PRE 2010 DOCSDate: May 19, 1967
Owner: _ W. Uulbert
Address
City of Fridley, Minn..
BUILDING PERMIT
N9 9264
BuilderRodney Billman
"3000 36th Ava ;,N . 76 .
Address --
P' • C61 L 1101�,a,
No. 5270 Street St. Imier Part of Lot
Lot — 6 Block 2 Addition or Sub -Division . __ Innsbruck 5th Addu.
Corner Lot —_ Inside Lot — x Setback 35 Sideyard
Sewer Elevation.._.____— 960.68 _ 963.68
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front 59' Depth 38' Height 20, Sq. Ft. 1987 Cu, Ft
Tuck Under Garaggront Depth ..._.. Height _ Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost J $27, 000 __ To be Completed gztpx 91%67
SEWER LOCATION 57' Notth of Manhole
WATER LOCATION 97' North of Manhole
In consideration of the issuance to me of a permit to construct the building described above I agree
the proposed work in accordance with the description above serth and in corn ce h ail provIsia
ordinances of the city of Fridley.
$100.00 NS
In consideration of the payment of a fee of $ 57.00 , permit is hereby granted to Rodney Billmaa,
Inc. 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.
CLARENCE BELISLE
Building Inspector
NOTICE:
This permit does not cover the construction, installation for whing, plumbing, gas heating, ewer or water. Be sure to as
the Building Inspector for separate permits for there hems.
a
eta
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLE'Yj MINNESOTA
OWNER'S NAMEBUILDER
ADDRESS ADDRESS -3� %/
LOCATION OF BUILDING
N0.�STREET �C �f / /� PART OF LOT
LOT G BLOCK ADDITION OR SUBDIVISION �-a..,Z, A �� : /t- r g--
CORNER LOT INSIDE `LOT ,_L SETBACK SIDE YARD
SEWER ELEVATTnN 94,0 / .P 'H'( TMnATT_ON ET,EVATTON �(o�• �6
Appl.ican att this form Certificates of Survey of Lot and proposed
building ocation drawn on these tificates.
97
DESCRIPTION OF BUILDING
To be used as: �J 1 C
ZZ"
Front Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
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.
(Schedule of Fee
®� y: V e C�
is can be found
Reverse Side).
laid Am wBTS:'eC5. AIT
Softs �eslh'r� ENGINEERING, INC.
Owl 6- A-funli-pal
Sur veyors
0,61 suaawe7
0
LO
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Li
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Loi ro, BLOCK 57-H ADDi-now
Abior-A COUNTY
9- A 1 tj A
herr by cer. hry Ad lb, i
a hw arrd ny-frcl I-epresedof f -i cPa -,Lrvvj 4P#e bowdjr;e5 W,'Ae 4�6-e
�tt�4,4�y,�, t*revn, oaddl r,54'e ewcTo-6p7e'd;, r'-Ilt7,V- COSWYOf 11717(l A5 5VrvCye,,Y ' me 1IM5
A.0 1.9-L- SUMIP8A.&I fNCYPVf0?1N5, INC.
5ui" I
City of Fridley $'
Application for Plumbing and Gas Fitting Perndt
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK 72
Number, Kind and Location of Fixtures Location - f /
i
I
� R
�iZ
z
,eZ,,Z!0
¢ �
U'
F
N
WATER HTR.
GAS
ELEC.
3
1—
3
In
O 2
,�
V
<
U�' �
� �
� p
�
Base
1st
1
3
1
j
2nd
3rd:E4th
' Future Connection Openings
Connected with
New Fixture, Old Openings
I
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures f Y x $2.00 $ ? &Pa G G
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 $ :3" U
New Ground Run Old Bldg. ...........
Electric Water Heater
GAS FITTING FEES:
1st 3 Fixtures .........................
Additional Fixtures ...................
Gas Range to 199,000 BTU ..............
REPAIRS & ALTERATIONS—Refer to Code
— x $3.25 $
_ x $2.00 $
NO. RATE TOTAL
x $2.00 $
x$.75 $
X $5.00 $
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, �i /� 19_
Owner
Kind of Building b
Used as ss
To be completed about
Estimated Cost, $ ) > �ew.yuilding,(jz
Ol Permit No �/ Permit No. r�1 5
Signed i'
By S-c�
Business Phone No - 2 h7
ROUGH 6 - ! - � 7 *15-6.0
FINAL
Description ................................................$
TOTAL FEE $
.52-84-915.51
City of Fridley
Appillcuffm for Numbing and C"n Fitt hemit
Dept. of Ridge. Phone 580-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fiuftm
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 .............. s $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures • • ................ 1 x $2.00 $ 2.00
Additional Flxtures .................. x $ .75 $
Gas Range to 199,000 BTU.. . .x $5.00 $
install (1) gas grill 3.00
REPAIRS & ALTERATIONS—Refer to Code
Laea>faM 5270 St_ Imier Drive
City of Fridley:
The .undersigned hereby makes application for a permit for the- work herei
specified, agreeing to do 411 work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that aIL the fact
and representations stated in this application are true and correct
Fridley, mi. July 14o 1971 19—
Owner William Culbert
Kind of Building frame
Used as residence
To be completed about July 19, 1971
Estimated Cost, $ 10.00
Old XNew. Building Permit No. 1;- - - Permit No.
$i B
y
Business Phone i
ROUGH
Description ...............................:....... .... ..... 4 ®ate'%' Surcharge .50¢
TOTAL FEE .00
MMUMMMMMM113'm
.NEON
ENEEMENNEMEM-1
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 .............. s $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures • • ................ 1 x $2.00 $ 2.00
Additional Flxtures .................. x $ .75 $
Gas Range to 199,000 BTU.. . .x $5.00 $
install (1) gas grill 3.00
REPAIRS & ALTERATIONS—Refer to Code
Laea>faM 5270 St_ Imier Drive
City of Fridley:
The .undersigned hereby makes application for a permit for the- work herei
specified, agreeing to do 411 work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that aIL the fact
and representations stated in this application are true and correct
Fridley, mi. July 14o 1971 19—
Owner William Culbert
Kind of Building frame
Used as residence
To be completed about July 19, 1971
Estimated Cost, $ 10.00
Old XNew. Building Permit No. 1;- - - Permit No.
$i B
y
Business Phone i
ROUGH
Description ...............................:....... .... ..... 4 ®ate'%' Surcharge .50¢
TOTAL FEE .00
a
Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ..........................$10.00 $ O
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
6.00
$
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
$10.00
$
Furnace Shell & 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
$ _, c
Additional Fixtures .................
x .75
$
Gas Range to 199,000 ...........
x$ 5.00
$
AIR CONDITIONING R.�tiV ®�
$ i C�
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
TOTAL FEE
t
ROUGH
FINAL
-
Dept. of Bldgs. Phone 560-3480
Location 5270 St. Imer
City of Fridley:
The undersigned hereby makes application for a permit for the work hereic
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.
Minn , 19 —
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $_
Old -wilding Permit No. `�i c Permit No. �i ✓ l ��
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Wa Warm —No ✓
Trade Names— / 016267- Size No d
Capacity Sq. Ft. E.D.R. ® 0 BTU H.P.
Total Connected Load N71, ®Q Kind of Fuer
BURNER — Trade Name C Size No
Capacity Sq. Ft. EMM BTU H.P.
(REMARKS—OVER)
Signe
COID042 B rone
F
Effective Aug. 1, 1981
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING
SYSTEMS AND DEVICES
RATE SCHEDULE
-M /
Drr
RESIDENTIAL MTE
TOTAL
Job Address �� 7 D `9k . T i� r , o e.
Furnace Shell and Duct Work,
$ 21' 00
$
Department of Buildings, 6431 university Ave. N.E., Fridley, MN 55432
Burner
City of Fridley
Gas Piping $ 1.00
$
Tel. #571-3450
(piping needed with new furnace)
S
The undersigned hereby makes application for a permit for the work herein
Gas Range S
—" 10.00
specified agreeing to do all work in strict accordance with the City Codes
10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
Gas Dryer$ o
facts and representations stated in this application are true and correct.
Minn.Mna. J— D 19,
Air Conditioning (all sizes) $ 10.00
o
$
Fridley,
All Others/Repairs and Alterations
n
OWNER r I I LLn, C L) I he rt
�A.7
l% of Value of Appliance or Work
S
-Fra
KI VYl e
ND OF BUILDINJG�
w
COMMERCIAL/INDUSTRIAL
USED AS "' _
lk of Value of Appliance or Work
S
TO BE COMPLETED ABOUT
ESTIMATED COST 1a—
State Surcharge
$ .50
OLD -NEW BUILDIIiG PERMIT NO. PERMIT NO.
' TOTAL Fn
$ a ®. Z
Reinspection Fee ($15.00)
$
pESCRIPTIaN OF FURNACE/BURNER
Rough Insp.
Date
Final Insp. �'� 2.5'- t
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERNIT IS $10.00
PLUS $.50 STATE SURCHARGE
Attach stack verification fom with replacement furnace permits
HEATING or POWER PLANTS, Steam, not Nater, warm Air- No.
Trade Name s`\I 1l� Size No. -3q 7 / �jq -3(0/00
Capacity Sq. Ft. EDR BTU ,,//up
1
Total Connected wad kind of Fuel 14.6.-
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
CITY OF FRI DLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
.. THIS FOR14 MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION 5-2-20 St .Trn i C r �) r. DATE s - d
OWNER W: B I i n rn Culbert ADDRESS S Q rn e-.,,
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are lodged within
4. That it is securely supported
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU 1004000
All Other BTU
TOTAL 0o
REMARKS
HEATING PERMIT I
SIGNED
Licensee
by
Add res s ,J-� (�,�
Telephone - (eaQO
Fridley City License #9 531
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATIO
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective On May 10, 1999
N AND AIR WWITIONING SYSTEMS AND DEVICES
JOB ADDRESS �2 Z- - S�-
Rate TOTAL
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $ 5.00
PLUS THE x.50 STATE -SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
OWNE
$�
BUILDING USED AS -
ESTIMATED COST c-?e)rl
PERMIT NO.�
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units f lcle One (Steam) (Hot Water) arm Air
$
Trade Name_ f/ ✓� Size No..?r o
v
BTU U ae HP EDR
$
Fuel %� �_ Total Connected Load
Burner Trade Name Size No.
$
BTU HP EDR
$ The undersigned hereby makes application for a permit for the work herein
specified'agreeing to do all work in strict accordance with the City Codes an
$ 50 rulings of the Building Division, and hereby declares�t-hat all the facts'and
representations stated in this application are'true and correct.
r
HEATING CO L
Signe ` l DATE
Approved By -- Rough -In Date Final Date (p
CHE E TEY AND STACK VE UICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes No ( )
2. Is free from rust or deterioration Yes No )
3. Has no foreign objects lodged..within Yes XNO ( )
4. Is securely supported Yes( No ( )
�C
5. Meets all current ode:requirements for size /
and total BTUs -connected Yesk No ( )
6 Has total heating BTU's of
All other BTU's-( GG
TOTAL BTU's %ZG G C- a
7. Has a liner been provided for water heater Yes No ( )
8. Has combustion air been provided for water heater- Yes No (-)
Remarks:
List ALTERATIONS Beine Done: .
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIVISION
Effective On January 1, 1999
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOBADDRESS 5T16 S � .
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
$
representations stated in this application are true and c rrect.
(Side Vent — Fill Out Back)_
,
Gas Piping (Needed with new furnace,
$10.00
$
but not replacement)
OWNER _±MLL ek)I)L� St&0qL4
Gas Range
$10.00
$
BUILDING USED AS
Gas Dryer
$10.00
$
ESTIMATED COST PERMIT NO. / G
*Air Conditioning —All Sizes
$ 25.00
$
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
DESCRIPTION OF FURNACE AND OR BURNER
$ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
$ Fuel Total Connected Load
$ .50
TOTAL FEE $
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name
Size No.
BTU HP EDR
S Cis Cod ��'rTr 7✓e�,�'c
HEATING COMPANY
Signed By Tel No.
L
Approved B Rough—In Date Final Date
BC07)Ito7,1
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
L Has been carefully examined Yes () No ( )
2. Is free from rust or deterioration Yes () No ( )
3. Has no foreign objects lodged within Yes O No (.)
4. Is securely supported Yes () No ( )
5.
0
Meets all current Code requirements for size
and total BTU's connected
Has total heating BTU's of
Yes ( ) No ( )
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes ( ) No ( )
8. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO: �i'� e %• r S
Signed By:
Date:
SUBjEGi
City of Fridley
33554
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
1.______
r PROTECTIVE INSPECTION SEC.
f
E�
1,
NUMBER
REV
DATE
PAGE OF
APPROV"""EiiirrrD"' BY
CITY HALL FRIDLEY 55032
L j\ 763-571-3450
910415
5/27/03
JOB ADDRESS 5270 St Imier Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
2
Innsbruck 5 Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Roger Stenberg 5270 St Imier Drive NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Sela Roofing & Remodeling Inc 4100 Excelsior Blvd, St Louis Park NN 55416
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
612-823-8046 1050
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
Reroof House & Garage (27 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
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
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
$3,126
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1.56
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-
$97.25
Fire SC $3.13
TRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FS EE
TOTA EE
Licens $5.0
$ 06.94
SIGNA
EN OP
LVALI DATED HIS IS YOUR PERMIT
G
BHA INSP
-jr OATE
S,GNATURE OF OWNEROF OWNER BUILDER, (DATE,
NEW [ J CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address
Legal Description:
Owner Name & Address: _ 6 e 6, Tel. #
Contractor: SELA ROOFING & REMODETMG zw MN LICENSE # 16
00 EXCELSIOR ELyD. Tel. #
Address: am �.�,:np , a �e _
ED#001050
Attach o 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 Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: �-a �- 3 APPLICANT: S'C-6-f iauoe S Tel. # �[j
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
TOTAL $ IG1 z I STIPULATIONS'
CITY USE ONLY -
Permit Fee
$.�5�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1275 per SAC Unit
License Surcharge
$ D®
$5.00 (State Licensed Residential Contractors)
Curb Cut 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 $ IG1 z I STIPULATIONS'
Building
$
BUILDING
See Back Page for Fee Schedule
Permit No.: UT
inspections
RESIDENTIAL APPLICATION
surcharge
Received By:" t
3. 17
(.0005) times the total job valuation — Minimum $.50
'ire Surcharge
MA" 2
763-572-3604
.001 x Permit Valuation (I/10%)
CITY OF FlaIDLEY
$
Date RM
r�
DATE Ot a L ��0
YOUR E-MAIL ADDRESS
, o car a� Q d� r 0 J) A S, ( o/n
SITE ADDRESS �7 ;t
7 C) S j I n / d,. m I.#r �.
M
$
ft + 6 ft = ft x $20 = $
FIIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: 0 gze f !`
$
TENANT
ADDRESS: 61? 7 O 5 O 1.,f % � /''
�y�.
CITY � d l STATL�=GIP Sett 71
$
PHONE:_ 7 L 3
Agreement necessary ( ) Non Necessary ( )
'otal Due
NAME:_ Pella Windows &Doors
oC/t bo Vdir Jow s
CONTRACTOR
15300- 25th Avenue N.- Suite 100
q � 3 y
SUBMIT A COPY OF
STATE LIC
Plymouth, MN 55447
YOUR STATE LICENSE
ADDRESS: 763 745-1400
CITY STATE—ZIP
WITH APPLICATION
PHONE
PROPERTY TYPE
'SINGLE License# 20165884
fE
❑ TWO FA I
- -DRIES
PERMIT TYPE
E1ADDITION ❑ GARAGE/SHED
iWW11,1DOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
`15,MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: -7 n L(OW it P 16 G M
>IZE OF IMPROVEMENT LENGTH
WIDTH HEIGHT Sq. Ft.
ZOOFING
❑ HOUSE ONLY
DUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
3A -RAGES
3A-RAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
'ROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
'ROPOSED HEIGHT:
>TDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
7 Vinyl
❑soffit
ADDITIONS, & PORCHES SUBMIT:
7 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
V EXISTING OPENINGS�Yes ❑AIo LOCATION OF WINDOWS
k e A)
?R FOR NEW OPENINGS -DESCRIBE
SIZE OF LI V I n4 Pearl r L d,.' �
f
PENING CHANGES &
b4 M14 / r•
lr
'YPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 7 R L13 OCCUPANCY TYPE
'ermit Fee
$
1,5 3. .0
See Back Page for Fee Schedule
'Ian Review
$
65% of Building Permit Fee
surcharge
$
3. 17
(.0005) times the total job valuation — Minimum $.50
'ire Surcharge
$
1 9
.001 x Permit Valuation (I/10%)
,icense Surcharge
$
.j' , o o
$5.00 (State Licensed Residential Contractors)
AC Charge
$
$1450 per SAC Unit (Plans to MW CC for determination)
;urb Cut Escrow
$
ft + 6 ft = ft x $20 = $
,rosion Control
$
$450 Conservation Plan Review
ark Fee
$
Fee Determined by Engineering
ewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
'otal Due
$
17 D. 1 L
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
enformancd with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
ermit but only an application for a permit and wor is not to start without a permit; that the work will be in accordance with the approved
Ian in the case of all work which requires review d proval of plans.
[GNATURE OF APPLICANT PRINT NAME / [ i M -1 J I 1 141 1� DATE 2 R 1 ��