PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn.
Date /Ii / .® X ....................
Owner...........................
Address ¢ .a /..... ... ........
A1° 2R12
Build r`' .......................
Address.........................................
LOCATION OF BUILDING
No. ....// ... Street .. ,,/(,�.�.. .............. Part of Lot .......................
Lot ...--,Y ........ Block ... ......... Addition or Sub -Division . ............ .
Corner Lot ............ Inside Lot ..Y........ Setback �/ �' Sideyard / ./ .................
DESCRIPTION OF BUILDING
To®bye Used as:
46 Front .. Depth . ... Height /f ...... Sq. Ft.149N.A Cu. Ft. ........
*041r;........ Front ........ Depth ........ Height ......... Sq. Ft.Cu. Ft. ........
Type of Construction��� � _ ... Est. Cost �S� , @ ............. To be Completed/
In consideration of the issuance to me of a permit to construct the building describedabove, I agree to do
the proposed work in accordance with the description above set fo in co pli with all provisions of
ordinances of the village of Fridley.
.... ... � ,,. " ......-. d �.�.s............ .
�✓ In c® i the payment of a fee of $., f... permit is hereby ranted to ...........
to construct the building or ad dition 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 with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. / z" I /
Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
J
SUBJECTERM
City of Fridley
20193
AT THE TOP OF THE TWINS
BUILDING
'
P E R M I T
_
r
RECE O.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�7
�,6
i
j 7
= "1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
1
11/14/89
/ /
JOB ADDRESS 6122 Woody Iane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
2
Moore Lake
HMS.
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Strand 6122 Woody Lane N.E.
571^7289
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
D & D home Improvement Inc. 7401 Central Avenue N.E.
784-7543
4 ARCHITECT OR DESIGNER MAILADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION Ck ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install aluminum soffit
9 CHANGE OF USE FROM
TO
STIPULATIONS
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 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
$10179,
$
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
"59
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.
$29.00
_
PLAN CHECK FEE
TOTALFEE
_14
$29..59
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
BLDG )NSP
L f1 E
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
J
NEW [ ]
ADCN [ ]
AMER
R-1 AND R-2
Building di n Permit Application
Construction Address: ,� o
Legal Description:
Effective 5/1/88
Owner Name & Address: Tel. # `7
Contractor: J-� 0Vc r- Tel.
Address: —Ile) C-eAtn a PM AIF
Attach to this application, a Certificate of Survey of the
lot, with the proposed Construction drawn on it to scale.
IMMAR I MUM CF
LrMG AREA: Length Width Height Sq. Ft.
CRRAGE AREA: length _ Width Height Sq. Ft.
DDCR AREA: Iength Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot Ft. Yd Setback Side Yazd Setbacks
Type of Construction: %la, 5,n0E-or, Estimated Cost: $_ 2 2 I
Approx. Completion Date: rj
Proposed Driveway Width If New opening Is Desired:
Width + 6' See Back Page
DATE: `�- APPLICANT: Tel. # -7,3L7''72,15"/3
Permit Fee
State Surcharge $ ��
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Chane $
CM= USE Qi�LY
Fee Schedule cn Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by E Mineering
Necessary [ ] Not Necessary [ ]
SUBJECT
P
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF -
APPROVED BY
612-571-3450
910-F15
6/2/97
JOB ADDRESS 6122 Woody Lane NE
I LEGAL
LOT NO.
BLOCK
TR ACT OR ADDITION
SEE ATTACHED
DESCR.
3
2
Moore Lake Hills
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Clinton Strand 6122 Woody Lane NE
571-7289
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 O ALTERATION ❑R REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House
9 CHANGE OF USE FROM TO
STIPULATIONS
Install building wrap and have inspection
of same unless
manufacturer's specifications state it is not required.
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
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
$4,000
$2.00
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-
$87.25
Fire SC $4.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
T AL FEE
$93.25
SIGNATUREOF CON TRACTOR OR UTHORIZED AGENT (DATEI
I$ YQUR P�iMI
��.��PR�LYVAL�IEDTHIS
BV6G INSPF
/vI/)
DATE IF I
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/97
ADDN [ ) CITY OF FRIDLEY
ALTER [ ) SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: D a el/,v /-,I N e
Legal Description:
Owner Name &Address: Tel. # 52 f 7 a 81
Contractor: �-e%7C �l `s MN LICENSE#
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Tel. #
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 P Hgt/Ground Sq. Ft.
S of l,'Pq V lOV A
Driveway Curb Cut Width Needed:
DATE: — 177 APPLICANT:
Permit Fee $
Fire Surcharge $
State Surcharge $ ., 490
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ s
STIPULATIONS:
Ft. + 6 Ft =
Estimated Cost: $ 1/00 o
(Fee Schedule on Back)
Ft x $ = $
Tel. #
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$950 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 [ ]
O
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
August 1, 1997
Mr. Clinton Strand
6122 Woody Lane
Fridley MN 55432
Subject: Drainage Utility Easement
Dear Mr. Strand:
PW97-118
The City is proposing to install a second storm water line for Woody Lane. This line would extend across
Mrs. Nelson's property, dropping down at her retaining wall and then over a corner of your property to Mr.
Utter's property for the pipe's connection to the Central Avenue drainage system.
To install this line we request a 10 -foot drainage utility easement along the southerly back line of your
property.
Request you and your wife execute the attached drainage easement so that we may initiate a contract for
early installation of this additional storm water line.
If you need any additional information regarding this project, please contact me at 572-3550.
Sincerely yours,
e
John G. Flora
Director of Public Works
JGF:cz
Attachment
Easement
Individual(s) to Corporation(s)
or Partnership
No delinquent taxes and transfer entered; Certificate oFReal Estate Value
() filed ( ) not required
Certificate of Real Estate Value No.
19_
County Auditor
STATE DEED TAX DUE HEREON:
Date .1997
FOR VALUABLE CONSIDERATION, Clinton L. Strand and Mary A. Strand (husband & wife),
Grantor(s), hereby conveys an easement to The City of Fridley, Grantee, a Municipal corporation under the
laws of the State of Minnesota, real property in Anoka County, Minnesota, described as follows:
A permanent drainage and utility easement lying upon Grantor's real property legally described as Lot 3,
Block 2, Moore Lake Hills. The drainage and utility easement shall lie southerly and southeasterly of a line
being 10 feet northerly as measured at right angles to the southerly line of Lot 3, Block 2, Moore Lake Hills.
The City of Fridley hereby accepts this easement for drainage and utility purposes.
William A. Champa - City Clerk /I' -
Clinton
-
Subject to easements of record.
Clinton L. Strand
Mary A. Strand
STATE OF MINNESOTA )
)ss
County of Anoka )
The foregoing instrument was acknowledge before me this — day of , 1997, by
Clinton L. Strand and Mary A. Strand (husband & wife), Grantor(s).
Signature of Person Taking Acknowledgment
THIS INSTRUMENT WAS DRAFTED BY:
City of Fridley
6431 University Ave NE
Fridley, MN 55432
(612) 572-3550
� / l
o O /
-PROPOSED *
STORM SEWER HDPEPROPOSED
EASEMENT
—EX 12" CMP M H 1
TO BE ABANDONED \
/ CB1
EX CB
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
m Fridley, MPI 55432
a 763-572-3604 FAX 76'3-5711287
RuE CHEDU4E
,�gsldentlal
Furnace Shell and DUCt Work. Sumer &
also Replacement Furnace
Gas Piping (Near Furroce. Fireplace, Insert)
Fireplace Insert
Gas Range
coos - C0,5 %--j
Effective 4IV2004
APPLICATION FOR POWER PLANTS RND HEATING, COOLING, VENTILATION a
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES a
JOB ADDRESSFee IQW
Owner_
$35 -CO $ ff
$10.00 $
$15.1)0 $
$10.00 $
Gas Dryer $1o.00 S
*Air Conditioning -All Sizes $25.00 $ I Ui
Ali Other Repairs orAitera. dons (Liston Back)
} 1% of Value of Aotance or Work $
Lu Minimum Fee $15.00 for Residential or 5% of cost of
H Ireprovernent whichever is greater on work leas than $500.00
LL
o ution
Corn r iaUindustr7elf9ratital
1.25% of Value of Appliance or Work (List on Beck)
i� Minimum Fee $35.00 for GorrumercaVlndustriai/bmtltutional
State Surcharge$ ----0.'0
(if permit fee is over $1,000 muldply by .0005) O S o
TOTAL FEE $
*Air Conditioners cannot be placed inside yard without written approvei
from adoining properLY owner - Copy to City
8uildiingUsed As_ La@A�; X/
ESTIMATED Co S- T 74PERMIT N0
# of Beating Units_L_ Cirde One (Steam) (Hot Water) (Warm Ai
Trade Nam elr�P/�' Size No
BTU 70, HP __ � EDR
Fuel C - A Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
The undersigned hereby makes appy for a permit for the work herein
spewed agreeingto dao all work in strict accordance with the City Codes
and ruNngs of the Building Division, and hereby declaresthat all thefacts
and represendations stated in this application are true and correct.
HEATING 00_ / Oi i �/' //,+Z.f
SISI
Tel # ��
FAX # Date
Fox
FILL dUl' BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Rough -in Dale Frial Date
Approved by
FROM :KRINKIE
1b; 4Y
FAX NO. :6514894022 May. 02 2005 10:57AM P2
k -iii ur rmiuk-L-i
FROM :KRINKIE FAX NO. :65148$4022 May. 02 2005 10:57AM P3
r ,
£0'd 7ti101
FILL IN COMPLETELY FOR RI;PLAtit_A11t=N t ru�v tavRr��••"' •'•+
'-•'•••.••........... _
COM VENT. VENT C N CTOR AND COMTUSTtaN AtR VERiFiCATl4L
natq. the undersigned hereby verifies that the
When rept _ nn eXi
venting has been examined and is free from rust, deterioration, obstructions.
Yes lata )
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets all current codes and manufacturer
number of elbows and termination.
Yes Not }
specifications including sizing, "th,
The undersigned also verifies that the replacement unit is a listed assembly
TNs wes
and meets the current codes ural Furnace Ventinnufacturees g Tabs � {eations.
Include AGA.GAMA Category
Yes)< No( )
assisted and natural draft appliances.
TheSill o Horeb ie r is sized and Installed to meet the current codes
Ye No()
and manufacture's specifications.
When rewired to I a new co tion air.it will be sized and installed
Yes No ( }
to meet the current codes and manufacturer's specifications.
When inVIII Q a nod ventai R SVStA111, the undersigned hereby verifies that
It is a Usted assembly and meets the current codes and manufacturees
speacations. This does include AGA-GAMA Cat0gory I Central Furnace Yes No( )
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed Owectly aftw
an appliance has been removed from the common vent and vented Yesy) No
separately as per current codes. ii
Appliance 01 Type A f. BTU tnput Fan Assisted or Nat
Appliance #2 Type . Y BTU Input Fan Assisted or Nat _ o
Appliance #3 Type aU Input Fan Assisted or Not _
Total Appliances Trial Btu input 7�j
Common Vent type Vent Height Diameter inches
Appliance #1 Vent Connector Height ! ft Length t Diameter in Type
Appliance 92 Vent Connector Height ft Length _ €t Diameter in Type _ --
Appliance #3 Vent Connector Height _ ft Length . ft Diameter in Type
P r _ — �--- k- v4, A,– - G .1C+ ^ 11%],N � ViLW Aec
it
t7Vri?I.A -in 1 1 TI
Pb! QT CVJP*P-RP->4,4H
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
DAKDAL 2 200
CITY OF FRIDLEY
DATE YOUR E-MAIL ADDRESS r � C" l I
SITE ADDRESS
THIS APPLICANT IS: , OWNER ❑CONTRACTOR
PROPERTY
NAME:f
ADDRESS: CITY r-1 el STA ZIP�a
TENANT
77
PHONE: — LJ
CONTRACTOR
NAME: '— _E r) Ot L
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE—ZIP-
TATEZIPLICENSE
LICENSEWITH
PHONE FAX
APPLICATION
PERMIT TYPE
016INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW h6PLACFMENT
TYPE OF WORK:
DETAILED DESCRIPTION OF WORKL� (, f C- S
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS SHOWER _ WATER PIPING
_ _FLOOR _
GAS PIPING mw ciarrrcEmk) SWIMMING POOL _ WATER SOFTNER ($35)
—BATHTUB _ _
CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
_ _ _
—DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge T 50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
State Surcharge = $ 50
Total = $oo
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of 11 w r i %hiequires review and approval of pians.. 7
�!
SIGNATURE OF APPLICANT PRINT NAME c�T1 CQ DATE
_ ®. 1 9 ®- _.. 'I F.1010 IM490.111VIX r > �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
13 Wading
BUILDING
Permit W0--'ZfAhAX10
Inspections
RESIDENTIAL APPLICATION
jived BY:
763-572-3604
9 See Back Page for Fee Schedule
CITY OF FRIIDI,,Li Y
Date U 0 2
763-502-4977 FAX
Fire Surcharge
$ .001 times the total job valuation
Surcharge
$
EFFEC[IVB I-1-09
Lige Surcharge
DATE TI Z.C�lC�1
YOUR Ub1AIE AUUltESS i
srm ADDRFSS [
t R) fie cP %`I- E -
$2000 per SAC Unit (Plans to MOdCC for determination)
THtS APPLICANT IS:
D OWNER t51CONTRACTOR
ft + 6 ft = fix $21 = $_
PROPERTY OWNER/
NAS
— - S450 Conservations Pian Review
TENANT
ADDRESS: Q _ CITY
STAVE 23P_
Suwrrer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
CONTRACTOR
NAMF
J)0Make checks payable to: Elft' of Fr1t Attu&
STATE LICENS sL Y-1 EXP DATE
3 —2—o 1�
YOUR STATE LICENSE
AND C159TWICATE OF
,
ADOPESS: g) t � :X&rrvez A XG cn y
STATF,�%S TPMaw
INSURANCE
PHONE 7j�C.) 0 FAx 2
PROPERTY TYPE
IZE_0
Q SINGLE FAMILYlI&V CONSTRUCTION SUE-
0TWO I:AMLY/NEW CONSTRUCTION STORIES
PER1W T1 M
0 ADDI'T'ION 0 GaA"GEISHM LI VANDOWS
A BASEMMNT FINISH W ROOF 0 DRAIN TILE
❑ DECK 0 SWING E3 OTHER
❑ SWDAMF rr POOL
TYPE OF WORK:
0 NEW HOME CONS tTtUCTION ❑ ADDITION
QS MAINTENANCFAMPAIR I] REMODELING
mcpjw wow BnNa ooN - `r
SIZE OF IMpROVENOW
LENGTH T1I HEIGHT �
WIMMHOUSE ONLY
'NUMBER OI: SQUA.R]ES , O ROUSE & GARAGE
RASEM q4r REMODELING SC1T =
i Existing
Floor Flan
❑ ATTACHED GARAGE
2. Proposed floor plan
MOP�OSED SIZE:
0 DETACHM UATiAGE
3. Liu of somewral mambas to he used
PROPOSED HEIGHT-.
FOR NEW C;UNS'1'RTICI'IOTI IAICLUDINt3 IyP.CICS,
SWINGPok
ADD
D acyl
MOM
1. Sita PlanlSurvcy strowing fico eatfstin8 ao ttecures
13RlumIDm
Q Trim
and DwPosed inoied.
0011=
CI Fascia
2. Two sm ofev anxt+on plan
wl+ MMWS
3. Energy
CalcdMi0M
IN EXISTING OPENINGS CYea ONO LOCATION OF MDO WS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF — -
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FZ09 ARE BASED ON `V'ALUATION, lNCLUDINGr THE COST OF L"OR AND MATERLAM
SING U.B.0 FEE SCHEDULE)
`D'I'AL SOB VALUATION $
b r� Cp TYPE
Permit Fee
$
9 See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ .001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Nlinimure $.50
Lige Surcharge
$
$5.00 (State LicensW Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MOdCC for determination)
Curb Cut fAcrow
$
ft + 6 ft = fix $21 = $_
Erosion Contml
$
— - S450 Conservations Pian Review
Park Fee
$
Fee Determined by Engineering
Suwrrer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due y
$
J)0Make checks payable to: Elft' of Fr1t Attu&
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I soknow ledge that the Information ahnve is complete and acauraW that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Mimesota Construction Codes; that I 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 rwott will be in accurdance with the
approved plan in the case of all corkwho requires review and approval of plats.
SIGNATURE OF AI PL.ICANT
Wb' b4:9£:04 600Z/9/L :a;ea £2 :abed O£££96Z£9L :ula-1
1
Building
BUILDING
Permit rto. _`_Qg
Inspections
RESIDENTIAL APPLICATION
Received By:_
763-5
CITY OF FRIDLEY
_*72-3604
Da 1'
DATE �✓� 1 Z- b
YOUR E-MAIL ADDRESS 5 P i rSon l� Citorr� /oi0 �9C �Gt f
� Xc! 'recf •m».►
SITEADDRESS , w7 -z wcodsj %_ay
THIS APPLICANT IS:
❑ OWNER `CONTRACTOR
PROPERTY OWNER/
NAME: W1Qr %j P t nr S+t'..4✓ d
TENANT
ADDRESS: (V t ZZ RDOG{ tit (. J� CITY FrscI l -e_�2
STATHk I%LIP. SSL 3 Z
PHONE: (7&3) $?
CONTRACTOR
NAME: ry l` W `; O w 60,
SUBMIT A COPY OF
STATE LICENSE # ZO �i�; R i0? Z EXP DATE 0311 Z
YOUR STATE LICENSE
ADDRESS: 100 E}w�X WCl JA/ CITYJII$tAJ ,e STATIJ*4IP 5
WITH APPLICATION
PHONE FAX ?toll 51
PROPERTY TYPE
J11 INGLE F /NEW CONSTRUCTION SIZE
p TWO AMIJ,Y/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ADDITION ❑ GARAGE/SHED
fVINDOWS
❑ BASEMENT FINISH ❑ ROOF DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR REMODELING
DESCRIBE WORK. BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
I5 HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE 1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE 2•
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
❑ Vinyl
FOR NEW CONSTRUCTION INCLUDING DECKS, -
❑Soffit
❑ Aluminum
❑Other
ADDITIONS
❑Trim I .
& PORCHES -SUBMIT; '
Site Plan/Survey showing the existing structures
❑ Fascia
and proposed project
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGSYes ❑No LOCATION OF WINDOWS 3.
Energy Calculations
OR FOR NEW OPENINGS- ESCRIBE SIZE OF,
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OFWINDOWS
AT.T.T'iVIWQ ADL`IDA
QT.T1tJ'ArTiAm 1 r __ __O
• -- _ �_.. �... . ,.., .,iV -1-11 A 1-N9 UNCLU JUNG HE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ,,'3®k 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
$
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)
$1675 per SAC Unit (Plans to MWCC for determination)
-ft +6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinanc and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicatio f r a pe 't and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w h requ' review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME ICO$-�� DATE_
FM