PRE 2010 DOCSCiiy of Fridley, Minns
BUILDING PERMIT N® �677
Owner:
Address47
L9CATIO OF DING
No.Str t — I" __ Part of _ ----..
Lot _ Bl ck Addition or Sub-Divon ..�
corner Lot _ Inside Lot i�_ Setback _ Sideyard --• –
Sewer Elevation Foundation Elevation -- --
DESCRIPTION OF BUILDING
To Used .,.
" Front Depth Height Sq. Ft. CU. Ft.� `
Depth eight Sq. Ft. Cu.
Type of nstruction Est. fro 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
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
theexpress 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. Yn A
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wirings plumbing, gas bating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items:
� 4 �
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY# MINNESOTA
Owner's Name*4&j2_ � uilder
Address Address�.�,,,_1
LOCATION OF BUILDING
No. 46' StreetC���Part of Lot
772,6
Lot Com_ Block Z__ Addition or Subdivision
Corner Lot Inside Lot_ X Setback-,--Side-Yard Jr
SEWER ELEVATION FOUNDATION ELEVATION,
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
To bQ used as:
DESCRIPTION OF BUILDING
Deoth � . Heicjht ®f
Sq. Ft. /J Cu. Ft.
-Front,Depth �L �. Height
sq. Ft. Cu . Ft .p.4_7 79
Type of Construction Estimated Cost 44,,_O,
To be Completed_ -1
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 ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correct,. J /J
DATESIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for Plum ing and Gas Fitting Porn*
Dept. of Bldgs. Phone SII 4-7
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
I6'
yr1
yyj
y[
y
VI
Y F
•�/,
K
0 N
Z
Z_
p�U'
W
x 1.00
W
Ci
Catch Basin ............................
x 3.25
_WATER HTR.
x 2.00
$-20-0
•
W Vy�
Z ..
= U,
Z
Y
i}a
`aC
Z Z
$
Q
x .50
10-
a3
j
U`d
(��c
Z
coo
N
GAS
ELEC.
3
m
3�
OLL
N
LLD
cpm
Base
y
F
1st
/
2nd
_
3rd
4th
• Future Connection Openings
Connected with
Sewer
Nov Fixture, Old Openings.
Cesspool 0
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
X, O "
Number Fixtures .............. .......
x $1.50
$
Future Fixture Opening ................
x 1.20
$ `1 0
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ............................
x 3.25
$
Water Heater (Up to 200,000 BTU) ......
x 2.00
$-20-0
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 $Aji� 1/10
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 trued and correct.
Fridley, Minn �G �' �6 ! /
19—
Owner
Kind of Building -,V-
Used
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No. ,.—Permit No.
ROUGH /2- /? - (-(
FINAI,
Z-
FINAL
d2 2M 7.59
Business P44be No
Application for Power Plants and Heating, Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
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 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
STEAM or HOT WATER SYSTEM
RATE
TOTAL
8.00
$
5.00
$
5.00
$
2.50
$
8.00 $
2.00 $
5.00 $
5.00 $
2.50 $
Furnace Shell & Lines—to 400 sq. ft. IDR 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 DATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$�
ALTERATIONS & REPAIRS
TOTAL FEE
$
Dept, of Bldgs. Phone
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 a and correct.
Fridley, lei ---
Owner
Owner 195—
Hind of
Used as
To be completed about V
Estimated Cost, $ . "
Building Permit No.
DESCRIPTION OF
HEATING or PQW R PLANTS team, Hot. Water
195._
Capacity U Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fuel
BURNER — Trade Name Size No
Capacity. Sq. Ft. E.D.R BTU H.P.
11 POST IM -12-58
City of Fridley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
DIMING PERMIT
Date: April 28, 1972
Owner: —_-Dennis M— Ottem Builder .—fie
Address _____.�_7._4Q Rickaxd Road E. Address Same
No. - 140 Street _ Rickard Road N.E. Part of Lot
Lot—_...b_.__ __ Block _—.._. 2Addition or Sub -Division Gartens Addition
Corner Lot Inside Lot _ _ _ Setback — Sideyard
Sewer. Elevation Foundation Elevation _.._._..
DESCRIPTION OF BUILDING
To be Used as:
ConvertExistin Garage to Family Qom
g Front Depth . 9 9 ► Height _1 Q Sq. Ft. Cu. Ft.
_
__ Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost .1,500-00 To be Completed - 10 mnr+i-hc
Stipulations: The normal fire protection requirements be followed. There be no
windows on the east side of this garage. The existing driveway to be tom out and
replaced with sod.
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 fo and in co fiance ih provil�tons oP
ordinances of the city of Fridley.
e C
75 State Surcharge
In consideration of the payment of a fee of $ 9.00 , permit is hereby granted to Dennis Ottem
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 builftas
Within city limits and this permit may be revoked at any time upon violation of any of the provisions of said
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
P
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PtRMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME :; E lO N I S A'V G rt 1 C: ivA. BUILDER: � G
ADDRESS: �4 00, N (ZU �� N . ADDRESS: <r
NO:. STREET:
LOT: BLOCK: 2_ ADDITION:
CORNER LOT: INSIDE LOT:ETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
60, fc) 040 Front: Z Depth : 2 Z— Height : I G
Square Feet: Cubic Feet:
Front:
Depth: Height:
Square Feet; Cubic Feet:
Type of Construction:
To Be Completed: / ° /n'V S
Estimated Cost: $ /fid
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict 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: ?d /' ? Z SIGNATURE • 9u'�
(See Reverse Side For Additional Information.)
City of Fridley, Minn. 1140 0
6431 University Ave. N.E., Minneapolis, Minn. 55432
BUIMING PERMIT
mate: April 28, 1972
Oma; _ Dennis M. Ottem Builder. Same
,Address 140 Rickard Road N.E. Address Same
Nu 140 Street Rickard Road N.E. part of Lot
?got 6 Block 2 Addition or Sub -Division Garten ' s Addition
Comer Lot Inside Lot R Setback
Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Qqragp Front 261 Depth 24'Height 10' Sq. Ft. 624' Cu, Ft. 6240'
Front Depth Height Sq. Ft. _ Cu. Ft..
Type of Construction Wood Frame East. Cost $2, 500.00 To be Completed 10 months
Stipulations: Provide frost footings, hard surface drive
AV
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 descilption above set 'ante provisions of
Ordinances of the city of Fridley. `
s
1.50 Stat, Surcharge
In consideration of the payment of a fee of $ 1,2 _ p.0 , permit is hereby granted to Dennis Ottem .
to construct the building or addition as described above. This permit is granted upon
tine 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
FJddley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
W.ithin the
an city limits and this permit may be revoked at any time upon violation of any of the provisions ofordihsaid
0'ee'4 -.0—f=2C lf�"-----M_Xnspector
CLAMNCE BELISLE
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to see
the Building Inspector for separate permits for these items. I Al
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PhRMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM: EiU(U I S / I , l J/T T EPI BUILDER:
ADDRESS:_ 14 b l C Kip R D RD. J, C. ADDRESS:
NO:. 140 STREET:
LOT: 4v BLOCK: Z- ADDITION:
ATE ti's ,R— 0 'i
CORNER LOT: INSIDE LOT: X SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: (�g 4oac
Front:
Depth: 2 Height: I U
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: k4 m c Estimated Cost: $ Z 67-0
To Be Completed: / 0
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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: SIGNATURE: 4
(See Re erse Side For Additional Information.)
J
Land Pic' nning
Land Surjveying
Soils Testing
Civil Engineering
Municipal Engineering
yiee4i�� ane.
Engineers & Surveyors
Mortgage Loan Survey for UENNI S OT
0
\C oO)
-lq.oG,
LOT G, BLOCY, 2, GARTEN's ADDITION
COUN-PY cS ANC)KA
Highway No. 65 N.E.
Minneapolis,
Minn. 55432
lephone 784-6066
Area Code 612
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is
made only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is
understood and agreed 0 manumen s have been placed for the purpose of establishing lot lines or boundary
corners. Dated this�day of CH A. D. 191!L.
SUBURBAN NGINEERING, INC.
Enbinprs, Supve ors
r
3
B,-rG�- X35
11.9 � 33.5
;,, •
Q /
1,40
11�e�al
L`jNf,T
S
F
E rra�nq
I7Yr��. 563
en ^1Oad
I�
f
(>+
LOT G, BLOCY, 2, GARTEN's ADDITION
COUN-PY cS ANC)KA
Highway No. 65 N.E.
Minneapolis,
Minn. 55432
lephone 784-6066
Area Code 612
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is
made only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is
understood and agreed 0 manumen s have been placed for the purpose of establishing lot lines or boundary
corners. Dated this�day of CH A. D. 191!L.
SUBURBAN NGINEERING, INC.
Enbinprs, Supve ors
r
3
City of Fridley
SUBJECT
PERMIT NO.
AT THE TOP OF THE TWINS
BUILDING PERMIT
2
Ir
COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
612-571-3450
NUMBER
910-F15
REV
DATE
4/11/95
PAGE OF
APPROVED BY
JOB ADDRESS 140 Rickard Road NE
1 LEGAL
DESCR.
LOT NO.
6
BLOCK
2
TRACT OR ADDITION
Garten's Addition
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Bob Jenson 140 Rickard Road NE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
ROn's Roofing 1567 Ferndale Avenue NE, Fridley MN 55432
572-8093 EXEMPT
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 f REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (16 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT
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
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$1,200
SURTAX
$.60
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-
STRUCT THE PMANCE OF CONSTRUCTION
$29.00
Fire SC $1.20
PLAN CHECK FEE
N/A
TOTALFEE
$30.80
I NATURE OF CONTRACTOR ORAUTHO I EDAGENT IDA E)
WHEN PAAOA/PERLY>ALIDATED THIS IS Y UR PERMIT
BLO `INSP
MATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit_ Application
Construction Address: I9 �
Effective 1/ 1/95
omw
Legal Description:
Owner Name & Address: �i �� 5 ►� Tel. #
Contractor: �r �`J a -- MN LICENSE #
� 1 �i z r r��� � a Ley Tel. #
Address: 1
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width
Length Width
Len Width
�`kA ac S
Comer Lot [ ] Inside Lot [ 1
Type of Construction:
Approx. Completion Date: _
Ft. Yd Setback
Height
Height
Hgt/Ground
121! r�- Ai
Sq. Ft. JA �00
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimated Cost: $ 6-/�
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft x $ _ $
DATE: `-J / �� APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �9 0 L
$ 30, � 6)
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,00 Valuation
$850 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fey. D&ermined by Engineering
Agreement Necessary [ ] Not Necessary { ]
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 1998
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572* -3604 —REFFOGERATIOtiANDAIRCONDITIONtNGSYSTEMS-ANDI)EVICE-S
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate
TOTAL
specified agreeing to do All work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $30.00
$ 3D, 6b
representations stated in this application are true and corre&
(Side Vent - Fill Out Back)
gle-- ------,1998
13
Gas Piping (Needed with new furnace) $10.00
OWNER_16
Gas Range $10.00
$
BUILDING USED AS
fees Dryer $10.00
$
ESTIMATED COST ,qy�(o cvD PERMITNO. 17
I
*Air Conditioning - All Sizes $25.00
$_4216D
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Afterations, (LIST ON BACK)
No. Heating Units Circle One (Steam) (Hot Water) rm Ai
1 % of Value of Appliance or Work
$
of
C Size No. c
Trade Name -4h r- LX^ o2
Commercial/Industrial
BTU S70. ax) HP k1s EDR
1.25% of Value of Appliance or Work
$
Fuel _N) , � (��, Total Connected Load
State Surcharge
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
$
REINSPECTION FEE $42-00/Hr
*Air Condtioners can not be placed in a side yard without
written permission from adjoining property owner.
Rough -4n Date Final Date 50
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
Z
i
CHUyINEY AND STACK VERIFICATION
Th� underjigned hereby verifies that the existing chimney or stack:
1. ( Hia$ been carefully examined Yes No ( )
2. ; Is Free from rust or deterioration Yeses) No ( )
3. Ha' • no foreign objects lodged within Yeses} No ( )
i
Yeses) No ( )
4. Is securely supported
a
i
6
7.;
91
Mets all current Code requirements for size
and total BTU's connected
11�� total heating BTU's of
All other BTU's fl
,{
TOTAL BTU's 90• ®o 0
Halo a liner been provided for water heater
Has combustion air been provided for water heater
cs:
Lijt ALItRATIONS Being Done:
ij
i
TIN CO:
i
Yeses) No ( )
Yeses) No ( )
Yes )No(}
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On May 10, 1999
MARK NUMBER OF FIXTURES TO
BE INSTALLED
ON EACH FLOOR
:r=::>:• Wash
Shower ...:; Tray
....�'..�:::::�:::
4 r -:::::
...........::.:.......
� .. • : •:
::s..
Floor
Drain
;: Auto. Gas
:.
i.....
n
i`(�`�.. Washer ���;.::,.;<:::::: Ra e
I :: Water Heater
StonesUrinal
�``.. Gas E
Ga lec
Basement
Floor 1
Iri
Floor 2
Floor 3
I
F oor 4
3
PLUMBING FIXTURE RATES: NO. RATE
New Fixtures
Old Opening, New Facture
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 () 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
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
l�e�
TOTAL JOB ADDRESS /
The undersigned hereby makes application for a permit for the work herein
00 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.
.1999
Owner
Building Used As
Estimated Cost PERMIT NO.
PLUMBING
SIGNED BY
Approved By &z Rough -In Date
TEL NO.
Final Date S/6
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
V . . W
SuBjECT
PE
City of Fridley
9511
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
r PROTECTIVE
i /"'1•� CITY HALL FRIDLEY 55432
'
NUMBER
REVDATE
PAGE OF
APPROVED BY
L .--_�
612-571-3450
910-F15
5/20/99
JOB ADDRESS 140 Ri ckard Road
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
2
Garten's Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert Jensen
572-0525
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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 O ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Remodel kitchen, three windows
9 CHANGE OF USE FROM TO
STIPULATIONS
Install smoke detectors to meet the State Building Code
- in each sleeping
room and on each level of the house.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 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
$50O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
50
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
$23.50
Fire -SC $.50
PLAN CHECK FEE
TOTALFEE
' SIG 4 U OFCO OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY (DATED THIS IS YOUR PERMIT
BLO INSP
�J
S� NATURE OF O A ,I N A BUILDER, DATE,
NE
V . . W
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1\
BUILDING PERMIT APPLICATION
Construction Address: A16 C ,) o�
Legal Description:
Owner Name & Address: Tel. # P®)�
Contractor: (�} C,OAN MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHERf�
lhwlf
Construction Type:_
DESCRIPTION OF IMPROVEMENT
Length Width Height- Sq. Ft.
Length Width Height Sq. Ft.
,fit ,i• •�-
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: S -o;b- %APPLICANT: Tel. #
CITY USE ONLY
STIPULATIONS:
r
Permit Fee
$ S
Fee Schedule on Reverse Side
Fire Surcharge
$ S
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1050 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
$ ,So
STIPULATIONS:
r
Building
Inspections
763-572-3604
DATE C C'A
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDEN'T'IAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
❑ OWNER
Permit NO.:
Received By:
Date Rec'd:
ADDRESS: CITY STATE ZIP,
Yrobullt Amenca
PHONE: 2C 3- Esther Dahl, contact
NAME: 2211 11th Ave E
STATE LICENSE EXP DA North St Paul, MN 55109
ADDRESS: 651-770-5570
PHONE
FAX
❑ ADDITION ❑ GARAG
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMM
TYPE OF WORK:I ❑ NEW u
❑ MAINTENANCE/REPAIR ❑
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
❑ DRAIN TILE
❑ OTHER
HEIGHT
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 SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
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 1997 U.B.0 FEE OCCUPANCY TYPE
TOTAL JOB VALUATION $�
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ S Ob
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 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 work which re Fires revieNy and approval of plans. aa
SIGNATURE OF APPLICANT , , �� PRINT NAME V� h 1 d� (,T/ DATE `fl. cid — r
Building
$ Sj
BUILDING
Permit No.:
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
A
-Aft CITY OF FRIDLEY
DateWD-J�2011
DATE 11,41 JL
% tuul YOUR E-MAIL ADDRESS J— 10
04&JLQ_4JX. /L /v
SITE ADDRESS 0C'
A b
$1675 per SAC Unit (Plans to MWCC for determination)
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
ft + 6 ft = ft x $21 =$
PROPERTY OWNER/
NAME: _'
$450 Conservation Plan Review
ADDRESS: ` � CITY
46!%
STATE
TENANT
Sewer Main Charge
PHONE: 527 ►�
Agreement necessary ( ) Non Necessary ( )
CONTRACTOR
NAME:
Make checks payable to: City of Fridley Attach Stipulations
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
Cl NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
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:
FOR NEW CONSTRUCTION INCLUDING DgCKS,
tnyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other .
❑ Fascia
and proposed project
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
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:
TOTAL JOB VALUATION
Permit Fee
$ Sj
See Back Page for Fee Schedule
Plan Review
$ ':*
65% of Building Permit Fee
Fire Surcharge
$ 2-5-0
.001 times the total job valuation
Surcharge
$ 1 - L4
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
-Cts-
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 work will be in accordance with the approved
plan in the case of all work wh)gh requires review and approval of plans. n . _ f o .
SIGNATURE OF APPLICANT