PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: ........
� 4
Owner: - - •-••- _:._................
-71
Address ----.--_----- ._.........
N® 48'74
z
Builder
Address _.. ._ _:.. d._........
LO 10 F - UILDING
No.:.. _:....... Street ....._ _....,�_: ............... Part o Lots .._...... _ ._ _..........
Lot :.......... Block .....- ........ ........... Addition or Sub -Divi on r ... , & . ........
Corner Lot ............... Inside Lot .--- Setback .. _....:.:
Sewer Elevation ....._ ..................... ....... ..................... ...................................... _.. Foundation Elevation .................... .............. _.............
DESCRIPTION OF BUILDING
To bf Used as
y
� AA
. ' - - ✓ . __ Front ..._ _.. Depth ...:. ..:_:. Height -.. Sq. Ft. Cu.
...... Fron Depth ...., Height ... Sq. Ft. _.. Cu. Ft..`
�9 „ ... To be Completed -------.........__.........._..... ..............
Type o Crnstruction ... ":fir...... Est. Cost..., ,... .. .... ....
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.
00
In consideration of the payment of a fee of %P-4- 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 fi any of the provisions of said
ordinances. ' Az?
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, SCAU A Idee,thea to see
the Building Inspector for separate permits for these items. ��11 �Y 99V T °�1
IV (1T eLl7unRl7 OLAT-
4
ION OISY PRIVATE LAND COVENANTSS AND
"';; BUILDIN"� RESTRICTIONS.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name
OF
No. �/ ,� / Street - f /L `j to V L1 -U14$1 MrTl ti
Lot Block. Addition or Sub.D
Corner Lot_ side Lot Set Back AIj Sidel-
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Height ��
Sq. Ft. Cu. Ft. , $4 0 3-0
nt 9-a/ Dept � Height
Sq. Ft. Ci Cu. Ft. % 0 Q
Type of Construction C' Estimated Cost IA
To be completed
The undersigned undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and cogpSp. n a
��ON WIA CA. /
(A Schedule of Fee costs can be found on the Reverse Side.)
T
City of Fridley
Appaication for Plumbing and Gas Fitfiing Pi
Dept. of Bldgsr Phone
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
2�
TOTAL
Number Fixtures ......................
x
$1.50
$�
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
N
WATER HTR.
GAS
EHEC.
x
3.25
$
�9
...... x
2.00
3��.
e�
x
S�
U�
<
4a
O
R
x
$1.50
$
Additional Fixtures ....................
3(j
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
Base
1st
2nd
_
3rd
_
4th
' Future Connection Openings
Connected with
I
Sewer �
New Fixture, Old Openings
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$�
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU)
...... x
2.00
$ 5k
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................T
x
$1.50
$
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ....:...........................................$
TOTAL FEE $
'4
/d
7U
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 applic on are t e and correct.
y, Minn 19
Ownergi�zg: ,—
Kind of Building �L
Used as
To be completed about —
Estimated Cost, $
Old—New. Building Permit
ROUGH
FINAL
dz 2M 7-59
By_L.g
Business Phone
No. �-
Application for Power Plants and Heating. Coaling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ ® 010
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. EDR Steam .... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
CCAS BURNER (up to 400,000 BTU) ....................... 5.00 $ ,-,- 0
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
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
$
REMARKS:
Dept. of Bldgs. Phone SII 4-7470
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn , 195Z-0
Owner LX11 ! .
195—
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old- e ' Building Permit No.
195—
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Wate Warm —No- Z
e
Trade Name A Size No- /0,.-.':
Capacity—,S/q. Ft. E/.D.R BTU H.P.
Total Connected Load z Kind of Fuel�� "�"� rrLL��
BURNER — Trade Names ', Size No- 12.4f10. '
Capacity Sq. Ft. E.D.R /D 00 d00 0 BTU H.p.
SUBURBAN HEATING & SHEET METAL
8419 CENTER DRIVE N. E.
Signed MININEARGLIS 21, MIWN
o gee
11 POST 1M-12-58 Business Phone No- -5401 � X47ep
Ddb az
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS /67 FRIDLEY, MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall I Ceiling Roof Floor Kind How Applied
eNo I No 19--i-0 Zp -f�,f I
/ Fl.l~ .., _. Ji. Room I LenQth.i ® Width Height 9 II / FLI R I Length /. A / idth / 71 Heisrht,'/
Windows and Doors—Crackage and Area
moi' -....0..' do
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
2- �®
i
�-
nfiltration
l
' '
Coef. Btu
Glass
Infiltration
<
SS
Exp. wall
,
-i
Exp. wall p
Net exp. wall
Net exp. wall1v
15,
X/0
Int. wall
Net exp. wall
t:z
Ceiling
Ceiling
S
Floor
®� ®®
Floor
Ceiling
®
"notal Btu. 113,1.2-V
Required sq. ft. E.D.R. or sq. ins. W.A. Leader are
FI m I Length z/ Width /V/ Height /
Windo s and M sL--Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack I sq. ft.
31Y
2- Zt-/ 2-d 1;?? ® L2/,,o
Coef.l Btu
Glass Z�
Exp. wall
Net exp. wall
Int. wall
Ceiling d' ue 99
Floor"
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I m I 0_L— IT _-L me -2.t , In i
_- w,+ ---7— 1---" --- . ...'
Windows and Doors; Crackage and Area
moi' -....0..' do
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack ft.
i
Net exp. wall 0
Int. wall
Coef.
Coef.1 Btu
Infiltration
y ,
,�W
Glass
,
-i
Exp. wall p
2J
Net exp. wall1v
Int. wall
Net exp. wall
_,1'r4z16
Ceiling
Int. wall
S
Floor
Total Btu.
Required sq. ft. E.D.R.I or sq. ins. W.A. Leader area I -as>
Windows and Doors—Crackage and Area
Btu
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack ft.
Esq
%/ y / fir✓
Net exp. wall 0
Int. wall
Coef.
Btu
Infiltration
,
,�W
:?,
Glass
-i
�',$-
2J
Exp. wall
Net exp. wall
Net exp. wall
,
/®
Int. wall
Int. wall
Ceiling
Ceiling
S'
®
& 0
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leider area
FI.I Room I Lenstth %.?_ / Width 41/ Height P/
Windows and Doors—Crackage and Area
Btu
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Glass
Exp. wall
Net exp. wall 0
Int. wall
Coef. Btu
Infiltration
2 .
Floor L3 15—
,�W
Glass<
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
�',$-
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. itis. W.A. Leader area
F1.1 Room I Length / Width / HeightV/
Windows and Doors--Crackaste and Area
No.
Coef.
Btu
Infiltration /7 50
Glass
Exp. wall
Net exp. wall 0
Int. wall
Ceiling L2
Floor L3 15—
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/h
SUBJECT
®P NO.
of Fridley
25080
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir?City
COMMUNITY DEVELOPMENT DIV
~
r PROTECTIVE INSPECTION SEC%
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
5/21/97
JOB ADDRESS 497 Rice Creek Terrace NE
T LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
4
Rice Creek Terrace Plat
4 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Florence Zawislak 497 Rice Creek Terrace NE
571-4460
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
D & D Home Improvement Inc 11773 Magnolia St NW, Coon Rapids MN 55448 4840
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
757-7780
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C. REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (25 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
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,062
$1.03
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIO F ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$74.75
Fire SC $2.06
STRUCT N O THE PERFOR CE OF CONSTRUCTION
PLAN CHECK FEE
TO AL FEE
License S
$5.
$82.84
SI NATURE OFCONACTOR OR AUTHORIZED AGENT IDATEI
p
ALIDA EP THIS IS YOUR PERMIT
�ILIG
7
DATE
SIGNATURE OF OWNER IiF OWNER BUILDERI IDATEI
NEW [ l
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
%?46
Effective 111/97
Owner Name & Address: 2EZVX�-e /.��� Tet. # sr` J & 0
Contractor: a Tm rouement, !no _ MN LICENSE # 4840 _
Address: 11723 Maaanal i a Stx'eat NW., Cnnn uani ria r-gA4$ Tel. # 757-7780
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: — Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: '� ' APPLICANT: 0^ Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
CITY USX ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1110th%)
$.501$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ I Not Necessary [ ]
CIiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
LICENSE AGREEMENT
The undersigned Florence Zawislak being the fee owners of certain property located in
Fridley, Minnesota, at 497 Rice Creek Terrace , and legally described as:
14-30-24-21-0056
hereby grant to the City of Fridley, Minnesota, and that the City's employees, a license for the
purpose of gaining access across the above-described property to a retaining wall and other structures
adjacent to Rice Creek.
This license is only for the purpose of allowing the aforementioned persons access for maintenance
purposes. This license is intended to last ten (10) years from the date of its execution, and is not
transferable or useable by any persons other than those designated herein. By accepting and using
this license, licensee hereby agrees to repair any and all damage caused by the City or its employees
while using this license on the above-described parcel.
Signed:
Florence Zawislak
Subscribed and sworn to before me this T day of � 998.
Notary Public
Y
------------------
JOAN M. BUDNICK
NOTARY VU81lC - NNOWW too GOOM110011-11-0 --- M
A
Mor Caaml�m Eimbtar.7t. m00
Building
$ j'Z . 2
BUILDING
Plan Review
Permit No.:.a?616-b
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
Received By: MIGLW
763-572-3604y
$ Q ly_
CITY OF FRIDLEY
rat
763-502-4977 FAX
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
EFFECTIVE 7-I-2010
ft + 6 ft = ft x $24 = $
Erosion Control
DATE
YOUR E-MAIL ADDRESS
Park Fee
SITE ADDRESS
c
Sewer Main Charge
THIS APPLICANT IS:
❑ OWNER *_CONTRACTOR
Total Due
PROPERTY OWNER/
NAME: S' .�
TENANT
ADDRESS:"I .r;e ewO L;& w
CITY � STATEAV2IP_9,
PHONE:
CONTRACTOR
NAUE:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # dG3 '7.2 9
EXP DATE 3 /®
AND CERTIFICATE OF
�A
ADDRESS: M 46 a ils" NE
CITY 61 1e —STATE,�ZIP
INSURANCE
PHONE
111✓SINGLE FAMILYINEW CONSTRUCTION
FAX
SIZE
PROPERTY TYPE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES_
PERIVIIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH XROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWINIMQdG POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ODELING
DESCRIBE WORK BEING DONE: fa
O
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT sQ FT 3O
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES 3a WHOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
GARAGES
JNiATTACHED GARAGE
2. 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
ADDEEIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I . Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS –PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
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 S Roo& Ar OCCUPANCY TYPE
Permit Fee
$ j'Z . 2
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$ Q ly_
.0005 x Permit Valuation Minimum $5.00
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $24 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ "'7 C?
Make checks navable to: City of Fridlev Attach Stinulations
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 fo aAM—.
work is not to start without a permit on site, that the work will be in accordance with the
approved plan in the case of all r h' es review and approval of plat>q bf®®�SIGNATURE OF APPLICANTPRINT NAME .11 !w • A DATE %
APPROVAL INSPECTOR SIGN F
PLEASE NOTE: $WARATE PERMITS ARE REOUIRED FOR PLUMBING ELECTRICAL AND MECHANICAL WORK