PRE 2010 DOCSCity of Fridley, Minn.
BUR DING PERMIT N° 5269
Date: ±ice,
Ovvner: d' .,�•_c' (� ".,'" Builder --
Address Address "} --
t LO IO F BUILDING
No. —� Street' _ _ Part t
Lot rs _ Block--;sr`�"--- Addition or Su on
Corner Lot Inside Lot ^'� "" Setback 1; n —_ _ _ Sideyard 44J
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To• u 1 f Ij
� ' Front Depth Height Sq. Ft. Cu. FtG*r
Ferro Depth o Height �R Tj Sq. Ft. Cu. Ft.
Type of Construction : , e Est. Co �L '""""iro 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 all provisions of
9rdinances of the city of Fridley.
�n
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
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time uponvi tion y of the provisions of said
ordinances. .^"
Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure _to see
the Building Inspector for separate permits for these Items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Builder ---'
Address
Address --i Ar`�
No.
LOCATION OF BUILDING
Drw�
Lot 3 Block.- Addition or Sub.Div
Corner Lot.Inside Inside Lot 1/ Set Back
of Lot
SEM ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
cx-�
Front Depth 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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and correct.
DATA __ J � � � �" I SIGNATURE
(A Schedule of Fee costs can be found on the 1teverse Side.)
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SU 4-1
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
10
Z
Y F
K Z
Q
V4y�
Z
Yf
O
�a
W
z
7Z
(N9
Z
z
e?a
F
N
WATER HTR.
GAS
ELEc
3�
��
o�
uJo
cgm3
t9 °d
U4n
t90
Base
1st
j
1
2nd
_
3rd
4th
• Future Connection Openings
Connected with
Sewer
New Fixture. Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
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 $a- M
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 a' IS -0
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 apn�e-
tion are true and correct.
d� Fridl�yl lylinn
Kind of
Used as
To be completed about
Estimated Cost, $
Old ew. uilding Permit
ROUGH ✓
FINAL
a z 2M 7.39
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 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $—
each add. 60,000 BTU ........................ 2.00 $ _
Replacement of Furnace ............................. .§.00 $
Repairs & Alterations—up to $500.00 ...:e ............ 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or 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) ................. I ..... 5.00 $—X
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
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE $
111,
Dept. of Bldgs. Phone SU. 4-7470
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 true and correct.
Owner
194
Kind of Building
Used as
To be completed about
Estimated Cost, $ `
Old New uilding Permit No. L1 c6 5?/ Permit No. IS'/ 7
DESCRIPTION OF WORK
HEATING or POWER PIJUM—Steam, Hot
Trade Name Size No-6—?JZ/00 C
Capacity Sq. Ft. E.D.Re520BTU H.P.
Total Connected Load 4! � ; Kind of Fuel
BURNER — Trade Name_ Size No
Capacity Sq. Ft. E.D.R BTU H.P.
'-j , L�- a ' '/1'Signe
By
Ir
.J-,j,� -4z 2M7-39 Business Phone No-
(REMARKS -OVER)
D•J6 r v �®J ® ���� --_
HEAT LOSS CALCULATIO S �%M DEPARTMENT OF BUILDINGS f�T.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
ows P09rs Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
o I e ler' 19_
Room Lenstth�/ Width /SG Heistht A 0 If Fl.l n Room I Lenstth/4/ Width �� 'Height ®
Windows and Doors—Crackage and Area
--
.
Width Height No. of Lineal f . Area
No. of pane of pane lights o�fcrack sq. ft.
g
�0 1 S®. ® /,fo
Exp. wall -�
All�"p
Net exp. wall
/�G.
174
/ ,9
Coef.
Btu
Infiltration
eO3
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
--av
746v
Exp. wall G
?/,
Glass
Exp. wall
Net exp. wall
Int. wall
C-6,
/®
'Q
40
Exp. wall .fes'
1
/p�sv
Floor
Int. wall
Net exp. wall
Net exp. wall
Ceiling
.21910
Int. wall
Int. wall
® C
Ceiling
Ceiling
/6(�®
Floor
Floor
®
Total Btu.
Require . E.D.R. or sq. ins. W.A. Leader area
1 m I Va jur A R.°.°,.. 11 e....+6 % 7 QJaok /9
Win and Doors—Crackage and Area
--
.
Width Height No. of Lineal ft. Area
No. of pane of pane lllffhtts off crack eq�Jft.
Ky
Exp. wall -�
Net exp. wall
Coef.
Int. wall
Infiltration
Coef.
Btu
Infiltration
eO3
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
--av
746v
Exp. wall G
Ise-
Glass
Exp. wall
Net exp. wall
Int. wall
C-6,
/®
Ceiling
Exp. wall%
1
/p�sv
Floor
Int. wall
/-2415-
Net exp. wall
Ceiling
0 16
Int. wall
® C
Ceiling
Floor
®
/
Total Btu.
Required s D.R. or sq. ins. W.A. Leader area
FLINPVe Room I Length % — Width
Windows and Doors—Crackage and Area
Il
Height No. of Lineal ft. Area
Na. of pane of pane lights of crack eq. ft.
e "-7/1 �L /% �1 �.
Coef.1
Btu
Infiltration /
Width Height No. of Lineal It. Area
No. of pane of pane lights of crack sq. ft.
Glass
Exp. wall -�
Net exp. wall
Coef.
Int. wall
Infiltration
Ceiling T /®
--?f
1
Floor
Total Btu.
eO3
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
--av
746v
Exp. wall G
Windows and Doors—Crackage and Area
Width Height No. of Lineal It. Area
No. of pane of pane lights of crack sq. ft.
]j
Coef.
Btu
Infiltration
Infiltration
--?f
1
/.;;v
Glass
11,700
--av
746v
Exp. wall G
Ise-
Exp. wall
Net exp. wall
Int. wall
C-6,
/®
Ceiling
®
/p�sv
Floor
Int. wall
/-2415-
Total Btu.
Required ft. D.R. or sq. ins. W.A. Leader area
Fl.l v Room 1 Len9A J/ Width eight /
Windows and Doors—Crackage and Area
Width Height No. ofLineal it. Area
No. of pane of pane lights of cracksq. ft.
]j
Coef.
Btu
Infiltration
45-
9d
11,700
Glass
J'
Ise-
Exp. wall
C-6,
Net exp. wall
/®
o
Int. wall
Ceiling
6®
Floor
® C
Total Btu. SSS&
Required sq. ft. E.D.R. or sq. iris. W.A. Leader are;/jHe;sthtf/ F1.1X—. /;e _ Room I Lenath -fl ff Width
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
T 3 %§-
Coef.
Btu
Infiltration
45-
Glass
Exp. wall
Net exp. wall
®
Q
Int. wall
Ceiling
6®
Floor
® C
Total Btu. 16-.5
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
City of Fridley, Minn..
BUILDING PEPMT
t
Owner:
6ea el
Builder
Address
Address
LOTIO , OF U ING
No. � Street o Part o t
Lot Block - Addition or Sub -Di
Corner Lot _ Inside Lot �9�back �_ ideyard s
Sewer Elevation _ Foution Elevation
DESCRIPTION OF BUILDING
oe
T lat,
Front Depth _ Height Sq. Ft. 7A` Cu. Ft. �
Front / A0 Depth _ 1--2eight /_6 Sq. Ft. Cu. Ft. 99-0
Type of Construction Est. Cost IV 12!e '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 compliange with all provisions of
ordinances of the city of Fridley.
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
done in, around and upon said building, or any thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reg location, construction, alteration, maintenance, repair and moving of buildings
we city limits and permit may be revoked at any time�p� vio of the provisions of saidcm
Building Inspector
NOTICES
Sb perm* does not corer the construc&n, hufallaMon for whium plumbing, one heathrg, Sewer or water. as sere to see
the MIA* hopecter for Separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
06 t �,a' S
LOCATION
NAME;° G/,d %
fti9/ySE/r/ BUILDER
�iflfl� %Z%P
ADDRESS
/® �! ® �f�✓®.E
. ,Qi P 16F • ADDRESS -/050
le/y,0�f
-4.
AR- P-4-
LOCATION OF BUILDING
No. "d 5W Street /—/, � Part of Lot
Lot 3 Block Addition or Subdivision 1-y"W#,4A-
Corner Lot Inside Lot � Setback Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this,form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates..
DESCRIPTION OF BUILDING
To be used as: ' �—
�Ti9/PA(d� i Front f 7 �F1'h aZ Height
Sq. Ft. Cu. Ft.,2�
s Front ,/ G Depth ci- d --Height fc�
Sq. Ft. �- Cu. Ft. j
Type of Construction �/i��%%/_= 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
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE G / y /lv 3 SIGNATURE �� D
(Schedule of Fee Costs can be found on the Reverse Side).
SUBJECT.ERMI_.
City of Fridley
o 18719
AT THE TOP OF THE TWINS
BUILDING
PERMIT
_
r
�
EIPT NO_.
•COMMUNITY DEVELOPMENT DIV.
may____.__,
r PROTECTIVE INSPECTION SEC.
r
/
1 i
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
j 612-571-3450
910-F15
10/22/86
/
JOB ADDRESS 1050 Lynde Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
3
Lyndale Builders, 6th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Walter Hansen sane
571-1956
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
same Same
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
R-1
7 CLASS OF WORK
❑ NEW IR ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
15' x 22' living area addition
9 CHANGE OF USE FROM TO
STIPULATIONS
1. Provide fire alarm in basement and in hall
leading to bedroans
in existing house.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Frame
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
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
$16,300
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.
$122.50
PLAN CHECK FEE
TOTALFEE
$30.63
$161.28
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI .,
%
r WHEN PROP
LY D TED
IS IS YOU PERM
4
7 'w pa a—
It ZZ
BLDG INSP
SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI
f1ATE
NElf; [ ]
ADDl:. [;�J
ALTER. I J
Construction Address
City of Fridley
FR -1 AND R-2 i
Building Permit Application
Effective 4/1/8c
Legal Description:
Owner Name i Address: �A%4� Tel.
%� i J S
Contractor: Tel. s 7/" /9S�
Address: 1'5� S G �yly�/"
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Corner Lot [ ]
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
%S i. o't2FT-
Length Width7• Height —_ Sq. Ft.
Length Width - Height Sq. Ft.
Length __ Width - Hgt/Ground Sq. Ft.
Inside Lot [XJ Ft. Yd. Setback - Side Yard Setback
Type of Construction: ",12/27-P Estimated Cost: 'Z
Approx. Completion Date: ( �7
`� 4 r)� g te) "^ -Z L Alt. A A l t P
Proposed Driveway Width If New Opening Is Desired:�
See
� Back Page for Explanation
� 69L 7�{� / - Nlr� ly 5 E 1'U Tel. !1
5
DATE: //3 'a-/ -
APPLICANT:
CITY USE
ONLY
Permit Fee
.�
Fee Schedule on Reverse Side
Plan Check
C� .���
25% of Building Permit Fee
State Surcharge $,8
$.50/$1,000 Valuation
SAC Charge
4
$475 per SAC Unit
Park Fee
$
Fee Determined by Engineering
Sewer Hain
Charge
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
I
STIPULATIONS:
ppo-% &
F16-1 A'C Aaw% /il.
&j.-4on6 "l 1 %},/) t,,j
z �U '
Lond Planningcfa&"4r"L 075-11�hwy ACS A[E.
Lond Survey�y Afhvgwl�s 2/.
SOUS TFStf;?y ENGINEERING, INC. Afaix°'°
Civil b Munuipol I (` J Sl/nrrf 4--61166
Enpeermq Engineers SurVe DA5
v�eT iP
• _
certificate of sur��1" E-1 �. M DEVELOPMEMT CO
-7 5,3 rew
LT 3 BLOCK 3 —�-
LYNDALE BUILDERS
. •
6TH ADDIT ION
/ hrxrby cern y #at' + mc, rePM5eftl4h� 7 Ora survey el& ,ivcw ries eme Air dsua►&cl laid; wad
o�'f6e lnrvlion cj'on a�Idut�s fh�aar�`•'�rrl+o/l rr�d/e �vocfimanff , �ni ar arl said lwAd. As surveyed 6y m� //'�.....r.: qf� j ,!
Ia r _ a.o. r • a ! SUA
URBAN ENGlNEE IINC. �
'Surre ors ��
II
•00'+/g ��� 990,�9q
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1991
6431 University Ave NE
Fridley. MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION._
572-3604 REFRIGERATIO'4
AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 1050'
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work
Residential
Rade
TOTAL
herein specified agreeing to do all work In strict accordance with the
Furnace Shell and Duct Work, Burner -
city codes and ruling of the Building Division, and hereby declares
Also Replacement Furnace
$ 20.40
$-Z6 - D0
that all the facts and representations stated in this application are
..
true and correct. Oct q 9199
Gas Piping (N9eded with new furnace)
$10.00
WCL ', 11
WQ
OWNER
Gas Range
$10.00
$
BUILDING USED AS
Gas Dryer
s iomo
$
��� C�
ESTIMATED COST PERMIT NO.
*Air Conditioning - All Sizes $10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
I% of Value of Appliance or Work $
CommercIaUirKustrial
1 % of Value of Appliance or Work $
State Surcharge $ .50—
TOTAL FEE $
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS 115.00
PLUS THE S.50 STATE SURCHARGE
REINSPECTION FEE $30.00
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units QQ5 Circle One (Steam) (Hot Water) (Warm Airy
Trade Name LZI')rO X Size No.
BTU -15 1 DOCS HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEA
Tel No. /-/aq_Z-4lo
Approved By M F Rough -In Date Final Date
'Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
C
5. Meets all current Code requirements for
size and total BTU's connected Yes. No ( )
5. Has total heating BTU's of
All other BTU's 32(9)OC)
t d}
TOTAL BTU's
Remarks ,
Nci 012110 7P-�
List
Alterations Being Done:
HEATING COMPAN
Signed By
Date
CHIMNEY UM BTACE VERIFICATION
The
undersigned hereby verifies that the exist.inq
chimney or
stack:
1.
Has been carefully examined
Yes
No ( )
2.
Is free from rust or deterioration
Yes
(X)
No ( )
3.
Has no foreign objects lodged within
Yes
()
No ( )
4.
Is securely supported
Yes
(x)
No ( )
5. Meets all current Code requirements for
size and total BTU's connected Yes. No ( )
5. Has total heating BTU's of
All other BTU's 32(9)OC)
t d}
TOTAL BTU's
Remarks ,
Nci 012110 7P-�
List
Alterations Being Done:
HEATING COMPAN
Signed By
Date
SUBJECT
PERMIT NO.
City of Fridley
--(
%
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
11
• _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
326
/—"1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATEPAGE
OF
APPROVED BY
1'' 612-571-3450
910-F15
7/17/97
JOB ADDRESS 1050 Lynde Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
3
Lyndale Builders 6th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Walt Hansen 1050 Lynde Drive NE 571-2602
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Wellington Window & Door 3938 Meadowbrook Rd, St Louis Park, MN 55426 933-6300
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 Gj ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace living room window (full length to knee high)
9 CHANGE OF USE FROM TO
STIPULATIONS
Install smoke detectors to meet 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
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
$3,774
$1.90
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE UTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROV!kIONA OF ANY OTHER ATE OR LOCAL LAW REGULATING CON-
$87.2x5
Fire SC $3.77
STRU 10 R TH5PERFOR NCE OF CONSTRUCTION.
—7/1
PLAN CHECK FEE
TOTAL FEE
7�
$92.92
IGNATU EOFCONTRACT OR AUTHORIZED AGENT IDATEI
HEN PROPERLY V ATED THIS IS YOUR PERMIT
c
BOG Ihot, iAiE
S,GNATURE OF OWNERoF OWNER BUILDERI IDATEI
NEW [ ] Effective 1 / 1 /97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�
BUILDING PERMIT APPLICATION
ConstructionAddress: IDSD �A�2 C`� . tri (eX t t-1 dQ -SS<-j'j 2 -
Legal
Legal Description:
Owner Name & Address: (�A,-E- (-��v�5e,�1 Tel. # 57/ — e-&Z>Z—
Contractor: L.OeZ j �� ��,�.�w d,- {�®ar- MN LICENSE#
Address: Tel. # 41-3-2>
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 q. Ft.
OTHER: -l�jl � l i" iAd t'®C>� o.tire ow �S�h c_E
Construction Type: Estimated Cost: $ 3, 7 714
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: ��7 -7 APPLICANT: Tel. #
Permit Fee
$ F 9,
Fire Surcharge
$ •'%'%
State Surcharge
$ /,
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
CITY USE ONLY
Fee Schedule on Reverse Side
001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS: --
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