PRE 2010 DOCSCity of Fridley
SUBJECT nRMIT
13925
AT THE TOP OF THE TWINS
BUILDING PERMIT"
i �
RECEIPT N
' COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF APPROVED BY
812-580-3450
910-F15
2/16/77
10B ADDRESS 1565 61st Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
10
4
Rice Creek Estates SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Dennis O'Keefe
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Pine Tree Builders Inc. 8535 Central Avenue
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK WINNING
Construct a 38' x 28' Dwelling and a 22' x 24' Garage 13014A -P
SEPERATE PERMITS REQUIRED FOR W IRINGITELEPHONE -ELECTRIC -GAs
9 CHANGE OF USE FROM NEAT NG, PLUMBING ANDTSIGNS. REQUIRW BY l
STIPULATIONS provide a hard surface driveway.Provide a verifying Eying surrey before
capping. Provide sod in the front and side yards. Provide proper excape windows
in the bedrooms.
SEWER LOCATION: (Approx. 9' Deep) 90' East of Manhole (Inv. 945.54)
WYE ELEV: 941.22
TOP OF FOOTING: 944.50
WATER LOCATION: 9.6' West of Sewer
UM Curr OF FRIDW DOES NOT GUARANTEE TME `NWIMPORTANt�
ACCUBAGY OF UTN.ITY LOCATIONS AND ELEVATIONS. NOTIFY THE FRIDLEY ENGR.
rms DATA 15 FOR IWO1tIUMN PURPOSES ONLY AN'J DIVISION REGARDING
C
FMONS USING ft SlMW WRIFY TMA 1!{FORMA1WH REMOVAL AND REPLACEMENT
ON THE SITE. AT DRIVEWAY OPENINGS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood
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
R-1
1064+528
30,992 To
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
I
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES TYPE OF WORK WILL BE
$49,105
$24.55
WITH WHETHER SPECIE EDNING HER INIOR NOT. THE GRANTING OF AO PERMIMPLIED T
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$123.97
$375.00
ST ON OR THE PERFORMANCE OF CONSTRUCTION.
a
PLAN CHECK FEE
TOTALFEE
$30.99
$554.51
SIGNATUREOF CONTRACTOROR AUTHORIZEDAGENT(DATE)
M
- . WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
r
0 a-/6 -n
BLDG INSP DATEI
SIGNATUREOF OWNER(IF OWNER BUILDER) (DATE)
lies
Etc.
Ll
CERTIFICATE OF SURVEY
FOR: Pine Tree Builders, Inc.
0-50.1)
T10. U C_ (930.5)
A
'-Uiikit3 Drain'l
Qge Easement}
CIA
N4 to 0
5
's A*
0%b
" k9
Ln
X\/ N E
10 Denotes iron monument
952 9]
'MARMING
digging C811 10081 utilib*
6A(67Wt16- FIE11 9 4 $��o C11t17,-15&WZ F_
Before
TREPHONE - ELECTMO
REQUIRED
V
Descriptions Lot 10, Block 4, RICE CREEK
ESTATES, Anoka County,
Minnesota
CITY -OF MDLE-Y OW NOT 0�1161EOF
A VAT•
UTILITYtiY �4kTIONS
jDATAjS VQR `ONLY AND
_0
SNS USING ir, WOULD Nv�, 11*0, TIC",
ON 1w SITE
0952.91 Dencries
proposed groxie_
r)own & country
I fiereby certify that this is d ii -tie
and correct or j survey of
Alb 6,
the bokjndmws*)f th,,ahove describ,r(J
I
land and of the l0Cat10n0f ail bUll(jingS,
it any, IhLruon_andall visible encroachinct)(s,
if from or un ;aid lanwd.
7.�'.-
,Sur,ve.#orJ �
Laid Surveying e Site Plinning25-irbi
As surveyed by rw this .1jy of 19,15.
Civil Engineering
H,8 Io 101h Av, N. (1 94 iit Hooiv: Av N)
Brt)uklyn Kirk, MN 5)5428
40'
Phone 533 1340
Mien. Req.
No. _.._k09f44_.
����-rte.
APPLICATION FOR RL'SJDENT1A4.,
OR ADDITION BUILDING', PERMIT
CITY`O'F FRIDLEY, MINNESOTA
OWNER' S NAME : `L V lu,4, ®lkZ f-= F E_ BUILDER: (' i 1J is AL.t W Fes -X4 o
ADDRESS:
NO:. W65- STREET:
ADDRESS:sS3s Cxe-I-WA4L
LOT: / BLOCK: Y ADDITION; &e.
CORNED. LOT: INSIDE LOT:_—SETBACK: ISS- —SIDEYARD: S -+ 10
Applicant attach to this form Tcao Certificates of Survey of Lot and Proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: A144 It-, *M /41 AW P-li-
�d•� Front: 2.1 C Depth 2.� / Height 2 �-
�ii Square Feet: < 6 Cubic feet:
iOQ Front: Depth: 2 - eight: / f
Square Feet; ��� Cubic Feet: 1; d
Type of Construction: W Estimated Cost: $ �,
To Be Completed: C�20
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 Dei .,irtment of ]itiildinns, and boreby
declares that all the facts and representations stated In this application
are true and correct.
DATE: L' 7 S ICNATURE
(See Reverse Side For Additional Information.)
t, -30'.? % 4/L �~-1VT .."
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1
CITY OF MIXING DEPA RT) ENT ""17-119
EXTERIOR—EMMIMAAGE "U" COIVUTATION
(To be submitted with building permit application)
One or two family dwelling k Opener
All other
Site address
COlitr9CtOP. none
LINEAL FT. OF
EXPOSED WALL ft. above grade -
TOTAL. EXPOSE, WALL A REA 3,�. F7.
OPAQUE WALL CONSTRUCTION. "U" vaiie x area
lUrALSs �i �. , Sq.
TOTAL (U) (A) VA I-UE3 �g �. = , / A 10. Tw
DIVIDED 9Y TOTAL WALL A R.EII
r
AVERAGE "U" .17 or less for 1 & 2 f i ly dee Ings
.22 or less fJr all otne ings
ROOF/CEILING :
TOTA L A RIA : //� . s q. ft.
Detail reference "u" x
f rom "U"� ,j x
attached sheets. "U" �I
Describe openings . G x
in roof. "iI" x
ft. `>3. � (U)'A)]
sq.
'.
~ U" . O %�
X
:.i .7 .
i` t . /.�oJ . ; meg
, ! A
/ • � 1 !' ` �
ft.
"LJ" . G
X
S
��. ��.� ��
Ju
• 5D ��' (J i i A 1
-
'7o •�� v (U)(A)
Detail reference Co,�c.� a' 3
"U" x
914.
f v , /7®• //..Z v (U) (A )
attached sheets a
"'J"
x
-y .
f •
('J) (A )
IOU"
x
"U"
x
. .
: t .
• ('U) (A 1
num
"tin
x
sq.
f t.
l U i; A J
WINDOWS: "U"
value x area
Make do type
" J"
xq.
%'; .
(U 1 (A i
w n
"U"
x
sq.
ft.®
(U ) (A ?.
x
sq.
:t . `�
" //2.9 S (U) (A }
U IT
IT
(V) (A )
DOORS: "U"
value x area
Make do type
"U"
x
f!,.
`®�
(U) (A)
n If
w Off
%
3q
ft
• (U)(A)
n "
��!G+•✓�y,K r'g_"U"
��
x
Sq,
,. �. .00
�. �� (U)(A)
IT n
"U,
X
�.
L.
• (U) (A )
lUrALSs �i �. , Sq.
TOTAL (U) (A) VA I-UE3 �g �. = , / A 10. Tw
DIVIDED 9Y TOTAL WALL A R.EII
r
AVERAGE "U" .17 or less for 1 & 2 f i ly dee Ings
.22 or less fJr all otne ings
ROOF/CEILING :
TOTA L A RIA : //� . s q. ft.
Detail reference "u" x
f rom "U"� ,j x
attached sheets. "U" �I
Describe openings . G x
in roof. "iI" x
ft. `>3. � (U)'A)]
sq.
ft •
(U) (A
sq.
ft. 72�
3✓. r (U)(A)
---(U)(A)
sq.
ft.
Pr,' -�
�`�•
;U)(A)
�(U)(A)
q.
ft.
TOTALS 14f'." Sq. ft.�. - ((')(A )
TOTAL (U) (A) VALUES ;-/ = • oyer AVG . ,
DIVIDED BY TOTAL ROOF
CEILING AREA �Z rx//
AVERAGE U .,15 for ventilated roofs 471,
.10 for all other construction ,�;7 /�?�:.,� Cia•�%��-/
to
WALL SECTION3P N rMaN.Qr Sv�M
NOTE: USE 122 OF OPAQUE WALL AREA'FOR
FRAME CONSTPXCTION LONS UCTION
1
Z �
3
q 4
5: 5
,� L 6
FIG..#l;-�_P EW
FIG. �1 `:.SECTYON
1
r�
110. #3 , SECTION
PAGE
(R) VALUE
0.68
1.
2.
3.
4.
5.
6.
fluff= 1 /R= . /�'
41F
0.17
A `A6
0.68
0 : 7.
"U"at l / R= 048
FIG. # 1 t/r 11 p ,�yyj,� ��ll �}
COMB. "U";(.12 X •'Zir )T(..80 X wV�`I—)� . aIs`
1.
2
interior air film
_0.6_8
71/.
111
110. #3 , SECTION
PAGE
(R) VALUE
0.68
1.
2.
3.
4.
5.
6.
fluff= 1 /R= . /�'
41F
0.17
A `A6
0.68
0 : 7.
"U"at l / R= 048
FIG. # 1 t/r 11 p ,�yyj,� ��ll �}
COMB. "U";(.12 X •'Zir )T(..80 X wV�`I—)� . aIs`
1.
2
interior air film
_0.6_8
71/.
111
.
3
jrle t P sr;' Ogffg- f.
ag
9 '' fir rM TO,4
.Z4910z"
6r
5.laf..'
ei'*1G.,..
6.
...'
Exterior air film
`TOTAL (R)
!
"u". I /R= 0406
1.
Interior air filIg
x.68
2.
`
3.
as
5r
$.
Extefior eir film
Q 7
TOTAL
"U"*1/Rd 4?
G
WALL S=TION - '7ii�6f �'s /'r "f�,�'/ i k�i+�' PAGE
NOTE; USE 12 OF OPAQUE. WALL AREA FOR 3"'1?Z" , 'v1� r `� �•^: r e ";sy; Al
FRAME CONSTRUCTION CONSTRUCTION (R) VALUE
-lip Tr -4-
1. Interior air film 0.68
6,.9"optes air ftlm,(!#kj7X'ff L -►S
TOTAL (R)
'm h �SEGTION
a •
Q y
d jl� 7
•
a
FIG. #3 SECTION
1
2
3
4
.g
6
"U"= 1/Rs .. 114
0..69
.4
/.ate
"U"=1 / R= . oG7
FIG. #1
COMB. 'U"=(.12 X 114
1. Interior air film M8.
4. 1/fly .�Yr
5 . Ki ri ! e.410a
6. --4a i air filthO,v w *
TOTAL (R)
►lull- 1 /R_
c
1. Interior air file c68-.''.
2.
3.
5.
6. air
TOTAL ��� ���►�
"u'l=1/a.- .40-,
so
f
elo*,O or^v ,C, ice.
I. Interior air film 0.68
2.
3. Mterior, air fUm
TOTAL (R)
9•
:.a��-*�•^x+,-.r�r..'-.T.-rra,•,r t 1
Y p F
1 � �
,
Art6ftdr. Mr lik r�!m11 -r r
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I. 'Y �py�Y � !, � -,.ice{ - r ��4si�f �� • wr"7.'� ` �� kit,�M !� f t�'Y 4r, :�*' i rG..I.
� `' ��,. rA �, '�` 'Jt i'� � t i r"�' r .. •. r >, � '�laa £ �4V 1 ... - �
� yyy I�
Y 1 4IY'M !�* •i r vM� _ .� L.Y, yrify -+k
*M � v M: M !l � •���T � rel � F ^d R
777
+ . 4 r - Irrllijij�+i�+�ll�ara4.�i. nh'+�J�ln+r -777777'
7777 i
- 1 :•�f ""air, - O "� ��r�r �
f ` � , ,� •• it � • A � � � V'�
w ,lt}�.. ��'{�,�.! a �, : � �i •�k»;.5 a ,',A, .+ w a.
�� f' A M°•+ y $ { X Ct
fi�-V-
119,(,(
+ 4.w w•'�Y n'� r � s✓, i� ',`A n� ir,�n hn T,.. �` p5 �'q 31' A": a A i
yy >YAP.,14
k 67
3r s { `3 w �� � F •- � ams~ � ._ "-_ � �+ ` k "`� 1•{ � T �1."r �A e`
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a 4• r s r M F Y r r
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M � ! � ;+�4 I �+: �.4, n� F�, si ' ��- I %t � •4. a;s � A:. ,� r '. ,, Sr �'.' � . a 4 i . ��� 1 s.
s ` ��' �!^ ""l +t �� *'•'� 'e �,;. i R I a ` `zM +v �Ki A'��n a�iX> ��, '�a �� �. 5 ;}' S +r �, <
l,s ��yee.. �•.irsx+.`al�,#' :c�.:'�9..1_ rz_ , ��7s�`v:`1' * �..}::� __fE r� Y".v � � i �'�Mt.,�_ . ,3 . , sP .ate � _ � '�- - - �.dd.:�::...irk ..- ,t ..''��.`�`�`�%' A �X } '�.
CITY OF FRIDL EY T4s
L
E APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLV,•WING FIXTURE R?TES: NO. RATE
_' er 'Fixtures
7,ature _ ititure O?ening
Ne:. .-fixture, Old Opening
G=tc.. Bcsin
water 'eater - to 99,C00 BTU
1CO,G30 A.J to 199,000 BTU
Water Sc_tener
Vow Ground F_n Old Building
Electric ::a=er Feater
GAS FITTING FEES:
Ist 3 fixtures
Add-tio nal F:J.tures
Gas Range to 199,000 BTU
Rr?AIRS & ALTZI ATIONS
First 5100.00
each add. $I^•0.00 or fraction
x
$3.00
yL_ x
$2.00
•
$2.00
gal
r
U
$5.00
K
o
x
Water
x
$5.00
x
$5.00
Aja
',^'J
7r J
..i
J
•:;
C
n j.;i
^ I 0
O
LO S U
I
C1
N
I
9: v
w
U CnI•L ��
U
.^�
U
O
:a::
ilec
1 3rd i
l
F1
'
I
I
_,.,.re Cor .ec _ion. opening
� Con--ec _ed with Sewer
(`) _ New Fixture, O'_a. C: _ning
l Watcr
PARTIAL RATE SCHEDULE
PLV,•WING FIXTURE R?TES: NO. RATE
_' er 'Fixtures
7,ature _ ititure O?ening
Ne:. .-fixture, Old Opening
G=tc.. Bcsin
water 'eater - to 99,C00 BTU
1CO,G30 A.J to 199,000 BTU
Water Sc_tener
Vow Ground F_n Old Building
Electric ::a=er Feater
GAS FITTING FEES:
Ist 3 fixtures
Add-tio nal F:J.tures
Gas Range to 199,000 BTU
Rr?AIRS & ALTZI ATIONS
First 5100.00
each add. $I^•0.00 or fraction
x
$3.00
yL_ x
$2.00
•
$2.00
x
$5.00
r.
$5.00
x
$10.00
x
$7.00
x
$5.00
x
$5.00
x
$3.00
x
$1.00
x
$10.00
State Surcharge
TOTAL FEE
FZZ
• (SJ 0.00)
$5.00
$2.00
TOTAL
S�
S�=
$
Job Address L J
UeparLmont. of Buildings
City of Fridley
Tel. 1.571-3450
The undersigned hereby hakes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. '192.7
OWNER
i
KIND OF BUILDING
USED AS
TO BE CO.IQLETED ABOUT
ESTIMATED COST � � O O �tJ
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By p
Tel.'Co. 7R/ � / /
ROUGH INSP.
Date
FINAL INSP. 6-1,i - 7 7
Date
APPROVAL FOR PER'4IT 41 A,
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION
AND
4.00
AIR
CONDITIONING SYSTEMS AND DEVICES
7.00
PARTIAL RATE SCHEDULE
each addn. 50,000 BTU
6.00
$
OIL BURNER- to 3 gal. per hour
$10.00
$
each add. 3 gal. per hour
//
� '
Z
$
GRAVITY WARM AIR:
RATE
TOTAL
Job Address (��
_,
Furnace Shell & Duct Work
$12.00
$
L lJ
1st 3 Fixtures x
Replacement of Furnace
7.00
7.00
$
$
Department of Buildings
$
Repairs & Alterations -up to $500.00
4.00
$
City of Fridley
Repairs & Alterations each add. $500.00
AIR CONDITIONING
Tel. #571-3450
FAN HEATING SYSTEMS See Fee Schedule
MECHANICAL WARN AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTEM:
�d The undersigned hereby makes application for a permit for the work herein
$12.00 $ J, _ specified agreeing to do all work in strict accordance with the City Codes
4.00 $ and rulings of the Department of Buildings, and hereby declares that all the
7.00 $ facts and representations stated in this application are true and correct.
7.00 $ ��
4.00 $ Frid Minn. � r 19
-
OWNER iiC.����
Boiler & Lines up to 100,000 BTU
$12.00
$
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
each addn. 50,000 BTU
6.00
$
OIL BURNER- to 3 gal. per hour
$10.00
$
each add. 3 gal. per hour
10.00
$
GAS BURNER- from 100,000 BTTJ to 199,999 BTU
$10.00
$
(over 199,999 BTU see Fee Schedule)
$
GAS FITTING FEES:
L lJ
1st 3 Fixtures x
$ 3.00
$
Additional Fixtures x
$ 1.00
$
Gas Range; to 199,000 BTU x
$10.00
$
00
AIR CONDITIONING
$ /0.
FAN HEATING SYSTEMS See Fee Schedule
$
VENTILATING SYSTEMS.
$
ALTERATIONS $ REPAIRS
$
—� State Surcharge
$ .50
TOTAL FEE
$S®
ROUGH INSP. REINSPECTION FEE
Date ($10.00)
FINAL INSP.
Date
APPROVAL FOR PERV:IT �.
i
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMAED COS. G
()L&" - NEW B LDING PERMIT NO.
PERMIT NO. A0_9
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, �Air--o.
Trade Name Size No.
Capacity �1Sq. Ft.
o�ED/R� BTU &5J41_`11P
Total Connected Load �T� !/C/ Kind of Fuel—�
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP ___
/ . I
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 � M /,� 0 � n `-
Company Q
Signed By
Tel. ;.o.
�co�� 4.
Suburban for Conditianirico�
8419 °'enter Drive
Minnea0dis, INinnesota 55432
May 3, 1977
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
Pine Tree Builders, Inc.
2001 - 105th Avenue N.E.
Blaine, Mn. 55434
Re: Final Inspection at 1565 - 61st Avenue N.E.
Dear Sirs:
A final inspection was made on April 29, 1977 of 1565 - 61st Avenue N.E.
and the following items were noted which must be completed before the
structure can be finaled out;
1. Provide a hard surface driveway by July 15, 1977.
2. Provide sod in the front and side yards by July 15, 1977.
3. Provide house numbers on structure by May 11, 1977.
4. Install joist hangers at stairwell header by May 11, 1977.
We will expect the above items to be completed by the scheduled dates
when reinspections will be conducted to determine compliance. If you
have any questions on these items, please feel free to contact me at
571-3450.
Sincerely,
ROW HOLDEN
Building Inspector
RH/mh
0
SUBJECT
PERMIT NO.
City of Fridley
25096
Q
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV
- _
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
j 612-571-3450
910-F15
5/27/97
JOB ADDRESS
1565 61 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
10
4
1 Rice Creek Estates
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Pete Leschisin 1565 61 Avenue NE
572-9007
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Thurs Roofing 5717 113 Ave N. Chmplin6
24-5624 9346
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (20 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with
the 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
SQ. FT.
CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,650
$.82
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTA EE
Li e SC
.00
Z$61.47
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
p
IDAT THIS IS YOUR PERMIT11.0
RAG INSP OFQAiE
MPL .
S)GNATURE OF OWNER)IF OWNER BUILDER) IDATEI
0
NEW ( ] Effective 1/1/97
ADDN L ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
s�
ConstructionAddress:
Legal Description:
Owner Name & Address: _ pe f r :5,*, YU Tel. #
Contractor: v V- —' MN LICENSE # c�'E
Address: /7 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: )r)A,
Construction Type:�'e6QCDF )4�r. 0) Estimated Cost:
(Fee Schedule --on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: S--,:;)--2 — 7 APPLICANT: ., l ` ` _ Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ ,.� , (�()
Fee Schedule on Reverse Side
Fire Surcharge
$ /, �S
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
_
$ , QO
$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
$ C
STIPULATIONS: