PRE 2010 DOCSCity of Fridley
SUBJECT
PER
13400
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
i.
� • ______ COMMUNITY DEVELOPMENT DIV.
t.
RECEIPT
r PROTECTIVE INSPECTION SEC.
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1 i �
�CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-560-3450
910-F15
3/4/76
JOB ADDRESS 1360 Osborne Road N.E.
1 LEGAL
LOT NO.
5
BLOCK
2
TRACT OR ADDITION SEE ATTACHED
Meadowmoor Terrace
DESCR.
SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Lambert Petersen 1917 Old Hwy. #8, New Brighton
3 CONTRACTOR MAILADDRESS 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 ❑
X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑- MOVE ❑ REMOVE
X
8 DESCRIBEWORK
--'IMPORTANT'"'-
Construct a 24' x 39' Dwelling and a 24' x 24' Garage
NOTIFY THE FRIDLEY ENGR.
DIVISION REGARDING CURB
9 CHANGE OF USE FROM TO REMOVAL AND REPLACEMENT
AT DRIVEWAY
STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before
capping. Provide sod in the front and side yards. .
SEWER LOCATION: "Y" 195' East of Manhole
■�ARING
WYE ELEVATION: 892.24 Before di `®
aging telt local
TOP OF FOOTING: 894.24 Minimum utilities
TELEPHONE
Inv. Elev of Manhole 891.46 HONE - ELECTRIC - GAS Etc,
WATER LOCATION: 8' East of Sewer Service SFpREQUIRE® BY
LAW
THE CITY OF FRIDLEY DOES NOT GUARANTEC TFIETiAR'gTeACC/0
URACY UTILITY
S LOCATIONSF
EL�ATIOdS.ASDA
IS INFORMATION ;TOPOSES
�4U11/ S�
PERSONS USING IT SHOULD VERIFY THE INFORMATION
ON THE SITE.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPAN UP(�CUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood Frame
V
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT. 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
,,AA�
912+576 1 ,488+5*10
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.
$31,320
15.66
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-
$46.71
$350.00
STRUC N OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$412.37
SIGNAIV50OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
- HEN PROPERLY VALqfTED THIS 1P YOUR PERMIT
BLDG INSP DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
CERTIFICATE OF SURVEY
JAMES L. KURTM
LAND SURVEYOR
730 -40TH AVENUE N.E.
COLUMBIA HEIGHTS 55421 788-9769
I NERESY CERTIFY THAT TH16 SURVEY. PLAN. OR REPORT WAS PREPARED BY M6 OR UNDER MY DIRECT. SUPERVISION
AND THAT 1 AM A DULY REGISTERED LAND SURVEYOR UNDER THE LAWS Or THE STATE OF MINNESOTA.
r DATE MARCH Iy z6
: SCALE I"=
30'
MINNES0+A EGISTRATION NO. 5332 0= IRON MONUMENT
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Os3opxR'F- R � p,
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No 3 � o �,�.,.
0 M` V°' ri a 3
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EASEMEhIT
Survey of
Lot 5, Block 2, Meadowmoor Terrace, Anoka Co., Mn.
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• •APPLICATION FOR RL•SI'DL'NTIAL., ALTERATION,
OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
01J1dER S NAriE : „�°° �� �-�',� �"� �� BUILDER:
ADDREss : Aor - - ADDRESS:. > 9�� ®Z)� ;� IPArj),��,�
NO: > to ® STREET: j,575'Aa
LOT: -� BLOCK: y ADDITION: ��� �✓� l�®
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Ta;o Certificates. ?f Surve ..of Lot and•proposed
building location drawn on these Certificates.
• P
DESCRIPTION OF BUILDING
To Be Used As:
�1 /Front : Depth • • Height: l
. - Square Feet : `1 ? Cubic . Feet : 19. T
57
• �/� Front: 2,Depth: Height:
Square Feet; S Cubic Feet:/o
Type of Construction:?' Estimated Cost: $`
TO -Be Completed:F`� 7
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.
•SIGNATURE
•
DATE:
(See reverse Side For Additional information.)*
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CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Job Address
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. /0—/ , 19 .�-�
OWNER 11 —1 / _ z- , 1-4
KIND OF BYING
JSED AS
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
ESTIMATED COST
N
N
TOTAL
o
PLUMBING FIXTURE RATES: NO.
%
W
Water
Number Fixtures
x
A01
$
Future Fixture Opening
x
A
$
y
fl,
w
x
$2.00
Heater
ani
4.1
.�I
x
q
$
E
.[ ra
Water Heater - to 99,000 BTU
x
M
ro N
o'
100,000 BTU to 199,000 BTU
x
$10.00
«r
v
es
Water Softener
c
N
4
x ++
a K
v
3
$4
O
.c a
•N
0 ai
a
ROUGH INSP.
O
a O
r
•�
,C:
�Natl
•.I
,!C
$
•u
GAS FITTING FEES:
1UJ
N
71
N
N
.0
U
7
1st 3 fixtures
x
..0
ro
o
Q W
.oc
vs
poi
W
ra ro
U RI
a ro
RC 3
a"4
U
£
ro
U
�'
O
as
lec
APPROVAL FOR PERMIT
CQP7
x
N
3
REPAIRS $ ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT
IS $7.50
State Surcharge
$ .50
TOTAL FEE
$
1st
REINSPECTION FEE
($30.00)
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
Job Address
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. /0—/ , 19 .�-�
OWNER 11 —1 / _ z- , 1-4
KIND OF BYING
JSED AS
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
ESTIMATED COST
TOTAL
PERMIT NO.
PLUMBING FIXTURE RATES: NO.
RATE
OLD - NEW BUILDING PERMIT NO.
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
CompanyNew
Fixture, Old Opening
x
$2.00
$
Signed By
!�
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
Tel. No.
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
ROUGH INSP.
Date
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
FINAL INSP.
Date
1st 3 fixtures
x
$3.00
$
Additional Fixtures
x
$1.00
$
APPROVAL FOR PERMIT
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS $ ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT
IS $7.50
State Surcharge
$ .50
TOTAL FEE
$
REINSPECTION FEE
($30.00)
�3:�m���Yd� iWi ��..,.�;..p ��i ....•'Le C[!���..� iQr'i.^•MyR^ ^ t� /+.e+!�•.�,e' 4�. M1��s-•:�T �q �]r.+�..��. r,. ..y..+�n�A �.... ��
.� : mti. �..i 8-G... _r:d �e..¢.;1: ti..'..-� .��`q •t+�ee��:3i.w�= � l'Ib Ytia�+4io�Ltlq ft�iv+... s.rr?:r.,a l�ssei 4..e+�
g�a4a ..rj'•Nr.vSJC1:Ga1iYi..� �� Wd`rJ4ol it363� JO�:ibYvir-a9
PARTIAL RATE SCHEDU�E:
GI4ATIT°I WARM AIR: i11147 TOTAL.
Ftanace Shell & Durt Work 510.00
Rep's^e-hent of Furna-e 6.00
P.rpa:-t & AlIrmt.ors--up to $500.00 6"* S
Repairs & A.:terations each add. $500.00 3 OU "o
I!MCR. WARM AIR
FVrnaee Shell & Duct Work to 170,000 BTU ..$1000 $
esch add. 60,000 BTU 3.UV S
Replacement of Furnace 6.00 $
Repairs & A!t, *ations--up to SS00.00 6.00 $
Repairs & Alterations each add. ".00 3.00 $
tDr4. of B!13gm. it hono =- - _V_3
!]
City of Fridley:
The mrxlersigned here*y makes application for a permit for the work herei
specified agrcring to do all work in strict acco-dance with the City Ordirarn
and ruling of the Depa. -Tient o" F3-mldin,;s, and hereby decL•-es that all the fac
and represPntatiuns %!atri in this application are true and correct.
F r-dley. Minn :2 / _-L,619
Owner V Lk' - -IL' �-� 4-1
Kind of Building
Used as . Q_•c ti�-2L®�_��,t/
STEAM or HOT WATER EYSTEN
5.00
$
To he completed about
ovzr IS -1=0 BTU Soo Fee Schodule
A
Fsr^.acr She:l Sc Lines-- to 400 sq. is F.DR Stearn
?IQ ^^
S
Estimated Calc, $
n -mace Shz1 & Line ---to 640 sq ft. EDR Hot Water
1000
S.
/
Gas Range to 199.0
Ol New. uilding Permit No. Pormit No. (06915
Each add 20Q sq. tt. EDR Steam
inn
$
State Surcharge
Each add. 320 sq. ft EDR Hot Water
3.00
S
Sro Fe®
OIL BUPKEP.-to 3 gal. per hour 6.00 S
over 3 gal. per hour --See Fee Schedule
GAS BURNER Cup to IcV.000 BTU)
5.00
$
ovzr IS -1=0 BTU Soo Fee Schodule
GAS FITTING £iB3:
NO RATE
TOTAL
Ist 3 I)xtures
%S 200
S
Additlo^al FIxtures
_ z .76
Gas Range to 199.0
a$ 5.00
S
AIR CO:w`�IT omrNt�T �\
State Surcharge
$
.50
Fd.N F..:.aTiir'r ie T dT"�
Sro Fe®
` ®
AI.TrnATSOPM & EXPALAS
TOT&L M
ROUGH
rzzCR.1_%_11O1AI or won=
h" EATING or POWER PLA.NZ 5,q amara. Hot Water, Warm Air—No
Trade NameSizt Pdo_ � g
Capacity_. _._ ^ Sq. fit. E D.R BTU /J � EU
Total Connected Load-- _— Kind of F�ml ..
BURNER — Trede Nanao Size No r/L0
Capacity Sq. Ft. EDR BTU Pi
tresaasaa- 0yrit)
f
City df Fridley -
c4now® for Md C"s NOV Famb
Dart. of Man Phans BOD -343D
DESCRIPTION OF WORE j - j' 6
Number, Kind and Location of Fixtum !fin (�
PARTIAL RATE SCHEDULE
PLIIMSMG FIZTURB HATES:
NO. RATE TOTAL.
Number Fixtures ......
z MM
� ' G ►}
Future Fixture Opening ................
Z z $L50
$L_ 3)
New Fixture Old Opening ..............
z $1.80
$
Catch Basin .... ----------------•
Water Heater (Up to 99.000 BTUs
... , .- .� . _ z $3.00
t, '
-Ikw Oround Run Old Bldg. - - .......-
.:•----.-.-.. #t ffi
-$
>:6M.o Watm 8astar
_ $200
_ 'TAt6 FEES:
110. RATS TOTAL.
S ..........................
lldditk all Fiztum ............ , .......
_:..._.._ z $ .T6
t�mt -Boup to 199,000 BTU ..............
N
MUM
REBBOLIMBEEMEMEN
MM
mom
M., 770 -1.w.,. -),l
PARTIAL RATE SCHEDULE
PLIIMSMG FIZTURB HATES:
NO. RATE TOTAL.
Number Fixtures ......
z MM
� ' G ►}
Future Fixture Opening ................
Z z $L50
$L_ 3)
New Fixture Old Opening ..............
z $1.80
$
Catch Basin .... ----------------•
Water Heater (Up to 99.000 BTUs
... , .- .� . _ z $3.00
t, '
-Ikw Oround Run Old Bldg. - - .......-
.:•----.-.-.. #t ffi
-$
>:6M.o Watm 8astar
_ $200
_ 'TAt6 FEES:
110. RATS TOTAL.
S ..........................
lldditk all Fiztum ............ , .......
_:..._.._ z $ .T6
t�mt -Boup to 199,000 BTU ..............
ROAM& li1LMATIONS—d0w to Colt
c��
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432 d
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2000
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"*
III:e�1111111111111117_�vo
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$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
TOTAL JOB ADDRESS 6A -ME & V&jvC-k
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.
ILLG, GORDON
2
1360 OSBORNE ROAD NORTHEAST /� , 20 02)
FRIDLEY, MN 55432
(612)786-3545
Building Used As 242-5 i ae,'AC L
Estimated Cost dz PERMIT NO.
Eq % ?M
PLUMBING MPANY arb6m Ium&1^°L
SIGNED BY TEL N0. Z% "T 3
Approved ByRough-In Date Final Date ;'/'
a� v/6
7
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
.............i'.:::.:.
....��::::::
<»<
Wash
"'">.....
....�...........
FI o
o r
?l�?l.:...
Auto.
>���``�'
..................
Gas
r Heater
Stories
....
i al
.....Shower
Tray
Drain
Washer
mange
Gas EI
Basement
a t`
Floor 1
Floor 2
I
Foor3
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"*
III:e�1111111111111117_�vo
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$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
TOTAL JOB ADDRESS 6A -ME & V&jvC-k
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.
ILLG, GORDON
2
1360 OSBORNE ROAD NORTHEAST /� , 20 02)
FRIDLEY, MN 55432
(612)786-3545
Building Used As 242-5 i ae,'AC L
Estimated Cost dz PERMIT NO.
Eq % ?M
PLUMBING MPANY arb6m Ium&1^°L
SIGNED BY TEL N0. Z% "T 3
Approved ByRough-In Date Final Date ;'/'
a� v/6
7
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing 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 manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No ( )
When Installing a new venting system, 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 Type and Size/Common Vent and Vent Connector Infonnation
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
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date
UIYOF
ETi1DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
November 26, 2001
Mr. Gordon Mg
1360 Osborne Rd NE
Fridley, MN 55432
Re: Final Inspection at 1360 Osborne Rd NE
Contractor: Norblom Plumbing Co
Dear Mr. Mg:
A plumbing permit was issued on February 22, 2000 to install a water heater at your address.
According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted
on the plumbing authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Plumbing Code. We will keep your permit open for another 30 days and if we
do not hear from you within this time to set up the inspection, we will expired the permit and no
firrther action will be taken.
To set up the inspection, or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerelv.
D7/mh
PIP
SUBJECT
P
City of Fridley
33172
AT THE TOP OF THE TWINS
BUILDING
g U I L D I N G
PERMIT
r
RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
_LTL �/
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
763-571-3450
910- F 15
10/16/02
JOB ADDRESS 1360 Osborne Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
Meadowmoor
Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Gordon Illg 1360 Osborne Road NE
786-3545
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Sela Roofing & Remodeling 4100 Excelsior
Blvd, St Louis Park, MN 55416
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
612-823-8046 1050
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Tuckpoint chimney; install new cement cap
9 CHANGEOFUSEFROM
TO
STIPULATIONS
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
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
$2,000
$1.00
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-
STRUCTION OR THE PER 0RMANCE OF CONSTRUCTION
PLAN CHECK F
TOTA FEE
,r�
L1cens SC 5.0
7.25
GNAru RE OF CON• ALTO Op urHO ZE ENTI IDATEI
W N OP
ALID T THIS 1S YOUR P MIT
BL NSF' JP
FEAT
S,GNATURE OF OWNER.IF OWNER BUILDERI IDATE,
PIP
NEW [ ] Effective 1/1/2001
ADDN [ J CITY OF FRIDLEY (763)
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
" BUILDING PERMIT APPLICATION
Construction Address: M'00 (O5 L C'y-rU2 R 0 6L C�
Legal Description:
Owner Name & Address:Tel. #
Contractor: SELA ROOFING & REMODE ANG. MN LICENSE #
4100 EXCELSIOR BLVD.
Address ST�L�vIS PARK, MIDI 554 � Tel. # f�(Z $Z3 e S� �(o
ID #0001050
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:
�uc K PC" G(n � n�t—y
Construction Type;1�0'5+4(( (U -W Ca4v-o vc� e44> Estimated Cost: $ 2®®®•
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: APPLICANT:Tel. #
T
CITY USE ONLY -
Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee
$ 6 eO. �S� Fee Schedule on Reverse Side
Fire Surcharge
$ '?.moo .001 of Permit Valuation (1/10th%)
State Surcharge
$ /, dry $.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
STIPULATIONS:
3 27 aS
A
3uilding
BUILDING
$
Permit No.:
nspections
RESIDENTIAL APPLICATION
65% of Building Permit Fee
Received By:
763-572-3604
CITY OF FRIDLEY
Fire Surcharge
Date Recd:
)ATE Nk O S� YOUR E-MAU, ADDRESS CK -r b 'r 1 S+ S -ice VviS 11 ° LO V�"
.ITE ADDRESS t3 1® 0 5 b ®am u--- e. 4
$
'HIS APPLICANT IS: ❑ OWNER °'CONTRACTOR
SAC Charge
PROPERTY OWNER/
NAA; o i l
Curb Cut Escrow
Q OS bO'^' CITY "� `�
STATE_ )PL
TENANTADDRESS:
$
PHONE:
Park Fee
CONTRACTOR
NAME:
Sewer Main Charge
STATE LICENSE # \ 3 ,3 EXP DATE 3 1 O k7
.1 't "L I v -'-r STATEZIP ✓� S 3%�
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
ADDRESS:L O !n SSSt rA AtisL CITY
PHONE 3 � S 3 Z FAX 3 S ^
�a
PROPERTY TYPE
❑ SINGLE FAIYMY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH -0:�,OOF ❑ DRAIN TLE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: T < Cf 4 S• e o AwLe en
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT S . Ft
GOOFING ❑HUE ONLY
VUMBER OF SQUARES ❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
Floor Plan
3A.RAGES — ❑ATTACHED GARAGEProposedExisting1.
2.
floor plan
?ROPOSED SIZE: ❑ DETACHED GARAGE
3.
List of structural members to be used
��/
>ROPOSED HEIGHT:
'>IDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
:3 Vinyl ❑Soffit
ADDITIONS & PORCHES SUBMIT.•
:1 Aluminum ❑ Trim
1.
Site Plan/Survey showing the existing structures
:3 Other ❑ Fascia
and proposed project
2.
Two sets of construction plans
R'INDOWS
3.
Energy Calculations
N EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
DR FOR NEW OPENINGS -DESCRIBE SIZE OF
DPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
,2
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA ER AI `:
(USIN TBE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
6257 See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
.001 x Permit Valuation (1/10%)
License Surcharge
$
(It� $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
on 4 Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks pqable to: Ci of Fridle Attach Stipulations
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 appli 'on for a permit and work is not to start without a permit; that the work will be in aedordance with the approved
plan in the case of all wor w 'c r s r iew and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME Irl r"�`J Vim" DATE l�
Building
$
BUILDING
See Back Page for Fee Schedule
PIan Review
Permit No.: r -0
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
$
Received By: lJ
763-572-3604
Fire Surcharge
CITY OF FRIDLEY
(
.001 x Permit Valuation (1/10%)
Date Rec'd: C'r�
DATE S
YOUR E-MAIL ADDRESS
$5.00 (State Licensed Residential Contractors)
6061 -
SITE ADDRESS /.3&0
QS hO r P? -e, NE,
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
ft + 6 ft = ft x $20 = $
Erosion Control
PROPERTY OWNER/
NAME: FTAY6e02,? ¢
$450 Conservation Plan Review
Park Fee
ADDRESS—0 P - CITY
_STATE/ ZIP SS 3
TENANT
$
PHONE: 7&3-7796 — 3 S
Agreement necessary ( ) Non Necessary ( )
Xtal Due
CONTRACTOR
NAMF-:_ RENEWAL BY ANDERSEN
Make checks payable to: City of Fridley Attach Stipulations
SUBMIT A COPY OF
STATE LICE 1920 COUNTY RD. "C" WEST
YOUR STATE LICENSE
ADDRESS:_ ROSEVILLE, MN 55113
CITY
STATE ZIP
WITH APPLICATION
PHONE C51-264-4777
wo LICENSE #20130983
PROPERTY TYPE
❑ , -)S
PERMIT TYPE
IJADDMON ❑ GARAGE/SHED ARIVRNMOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
ANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: -
SIZE OF IMPROVEMENT LENGTH WIDTH
GHT S .
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
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.
3.
Two sets of construction plans
Energy Calculations
EXISTING STING OPENINGS 117 es
❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF S{iY� P/GLY��dLLS
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 $_ OCCUPANCY TYPE
Permit Fee
$
-2a 3 3&;'
See Back Page for Fee Schedule
PIan Review
$
65% of Building Permit Fee
Surcharge
$
(0,43-0
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
(
.001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Xtal Due
$
Make checks payable to: City of Fridley Attach Stipulations
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 quires re 'e and approval of plans.
SIGNATURE OF APPLICANT I PRINT NAME "� DATE O