PRE 2010 DOCSENERGY REQUIREMENTS
,This form to be completed and submitted with building g permit applications
r
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
OWNER ,l%Lnn *A. k-"! N Go S 4
SITE ADDRESS W_ t\1W c) iR
CONTRACTOR A DATEAc< Il Iff'VHONE, 5- 21 .35/4
Determine working square footage of each.
I. Total exposed wall area ..... sq. ft. x ®l = e o Z
LO2. Total roof/ceiling area .... 1760 sq. ft. x �`c = 'e
Total exposed wail area above floor
a. Total wall window area ........................... 4--
b. Total door area ...................................
c. Total sliding glass door area ....................
d. Total fireplace wall area ........................
e. Total wall framing area (average 10%) .............
f. Total net wall area above floor .................. 1 -7
g_ Total rim joist area
I- Y, 4- 155 -rut;? CA- e
Total exposed foundation area =
h. Total foundation window area .....................
I. Total net foundation area above grade ............ !%it,
Determine "U" value of each wall segment. 1
`J a. X $sun — m
b. x "un =
C. X e,�n B �� F
'6�r ,'�—
d. X "Un =
e. X "Un =
'07 f._L-- X "U"
g. X nun
h. X "lir a
i. X nus
� a V
3 ......................................... .Totes
If item /3 is the same as, or less than item H. you have met the intent of
2 MCAR 1.6005 (4.3)
Total exposed roof/ceiling area =
J. Total skylight area .............................
k. Total roof/ceiling framing area (average 10%)....
1. Total net insulated roof/ceiling area ........... ,
Determine "U" value for each roof/ceiling segment.
X "U" -
k. X "U" _
4..........................................Total = e-7 4 -
If
If total of #4 is the same as, or less than #2, you have met the intent of
2 MCAR 1.6005 (4.3.2.2)
Alternate Building Envelope Design
To utilize tht total envelope system method, the values established by the
sum of items #3 and #4 shalt not be greater than the sum of items #1 and #2.
L J a y + 2. a 1 =
3. + 4. _
ell—
I IV
� e `r �
VVI OC40+1
4
Ir.
SUBJECT
PERMI
City of Fridley
18170
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
• COMMUNITY DEVELOPMENT DIV.
?03/
PROTECTIVE INSPECTION SEC.
i �
I CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
j 612-571-3450
910-F15
8/22/85
JOB ADDRESS 850 West Moore Lake Drive N .E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
Shorewood 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Delmar Kingsriter 850 West Moore Lake Drive N.E. 571-2427
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
8 DESCRIBE WORK
Interior Alteration in Dwelling and a 24' x 141 wifNx Addition
9 CHANGE OF USE FROM TO
STIPULATIONS Finished lower level is for relative use only -- can never be rented
as a separate living unit.
'SEPARATE FFA'117 R70YlRED FOR
WIRING, KASI; G, PL MBING AND SIGNS.
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 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
1
I 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 000 $10.00
$20,000
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$140.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$ 3.5.13 $185.63
GN TU OF CONT ACT 0 R A UTLO Rf DAGE NT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
. 3 f .
IGNATURE OF O N IIF O ER BUILDER) (DATE BLDG iNSp Df7E
TE
16r
NEW I [ ] City of Fridley Effective 4/1/84
ADDN. [�` f R-1 AND R-2
ALTER. [14 Building Permit Application
Construction Address: M®ORE L DAtI/L AA10L�yl
Legal Description: -
o
Owner Name &Address: ZFJ m om >m6S R1 7'p- 4Q MrJE $ Tel. #,f?0 A VAL %
Contractor: SM LX Tel. #
Address: -4�r
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 _.L_l�
Height ,�
Sq.
Ft. 6V- 23
GARAGE AREA:
Length
Width
Height
Sq.
Ft.
DECK AREA:
Length
Width
Hgt/Ground
Sq.
Ft.
OTHER:
.0ibl
Corner Lot [ ]
_zVUi
I side [
Ft. Yd. Setback
Side Yard
Setback
/Lot
Type of Construction: [4*A1, kM*A
Estimated
Cost:
Approx. Completion Date: %'�'VT
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: (Nr APPLICANT: A A.. Tel. # 3v4 d
44
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
71 1 S ��-� �a - 0
J6,S-,6e3
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 [ ]
L o v, �N, k i -5 U L
b
,L",- T I UA
a
ASSEMBLIES of GOD
P.O. Box 48377
DIVISION OF FOREIGN MISSIONS Nairobi, Kenya
Area Representative, Eastern Africa
UCAND
Rev. Del Kingsriter P.O. Boz 48377 RUANDA
Nairobi, Kenya BURUNDI
TeL 512231
850 W. Moore Lake Drive
Minneapolis, Minnesota 4432
August 20, 1985
Mr. Darryl Clark, Building Inspector
Fridley City Council
Fridley, Minnesota 55432
Dear Mr. Clark:
SUDAN
I am leaving two sets of plans for your consideration for the improvements
at 850 W. Moore Lake Drive, as we discussed in your office yesterday.
0 SEYCHELLES
0 MAURITIUS
Also I am enclosing a photocopy of the survey plan. You will note that there
is a 9' 4" span between the corner of the garage and the property line, instead
of the normal 10'.
My mother-in-law has explained this survey that shows there was an adjustment
of additional street footage given to Mr. Hayes, and additional lake frontage
given to Mr. Hozempa. This was at the request of Charles Hayes, the resident
at 840 W. Moore Lake Drive, enabling him to have a larger cement slab off the
road in order to park a second vehicle.
The 9.4 feet is at the front of the garage and falls very slightly away toward
the lakeshore, as you can see, so that it may come very close to the 10 foot
span where the addition is to be placed. You will also note that the 9' 4"
span is not between the house but between the garage and the property line;
and also that on that side of the addition there are no windows, as both the
upper and lowel levels of the addition will be storage.
Thank you for your kind consideration of this matter.
Very since ely yo rs
elmar Kingsriter
DK mk
Enc.
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Oft Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Not Water Heater
Gas Range
Gas Dryer
NO.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $
(S1S.00)
RATE
$ 5.00
$ 3.50
$ 1.50
$ 4.00
$ 5.00
S 5.00
$ 5.00
$ 5.00
$ 5.00
S 7.00
S 5.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
TOTAL
,w -
S
S .50
$11 .fo
Ettective Aug. 1, i9ta
Job Address � � . Ma j �� LSCT1 B /'gyp, l ® to
d y
Department of Buildings (✓ �` t fSs
City of Fridley
Tel. 0571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
9
Fridley, Mn. �, B 19
OWNER
KIND OF BUILDING _,
USED AS
TO BE COMPLETED ABOUT
v�oo
ESTIMATED COST 4sw ♦ ®'Ci 70
OLD
OLD BUILDING PERMIT NO. PERMIT NO.
/�� • J=1�-._���Zl/L iii % .�►_;.
ROUGH INSP.
Date
FINAL INSP. — jl
Date
APPROVAL FOR PERMIT !"'
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
A
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,as
gler
lot
1
d
a
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(•) - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Oft Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Not Water Heater
Gas Range
Gas Dryer
NO.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $
(S1S.00)
RATE
$ 5.00
$ 3.50
$ 1.50
$ 4.00
$ 5.00
S 5.00
$ 5.00
$ 5.00
$ 5.00
S 7.00
S 5.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
TOTAL
,w -
S
S .50
$11 .fo
Ettective Aug. 1, i9ta
Job Address � � . Ma j �� LSCT1 B /'gyp, l ® to
d y
Department of Buildings (✓ �` t fSs
City of Fridley
Tel. 0571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
9
Fridley, Mn. �, B 19
OWNER
KIND OF BUILDING _,
USED AS
TO BE COMPLETED ABOUT
v�oo
ESTIMATED COST 4sw ♦ ®'Ci 70
OLD
OLD BUILDING PERMIT NO. PERMIT NO.
/�� • J=1�-._���Zl/L iii % .�►_;.
ROUGH INSP.
Date
FINAL INSP. — jl
Date
APPROVAL FOR PERMIT !"'
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
f
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
'
RATE SCHEDULE
RESIDENTIAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
• Air Conditioning (all sizes)
RATE
$ 20.00
$ 10.00
$ 10.00
S 10.00
$ 10.00
All Others/Repairs and Alterations
It of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
It of Value of Appliance or Work
State Surcharge
TOTAL !EE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp. 7
Date
Approval for Permit !
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCHARGE
TOTAL
$ ,.b tt
5
S
S
$ 0.0
S
Attach stack verification form with replacement furnace permits
*Air Conditioners can not the placed in sid.• yard without
written pt•rmission from adjoining neighbor.
Effective Aug, 1. 1981
�y
Job Address
Department of Buildings, 6431 University Ave. N.E., Fridley. MH 55432
City of Fridley
Tel. 0571-3450
The undersigned hereby waked application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
OWNER
RIND C
Fridley., Minn. 'Kd'�")q . l9
USED AS
TO BE COMPLETED ABOUT �% /k6
ESTIMATED COST .91200- -
OLD - NEW BUILDING PERMIT N0. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Not Water warm Ai No. 7
Trade Name(f size No.�����Ll/®3�
Capacity �C;, Sq. Ft. CDR BTU HP
Total Connected load Kind of Fuel
BURNER - Trade Name
Size No.
capacity Sq. Ft. EDR BTU HP
Company 7
i
Signed By
Tel I. Na.
CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FOR14 MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
I]/
LOCATION I to e � GATE �� "096
OWNER F b Kinns R d ADDRESS C R It
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are lodoed within
4. Ttat it is securely supported
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
All Other BTU
TOTAL
REMARKS n S+ont b II F, CL) L a n
HEATING PERMIT !
0
I
SIGNED AL —Z
Licensee
by
Address I3SCcA NVE
Telephone 05 77 - to CS Lo
Fridley City License
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1,199k(
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS P� C 4) -
Residential Rate TOTAL
Furnace Shell and Duct Work, Sumer -
Also Replacement Furnace $ 20.00 $
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00 $
Gas Dryer $ 10.00 $
*Air Co ditioning - All Sizes $10.00 $
(-'Li
All Ot /Repair & Ae tions ( ST BA K)
1% of lue of Appliance or Wor $_
CommercialJindustrial
I% of Value of Appliance or Work
State Surcharge
TOTAL FEE
$x50
MINIMUM FEE FOR ANY HEATING/COOLING)VENTILATION
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.
The undersigned hereby makes application for a permit for the work herein
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.
, /0-� .1994
OWNER 5-71 -3Y41
BUILDING USED AS �j
ESTIMATED COST _� yr �_� PERMIT NO.
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Bumer Trade Name Size No.
BTU HP EDR
HEATING COMPANY WVIWWG
Signed
Approved By , Rough -in Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
COY MD STACK YYBRUR A ON
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been c arefally 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 ( )
Remarks:
c
List ALTERATIM Was Done;
HEATING CO:
Signed By:
Date:
SUBJECT
PER
City of Fridley
�e q
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV
______
r L PROTECTIVE INSPECTION SEC.
/
NUMBER
REY
DATE
PAGE OF
APPROVED BY
"1 CITY HALL FRIDLEY 55432
612-571-3450
910-F15
4/11/9
JOB ADDRESS 850 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
1
TRACT OR ADDITION
SEE ATTACHED
DESCR.
/{
1
Shorewood 2nd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Delmar Ringsriter 850 West Moore Lake Drive NE
571-3468
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 p _
❑ NEW ❑ ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Install dividing wall in garage storage area; install door
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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
$ 175
$ 50
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOT FEE
7$21.67
SiG)GNATUREOFCO AGENT IDATEI
0, PA100P
VALIDATEjt THIS IS Y PE�i MJj
SIGNATURE/E/'Ce/F OW NER UFOWNER BUILDER] IDATEI7
al-09fINSP
OU TE
NEW [ ] Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION 41-0-)6
ConstructionAddress: SCS 0 `� RE "�Y t3
Legal Description:
Owner Name & Address: ,&r �sz% Tel. # --5' 1
Contractor: JL MN LICENSE #
Address: T-50 I k- � � � � , v L r cl, Tel. # _�5: )I
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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 Sq, Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
G
Construction Type: A *C 0 C 15 Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:.,_ Ft. + 6 Ft = Ft x $ _ $
DATE: 1 APPLICANT-: QC 1_ t -to. Tel. #S %) 3'11-9
CITY USE ONLY
Permit Fee
$ 07/ 40
Fee Schedule on Reverse Side
Fire Surcharge
$ • /'7
.001 of Permit Valuation (1/10th%)
State Surcharge
$ .SO
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
Sketch of proposed improvement to our garage at 850 W. Moore Lk. Dr.,
Fridley.
Please note that the improvement is very minimal and may not even
involve a permit. But I want to be safe rather than sorry.
When the house and garage were built, we allowed fora storage area
as shown in the sketch. Currently we have shelves in the storage
area. All we are asking is to reconfigure the storage area with
shelving that can be accessed from the garage as well as from the
porch.
This will be done by a family friend who has helped us with small
repair projects in the past. He is not a contractor, but only a
family friend and handyman.
The cost of this work will be under $200.00. I hope you can understand
my sketch. Note that there will be no change to the present structure
except to reconfigure the shelving and a door between the present
storage and the porch.
Proposed change attached.
y V ..l" j. - [('T.�4 `' ' t t
.+5 t
�. \ V -._� 'i'.. '^-_'\`. �"�^`^'-� - :w^_�' Il . 'LV,`. _!- -6a�-w.�-/' .....,"d�..�- •,� � . � a ~ Y \i � f ••� t ..
. r � lam_____._•-_ � f \ �� � . ,; ; —
1"! --�_
i7t '
:,_�/ • � _. _ ... __. _.. _ .. . , a,,,a, _ - __ mac:
01
SUBJECT
City of Fridley'11466
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
R I T NO.
`v ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
r PROTECTIVE
1 �
1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
"'j 612-571-3450
910-F13
5/14/99
JOB ADDRESS 850 West Moore Lake 1M Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
Shorewood - 2nd
SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
Marlys Kingsriter
571-3468
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 ❑ ADDITION O ALTERATION G9X REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (25 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2185
1.09
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
Fire SC $2.19
PLAN CHECK FEE
TOT FEE
6.53
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT MATE.
PO
ID THIS is Y PERM
n
S,GNATURE OF OWNEROF OWNER BUILDER. I DAATEI
'A�
INSo
pATE
01
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Ado
BUILDING PERMIT APPLICATION
Construction Address:k. 0
Legal Description:
Owner Name & Address: Tel. # 6ly
Contractor: Ow (r1. -K MN LICENSE #
Address: ftim 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 Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: i& -949F 4 4 G--Lak��J'Estimated Cost: $ c� % �S
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $
DATE: 6-- t q qAPPLICANT: , Tel. #
CITY USE ONLY
Permit Fee
$
93- o-? -6—
Fee Schedule on Reverse Side
Fire Surcharge
$
aR . /7
.001 of Permit Valuation (1/10th%)
State Surcharge
$
/-07
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ J Not Necessary [ ]
TOTAL
$
6 • �3
STIPULATIONS:
SUBjECi
City of Fridley
33958
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir
RECEIPT NO.
�• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC
59r
UMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEV 55432N
L J` 763-571-3450
9taF15
10/9/03
JOB ADDRESS 850 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
Shorewood 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Marlys Kingriter 850 West Moore Lake
Drive NE 763-571-3468
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
D & S Construction of MN Inc 480 206 Ave NW, Cedar, MN 55011 612-369-7077
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
6652
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW O ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 10' x 14' Deck
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan.
WARN11%
'"Ors gigging gging
call for
all Utility locations
O02
Ry
w
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
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 1 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
$1,735
$.86
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$69.25
Fire SC $1.74
ORMANCE OF CONSTRUCTION
29z��
PLAN CHECK FEE
TOTAL FEE
icen a SC $5.00
$76.85
SIGNATURE OF CON TRACTOR OR AUTHORIZED AGENT (DATE,
EN PROPERLY VALIDATED THIS IS YOUR PER IT
.NSI BATE
S-GNATURE OF OWNER,IF OWNER BUILDER. iOATEi
NEW [ ]
ADDN []
ALTER [ l
-.
Construction Address:
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
'So U\-"'
Effective 1/1/2003
(763) 572-3604 Bldg Insp
'(763) 571.E 1287 Fax
Legal Description:
Owner Name & Address: i �.i�+ e�ii < �,� ®®�— Tel,
Contractor. ,�'� C "'� ti c ° MN LICENSE #_" _-5.2-
Address:
Address: L -f 6" .•f --L/ rr� �, � � � el. #. .3e9 I o-2-2
Attach
2 -
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 Height __ Sq. Ft.
DECK AREA: Length Width 1VO Hgt/Ground Sq. Ft.
OTHER:
4 -
Construction Type: AL,, 6'i— 9�Estimated Cost: $�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
—,�,_-36�' +r
DATE: 3 ? APPLICANT: - —
Tel. # ��/�
11
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
Fire Surcharge
State Surcharge
SAC Charge,
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [
617.
/ N I f .V
� � y T•io�s` S3LOtt��.
40
21 ti SQL..
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