PRE 2010 DOCSCity of Fridley, M ms
BUILDING PERMIT X® 4274
Date: ....._...1._._. _ ._.� _.®. �� .� ._.......................
==- Builder ........... ...._......:_...._..._..__..._...__...._.__ _ .....__..__.� _.._
Address.............. .... ............. __._ ... _.__ _._ _ _ .__........... Address ......... _. _. _. _. _. _._......__.._..__.._..._._.._ _..._..._.._..___..__
LOCATION OF BUILDING
No...
.....
°.... Street _.._. ._.._.........._....._ -....'
................ +Parrtfot....._........._.._..._.._.._..Lot ....... ................. Block ....._......... ..............I......... Addition or Sub-Divisio.- -_._� ..._._......._........... ..
CornerLot .................................... Inside Lot.....A.......................... Setback..............................yard..... -............. -............................ .............. _...........
Sewer Elevation .......... ......................... _............. ...................................................... Foundation Elevation
DESCRIPTION OF BUILDING
Tobe Used as:
...4. ....r ..... ..... Front ----- ----- --_....f Depth ..... ................. Height ..............-(_.. �Sq. Ft. -------...__...._ Cu. Ft......................
..iw"..�. ......... Front .Zr�..�..eDepth ...�Height`..��-_'� Sq. Ft �_Cu. F't..�._�_� �
Type of Construction............................................................ Est. Cost..914Pt.. l .:.... To 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. n / l
In consideration of the payment of a fee of $....7 ............ ...... permit is hereby granted to
.... _...... _._.................. _.......... ._... _...... 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.
Building Inspector
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.
SUBJECT
PE�-NO�o
City of Fridley
1805i
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIP
`-------- COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/10/85
JOB ADDRESS 6180 Trinity Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
2
Sylvan Hills
Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Lester Larson 6180 Trinity Drive N.E. 571-7818
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Award Roofing 7801 Regent North
560-8849
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
8 DESCRIBE WORK
Reroof Dwelling
9 CHANGE OF USE FROM
TO
STIPULATIONS
Roof can be 2nd layer but not 3rd. I.nstall ridged
galvanized valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Asphalt
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
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1' 200
$� 60
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
OV SIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$ZO.SO
S R CTION OR THE PERFORMANCE OF CONSTRUCTION.
1
AN CHECK FEE
TOTAL FEE
$21.10
SIGNATURE ONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY LIDATED HIS IS YOUR PERMIT
v �
I
BLDG INSP
ppm
.2 6.° 1bs
I OAJE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW [ ] City of Fridley Effective 4/1/84
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: iQ1 t ® 1� (<\D \rtso'
Legal Description: -d
Owner Name & Address: CL l-A��� ° rtC�� ` Tel. #
Contractor:I�C�AQ� �c��� a Tel. #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Corner Lot [ ]
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Inside Lot [ ] Ft. Yd. Setback
Type of Construction: V ERcoF
Approx. Completion Date: 6 010 Le s
Proposed Driveway Width If New Opening Is Desired:
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setback
Estimated Cost: $ 2 0
Alt. A Alt B
$ $
See Back Page for Explanation
DATE: --fid APPLICANT: 42�0a , V Tel. ��0 At 1q
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
25% of Building Permit Fee
$•50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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 Valuation Fees
$1.00 to $500.00 $10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
$100,001.00 and up $433.00 for the first $100,000 plus $2.50 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 been constructed will be required before proceeding with the framing.
s . . .
SUBJECT
P �•-
City ®f Fridley
2077 0
AT THE TOP OF THE TWINS
BUILDING P RMIT
i
R CEIPT N0.
1 L'-___-_ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/19/91
JOB ADDRESS 6180 Trinity Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
2
Sylvan Hills Plat 2 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Larry/Barb Shuckhart 6180 Trinity Drive ME 572-2033
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 3F ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
I.nstall patio door and temporary step
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
�'.
STALLS GARAGES
VALUATION SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$500 $'50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$15.00 Fire SC $,50,
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
6 00
SIGN TUBE OF CONT ACTOR OR AUTHORIZED AGENT IOATEI
.ERLY A H YOUR ERMIT
l
7 %ATEI
DATE
SiGNATU OF OWNER OF OWNER BUILDER)
NEW [ ] Effective 1/1/91
ADEN [ ] R-1 AND R-2
AIM [� Building Permit Application
Construction Address: / %� v -s ® // 1-;72
Legal Description:
Owner Name & Address: Za rr u A�, A a.- ;1-8 3 3
Contractor: Tel. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
EESML=CJq OF Iran. n'
LIVIM AREA: Length Width Height Sq. Ft.
GRMM AREA: lezx;th Width Height Sq. Ft.
DBCR AREA: length Width Hgt/Gmund Sq. Ft.
Oma:
Corry Lot [ ] Inside lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ .5-® o , e- w
Approx. Completion Date: ,
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: 9 -7 / APPISCANT: Tel. # _577 A - ao 3 3
Permit Fee $ is C6
Fire Surcharge
$®
State Surcharge
SAC Charge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Charge $
TOTAL, $ too
CITY USE CHLY
Fee Schedule on Reverse Side
.001 x Permit valuation (1/10th �)
$.50/$1,000 valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by RVi neer; ng
Agreement Necessary [ ] Not Necessary [ ]
The Chief Building Official shall, before issuing permits for the erection of any
building or stricture, 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:
$1 to $500 $15 (MinfiM Fee is $15 plus surcharge)
$501 to $2,000 $15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additiona.1 $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPHUMCK EBtWW
(Concrete Cxrb 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.
Permits for construction will be issued a minimum of 24 hours frcm 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.
m
SUBJECT
P E R
City of Fridley
610
AT THE TOP OF THE TWINS
U I L I I \�
PERMIT
®
RECEIPT NO.
i COMMUNITY DEVELOPMENT DIV.
_
L PROTECTIVE INSPECTION SEC.
)aq
NUMBER
REV
GATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/14/94
JOB ADDRESS 6180 Trinity Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
2
1 Sylvan Hills Plat 2 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Larry Shuckhart 6180 Ttnity Drive NE572-2033
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
R
B DESCRIBE WORK
Construct a 41' x 18' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
RNI
BOOM dining t911 tbt
all 'atility lahlibm
-OD02
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$5,705
$3.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON.
$81.00
Fire SC $5.71.
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$89.71
S ATURE OF NT CTOR OR AUTHORIZED AGENT IDATEI
/-R
��
,p WHEN ALIDATED THIS IS YOUR PERMIT
y///J��jf�/f�'7/p
SIGN U E OWNERtIF OWNER BUIL -sc--IDATEI
$LW INSP GATE
NEW [ ] Effective 1/1/94
ADDN . [ ] CITY OF FRIDLEY
ALTER - [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name & Address: Tel. # 5'72L, -7-07'r
Contractor.MN LICENSE #
Address:
Tel. #
Attach. to this application, a Certificate of Survey of the
lot, with the.proposed construction drawn ori it to scale.
LIVING AREA: Length
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length �� • Width 1$ , Hgt/Ground 33 p Sq. Ft. dD
Comer Lot [ ] Inside Lot PC Ft. Yd Setback
Type of Construction:
Approx. Completion Date: Ser, t 9 L/
(Cost
Side Yard Setbacks
Driveway Curb Cut Width Needed: Ft. +610vt = Ft x = $
DATE: 6 - - g APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge,
SAC Charge_- $
License Surcharge $
Driveway Escrow $
Erosion Control $
Park Fee $
Sewer Main Charge $ _
TOTAL $
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
Tel. # $ 2 r Za TY
.001 of Permit Valuation (1 / 10th %)
$.50/$1,000 Valuation
$800 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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
$1 - ' to $500
$501 to* -$2,000
$2,001 to $25,000
$25;001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, -to and including $2,000.-. .
$45 for fust $2,000 plus $9 'for each additional $1;000
or fraction thereof, to and including $25,000
$252 for first $25,000 plus $6.50 for each additional $1;000
or fraction thereof, to. and including $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fiw:don thereof, to and including $100,000
$639.50 for first *$100,000 plus $3.50 for each additional -
$1,000 or fraction thereof, to and including $500,000
$2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$3539.50 for the first $1,000,000 plus $2 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 DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On August 1, 1995
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO, RATE TOTAL JOB
New Fixtures
Old Opening, New Fixture,
4 1 � 1� I'
4 '�
�
ii�
�
Blow Off Basin
®RIPTIS
Kim
Catch Basin
Rain Water Leader
9�
-�
ry ..?i
Q.
: Y�.�•["moi..
_4�.
Water Heater — Gas**
Gas Range**
Gas Dryer**
{) No
Type
ncu9h'�p��'%in�5�1I�51�
ISIMM
Y
��VY!5E
Rffil
. i
6
' !NyNx' ,I_4niF.i+i i::F
,,.,,� ...
s.•,� 1 �
„�,._:..ey ��3iii�ill.
�_
9.,
a
w i -EN, 1�m
_ -�
-I—
PLUMBING FIXTURE RATES: NO, RATE TOTAL JOB
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**
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 $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge .50
TOTAL FEE $ rJ�
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in stmt 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.
Owner
Building Used As k2n&
Estimated Cost 5 " Q ° PERMIT NO.
PLUMBING COMPANY
SIGNED BY TEL N0. 7,P3 l6 4
Approved By 1-946. Rough—In Date_ Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $2000
PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.
SUBJECT
PE
City of Fridley
_- 3 910 9
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV
I L PROTECTIVE INSPECTION SEC���
%
r
/'-'i CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
12/12/95
� �
JOB ADDRESS 6180 Trinity Drive NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
2
1 Sylvan Hills Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Larry/Barb Shuckhart 6180 Trinity Drive NE
572-2033
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Custom Remodelers Inc 8729 Central Ave NE Blaine MN.
55434 784-2646 1748
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
8 DESCRIBE WORK
Kitchen Remodel
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors as per UBC 310.0, adjacent to all sleeping
areas and on all levels of home.
SEPARATE P"P7RM8B 3 �� Q1 $'�
�e ttT1� �+ �R •'I �y°'p'
��gp
WIRING, c p ➢
Fop
�
Y YMh...ATl�
i
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
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
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
�+
State SC $1.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,000
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
P OVISIONS OF ANY OT ER STATE OR LOCAL LAW REGULATING CON-
Fire SIC $3.00
ST UCTION OR THE P R NC- F CONS TION
$74.75
Af/ / �
�//
PLAN CHECK FEE
TOTAL FEE
I�//
License SC
$5.00
$84.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPE VALIDATED THIS IS YOUR PERMIT
�fe✓_ A NLI �
- BLE INSP
��� / C ���I 'd
TgATE
_
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW []
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 9
Description Legal tion e ' ?
g P� Grp,
Effective 8/l/95
Owner Name & Address: - ligg / Tel. # — 3
Contractor: SLS Jv C-- MN LICENSE
Address:�J// �, Tel. #
Attach to this application, a Certificate of Survey of
lot, with the proposed construction drawn on it to scale.S y� Z/
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: )�'-4r I— -r-
Comer--r-
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction:
R_ee 6 aj- e e Estimated Cost: $
-3 eD -0
Approx. Completion Date: Z.2 1// r -S ci Z ce
(Cost on Back)
Driveway Curb Cut Width Needed:
F + 6 Ft = Ft x $
_ $
DATE:Z5-APPLICANT-.
G
Tel. # $ 9-2 / �
CITY USE ONLY
Permit Fee
$ '%
Fee Schedule on Reverse Side
>; �'v�'G� .0G 7J As'
Fire Surcharge
$ ➢
.001 of Permit Valuation (1/10th%)
616c -5xi, Cy - 41-4 lam,
State Surcharge
$
$.50/$1,000 Valuation
6� -76 1
SAC Charge
$
$850 per SAC Unit/
�,�,/�
License Surcharge
$ &
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
Park Fee
$
$
$450.00 Conservation Plan Review
Fee Detmnined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
s
STIPULATIONS:
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 fust $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 fust $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 fust $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 fimction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the fust $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 const uc ted
will be required before proceeding with the framing.
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 - FIII Out Back)
Gas Piping (Needed with new furnace)
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
Rate
$ 30,00
$10.00
$10,00
$10.00
$ 25.00
Effective On January 1, 1997
JOBADDRESS
The undersigned hereby makes application for a permit for the work herein
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
$ representations stated in this application are true and correct.
H- 2-9 9" ,199V
State Surcharge 50
BUILDING USED AS 1 r�c7
ESTIMATED COST PERMIT NO. /
DESCRIPTION OF FURNACE AND OR BURNER
No, of Heating Units Circle One (Steam) (Hot Water)arm Air
Trade Name_ f � d Size No,-// j
BTU HP EDR
Fuels J r4 , Total Connected Load
Burner Trade Name
$ ,�� BTU HP
TOTAL FEE ,
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
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.
Size No.
EDR .
ROYALTON HEATING & COOLING
HEATINGCOMPANY4120 - 85th AVEN« IF NQ '
BROOKLYN PARK, MN 55443
Signed By PHON5I-8333
'FrSTACK
'I -o a q- 3 3.3
Approved Byh-In Date Final Date
l
FILL OUT BACK SIVERIFICATION ON
REPLACEMENT FURNACE
cEnAEIqEY AND STACK VERIFICATION
The undersigned hereby verifies that the -existing chimney or stack:
1. Has been. carefiil y,.ex.axnined = Yes No
2. is free from nW or deterioration Yes(,-)" No
3. Has no foreign objects lodged within Yes O No
4. Is securely supported Yes No
5. Meets all current Code requirements for size
and total BTU's connected Yes ONo
6 Has total heating BTU's of -XW
All other BTU's -3 C-), JjQ0d
TOTAL BTU`s
7. Has a liner been provided. for water heater Yes lo No
8. Has combustion air been provided for water. heater Yes 0 No
Remarks:
List ALTERATIONS Being Done:
HEATING CO: ROYALTON HEATING &.COOLING
4120 - 85th AVENUE NO '
Signed By: MN 55443
Date: PHONE 424-83.33
HOUSE HEATING TEST RECORD
ADDRESS L AA APT. —FLOOR —CITY
1 OWNER
HEAT LOSS —DATE HTGANST.
SOLD BY
Electrical Work* By —
TYPE OF HEAT GA
—INSTALLED BY
Gas Line By
FA
,,—HW —STEAM —SPACE HTR.
GAS DESIGN
MAKE MAKE OF BURNER
Model
Model
Max. BTU Rating
Serial
INPUT 2N
"2L (2 MAKE OF FURNACE
CONTROLS
THERMOSTATd_) Heat Plug
Valve— 4 2 b'�_/
Limit J/ 11 xi", " i
Limit Setting
Fan Setting —--
Pilot Type r7 Tr f I
Pilot Make
Pilot Model -
Pilot Timing
L W r t nit
Model
UNIT HTR. —OTHER
CONVERSION
SUBURB
Vent Size
KIND OF LINER SIZE NONE
DraftHood Regulator
Filters Size —Nu r7 --
Chimney Location Inside -1,o' Outside
Chimney Construction � I o_.y , " ?"-Ij I I i,
Smoke Bomb ___Wiring
Or a I t (ax, (;-1 Test To 9
u Door Pressure Lighting Inst.
rPercent C AO-6—
Pressure :0 Date Tested
Input CFH ___z 0 Company Testing
'� I �) -Percent CO Name of Tester'
Stack Temp. J
Form 235
U!�
Building
PLUMBING
Permit No.: CCI G c i
Inspections
RESIDENTIAL APPLICATION
Received By:
o
763-572-3604Da'd
CITY OF FRIDLEY
J / 1
DATE YOUR En -MAI. ADDRESS
SITE ADDRESS L % fy �i t rn��I �d L✓ °� ��
THIS APPLICANT IS: o -OWNER ❑CONTRACTOR
PROPERTY
NAME: yr . 4. C e C
ADDRESS: Ific?<A r ►� CITY , e' - STATAA jIPS �7 Z
OWNER/
TENANT
PHONE: %�' ���' SO
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE ZIP
LICENSE WITH
PHONE FAX
APPLICATION
PERMIT TYPE
4 SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
ANEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK :ra CGT e r- 5,+�
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FEMRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS SHOWER _ WATER PIPING
_ _FLOOR _
BATHTUB GAS PIPING (NEED crrrrrcE,vsE) SWIMMING POOL WATER SOFTNER ($35)
_ _
CLOTHES WASHER KITCHEN SINK WATER CLOSET 5BACKFLOW PREV. ($15)
_ _ _
_ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
—DISHWASHER
WATER METER OTHER
P 1viT FI?7EI S,.ta 00x
W a. , slt 0Q"t111$S
SI&� 4.
7'4.
Permit Fee $ / $` .
. .,
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $. �
State Surcharge = $ .50
Total = $
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 repirr s and approval of plans.
-review
/ / l
SIGNATURE OF APPLICANT cS�-1� 1� PRINT NAMEN `'� � i C.e � DATE
�e.� .,
n •
li' P u �'•M '�Y^iD ,Y:, u�,-',+ ..�'Y.. ) '�..- M11..,Y,_ luY.,.r .) -. M Y7 y„4.,
Y
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
BUYidin�
$
BUILDING
Permit No.:
Inspections
$
RESIDENTIAL APPLICATION
Received_ By:
763-572-3604
$
CITY OF FRIDLEY
Date APR
763-502t-4977 FAX
$
Erosion Control
$
Park Fee
$
EFFECTIVE I-1-09
$
/ r
DATE 7 �� ��' YOUR E-MAIL ALPDRESS b r- fAC �
$ 5 �—
hh
SITE ADDRESS r : ✓� ' �! L1 r i ve A/�,
P
THIS APPLICANT IS:
1"WNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: B r La C - -/7"41 e C
ADDRESS: - e ( �- U 1, CITY T ✓ '' 0
STATEyZIP S �3 -
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: (y J0 c" �, t P �-
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS. & PORCHES SUBMIT:
❑ Vinyl
❑Soffit
1. Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EMS'1;ING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OEWINDOW 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 $ _ OCCUPANCY TYPE
Permit Fee
$
Plan Review
$
Fire Surcharge
$
Surcharge
$
License Surcharge
$
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$ 5 �—
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)
$2000 per C Unit (Plans to MWCC for determination) °
rE ft= �� ftx$22=$ 2512—
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks uavable to: City of Fridley Attach Stipulation
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 on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
s� 71d / 1 DATE
SIGNATURE OF APPLICANT �1'-c-c_.2._2 ��,�^,� _�� PRINT NAME �b'' :-t c v � � �
Page 2 - Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Oficial 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
$23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000
$23,50 for 1" $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000
$69.25 for 1" $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for 1' $25,000 plus $10.10 for each additional $1,000 or fraction,
to and including $50,000
$50,001 to $100,000
$643.75 for V $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for Ig $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000
$3,233.75 for the 1' $500,000 plus $4.75'for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up
$5,608.75 for the Ig $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977