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_: � , �"rjidley, �atn�e�ta. regarding �oca�ion, `c�nsia.�uction, altera#on, �n�itenancC, repafr aad mioving of budidin�s vvitl� ., �
in ;khe vilIage 3itnits �nc� this`perinit ma� be revokec� ,a� aziy tizn+� ,upoa v3olaticun oP arry o€ tki� provisions of �Sai�i.. ':
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�� iisewer cr� wa�E�r. Be �re #o see �Bufilding Inspecst�tr fae separa�e Aerrrtits fer iteci�s. " ` i
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C
n
` � CgIMNBy AND BTACR VVBRIFICATION
�
The undersigned hereby verifies that the existing chi.mney or sta.ck:
l. Has been carefully examined Yes ( j No ( j
2.. Is free from rust or deterioration Yes () No ( j
3. Has no foreign objects lodged within Yes O No O
4. Is securely supported Yes (�) No O
5. Meets all current Code requirements for
size and total BTU's connected Yes () No t)
6. Has total heating BTU's of ___
All other BTII's � �
TOTAL BTU's � •
Rema
i� cs �'l�i � � �.— i i� �
List Alterations Beinq Done:
a
HEATING COMPANY
Signed By
Date
\
� -
-
ADDRESS �
OCCUP�NT
HEAT LOSS
SOLD BY �
Eleetrieal Work Bp
TYPE OF HEAT
MAKE
Model 1
Ssria l �
INPUT �
Max. BTU Rating —
MAKE OF FURNACE
Model
CONTROLS ``
THERMOST T � Heat lug Vent Size �
Valve KIND OF LINER SIZE�NONE
Limit Draft Hood Regularor
Limit S�»in9 Filters Size �D� �
Fan Setting Chfmner Location I e Ou`trlds
Pilot TYP� /, Chimnsr Construetion � , 6'� �,f�["�
Pilot Maks �
Pilot Model Smoke Bomb Wiring
Pilot Timing Draft Test Tag
L.W. Cut Off Door Prsssurs L htiny Inst.
6
Pressure -` Pereent CO� Date Tested "
Input CFH Percent OZ Company Teating C° ^
Sraek Temp. _ � Psrce�t CO Name of Tester
Form 235
� � SUBJECT PF$A�LLNO.
City of Fridley - —,
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T ��� v� �
i � !
� � -
COMMUNITY DEVELOPMENT OIV. RECEIPT NO.
' � �: ------� 4.�� ��
r � � PROTECTIVE INSPECTION SEC.
i � ,
i
L.-_- ,� ��r��� �,� CITY HALL FRIDLE� 55432 NUMBER REV OATE PAGE OF APPaOVED Bv
j �� 612-571-3450
910-Ft5 7 1 97 � �
JOB ADDRESS 6278 Baker Avenue NE
1 LEGAL LOT NO. BLOCK TqACT OR ADOITION SEE ATTACHED r
oesca. Pt 12 2 Moore Lake Highlands SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Shermon West 6278 Baker Street NE 586-0349
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
B& B Roofing 6760 Madison Street NE, Fridle , MN 55432 571-0248
4 ARCHITECT OR DESIGNER MAIL ADDqESS ZIP PHONE LICENSE NO
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
X
8 OESCRIBE WORK
Reroof House & Garage (25 Sq) 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 OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEFi WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of �AWS VALUATION SUHTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2�08,r $1.04
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PRO ISIO OF ANY OTHE STATE OR LOCAL LAW REGULATING CON- $7(}. �S
ST UCTI N OR THE PERFO ANCE OF ON RUCTION. �''i. SC �Z.O9
PLAN CHECK FEE T L FEE
/ � Licen e ,$5. $gZ,gg
SIGNATURE CO � ACTOR OR AUTHOAI D AGENT IDATEI p Y VALI T � HIS IS VOUR PER/M��T
_ � ?�� /c/eJ ,
SiGNATURE OF OWNER iiF OWNER BUILDERI IDATEI LDG INSP f16TE
NEW
ADDN
ALTER
��
�]
��
CITY OF FRIDLEY
SINGLE FAMILY ,AND DUPLE , R-1 AND R-2
BUILDING PERMIT APpI,ICATION
Effective 1/1/97
;� �_
r'
ConstructionAddress: � �� /�� � � .
Legal Description: �� � � yL � � � �
Owner Name & Address: ��/� /Z � � (� � S � Tel. # ��� — (� ,> � c/
Contractor: _� �j ��� �� MN LICENSE # D �7'a—
Address:_ �� �(p� �'/�ij��� � - �--
Tei. # .S 7/ pa y�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIpROVEMENT
LIVING AREA: : Length � Width Hei t
� Sq. Ft.
GARAGE AREA: Length _ Width Height S Ft.
DECB AREA: q�
�n� Width Hgt/Ground Sq. Ft.
OTHER: �L.�l�c��- o'{"cJ �5 �
- - �°` ��`r_eSt� �`°, ��>���. �-
Construction Type:
Estimated Cost: $ �G��-� �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _�
DATE: _ / � � APPLiCA►NT: �/�/� `� �� %i�� C . Tel. # � %� Oo2 �/i�
d
Permit Fee
Fire Surcharge
Sta.te Surcharge
SAC Charge
License 5urcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPiJLATIONS:
� ��� �� �
� , ���
$ /. p �
$
� �: c� �
$
$
$
$.
$ l "r�_ ��,��`o
CITY USE ONLY .
Fee Schedule on Reverse Side .
.(�1 vf Pernut Valuation (111(#h%)
$.SOI$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Ait. "B" Above
$450.00 Conservation Rlan .Review
Fee Determined by Engineering
Agreement Necessary j] Not 1Vecessary [ j
�, , . �.
NEIN "
Ad171�
AI.TER
� � � rl i `
- .
[ l CI iY �F �RIDL�Y Etiec�ve 9t1/2004
I j 643'i Uruv�r.�ity Aae N�. Fridley. MN 55432 {T83► 5fi2r3604 Bldg lr»p
(] �INGt,E FpMILY qND DUPL�S !�-1 AND R x (763) 5T4-1�67 Fax
BUlIDING P�RMI`I' APPUCATION
Gonstruction Addre
Lec��l D�cription: ,
Owci�r Nam+e & Adc
Cantractoc,
Acidt+�ss:
�LA ��IPdG & RE�
�4'IAO EXCELSIC
ST �.+C�UIS �'ARIt,
11� �ClOti1C
- - - �� 1.�1�1 �°�-sk+ ',' " . a�� � ,
MN IIC�NSE �
� �.J�l Fi��i�4G EMt7DEUl�r, �w�„ - - Te�. # 6i� - ��� 3''� �
4f1�p EXC�LSIC?R BLVD.
��r�,1i����qD1ic�� a Gerti�icate of Survey of the
- b I v�i'�`t����sed constructivn drawn on it to scale.
� BLV � '
� � �1� DESGRtpTi�N O� IM[�R�VEMENT
�
�IVING AREA=Lengtl , Widt� � Height � Sq. Ft
GARAGE p►REA: �ength Width �,_, H�ight Sq. Ft. ..., __
DECK ARE.�►:
�THER:
Length Width _ __ NgtlGround � Sq. FG
� ��Constrvction Type:,, ' - � stimated Cost: � � _ _ _
prN�way Curb Guf ' t dth Ne�ded: Ft + 6 Ft =,,,,_,Ft x� _�
1 �r
DAT�: � ' I � p�L1CAN7: � '� '� �`� �� # �--� �•� ���
�
�� m-e.i�
CaU (763j 572-3604 fc 'ermit Fees if mailing tn applica#ian. Fax tcy 763,571-�tZ87 i# using credi� card and vv�,will calt
ycu foe card numb�rr.
Permit �ee
Fire Surcharge
Stafie Surcharg�
SAC Gharge
Lic,�t�se Sur�harg+
CUI�3 CUt �SGr�w
ErOS10t1 ��ntrpl
Park �'ee
Sewer Main Ch�r+ :
To'�AL
�17Y US� �NLY -
$ ���� �`� ^
$ �%�
$ ���
$
� �'d�
�
$
�
$
� � �'
�ee Sch�dule �n Reverse Side
.001 of Permit Valuation (111 oth°1�)
�.5CN$1,�?00 Valuatiar►
�'1350 per �AC Unit
$5.OQ (�ta#e Licensed Residential Cvn#ractors)
Aft. "A`' or A{t. ,�g�� Above
$450.00 Conservation Plan Revi�w
l�ee 17etermined by �t�gineering
Agceemeht Neces,ss�ry [ l Not Nec�s�ary [ l
S71Pt�LATIC3NS•
�.r Z' d �S8 ' 0�1 S3�aS �NI�00�1 ti�3S Wki T S: 8 900� ' 0 T' H3�