AF - 35531SUBJECT M.-,�. ����':`..`..:
City of Fridley 2 7 3 4 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� ; y ______ COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. L��Q�
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� � /"'1 � CITY HALL FRIOLE`/ 55432 NUMBER REV DATE PAGE OF APPHOVED BY
�""� � �'' 612-571-3450 9t0-F�5 � �
8/21/98
JOB ADDRESS
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
SNEET
OESCR. S H � O
2 PIiOPERTY OWNER MAII ADDRESS ZIP PNONE
Johnson
3 CONTRACTOIi MAII ADDRESS ZIP PMONE UCENSE NO.
Gates Roofin 4640 Ximine -
4 ARCHITECT OFi DESIGNEF MAIL ADOFiESS 21P PHONE LICENSE NO.
5 ENGINEER MAII ADDHESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
. p NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOAK
Reroof house and ara e 25 S T r-o
9 CHANGEpFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, H.EATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOF A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINED THIS APPLICATION STA�LS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS Of �AWS VALUATION SUATAX
AND OFDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMP�IED '
WITH WHETHER SPECIFIED HEREIN OR NOT. TME GiiANTING OF A PERMIT ZOSS
DOES NOT PAESUME TO GWE AUTHOR�TV TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANV OTMER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �]�F. JS Fire SC Z.OH
PLAN CHECK FEE TOT EE
'� �^' ��~ Lice 5.0 8 7
SIGNATURE O� CON'RA OR AUTNORIZED AGENT IDATEi EN FOP VALIOA ED S IS VOUR PERMIT
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�S�GNATUREOFOWNEAi�FOWNERBUILDEAi ' �OATE� BLD �NSP �1FiE
NEW `" - [ ] Effective 1 / 1 /98
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 /
BUILDING PERMIT APPLICATION �� �%�
ConstructionAddress: �� %� �� S�"
�� �
Legal Description:
Owner Name & Address: �D�h'1SnV1 6 d�� �//f' � ,�� Tel. #
Contractor: _�G�'pf �jp�1�1�( MN LICENSE # � %��
Address: y6 ya iiil'ri9111f S lh �!�/MD��� i%j/ ��(�� Tel. #�S� �0�/3
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn ,on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
�S s�. -----
Construction Type: �C�%�'(� ��' f OGT Estimated Cost: $.��v v �4�j�^
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
�
DATE: " � �' �� APPLICANT: �� / Tel. # 3b " �'
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License 5urcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� L �Y
$ Q?_ 0 8
$ �, D `-�
$
$ � ��
$
$
$
$
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CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.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 [ ]
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BUII..DING PERMIT FEE SCHEDIJLE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,041 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Mmunum Fee is $21 plus surcharge)
$21 for first $500 plus $2_75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first'$2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $SO,OOU plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for iirst $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25� for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,0OO,OQO
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Onl )
Y
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15 .75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certifcate of Survey of the lot, showing the location of the foundation once it has it has been constructe.d
will be required before proceeding with the framing.
sue�ecr P T N O. !
City of Fridley 2 717 6
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
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COMMUNITY DEVELOPMENT DIV. ��
r � ~ � PRO7ECTIVE INSPECTION SEC. ��
� �
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� � �"'1 � CITY HALL FRIDLE� 55132 NUMBEF REV. OATE PAGE Of APPROVEO 8Y
�_...'�'' �•' 612-571-3450 9t0-Ft5 8/13/98 / /
JOB ADDRESS
6271 Able St
1 LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHEO
oesca. S 80' of 8 2 Moore Lake Hi hlands SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PMONE
Ruth Johnson 571-1681
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Town & Countr Roofin 4 N Ma 4-4233 20091282
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL AODRES3 ZIP PHONE LICENSE NO.
B USE OF BUtLDING
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE � REMOVE
8 DESCRIBE WOFK
-off
9 CHANGE OF USE FROM TO
STIPULATIONS ,
Underlayment must comply with State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
TMIS PERMIT BECOMES NULI AND VOIO IF WORK OR CONSTRUCTION 20NING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTEf± WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIFV TNAT I HAVE READ ANO EXAMINE� THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF �AWS VA�UATION SURTAX
AND ORDINANCES GOVERNING TNIS TYPE OF WORK WILL BE COMP�IEO
WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GRA NG OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VI CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER TATE OR LOC LA EG LATING CON-
STRUCTION THE PEAF ANCE OF CO rv Fire SC �Z.OH
� LAN CHECK FEE TOTAL FEE
License SC 5.0 82.87
SIGNATUAEO � ACIOAOA i2 oa iDATEi WHEN PROPERI AIIDATED THIS IS VOUR PERMtT
� 1 �
SiGNATUREOF WNEAUfOWNERBUILDEAi IOATEI 8 G �N$P � r•TE
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_ __ _ _._ ._ __ _ _.
AUG-13-1998 08�42 FROM CITY OF FRIDLEY TO
....., i �
ADDN I] CITY OF FRIDLEY
ALTER [ J SINGLE FAMYY.Y AND pUpLEXES R-1 AND R-2
BUYLriiNG P�T APPLtCaTION
CoasuuctionAddress: �D 2,� � � LE ��
Legal bescription:
Owner Name & Address:
Contracu
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER;
8589320 P.03i02
rrir.t:uvr ti i�ya
c� ����
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_ Tcl.# �'�` -�lnRl
Nnv z.ic�vsE �,��� 2R�
}�_Tcl. # lpl�-` "Le - U.�, �
Attach to this application, a Certificate of Survey of the
lot, with the ptoposeci constcuction drawn on it to scale.
DESC�ON 4F ID�II'RO�'�I'
Letigth Width Height Sq. Ft. _
-
Length • Width Height Sq. Ft.
Length Width . HgVGround Sq. Ft.
����
, �.
Consavcdon Type:� (Z.b n � Estimaud Cost: $, -- - � - a �O � �
(Fee Schedu2e on Back)
Driveway G�rb Giu Width N�ded: Ft. + b Ft =_, Ft x$ = S
DATE:
Pernut Foe
Fire Surcharge
sm� s�e
SAC Charge�
Licease Sut+charge
Driveway Escrow
Erosion Control
Pazk Fee
S�wer Main Charge
TOTAL
• STIPUI.ATiONS:
T�. � cQ�z—���--��3
$ �. S Fce Schcduk on R�.wcrsc Sid�c
$ �- U .001 of Permit Valuation (1llOch%)
$ � a � $.so�si,000 v��aoa
$ $�000 per SAC Unit
S �- C�O SS.00 (State iiceasod Rcsidential Contractors)
S Alt. 'A" or Alr. "B" Above
$ $450.00 Conservacion Pla�a Review
$ Fee Det�ermined by Engineerin8
$ Agrocment Necessary [ J Not Necessary ( J
$��
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CITY OF fRiDLEY INSPECTlON OIV. . 3�7� �� Effective On January 1,1893
6431 Untversity Ave NE . .
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
v72-3604 REFRIGERATION AND A1R CONDITIONING SYSTEMS ANp DEVICES �
� JOB ADDRESS (Dr,(%� (�:blPi S�` IU� '
flATE SCHEDULE �
The undersigned hereby makes appiication for a permit for the work herein
Residential � Rate TOTA� spec'rfled agreeing to do aii work in strict accordance with the City Codes and
Fumace Sheli and Duct Work� Burner — ru(ings of the Buiiding Division, ansl hereby deciares that ail the facts and
Also Rep{acement Fumace $ 20.00 � � representations sfated in this appiication are true and correct.
,:� . , �% o��% �1993
Gas Piping (Needed with new furnacej $ 10.00 $
. OWNER_�_r�n ie�l' °+-i�Ll.� �1C�SC`�1"'�
+.
Gas Range $ 10.00 $ ' . .
. . `�Zt'�`f�Y�e'-�
BUILDING USED AS�P� .,� _
Gas Dryer $ i0.00 $ c .
� ESTIMATED COS? __ � I �_ �� " PERMIi NO. ��
*Afr Conditioning — Atl Sizes $ 10.00 $� � � �
' QESCRIPTION OF FURNAC� AND OR BURNER
Ali Others/Repalrs.& Alterations (LIST ON BAC� '
1% of Value of Appiiance or Work $ y,(�i' No, of Heating Unfts Circle One (Steam} {Hot Water) (Warm Air)
Trade Name Size Na
Cammerciai(Industrial BTU HP EDR `���.
1% ot Vafue ot Appliance or Work � Fuei � Total Connected Load '� �
• O
State Surcharge ,50 Bumer irade ame Size No.
STU HP EDR
TOTAL FEE
� /�� HEATI G MP
MINiNtkihA FEE FpR ANY HEATINGICOOLIN�ENTtLATiON
REFRfGERATIUNIAiR CONDtTiONlNG PERMIT 1S �15.OQ ' e
PLUS THE �.50 STATE SURCHARGE
R1R �UALlTY. tI�G. -
�rif1 �v�O7J ,M 'j
'7 �", "7 _ �,t� i_t i-�. �
REINSPECTtON fEE $30.00 . proved B`��� Ro�� h—in Date Final �� c-► .
p Y 9 Date ����
*Air Condfticnets can not be placed in a side yard without
written permission fram adJoi�ing property owner. FILL OUT BACK SiDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
.
_., .., .... .:...... . �c :,:.... ,.:..... ,.,......, .;.....�. .,
CHIrIIJEY AND STACR VSRIFICATION
The undersigned hereby verifies that the existing chzmney or stack:
1. Has been carefully examined ' Yes ( j No ( j.
2. Is free from rust or deterioration . Yes O No O
3.- Has no foreign objects lodged within Yes O No O�
4. Is securely supported � Yes (�) No O
5. Meets a11 current Code requirements for
size and total BTU's connected Yes ( j No O
6. Has total heating BTU's of
All other BTU's
,' . � ,
' TOTAL BTU's ..
Remarks �
List Alterations BeinQ Done�
` , � �� .� n t� �C�
°�-- �: � �C. -
•• ` Lc.4--,
,
2619 COQN i�APfD� �QU1.�VARD .
HEATING CoMPANY r.nnn� R4p1DS Mh 5�a.�� '`
.j ; �' .
Signed By� �; �
��,
Date _ <`�'��� . , :p
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