PRE 2010 DOCSDate: ... �.,..... .. .........
Owner:
Address
City of Fridley, Minn.
BIUILDING PERMIT
Builder
Address........... ..... _............... ....... _.__.._....._..._.__...... ...... _... _..........................
L CATION !fBUILDING
6^
No. _ ._ Suet ........... _..- .._. Part of Lot ....._.......... __......_..... _............. ...
Lot ....._..... --- -------- Block ...._... .- Addition or Sub -Division+^ -
Corner Lot ..... _........-..._...._........ Inside Lot ....._..�............. Setback ...... .., ...._.._.... Sideyard ..... f �:m.. """�. `'=......_...........
SewerElevation....._.._........._............._....-•----..._......._...:_..........---........._.............. Foundation Elevation ................................... .............. .............. _..... ..........
DESCRIPTION OF BUILDING
Tobe Used a,gpr
. ...... Front -.. Depth d Height •-a, `....... Sd. Ft. p'� Cu. Fi��!�� .
-; �..... Front ....
Depth ..... Height sq. Ft. . i� '.. Cu. Ft.. ..
p g -
Type of :construction - _:.. Est CoS __........ 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. .................. _.._........._............._......._..
W_._....._..._..__.._..._._.._........ 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- 11and moving of buildings
within the city limits and this permit may be revoked at any time u on�vi tion of tiny of the provisions of said
ordinances. YQ
i
,.M:,,;i`4('__e.J ` 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.
4
"PF-
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Builder
Address
BUILD3XG
No. Street Port of Lot
Lot ock. :� Addition or Sub"Div. 1 N :S
Corner Lot Inside Lot! t Back s Side -Yard 0 2)
SEWS ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Q JL 1`j Ail % Lz? Front _ ,,. Di
Sq. Ft.`�� Cu. Ft. �A
Sq. Ft.
Cu. Ft, 0 6)
Type of Constructio
���� :y��, Estimated Cost 2,2
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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true andeoa t. r� e
?-c��x/.. b L�2
DATE SIGNATURE
(A Schedui of Fee costs can be found on the Reverse Side.)
���
®i
f� n. T
'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 buiiding,.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 elevators or for the erection of any fireproof
addition, for similar occupancy, to any existing building shall be at the
rate of $1.25 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�r
for each such building or addition. Ninety Cents for each one thouslnd
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.
2.5. For repairs or alterations to an existing structure, the fee shall be
at the rate of $3.00 for each Five Hundred Dollexs ($500.00), or fraction
thereof in the cost of all proposed work.
2.6. In nocaseshall the fee charged for any permit as set forth in
Sectipn2'be less than $4.00.
T
City of Fridley
Application for Plumbing and Gas Fitting Penidt
Dept. of Bldgs. Phone SII 4 -
DESCRIPTION OF WORK P�
Number, Kind and Location of Fixtures Locatio
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
y
x $1.50
$tJ
y,
Iii
�T{
$
�U'
0
�
F
N
WATER HTR.
GAS
ELEC.
3.25
?iV
a�
x 2.00
3�
onLL
New Ground Run Old Bldg . ............
ez
V
Q3
t�9d
a4
O
� RATE
!--0--
TOTAL
1st 3 Fixtures .......................
..
x $1.50
$
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
Base
x 2.00
$
X
1st
2nd
_
3rd
_
4th
• Future Connection Openings
Connected with Sewer
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x $1.50
$tJ
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ............................
3.25
$
Water Heater (Up to 200,000 BTU) ......
x 2.00
$
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
� RATE
!--0--
TOTAL
1st 3 Fixtures .......................
..
x $1.50
$
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $17 0 0
City of Fridley:
0 -
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and h eby declares that all the facts
and representations stated in this application ar7t ue anA correct.
Fridley,
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No Permit No.
t
Signe '+�
By a
Business Phone No _
ROUGH / ' 2- 7—
FINAL
.41�42 2M 7-39
19�
`^'x,-"°," �^p�rvcenp'i, ..�. ,.- R•.w'Rc ^i✓�0` x;Kyi�f'4P � i a'y� ".lgviv=.I- t + w4T'!"� s � ,:�`: v� r �, � ., �...-, t •'�mf ,;
":+" FY a �� z�'�p1'���� �Y � ���""`".``�-� � ;�,.✓` W �: n'".r_,p4� �i""ia rti',"`S'i',�;a '';;�t -u9p
SEDGWICK HEATING & AI'R' G'ONDITIONING CO. .. •HEAT-ING• ... JOB NO �
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (612) 881-9000 TEST RECORD
ADDRESS AZ ZI .1" (4 f. -I CITY Ix y
OCCUPANT OWNER �t
SOLD BY ocm/? INSTALLED BY—
MAKE MODEL
SERIAL NO. 7- 30&73 INPUT o
THERMOSTAT 4 " ����� VENT SIZE (, eve
VALVE WAX 5 TYPE OF LINER VIA g
LIMIT %ase Y eZ_ LINER SIZE
LIMIT SETTING FILTERS: SIZE NUMBER
FAN SETTINGS WIRING
PILOT TYPE 41L''rMm TEST TAG
IGNITION MODEL &Lqur
PILOT TIMING
PRESSURE 2,0 Id Cf PERCENT CO2
INPUT CFH PERCENT OZ
STACK TEMO 7 ✓ PERCENT CO
FORM. 236 (REV &4880 — l ®5
LIGHTING INST.
DATE TESTED
COMPANY TESTING 5<b (4Ayl)
NAME OF TESTER
FORM DISTRIBUTION: ITE COPY - JOB YELLOW COPY - CITY
1�
J f Application for Power Pk mts and Pleating. Cooling. Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
i
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ...........
each add. 60,000 BTU ......................
Replacement of Furnace ............................
Repairs & Alterations—up to $500.00 ................
Repairs & Alterations each add. $500.00 .............
STEAM or HOT WATER SYSTEM
RATE
TOTAL
8.00
$
5.00
$
5.00
$
2.50
$
8.00
$
2.00
$
5.00
$
5.00
$
2.50
$
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDA Hot Water ..................
2.50
$
OIL, BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TO
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
eAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE $ `
REMARKS:
Dept. of Bldgs. Phone SU 4-7470
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
owner
Kind of Building
Used as
To be completed about I/ NOV R 1 1960
Estimated Cost, $ E
-61F w ding Permit No. 6 �� 6
195-
195-
195—
HEATING - -M—.eat
, Warm Air—No'f�
Trade Name`4' `° > Size Qz.: `�
Capacity.
Sq. Ft. E.D.R 4, BTU H.P.
Total Connected Load
f
Fuel
BURNER — Trade Nam
J Size o g�
Capacity
Sq. Ft. E.D.R/)" '�� BTT�� '
GE®. SEDGW C1< EiTG. &
CQ
¢�
1001
1001 Xenia Av. S.
Minneapolis 16, Minn.
Signed 411 '
By
11 Posy IM -12-58
Business PhoNo
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips*
S.H.V.E, Construction No.
Guide
WindowsI —.
Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind
Yes—No Yes—No 19
/ FI.IL I ►1.t h s li Room l Length �? L. Width PA Height St", II A Room I Length
Windows and Doors—Crackage and Area
Width
f 1G{a{{a
Width Height No. of Lineal ft. Area
No. of pane of pane is
lights of crack sq. ft.
49 6
k
'
Infiltration
3
Coef.
Btu
Infiltration
Infiltration / ,3
Net exp. wall
Int. wall
311
3Y3 Q
Glass
Floor
Exp. wall (LY
Floor
Exp. wall "A,-
Ceiling
(�
Int. wall
Net exp. wall
Ceiling
y0i {7
i
Floor
Int. wall
Ceiling ;L
Ceiling (®�
(a
Floor
/(®
Floor ® PLS -C
/-* a -
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
L`I I . A Pi. d/ n - - - I t .t avr t.1 e 9 t r • I.
D {•i ` v�p t�P9�I� a\Wl{{ 1 LG{{�a{l A {Ya{{
Width
f 1G{a{{a
Windows and Doors--Crackage and Area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Z�13
Infiltration
3
Glass
Coef.1
Btu
Infiltration / ,3
Net exp. wall
Int. wall
Exp. wall
Net exp. wall
Glass
1
Floor
Exp. wall (LY
Floor
-
Net exp, wall
Ceiling
Int. wall
Floor
Ceiling
Floor
Total Btu. ; / ® 0
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I FIAK 1 _ Room I Length 14,4 Width / I/ Height 57
Windows and Doors—Crackage and Area
Width
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
3 40
Windows and Doors—Crackage and Area
Coef. Btu
Infiltration
3
Glass
6
Exp. wall
39
Net exp. wall
Int. wall
Exp. wall
Net exp. wall
Ceiling
1
Floor
l
Total Btu.
sq. ft. E.D.R. or sq. ins. W.A. Leader area
MINNEAPOLIS. MINN.
Insulation
How. Applied
Width f 3 Height
Windows and Doors—Crackage and Area
Width
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
3 40
Windows and Doors—Crackage and Area
Coef. Btu
Infiltration
Coef.
Glass
6
Exp. wall
39
Net exp. wall
Exp. wall
Net exp. wall
Int. wall
1
Ceiling:z, Z
l
Floor
Total Btu. I!o ��
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 FI.I *. '4 AA Room I Length // Width ` Height 9v
Windows and Doors—Crackage and Area
Width
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Coef.
Btu
Infiltration
Glass
39
0
Exp. wall
Net exp. wall
70
1
B
Int. wall
515
Ceiling
Floor
®�
Total 11tu. 1 3 0.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I Length
Width
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Coef.
Btu
Infiltration
T
Glass
515
Exp. wall
Net exp. wall
®�
Int. wall _
Ceiling ;L
L
(a
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 7—
City of Fridley, Mamn.. 'N9 9528
BUILDING PERMIT
Date: ...._
Oct 27, 1967
Owner: Willis Unke Builder Same
Address 1422 Trollhagen Address — Same
LOCATION OF BUILDING
No. —1422-- Street _ p7 lhag _ _ _ _ Part of Lot
Lot 2 Block 3 Addition or Sub -Division ._._.._. Tnnsbxtick 2nd
Corner Lot Inside Lot Setback _ _ Sideyard —
Sewer Elevation —_ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garden House Front 12' Depth 51 Height 81
Sq. FL 60 Cu. Ft. 480
Front Depth _ Height Sq. Ft. — Cu. Ft.
Type of Construction Frame Est. CostTo 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 q� forth and in compliance ,with%�all provisions of
ordinances of the city of Fridley. C-9-dil .y, ,?
In consideration of the payment of a fee of $- OMEM permit is hereby granted to...._.. Willis Unke
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
CLARENCE BELISLE
Building Inspector
NOTICE.
This permit does not cover the construction, installation for wiring, Plumbing, ear heating, sewer or water. Be saga to no
the Building Inspector for separate permits for them Mems.
j
APPLICATION FOR BUILDING PERMIT
CITY OF FRA -:.EY, MINNESOTA A-cOWNER'S NAM�' G BUILDER
ADDRESS '� Z A0DRE�/
1 LOCATION OF BUILDIM
N0. / ,
STREET J�c) / i. 1 ; .SRT or LO � ' ...
LOT BLOCK ADDITION OR SUBDIVISIONr JLU,�1r(%el'[. ��(P
fir, ...r.l, rlw..�p.r
CORME& LOT,,.,, INSIDE LOT SETBACK SETBACK SID&YARD
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates.of Survey of Lot aud,proposed
building location drawl -on these Certificates.`
DESCRIPTIt3�T OF BUiLD]ENG
�.
To Be Used Ari
(3rM)Dr-JAJ v u, ,C Frnnt .12, De®th Heiaht
Front Depth height:
Sq, Ft. Cu. Ft.
Type of Construction n }'Q�i ,",,,,Estimated Cost
To Be
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 aAd correct.
GMIM�
(Schedule of Fee Costs can be found an the Reverse Side).
C
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATIO14 AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 1414 A / / �_
RATE SCHEDULE
U
The indersigned hereby makes application for a permit for the work
Residential
Ride
TOTAL
here,n specified agreeing to do all work in strict accordance with the
Furnace Shell and Duct Work, Burner -
city codes and ruling of the Building Division, and hereby declares
Also Replacement Furnace
$20.)0
$
that all the facts and representations stated In this application are
,,
true and correct. �� ��'��� ,1991
Gas Piping (Niaeded with new furnace)
$10.00
$ Le
OWNER.���
Gas Range
$10.00
$
BUILDING USED AS
Gas Dryer
$10.00
$
ESTIMATED COST 4-175 � PERMIT NO.
'Air Conditioning - All Sizes $10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
CommerciaUlndustrial
1 % of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE $ 10. &)
MINIMUM FEE FOR ANY HEATING/COOLINGIVENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Un' s Circle One (Steam) (Hot Water (Warm Air
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name.® Size No. 101-0
BTU HP EDR
HEATING COMPANY HEATING & AIS Co.
8910 i v e��� �c.. J.
MINNEAPOLIS, hIN 55NLO
Signed By Bat VNo.
Approved By (TJ Rough -In Date Final Date� -CI
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
h
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's connected Yes ( ) No ( )
6. Has total ileatia BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
Building
PLUM13ING
Permit No.: `C � �
Inspections
RESIDENTIAL APPLICATION
-Received BIS
763-5723644
CITY OF FRIDLEY
JDate Rec'd: -,
DATE May 19, 2006 YOUR E-MAIL ADDRESS wnelgon a larsonplumbing.com
sITEADDRESs_ 1422 Trollhagen Drive
_
THIS APPLICANT IS: E] OWNER INCONTRACTOR
PROPERTY
NAME: Willis Unke
ADDRESS: 1422 Trollhagen Drive CITY Fridley sTATEMNzIP55421
OWNER/
TENANT
PHONE: 7-QMZ1-4265
CONTRACTOR
NAME: Larson Plumbinq, Inc.
STATE LICENSE w 3341 PM EXP DATE 12/31/2006
SUBMIT A COPY OF
YOUR STATE
ADDRESS: 3095 -162nd Lane NW CITY Andover sTATEMN zip 55304
LICENSE WITH
PHoNE 763/427-7680 FAX 763/427-9448_ - --
APPLICATION
PERMIT TYPE
M SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
O NEW 0 REPLACEMENT
DETAILED DESCRIPTION OF WORK Water Heater Replacement
PER MS 16B.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 $540, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINKILAV DRAINS —SHOWER _ WATER PIPING
_ —FLOOR
GAS PIPING aaw cm.ucrosz) _ SWIMMING POOL WATER SOFCNER (S35)
`BACKFLOW
—BATHTUB
CLOTHES WASHER —_ KITCHEN SINK _ WATER CLOSET __ PREY. ($15)
_
DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER —OTHER
'"IS •.
:..... _ . • . M::,..g� ....:.:� : ;� .
lEG :{O�t,.. •
..f4' ,"F�^�"i � ::%•�,':3<,:•]Tl; •'C.'.4J.> ~"^5'Y9d. of nuc)'• v y)
>r>:� •s:.r . I; FOit PR(J7El✓ I S>OER ` 500
Permit Fee . $ 5 .00
Number of fixtures @ $10.00 x $10.00 = $
Surehar •e .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $3f.00 x $35.00 = $
TOTAL DUE 35 .50
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 c o I] work wh' xequires eview and approval of plans.
SIGNATURE OF APPLICA PR1NT NAME Michael Malonski DATE 5/19/2006
tt�� [f r.+... •rT
.::':.
�. ��y.:.MT ��. '.il~
...,:...'y� :.J�a... �.3,'. �.. �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
Inspections
763-572-3604
DATE o!J.!Q_
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
' . . 'Received
-
-- -- -
❑ OWNER
ADDRESS: �® CITY
PHONE:
NAME:
STATE LICENSE #
ADDRESS:
PHONE
❑ SINGLE FAMILY/NEI
❑ ADDITION
❑ BASEMENT FINISH
❑ DECK
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #20130983
651-264-4777
❑ GARAGE/SHED
❑ ROOF
❑ SIDING
❑ SWIMMING POI
❑ ADDITION
❑ REMODELING
'ATE ZIP
t STATE ZIP.
❑ DRAIN TILE
❑ OTHER
DESCRIBE WORK BEING DONE: S,
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT So- Ft.
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
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 sttuctur
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
'WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
THE 1"TOTAL JOB VALUATION $ (USINQ Q dill ? U.B.0 FEE 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
e
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attac
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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an applicati for a permit and work is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work ich requ' review and approval of plans.
SIGNATURE OF APPLICANT I PRINT NAME �a(CL&W56YN DATE