PRE 2010 DOCSCity of Fridley, Minn.
BUIOLDING PERMIT N° C5021,)
Date: --�
Z;U4Owner: Builder
Address _ _ Address ---
LO ATI OF BUILDING
No... Street _._ Part j It
_
_ r
06
Lot _ _ ._ Block - Addition or Sub-Divisio
Corner Lot r __ Inside Lot Setback —6Sideyard _-
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To 1 b Used n
Depth Height . Sq. Ft...+e._.. Cu. Ft.-
F
_ Depth Height Sq. Ft. Cu.Ft. 4grecv
of Construction Est. Cost � ""� 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 forth and m 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, Nnnesota 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
ardinanepa-
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 those items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name'
ce m ili�
Builder
Ar, d
Address
Cvd
kl, Address
36 IV
LOCATION OF BUILDING
No. -5-Z& Street _A rGr,�✓� Part of Lot
Lot /� Block Addition or Subdivision �,,
Corner Lot ,Inside Lot Setback Side -Yard /0
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:
4w 01�/ Front W)-' Depth Height
Sq. Ft. 10A Cu. Ft.
14 v. / c" C/Front �'� Depth ` Height.
Sq. Ft. Cu. Ft.
Type of Construction A2, C Estimated Cost / C®O 0'�e
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 andruling of
the Department of Buildings, and hereby declares that all the facts and representations
stated in this application are true and correct.
/ , v /.6 o
(A Schedule of Fee Costs can be found on the Reverse Side.)
i
�d
' Application for Power Piants and Heating, Cooling, Ventilation, Refrigeration and
y Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII7470
"/ . Z2
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 5.00 $
Repairs & Alterations --up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or BOT 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 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
.Addi1st 3 Fixtures x $1.50 $.—
Additional
tional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN BEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
i
R$MARKS:
See Fee Schedule $
TOTAL FEE $
I--
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, XBnn_ 195—
Owner�` 195—
Kind of Building
Used as
To be completed about
195—
®t�
Estimated Cost, $ (� 00
ew.-A3uilding Permit No.
m'.4 in, I
DESCRIPTION OF WORN
HEATING ffeb=NgMer, Warm Air—No-
Trade Nam Size Nom
Capacity. Sq. Ft. E.D. BTU H.P.
Total Connected Loa Kind of Fue
BURNER. — Trade Nam , Size
Capacity Sq. Ft. E.D. Off'
1 - .
H.
-D" Alp 1001 Xenia Av. S.
Minneapolis 16, Minn.
Sign
By
oQW11 POST 1M-12-58 Business Phone qo
v
HEAT L SS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.uidH.eV.E, Construction No.
G
Windows I Doors Reference Out. Wall . Int. Wall Ceiling Roof Floor
Yes—No Yes—No 19—
e Fl J I' :a , a Room l Length S a Widths ' Hei>zht II Y F11175,0,,/V
Windows an
Doors—Crackage and Area
f
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.
sem+•
v
Coef.
Btu
Infiltration
Coef. Btu
Infiltration
Btu
Glass
.'
•,
Glass
mp
Net exp. wall'
121 .
Exp. wall
;,
Int. wall
-
1
4 -
Net exp. wall
Int. wall
Floor
Int. wall
Floor
Floor
Ceiling.
:>
Floor
Floor
Total B°tu. ;"Z sWz' .
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I F1.1 ie' Room I Length n Width Height `'
Windows and Doors—Crackage and Area
v'
^,A
f
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq ft.
t
a ¢�
v
Coef.
Btu
Infiltration
Infiltration
Coef.
Btu
Glass
Glass
' fS,
Exp. wall c fir''y
z V,
Net exp. wall'
121 .
Exp. wall
Int. wall
1
4 -
Ceiling
Int. wall
Floor
Ceiling/ 3 et`f
Total Btu. �a
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Y FIA °I ., Room I Lenirth Width 'Lf Height `fit
Windows and Doors—Crackage and Area
v'
^,A
�^
Width Height • No. of
No. of pane of pane lighta
Lineal ft. Area
of crack sq. ft.
a ¢�
v
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
Glass
' fS,
Glass
z V,
Exp. wall <10
121 .
Exp. wall
Net exp. wall
1
4 -
Int. wall
Int. wall
F
Ceiling
Ceiling/ 3 et`f
Floor
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
Windows and 1
width H;
No. of pane of
µ
MINNEAPOLIS. MINN.
Insulation
Kind How Applied
Room Length ;' Width Height
ors—Crackage and Area
ht Lineal ft. Are
lig a
e(
lights
of crack eq ft: ,.
Btu
Infiltration IV,'
Glass
Exp. wall. ."
Net exp. wall
Int. wall
Ceiling a'
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
'' Fl.la ,�f Room I Lensrth ? �' Width 7" Height
Windows and Doors—Crackage and Area
�^
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
a ¢�
Coef.
Btu
Infiltration
-117
177
Glass
' ,
Glass
Exp. wall Vii,. 3I,
RN»'
4-0
1
Exp. wall
Net exp. wall
/ '
Int. wall
Ceiling/ 3 et`f
Floor
Ceiling"<
:>
Total Btu. r r U
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Rmm I L.enath 0 Width ' '"HeisLht
Windows and Doors—Crackage and Area
Height No. of Lineal ft. Area
No. of.pane tights of crack sQ ft.
rWidth
i., s>
Coef.
Btu
Infiltration
177
3 l'"-
' ,
Glass
4-0
1
Exp. wall
Net exp. wall`
Int. wall
Ceiling"<
:>
Floor
Total Btu.
ft. E.D.R. or sq. ins. W.A. Leader area
r- I .1M ,:.s ♦ ;+ - s��' i�P�. `�.. _�� A,e� rcr�� ..a'"4 ... vu '. Ai �"" v f1j!'p:
D56 400
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS MINK.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
Yes—No Yo Yes—No 19____ 4
IFI $ r ,>' Room l Length . —/' Width I Height r° ` II Fl.l 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.
Width Height No. of •Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Coef. Btu
Infiltration
Btu
Infiltration
Glass
2
Exp. wall
';
Net exp. wall
v
Int. wall
S,
Int. wall
Ceiling
Floor
"
Total Btu: .
Required sq. ft. E.D.R. or sq. ins. W.A.' Leader area
Fl.l 0 e &,i, „ ,. Room I Length sr. 1 Width 1P,Height s' "
Windows and Doors--Crackage and Area
Width Height No. of Lineal t. Area
No. of pane of pane lights of cra k Area
ft.
Width Height No. of •Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Exp. wall
2
Glass
';
a 0%o
w
Exp. wall 4 AT gw.
F
Net exp. wall
`;, r
S,
Int. wall
Ceiling -
"
rw
Floor
Total Btu.
Required sq.. ft. E.D.R. or sq. ins. W.A. Leader area I `
1:1.1 Room I Lenirth Width Height
Windows and Doors—Crackage and, Area
Width Height No. of Lineal t. Area
No. of pane of pane lights of cra k Area
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
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane 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
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
of cane of pane lights oL crack sq. ft.
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
FI -1 Rmm I Lenath Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane 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
City of Fridley, Hinm N° 8067
BUILDING PERMIT
Date: June 29,65
Owner: Forrest D. Bundy Builder Forrest D. Bundy
Address _ 576 Rice Creek Terrace Address Same
LOCATION OF BUILDING
No. 576 Street Rice Creek Terrace Part of Lot
Lot 11 Block 3 Addition or Sub.Division Rice Creek Terrace., 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 Height Sq. Ft Cu. Ft.
Type of Construction Est, Cost __$7s500,00 To be Completed
Storm Damage Repair
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 Band ffi comp nce with provisio� o
ordinanttzs o the city of Fridley. i
In consideration of the payment of a fee of $ permit is hereby granted Forest D's Beet
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,
onshaII conform in all respects to the ordinances of
Fridley, Minnesota location, itmay
be ctio�al t any tirnem maintenance,
any of the provisions of :saiand moving of d
within the city limits and this
ordinances.
Allen Jensen Building motor
NOTICE:
Ub pont don no emw the eendmetion, mon for whdng, Plumbing, ga headn& Iowa or water. Be n to as
the Building la "w- for eeperete pwoft for flare kens.
s ��
OWNER'S
ADDRESS
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
�� _ Street Part of Lot
-LOT . K ADDITXON, OR SUBDIVISION
Corner Lot Inside LOT Setback Side -Yard
-SEWER ELEVATION FOUNDATION ELEVATION, .
Applicant attach to this form Two Certikicatni of Survey of Lot and proposed
building location drawn on these Certificates,
To be used as:
DESCRIPTION OF BUILDING
Front Depth height
Sq. Ft. Cu. Ft.
Front Depth. Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost___,.._L , p,
To be completed
She 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.
e of Fee Costs can be found on the Reverse Side).
Engineerin
Sewer
Water
Parks
Streets
Maintenance
MEMORANDUM
TO: John G. Flora, Public Works Director PW90-380
FROM: Mark A. Winson, Asst. Public Works Director N*J
DATE: September 28, 1990
SUBJECT: Drainage Behind 568, 572 and 576 Rice Creek Terrace
On Wednesday, September 19, 1990, I met with Mrs. Betty Carlson
(568 Rice Creek Terrace), Mr. & Mrs. Pete Pierce (572 Rice Creek
Terrace) and Mr. and Mrs. Mark Bechtum (576 Rice Creek Terrace)
regarding storm drainage along their rear property lines. There
is a six (6) foot drainage and utility easement along the rear
property lines as well as the adjoining properties for a total of
a twelve (12) foot easement. There is a catch basin in the
southwest corner of the Carlson's property, which is the outlet for
a storm water in this area.
The Pierce Is have had a continuing problem with a low spot at their
southwest corner. During most rain storms and spring thaw, water
stands in this low area and on a number of occasions, has flooded
their storage shed which is approximately twelve (12) feet from the
property lines. The ponding is caused by the flat slope through
the rear yards of all these properties and that the grade is
actually slightly higher in the Carlson's property than the low
point at the Pierce's property. The problem is further compounded
in that filling the low area to an elevation that would permit
drainage would further flatten the slope across the Pierce property
which would increase the already existent danger of water backing
up into the Bechtum's walkout basement.
I presented four (4) alternatives to rectify the ponding problem:
1. Fill low area in Pierce's yard in order for storm water to
proceed down to the catch basin. This idea was rejected by
Bechtum and Pierce as this would flatten the grade and
increase the possibility of water backing up into the
Bechtum's walkout which is very low in comparison to the catch
basin.
Page Two - PW90-380
2. Create a swale across a portion of the Pierce's yard and all
of the Carlson I s yard in order to create a direct grade to the
catch basin. The average depth of this swale would be 5 to
6 inches with a width of approximately three (3) feet.
3. Install a 6 -inch PVC storm drain in a shallow trench from the
low point in the Pierce's yard to the catch basin on the
Carlson property. The City would provide and install the pipe
in shallow, narrow trench excavated by Pierce and Bechtum.
4. One (1) or more of the parties involved could petition the
City to institute an improvement project, the cost of which
would probably, but not necessarily, be assessed against the
benefitting properties.
The pro's and con's of each alternative were discussed. Alternate
1 was generally rejected due to the adverse affect on the Bechtum
property. Alternate 2 was initially rejected by Mrs. Carlson due
to the effect on her shrubs and lilacs in the easement. Alternate
3 appeared to be a good compromise except there is some question
as to the effectiveness of the shallow drain line. I explained
that Alternate 3 would drain the low area but would have little
effect on the ponding during the spring thaw. Mr. Pierce indicated
that if none of the first three (3) alternatives were done, he
would be pressing the improvement project alternative.
When I left the meeting, Mrs. Carlson was going to discuss the
shallow drain pipe alternate with her husband and the engineers
where she worked.
On Tuesday, September 25, 1990, I met with Mr. & Mrs. Carlson to
bring Mr. Carlson up to date on the previous meeting and to answer
any questions they had. Based on my discussion with the Carlson Is,
it appears that they would possibly go along with the swale
alternative. They wanted to take some time to consider their
stance on this problem.
It should be noted that throughout the discussions, it was
mentioned many times that the catch basin in the Carlson's back
yard and in Rice Creek Terrace backup during heavy storms.
At this point, I am awaiting on a response from the Carlson's as
to which, if any, of the alternatives they would accept.
MAW/ts
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
October 3, 1990 PW90-274
Mr. & Mrs. Gerald Carlson
568 Rice Creek Terrace
Fridley, MN 55432
SUBJECT: Rear Yard Drainage Swale -
568, 572 and 576 Rice Creek Terrace
Dear Mr. & Mrs. Carlson:
From our phone conversation on October 1, 1990, it appears that
you have agreed to the construction of a swale in the rear yard
drainage and utility easement on your property in order to allow
for better drainage from the properties to your east. The
construction of the swale was one of the alternatives that I
presented to you and your neighbors as a solution to the ponding
problem the Pierce's are experiencing and to help lessen the danger
of flooding to the Bechtum's lower level.
The swale will start essentially in the Pierce's rear yard and
extend to the catchbasin located in the southwest corner of your
yard. It will be, on the average, 6 inches deep and 3 feet wide.
The City engineering staff will stake the limits of the easement
and provide stakes indicating the location and depth of the swale.
When possible, I will visit the site to provide technical help to
Mr. Pierce and Mr. Bechtum, who I understand will be doing the
actual work.
All the parties involved in this matter need to understand that the
construction of this swale will help the drainage through the area
during small rainfall events and provide some relief during the
spring thaw. During heavy or prolonged rain events, there will
still be temporary flooding in the easement as the main storm
system reaches capacity.
I hope I have outlined everyone's understanding of what is to take
place. If not, please contact me.
Sinceypely, QQ ��
�. A�`"�—
M k A. Winson, P.E.
A sistant Public Works Director
MAW/kn
CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS -'-D1:Z(, Ci- CPf � 4
RATE SCHEDULE
OWNER Al44-All f3id, f„tyt
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner - BUILDING USED AS s°
Also Replacement Furnace $ 30.00 $
(Side Vent - Fill Out Back) ESTIMATED COST PERMIT N0.
Gas Piping (Needed with new furnace, $ 10.00 $
but not replacement) DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00 $
No. of Heating Units_ Circle One (Steam) (Hot Water) (Warm Air)
Gas Dryer $ 10.00 $ Trade Name Size No.
BTU HP EDR
*Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No.
1% of Value of Appliance or Work $ BTU HP EDR
Commercial/Industrial f4-R"C' � � �� (' AP/'�
1.25% of Value of Appliance or Work $ 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
State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE $ ���
DATE z a &Lco
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO /T/ AS
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE Signe e TEL #
REINSPECTION FEE $47.00/Hr "bi
*Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date
written permission from adjoining property owner.
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
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date:
/,;z 3, 7-0
Building BUILDING 7Received
Inspections RESIDENTIAL APPLICATION y:763-572-3604 CITY OF FRIDLEY l:
DATE �— I I —� ��Lf YOUR E-MAIL ADDRESS
SITE ADDRESS S" � 7-�e✓l A1P
THIS APPLICANT IS: ❑ OWNER XONTRACTOR
PROPERTY OWNER/ I NAME: & of e4f' U-1
TENANT ADDRESS: 5- % (o /4 e -r 690,d 7-eA - CITY,
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
PHONE: 76-7
NAME: TWIN CITY HOME ROMPUM INC.
STATE LICENSE #
ADDRESS:
PHONE
SINGLE FAMILY/NEW
❑ TWO FAMILY/NEW CC
❑ ADDITION
❑ BASEMENT FINISH
❑ DECK
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
TE!�Aim 5-5--,7 2.
�(%�IATE
Lft ftL IN 5M CITY STATE ZIP,
❑ ROOF DRAIN TILE
I LSIDING OTHER
❑ SWIMMING POOL
❑ ADDITION
❑ REMODELING
LENGTH WIDTH HEIGHT
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBM11:
I . Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS 14es [NO LQCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES & 2
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 $ i'COd® • &V OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
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$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley 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 ordinances and codea of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application fa a pe . and work is not to start without a permit; that the work will be in accordance with the approved
t
plan in the case of all work w re and approval of plans. ,1
SIGNATURE OF APPLICANT PRINT NAME � 15' ,,v,",q,.," " DATE q-11-4 C4
$
$
2. S'0
$
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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$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley 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 ordinances and codea of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application fa a pe . and work is not to start without a permit; that the work will be in accordance with the approved
t
plan in the case of all work w re and approval of plans. ,1
SIGNATURE OF APPLICANT PRINT NAME � 15' ,,v,",q,.," " DATE q-11-4 C4