AF - 36432City of Fridley _
APP�icafion for P'hNnbieg and Ga: Fitii�q hn�if
Dapt. of Bldys. Phon� Se0-3450
DESCRIPTION OF WORIC �� � �� � ` /� �
KumMr, Kind and Locatfoa oi Fixtures s�
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PARTIAL RAT� SCHEDULE
S�w�r �-
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PLIIMSING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures . . . . . . . . . . . . . . . . �'J x a200 a 'S�• U U
Future Ftixture Opening . . . . . . . . . . . � x E1.50 = �� •_.�"�
New Fixture Old enin �
on g . . . . . . . . . . . x 31.50 E---
Catch Basin . . . . . . . . . . . . . . . . . . . . x a3.25 s ,-�-
Water Heater :Up to 89,OOU BTU� ...• f x 33.00 : °� Q D
New Ground Run OI� Bldg. . . . . . . . . x a3.25 $
Etsctric Wat�r ii�at�r . . . . . . . . . . . . . . s s2.00 t
�AS FITTIMG FEES: NO. RATE TOTAL
lst 3 Fixtures . . . . . . . . . . • • . . . . . � x 52.00 : � . CJ O
Additional Fixtures . . . . . . ..... . . . . . x i .75 i
Gas RanQe to 199.000 BTU .. ..... ....... x 55.00 �
REPAIRS � AL?EAATIOIfb—R�i�r to Cod�
Descriptton . . . . . . . . . . .. . . .. . .. . . .... . . . ... . . .. . ... . ... . ;
TOTAL !'EE •� . D p
City of Plridley:
The undersigned hereby makes application tor a permit for the woak herei
specified, agreeing to do all work in sttict accordance with the Cit,T Ocdinance
and ruling o! the Department o! Buildinga, attd hereby declues that ai� the tacl
and representations stated in this application are true and correct
'dley. Mian G - � , 19L,/
Owner
� �3 ,
/ Kind of Building
Used as
To be completed about
�i
Estimated Cost, � ��'a
Ol Ne . Bui2ding Permit No. Permit No. � _
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e
ROUGH
FINAL �%
Signed
sy____ -
Bu ness Phune No- �� �—�� 3�
City of Fridley, Mi.nn..
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: Ma3�8y.._1971
p��; B��a?-d g�s�rQ.ng, Buiider _._Rodne�B.illma.n Inc �._.___..____
Addresa ._...._.____ ..�. Address ._151 Silver_Lake__Roa_ds,_New Brig.hton
LOCATION OF BUILDING
Na 1522 S�t ____ Berne._Road .N.E.��._-. --- Part of Lot ._._.�.
� 10 B;ock ___. 2 �..._._____ Addition or Sub-Division ___.:_ Innsbruck .5th Addition
Corner Lot ..._ ____ Insicle Lot �.___�._.--- Setback .___.__.__�S. �...____.. Sideyard _....._._..._..__
5ewer Elevatian
Foundation Elevation
DESCRIPTION OF BUILDING
To 'be vsed as:
-�? P�. �__ i Yi .g _.._ Front _.._..2�.� ._ Depth 2�_..�.� � Height _..2 �-�---_.. Sq. Ft. __.1442 cu. Ft. _.w
___ Front ..��..._.. Depth Height •---_._._____ Sq. Ft. _----.._.._____ Cu. Ft. _.....
Type of Comstruction �:x�2,m�____ .._. Es� Cost ..�6�,000, 00.._._._. To be Completed __ Aug. _15� 1971
SEWER LOCATION: 63' East of Manhole "Y" Elevation: 981.07
Inv. Manhole elevation: 982.98 Top of Footing: 984.07
WATER LOCATION: 10' West of Sewer
Minimum elevation 18" above centerline of street. Provide hard surface drive.
Provide Verification Survey before framing.
In consideration of the issuance to me of a permit to
the p�oPosed work in accordance with the descxiption abo•
Ordinances of the city of Fridley.
the building described above, I agree to do
�th and in�co� h� 'ance with all �ovisions o!
/..J� .(�u-�-�,�,--- �+-�-c�/-?
.� �,.,.1� /, � . /c. '
In consideration of the payment of a fee of $ 54. 00 _._�� pexmit is hereby granted to�.. RodneY B�.11m2.n
to construct the building or addition as described above. This permit is granted uposi
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any paxt thereof, shall conform in all respects •to the ordinances oi`
l�'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of building�i
pYithin the city limits and tlais pernut may be revoked a t any time upon violation of any of the provisions of 8aid
ox�dfnances.
��ci�� � i Building Inspecto�c
HANK MUHICH
NOTICE:
This permit does not cover the construetion, installation for wiring, plumbing, gas heating, sewer or water. Bs sun to sw
t6s Building inspeefor fo� separata permits for these items. '
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AP.P�,ICATIGN � CR. BUIL�IN'u PEEZMTT
� TTY OF FRIDLEY 9 MI?�TNESOTA
C��+I�EFt pS IVAl`� ��� /2 i 7r RTJTL,DER r� �� �`l7A"N ��:
ADDRE�S A�JR��S /J % _ S;"�.E,� �,/f�� �1�'
r � r T, j,. /YG/-r� ��J�2i������ ��'/d�r
LCUAI'�ON Or BiJII;DI�t��
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�o o `� �'- s�x� P �n �o ,�%
LOZ �p BLOCK � A_7DITIGN OR SUB�IV�SIOI�T
� CR.�^,ER. I,CT
SE[nTIl� ELE`iiA� I C?T:
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INSI�E %OT � SE�!'BA ;i� �� �I�EYARD
TOP (�r � OGmI?� ta
Ap�1.�car._t a��ach to this To,y�. 'I'�Tc �":��tiiivat�� c�" Su.�vey o.f Lot an�
pr�oposE� bui���ing locatio�z u��,�� ors -ches�� ue�°tif icat�� a
7ES',�',R.��"i �_OI� Ci' B�'IIaD.;.N{:�
'I'o �e Js��. A� : �,. O
'-� �� r F�c�nt.�-�' Z De�th � � � ��� HPight � � �2 y
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�quare �°ef=t��y��ubic Fec-_�t
Fr°o:nt
De�;th Height
�qu�re y'eet �ubic Feet
T,ype oi Const�uct�o.n�j��j�- E�timated Co�� lo a��?
To Be Completed
� . - -
The unde�sign.ed hereby make� application for a permit for �he �ork
herein speciiied9 agreei�g to do all work in strict ac�ordancP with the
rit.y o.f Fr�.dle,y Ordinar,ces an� rulin.gs of th� D�par�t�ent o:� Building�,
a.nc� h��Eby �.ecla,re� that al.i t;he i�cts an� r�p_�esertations stated i.n
�hi� appli�ation a.�e t�ue �,�e� co�rect o
DATE S iG?�ATUEE
(�che�.ule oi Fee Costs ca�? be fourid on the Reverse Sidea �
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BUIi.�DIP�i� PERMIT �'EE SCI�DLTLE
SECTION 2 o The In�p2ctox^ oi l�uildings Uhall, 'a�f°o�^e is5�uing per�it�
for the �x�eotio.n oi any building or st�°uctur�, o� ior �ny additio� to az�y
�xisting �tx°u�tur� or buzl�iz�g, or ior a�.y �,lte��,tion or repairs to any
existi.ng bui�,r3ing or st�u�tu�e9 upon a��Zi��.�yon therei���, yPqui�� the
pa,ym.ent py the a,;pplic�,�t f"o?^ �uch permit oi iees to tt.� amoun � herel.�
belo�p set forth a.r_� in th� ma:tiner hez°ein p��ovz��d to��9it:
U.r�iior� Bui�.ding rode � Typ� 1 9 2, & 4 -$1 � 75 iox° each one thous�.�.d
cubic ieet, o� fr�,�tion the�eof 9 in. �uch cubical c�ntent� o T,ype 3 8e 5�-
$1 � 50 for eac� o.ne thou: �..i�d cubic f'eet o
For the pu�pose o�' com�suti.ng fees �or bui?�.ing permits9 the cubical
contents of an,y building or addition to a uniform height th.�oughout by
multiplying the �round area cove-�ed from a point six (6� inches below
+he iloor line cf the ba��ment or the ceilar to the aver�,ge height of
the upper° �uriace or to th� average height o� the roof �u�iace of thE
main gable oi a pitched roof<
For repairs or alterat�o.�s to a.n existi.ng �tructu��, the iee shall be
at the �ate of $3000 pe� each f'ive hundred dollars ($500�00) or
iraction thereoi ira the �o�t cf all proposed �orka
I.n no case shall the �eF cha�gec� ior an�r permi� as set f"orth i.� Secta.o.ra
2 bE les� than $5oQ0o
NSSSD Co.nneetion Charge� based ozi lo�ation - Ar�a 1 or 2e
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HEAT LOSS CALCULATIONS D�PARTMENT OF BUILDINGS
— I A.S.N.V.E, - � Construction No. Insulation
Wcatherstrips (',uide `
How Applie
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Application for Power Plants and He�rting, Cooling, Ventilation. Refrigerafion and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GAAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work . . . . . . . . . . . . . . . .. . . . . . . . . . . $10.00 �
Replacement of Furnace . . . . . . . . . .. .. . . . . . . . . . . . .. . . . 6.00 S
Repairs & Alterations—up to $500.Q0 . . . . . . . . . . . . . . . . . . 6.00 $
Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . .. 3.00 $
MECH. WARM AIR
Furnace Shell & I?uct Work to 12U,000 BTiT . . . . . . . . . . . . $10.00
each add. 60,000 BTU .......... .. . ... . . .. .. . 3.00
Replacement oP EY�rnace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.00
Repairs & Alt+erations--up to $500.00 . . . . . . . . . . . . . . . . . 6.00
Repairs & Alterations each add. $500.00 . . . . . . . . . . .. . . 3.00
$—c '`
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$
$
3TEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. FDR Steam .. $10.00 $
Fumace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 3.00 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 3.00 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 6.00 $
over 3 gal. per hour—See Fee Schedule
�GAS BURNER (up to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . b.00 $ '
over 199,000 BTLT See Fee Schedule
GAS FITTING FEE5: NO RATE TOTAL
lst 3 Fixtures x$ 2,Qp $�
Additional Fixtures ................. x .7b $
Gas Range to 199,000 . . . . . . . . , x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SY3TEM
ALTERATIONS & REPAIRS
ROUGH
FINAL � •
�
See Fee Schedule
���
TOTAL FEE ��L�' _
Dept. of BIdga. Phone 560-3450
���
�
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'
City of F4�idley:
The undersigned hereby makes application for a permit for the work hereir.
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridiey,
Owner ��K
Kind of Building �/�/���
Used as �%��� �� V �
To be completed about L`/ �� y '�/
Estimated Cost, $
9►S�, `
Old New Building Permit No. Permit No. ��
DESCRIPTION OF WORR
19 �
HEATING or POWER PLAN75—Steam, Hot Water, arm Air No. /
Trade Name_ �����r' Size No. �j ���
Capacity Sq. E't. E.D.R. BTU H.P.
Total Connected Loa � Kind of Fue �j (�_
BURNER — Trade Name • � Size No. U
Capacity Sq. Ft. E.D.R BTU g,p,
(REMARKS—OVER]
sz
RAY N. WELTER H EATI N�'3 CO.
Signe •
gy MINNEAPQLIS 7 MINNESOT�
Business Phone No- e ��/����
�il� Of rTIC��e�/
Applica�ion for Plu�nbing and Ga� FiMi�q hn�it
Dept. of Bldq�. Phon� 980-3�90 -
DESCRIPTION OF WOR1C ���� � � _ ���� 6��
Niumb�r, Kiad and Locatfon o! Fixturss �����' ,
3 �I � Ii�I • I �N I�►10 �
����
�■�
2nd
3rd
4th
• Fuxur� Coan�ctsoa Op�niaos
* N�w Fixtur�, OId Op�niays
J4 I� � ItJ � I< � I(�'1 � IO � I(! V I I I N� G STE� NTEC.
PARTIAL RAT� SCHEDULE
Sew�s�
��� n
PLUMSIIdG FIXTURE RATES: NO. RATE TOTAL
� , � /1 �'
Number Fixtures . . . . . . . . . . . . . . . . � x a2.00 E,..��e v ••
�ture Fixture Opening . . . . . . . . . . . � x a1.50 S—,� Q �
New Fixture Old Opening . . . . . . . . . . . x E1.50 ;_._
Catch Basin . . . . . . . . . . . . . . . . . . . . x �3.25 =
Water Heater :Up to 99,000 BTU). •.. x a3.00 = ?� �
New Ground Run Old Bldg. . . . . . . . .
El�ctrk Wat�s H�at�r . . . . . . . . . . . . . .
:AS FITTING FEEB:
Ist 3 Fixtures • • . . . . . . . . . . . . . , .
Additionsl PY:tures . . . . . . ..... . . . . .
Gas Ran�e to 195,000 BTU . . ,.. . . . . ...
AEPAIAS � ALTERI►TIOIIS—R�i�s to Cod�
_ x a3.25 S
_ = i2.00 =
NO. R11TE TOTAL
— x 32.00 ; o? c� O
—x=.7b i
x �6.00 i
Deacriptlon . . . . . . . . . . .... ....... ...... . ..:... . ...... ..... _
T"O'PAI, l�'EEi.��_
(SU�RCHARGE $ 1/5�)
.�ay.sa
city oi PYidley:
�
The undersigned hereby makes application tor a permit tor the sork heni
specified, agreeing to do $ll work in strict accordance with the CitJ Qrdinance
and ruliag of the Department o! Buildings. arr.d hereby declares that ai} the tact
and representations stated in this appHcat3on are true and mrrect
Fridley, �Kinn 19�
Owner ��/ K � �s-t
Kind of Building
Used as
To be completed about
Estimated Cost, a�.�L(�� C/
/ /
Old New uilding Permit No. Psrmit No, �� �(O
Signed �j
g -- -- -
siness Phune No �� � f�'�'� �� o�...�
ROUOii f " � � � Z
£INlIL l ` 3 " 7 �
HOUSE HEATING TEST RECORD :
ADDR ESS /�-� � -� - � �� , ,r..'� ;� `Y '
APT. OOR CITY ` SU�UR
OCCUPANT OWNER � .. ,�;��. a
HEAT LO55 DATE HTG. INST. GAS C0. METER BADG `�"��3 °�*�
SOLD BY 1NSTALLED BY • �. �''�`C
Electrical Work By Gas Line B `�_�,: ��` `
Y ' °
TYPE OF HEAT GA, FA HW STEAM SPACE HTR. UNIT HTR. 0�'HER ' °�` * �-���
� ,�
� A ,;-a �
,,., ���DE51 �� � .� CONVERSIQN ' _ ' �� ��Y���;
MAKE ---� �'' MAKE AF BURNER � � ��
4 �4 � �F�4� �
Model � � ,���.1�/ °���i�e�. �"�-% � � � � � �,�<�+a� `�
- Model
Sericl '����-g'�—• �J'�� Max. BTU Rating t '��;� �+,_�
_ >_
INPUT � °� �� � � � � MAKEAF FURNACE �� � � ��` t ������
Model �� k r; ;;
�� CONTROLS '�
THERMOST T� eat Plu :Vent 5ize � ���f ,� ��:
Valve �- �`-U A„�!!� �,.'� .� KIND OF �INE_R t� ; �'` ,, �: _
, SIZE�NONE
Limit ��� -1����-T.� Droh Hood ��e�' Rsgulator
Limit Settin9 � Filters Size Number ��:?��`,e� �'
Fan Setting ��f� -~l�%.i`� �' ,�< :nrs
Chimney Loeation Inside 'Outside � • �-�.
Pilot Type Chimney Construetion �k� .�-�- • _.!
Pilof Make �: -�"
Pilot Model ` Smoke Bomb Wiring �� �
f Pilot Timing i��-�-�� Drcft L� �~ �
Tesf Tog
L.W. Cut Off � Door Pressure_ Lighting Inst. +
.r . ¢ Q..' !' �- /.� �'^'"/�r.�.� �''�i� �� �' ..� � •
Prossure �''�' Peres�ent CO ate Tested ��3� �j
InputCFH ��-� PerC'�����• ��' ��mpany Testing _
�. Stack Temp. � Percent CO ��� Name of Tester �� -��` .''
�. Form 235
`�__ _ _ - __
sue�ecT PERMIT NO.
City of Fridley o 18371
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � . RECEIPT NO.
� ` ___. COMMUNITY OEVELOPMENT DIV. �
r � y � PROTECTIVE INSPECTION SEC. aO ��.�j
1 � �
1 � /'�'1 � CITY HALL FqIDLEV �JS43Z NUMBEfi REV. OATE PAGE � OF APPROYEO BY
�""��� ,�' 612-571-3450 9t0-F15 4/10/86 / /
JOB ADDRESS 1522 Berne Road N. E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ZO 2 Innsbruck 5th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
George Fischer 1522 Berne Rosd N..E. 574-1729
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Feyereisen Construction 4037 HTest Broadway, Mpls. 55422 537-4566
4 ARCHITECT OR DESIGNER MA�L ADDFiESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUI�DING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRBE WORK
Reroof Structure
9 CHANGE QF USE FROM TO
-STIPUTATIONS
X� Roof can be the second layer but not the 3rd. Install ridged
galvanized valleys.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUM8ING, HEATING, TYPE Of CONST. OCCUPANGY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCT�ON ZONING SO. FT. CU. FT.
AUTHORIZE� IS NOT COMMENCED WITHIN 60 DAYS, OF IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOfi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFF3TREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAILS 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 COMPUED c�
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GfiANTING�OF A PERMIT Y1�4aO $`70
DOES NOT PRESU GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROV NS OF NY OT R STATE LOCAL LAW REGULATING CON-
CTIO OR HE P E OF CONSTRUCTION. $23. SO
` LAN CHECK FEE TOTAI. FEE
� ., � �j $24.20
SIGNATUAEOFCONTRACTOFORAUT OA�ZEDAGENT IDATEI WHEN PROPERLY I TED THIS IS YOUR P RMIT
� �v �
SiGNATURE OF OWNEAiIF OWNER BU�LDEA� IDATEI BIOG iNSP f�AT
NE�' [ l City of Fridley Effective 4/1/84
A�Dt;. [ 7 rR-1 AAD R-2 �
pLTER. [ ] Building Permit Applfcation
Construction Address:
ZZ
Legal Description: �O / ��� ,�L . �, �.fJ �US�i� � � �� � D��
Owner Name & Address : ���`�-�+"6' �1 S C�L#°F+ � Tel . # �774 � �7 Z 1
Contractor: T���!Q-�L �£l�l �O1�V�T 2�.�t..Tot� T-el .# 53?- �7LG�
Address: `���� ��• �2•-v��fJv.-�� ---
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction draxn on it to scale.
DESCRIPTIOA OF IHPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECR AREA: Length �lidth Hgt/Ground _ Sq. Ft.
OTHER : �� �00 � ___.
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback
Type of Construction:
Approx. Completion Date : �"-' � l' v�
Proposed Drivexay Width If Nex Opening Is Desired:
DATE: � 1 _ V �
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
SeKer Main Charge
��
STIPULATIONS:
Estimated Cost: � ��-��
Alt. A Alt B
� �
See Back Page for Explanation
.,
APPLICAN : - '�--...__�.°--� Tel. # �3 7 ���°�"
CITY QSE ONL7 ,
� ��-5� Fee Schedule on Reverse Side
$
� ��
3
$
�
� �-ya�
.,; _
_ :,
_ �-.� �� � o
25x of Building Permit Fee
�.50/�1,000 Valuation
�425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BDII.DIIiIG PERMIT fEE SCHEDOLE
The Chief Building Official shall, before issuing permits for the erection of ar.y
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 applicatio n
tr.erefore,, require the payment by the applicant for such permit of fees to the amount
herein belo� set forth•and in the manner herein provided to-xit:
Total qaluation
=1.00 to �500.00
E501.00 to a2,000.00
Fees
r.
�10.00 (Minimum Fee is �15.00)
#10.00 for the first �500 plus �1.50 for each
additional �100 or fraction thereof, to and including
�2,000.
�2�001.00 to $25,000.00 a32•50 for the first �2,000 plus �6.00 for each
additional �1,000 or fraction thereof� to and
including �25,000.
525,001.00 to a50�000.00
�170.50 for the first
additional �'1 , 000 or
including �50,000.
�25,000 plus �4.50 for eaeh
fraction thereof, to and
�50,001.00 to �100,000.00 a283•00 for the first �50,000 plus �3.00 for each
additional �1,000 or fraction thereof� to and
including �100,000.
�100,001.00 and up
�433•00 for the first �100,000 plus �2.50 for each
additional �1,000 or fraction thereof.
DRIVEiiIAY DEPRESSIOH ESCR01i
(Concrete CurL Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Drivexay width plus
6 feet times �13•50
Alternate "B": Aenoval and replacement of curb and gutter and install a 3 foot wide
approach uith 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 alloK for proper review of the proposed structure and of the�
construction site.
A Certificate of Survey of the lot, shoving the location of the foundation once it
has been constructed xill be required before proceeding with the framing.
�
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 199f
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas
NO. RATE TOTAL
$ 7.00
$ 4.00
$ 5.00
$ 7.00
� $ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
Gas Range $10.00
Gas Dryer $10.00
Back Flow Preventer Requ���GY�es (� No �
Type �i�r c v� �s $s.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
JOB ADDRESS / �2°� �e�n e ��. . " `
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 Building Division, and hereby declares that all the facts
and representations stated in this application are t�ue and correct.
�v� , i99f
Owner � �Uf� [ ' S C� '
Building Used As S� �' S L`' �""'' �
�
�
Estimated Cost °�� PERMIT O. �����
PLUMBlNG COMPAN�� ��`'�f� T ��(-�r;nJ�/l��
SIGNED BY
Approved By ��._ Rough-In Date
TEL N0. ���v 6J� �
Final Date � S � ��
.50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
$�� � S� PLUS THE 5.50 STATE SURCHARGE
CITY OF FRIDLEY INSPECTlQN D(V,
6431 Universiry Ave NE
Fridley, MN 55432
872-3604
i� i�����1�
APPLICATION FOA POWER PIANTS AND HEATlNG, COOLING, VENTlLATlON,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AIVp DEVICES �
Residential
Fumace Shei! and Duct Work, 8urner —
Aiso Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — Atl Sizes
All OthersJRepaits 8c Alterations (LIST ON BACK)
1�0 of Value of Appliance or Work
Commerciai/1 ndustrial
t% of Vaiue of Appliance or Work
Rate 70TAL
$ 20.00 $�„�D.
$ �o,00 ���D
$ 10.00 $
$ 10,00 $
$10,00
State Surcharge
TOTAL FEE
$
Effective On January 1; 1993
JOB ADDRESS /5 Z-Z � r'�' � 2�. �
The undersigned hereby makes application for a permit for the work herein
specifled agreeing to do ail work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct,
/�-(o ,199�
OWNEFi �°�vrT-C „��'Sc�i-C� : �
BUILDING USED AS ��CS 1��w 7��� ��:
ESTIMATED COSt %,��-'U `�� PERMIT NO. � / �vU
.�.�� : • • : :,.� •; �:. _:
$'� No, of Heating Units � Circle One (Steam} {Hot Water) a'�
Trade Name S(ze Na. ������-�...�°�,
..� BTU HP EDR �
$ Fuel Total Connected Load , r.rr� �
$ ,50
��.�
MINIMUM FEE FaR ANY HEATING/COOLtNGNENTii.A ION
REFRIQERATIONJAIR CONDITtONiNG PERMIT IS $15.OQ
PLUS THE 5.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditione�s can not be placed in a side yard without
written permission from adjoining property owner,
Burner T.rade Name Size Na '
BTU HP EDR
HEATING COMPANY �G�� rSa � /j�c� .�
Signed By J � I No. %�' 2-' �! 7�'Z
Approved RoUgh—!n Date Final Date � �.
FiLL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLAC�MENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (� No O
2. Is free from rust or deterioration Yes (� No ()
3. Has no foreign objects lodged within Yes (�,y No O
4. Is securely supported Yes (�) No ()
5. Meets all current Code requirements for
size and total BTU's connected Yes (�) No O
6. Has total heating BTU's of ��d � �
, All other BTII' s _�E��_ D Dr� `
TOTAL BTU' s J ���� ��
�
Remarks
List Alterations Beinq Done:
e
HEATING COMPANY ��`
Signed By �,� �� Sa� /�/'�9 f
Date _ / ,� � /'�� ��
�-��
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
ADDRESS : 1522 BERNE RD NE
PIN : 253024110057
LEGAL DESC : INNSBRUCK STH ADD
: LOT 10 BLOCK 2
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT O.: 2004-014�i
DATE ISSUED: 08/26/2004
VALUATION : $ 42,808.00
NOTE: SEE NOTATIONS ON PLA�I.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE
2000 INTERNATIONAL RESIDENTIAL CODE. CONSTRUCT AN 18' X 25' ADDITION TO DWELLING.
�
APPLICANT
BRENNY TODD 5& KRISTINE K
1522 BERNE RD NE
FRIDLEY, MN 55421
� . � :
BRENNY TODD S& KRISTINE K
1522 BERNE RD NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
re,g�rlatin�c,Qns�ruction or the performance of constrµction.
Bldg
BUILDING PERMIT FEE
PLAN CHECK FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
TOTAL
� �
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
573.05
372.48
42.81
21.40
1,009.74
AUG-10-2004 11�15
�s��• ' '
ADON na
ALTER �j
ConstfuC#ion Address:
Legal Description:
�
: �� �
CITY OF FRIDLEY �� � P.61�64
VI 1 1 VI 1 1\ILJLL 1 ��� I�II�'34�IY�. Y/ 1liV\A
fi431 llnive�fty Ave NE, Fridley, MN 55432 V (T63) 572-3604 Bldg Insp
SiNGL� �AMlIY AND DUPL�XES R-1 AND R-2 (763} 577-1287 Fax
BUII,DING FERMiT APPLICATION
/�� 2 �!���
T /d . ,Q1ec� �Z , �✓�s�v�.� �" �� _ � r�uN
Owner Narne & Addr s: /b� � ��"'"`9 / °S'?��� Tel. # .�/? - ��%'" �63 2
�
COntraCtOr. O/!�E O�vac✓ �. � � MN LICENS� #
Address: � Tet. #
LMNG.ARFA:
GAR�4GE AREA:
Attach ta this application, a Certificate of Sutvey of the
bt, with the proposed canstruction drawn on it ta scale.
DESCRIPTiON OF IMPROV�MEN'C
J ! � 1f �U ,
�
Length /� '. Width 2� Height �� � Sq. Ft �S� � �i' ��. �
Length � �i Width H�i�)tt Sq. �t
DECK AR�A: leng#h Width Hgt/Ground 5q. Ft �
OTHER: �vhi�.)�vlts�l ���_v�rtc����%8 � a;�S_.. `�C� %' /3c� 5r�
Construction Type: y D� �� ^� - Estimated Cost: $_,,,�� �4 ����1 ��-- ��
Driveway Curb Cut Wtdth Needed: Ft * 6 Ft = Ft x$ �$
� d � o�� ���� �Z ���1-��63 �
DATE: �7 Ai�PUCAINT: Tel. #
,.
Call (7f3j 572-3604 for Permit Fees if mailirtg: in application. Fax to 763-S11-9287 if usirtg credit card and we wip catl
_:,you for card number.
Permit Fe�
P[an Review
Fire Surcharg+�
State Surcharge
SAC Charge
�ic�nse Surcharge
Curb C�,t Escrow
Erosion Cantrol
Park Fee
Sewer Main Charge
`�•�r��
� �73�v�
$ 3 �
$ �
$ a�.�o-
$
.$
$
$
$
$
$ I00 q> 7�'`
C1TY USE QNLY -
Fe� Schetiul� on Reverse Side
�i5°/a of Permit �ee
.001 of Permit Valuation ('i/9Qth%)
$.5Q/$1,000 Vafuation
$1350 per SAC Unii
$5.Q0 (State Licensed Residential Corttractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
.. � �
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O��§ �� N� Am 1522 Berne Rd. NE
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BLAINE,MN.55449
PHONE (763)780-5538
ADDRESS
PIN
LEGAL DESC
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�'%L-36U4 r��:
: 1522 BERNE RD NE
: 253024110057
: INNSBRUCK STH ADD
: LOT 10 BLOCK 2
571-11if7
PERMIT NO.: 2004-01650����y�(,s
DATE ISSUED: 09/22/2004
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES V4ID 12 MONTHS AFTER PERMIT ISSUE DATE.
# INSPECTIONS 2
APPLICANT
BRENNY TODD S& KRISTINE K
1522 BERNE RD NE
FRIDLEY, MN 55421
OWNER
BRENNY TODD S& KRISTINE K
1522 BERNE RD NE
FRIDLEY, MN 55421
ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
ELECTRIC FORM FEE
TOTAL
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give autharity to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp
Date
S�YAIZAT� PERMl'TS 1tEQU1RED FOR WURK OTHER THAN D�SC;K1B�ll At3UV�.
40.00
0.50
1.00
41.50
.
CITY OF FRIDLEY BUILDING INSPECTION
6431 UniversityAve NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, 8urner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
�, .��� � a
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND A1R CONDITIONING SYSTEMS AND DEVICES
Fee Total
$35.00 $
$10.00 $
$10.00 $
JOB ADDRESS
Owner.
�z z ���.---�� .�..�
) L7 �°•�s� �
, �
Building Used As �s'��"'�
ESTiMATED COST ���� PERMIT NO c.--'\Ln✓�t ��'� ���
DESCRIPTION OF FURNACE AND BURNER
$10.00 $ # of Heating Units ( Circle One (Steam) (Hot Water) (Warm Air
Trade Name Size No.
$25.00 $r�=v� BTU HP EDR
Fuel Total Connected Load
A(( Other Repairs or Afterations (List on Back) �
1°� of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater on work less than $500.00
Commercia flndustrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
RElNSPECTION FEE $50.00/HOUR °
� r J�O
$
$ .50
� 33 �a
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
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
and rulings of the Building Division, and hereby declares that aIl the facts
and representations stated in this application are true and correct.
HEATING CO
Signed — � Tel # �l2' 9�� �`-3Z
FAX # Date � o �'" U
Approved by Rough-in Date Final Date
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacins� an existina furnace, 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.
The existinq combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
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 ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventinq svstem, 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 ()
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.
No ( )
Yes ( ) No ( )
Appliance Tvpe 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 Tc�al 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)
Z �" ��,� �v� rs w / Y �� �,�s �-x. s
Z �l�o Ji � � ��` f✓/L/�' �iL �g�5 TCr� Gv� �i/eT S -
HEATING CO:
Signed By: Date :
- -- -�-,..
CITY OF FRIDLEY PERMIT NQ.: 2004-01649 �-
6431 LINIVERSITY AVENUE NE ``-----_ - .
FRIDLEY, MN 55432 DATE IssuEn: 09/22/2004
�63) 572-3604 FAX: (7631571-1287
ADDRESS : 1522 BERNE RD NE
PIN : 253024110057
LEGAL DESC : INNSBRUCK STH ADD
: LOT 10 BLOCK 2
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 750.00
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AN AIR CONDITIONER; 2 DUCTS WITH DIFFUSERS; 2 RETURN AIR REGISTERS.
# A/C UNITS 1 VALUE OF APPL OR WORK 750
# FURNACES 0 # GAS DRYERS
# GAS RANGES 0 VALUE (FOR MII�TIMUM CALC)
APPLICANT
BRENNY TODD S& KRISTINE K
1522 BERNE RD NE
FRIDLEY, MN 55421
OWNER
BRENNY TODD S& KRISTINE K
1522 BERNE RD NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of onstruction.
Applicant � �Date
: � _ JI�%�!� �� �ID�1
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
SEPARATE PERMITS REOUII�ED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
750
0.00
0.00
0.00
0.00
25.00
7.50
0.50
33.00