PRE 2010 DOSCCity of Fridley, Minn.
BUILDING PERMIT N? L -14-1v
Date:
owner: Builder 4
Address. ............................... ........ . Address
LOCATION OF ABUIL ING
No.
Moor
Lot l3lock.,;. IngJAp T44" Addition or Sub -Division
Corner tot 0!
4, 4�
Setback �o S1, d
Sewer Mevation Foundation Elevation
DESCRIPTION 'OF BUILDING
To Used
4(/
Front 'Xr-A Depth Height
Sq W Ft Cu. Ft
Fron pt
Depth Leight q
CM OV47 - I S
00
Type of Co
Won dtion Est. be Completed ..........
In consideration of, the Issuance to nle of a pe b ?h agree to do
cri " the
building
the
work In accordance with the description
forth Zrithlil'provisions of
0 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 grptedeMployees and workmen, in all n
Zk
the express condition that the person to whom it is granted and his agents, w
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 bz"Alnp
within the city limits and this permit may be revoked at any timeof any of the provisions of said
UT
ordinances.
LI -i *4� 0 Me- 10 0 -0 -al _
NOTICE:
premb does not cover the condrudion, IndaMen for wring, phanbing, gn boding, swer or water. Be sure to aft
tlro Building Inspector for soparde poroft for then it"M
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM
BUILDER
z_4 _&CA -1
ADDRF.§s ADDRESS
LOCATION OF BUILDING
No. Street Part of Lot
Lot Block Addition or Subdivision s , .a 61h I da^ Ad24
Corner Lot Inside Lot ?Z Setback 3 S 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— ' -
To be used as:
DESCRIPTION
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost C
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 _ _STGNATIME
(Schedule of Fee Costs can be found on the Reverse Side).
a A
City of Fridley
Application for Plumbing and Gas Pitting Permit
DepL of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
e
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, b1"inn. 2 19
Owner ` �°`
Kind of Building
Used as
of
To be completed about
inL-
PARTIAL RATE
SCHEDULE
Estimated Cost, $
� �
Z
�Q
O�
<
5a
�q6
PLUMBING FIXTURE RATES:
N
0
`�0
F
N
WATER HTR.
GAS
ELEG
Number Fixtures ...................
6Q
x
<�
$ e% ®
Signet— yh,
Future Fixture Opening
x
1.20
$ 2` ®V
By
O
x
1.00 '$
Business Phone No
®�
Catch Basin ...... .....................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
Base
$
ROUGH
New Ground Run Old Bldg. ............
x
3.25
$
1st
`
Q
GAS FITTING FEES:
NO.
RATE
TOTAL
1st 3 Fixtures ..........................
x
$1.50
$� ,
2nd
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
_
3rd
_
4th
• Future Connection Openings
Connected withI
Sewer El
New .Fixture. Old Openings
Cesspool
e
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, b1"inn. 2 19
Owner ` �°`
Kind of Building
Used as
of
To be completed about
inL-
PARTIAL RATE
SCHEDULE
Estimated Cost, $
� �
�
old—euilding Permit No
Permit No.
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ...................
x
$1.50
$ e% ®
Signet— yh,
Future Fixture Opening
x
1.20
$ 2` ®V
By
New Fixture Old Opening ..............
x
1.00 '$
Business Phone No
®�
Catch Basin ...... .....................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
ROUGH
New Ground Run Old Bldg. ............
x
3.25
$
FINAL
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 $ ® d z VA 7-59
Date:
Owner:
City of Fridley, Minn,
6431UniversityAve. N. E., Mugm�eaapvoIis, Minn.. 555432
December 8, 1972
Duane Prairie
Builder Kraus -Anderson
Address _ 4R9_Ricg Creek Terrace N.E. Address Minneapolis
xo 489 street
.Xot 7 Block
4
LOCATION OF BUILDING
Rice Creek Terrace
Part of Lai
Addition or Sub -Division Rice Creek Terrace Plat 4
Corker Lot inside Lot Setback
Bower Elevation
Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Fireplace Front Depth Height __ Sq. Ft. Cu. Ft.
Front Depth . Height Sq. -Ft. Cu. Ft.
Type of Construction Stone & Brick Est. CostJ. To be Completed December 31, 197231
?Ouu
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.
C�d
In consideration of the payment of a fee of $ 6.00 y permit is hereby granted to Duane Prairie
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, AUnnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
�i city ]units and this permit may be revoked at any time upon violation of any of the provisions of said
dinannae
Building Inspector
DARREL CLARK
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sawar or water. Be sore to we
the Building Inspector for separate permits for these hems.
APPLICATION FOR RESIDENTIAL, ALTERATION#
OR ADDITION BUILDING PERMIT
CITE' AF PRIDLEY, MINNESOTA
_Z(f
LOT,- BLUCK;
OORM LOT;
Mill
'm
M V
r
LOT; ^SFTBACRII SIMAR.D:.
.: "t-4«ate "ch to ft" fmmT io Certificates of Surv2X of Lot and Proposed
Wldftg 14mation drama on cbmw Certificates,
VESCRIPTION OF BUILDING
To Be Used As:
—Height:
Sgaaare Fact; Cubic Vvetj
Front; Depth; Height;
Square '{Bet; Cubic Feet;
Trfa of Conotructioal Estimated Casts $ 80 4 -�'o �000°l
a�
TM uudervigaed hereby =*ass applica"an for, a permktt for the work herein
VpaQjfje4, agreeing to do all work in stttet accordance with the City of
,tdley Orders and Tuiiap Pf the Department Qf Bu4d$n8s, MW 'hereby
+docla;rep dKt all the facts and representations stated la this application
axe true =4 correct,
vz � % t-1 ll_� A- I N
a 6TrXATUU .
(Oft Ro,►eoo We For Additional Informatim,)
City of Fridley
SUBJECT
P 0.
1 42
AT THE TOP OF THE TWINS
!f
r
BUILDING PERMIT
R E1 NO.
COMMUNITY DEVELOPMENT DIV.
/
r PROTECTIVE INSPECTION SEC.
([�
CITY HALL FRIDLEY 55432
j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
8/11/77
JOB ADDRESS 489 Rice Creek Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
4
Rice Creek Terrace Plat 4 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Duane Praire 489 Rice Creek Terrace N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Tri-Co Builders, Inc. 2261 Fair Oak, Anoka 427-6250
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
Construct a 12' x 20' Addition and a 121 x 20' Deck
9 CHANGE QF USE FROM TO
-STIPULATIONS
Call for .inspection before installing hidden header
iVAftjjG
RATE PERMITS REQUIRED FOR WIRING BWo
SSPE Q , re digging
local HEATING, PLUMBING AND SIGN.& TELEPHONE. CallECTloc
!al utilities
GAS�'���1RED � etc. .
y LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS 'VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
$]0,000
$S.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-
$48.00
STRUCTI R THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
Q
2
$53.00
SIGNATUREOF CONTRACTOR OR AUTHORIZ DAGENT IDA E) q
LY
WHEN PR PERVALIDATED THIS IS YOUR
PERMIT
6A� 4 (—q
BLDG. INSP DATE
SIGNATUREOF OWNER(IF OWNER BUILDER) '- IDA )
APPLICATION FOR RLSIDENTIAL, ALTERATION,
OR DDITION BUILDING PERMIT
CITY OF I-RIDLLY, �HNNESOTA
/" vf---
MNER I S NAME : _ A /'V ,i a� $U ILDER : �� c� tt
ADDRESS ��� � � '.. f0 ,Z -p ADDRESS 2
tj e,
CJG�
STREET•2. �'=QQI:t.(.. �1C./�R' a Q� - Q
LOT: BLOCK: � ADDITION • /u.&A.- .
CORNER. LOT INSIDE LOT: SETBACK: SIDEYARD;
Applicant attach to this form Two Certificates of Survey of Lot and proposed
buildirtg location drawn on these Certificates. _
DESCRIPTION OF BUILDING
To Be Used As:
T a -a —Front. Depth: Z -o Height :_-C3
Square Feet: Cubic Feet:���
�ctc Front:
/1:
Depth: Z -el - Height
Square Feet; Cubic Feet:
Type of Construction: 1) °d��0 �. Estimated Cost: o•`" _"-t
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict accordance with the City of
ridley Ordinances and rulings of the Department of Buildings, and hereby
declares that -i11 the facts and representations stated in this application
are true and torrt-ct.
DATE: SIGNATURE:4i",
(See Reverse Si For Additional I formatioi
Y
~��dm
j�� +
TRI - CO BUILDERS, tai_
7555 VAN BUREN N. E.
MINNEAPOLIS, MINN. 55432
ENERGY CONSERVATION SUPPLEMENT TO BUILDING PEIkMIT APPLICATION
PLANNING AND INSPECTTON ULPARTMENT
CITY OF FRIDLE,Y, MIN11ESOTA
This supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE
AVERAGE. "U" FACTOR INFOW4ATION. This information is required so the BUILDING
OFFICIAL can determine that submitted plans comply with the ENERGY CONSERVATION
DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S
responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA
in the plans; submit product specifications, if needed to support the "R" and "U"
factors used; and to assure construction is per approved plans.
JOB LOCATION: �%' i4,111 C0
e C
OWNER/CONTRACTOR: e V ' '
ADDRESS :,�, PHONE:
�
A. Determine the Total, Exposed Wall Area as follows:
1.
Total
wall window area
2.
Total
door area �� �'�
3.
Total
sliding glass door area
--
4.
Total
fireplace wall area
�1
5.
Total
wall framing area (average 10%)
6.
Total
net wall area above floor(average 90%)
7.
Total
rim joist area
> a°
Subtotal: Total exposed wall area above
floor
8.
Total
foundation window area
\
9.
Total
net foundation area above grade
��
Subtotal: Total exposed foundation area
r
GRAND
TOTAL EXPOSED WALL AREA
/ V.
B. Multiply
the GRAND TOTAL EXPOSED WALL AREA X
.17
=' IJ -, ;°
Item I -3 3q,
C. Determine
the Total Exposed Roof/Ceiling Area
as follows:
10.
Total
skylight area
ti
11.
Total
roof/ceiling framing area (10%)
j -3
12.
Total
net insulated roof/ceiling area
GRAND
TOTAL EXPOSED ROOF/CEILING AREA
D. Multiply
the GRAND TOTAL EXPOSED ROOF/CEILING
AREA
X .05 = �J �,
Item II /s �✓
0�
sem"®
E. Determine the "U" value of each segment (1-9) and multiply by the area as
i:ulLc,vr:::
2. x
3 . X It U tt �� _ -
t �- J
to v' 4. �' X
r —
5. _ x foul# / / p
6.e x glut# C)
`.
7. / C ,ter' X tt U tr n %� �! !'' - 6 D
ADD 1-9 FOR TOTAL WALL SEGMENTS = �" ITEM III
F. Determine the "U" value of each segment (10-12) and multiply by the area as
follows:
10. X "i7" .�
11. g lout#
12. 1 a 10 tl - c
X
ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS CITEM IV
G. If Item III is the same as, or less than Item I, you have met the intent
of State Building Code 6006 (c) 2.
H. If
Item
IV is the same
as, or less than
Item II, you have met the intent
of
State
Building Code
6006 (c) 1.
I. Add
Item
I
+ Item II
J. Add
Item
III -�
+ Item IV
A
K. If the sum of Items III and IV are less than Items I and II, you have met the
intent of the Code for total envelope system.
V
The undersigned, as applicant for a building permit, hereby affirms a above
information has been prepared and submitted by himself or under his direction,
hereby acknowledges the information to be correct and accurate; and hereby
presents {t1"e.(ifq't� rte required plans in support of the building permit
applicatiogvr' VAN 8UREN N. F-
11 rMiNfv[ ,^,MGUS, MINN. 554321
By: �.v--� i � _ DATE: / C/ '/� 7
-_-i
17
SUBJECT
PT NO.
City of Fridley
® J E 249
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
REC
COMMUNITY DEVELOPMENT DIV.
�3
r PROTECTIVE INSPECTION SEC.
/
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
j 612-571-3450
910-F15
10/15/85
JOB ADDRESS 489 Rice Creek Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
4
Rice Creek Terrace Plat 4 SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Duane Prairie 489 Rice Creek Terrace N.E.
571-3993
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Tri-Co Builders 2261 Fairoak, Anoka, MN 55303
427-6250
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK ❑ NEW X7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
26.x 10 addition
9 CHANGE OF USE FROM TO
STIPULATIONS
Soil correction may be necessary.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
wood
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 WOR K 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
$14,050
$7.03
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 PERFORMANCE OF CONSTRUCTION.
�/
P �°� i®C�
PLAN CHECK FEE
$27.63
TOTAL FEE
$145.16
SIGNATURE OF CONTRACTOR O UTHORI ED ENT tDATE)
WHEN PROPERLY
VALIDATED THIS IS YOUR PERMIT
SIGNATURE OF OWNE'iR)IF OWNER BUILDER) IDATEi/,5
BLDG )NSP
DATE
17
NEW [ ] City of Fridley Effective 4/1/84
ADDN.1 �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: 1 ,fiel �t �
Legal Description: !'
�o f J �3�0 e/ iC��, r�61 e12r4, ,g_.
Owner Name & Addx ess : ` ?f Tel . # %/- 9�/-3
Contractor:�d-�` Tel. # �a7���s
Address:
Attach to this application, a Certificate of Survey of the
lot With the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT �c
LIVING AREA: Length 1 Width /0 Height O Sq. Ft.
GARAGE AREA: Length
Width
Height Sq.
Ft.
DECK AREA: Length
Width
Hgt/Ground Sq.
Ft.
OTHER:
---
q(1. 14 d' cl.el"_ 2
sLuU(SC .9(66
Corner Lot [ ] Inside
Lot [VI Ft. Yd. Setback
Side Yard
Setback
Type of Construction:
L12's M -.!z—
Estimated Cost: $
1q,oco,)()
FF�� /
S�
Approx. Completion Date:
�l/ �
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee -
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT: Q aTel.
CITY USE ONLY
$ Fee Schedule un Reverse Side
$ 25$ of Building Permit Fee
$ `�.$.50/$1,000 Valuation
$ $425 per SAC Unit
$ Fee Determined by Engineering
$ `s
Agreement Necessary [ ] Not Necessary [ ]
,-Pk �j e C F`�5 '1- 01
c.
Main Office 571-6056
UBURBAN 6875 Highway No. 65 N.E.
NOINEERINO I Minneapolis, Minnesota 55432
IpG
_South Office 890-6510
0 Civil & Municipal Engineering • Soil Testing • Land •Surtreying • Land Planning BurnsvilleClif,
Road
Burnsville, Minnesota 55337
Mortgage Loan Surveq for iol� CIO
fl
42 e Ota -t el ►, �0. ��`�
0 1 AP 0 ?
.f 2? Ill �,� �,►
7,114/
X X
L07 i is
Rica 4L
4;u6iCerA to aa . Amo�,aili Co(A
This is a true and correct representation of a survey of the boundaries of the land above describedand of the
location of oil buildings, if any, thereon, and all visible encroachments, if any, from or on said land. this survey is
made only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is
understood and agreed no monuments have been place fon the purp se of establishing lot lines or boundary
corners. Dated this � cloy ofi[—. A. D. 19 e:.,
s SUBURBAN GIING, INC.
r
Engine* r�� Surveyors
S by.
Not Published: All Rights Reserved
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE Wi TH
FAX 76 hg _S' 5% 6 f
'! c'q
IPERMT TYPE i KSINGLE FAiVIILY 0 TWO FAMILY 0 TOWNHOUSE `
TYPE OF WORK; 1 E3 NEW C REPLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 168.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor_ _ ^ ..:.05 =__
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SDZULAV
FLOOR DRAINS
— SHOWER
®WATER PIPING
BATHTUB
CCAS PIPING (Am crrrucuno
_._ SWIMMING POOL
_ WATER SOFTNER ($35)
CLOTHES WASHER
_
KITCHEN SINK
WATER CLOSET
BACKFLOW PREY. ($I5)
_ DISHWASHER
_
_ LAUN7DRY TRAY
XWATER HEATER ($35)
FOR IRRIGATION
WATER METER.
OTHER
Permit Fee $ 6® Number of fixtures @ $10.00 x $10.00 =
Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ _ Number of fixtures (a $35.00 x $35.00 = $
State Surcharge = $_____!LO
Total = $
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 pian in the case of all work which r uir rev' and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME�.�
City ®f Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572a-3604
WAV. 7A'1_1;f)') A077
Building
BUILDING
Permit No.: „ ,
Inspections
RESIDENTIAL APPLICATION
Received By: i2L
763-572-3604
CITY OF FR[DLEY
qJftcYj-"
DATE b 30V�AOS
t
YOUR E-MAIL ADDRESS luSc�d @QL%
n 1 p C• C
SITE ADDRESS
r'a 5
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
$
PROPERTY OWNER!
NAME:
SAC Charge
ADDRESS: CITY
STATE ZIP
TENANT
Curb Cut Escrow
syn
PHONE:^L0 _3 " S� Q _ Q2�
NAME: Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE #_ 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113 f
STATE—ZIP—
ATEZIPWITH
WITHAPPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/NE`
651-264-4777
Sewer Main Charge
PROPERTY TYPE
❑ TWO FAMILY/NEW G _
❑ ADDITION ❑ GARAGE/SHED INDOWS
Total Due
PERMIT TYPE
l , t oLl
13 BASEMENT FINISH 13 ROOF DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING
DONE: -2"
SIZE OF IMPROVEMENT LENGTH WIDTH
HE T . Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
Proposed floor plan
PROPOSED SIZE:
133. 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 structure
❑ Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
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:
(USIN T 1997 U.B.0 FEE SCHEDULE)
ION
TOTAL JOB VALUAT$ OCCUPANCY TYPE
Permit Fee
$ Lac).
10
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
, og
.001 times the total job valuation
Surcharge$
r'a 5
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
5) 0Q
$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
_- $
l , t oLl
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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
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 approve
plan in the case of all workwWoh =A&,0t2r&INTNAMEAQdrA
and approval of plans.
SIGNATURE OF APPLICANTQ-Y1Sn 1fk.7 DATE��
.. x . r r. „ I „ IFrom: unknown Page: 2/2 Date: 10/6/201012:36:02 AM 1-1 1 , � .. Lr `
Building
MECHANICAL
Permit No.: () -011 &q.
Inspections
RESIDENTIAL APPLICATION
'Received By: fy�
763-572-3604
CITY OF FRIDLEY
'� 1
763-502-4977 FAX
Ek'FECtIVE 7-1-2010
�t
.SATE L./• +�+ 1 V YOUR E-MAIL ADDRESS +/ei+�"41
SITE MDRESS Co 40% 1C' /R.i
'PHIS APPLICANT IS: 140WNER MCONTRACTOR
PROPERTY
tr
NAME:_WV i V#464r*
t7WNlElIs1
ADDRESS: ► A,60.+ CAF 400- oiilf/�' ITY fry* �r STATEI�lI'�ZIP�1` &
-' - -..�.-
TENANT
PHONE: "Ebb« 6"NO ' -Wds
CONTRACTOR
COMPANY NAME;
SUBMIT A COPY OF
CONTACT PERSON: _
YOUR STATE
STATE LIC :M EXP DATE
LICENSE WITH
ADDRESS: CITY STATE ZIP
APPLICATION
PRONE FAX
PERMTT TYPE
J1 SINGLE FAMILY 0 TWO FAMILY D TOWNHOUSE
TYPE OF WORKS JQ
rr�r R REPLACEKWr ❑ Ai.'Ik2tATION/REMODEL
DISTAILM DESCRIPTION OF WOI;I^4C. ..o ont- i
KES ARE BASED ON SIO -00 PER FIXTURE, EXCEPT WMM NUM. WXRMF$: (J OXCATS TOTAL NUMBER OF EACH BELOW)
PROVIDE REAI,T LOSS CALCIS PER MANUAL J 2M A911RAE HANDBOOK.
Equipm= t IrAW1cd MFG: MODEL: 3TLEJB'Tu
_
MODELI: STU
MODEL9_A 001 SIZEIBTU -740000
*A/C $25.00 _PIREPLIICE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIR TO AIR EXCRANGEER $15 _FIREPLACE (WOOD) $35.00 XEW GAS GRILL $10.00
HOnm $35.00 A- FURNACE $35.00 GAS UNIT ATR $10.00
CHNNEY LINERS 10.00 _GAS DRYER $10.00 -POOL HEATER $35.00
Tn1CTWORK$10.00 ' _WPIPING$10.00 VSNM ATOR$15.00
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TMS IS AN APPLICATION FOR A MKT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the infouw6on above is complete and accurate; that the work will be in
conforRmcc a with the ordinances and codes of the City of Fridley and with the NlInnesota 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 is the case of all work WW&16=uim review and approval of plans,
,. t&*
SIGNATURE OF AP,PJ.JCA,hi�: r1
r+-" PRINT NAME • Mir I14++moi DA1� +
APPROVAL INSPECTORS SIGNATURE DATE
'.:'.'`:.PLEASE.No.TE 'WARKTE'PERMITS'A tE`: U�ECrk'ORj3=j 0-Ei.ECMCAI:AND.M6CMNIC.AL W0FX.-" '
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX 763-502-4977