PRE 2010 DOCSCity Fridley, of Fy, Minn. i
e
BUILDING PERMIT N° 4427
Date:....._.....:...1_........ 0.--......_...- ..... ... ..............
Owner: ..-- . ----- / ---'•`•.r[.° ---------------- Builder ..........&g!::t ..-............_.._........._........ _._....
Address V/ ( (.................................P r
.._..... ....... .. _.�..,........ Address....._...................... I. ............ _-------------._......._......._...----_...---..
.----L . Q -•---.TION OF BUILDING
No. Street .- .mss ---.... ---A.................................... Part of Lot ....._........................ -------•---------q---------.._.. ...........
_
Lot ........f ................... Block ....................................... Addition or Sub -Division �F
107
Corner Lot .._.__ .......................... Inssi Lot .......... ..... Setback .. .................. Si eyard .._...._/ 4��.............---.........................------....
Sewer Elevation ..........-.---?----.-.----7�............. ................ ................... -..-- Foundation Elevation -- 47.677,-
DESCRIPTION OF BUILDING
To be Used e
_.. ............_..._ Front _./_......... Depth ..... Height-.�.... Sq. Ft.9 Cu. Ft./FO
_.._.._........................_........................ Front .................... Depth . _... ........... _.. Height ...._._....._ Sq. Ft. ....................._. Cu. Ft.........................
: � ...
Type of Construction......................... ........... ...... Est. Cost ... �.. 11- .. -... To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree tty do
the proposed work in accordance with the description above set foi h compliance wl 'pr W 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, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon viola of any of theprovisions of said
ordinances. Oil
Inspector
1
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
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Budder _
Address!. Address
/
LOCATION OF BUILDING
No. /�® Street '-9�J , �� Part of ,Lot
Lot zz Block Addition or Sub.Div.
Corner Lot. Inside LotSet Back. tea- Side-Yard_��
�» �y♦ �
SEWER ELEVATION FOUNDATION ELEVATION21� / cS
s ;� -
Applicant attach to this form Certificate of Survey of Lot and.proposed building
locatioU Sa Y5647 DESCRIPTION OF BUILDING •_ __.•,-_
To be used as:
Front Depth G Height
Sq. Ft. Z� ® 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 a�-the facts and representa-
tions 'stated' in his application :are true and corre'`
o �.
(A.Sehedul.e of Fee costs can be found on the Reverse Side.).
. a0 40
c� City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK Location
Number, Sind and Location of Fixtures
• Future Connection OpeningsI uonnecien witn
New Fixture, Old Openings Sewer E]
cesspool rl
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50
Future Fixture Opening ................ x 120
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25
Water Heater (Up to 200,000 BTT) ...... Z x 2.00 4O
New Ground Run Old Bldg . ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ e2
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE • •5�2
City of Fridley:
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 representations stated in this application are true and correct.
Fridley,. 1990
a
Owner % �tic1 19
Kind of Building - 19
Usedas �X o
To be completed about
Estimated Cost, $
Old—New. Building Permit No 5`
47
Sign
Business o
Connection Permit No . .......................................................
Water
v
FEB 19 1960 ��� Sewer
Meter Deposit
V9
i l 1 -8-58
WATER HTR.
VI
S U1
o�
LLo
U
$m
�a
�i
F
N GAS ELEG
a
a3
t�4c
(90
Base
/
1st
2nd
3rd
4th
• Future Connection OpeningsI uonnecien witn
New Fixture, Old Openings Sewer E]
cesspool rl
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50
Future Fixture Opening ................ x 120
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25
Water Heater (Up to 200,000 BTT) ...... Z x 2.00 4O
New Ground Run Old Bldg . ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ e2
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE • •5�2
City of Fridley:
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 representations stated in this application are true and correct.
Fridley,. 1990
a
Owner % �tic1 19
Kind of Building - 19
Usedas �X o
To be completed about
Estimated Cost, $
Old—New. Building Permit No 5`
47
Sign
Business o
Connection Permit No . .......................................................
Water
v
FEB 19 1960 ��� Sewer
Meter Deposit
V9
i l 1 -8-58
op -
Application for Power Pimts and Heating, Ging, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ FS el C�
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
AM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
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
1st 3 Fixtures ...................... x $1.50 $�
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 $
Dept. of Bldgs. Phone SII 4-7470 �Q
Lneafinn 6 / &6 — 6 ` �`-
City of Fridley:
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 representations stated in this application are true and correct.
'dley, 19�
LZOwner _s _��`�z�_� 1� 195_
Kind of Building �� �l a' A 195—
Used as ✓ ?r��=_
To be completed about
Estimated Cost, $
Old—New. Building Permit No.
i
DESCRIPTION OF WORK
HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No
r �
Trade Name— Size No
Capacity S f-" Sq. Ft. E.D.R� BTU H.P.
Total Connected LoadKind of Fuel
e
BURNER — Trade Name Size No
Capacity.
REMARKS:
11 POST IM -12-58
Sq. Ft. E.D.R BTU H.P.
Sign `
By
Business Phone No
Y
Ali ,..�►.. `_
DEAT LOSS CALCULATI .. PIPARTM T 0 B3� ILPQNGS
Weatherstrips .. Conamction No.
S Cc 1i S -T �_;D.
Plato .lym MINN.
Insulation
s s
Reference Out. Wall Int. Wall t ening Ron¢ F1�r i Ibaw
3E box
FI. Room Length 9 S Width I-Z�! height RS F1.0 L>,Eb Roomt LA l- ®VkM
Windows and yrs----Crackage and Area _ Windows and Door-Crotkap and Arta
Width NiTg6t No. of lasal f Arno ®Vldth Height No. oQ peal t. firms
t, of pane of pane Ilghte of crock oc9 ft. Ne. of pane of pane llghtc eQcrt,ok rL
Z. 3z zz PA ?, - -24 1 ?L. 1 -3 Z� I Z 2.
Total Btu. I 9
Required sq. ft. E.D.R. or sq. ios. W.A. Uader area
Fl.I War. h a -i Room I Length 1 � - Width I 19- I-6ihtA-
Wgfdows and Doom--Crackage and Area
1
1 '-
VIUV Hell ht No. of Lineal ft. Aron
No. of pane of pane lights of crack eq. ft.
t Height No. of
No. of pane of pane Ilghte
Z 4 o L 3�►
z 4-
d za z0 •L, 14
19 2
Coef, Btu
19
I ratios
2000
Infiltration
Glass 601.50
3,050
Glass
Exp. wall
4"W'w
Not exp. was
Int. wall
i�sj
1910
Nd exp. was
I
Int. was
Ceiling
1 Floor
Ceiling ZZ
10 Z ZU
Floor Lzz I
1 1 15.3(.
Total Btu. I 9
Required sq. ft. E.D.R. or sq. ios. W.A. Uader area
Fl.I War. h a -i Room I Length 1 � - Width I 19- I-6ihtA-
Wgfdows and Doom--Crackage and Area
=- Height eS 14
1 '-
VIUV Hell ht No. of Lineal ft. Aron
No. of pane of pane lights of crack eq. ft.
t Height No. of
No. of pane of pane Ilghte
Z 4 o L 3�►
z 4-
d za z0 •L, 14
1 Aq
Infiltration a
19
Glass Z
Coif.
Btca
In1hration
Glace
ln6ltratsonI
IP
401
5-0
OT 0
0 Q
Nist exp. wall
Int. wall
Ceiling
19
V50
loils.
to
1500
lat. wail
Ceiling
143
Floor
1
143110,01
Tatal Btu. I
Required sq. ft. E.D.R. or sq. ins. W.A. L:ta&r area
M.1 VMD tCoomt I Length x- W fth
=- Height eS 14
Women and Doors—Crackage and Area
;
t Height No. of
No. of pane of pane Ilghte
Llnoal ft. Area
of crack sq. It.
z 4-
d za z0 •L, 14
1 Aq
Infiltration a
�.
Glass Z
1 ®®
Exp. wall
Coef-F. Btst
ln6ltratsonI
IP
401
Glass
OT 0
Earp. wan
Net exp. wan
Int. wall
Ceiling
I p c
Floor
Total Btu.
0--i•-A -.- ft. E.D.R. or sq. ins. W.A. Leaakr area
MEE
O
Total Btu.
Width
Required sq. ft. E.D.R. or sq. ins. W.A. L&&&r area
;
FU Roosm I Length 111L Width 'WIL
q.
Windows and Doors--Crackage and Area
14th Helght No. of Lineal ft. Atm
No. of pane of pane lights of crack sq. ft.
-24 -z4 IL 5 Z
d za z0 •L, 14
1 Aq
Infiltration a
�.
Glass Z
1 ®®
Exp. wall
Net exp. wall
Int. wall
1 i
Ceiling q8 10
Ago
Floor
Total Btu.
Rewired sq. ft. E.D.R. or sq. ins. Wk LYaa&r arm
F1.1 bAlg Room I Length Z;V
Width
Windows and Doors---Crackage and Area
_
dt a kt o. of Ineal
Aron
N^. of ee OQ M. II 0!e of Crack
eg• !4
d za z0 •L, 14
1 Aq
Infiltration
Glass
Esp. wall
Not exp. wall
Int. well
Ceiling
Floor
Total &u.
Required s% f4. EDA or sq. ins. W.A. Leader arsa
City of Fridley, Minn.
BUILDING PERMIT N°s o 5 3
Date:
.�7F
�.
Owner: Builder --
Address Address
LO TION OF BUILDING
No. Street --% rPJ� =.q.r
Part of Lot
Lot __ Block Addition or Sub -Division Z-1 01 ff
Corner Lot _ Inside Lot Wb ack Si yard , -t
Sewer Elevation Ation Elevation
DESCRIPTION OF BUILDING
To as: ., � � ,,
Front Depth JZ -1— Sq. Ft. 10XCu. Ft Ar
Front DepthHeight Sq. Ft. Cu. Ft
Est. Es. - 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 onmplianae with 21 provisions of
ordinances of the city of Fridley.
wit
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, repair and moving of bu IM—
within the city limits and this permit may be revoked at any time upon viola, any of the Provisions of said
ordinances.
Building Inspector
NOTICE
ihia permh don not cover the censtruedon, hwaWan for whiny, phnubiny, yn heathi% ower or water. Be sun to sa
the BuNiey Inspector for separate permits for thea fines.
u
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY' MINNESOTA
Owner's Name ,r P' 1 Builder.
A
Address /� �� _A�.<r
'LOCATION OF BUILDING
No. Z6 Street _ l J s part of Lot
Lot Block_ -Addition or Subdivision
Corner Lot Inside Lot L- Setback 6dA&j® Side -Yard s
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be7,
s d as:
,�7
,* Front / Berth Height j
Sq. Ft, Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of ConstructionEstimated Coat / y 0 j,--'
To be Completed A4 0
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City`of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE - — G SIGNATURE `
(Schedule of Fee Costs can be found on the Reverse Side).
s
--- --�
16 x 2-2--
B I cd'o ku .ADDRESS VALUATIOU
TYPE 7 -Izf
4 � o
................................................... .................. .... ..... . ............. . .. ........ ............................................ . ................... ................ I ......... . . ...... ......... ...
�V-
f4
r
.............. ................ . ........ . ............................... . ............. . .. I ........ .. . .......................................................................................................................... . ......................... . ..................
•
City of Fridley, Minn.
BUILDING PERMIT
Date: Na 271 1965
Owner: Edwin F. Dudley Bider The Nelson Co.
Address 6180 6th. Street N. E. Address 2509 Rasa Take Rd.
� ewl 61/
N° '7593
LOCATION OF BUILDING
No. 63-80 Street 6th. Street N. E. Part of Lot
Lot 11 __ Block 2 Addition or Sub -Division Uplands, 2nd. Addition
Corner Lot Inside Lot Setback Sideyard
Sewer Elevation ____ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost 16,0CL— _ To be Completed
Storm Damage Repair
In consideration of the issuance to me of a permit to construct the building�ce
ve I to do
the proposed work in accordance with the description above set forth and afl ons of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 5.00 , permit is hereby granted toTh® Nal gon Go_
to construct the building or addition as described above. This peermit 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, Minnesotag location, construction, alteration, maintenance, repair and moving of buildings
within the city limits andtthis permit may be revoked at any time upon violation of any of the provisions of said
ordinances
NOTICE:
M pumb des not effm the cendmdlve, Wandlon for wbin& phmible0, ea bath, www w wdtw. Be sono to res
the Bedding Inspector for eepeMa p mnift for thew Nems.
APPLICATION. -FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME RZ J; ,
r LOCATION,OF BUILDING
No.- Street Part of Lot
LOTS " BLOCK _ADDITION OR SUBDIVISION a
Corner Lot`Inside'LOT Setback Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and.proposed
building location drawn on these Certificates.
DESCRIPTION QF BUILDING
To be used as:
Front Depth - Height
Sq. Ft, Cu. Ft.
Front
Depth Height
Sq. Ft. Cu. M..
Type of Construction — Estimated Coo
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 of Fridley.Ordimances
and rulings of the Department of Buildings, and hereby declares that all the facts
an& representations stated in this application are true and correct.
DATE SIGNATURE
(Schedule(rFee Costs can be found on the Reverse Side).
suBJEcr
PER
City of Fridley
20249
AT THE TOP OF THE TWINS
BUILDING
PERMIT
ECEIPT .
• COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 �
� CITY HALL FRIDLEY 55432
(,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
.--.� fir'-',•J
612-571-3450
910-F15
2/26/90
JOB ADDRESS 6180 - 6th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
11
2
Uplands 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Edwin Dudley 6180- 6th.Street N.E.
571-3835
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Amre 3700 Annapolis Lane, Plymouth., MN 55447
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 j] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Soffit/Facia
9 CHANGEOFUSEFROM 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
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
$2,300'
$1.15
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-
$54.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$55.15
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) w
WHEN PROPERL HIS IS YOUR PERMIT
SP
-_�_ nATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NLW [ ] Effective 5/1/88
ADCN [ ] R-1 AND R-2
Building Permit Application
Construction Address: U/�® Wp rl
Legal Description.-
Owner
escription:owner Name & Address: le TeX Tel. # �/• �3�"
,
Contractor:.
�a� KJP7
Attach to this application, a Certificate of Survey of the
lot, with the proposed constriction drawn on it to scale.
LYYING AM: length Width Height Sq. Ft.
GRRACE AIM: Ipxrjt}, Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Graud Sq. Ft.
07HER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Cf�cks
Type of Coi V O;f �C�ia Estimated Cost: $
Approx. CMnpletion Date: %' ® •Ro
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
�• �� .I�' Width + 6 ° See Bach Page
DATE:I�' APPLI Tel. #
Permit Fee $ CEJ%"�
State Surdorge $__117
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
T�� 1'
STIPULATIONS:
C=Y USE Di�II.Y
Fee Schedule on Reverse Side
$.50/$1,000 valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by; rw�ari
Nary [ ] Not Necessary [ ]
`i
SUBJECT
PERMIT NO.
City of Fridley
0 5 S 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
1 1
COMMUNITY DEVELOPMENT DIV.
1 V PROTECTIVE INSPECTION SEC.
1 ,
1
CITY HALL FRIDLEY 55432
NUMBER
GATE
PAGE Of
APPROVED BY
612-571-3450
910-F15-179/20/90
JOB ADDRESS 6180 -- 6th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
11
2
Uplands: 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Edwin Dudley 6180 - 6th-Street N.E. 571-3835
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.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑X ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 121 Three Season Porch with_ lass:
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan.
On all new roofs or tear-offs and replacement roofs,
that 2 layers of 15 lb. felt,
State Code requires
be installed to a point 24 inches
mopped together,
�'�Iizo up from exterior wall line, or the use of other
Before digging call for approved underlayment membrane.
all utility locations
454-0002
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
S0. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED. n1
I 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
$4,200
$2,10
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-
$72.100
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PL N CHECK FEE
TOTAL FEE
F' e. SC $4.20
-$78.30
IG AtUREOFCONT RORAUTI IED AGENT (DATEi�j
WHEN PROPERLY VAL T D THIS IS YOUR PERMIT
SIGNATURE OF OWIUEROF OWNER BUILDE r (DATEi
SLOG WSP ATE
`i
NEW [ ] Effective 8/16/90
ADEN 1-1 AND R-2
ALTER [ ] Building Permit Application
Constriction Address: / gD — 6 � �P, V L�
Legal Description:
owner Name & Address: 4F 1 61j I A,) (� a `% s as Cc ke7lel.. # 7
Contractor: J 2 g • Y1,t e, S Tel. # Z 0L4
.dress:, art-aPte- Gcz�,e 5�3 6!5
Attach to this application, a Certificate of Survey of the
lot, with the proposed construc- cn drawn on it to scale.
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DBM ARM
oma. �A Length Widtlyx/ I� t�►. sq c'l lye
Corner lot [ ] Inside Lot [� Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost:
Approx. Completion Date: %0—
Proposed
ca
Proposed Driveway Width If New Opening Is Desired: �Ft. $ $
� Width + 6' See Back Page
nATE • - /�- % APPLICANT: J r A� e i Tel .# S-71- 3 l S
Permit Fee $ �„
Fire Surcharge $ y.L®
State Surcharge
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Marge $
CITY USE QTLY
Fee Schedule on Reverse Side
.001 x Permit Valuation (1/10th �)
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ) Not Necessary [ ]
4tOd
Widu
3 �c S✓
072
CL
9' W.
i N3K 3 S V3
C
;�1
3
1
- M
s
3
---I
On all ne400fs or Inar-offs and replacement roofs,
State Code requ'res rF,,.: 2 l'3}ers of 15 Ib. felt,
mopped together, 1-e ins'a;'Ied to a point 24 inches
up from exter7or dw: ! Eine, or the use of other
approved 6nderlayment membrane.
/ate✓���%
z� 6 Vow S
eV e
o
A)Vl6L
Q o
s �.c ,•
Q?' c Pope. /0� p i x 61
� 11 pet,
�- I
bi
Cl
•
9
SUBJECT
P MIT NO.
City of Fridley
26649
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
No
COMMUNITY DEVELOPMENT DIV.
L _ PROTECTIVE INSPECTION SEC.
9
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/16/98
JOB ADDRESS
6180 6th St. NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
11
2
1UPlands, 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ed Dudley
-
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Midwest Siding & Roofing
-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20010277
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW D ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (26 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with State Building
Code.
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 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2168
11.08
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
ST OR THE PERFORMANCE OF CONSTRUCTION.
$74.75
Fire SC $2.17
PLAN CHECK FEE
TOT FEE
/
icense S $5.00
$ .00
SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT (DATE)
N ROP
VALIDATW THIS IS YOUR PERM
]
G )NSP
1 + Q
'If '
GATE G/!l
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITT OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
0
ConstructionAddress: &/90 f---4 -5i /- /bLE_ -
Legal Description:
Owner Name & Address/: 5^d 6 V d l z - "t Tel. # S 7/ - 3 9 3_5
Contractor: 64 ewes h � � F 1Zc) L h g MN LICENSE # ;�OoI6; 7 )
Address: jgg7 q C� la e s `�1�� z121L �e Tel. # V/6 -51ka Y
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: A'Se &- (Pe:�-'k4 ir
Construction Type: Z_c xc,, fezf -o Estimated Cost: $ % �^
r
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 2 - APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
7riveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
a
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
Effective On May 10, 1999
JOB ADDRESS UI<3® Lo 71L
OWNER E
Rate TOTAL
BUILDING USED AS I CA
$30.00
$ 30.00 $ -30M
®`ti
l
ESTIMATED COST PERMIT N0. / �y��
$ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units Circle One (Steam) (Hot Water) rm A
$ 10.00 $ Trade Named alM �- Size No. 333 @�14V0 lP-0 �o
BTU UO HP EDR
$ 25.00 $ Fuel KL . Cs • Total Connected Load
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.
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
representations stated in this application are'true and correct.
BLAINE HTG. A,C ELECT., INC.
{� 13562 CENTRAL AVE. N.E.
HEATING _� 11 &NOKA, FIN 55304
CEMWNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes V) No ( )
2. Is free from rust or deterioration Yes No ( )
3. Has no foreign objects lodged within Yes (7C) No ( )
4. Is securely supported Yes No ( )
5. Meets all current Code requirements for size
and total BTU's connected Yes V-) No ( )
6 Has total heating BTU's of (A
All other BTU's 0
TOTAL BTU's (? t
7. Has a liner been provided for water heater Yes () No (X�
8. Has combustion air been provided for water heater Yes ( No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
BLAME HTG. A,C ELECT., INC.
103562 CENTRAkAVE. N.E.
HEATING
AIR CONDITIONING
AND ELECTRIC, INC.
s�_
ADDRESS_
OCCUPANT
HEAT LOSS DATE HTG. INST. 7 —/ L— -7 7
SOLD BY
Electrical Work By -1 SIM Ar
TYPE OF HEAT GA_ FA_X HW STEAM SPACE HTR.
GAS DESIGN
MAKE
Model OLD
Serial
INPUT
HOUSE HEATING TEST RECORD
APT. FLOOR CITY IUBURB
OWNER &—d
INSTALLED BY
Gas Line By _,
u.�ti:u.f■I�•7::I a.l
16_�•7a'14.i9161"I
Vent Size !®
7
KIND OF LINER % SIZE T NONE
DraftHood Regulator
Filters Size Number
Chimney Location Inside 14 Outside
Chimney Construction
Smoke Bomb Widng
Draft Test Tag
Door Pressure Lighting Inst.
Date Tested
Company Testing
Name of Tester _
Pressure Percent CO2
Input CFH Percent 02
Stack Temp. Percent CO
CONTROLS
THERMOSTAT
= Heat Plug
Value
Limi
Limit Seta Vow
Fan Setd-na0 l�
Pllot Type
Pilot Make
Pilot Model 1 :1
PIIo1 Timing WK_ SrfC
,
L.W. Cut
Pressure
Percent CO2 2
Input CFH 00OL&A>
Percent O2
Stack Temp.
Percent CO
HOUSE HEATING TEST RECORD
APT. FLOOR CITY IUBURB
OWNER &—d
INSTALLED BY
Gas Line By _,
u.�ti:u.f■I�•7::I a.l
16_�•7a'14.i9161"I
Vent Size !®
7
KIND OF LINER % SIZE T NONE
DraftHood Regulator
Filters Size Number
Chimney Location Inside 14 Outside
Chimney Construction
Smoke Bomb Widng
Draft Test Tag
Door Pressure Lighting Inst.
Date Tested
Company Testing
Name of Tester _
Pressure Percent CO2
Input CFH Percent 02
Stack Temp. Percent CO
SUBJECTER
I -NO.- ---::
City of Fridley
3 i 95
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
____ _ COMMUNITY DEVELOPMENT DIV.
-
v
572-3604
RECEIPT NO.
v
r PROTECTIVE INSPECTION SEC.
(/J
NUMBER -
REV
DATE
PAGE Of
APPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910415
7/5/01
1013 ADDRESS 6180 6 Street NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DES CR.
11
2
Uplands 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Edwin Dudley 6180 6 Street NE 763-571-3835
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
M J Construction 8071 Rancher's Rd, Fridley, MN 55432 763-785-8851 20233970
d 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
O NEW O ADDITION 0 ALTERATION k7 REPAIR 0 MOVE 0 REMOVE
B DESCRIBE WORK
Install bay window
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk
and flash all exterior openings.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OFCONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
$4 233
$2.11
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•
111.25
Fire SC $4.23
STRUCTI OR THE PERFORMANCE OF CONSTRUCTION
'—
PLAN CHECK FEET
AL FEE
6]rj
J
SC $5122.59
Licen .
SIGNATURE Of CON. ACT AORAUTMOR"ZED AGENT I iEI
VAED THI IS OUR PERMIT
WPRQAWLIDY
pi�S,GNATURE OA TE
Oa OWNEAo60WNER BUILDERIIOATEI
NEW [ ] Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 0 Y-1 &+ IV i ,
Legal Description:
Owner Name & Address: _ �; r"1 DUA U -LA Tel. #-7Lo',_ s7-71 - 3
Contractor: M,[ C c tnsfr( i-C.bu!:� MN LICENSE #
Address: RL -"l I '(�C�'1C'�L4__rS ` Y�C��9--��, Tel. # 1OS" -�R S-
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
Length Width
Height Sq. Ft.
Hgt/Ground Sq. Ft.
Construction Type: n `pl &L-li j stimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
-7/DATE: 01 APPLICANT: N l Ci)U aCS2nQxCXS`i-rUdk o Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Call (763) 572-3604 for Permit Fees if mailing in application
$ 2-`5 Fee Schedule on Reverse Side
$ t-1 b Z;7 -p .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
Building
BUILDING
Permit No.: Uv D IT S7
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604'
CITY OF FRIDLEY
GAUL - i'2007
DATE A
YOUR E-MAIL ADDRESS LJf_->aMd 91FDf-Dile0C,
Cary-%
SITE ADDRESS
no .
THIS APPLICANT IS:
❑ OWNER WONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: Y CITY
-
STATE -ZIP -PHONE- 10
NAME:
Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113
STATE ZIP
WITH APPLICATION
PHONE
License #20130983
13SINGLE FAMILY/NEI
PROPERTY TYPE
❑ TWO FAMILY/NEW G 651-264'-4777
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:Cii,�S
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ 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
❑Soffit
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Aluminum
❑ Trim
ADDITIONS.
1.
& PORCHES SUBMIT:
Site Plan/Survey showing the existing structure
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATIOF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF X
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S t0, AM (Wrl IPANrY TVPF.
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ s,,
$ ID • (1)
$ :3 (00
$ 15,00
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)
$1550 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 Attac
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 ben
conformance with the ordinances d codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not.
permit but only an application f a permit and o k is not to start without a permit; that the work will be in accordance with the approvec
plan in the case of all work whic uires revie d approval of plans. �l _ ,, °p Q
SIGNATURE OF APPLICANT I `�A �4_i11 ► `! DATE
Building
BUILDING
Permit No.:�4X3
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Dated' _ 07
DATE �' -` 'd YOUR E-MAIL ADDRESS AA44yscLi-
uno . CO/1A
SITE ADDRESS % ! CO S''�
.0005 x Permit Valuation Minimum $.50
THIS APPLICANT IS: . ❑ OWNER t EONTRACTOR
$
PROPERTY OWNER/
NAME: IEJIIIJ I"...
SAC Charge
TENANT
ADDRESS: I J fk S ?e CITY Q.
S-rAT> IP9�4;4132,,,
Curb Cut Escrow
PHONE: 5Z t —38$5
CONTRACTOR''�
NAME: C Ran • r-•
$
SUBMIT A COPY OF
STATE LICENSE # O ZR 1045 EXP DATE O
Park Fee
YOUR STATE LICENSE
j-,4- CITY
ADDRESS: 2 D UJ
1rIJ4,;w STATLIP Si* -o
WITH APPLICATION
PHONE(a51 ''Z�.�{�S?2.1 FAX 4r5 -3$e -4(.(v l
—
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
$
,;j .z1v1.
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑GE/SHED 13WINDOWS
❑ BASEMENT FINISH OOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
NEW 11ADDITION
ANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES— MOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES ❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE: ❑ DETACHED GARAGE
2.
3.
Proposed floor plan
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim
1.
Site Plan/Survey showing the existing structures'
❑ Other ❑ Fascia
and proposed project
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations ,
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF 'WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan. Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
Z
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
�i ; M
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
,;j .z1v1.
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit 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 wh' h requires review a d approval of plans. JJ ✓ry
SIGNATURE OF APPLICANT PRINT NAME Kay� (n . r4441 -! DATE ( J