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BUILDING PERMIT
I! N0 2183
Tillage of Fridley, Minn.
!i
Date II �. y �% .. ... .
Owner ;3� ; Builder ,
Address 1.:y Address
LOCATION OF BUILDING
No. .. . vk J . Street .t ... ...... Part of Lot .... ............... .
Lot .. ... Block .. . , . .. Addition or Sub -Division ..........................
r.
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. .. - . ac �uacx . ,. . , . aiaeyara :: ..............
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Fi. Cu. Ft... .
+ - Front Depth Height . .... Sq. Ft......... . Cu. Ft. ........
Type of Constructil
` ► Est. YCost } 1.. .... To be Completed.: �.. i
ii
In consideraiior�'I
u
of the issuance to me of :a permit to construct the building described above, I agree to do
the proposed work
accordance with the description above set forth and in -compliance with all provisions of
gage
ordinances of the
of Fridley.
.6. ....
consi tion�iOf
the payment of a fee of $.,., :. permit is hereby granted to ..
... to construct the building r addition as described above. This permit iOQ s grafi ted upon
the express condo
that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and
Fridley, Minnesota
in `village
upon said building, or any pant thereof, shall conform in all respects to , the, ordinances of
din location, construction, alteration, maintenance, repair and moving of buildings with-
the limits
nd this permit may berevokedat any time upon vlolatior, of any of, the provisions of said
ordinances.
,.'. ding, Inspector
NOTICE:
II
This permit i�oes
not eov�,fi the construction, instalJatl6n or alteration for wiring, plumbing, gas heating,
sewer or water, Ito
sure to seethe Building lnspeetor for separate permits for these Items.
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^a� MINNE3OTAYDEPARTMENT OF HEALTH Seal es to Well and Boring H 9
WELL OR BORING LOCATION
County Name WELL AND BORING SEALING RECORD Minnesota Unique No.
Minnesota Statutes, Chapter 1031 or W -series No.
Anoka (Leave btank tf not known)
Township Name Township No. Range No. Section No. Fraction (sm. - Ig.) Date Sealed Approximate Date Well
l= ri d1 g 23 1 114 I N la 6-7-94 or Boring Constructed
Numerical Street Address or Fire Number and City of Well or Boring Location
7665 xi 68 68
gy en Fri j e Depth Before Sealing ft. Original Depth ft.
Show exact location of well or goring g Sketch map of well or boring Static Water Level Accurate
in section grid with "X location. showing property lines,
N roads, and buildings. ❑ Approximate
W
EE
ME
MEMO
OMEN
s
CK Single Aqu'rfer El5 X Multiaquifer ft: below above land surface
E CASING TYPE
® Steel ❑ Plastic ❑ Tile ❑ Other
%F Mlle
_ k 65, 58
S" Screen from to ft. Open Hole from to ft.
�— 7 mile — .ow .�.. ,.+.. .:s. _
,,. O BSTR UCTIONlDEBRfS/FILL
Obstruction ❑ Debris ❑ Fill
PROPERTY OWNER'S NAME
Greg Loftness 56' 114n d..p. _I jet
Type of debris/obstruction
Mailing Address if different than property address indicated above.
Obstruction/Debris/Fill removed? EWes ❑ No
PUMP
Same
❑ Removed EXNot Present ❑ Other
CASING
GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO
FORMATION
Diameter Depth Set in oversize hole? Annular space initially grouted?
If not known, indicate estimated formation log from nearby well or boring.
in. from 6 to 65 ft. ❑Yes W No 11 Yes ❑ No El Unknown
in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
No Annular Space Exists
❑ Annular space grouted with tremie pipe
❑ Casing Perforation/Removal
in. from to ft. ❑ Perforated ❑ Removed
in. from to ft. ❑ Perforated ❑ Removed
Type of perforator
❑ Other
GROUTING MATERIAL
Grouting material fit Cfflt from 6 to 68 ft. yards 2 bags
from to ft. yards bags
REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING
from to ft. yards bags
n
from to ft. yards bags
UNSEALED WELLS AND BORINGS
n Other unsealed well or boring on property? ❑ Yes EXNo
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed in accordance with Minnesota Rules; Chapter 4725. The information contained in this report is
true to the best of my knowledge.
MorkWell Co., Inc. 02133
Contraess Name License or Registration No.
-22-94
Aultirized Representative Signature Date
LOCALCOPYH 2 Q Randy Danielson
Name at Person Sealing Well or Boring
HE -01434-01
CITY OF FRIDLEY INSPECTION DIV,
Effective On March 1, 1996
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
1 ■ r
Residential
Fumace.Shell and Duct Mork, Burner —
Aiso Replacement Furnace
(Side Vent -- Fill Out Back)
Gas Piping (Needed with now furnace)
Gas Range
Gas Dryer
*Air Conditioning — AN Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercialli ndustrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$10.00
$10.00
$10.00
$ 25.00
State Surcharge
TOTAL FEE
,JOB ADDRESS__ 2"10 Ug h E "', e.r'
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.
OWNER_ Re,6 4- �.;►�,. ��a r\ 7%q ® 3 31 C
13UILDING USED AS-16�.A.
C I ESTIMATED COST i Ic-o, PERMIT NO.
DESCRIPTION OF FURNACE AND OR BIJONER
$ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP _ EDR
$ d�Fuel Total Connected Load
� 50 Burner Trade Name Size No.
-SD
BTU HP EDR
MINIMUM FEE FOR ANY HEATINIG/COOLINGNENTILATiON
REFRIGERATION/AIR CONDITIONING PERMIT IS 125 00
PLUS THE S. STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
HEATI PANY A * �1� :,.� -� A,,p �"PL
Signe TeI No. nto-1�300
Approved By Rough --In Date Final Date
FILL OUT BACK SIDE F R STACK VERIFICATION ON
REPLACEMENT FURN4i
0
List ALTERATIONS Beirut_Done:
HEATING CO:
Signed By:
Date:
CHIMNEY AhM STACK VERMCATION
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 heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes {
}
No
{
)
8.
Has combustion air been provided for water heater
Yes ()
No
(
)
List ALTERATIONS Beirut_Done:
HEATING CO:
Signed By:
Date:
IEW [ ] CITY OF FRIDLEY
1DDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
1TER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: u A V 23 UR IIV S T -'4
Legal Description:
Owner Name & Address: �tNNI S R ED R I c I f5aaa Tel. # 2a.? -717 -7q -?7
Contractor. MN LICENSE #_,
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to *scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width 20 Height �K Sq. Ft .�
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER:
7
Construction Type:
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft r+ 6 Ft = Ft x . - $
nDATE: - 3- �5 APPLICANT: Ir Tel. # --,2 /U
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee,
$... 10. 125Plan
Review r `Y'
$ l O s . 00
Fire Surcharge
$
State Surcharge -
$ - 14
SAC Charge
$
License Surcharge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 [ ]
STIPULATIONS:
0
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
$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)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20.00.
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 existing foundation will be required before
proceeding with the framing. New Houses Only
Building
BUILDING
Permit NoZZU'lloaLfa3
Inspections
RESIDENTIAL APPLICATION
Received By:
763572-3604
CITY OF FRIDLEY
Date w
763-502-4977 FAX
Surcharge
$ ti (
.0005 x Permit Valuation Minimum $.50
EFFECTIVE 1-1-09
$
DATE ` I7 -,;?-,,Z YOUR E-MAIL ADDRESS +-
SAC Charge
SITE ADDRESS �l�% �r�6 ('1;T_k ' C5/ A exj 5 -7 -
7 -THIS
$2000 per SAC Unit (Plans to MWCC for determination)
THIS APPLICANT IS: OWNER ❑CONTRACTOR
$
PROPERTY OWNER/
NAME: 1 S / i eD12 /C (�S`C��>✓
$
jcSTATE&/ IP
C/%�lVlCITY
TENANT
$
PHONE: 7_123 "" ;7 / 7 — —7 C? %
Sewer Main Charge
CONTRACTOR
NAME: !v �, U Ov �'[�
Total Due
6�e
STATE LICENSE # EXP DATE
Make checks payable to: City of Fridley Attach Stipulations
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPESINGLE
FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
°DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ErkDDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
7--)4_pG P<
DESCRIBE WORK BEING DONE:
, f
SIZE OF IMPROVEMENT 6, x 1 LENGTH 2 WIDTH G, 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 EXISTING 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 $ oc in %15 ^'Ra OCCUPANCY TYPE
Permit Fee
$r I
See Back Page for Fee Schedule
Plan Review
$ ` + ,
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$ ti (
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ (l cid
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit nd work isnot to start without a permit on site; that the work will be in accordance with the
approved plan in the base of all.,work. Ich r uire Rev,ew and approval of plans. T / `'7 �/
SIGNATURE OF APPLICA1 � �� did -- PRINT NAME UL 1U w c S t' l�[,�i« c(15�ADATE �(` ('a o
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 1s` $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000
$391.25 for I' $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 1r$50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for I' $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 1' $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
Design fil AM A . � :. P � � 411712009
* * * Take this sheet to the Building Materials desk to purchase your materials.
You selected a 1 level deck with:
Pressure Treated Framing Material
4 x 4 Framing Posts
514" x 6" Cedar Deck Boards
Pre -cast Footings
Premium Gold Saui.re Drive Screws
Galvanized Framing Fasteners
Handrail selections:
36" Horizontal Handrail Railing
211x2"06" Pressure Treated Sq. End Spindles
41'x4"x48" Pressure Treated Utop Notched Railing Posts
2"x4" Pressure Treated Hand Rail
Below is a section of the railing style and
options you have selected for your deck.
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Spindle placement is approx. 4" apart depending on style
You may buy all the materials or any part at low cash and carry prices. Because of the wide variable in codes,
Menards cannot guarantee that materials listed will meet your code requirements. Check with your local municipality
for plan compliance and budding permit. These plans are suggested designs and material lists only. Some items may vary
from hose pictured. We do not guarantee the completeness or prices of these structures. Tax or and delivery not included.
"mac
Illustration intenddd to show general deck size and shape.
Some options selected may not be shown for picture clarity.
Today's cost for materials estimated in this design with options$462e70
*The base price includes: 40 PSF deck live load, AC2 treated - horizontal 2x6 *?ASE price): $340.90
deck boards, 4x4 posts, 2x8 joists and beams, galvanized framing fasteners, **""If purchased to
�ay you save; 92.94***
AC2 treated 36 Vertical handrail to joist without posts, and premium screws. *'"`Monthly B1G Card Payment would be: 112.99*""
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Illustration intenddd to show general deck size and shape.
Some options selected may not be shown for picture clarity.
Today's cost for materials estimated in this design with options$462e70
*The base price includes: 40 PSF deck live load, AC2 treated - horizontal 2x6 *?ASE price): $340.90
deck boards, 4x4 posts, 2x8 joists and beams, galvanized framing fasteners, **""If purchased to
�ay you save; 92.94***
AC2 treated 36 Vertical handrail to joist without posts, and premium screws. *'"`Monthly B1G Card Payment would be: 112.99*""
Post and Beam Dimension Sheet
Design# 9081
12'
Posts 1'-6" g
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Layout dimension sheets are intended as a construction aid.
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Not all options selected are shown.
Beam Layout for Your Deck
The Scale is 114"T
Design# W4
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Mark Length _ Description
A 12' 2-2x8 Micropro Treated
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Layout dimension sheets are intended as a construction aid. Not all options selected are shown,
Joist Layout for Your Deck
The Scale is 1/4 :1
Design# 90814
Mark
Length
A -- -
519"
B
.11'9"
r~
5'10- 1 /2"
D
12'
Descri tion
8-2x8 Micropro Treated
1-2x8 Micropro Treated
2-2x8 Micropro Treated
1-2x8 Micropro Treated
Rim joists to be face -nailed to joists -& ledgers with 3-112' (16d) galvanized nails.
Usage
Joist
Ledger
Rim joist
Rim joist
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Layout dimension sheets are intended as a construction aid. Not all options selected are shown.
Design #:90914 n :,>w,.,.p 4/1712009
* * * Take this sheet to the Building Materials desk to
materials. * * *
Level 1: 12' x 6'
3' off the ground
Horizontal Decking
ft ontilever nn jois s
2" x a" RPamS 11
PPPP��� S A.
40 PSF Deck Live Load
b -?Sr- ZIS W U
Today's cost for materials estimated in this design with options:$462.70
*The base price includes: 40 PSF deck live load, AC2 treated - horizontal 2x6 *(BASE price): $340.90
deck boards, 4x4 posts, 2x8 joists and beams, galvanized framing fasteners, ***If ppurchased today, you save:192.94***
AC2 treated 36" Vertical handrail to joist without posts, and premium screws. 'Monthly B1G Card Payment would be:12.99***