PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMITr�"
® 4832
Date:..::...... .................. .:
Owner: .------.._..».........._.. .......... :.............................. ... . ............... Builder _.... . i ._.._.... _
Address... __.................... _ ._.._.._..__...._..._»_ _ _.»_..._... Address . ............. _.
LOCATION OF BUILDING,
No.... 46 Street _........+._.... ...................... ..... Part of Lot, .............
o �
Lot ....................................... Mock ............ ............................ Addition or Sub -Division _ �'r _ '. `... ....._ ... .........e_ ....-
Corner Lot .......................... Inside Lot ------.... v........ Setback ....._.�:±_ ° .................. Sideyard ....._.le ....................-------
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To Used as
. _ Front ..._✓_.�_.. Depth #16..... Height ... .... Sq. Ft. , . Cu. Ft;,—Z(,;�- .
.... .....------ ............._.. Cu. Ft..................--....
...._............._.....----..._......._......._ ... Front Depth --. Height Sq. Ft.
Type of Construction .;.;.e rt 4. �R. ' Est. Cost.._ %.4 :_ ""r ... To be Completed ..... .............. »......................_........
G
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.
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 the city limits and this permit may be revoked at any time upon -violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
ki;
APPLICATION FOR BUILDING PFR W
CITY OF,FRIDLEY., MINNESOTA:
J
Owners Name -Builder
Address Address-,"' L
LOCATION OF BUILDING
No. Street Put of Lot
Lot Blockj Addition or Sub.Div.A"7L-
Corner Lot Inside Lot Set Back Side -Yard
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.
-Front Depth Height
Sq. Ft. Cu. Ft,
Type of Construction
_Estimated Cost ;,.,�
-z
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 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 correct.
DATE, SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
Application for Power Plants and Heating, Cooling, Ventilation, .ReMgeration 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 $
.each add. 60,000 BTU .... . ........ . ....... 2.00. $
Replacement of Furnace ............................. §.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
GAS BURNER (up to 400,000 BTT) .......................
5.00
$ ✓
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
$
ROUGH
FINAL
Dept. of Bldgs. Phone SII. 4-7470
Location
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 tpue and correct.
Fridley,
Owner
Kind of Building
Used as
e
196__�o
To be completed about
o®
Estimated Cost, $ Z�co
Old ew. uilding Permit No. °-� Permit No. C�
DESCRIPTION OF WORK
HEATING or POVER PLANTS—Steam, Hot Wa r, Warm Air: Nom ^ %
14
Trade Name _ 1«ee dCJ Size No /2 —
Capacity rSq. Ft. E.D.R- Z04 BTU H.P.
Total Connected Load Kind of FuX" , --
BURNER — Trade Name Size No
Capacity.
(REMARKS -OVER)
.+Q4E 1M 7-59
Sq. Ft. E.D.R BTU H.P.
RAY N. WELTER HEATING CIS
Signed 4637 CHICAGO AVE.
MINNEAPOLIS 7, MINNESOTA
By
Business Phone No �/ `�� ' d b
HEAT LOSS CALCULATIONSDEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E, Construction No.
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
e No a —No 19—
Fl. oma, a ms, Es Room 1 Length /-1 ®. Width Or . Height am II / F1.1 "
Windows a d Doors—Crackage
and Area
Width HeightNo. 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 pane lights of crack sq. ft.
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Int. wall
Glass
Glass
Exp. wall °
"
Exp. wall
�4
Net exp. wall
Net exp. wall
Int. wall
Ceiling(
Floor
Ceiling;
v
Total Btu. 1-0
Required sq #t. E.D.R. or sq. ins. W.A. Leader area
I F1.1 n ,A Room I Lenstth 1. .. Width 1.2 Height
ffS-
Wjndows and Doors—Crackage and Area.
Width HeightNo. 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 pane lights of crack sq. ft.
_ f -*.w
0
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Int. wall
Ceiling
Floor
Glass
"
Exp. wall
�4
/
Net exp. wall
Int. wall
Ceiling;
v
Floor
1
14144
Total Btu. 13 6 a
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.1 s v Room I Length j / SL.Width .0 Height' ��.•
Windows and oors—Crackage and Area
Width ,Helght No. of Lineal ft. Area
No. of pane of pane lights I of crack I so. ft.
Coef. Btu
Infiltration f?..
Glass 443 -g' /.
Exp. wall
Net exp. wall „
Int. wall
Ceiling /0 A
Floor
Total Btu. f
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
S, MINN.
Insulation
Kind How. Applied
Rani n I Length 92 Width PP Height 9 6_
Windows and Doors—Crackage and Area
Width HeightNo. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall Y -
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft.1
F1
Windows and
Wldth 7
No. ' of ".no '
%cl
or sq. ins. W.A. Leader area
m I Length,?o .0width
=Crackage and Area
No. of I Lineal ft. I Area
lights I of crack sq. ft.
Height
I I I I I • 1 , l Uoet.l tstu'
Infiltration AR U7 .3 ./
Glass
Exp. wall j""
Net exp. wall
Int. wall
Ceiling
Floor oo 0
Total Btu. en
Required sq. ft. E.D.R. or sq. his. W.A. Leader area
F1,1, Room I Length 0 Width 4 Height '
Windows and Doors -Crackage and Area
Width Helght No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Infiltration
Glass .23
Exp. wall ")ef .2141
Net exp. wall )
Int. wall
Ceiling zsq If
Floor 144 Y1,
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Btu
n -s6 7 s
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E. Construction No.
Guide
WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floi
Yes—No Yes -No 19—
r9I n - - I r _ -.t_ .,s A gar_-I.t u_s_t. 6 0u
.., L�
. , ......a
... I -n. .....
" -w ....fl... --
Windows and Doors-Crackage and Area
Width Height No. of
No. of pane of pane lights
Lineal f . Area
of crack sq. ft.
Coef.1
Coef. Btu
Infiltration
AD
Glass Eii
Soo /.a
Exp. wall ; a "" x {
X- . .
Net exp. wall
Coef. Btu
Infiltration
Net exp. wall
Ceiling .
IL 76,
Glass
Exp. wall
je 4, / .
"
Net exp, wall
Floor
i
Int. wall
Ceiling
Floor
!
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length ,;2 E - Width
Windows and Doors— Crackage and Area
Width Height No. of Lineal ft.�S�Q.a
No. of pane of pane lights of crackt.
MINNEAPOLIS. MILAN.
Insulation
Kind How. Applied
13 F1.1 ARoom I Length / 0'—Width
GrHeight ay
Windows and oors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No. of I Lineal ft. Area
No.. of pane of PaRe lights of crack sq. ft.
1 1.
Coef. Btu
Coef.1
Coef. Btu
Infiltration
AD
Glass Eii
Soo /.a
Exp. wall ; a "" x {
X- . .
Net exp. wall
wall
Net exp. wall
Ceiling .
Floor.��,
Total Btu. 174
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Height �,( Room (Length d Width Height
Windows and Doors-Crackage and Area
Width Height No. o! Lineal ft. Area
No. of pane oP Dane lights of crack sq• Pt.
o ARJE. AT,' m
Coef. Btu Coef. Btu
Infiltration Infiltration :.'
Glass Glass
Exp. wall Exp. wall0 44o
Net exp. wallNet exp. wall m /.
Int. wal c) Int. wall
C f,31,is 'b Ceiling
Floor , Floor. / ' i4
Total Btu.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. iris. W.A. Leader' area
`Fl.( ' -P-kW. Rooin ( Lenath Ftp Width 41 He ht 1� M-1 ll�eefm I Length Width Heiaht
Windows and Doors—Crackage and Area
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 pane lights of crack sq. ft.
r
1 1.
Coef. Btu
Coef.1
Btu
Infiltration f
-
Glass
Net exp. wall
X- . .
Exp. wall
Ceiling
Net exp. wall
Floor
Int. wall
Ceiling
Floor
.2
Total 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 pane' "of.pane lights of crack sq. ft.
1 1.
Coef. Btu
Infiltration
Glass
Exp,.: wall
f
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Date: Luk 12 1965
ovrmer: Ken Firnstahl
City of Fridley,
BUHDING PERMIT
Builder Harvey Peterson
Address 565 Rice Creek Terrace Address 15 Glen Greek Road
LOCATION OF BUILDING
,297
No. 565 Street Rice Creek Terrace N. E. Part of Lot
Lot 33 _ Block 2 Addition or Sub -Division Rice Creek Terr., Plat 7
Corner Lot ._ Inside Lot Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft Cu. Ft
Front Depth Leight Sq. Ft Cu. Ft
Type of Construction Est. Cost JERM To be Completed
$52000-00,
Storm damage repair
In consideration of the issuance to me of a permit to c building des bed Bove I agree to do
the proposed work in accordance with the description above se,7 and in comp ce }�ith 09'!1 provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $_1Si,90_, permit is hereby granted toHaryey Pete
te to construct the building or addition as described above. This t is granted upon
hexpress condition that the person to whom it is granted and his agents, employees an 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 location, cronstruetion, alteration, maintenances, repair and moving of buildings
within the city limits permit may be revoked at any time upon violation of any oP the provisions of said
ordinances.
Allen Jensen Building Inspector
NOTICE:
'B h p0rmit 41009 not aovsr the aonstruatioe, halalidlen for Whine, plying, gas hosing, sewer or wafer. Be sure to seg
*e Bulming Mqm t r for 09p"do pwmBs for these items.
- -.
APPLICATION FOR;BUILDING PERMIT
CITY.OF FRIDLEY, MINNESOTA_
OWNER'S NAME' S®n Firnstahl BUILDER Harvey Peterson
ADDRESS -.565., Rice Creek -Terrace. DRESS 151 G]ea" Creek 'Road
LOCATION OF BUILDING
No. 565 Rice Creek Terrace
Street
Fart of Lot
Lot I Block
Addition _or
Subdivision
Corner Lot Inside
Lot
Setback
Side -Yard. -
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this -form Two.Ccrtificates of Survey of Lot and proposed build-
ing location drawn -on these'Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front Depth_ Height
Sq, F.t. Cu.,: Ft.
Front Depth Height
Sq. Ft.. Cu..:Ft.
Type of Construction ' Estimated Cost �0 C50
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.ef the Department of Buildingsy and.,hereby.declares that all the facts and
representations stated in this application a",true and correct..
DATE SIGNATURE
.,(Schedule of Fee Costs can be found on the Reverie Side).
Date: May 10, 1968
Owner:
Address
City of Fridley,
BUILDING PERMIT
Ken Firnstahl
565 Rive Creel Terrace
No
Builder, W. P. Beach Co.
Address 5505 56th Ave. N.
9'726
LOCATION OF BUILDING
No. 565 Street _ Rice Creek Terrace Part of Lot
Lot ._._ 13 _ Block 2 Addition or Sub.Division .R-Jce_ Creed Jerrace Plat 7
Corner Lot Inside Lot _ Setback — Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Storm Shelter & Front _16' Depth 10' Height _ 8' Sq. Ft. 160 CU, Ft 1280
Storage Front Depth Height _ Sq. Ft.. _ _ Cu. Ft.
Type of Construction _ _ game Est. Cost — 15 00.00 __ To 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�7 and in compliance with ah provisions of
ordinances of the city of Fridley. 4 � / / .---) — A
rn consideration of the payment of a fee of $ 5. 0 _ _ _., permit is hereby granted to W • P. Beach C o .
the ress
to construct the building or addition as described above. This permit is granted upon
expcondition 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 of the provisions of said
ordinances.
d
Clarence Belisle'
NOTICE:
This permit does not cover the construction, Installation for whing, plumbing, gas heating, sewer or water. Be sure to an
the Building Inspector for separate permits for them items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
BUILDEt`�1 P
ADDRESS LS
LOCATION OF BUILDING 0'Ir s
av
N0... � _ L--STRE1
LOT_, ,_BLOCK �il?DITI011T ;OR SUBDXVISION _ -_ -•---- --
CORNER LOT INSIDE LOTSSSUACK I
SEWER ELEVATION TOP OF FOOTING
Applicant attach �' � d roposed
. p .�o .this �p�,Tr�o� C,e�ti��.�at�s ��,"'��� i9�; .•P F
building location drawn on these Certificateq,.-
tit!. � .. 'Ib
DESCRIPTION OF BUILDING
Height 1
> Square feet 0 Cubic Fget,�
Front Depth Height
Square feet Cubic Feet
Type of Construction kstimatec Cost C �
To Be Completed
The undersigned hereby,makes application for a permit for,the work erein
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„N _X0, 19�.>..SIGNATURE�1
(Schedule of Fee Costs can be found on the Reverse Side).
Paww Manna @rA VlaaWim- o T �' g ®® cmd
Air Cas Oaflcmhq Symms wd Davkw
GRAVM WAIF AM:
RATE
*TOT
Furnace Shell & Duct Work
.810.00
Replacement of Furnace
6.00
1st 3 Fixtures
Repairs & Alterations—up to $500.00
6.00
$
Repairs & Alterations each add. $500.00
300
$
Ill. WARY AM
0
ate Sur harge
Furnace Shell & Duct Work to 130,000 BTU
..$10.00
E
ecch add. 60,000 BTT . .........
3.0U
3
Replacement of Furnace
6.00
3
Repairs & Alterations. --up to $500.00
6.00
$
Repairs & Alterations each add. $300.00
3.00
$
ZTZAM ax HOT WATER f3'iffl'iiEM
Furnace Shell & Lines—to 400 sq. ft. FMR Steam $10.00 $ —�
Furnace Shell & Line to 640 sq. ft. EDR Hot Water 10.00 $.
Each add 200 sq. ft. EDR Steam 3,Mt $
Each add. 320 sq. ft. EDR Hot Water 3.00 $ _
OIL BURNER—to 3 gaL per hour 6.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to IMOOO BTU)
5.00
$
over 119,0OO RM fes Fee schedule
GAS FITTING
NO RATE TOTAL
1st 3 Fixtures
z$ ZOO
g
Additional Fixtures
x ,76
$_ _
Gas Range to IN,
B $ 5.M
0
ate Sur harge
/4.of .50
AIR COEDMONW, 0
FAN I TMO 848 tea Fee ac
Y a 67STM
AL TIONS a. MEPAIM
TOYS rM$
City of Fridley:
The undersigned hereby makes application for a permit for the work here&.
specified, agreeing to do all work in strict accordance with the City OrdimA=ev
and ruling of the Department of Buildings, and hereby declares that all the f
and representations stated in this application are true and correct.
Owner
Kind of
Used as
To be completed about,
d
Estimated Cost, $
ld New. Building Permit No. Pormit No, �o —
�;';ate 'z 3 �" �i i� ;• ,r< x :�
HE. 77NG or POWER l NTS --Steam, Hot Water, Warm Air—No
Trade Name Sim No
Capacity------ Sq. n E.D.R BTU
Total Connected lad KIMIA of rMl
BURNER -- Tree No SLW i?IIo
Capacity sq. 1Ft. E.%i
tsaa�—omar�n ' a:..
SUBJECT
P IT N0. '-
City of Fridley
1 19252
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
lyfp0
1
I�
1 "Ti CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
BY
�.j 612-571-3450
910-F15
10/26/87
rROVED
JOB ADDRESS 565 Rice Creek Terrace N.E.
1 LEGAL
LOT NO.
1 3
BLOCK
2
TRACT OR ADDITION SEE ATTACHED
Rice Creek Terrace Plat 7
DESCR.
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Kenneth Firnstahl 565 Rice Creek Terrace N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHON CENSE NO.
H.C.R. Contracting 17555 NQwthen Blvd N.W., Anoka 55303 7�3-53 0
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
1�esidential
7 CLASS OF WORK
❑ NEW :j] "ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 101 Deck. a.nch 61 Ratio Door
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan
` SEPARATE P*rRM(T9 Rr"rQUIRED F®Rr
Before",--di 1g call local Utilities WIRING, HEATING, PLUMBING AND SIGNS.
TELMIGNE - ELECTRIC' GAS Etc.
REQUIRED BY LA
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. OWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
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
$1,600
$.80
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUM O GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS A THER STATE OR LOCAL LAW REGULATING CON-
$26..550
ZSTRUCTION PE MANCE OF CONSTRUCTION.
tel(\\
PLAN CHECK FEE
TOTAL FEE
^
$6.63
$33.93
U F ONTRACTORORAUTMORIZEDAGENT (DATE)
_. VANHEN PROPERLY VKPATED THIS IS YOUR PERMIT
/ p
AC��C(otJ
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG )NSP t)p E
NEW [ ]
ADDN. [v ]
ALTER. [ ]
Construction Addri
Legal Description
City of Fridley Effective 14/1/86
L R-1 AND R-2�
Building Permit Application
Owner Name & Address: Ai s -k a h L Tel. #
Contractor: Tel. #
Address: �`15�� N0kk,4k L, -'V-b1QcA )J UJ' &dc -A Mei S.�;.?o-3
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.
nARAnR AREA:
DECK AREA:
OTHER:
Corner Lot [ ]
Length Width Height Sq. Ft.
Length J__ Width /Q Hgt/Ground 5 -ID Sq. Ft. f 1-Q
67
OT -AJ SRte`— �% Q3 _p C)o
1w)((6,
Inside Lot [6]
Type of Construction:
Approx. Completion Date:
Ft. Yd. Setback Side Yard Setback
Estimated Cost: $*�d-
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: M14- $ $
ee Back Page for Explanation
DATE: 1�' APPLICANT: Tel. 02�~ 5350
CITY USE ONLY
Permit Fee
ne
$ 01(o ��
Fee Schedule on Reverse Side
Plan Check
$ C.& S
25% of Building Permit Fee
State Surcharge
$ 19 U
$•50/$1,000 Valuation
SAC Charge
$
$ 525 per SAC.Unit
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
TOTAL
$
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: Lj:�
44
6 ®o
•
0%.60
CINOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
LICENSE AGREEMENT
The undersigned Brooks DeLisle Berg and Linda Sue Dykstra Berg, being the fee owners of certain
property located in Fridley, Minnesota, at 565 Rice Creek Terrace, and legally described as:
143024120071
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.
Brooks DeLisle Berg
t� �
Linda Sue Dykstra Berg
Subscribed and sworn to before me this I day of
Notary Public
JOAN M. BUDNICK
i NOTARY PUBLIC - YID{NMA
4 ..,,,tet ►MCorangiouEWMOJIi►�I.l�
�l 1998.
a
SUBJECT
PERMIT NO.
City ®f Fridley
2 6481 \'
AT THE TOP OF THE TWINS
BUILDING
E R
M I T
�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
1 v PROTECTIVE INSPECTION SEC.
f 1 �
1
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/7/98
JOB ADDRESS 565 Rice Creek Terrace NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
2
1 Rice Creek Terrace Plat 7
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Linda Berg 565 Rice Creek Terrace NE
571-0714
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Western Cedar Supply 705 North Hwy 169 Plymouth,
MN 55441 541-0304 20014207
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 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (30 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 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
$2,502
$1.25
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 -
$74.75
Fire SC $2.50
ION OR THE PERFORMANCE OF CONSTRUCTION.
-
PLAN CHECK FEE
TOTAL FEE
7 7-
License SC
.00
$W 0
S UR&OFCONTRACTORDRAUTHORIZEDAGENT IDATEI
RO
F
SLOG 5
RLY L
TED THIS OUR PERMIT
� >
PATE
SIGNATURE OF OWNEROF OWNER BUILDERi iDATEi
a
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:�C� c x be le-- r r 4e
Legal Description:
Owner Name & Address: 1 ir,_oA &--xc, Tel. #
Contractor: vj-s t'L' Ct04-0- g L:j _ MN LICENSE # Zoo 1 L(2,0 -T
Address:.
_7th S AU�" `7 ((Q �L ��-� Tel. #
o�-�
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 EWPROVEMENT
Length Width Height
Length Width Height
Length _ Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: /cF �'- Estimated Cost: $'
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 7,
71
APPLICANT: Tel. # `(<-03 a
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ / L/, %S
Fee Schedule on Reverse Side
Fire Surcharge
$ /
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$ /.�P $.50/$1,000 Valuation
SAC Charge
$
$1000 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:
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping eeded with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective On January 1, 2000
JOB ADDRESS s lr!t' C' 2c �� ✓✓�- �"�
OWNER Liv V t10 V
Rate TOTAL
BUILDING USED AS
$ 30.00 $
ESTIMATED COST 2 3 Co ® PERMIT NO. D�
$ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units l Circle One (Steam) (Hot W t (Warm Air)
$ 10.00 $ Trade NameM_a_!�c s r` tt Size No. R
BTU HP EDR
$ 25.00 $ Fuel Total Connected Load
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
$ BTU HP EDR
$ 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
$ .50 rulings of the Building Division, and hereby declares that all the facts and
I e�7 C -b representations stated in this application are true and correct.
TE ®0
HEA N CO
CA
�J`-� �1
�/
Signe TEL #
Approved By Rough -In Date Final Date CIU
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 Information
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
O
ALTERATIONS: (Describe)
e�
c
S
`i
HEATING CO:
Signed By:
Date
1
0
SUBJECT
PERMIT NO.
City of Fridley
32347
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
______
~
a�a�
r 1 PROTECTIVE INSPECTION SEC.
1 �
1 ; �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
12/6/01
JOB ADDRESS 565 Rice Creek Terrace NE;
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
2
Rice Creek Terrace Plat 7
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Kurt Morse, 565 Rice Creek Terrace, Fridley, MN 55432
763-586-0819
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Renewal by Andersen, 350 73rd Ave NE, Fridley, MN 55432
763-502-4777 20130983
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Dwelling
7 CLASS OF WORK
❑X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace 5 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.
Caulking and flashing for all exterior openings.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$5,755.00
$2.88
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
$125.25
Fire SC $5.76
PLAN CHECK FEE
TOTAL FEE
$5.0 cense
$1,118.89
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
ENP3IROPWJfALIDATEQfHIS
IS YOUR PERMIT
SIGNATURE OF OWNER pF OWNER BUILO.ERI IDAiEI
IN50
RATE
1
0
Effective
,.9
ADDN CITY OF 11? ;
ALTER SINGLE FAARLY AND DUPLEXES R-1 AND R-2
BUILDING 1 E.. 'tAPPLICATION
Construction Address:, ® C S\
Legal Description:
Owner Name & Address: 'c c 't``. Tel. #34Q5. . • ON9
Contractor:. t �� MN LICENSE #
Address:
350 -73rd Ave. NF
Fridley, MN 55432
763-502-4777
Attac #MN20130983
lot, V
Tel. #
eyof the
:to scale.
LIMING AREA:
Length
Width Leight
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA:
Length
Hgt/Ground
Sq. Ft.
OTHER:
�R%nt1xri
_Width
G I•`%IAw --_
/1r% /I Mt
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: A • . -M APPLICANT: � rti.r-. Tei. # R5� • ? 4�� • IDOy�'
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1110th%)
$.50/$1,000 Valuation
$1050 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 [ ]
STIPULATIONS. �' / LS. ����®• • l y ��/�L�'� G
SUBJECT
City of Fridley
397 3 �I
AT THE TOP OF THE TWINS
BUILDING PERMIT11
r
RECEIPT NO
COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
1 � �
NUMBED
REV
DATE
PAGE OF
APPROVED BY
� CITY HALL FRIDLEY 55432
L J ` 763-571-3450
910415
110/15/03
10B ADDRESS 565 Rice Creek Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
13
2
Rice Creek Terrace Plat 7 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Kurt Morse 565 Rice Creek Terrace NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Allstar Construction 8401 73 Avenue N, Brooklyn Park, MN 55428 763-593-5325 3247
d 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 jJ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install soffit & fascia
9 CHANGEOFUSEFROM TO
STIPULATIONS
Install soffit ventilation to meet 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
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
@
$2,550
$1.27
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
PLAN CHECK
EE
TOTALFEE
cens
SC $5.00
$92.07
S'G RE 'CONTRACTOR OR AUTHORIZED AGENT 4DATEi
HI PROPERLY VALIDATED THIS IS YOUFY PERMIT
_/
0�
BLO HSP gAtE
SGNAiu RE OF OW NER ��� OWNER BWLDE Ri iDATE,
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 R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: J�� °�� Grp e ';7�
Legal Description:
Owner Name & Address: kU u- k- V-%-, r, .5 e- e r&e k lin el. #
Contractor: ey%/ Z'f ,- C:f'��4 r ` MN LICENSE # 7
Address: Nz0 % % 3 v� R1� Tel. # 793 -"S -
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: Len th idth Hgt/Ground Sq. Ft.
OTHER: c TZS-rm
Construction Type: Estimated Cost: $ 2 4 J or
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 16IJ—l-17- G-j� APPLICANT: hl+ll,�17," - CO�i �� Tel. #_%6W��������
Call (763) 572-3604'for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
TOTAL $
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. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY PERMITO.:
2004-00913
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 06/15/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 565 RICE CREEK TER NE
PIN : 143024120071
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GARAGE, ATTACHED
VALUATION : $ 5,306.00
NOTE: CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
PROVIDE HARD SURFACE DRIVEWAY. SEE NOTATIONS ON PLAN.
CONSTRUCT A 10' X 24 GARAGE ADDITION.
STATE LICENSED CONTRACTOR 1
APPLICANT
BUILDING PERMIT FEE
PLAN CHECK FEE
125.25
81.41
HOME PRIDE BUILDERS (20072528)
1650 99 LANE NE
FIRE SURCHARGE
5.31
BLAINE, MN 55449-
STATE SURCHARGE, VALUE
2.65
LICENSE SURCHARGE
5.00
TOTAL
219.62
PAID WITH CHECK # 11388
OWNER
HELPS DIXIE L & MORSE KURT R
565 RICE CREEK TER NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not ume t give authority to
violate or cancel the provi 'o f o state or local law
regulating r e ce of construc onj
Applicant Datet,,
Bldg his 1�F[fe'L/: �
' r
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW [ ] CITY OF FRIDLEY P-'51 9 %Cd Effective 4/1/2004
ADDN] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION ;06 I�
Construction Address: 'el�!I- epee /° �-e6 Q—
Legal Description:
Owner Name & Address: � � 14/0"5'7- � � 1)'i%e- 141-vef Tet. #—>6-)-,M
Contractor. �''�--/®�/G°�jc'�''� MN LICENSE# �a��
Address: Tel. #
r
Attach to this application, a Certth
lot, with the proposed construction
DESCRIPTION OF
LMNG-AREA: Length _ Width H,
GARAGE AREA: Length��t Width- H'
DECK AREA: Length Width H
OTHER:
of Survey of the
m on it to scale.
Sq. Ft
_ Sq. Ft 2 Yrs
Sq. Ft
Construction Type: 1-10
Estimated Cost: $ "�"- COD?06
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x
DATE: APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ ISS.
k L41
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
TOTAL $ 0 19 - ® STIPULATIONS:
BuildingBUILDING
$
See Back Page for Fee Schedule
Plan Review
Permit No. -
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
.001 times the total job valuation
Received By:
763-572-3604
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ SD(-)
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
CITY OF FRIDLEY
Curb Cut Escrow
—
DATE
YOUR E-MAIL ADDRESS
$
SITE ADDRESS `J �S
� C---eC (•Q -fit 7 • f vcac t
$
THIS APPLICANT IS:
❑ OWNER XCONTRACTOR
$
PROPERTY OWNER/
,
NAME���iPd
$
TENANT
ADDRESS: CITY
STATE—ZIP
p� Q
NAME:
Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113 (
STATE—ZIP
WITH APPLICATION
PHONE
❑ SINGLE FAMILY/NPLicense #20130983
PROPERTY TYPE
❑ TWO FAMILY/NEW C 651-264-4777
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED WINDOWS IbMr
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ EW ❑ ADDITION
J&MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: i
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ 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
❑ Vinyl
FOR NEW
CONSTRUCTION INCLUDING DECKS,
❑ Aluminum
❑ Other
❑soffit
❑ Trim
ADDITIONS.
I.
& PORCHES SUBMIT:
Site PLmvsurvey showing the existing structure
❑ 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 �O NUMBER OF WINDOWS
A,- r c.r.n A1CL' nA.S 1J VN VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
'AL JOB V
ATION S -J. RSS—
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ a.
.001 times the total job valuation
Surcharge
$ `(
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ SD(-)
$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: Ci 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 it
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 work Vch requir eview and approval of plans.
SIGNATURE OF APPLICANT G PRINT NAMEJ�G o 1/1 ,Sdf,� DATE !-Lac-6+
W.