PRE 2010 DOCSCITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1991
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH Fi 0M
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures 16 $ 7.00'
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas
$10.00
Gas Range
$10.00
Gas Dryer
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge .50
TOTAL FEE $&
JOB ADDRESS /2�&O — �� .
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
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
199
Owner L .r, .w �.
• Building Used
Estimated Cos
PLUMBING COMPANY 1�mc1 1
SIGNED BYIM a_a. * j OC' p f` TEL N0. ` 119
Approved By l� f � Rough -In Date Flnal Date ~��
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
SUBJECT
PE
City of Fridley
213 51
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
RECEIPT NO.
_____ COMMUNITY DEVELOPMENT DIV.
�-- � PROTECTIVE INSPECTION SEC.
y y� 0 �
r �
��--1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/22/92
JOB ADDRESS 1020 67th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
1
Michael Servetus 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Brickner Builders Inc 6240 Hwy 65 #208, Fridley 55432 574-91871 3440
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
(R NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 24' x 30t Dwelling and a 241 x 221 Garage
SEPARATE PERMITS REQUIRED FOR
9 CHANGE OF USE FROM WIRIM, HLAI ING, PLUMBIN"d AND SIGNS,,
STIPULATIONS See notations onlan. Provide Cit with
p y copy of verifying survey before
capping. Provide sod in the front and side yards. Provide a hard surface driveway.
Paid Park Fee of $1,500.00.
SEWER LOCATION: 48' W of M.H. (W. Inv. 862.59) WYE ELEV: 862.78
TOP OF FOOTING: 866.28 Minimum
WATER LOCATION: E of and in same trench as sewer service.
DRIVEWAY DEPRESSION: N/A
WARNING
THE CITY OF FRIDLEY DOES NOT GUARANTEE THE
ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS, Before digging. call for
.Ott y#�litylocations
THIS DATA IS FOR INFORMATION PURPOSES
ONLY
AND PERSONS USING THIS INFORMATION
SHOULD REQUIRED BY LAW
VERIFY IT ON TWE SITE;
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED 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 1.20 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
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
$115,665
$57.83
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE Fire SC
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$695.50
$700.00 115.67
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
License SC $5.00
TOTAL FEE
$1,574.00 + PF
` �� �a'✓ �� / (
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
OP RL ,V AT D THIS IS YOUR PERMIT
77
�,A,i
DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEIP
..v. ... v.. vv ...v.. .. v .. ..... .. ... vv. .... v...v ..... ... ... v.: <v v.v v.. ..v .v. v.v. .♦ v. v. v..v♦v. v v. v. v. v. v. ..�. .vv. ..... .. .. ... v.
NEW Effective 3/1192
ADDN [ CITY OF FRIDI.EY
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
h
Construction Address: 0 9, 0 r, 7 0, 0, ni �
Legal Description: L oT I L o c k I MIC-�40 C (_ 3 C 2 U C TU S
Owner Name & Address: 66C\CK (U tdl j 3 W LQ EfL5 - N C . Tel. # '5�7V—,VE-7 I
Contractor: C\CN 41- 0 U_X Lk O L fc-5 1 AJ L MN LICENSE # 000 3 yY (�
Address: 6-W-10 ® I-+Wy 65- ®g' F�L 1 C)C C r M) v► n Tel. # S 2 V - ` *- % f
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. _204)
GARAGE AREA: Length Width
Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ j Inside Lot j ] Ft. Yd Setback _
Type of Construction: �®
Approx. Completion Date:
Driveway^ Curb Cut Width Needed: Ft. + 6 Ft =
Side Yard Setbacks
Estimated Cost: $
(Cost on Back)
Ft x $ = $
DATE: 9m2 APPLICANT: Tel--#
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ d ��� .001 of Permit Valuation (1/10th%)
State Surcharge $9 % , $.50/$1,000 Valuation
SAC Charge $ 20a $700 per SAC Unit
License Surcharge $ o ® $5.00. (State Licensed Residential Contractors)
Driveway Escrow $ - Alt. "A" or Alt. "B" Above
Park Fee - $ Fee Determined by Engineering
Sewer Main Charge $ _- r Agreement Necessary [ ] Not Necessary [ j
TOTAL
STIPULATIONS:
$73 �)
r , 00
J.B. ANDERSON'S
�wchitecWW consultants
8006 303T. s.f. OSSW MN. 66369 pm-. (612)-424-OTT2 u n _
Plan '
Date —1-Zz--r-,L
Owner,
Contractor,
Site Address:
I)TOTAL EXPOSED WALL AREA z0 sq. ft
2) TOTAL EXPOSED R00F/t EILING AREA It�®`1 sq. ft. x
WALL AREA CALCULATIONS -
TOTAL WINDOW AREA
GLAZED
TOTAL DOOR AREA
TOTAL GLASS DOOR AREA
GLAZED
TOTAL FIREPLACE WALL AREA
TOTAL WALL FRAMING AREA
NET INSULATED WALL AREA
TOTAL RIM JOIST AREA
TOTAL FOUNDATION AREA (EXPOSED)
to sq.tt. X'u" 147- =
sq.ft.z'U-
y sq.ftx'U",1}�
sq.f t. z "U'—
L, 61sq ft x "U" I'll = I �'
olull
(, sq.ft. x'U" � Vii _= '
-7 Sq.ft.xtU1f ' 1/= I Pic
TOTAL FOUNDATION WINDOW AREAsq.ft.zU
3) TOTAL
If item 3 is the some as, or less than item 1, you have met the intent of
2 MCAR 1.16008 A and 0.
ROOF/CEILING CALCULATIONS.
TOTAL SKYLIGHT AREA
TOTAL ROOF/S,EILING FRAMING AREA
NET INSULATED ROOF CEILING AREA
sq.ft.x U
4) TOTAL
TOTAL
If item 4 Is the some as,or less than item 2, you have met the Intent of
2 MCAR 1.16008 A and 0.
ALTERNATE BUILDING ENVELOPE DESIGN
To utilize the total envelope system method, the sum of Items 1 and 2 shall
be greater than the sum of Items 3 and 4.
1)
+2)
3) +4)
I hereby certify that the building here described meets or exceeds the ate of oto
'4�z
Energy Conservation Act.
(signed)
6�7—
c::r.� CONSTRUCTION
FRAMING SECTION
I interior air film 0.68
2 A.
S4 inches of soft wood �, 1
4 zsl sti.+¢a+E
5 •5�0�►-� al
6 exterior air film 0.17
TOTAL R L o
U = I/R ' o2
SECTION (INSULATED)
I Interior air film
0.6
4- e-3
2 " S W-. 94-4e-
19, o
3S,e ia.,a.4 ,-,s
, an
4
5
6 exterior air film
0.17
TOTAL R Z3 , I "1
U = VR - - _
DIST SECTION
I interior air film
0.68
2
19, o
3 '1 5.. ....�-o
, an
4 L IV
5 lh- ,= l
6 exterior air film
0.17
TOTAL R - (;:P 1
U = I/R o=O0
ATION SECTION
I interior air film 0.68
2
4 exterior air film
5 0.17
TOTAL R
U = I /R �'
VENTED
CONSTRUCTION
CEILING SECTION (INSULATED)
(1 linterior air film 0.61
(3
(4 exterior air film (still) 0.61
TOTAL R 45.-222,
U = IA
CEILING FRAMING SECTION
(1 interior air film 0.61
(2 '�8 SH:accac I Sta
(3 ZFEI
(4 interior air film 0.61
(5 winches of soft wood 4,s5;
TOTAL R
U = I/R 'DZLP
CEILING SECTION (INSULATED)
( 1 interior air film 0.61
(2
(3
(4 exterior air film (still) 0.61
TOTAL R
U = I/R
CEILING FRAMING SECTION -
( I.interior air film 0.61
(2
(3
(4 interior air film 0.61
(5 inches of soft wood
:TOTAL R
U = I/R
EXPOSED BEAM CEILING SECTION
(,1 interior air film 0.61
(2.
(3
(4
(5 exterior air film 0.17
TOTAL R
L = I/R
x 6-Y,4- IF
x x,24
• a
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING
SYSTEMS AND DEVICES
JOB ADDRESS i0 ) C-�
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work
Residential Rate
TOTAL
herein specified agreeing to do all work in strict accordance with the
Furnace Shell and Duct Work, Burner -
city codes and ruling of the Building Division, and hereby declares
Also Replacement Furnace $ 20.00
$
that all the facts and representations stated in this application are
true and correct.
Gas Piping (Needed with new furnace) $ 10.00
$
OWNER � ��'�t�•� ''
Gas Range $10.00
$
'
BUILDING USED AS��
Gas Dryer $10.00
$
*Air
1E,nc
ESTIMATED COST 0 U •' PERMIT N0. / f
Conditioning - All Sizes $10.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
Commercial/Industrial
BTU HP EDR
1 % of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
$ .50_
Burner Trade Name Size No.
TOTAL FEE
$
BTU HP EDRF
SpW IlE alio ASR
i,,
��o WEST LAKE STP.E.Ei
410
HEATING COMP Yom' i• �tVs`i�Us.� .�
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
Signed By Tel No.
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE
Approved By C/�`� Rough -In Date Final Date well
$30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or, stack:
1 Has ' been ,, carefully .exitined Yes
2. Is free'from rust or deterioration Yes ( ) No ( )
3. Has no foreign objects lodged within Yes ( ) No ( )
4. Is securely supported Yes ( ) No ( )
5. Meets all current Code requirements for
size and total BTU's connected Yes ( ) No ( )
6. Has total heating BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
�e
HEATING COMPANY
Signed By '
Date
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Effective On January 1, 1991
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
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
Rate TOTAL
$ 20.00 $ "�O, Do
$10.00 $ /10,00
$ 10.00 $
$ 10.00 $
*Air Conditioning - All Sizes $10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE $ D • go
JOB
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 and ruling of the Building Division, and hereby declares
that all the facts and representations stated in this applicatio a e
true and correct a ,199
OWNE
BUILDING USED
ESTIMATED COST 00
PERMIT NO. ,le) 6
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating snits Circle One (Steam) (Ho 1 t ) (W rm Air)
Trad I me ' ✓i -P Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU H P , EDR
HEATIN
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
Approved By Rough -In Date
Final Date C)t -tl t
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes
( )
No
( )
2.
Is free from rust or deterioration
Yes
( )
No
( )
3.
Has no foreign objects lodged within
Yes
( )
No
( )
4.
Is securely supported
Yes
( )
No
( )
5. Meets all current Code requirements for
size and total BTU's connected Yes ( ) No ( )
6. Has total heating BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287.
August 19, 1992
Q
TO WHOM IT MAY CONCERN
Re: Soil Condition at 1020 - 67th Avenue NE, Fridley, MN
Please be advised that on May 21, 1992, the City Building Inspector
performed a .footing inspection at 1020 - 67th Avenue NE. The
forms, soil and building location were approved for the pouring of
concrete for the footing for the house and garage. Poor soils were
not present at the footing elevation.
Please feel free to contact me at 571-3450 if you have any
questions on this matter.
Sincerely,
y
C1fYDE E. WILEY
Building Inspe for
CEW/mh
CC: Brickner Builders Inc.
Walsh Title & Real Estate Services Inc
FA
SUBJECT
PE _
City of Fridley
An 6 09 7
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
I_ COMMUNITY DEVELOPMENT DIV.
tr PROTECTIVE INSPECTION SEC.
r
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
' 612-571-3450
910415
5/28/98
JOB ADDRESS 1020 67 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
1
Michael Servetus 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Yongda Wang 1020 67 avenue NE
572-8661
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 ❑ ADDITION ❑ ALTERATION [j REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct deck railing on existing deck
9 CHANGE OF USE FROM TO
'
STIPULATIONS
See notations on plan.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIREO 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
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
@
$500
$.50
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-
Fire SC $.50
STRUCTION PR THE PERFORMANCE OF CONSTRUCTION.
$21.00
a
PLAN CHECK FEE
TOTAL FEE
$22.00
NATURE OF CONTRACTOR ORAUTMORI DAGENT (DATE)EN
I
ROP
g<
BLD -NSF'
VALIDAT D THIS IS YOUR PERMIT
ri E
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
FA
NEW [ l
ADDN [ ]
ALTER [ ]
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
Legal Description: ro Z
�%/ 4.0'`- De`s /
z X74,4v &k Tel. # �/a -1
Owner Name &Address: ��i /ll istdi4 G�I�fN �/ a
Contractor: MN LICENSE #
Address:
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 DIPROVEMENT
Length Width Height
Length Width Height.
Length Width Hgt/Ground
A el
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: -T; e, f e uJ o rl Estimated Cost: $ - 5�0®
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 3-- a APPLICANT: Tel. #
L'/ -
CITY USE ONLY
Permit Fee
$ ,
Fee Schedule on Reverse Side
"ire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 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:
5
`�J
9�
cr
SUSJF&
PERMIT NO.
City of Fridley
28265
AT THE TOP OF THE TWINS
BUILDING
PERMIT
�
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
! S
_
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
10/15/98
10B ADDRESS
1020 67th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
1
1
Michael Servetus 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Yongda Wang572-8661
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Ideal Roofing 1680 McAndrews Rd Burn435-3061
20147912
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
O NEW 0 ADDITION O ALTERATION gk REPAIR 0 MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage 32 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. '
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$2742
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-
STRUCTI N OR TH PE OR ANCE OF CONSTRUCTION
74.7,5
I,
q
PLAN CHECK FEE
OiAI FEE
SIG ATURE OF'tONTRACT5R Op AUTHORIZED AGENT ,DAr .
NMPEYVA_
D THIS IS YOUR PERMIT
QA1E
S-GNATURE OF OWNMIF OWNER BUILDER, ,GATE,
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ^ lnc2 6 ��%�h Ape �l%% )C-r,�Ae
Legal Description:
Owner N
Contracti
Address:
Effective 1/1/98
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF DWROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: l2 - LLS ef t (?a (G?- 6P to / - 1d(/of
Construction Type: 01 Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: �C� APPLICANT: P_,fP%` Gj e ele Tel. # ���- 9S
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
zl %S C r CITY USE ONLY
$ /7 75' Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/10th%)
$ /,-3'7 $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ 5,00 $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 [ ]
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
1%W -M11112 N Xl :RWILIM1 %W-0 VA;IA
ADDRESS 1020 67 AVE NE
PIN 133024230068
LEGAL DESC MICHAEL SERVETUS 2ND ADD
LOT 1 BLOCK 1
PERMIT TYPE BUILDING
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE WINDOW/DOOR REPL
PERMIT O.: 2004-01597 a
DATE ISSUED: 09/14/2004
VALUATION : $ 2,135.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
REPLACE ONE PATIO DOOR WITHIN EXISTING OPENING.
STATE LICENSED CONTRACTOR 1
APPLICANT
RENEWAL BY ANDERSEN (20130983)
1920 W CO RD C
ROSEVILLE, MN 55113-
(763) 502-4777
OWNER
BAO VANG
1020 67TH AVE NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time atter work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Bldg Insp °F^^ yt Date
BUILDING PERMIT FEE
83.25
FIRE SURCHARGE
2.14
STATE SURCHARGE, VALUE
1.07
LICENSE SURCHARGE
5.00
TOTAL
91.46
PAID WITH CHECK # 37043
er►nit Inspection
Will Be � arks
T® �® ailed
meowner To post
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
04/02/2004 FRI 13:21 FAX ELDER JONES 1 � �a- . Cih 001/001
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address
Legal Description_
Owner Name & Address:
Contractor.
Address: RENEWAL BY ANDERSEN
1920 COUNTY ROAD "C" WEST
ROSEVII,LE, AIN 55113
MN LICENSE
Tel. #low l - ol101-
icate of Survey of the . -
,i drawn on it to, scale
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. F'
GARAGE AREA: Length Width Height Sq. F
DECK AREA: Length Width HgVGround _ Sq. FL
OTHER: f i(�� V
Construction Type: Estimated Cost $
Driveway
'Curb
r\Cut Width Needed: Ft, + 6 Ft = Ft x
DATE: - 1 _v4 APPLICANT:4�rj A n&y�_n6l� Tel. # QS 3 - 3 S% tl W 4
Call (763) 672-3604 for Permit Fees if mailing in application. Fax to 763-577-727., if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
Fee Schedule on Reverse Side
$ 65% of Permit Fee
$ c, .001 of Permit Valuation (1/10th%)
$ Q'] _ '$.50/$1,000 Valuation
$ $1350 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 [ ]
$ . Ada STIPULATIONS: