PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N?.(:-EO1
Date:
Owner: Builder — —
Address Address
LOCATION BUILDING''"
No. '* Street Part of
Lot 74EL__ Block Addition or Sub -Division . " "-.0
Corner Lot _ Inside Lot AEf'! Setback Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
T U ae
Front Depth Height %� /„ " Sq. Ft. Cu. Ft. 0
Fro t DeptheighSq. Ft. Cu. Ft.
AV
Type d ci3en _ Fit. C�� � _ To be Completed
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with ail provisions of
ordinances of the city of Fridley.
At
In consideration of the payment of a fee of$� - , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
e in,7;d
dley, hin thnances.
NOTICE:
ihb porn* don not cover the construction, hutaWtion for wWno, phmtbiag, on ,heating, sewer or water. Be core to see
the BWMbg Inspector for npm to pwm% for these boon.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEX, MINNESOTA
Owner's Name Builder
Address® Address
LOCATION OF BUILDING
r
Nb. - ` 6 Street Part of Lot
o
-Lot__/ Block Addition or Subdivision ,�_
Corner Lot Inside Lot Setback Side -Yard
SM1ER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
To be used as:
DESCRIPTION OF BUILDING
FrontDepth Height
sq. Ft. cu. Ft._
Front Depth Height
sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
To be Completed
The undersigned hereby makes application for a permit for the work
herein specified, agreeing to do all work in strict accordance with
the City of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and co t.
DATE a" SIGNATURE r
(Schedule of Fee costs can be found on the Reverse Side).
City of Fridley
Application #or Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
y?�
3
�J
Z
Y
C Z
N
~Z
O�z
W
Z
�d
too
•
F
t
N
WATER HTR.
GAS
ELEC
Base
1st
2nd
3rd
_
4th
• Future Connection Openings
New Fixture, Old Openings
I
Connected with
Sewer �
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
0
Number Fixtures
....... .............. x $1.50 $�—
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ...... x 3.25 $
Water Heater (Up to 200,000 BTU) ...... x 2.00 $
New Ground Run Old Bldg . ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $—%
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this applicatio)f are true and correct.
Owner
Kind of Building
Used as
- -3�-
To be completed about
Estimate ost, $
Ol New. ding Permit
ROUGH
FINAL
.QW42 2M
19_&—�'
Application for Power Plants and Heating. Cooling. Ventilation, Refrigeration and
. Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MEC*. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
r
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM as HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq.- ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ...................
2.50
$
OIL BURNER—to 3 gal. per hour 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50. $
Additional Fixtures x .50 $
Gas Range to 200,000 BTU x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $ r G 0
ROUGH
FINAL
—
A
Dept. of Bldgs. Phone SU 4-7470
-44- Z. f- 4� 1-- L;f
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby `declares that all the facts
and representations stated in this application are /t e and correct.
(1, Frifty. Minn /6 / -'- 18
Owner
Kind of Building
Used as
To be completed about _
C
Estimated Cost, $
Old ewa lding Permit No. e d' %e3 Permit N
DESCRIPTION OF WORK
HEATING or POWER am, Hot Water, Warm Air—No
Trade Nam / Size No
C
Capacity Z Sq. Ft. E.D.R BTU H.P.
Total Connected Load ) 6 D Kind of Fuel-: -�
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVERT
Signe vxr_z/v
r
By
- 42 2M Business Phone No
11
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN.
Weatherstrips A.S.H.V..
Guide Construction No. Insulation
Windows Doors Reference Out. Wall I Int. Wall Ceiling Roof Floor Kind How. Applied
Yes—No I Yes—No 19—
/ F1.I Z X�? - Room Length Jq- 4 Width // Heiaht V II Fl.l Room I Length Width Height
Windows and Doors—Crackage and Area
I
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
7
I I
---[-
I t I
I Coef. Btu
Coef. Btu
Coef.
Btu
Infiltration
s'o
3
,'$4
Glass
Z s
6,0
5 a a
Exp. wall
3 T
Int. wall
Q ell
Net exp. wall
j
la
55-4
Int. wall
S
3g,y D
Ceiling
15�-Z-x
Floor
f
3 -r -4
Total Btu.2- $, ,� 300-1
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 f 5' .— A --R-6om I Length y 7 Width 2 z Heiaht 7 -
Windows
Windows and Doors--Crackage and Area
I
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lighte of crack sq. ft.
7
I I
---[-
I t I
I Coef. Btu
Coef. Btu
Coef.1
Btu
Infiltration
s'o
Ji
/moi® o
Glass
Z s
6,0
5 a a
Exp. wall
3 T
Int. wall
Q ell
Net exp. wall
/103
15eg
515-3 Z.
Int. wall
S
3g,y D
Ceiling
15�-Z-x
Floor
f
3 -r -4
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
I
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
I I
---[-
I t I
I Coef. Btu
Coef. Btu
Infiltration
Glass
Glass ll,-,4,rZo
ss 53,9o-?
Net exp. wall
Exp. wall
[° ®P,ae 41 /.-led
Net exp. wall
/Alv T _ / ®
3 T
Int. wall
Q ell
Ceiling lyT
7 z o o a
13 U
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
I
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
I I
---[-
I t I
I Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors--Crackage and Area
Width Height No. o! Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane llghts of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
D136 ' 9 s
ie L � e5 Z �'` �°
HEAT LOSS CALCULATIONS DEPARTMENT OF BZJILDINGS / MINNEAPOLIS MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof LFloor Kind How. Applied
No a No 19—
F1.1 . Room Length -7,,4 Width Height Jr II Fl.l /. 7- Roomy Length ' Width Height
Win ows an
Doors—Crackage and Area
Infiltration ? /1
Width Height No. of Lineal ft. Area
No. of pane of pane llghts of crack eq. tt.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
O
T Af
Coef. Btu
Coef.1
Coef.1
Btu
Infiltration
r� ,
, �/
Glass
L
�� G
v
Exp. wall
Int. wall
Net exp, wall
r
/.-j
--7,/64
Int. wall
Floor
Ceiling
;r?s
f✓t sI
Floor
Total Btu. I / 11 �e 9
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room I Length Width Height
Windows and Doors—Crackage and Area
Btu
Infiltration ? /1
Width Height No. of Lineal ft. Area
No. of pane of pane llghts of crack eq. tt.
? 72
z 6
T Af
Coef. Btu
Coef.1
Btu
Infiltration
9-7
1"7 .7 Sir
Glass
Floor
7- 20 9e
Exp. wall
�� G
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Net exp. wall
Int. wall
Ceiling > ,-
,
/ 51-4/ fj
Floor
Total Btu. I
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F/1-1 Room I Length Width Meight
Windows and D ors—Crackage and Area
W1dth Height No. of Lineal ft. Area
No. of Wane of Wane lights of crack ec. ft.
JCoef.j
Btu
Infiltration ? /1
// -/ p
Glass Z10
z 6
Exp. wall
Coef. Btu
Net exp. wall (
o
Int. wall
9-7
Ceiling
+�
Floor
m
r 7 -
Total Btu.
�� G
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. o pane of pane lig to of crack sq. ft.
Coef. Btu
Infiltration 73
Glass
=57
Exp. wall
9-7
Net exp. wall
Int. wall
Ceiling
m
r 7 -
Floor
f.
Total Btu.
Required sq. ft. E.D.R. or sq. ims. W.A. Leader area
F1J I Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. B
Infiltration
Glass
9-7
Exp. wall
Net exp. wall
Int. wall
Ceiling
/4
Floor
f.
Total Btu.
Required sq. ft. E.D.R. or sq. his. W.A. Leader area
A.1 2 m I Lena-th2-Width eisrht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
/4
Int. wall
Ceiling
70V C.0
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Y
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING
SYSTEMS AND DEVICES ,-i
�`
JOB ADDRESS Zf c &f
RATE SCHEDULE
a
The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes ar
Furnace Shell and Duct Work, Burner -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$ 20.00
$
representations stated in this application are true and correct.
(Side Vent - FIII Out Back)
1995
Gas Piping (Needed with new furnace)
$10.00
$
269
OWNER
Gas Range
$ 10.00
$
BUILDING USED AS J l
Gas Dryer
$10.00
$
CL
NO..,
ESTIMATED COSTPERMIT
*Air Conditioning - All Sizes
$10.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
Commercial/Industrial
BTU HP EDR
1 % of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
TOTAL FEE
FEE $30.00
*Air Conditioners can no Ubi placed in a side yard without
written permission from adjoining property owner.
I
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY f
Signed By-tdel No.
_= Approved By ` Rough -In Date Final Date4Z�
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
CHIMNEY 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
( )
S.
Meets all current Code requirements for .size
and total BTU's connected
Yes ()
No
( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes ()
No
( )
8.
Has combustion air been provided for water heater
Yes ()
No
( )
Remarks:
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Stories
Basement
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Ba. h....
Wash Floor >GtOh<::: Auto.
Urinal 1`u'> Shower ;SinLTrayaiuh>w'? Drain .Wash
NO. RATE TOTAL
New Fixtures 3
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type .
$ 7.00 It 2-11,00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Effective On March 1, 1996
Gas iVl(SC>>" Water
Heater
Range
`f<`<>>
Ext.
:...... Gas
JOB ADDRESS_ L-�Z.�c� Litrt,2_ AJ . �. 4--k4 CrL y
The undersigned hereby makes application for a perm it 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 AA,
Building Used Asi,,�v
Estimated Cost
$15.00 PLUMBING COMPANY
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .5500%
TOTAL FEE
40/1-1 .1996
PERMIT NO.__ ,` °��
SIGNED BY TEL NO. 5-1 -17`Jsc
Approved Ely /���U�'� Rough -In D
g ate Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SO INCHES.
SUBJECT'755170*_'
IT 0.
City of Fridley
-
2 6 0 0 4
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
I �• ______ COMMUNITY DEVELOPMENT DIV.
I v PROTECTIVE INSPECTION SEC.
r
1 �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
4/29/98
JOB ADDRESS 6565 Lucia Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
12
1 Don's 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Michael Broos 6565 Lucia Lane NE
571-7756
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
8 DESCRIBE WORK
Reside House; Soffits & Fascia; Replacement windows; new front door
9 CHANGE OF USE FROM TO
STIPULATIONS Install building wrap and have inspection of same
unless manufacturer
states wrap is not necessary. Install smoke detectors to meet the State Building
Code. Install soffit ventilation to meet the State Building
Code.
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 60 DAYS, ORIF 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
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
$9,000
$4.50
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-
Fire SC $9.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$149.75
PLAN CHECK FEE
TOTAL FEE
14 2
4
1 $163.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPE XALIDATED THIS IS YOUR PERMIT
Lglb INSP
r�ATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �pvq
ConstructionAddress: (p5 (o S s �� a� LA'r\.� A -
Legal Description:
Owner Name & Address: Ilkcw"a o Q(� (J'� c�e�5 Tel. # 5-7 1--T-75(,
Contractor: ow r"¢ MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA:
Length
Width
Height
Sq. Ft.
GARAGE AREA:
Length
Width
Height
Sq. Ft.
DECK AREA:
Length
Width
Hgt/Ground
Sq. Ft.
OTHER:
Q A ,
y 0-
w,ro-o
4-n e,—
o0 -S � 4r9-.-- Az)o r
Construction Type:
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $
= $ °I loon
DATE: W�A q06- APPLICANT: `►�r � f� Tel. # 5�7 1 +4
so(- --) IZ3 w
Permit Fee
$
Fire Surcharge
$
State Surcharge
$ G
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
4'��Ow- 0,&Wf
.001 of Permit Valuation (1/10th%) A / 510,, q
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors) '*'4464tz
Alt. "A" or Alt. "B" Above 6aw.
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
City of Fridley�o
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
PSR
_�,
i 24282
Ir
` • _ COMMUNITY DEVELOPMENT DIV.
r 1 � PROTECTIVE INSPECTION SEC.
i
CITY HALL FRIDLEY 55432
612-571-3450
R
^D
NUMBERREV
910-F15
DATE
6/18/96
PAGE OF
APPROVED By
JOB ADDRESS 6565 Lucia Lane NE
1 LEGALLOT
DESCR.
NO.
12
BLOCK
2
TRACT OR ADDITION
Don's 2nd Addition
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Michael Broos 6565 Lucia Lane NE
571-7756
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 I ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Interior alterations to basement
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
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
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$4,500
SURTAX
$2.25
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
C4 I t %t a
PLAN CHECK FEE
TOTAL FEE
$106.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
WHEN PAOPERL DA D THIS IS VOU PERMIT
�MATEs
BLDG 1NSP
GATE
SIGNATURE OF OWNEROF OWNER BUILDERI TEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
ConstructionAddress: (05(x, S LL'LtA —LAY— 9 t • :..
Legal Description:
mf
Owner Name &Address: `.k,{�p� (�. �S 5 Tel. # S
Contractor:
Address:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: rf-nr.� .b
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ 4 , SpQ
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: %l $ (Q�_ APPLICANT:
A k c,I., , (X. Q4ocLQ Tel. #
CITY USE ONLY
Permit Fee
$ . 71
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 2• Z
$.50/$1,000 Valuation
SAC Charge
$
$900 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 [ ]
TOTAL
STIPULATIONS:
SUBJECT
PER
City of Fridley
8 4 8
AT THE TOP OF THE TWINS
BUILDING
PERMIT ('i'6'
r
1 ,
_______ COMMUNITY DEVELOPMENT DIV.
V
PROTECTIVE INSPECTION SEC.
,
r
7(039
1
NUMBER
REV
GATE
PAGE OF
APPROVED
APPROVED BY
CITY HALL FRIDLEY 55432
CITY
612-571-3450
910-F15
7/28/98
JOB ADDRESS
6565 Lucia Ln
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
12
2
Don's 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mike Broos
571-7756
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Quality Contractin 11380 i t
427-7733 7035
4 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 ❑ ALTERATION N REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (19 S) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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 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
158
$.79
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF NY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT N HEP RFORMANC OF CONSTRUCTION.
$51.25
Fie SC $1.58
III
PLAN CHECK FEE
TOT EE
I
7/_a4S
62
P OPE
ALIDA E THIS IS UR PERMIT
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT I (DAT
r BLD -NSP
r
GATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �b G
ConstructionAddress: to 2-1
.� C:� 6 6s�--
Legal Description:
Owner Name & Address:
Contractor:
Address: A/* 3 a
4d . C
Tel. # iS 7 i 77S-(
MN LICENSE # &
Tel.# �f2"?
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: Length Width Hgt/Grouu d Sq. Ft.
OTHER: • /g ol� I q ��� � r (." ;Z .
Construction Type: e 1- a f r -e V 0 timated Cost: $ �s
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 F = Ft x $ _ $
DATE: 1_2 �(- APPLICANT- Tel. # 7 ._ T?
TOTAL
STIPULATIONS:
r
CITY USE ONLY
Permit Fee
$ �� ��
Fee Schedule on Reverse Side
Fire Surcharge
$ ��
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 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 [ ]
TOTAL
STIPULATIONS:
r
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION �..�i % � y ell. 5(f J
Construction Address: � � �� �- U Ll � �C O� �6®
Legal Description:
Owner Name & Addressor
Contractor: % Q
Address:
Tel. # LU- 5 71 - -75to
MN LICENSE # r-QO cM
Tel. #
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: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: (, 18 ItzC ,% � GlarEstimated Cost: $ C> • 00
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: ) I u . APPLICANT: V
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
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
$ B3 --Z-
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ 7/•s7et"" STIPULATIONS:
Building
MECHANICAL
Permit No.: 01jo 4-W
InspectionsW��
RESIDENTIAL APPLICATION
Received By
763-572-3604
Da ,APR 200
CITY OF FRIDLEY
763-502-4977 FAX
EFFECTIVE 2-19-09
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS &5& 57 L IA e_t r, L n
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: Mike s
OWNER/
ADDRESS: & S40!5 CITY STATE ZIP
TENANT
PHONE: -7&3 -$ 7I -
CONTRACTOR
COMPANY NAME: - - -
x
CONTACT PERSON''® 8 Home Tedutdogw% I=
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # Ucense 20512080 EXP DATE
_9700_W_FiilMl&W
LICENSE WITH
AVS
ADDRESS: Roee.Kltle. MN 55113 . CITY STATE ZIP
APPLICATION
PHONE 'L�-851/833-2581 FAX
PERMIT TYPE
RSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK'
kNEW ❑ REPLACEMENT ❑ ALTERATIONIREMODEL
DETAILED DESCRIPTION OF WORK 'jr �. l I 6AS W e-
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT SERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: Aj CG 4 a 1 w � o r MODEL: 14 o u Lk 7i3 SIZE/BTU Q ,&-x-eV
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZE/BTU
_A1C $25.00 jFIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10,00 _GAS DRYER $10.00 _POOL HEATER $35.00
_DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
„y R� � —�.: � ..i� <5��� �� � a.. troy. • ;.r��' ys�� � y rEA €� � bt � sE �� € �,.� �1
S.� d bkn - sE x"�'
apt � "� '�"z Y`�..y
�`"£ _ r _.,� x,. % a d 3 ,y � .`�"„� ;z' } �` •F,=
�•r> � ,� '%`:✓S� U4 � d� � ) �n� i ��'�� �e�ft�CW�Z t€ b5�3��cM'�` r�z wZ� N2
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I 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.
SIGNATURE OF APPLICANT - PRINT NAME 1CV 1 n fS C DATE 13JO
F y T
k .ns Y.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977