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AF - 44803� � • �J City of Fridley, Minn. BUILDING PERMIT N° �9��5` 8113 nate: ._._. J'� 6_' 196� ._.._. Owner: __......._.. �ahle Builder S. E. Te�lin.---___.._.__. _.._._ _._..._.._.� -----.._.._...�_ 599� Ben am�.n St. N. E. 1251 (iardena Ave. Address_.._._._.._.:._... � _ � __._—...�.__.._.._____..__ Address ....� �....._...._.._____. ._.._.._..�_._._. — LOCATION OF BUILDING No. 5993 ___ s�t Be�amiii Street �. E. .. Part of Lot _......._.._.. Lot _.___.......�._._.__ Block _._..._�__ Corner Lot _.___._.._.__ Inside Lot Sewer Elevati� Additian or Sub-Division Setback .__._.__._.____..�._ Sideyard __.._._ Foundation IIevation ._.__._._. DESCRIPTION OF BUILDING To be Used as: New D�aelling ____ _ Front ��...w Depth __�8 Height .�.Q._.__._ Sq. F't.l�l�2..__ Cu. F't. 2 � A'tt. Gar e._._....._. Front 22__._._ Depth ___....21 Height _.._�:fl_� Sq. F��6�:.........._.. Cu. Ft �:b2Q Type of construction _.._.._._._...__..�. _w.. Es� Cost �17�000.� .-_-_-_.. To be completea __:_ Same as Model Home at 5951 Gaxdena 7�ane, except No Firenlace. � Legal �escripticmz Outlot 1, Worrel's Addition and the I�orth 53 ieet of the West 165 Peet of lot 7.{t� �uditor's Subdivision No. 9�� all in Anoka County, Mi.nnesotaF and subject to an easement for street purposes over the �%sterly 3� feet of t�at part of said lot ].la., above described. In caonsideration of the issuance to me of a permit to cons the building described ab�ve, I agree to do th� pmpoaed work in acc�ordance with the d�scription above set orth in compliance with all pravisions of ordinances oi the dty o! Frfdley. In caa�sideration of the payment of a fee of �_ �9 •� _._.., pernnit is hereby granted to S8m Te�'A17.A to construct the bufiding or addition as described above. This permit is granted upo�s the express condition that the person to whom it is granted and his agents, employees and workmen, in all work doae in, ar�nd and upan said building, or any part thereof, shall conform in all respects to the ordinances o� Frfdley, Minnesota regarding lacation, construction, alteration, maintenance, repair and moving of bufldings within the dty limits and this permit may be revoked at any time upoa violation of ar�y of the provisiaa�s o! satd ordinaua�. All� Jensen Builain8 �ns�ecta� NOTICE: ihis p�nait doa nef �ewr fh� eena�veHoe, M�faIl�Nee fer rrlrin�. Plu�bino. Ya 6NNn�, »w�' w wata. d� arra to sN tM 6uiWieo Intp�elsr for ap�rstr p�e�ils for t6�a i�m. ow�x • s rt�ar� --• APPLICATIOM FOR $UILDING PERMIT � CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILAiNG v� �`ION OR SUBDIVI�ION . :. � Lot�_Inside LOT �,Setback Side-�Yard C/'/� of Lot .�.�._._..�.,.. ,$iWER ELEVATION FOUNDATIOA ELEVAfiI01� / Applicant attach to this form Two Certificates of Survey of Lot and proposed building ]:ocation drawn on these Certificates. /� DESCRIPTION OF BUILDING � � To be used as : .___.._.. ___ __ _. ` -�-�---__ _—,___ _�_.______�f `. _ - - _ - - �-a � �C..� peptl� � Height '� sQ. �t.1 � % 6 cu. Ft.� � -3 °�- � i/`-� v`.' r . j�`i'OLlt _,_, � �. Depth c�- / gei�ht � d -----�--- -. Sq. Ft._ . T� �� Cu. Ft. ��—d ' -----p o �ype of Coustruction Estimated os 4 0`+ To be completed �he undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in� strict accordance with the City of Fridley Ordinances and rulings of the Department of Build�ngs, and hereby declares.that a11 [he. facts and representations stated in this application are true and correct. � � / ��SIGNATIIRE G--�-� (Schedule of Fee Costs can be faund on the f �� (: ��'�` �2.- G�-- ��. • .-�-�;� � : Side). � � s� / . /. = � - - ,�-�� _ - ��- City of Fridley, Mi.n.n.. 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Da�: October 15, 1971 Owner: William J. Kahle Builder ........��.,�„d,.. -•-•-----_...._..-- -__.____........_..�..�.. _ Address 59�3 Benj amin St . 13.E'. , Address �. � -------••--�------_ _.-- --..._---•-••-----.___.._____..—.._.-- � � � � � � � LOCATION OF BUILDING No. ------5993----_..... street --------....B�.a�m;i�.x�..��..�._.N..E.:.._.___.�__ Part of Lot LotQt�.�l.cz�...1____ Block ----------.---------------------------------- Addition or Sub-Division IeIS27C.x.�I.�.S_.�l.�...�._P�'..,_A.i..�A.� - Corner Lot Sewer Elevation Inside Lot ....._..._.._._X ._..__. Setback _..:_._....__,..______ Sideyard Foundation El�vation .._. __....._...._.. DESCRIPTION OF BUILDING To be Used as: Stairway & Roof ------•-----------------------.-•--.._ Front ___...___._.. Depth _�__�..._ Height _.._.._.._......_ Sq. F't. Cu. Ft _.�..�..�---._:...._---------•----...-----_ Front __......_.____ Depth _..__.....__ Height _..._._._...__ Sq. F� ....� Cu. Ft. Type of Construction ___�ememt .Block ry�� C�t �$500.00 _� To be Completed ___.10�15/72 In consideration of the issuance to me of a permit to construct the buiiding described ove, I agrec tp c'b the proposed work in accordance with the description above s t forth and ' co li ce 't all provis3ons ot Ordinances of the city of Fridley. "� /,Y1�1 }� /. �� =�� ULS - w�tP C�i-,-��p° • . . In consideration of the payment of a fee of $__ 5• 00 ._..__., permit is hereby granted to William J. Kahle ._._._._.._.._.._.__.._...._ ..:...................___....__ to construct the building or addition as described above. This permit is granted up�n the express condition that the person to whom it is granted and his agents, employees and workmen, in all woTk done in, around and upon said building, or any part thereof, shall conform in all respeCts•to the ordin$uCes Of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving o� buildilig8 yyithin the city limits and this permit may be revoked at any time upon violation of any of the_provisions of Said oz�dii►ances. arence Belisle ►� r NOTICE: This permii doea not cover the construetion, inatallation fo� wiring, plumbing, gas heating, sewer or water. Bs sur� to sN ths Building Inspector for sepawte permits fo� fhese ifems. r � AP.PLICAT'ION FOR RESIDENTIAL, ALTERATION, OR ADDITiON BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA , .�l� . . � � ��.�- OWNEA S NAME ; ,v"�- � BUILDER : � �A,ADRESS ;.��I �--3 �� aJ, �� cJ �Sfi - ,ADDRESS • NO • . 5��`3 STREET • �� N I � �`� 'N IA'�t�v��a�" \ BLOCK� ADDITION:V�o r e�1 s��Q N��'� � S� y� CORNER LOT: INSIDE LOT: �/ SETBACK: SIDEYARD; ,�pp��.cant �ttach to this form Tt�o Certificatea of SurveY of Lot and pxogosed building l.ocatioxt d�awn cm these Certificates, HESCRIPTION OF BUILD,�NG To Be Used As :� 6to �� " o`�� 2 S�"�� V 1''�<�y d� ��; o ��1�� 1 � W a/Front : Depth : Height : Squaxe Feet: Cubic Feet: Fxont: Depth: Height• Squa�e Feet; Cubic Feet: �►pe of Conatruction: �M �-�� o �-K Estimated Cast: $�04. / To �e Campleted; The undezsigned hereby makea applicatitin for a�ermiC for the work herein epec�,fied, agreeing ta do all Moxk in attict accordat►ee wi.th the C�,ty of Fridley Oxdinance� aad ruliaga of the Department of Buildings, and hersby declares that all the facts and representationa atated ia this application are ts�e and correct. DiATE: SIGNATIIRE:��o`� � (See Reveree Side For Additiaaal Information.j . ,�. �, f,..`_ _ .� �.r � �. ,,,t ,� "; .f � ._, _; ` . ._�. �� _ : :� , t SUBJECT NV . City of Fridley _ 17150 ATTHETOPOFTHETWINS gUILDING PERMIT � ;, , � RECEIP . � • COMMUNITY DEVELOPMENT DIV. ' j L �"" r � � PROTECTIVE INSPECTION SEC. ��D � � � � � /"�1 � CITY HALL FRIDLEV SS432 NUMBER REV. DATE PAGE Of APPFOVED BV � ---'�'. .'� 612-571-3450 910-F15 5/19/83 / / JOB ADDRESS 5993 Benjamin Street N.E. 1 LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED oESCa. Outlot l, Worrel's A dn. & pt. of Lot 14, Aud. Sub. #92 sHeer 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Michael Walus 5993 Benjantin Street N.E. 571-8199 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 � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE QF USE FROM TO STI PU LATIONS Roof can be 2nd layex but not 3rd. Install galvanized valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELE��TRICAL, PLUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. �S hdlt THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. N0. 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. AI.L PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED yi`$OO.00 WITH WHETHER SPECIFIED HEREIN Ofi NOT, THE GRANTING OF A PERMIT y�. SO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE P,ROVIS�ONS OF ANY OTHER STATE OR LGCAL LAW FEGULATING CON- STRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. �S`�.S.00 LAN CHECK FEE TOTAL FEE $15. 50 Si ATUae oF c ITRACTOR OR AUTH_RIZED AGENT �on7Ei WHEN PROPERLY V IDATED T IS IS YOUR P MIT " CGr�.- s r ( � � SiGNA7UREOFOWNERiI NERBUILDERI IDAT 1 LOG �NSP �ATE 0 CITY OF FRIDLLY �fteetive �►ug, i, 1961 APPLICAT1Qi FOk RES1DtHTI/1� B�lLDl1iG PLRi�IITS (Nh,r. Alterotions. Additions. or Repairs) ONNER: „1%,7�[�A�rr DAvz,� Gt//�4��5 ADDP.ESS: ��`7 � 3 8��3�4�.,��'s . — �.a•� t< TEL AO • �' 7 / —�� `�ci ,� �-�� -ir�� c� � r - — BUILOER: _ _ ��z� . — ADDftLSS: ��f�-��c-� TEL N0: , Constn,ction Lccation . szx�r �o: � t 9 3 crr�r: _ f� �v�,4 �yv �_ -c i -�,�.00c= �_�._� �DAITION: 1,�� e�� `s � A�. �` �4- s. ��.z Coznez Let: �__! In=ia� Let: `� ktbacY.; __ Sideyezds: Ap�]icant att�ch to t)�is form !vo Certificates of SLrvey of lot and pzoposed buil�ir�g Iocatian drawn on oeztificates to scale. DESCRIPTIO�t OF COf��STP,UCT101� � ��U�- r Frcnt: Depths Height: 6quart Feet: Qabic Feet: , FsonL: DeptA: Hefght: Square Fest: Wbf c Peet: ,�/3l�r�itl C � , • � 4ype of Cbr.struction s_ N G— �/ �� l= , Estfa�ated Cost: : d ---_-.---� ... Rb B� Cbr.�p2cteQ: c'��3/ ( ' • r �Zt• � �t• 8 pzoposed Drivc�+ay i►idth If Ncw Opening is Desired: %V :� _ . . . SEL R?,VER;E SIDi OF SHF�T . . • • si�e undessioned bereby �nat;es arpiie�tion foz a pei-rsit �cr the ��ezk hereir� specffied, . egreeinq to ib ,all vork it, stzict accozdsnce with the City of Fridley Ozdi��ances a�id ruli�i9s of !he Dep�=t�nc�t of Duildingt, and t�ereby declares thrt all tt�e facts and scpresr�trticns stated 3n this applic�tion are true and co:rect. a1TEz � n . ��l 4;�d'� ._, s i c�rzvr� : /,i �./ atipulatio�s: � /�_d� S� �._----�--`—�� .. ..� sue�ecT PERMIT . c�ty of Fridley � 827 AT THE TOP OF THE 7WINS g U I L D I N G P E R M I T - r ; � RE O. � i L��_��_, COMMUNITY DEVELOPMENT DIV. �%� � � PROTECTIVE INSPECTION SEC. 1 . � l-_•• A,�/"'1,,j CITY HALL FRtDLEY 55432 NUMBER REV. DATE PAGE Of APPROVED BV i �� 612-571-3450 g10-F15 11/6/85 � / JOB ADDRESS 5993 Benjamin Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION ATTACHED oescR. putlot 1 Wor�el' s Addition & 53' of Lot 14, A. S. ��T 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Michael D. Walus 5993 Benjamin Stxeet N.E. 571-8199 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MqIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residen tial 7 CIASS OF WORK ❑ NEW ❑ ADDITION �1 ALTERATION ❑ REPAIR � MOVE ❑ REMOVE 8 DESCRIBE WOFiK Install a bas�nent window and window well (couered? 9 CHANGE QF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 7HIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT. ' AUTHORIZED IS NOT COMMENCED WITHIN 60 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 �' S7ALLS 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 $1t 20Q yS` �FjO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GF±ANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHAFiGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $2O. SO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $21.�.0 1 NATUREO CON' C OF70RAUTHOAl2EDAGENT IDATEI WHEN PROPERLY V ATED THIS IS YOUR PER IT � ��--- i/-�--�� -� - � , SiGNATUREOFOWNER�iFOWNER8UILDER� �DATE� BLDG iNSP - D 7E NEw L ] ADDN. [ ] pLTER. [ ) City of Fridley Iy R-1 AND R-2 j Building Permit Application Effective u/1/8� C��,�.L v- � /r' - )')') � �,1� . Construction Address: ) � [.3 �� 4v�t%.� ST. ��-r � �/ Legal Description: D�r� T 1 w��c��`S .4.dOz7��- 53` oF c_o7 �g �Sc�eazv�.�. � 2. 30� �a' �` Owner Name & Address : 11 `k��'t � ��`�J � � `13 ��``��"'�' Sj'� Tel . # � 7� -�� rC �( Contractor: S �� F Tel. � � Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construetion drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECR AREA: Length Width Hgt/Ground Sq. Ft. OTHER : B�,S �. �, � � h�D D w q- c�.-,Z.�Da c� LvFC� i c �✓�rc�� - Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback Type of Construction: Estimated Cost: $ � Z� Approx. Completion Date: j2 -3� �� 5� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ � See Back Page for Explanation DATE: �/" �-�� APPLICANT: �LcE�F��c �✓- V K�L k I Tel .��7� �� Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge '1'OTAL STIPULATIONS: CITY � �� $ $ $ � $ $ � I . ( (.3 '� ^ G �,1..� �o � - �O .U� `� '�C �, �'� � � d .,,,� a � • �v IISE ONLY Fee Schedule on Reverse Side 25� of Building Permit Fee $.50/$1,000 Valuation $�+25 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] � sue�ecr R � City of Fridley 3 22 i� 0 AT THE TOP OF TME TWINS g � f L D i N G P E R M I T r � � RECEIPT NO. � � � • COMMUNITY DEVELOPMENT OIV. I � r � y � PROTECTIVE INSPECTION SEC. ��0� i � � �"�ti � CITY HALL fRIOLE� 55132 NUM9ER REV O�TE P�GE OF �PPFOVEO 8v �'""�" �'' 612-571-3450 9�0-F15 10/18/O1 � � 10B ADDRESS 5993 Benjamiri Street VE 1 LEGA� �OT NO. BLOCK TRACT Op AbOITION SEE ATTACHEO oescR. pt 14, Out ot 1, Worr 1's Addition & Aud. Sub. 4�92 SHEEi 2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE Nary/Nlichael Walus 5993 Benjamin Street NE 763-571-8199 3 CONTqACTOR MAIL ADDRESS ZIP PHONE IICENSE NO S d�.IT12 a ARCMITECT OR DESIGNER MAIL AOORESS 21P PHONE LICENSE NO. 5 ENGINEER MAI� AOORESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residentia�. 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE 8 OESCRIBE WOHK Reroof House & G4rage (22 Sq) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must compiy with the State Building Code. TYPE OF GONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIREO FOR ELECTR�CAL, PLUMBING. MEATING. VENTI�ATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VO�D IF WORK OR CpNS7RUCT10N ZONING SO. fT CLL FT AUTHOR12ED IS NOT COMMENCED NJITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANV TIME AFTEF7 WORK IS COMMENCEO. NO DWIG. UNITS OFFSTREET PARKING I HEfiEBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS APP�ICA710N 1 STA�LS GARAGE$ AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING TMIS TVPE Of WORK WI�� BE COMP�IED W�TH WMETMER SPECIf1ED HEREIN Oii NOT. THE GRANTING OF A PERMIT �2,358 $1 .18 OOES NOT PRESUME TO GtVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON• $83.25 Fire SC �2.3C) STRUCTION OR TNE PERfORMANCE Of CONSTfiUCTION PLAN CNECK FEE T L FEE 86.79 S�GN11U%�E O� CON"�7ACTOp OQ �UTMOQ�ZED �GENT iO�iE� ME PR Y VALIpAT TF�IS IS VOUR PEpM�T .� �' /a-��-�/ S�GN4TU�7E OWNEA��FpwruEaBU��DEA� iO�tE� 8� 1NS�' f��,fE rvEw ( l ADDN [] ALTER [ J Effective 1/1/2001 CITY OF FRIDLEY .(763) 572-3604 Bidg insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: j`J �g �PY1 1 GU�'I i l� SZL /U� Legai Description: � Owner Name 8� Address: i�-i�VJ ��1f� I C�.2 � l�c� 1�15 Tel. #�7 (0 3-- S��i i�-g 1 R �j Contractor: �,P I T� MN LICENSE # ti%`} Address: � 99.3 ��1'L 1G�7 J'`��ti� Tel. # 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 IMPROVEMENT Length Width Height Sq. Ft. length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. �Q- rooF haus� � ��a� �t a� -� Construction Type: �� -iCfl�Y� Estimated Cost: $ ol��c Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x� _$ DATE: /0 � APPLICANT: '' Tel. #�3 ✓�� I j�' CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ C�. �S^ Fee Schedule on Reverse Side Fire Surcharge $ -3b .001 of Permit Valuation (1/10th%) State Surcharge $ /. / o° $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ $1150 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "6" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] � g�, �� TY t�= FRIDLEY INSPECTION DIViS10N 7"� `d 1� �� v� �� Sl� � ��' i/_ 6431 University Ave NE , Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITiONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - A{sa Replacement Furnace (Side Vent - Fiil Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes , All Others/Repairs & Alterations (LIST ON BACK) 1°�0 of Value of Appliance or Work Commercial/Industrial 1.25°Jo of Value of Appiiance or Work Rate TOTAL 0� $ 30.00 $�_" $ 10.00 $ JOB ADDRES OWN Effective On January l, 2002 BUILDING US�D AS g'��G�� ESTIMATED COST� �� PERMIT N0. �� DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heatin Units� Circle One (Steam) (Hot Water) arm Ai $ 10.00 $ Trade Name �. Size No r1') � Q� BTU o HP EDR $ 25.00 $ Fuel Total Connected Load �.�,,,,,�; �`� .. ,,, . Burner Trade Name Size No. ��'�� `�1a0� $ BTUI�JD,`�lOU , HP EDR State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25 00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr $ 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 aihthe facts and �50 representations stated in this app{ication are true and correct. , '' DATE ��r�' �� . , HEAT{NG CO � , Signed TE # �� 3- �iT'% ��S// FAX # �j ��p��_ *Air Conditioners can not be placed in a side yard without Approved By � Rough-In Date Final Date written permission from adjoining property owner. THE BELOW MUST BE FiLLED IN WHEN REPLACING FUEL BURNING APPLfANCES OR THE APPLICATION WILL BE RETURNED •uu�► ► ► �►► •: _►� •�i� •► ! : : ! •► When rP la .in� an existino f�rance, 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. The venting system is plasticlPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The Pxis � �omhustion air is sized and installed to meet the current codes and manufacture�s specifications. When required to �nctall a n w.�mhustion air�,it will be sized and installed to meet the current codes and manufacturer's specifications. - When inctallin8 a new venting�ct�m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers , specifications. This does include AGA-GAMA Category I Central Fumace Ventirig Tables for fan assisted and natural draft appliances. Yes � No ( Yes'(� No ( ) I' Yes (Vji No ( ) ,�r Yes( ) No( ) Yes (�}, No ( } Yes � No ( ) Is the common vent and vent connectors sized and installed coRectly after an appliance has been removed from the common vent and vented separately as per current codes. Yes (�;� No {) '` A�,nliance T�,�e and Si e/('ommon ��ent and ��ent -onnector Information Appliance #� Type � BTU Inpui��,_ Fan Assisted or Nat �_ Appliance #2 Type BTU l�put Fan Assistzd or Nat Appfiance #3 Type BTU Input � Fan Assisted or Nat Total Appliances 1 Total Btu (nput � 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 e +.. .a ...,-. .,,.:,�.. . .., -.. :, •, . „v . . s - .tw ... .. , � . .,, r :. y . g ..� . -- .: .. = c . c„ -. . . . . ., e,. _-. . ,r>+*.. a -�,..,: . r Y -. .., � .� ..w--.� �s. ....�... -- --�..... . �. . �j " � ��' , , �liOUS HEATING TEST RECORD , ADDRES ' APT.�� L�O%'� R CiTY SUBURB OCCUPANT OWNER'fL'%-r�� ,_ HEAT LOS DAT G. INST. SOLD BY INSTALLED Y ��-��IL� � � y. Elsctrieal Work By Gos Lin� B � , �` TYPE OF HEAT GA FA �HW STEAM SPACE HTR. UNIT HTR. OTHER �'" - �' . €. , � � � GAS DESIGN CONVERSION �� MAKE � � � MAKE OF BURNER � �x Mod�l Modsl , Ssriol �" �rlax. BTU Rctin9 ,^ 'INPUT � MAKE OF FURNACE _ • THER�Volvs Limit �'""1�i Limit 5ettiny Fan Setting _ Pilot Type� Pilot Make Pilot Model _ - $�,�L--ONTROLS Heat Pluy Model V��t Siza �% �� PU�- � KIND OF LIN�E�R,_,� ��U L SIZE�_NONE Droft Hood -�� / a.� R� ularor ��-�' . Fi It�rs Size % �° umb�r Chimney Location I sids .� Outsid� , Chimn�y Construction � `%5 � Smoks Bomb � Witing ' Pilot Timing �`A' 1e. Draft T�st Tap _� /� L.W. Cut f Door Pressure Liyhtiny Inst. Prossure"'" °�` Pateent CO2 � Dats Testsd ` ` G ;^� l � A! Input CFH �`''�� Peresnt 02— Company Testing 5'to�k Tsmp. � y� Perc�nt CO Nams of Tsstsr ! Form 235 °, �. _.. _ _ CITYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 March 23, 2004 Mr. Michael Walus 5993 Benjamin Street NE Fridley, MN 55432 Re: Final Inspection at 5993 Benjamin Street NE Contractor: Anderson Heating & Air Cond Dear Mr. Walus: A mechanical permit was issued on February 10, 2003 to install a furnace and air conditioner at your address. According to the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the work authorized by this permit. As of this date the final inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, the permit will be marked "no inspection called for by homeowner after notification" and expire the permit. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh Suilding Inspections 763-572-3604 DATE �' L-��= SITE ADDRESS ^ THIS APPLICANT IS � PROPERTY OWNER/ I NAME: TENANT �.,. CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY h k � � / �CONTRACTOR 4 � l.L►;.a.y.t;�c �-,��'• STATE LICENSE # � ADDRESS: PHONE " INGLE FAMILY/NE ❑ TWO FAMILY/NEW ADDITION ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: I❑ NEW O MAIN'I DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT � 70 7"� FAX CONSTRUCTION ❑ GARAGE/SHED ❑ ROOF ❑ SIDING � ADDITION AIR REMODELING �x�,`�,a , ! � W- I� Permit No.: �CG"�'Z�S ' Received By: Date Rec' d: L?O /Q.�l'�� •••• / Lt� l� a /Yj �Y ' ! �1. CITY STA EXP DATE � � ' CITY�Of.S!✓�S /�J�t% SIZE STORIES ❑ WINDOWS O DRAIN TILE ❑ OTHER )L , � �� '�jt WIDTH /�' 12• fj HEIGHT i ROOFING ❑ HOUSE ONLY � \ NUMBER OF SQUARES ❑ HOUSE & GARAGE � GARAGES O ATTACHED GARAGE � PROPOSED SIZE: ❑ DETACHED GARAGE � PROPOSED HEIGHT: � � SIDING � ❑ Vinyl ❑Soffit �j ❑ Aluminum ❑ Trim i/ �S . 17 Other ❑ Fascia � � WINDOWS � �Q� IN EXISTING OPENINGS ❑Yes UNo LOCATION OF VJINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF �O A OPENING CHANGES & � _ � TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LAB(�R AND MATERIALS: (USING THE 1997 U.,B. FE SCHEDULE) TOTAL JOB VALUATION $ Z'�� Stfl %d 2�5.�9�OCCUPANCY TYPE 2 �zrn 'S3/l2- =� Sq. Ft. UBMIT: nbers to bc used NCLUDING DECKS, BMTf: wing the existing sWctures tion plans Permit Fee $ . d� See Back Page for Fee Schedule Plan Review $ � a � 65% of Building Permit Fee Surcharge $ (.0045) times the total job valuation — Minimum $.50 Fire Surcharge $ �. .001 x Permit Valuation (1/10%) License Surcharge $ 5, OO $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Gurb Cut Escrow $ ft+ 6 ft= ft x$20 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary O Non Necessary O Total Due $ 3 .`..� Malce checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclrnowledge 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 whic quires evie n proval of plans. 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