PRE 2010 DOCSSUBJECT
City of Fridley
5.4_ 9
CPR1iTT
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
N
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
7,1�
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/26/79
i
JOB ADDRESS 6110 Trinity Drive N.E.
1 LEGAL
LOT NO
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
lO
2
Sylvan Hills plat 2 SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Clarence Otten 6110 Trinity Drive N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548
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 ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Rexpof house and garage
9 CHANGE OF USE FROM TO
STIPULATIONS Roof can be second but not third roof. Install ridged galvanized
valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
1
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 TYPE OF WORK WILL BE
$.75
WITH WHETHER SPECIE EDNING HER INIOR NOT. THE GRANTING OF AO PEMPLIED RMIT$1/5OO
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 PE R ANCE OF CONSTRUCTION.
$9.00
PLAN CHECK FEE
TOTAL FEE
_7
l
$9.75
A
SIGNAT R OF CONT T RORAUTHORIZEDAGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�i
BLDG INSP O! TE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
IF CITY' OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: Clarence Otten
BUILDER: �:ilton L. Johnson Co.
Address: 6110 Trinity Dr N E Address: 2513 Central N E
No.: 6110
LOT:
Tel. No.
Street: Trinity Dr N E
BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: Roof House & garage Estimated Cost:
1,500®00
To Be Completed: 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:
�' ` % SIGNATURE:
Stipulations:
r BUILDING PER141T FEE SCHL'%LE
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 CONSTRUCTION: 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 $11.75
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 $15.40
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 hei ht of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the f e 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.
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.
CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL RATE TOTAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00 $
Gas Piping $ 10.00 $
(piping needed with new furnace)
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
* Air Conditioning (all sizes) $ 10.00 $
All Others/Repairs and Alterations
18 of Value of Appliance or Work $
COMMERCIAL/INDUSTRIAL
18 of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE $ 1:5 -
Reinspection
aReinspection Fee ($15.00)
Rough Insp.
Date
Final Insp.
Date
Approval for Permit r�
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
s /f
Job Address
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
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.
OWNER
KIND C
USED P
Fridley, Minn. /74Cf- /e , 19, -?,7
TO BE COMPLETED ABOUT_ r Z d'
ESTIMATED COST Z -J ?ZE P /�
OLD - NEW BUILDING PERMIT NO. PERMIT NO. /® C/V
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company
Signed By
Tel. No. ���
Fill out back side for stack verification on replacement furnaces
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 ( )
No ( )
4.
Is securely supported
Yes ( )
No ( ).
5.
Meets all current Code requirements for size and
total BTU connected
Yes ( )
No ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company _
Signed By
Date
SUBJECT
City of Fridley
(1;72--5
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
�3
J
e ,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
=
I ---1 CITY HALL FRIDLEY 55432
612-571-3450 1910-F15
6/23/98
10B ADDRESS 6110 Trinity Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9 10
2
Sylvan Hills Plat 2
SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP PHONE
Clarence Otten 6110 Trinity Drive NE
571-1179
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 jJ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (22 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
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$1,834
$.92
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL E
$6 5
SI TURREEOF„CONTRACTOR ORAUTHORIZED AGENT IDATEI
PR PE
r BLDG NSP
ALIDATE S IS Y UR PERM
TATE
SiGNaTURE OF OW NEP IIF OWNER BUILDERi IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & A s:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
6e 0)
Tel. #
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWROVEMENT
Length Width Height Sq. Ft.
Length Width Ijeight Sq. Ft.
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Estimated Cost: $ 1 a,2 f
(Fee Schedule on Back)
Ft x $ = $
DATE: ke; v APPLICANT: � Tel. #op
TOTAL
STIPULATIONS:
W
CITY USE ONLY
Permit Fee
$ 5
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 2,2
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
W
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 $500,0.00 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 framing.
CITY OF FRIDLEY INSPECTION DIV.Effective On May 10, 1999
6431 University Ave NE D' (� M
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER
OF
FIXTURES TO BE INSTALLED
ON EACH FLOOR
Stories..
'
•�`•"
.�Ql�t...:
nal
a
...� ::
h
� Shower
`'t•'tt����<:.
t�3�`:�<<�
Wash
Tray
r �I�#�l<��::<`'
FloorAu
Drain
o .�Gas
"iS:l�gti•:•:
J.
�tl��:<:: Washer �': - Ran a
: Water Heater
•iih �'F.•:ti
f ..
•:..Y.v..
..::,. G
Basement' t
Floor 1
�� �;�•••
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas""
Gas Range"
NO. RATE TOTAL
No
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 $ .50
TOTAL FEE $
JOB ADDRESS�.�pi�J�
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.
OTTEN, ALICE/CLA
6110 TRINITY DRIVE NORTHEAST
Owner_ FRIDLEY, MN 55432
(612)571-1179
Building
,1999
Estimated Cost L100 PERMIT NO.0` (6p;?.2'
Li C®.
.(612) 327-4033
PLUMBING COMPANY 2905 ,ARFIII° So.
LcPNNEAPOLlS_b MN •664f?8-
SIGNED BY dimfove-1 TEL N0.
Approved By Rough -In Date Final Date
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
June 29, 2001
Ms. Alice Otten
6110 Trinity Drive NE
Fridley, MN 55432
Re: Final Inspection at 6110 Trinity Drive NE
Contractor: Norblom Plumbing Co
Dear Ms. Otten: -
A plumbing permit was issued on October 18, 1999 to install a water heater at your address.
According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted
on the plumbing authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Plumbing Code. We will keep your permit open for another 30 days and if we
do not hear from you within this time to set up the inspection, we will expired the permit and no
further action will be taken.
To set up the inspection, or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
Building
$
BUILDING
Permit No.: , -006,77
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By: V
763-572-3604
Surcharge
CITY OF FRIDLEY
Date Rec'd: LJ �
DATE - 06 YOUR E-MAIL ADDRESS M
G'T
SITE ADDRESS
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
THIS APPLICANT IS:
❑ OWNER ONTRACTOR
$
PROPERTY OWNER/
NAME: c4e—o)IJ
$
ADDRESS: � 7ltIs c / e/� CITY (^� ��l
e
STATE_ZT S"J rtt 3 21
TENANT
Agreement necessary ( ) Non Necessary ( )
PHONE: 0
$
CONTRACTOR
NAME: to A Aeti4— e—z
STATE LICENSE #_ DATE
SUBMIT A COPY OF
7 LCITY �/
�A2
It STATE_ZIP_53S
YOUR STATE LICENSE
WITH APPLICATION
ADDRESS: ,
PHONE7b �-S-60 - &Iii FAX 6-4'C)^ � a�
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISHOOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT _ LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
NUMBER OF SQUARES
—
GARAGES
PROPOSED SIZE:_
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPF. nF WINDOW TO BE INSTALLED
.OUSE ONLY
[OUSE & GARAGE
TTACHED GARAGE
ETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
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
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ '53 00 OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
ori e�[� $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
$
v C 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 which requires review and approval of plans.
SIGNATURE OF APPLICANIV PRINT NAME DA