PRE 2010 DOCSDate:
Owner
Ad
City of Fridley, Mian..
WELDING PERMIT
N°(5�_)5
er
dress _
7ddr#ess
4 L(O�CAATTIO B LDING
No. Street— Part Tnt
Lot �__ Block Addition o ub-Division r
Comer Lot 1___ _. inside Lot Setback y_y _` Sideyard _
Sewer Elevation — - _ Foundation Elevation —
DESCRIPTION OF ' BUILDING
To
Front Depth Height Sq. Ft Cu. Ft
Depth Height
T- t {� Sq. Ft Cu. Ft.
Type of Cons Itruction Est. Cost � be Completed
In consideration of the issuance to me. of a permit to construct the building described above, I agree to do
the proposedrk in accordance with the description above set forth and in compliance 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 part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, . alteration, maintenance, repair and moving of buildings
within thordinane ci� y limits and this permit may be revoked at any time upon violati f any of the provisions of said
Building Inspector
NOTICE:
Thisrmit does not cover the construction, Installation for wiring, plumbing, Baa heating, sewer or water. Be sure to sae
the Build4 Inspector for separate permits for these items.
J jl
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builder
Address- Address
LOCATION OF BUILDING
No. Z? Street Part of Lot
Lot lBlock c A dit on or S • s on�"
Corner Lot Inside Lot_, K __Setback ide-Yard. /0
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of survey of Lot and
proposed building location.
To be used as:
DESCRIPTION OF BUILDING
a -d- % F-67
la Front�Depth e___Neight
sq. Ft . Z®Ar CU. Ft.
Front____._Dep•th Height
sq. Ft. Cu. Ft.
Type of Construction__; Estimated Cost
To be Completed /dQ
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 correct.
DATE S, SIGNATURE
(schedule of Fee Costs can be found on the Reverse Side).
. .+
Y
Application for Power Plants and. Heating, Cooling. Ventiiation..Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
1.
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU ...................... .
Replacement of Furnace ..............................
Repairs & Alterations—up to $500.00 ... ............
Repairs & Alterations each add. $500.00 ...............
STEAM or HOT WATER SYSTEM
RATE TOTAL,
8.00 $
5.00 $
5.00 $
2.50 $�
8.00'
2.00
$
§.00
$
5.00
$
2.50
$
Furnace Shell & Lines—to 400 sq. ft. IDR 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
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
Ps+
FINN,
IF
See Fee Schedule
$
TOTAL F$E $
Dept, of Bldgs. Phone SU. 4-7470
8' Y3
City of Fridley:
WWR
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. 19
Owner.
Kind of Building
Used as
To be completed about
e_
Estimated Cost, $ 0
Old Ne . Building Permit No.
Permit No.Z762
DESCRIPTION OF WORK
HEATING or POWER PLIUM--Steam, Hot Wa Warm Air No-
Trade
o Trade Name �P Size Noj�! G l aa
Capacity /USq. Ft. E.D.R BTU H.P.
Total Connected Load_ c/4 ;� Kind of Fuel Aefe
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Signed-�•
ByIdey
42 1M 7_ Business one %o X��
s9
HEATING AND AIR CONDITIONING. INC,
4410 EXCELSIOR BLVD. MINNEAPOLIS 16, MINN,
(REMARKS—OVER) WA. 66567
CRONSITROMS HTG. & AIR COND., INC. Job Name
4
`'-4410 Excelsior Boulevard, Minneapolis 16, Minn.
�e
NEAT LOSS CALCULATIONS Job Address
.S.H
Weatherstrips Guidee E, Construction No. I Insulation
I
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor I Kind How Applied
Yes—No Yes—No 19—
Room I Length Width / /P Height So'- Fl Room I Length /® Width /iJ Height
Windows an ours—Crackage and Area
Width Helght No. is Lineal f . Area
No. of pane of Dane hte Ilgof crack e,
. tt. r
O V RA fi 1 �1
Btu
Infiltration 7�
Glass
Exp. wall ;F? 9, X g— 30—L/
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu. OD
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ F1.1 { Room Length Width ® Height
Windo and Doors--Crackage and Area
Width Height No. of
No. of pane of -pane lights
Width Height No. of Lineal ft. Area
No. of Dane of pane lightof crack sq. ft.
�n 1
1(4
fie ® / o
Coef.1
Btu
Infiltration
Coef.1
Btu
Infiltration
Glass
/ �a
11r
t,
01
ej ode
Glass'
Exp. wall
Net exp. wall
/2TZ
`
�
Int. wall
Exp. wall
5
v
Int. wall
a
Net exp. wall
Ceiling
®
(0
/5.
P o o
Int. wall
Ceiling
Floor
Total Btu. 1 91.6 0
Required sq. ft. E.D.R. or sq. -ins. WA. Leader area
Fl.l i-4.. .. !? Room I Length / .7 — Width w< 4 Height A
Windows and Doors—Crackage and Area
Width Height No. of
No. of pane of -pane lights
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack Area
ft.
L 20
Coef.1
Btu
Infiltration
Infiltration
46
--T176
Glass
/ �a
Glass
t,
Exp. wall
e e 0 e)
Exp. wall
Net exp. wall
/2TZ
`
�
Int. wall
v
Ceiling
Int. wall
a
Floor
Ceiling
Floor
Tbtal Btu. 1 A 0
Required sq. ft. ED.R. or Sq. ins. WA. Leader area
Windows and Doors—Crackage and Area
Width Height No. of
No. of pane of -pane lights
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack sq. ft.
0-9, 1� 10
Coef.
Coef.
Btu
Infiltration
di -I
/,2 &a
-
/ �a
Glass
t,
Exp. wall [ v
t ,
Exp. wall
Net exp. wall
`
.
Net exp. wall
v
Ceiling
Floor
Int. wall
�'
Ceiling
Floor
® 0
/5.
P o o
Floor
Total Btu. VO
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
i Fl.l Room I Length I --L Width Height
Windows and Doors—Crackage and Area
Width Height No. of
No. of pane of -pane lights
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.
Btu
Infiltration
s
di -I
/,2 &a
Glass
q 0
t,
Exp. wall [ v
t ,
Exp. wall
Net exp. wall
.
Int. wall
Int. wall
Ceiling
Floor
{
�'
Total Btu. Ir 0
Required sq. ft. ED. or sq. ins. WA. Leader area
A F1.1 nom I Length G 6 Width 6/ ` Height
Windows and Doors--Crackage and Area
Width Height No. of
No. of pane of -pane lights
Lineal ft. Area
of crack sq. ft.
Coef.1 Btu
Infiltration
q 0
Glass
Exp. wall
x
Net exp. wall
Int. wall
Ceiling
0 0
Floor
Total Btu. &;70
Required sq. k. ED.R. or sq. ins. WA. Leader area
CRONE
9ROMS HTG. & AIR COND., INC. Job Name
4410 Excelsior boulevard, Minneapolis 16, Minn.
z. NKAT LOSS CALCULATIONS Job Address
AS..V
Weatherstrips SHVE Construction No. I Insulation
Guide.E.
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof FloorI Kind How Applied
Nes—No Yes—No 19—
I F1.1 K�Vx Room I Lenath V Width `i Height II F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
, e�
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 Dbors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. h. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Lenath Width Heiaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Tbtal Btu.
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. of Dane 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 Dane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. iis. W.A. Leader area
Fl.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. at Lineal ft. Area
No. of pane of -pane tights of crack sq. ft.
Coef-I Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
suBaEcr
PER O.
City of Fridley
13456
AT THE TOP OF THE TWINS
BUILDING
a
r
PERMIT
RECE
`y _ COMMUNITY DEVELOPMENT DIV.
�
a n
r � PROTECTIVE INSPECTION SEC.
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L J\ 612-560-3450
910-F15
14/14/76
JOB ADDRESS 7843 Pearson Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
12
3
Pearson Is Craigway Estates SHEET
7—PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Francis Archer 7843 Pearson Way N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAILADDRESS 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
Construct a 22' x 14' Addition to. dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Addition must comply with the State Energy Regulations
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
308
3080
ANY 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.
$3.80
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$7,600
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-
$26.84
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$30.64
SIGNATURE OF CONTRACTOR OR UTHORI DAGENT (DATE)
-.1U
WHAE`N PROPERLY VALIDATED THIS IS YOUR PERMIT '"•'
BLDG. INSP DATE v
NATURE OF OWNEA IIF OWNER BUILDER) (DATE)
or .fraction thereof in the cost of ,all proposed work. T
at
.G._ 3n no case shall the fee charged for any permit as set forth in
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. •APPLILA11UN PUR A1;b11J1;A1ani,.,
OR ADDITION•BUILDING PERMIT
• CITY OF FRIDLEY, MINNESOTA
e 01411ER I S wzm : c r .S– t3;. BUILDER:
• - SS • ADDRESS
ADUItE �� 3 �c� �rs�-��
�
NO:. -STREET: PDQ rSO" l 1V F
LOT: BLOCK: � ADDITION: -ea hs®n's ima r a hS�Q7s
;j
Rr;ER LOT: INSIDE LOT: 1C SETBACK: -- SIMARD:
CORNER
.1
Applicant attach to this forte. Tiro Certificates. If Surve of Lot and .proposed
• '�
building; location di -Awn on these Certificates.
e
DESCRIPTION'OF BUILDING
' To Be Used As
epth:1
Front • Depth:-
T-1(3,,L) Square Feet: Cubic . Feet :
• /�
Front : ' 12–Zr— Depth: I t{- Height
.. Square Feet; 30a Cubic Feet: 660
Type of: Construction: o2Ak L& 72 6k Estimated Cost: $ P% 6,00
To Be Completed:
The undersigned hereby makes application -for a permit for the work herein
specified, a;reeing to do all work in strict accordance with the City of
-
Fiidley 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.
w RATE: 'Y ` /� SIGNATiSI'.E :
• (See Reverse Side For Additional Infor-, ation.)'
AGREEMENT
owner of t
� he property located
at �� �i2�� /�%-
have no objection to the City allowing
the construction of a to be located at ZdIQ
without the required certificate of survey that the
City ordinarily requires for all new construction.
Signature
Addkess
--9 -i7 7/6
Date
'Witness(/
CIlYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
October 31, 1990
Owner/Occupant
7843 Pearson Way N.E.
Fridley, MN 55432
RE: Monument Sign at East River Road/Pearson Way N.E.
Dear Owner/Occupant:
The monument sign located at the above referenced intersection has
experienced substantial deterioration and is in poor condition.
I have been unable to locate anyone who could be held responsible
for the maintenance of this sign. This monument sign, which is
located within the City right-of-way, has become an eyesore and it
also constitutes a health and safety hazard.
The City is currently considering removing the monument sign from
this location for the reasons cited previously. Please contact me
at 572-3595 on or before November 20, 1990, if you have concerns
regarding this possible action, so that these may be taken into
consideration.
Sincerely,
Steven Barg
Planning Assistant
SB:ls
C-90-946
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
P NO.
7 316
r
�• COMMUNITY DEVELOPMENT DIV.
may_ --'---
r PROTECTIVE INSPECTION SEC.
i =
CITY HALL FRIDLEY 55432
612-571-3450
RECEIPT NO.
52.50
NUMBER
910415
REV
DATE
8/20/98
PAGE OF
APPROVED BY
JOB ADDRESS
7843 Pearson Way NE
1 LEGAL
DESCR.
LOT NO.
12
BLOCK
2
TRACT OR ADDITION
1 Pearson's Craig-way-EstatesSHEET
SEE ATTACHED
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Frank Archer.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Norway Builders Inc. 450 W. County Rd D Npw Brighfirin 55119
481-5899
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
Reroof house and garage (27 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State 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
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
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 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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
VALUATION
SURTAX
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2251
$1.12
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$74.75
Fire SC $2.25
�( `
PLAN CHECK FEE
TO7TA'7EE
e0�/9
Licens 5.002
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
ENRO
BI G INS-
VA IDA D IS IS V R P MIT
r •
DATE
S,GNATUREOFOWNER�IFOWNER BUILDER) IDATEill
Pwepaizd Plan Check $
Estimated Cost S
Receipt #
Effective 1/1/98
CITY OF FRIDLEY
R-3, COMMERCIAL & INDUSTRIAL
BUILDING PERMIT APPLICATION Al`
Construction Address A3Ae rA &4y Zoning
Legal
Owner & Address � a ���� Tel#
ampacroR & ADDRESS i),6. ` &Wz,d�/�s 1,vc �/sa �u�rr� /�D NEua Tel#!i835`�9f
Architect Reg. # Engineer Reg -#
BUILDING CONSTRUCTION
TYPE OF WORK [] New [] Addition [] Alteration -Describe
OFC. AREA: Length
Width
WHSE AREA: Length
Width
aIHER AREA: Length
Width
Height Sq. Ft.
Height Sq. Ft.
Height Sq. Ft.
APPLICANT /I�ol1�,��Y �uJt1lF,es fie} 4y WJ Tel #
Sq. Ft. x $
Sq. Ft. x $
Sq. Ft. x $
VALUATION
Cost/Sq.
Ft. =
Valuation
Cost/Sq.
Ft. =
Valuation
Cost/Sq.
Ft. =
Valuation
Date �G7p
$ )
TOTAL VALUE
Building Use Construction Type Occupancy Group
Aix Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No
Performance Bond Amount $ See Reverse for Schedule Received []Yes []No
Permit Fee
$
! 7• %S�
$
Fire Surcharge
$
a5�
State Surcharge
$
/ • / a2
c�C ,�3 r P•-
$ S _ d
Erosion Control
$
Park Fee
$
Spec. Assessments
$
Driveway Escrow
$
TOTAL
$�,
/02
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/10th o)
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1000 per SAC Unit (Plans to MKCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] Not Necessary []
feet x $13.50/foot
ATTACH STIPULATIONS
Building
$ 93.2�
BUILDING
Pernlit No.:
Inspections
$
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$ 6LOO
CITY OF FRIDLEY
Date Rec'd: ('9
DATE (✓J
YOUR
N 9 T'0
$
E-MAIL ADDPESS
uici s C IAC-' c (e • teo
SITE ADDRESS %ee{3
eo,Scvn ,F /P./
Total Due
THIS APPLICANT IS:
❑ OWNER WONTRACTOR
PROPERTY OWNER/
NAME: l
TENANT
ADDRESS: O o J
CITY_ _ r� <J�e i STATEN&P
PHONE:
CONTRACTOR
NAME; i
S &&2ee r
STATE LICENSE # D3 O� EXP DATE .3 _? %
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:
CITY 5 STATE"LIP_ 2�
WITH APPLICATION
PHONE X3 535- S7® FAX
X-7 S S 5
PROPERTY TYPE
WINGLE FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH OROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �Gv 61�7
SIZE OF IMPROVEMENT LENGTH
WIDTH HEIGHT Sq. Ft.
ROOFING
C
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
I. 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:
(USING THE 199 a B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 1 r OCCUPANCY TYPE
Permit Fee
$ 93.2�
Plan Review
$
Fire Surcharge
$
Surcharge
$
License Surcharge
$ 6LOO
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
-ft +6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev 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 ordinanc s 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 ora pe t and k ' not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w h re s approval of plans.
SIGNATURE OF APPLICANT PRINT NAME f�V"d � 76Z%110 ►' DATE_ 1P— C7" ®(D