AF - 35691�,
n
City of Fridley, Minn.
BUII.DING PERNIIT
Date: . . �. .�. � / . . � � . . . . . . . . . .
Addr�ss ......................................
������ .
�
N� 3�79
Builder .:1.� ........... .. '�� .. . ......
Address ..............................���....
LC3CATI�V OF BUILDINC
No. ��;7,� Street ... ......... ..�.�.�#. .a�` ..�i ... Part of .... ........ .......
a � � ,.....t!%'���
Lot . � �.. .. . Btock . . . ..� .. .. . .. . Addition or Sub-Division . . . . .. .. . . . . . . .. . . . . . . .
� �
Corner Lot ............ Inside I,ot ..... ...... Setback .�`�.. SideY� •�� .� ................
DESCRIPT[ON OF' BUILDING
To be vsea as• �,, . �, /� aZ I ���9 T
,�/•G /� � G o ��
� . . . . .. � . . . Front !.4 :��. . Depth �4� �. . Height �/. . : � 5q. Ft.� Cu. F't. ����'
. . . . . . . . . . . . . . . . . . . . Frpnt . . . . . . . . Deptb� . . . . . . . . � Height . . . . . . . . Sq. Ft. . . . . . . . . Gti. Ft. . . . . . . . .
Type of Construction ................... Es�
r To be Completed : . . . . . . . . . . . . . . . . . .
Ea considera,tion of Y.he issuance to me of a pernait to construct the building desribed above, I agree to do
the propased work in accordance with the descrIptton above set forth and fn compiiance wi rovisions of
ordinances of the dty of Fridley.
i ����.�_
....e. .....:. ................. .
�
In consideration of the payment of a fee of $. . . � . . � permit is hereby granted to . . . . . . . . . .� . . . . . . . .
••.•. to construct the bwllding o�addition as described above. This ermit ie
P gran'ted upon
the express condition that the person to whom it is granted and hia agents� employees and worl�en, ia ail work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinancaes of
Fridley, �innesota regarding loc�.tion, construction, alteration, maintenance, repair and moving of buildings with-
fn the dty limits and this permit may be revoked at any time upon violation of any of the provisions of sa3d
ordinances.
.... Buildiag InsPector
NOTICE:
Thls permlt does not cover the constructlon, Installatlon or alteration fo� wlring, plumb(ng, gas heating,
sewe� o� water. Be eure to see the Bultding InBpector for separate permits for these ttema
� �
��� .�9�,/
�
. t. :,�: . �� " APPL�Ci4�TON .FOR BuILD�TG PERMIT
. . CITY OF FRIDLEY, MINNESlOT.A.
, . ,. . _ � . .
.. .. j %� - . •
flwrie�s' 1Vame ,��� >` � /"�J� Builder '�— ���i` . '
� ^.� Address �Qi�-'i�FSc��/la�'�� r� . Address. ��/'.��c�. .�, � .
_ :. ..
: LOCI�TION OF BUILDING
; .. _ , .., :
No. � � S�reet [: a���6�E. , Part of Lot . - - ._.,,,.
-- � - • Lat s�:�` {� Black . - ' �ddition � or Sub. Div. � �/f�ce�J, i'�/!�o �-
0
�� Corner Lo� , Inside Lot `� Set Back ��
Applicant at'tach td this `form CErtifica.te of Survey of Lot and �roposed;
building location. � . . _ - ..
. - � � DESCR.IPTION OF BUILDING
, . �''To be used as /��S/'/>c�•r>C.E � � ., �' •
.. ; : , ._
i ,/ �
,_:._ k'ront _�. Depth � `�'°"� Heig�at� �
�.�. �� . � � �� ���. �:� Z D C� :: :� . '
, H`rorit Depth �eight
Sq � � �'t • Cu • Ft . . p-t)
. � ;
e of Coiistruction � �� � - . ' ,fj� ���
Typ ..� ; Estimated Co t � . . _.. .
. To be completed � ?� _t'2.���'�' � �.�
The und�rsignac� hereby �kes applica�ion for �, permit for.the work
_ �
herein specified, `agreeing to �do all work �:n strict accordance with� the
C3:ty Ordinaiices �nd: ru1:?.ng of the Departr�ent c+f Buildings, and hereby
declares that all the.facts and representa.tions.stated in this applieation
are true and �co rect, • �
Date � � � Si ature � �� a
�
(A Schedule of Fee Costs can be found on the Reverse Si e).
_ � x �
0
n k �
� � ,_ .
BUILDING PERMIT �EE SCHEDUZE'
Section 2. The Inspector of Buildings shall, before issuing any permit
for the erection of any bu�lding or atructure, or for any addition to
any existing building o� structuxe, or for'any alterations or repairs,ta
any existing building or structurep upon applica.tion thereior, require
the pa�rment by the_apglicant for such permit of fees to th�:amaunt
here3.n below set forth and in the mann.er herein provided to-wit:
2.1 For any such perr:�t for the erection of any fireprooi building, '
other than a garage,.waxehou:,e, #actory or grain"elevat�r., or ior the
erection of any fireproof addition,. fbr simil�,i' occuparicy, to any
existing bui.lding sha11 be at the x�ate of �1.,40 for ea.ch one thous�n.d
cubic �eet, or fra ction thereof; in such cubical contents.
2.2 For any auch permit for the erection of any fireproof garage, wase-
house� factory or grain elevator,_or i.o� the erection oi ariy fireproo�
addition9 for similar occupaizcy, to any existing building shal,l be at the
rate of �1.25 for each one +housan.d cuYsic fe�t, classified as "fireproof"
by Section 502 of the Minn�a.po]_is Building Codea '
HOUSES -'�'_
__
2.3 Far any , such per�it.. for .tY�e exaction of any non-fireproof bui�.cling ,
other than a garage9 w�reY�otise, factor� €rr grain elevator, -o���y �
non-fireproof..addit�,on,. for sini.lar, occupar�cy, to •an'� ex�.,sting bui],d3.ng. .
Permit �1e00 for each one thousand cubic.feet. _'
GARAGES
2.�, For any such permit ior the erection of any non-fireproof garage,
warehouse, factory or grain �levator, or for �hE srection_of any non-
fireproof,addition, for si.milr�r occupa.ncy, to any existing building or
for eacki such building or additiona Nine-Ey 'Ce�.�s for each one
thousand cubic feet or fraction thereof, in the cubical contents thereof
with a miriimum _of__�l�e00a � ---... - _ . .. �
For tYie purpose of comPuting fees for buildin.g permits �He cubical- . ��•
contents of a,ny building or addition to a uniform height throughout by
multiplying .�he.;_gxouxa.d area c�vered from: a point si.x (6)' inEhes.._belata .. .. -
the flc�or line of the baser�ent or cellar to the average height of the
upper s�urface or to the averaoe height of..the roof surface of the.main � •�
gable of a pitched roof� : . _
2.5 For repairs or al�erations to an exiating structure, the fee sha.11
be at the rate of �3000 fo� each Five Hundred I�ollars (�500.OQ.)., or
fraction thereoi in the cost o7 a11 proposed work,, . _.
� .
2.6 In _�,o case shall tlze i ee �harged �o-° an�; perm:i.t as set forth in
5ection 2 be less thax� .�L�,00�
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City of Fridley, M.inn.. _� 15 ��,;,
6431 Uruversity Ave. N. E., Miinneapolis, Minn. 55432
�_ `_
BUILDIIITG PERMIT
Date: ...._..Au,gLtist- � Sr.lA72
Owner: B. T. Rybak Builder �ame
Address 5843 Central Avenue N.E. Ad��s Same �
LOCATIOiV OF BUILDING
No. _._.'S.$.�3...� Slaeet Cen tra l Av n ti p 1`T F Part of Lot
Lot —.3.1.-.._`_ Biock .�_._..�.._..__._..__�_ Additiori or Sub-Division �1.a.Yksti sa Mannr AAa; t;.,,,
Corner Lot ...___.__._.._... 7nside Lot w_ � Setback ___. Sideyard
, Sewer Elevation _.:_.__� . � Foundation IIevation ___..
DESCRIPTION OF BUILDING
To be Used as:
;;Porc3� Alterations __ r-I.ong �p� Height Sq. F't. �, �
_._..__ Front Depth Hei�ht Sq- Ft. Ctt. Ft. _...�„
Type of Construction F�t, Cost .�_$� 000 . 00 To be Completed 1 mont�,_,
Stipulation: Porch and extension of porch not to be enclosed. Maintain 40 foot
setback.
In considera,tion of the issuance to me of a permit to consiruct the building descri}�ed g}mve, T agree tQ do
'�he pro�msed work in accordance with the description above set forth aad in mpliaace yvith a11, ons pP
Ordfinances of the cfty of Fridley. �
� a t a $ t lia r1x e
In consideration of the payment of a fee of $ 6. 00 •
, germit 3s hereby gTa�lted, to Mr�vhak
to construct the building or addition as described above. This permit is granted uppri
the express condi4ion that the person to whom it is granted and Tnis agents, employees and worl�nen, �tn a11 Work
done in, around and upon safd building, or any part thereof, shall conform 3n ali respects .to the orc�inances oF
Fridley, Minnesota regarding locatian, construction, alteration, maintenance, repair and moving of bw11d3IIg�
vPi� � city limits and this permit may b� revoked at any time upon violation oP any of the provl�tons o� Said
f
��
CLAREN � BELISLE
NOYICE:
7hia permit �oes noi eovee the eonatruetion, instaRafton for wiring, plumbin8. 8� bee�e. �er or wator. Ba sore 6p �e
4hs Building Inspeeto� fo� .separata permits fo� These items, A.
�
A�.P�ICATION �OR RESIDENTIA�, A�TERAT�QN,
OR AllD���ON BUI�D�NG p�}�y��
CITY OF FRID�EY, �INN�SOTA
� � � � � /�
� � � i _� �/ � - � � � ���'�.,,
I � %� ti � / - -
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r�o:�„v`� 3 s�E�: �- � � ��
�; BLOCK• ADDITION
0
CORNER LOT: INSIDE LOT: � SETBACR: SIDEX�tDs
�
�pp].i.caat attach to thia form �o Certificates of Survev of Lot as�d p�o�c��e�d
buildiag location drawn on theae Certificates.
HESCRIPTION OF BUILDING
To Be IIsed As;
;
' " _ Front•
� ` ' , ° DePth : Height :
Square Feet: Cubic Feet:
' Front: Depth: Height;
Square Feet; Cubic Feet:
'.�►pe of Construction: Estimated Coat: $ ;'�;"
---=--- -�,�
�a �e Campleted:
The underaigaed hereby makea applicativa for a pes�nit for tt�e .wc��1� ����
�pec��i,�d, agreeing to do all work in attict accordance witi� the C�,ty q�`
�'��,s�1e3r 0ldiaaaces and suliags of the Depart�ment of Buildiags, and �e�+�bT
d�al��es that all the facts aad iepresentations stated in thie app7.�,����,�
a7ce t�rue and correct.
�i� ; SIGNAT[TRE :
(�e� �teveree Side For Additionai Information. ) ,� `�' ��� ��'� �b�� � °�� �� �` `� � �� � ��
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$UILDI�G PERMIT FEE SCHEDULE
S�CT�ON 2. The Tnspector of Buildings shall, before issuiag permit$ fox �h�
exectioa of any building or structure, or for any addition �o any existin$
bui].ding or structure, or for any alteration or repairs to any ex�etiAg
bui,ld�ng ox str�cture, upon a.pplication therefore, require the paymentt by �h�
applicant for such permit of fees to the amount herein below set foxth axld i.1'�
the yo,anner herein prwided �o-wit;
TJNIFQRM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cub�,c
�p�,�, ox fraction thereof, in auch cubical contents. Type 3� 5-$�.�5 �Qx
estch one thousand cubic feet.
ADDITIONAI. INFORMATION
k'or the purpose of computing feee for building permite, the cubical contents
of any building oa additioa, ie determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or tlie cellar to the average heights of the upper surface or to the average�
height of the roof surface of the main gable of a pitched roof.
�Qrerofa13800r erte� hifivethundr d dollarst($500r00) or frac ioalthereoftin
xat $ P
the cost of all proposed work.
Iu ao case shall the fee charged for any pesmit as set forth in Sec��,�xb � b�
less than $5.00.
VFRIFICATION OF FOUNDATION
�p�; Permite for eon�truction will be iasued a mini�um of 24 hou�cs fxotp �k►�i
�i,me of application, to �l1ow for proper review of the proposed structuxe atid
af the conatruction site.
,A Ce7rtified Survey of the lot, showing the location of the found�tt�,At�� AAS�� �+t�
ha� been conetructed, will be required befo�,e proceeding with the i7C'�n$*
CERTIFICATE OF OCCUPANCY
Application for a Certificate. of Occupaacy shall be made tea (10) da�►s ��C�A�
�p the use or occupancy of any structure for which a building pesmi� k�a� b��
iseued; and said structure shall not be used or occupied until a Certificat�
o� Occupancy has been issued.
,
' .�
SUBJECT PERM �
City of Fridley � '
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T • 4059
i �
� �
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COMMUNITY DEVELOPMENT DIV. RE EIPT NO
r j � PROTECTIVE INSPECTION SEC.
' i '
�� /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPqOVED BY
----� • •�� s�2-sso-3aso 5/5/77 � /
910-F15
10B ADDRESS 5843 Central Avenue N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3], 4 Parview Manor SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Bernard Rybak 5843 Central Avenue N.E. 571-1892
3 CONTRACTOR MAILADDRESS ZIP PHONE UCENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL RDDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 34° x 24' Addition to dwellin
9 CHANGE OF USE FROM TO
STIPULATIONS provide header design in garage wa11 before installing. Maintain
integrity of firewall in garage ceiling. Provide 20 year built up roof
over patio deck under indoor outdoor carpet.
����
Before dig�ing �alf local S
��LE��oP�E - ELECT�IC - GAS �tc.
S'EPERATE PERMtTS RE�UIRED FQR 1KlR1NC� �E��IRED �� yy
HEATiNG, P�UMBING AND SIGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIOfdING. WOOCl FYdffie
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $`6�000 yS3.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ' $3G.00
PLAN CHECK FEE TOTAL FEE
¢ '' $39.00
�( EN R ERLY VALIDATED THIS IS YOU 'P MIT
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
✓ ` ,� y� � ��� �
SIGNATUREOFOWNERIIPOWNE DERI IDATE) BLDG.INSP qA7E
CITY OF FKIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
�NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) �
OTn1NER: � %�, r,�c-� � BUILDER: ..���n�--
Address: �� �j � �� `��' Address: _ �� �/3 y,�_ �sr �
--- - �—
Tel. No. : ��� � � ��,
No.: .�'� y� st��t: C�"�-�J��v
LOT: _ ��/ _ BLOCK: � ADDITION: _ ��V'� � �(/ �y(��� 2
CORNER LOT: �' INSIDE LOT: �} _ S;TBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certifa.cates.
DESCRIPTION OF BUILDING
To Be Used As:
,/��,(��'a /�o u 5� Front: 6�� Depth: ��_ Height : � D
Square Feet: Cubic Feet:
Front� Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: l,��Q Q �'j.f A/� Estimated Cost: $� �(� Q
To Be Completed: � /� (J %�/ % �
Alt. A Alt. B
Prop�sed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do aZl work ir. strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: _�'°— !�` - , �_ SIGNATUFE:
Sta.pulations :
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BUILDI��G PERMIT FEt SCHEDULE
SECTION 2. The Inspector of Buildings 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 repairs to any existing building or structure, upon applicatian
therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
NEW CONSTRUCTIOPd: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$15.40
�11 �l:_ l •' : �
For'the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or th� cellar to the
average heights of the upper surface or to the average height of the roof surface
of the mai.n gable of a pitched roof .
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In no case shall the fee charqed for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATIO� OF FOUNDATION
NOTE: Permits for construction will be issued a miniminn of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the 1ot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
CtRTIFICATE OF �CCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a buildi.ng permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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GEO. SEDGWICK HTG. & AIR COND. CO. ,�# 2�Q ��
HOUSE HEATING TEST RECORD
ADDRESS �S �� C�/l/%/'� /� �,,,� �-� CITY FR��B- � Y
OCCUPAAIT OWNER _�� � W Ai p° r� ��
HEAT LOSS__ pqTE HTG. INST.
SOLD BY
Electrical Work By � tifY/��/� INSTALLED BY�'� �°�'� r vV (CK
TYPE OF HEAT GA_, FA Gas Line.By _ C-�'� _�,� ���� c K
-�C— NW_ STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE �� 1, MAKE OF BURNER
Model � 11 f� — .� � Modef
Seeial % � � � '�') �
INPUT — L��p [j (� Max. BTU Rating
MAKE OF FURNACE
Model _
CONTROLS
TFIERNIOSTAt�]�_ {�eat Plug
Valve _ 1% �� C 1/ bi �
Lirreit.__L S/D /� /.� �
Limit Setting � t��
Fan S�tt6ng — / .�- � ° ��
Pilot Type ��
�'ilot M�ke
Pilot Model
Pi9ct Timing _ .-� � �'�r
L.UV. Cut Ofif
Fressaare _�_ � f� Percent C�Z _ t��s
lnput CFH � Percent 02
�tack Temp. � � �' Percent CO •—�
Vent Size � � r
KIND OF LINER SIZE.__ NONE
Draft Hood ��'�7� �� (s Regulator
Filters Size Number
Chimney Location lnside�_ putside
Chimney Construction —
Smoke Bomb Wiring �IC
Draft QIC Test Tag
Door Pressure Lighting Inst. �
Date Tested ._� ° ,� ° % % j
Company Testing �-�0 �'Z n � r � � r �i s.L � ��.. ���, �
Name of Tester A��'iJi'' j�' -�
c�� C hF-
�orrra 235
City of Fridley �
AT THE TOP OF THE TWINS
i �
� �
� �v �_�_� COMMUNITY DEVELOPMENT DIY.
r � � PRpTECTIVE INSPECTION SEC.
� . ,
� _ �"'1 � CITY NALI FRIOLEY S.S1�2 Nw
������ � ,�� 612-571-3450
J08 AODRESS 5843 Central Ave. NE
t LEGAL �OT NO. BLOCK TRACT OR/
�U I�.DING PERMIT
s�aF�s
REV
oescR. 31 4 Parkview Manor
2 PROPERTY OWNER MAIL ADDRESS
Rybak 5843 Central Ave NE
3 CON7RACTOR MAIL ADDRESS
Gates Roofing 4640 Ximines tN P
4 ARCHITECTOROESIGNER MAI ADDRESS
P_'ll�T 5
OATE VAGE O:
7/31/00 / /
PMONE
550-
PMONE
3126;
�"�
RECEIPT NO.
��6�
��PpOVED 8Y
SEE ATTACHED
SHEET
LICENSE NO
6783
LICENSE NO.
5 ENGINEER MAIL ADORESS IIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CIASS Of WORK
O NEW � ADDITION O ALTERATION �t REPAIR � MOVE 0 REMOVE
B DESCRIBE WOHK
Tear Off and Reroof House and Gara�e 23
9 CHANGE OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATINC3, TTPE OF GONST. OCCUPI
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SQ. FT
AUTHORIZED IS N07 COMMENCED V�!ITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 OAYS AT
ANY TIME AF7ER WORK IS COMMENCED. NO. OW�G. UNI7S
I HEREBY CERTIFV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1 STALLS
AND KNOW TME SAME TO BE TiiUE ANO CORRECT. ALL PROVISIONS OF LAWS yp�UATION
ANO ORDINANCES GOVERNING THIS TYPE Of WORK WI�L BE COMPGIED ,�'2 O�.OeOO
WITH WHETHER SPECIFIED HEREIN Oii NOT. THE GRANTING OF A pERM1T a
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OFi CANCEL THE pEpMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- �83 2S
T CTION OR TME PE FORMAN OF CONSTRUCTION .
PLAN CHECK FEE
� 7 � �`�� Licen C
� •
S�GN4TUaEOFCON"aACTOpORnUrMOAi2EDeGENT 10ATE� � . �., n....� _,
i�F OWNEA BU4DHR� �DATEi r
`1 L�
CYGROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
GARAGES
SURTAX
' $1.01
SAC CNARGE
ire SC $Z.O1
TOT L FEE
$91.27
) T THIS IS YOUR P iiMIT
� 7.-3�..�-r �
N � � � Effective 1 /1 /2000
ADDN [ ] CITY OF FRIDLEY
ALTER [.] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (�63) 572-3604 Bldg Insp
BUILDING PERMIT APPLICATION �� 1,.�
. ���' �W
Construction Address. S� C�.1 ��� �a c N�" �
Legal Description:
Owner Name 8� Address: Tel. #
Contractor: C--� °� ��o �� � MN ucENSE#_ � � �3
Address: �/�o �/O , y� ; n , ' (��2� C��r�-i Tel. # _ SS� � ' � O G(3
� s-�y�
LMNG 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
G�c'o� �✓�
�Ground Sq. Ft
�,� i f �� /� ���
Construction Type: v�t' ►Q�� Estimated Cost: $ � �/ L�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x� _$
DATE: � - 3 � " �`� APPLICANT: � �� Tel. # ��� � d � �f 3
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ ��S Fee Schedule on Reverse Side
Fire Surcharge $ �. C� / .001 of Permit Valuation (1/10th%)
State Surcharge $ /_ / $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$.
$1100 per SAC Unit
$ �� �� $5.00 (State Licensed Residential Contra�tors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ � Not N�ecessary [ ]
� %- � `�
BUIIrDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 tv $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$SO,OQ1 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,OU0
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each add.itional $1,0�
or fraction thereof, to and including $50,000
$643.75 for first $50,0� plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1(�,000 plus $5.60 for each additional
$1,Q00 or fraction thereof, to and including $500,000
$3,233.75 for the first $SQ0,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,00O,OOD plus $3.15 for each additional
$1,�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUINDATION
Permits for construction will be issued a minimum of 24 hours from the time of application Yo a11o�r for p�op�'
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it 1� been �o���� will
be required before proceeding with the framing. New Houses Onlv
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� THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
e��iu•► I ► I ► •►► •: �►� •ii: �•► _ : I : ' •�
When jpJ�t3p an -Y� ^g �ran __, 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
specfications 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 manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The �Yi�ne cnmh���tion air is sized and installed to meet the current codes
and manufacturer's specifications.
Whet1 �eqUl�ed t0 �nctall a new cemb�ctien air� it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When ���tslline a ne��a ventin�yye±em, 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 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
separately as per current codes. Yes () No ()
� • � :�i��=ar�:��.�ii:r�i...0. ' _ � �_ _" � _ _�_� � " • � • �11 . • �
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 Total 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
�_ ;., ._ : - -
HEATING CO:
Signed By: Date :
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C[7YOF
FR[DLEY
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FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 30, 2004
Mr. John Thayer
5843 Central Avenue NE
Fridley, MN 55432
Re: Final Inspection at 5843 Central Avenue NE
Contractor: Shiloah Water Co Inc.
Dear Mr. Thayer:
A plumbing pemut was issued on February 27, 2003 to install a water softener at your
address. According to Section 4715.2800 of the State Plumbing Code, a final inspection
shall be conducted on the work authorized by this permit. As of this date the 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 pernut open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "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.
Sincerely,
DA E NSEN
Buil ' g Inspector
DJJmh