PRE 2010 DOCSof
SUBJECT
PE IT
City of Fridley
20198
AT THE TOP OF THE TWINS
BUILDING
PERMIT
R
• COMMUNITY DEVELOPMENT DIV.
r i � PROTECTIVE INSPECTION SEC.
qqcl
1 � i
�'--1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED 8Y
612-571-3450
910-F15
11/14/89
JOB ADDRESS 100 - 711i Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
1
1
Riverwood Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jerry Tollefson Construction Inc. 311 Sunrise Lane, Champlin, MN 55316 427-7745
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
J NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 461 x 24' Dwelling and a 221 x 221 Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide a hard surface. driveway. Provide sod
in the ,front and side yards.
Provide City with copy of verifying survey before capping, Paid $1,5Q0.00 Park Fee
Paid for a 161 + 61 = 221 x $13.50 = $2.97,00 Driveway Curb Cut.
WATER & SEWER LOCATIONS: See Engineering Dept.
WARNING
Before digging call for
all utility locations
454.0002.
SEPARATE PERMITS REQUIRED FOR
REQUIRED BY LAW
;ZING, HEATING, PLUMBING ARID SIGNS.
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
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
I
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND.ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$68900
$34.45
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
F
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-
$3755.50
$Credit From SCh.
S UCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
fl-/ y�'
N/A
$409.95 + DW & PF
SIGNATU EOFCONTRACTOR OR UT O ZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
SIGNATb4ttOT 0W N E R U' ER UI i (DATE)
I BLDG INSP
DATE
of
PROPOSED HOUSE LOCATION FOR TOLLEFSON CONSTRUCTION
g,5a o
�pW
tet/. 7p c /
G oaa�
+011
�
71 1/2 Way •• 49°
ao, o
V a
`scp� CQ D
` �A O
scale : 1 inch = 40 feet
Lot 1, Block 1. Riverwood Park, Anoka County, Minnesota.
Denof rs /ra.r ~04400"eAr / 494 w
1 hereby certify that this survey, plan plat, prcliminary plat or report was prepared by me or under
my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State
ofinnesota.
Ree. No. Date Job No. Book No.
•7 _ M O •d a : Nt.. . s .e ai \ .,th n: .utt{1lf . A •::fit tit :.a i4'w . : i73"Oi`.•*0M---7fflW 'w-
,NEW Effective 5/1/88
ADDN [ ] R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address:1A t9 "gV
%
Legal Description: _ Ls17 � o'oml
Owner Name & Address: 'rel. #
Contractor: rry '7�i(�° rrs crr't 64y"W7 ru —Tel. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
KPF OF II�l�AII�TP
LTVnr. AREA: Length 5;'6 Width—
y Height Sq. Ft.
GRRAGE AREA: Length a a width a a. Height Sq. Ft.
EECR AREA: Length Width Hgt/ Sq. Ft.
off:
Corner Lot [ ] Inside Lost N Ft. Yd Setback 3 Side Yard Setbacks --'s J"
Type of Construction: �� ,� ,�„ Estimated Cost: $
Approx. Cmnpletion Date:
cA
Proposed Driveway Width If New Opening Is Desired: /�Ft.
dth + 6' See Back Page
DATE: ,�� APPLIMM: ��� Tel. #
u-
cITY USE OBII,Y
Permit Fee
$ P)M
State Surcharge
$
SAC Charge
$ co's,do r
Driveway EsG�c ,ow
$ 2q7, No
Park Fee
Seww Main (lharge
$
S'L'IP MATIONS:
Fee Schedule on Reverse Side
$.50/$1,000 valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Necessary [ ] Not Necessary [ ]
r
_ hmse -
_,G07 51 r '7,416
COMM. NO.
Planning Design Inc.
1611 Highway 10 N.E.
Minneapolis, MN 55432
612-780-1920 '
Minnesota State Energy Code Calculations
Based on Chapter 5 of the Model Energy Coda'
1983 Edition -- Adapted 1/1/84
Owner: COMM. NO: 867
Site Address:
Contractor: Phone:
Bldg. Class: Al Al for Single Family/Duplex
A2, residentia►1 < 3 stories
Over 3 stories
Other
GENERAL INFORMATION
Note: The section designations ("Section A",' "Section B" etc.) are fc
convenience in calculations only, and are not related from one set'of
calculations below to the next.
1. bldg. Walls Perimeter x Wall heights, Area
ground to save
Section A 76 14.95 1136.2
Section 8 72 9.67 . 696.24
Secti6n C i 0 0 0
Section D Cu G 0
Gross Wall Area 1832.44
2.
Building dimensions Floor or
Ceiling
Length x Width Area
Section A : 44 SO 1320
Section B : 1G 4 40
Section G 0 0 0
Section D o 0 s 0
Total fioor or ceiling area 1360
3: Rini J6isf_Pisi^irneter m 148
Floor joist 2 by (e"; 10", 12" or 16")l: 10
Rini Joist Area - 123.3333
4: Doors ,
Area: 37:8 Thickness (inches): 0
' Rer i inter ( feet) : u
Type of c-6hitrriction:
5. Total d66r's perimeters 0
6. Windows
`
U
f actor:•
0.52
Manufacturer:
;
State approved: YES
Height x
Length x
Number
j
Total �
Type
(inches)
(Inches)
of glass
SgFt
units
CASEMENT
36
16
70
28
5
25
CASEMENT
36
''
10
83.33
CASEMENT
66
24
2
12
CASEMENT
48
24
2
16
CASEMENT
60
24
3
30
CASEMENT
0
0
0
0
0
0
•0
0
0
0
0
0
0
0
0
0
u
0
0
0
0
0
0
0 -
7.
Window glass area (SgFt) a
174.33
Type
Height x
Length
x Number
a Total
(feet)
(feet)
units
SgFt !
8: Patio Door:
0
0
0
0
9: Atriumi
6.85
3
2
41.1
lU. -Fi Fep 1 ace area
0
Width:
U
Height:
Total Sq Ft
0
ii. Exposed Foundation
Reighit:area As
0.67
Perimeter
area A:
148
Sq Ft' area A =
99.16
,
Exposed Foundation
Hei.g6i .area b:
0
Perimeter
area 8:
0
S4 Ft area b a
0
12.
SgFt
U factor
U x A
Gross wall area
1832.44
_ minus
Window area
174.33
0.52
96.65
Patio door area
0
0
0
Atrium area
41. 1
0.44
18.08
Rim joist area 123:333333333
0.041
5.06
• Door area
37.8
0.14
5.29
Fireplace area
Exposed Found.
0
_99.16
0
0.14'
0
13.88
* Framing area
183.244
0.095
17:41
eigLial s
Totals for net wall:
1173.4726667
•0.043
50.46
0
-o=al
s for gross wall
area:
200.83
y
s Framing area is 10%
of gross wall area
13.
Gross wall #rea x
factor below a U x A per code
Factor is .11 for
A-1 single family & duplex
.23 for
A-2 and other residential
.23 for
other buildings
. 28 for •
over 3 stories
Factor is&
0.11
BTUH
201.5684 MUST 6E > OR m
200.83
(calculated aboya)
"
14.
Gross ceiling area
a
1360
15.
Ceiling #r-amiAg area
(10% of ceiling area)
136
ib.
Joist Awealu'/. of
ceiling area
17,
Nqt ceiling area (Gross
ceil. area - Joist area) a
1224
18.
U ceiling;'
0,021 v Net veil. area
'25.704..
19.
U f- F*ng
0.024 x Joist area
3.264
20.
Total of item 18 x item 19 a
28.968
2i.
Eross ceiling area
x factor below U x A per code
Faetor is .026 for
A-1 single family & duplex
.0a3.for
A-2 and other residential.
.06 for
other buildings
Factor iso
0.026
@TUb
35.36 MUST 8E > OR
?.®.96Q
(calculated aOpve)
'
0
UALL
SZC?1011
STUD
StCTlOH •
2ND DALL
SECTION
Exter for air f l lea ' R • .l 7
R TOTAL
Interior air flim R=- 6
.8
Interior rail
I7•O0
(U411) •t1 . l
Insulation
G10Op'
,(Rim
r�-- Sheathing
-Z,Q?0'
SLding
joist).
Oute Ida air flim
Sheathing
�,
R TQ YAL
1
instda it film
68
Inter lar wet
157
Rz .17
stud Re.
6 �
0
(rramingj U•o .
Sheath1'�
• ing
yo
..
Siding
Inter for sir film
R• .68
Outside air Illm
•
TOTAL
tom
Instde air flim R=
068
roundatton
Interior wall
. iFd1l.' u • � .
• , "�
Insulation
Extarlor air film
QU�1l � O 4• �.,
Sheathing
dL
�1` Exterior *all covering
��1.I3
,�.3-•
Exter for air f l lea ' R • .l 7
R TOTAL
Interior air flim R=- 6
.8
0 Insulation
I7•O0
'-' • l� Inch soft wuud
RuI.88
,(Rim
joist).
Sheathing
�,
1
Exterior -wait covaring
Pati
•
Exterior air film
Rz .17
*R TO CAL
'Z'� r'o •.
Inter for sir film
R• .68
•
Insulation
tom
roundatton
1,•Z •
. iFd1l.' u • � .
Extarlor air film
Re 1i
•
R TOM
��1.I3
,�.3-•
E:cpvsed stuck
•
• Cal
w ,V .Vt]
a
® 4® U
® eUr-4
Air. F I Ing
.In, 44 euV
Joist
Calling ®5G
Air FOIal
total A 45070
4 -u21
® ®® �LV� �✓ FILAI. nui1r on C.1111EUML CEI11O14
0.61
•
New
•
e
e`
I
R YAUIE
Ea1:11.IOfd '
InslJn air film 0.61
CRllin •
Joist j; Elsa o
lnsoIatloft
Air sp,ce
Rao darklsi� �.
Insulation
Oil I1t-up roof
luta lde air
Iota! A
I®u
,w li�flltr•atlnio .3 ctmllOneal runt nr crack g
Io l l •
o.,ot .9 J�mr B'of l l to•.ttlon 0.3 cfmf sillt•mre Not. jrPdoor 41111 minimum cnJe reiulrement
-esldeietlal doijr 111111tratlon 01.0 cim/Ilileal (out of crack
2" caietr•!Ld block nai Iniul•ttlon +•.�1 n 1.1
2" concrRte block Isisulated cares ■ .i6 A 1.0
Zp I fgliUwe Iclot 1110ck - ■ ,'Z n J.1 '
2" I1911tits IIII t black loilulat'd cores ■ •12 n 8.] .
1914 glass ! .I.IJI ulth'.•stormifIndaw .54 �.
�11Is gloss ■• .53 :.
pie glass ■ .41
xterlur walls slid celII"Is n",�t' 11tva a r1lit) I•'barrier JU.lu pae•11111318161111131816i �,t.1.
l,•1rrIP_9• ,uu't he* on the 113111e.. (I,r±atell 2Idr.I ®f cell.
barriers of tl,e pmlretl,elene till" film I,av,, nd A value. '
0
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
Back Flow Preventer Required.
Type
NO.
RATE
m
$
>,
m
�3
rd
3.50
o
k
v
$
Water
u1
4.00
r
N
5.00
E
m
5.00
e
+gp�
W
w
r�
Heater
5.00
$
�
$
5.00
W
�.14
3
H
$
�
$ �Sfj
pZ
54
G) UU1
•rel
x
1 5
U a
T5 �
ci
aNi
m u
a
W
S
a w
g
u
3
o
lec
(AA
it
aroa
W
M
as
let
J
1
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
Back Flow Preventer Required.
Type
NO.
RATE
TOTAL
$
5.00
$�.OD
�3
$
3.50
$ • S�
$
1.50
$
$
4.00
$
$
5.00
$
$
5.00
$
$
5.00
$
$
5.00
$
$
5.00
$
$
7.00
$
$
5.00
$ �Sfj
$ 10.00 $
$ 10.00 $
Yes ( ) No ( )
$ 5.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or Appliance
State Surcharge
Reinspection Fee $
($15.00) TOTAL FEE
S
Effective Date May 1, 1988
Job Address �_ 7? G�O(
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 12- %� , 19
OWNER -r- lrry %C// fSQoy� �c�s
KIND OF BUILDING
USED AS e
TO BE COMPLETED ABOUT J ' �Z 5 e?o
ESTIMATED COST
OLD NEW'!qLDING PERMIT NO. J� /
Company
Signed By r JL c i�
Tel. No. Z�
ROUGH INSP.
Date
PERMIT NO. A' Y (1 4__
FINAL INSP. 2! -.✓ - �?® 04
Date
APPROVAL FOR PERMIT 0:h"
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
QESIDENTIAL
RATE
TOTAL
Furnace Shell and Duct Work,
2-0
Burner (Also replacement furnace)
$
20.00
$
Gas Piping
$
10.00
$ � C)
(piping needed with now furnace)
Gas Range
$
10.00
S
Gas Dryer
$
1Q.00
$
* Air Conditioning (all sizes) $ 10.00 $ All Others/Repairs and Alterations
It of Value of Appliance or Work $
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
State Surcharge
TOTAL !EE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp. 29 6W
Date
Approval for Permit nD�
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
$ .50
$'30' D
S
Job Address I L?U � L -'L" ''�
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Tel. #571-3450
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 Department of Buildings, and 4ereby declares that all the
facts and representations stated in this applicat on are true and correct.
OWNER Vo
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
Fridley, Minn. A -4=) - ':�6 , 19 (57
C -P
ESTIMATED COST (O C) U,
OLD -O@KiigiPERMIT NO. PERMIT NO. /0
DESCRIPTION OF FURNACE/BURNER %
HEATING or POWE1Rt PLANTS, Steam, Hot Water, rm Air No. /
Trade Name )-jam X Size No. C?
Capacity Sq. Ft. EDR BTU HP
7btal Connected Load —( �j Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTUHP
Company 1 "
Signed By
Tel. No. 43 4 ^� — 711 -�c bp,. -
Fill out back side for stack verification on replacement furnaces
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 connected Yes ( ) No ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company _
Signed By
Da to
w �
CITY®F
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
February 27, 1990
Jerry Tollefson Construction Inc.
311 Sunrise Lane
Champlin, MN 55316
Re: Final Inspection at 100 - 71 1/2 Way N.E., Fridley
Dear Sirs:
A final inspection was conducted on February 16, 1990 of the above
address and the following items were noted which must be corrected
before the structure can be finaled:
1. Post address on structure. Off -
2.
f2. Provide garage floor and step.rk�-
3. Provide front step to dwelling.ne
4. Provide hardsurface driveway. nK
5. Provide sod in the front and side yards.
We will expect item 1 to be completed by March 12, 1990 and items
3 through 5 to be completed by June 1, 1990 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,
(zia�=Q?-ZP
DARREL G. CLARK
Chief Building Official
DGC/mh
CITYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
June 5, 1990
Tollefson Construction
311 Sunrise Lane
Champlin, MN 55316
Re: Final Reinspection at 100. - 7112 Way N.E „ Fridley
Dear Sirs:
A final reinspection was conducted on ,Tune 5, 1990 of the above address
and the structure was -approved and finaled out as constructed.
If you have any questions on this matter, please feel free to contact me
at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
.sk
JOB ADDRESS
RATE SCHEDULE
OWNER
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner - BUILDING USED AS
Also Replacement Furnace $ 30.00 A M-1 LL
(Side Vent - Fill Out Back) ESTIMATED COST ><� �� PERMIT NO.
Gas Piping (Needed with new furnace, $ 10.00 $
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
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units.*,"Circle One (Steam) (Hot Water)
$ 10.00 $ Trade Name Size No.
BTU _HP EDR
$ 25.00 $ , rC Fuel Total Connected Load
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS X25.00
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 nd c rrect.
DATE `t�
HEATING C + Y�Q Q�. tm L oe-�
Signed TT
S
Approved By Bough -In Date Final Date c,6
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed .By: Date :
+k PS04'
Building
$
BUILDING
See Back Page for Fee Schedule
Permit No.• ' vd -776
6*
Inspections
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604
.001 times the total job valuation
CITY OF FRIDLEY
$_
Date Rec'd: ?
S 0%
License Surcharge
$
DATE -
YOUR E-MAIL ADDRESS r-obbritril,ni.,+MB.
►� e COM
SITE ADDRESS 100 -71172-- W 4:Y
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
$
PROPERTY OWNER!
: 'okn a asv "v i—
Erosion Control
TENANT
ADDRESS: I O O -71CITY r X �'f
STATES ZIP S' 3 Z
Park Fee
PHONE: Z7 ,$3 5'72--1336
CONTRACTOR
NAME: Aftir i � )(4e-1 1 ex
$
SUBMIT A COPY OF
STATE LICENSE # 260 3 7tbC� EXP DATE 3I3 O `g
Total Due
YOUR STATE LICENSE
ADDRESS: 341 71ft W A -t Al c- CITY STATEAriP s��I32
WITH APPLICATION
PHONE G 31 7C`4 –a9 3 FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
O FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH XfROOF 13DRAIN TILE
❑ DECK IrSIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW Q6ADDrrI0N
❑ MAINTENANCE/REPAIR ZaREMODELING
DESCRIBE WORK BEING DONE:errt'CSO
9Lk to
SIZE OF IMPROVEMENT
�'T LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
Q Lt
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
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 ONo 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 THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 5?06 —;Z- OCCUPANCY TYPE
Permit Fee
$
. 06-
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
�. �'
.001 times the total job valuation
Surcharge
$_
f , L4-7
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
6; ,
$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 $2 I =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
` _,
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 ch req . es review and approval of plans.
� jj�� ` x%22 �
SIGNATURE OF APPLIC PRINT NAME 116 )� Til Id% DATE l 7
Building,
PLUMBING
Perm* No.• 20C& 011
Inspections
RESIDENTIAL APPLICATION
Received By:W6 ;
763-572-3604
D PR 2
CITY OF FRIDLEY
DATE "I O YOUR E-MAIL ADDRESS
SITE ADDRFA .
Diane Naumovich
THIS APPLICANT IS: Owt` 100 71 st 1/2 Way Northeast
PROPERTY N,�,,�; Fridley, MN 55432
OWNER/ ADDRESS: 7635721336 STATE ZIP
TENANT
PHONE:
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # C% EXP DATE
A' /y _STATE -&41M S'Sy09'
YOUR STATE ADDRESS /e S CITY A
LICENSE WITH . PHONE ?- A103 FAX —
APPLICATION -
PERMIT TYPE
SINGLE FAMII,Y ElTWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
❑ NEW XREPLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. CMisshould_reflect only.the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor X.05 =
'•FOP -PROJECTS WHERE LABOR EXCEEDS -W- ARE BASED ON $10.00 PER FIXTUR...,•EXCEPTsVg&-RENDTE l : IXT-U ES:.. .(KATE TOTAL
NUMBER OF EACH BELOW)
_ BATH SINK/LAV _FLOOR DRAINS _ SHOWER _ WATER PIPING
_ GAS PIPING (NEW MYLIMSE) _ SWIlIRMWG POOL _ WATER SOFTNER ($35)
—BATHTUB
CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
_
_DISHWASHER _-LAUNDRY TRAY LWATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15,00 = $
Number of fixtures @ $35.00 a_ x $35.00 = $ 36'.0o
TOTAL DUE $
State Surcharge = $ .50
Total = $ O
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 w r w is re es review and approval of plans:
/ /
SIGNATURE OF APPLIC P NAME Je. X/44/001 DATE Zj 117
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-5024977