PRE 2010 DOCSSUBJECT PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
R EIPT
• COMMUNITY DEVELOPMENT DIV.
INSPECTION
r � � PROTECTIVE SEC.
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-580-3450
910-F15
LO/30/74
JOB ADDRESS 6460 Squire Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
4
Harris Lake Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Brickner Builders 6245 Ben More Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 50' x 30' & 24' Dwelling and a 22' x 22' Garacre
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway. Provide a verifying survey before
capping. Check windows for fire escape minimums.
SEWER LOCATION: 7' North of Manhole (N. Inv. 879.68)
Wye Elevation: 879.66
Top of Footing: 883.00 Minimum
WATER LOCATION: 10' North of Sewer Service
SEPERATE PERMITS REQ111RED FOR WIRING;
HEATING, PLUMBING AND SIGNS.
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
R-1
1436
28,128
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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$33,898
16.95
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
F ERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION PERFORMANCE OF NSTRUCTION.
$61.00
$300.00
PLAN CHECK FEE
TOTAL FEE
�s/�✓✓'�' �� '70
377.95
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI 11.1WHEN
PROPERLI DATED THIS IS.YOUR PP�\EERMIT
V �V
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG INSP DA E
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME- : � BUILDER:'
47
ADDRESS: A.DDRES S : G � de e /J �.
NO:. STREET:
•
LOT: L BLOCK: L ADDITION :,��✓1/L�
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:_
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building locatioW drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front:
® Depth: 6 f Height:
Square Feet: Z/3 Cubic Feet: w
� Front: `2 2 Depth: 2 Z Height:
Square Feet;�=f---Cubic Feet: �� d 7
Type of Construction: Estimated Cost:
ry}
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.
DATE: �y SIGNATURE •::::��
(See Reverse Side For Additional Information.)
VY9
-BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or,repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the manner herein provided to -wit:
UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3 & 5*- $1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
orthe cellar to the average heights of the upper surface or to the average:r
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of'24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
Land Planning Sir(/lr�/frj1
6875 Highway No. 65 N. E.
land Surveying j�` (
('. ` f j�`
Soils Testing
/� Minneapolis,
• Minn. 55432
(�/
Civil Engineering
Telephone 784-6066
Municipal Engineering Engineers & Surveyors
Area Coda 612
Certificate of Survey for ER)
BUILDERS
1 )0
�.
GARAGE
�< N
\ '�// 1
N 35;,5 OO
j1
\V0
pQOQO$ED 15.61
N
zq,ao �, IID
Scale. 1"=�`, 4k
Ib .o 0
135.DU
LOT 4 BLOCK
H ms LAa ESTATES
Anaka Caunfy
I hereby certify that this is a true and correct representation of a survey of
the boundaries of the above
described land, and of the location of all buildinq<. thereon, and all visible encroachments, if any, from or on
said land. As surveyed by me this day of_ OCTor$6Q A.® 19 l3
c DENOTES IRON MONUMENT SUBURBAN ENGINEERING,
INC.
Engineers
br r� -f
DENOTES DPPIWP TE UTLTY EASEMENT'"
Surveyors
•
'-Faf Foo7lAJ6-- ?,?3 - 00
T -g
r v1 c
City of Fridley
Din f m hbg and
Dept. of Bldg$. Phone W"
DESCRIPTION OF WORZ
Number, Kind and Location of Fixtures
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, ARinn // /I -P 19L/
h
Owner ' flct.<<' � ' --;Q
Kind of Building
• Future Connection Openings Sewer
+ New Fixturr, Old Openings I spool a Used as
To be completed about
PARTIAL RATE SCHEDULE
Estimated Cost, $
WATER MTII.
GAS ELIC
Base
Old—New. Building Permit No.
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ............:....
� x $2.00
$ /
Signe _
Future Fixture Opening ..............
1st
$� S
BY_
Fixture Old Opening .....:....
. x $1.50
$ _
Business Phone No
5 9 si_0
Catch Basin ...........:........
x $3.25
$
2nd
x $3.00
$ • C' O
New Ground Run Old Bldg.........
x $3,2,5
$
ROUGH
Electric Water Heater...........
a $2.00
$
3rd
-%#1t3 FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures .............. • .
x $2.00
$_!L 0 0
Additional Fixtures .................
4th
$
Gas Range to 199,000 BTU..............
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, ARinn // /I -P 19L/
h
Owner ' flct.<<' � ' --;Q
Kind of Building
• Future Connection Openings Sewer
+ New Fixturr, Old Openings I spool a Used as
REPAIRS & ALTERATIONS --Refer to Code
Description .............................................;
TOTAL FEE $
.50 State Surcharge
To be completed about
PARTIAL RATE SCHEDULE
Estimated Cost, $
Permit IQo. (0
Old—New. Building Permit No.
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ............:....
� x $2.00
$ /
Signe _
Future Fixture Opening ..............
x $1.50
$� S
BY_
Fixture Old Opening .....:....
. x $1.50
$ _
Business Phone No
5 9 si_0
Catch Basin ...........:........
x $3.25
$
Water Heater (Up to 99,000 BTU) ....
x $3.00
$ • C' O
New Ground Run Old Bldg.........
x $3,2,5
$
ROUGH
Electric Water Heater...........
a $2.00
$
-%#1t3 FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures .............. • .
x $2.00
$_!L 0 0
Additional Fixtures .................
x $ .75
$
Gas Range to 199,000 BTU..............
x $5.00
$
REPAIRS & ALTERATIONS --Refer to Code
Description .............................................;
TOTAL FEE $
.50 State Surcharge
Fewer Roft and.,.ft%, Vemlabas avWtVmr= md 69
Ir Can "ideIng e
GIMTM WAS Ai;iflt =72 TOTAL
Furnace Shell & Duct Wow . $10.00 $
Replacement of nwwce 6.00
Repairs & Alterations—up to 3308.00 6 00
Repairs & Alterations each add. $300.00 3 W 3
is., « � is '�r r•7t
P% rmce Shell & Duet Work to 120,000 BTU ..$10.00 $ ��
each add. 60,000 VM . ..... 3.00 :5
Replacement of Furnace 6.00 $
Repairs & Alterations—up to $500.00 6.00 $
Repairs & Alterations each add. $808.00 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. FZR Steam $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Not Water 20.00 $.
Each add. 200 sq. ft. EDR Steam xon 1<
Each add. 320 sq. ft. EDR Hot Water 3.00
OIL BURNEFI—to 3 gal• per hour
6.00
$„_„®
over 3 gal. per hour --See
Fee Schedule
GAS BUR (up to M= BTU)
6
3 U C)
aver 299,000 BTU t" Fee Schedule
GAS FITTING FTES:
NO RA'Z'E TOTAL
Ist 3 Fixtures
_� xffi 2.00
S-
-2.20 -Additional Fixtures
z; •76
;__ _
Gas Range t0 M00
$$ a.
$
State Surcharge
.50
i<3I
AIR COIT[OP3¢3
�
EMT= STBTEN
lid Fee
WES `l G 373`
'641W
ALTERATTON3 & l:t A
P ;?°�
SAE.
A
a
City of Ptldlcy:
The undersigned hereby makes application for a permit for the work here€
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 fad
and representations stated in this application are true and correct.
Fridley, Mon
Owner,
Kind of Building
Used as /��'.f .�E'✓
To be completed about,
Estimated Cos>~ S -�
Old—New. Building Permit No. __ Permit No.
t•.w, ' Bey ,.. :�,:re
HEATING or PO • team Not Water, Warm Air—No
Trade Name aewee NJ- 31a. NmZ ee 3 e YA�
Capacity® _3j 00 0 ._ Sq, FL E.D.R BTU
Total Connected Load Z".0,t 104 Ktnd of
BURNER --- Trede No Size N®
(6 AVICS— )
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
each addn. 50,000 BTU
.AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
7.00
$
each addn. 50,000 BTU
GRAVITY WARM AIR:
RATE
TOTAL
Job Address dp
Furnace Shell & Duct Work
$12.00
$
$
Replacement of Furnace
Repairs & Alterations -up to $500.00
7.00
7.00
$
$
Department of Buildings
Repairs & Alterations each add. $500.00
4.00.
$
City of Fridley
1st 3 Fixtures x
$ 3.00
Tel. #571-3450
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU $12.00 • $
each add. 50,000 BTU 4.00 $
Replacement of Furnace 7.00 $
Repairs & Alterations -up to $500.00 7.00 $=
Repairs & Alterations each add. $500.00 4.00 $
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
$12.00
$
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
each addn. 50,000 BTU
6.00
$
OIL BURNER- to 3 gal. per hour
$10.00
$
each add. 3 gal. per hour
10.00
$
GAS BURNER- from 100,000 BTU to 199,999 BTU
$10.00
$
(over 199,999 BTU see Fee Schedule)
$
GAS FITTING FEES:
1st 3 Fixtures x
$ 3.00
$
Additional Fixtures x
$ 1.00
$
Gas Range to 199,000 BTU x
$10.00-
$
AIR CONDITIONING -
$
FAN HEATING SYSTEMS 1 See Fee Schedule
$
VENTILATING SYSTEMS
$
ALTERATIONS 4 REPAIRS3
$
State Surcharge
$ .50
TOTAL FEE
$ ��
ROUCB; INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
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 Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Minn. . 19_
OWNER
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT Z // /-7 5
ESTIMATED COST 160
OLD - NEW BUILDING PERMIT NO.
PERMIT NO. Qe a
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm.Air- No.
Trade Name Size No.
Capacity
Sq. Ft. EDR BTU
Total Connected Load Kind of Fuel
BURNER - Trade Name
Size No.
HP
REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP
L$10.00)
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
Company
Signed By
Tel. No.
1j
CITY OF FRIDLEY
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 $12.00 $
Replacement of Furnace 7.00 $
Repairs & Alterations -up to $500.00 7.00 $
Repairs & Alterations each add. $500.00 4.00 $
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$
each add: 50,000 BTU
4.00
$
Replacement of Furnace
7.00
$
Repairs & Alterations -up to $500.00
7.00
$
Repairs & Alterations each add. $500.00
4.00
$
STEPu,1 OR HOT WATER SYSTEM:
$
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
Job Address
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Minn. , 1926
OWNER C R R V_ C
$12.00
$
KIND OF BUILDING 40M L
4.00
$
�j =S C-
7.00
$
USED AS G� i 0 A<-
6.00
$
//�� g•
Lkr. -r S� i
TO BE COMPLETED ABOUT d- us
$10.00
$
10.00
$
ESTIMATED COST
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $
(over 199,999 BTU see Fee Schedule) $
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $
Additional Fixtures x $ 1.00 $
Gas Range to 199,000 BTU x $10.00 $
Cnrn rnNt�ITIONING $0
FAN HEATING .S See Fee Schedule $-
VENTILATING SYSTEMS ( $
ALTERATIONS $ REPAIRS_ , $
State Surcharge $ .50
TOTAL FEE $
ROUGH INSP
FINAL INSP.
REINSPEC'.PION FEE
Date (:,10. 00)
Da to
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50
OLD - NEW BUILDING PERMIT NO.
PERMIT NO. 62 08-24 4
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name /L% G R P,w - zE�oj (S Q/ % Size No.
Capacity 33 (>eo F> -(L9 Sq. Ft. EDR BTU IIP
Total Connected Load Kind of Fuel
BURNER - Trade Name
Capacity
Size No.
Sq. Ft. EDR BTU HP
Company p
Signed By �` LLJCJ
Tel. No. Jar%I -�Z®ro
2 -9C. -?7.5Z
(-tiy OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FI'T'TING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
N•.L.ber Fixtures
Future Fixture Opening
New Fixture, Old Opening
Catch Basin
Water Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
x
x
x
x
x
x
x
$3.00
$2.00
$2,00
$5.00
$5.00
$10.00
$7.00
New Ground kin Old Building
Electric Eater Heater
x
x
$5.00
$5.00
GAS FITTING FEES:
1st 3 fixtures
Additional Fixtures
Gas Range to 199,000 BTU
REPAIRS $ ALTERATIONS
First $100.00
each add- $100.00 or fraction
x •$3.00
x $1.00
x $30.00
State Surcharge
TOTAL FEE
REINSPECTION FEE
($10.00)
$5.00
$2.00
Job Address iso "( 6
Department of Buildings.
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the imork herein
specified agreeing to do all work in strict accordance with the.city Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 19
OWNER c-
, -_—
KIND OF BUILDING
USED ASLa�vQ
TO BE COMPLETED ABOUT
ESTIMATED COST 09140b
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By
Tel. No. — Z (
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT ill, k -
MINIMUM FEE FOR ANY PLUMBING PERKIT IS $7.50 PLUS $,50 STATE SUS
SUBJECTPER
City ®f Fridley
146
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
ECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
,
J�
'
1 CITY HALL FRIDLEY 55432
(�
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
"-' `'J 612-560-3450
910-F15
I
1/20/78
JOB ADDRESS 6460 Squire Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
4
1 Harris Lake Estates
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE.
Jerry C. Winslow 6460 Squire Drive N.E.
571-9206
3 CONTRACTOR MAILADDRESS 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 Cjj ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Finish basement
9 CHANGE QF USE FROM TO
STIPULATIONS call for a rough -in inspection before installing any sheetrock.
SEA -RATE PERMITS REQUIRED
FOR err RIAIGY
HEATING, PLUMBING
AND S�iVs
fi .
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTF1 AL, 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
R 1
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.
$.80
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,600
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$12.00
1�
. �1.� y aa -7 S.
�aNAruR �
PLAN CHECK FEE
TOTAL FEE
$12.80
FCONTRACTOR ORAUTHORIZED AGENT (DATE)
HEN PRO ERLY VALIDATED
THIS IS YOUR PERMIT
-
SI�URE OF OWNER (IF OWNER BUILDER) (DA El
BLDG WSP
DATE
• CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PEM1ITS
(NEW, ALTE=RATIONS, ADDITIONS, OR REPAIRS)
OWNER: 13UILUEI2:
Address: (.44 (60 SQLA►' l Rtor-- Address: bp -11)c
Tel. No.:
No. (0 `l (' O
LOT: q
Street: S•Q "►ke= batoa
BLOCK: 4/ ADDITION: A/A A 2L4- LA 9 L � Si�l7 E5
CORNER LOT: INSIDE LOT: ')(- SETBACK: SIDEYARDS:
Applicant attach 'to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front:
Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: F1iv1s1411v& b,466i 6A1 r Estimated Cost: $ /600
To Be Completed: /Z/-2-3
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 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. See reverse side for additional information.
DATE: z ® h S SIGNATURE: � • lJ�-��
Stipulations:
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection
of any building or structure, or for any addition to any existing building or structure,
or for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to -wit:
NEW CONSTRUCTIO14: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and _
gutter only; Driveway width plus •6 feet x ttt=#5 O
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x��
_ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
6 ''1
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
PERMIT NO.
2
r
�
• ______ COMMUNITY DEVELOPMENT DIV
r ti PROTECTIVE INSPECTION SEC
1 � i
1 CITY HALL FRIDLEY 55432
�.J 612-571-3450
RECEIPT
NUMBER
910-F15
REV
DATE
10/3/95
PAGE OF
APP VED BV
JOB ADDRESS 6460 Squire Drive NE
1 LEGAL
DESCR.
LOT NO.
4
BLOCK
4
TRACT OR ADDITION
1 Harris Lake Estates
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Paul Larsen 6460 Squire Drive NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
L J Roofing 10151 Foley Blvd NW, Coon Rapids HN 55448 767-0587 9036
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 j1 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (25 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
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
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
$2,000
$1.00
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.
$62.25
Fire SC $2.00
�� /f/1
SIGNATURE F ONTRACTORORAUTHORIZEDAGENT ID TE)
PLAN CHECK FEE
TOTAL FEE
WHEN PROP
LY VALIDATED THIS IS YOUR PERMIT
- B� G INSP
ff.)--6_�
DATE
_
SIGNATURE OF OWNER t iF OWNER BUILDER) (DATE)
NEW [ ]
ADDN [ ]
ALTER []
.:.•.::• :;o;,o.. :,o;+;>;• :.:.:...:.:.. :.:.;.; ;.:. ,; ,,.c , , .. , .....w . z .w ....................., ............
Effective 8/1/95
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
�37�z
ConstructionAddress: 1-10 U'/'e rtl
_
Legal Description:
Owner Name & Address: T't Tel. #
Contractor: �--. j o _ _ MN LICENSE # 90 3 6
Address: Tel. # - z
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 HgdGround Sq. Ft.
OTHER: Z S- S cr ��' hV-2 �" _
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: /4-% o Estimated Cost: $
Approx. Completion Date: U 0
TOTAL $ ,7c,125
STIPULATIONS:
(Cost on Back)
Driveway Curb Cut Width Needed.:
Ft. + 6 Ft = Ft x $ _ $
DATE: ®3of
APPLICANT:--
Tel. #
CITY USE ONLY
Permit Fee
$ 0?` �`� Fee Schedule on Reverse Side
Fire Surcharge
$ ;� , LC
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /, CC
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$ cC.,,
$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 $ ,7c,125
STIPULATIONS:
I
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to -wit: `
TOTAL VALUE FEES
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the flaming.
CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1998
6431 University Ave NE
Fridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS &tAPLO J �y n
RATE SCHEDULE
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.
HEATING COMPANY 91W �� SAA61- Aldi
Signed By
Approved By
FILL OUT BACK SIDE FOR
REPLACEMENT FURNACE
Tel No. 75g0�17Z
Rough—In Date Fina
VERIFICATION ON
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 correct.
(Side Vent — Fill Out Back)
Qom¢ ,1998
Gas Piping (Needed with new furnace)
$10.00
$
AF
OWNER 4r-sa .
Gas Range
$10.00
$
BUILDING USED AS bweJ1., yJ r
Gas Dryer
$10.00
$
ESTIMATED COST 3ZDD u d PERMIT NO.�
*Air Conditioning — All Sizes
$ 25.00
$ Z.rj• 00
_
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK
1%.of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) arm Air)
Trade Name %iP..n�g iu Size No. 1?TEI.��
Commercial/Industrial
BTU 10q,r HP EDR
1.25% -of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
$ .50
Burner Trade Name Size No.
5.5b
BTU HP EDR
TOTAL FEErJ$
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.
HEATING COMPANY 91W �� SAA61- Aldi
Signed By
Approved By
FILL OUT BACK SIDE FOR
REPLACEMENT FURNACE
Tel No. 75g0�17Z
Rough—In Date Fina
VERIFICATION ON
CHIMNEY AND STACK VERIFICATION
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 (-J'No ( )
4. Is securely supported Yes No O
fi
5. Meets all current Code requirements for size I
and total BTU's connected Yes
6 Has total heating BTU's of
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 (/f No ( )
Remarks:
List ALTERATIONS Being Dane:
HEATING CO:
Signed By:
Date:
X-110 --f
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 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS U [ l® `�"Qu� Ll �� Alva
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 correct.
(Side Vent - Fill Out Back) 10-1H ,1998
Gas Piping (Needed with new furnace) $10.00 $ j)
OWNER �Y' 1 G11 -J 0b�
Gas Range $10.00 $
BUILDING USED AS '
Gas Dryer $10.00 $
ESTIMATED COST 6 ®, y O PERMIT N0. 13 qI
*Air Conditioning - All Sizes $ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs 8. Alterations (UST ON BACK)
1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
Commercial/Industrial BTU HP EDR
1.25% of Value of Appliance or Work $ Fuel Total Connected Load
State Surcharge .50 Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE �,�JrD
BLAINE HTO. A1'C ELECT., INC.
135 2 CENTRAL. AVE. N.E.
HEATING P AIdOt�, MN 55304
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By el No. �� �(�� 0
PLUS THE $.50 STATE SURCHARGE S /� 01
REINSPECTION FEE $42.00/Hr Approved By Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR, STAC VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
Y
Remarks: r
ia!�iaa JaRk) I
II �r
Id
List ALTERATIONS Being Done:
BLAINE HTG. RIC ELECT., ING
13562 CENTRAL AVE. N.E.
ANOKA, MN 55304
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
31: G
Has been efully examined
Yes ()
No ( )
2.
Is free from"rust or deterioration
Yes O
No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
4.
Is securely supported
Yes (
) No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6
Has total heating. BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes (
) No ( )
S.
Has combustion air been provided for water heater
Yes (
) No ( )
Y
Remarks: r
ia!�iaa JaRk) I
II �r
Id
List ALTERATIONS Being Done:
BLAINE HTG. RIC ELECT., ING
13562 CENTRAL AVE. N.E.
ANOKA, MN 55304
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
Effective On January 1, 1997
JOBADDRESS
$10.00 $
*Air Conditioning — All Sizes - $ 25.00 $
All Others/Repairs & Alterations (LIST ON BACK)�'s
1 % of Value of Appliance or Work $
Commercial/Industrial
1.25% of Value of Appliance or Work
$
State Surcharge $ .50
TOTAL FEE
MINIMUM FEE FOR ANY HEATINGJCOOLINGNENTILATION
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.
BUILDING USED AS/�
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units
Trade Name,
BTU
Fuel
Burner Trade Name
Circle One (Steam) (Hot Water) (Warm Air)
Size No,
HP EDR
Total Connected Load
Size No.
BTU HP _ EDR
-
�1®W�r�t: • _1 � ::,w
HEATING COMPANY aMN 55'2+
�, o0
Signed B el No.
Approved By Rough—In Date Final Date
FILL OUT BACK SIDE FO TACK VERIFICATION ON
REPLACEMENT FURNACE
The undersigned hereby makes application for a permit for the work herein
Rate TOTAL
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
$ 30.00 $
representations stated in this application are true and correct.
1997
$ 10.00 $
OWNER.
OWNER .
$10.00 $
V
$10.00 $
*Air Conditioning — All Sizes - $ 25.00 $
All Others/Repairs & Alterations (LIST ON BACK)�'s
1 % of Value of Appliance or Work $
Commercial/Industrial
1.25% of Value of Appliance or Work
$
State Surcharge $ .50
TOTAL FEE
MINIMUM FEE FOR ANY HEATINGJCOOLINGNENTILATION
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.
BUILDING USED AS/�
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units
Trade Name,
BTU
Fuel
Burner Trade Name
Circle One (Steam) (Hot Water) (Warm Air)
Size No,
HP EDR
Total Connected Load
Size No.
BTU HP _ EDR
-
�1®W�r�t: • _1 � ::,w
HEATING COMPANY aMN 55'2+
�, o0
Signed B el No.
Approved By Rough—In Date Final Date
FILL OUT BACK SIDE FO TACK VERIFICATION ON
REPLACEMENT FURNACE