PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 4 0 3 3
�-
Date: .__ �._._._.6_.... �......._............._.... ....... _.... _... ..... ............
_..
Owner: C.-C.c... - .... ................... Builder ..... ......... ...._'�' ......_. _. _.
Address
Address
LOW19N N OF BUILDING
No..... ._ ._..._... Street ............. -.............. Part of Lot ..... ......... __._..._..._.._
Lot ........._........ Block ....._.....Q ........... Addition or Sub-Division--.......dz'..'W- _..._._.... .... -.. _....._....
CornerLot ...........>< ................ Inside Lot ....._ ................................ Setback ..... -........................... ........... SideYard ................ ..._. ............_.................---.....----...........
Sewer Elevation
To be Used as:
Type of Construction
Foundation Elevation
DESCRIPTION OF BUILDING
Front ' Depth . : � Height AO -'Ce Sq. Ft. Cu Ft G.
Front
........--• ....................D.. Est. Cost.:'.:..�.�e70? (11. ...
To be Completed ..... Cu. -Ft.
t
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. t
_...-.. - :_ ._..__.._�....._......._.._
t
In consideration of the payment of a fee o $.... .......................................
....., permit is hereby granted to....._.... ............. .................
_...__.._..._._........... _... ....... ..................... . to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. o _. ,
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 hems.
4
0
APPLICATION FOR BUILDING PERMIT
r CI'T`Y OF PRIDLEY, MINNESOTA
Owners Name Builder
Address
LOCATION OF BUILDINGNo
qU r
of
Blc�ek, , .. Addition or Sub.Div.Nm•
Corner Lot_/�, Inside Lot Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applic;ant--Attach:.t---thi:s ,form C .Ft4ica.te of Survey of Lot and proposed building
location :.
DESCRIPTION di • Bt=ING
j.
To be used as:
Front O ` :r,^,�.
Depth Height
•rpt -
Sq. Ft. "Cu. Ft.
Front ` 'p8pth height
.r
Sq. Ft..:--,, Cu. Ft...
Type !VfJgonstruotibn. �.J`u 3ZI, (Z�,): Estimated Cost
To be completed
The undersigned hereby makes application for a Je6tat-- for the York here3.ir# specified,
agreojnt to do; 411 work in strict accordance with the City Ordinances and ruling of
the Depart*pnt.of Buildings, and•hergby declares that all the facts and.representa-
tions stated iii this application are -.-true. and correct.
DATE SIGNATURE
3
ide
(A �Sche4u1p..,.of Fee costs can be found on the Reverse
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'dt-?fbr the; .ek,cion of any fireproof building,
other than a garage;,•'war°chouse, 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 -fQr eaOh ene thousand
- .__..
cubic feet, or fra, otion - thereof, 'in•' suchi cubical contents.
2.2 For any such .p@rr t.for the er-o-at16h of any fireproof garage, ware-
, `ctory or grain elevator, or for the erection of any fireproof
addition for similar occupancy,..Ito arty exist n"building shall .be at the ;r
rate of 1.25 for each one thousand cubic feet, classiflg4.• n fir
by Section 502 of. theOm Building --Code: -�"' ..] I
2.3 For joy..suoh permit for the erection of any non-firepr.�chfr{}dui] 0ji g
e than a garage,, -warehouse, factorairr- elevator, or any
r non-firepr�o` ec�t'iorr;' 'for"emilar occupancy, to any existing .building. j
$1.00 for e� c Rangy, ; .h4?�s nd (s is -feet:-.._._._._._...
2-4Aj, i Fbr any such permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevato11.1 r.1' Sir;,for- :the erection of any non-
:71fireproof addition, for'I�s T.ar occiipancy, to any existing building.., ,<j.u•• s =
for each such building or addition. Ninety Cents for each one
thousand cubic feet or fraction thereof, in the cubical contents thereof _
with a minimum of $4.00. --- - - ! _. � . _.• _ ._._--- - .--
__ Far -the purpose of computing fees for building permits tae -e�tbi cal""V"
contents of any building or addititar-to auniform height throughout.by
multiplying the ground area covered from a point six -(6)
the floor line :of the buement• or cellae--to--the average height of the Y"
-_ nipper--surfWce or to the average height of the roof :sur acc�• of the" % ri
gable of a pitched roof. ..,a •..•,(. , :-,n(
2.5 For repairs or.: alterat 6Is te an existing structure, the fee s 7„ r;�.:. }«
._._.be.-at--the-•rat-6*'oi' -$3.00 for each Five Hundred Dollars ($500,W-)-i--or
fraction thereof in the co.st...of-.-a�Ipp ro osed work.
�2.6 ~In no case shall the fee cha"#ed for. any permit' -as set. p' h Uzi �; --, z. :? ••-'�`
ri' 2 be •11 pan •1x.00: :
.F ^•i!r•i;>.••;.Sc)';( 1?17s.. .;•i,. - ss[• -M j!';.4...
� r•
SUBJECT
of Fridley
22827
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir?City
• COMMUNITY DEVELOPMENT DIV
_
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/26/94
JOB ADDRESS 901 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
2
Moore Lake Highlands
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Curtis Hebeisen 901 West Moore Lake Drive NE
571-3660
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
Reroof Garage (9 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
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
1STALLS 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
$675
$.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-
$.68
STRUCTION$19.00
OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$20.18
SIGTUR OF CONTRA RO AUT R12EDAGENT IOATEI
e
WHEN PROPS
VALI TED THIS'JS YOUR P R IT
LDG INSP
�( f
bA7E
&GNATU RE OF OWNER SIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/ 1/94
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2��/
9 F 10A Building Permit Application
ConstructionAddress: 961 — LL, A1,100 a 4- 4 <)-1, P
Legal Description:
Owner Name & Address:t� oma/ /a e'erj �(� Tel. # f 71-34 �6 0
Contractor:" MN LICENSE #
Address: 20Z -- , /4-;f o E % `' 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:
Corner Lot [ ] Inside Lot [ ]
Type of Construction:
Ft. Yd Setback Side Yazd Setbacks
Estimated Cost: $ C,; 'Zs-'
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ — $
-t
DATE: — -! � APPLICANT: Tel. # 67 0
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 19,00
$ 6P
$ ,fD
Fee Schedule on Reverse Side
..001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$$00 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
/S
Agreement Necessary [ ] Not Necessary [ ]
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
March 24, 1997
Curtis Hebeisen
901 West Moore Lake Drive
Fridley, MN 55432
RE: Vision Safety at 901 West Moore Lake Drive
Dear Mr. Hebeisen:
A recent inspection revealed that a pine tree at the southwest corner of 901 West
Moore Lake Drive appears to be creating a visual obstruction at the intersection of Able
Street and West Moore Lake Drive. This obstruction extends into what is called the
"vision safety zone" restricting a clear sight path for motorists at this intersection.
Please take the appropriate action to remove all obstructions from the vision safety
zone. I will be reinspecting on or shortly after April 7, 1997, at which time compliance is
expected. Feel free to call me at 572-3595 if you have questions or wish to discuss this
further. Thanks for your cooperation!
Sincerely,
Kurt Jensen -Schneider
Code Enforcement Officer
KJS:ls
CE -96-69
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from :adjoining property owner.
JOB
Effective On January 1, 2000
� o0
01 R) . MD-Gylel
__ ... ... OWNER V
TOTALcht
, }
BUILDING USED AS
$�sCTO
f
$
$ .50
ESTIMATED COST C�- Q LL V—U PERMIT NO. /5'
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) arm A'
Trade N me� Size No.
BTU HP EDR
Fuel NWt Total Connected Load
Burner Trade Name Size No.
=. BTU HP EDR
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 an
rulings of the Building Division, and hereby declares that, all the facts and
representations stated in this application are true and correct.
BLAINE HTG. A/C ELEC"I ARP'-
13562 CENTRAL AVE. N.P.
HEATING CO ANOKA, ISN 65304
� l
Signed ✓- TEL # '���2
r
Final Date ®�
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes No ( }
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes No ( }
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category 1 Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes V) No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes ) No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes ) No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes ) No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes (No
Appliance #1 Type Fall JAM ®t BTU Input �'��an Assisted Na
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height
Diameter
inches
Appliance #1 Vent Connector Height
Appliance #2 Vent Connector Height
ft Length
ft Length
ft Diameter
ft Diameter
in Type
in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter
in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By:
BLAINE HTG. A/
1355ANnKA MN 55304RAL AVE- N.�.
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
�SS-
Effective On January 1, 2000
JOB ADDRESS �Q1 k ICJ®Ya-
OWNERS l-�l
TOTAL
'
BUILDING USED AS��Sf1't
ESTIMATED COST C�C� PERMIT N0.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$
Trade Name Size No.
BTU HP EDR
$
Fuel Total Connected Load
Burner Trade Name Size No.
$�®
BTU HP EDR
$
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 an
$ .50
rulings of the Building Division, and hereby declares that all the facts and
$ as�representations
stated in this application are true and correct.
P�
BLAINE HTG. A/C A ELECT.INC,
13562 CENTRAL AVE. N.E.
HEATING C ANOKA, MN 55304
Signed TEL #
C
Approved By
Rough -In Date Final Date '/3`00
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes( ) No( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input Fan Assisted or Nat
Appliance #2 Type
BTU Input Fan Assisted or Nat
Appliance #3 Type
BTU Input Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS:
Grna
..
W-�iiiiiiiiiiii ii
�►
HEATING CO:
Signed By: Date :
SUBJECT
P01MIT NO.
City of Fridley
31389
AT THE TOP OF THE TWINS
B U I L ®1 N G
P E R M I T C'
1 �
0 • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
���®
1 e e
REV
DATE
PAGE OF
APPROVED BY
1 1 CITY HALL FRIDLEY 55432NUMBER
612-571-3450
910415
9/13/00
JOB ADDRESS 901 West Moore Lake Drive
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
Z
Moore Lake Highlands
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Curtis/Jan Hebeisen 901 West Moore Lake Drive NE
763-571-3660
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Nutzmann Bros Construction 736 1 Ave NW, New Brighton, MN 55112 651-628-0128
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
20043453
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION )] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Existing House (15 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1 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
$19534
$.77
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-
57.05
Fire SC $1.53
STRUCTI OR THE PERFOR NCE OF CONSTRUCTION
+i /
PLAN CHEC E
T AL FEE
'tom 133(66
Lic e C $
64.35
SIGNATURE OF CONTRACTOR R AUTHORIZED AGENT WATEi
H FOR
VAL ED THIS IS R P IT
S-GNATURE OF OWNER SIF OWNER BUILOERI iOATEi
AOG iN$
OATE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �ON 0
Effective 1/112000
(763) 572-3604 Bldg Insp
yff 133q
Legal Description:
Owner Name & A dress: Tel. #
Contractor. w%i 1 MN LICENSE #f�—
Address: fuel ���Z 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: '" Estimated Cost: $ l~�
Driveway Curb Cut Width Needed: Ft. + Ft = Ft x $ =$
DATE: Y 4L APPLICANT: Tel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ S� Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ e 6�� $.50/$1,000 Valuation
SAC Charge $ _ $1100 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 $ � �/ 3S
STIPULATIONS:
V>
SUBJECT
P
City of Fridley
3 0. 31
AT THE TOP OF THE TWINS
BUILDING
PERMIT
t
e ,
EIPT .. -
o
COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 ,
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
612-571-3450
910415
4/14/00
JOB ADDRESS go / j— w ��� " ��
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
2
Moore Lake Highlands SHEET
2 P PERTY OWNER AIL ODRESS
" 6L`
"PHONE
� � t C ZIP 6713 4 !/®
3 CONTRACTOR jo MAIL ADDRESS
ZIP PHONE LICENSE NO
Curtis/Jan Hebeisen 901 West Moore Lake Dr' 571-3660
4AICHITECT 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
Construct a 20' x 12' Addition and a 24' x 12' Garage Addition
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plans.
A N ISI `�
SEPARATE PERMITS
before digging call for
all utility locations
REQUIRED FOR:
454-0002
WIRING
REQUIRED RV LAVA'
��t�M$I1�Il� AN��� GAS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 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
r
$35,000
$17.50
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-
$492.25
Fire SC $35.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FE
TOT FEE
44.75
SIGNATURE
. OF CONTRACTOR OR AUTHORIZED AGENT iD
ENWROPY VALID TE THIS IS Y PERMIIL
/�4�,m/�
Wi�' ^SIGNATURUREE
OF OWNEROF OWNE�.
BlO HATE
NEW []
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Desc '
Owner Nan
Contractor.
Address:
04
Effective 1/1/2000
(763) 572-3604 Bldg Insp
Attach to this application, a Certificate of Survey of the o
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
GARAGE AREA: Length l Width Height Sq. Ft.
DECK AREA: Length Width—� Hgt/Ground Sq. Ft _
OTHER: t . c� l� A J� J `e N � W.w (z _ k � �" \ % ) t (1 )
v
Construction Type: oG Estimated Cost: $ r` e,
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: - 3b 6 0`
APPLICA T• Tel. #`)
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
l
Permit Fee $ 4y 9 Q..?YFee Schedule on Reverse Side
Fire Surcharge $ ,GO .001 of Permit Valuation (1/10th%)
State Surcharge $.50/$1,000 Valuation
SAC Charge $ $1100 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 $ V 4l .q[s
STIPULATIONS:
4
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX:
ADDRESS
: 916 W MOORE LAKE DR NE
PIN
: 133024330025
LEGAL DESC
: UNAVAILABLE
: LOT 2 BLOCK 3
PERMIT TYPE
: HEATING - LABOR BASED
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: FIREPLACE
VALUATION
: $ 300.00
NOTE: INSTALL GAS FIREPLACE - EXISTING GAS
DAN SAMPSON 763-571-3617
MASTER GAS FITTERS 651-748-8277
571-1287
PERMIT NO.: 2006-00623
DATE ISSUED: 04/19/2006
THIS PERMIT REPLACES #2006-00562 WHICH WAS ISSUED TO INCORRECT ADDRESS. DEPOSITED ON
4-12-06, RECEIPT 9929.
APPLICANT
MASTER GAS FITTERS
2263 N MCKNIGHT RD
SUITE 2
NORTH ST PAUL, MN 55109
(651)748-8277
OWNER
SAMPSON, DAN
916 W MOORE LAKE DR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
HEATING PERMIT FEE, LABOR -BASED 15.00
STATE SURCHARGE, MECH VALUE 0.50
TOTAL 15.50
PAID WITH CHECK # 10146
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
r;_J-0'r-2005 14:48 CITY OF FRIDLEY
P. 02/04
B'U'ilditit
M1 TCHANICAL
Permit No. -
Inspections
RESIDENTIAL APPLICATION
Received By:
7.63-572-3604
CITY OF ERIDLEY
Date Rec'd:
DATE YOUR EMAIL ADDRESS
STM ADDRESS ICU Y? 07.0t, eV e.
_ i i o _
THIS APPLICANT IS: 0 OWNER 01'r ACTOR
PROPERTY
NAME: n r'7
Cr- CITY r1 ! STATEi% .z 4 u14_y_.302
ADDRESS: C7/fry / �eK �
TENANT
I�'
- 7/-- & / %
PHONE,- 7& � -
~C .-)NTRACTOR
I
COMPANY NAME:s'osES TSUBMIT
A COPY OF
CONTACT PERSON•i/_� _ r
YOUR STATE
STATE LICENSE # W DATE
LICENSE
pN
�7
ADDRES L13 XV° D�%f�n�. CIT ,&_C1" '`7 S�" al�u f STATBT ZIi� JU 17
ICAT
-
PHON$ I oSl- -2 31? - S271 FAX-74/?-L?V e
PER.Mf TYPE
*40LE FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
0 NE"V 0 REPLACEMENT P"RATION/REMODEL
DETAILED DESCRIPTION OF WORK_— GCeS �`re I� _ AXI'S %•7cr ®I �s
PER MS 16B.665 the pennit fee is a minimum of SIS -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 PROJECT'S W1i E LABOR EXCEEDS $500, FESS ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) //��' �JJ�%
Egaipmontlnstalled MFG: /7eciT �,luw MODEL: � _ SIZE/BTU
���-
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEIBTU
,_A!C $25.00 FIREPLACE (GAS) $15.00 —GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GML $10.00
BOILER $3$.00 FURNACE $35.00 GAS UNIT KM $10.00
—GAS
CH N NEY LINER $10.00 DRYER $10.00 _POOL HEATER $35.00
_DUCT WORK $10.00 GAS PIPING $10.00TITIIATOR $15.00
$.t)("
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ 50 Number of fixtures @ $15.00 X $15.00 = $
TOTAL. DUE $ Number of fixtures @a $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 - $
State Surcharge = $�-,SO
Total = $
TMS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and i a6mowledge that the information above is complete and acemate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota-CoAstruction 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 case of all work which r ares review and approval of plans.
L/
SIGNATURE OF APPLIC J, ' PRINT N n �r✓ DATE_Z_
�tti�r�,.. .:4 �. C @:�aM'1 „t` +�'����r:�` "�...r"",a.�.fi1 . P.�ar�_G,'�P�F 0; D�, �:� `g_�,3v ���✓'�pE.�,.?t i' �� �a� ���;�h�;�,�Z�;
City of Fridley
Building 1 1 1 Department
6431 UWvexsity Avenue NE, Fridley,1 55432
.1'
sdi
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
(763) 572-3604 FAX: (763) 571-1287
REP v- D ON 4/19/2006
ADDRESS `,301 RICE CREEK TER NE
PIN 14302421on46
LEGAL DESC : RICE CREEK ERRA
CE PLAT
: LOT 1 BLOCK 1
PERMIT TYPE : HEATING - LABOR BASED
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE
VALUATION : $ 300.00
NOTE: INSTALL GAS FIREPLACE - HEAT & GLOW FB1N - EXI ING S
DAN SAMPSON 763-571-3619
MASTER GAS FITTERS 651-748-8277
0 �
APPLICANT
MASTER GAS FITTERS
2263 N MCKNIGHT RD
SUITE 2
NORTH ST PAUL, MN 55109
(651) 748-8277
1 RICE C TER NE
L 5432 ql cd,
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
PERMIT NO.: 2006-00562
DATE ISSUED: 04/12/2006
HEATING PERMIT FEE, LABOR -BASED 15.00
STATE SURCHARGE, MECH VALUE 0.50
TOTAL 15.50
PAID WITH CHECK # 10146
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.