PRE 2010 DOCS6'
i BUILDING PERMff
N9— a_ 2 0 0 4
Village of, Fridley,Mi�n>n.
i
.....!
Date
..d. ......
Builder k• "�
Owner .
.. ... .
ull .
Address ........................................
Address ....: ..
OF BUILDING
No.. °+?
_LOCATION
Street - ....... Part of Lot
Lot .,;
Block. . i ......... Addition or Sub -Division .. .... .. .
Corner Lot .......
Inside Lot e ....... Setback .,jijSideyard . -I . A ............
DESCRIPTION OF BUILDING
To Used/ as:
jjbe
all c :tI
Front ► . Depth . , ' f . Height Sq. Ft... .. Cu. Ft........ .
........... s. ....i!
Front ........ Depth ........ Height ......... Sq. Ft....:, ... Cu. Ft........ .
Type of Construction
dos
. .. Est. Cost ...... To be Completed.
r
J!
II
In consideratio
f
of the issuance to me of a permit to construct the building ,described above, I agree to do
the proposed work I
ordinances of the village
accordance with the description above set forth and in compliance with all provisions of
of Fridley.
xmideration
of the payment of a fee of $. "'. permit is hereby granted to ..° .. ... .. !.......
�. to construct the building or addition as described above. This permit is granted upon
......
the express . conditio
.... .
that the person to whom it is granted and his agents,,'ernployees 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
in the village limits
location, construction, alteration, maintenance, repair and' moving of buildings with-
and this permit may be revoked at any time upon violation f. any of the provisions of said
ordinances.
.wilding. Inspector
NOTICE:
This permit
does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water.
Oe sure to see the Building Inspector for separate permits for these items.
l
6'
City of Fridley, Minn.
BUILDING PERMIT
Ne 496'7,
Date:
Owner: - Builder .------ ............._...... _.._. ....... _._...............
__...._..
Address -.". _. _ Address'',' ,�.•-._..... _..........................
....
CATI 4 OF %� DING
No...... Stree _� _.... ':�- _.�!.... l I_..... Part of t ._._......._. _.
.' _ -
Lot ...... ............:...._. .:., Block ..... ........ ..... ............. Addition or Sub -Division .. "- ._ ".... ....... .
Corner Lot .................................... Inside Lot ....._..I '":............ Setback ... _....------... eyard ....._... ...-..................... _... ............... ......
Sewer Elevation_-----_---......_---_---•----_...................... ..... .............. _....................... Foundation Elevation
DESCRIPTION OF BUILDING
To be . s as:
...
Front ......: Depth ..."...--_-- Height ...._.... Sq. Ft. Cu. Ft.
.... ............ ..._..........._....................... Front ........... ............. Depth .................H ht ....._ � Sq. Ft. ................... ... Cu. Ft. ..... _.................
OK
Type of Construction ..�- Est. Cost..y,�i�.-•- ................ 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. ,
In consideration of the payment of a fee of $......., permit is hereby granted to. ... _............................ _.......... ........... ...
_.__._._.......... ..._ ...... ............ ............. to construct the building or addition as described above. This permit is granted upon
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 urn vio)ation,o� aAy of the provisions of said
ordinances. ,,�' ,) ; /,) �.AA
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.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners. Name . OeZ/ 4 D Le C 4�IAII Buil der 17 4 All /-
Address Le.°r._...r�l�>>. r.■ , ..p,P- , ,Address ,_.,......_.._..,,. �.r -
LOCATION OF BUILDING
No. "O a street i">f'i�y_� ,bAi VI -F Part of Lot
Lot Block. Addition or Sub.Div
Corner Lot___r__Inside Lot_ t Back Side -Yard
SFS. ELEVATION FOUNDATION ELEVATION __
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BU31DIKG
To be used 8
Front -� Depth V y Height. _
Sq. Ft. s,� Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
To be
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all.vork in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and correct.
DATE
(A Schedule of Fee costs can be found on the Reverse Side.i
BUILDING PERMIT FEE'SCHEDULE
Section 2. The Inspector of Buildings shall, before issuing any permit
for the erection of any building or structure, or for any addition to
any existing building or structure, or for any alterations or repairs
to.any existing building or.structure,.upon application therefor, 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:
2.1.For any such permit for the erection of any fire -proof building,.other
than a garage, warehouse, factory or grain elevator, or for the erection of
any fireproof addition, for similar occupancy, to any existing building
shall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2. For any such permit for the erection of any fireproof garage, ware-
house, factory or grain elevator; or for the erection of any fireproof
addition for similar occupancy, to any existing building shall be at -the
rate of J1..25 for each one thousand cubic feet, classified as "fireproof"
by Section 502 of the Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any non -fireproof building
other than a garage, warehouse, factory or grain,elevator, or any non -
fireproof addition, for similar occupancy, to any existing building.
Permit $1..00 for each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non -
fireproof addition, for similar occupancy, to any existing building or
for each such building or addition. Ninety Cents for each one thousand
cubic feet or fraction thereof, in the cubical contents thereof with a
minimum of $4.00.
For the purpose of computing fees for building permits the cubical contents
of any building or addition to a uniform height throughout by multiplying
the ground area covered from a point six.(6) inches below the floor line of
the basement or cellar to the average height of the upper surface or to the
average height of the roof surface of the main gable of a pitched roof.
a
2.5. For repairs'or alterations to an existing structure, the fee shall be
at the rate of $3.00 for each Five Hundred Dollar', ($500.00), or fraction
thereof in the cost of all proposed work.
2.6. In no- -case shall the fee charged for any permit as set forth in
=a 2" b
Sectie less than $4.00.
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
v �p�1
Job Address & 2� Le e-- /� Oct
Furnace Shell & Duct Work
$12.00
$
Replacement of Furnace
7.00
$
Repairs & Alterations -up to $500.00
7.00
$
Department of Buildings
Repairs & Alterations each add. $500.00
4.00
$
City of FridleyTel.
#571-3450
MECHANICAL WARM AIR:
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$
specified agreeing to do all work in strict accordance with the City Cbdes.:.
each add. 50,000 BTU
4.00
$
and rulings of the Department of Buildings, and hereby declares that all the
Replacement of Furnace
7.00
$
facts and representations stated in this application are true and correct.
Repairs & Alterations -up to $500.00
7.00
$
oc
Repairs & Alterations each add. $500.00
4.00
$
Fridley, Minn.
-1?- 101 c-- A, A t4
STEAM OR HOT WATER SYSTEM:
OWNER
Boiler & Lines up to 100,000 BTU
$12.00
$
KIND OF BUILDING
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
USED AS �4 �_ I l✓1
each addn. 50,000 BTU
6.00
$
TO BE COMPLETED ABOUT < 7
OIL BURNER- to 3 gal. per hour
$10.00
$0
each add. 3 gal. per hour
10.00
$
ESTIMATED COST / 3 5,
GAS BURNER- from 100,000 BTU to 199,999 BTU
$10.00
$ G
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
(over 199,999 BTU see Fee Schedule)
$
GAS FITTING FEES:
lst 3 Fixtures x
$ 3.00
$ CI®
DESCRIPTION OF FURNACE/BURNER
Additional Fixtures x
$ 1.00
$10.00
$
$
Gas Range to 199,000 BTU x
BEATING or POWER PLANTS, Steam, ,Hot Water Warns Air- No.
AIR CONDITIONINGcoFAN
$ ®e
Trade Name ���ca1"� Size No.
HEATING SYSTEMS see Fee Schedule
$
VENTILATING SYSTEMS
$
HP
Capacity Sq. Ft. EDR HP
ALTERATIONS $ REPAIRS
_BTU
State Surcharge
$ .50
Total Connected Load 54 Kind of Fuel
TOTAL FEE
$30.1
BURNER - Trade Name Size No.
ROUGH INSP. REINSPECTION FEE
Capacity Sq. Ft. EDR BTU HP
Date ($10.00)
FINAL INSP.
Company GTO VhG -� 4 ) 4
C. cl ` A e
A0.
Date
SignedBy
Fe"( -41-1-5, C r�C � ®
APPROVAL FOR PERMIT d ��
„ .
30/000 13p U Tel. No.
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50
PLUS $.50
STATE SURCHARGE
,; L.
2co,
Height •
of pane
Width Height No. of
Na of pane of pane ingjhta '
Llnoal ft.
of emels
Area
sp. ft.
ft -,A Ile •'
MT CAMUMNS
DEPARTMENT OF INSPECTION
WeIIt�C r�trflpS
A.S.. V.
g�.11,
L
C®n8tr@It tfloQ1 Eq®.
�6£i891 it1C�➢8
Windows
Doors
Reference
Out. Wall
tot. Won Ceiling
Roof
Floor
Kind How Applied
ea- n
Yes— 0
19_.._
Z
Enp. wall
Clams �
,
E ap. Wall
Net ezp. Wall
Int. wall
ceiling
r-loor
. Net enp. wall
Int. shall
Ceiling
Floor
Room B�ttgth
`�tidtla
mol�ht
F1.1 Room ngt11 4ltdtlt Height
Windows and Doors—Crachage and Area
Windows and Doore—Crachace and Area
Width Height No. of
No. or pane of pane lighto
Lineal tt.
of craelt
Area
ep. et.
Width
No. of pans
Height
of pano
No. of
lights
Lineal rt
or crack
Area
eq. ft.
2-
'q"
S0
20 1.
3o
/V
15-4
/0
Coe $
Btu
Coef. , BtuInfltration
_Class
"�
�®
e 0
1
Clasp
Fzp. small
F6 ?-
Viet a p. Wall
ntb
S 3 �
>t1
Ceil'ir►� � � �
Floor
Required sq., £t. E.D.R. or sq. ins. W.A. Raider area
a F1.1 T Room Len mh / Width 21 Rei-ght `)
�JindoWs °and boors--Cradmae and Area
Width
of pane
Height •
of pane
Width Height No. of
Na of pane of pane ingjhta '
Llnoal ft.
of emels
Area
sp. ft.
b
COSY.
BW
Itni�ltrIIt10
G18as
2
�®
Z
Enp. wall
Clams �
,
E ap. Wall
Net ezp. Wall
Int. wall
ceiling
r-loor
. Net enp. wall
Int. shall
Ceiling
Floor
Total Btu.
Required sq. it. E.D.R. or sat. ins. W.A. Lwder area
– rt.l. Koom ILength Width
_ Windows and Doors- Craelaage rind Area
Width Holgnt No. oe Lineal ft, Area
No: of pane_ _ot pane iegneo o[ oracn ea. «.
a
W ,t6ltratiom
�aJIIas
Xp. small r
t ?et exp. wall
i'It. Wallr4 eiling
I loor
"`otal Btu.
equired aq. ft. E.D.R. or sq. inn. W.A. Leo&r area
m
Eup. small
Net eEp. wall ;
lat. wall
Ceiling
Floor
Tt okml Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Lmder area
FI.I Room I Length Width �deeaid
Windows and Doors--Craeka,rre nnA A a
No.
Width
of pane
Height •
of pane
No. of
1113hto
Lineal it.
of crack
Area
M. ft. a
b
to
IInf�lteaQion
Clams �
,
E ap. Wall
. Net enp. wall
Int. shall
Ceiling
Floor
I ota! ltatu.
Required eq. ft. ED.R. or sq. ins. W.A. Leader area
FI. Roost I Length Width
- Windows and Doors--Crachaaeee and Area
eal&'3Ysa
Exp. wan
Net crap. scall
Int. Wan
Ceiling
Floor
Total Btu.
I lmuired sq. ft. Q.D.R. or sq. ices. WJL Ua &r aura
Btu
HOUSE` HEATING TEST RECORD
ADDRESS aaCSi-w e A AY_ APT. FLOOR
OCCUPANT Le- /f OWNER
HEAT LOSS DATE HT��INST. J
SOLD BY > ® j� INSTALLED BY —
Electrical Work By Gas Line By
TYPE OF HEAT GA FA L HW STEAM SPACE HTR.
Pilot Model _
Pilot Timing
Model
CITY SUBURB
!d
l,00
UNIT HTR. OTHER
CONVERSION
�d
Veno Size
KIND OF LINER 7' ��zzA® SIZE sly NONE
Draft Hood J? ®-- Regularor
Filters Size umber
Chimney Location Inside Outside
Chimney Construction 7�'b
Smoke Bomb
Draft
Wiring —
.Test Tag
L.W. Cut Off a C 11 Door Pressure Lighting Inst.
Pressure /�C Percent COa Date Tested
Input CFH d 0 `S Percent 02 Company Testing
Stack Temp. -3 C- Percent CO Name of Tester r 1
Form 235
GAS DESIGN
THERMOSTAT
MAKE
T;CCel—s-
MAKE OF BURNER_
Model
16 9 401
Model
Serial
Fan Setting
Max. BTU Rating —
INPUT
_
�� e)
MAKE OF FURNACE
Pilot Model _
Pilot Timing
Model
CITY SUBURB
!d
l,00
UNIT HTR. OTHER
CONVERSION
�d
Veno Size
KIND OF LINER 7' ��zzA® SIZE sly NONE
Draft Hood J? ®-- Regularor
Filters Size umber
Chimney Location Inside Outside
Chimney Construction 7�'b
Smoke Bomb
Draft
Wiring —
.Test Tag
L.W. Cut Off a C 11 Door Pressure Lighting Inst.
Pressure /�C Percent COa Date Tested
Input CFH d 0 `S Percent 02 Company Testing
Stack Temp. -3 C- Percent CO Name of Tester r 1
Form 235
CONTROLS
d
THERMOSTAT
Heat Plug y
Valve
o Imo' i
Limit
Limit Setting
Fan Setting
100
Pilot Type
Pilot Make
Pilot Model _
Pilot Timing
Model
CITY SUBURB
!d
l,00
UNIT HTR. OTHER
CONVERSION
�d
Veno Size
KIND OF LINER 7' ��zzA® SIZE sly NONE
Draft Hood J? ®-- Regularor
Filters Size umber
Chimney Location Inside Outside
Chimney Construction 7�'b
Smoke Bomb
Draft
Wiring —
.Test Tag
L.W. Cut Off a C 11 Door Pressure Lighting Inst.
Pressure /�C Percent COa Date Tested
Input CFH d 0 `S Percent 02 Company Testing
Stack Temp. -3 C- Percent CO Name of Tester r 1
Form 235
FA
SUBJECTIT
N
City of Fridley
30532
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT O
V
PROTECTIVE INSPECTION SEC..
A�
r � �
L ��"',•� CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
_--_
L J` 612-571-3450
910-F15
11/19/99
JOB ADDRESS 6200 Trinity Dr. NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
3
1 Sylvan Hills Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Terry Breza
508-0180
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION Nx REPAIR 0 MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (21 S Tear-off
9 CHANGEOFUSEFROM 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 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 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
$1835
$.92
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
$66,20
Fite SC $1.84
PLAN CHECK FEE
T AL FEE
68.96
SIGNATREOFCON'RACTORORAUTHORIZED AGENT IDATEI
10
W N P
LOG INSO
Y VALI A THIS ISYQU9���
MATE
SU NATURE OF NERiIFOWNERS LDERI IDATEI
FA
NEW[ ] Effective 5/10/99
ADDN [) CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
e
Construction Address: �[� C) j Yi) I
Legal Description:
Owner Name & Address: Tel. # 0
Contractor: e) MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length /Width Hgt/Ground Sq. Ft.
OTHER: Aje /� rY� c Q 611 Al- e is % C'r_
Construction Type:
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE:,Z-22— APPLICANT: Tel. #
Permit Fee
Fire Surcharge
$ c9�/
State Surcharge
$ 90?
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
���M-W-OM
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 PERNIIT 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
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 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 $15.50.
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 $23.25.
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.