PRE 2010 DOCSCity of Fridley, Minn. No 10074
BUILDING PERMIT
Date: Jan. 7, 196_
Rodney Billman Inc.
Builder Same
Address 151 Silver Lake Road Address Same
New Brighton, Minnesota 55112 Same
LOCATION OF BUILDING
__ Trollhagen Drive
No. 1546 Street part of Lot
Lot 7 Block 4 Addition or Sub -Division ____Innsbruck 5th Adda .
Corner Lot Inside Lot — x Setback 40' . Sideyard 10' 14'
Sewer Elevation 978.54 _ 981.54
Top of Footing
To be Used as:
Dwelling Front 63' Depth26'-26'Height Sq. Ft. 1700 Ft. 34,000
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost_ $2 6 000 To be Completed
Sewer Location 7' West of Manhole
Water Location 3' East of Manhole
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.
$100.00 Sewer Connection Charge
In consideration of the payment of a fee of $--4:6 . 00 , permit is hereby granted to Rodney Billman. 9
Inc. 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
ordinance=s
Clarence Belisle
NOTICE:
'This permit don not cover the construction, installation for wiring, phmahing, gas heating, sewer or wafer. Be anus to we
the Building hu pector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNEFz PS NAME BUILDER
ADDRESS ADDRESS
�/
LOCATION OF BUILDING
NO o "�';d' �fl. STREET
LOT BLOCKADDITSON OR SUBDI S10"
CORMS LOT INSIDE LOT ✓ SETBACK SIDEYARD /m
SEWER ELEVATION 9 74'. 2;_ TOP OF FOOTING 9V . -:S-
Applicant attach to this fori. Two Ce`�tificates of Survey of Lot and
proposed building location dralvm on these Certificates.
DESCR..PTION OF BUILDING
To Be Used As:
Front 63 Depth Z Height.�-1
gquare feet 9 Cubic Feet a
Front Depth Height
Square beet Cubic Feet
Type of Construction Estimated Co zy �'
To Be Completed
The undersigned hereby makes application for a permit for the Mork
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 andpresentations tate in
this application are true and correct.
DATE7:;:)-, 2 7 / t&/ / SIGNATURE
(Schedule of Fee Costs can be found on the Re rse Side��
y
SCK �6N$3
Q
NO. RATE TOTAL
fS�
SF
x $2.00
$ 2 6' -
Future
Future Fixture Opening
Y
o
r Q
f?
tea
Z
Catch Basin
.'ten
�
•
I
s
N
WATER HTR.
GAS
EEG
Base
Electric Water Heater
x $2.00
$
GAB FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..... .......
x $2.00
$
Additional Fixtures ..... ..............
x $ .75
$
Gas Range to 195,000 BTU ...............
x $5.00
$.
lot
2nd
3rd
4th _
° Future Connection Openings Connected with
Nen F1 , OldOpenb4pI SewLeer E]Y ❑
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures
x $2.00
$ 2 6' -
Future
Future Fixture Opening
> x $1.50
New Fixture Old Opening
x $1.50
$
Catch Basin
x $3.25
$
Water Heater (Up to 99,000 BTU) ....
' x $3.00
$ s�, 0
New Ground Run Old Bldg.
x $3.25
$
Electric Water Heater
x $2.00
$
GAB FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..... .......
x $2.00
$
Additional Fixtures ..... ..............
x $ .75
$
Gas Range to 195,000 BTU ...............
x $5.00
$.
AIRS & ALTERATIONS—Roses to Cods
Description ......... ........................ .............fit
TOTAL FM $zi
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct
Fridley, Minn-- 19—
Owner
Kind of Building
Used as
To be completed about
L
Estimated Cost, $
Old w: Building Permit No—C ® 0 7.`l _Permit No. //,ff3 7
Signed
By --
Business
Business Phone No–
ROUGH
o
ROUGH
Original
PERMIT for Power Plants and Heating. Cool-
ing. Ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of 1 Heating Planto be 6 Alle
Make ,Size 7,j 1-64 ;
Oil fared ; Coal fired ; Gas fired_' ; Gas Authorization No.
Approved
Final Inspection
19_
Inspector
Permit N° 4 391
Fee
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. _'j , 19%7
Owner &�� /L�J
Location L
Kind of Building- N
How Occupied
Work to be Commenced—,19—
To
ommenced ,19_
To be Completed ,19_
Estimated Cost, $ 57v • &6
Old -New, Building Permit No. 1 O., 0 7
Permission is hereby granted to CL4"� 6-'`'d ° to install—erect—use the material and devices described in the
above statement. This permit is granted up6n the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifica'pons set forth in the approved application for this
permit on file in the office of the Inspector of Buildings. f
✓� Z- , Inspector of Buildings
42 2M 1147 d
N? 4837
original PermitPLUMBING R'i FING 14 4(.f46
Permit
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Per Per
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., Fee
DESCRIPTION OF WORK II
Number, Kind and Location of Fixtures
Stories
K W
'�
d°
U
6
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rc
7
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e M
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It ❑
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3
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-+
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e
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WATER HTR.
CRAB
ELEC.
Basement
1
1st
'�
2nd
3rd
4th
Connected with Sewer -Cesspool Gas Piping for Openings
Permission is hereby granted 9�- /V - to do the plumbing and
gas fitting in the building described in the statement kereto attached, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection Date
Inspector.
City of Fridley .70
Owner
Location
Find of Building 4'1114�
e
Used as
To be Completed/ ,19_(� q
Estimated Cost $
Old -New. Building Permit No., i c) 074
Date
Inspector of Buildings.
lflla
Application for Power Plants and Healing. Cooling. Ventilation. Refrigeration and/
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......................... $10.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 6.00 $
Repairs & Alterations each add. $500.00 ............... 3.00 $
MECIL WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $
each add. 60,000 BTU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam ... .................. 3.00 $
Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $
OIL BURNER—to 3 gal. per hour 6.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) ....................... 5.00 $�
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures x$ 2.00 $ �°
Additional Fixtures ................. x .75 $
Gas Range to 199,000 x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
$
TOTAL FEE
Dept. of Bldgs. Phone 560-3450
Location ` ��,kJ
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.
Fridley, 112inn 19 _
OwnerQ-0 a,
Kind of Building''
Used as d� aM
To be completed about
Estimated Cost, $ 6
Old—New. Building Permit No. 1 0 ( b '1 �--Permit No. o 91
DESCRIPTION OF WORN
HEATING or POWER PLANTS–Steam, Hot Water, Warm Air—No
Trade Name i A'W cpc Size No- '��'j
Capacity Sq. Ft. E.D.R gQ BTU 9
Total Connected Load �� �51-1 b Kind of Fuel
BURNER — Trade NamSize No
Capacity Sq. Ft. E.D.R BTU H.P.
Signe.
By �S9�ir�L
<z Business
(REMARKS -OYER)
Ciity, of Fridley, Minn.. 11:34
6431 University Ave. N. E., Minneapolis, Minn. 55J2
1..
owner: D. R. No 1 i ng _ Builder Same
Address .1, _.T ollhagen Drive N.E. Address Same
No. 154.6 — Street —Troll agen Dxive N.E. Part of Lot
Lot __. _ Block Addition. or Sub -Division b r. u - 5th Add11tz ien
Corner Lot bmide Lot — X Setback — Sideyard
Sewer Elevation
To be Used as:
Foundation Elevation
Panel Basement __ Front __ Depth r Height __ Sq. Ft. Cu. Ft.
.__ Front — Depth Height Sq. Ft. Cu. Ft.
Type of Construction neling Est. Cost CC , 00_ To be Completed 6 months
Stipulation: Call for rough in inspection prior to covering walls.
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 $ 5. nn , permit is hereby granted to A• R. Holl n _ gr
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
vgithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said
ordinances.
� 7�siiding; 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 RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: 'D. `L W PLL_ ) N 6 EP- BUILDER: S4M C -
ADDRESS: J�'�fl �iLL1a�1�F1� OGL_ /Ii.E.ADDRESS:
NO:. I S�Zt6 STREET: %-� LC� L+i% ��,'V D R _ 1J,6 -
LOT
J,C.
LOT: 7 BLOCK: 4 ADDITION:77
�NNS�B �it'G�CK 5 T�
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
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:
PAIJE Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: PA )-)C- L) A/h Estimated Cost: $ 5
4
To Be Completed: '6 &A- %S
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: 2- %/77 L SIGNATURE:—L
(See Reverse Side For Additional Information.)
t
BUILDING PERMIT FEI SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below sett forth and in
the manner herein provided to -wit:
UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
City ®f Fridley
1 z AT TNR TOP OF TH9 TMIINi
rti-------. GotrauNlTY oeVELO'MBNT 01V,
1 i PROTECTIVR Neftcyom K",
-...1` r.. CITY HALL FRi0b96V $$0&
Job Address
Contractor
Kind of Building
on Date
10--__
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J
W
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PLUMBING, PERMIT APPLICATION
,r
0
0 2115/73 1 1 1 800
'Address Phone
.5
A cess Phone
Use
.stimate nG 1
Plumbing Fixture Rates:
NO.
RATE TOTAL
!�
! Number Fixtures
x
$2.00 $
Future Fixtures
x
$1.50
New Fixture -Old Open.
i
x
$1.50
Catch Basin
t
x
$3.25
Water Heater -99,000 BTU
�i
x
$3.00
Ground Run Old Bldg.
x$3.25
Elec. Water Heater
r
x
$2.00
Gas Fitting Fees:
1st 3 Fixtures
x $2.00
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
See
Description: Code
State Surcharge .50
TOTAL FEE $
!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 declare that
all'the facts and representations stated in this I
application are true and correct,
® GAS DESI CONVERSION
MAKE `kms 0 f MAKE OF BURNER
Model 4a a E) — d® —'3 Made].
Serial 5,$i , Max. BTU Rating
INPUT 44-14 MAKE OF FURNACE
Model
THERMOSTAT
Volvo
Limit
Limit Setting _
Fan Setting —
Pilot Type
Pilot Make —.
Pilot Model —
Pilot Timing _
L.W. Cut Off _
CONTROLS
WOeat Plug Vent Size
KIND OF LINE SIZE NONE
Draft Hood latr Regulator
0 _ Filters Si:e �0ri�_Number
e-, Chimney Location Inside � Outside
I Chimney Construction
i1
Pressure -__a, w �- Percent COZ —
Input CFH_. fo ® Percent 0�
Stock Temp. Percent CO
Smoke Bomb 1�f Wiring
Draft Test Too
Door Pressure Lighting lqst.
Date Tested _ ~�
Company Testing I
Nome of Tester `!
HOUSE HEATING TEST RECORD
�e v l /Aa
C
ri
ADDRESS
t '
APT. FLOOR CITY
UflURB
OCCUPANT
i
OWNER
HEAT LOSS
DATE HTIG. INSil
SOLD BY
�
4 INSTALLED BY
e c,..
Electrical Work By
°��
Gas Line By
°1 tl
TYPE OF HEAT
GA FA HW
STEAM --- SPACE HTR. UNIT HTR.
OTHER
® GAS DESI CONVERSION
MAKE `kms 0 f MAKE OF BURNER
Model 4a a E) — d® —'3 Made].
Serial 5,$i , Max. BTU Rating
INPUT 44-14 MAKE OF FURNACE
Model
THERMOSTAT
Volvo
Limit
Limit Setting _
Fan Setting —
Pilot Type
Pilot Make —.
Pilot Model —
Pilot Timing _
L.W. Cut Off _
CONTROLS
WOeat Plug Vent Size
KIND OF LINE SIZE NONE
Draft Hood latr Regulator
0 _ Filters Si:e �0ri�_Number
e-, Chimney Location Inside � Outside
I Chimney Construction
i1
Pressure -__a, w �- Percent COZ —
Input CFH_. fo ® Percent 0�
Stock Temp. Percent CO
Smoke Bomb 1�f Wiring
Draft Test Too
Door Pressure Lighting lqst.
Date Tested _ ~�
Company Testing I
Nome of Tester `!
-To d'/0 S(,'/- �&
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 REFRIGERATION AND AIR CONDITIONING
SYSTEMS AND DEVICES
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work
Residential Rate
TOTAL
herein 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 $ 20.00
$ ''
that all the facts and representations stated in this application are
true and correct. ,1991
Gas Piping (Needed with new furnace) $10.00
$
/J
OWNER !J
Gas Range $10.00
$
BUILDING USED AS
Gas Dryer $ 10.00
$
ESTIMATED COST �' �� PERMIT NO.
*Air Conditioning - All Sizes $10.00
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
/
1 % of Value of Appliance or Work
$
No. of Heatingynits Circle One (Steam) (Hot Water) arm Air)
Trade Name �� t Size No. �Z4 j003l "T
CommerciaUlndustrial
BTU IUO, &YJ HP EDR
1 % of Value of Appliance or Work
$
Fuel iJ • 6-- Total Connected Load
State Surcharge
$ .50
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
$ '5b.
HEATING COMPANY
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
�j o
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
Signed By r Tel No. / oov
PLUS THE $.50 STATE SURCHARGE
1
REINSPECTION FEE $30.00
Approved B Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
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 (-J No ( )
5. Meets all current Code requirements for
size and total BTU's connected Yes (LA No ( )
6. Has total heating BTU's of (o /,5- 0(,:: --
All other BTU's (�,((Ja s; J�rb
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date ����
MAR -14-2006 09:40A FROM:
T : 39Ud
TO:7635711287 P:2.2
:GI WdrLT:ZT Ru 9002-02-831
is ffaw, for 10
PER MS 168.665 the Permit fat is s Mini"M of W. or 5°/a of the tarsi Lost up #o'er- abould� flW curly► etfi► cbst of labor)
improveom , installation to replar,� mt of a residential fixture, excluding the ftwres. CTh 2
lx.OSR
Labor cast under $300 - S15.00. Labor east between 5300 to $500 = cosi of labor —� $EL1�RS NOTPD. �� {�Na1CA9't? Tt� 1 AL
F41t ARt7J'ECTS Vlr� 1�,$t}R iDCG'�5 1540, p�cE$.ASE1G O` StO.OD PPERFUCrt7� � S1ZFJ87tJ � �` -
NUAdRF.tz 8F FAEACH(riNj � �+l :� ' MODS,,: 5 . -
Equipq�ont Iau1aSlcd — tulQl}Ea.
A+1FG: �J
GAS F4 -, NOSA0VW S19.eD
ArG S25.OD F[RSPLACE (GA5) Sl GAS QRE L SIt"
535.00 „„ GAS U'1+1 T RM S10.00
r►IR TO AIR. EXCKANGFER Sts —F URNACS 535.90 }tf'J►T8k>i35.W
)3OSI.F.R S3S.0D "—� iS 0•� �L1+I�+1Tl1.A?dR SiS.00
GilihiIIdEY LIAIEti 5=0.99 ..,. ie v14AttdG SIO. - �� - xri�++[�ia
�•�+r r, ,nwn • _- - S11l.OS! 96 a
Number of MACS O Sl0.09 �C
}?e11y1it 1't Nuazber off�tf =5 (§$15.(!t1 _,� x 515,00 $
$urchne $ Numb" of fixtures 8 W-00__�,__ x �5.4Q - S.
TOTAL DUE Number of fixwm @ S35.o0 —x $35.00 -'S^
State Surcllargir
TMS L5 AN APPLICAi.TM FOR A pMMT--NOT 'VALID UNTIL MC CMED
isiforntatiozl above is ota Cl
etre sad saturate; the the worn will be it,
I b�ereby apply for a building permit and l aclmowledge that the
s is
conformance with the ordinances and codes of the city of rridley� and with thaut pc�ait t �°� in ao=dan eC with lthe
net a pumat but Only at: APPlieatim for a, pt=lt and Work is not to stun
aVroved Plan in tilt =9 Of aUw�ar3c which rcquires review and approval of 1. A
K ✓I A ,PO I~ DATE
SIC NATURS OF
City of Fridley
)Building Inspections Department .
6451 UrdVersity Avenuc NE, FridleY, MN 55432
763-572.3604
FAX: 763-502-4977
Tel Wb6t:tL SOW VZ ''dad 4SZ1t4S5;q' : 'CIN 50:3 F+vlp;4.� JG S%70: W08A
MECHANICAL!jLRt*�aa.>.��...'.Dt.t.
R)ESWENTIAL APPLICATION
yBuilding
Impe,eflons
'
::
763.572-3604
CITY OF FRIDLE
1R E -AMR. ADDKESS _.
DATE
J!!/ 411
Srrg ADVAM
TM AP'P1.IGANT 1S:
� bW11F�
FiLOPERTYtvM-74
pTE iP
OWNEW
ADriR1;55-_ —cm
TENANT
CON't`ftAC7f'+ X
COMPANYMA9:_ - Kline Corp.
DBA: Practice stems
SUBI� A COPY OF
Ca-ITAcr lr> :.
istRoad
43428 Shady Oak
YOUR STATE
STATE Ltt E e^
Hopkins, MN 55343
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APPLICATION952
.WRFSs:=
933-1868
1NQLE FAWLY 0 TW O FAMMY Q TOVOMOVSP.
PEitMIT TYPE
D><tEw D it�LAG1=. N 1 Q ALTMAnOMMNIODSI.
TYPE OF WOM
DETAI= DEscRpTION OF WORM
is ffaw, for 10
PER MS 168.665 the Permit fat is s Mini"M of W. or 5°/a of the tarsi Lost up #o'er- abould� flW curly► etfi► cbst of labor)
improveom , installation to replar,� mt of a residential fixture, excluding the ftwres. CTh 2
lx.OSR
Labor cast under $300 - S15.00. Labor east between 5300 to $500 = cosi of labor —� $EL1�RS NOTPD. �� {�Na1CA9't? Tt� 1 AL
F41t ARt7J'ECTS Vlr� 1�,$t}R iDCG'�5 1540, p�cE$.ASE1G O` StO.OD PPERFUCrt7� � S1ZFJ87tJ � �` -
NUAdRF.tz 8F FAEACH(riNj � �+l :� ' MODS,,: 5 . -
Equipq�ont Iau1aSlcd — tulQl}Ea.
A+1FG: �J
GAS F4 -, NOSA0VW S19.eD
ArG S25.OD F[RSPLACE (GA5) Sl GAS QRE L SIt"
535.00 „„ GAS U'1+1 T RM S10.00
r►IR TO AIR. EXCKANGFER Sts —F URNACS 535.90 }tf'J►T8k>i35.W
)3OSI.F.R S3S.0D "—� iS 0•� �L1+I�+1Tl1.A?dR SiS.00
GilihiIIdEY LIAIEti 5=0.99 ..,. ie v14AttdG SIO. - �� - xri�++[�ia
�•�+r r, ,nwn • _- - S11l.OS! 96 a
Number of MACS O Sl0.09 �C
}?e11y1it 1't Nuazber off�tf =5 (§$15.(!t1 _,� x 515,00 $
$urchne $ Numb" of fixtures 8 W-00__�,__ x �5.4Q - S.
TOTAL DUE Number of fixwm @ S35.o0 —x $35.00 -'S^
State Surcllargir
TMS L5 AN APPLICAi.TM FOR A pMMT--NOT 'VALID UNTIL MC CMED
isiforntatiozl above is ota Cl
etre sad saturate; the the worn will be it,
I b�ereby apply for a building permit and l aclmowledge that the
s is
conformance with the ordinances and codes of the city of rridley� and with thaut pc�ait t �°� in ao=dan eC with lthe
net a pumat but Only at: APPlieatim for a, pt=lt and Work is not to stun
aVroved Plan in tilt =9 Of aUw�ar3c which rcquires review and approval of 1. A
K ✓I A ,PO I~ DATE
SIC NATURS OF
City of Fridley
)Building Inspections Department .
6451 UrdVersity Avenuc NE, FridleY, MN 55432
763-572.3604
FAX: 763-502-4977
Tel Wb6t:tL SOW VZ ''dad 4SZ1t4S5;q' : 'CIN 50:3 F+vlp;4.� JG S%70: W08A
Building
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:,jA
763-572-3604
CITY OF FRIDLEY
DfUTCSEP 2nnR
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE 6AYOUR
E-MAIL ADDRESS
SITE ADDRESS G
G
THIS APPLICANT IS: ❑OWNER CONTRACTOR
PROPERTY OWNER/
NAME. Pg(Al4k OLAI
TENANT
ADDRESS: 16 H 6k.C4&1'3CITY EE �,J I
STATE ZIP
PHONE:L I I— &q — DA- �_G
NAME: —
1
ADDRESS: l CITY ��1 d1C'
�iI= STATEI�ZIP /i
CONTRACTOR
SUBMIT A COPY OF
PHONE (�'�1 I —®1�1 �� FAX
YOUR STATE LICENSE
STATE LICENSE <)Q-150011 6� EXP DATE
PROPERTY TYPE
Yk6INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYINEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
11BASEMENT FINISH PtROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: la Cat
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
11 Trim
and proposed project.
13 Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ � �� a 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
$
$ 1,
$>®(7
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)
$1825 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 Davable to: City of Fridley Attach
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 Ale approved 1 � in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICA �V V , _PRINT NAME ay ; DATEV��
MI
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