PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT
xvDate: Z "�
Owner: eL4ZABuilder
Address _ _ —.; _ Address
N4 5443.
O TION OF BUILDING
No. Sheet „' Pao.. of
_ Y..._ ___ _ _
AA
Lot _ _ __ Block — _ _ _ dditYon or Sub -Division -
of
Corner Lot --- Inside Lot Setback 57 Sideyard- - -
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To Used r ,:
Front Depth Height Sq. Ft. Cu.
'.iei t S . Ft. Cu. Ft.
Fro . t �_ Depth q -
Type o nstruction Est. � s S'R606 of-_ 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 in compliance with all provisions of
o aronces,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. ^ ,,-A 71
Inspector
NOTICE:
This permit does not cover the construction, installation, for wiring, plun"g, gas heating, sewer or water. Be sure to see
the Building inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, M7LN WOTA
Owner's Name Builder �.
Address Address
OF BUILDING ,
No. X l' ( Street_ a l l l o✓ Part of Lot
Lot Block Addition or Subdivisio
Corner Lot Inside Lot Setback,,,_Side-Yard ®Cw�
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used
DESCRIPTION OF BUILDING
im
Sq. Ft. ZR,. Cu. Ft.
�.�
_Front �Depth a- Height /
Sq. Ft. &= Cu. Ft. 5ZcX C-) 0
Type of Construction s Estimated Cost
To be Completed
The undersigned hereby makes a ication 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 he facts and representations
stated in this application are true and correct. A s
DA7� SIGNATURE,
(A Schedule of Fee Costs can be found on the Reverse Side.)
a�
City of Fridley
Appiicafion for Phunbing and Gas Fitting Po
Dept. of Bldgs. PhopejU 4.7470
DESCRIPTION OF WORK `
Location
Number, Kind and Location of Fixtures
rn
NO. RATE T6TAL
Number Fixtures
,�
_
......................
x>
Z
z
z
Qty z
�jo
�U' d
z
�U' 9M
z
e
F
s
N
WATER HTR.
GAS
ELEC.
Base
x 3.25
$
1
NO. RATE TOTAL
1st 3 Fixtures ..........................�
x $1.50
$
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
1st
r
t
2nd
0
_
3rd
4th
Future Connection Openings
New Fixture, Old Openings
Connected with Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE T6TAL
Number Fixtures
x $1.50
$�
......................
�
41 14
�
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
$
New Ground Run Old Bldg . ............
x 3.25
$
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 $'Fl,f ,-®
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
I Rridley -Vine. . ?- 5-�- 19L/
Owner
Kind of
Used as
To be completed about ® �/
D®
Estimated Cost, $
Old-guilding Permit No Permit
ROUGH c (0
FINAL
M
By td -Z c-z-f:!�i.
Business Phone
Application for Power Plants and.. Heating. Cooling, Ventilation, .Re%igendion and
Air Conditioning Systems and Devices
op
PARTIAL RATE SCHEDULE
.,;GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ................
RATE TOTAL.
8.00 $
5.00 $
5.00 $
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 x.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 BTU) ....................... 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
,(VENTILATING SYSTEM
'AALTERATIONS & REPAIRS
,.
6UGH
FINAL
-
$
See Fee Schedule
TOTAL FFE $ r
Dept. of Bldgs. Phone
City of Fridley,-
The
ridley;
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.
[�=7S* dl ii ii i�+'�1:IIIt��lf ld;�iF..illls
Owner /
Kind of Building e
Used as
To be completed about
Estimated Cost, $
T Permit No.
1 New. wilding Permit No. �
DESCRIPTION OF WORK
HEATING ter, Warm Air—No
216
Trade Nam _ Size No41�� 2
Capacity Sq. Ft. E.D.R BTU f� H.P.
Total Connected Loa Kind of Fuel-
BURNER
uel BURNER — Trade Nam Size No ,sem -Xe
Capacity Sq. Ft. E.D.1�®® BTU H.P.
GEO. SEDC ICK HTG. & AIR-COND. CO
1001 Xenia Av. S.
Minneapolis 16, Minn.
Signe 5-1611
Qh�_ 42 2M 7-59 Business Phone o
(REMARKS—OVER)
Dd6
j HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
A.S.H.V.E,
Weatherstrips Guide Construction No.
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No I Yes—No 19—
I F1.1 ttlal Room I Length 2_q Width L EHeight 7 Il / Fl
Windows and
Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
I C�
Width Height No. of Lineal ft. Area
No. of pang of pane lig is of crack sq. ft.
2-0 3-,4 3
_T_ `b' _3 7
17
Infiltration I
r_11
Glass
�^l
Coef.
Btu
Infiltration
Ceiling ' <
Int. wall
Glass
Maw
Glass
Glass
Exp. wall
®
d
a CPO
Exp. wall
Net exp. wall
Exp. wall
V
/
Net exp. wall
Net exp. wall
Int. wall
C$ilig
Int. wall
i
Clfg
Floor 14P
Floor
7 6
/
Total Btu. O
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I F1.1 La tJ Room I Length S-- Width Heischt
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
I C�
3a& X -7
G
Exp. wall X
Coef. Btu
Infiltration I
r_11
Glass
�^l
Exp. wall X
Btu
L-70
Net exp. wall
Ceiling ' <
Int. wall
Glass
Maw
Flaw
Glass
Total Btu. 1 1;33
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I F1.1 P, -It h eA.) Room I Length' Width Height
Windows and Doors—Crackage and Area
I)OV
Width Height No. of Lineal ft. Area
No. of p ne of pane lights of crack sq. ft.
3a& X -7
G
Exp. wall X
Net exp. wall
Coef.
Btu
Coef.1
Btu
Infiltration
Ceiling ' <
.
Glass
Maw
10
Glass
Exp. wall
4 V iA Room I Length / 3 Width
d
y
Windows and Doors—Crackage and Area
Width Height No.of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
/V F
Net exp. wall
Exp. wall
f el 5-
/
Int. wall
Net exp. wall
Int. wall
C$ilig
i
Clfg
Floor 14P
X PY
Gj v
[
Total Btu.
sq. ft. E.D.R. or sq. ins. W.A. Leader area
MINNEAPOLIS. MINN.
Insulation
Kind How. Applied
Room I Length ///Width `f Heissht
Windows and Doors—Crackage and Area
I)OV
Width Height No. of Lineal ft. Area
No of pane of pane lights of crack sq. ft.
3a& X -7
Exp. wall X
Net exp. wall
Coef.
Btu
Infiltration
Ceiling ' <
.
Glass
Maw
Total Btu.
Required sq. ft. E.D.R. or sq. ifis. W.A. Leader area
Exp. wall
4 V iA Room I Length / 3 Width
d
Height -7
Windows and Doors—Crackage and Area
Width Height No.of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
/V F
Net exp. wall
f el 5-
/
Int. wall
C$ilig
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room ( Length 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.
V�,v / -.,/-7,9> ®%
Infiltration �s'�13V
I)OV
('class
5-z
Exp. wall X
Net exp. wall
I /
Int. wall
Ceiling ' <
Ci °7
Maw
Total Btu.
Required sq. ft. E.D.R. or sq. ifis. W.A. Leader area
4 V iA Room I Length / 3 Width
d
Height -7
Windows and Doors—Crackage and Area
Width Height No.of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
/V F
Coef. Btu
Infiltration 1 3 f +_13Y
Glass yo S -D D U
Exp. wall ^ 1,W
Net exp. wall `7 , `I
Int. wall
Ceiling j 1 hj @ 17
Fleet:
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
4.. y
40-
D-56 7 s
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V. Construction No.
Guide
WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No Yes—No 19_
1 Fl.l A %1� Room I Length 10 Width / ) Height-) II FLI
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
No.of papp of pane lights
Lineal ft. Area
of crack sq.. ft.
V
I
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
Glass
Ceiling
f / 5
Glass
/
6-0
Exp. wall
�( 9
Net exp. wall
Net exp. wall
g
17
(,;
Int. wall
Ceiling
9,
S t
Flow
s
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
V F1.1 P 73ZJkoom1Lenstth / (e Width /V Height —,7
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.
/
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Net exp. wall
Int. wall
Glass
Ceiling
�'o 1
/y, -v
Exp. wall
Net exp. wall
1
cl
17
Int. wall
Ceiling 16 x 1,y
/ :7� F
s
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 lightp of crack sq. ft.
13 7
Coef. Btu
Infiltration
Coef.1
Btu
Infiltration
Net exp. wall
Int. wall
Glass
Ceiling
�'o 1
3,--6
Exp. wall
Net exp. wall
3 ?
-7
3
Int, wall
Ceiling
F
Total Btu. 1.6 ( q
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
MINNEAPOLIS. MINN.
Insulation
Kind How Applied
Rnnm I Length 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
Fl.l Room I Length Width Height
Windows and Doors—Crackage and Area
T Width Height No. of Lineal Pt. Area
No. of pane of,
ligh4s of crack eq. 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
F1.1 Room I Length Width
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack I eq. 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
Height
Btu
SUBJECT
City of Fridley6
6 4 3
QEC
AT THE TOP OF THE TWINS
BUILDING P E R M I TO.
r
• __ __ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
®�
r PROTECTIVE
1 i
= HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/17/82
JOB ADDRESS 861 Rice Creek Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
1
1 Brookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Bob O'Neill 861 Rice Creek Terrace N.E. 571-1272
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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
X _
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
S tee l/Alumi i
xura
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
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
$4,000
$2.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$44.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTA$L FES: 550
GN T ,DFCON ACTORORAUTHC IZIZEDAGE T (DATE)
WHEN PROPERL ALI DATED THIS IS YOUR ERMIT
-vBLDG INSP DAT'
- SIGNATURE OF O NER OF OWNER UILDER) (DATE)
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATI94 FOR RESIDENTIAL BUILDING PER14ITS
(Wert, Alterations, Additions, or Repairs)
OWNER:
ZZ
ADDRESS:
TEL 940: /.
• STRIET NO:
LOT:
BUILDER:
ADDRESS:
TEL NO:
Construction Location
STREET: ( 4.e -y-- o
BLOCK: ADDITION:
Corner Lot: Inside Lot: � Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
Front:
DESCRIPTION OF CONSTRUCTION
Depth: Height:
Square. Feet: Cubic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
Type of construction: _ Estimated Cost: $ 44.41&-,
1b Be Completed: � �,j� • +
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the work -'herein specified,
agreeing to co.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
ropresmtations stated in this applica
DATE: �� 7j. SIGNATURE:
Stipulations:
00
e
SUBJECT
PERMIT
City of Fridley
18 �05
AT THE TOP OF THE TWINS
BUILDING
P E R M I T
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION
I „�
t'-syD
r PROTECTIVE SEC.
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
j 612-571-3450
1910-F15
4/21/87
JOB ADDRESS 861 Rice Creek Terrace N, E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
3
1
B,xookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert O'Neill 861 Rice Creek Terrace N.E.
571-1272
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
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
j NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 141 x 171 Shed
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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
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
$800•
$,50
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-
$15,00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
-
\t.
$15.50
IGH URE FCONT ORA ZE ACENT (DATE) -
WHEN PROPERL
BLDG iNSP
LI DATED THIS IS YOUR. PERMIT
f)ATE
SiGNATURE OF O NER(IF OWNER BUILDER (DATE)
e
NEW
ADDN. [�J
ALTER. ( ]
Construction Address:
Legal Description:_
Owner Name & Address:
City of Fridley
�R-1 AND R-2
Building Permit Application
Effective 4/1/86
Tel. #/
Contractor; Tel. #
Address:
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'f--s= Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [''�� Ft. Yd. Setback Side Yard Setback
Type of Construction: W &-e� Estimated Cost: $fJ�9,
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: 46�� 2 APPLICANT: c Tel. # E-711
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Ch r,
TOTAL
STIPULATIONS:
$
$ 1
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$525 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
3. /
SUBJECT
PE
city Of Fridley
THE TOP OF THE TWINS
BUILDING PERMIT
("'-27683'^AT
�` COMMUNITY DEVELOPMENT DIV.
_--�
I v PROTECTIVE INSPECTION SEC.
r
7
,
I ,
NUMBER
REV
DATE
9/10/98
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910415
JOB ADDRESS 861 Rice Creek Terrance
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
3
1
Brookview Terrace 3rd A"ir Addition
SHEET
DESCR.
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Eunice O'Neill Same
3 CONTRACTOR MAIL ADDRESS ZIP PHONE
LICENSE NO.
Eilertson Construction 83 91st Ln NE Blaine 55434 786-4238 8250
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 3P REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house & garage (23SQ) 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
I 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
$1,971.00
Ux2l
$.98
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 $TRGE
SC $1.97
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$62.25
1'lre
STRUCTION OR THE PERFQRMANCE OF CONSTRUCTION.
PLIeMCHE�CK FEE
TOTAL
c nse S $5
00
$70.20
SI ATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
EN OPE rVALIDAT HIS IS
PE T
9LUf INSP
r
GATE
SIGNATURE OF OWNER OF OWNER BUILDER( (DATEI
3. /
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: R4
Legal Description:
Owner Name & Address: u N i c� pa /tai ,'L L Tel. #
Contractor: o ams o®✓ (f® iv S ^. MN LICENSE #
Address: 8-3 - 71 t� A 5-5-V3 ,V Tel. # _
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF I1IAPROVEMENT
Effective 1/1/98
LIVING AREA: Length
Width
Height
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA: Length
OTHER: ;2t�aff
W27-;
Hgt/Ground
,23 S--,-1-��
_Sq. Ft.
a o
U
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: tel- 0a - FX
APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ A 92
.001 of Permit Valuation (1/10th%)
State Surcharge
$ ®
$.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
$ /u:
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
D 30 ,qq Effective On May 10, 1999
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () Nc
Type
NO. RATE
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
TOTAL
JOB ADDRESS
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
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
ONEILL, EUNICE
861 RICE CREEK TERRACE NORTHEA
Owner FRIDLEY, MN 5432
(612) 571-1272
Building Used As
A ?a- '1999
Estimated Cost PERMIT NO. !C� 61l
NOPBLOM PLUMBING ice►.
PLUMBING COMPANY (61 2) 827-4033
--- -- — - - - - W.
Reinspection Fee $47.00/Hr SIGNED BY
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance -/
Approved By Rough -In Date Final Datefi !t;/
State Surcharge $ .50
MINIMUM FEE OR ANY PLUMBING/GAS PERMIT IS $20.00
TOTAL FEE PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMRFR OF FDM tRFC TC) RF INCTAI I Gn nM 1=erru 1=1 nno
Effective On Jan 1, 2000
.. a .. 8 ® . • •
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
NO. RATE
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
TOTAL JOB ADDRESS '/_ ' h �i L T�
(70 3)7! o I4-7 2--
The undersigned hereby makes app (cation for a permit for the work herein
specified agreeing to do all work in strict accordance with the city. codes
and rulings of the fuilding Division, and hereby declares that all the facts
.and representations stated in this application are true and correct.
Owner C n 6c' Is � bet u
Building Used As aS61k4r=,1U' tom,
Estimated Cost PERMIT NO.
1 3q,a
PLUMBING COMPANY
Reinspection Fee $47.00/Hr SIGNED BY
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
.Approved By
State Surcharge $ .50
MINIMUM i
TOTALFEE $M_r-PLUS THE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
TEL N0. IZ - -410 3 -
Rough -In Date Final Da
Z�
NY PLUMBING/GAS PERMIT IS S20 non
E SURCHARGE
COMMON VENT INFO ON BACK SIDE
m
_ ' .
® R _ iR
•
7
ENO"
R•
' R
Wrii �i
�®
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
NO. RATE
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
TOTAL JOB ADDRESS '/_ ' h �i L T�
(70 3)7! o I4-7 2--
The undersigned hereby makes app (cation for a permit for the work herein
specified agreeing to do all work in strict accordance with the city. codes
and rulings of the fuilding Division, and hereby declares that all the facts
.and representations stated in this application are true and correct.
Owner C n 6c' Is � bet u
Building Used As aS61k4r=,1U' tom,
Estimated Cost PERMIT NO.
1 3q,a
PLUMBING COMPANY
Reinspection Fee $47.00/Hr SIGNED BY
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
.Approved By
State Surcharge $ .50
MINIMUM i
TOTALFEE $M_r-PLUS THE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
TEL N0. IZ - -410 3 -
Rough -In Date Final Da
Z�
NY PLUMBING/GAS PERMIT IS S20 non
E SURCHARGE
COMMON VENT INFO ON BACK SIDE
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 asper 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 Cb:
Signed By: Date:
Building
$
BUILDING
Plan Review
Permit No.:e;!--
Inspections
Surcharge
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
CITY OF FRIDLEY
Date Rec'd:
DATE E -- YOUR E- MAIL ADDRESS
$5.00 (State Licensed Residential Contractors)
SITE ADDRESS 9 6 (
,
19, °CP
$1450 per SAC Unit (Plans to MWCC for determination)
THIS APPLICANT IS:
❑ OWNER WONTRACTOR
ft + 6 ft = ft x $20 = $
PROPERTY OWNER/
Nom; 0 h iGe fol
$450 Conservation Plan Review
TENANT
ADDRESS:C� (� : CJr, R h1,CITY
AZ7 r AE�STATE IPS
Sewer Main Charge
PHONE: 1— /a
Agreement necessary ( ) Non Necessary ( )
CONTRACTOR
NAME: '-;e rl' L4
f- --c--P
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: ", 2(9,9 i °' % e
de'k4 CITY STATEAZIP-J-a--
WITH APPLICATION
PHONE — -6 t — FAX
t�
PROPERTY TYPE
!- SINGLE FAMILY/NEW CONSTRUCTION
siz T
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
CA!'*, A Q
TYPE OF WORK:
❑ NEW ❑ ADDITION
CE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
C� •'kQ✓ �/1.a
SIZE OF IMPROVEMENT LENGTH
WIDTH HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
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
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project
WINDOWS
2. Two sets of construction plans
IN EXISTING OPENINGS []Yes ❑No LOCATION OF WINDOWS
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1922 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $__)?CC OCCUPANCY TYPE
Permit Fee
$
6 See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
e .001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
s 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 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 work3ilj be in accordance with the approved
plan in the case of all work which requires revAy and proval of plans.
SIGNATURE OF APPLICANT PRINT NAME/el?VIA �J �/% DATE