS
BUILDING P E R
WRECEIPT
NO.
• COMMUNITY DEVELOPMENT DIV.
r 1 � PROTECTIVE INSPECTION SEC.
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF APPROVED BY
L J` 612-560-3450
910-F15
7/3/73
JOB ADDRESS 115 Logan Parkway N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
1
Oak Creek Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Mr. Alvin Reding 115 Logan Parkway N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION CX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBEWORK Re-roof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Asphalt
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
R-1
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
l
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$225.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.5O
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-
$5.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
Cf oT° mg�- " 7- ;?- 93
1 $5.50
SIGNATURE OFCONTR- OR OR AUTR46RIZEDAGENT IDATEI
WHEN PROPERLY TED THIS IS YOUR PERMI
BLDG INSP
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE)
J
0
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME :_A.V BUILDER:
ADDRESS: //,J- /-e ADDRESS :
NO:. //vim STREET:_ Al �r.�GeJ i9 y
LOT: BLOCK: / ADDITION: ~C 67K CePX�
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
ACe ro o'fi Front : Depth: Height
D'V ell,'
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: IA- Estimated Cost:_
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: ,,_vy�.- A✓ / SIGNATURE •
(See Reverse Side For Additional Information.)
(� O
S�
�E_D
e
1
SUBJECT
PERMIT .
City of Fridley
® 3060
AT THE TOP OF THE TWINS
r
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED By
612-560-3450
910-F15
_3 _
JOB ADDRESS
115 LOGAN PARKWAY
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1 1
OAK CREEK ADDITION
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
3 CONTRACTOR MAIL ADDRESS
Z P PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ® ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
9 CHANGE OF USE FROM TO
STIPULATIONS
R�ErQUIRED FOR NmiNG•
WARNING-
� S
Sc'; Before digging C811,10C21 UU1*0
EpRATPErR*4
RMC�IqT
ta.
TELEPHONE - ELECTRIC • GAS EV-
0
REQUIRED fay SAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
FEMM
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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$13,000
$6.50
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$47.88
PLAN CHECK FEE
TOTAL FEE
$54.38
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN P PERLY VALIDATED THIS IS YOUR PERMIT
F-9@�
-30--7 SP
BLDG. INSP
.IIIA _ 30. 1.975
GATE
SIGNA RE OF OWNER IIF OWNER BUILD R) (DATE)
1
APPLICATION FOR RE'SI'DENTIAL., ALTEitATION,
OR ADDITION -BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: • ® J`� �' k) C" BUILDER: 2 / E,
ADDRESS: /� / �� d f,C� ADDRESS:
NO:. STREET:
LOT: BLOCK: r ADDITION: 0 A /2s= F k I`�c-1 Ci r 710 0 aJ
CORNER LOT: INSIDE LOT: e S SETBACK: J (0 SIDE -YARD:
Applicant attach to this form ' wo Certificates of Surve .. of .Lot and .proposed
building location dratan on these Certificates.
i
DESCRIPTION OF BUILDING
To Be Used As :
(-F/-o +j Front: �� �— % Depth: Z c� Height: T
.Square Feet : Cubic . Feet : Lv0 v
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: /�� Estimated Cost: $ Z �®
To Be Completed: 2)ed /976-- )1,C300,
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: Ajf ;2i —76 SIGNATURE : h
(See Reverse Side For Additional Information.)
J
SUBJECT
P
City of Fridley
�33Q5
AT THE TOP OF THE TWINS
BUILDING PERMIT
1f 1
COMMUNITY DEVELOPMENT DIV.
r 1 v PROTECTIVE INSPECTION SEC.
1 � �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
4/24/95
JOB ADDRESS 115 Logan Parkway NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1
Oak Creek Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Steve Montague 115 Logan Parkway NE
571-7574
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION .❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof House & Garage (25 Sq) Tear-off
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Underlayment must comply with
the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
I STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
@
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,875
$ . 94
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-
$43.00
Fire SC $1.88
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTALFEE
19
$45.82
SIGNATU OF CONTRACT R RA ORIZEDAGENT IDATEI
WHEN PROPE VALIDATED THIS IS VUR PERMIT
��
BLD INSP r)AT
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
J
NEW [) Effective 1/ 1/95
ADDN [ ] CITY -OF FR[DLEY'.
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND. R-1 ' ��6-
Building.
-
Building. Permit Application
CanstiuchonAddress: /- BL,¢i✓x�:y /U•.
Legal Description:
:Owner Name .& Address:.:%yE �oN7� Tel: #7_-7'7.
.Contractor: MN ;LICENSE#
Address: Tela.#
Attach to. this application; a Certificate of Survey of the.
lot, with. the proposed construction drawn on it. to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Lengtth� , /Width ` Hgt/Oround Sq. Ft.
OTHER: /C £/�0 A4WSE_ GsA. A� Sf . ��1L
Comer Lot (] Inside Lot [vf' Ft. Yd Setback Side Yard Setbacks
Type of Construction: /)pS 1f o6� Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + OFt = Ft x $ _ $
DATE: APPLICANT: Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ UO
Fee Schedule on Reverse Side
Fire Surcharge
$ /. 3 c�-;
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
O�
TOTAL
$�
STIPULATIONS:
SUBJECT
P
City of Fridley
2 9668
AT THE TOP OF THE TWINS
BUILDING
PERMIT
IPT NO.
`v -_-__- COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
6/11/99
JOB ADDRESS 115 Logan Parkwa
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1
Oak Creek Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Steve & Patty Montague
571-7574
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Greg Wills Exteriors 4246 Royce St NE M is MN 55421
788-0529
20037840
ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION XM REPAIR
0 MOVE ❑ REMOVE
B DESCRIBE WORK
Reside house and attached garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REQUIRED 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 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 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 WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$5380
$2.69
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$125.25
Fire SC $5.38
PLAN CHECK F
TOTAL FEE
Licen SC 5.
38.32
SIGN AE Of CONTRACTOR OR AUTHORIZED AGENT [DATE,
EN RO
81.0-NSP'
LIDA
THIS IS UR P�
17
IlAff
S-GNATURE Of OWNERJF OWNER BWLDERI IDATEI
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �b I
Construction Address:
Legal Description:
Owner Name & Address:"���� �� j 7u� �JJ�4��� � Tel. # S-71– -7S7�1
Contractor: ,�'��1�/ /� �>CT�1; I �� MN LICENSE #. 2-49 0.? -7 141
Address: o �f� S-� ti Tel. #
—F
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
DESCRIPTION OF EMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Estimated Cost: $ J ��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: f 1 APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ IcZ
$
E1
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]
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15
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
i TOTAL FEE
• . Mal MMIAM11
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner'.
>;�IC" tj Crorl`ell, 3MT x /4_c -,u, c;� �ryl
Effective On January 1, 2002
Q ktvf
JOB ADDRESS CjS n e
OWNER_NC-UC.-t 26 i -x
tic, I
TOTAL
BUILDING USED ASReSrVIOL)WR
$-301--L0
ESTIMATED COST PERMIT NO. i
$
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water)arm Ai
$ Trade Name � ruler Size No ®70
BTU 10L HP EDIT
Fuel &4:Lyra Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ The undersigned hereby makes application fora permit for the work herein
specified agreeing to do all work in trict accordance with the City Codes an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct. `
Center Point Energy MGCO ^ATE „-13"10 -2
13562 Central Ave NE . r�
HEATING CO Anoka, MN 55304
Signed TEL # 30.151 kRZ.,
FAX # =Y?2_7153 W16 I �_Dx
•
Approved By Rough -In Date Final Date 3 w o3
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
Stories
Basement
Floor
Floor 2
Floor 3
Floor 4
Effective On Jan 1, 2003
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RAARK All IAaRGR nG MYTI IRGG Tn RF INATAI 1 1=r1 r)N FAr.H FI n()R
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
NO. RATE TOTAL
Water Heater -Gas**
Gas Range** Ir -
Gas Dryer*v
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
JOB ADDRESS 11 �3 L-a<QA>'j P4CZY-V /A_'� N , V_— .
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
U- 1t0 ,20 C)3
Building Used As
Estimated Cost S� PERMIT NO. c) e
PLUMBING COMPANY
SIGNED BY TEL No. 7 - s% —75 % 4"
Approved BYIL Rough -In Date Final Date
$ .50
MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS $20.00
$� PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
� M�a �=-=
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
NO. RATE TOTAL
Water Heater -Gas**
Gas Range** Ir -
Gas Dryer*v
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
JOB ADDRESS 11 �3 L-a<QA>'j P4CZY-V /A_'� N , V_— .
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
U- 1t0 ,20 C)3
Building Used As
Estimated Cost S� PERMIT NO. c) e
PLUMBING COMPANY
SIGNED BY TEL No. 7 - s% —75 % 4"
Approved BYIL Rough -In Date Final Date
$ .50
MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS $20.00
$� PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When ro lar *nn an Pxostinn Mramp,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
specifications 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 current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The eY_ icting cnmenstinn as is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to install a now rnmhusfion air. it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When inc�ll_nn a new ventinn Syc em, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
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 #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
C��-OsE- o�� ' 2—SuP�L`7 x.12 HIEN S
LLos o F F" L A1g, VENTS . 4,00 3 5v PPL\l A) 2 .%
3 RE-TurZbv AI 4z VF -7 I'j Z— S
HEATING CO: o ga l ry 'r--"�z--
Signed By: /*,, Date
i
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
RATE SCHEDULE
Residential Rate
Furnace Shell and Duct Work. Burner -_
Also Replacement Furnace 1 30.00
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace, $ 10.00
but not replacement)
Gas Range X. $ 10.00
Gas Dryer $ 10.00
*Air Conditioning - All Sizes $ 25.00
E�
All Others/Repairs & Alterations (LIST ON BA ) I—,
1% of Value of Appliance or Work ,D� c'r t uw U �S $ l
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ .50
mi
Ettective January 1, 20U3
JOB ADDRESS
OWNER PATT'i Mohl�'AC� U E—
BUILDING USED AS
o0
ESTIMATED COST I5 CD PERMIT NO. ASA 96
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
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
specified 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.
HEATIN"O
Signed��"
FAX #'�`� �� Y'/Y— -7
Approved By Rough -In Date
DATE U/1 b /O �3
TEL # 76Z-5-7 1--7 S ?-4'
Final Date _3 -/ 10
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
r -nm ON Vr-NT, tr=NT CONNFGTQR AND OMR11STJQN AIR VFRIFIGATIr)N
When rapInnin0 an _Yishon Iran _P, 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
specifications 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 current codes and manufacturer's specifications. This does
indude AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes( ) No( )
The P -min inn comb IStinn air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes () No ( )
When required to i etali a naw combusHnn air. It will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes( ) No( )
When jpctallono a new venting i Pm, the undersigned hereby verifies that
it is'a listed assembly and meets the current codes and manufacturer's
spedfications. This does include AGA -LAMA Category I Central Furnace
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.
Thy and SSP/Cnmmnn Vent and Vent r=nnnentor
Yes ()No( )
Information
Apnli nnp
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
Al 1 R4 I R 11Y1-
aC)o 3 sv?PL7 P kfL 1 alt VF -r-07
HEATING CO:
Signed By. Date:
i✓l d V �,r I-MLJLL�'7 iivSfJf=c: l IUN DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBFR OF FIXTURES TO BE INSTALLED ON EACH FLOOR
CliClaiVU i -Al Jail i, -;Uuj
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
NO. RATE TOTAL JOB ADDRESS 111; Lr)cipyin 81A -)E
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas"
Gas Range"
Gas Dryer" _
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
LO - /U 2063
Owner ao-yP0b n1 - GLs)'�l0
Building Used As haaaj.
Estimated Cost Sam= PERMIT NO. ri ,
PLUMBING COMPANY O, L,..1C ftI Q .
SIGNED BY TEL N0.
Approved BY
_ Rough -In Date Final Data
$ .50
TOTAL FEE $� PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
r'OMMON VFNT, VFNT r.QNNFnTQR AND MIVIRUSTION AIR V RIFICATION
When replaning_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
specifications 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 current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The axin inn emmN mHnn air is sized and installed to meet the current codes
and manufacturers specifications. Yes( ) No( )
When required to inetall a new rnmhi istinn air. it will be sized and installed
to meet the current codes and manufacturers specifications. Yes () No ( )
When inc ^wing a n _w venting -ystem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Furnace
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 #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
HEATING CO:
Signed By: Date :
ul
SUBJECT
City of Fridley
4025
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
REC I O.
COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
�4
NUMBER
REV
DATE
PAGE OF
APPROVED Br
� CITY HALL FRIDLEY 55432
1 763-571-3450
910-F15
11/14/03
JOB ADDRESS 115 Logan Parkway NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1
1 Oak Creek Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Patricia Montague 115 Logan Parkway NE
763-571-7574
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
A ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION Lj ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Kitchen alteration
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS ARE REQUIRED 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 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1 ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
@@
@
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$6,000
$3.00
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-
$125.25
Fire SC $6.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN C ECK FEE
TOTAL FEE
$134.25
TUBE OF CO "RACTOR OR AUTHORIZED AGENT IOATEI
HEN PROPERLY VALIDATED THIS IS YO R PE MIT,,..
B G .NSP
f�ii
S,GNATURE OF OWNEROF OWNER.U'LDFRI IDAiEI
ul
NEW [ j CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [v,)' SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address: y m u ��/o ry c�r Tel. # 7/ 5%
Contractor: ''m MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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 9 Sq. Ft.
Length I Width
Width
n , , -
Height Sq. Ft.
nd Sq. Ft_
Construction Type: R67`1012 e --Z- Estimated Cost: $_ 61)60
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: ah APPLICANT:.ki k ,.: r. C C' Tel. #
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.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL $ -13 LLt a
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [ ]
• CITY OF FRIDLEY PERMIT NO.: 2003-00079
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED:
572-36U4 YAX: (763) 571-1287
PRINTED WITHOUT ISSUING 11/14/2003
ADDRESS
: 115 LOGAN PKY NE
PIN
: 103024420022
LEGAL DESC
: OAK CREEK ADD
: LOT 6 BLOCK 1
PERMIT TYPE
: BUILDING
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: ADDITION/ALTERATION
VALUATION : $ 6,000.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651454-0002 FOR UTILITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER SECTION
310.9.1.2 OF THE 1997 UNIFORM BUILDING CODE WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF
$1,000 ARE MADE TO RESIDENTIAL DWELLINGS.
APPLICANT
MONTAGUE, PATRICIA & STEVEN
115 LOGAN PKY NE
FRIDLEY, MN 55432
OWNER
MONTAGUE, PATRICIA & STEVEN
115 LOGAN PKY 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 wort
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
regfiIa'ting cons"ction or the performance of construction.
BUILDING PERMIT FEE 125.25
FIRE SURCHARGE 6.00
STATE SURCHARGE, VALUE 3.00
TOTAL 134.25
PAID WITH CHECK # 6287
SEPARATE PERMITS REQUIRED FOR W(?RK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY PERMIT NO.: 2003-00079
6431 UNIVERSITY AVENUE NE DATE ISSUED:
FRIDLEY, MN 55432
(763) 572-3604 FAX: (763) 571-1287
PRINTED WITHOUT ISSUING 11/14/2003
ADDRESS 115 LOGAN PKY NE PERMIT APPLICANT:
PIN 103024420022 MONTAGUE, PATRICIA & STEVEN
LEGAL DESC OAK CREEK ADD 115 LOGAN PKY NE
LOT 6 BLOCK I FRIDLEY, MN 55432
PERMIT TYPE BUILDING
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
VALUATION: $6,000.00
KITCHEN ALTERATIONS PER PLAN.
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 5 PM
INSPECTION TYPE DATE INSPECTOR INSPECTION TYPE
FOOTING
FOUNDATION
ELECTRICAL ROUGH -IN
PLUMBING ROUGH -IN
HEATING ROUGH -IN
FRAMING
INSULATION
DRY WALL
SMOKE DETECTORS
ELECTRICAL FINAL
PLUMBING FINAL
HEATING FINAL
FINAL
DATE INSPECTOR
INSPECTION COMMENTS:
IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL
WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT.
THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE.
I I I
CITY OF FRIDLEY PERMIT NO.: 2004-0035ke!�(6431 UNIVERSITY AVENUE NE
rAmV reerrvn. 111/14/1711Ad
r n�LLJu z , im'm Z10'qj.&
572-3604 FAX: (763) 571-1287
ADDRESS
115 LOGAN PKY NE
PIN
103024420022
LEGAL DESC
OAK CREEK ADD
LOT 6 BLOCK 1
PERMIT TYPE
ELECTRICAL
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: FEE SHORTAGE
VALUATION
ENTER FEE AMOUNT 44
APPLICANT
MONTAGUE, PATRICIA & STEVEN
115 LOGAN PKY NE
FRIDLEY, MN 55432
MONTAGUE, PATRICIA & STEVEN
115 LOGAN PKY 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 wort
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
FEE SHORTAGE AMOUNT
TOTAL
PAID WITH CHECK # 6437
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
44.00
44.00
�Fz1 bucc c4,41 GKRk-b6I d6 i - "q
Building
BUILDING
Permit No • - , '?
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
DATE
YOUR E-MAIL ADDRESS Y RC1`
pc ,,—C 6 y Y
SITE ADDRESS
�S
THIS APPLICANT IS:
❑ OWNER YGONTRACTOR
PROPERTY OWNER/
NAME rpbn
TENANT
4-0
ADDRESS: T CITY
STATE—
ZIP—PHONE, T)03. 511 — T51 y
NAME:
Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113
STATE ZIP
WITH APPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/NEI
PROPERTY TYPE
❑ TWO FAMILY/NEW G - 651-264-4777
❑ ADDITION ❑ GARAGE/SHEDINDOWS
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF C3DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK-
❑EW 13ADDITION
AINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:NQ 0
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GAMAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
❑ Vinyl
❑Soffit
FOR NEW CONSTRUCTION INCLUDING DECKS,
Cl Aluminum
❑ Other
❑ Trim
ADDITIONS
1.
& PORCHES BMIT•
Site Plan/Survey showing the existing structuu
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
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
TOTAL JOB VALUATION $ 1533 1-- U.B.0 FEE OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary
$ S S_ Make checks oavable to: Citv of Fridlev
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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understated this is not
permit but only an applicatlop for a permit and work is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work ich requir eview and approval of plans.
SIGNATURE OF APPLICA PRINT NAME { DATE dj�f
Building
BUILDING
Permit No.: COS b
Inspections
RESIDENTIAL APPLICATION
Received By: I
763-572-3604
CITY OF FRIDLEY
woopwa izinnq
DATE S G►,�-�5 YOUR E-MAIL ADDRESS W JK�G� t 11S
iLO .�(j
SITE ADDRESS INS Lm Q n 2Ea j V -L&-" Nj, e
THIS APPLICANT IS:
4.0# EIOWNER itChO,�NTRACTOR
PROPERTY OWNER/
NAME�� • `,a n}(.,:k (,%—Q
TENANT
ADDRESS: CITY
STATE ZIP
PHONE: aLa J �' ...
NAME:
Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE #_ 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113 t
STATE ZIP
WITH APPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/N0
PROPERTY TYPE
❑ TWO FAMILY/NEW G 651-264-4777 _
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING I] OTHER
0 SWIMMING POOL
TYPE OF WORK:
❑ NEW 13 ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: IQ_Q z.&0' (, �,�;��
T�LENGTH
"
SIZE OF IMPROVEMENT WIDTH
HEIGHT . Ft.
.ROS
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
❑ Vinyl
❑Soffit
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Aluminum
❑ Other
❑ Trim
ADDITIONS_
1.
& PORCHES SUBMIT:
Site Plan/Swvey showing the existing structur
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF -RWdJGpev-. a -toXy&
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 THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 2 t-$4 a ' OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attar
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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an application for ait and work is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work ich eview and a roval of plans.
�j
SIGNATURE OF APPLICANT PRINT NAME /i101.tt�. ��Q(1Sdj/� DATE Iv