AF - 43904Date
Owner
BUILDING PERMIT
Village of �ridley, Minn. N� 2 3 0 3
� ' �'�� � : `� � � : � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
""'.�"����`�l,�„�' Builder :�""�:g.°�� ��' .. .. .... .. . .. .. .. .. .. ...
,�'�- � ���',�" � �'#��y���",�iL.. �`'�ti��w1A
Address � � �?' � .�:�".�+s ��� �-�� E'°.��i Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCA'i'ION OF BUILDINCi
No. . �+��,}��. . . . . .�"�"'..'����� +�.�.�r- �-� . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
Street
,.w
, ,��, ,`'� �'�` �`���-�G��' �'�� �=z""`�
Lot .... ........ Block .....�........ Addition or Sub-Division . ..... . ..... ..............
�
r
Corner Lot . . . . . . . . . . . . Inside Lot . . . . . . . . . . . . Setback . . . . . . ''�'!�. Sideyard :�� ��� . . . . . . . . . . . . . . .
DES�CRIPT[ON d�F BUILD6NG
To be Used as:
,�^���`��'ri . . . F'ront .� .�'�. �. . Depth,�� . . . . Heig.zt d. ."'.''�.�.•!. .. Sq. Ft. . . . . . . . . Cu. Ft.
�• ........
�
..... .. .. .. .. .. ... . . Front . .. .. .. . Depth . .. .. .. . Height . .. .. . . .. Sq. F't. . .. .. .. . Cu. Ft. . .. .. .. .
Type of Construction��:�:`�`::� .. Est. Cost .��.:�:��.. �........ To be Completed .�':'`.�'!�"��=:'........
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
...................................................
co�}Sideration of e payment of a fee oi $�+�. :°. :, permit is hereby granted to �'�� �:���`�.. :`�.
�::w�` �. S�°� ��. ....�"�o`'�'onstruct the building or addition as described above. This permit is granted upon
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 part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regaxding locai3on, construction, alteration, maintenance, repair and moving of buildings with-
in ihe village limits and this pernut may be revoked at any tune uPon violation of any of the provisions of said
ordinances. .t , . �t
. . : : ,�,.': . . �! . a: �� �:_.�_ ;' �"iLc`: . Building Inspector
NOTICE:
� This permit does not cover the construction, installation or alteration for wirPng, plumbing, gas heattng,
sewer or water. Be sure to see the Building Inspeator for separate permits for these items.
?"� �"-.
�.�:�.:.: _
>-
w
J
Q
�
L.L
! 1_.
O
�
�
U
�
A
�
Q
z
0
�
Q
�
W
�
�
t1.
w
�
z
0
d �n
.�. W
U
Z >
w w
� Q
. ra
z ¢
J (n
O �
U F-
�
� }
� N
Z
.-. �
F- z
Q �
W Z
S O
A I-
Z ..
Q C�
Z
� O
F-- U
Z
J �
� Q
�
W
3
0
�
CL'
O
LL
z
0
H
¢
�
J
n..
R
N
N
u
�
�
A
h
N
�
a
b
�
.,�
�
� � O
o � v
1� 3��7 I�
� � n
� o �
a� �
A U H
a, �
►°1iv�u �I
N O rl A! .-1
.4 U N �
N N N U
O •-i .[
3 v u �
c�c�mro
,�J '+�� H c� � .
►i .0 .-�i � O
N �-1 N Y
� 3'U �
E U A � �
ui ros�,�+ �
ro o 'G � �
!J U C. �r1
W � ro � �
A U N rt
� 1 R N , C.
u 1� •.i •.i
ro N ro x �
a a��.+�
ax°� � �
N B O J� ►1 � •
� ro � N w
N
�. o N a
� y � �
�"q�
ro � x a�i �� �
� �J � N
•°' N o a (.�" '
N � N H
'U 'tl C. 'tl
� W � ro
c, •�+ H u, a
E a � w o
..-1
d
o „.
H
vr uy v� y. ur vr vr vr ur
(=7 O O O O O O O O O
E' Nnr c nia�rr cr
`` � �
� y. �
0
_ °o � o
AO O O
_ °ou°i o o�
N
N
w '^ 'd 'i � v
�ro
� y � � ,°� x
—i o � a`di o � � �
d s a� i m� ..
'
¢ fj � .� � a ° ° � � �.�i c�'n
H
n. •• �rob -s w��s��iH �ii
°' c0 �'�' wvv cc,�t
� .�i °�" `� �;d °.+'+" E.,
w ��a� `� ar roya� �
i � � ."- .t : d .-
c� in ��aw �n� �w`� H(�
� � U � H � U O) U }1 ►1 :4'
�� a m•� •� H '" .-iOi �� ro c�
H �i n� n� o, i
rno�a o
� waa°� ,-�d �" a"aa� �,
� W �
t� � N
\\
�b
�
�
�
0
� � �I
�}
�
O
a
H
N
�d
w
w
O z
� N
d
o a
:� z
H
� H N ~
a r� o �a
O +� U H �
w � i
z w �p H Q
� � H W O
• ��
�
a el
x a
. �° �
�
z° c� �
�1 G�i
W a � a+
0
� � z � ro
w ro *".
(x�j `� N J4
�z �1 tA
ai �
+�
w 3 A
0 o W
�: �;
p � k' �I
H
a � �
� �
a � �
z Gi
� �° s
�
3 y
o +�
a �
a
S-1 N C.
� 2 � U
�my.� a�y �
x E U H
z
C1
N
ui
x �
�
�➢.
� �
�
� 1`
�
� v
�
ol� �
� P° -
� y z°
� � �;
W U u E'
N •
w
b�
�
�
�
7
ro
ro
N
t �
a w
� �
� �� u�i .
. `
� ur vr nr vr ar vr ur vr �s ut uy vr vr ur ur ur
O O O O O O O O O O
O CJ O O O O O O O O
ri�r��o 00 o r��o
� �'-t v-{i ur �n r�is ba w
S� W
x 4 x °�' � �
a �t N H
rn I I I � +' H
�s
o; d v a�
' � .-� N (/l
H � b �
°° ] � °u � � w
°o � �� Duui ca `n
o� a��� o w � o r---.,._��
1
.0000 � ro o u�i N ia a
i
n� ° u°, a"' °� ,� w o w ui a
aNi �`c�3 .-°.�' � `r' ti o m w a `c�� �' �.�-' ^.cn- � a
��a,ro v° ro wm wa o t' �vicn�
M 1� � �
~.G �.c4 I.[: I 6� C7 •.a H C� C7 fn
ti�i N O a�t � ai � '� '-' .-'�i � � H '/.. '/. `/.
ua (tj H H H O
N a� � o: ar H p W a-C
4 a°a °� a�a.�°. w c�xFw
N � .{ H�W.-7
' o c� c� •r,w>�
W
W
w
O
H p
'�'� O
W O
a �
z �
H
�3a
�
1 �
� ; �
ci .a` o w
� a
OS
a a °
H H �
� � a
� w a
/
"�1�
�
�
\
(�
I
`.�
0
L�1
r
N
H
H
�.
a
�
z
H
�
�
x
°w
W
J
H
z
�
SUBJECT
City of Fridley ° 17 5 5 6
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T CEIPT NO.
r
� `� ______ COMMUNITY DEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC. /�� 7�
�
� i �
l_-__ A �r���,,, CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-F15 6/18/84 / /
JOB ADDRESS 5795 Central Avenue N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION . SEE ATTACHED
DESCR. 25 4 Paskview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerry Seeman 57�5 Central Avenue N.E. 571-3432
3 CONTRACTOR MAILADQRESS ZIP PHONE LICENSENO.
D& D H�e Improvement Inc. 7401 Ceni�al Avenue N.E. 784-7543
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residenti.al
7 CLASS Of WORK
❑ NEW ❑ ADDITION � ALTERATION � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
AI..UIn1.T1UIIl �3C7.�� Cjllt'tP�'3
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL 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. NO. 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. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES CaOVERNING THIS TYPE OF WORK WIIL BE COMPLIED $742 yS` . SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GFiANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISI S OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
TRUCT OR THE PERFORMANCE OF CONSTRUCTION. $ZS.00
PLAN CHECK FEE TOTAL FEE
$15.50
GNATUREOFC NT ACTO ORA OHIZEDAGENT 1 TEI WHEN PROPEFLY VA ATED THIS IS YOUR PERMIT
SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG INSP � TE
NEW L ]
City of Fridley Effective u/1/84
ADDN. L 7 R-1 AND R-2
pLTER. [ ] Building Permit AppliQation
Construction Address:.�
Legal U�sariptioa: �-a !
Owner Name & Address: �
Coatraotor
��
�� � i V � P
' Tel. 4� ��
� 7t5�'��
Tel. �
Address: �Q� �FiY!/i�� �%'� ��� —
LIYING ARFA:
QARAGE AHEA:
DECg AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIOH OF II�IPaOYEMENT
Length Width ____.�__._ �ei6ht Sq. Ft. ______
Length _._ Width .__ Height Sq. Ft. _
Length _ Width __ Hgt/Ground Sq. Ft. _
Corner Lot [] Inside Lot [] Ft. Yd. Setback _ Side Yard Setback �
Type of Construetion: �/�%y%� �� �/�C�� Estimated Cost: $ �
Appro�c. Completion Date: ✓� �
Alt. A Alt B
proposed DriveWay Width If NeW Openin� Is Desired: $ � -
See Baek Page for Explanation
DATE:
� � � APPLICANT: �� ./�I'���e/ �L����� - Tel. � g o
Permit Fee
Plan Cheek
State Sureharge
SAC Charge
Park Fee
S�rer Main Charge
TOTAI.
STIPULATIONS:
CITY 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 NeQessary [ ]
BIIII.DING PERMIT FEE SCHEDIILE
The Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for any addition to any euisting building or structure, or
for aaq alteration or repair to any euisting building or structure, upoa applicatio n
therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the maaaer herein provided to-Wit:
Total Valuation
��.00 to a5oo.o0
�501.00 to $2,000.00
$2,001.00 to $25�000.00
$25,001.00 to $50,000.00
Fees '
r
$10.00 (Miaimum Fee is �15.00)
$10.00 for the Pirst �500 plus $1.50 for eaah
additional a100 or fraetion thereof, to and ineluding
�2,000.
$32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
including $25,000.
$170.50 for the first
additional �1,000 or
ineluding �50,000.
�25,000 plus $4.50 for eaeh
fraction thereof, to and
�50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraetion thereof� to and
including $100,000.
$100,001.00 and up
��33.00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraction thereof.
DRIYEfiAY DEPRBSSION ESCBW
(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 replaeement of curb and gutter and install a 3 foot wide
approaeh with 6 ineh depth - Driveway Width plus 6 feet times $15.75
VFRIFICATIOA OF FOIINDATION
Permits for eonstruction Will be issued a minimum of 24 hours from the time of
application to allow Por proper review of the proposed structure and of the
construction site.
A CertiPicate oP Survey of the lot, showing the loeation of the foundation onee it
has been aonstructed Will be required before proeeeding with the framing.
sue�ecr E R .
City of Fridley o 17990
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � CEIPT .
� • COMMUNITY DEVELOPMENT DIV. � / ���
' LL �����-�
r � � PROTECTIVE INSPECTION SEC. b
1 � �
� � �"��1 � CITY HALL FHIDLEY 55432 NUMBER fiEV. DATE GAGE OF APPROVED BY
�'""� � ,'� 612-571-3450 910-F15 5/2Q/85 � �
JOB ADDRESS 5795 Central Avenue N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ZrJ 4 Parkview l�anor SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Jerry Seeu�an 5795 Central Avenue N,E. 571 3432
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDIN(3
Residential
7 CLASS OF WOHK
❑ NEW � ADDITION ❑ ALTERATION O REPAIR 0 MOVE ❑ REMOVE
8 DESCRIBE WOHK
Construct a 12' x 15' Sc�een Porch Additi,on to Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
�iIARNING
SEP�1R�i� P��9VIt�'S �t�F,l�� FQR Before digging call local utilities
�i�l��� ��T���, ������� �D SfG�lS. �F�EPHONE - ELECTRIC - GAS Etc.
REQUIRED BY LAW
TYPEOFCONST. OCCUPANCY(3ROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 6Q DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. • NO. OWLG. 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. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $,3�L�OO • $�-•7Q
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $44, SQ
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$11.13 $57,33
� IGNATUREO oN�RACTOROR NORIZEDAGENT ��,\ IDATEI WHEN PROPERL A IDATED THIS IS YOUR PERMIT
' „� . �d ���v�'�-� � a� —
SiG ATURE WNER �IF p� � NER BUIIDER� �DATE� BLDG �NSP � � TE
I`
� �
p� [\] City of Fridley Effective 4/1/84
ADDN. QC] R-1 AHD R-2
pI,TER. [ ] Building Permit Appliaatioa
ConstrucLion Address\
Legal Desoription:�
Owner Pame & Address:
Contraator: .�
Addreas
aS
c
Tel. � S% / � 4�3 �._
. #
Attach to this application, a Certifieate of Survey of the
lot� vith the proposed construction draWn on it to scale.
DESCRIPTIOB �OF IHPHOYEI�+�NT
LIYII�IG wREA: Length Yidth Height Sq. Ft.
GARAGE AREA: Length iiidth Height Sq. Ft. �
DECg AREA: Length Yidth Hgt/Ground Sq. Ft
0'fHER :
� X / 5 n,a ���, -� .�:,� �
. ���� 18,�2� �Q •
Corner Lot [ l. Inside ot [] Ft. Yd. Setback Side Yard Setba�k �_
Type of Construction: v� Estimated Cost: �
Approx. Completion Date: G/ S�� j ��� �
Alt. A Alt B
Proposed Drive�ay Width If Ne� Opening Is Desired: � �
See Back Page for Explanation
. '���� APPLICANT. , Tel. � S��"'3 �3 �—_
DATE: _
CITY SE 0
Permit Fee � �o� Fee Schedule on Reverse Side
Plan Check � �l� � 25� of Building Permit Fee
State Surcharge � �.iU �.50/�1,000 Valuation
S,AC Charge � a425 per SAC Unit
Park Fee � Fee Determined by Engineering
Se�rer Hain Charge �
T�� a �,� Agreement Necessary I J No� Necessary []
STIPULATIONS:
BIIII.DIAG PERMIT FEE SCABDIILE
The Chief Building Official ahall, 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 atructure, upon application
tberePore, 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-xit:
Total Yaluation
=1.00 to �500.00
Feea
=10.00 (Minimum Fee is �15.00)
�501.00 to a2,000.00 �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 �32•50 for tbe first a2,000 plus �6.00 for each
additional �1�000 or fraction thereof, to and
including a25,000.
�25,001.00 to �50,000.00 �170.50 for the first �25,000 plus �4.50 for each
additioaal �1�000 or fraction thereof, to and
including �50,000.
�50,001.00 to �100,000.00 �283.00 for the first �50�000 plus �3.00 for each
additional �1,000 or fraction thereof� to and
including a100,000.
�100�001.00 and up
��33•00 for the first �100,000 plus �2.50 for each
additional �1,000 or fraction thereof.
DRIVEHAY DEPRESSION ESCROiI
(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 xide
approach With 6 inch depth - Drivexay aidth plus 6 feet times a15.75
VERIFICATION OF FOIINDATION
Permita for construction Will be issued a minimum of 24 hours from the time of
application to a11oW for proper revieW of the proposed structure and of the
construction site.
A Certificate of Survey of tbe lot, shoWing the location of the foundation onee it
has been aonstructed Will be required before proceeding with tbe framing.
.
3��
��� ���
�� lc? e �
�°
T
d
�
` Zr
`�
�
4
f
�
} • _ _ /7¢� _ ' -
i_ ._
+-- .
, �b ��i . ' - --�
Jois`ts' ��.x�� �(�'' o. �, �
CDr1a�N A� z�� DG� � .
} ' ' . "
- . � .
� - � . . . .. -__ " r . , .
o�
�
i
• -- ---r- - � _ � .� � --
. -
. . . __ _ r,..� _.. . _ . ... __.. . - .. . __ . , .
�_- ,.. . _ _ . _ _
� r
= D
� 1
� n
� p,
3 0
N �
� y
�
o �
3�
a '"
o�
7�
� A
� a
0
� �
� �
i `D
� m
�Q
�
�
C
�
� �
� r
�O
nc
�
Z n
� �
��
�v
Zm
D 0
n �
m
�
D
Ci
�
<
m
�
�
n
�
z
Z
�
m
2
�
�
n
�
Z
m
m
�,
0
0
D
�
'a
O
�
c%
�ao
�
�)
�
0
c
co
�
I
�
0
�
m
�
�
v
�
�
0
�
�
1
/"
�
N
�
�
a
m
Z
0
�
�
�
_
�
z
�
n
O
3
a
z
�
So'
�
�
�,
�J
�
O
>
r
�
m
m
�
�
m
�
�
�
�
�
�
...� �
0 3
�m
�
� �c
� '
�, �
a�
v
� �
8
�
O
�
� D
�O
-�r. �
�
� �
� ,o
°� �
D n
� �
�m
��
O ;
G y
��
-�i
�
a
n
�3
� � �
�' 4�/OY
�
� o �Ca
� m
C �
m
1
a
�
2
m
m
2
'�
�
m
z
0
m'
v
�
c � � p
� C � o
� z=
1 � m �
�
0 m
p �c
�
r, y
�
S
� � n
� A
�
c�
� 'm
�
� �
a tn �
�°m�°3
aoav
� o
�
2
o ;� �
�
0
�
3
>
G
�
n
�
�
Z
O
�
z
n
m
z
v
�
m
c
�o
Z
m
�
,
D
n
0
�
a
0
�
7
m
i
D
N
y
�
�
N
v
m
�
y
�
a�
�
�
� � �
J J ..d
0 � o
� 0 0
� � �
�
�
D
�
0
O
�
D�
0
�
�
�
m
�
�
z
O
�
�
..
Oo
C
r
v
Z
�
C
N
v
�
c,
I�,
�
�.
�
�
N
�
�
�
m
z
�
�
a
�
�
�
C
�
�
�.�..
�
�
0
�
�
y C �
o � �
���
� �
� N�
°1 ?
��
W �
� a
�°
m �
80
�
m
c
�
1
�
�
�
�
� �
0 �
�
\r Q
� a
� r
v-
O 4?� ?-1
� � ~ � � �
m �°-'03�
I� °' ? � a' m
A � � � H
� O � 7 A
'� � c� a � �
� :" a' c o' a
� n��m
�. 1
1 Q m
� � � �
� � �� �
��°o�
� °Da�
\ ..► C p tD
2 � 0' fn fn
°�l �, v o �°
��x�
� $,o''
� '�-
� 3 � � o
�'a��
v � ��
����
� � ' �
�a�o
� � � � s
���
�� � y � O
� ��
��
� � c�o
✓ �
a
m
�
c�
_
�
�
�
m
I�
�
[�
�
�
�
CHI�IIIEY AND BTACR VSRIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�' No ()
2. Is free from rust or deterioration Yes (� No ()
3. Has no foreign objects lodged within Yes (�Jj' No ()
4. Is securely supported Yes (r� No ()
5. Meets all current Code requirements for
size and total BTU's connected Yes (� No O
6. • Has total heating BTU's of � j�c�� �c�
--
— All other BTU's -- - �( G U-'
TOTAL BTU' s �.�� o � �
Remarks
L�� �l� S`' '
List Alteratioas Beinc Done:
/I/� �Ci� � �'G�.�
HEATING COMPANY
Signed By
Date
n
�1
,
C�
�
�
C
�
O
Z
�7
�
D
r
r
W
m
-v
�
O
v
m
v
�
m
�
C
C7
�
m
�
O
Z
�
0
J�
D
Z
v
D
�
r
m
�
D
�
*
O
D
r
-n
m
m
�
d
rn
�
c
�
�
m
cQ
m
� �
� �
?,,,� D
�
Z �
�
3 °<
c �
� a
�
'17 �
m
m
91
�
a
Z
-<
�
C o
� �'
Z �
� m
a
y
'd
rn
3
�
..�i -n
Gi1 �
N
p 0
� �
�
n
�
�
n
�
7
�
.� �'- m
r�
�
� � m
2 c�
°.m=
� ��
'�
� Z N
�, v �
-rt O o
� � o
0
m mi
o D,
� �
-a �
� z
� v
D
�
m
�
0
� -
�
�
z
m
v
�
Lfl
0
t)'1
�
�'T1
�
�
m
w �� c,� Z Z Z� n ai = m " m`
v v v
`G � N y C�D N (rtD � 7 '- � � O �
� -n � � � O p -o �!
� � � �
o `� � _ _ � � � W � N � �
� � � � � 4:; � '� � d 7 � fD
-,
� * � -, 5 � � �'. w y
� � � tfl �i � 7 N
m co Z
� � D � �
m � �a -� m
? y � �°- � � ?1
� � A n � .. �
.n cu c�'u
m
a.
.-.
m
�
�
I. � I !� I I I I I I I I
�
C
�
Z
�
�
c
�
m
�
m
�
z
O
� ������������
� -�o��s0000000 �--�
0 0 0 0 0 0 0 0 0 0 0 0 o m
0 0 0 0 0 0 0 0 0 0 0 o Q
�
R�
� m oo p m m u, -�
c � � � Q a � �
o�o � ° m m 2�; �
z � � � � �• � a
C� fD y (O �
� C N
� � m � -�" � �
� �' D �s�•o,
-i D o �
co
Z � W 3
-� �, � �. �o m
� ��w= �* GL Q- �.
� Z v�''' v c��n � � cc. N``
'� � N�m� � � � d
�
��T o���7� � s v��,: � u�,
p w N Z D� � N > >' .d
V r cn r� 'v u► �
P � � Z � � n- � �
s �
� � =��o
�'� m � � � �,
�Co �,��o
� � �
�m = � a !� �
�� m 2 � � �
..._� � m N � �
z =-I --i � su m � .�
�p �� � � o
� ' ��� — ���� � �.
♦��� � A �
W (p –
• � 3 �(� O
� � � O �
��-y� � N � �
�V N N N
�` " N .. _.
('� O
�
�
�
r
�
O
m
D
v
�
�
r'D
ri'
�
S
�
�
a
�
�
Z
C
�
W
m
�
0
�
�
X
�
C
�
�
�
7
�
n
�
�
D
n
7
;
n
>
)
C
�
)
)
�
FILL IN COMPLETELY FOR REPLACEMEN�' FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacina an existing furnace, the undersigned hereby verifies that the '
venting has been examined and is free from rust, deterioratiori, 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 Fumace Venting Tables for fan
assisted and natural draft� appliances.
The existina cor�abustion 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 cuRent codes and manufacturer's specifications. L'�
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventirta 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 Cer�tral Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented Yes () No ()
separately as per current codes.
A liance T e and Size/Common Ver�t and Vent Connector Information
Appliance #1 Type BTU Input _ Fan Assisted or Nat
Appliance #2 Type BTU fnput Fan Assisted or Nat
Appliance #3 Type _ BTU Input Fan Assisted or Nat _
Total Appliances Tota) Bfu Tnput -
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 Diamete� in Type
ALTERATIONS: D�scribe ��
HEATING CO:
Signed By: Date :
Building PLUMBING Pennit rTo.���i -t1GG� �
Inspections RESIDENTIAL APPLICATION xeceived By:
763-572-3604 CITY OF FRIDLEY n��°�:AN 2 2009
763-5�2-4977 FAX EFFECTIVE 1-1-09
DATE �` �ff `� � YOUR E-MAIL ADDRESS
SITE ADDRESS �S' 9 e T 11� L� fi � �
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY NAME:_ �T{ �� %��� I yE �z
TNANT �DRESS: �S" % �I �' �� � �! � N /�� CITY_ 1�/�b�Se�/ STATE An/✓LIP .SJ� !�
PHONE: G %p� - �G �— 03�0 ` C e / �
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE
LICENSE, BOND AND STATE BOND # EXP DATE
CERTIFICATE OF �DRESS: CITY STATE ZIP
INSURANCE pHONE FAX
PERMIT TYPE � STNGLE FAMILY � TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW C9'REPLACEMENT
DETAILED DESCWPTiON OF WORK S�%./ T p�� f/�/��c d �'� ✓ p/A I!, t J�C ��da c e�c h%`
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$I5.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge
OR .
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVi�. MINIARUM FEE $15.50.
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMRVG POOL WATER SOFTNER ($3'S)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRI� 7RAY WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
� � -.
'� .r � „ ...�+,'�� �'.�:, ._ .... ,. -.o;., . ... , „'�� ,.. ,�'.le�' ����y�'rs � �' w� :r.��� �� �,� �: �'f'�' ��y� au��' � �-��e
�i � �v' :�. ..�.
Permit Fee $ . � � Number of fixtures @ $10.00 �"��� � � � � �
x $10.00 = $
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
INIMLJM $15.50) � (MINIMUM $ I 5.50) Tota1= $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge 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 on site; that the work will be in accordance
with the approved plan in the case of all w rk hich reyuires review and approval of plans.
SIGNATURE OF APPLICANT i PRMT NAME �R�%� /� J���° V DATE U' I����
��? �'�� s . �� ���� �.r_ .,� ._ _.y� _ `,. r . _,.'`��� ������s, .� � _�,_ � ��. � �.?�+ �»����� ����` � ;
,,
�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�
Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.��'� 7�
Received By: '
Date R��dD F o 5 20
DATE O P' 6.J�' O� T YpUR E-MAIL ADDRESS �'�j ; II Y� R B Colr+a+J T. li%G 7
SITE ADDRESS S 7`�l S' Cen 777 A!-. .,
THIS APPLICANT IS: LI OWNER
PROPERTY OWNER/ NqME: r^I� F D /�I i//Y�'IZ
TENANT ADDRESS: .5�� ��� �� ��� J+ Ji� J� � CITY RArl1f'e �/ STATE�ZIP_Sr,I�T
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
STATE LICENSE #
ADDRESS:
QSINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILYMEW CONSTRUCTION
❑ ADDIT[ON ❑ G�SA G
❑ BASEMENT FINISH L9i�pOF
❑ DECK ❑ SIDING
TYPE OF WORK: ❑ NEW HOME CONSTRUC7'ION
❑ MAINTENANCE/REPAIR
DESCRIBE WORK BEING DONE:_f � c. J�eo �'
SIZE OF
ROOFING
NUMBER OF SQUARES ��
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
O Other
WINDOWS
IN EXISTING OPENINGS ❑Yes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
EXP DATE
CITY_
FAX
SIZE
STORIES
:/SHED � WINDOWS
❑ DRAIN TILE
❑ OTHER
NG POOL
❑ A9BI-'FION
�EMODELING
�-IOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
❑ Trim
0 Fascia
LOCATION OF WINDOWS
NUMBER
WIDTH
HEIGHT
ATE ZIP
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATE.RIALS:
(U I G THE 1997 U.B.0 FEE SCHEDULE)
COTAL JOB VALUATION $ ���'�� �' OCCUPANCY TYPE
Pertnit Fee
Plan Review
Fire Surchaige
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$
$
$ �
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (P(ans to MWCC for determination)
ft+6ft= ftx$2l=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pa_yable to: City of Fridlev Attach
THIS iS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conforma;nce 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 on site; that the work will be in accordance with the
approved plan in the case of all work�vhjct� rec�uires review and approval of plans.
SIGNATURE OF'APPLICANT '�S•� N��i� PRINT NAME F�%Z FD I�i'I��P�' DATE C% /� - O S" D J�
Page 2- Building Residential Application
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 tlie amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 151$500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $]00,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 15` $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction �
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604 �
Fax: 763-502-4977