AF - 37067e
City of Fridley, Minn.
BUILDING PERMIT
Date: ._Janua?y..._14:..__l9 71____..-- -
Owner: Darwin Bose11 Exterior Design Service
...__ .........................._.._..._..._. ._..._..__...._...._._...._......._..._.._._..— Builder
. ..._.._. ..__ ___.. ........
Address .:g..6617 Central Avenue paaress .._6391 �p��.�� Street
��� � �
�--,
N° 10932
,.�
LOCATION OF BUILDING
No. .._ 6617.._...__ Street ....._ Central Avenue N.E. .___. ___..... Part of Lot __-...__.
_ __ . .... .__._...—
�t Pt 9�__., 10,,.... glock ..._ 1 ._..._ ... Addition or Sub-Division Dennis Addition
Corner Lot
Sewer Elevation
Inside Lot ___._-X ....__....... Setback ... ____.___ SideYard
__...._ ... ......_......._ _.__ _.__... Foundation Elevation __.___...
To be Used as:
soffit
Alutzl.._C.4y.er..._for FYont ....
_... __._ ... . __.......____....._ Fmnt
Type of Construction _A1um
DESCRIPTION OF BUILDING
..--_ Depth ...._ ..............__ Height __.__.__...__.
__._. Depth _. _...____ Height ...__.........____
_.. Est. Cost _._$�50 00
Sq. FC _..._ ............._.. Cu. Ft
Sq. Ft . . ............. C�. Ft _._--...._
To be Completed January� 1971
In corisideration of the issuance to me of a pernvt to constrvct ihe building described above, I ag�ee to do
the proposed work in accordance with the description above set f�d in� with all provisiona of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $.... 6..00 .___ permit is hernby grented to.._Exterioi Desig�
_..._..__......... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said bullding, or any part thereof, shall mnform in all respects to the ordinances of
Fridley, Minnesota regardit�g location, construction, alteratioq maintenance, repair end moving of buildings
within the aty liadts and this permit may be revoked at aqy time upon violation of any of ihe provisiona of said
ordinancea
`�/�_�__��. l���B�� ����
NANK MUHICH
NOTICE:
Thia p�rmh dw� ne� cov�r Nu �en�Irvc�bn, i�unlHNen fer wir6ip, Plumbinp, p�s h��Nny, uw�r w wM�r. 8� wn b iw
1h� Building In�pMOr fer wp�raN p�rmNs for fha� IMm�.
u
C�
APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITIO� BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
.� ! 1-,-f-�
OWNER`S NAME�/����, �L' �SC�SI�cL l_ BUILDER•17,��1�/'�� �/� ✓�iS �i �,.�� �iCi<v��C/�
annxESS:_�.�( 7 �/; ���i/%t / ���7C annxESS: E l � / ��10 �-i�d�C . N. /,
NO:. ^ �i � STREET: � � _ �
� �
LOT: �� ¢� BLOCK: � ADDITION: � �
CORNER LOT: INSIDE LOT: � SETBACK: SIDEYARD;
Applicant attach to this fo� ltao Certificates of Survev of Lot and proposed
building location drawn on these Certificates.
llISCRIPTION OF BUILDING
To Be Used As: -
/� � , ��t��' ���/ � �
�1������ L ` ` �`�� Front: Depth: Height:
Square Feet:_ Cubic Feet:
t: Depth: Height:
Square Feet; Cubic Feet:
,� n .
Type of Construction: `l�'� �'/�� �; C(,'%/� Estimated Cost:_$ %)� ,c�
To Be Completed: �_�,/ ��
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stYict accordance with the City of
Fridley Ordinances and xulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
� ; � ��
�DiATE: �� i� j -{ / � i SIGNATURE• �' 1- �� �,-�}--�_
i
(See Reverse Side For Additional Infoxv�ation.)
.
• • '
BUILDIVG PERMIT FEE SCHEDUL�
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 tu 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 pravided to-wit:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
.4llDITIOhAL I,tiFORh1ATI0N
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is detexmined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average�
height of the roof surface of the main gable of a pitc}�ed roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 pex each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
leas than $5.00.
VERIFICATION Of� POUNDATION
NOTE: Pexmits for construction will be issued a minimum of 24 hours fran the
time of application, to allow for proper review of the proposed stxvcture and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
hae been constructed, will be required before proceedinrt with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building pexmit has been
issued; and said structure shall not be used or occupied until a Certificate
of Oc'cupancy has been issued. -
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6���NE HEAriN� HOUSE HEATING TEST RECORD
AIR CONDITIONING
AND ELECTRIG MC.
ADDRESS (�E: i] �J L � l`y(_;�(��/ � .i�<�. i APT. FLOOR dTY �Ll SUPU�'? �_
OCCUPAN7 �d�kc K,�e-«� r OWNER S��-�e
HEA7 LO55 'DIATE HTG. INS7. 7- ii- q a.
SOLD BY �'� FY �, INSTALLED BY B��NE HTO, A/C & ELECT. INC _
Eleclrical Work By Gas Lino By �t•
TYPE OF HEAT GA_ FA � HW_ STEAM _ SPACE HTR. _ UNIT HTR._ OTHER �
GAS DESIGN CONVERSION
MAKE � ✓ ��-�-� MAKE OF BURNER
Model � Model
Sarial L Max. BTU Raling
INPUT MAKE OF FURNACE
Model
CONTROLS ��
THERMOSTAT7���� 7 Heat Plug Vant Siza S
Valve ' W <i� KIND OF LINER /f L[<.v�+— SIZE S NONE
Limit � ��rtic�i DraXHood Ragulator
Limil Seaing / 9C � Filtera Size � b x�-S �( Number �
Fan Satting T, �ti-�c� Chimney Localion Insido x Outsida
Pilot Type -i ` � Chlmney ConstrucUon I�7,] Sr+�u�o tU �� �� e..�
Pilot Make ,�,� •
Pibt Model �7� 7 Smoke Bom6 Wiring � � 5
PilolTiming �O�if'�� DraR 7astTag i'6S
L. W. Cu� Oft Door Pressure Lighling lnst � c�
Pressura 3 � PercentCO, .�(J DaleTested —� �
InputCFH ��O � U Perwnl O, �//' .S CompanyTesting �/� (_ 1
Stack Temp. �/� Percent CO • � Name of Tester �//D. cC
Form 235
�" p�� ���'��p •�'(� . M�nnesota Well antl Bonng ,
WELI OR BORING LOCATi ��NESOTA DEPARTI.9ENT OF HEALLI Sedling Na H 419 9�
o�,���iyNTme WELL AND BORING SEALING RECORD M�^^esmeu��QUeNa
�drnnesola Statufes Ghaplei iLl3i or W-senes No,
Pnrw;M1ip Neme TownsM1ip No Pange Nn. Sec:inn No FrTeLOn Ism � Ig 1 Oale Seale� Approx�male �ale Wee
` � _ oi 6anng Consimcten f
�� �
Numer!-a'. Sbs �. Atltlress or Flra Number ana Cny ol Well oi Bonng Locauon
prplh f3✓�ore SealmV �— li Dnpma� DeWM1 /�� �I
S�Ow eaaC IpCelioO o� W2il or Wn� Skelc� map o� we�� o� bo��n,� Slal¢ WaIP Level � Recurale
�,ccNon ynrl wnh -x ` locauon. sbowinq Oropeny hnes
N ` roatls. antl bmltlings ❑ Approximnte
L
�� �-� --- -- � �� �.S,iy.r4��le. [I W.u,iawb,i � � 1� �'valow aboveianosu�ace
W __ _ _ _ _ __ E .\
Cl51NG TYPE
"'_ " _ _ _ __� Ti ��
n � I Sio,.i ❑ P�asu� ❑ r�ie ❑ Oine�
.�..___ _'_ __ � c
� 5 � ��. �\ s�,ee� o-am io - n o„��.�ci� i��,�, �� n
I�-- �'"^° � 09STqUCT10N/�EBRI5/FILL
PROPEPTY OWNER'S NAME �'�bsi�ucim� ❑ Cs�ns ❑ Fii
- � "' ' ° ��u � � Tvpeal nebns�ohslmclion � ��� � ��J r � !�� '�� � • �
�.1A 1i1�4 4tlt1'�`.' ' J��1(!I�!n�;��ln prapElly Odtl!¢H6 intliCB1B� d�UV^_ �
ObsVUCUOrv'DeOnvFll ramoved� Ves ❑ No
PUMP
��' ✓"l�
Rrr � vetl �J Not Prese�l ❑ OIM1ee
CASING
GEOLOGICALMATERIPL COLOR HpA0NE550F FROM TO
FOPMATION
- - Diameter Deplh Sel �n overs¢e M1o�e? AnnWar space nina���� voifetl°
nni Fnnwn ntlicate?slim(tletl IormaLOn log irom nearby well or bonng , Ic
�_ in. Imm � m iL� H ❑ Ves �NO ❑ 1'es ❑ No � Unknown
in trom lo fl. ❑ Yes ❑ No ❑ 1'es ❑ No ❑ Unknawn
n trom io H ❑ ves ❑ No ❑ ves ❑ rvo ❑ unxnown
-- METHOD USEO TO SEAL ANNULAfl SPACE BETWEEN 1 CASINGS, Ofl CFSING AND BOHE HOLE:
q Nn qnnular Space Exisls
v,
❑ Rnnular space qmu�etl wilh Irem�e pipe
� ❑ Casmg Pedora�ioNRemovai
m. Irpn b II ❑ Pe�oraleE ❑ Removea
m. irom to M1. ❑ Fedoratee ❑ Pemovetl
- Type ot pedoralor
❑ Otner
GROIITING MATEHIAL
Gmming maleriel i i' In+��Q h! Imm � to �(� M1. _ yartls � baGs
Irwn lo fl yaNS bags
REMARNS, SOURCE OF DATA. DIFFICULTIES IN SEALING
` Irom lo �� yards bag5
1� 1I 1
`� \ _ i ` 11 � ' - � J\�� �
V�� Irom m �i yartls bags
� UNSEALED WELLS /.NO BORINGS
1/\i n \ �
1 1 J� ; � 1 i Othor unsealetl well or bonny on pmpeny� ❑ Ves o
, , , ',
LICENSEO OR REGISTEPED CONTRACTOR CEPTIFlCATION
This well or bonng was sealetl m accortlancn wrth Mmnesola Pules Chapler 4725 The inlartnat�.nn cnnnineel in ihis repo0 �s
Vua to t�e besi ol my knowietlge.
���,�rr� Z71��/
Convacro. Business Na`me License or Fegisvahon No
i �� 1
AmhorvetlReyie pntafive Signamre Dare
<.A�,,,,�.� H 41996 �, h� �, •�� � -� � q3 � --
Name ol Pe.son Seeiinq Well oi Bonng
HE-0tl9J-Ut _ ._
AUDRESS
PIN
LEGAL DESC
PERMIT TYPF.
PROPERTY TYPF.
CONSTRUCTION TYPE
VALUATION
CITY OF FRIDLEY
6a31 ChIVERSITY AVENUE NE
FRIDLEY, 1V7N Si432
�i�-sdua r.ax:
: 6617 C6NTRAL AVIS 1�F�
. 133034130038
: UNAVAILABLE
: LOT f3LOCk
: ELECTRICAL
: RESIDHNTIAL
: ADDITION ALTERATION
��/1-lltf7
PERMIT NO.: 2004-01447
DATE ISSUED: 09/O1/2004
NO'I'li BLECTRICAL PERMI'i BECOMGS VOID 12 MONTHS AP"I'ER PERMIT ISSU[: DATE. INSTALL SAVERS SWITCI-I..
# WSPECTIONS I
APPLICANT
HUNT 6LECTRIC CORPORATION
2300'iERRITORIAL RD
ST PAUL, MN 551 Ia-
OWNF.R
RIEW6 LARUI? A
6617 CENTRAL AVE NE
FRIDLEY, MN Si432
ACREEM�NT AVD SWORN STATEMENT
This permit becomes null nnd void if work or construction
authorized is not commeneed witin 60 days or if construction
or work is suspended or abandoned for a period of l20 days
nt any time after work is commenced.
I herebv certilv that I have read and examined [his
applicatiun and know the same to be true and correct. All
provisions of laws and ordinances �oveming this type of worb
will be complied wilh whether specified herein or not "i'he
erantino of a perinit does not presume to aive authoriq to
violate or cancel the provisions of any other s[ate or local law
regulating construction or the performance of construction.
Bld� I
ELEC PERMIT FEE - MIN (RESp
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK 4 I 17431
SEPARATE PERMITS REQUIRED FOR WORK O7'H6K INAN llLJCKIt3tU AHV V�:.
20.00
0.50
20.50