PRE 2010 DOCSjw(o, 7(-,
City of Fridley, Y[inn. 9786
BUILDING PERMIT
owner: James Glaser Builder Bruce
Address Address 12841 T§Wlor St., Anoka
LOCATION OF BUILDING
No. 16-- Street ----icer_� wak Way Part of Lot
Lot 2 Block 2 Addition or Sub -Division .____ Edgewater Gardens
Corner Lot ._ Inside Lot — X Setback3 5'5' — Sideyard — 151
Sewer Elevation 833-00 qR&ALtm _ 836 (Approx. )
Top of Footink
DESCRIPTION OF BUILDING
To be Used as:
Dwelling with Front -44'_ leper 2 bight _20 __ Sq. Ft. _116.6_ Cu. F't, -2;.,.32.0
tuck -under garage]FrontDepth height Sq. Ft. Cu. Ft -
Type of Construction ._ _ ame Est. Cost __$2Q, 000.0(0 be Completed _ _?got .I_,_.1968
SEWER. LOCATION - 921 W. of Manhole
WATER LOCATION - 31 E. of Manhole
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 com fiance with ;h provisions of
ordinauoes of the city of Fridley.
In consideration of the payment of a fee of $ _3 5 - 00 —., permit is hereby granted to
Const. 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. ,.I-\
Building EQUEW
Official
NOTICE:
Tk% permit does not cover the construction, hntallatlon for whiog, phmbing, gas hearing, sewer or water. Be sure to no
the Buildles Inspector for separate permits for these item.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S Nom:: S : " G- _;g S -a Y BUILDER, R Ir U s
LOCA�Icd ;OF Bt i — IG
No. STREET _ {;
L BLOC�C ADDITION OR SUBDZVIZQN.'
CDR tEE LOT „ nINSIDE LOTSETBACit i'j 3rID8'fARD
SEWER E%ENATION TOP OF FOOTING
Applicant attach .to. this-. form Two Certificates
Wilding location drawn on thesie-:Cert ficates.
DESCRIPTION OF BUILDING
To Be Used As:
of -fttveq- df* Lot and proposed
-nj 22W FroutT. '0� e° .Depth _Height-- 0
q .
S uare feet.. / Cubic Feet'
Font DepthHeight_.
Square feet Cubic Feet
Type of Construction Estimated Cost
To Be Completed )� �._.....___..
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DAT �ra _SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
F
City of Fridley
Application for Plumbing and Cas Fitting Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures ......................
N
$
=
Z
x $1.50
C
Z
O irii
x $1.50
w
?
O
•
F
•
N
WATER HTR.
GAS
ELEC.
Base
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE
TOTAL
1st
.�
1st 3 Fixtures ..........................
x $2.00
$
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
2nd
3rd
4th
• Future Connection Openings
Now
e New Fixture. Old Openings J
Connected with
Sewer �
cesspool �
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures ......................
x $2.00
$
%
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ............................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE
TOTAL
.�
1st 3 Fixtures ..........................
x $2.00
$
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ...............................$
TOTAL FEE $
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.
Fridley,
Owner
Kind of Building
�
Used as . --Lo�—
To be completed about /
Estimated Cost, $
Old Building Permit No Permit No.%–
ROUGH
FINAL
d2
By----�
Business Phone
el�
Application for Power Plants and Heating, Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE
TOTAL_
Furnace Shell & Duct Work
.......... $10.00
$ ��
Replacement of Furnace .............................
6.00
$
Repairs & Alterations—up to $500.00 ..................
6.00
$
Repairs & Alterations each add. $500.00 ...............
3.00
$
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $
each add. 60,000 BTU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .
....$10.00
$
Furnace She/11 & Line—to 640 sq. ft. EDR Hot Water
... 10.00
$
Each add. 200 sq. ft. EDR Steam ......................
3.00
$
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 199,000 BTU) .......................
5.00
$
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x$ 2.00
$
Additional Fixtures .................
x .75
$
Gas Range to 199,000 ...........
x$ 5.00
$
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
p, ROUGH
See Fee Schedule
$
TOTAL FEE
Dept. of Bldgs. Phone 560-3450
/ic, —
City of Fridley: V
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 tru and correct.
A—
Fridley, Minn19
Owners—�
Kind of
Used as
To be cc
Estimated Cost, $ 4 U ra e
Old ew. uilding Permit No. 69TI(ep Permit No.
DESCRIPTION OF WORN
HEATING or POWER team, Hot Water, Warm Air—No
Trade Name Size
Capacity Sq. Ft. E.D.R. AU�U H.P.
Total Connected
BURNER — Trade Name Size
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER'
04110�042
HEAT LOSS CALCULATIONS46,
A. S. H. V. E.
Weatherstrips Guide Construction No. Insulation
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No Yes -No 19— I 1__
I
` Fl. I Room I Length I Width 9 Heilxht II ® Fl. 1 47 - Room I Length !L' , idth Height
Windows and ors—Crackage and Area
Windows and Doors—Crackage and Area
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq, ft.
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq ft.
�r
3 C>'�
�
�)
—XV
77T
Coef
Btu
_
�—
Coef
Btu
Infiltration
e _
Infiltration
- __4
Glass
Glass
Exp. wall ;►�
Net exp. wall
t-
-
Exp. wall
Net exp. wall
Int. wallInt.
wall
Ceiling
-116t),
/ . Li
rY " , t',
Floor
c
,Ceiling
Floor
Total Btu.
Total Btu.
Required sq. ft E.D.R. ora . ins: W.A. Leader area
Required sq. ft E.D.R. ora . ins. W.A. Leader area
Fl. �7 Room I Length / L—Width�� Height
- Room Length ? Width �j Height
Windows and Doors—Crackage and
Area
Windows and Doo rs—Crackaga and Area
No.
Width Height
of page of pane
No.'!f
ltghta
Lineal ft.
of crack
Area
sq. ft.
NO.
Width
of pane
Height
of pane
No. of
lights
Lineal ft
of crack ,
. Area
ft
Coef
Btu
Coe#
Btu
Infiltration112111c
Glass
a )
C---
Infiltration
Glass
"
�`t'
Exp. wall_ V
-- -
Exp. wall C F
11,17
Net exp. wall
In
I Net exp. wall
Int. wall
Int. wall
Ceiling
Floor
7
% ''
`,
Ceiling
Floor
& o
a
L
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. ins. W.A. Leader area
Room ! Length s :Width 1,25 Height
`?, Fl. 12oom Length 7 Width/ Height
Windows
and
Doors—Crackage and Area
Coef Btu
Windows and
Doors--Crackage and Area
Coef Btu
No
Width
of
Height
of pane
No. of
lights
Lineal ft. Area
of crack sq. ft.
No.
Width
of pane
Height
of=
No. of
lights
Lineal ft.
of crack
Area
sq. fL
ppane
4
v !^
Infiltration
Glass—
Infiltration
Glass
-
Exp. wall .+ ' f
Exp. wall
R
Net exp. wall
A
6"
Net ex wall
p•
r
r
Int. wall
Int. wall
CeilingC
Floor c
��
a
�� `°� +
oorg l ,,
4'
_
Total Btu.
,Total Btu.;
6
Required sq. ft E.D.R. or sq. ins. W.A. Leader area
Required sq. ft E.D.R. or sq. ins. W.A. Leader',area
a
HEAT LOSS CALC,OLATIONS
Weatherstrips
.
A. S. HV. E. Guide
Reference
19-
Construction No.
Insulation
Windows
I Doors
Out. Wall
Ilnt. Wall
1__Seiling
Roof
FloorZKd
How Applied
Yes --No
Ye o
I
I
�_:
nom L
l Length �idth � Height
� Fl. ,, �., gth '' Width Height C,
Windows
and Doors--Crackage
and Area
Windows an Doors---Crackage and Area
No.
Width
of pane
Height
of panne
No. of
lights
Lineal ft.
of crack
Area
sq, fL
No.
Width
of pane
Height
of pane
No. of
lights
Linea ft.
of crack
Area
sq. ft.
Lp
1±4
Coef
Btu
Coef
Btu
Infiltration"'—
Infiltration
Glass
a
�� -
�;
Glace
=
ne':
Exp. wall 2-46A
Exp. wall
a '
Net exp. wall
c� G
y
�� ,.r.
Net exp. wall ���,
f-,4
Int. wall
Int. wall
CeilingCeiling
-
F100!
4
t.b
Floor
I
Total Btu.
Total Btu.'
Required sq. ft E.D.R. or sq. ins: W.A. Leader area
Required sq. ft E.D.R. ors , ins. W.A. Leader area
oom Length Width Height
171.1 Room I Length Width Height
^Windows and Door s—Crackage and Area
Coef Btu
Windows and Doors=Crackagn and A
Coef Btu
No. Width Height
of pane of pane
Na
lights
Lineal ft.
of crack
Fi2�
Area
sq, ft.
No•
Width
of pane
Heigh!
of pace
No. of
Tights
Lineal ft.
of crack ,
.IArea
sq. ft
Infiltration,
Infiltrations
` Glass
-=
-
�,;
Glass
Exp. wall
Exp. wall
Net exp. wall
n
Net exp. wall
Int. wall
Int. wall
Ceiling
�.�`
��
Ceiling
Floor!17771
Floor
Total Btu.
a `
Total 'Btu.
Required sq. ft E.D.R.. or sq,, ins. W.A. Leader area
I
Required so. ft E.D.R. ors . ins. W.A. Leader area
Fl.1 Room Length Width Height
Windows and Doors —trackage and Area
No Width Height No. of Lineal ft. Area
of pane of pane lights of crack sq. ft.
.Fl.1 Room I Length Width Height
Windows and Doors---Crackage and Aaea,
Width Height No. of Lineal ft. Arca
No. of pane of pane lights of crack
T
Coef
Btu
Coef
Btu
Infiltration
Infiltration
Glass
Glass
Exp. wall
Exp. wall
Net exp. wall
Net exp. wall
—
Int. wall
Int. wall
Ceiling
Ceiling
Floor
Floor
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. ins. W:A. Leadet area
City of Fridley
Application for Plumbing and Cas Fitting Permit
Dept. of Bldgs. Phone 560 -
DESCRIPTION OF WORK Location Ate
Number, Kind and Location of Fixtures
x $2.00
$
Future Fixture Opening ................
x $1.50
$ •5-0
New Fixture Old Opening ..............
x $1.50
$
8,�
x $3.25
K3
�d
�U' �a
UN'
0090
F
N
WATER HTR.
GAS
ELEC
Base
f
NO. RATE TOTAL
1st
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old OpeningsSewer
I
Connected with
El
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ........... ..........
x $2.00
$
Future Fixture Opening ................
x $1.50
$ •5-0
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ...... .....................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
s $2,00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures .......................... x $2.00 $
Additional Fixtures .................... x $ .75 $
Gas Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
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.
Fridley, Minn- a 19�f.
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old. Building Permit No ` d Permit No.��
Signe
By-L�1/-t
Business Phone No
ROUGH
FINAL
Description .............................
.................
TOTAL FEE $ 4z
Si
LAI,cuc�� a��
.('jA.q.(.1o6'iafm '911ce LAND SURVEYORS
101 . 30, HIGHWAY 65 NORTHEAST MINNEAPOLIS, MINNESOTA 55433 Telephone
784-5480
Dorilla Christenson
Certificate of Survey: C
40
VA
Lot 2, Block 2, Edgewater Gardens,
Anoka County, Minnesota.
1 HEREBY:CERTIFY- THAT,,TNIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES
OF THE ABOVE DESCRISED.LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN.
CROACHMENTS, IF ANY, FROWOR ON, SAIDIAND.,
AS SURVEYED BY ME THIS.....1fth ..... DAY OF ............ May .......................... A.D. 19...68....
N. C. HOIUM AND ASSOCIATES, INC. - LAND SURVEYORS
. ......... ..
SUBJECT
PERMI
City of Fridley
' 165.3
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RECEIP
...... COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
r
Zo
,
---'i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
,•j 612-571-3450
910-F15
4/22/82
JOB ADDRESS 16 Rice Creek Way N.E.
1 LEGAL
LOT N0.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
2 1
Edgewater Gardens SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
James Glaser 16 Rice Creek Way N.E. 574-7424
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 15' x 40' Garage Addition
9 CHANGE QF USE FROM TO
STIPULATIONS
b7 Ail
SEPERATE PERMITS REQUIRE® FOR IRIN ��;�,���;
HFATING, PLUMBING AND SIGNS® s
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
wood Frame
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
600
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
$5,670
$2.84
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SACCHARGE
ANY OTHER LOCAL LAW ON-
REGULATING CON-
PROVISIOSTRUCT
$56.50
STRUCTIONTHE PERFORMANCTE E OF CONSTRUCTION.
ON ORF
PLAN CHECK FEE
TOTALFEE
$59.34
GNATUREOFCO 'RACT RORAUTHORIZEDAGENT (DATE)
WHEN PROPERLY LIDATED THIS IS' YOUR PERMIT
`
d
IGNATUREOF WNERII NERBUILDERI. IDATEI
BLDG INS f�AT
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATM FOR RESIDENTIAL BUILDING PERMITS
(14w, Alterations, Additions, or Repairs)
OWNER: �a�es � ��s�-/�. BUILDER: ZyArkies A(94isew
ADDRESS: /�IYEADDRESS: /6lrF /2i-c� �'/+w�/c evc
TEL N0: TEL 140:
Construction Location
STREET NO: STREET: _,fFCG (i4, -e )C �P
LOT: Z BLOCK: Z ADDITION:
a
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.
DESCRIPTI0N OF CONSTRUCTION
mil/myront:Depth: Depth: �® Height: /3
Square. Feet: 100 Cubic Feet:
I
Front: Depth: Height:
Square -Feet: Cubic Feet:
SV;b
Type of Construction: M u) A J 1e 10 o av Estimated Cost: $
To $e Completed: 30 _ 8Z
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the cork* herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: `��lZ SIGNATURE:
Stipulations:
1l
AGREEMENT
_,i, (�%ls``7f , owner of the property
� n
located at �` , have no objection to the
City allowing the construction of a �,q jc,e /�f c4� i a®o✓ to be
T
located at f /1(C Qrec (A*,.! le Ce�c y without the required
f
certificate of survey that the City ordinarily requires for all new
construction. '
r
C
Sign ure
o'd
Address
r -,' Z,
Date
W' ess
J. 0-54otutlla�1�{i .;.S�OG�CteS, 11C. - LAND SURVEYORS
10130 HIGHWAY 65 NORTHEAST — MINNEAPOLIS, MINNESOTA 55433 Telephone
784-5480
Dorilla Christenson
Certificate of Survey: Y/ C E
771-�
Jr
f � l
Lot 2, Block 2, Edgewater Gardens,
Anoka County, Minnesota.
is
�A.
DE=N YE' V< -'i C.
I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES
OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN.
CROACHMENTS, IF ANY, FROM OR ON SAID LAND.
AS SURVEYED BY ME THIS.....1.8.ttl..... DAY OF ............ May ........................... A. D. 14...68....
N. C. HOIUM AND ASSOCIATES, INC. - LAND SURVEYORS
..................... ........ti.t.. f...'...................................................
a �
0
City of Fridley'f78994
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
�
• COMMUNTY DEVELOPMENT DIV.
I 6L -------- I
r PROTECTVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
' 612-571-3450
R
NUMBER
910415
REV.
DATE
6/04/87
PAGE OF
/ 1 / 1
APPROVED BY
DC
JOB ADDRESS
16 Ric Creek
1 . LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
I
I Edgewater
Gardens
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Jim and Jny Glaser 16 -Rice Creek Way N -F-
Fridley
55432 754-7424
3 CONTRACTOR MAIL ADDRESS
Nnrthwpqtpi�n rnmpany 946 W- Main St Anoka..
MN
ZIP PHONE LICENSE NO.
5r,'103 421-2313
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Redwood Deck 12' by 26' Height 3'
312 sq.
ft.
9 CHANGE QF USE FROM
TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
deck
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
312
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
$2 150.00
1.07
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.
.-26'" .36.Q
0
• ® l� •,
PLAN CHECK FEE
TOTAL FEE
lvirl/ Lr//
$ 9. §3 - - -,
$49.20
SIGNA URE OF CONTRACTOR OR AUT O $AGENT (DATE)
WHEN PROPERLY
h ---t
BLDG INSP
yq
VALIDATED THIS IS YOUR PERM
ICA (.ZAO
ria E•
SIGNATURE OF OWNERIIF OWNER BUILDER) IDATEI
NEW [ J
ADDN. [ ]
ALTER. [ J
Construction Addri
Legal Description
City of Fridley Effective 4/1/86-
R-1 AND R-2
Building Permit Application
Tel. l �5 Y _�7
Owner Name & Address:
as ,`
Contractor: Tel. "����v� ��� /1 Tel .
Address: ✓ Ll� �� �`� ' f�i�b`i' ��C2
Attach to this application, a Certificate of Survey of the
lot, with the prpposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width _ Height Sq. Ft.
DECK AREA: Length_ Width --— Hgt/Ground 31 Sq. Ft.
r+�
OTHER:
311 % 6A41 _ 21(01t. t&
Ft. Yd. Setback�MLSide Yard Setback
Corner Lot [ ] Inside Lot [�]
Type of Construction:
�� 441wx) Estimated Cost: $
/
o v
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired:
See Back Page for Explanation
DATE: APPLICANT: �� c Tel.
CITY USE ONLY
Permit Fee $ s8•Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ .001 $.50/$1,000 Valuation
SAC Charge $ $ 525 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Q� ,� Agreement Necessary [ ] Not Necessary
`7 L J
TOTAL $
STIPULATIONS:
33S*
SUBJECT
PERM I.T NO
City of Fridley
19053
AT THE TOP OF THE TWINS
BUILDING
PERMIT
_
f Q� IPT N.p,-
"`
1 `y COMMUNITY DEVELOPMENT DIV.
r i PROTECTIVE INSPECTION SEC.���y
� I
`
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/6/87
JOB ADDRESS 16 Rice Creek Way N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
Edgewater .Gardens
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
James Glaser 16 Rice Creek Way N.E.
574-7424
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 X ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
6 DESCRIBE WORK
Install patio door and change three windows
9 CHANGEQFUSEFROM TO
STIPULATIONS
See notations on plan
SEPARATE PERM`rTS REQCdrRED FOR
WIRING, HEATING,
PLUMBING AND SIGNS.
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
$1,700
$'85
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-
$28.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$28.85
SIGNATURE OFCONf/TRACT
�QRORAUTHORIZED AGENT I ATE)
WHEN PROPERLY V I ATED THIS IS YOUR PERMIT
/ Sk�
EOF CURER (IF OWNER BUILDEM (DATE)
BLDG INSP
OAT
NEW [ ]
ADDN. L ]
ALTER. [ ]
Construction Address:
Legal Description: G
City of Fridley Effective 4/1/86
R-1 AND R -2I
Building Permit Application
Owner Name & Address: _,�� AT :: a-,:IgzaEt� Tel. # 7�
Contractor:_ --s' 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 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
R',
Type of Construction: .Estimated Cost: $ Z 7
Approx. Completion Date: l/- /- S�'
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: APPLICANT:4 Tel. # Jr- % Z
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
4
STIPULATIONS:
ply.
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 [ ]
8
(r)®(-)
rax laZ�zj Ito o
X9,0®
SUBJECT
PE
City of Fridley
x_rOO 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE
L-______ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
3Y4 y
1 . i
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/16/89
/ f
JOB ADDRESS 16 Rice Creek Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
T27
2
Edgewater Gardens SHEET
PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jim/Joy Glaser 16 Rice Creek Way N.E.. 574-7424
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Patio Enclosures Inc. 6319 Cambridge Street, St. Louis Park, MN 55416 920-1575
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 0 MOVE O REMOVE
8 DESCRIBE WORK
Construct a 7.51 x 11.5' Three Season Porch on Existing Deck
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, ORIF 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
$1,850
$.93
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRES E GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS O OTHER STATE OR LOCAL LAW REGULATING CON-
$43.00
STRUCTION PERFO M OF CONSTRUCTIONAAAT�El
P N CHECK FEE
TOTAL FEE
$43.93
SIGNATOR- OFCONTRACTORORAUTHORIZEDAGENTR
HEN PROPERLY V ATED THIS IS YOUR PERMIT
BLDG )NSP qaT
SIGNATURE OF OWNER 0 OWNER BUILDER) (DATE)
NEW [ ] Effective 5/1/88
ADEN R-1 AND R-2
ATS [ ] Building Permit Application
Constriction Address:
legal Description: L® T
Owner Name & Address: ZT11n i Tel.
Contractor:
Address: '05�'Yw
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: length Width
GAPJ E AREA: Length Width
DECK AM: length 2✓ Width
oma: 3 Sc,-4so-j 9mc,".- j -A11.5-
Height Sq. Ft.
Height Sq. Ft.
H t/Grour:d Sq. Ft.
PU -- jVrz.,
Corner lot [ ] Inside lotlzos�/'
. Yd Setback .S` Side Yard Setbacks
Type of Construction: ted �:
Approx. Completion Date: Ige
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Bqqk Page
DATE: �s®"�1�' APPUCANr• Tel. #
Permit Fee $ �?�-,
State Surcharge $
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main charge $
$ �3,IkI
- --
ULUMNS:
MY USE caw
Fee -Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Mten med by Engira ring
Agreement Necessary [ ] Not Necessary [ ]
0
%8"'-6
!qx 2
Ll3,Oo
J.
94011um
Ale*
' LAND SURVEYORS .
10130 HIGHWAY 65 NORTHEAST — MINNEAPOLIS, MINNESOTA 55433
Telephone
784-5480
Dorilla Christenson
Certificate of Survey: / Pic
h".,
VA
V
Lot 2, Block 2, Edgewater Gardens,
Anoka County, Minnesota.
I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES
OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN.
CROACHMENTS, IF ANY, FROM OR ON SAID LAND,
AS SURVEYED BY ME THIS.....Iath..... DAY OF ............. May ........................... A. D. 19...68••••
N. C. HOIUM AND ,ASSOCIATES, INC. - LAND SURVEYORS
1 ....d.. T :........................................................
` ..�.. 4
P
SUBJECT
P RM
City of Fridley
2 8 09 6_�
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r PROTECTIVE
o .
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1 CITY HALL FRIDLEY 35432
612-571-3450
910-F15
10/5/98
10B ADDRESS
16 Rice Creek Wa
1 LEGAL
LOT NO. OLD
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2 2
I Edgewater a
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Jim Glaser
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Richard Hastings Contr.-
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 Tx REPAIR
❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage 24 S Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED 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
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 SE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2056
1.03
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEEL
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$74.75
ire SC $2.06
PLAN CHECK FEETOT
EE
®
icen e
8
SIGNATURE OF CONTRACTOR OR A fMORiZEO AGENT i ATEi
ENROP
L VALID THIS IS PERMIT
9l iNSP
eYOUR
L. VVV r'A rE
S-GNATURE OF OWNER OF OWNER BURDERII tDATE. -
NEW [ Effective 1/1/98
ADDN [) CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION g10
O
ConstructionAddress: Ciz L'j A
Legal Description:
Owner Name & Address:Tel. #
Contractor. k z o 4x�� e d`(� ..� MN LICENSE # e10
Address: 63 3 1 y.c- e_t? R_ Tel. # S F6 K.
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E%IPROVEMENT
LIVING AREA: Length
Width
Height
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA: Length
Width
Hgt/Ground
Sq. Ft.
OTHER:
$ 1,63
$.50/$1,000 Valuation
SAC Charge
Construction Type:'—FE A k 0 FF
ItK 0 1Z a F
Estimated Cost: $
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft =
Ft x $
_ $
DATE: ICALF APPLICANT:_ 4-�41. Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ %S
Fee Schedule on Reverse Side
Fire Surcharge
$ o ®(
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 1,63
$.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 [ J
TOTAL
$
STIPULATIONS:
City of Fridley"33177
SUBJECT
IT `i
AT THE TOP OF THE TWINS
BUILDING
PERMIIT
r
R T NO.
COMMUNITY DEVELOPMENT DIV.
r - PROTECTIVE INSPECTION SEC.
�
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L „ 763-571-3450
910-F15
10/16/02
JOB ADDRESS 16 Rice Creek Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
Edgewater Gardens SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jim/Jan Glaser 16 Rice Creek Way NE
763-574-7424
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Patio Enclosures Inc 2123 Old Hwy 8, New Brighton, MN 55112 651-631-1100
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
1676
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Lk ADDITION O ALTERATION O REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 61 x 8` Porch Addition
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS
Before di ,n
REQUIRED E
e!s �g �u f®�
utility 9®cations
WIRING, UETIQ
002
PLU GI > �. Y Sr"fogAw
r
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
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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
I 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
$.78
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,565
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHERTATE OR LOCAL LAW REGULATING CON -
$57.05
Fire SC $1.57
TION OR THE PERFORM CE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
d
Licen C $ 0
$64.40
SiGNCON TRAC OR AUTHORiZEO AGENT (DAT ,p
TED THIS IS YOUR RMIT
_
XL—'Z_
5L. r� E
S-GNATURE OF OWNEROF OWNER BUILDER,--- IDATE. 1141
NOV-04-1999 11:05 FROM CITY OF FRIDLEY TO 6516312521 P.01i02
NEW l 1 Effective 5/10/99
ADDN _ [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
r 1 1 1 1 1 I ' 1 1 ` frl"'M
Legal Description: '
Owner Name & Address: �� J NE /f Tel. # [®3
Contractor.�I AU eo rlas- a i s _ Zz e, NSE # C -
Address: �I A 3 0�C� Z -k V �? Tel. # QUi i/-,1106
Attach td" this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EMMOVEMENT
LIVING AREA:
Length Width
- Height
Sq. Ft.
GARAGE AREA:
Length Width
Height
Sq. Ft.
DECK AREA:
Length Width
Hgt/Ground
Sq. Ft.
OTHER
Construction Type: 5 I
L0 rCLca M
Estimated Cost: S
P c1v
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $ _ $
DATE: e'
APPLICANT:
Tel. #_451. J j ;f' // GO
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ 5 70 014)
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONL
Fee Schedule on Reverse Side
.001 of permit Valuation (1/10th%)
$.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
Agreeme»t Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT '20 -�;
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
s
PLUMBING FIXTURE RATES:
NO. RATE TOTAL JOB ADDRESS
New Fixtures
$10.00
Old Opening, New Fixture
$10.00
Beer Dispenser
$10.00
Blow Off Basin
$10.00
Catch Basin
$10.00
Rain Water Leader
$10.00
Sump/Receiving Tank
$10.00
Water Treating Appliance
$35.00
Water Heater -Electric
$35.00
Water Heater - Gas** �_
$35.005 CQ
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge $ '6o
M
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.
DATE: � —CS- 06
OWNER
BUILDING USED AS
ESTIMATED COST ®� cc PERMIT NO.
20
PLUMBING COMPANY PI Dew01 )(—S
SIGNED BY �, TEL NO. l�J �l �1340
Approved By 4,.L,,' Rough -In Date Final Date
,
TOTAL FEE $ 35 5o OF, THE, IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE? 1
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE 3�2_.60
FILL IN COMPLETELY FOR REPLACEMENT FUEL BUf#NING APPLIANCE PERMITS
COMMON VENT: VENT CONNECTOR AND COMBUSTIONAIR VERIFICATION
When replacing an existing Nirnace, the undersigned hereby verifies that the
BTU Input.. Fan Assisted or Nat
venting has been examined and is free from rust, deterioration, obstructions,
BTU Input Fan Assisted or Nat
and is securely supported and firestopped where required.
Yes O No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
Total Btu Input
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 O 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 :
Building BUILDING Permit No.:CT-4 1
Inspections RESIDENTIAL APPLICATION Received By:
763572-3604 CITY OF FRIDLEY Date Rec'd:
DATE — / 4 �
YOADDRESS
See Back Page for Fee Schedule
Plan Review
SITE ADDRESS
65% of Building Permit Fee
Fire Surcharge
$ C _00
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
THIS APPLICANT IS:
V OWNER ❑CONTRA OR
$5.00 (State Licensed Residential Contractors)
SAC Charge
PROPERTY OWNER/
NAS;ES
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
CITY
STATEd
TENANT
Park Fee
ADDR.
Fee Determined by Engineering
Sewer Main Charge
$
PHONE:
Total Due
$ 6/6y
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDS:
CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
SINGLE FAMILY/NEW CONSTRUCTION
SIZE
PROPERTY TYPE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED
AWINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑NEW ❑ ADDITION
❑ MAINTENA 4CEIREPAIR JaREMODELING
DESCRIBE WORK BEING
DONE:
SIZE OF IMPROVEMENT LENGTH
WIDTH
HEIGHT Sq. Ft.
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
BASEMENT REMODELING SUBMUL
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project-
2.
roject2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes Klo �ON.O�'"_" _WIND W
OR FOR NEW OPENINGS -DESCRIBE SIZE OF s'
OPENING CHANGES &'
TYPE OF WINDOW TO BE INSTALLED R OF W1ND0 S
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 10 00. 00 OCCUPANCY TYPE
Permit Fee
$ 39'• -75-
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ C _00
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$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 $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ 6/6y
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 work will be in accordance with the approved
plan in the case of all workhich requires r ew and approval of plans. �(
SIGNATURE OF APPLICANT �2i�1 � /irPRINT NAMF�- /yl ��/iSP�L DATE