PRE 2010 DOCSVM Fr
ae o f $dle Minn.
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RHJHHMING PERMIT
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Office of INSPECTOR OF BUILDINGS
Owner
Architect Fridley, Minn., 19,
Builder
LOCATION OF BUILDING
No. � Street = Part of Lot
Lot Block Addition or Sub -Division
1
DESCRIPTION OF BUILDING
Front '� "- Depthl_,�"" ��, Height__f?_' Stories ` , �'-•_Manner of Construction -,,,"4'
To be used as To be completed >, "''estimated Cost
yY y r P ••
Permit is hereby granted to {� to
the building' described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the 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.
Inspector of Buildings.
�J
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I3 hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
tea-- r
�. "orf` r .., ,e n'".."�y 7A -''"' ,.-� '' ,' , �,.n., •.....-'s,.
Subscribpd and Sworn to before me at Fridley,
day of 2 A.D. 19 `
I
Minnesota,' Ws o
cr 11-711
Village of Fridley, Minn.
BUILDING PERMIT
Date: h .... .....�........ ............
Owner a ........... �.
Address.�......`
N? 1845
�p
Builder............................................
Address.............................................
�!W!
ON OF BUILDING
No.'s? J... Street .... ................... Part of Lot ..............
Lot ...... .... Block ........... :?77Addition or Sub -Division .......�
,y
Corner Lot ...V....... Inside Lot ........... Setback ........... Sideyard .............................
DESCRIPTION OF BUILDING
To be Used as:
....... I ......... I... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
..................... Front ........ Depth ........ Height ...... Sq. Ft. ........ Cu. Ft. ........
a
Type of Construction .................. Est. Cost .... ...... To be Completed ..................
"06 611.IsC".1
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
e proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
In consideration of the payment of a fee of $..', permit is hereby granted to 5..z,
......................... 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 with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. �/
:.��......... ....... 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.
Application for Power Plants and.Heating. Cooling, Ventilation, .Refriesration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII. 4-7470
GRAVITY WARM AIR: RATE TOTAL, Location @ i
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ................. City of Fridley: ......... 5.00 $
The undersigned hereby makes application for a permit for the work herein
Repairs & Alterations—up to $500.00 .................. 5.00 $ specified, agreeing to do all work in strict accordance with the City Ordinances
Repairs & Alterations each add. $500.00 2.50 $ and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
,r
each add. 60,000 BTU .... . ................. .
Replacement of Furnace .............................
Repairs & Alterations up to $500.00 .................
Repairs & Alterations each add. $500.00 .......:..... .
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam_ ......
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
Each add. 200 sq. ft. EDR Steam ......................
Each add. 320 sq. ft. EDR Hot Water ..................
8.00
$
2.00
$
0.00
$
5.00
$
2.50
$
Owner
Kind o.
Used as a
To be completed about
8.00 $ Estimated Cost $
8.00 $ Old—New. Building Permit No. Permit No.
2.50 $
2.50 $
DESCRIPTION OF WORD'
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
_J
1st 3 Fixtures x $1.50 $T�
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE
ROUGH
FINAL
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Size No.
67c
N'
Capacity Sq. Ft. E.D.R BTUZL 62 6) H.P.
Total Connected Load Kind of FueL ell 4_2
BURNER — Trade Names. ` Size No
Capacity Sq. Ft. E.D.R BTU H P.
(REMARKS -OVER)
By
42 2M 7-59 Business Phone No's
IM6 az
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E, Construction No.
Guide
ndows( oors Reference Out. Wall Int. Wall Ceiling Roof Floor
s No Yes N,o 19—.
Fl.I -/ � ;A" Room I Length 9Y- (0 Width Height II Fl.l
Windows and Doors—Crackage and Area
Width Height
No. of pane of pane
No. of Lineal ft. Area
lights of crack sq. ft.
tea V
I/ � �3
Coef. Btu
Infiltration
Glass
Exp. wall 4
Coef. Btu
Infiltration
Infiltration
Int. wall
ti
Glass
Floor
Exp. wall
Exp. wall
Net exp. wall
Net exp. wall
Exp, wall
Int. wall
Ceiling'4'''°'
Floor
Floor
Int. wall
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.I �5 � .1 Room I I.anath ,'V Wirlth 14.;.ht F `
Windows and Doors—Crackage and Area
WidthH eight No. of Lineal ft. Area
No. of pane of pane light's of crack eq. ft.
Area
sq. ft.
T3 77-
I/ � �3
Coef. Btu
Infiltration
Glass
Exp. wall 4
Net exp. wall
Infiltration
Int. wall
ti
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI -I 7)/ o 6,10 Room I Lenath / "®F ° Width / k I? ° Heiaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft.
No. of Dane of pane lights of crack
Area
sq. ft.
T3 77-
I/ � �3
Infiltration
Glass
Exp. wall
Coef. Btu
Infiltration
Infiltration
ti
Floor
Glass
Glass
Exp. wall
Net exp. wall
c �A
Exp, wall
Int. wall
Ceiling
Net exp. wall
Floor
1 btal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I
FRIDLEY, MINN.
Insulation
How Applied
Room I Lenath /A I Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft.
No. of pane of Dane lights of crack
Area
sq. ft.
T3 77-
I/ � �3
Infiltration
Glass
Exp. wall
Coef. Btu
Coef. Btu
Infiltration
ti
Floor
Glass
Glass
Exp. wall
Exp, wall
Net exp. wall
Net exp. wall
Inc. wall
Int. wall
Floor
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1 IL'4 P, r, . c mt IZMM I I PPnath �` I '^ WrIth 7" 14a abt
Windows and Doors—Crackage and Area
Width Height No. ofLineal
No. of pane of pane lights
ft. Area
of crack eq. ft.
�
Infiltration
Glass
Exp. wall
Coef. Btu
Infiltration
Int. wall
Ceiling
ti
Floor
Glass
Exp. wall
Net exp. wall
Inc. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
F1.I Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane Of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
ti
Floor
1 otal Btu. 1
Required sq. ft. E.D.R. or so. ins. WA. Leader area
City of Fridley, .Minn.
BUILDING PERMIT
Date:
Owner:
Address
LO IQ N BUILDING
No ,_....: Street ....._ .a,:...�....._...........__.._.......... Part;o.. _.. _....._.
Lot .._...:t.i .... ..... Block ....._... _p......--..-:. Addition or Sub -Division ..-....°.a'4��....:._......----..._._....._. _
Corner Lot
---------- inside Lot ............................ _........ Setback ............. _.:.................. .....: Side' d .............. -........... .----_.....__...._._......_. ..............
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING.
To be.%sgil as:
rid ys m
,r'! �.. Cu. Ft.
.... Front ---_ Depth .:.:: ..._.. Height .at' .. -----..... Sq. Ft.. _
_.:............................ :... ........ rol Depth -=:.. eight Sq. Ft. ..... _............. L, Cu. Ft. ..... _.................
Type of Construction ��..' ..... Est Co 4 V......................---... To be Completed ....._ ............._.._........._.
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $. ..... ._..............., 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, repaiiF Viand moving of buildings
within the city limits and this permit may be revoked at any time.,,u n olation of y of the provisions of said
ordinances. ',eti
Inspector
NOTICE:
This permit does not cover the construction, installation for wiring,, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
T,
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name,;,_ Builders -�
1
Address�Address
LOCATION OF BUILDING
i
No. S IFl Street :2, >1 r Part of Lot
Tot Block. Addition or Sub.Div.
Corner Lot__/�,_Inside Lot Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as: ®�a
e� Front f Depths Height
S. Ft, Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft,
Type of Construction �„ Estimated Cost
To be completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and represents -
tions stated in this application are true and correct.
DATE _ 0 SIGNATURE r`
y A� �r111 1 x.11
(A Schedule of Fee costs can be found on the Reverse Side.)
SUBJECT
PE
City of Fridley
2 o g 0 7
P,AT THE TOP OF THE TWINS
B U I L I N G P R I T
1
_ COMMUNITY DEVELOPMENT DIV.
AO PROTECTIVE INSPECTION SEC.
�b 7P
r ; ;
CITY HALL FRIDLEY 55432
!"'""ilk"
NUMBER
REV.
DATE
PAGE Of
APPROVED BY
612-571-3450
910-F15
7/1/91
JOB ADDRESS 5851 - 21-2 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
30
22.
Hyde Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jeanet Leader 21324 Lake George Dr., Cedar MN 55011 753-2054
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
IRNK17AMEN Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION jJ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Reroof Garage; Reside House
9 CHANGE OF USE FROM TO
STIPULATIONS
Un all new
roofs or
State Code tear -offs and
re replacement
P cement roofs,
mopped to Quires that 2 layers
of
UP from a tether, he installed to 15 16. felt,
xterior
approved wall tine, or thea Point 24 inches
anderlayment
Membrane. use of other
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
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 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$5, 5OO
$2.75
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$89,25
,iGNATURE OF CONTRACTOR OR AiIHORi2ED AGENT IDATEi
WHEN PROPERLY V THIS IS YOUR PERMIT
TTED
BLDG WSP NA E
SIGNATURE OF OWNER WAY R BUILDERI I A EI
Mu [ l
ADrV [ ]
AL's [ l
Owner Name & Address: t
Effective 1/1/91
R-1 AND R-2
Building Permit Application l
Z®7 3 C) Ane �
Attach to this application, a Mrtificate of Survey of the
lot, with the proposed omwtruction drawn on it to scale.
nIF ctam CW T11 C I FVE24M
LTVM AM: l e x th Width Height Sq. Ft.
GAPUAM AM: Length Width Height Sq. Ft.
DECK ARF1si: Length Width Hgt/ Sq. Ft.
07MM: V e V 5 q rq W -- -7 parrs- At
Conjer lot Inside- Setbacks
�.- •., _ ._
Approx. Ccupletion Date:
Prcposed Driveway Width If New Is Desired: Ft.
/U `/5
Page
APMOM: /�
Permit Fee
$� �®
Fire Surdmrge
$ SGS
State Surcharge
$ . 70
SAC Q=Ve
$
Driveway Escrow
$
Park Fee
$
Sewer Main OnMe $
$ CrS_
STIPUTATIMS:
L
Fee Schedule on Reverse Side
.001 x Permit Valuation (1/10th $)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ l Not Nary [
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
I MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS
New Fixtures $7.00 The undersigned hereby makes application fora permit for the work herein
Old Opening, Now Fixture $ 4= specified agreeing to do all work In strict accordance with the city codes
Beer Dispenser $5.00 and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin $7.00 and representations stated In this application are true and correct.
Catch Basin $7.00
Rain Water Leader $7.00
Sump/Receiving Tank $7.00
Water Treating Appliance $10.00 Owner 6
Water Heater —Electric $7.00
Water Heater — Gas $10.00 Building Used As _4/6Aj
Gas Range $10.00
Gas Dryer $10.00 Estimated Cost PERMIT NO. 7)
Back Flow Preventer Required )Yes O No
Type -$5.00 PLUMBING COMPANY
Reinspection Fee $30.00 SIGNED BYe,,*e,�', 4j s� � TEL NO.�
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
Approved By Rough—in Date Final Date
�c
A
State Surcharge $ so
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
TOTAL FEE PLUS THE $.50 STATE SURCHARGE
Urinal
Shower
Wash
Tray
A.........
r
Drain
Auto.
Washer
Gas
Range . . . . . . . . . . . . . . . . . . . . . . .
Water Heater
Gas Elec
Stories
Basement
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS
New Fixtures $7.00 The undersigned hereby makes application fora permit for the work herein
Old Opening, Now Fixture $ 4= specified agreeing to do all work In strict accordance with the city codes
Beer Dispenser $5.00 and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin $7.00 and representations stated In this application are true and correct.
Catch Basin $7.00
Rain Water Leader $7.00
Sump/Receiving Tank $7.00
Water Treating Appliance $10.00 Owner 6
Water Heater —Electric $7.00
Water Heater — Gas $10.00 Building Used As _4/6Aj
Gas Range $10.00
Gas Dryer $10.00 Estimated Cost PERMIT NO. 7)
Back Flow Preventer Required )Yes O No
Type -$5.00 PLUMBING COMPANY
Reinspection Fee $30.00 SIGNED BYe,,*e,�', 4j s� � TEL NO.�
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
Approved By Rough—in Date Final Date
�c
A
State Surcharge $ so
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
TOTAL FEE PLUS THE $.50 STATE SURCHARGE
1.11 T Vh' r-MIULCT IINOrtk.I IVIN UIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
tnecuve Un January 1, 1993
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
JOB ADDRESS 5WSl Z �Z. 5 Alf
New Fixtures
$ 7.00
The undersigned hereby makes application for a perm it for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7,00
and representations stated in this application are true and correct.
Catch Basin
Rain Water Leader
$ 7.00
$ 7.00
Z6 199
Sump/Receiving Tank
$ 7.00
)
Water Treating Appliance
$10.00
Owner 14,s,0i2Evj /7 C,.F&y60!
Water Heater —Electric
$ 7.00
Water Heater — Gas �`
$10.00®rte
Building Used As %��✓G
Gas Range
$10.00
a
Gas Dryer
$10.00
Estimated Cost PERMIT NO,
Back Flow Preventer Required ( )Yes () No
Type
-$5.00
PLUMBING COMPANY 0Et%W'6!.
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
SIGNED
N
TEL N0.
Approved By Rough—In Date Final Date
$ .50 fl
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
$ 15.5® PLUS THE $.50 STATE SURCHARGE J�� 9
SUBJECT
PERMIT NO,__....__.,.
City ®f Fridley
2 2 91
AT THE TOP OF THE TWINS
BUILDING PERMIT
i 9
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
ti'------- PROTECTIVE INSPECTION SEC.
*a259
"6 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
1/27/94
JOB ADDRESS 585: 212 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
31 30
n. 22
Hyde Park SHEET
2 PROPERTY OWNER MAIL ADDRESS - ZIP PHONE
Alvin I-iogenson 5851 2� Street 10 571-3601
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Dale Cole Construction 6452 Bluebird Circle, Maple Grove MN 55369 559-2045
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 X ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Interior alterations and add bay window
9 CHANGE OF USE FROM TO
STIPULATIONS
See stipulations on plan,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
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
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$5f Q00
$2.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$72,00
Fire SC $5.00.
STRUCTION OR PE OR ANC OF CONSTRUCTION.
PLAN CHECK FEE
License SC $5.00
TOTALFEE
$84,50
q `
i?I 7-7
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
WHEN PROPS Y VALIDATED THIS IS YOUR PERMIT
-I�-9�
B DG )NSP
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW []
ADDN J1 ] CITY OF FRIDLEY
ALTER [ ]. SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
s T,
Construction Address:
Legal Description:
�/� 6 %
%7/
Owner Name & Address:
% PI`N %�6 I+f aN
j-1
_
a s Tel. #
Effective 1/1/94
Contractor: G� �? MN LICENSE #
Address: Tel. # ��t
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER: /l9
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Comer Lot N Inside Lot [ ] Ft. Y/- ,SSetback Side Yard Setbacks
Type of Construction: �, ,�� Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft. = Ft x $ _ $
DATE: ) - 2 d. -. 1y APPLICANT:��
CITY USE ONLY
~ Permit Fee $ �; °' Fee Schedule on Reverse Side
Fire Surcharge $ ;r .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $800 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:
SUBJECT
E
City of Fridley
Q�
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
R NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC
&
r
CITY HALL FRIDLEY 55432
".'
NUMBER
REY
DATE
PAGE OF
APPROVED BV
612-571-3450
910-F15
4/12/9
/ /
JOB ADDRESS
5851 Z 1/2 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
30
22
1 Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Andrew Ha enson 5851 2 1/2 Street NE
571-3601
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Dale Cole Construction 6452 Bluebird Cir Maple Grove MN 559-2045 6907
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
X
B DESCRIBE WORK
Reroof House 8 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
$640
$.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-
26.50
Fire SC $.64
STRUCTION OR E PE FORMAN E OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
' --
License
SC $5.00
$32.64
SIGNATURE OF CONTRACTOFLOR AUTHORIZED AGENT IDATEI
WHEN PROPE ALIDATED THIS IS Y ngUp-RAPERMIT
SIGNATURE OF OWNER I IF OWNER BUILDERI IDATEI
BLW INSP
f�A TE
NEW [ ] Effective 3/1/96
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name & Address: Tel. # S
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 Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback
Type of Construction:
Approx. Completion Date: L
Side Yard Setbacks
Estimated Cost: $.,...1
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + Ft = Ft x $ _ $
DATE: - IA APPLICANT:
_ Tel. #�%�
CITY USE ONLY
Permit Fee
$ ��-. S �\
Fee Schedule on Reverse Side
Fire Surcharge
$ 6
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$ , S—('
$.50/$1,000 Valuation
SAC Charge
$
$900 per SAC Unit
License Surcharge
$ . UD
$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:
- -
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit#
Residential Application
City of Fridley
See Back Side For Required Information
Date — aM Site Address: 151-A5 I Q a E YL)
The applicant is: (cirlce one)
Owner on ractor
Property Owner: J M
-64C
Address:
City:
State: A aJ Zip:
Phone: o -�-
Cell: Fax:
Contractor Information
Company Name: Rivar
CRY Sheet Metal, Inc.
Contact Person:
-B St o Suite 39 S �!
Address:
hAhl 55A3
City:
to e:
Phone: (763) 7 199 Fax Fax:
Email:
MN Bond# & Exp Date
Type of Work (circle one):
New a laceme Alteration/Remodel
Detailed Desc ' ion of work:
1e
Equipment Installed: MFG:
Model:&j� Size/BTU:
MFG:
Mode1:6976 Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas Grill $10.00
A/C $25.00
Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Air to Air exchanger $15.00
n—'umace $35.00 _Pool Heater $35.00
_Boiler $35.00
_Gas Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00
_Gas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $ 35-606 (Total from above -Minimum fee $35.00)
Surcharge $
0.50
Total Due $
d Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical 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 case of all work which requires review and approval of pians.
Signature of Applicant: d"-2 Date:
Approval Inspector Signature: Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. ]MC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a_ Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
From: unknown Page: 112 Date: 7/28/2008.8:54:01 AM
Building
$
BUILDING
Plan Review
$
Jhspcc ions
Fire Surcharge
RESIDENTIAL APPLICATION
m I, ' .001 times the total job valuation
Received 13y
763-572-3604
1,05 .0005 x Permit Valuation Minimum $.50
CITY OF FRIDLEY
$
n 0
763-502 -4977 FAX
$
$1825 per SAC Unit (Plans to IvIWCC for determination)
Curb Cut Escrow
$
A * 6 ft = ft x $21= S. ,^
EFFE v� I -I -os
$
$450 Conservation Plan Review
DATE r ''
YOUR E-MAIL ADDRESS to on G4X a
SIZE ADUMS
Sewer main Charge
$
THIS APPLICANT IS: ❑ OWNER 91CONTRA.CTOR
Tatal Doe
PROPERTY OWNEI!/
NAM --V eL If @ .e IM 6L h
ADDRESS: J.1. f I CITY �
PHONE: '-- W 7 - ;L&1'9
STATE ZiP�
TENANT
Nom: e At/s
CONTRACTOR
ADDRESS: L++ .� c1TY O
3TATIr�IP
SUBMIT A COPY OF
PONE - FAX
YOUR STATE LICENSE
STATE LICENSE # `, 0 S" +C! _ . . EXP DATE
i
PROPERTY TYPE
❑ SINGLE FAMILYINEW CONSTRUCTION SIZE
❑ TWO FAMILYINEW CONSTRUCTION STORIES
PIS' EMIT TYPE
❑ ADDITI N O c3ARA4Sm 0 WINDOWS
❑ BASEMENT FINISH 9 ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING FOOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
Q M�ANCkJMAIR Q REMODELING
DESCR113B WORK BITING DONE: a C, i^
SIZE OF OVEIv1ENT
LENGTH WIDTH HEIGHT AFT
/
❑HOUSE ONLY
BASEMENT
REM PUMSUBIVIIT-
NUMBER OF SQUARES i
IF HOUSE & GARAGE
1,
Existing floor Plan
❑ ATTACHED GARAGE
2.
Ptoposed floor pian
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUC'T'ION INCLUDING DECKS,
D Alumirnam
❑Soffit
0 0=Tft
ADDITIONS_
1.
& PORCHES SUBMIT:
Site 'Plan/Sumey &owing the existing stntaturms
C3 Other
tl l:asda.
2.
and proposed pmpjeot
Two seta of construction plane
zzmaw
3.
Energy Calculations
IN EXISTING OF"GS ❑Yes LINO LOCATION OF WINDOWS
OR FOR NEW OFENiNGS-DFBC UBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW 7-0 BL' iNSTALLFD NUMBER OF WINDOWS
AIJ, FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND iVJA ERIAL5:
u � ,(USWF TUE 1997 UAC FET SCHEDULE)
Permit Fee
$
-a See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
m I, ' .001 times the total job valuation
Surcharge
$
1,05 .0005 x Permit Valuation Minimum $.50
License Surcharge
$
5, 0 $5.00 (State Licensed Residential Contractoxs)
SAC Charge
$
$1825 per SAC Unit (Plans to IvIWCC for determination)
Curb Cut Escrow
$
A * 6 ft = ft x $21= S. ,^
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Deteriniined by Engineering
Sewer main Charge
$
Agreement necessary ( ) Non Necessary ( )
Tatal Doe
$
Li, e 1111 Make cheelks voyable to: City of Fridley Attscit__ ulatiotas
TATS 1S AN APPLICATION FOR A PE UU-NOT VALID UNTIL FROCESS.ED
I hereby apply for a building pmrmh and r acknowledge that the iefbnaefion above is complete and scomte; that the work will be in aonrirtmance with tha ordh=oes and codes
of the City of Fridley and with the Mirmm�o • ConstrucW* Coder illatt. I unden,tand tbb Is not a permit but only an mpplieatioo for a pa wit and work is not to smrtr10
a
permit on s* that the work will be in c N a w t n the case of all work which requires review and approval of laps. I1
SIGNATURE OF APPLICANT PRINT NAME Ic t X11 �{.Y cC �t1 S Q FYI DA E /
APPROVED BY DATE