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AF - 35641CiTY �F FkIDL�Y APPLICAIION FOR PO'�ER FLANTS AND HEATING, COOL?NC, VENT:ILATION, REFRIGERATiON AND AIR CONDITIONIN6 SYSTEMS AND DEVICES PARTIt�L RATE SCHED'uLE GR.a:"IT1' li:aR�i :aIR: R:a';1: TOi'.1L =',:�r.ace Shell & Bcct Work $1<.00 $ �e��acar.._ :t of =vrr.acc 7'�� $ :.e��irs S :+lteraticns-up to $500.00 �"'� $ R-=pairs s i,lterations each add. 5500.00 4.C�0 $ :i��x.�,�zc:�i.. .ti.��i :�i�.: F.�rza�e S�eil 6 Duct tnor;c to 100,000 STU Each ac::. SJ, "v00 STJ Replace^ent o." Furr.ace Re_ airs & A2:.eratiio.^.s-up to $500.00 �e_airs & Alterations each add. $500.00 STr.=+.�. UR f'.�T �ti.aTiiR �l"S 1 L�l : r:,iler � i.ir.�s uo to 100, OJO BTII eac.. ac: n. 50, Ou0 BTti Boiier crly np �o 100,00C BTU eacY: ad :n. 50, 000 BTU J:L Blii\ER- to 3 gal. per hour each a�3. 3 gal. per hour GyS Bli.�2\�R- �ror,t 1Cv,000 8-`� to 199,999 BTD {aver 159,99� BTu see Fee Schedu7e) $12.00 4.00 7. C)0 7.00 4.b0 S S S� $ S $12.00 $ 4.00 $ 7.00 S 6.00 $ $10.Q0 $ ' 10.00 $ $l0. Q0 $ �O . � $ -- :�aS FIT; :\� Ft=ES: is� 3 F�xtures x$ 3.Ci0 $ Ac3;�ic::a1 rixtures x $ 1.U0 $ Ga� Rar.;e to 199,000 BTU' • x $10.�)0 $ .�.IF CO\llITI:;\I�G �� S _ 'r':�\ H�aT?\G S1"�TL�1S � See Fee Schedule $ t"E\TiLaTI\G S�'ST��•�IS S ALTERaTIt�\S � REPaI RS _ 5 S Sta:e Surcharqe $ .50 TO�FiL FEE $ /�, . S (J RJuG3 ItiSF. Gate s L�IAL I\SP. Daie a��:.v�i FOR FEi..'KIT 7�� IiEIN5PECTICN ?EE • (.$10. 00; :SI1L�:uM FcE FO� ANY FI:ATING PER":IT IS $7.50 Job Address IiepartmenY of Buildings City of Fridley Tel. #571-3450 � The undersigned rereby makes application for a permit for tae work herein specified agreeing to do all work in strict accordance with the City Coces • an@ rulings of the Department oi-Buildings, ar.d hereby declares that all tne facts�and representations stated in this applicaticn are true and correct. Fridley, t�inn. �' �� 1�! � i /'1 n . OWNER KIND OF BJILDI�IG USED AS TO BE COMPLETED ABOUT Ul '�� `%� ESTI,IATED COST —ZJ `� _ OLD - NEW BUILDING PERMIT NO. � PERMIT NO. DESCRIPTI021 OF FJtZD7ACE/BURUER HF.�ITING or POWER P:.ANTS, Steam, Hot Water, arm Air- o. Trade Name ' Size D;o. L-r /�,�fJ • Capacity Sq. Ft. EDR BTU � Y� Total Connected Load 3tind of Fuel ' _ BURNER - Trade Name Size I1o. Capacity Sq. Ft. ELR BTU Hp �7 �'c�ciu,s' . v Ccmpany ' Si�;ned By ��u��' o TE:1. No. �o�S�'�J.� � sus�ECT PERM . City of Fridley _ 15 215 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f � � , � CEIPT NO. • COMMUt�11TY DEVELOPMEN7 DIV. � �ti: ----- � r � � PROTECTIVE INSPECTION SEC. � � � 1 � /'��L � CITY HALL FRIDLEY 55432 NUMBER REV. DATE � PAGE OF APPROVED BV �----�: �.� 612-571-3450 910-F�5 5/25/79 / / 10B ADDRESS 6334 Able Street N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oesca. g,10 6 F'lorence Park sHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Gerald Bergum 6334 Able Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHI7ECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAI6 ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUiLDING . Residential 7 CLASS OF WORK " � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 26' x 24! detached garage 9 CHANGEQFU$EFROM TO STIPULATIONS px.OVldO a hard surface driveway. Agreement signed by neighbor for constructian withraut survey. SEPERATE PERMIrS f�Et�U(RED F�R Yl11�ltttC� HEATfNC, Pi,UM81NG AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUFRED FOR ELECTFtICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. WQOC� FY'd.Ttl@ THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHtN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED'FOR A PERIOD OF 120 DAYS AT R 1 624 C24O ANY TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION �- STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND AROINANCES GOVERNiNG THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �5► 223 $2. 61 DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR tOCAL LAW FiEGULATING CON- STRUCTION OR THE PERFOFiMANCE OF CONSTRUCTION. 524.96 PLAN CHECK FEE TOTAL FEE yS`2 %. 5% SiGNA REOFCONTfiA OaORAUT iZEDnGENr �DnTE� WHEN PROPERLV VALIDATED THIS 1S YOUR PERMIT �. ,�'�d �- , �J ��SiGNATUREOFOWNER�IFOWNE BU�LDER1 � � IDATEI � BLOG INSP � DAT h� ;. .# _ �'.y �'i y. t • `?":' �, , 3 'IY, ,,��♦ .��''�1�1i`�'��l.i..}''"+ .`a�� '� !' f • ' 3 '` , < � , CZ"C�Y 01= �=IZII)LI�Y . � , • 1�t'f�'t..�c�n�rza�t f�0(Z Rf�SI1)t�tJ�'i,'1L� t'>U)I..111r1G t'i�fzMI'fS , • tI�J�:w, (1�.��:rznr 1 o►�s, /l>>lll T� oi�s, o�i (��i�ni �zs ) .; ,�� , ot��irr�: , ruxr,��;�i: ___�,� �� aar�� : �,/ � 3�.�� naaz-�� • 7r� a. . iso . � t�o. �_ ��2�--J- Str eet : �� 1 �". �I ,� CL�—� , , r,OT: q� �- D }37ACY: �o nDDI'�I(�;a: �%/ov � n�� e � c�`` __L�_.___-+�--- � CQ12N1.R LO�': IIdSIDE 7AT: � S::TBI1CY.z SIUL•"YI�RD5; . APZ�Iica'r,i: attach t:a L-his fonn ��vo Certii�_cat_e�. of Survey of LoL- and proposed bu�.Zdir�g locaL-ion dr_awn on these C�rL-ificates. • DESCRIPTIOI'� OF Bl11LDIi�G To 33e Used As : ' �.2 y � Jlea. ht : �� / • . �-��" Fxont: Z� Depth : 9 _ �. Square Feet: �0�4' Cubic Fect: O�`F � — �I`ront: Depth: � Heiqht: -- — Square I'eet: � C�zbic Feet: � • � Estimated Cost: $ �o e d�f �`ype of Construction: �c�rD ��1�w�� - �.b IIe Completed: /T /�% � � . Alt. A Alt. B Px'oposed Driveway I�TidL-h 7t i4ew Opening Ts Desired $ S • (SEJ: 12IiVERSE SIDE OF SH�ET) ?'lie u�idersig�zed herek�y makes ap�licat�ion for a peimit for the work llerein � specif:a.cd, agreeing to do all �eork in st.r�.ct accnl.dance �oith the Cit}� of . Fx�dley Ordinances ai�d rula.nc�s of tlze De��attment of_ ruildiiigs, an� licreby dec�ares L-hat a�l tlie facts ar�d re��resentatia�ZS stated in i:his applicaLion a,re true and correct. �See xevcrse s�de for acic4iL-ional a.nf-orn�ation. DAT� : S IGNATURi: : S�,ipulations: . - � . `� . O� �, � �,��: � � � � � � . . �"" � , � . � �_2-�. `;,. .. , ;. BUILDI[�G f'FRPY1IT f=Et SCiiEDULE S�CTION 2. The Inspector o� I3uilain�Ja _:1ir-�:t1, beFore issuing penniLs for the ere:cta.on ot any building ar structure, or for any addi�.ion to any existing Uuilding or stYUCture, ar `or any alt•eration or repairs 4o any er�isi:ing building or stnzcture, upon application therefore, require the payment by the app?i.canL- for-such permit o�f fees to the amount herein below set Eorth and in the manner }i:�rein providc�d to-wiL-: N�W CONSTRUCTION: Single Family Homes and Garaqes: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit �ee. . DRIV�WAY ll�PRESSION: (Concrete Curb Stree±�s Only} • Alternate A: Removal arid replacemen�. of concrete curb and gutter only; D.riveway wiclth plus 6 feet x$A��75 � Alternate B: Removal 4?nd relplacement of concrete curb• a�id . gutter a��c� instal.7. a 3 foat wide approach with �� 6 incn c: �.�pth; Driveway wi��ith plus 6 ie�t x$Z'7. 85 - ADDITIONI��. I�}1=0RMATION � For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by mul�ipl�ing the graund area covered from a po.int six (6) inches below the floor line af the basement or th� cel2ar to the averaqe heights of the upper sur_fac� or to the averaqe height of the roof suriace of the main gable of a pitched roof. � • For repairs or a1te�'ations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars-($5�0.00} or fraction thereof in the cost of all proposed woxk: . - • Tr_ 4no case �;ha11 the ��ee charcfed for any- �ennit as set �orth in Section 2 be less than $7.50 pTus $.50 state surcharge. � _► � � � � ��' �� NOTE: Permits £or construction will be issued a mix�imtnn of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. . � : : � :►. Application for a Certificate of Occupancy shall be made ten (l0� days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure sha11 not be used or occupi+�d until a Certificate of Occupancy has been issued. 0 • . � , AGRE�2�IENT �� I, , owner of the property � F �«� located at �; hav no objection to the City allowing the construction of a � f� ,C/� [� G- to be located at ��- �Lh1,Qf �'� %�,f�, without the required certificate of survey that the City ordinarily requires far all new construction. � Signature �' ��G � � . , Address �� I G r �� Cl / n.C�, ��'�� . . Date / /� ' /�� .. �. [_ ,, . . ��V � V' �`�3 a �� - .�^^""`"�r; �,,"' �„`,. �.. / ...._..__ __. / .f .. •� � �,. �i � � � CITY OF FRIpLEY INSPEGTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 . RAT� SCHEnULE ��/g� �4PPL(CATION FOR PC)WER PLANTS AND HEATING, COOLING, VEN7ILA'�I�N, REFRIGERATION A�JD AIR CONDITIONING SYSTE6VIS AND DEVICES Residential . Furnace Shell and Duct Work, Burner – Also ReplacemHnt Furnace (Side Vent – Fill Out Back) Gas Piping (Need�d with new fumace) Gas Range Gas Dryer *Air Canditioning – All Sizes All Others/Repairs & Alterations (LIST ON BACl� 1% of Value of Appliance or V1/ork Comm�rcial/I�dustrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $_ ��C�W $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ $ $ 5tate Surcharge TOTAL FEE $ .50 �..� � �9_NIMUM FEE FOR ANY HEATING[COOLIWCNENTILATION RF�FRIGERATION/AIR CONDITIONING PERMIT IS 25.00 PLUS THE $.50 STA7E SUACNARGE REINSPECTION FEE $42.00/Hr "?,ir Conditioners can not be placed in a �ide yard without �vritten permission from adjoining property owner, 0 Effective On March 1, 1996 �� JOB �4DDFiES;�_�� ,�� The undersign�d hereby makes application for a p�rmit for the work herein specified agraein� to c�o all work in strict �ccorc�ance with the City Codes and rulings of the Buiiding Divi"sion, and hereby declares that all the faats and representations stated in this application are true and correct. �1.�� ,1996 OWNEFI�� `��/ni10��' S 7r� –,2 5lC,� f BUILDING USED AS ESTIMATED COST � ��.�i PERMIT N0. /�3Ca5� I��SCRIPTl�N �QF FURNA�E AND �OR BURNER No. of Heatin ,Units Circle One (Steam) (Hot Water) (Warm Ai"r} Trad� Mame Size No. p°� BTU�.O�}C� HP EDR _ Fuel �,��- . Total Connected 1,oad Burner Trade Name Size No. BTU HP EDR HEATING CGM Sig Approved By ---d— -�3�3 Rough–In Date Fina� Date FILL OUT BACK SID�OR STACK VERIFICATION ON REPLACEMENT FURNACE � CHIlVINEY AND STACK VERIFICATIOI\T The undersigned hereby verifies tha� the existing chimney or stac'k�: l. Has been carefully examined Yes (� No O 2. Is free from rust or deterioration Yes (✓f No O 3. Has no foreign objects lodged within Yes (I�j No O 4. Is securely supported Yes (C� No O 5. Meets all current Code requirements for size and total BTU's connected Yes (�No O 6 Has total heating BTU's of a � All other BTU's �� TOTAL BTU's �/f a� 7. Has a liner been provided for water heater Yes O No �) 8. Has combustion air been provided for water heater Yes () No l�jC,) Remarks: List ALTERATIONS Being D� HEATING CO: Signed By: Date: � . � HOUSE HEATING TEST RECORD ADDRESS APT. FLOOR CITY SUBURB OCCUPANT OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY ' El�chieol Work' BY Gas Lin� Br TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. ' OTHER GAS DESIGN CONVERSION MAKE �.MAKE OF BURNER Mod•I Mod•I SKial Mox. BTU Rotiny INPUT MAKE OF FURNACE Mod•I CONTROLS THERMOSTAT � H�at Plu� �� V�nt Siz• Volv � KIND OF LINER SIZE NONE Limit ` -- Droft Hood Rpulawr Limit S�Niny 1 Filt�rs Si:� Numb�r Fan Ssttinp Chimn�y Loeation Insid��._Outaid� Pilot Typs Chimn�y Construetion ` Pilot Make Pilot Model _ Smok� Bomb Wiriny Pilat Timiny D►aFt i T�st Toy L.W. Cut Off Door Prossuro Liyhtiny Inst. Pressur� P�re�nt C0� Dats Tsst�d I�put CFH P�rc�nt 0� Company Testing �_ � Srock Tsmp. - P�re�ot CO Nom� of T�sf�r Fwm 235 Iat: W� � `.: �.r � .7 �, , � -�� !rrf ...�� 1�; .. �� .��'i��t. �.�`i�:..�.. �llE��r �i'.�'.��l� _ _� ��i�il�� -�—�-- -� -- ��;� �� r�� ,,��■rr�r ,�,,,�_ �,,,,,�„�ri�r� �� , � �� F�� I , � � � � Etl �6. 16.•� � � � � N� f ��r:�i��-�I%=. ��i� �� i�i��C� �� M SUBJECT c�ty of Fridley � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � � ; L___��_ COMMUNITY OEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. i � � _ �"'� � CITY HALL FRIDLE� 55132 NUMBER �""�" �'� 612-571-3450 9�0-Ft5 JOB ADDRESS 1 LEGAL ��T NO. BLOCK TRACT OR ADOITION DESCR. 2 PROPERTV OWNER MAIL ADDRESS Thomas 3 CONTRACTOR MAILADDRESS Donner Const. Co. 6305 Camden N 4�308 B. 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAII ADORESS 8 USE OF BUILDING Residential 7 CLASS-0F WORK pEV DATE PAGE Of 4 /7G /�4 / / ',�...... .. . 27404 RECEIPT P(O. �� APPROVED BY SEE ATTACHEO SHEET 21P PHONE ZIP PHONE LICENSE NO. f 55430 566-5377 6904 ZIP PHONE LICENSE NO. ZIP PHONE LICENSE NO. ❑ NEW O ADDITION ❑ ALTERATION �} REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house and gara�e (27 Sq) Tear-off 9 CHAN(iE OF USE fROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINED THIS APP�ICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH WMETHEF SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION R TH ERF ANCE OF CONSTRUCTION. PLAN CHECK FEE �r°��'" �`' License S�GNATURE OF CON7 A OR Op AUTHOR�2ED AGENT IDATEI � N P � $iGNATUFEOFOWNEAi��OWNERBU�IDERI IDATEI 9L �N P OCCUPANCVLOAD CU. FT. OFFSTREET PARKING STALLS GAFiAGES SURTAX SAC CHARGE ' FEE NEW ADDN ALTER �� [l �� CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: � � P�i' Legal Description: Owner Name & Address: Contract� Address `%^�f Q i�� S Tel. # ENSE # � �� f Tel. # ,j �� `' S 3 �!� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIP'fION OF IMPROVEMENT Effective 1/1/98 LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �O O� J e� df=,� Z�7 � . Construction Type: Estimated Cost: $ �C�� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$ DATE: � �APPLICANT: Tel. # �� S .� �% Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Controi Park Fee Sewer Main Charge TQTAL ST'IPULATIONS: $ �j�/. �s^ $ o?- � s�. $ /, / � $ $ �:vd $ $ $ $ $ � 36 �a- 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 [ ] Nof Necessary [ ] .� BUILDING PERMIT FEE SCHEDULE 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 $2,001 to $25,000 FEES $21 (Minimum Fee is $21 plus surcharge) $21 for �rst $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for �rst $2,000 plus $12.50 for each additional $1,000 br fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000, 001 and up $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $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 $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fracCion thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) 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 deptli - 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 Certificate of Survey of the lot, showing the location of the foundafion once it has it has been constructed will be required before proceeding with the framing.