PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT
N. C�87
Date:"
Owner: C„�`'r Builder,,--
Address Address
LOCATIO F BUILDING
No. Street P of Lot
Lot _ _ _ ___ 81ock Addition or Sub -Division
Corner Lot _ Inside Lot Setback's Sideyard
Sewer Elevation Z - --� —rFom Uden Elevation
DESCRIPTION OF BUILDING
Tg'11 Used
Front i Depth Height. Sq. FL'� Cu. Ft.
Front - Depth Leight Sq. Ft. Ca. Ft.
Type ofConstritction�s Est. 1 o 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
ordinances of the city of Fridley.
Fl<
In consideration of the payment of a fee of 401- , 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 upon violation of any of the provisions of said
ordinances. -moi
Building Inspector
NOTICE:
Sh psmh don not coves the construction, hutalletlon for `chine, plumbing, gn haallog, sawar or water. Be sure to we
tho Building hupoetor for sspwab pwmhs for those home.
APPLICATION FOR BUILDING PEMMT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAIL j/ % L L C . 7— BUILDER eZt L L C,_r y 411 y( -s
ADDRESS ADDRESS :IPJ
LOCATION OF BUILDING
No. Z3 3 O Street 14 Q A" p rN 4&.,.�o Part of Lot
Lot , Block z, Addition or Subdivision l"I 2 ►d
Corner Lot Inside Lot Setback Side Yard G' 10
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
To be used as:
DESCRIPTION OF BUILDING
Front � D.:s.th Z He
Sq. Ft. Cu. Ft.
ay t� Front AW) Depth ]Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost .b O d `n
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 / z
(Schedule of Fee Costs can be found on the Reverse Side).
r
City of Fridley, Minn.
BUILDING PERMIT N? _ 6887 �7
Date: - Z—
i
Owner: Builder
Address Address
LOCATIO F BUILDING
No. Street Part of Lot
"-
Lot _ _ ►1_Block - �. Addition or Sub -Division _
Corner Lot Inside Lot Setback �� _ Sideyard ,V+
Sewer Elevation Pounda0en Elevation 9- 7 z
DESCRIPTION OF BUILDING
T U as: /
Front Depth Height 1C Sq. Ft. Cu. Ft V Z-6
a Front Depth Height It' Sq. Ft. j4 0 Cu. Ft. 6L6
ce c7
Type of Construction A �4,0..__.._._ Est.
_�1 o 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 pr°�ons of
ordinances of the city of Fridley. 1 4 /J /J
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
F
dley, hin theinances. /l
Building Inspector
NOTICE:
Thin permit don not cover the condrucdon, hutalWon for wlring, plumbing, gas heating, sewer or water. Be sura to as
the Building hupseter for csparats psrmka for them heam
:Pc//6eo
Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470
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 ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam ......
8.00
$
Furnace Shell & Line—to 640 sq. ft. IDR 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 $ " a"a
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 $ -
Location 7-530 -0eem 0 R E/ d_ ooy'yg-
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.
Fridley, Minn_ i�'Z -5. 19 , 19 (
Owner /�"7i Z -L 52 e:rY / ra o L D
Kind of Building /�_ tq n7
Used as n CA" 'r� L L. J IV
To be completed about
Estimated Cost, $ .r® 0 - 02
Old ew uilding Permit No. �
OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, arm Air No.—L
Trade Name W, /0'> 14 ✓'SAS 0 a) Size No /// 7 _ ® 0
Capacity Sq. Ft. E.D.M/ BTU H.P.
Total Connected Load —1 % 7` Kind of Fuel 4SA9
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Signed ..Ja_.i�
By G �'� � .
CO
<z 2M Business Phone =I Xenia Ay. S.
Minneapahs 16, Minn.
(REMARKS -OVER) U. 54611
D,36 7.41al.9 NIq
ed
,p
`` 2 3
HEAT LOSS CALCULATIONS
DEPARTMENT OF BUILDINGS O"_
`1NNEAPOLIS, MINN.
Weatherstrips
A.S.H.V.E.
Guide
Construction No.
Insulation
WindowsI
Dors
Reference
Out. Wall Int. Wall Ceiling Roof Floor
Kind How Applied
e No
e—�s No—
19—
Exp. wall'
® er
F1.1 A''�Y Room l Length »widtha, Height II x Fl.l A,.i�, ®r,"Room I Length C' Width I Heizht .?
Windows and Doors—Crackage and Area
..
-- ..
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq• ft.
fit=
a
Coef.
Coef.
Btu
Infiltration
e IV
i a 170
f'AY
'
Glass
Exp. wall
vo4)
Exp. wall'
® er
k:®
Net exp. wall
Int. wall
Net exp. wall
1'
r
Ceiling
ge-,
Ito
Floor
71 e;
72 0
Floors
,?..
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ F1.1 A 4,12 Room l Length , fj Width 3 Height S'
Windows and Doors—Crackage and Area
..
-- ..
WidthHeight No. of Lineal ft. Area
No. of pane, of pane lights of crack sq. ft.
fit=
61
Coef.
Btu
Infiltration
l
e IV
i a 170
Glass
y
0
vo4)
Exp. wall'
® er
k:®
Exp. wall
Net exp. wall
1'
.3
Int. wall
Ceiling P
10
72 0
Floors
; $%
Ceiling
s
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. `` Ln- Room I Length .1-0 Width i t Height V
Windows and Doors—Crackage and Area
..
-- ..
Width Height No. of Lineal ft. Area
No. of pane of pane llghts of crack sq. ft.
tF !
�+
61
Coef.1
Btu
Infiltration
'y
e IV
i a 170
Glass
y
0
vo4)
Exp. wall`
® er
k:®
Exp. wall
Net exp. wall
/
v
Int, wall
Ceiling 2 t� t'd
10
F o"(1
Floor 2 01/
; $%
Ceiling
s
Total Btu.
' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and oors—Crackage and Area
..
-- ..
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
r 49 �/ 0 P s
61
Coef.
Btu
Infiltration
Infiltration
!,
7x
Glass
`
Glass
Exp. wall'
® er
k:®
Exp. wall
Net exp. wall
Int. wall
/
v
Ceiling
Floor
F o"(1
Total Btu. I -I e .
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
----- ---a-- -
Windows and Doors—Crackage and Area
..
-- ..
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
r
2—
61
Coef.
Btu
Infiltration
,
'.
1
`
Glass
C
R
k:®
Exp. wall
3411
Net exp. wall_`
N :
•°
Int. wall
Ceiling
Y /
��,�
..,.
Floor j
+ 9 �
� ` !1
00!
Total Btu. 1 &9,4-
Required sq. ft. E.D.R. or sq. itis. W.A. Leader area
F1.1 Room I Length - J Width io7 Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane llghts of crack SQ. ft.
.o. e,gs,•
Coef.
Btu
Infiltration
,
1
`
Glass
Eap. wall
3411
Net exp. wall
N :
•°
Int. wall
Ceiling /
Floor OPI if
"1 otal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader arra `
City of Fridley
Application for Plumbing and Gas Fitting Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
y
0
0
�a
u O
F
N
WATER HTR.
GAS
ELEC.
Base
d
1st
tl
2nd
3rd
4th
• Future Connection Openings
* New Fixture, Old Openings I
Connected with
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $ O
Future Fixture Opening ................ Z x 1.20 $ Z 64
New Fixture Old Opening .............. x 1.00 $
Catch Basin ...... ..................... x 3.25 $
Water Heater (Up to 200,000 BTU) ...... x 2.00 $ Z' �®
New Ground Run Old Bldg. ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ / SG
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE
Dept. of Bldgs. Phone SII 4-7470
Location :3 3 d' Ale) /Z �/ L /-1 •�/�
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 application are true and correct.
Fridley, Minn FEB 19 1964 19—
Owner L/?i /3 G '0 'e S
Kind of Building
Used as .D 40.
To be completed about "", / C 5
Estimated Cost, $
Old—New. Building Permit No Permit No.
Signek ®ND® PLUMBING CO.
e _
By w
Business Phone No
ROUGH
FINAL
10 °
SUBJECT
PE IT NO.
City of Fridley
16 9.31
AT THE TOP OF THE TWINS
B U I L D I N G P E R M I T
r
RE C
COMMUNITY DEVELOPMENT DIV.
f /
r PROTECTIVE INSPECTION SEC.
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
/'--1 CITY HALL�FRIDLEY 55432
612-571-3450
910-F15
3/7/83
/
JOB ADDRESS 7330 Memory Lane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
2
Melody Manor 2nd Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Janet Belstler 7330 Memory Lane N.E. 784-3245
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION E2 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Structure (Rear Only)
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.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
$1000
$.55o
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OT STATE OR LOCAL LAW REGULATING CON-
$17.50
STRUCTION OR THE PERF MA CE OF CONSTRUCTION.
PLAN CHECK FEE
TOTg-FS= 00
1
SGNATURE OF CONTRA T Ro AUTHORIZED AGENT 1 ATEI
WHEN PROP E Y VALIDATED THIS IS YOUR PERMIT
r
� �
O
BLDG INSP i DATE
SIGNATURE OF OWNER I IF OWNER BUILDERI (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESI101TIAL BUILDING PER4ITS
(New, Alterations, Additions, or Repairs)
OWNER: 1f1/yim 7- 4 S7-4 e -0 -
ADDRESS: 17.3 3 5 e1 ff
TEL NO: `T - 3 a Y !r
BUILDER: �,` LIN .3 h . Jo /1 w so 'd
ADDRESS: o2s-I 3 CC ^.) T�� � �� � AJS_
TEL NO:
Construction Location
STREET NO: '73 3 ® STREET: A 6_/71 o A- '4 q nJ e
LOT: BLOCK: ADDITION. -
Corner Lot: Inside Lot: Setback,: Sideyards:
Applicant attach to this form tcao Certificates of. Survey of lot and
proposed building location drawn on certificates to scale.
nFSrRTPTTntd nr- rnm'�TPHrTMM
Front: Depth: Height:
Squane.Feet: Cubic Feet:
Front: Depth: Height:
Square - Feet: Cubic Feet:
Type of Construction : �f Lee A2 0^I 1, y ► Estimated Cost: $ L 0-0—
//e��,° .
Tb Be Completed:Ut � f, s
_ Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
Mie 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: 3 e .7 - fiTr.."AI,IIII . JA Y\1 /
Stipulations:
111 I T Vr rMIULCT INortka I IUN UIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
hneetive un January I, i qui
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Stories
a h l I W sh
Urinal I 'I'..Ij`� S'`�'�'��`:�
Shower
h ': Tr
. KtkC...
`•. FI r
<�;<`I�:���.y»>�� o0
`'•��ttl�tti���; � D ai
��•�' '•
':�a�5��`�'`>'•. �
Auto Gas
Was er �''``(?':`>� ane
h R
•�S`..<>�
.,.i>''<:.
F Xti
Water Heater
Ga s Elec
Basement
F loor 1
-
Floor 2
FI 3
oor
loo 4
F 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
Water Heater — Gas
Gas Range
17
NO. RATE. TOTAL JOB ADDRESS
17"
3 3c )4 47
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 •$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $ /5. S
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do ali 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._ ke- 1._J it f_ le a .�-Lk e .�
Building Used As �_," N L`
ka
Estimated Cost 6-6 APERMIT NO,
PLUMBING
SIGNED BY � � % _ g TEL N0. S 3 ?`l 7
Approved 13,*4
Rough—In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
SUBJECT
City of Fridley
=49�9
AT THE TOP OF THE TWINS
BUILDING
PERMIT
� �
RECEIPT NO.
��: -'---- COMMUNITY DEVELOPMENT DIV.
,/`�
l.�C/OV
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEV 55432
j 612-571-3450
910415
7/8/98
JOB ADDRESS 7330 Memory Lane
1 LEGAL
LOT NO,
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
S
2
Melody Manor, 2nd Addition
SHEET
2 PR9P RTY OWNER MAIL ADDRESS
ZIP PHONE
MiNale D. Emerson 7330 Memory Lane NE
792-2763
3 CONTRACTOR MAIL ADDRESS
ZIP 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
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION YE7 REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Re -roof House and Garage (26 Sq) Tear -off
9 CHANGE OF USE FROM 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
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. D jLG. 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
$2,168
$1.08
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-
$74.75
F h SC
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
re $2.16
PLAN CHECK FEE
TCAAL FEE
77.99
Lice C
$0
ATU E CO HAC OA OR AUTHORIZED AGENT •�/ q/�I�DAT
WIMP
Y VALID D THIS IS.WR RM
/ G
f r
SIGNATURE OF OWNER pF OWNER BUILDERI IDATEI
, g INSP
DATE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY, OF FRIDLEY
ALTER [ ] SINGLE FAME LY AND DUPLEXES R-1 AND R-2 aG
BUILDING PERMIT APPLICATION U
ConstructionAddress: 7S s () ,-n, 1A,
Legal Description:
Owner Name & Address: Tel. #(e�' o Z) -2 o Z 2-742
Contractor: 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 BIPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER: /Z__ �, ��e �,s�CO
i
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
C
Construction Type: r"C, . Estimated Cost: $�
(Fee Schedu a on Back).
Driveway Curb Cut Width Needed:
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
driveway Escrow
3rosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ /- S;—
$ .i4,
Ft.+6Ft=x $ _$
!� Tel.
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
i
SUBJECT -
P
City of Fridley
3151 0
AT THE TOP OF THE TWINS
?
BUILDING PERMIT
r
R O.
: `v COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r � �
VA
NUMBER
REV
DATE
PAGE Of
AooROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
10/24/00
JOB ADDRESS 7330 Memory Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
Melody Manor 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Mike Emerson 7330 Memory Lane NE
792-2763
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
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Lk REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace windows within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
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.
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 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
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
$3,000
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHE TE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERF MAN E OF CONSTRUCTION
PLAN CHECK FEE
TOT LFEE
87.75
51G c ON' ACTOR ORAUTNORiZEDAGENT iDAT
EMPR.PVAL10 T THIS IS YOUR PERMIT
/� —,7S 00
5-GNATURE OF O
B '•.NSP
GATE
i
NEW []
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name &
Contractor:
Effective 1/1/2000
(763) 572-3604 Bldg Insp
Tel.# 7�'Z 22
MN LICENSE #
Address: 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 a✓ estimated Cost: $
Driveway Curb Cut.Width Needed: Ft. + 6 Ft = Ft x = $
E�
DATCit/ APPLICrfc
CITY USE ONLY - Call (763) 572-3604 for Permit Fees If mailing in application
Permit Fee
$
33 - A S7
Fee Schedule on Reverse Side
Fire Surcharge
$
2-00
.001 of Permit Valuation (1/10th%)
State Surcharge
$
/,
$.50/$1,000 Valuation
SAC Charge
$
$1100 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
$ �. (S✓
STIPULATIONS:
Pm
SUBJECT
City of Fridley
7120671)
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
R
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
572-360
r
!.r
r
I j 1 CITY HALL FRIDLEY 55432
"''s
NUMBER
REv
DATE
T PAGE OF
APPROVEO By
612-571-3450
910415
8/8/01
JOB ADDRESS 7330 Memory Lane
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
2
Melody Manor 2nd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Mike Emerson, 7330 Memory Lane, Fridley, MN 55432 763-792-2763
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Mike Emerson
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK IN NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Siding
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to -protect the interior
wall covering. Exceptions for this momw provision would be if sheathing is
an approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in its application guidelines. Call for inspection of wrap
before covering.
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 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
$3,000.00
$1'50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$83.25
Fire SC $3.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
a
'a
1 $87.75
TU OF N"R XQA OR AUTHORIZED AGENT TES
HE ROPERLY VALIDATED THIS IS YOUR PERMIT
Oj4AI.
;1 410�11
19,41 9_01/
-G ATUREO , OWNERBU4DERi
LD S GATE
Pm
NEW (j Effective 1/1/2001
ADDN [ j CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:4?JD IZ� Z—AAIL
Legal Description:
Owner Name & Address =L Tel. # '? 9 Z'• 2'� �3
Contractor: 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 Sq. Ft.
Length Width
Length Width
Height Sq. Ft
Hgt/Ground Sq. Ft.
S7101h .-Q
Construction Type: Estimated Cost: $��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: V "667 APPLIC T• Tel. #
CITY USE ONLY -
Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee
$ 3, Fee Schedule on Reverse Side
Fire Surcharge
$ .001 of Permit Valuation (1/10th%)
State Surcharge
$ / �'C� $.50/$1,000 Valuation
SAC Charge
$ $1150 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 $ P9 Y�
STIPULATIONS:
0.
SUBJECT
P
City of Fridley
3376
AT THE TOP OF THE TWINS
BUILDING PERMIT
i �
R
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
I . �
i ��"' �•� CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
--_-
1 763-571-3450
910-F15
8/6/03
JOB ADDRESS 7330 Memory Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
1 Melody Manor 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Mike Emerson 7330 Memory Lane NE
763-972-2763
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
B USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 15' x 21' Addition to house; a 15' x 20' Garage addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS WARNOING
REQUIRED FOR:
(before digging call for
WIRING, HEATING utility locations
all
PLUMBING AND SIGHS
4540002
LAW
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 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
1
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
$35,094
$17.55
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
PLAN CHECK FEE
TOTALFEE
$554.99
RE o CON'RACTOR OR AUTHORIZED AGENT iDAT
EN PROPERLY VALIDATED THIS IS YQ1jR PE MIT
S.GNATURE OF OWNER,,F OWNER ILOE DATES
hCOG o4sp
�� Tf
NEW [) CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [) SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION
Construction Address: %3 3 4) /"9,/" O"Zy 4
' -41 -IL
Legal Description: Loi S% 13C or_x_ 7_ * L G 0 b V IWA&I-0 Z.� ef 'dD®/ 1 / n
Owner Name & Address: A / /C �fyl f12�Sr� Tel. # 3
Contractor. /,/O^r MN LICENSE #
Address: Tel. w oa e 7 9(V/__7S_/9
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 /� � YZ " Width .21�-21' Height lS' d Sq. Ft. 3 2-1-967
GARAGE AREA: -Length/ 5'2, VZ Width 8 11 Height , '9. bq. Ft. 3/y,
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER•�f���-ems
Construction Type � � �� Al ��`� ��� � Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
e LL -
DATE:
APPLICAN Tel. #__62 Z~ n 6 f 76/.
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-5714287 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 $ _ 4
DgkeAk&i=W91flWA1
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. 'W or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On Jan 1, 2003
MARK NUMBER OF
FIXTURES TO
BE INSTALLED
ON EACH FLOOR
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Urinal
` Shower.... :.:::.:
Wash
Tray.Drain
:It :>;:::::.<.:::>:
Floor
:: :::::::>::>
Auto.
Washe
?IS::::::::» Gas
Range
(i%:::::::>:> Water Heater
...... lec
Stones
..::...::.;:.
Basement t
$10.00
��99
Building Used As /401'1.2®
$10.00
$10.00
Estimated Cost PERMIT NO.
"Floor 1
<'>'<
Floor 2
I
F o0 r3
Floor 4
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
Water Heater - Gas"
Gas Range"
UOJ
Gas Dryer _
Back Flow Preventer Required ( )Yes () No
Type
RATE TOTAL
JOB ADDRESS`? 3 3 D Ax /,,P?oZ, L.�
$ 7.00
The undersigned hereby makes application for a permit for the work herein
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
$ 7.00
and representations stated in this application are true and correct.
$ 7.00
$ 7.00
, 200
$ 7.00
A/,/ �G' %c" -C 0Y�/
$10.00
Owner
$ 7.00
$10.00
��99
Building Used As /401'1.2®
$10.00
$10.00
Estimated Cost PERMIT NO.
$15.00 PLUMBING COMPANY,• O&L/�
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS.
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
$ .50
$
cl-111
Approved By Rough -In Date
TEL N0.2 9 Z d
Final Date 3A? 454
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. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When raplar-onn an axestong 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 manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes( ) No( )
The ex_ r�nn r_nmh int;nn arr is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to incfall a naw cnmbtictinn airy it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When ln�linn a new vantina sye _m, 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
HEATING CO:
Signed By: Date:
• r
Effective January 1, 2003
CITY OF FRIDLEY INSPECTION DIViSION „
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR 1�6' WiR PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
JOB ADDRESS D �✓����L�
RATE SCHEDULE
• OWNER Al/C S F14-tfc )fS C)"
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner - BUILDING USED AS
Also Replacement Furnace $ 30.00 $ 30-13
(Side Vent - Fill Out Back) ESTIMATED COST PERMIT NO.
Gas Piping (Needed with new furnace, $ 10.00 $
but not replacement) DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00 $
No. of Heating Units Circle One (Steam) (Hot Water) arm r)
Gas Dryer $ 10.00 $ Trade Name Size No.
BTU HP EDR
*Air Conditioning - All Sizes $ 25.00 $ S^ Fuel ll/W7' Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No.
1% of Value of Appliance or Work $ BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work $ 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
State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and
$ SS s�D representations stated in this application are true and correct.
TOTAL FEE �'
DATE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING C �'
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE Sign TEL # ?G 7
FAX #
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without Approved By ough-In Date* Final Date IY
written permission from adjoining property owner.
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
j_ -IMM M V NTS VENT CnNNFCTnR AND CnMBI IRTInN AIR VERIFICATION
When , 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 (Ck No ( )
The venting system is plasticlPVC and meets all current codes and manufacturer
specifications, including sizing, length, number of elbows and termination. Yes Q1 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 0) No ( )
The gaY�n cnmhtoaH ,n air is sized and installed to meet the current codes
and manufacturer's specifications. Yes (a No ( )
When required to i titan a new cnmbtjctlnn ai ; it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes (co No ( )
When InaWling a new ventinnsT tem, the undersigned hereby verifies that
it iia' 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 (X) 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 0 No (; )
Appliance #1 Type I'�-v rA14 r- V-�, BTU Input Fan Assisted or Nat
Apppance #2 Type6d7'wa rF 2 /J£dT' BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 2- 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
ALTERATInNA- Cnascrihal /EE e ®G4f I
�(Je /4:,�acrb AIrL lW New AA0'111Av
HEATING CO:
Signed By: - Date: /
,;2'7 9d
Building
$
BUILDING
SAC Charge
Permit No. CIDC�3
Inspections
Curb Cut Escrow
RESIDENTIAL APPLICATION
ft + 6 ft = ft x $21 =$
Received By:
763-572-3604
$450 Conservation Plan Review
CITY OF FRIDLEY
$
Date Recd: 1n 2
DATE `(}
YOUR E-MAIL. ADDRESS
Agreement necessary( ) Non Necessary ( )
SITE ADDRESS _7 3 3 U
&4 _ee— U r2
Make checks payable to: City of Fridley Attach
THIS APPLICANT IS:
ROWNER ❑CONTRACTOR
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
PROPERTY OWNER/
NAME: &fi4- p r c4�,
TENANT
ADDRESS: % 3 3 b e YL CITY kyr / STATUle.�,Zn'—M6 Z_
PHONE 7" _—:2!2 T — 'Z ? J
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE_ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
XSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWINI IING POOL
TYPE OF WORK
❑ NEW ❑ ADDITION
❑ MAMTENANCE/REPAIR ❑ REM//ODELING
DESCRIBE WORK BEING DONE: e 3-S /eve ielCsr�
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ 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
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ 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:
(USINGTHE 1927 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S OCCUPANCY TYPE
Permit Fee $ 'r;0 See Back Page for Fee Schedule
PlanReview $ 65% of Building Permit Fee
Fire Surcharge $ , 001 times the total job valuation
Surcharge $ ` S(� .0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary( ) Non Necessary ( )
Total Due
$
Make checks payable to: City of Fridley Attach
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 or p t 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 wor q es review and approval of plans.
SIGNATURE OF APPLIC PRINT NAN���2P/J S:q DATE / L
47