AF-R - 37184Caty of Fridley, Mian.. �
BUILDING PE�IT N° 5 5 6 9
nat�: �""",�� °-� ��
oWner: - '�' �,�� �`�' �-�,m�' " �"� � suilaer �
_ �
Address ..— Address
%� 9 CA_���N OF BUILDiIVG
No. �,� Street .�^� Part Lot
Lot �_.�._,.__ Block /� Addition or Sub-Diviaiog � �'�'
f
Corner Lot —� Inside Lot � Setback 5ideyard��� �i
Sewer IIeval3on Foundation IIevation
DESCRIPTI�N OF BUILDING
T��t�. � � r�
!� Front ..Q� Depth =�� He3ght � Sq. Ft��� Cu. FL +����
t Depth ��. Height � Sq. Ft Cu. F't.
Type of ConstructYon Fst. Cost ���±��� __ To be Completed �
In consideraf3on of the issuance to me of a percriii to construct the buildfng described above, I agree to do
the propased work in accordance with the descri�tion above set forth and in compliance with all provisions of
ordivanoea of the dty of Fridley.
�
�
Ia cansideral3on of the paymeat of a fee of $� , permit 3s hereby granted to
to construct the buiIding or addition as described above. This permit is graiited upon
the expre� condition that the person to whom it is grented and his agents, employees and worl�en, in all work
done in, around and u�n said building, or any part thereof, shall conform in all respects to the ordinances of
F'ridley, Minnesota regarding locat3on, conatruci3on, altera.tion, maintenance, repair and moving of buildinga
within the dty limits and this permit may be revoked at any time upon violatalo�of any of the provisions of said
ordinancea .
� - � r�- - -''°v� _,t`m--��r��t,R.�-� guildin8 7nspector
NOTICE:
This penatt does aot iove� ths cons�rodToe, installation for �rUine, plumbinp, eas haadng, sewer or waMr. Be wro to se�
fhe Bnildirts lespeetor for mparate pormNs for f6as Neeus.
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MARR1f 8. _JOHNSON
ROBERT B. MEREDITH
C.. DONALD COULTER
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(�j�{��j, C,�Q� tOBIII FBANCE AV6. BOUTH
MIPFNEAP(SLi9 00. MIN�NE90TA
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og� �LL'at �, Ks.Cack I,, i: C7 ��;� /1(� � l� ,� U£�' M H N C� i2, Nr�ok� C'oc�u�-.�'�, l'l�i.�rn�c►t�. �� cloea, du'�:
p�at.t �o .�hn.ru 'tinz,n�couemer...t,�. o� er�caor4chf�n�., ti� a�ru�. �l�. �rtivey�d by n�.e �.�ri.�. l��.h ck�.c� o�
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APPI�ICATI0�11 �'01.3 BUIi�D3.L+TG PERMIT
Ci� O�' I'Ii�D�EY, 1+2�L�t1ESOTA
f
,
Owne�'s Name � Buildes � ;o
Rddress Address
LOCATION OF SU�I�DIIITG
No e �� Street �� ,�� �,�- Part of Lot e
�,o� �, ______ sio�x �' �aa�t�.on or s��i��.8�.0 ��
�
Corner �ot �nside Lo� � Setback� ide-Yard
�E�IEIa ELEVPiTIQN FOUNDATaON' EI�EVATYON
�ppl�.cant at�ach to th�ts �a�n C�rti��.cate oiE surv�y of Lot and
proposea huilding loca�ion.
DE ,CRIPTION Oie' HU3L�3.L�TG
i o Ioe used as o
. s s .� /� _ s .�o� /� � � � f ? ��
s� e Ft., . 3 j��� � cu. �t.�� �� �
Front„_ Depch L�eight
Sg. Ft. Cue Ft.
� � �✓
lype o� Construc�tion Es��.rrnated Cos•t�
To be Completed
The undere�.gned hereIoy makes application �or a pe�mit for the work
herein specified, agreea.ng �o do all work in strict accordance with
the City o� �r�.dley or�inances and ruling o� the Depar�cme�t o� Build-
ings, and hereby declares that all the fac�s and represen�:a�ions
s�ated 3n this application are true and corr�ct.
D�iTE � .� � �— �� SYGNATtTRE�� � '�� =C...�
(Schedule of Fee Costs can be �Eound on the Rev�rse Side).
. /�'� !•--� �
r D� �
BUILD�NG PER1�tIT FEE SCHEDULE
Sec�cion 2. The Tnepector of Builcii��s shall, before issuing any
pe��n��: yo�c the e�ec•�ion o� any building or structure, or for any
addition to any o��s�ing bui].ding or s��ucture, or for any alterations
or repairs to any oxist�.ng build�tng or . atruci:uz�,_. upon appi3cation
�h�re�or, require the paynnent by tche a,�plicant ior such permit of
�ees to the amount hereia below set �orth and 3.n the masuser herein
pxov�.ded to wits '
2�.,. For any such permit for the erection o� any �ire-p�oo� building,
oi:her than a garage, warehouse, factoYy or grain elevator, or �Eor the
erec�.ion or any :���e-p�oof addition, �or similar occupar�cy, to any
exis�t�ig building sha11 be at the rate of $1.9�0 for each ono thousarid
cu:6�ic feet, or �ract3on thereof, in such cubical coatents.
2.2. For a.ny such p�rmi,�t �or the erection of any fire-��oof garage,
warehouse, fac�tory o�c gra�.n elevato�c, or �or iche erection or any fire-
proo� addition, iox similar occupancy, �to any existing bu�i�ding shall
be at the ra�ta of $1.25 �or each one thousand cubic feet, classi�ied
as "�iseproo�" by Sect3on 502 of the M�.nneapoiis Building Code..
HOUSES
2.3. For any such perm�,t for the er�c�.ion of any non-fireproo� bu3.ld-
Sng other than a garage, warehouse, �ac�ory or grain eleva�tor, or any
non-t3reproo� addi•�ion, for similar occupancy, to ariy exis�ting buildinge
Permit $1.00 gor each one thousand cubic feete
GA�AGES
._,.
2.�. For any such �ermi� �Eor th� ereation o� any non�fireproo�
garage, warehouse, �acto�y or grain elevator, or for the erection of
any nor�-gireproo� add�.�ion, ;cor aim3.lar occupancy, to any exist3ng
.building or for each such building or addition. Ninaty Cen�ts for �ach
one �housand cubic �eet or �raction ichereos, in tha cubical contents
the�ceof wi�th a mininium oc $4v00.
For �he purpose os computing fees for building permits the cub3.ca1 con-
ten�s o�E any buil�inc� or additior� to a uni�orm height throughou� by
multiply�.ng the ground a�ea covesed •;:rcom a point six (6) inches below
�the floor line o� �he basement or cellar �o the average heighic of the
uppe� surface or i:o 'che average heigh� of the roof auriace o� the main
gable oi a p�tched Yoof.
.5... For repairs or alterations to an,existing structure, the �ee
shall be at the rate of $3.00 per each F3ve Hundred Dollars ($500.00)
o� �raction thereor �n �the cos� o� all proposed work.
�2.6. �n no case shall the fee charged ior any permit as set fortb �.n
Section 2 be less th� $4.00. ^
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NOTICE OF FIRE
TO: BUILQIN� INSPECTIaM
ASSESSING
FROM: RICHARD H. LARSON, DEPUTY FIRE CHIEF
DATE: 4/7/98
SUBJECT: FIRE DAMAGED STRUCTURE
A fire has occurred at: Date of Fire:
� 1m o � /o�
179 Charles St. � �Q��, q.��gg
�t,�� �e�i i
'7'`�" s�-�-�� � 7- 9�
<;��`�.s,r � ,
SuBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� :
� ' COMMUNITY DEVELOPMENT DIV.
� � �. ------�
r � � PROTECTIVE INSPECTION SEC.
i ` �
, /"'1 � CITV HALL FRIDLE� SS43P NUMBEN REV DA�E PAGE OF
�'""� � �'� 612-571-3450 910-F15 4/17/98 / /
J08 ADDRESS 179 Charles Street NE - Apt 4�'2
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. 2 1 Robyn' s River Ma.nor
2 PROPERTY OWNER MAIL ADDRESS Z�P
Charles Schwartz 5916 Medicine Lk Rd, Mpls., MN 55422
3 CONTRACTOR MAIL ADDRESS ZIP
TimberCraft Remodeling 215 Old Hwy 8, New Brighton MN 55112
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
5 ENGINEER
6 USE OF BUILDING
Apartment
7 CLASS OF WORK
MAII ADDRESS
25940
RECEIPT NO.
1���
APPROVED 8Y
SEE ATTACHED
SHEET
545-6278
PFIONE LICENSE NO.
633-8611
PMONE LICENSE NO.
PMONE LICENSE NO
❑ NEW O ADDITION � ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Fire Repairs
9 CHANGE OF USE FROM
TO
STIPULATIONS See Bid list for repairs. Install smoke gaskets for hallway entry
door.
'���a�4'rE �'ERIVIITS REQUIREb FQ�R
VVl�R4NG, HF� 1 ly,v, F'L�i�9B13VG AIVD �IGit�S.
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBIN(i, NEATING,
VENTILATING OR AIR CONDITIONING.
THIS PEf;M1T BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO POR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
WI H WqHETHER SPECIF ED H REIN'OR NOTOTHE GRANTING OF AOPERM T �S, 975
DOES NOT PRESUME TO AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF AN OT STATE OR LOCAL LAW REGULATING CON-
STRUCTIO T PE ANCE Of CONSTRUCTION. �ILZ.ZS
.� r t, PLAN CHECK FEE
(! J� NO
IGNATURE Oi ONTRACTOR OR AUTMQR12E0 AGENT � 1DA I N R�
$iGNATURE FOWNEFUfOWNERBUILOERi IDATEI _ . '-"p� , iNCp
SQ.
STALLS
GROUP �OCCUPANCVLOAD
CU. FT.
OFFSTREET PARKING
IGAFiAGES
SURTAX
$2.98
SAC CHARGE
Fir SC $5.98
TOTA F E
$ .21
11T
�
�
�
ADDN
ALTER
C
` J �[ ] CITY OF FRIDLEY
[�� � SINGLE FAMII.Y AND DUPLE -
BUII.,DING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
er Name & Address:
on`tractor: l �'M
Address: i G` , 1}�� ,� "% 1-c
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
�L
���-��
Effective 1/1/98
��
�� �
a ��
�,2%�Z. Tel. # �..i- `C'� 7 �
MN LICENSE # ��� � `/�
Tel. � �-�j � '����
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRII'TION OF IlVIPROVEMENT
Width
Width
Width
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
�`.� _ ��
Construction Type: ' � �<<c ° � Estimated Cost: $ ,� � �.� �
�
� (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
�
DATE: C �� APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
Li�g�pse �S c ge
���
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ �1�•���
$ .s' ��
� �. 98
$ --
$ "�
$ `�'�...�T
$
$
$
$ /o?�•dt'�
Fee Schedule on Reverse Side
Tel. �
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation .
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�T'IPULATIONS: �j��� _���!>T�_
����-E ���-�- /�.������ %
•a
BUII�DING PERNIIT 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 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fracrion thereof, to and including $2,000 �
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,(}00 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 plus $5.00 for each additional
$1, 000 or fraction thereof, to and including $500, 000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,OQ0 or fraction thereof, to and including $1,OOO,Q00
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A°: Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.�.
Altemate "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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum 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 lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
�.
.
TimberCraft Remodeliag & Restoratioa
215 Old 8lghway S
New Brighton, I+II�T 55112
(612) 633-8611
(612) 633-8859
04/16/98
Client: Nathan Schwartz
Address: 179 Charles Street #2
Fridley, MN 55432
Estimator: Peter J. Murlowski
Reference: Dester Kile
Estimator
Company: ServiceMaster
Address: P. O. Box 6625
St. Paul, MN 55106
Estimate: SCHWARTZ
File Number: 200236
Res. Ph: (612)545-6278
Bus. Ph: (612)633-8611
Fax: (612)366-8859
Bus. Ph: (612)774-7041
Fax: (612)774-8933
TimberCraft would like to submit the following estimate for damage repairs
to your property. Attached is our breakdown of the required repairs.
TimberCraft will guarantee these prices for 30 days. If an agreement has
not been reached with TimberCraft within the 30 days we reserve the right
to increase prices for labor, materials and project scope.
This eatimate is based on doing all the work liated. All changes in acope
will require a signed change order. Price changes will be based on both
the change order and on how the change order affects the rest of the
project. •
Nathan Schwartz
koom: Ritchen
TimberCraft Remodeliag & ReStoration
04/16/98 Page:2
Lx�xHs il'6° x 9'6° x 8'0°
R&R 1/2�� drywall - hung, taped, floated, ready for paint
R&R 5/8" drywall - hung, taped, floated, ready for paint
Seal then paint the walls & ceiling (2 coats)
R&R Cabinetry - lower (base) units
R&R Cabinetry - upper (wall) units
R&R Countertop - post formed Formica
R&R Baseboard - 3 1/4" stain grade
Stain & finish baseboard
R&R Sink
R&R Sink faucet
R&R Resilient (v/a type) tile flooring
R&R Light fixture
Detach & Reset Radiator cover - Large
R&R Aluminum window, horiz. slider 12-23 sf
Room: Bathroom
Mask and prep for paint
Seal then paint the walls & ceiling (2 coats)
ELECTRICAL (need to wire GFI outlet)
Stain & finish door (per side)
Paint door trim & jamb (per side)
Room: Hallway ,
Seal then paint the walls & ceiling (2 coats)
R&R Light fixture
R&R Smoke detector
Stain & finish door (per side)
Stain & finish baseboard
Paint door - full louvered (per side)
Remove Carpet - (material and labor)
0
u
336 SF
110 SF
446 SF
6 LF
12 LF
6 LF
42 LF
42 LF
1 EA
1 EA
110 SF
1 EA
1 EA
1 EA
LxWxHs 7'0° x 5'0° x 8'0°
24 LF
227 SF
Open Item 1 Ep,
1 EA
1 EA
LxWxBs 16'6" x 3'0° x 6'p°
362 SF
1 EA
1 EA
3 EA
39 LF
4 EA
6 SY
�
e
TimberCraft Remodeliag & ReatoratioA
Nathan Schwartz 04/16/98 Page:3
Room: Hall Closet LxWxHs 4'0° x 2'6° x 8'0°
Seal then paint the walls & ceiling (2 coats) 114 SF
R&R Interior door - full louvered 1 EA
Paint door - full louvered (per side) 4 EA
Paint - closet package (hall or linen closet) 1�
Room: Bedroom #1
Subroom 1s Closet
Mask and prep for paint
Seal then paint the walls & ceiling (2 coats)
Stain & finish door (per side)
Paint door trim & jamb (per side)
Paint door - full louvered (per side)
R&R Smoke detector
Remove Carpet - (material and labor)
Room: Bedroom #2
Subroom 1: Closet
Mask and prep for paint
Seal then paint the walls & ceiling (2 coats)
Stain & finish door (per side)
Paint door trim & jamb (per side)
Paint door - full louvered (per side) •
R&R Smoke detector
Remove Carpet - (material and labor) •
Room: Living Room
Mask and prep for paint
Seal then paint the walls & ceiling (2 coats)
Remove Carpet - (material and labor)
Stain & finish door (per side)
Paint door trim & jamb (per side)
9
LxWxH:
IacWxH s
LxWxHa
LxWxH:
12'0° x
5'0° x
13'0° x
6'0° x
10'0° x
2'6° x
10'0° x
2'6° x
LxWxHs 20'0° x 12'0° x
8'0°
8'0°
59 LF
605 SF
1 EA
1 EA
8 EA
1 EA
17 SY
8'0°
8'0°
63 LF
649 SF
1 EA
1 EA
8 EA
1 EA
19 SY
8'0°
64 LF
752 SF
31 SY
3 EA
3 EA
0
Nathan Schwartz
TimberCraft Remodeling & Restoration
04/16/98 Page:4
Continued - Living Room
Stain & finish baseboard
Paint door - full louvered (per side)
Room: Living Room Closet
Seal then paint the walls & ceiling (2 coats)
Remove Carpet - (material and labor)
Paint door - full louvered (per side)
R&R Interior door - full louvered
Paint - closet package (hall or linen closet)
Room: Entry Closet
Seal then paint the walls & ceiling (2 coats)
Stain & finish door (per side)
Paint - closet package (hall or linen closet)
Room: Ganeral Conditions
Dumpster load - 20 yard
ELECTRICAL inspection
Taxes, insurance, permits & fees (Bid item)
o . , .
LxWxH: 5'0° x 2'6° x
LxWxH: 4'0° x 2'6° x
64 LF
4 EA
• sue�ceT � -PEfl
City of Fridley � 28 �99
'� - AT TME TOP OF TME TW�NS g U I L D i N G P E R M I T
i � ' R .
� �• COMMUNITY DEVELOPMENT DIV.
� ; � - --- 3a �
r � � � PNOTECTIVE INSPECTION SEC.
� °" _� �"'1 � CITY MAIL FRIDLEv �,i' 1�2 NUMBEN nEV oATB v�GE O� APanOVED 9r
�°f--�' �•' 612-57�-3a50 9�aF�s 2/5/99 / /
��oe_no�Ress 101 Charles St,' 179 Charles St, 180 Charles St
1 LEGAI a �OT N0. BLOCK tRACT OR AODITION SEE ATTACNED
oescp. Lots 1� 2 Bl. 1, Lo 1, Bl. 2, Robyn's River Ma.nor SNEET
2 PROPERTY OWNER MAII ADORES$ 21P PMONE
Nathan Schwartz 5916 Madison Lk Rd, Crystal, MN 55422 612-325-4383
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
Minnesota Rusco Inc 9901 Smetana Dr, Minnetonka, MN 55343 612-935-9669
1 ARCNITECT OR DESIGNER MAIL AODRESS IIP PMONE LICENSE NO.
S ENGINEER MAII AODRESS . ZIP PNONE IICENSE NO
B USE Of BUILDINd
Apartments
� c�nss oF woAK ' �'
O NEW O ADDITION O ALTERATION Q REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
� Replace 186 windows in three buildings - egress requirements have already been met
9 CNANGE OF USE f ROM TO �
STIPULATIONS �'
At least one bedroom window in each sleeping room shall meet the egress
requirements per our conversations. Install smoke detectors in all sleeping room
to meet the State Building Code.
_<w. .,•i, z ; �.
SEPARATE PERMITS ARE REOUIRED fOq EIECTRICAL, PLUMBING, NEATING, TYPH OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTIIATING OR AIq CONDITIONING. '
TMIS PERMIT BECOMES NUIL ANO VOIO If WORK OR CONSTIiUCT10N ZpNING SO. FT CU FT.
AUTMORIZED IS NOT COMMENCEO WITHIN 80 OAYS, ON IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO fOR A PER100 Of 120 OAYS A7
ANY TIME AFTER WORK IS COMMENCEO. NO. DWL,G. UNITS OFfSTqEE7 PARKING
1 MEfiEBV CEpTIfY TMAT I MAVE REAG ANO EXAf�INEO THIS APPLICATION 36 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ yp�UATION SURTAX
ANp ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPIIED ��O�OOO � �3S.00
WITM WHETHER SPECIFIED HEREIN ON NOT. TME GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMOAITV TO VIOLATE Oii CANCEL THE pEqMIT FEE SAC CMARGE
PROVISIONS O� ANY OTMER STATE OR LOCAL LAW REGULATING CON- @
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION $699.75 � F SC �p7O.00
PLAN CMECK fEE TO A FEE
.804.75
S�GN�1TUi1EO�CON:1iACfOpOp�UTMOt1�2E0AGENT IOATE� EN OP LIO TMIS ��Up P RMIT
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J
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existing furance� 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 cuRent codes and manufacturer
specifica�ons 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 cuRent codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existins� combustion air is sized and installed to meet the cuRent 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 manufacturers specifications.
Yes()No()
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventins� svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
Aps�liance Tvae and SizelCommon 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 _ 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
ALTERATIONS• (Oesc�ibe)
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DE5C
PERMTT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
VALUATION
I # INSPECTIONS
CITY OF FRIDLEY
6431 iJNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-36u4 r�aat:
: 179 CHARLES ST NE
: 223024120017
: ROBYNS RNER MANOR
: LOT 2 BLOCK 1
: ELECTRICAL
: MULTI DWELL
: ADDITION/ALTBRATION
e
APPLICANT
REI ELECTRICAL CONTRACTORS
10645 CO RD 50
COLOGNE, MN 55322-
OWNER
SCHWARTZ NATHAN & DARLENE P
5916 MEDICINE LAKE RD
MPLS, MN 55422
1
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construcrion
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 l�ow the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
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 construcrion or the performance of construcrion.
Applicant Date
Bldg Insp
Date
s�i-iz��
PERMIT NO.: 2004-01534
DATE ISSUED: 09/02/2004
ELEC PERNIIT FEE - MIN (NON-RESI)
STATE SURCHARGE, ELEC FLAT
ELECTRIC FORM FEE
TOTAL
�r,rr�ic[� 1 r, rnnlvii i� tc�tluitc�l� r Vtc W Vlcli V 1 ti�K 1 riA1V 1J�Jl:KltS�ll At3U V�.
25.00
0.50
1.00
26.50
�
�v� /r�
Building BUILDING Permit No.
Inspections COMMERCIAL/INDUSTRIAL Received By:� '
763-572-3604 CITY OF FRIDLEY vat �IAY 14 2��8
763-502-4977 FAX EFFECTIVE 1-1-OS ��
DATE _ � �/, �%C� � YOUR E-MAIL ADDRESS
�
SITE ADDRESS l7 � C'f ��Lf�' ��v�
TENANT NAME: �/Lj`,� � SC��,�� Z. SUITE NUMBER �'S' ��
PROPERTYOWNER �AME: ��?�� ����/y�L��— ___
ADDRESS: �% �' CIJr Z,2G�s CITY L✓l��`� STATE�`l'EP eSS�l1°�
PHONE: �I�—' g�S— �3/ �! � '
ARCHITECT NAM�: �
ADDRESS: CITY STATE ZIP
CONTRACTOR NAME: o �/ �� £. C-Lia"ZC C- ZZ ( tn
* NOTE: CITY pDDRESS: ��S_S' d ����-vy .��� CITY G�O��- STATE� ZIPSS�/L�
LICENSE REQUIRED
FOR CONIlVIERCIAL, PHONE: ��,Sf- �ol y^��l 7!� CELL:(�„���%5,�� �j FAX:
INDUSTRIAL AND CITY LICENSE #: EXP:
MULTI FAMILY
PROPERTY TYPE ❑ T;OWNHOUSE ❑ COMMERCIAL/INDUSTR[AL ❑ INSTITUTIONAL
�°ivIULTI-FAMILY
PERMIT TYPE ❑ DITION ❑ NEW CONSTRUCTION ❑ OTHER
�MODEL ❑ ROOF ❑ SWIMMING POOL
PLEASE SUBMIT: 1: 4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SRECIAL INSPECTION
2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE
3. LANDSCAPE PLANS 7. PERFORMANCE BOND
4. ENERGY CALCS AMOUNT $
BUILDING TO BE USED AS: OFFICE sF WHS sF OTHER sF
TOTAL SIZE: STORIES FIRE PROTECTION (Y/N) AC(Y/N)
DETAILED DESCRIPTION OF WORK �
.� !G� -s- '7l �/U �'
' 7
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATE�IALS:
(USING THE 1997 UBC FEE SCHEDULE) ,� �.�
Sq. ft. x$ Cost/sq. ft. = Valuation $
Sq. ft. x$ Cost/sq. ft. = Valuation $
Sq. ft. x$ Cost/sq. ft. = Valuation $
TOTAL JOB VALUATION: $ � �7 �'
Permit Fee
Plan Review
Fire Surcharge
Surcharge
SAC Charge
Erosion Control
Park Fee
Special Assessments
Curb Cut Escrow
Total Due
$
$
$
$
$
<--
THIS IS
I hereby apply for a building permit and I acknowledge
of the City of Fridley an w�th the Minnesota Co
permit on site; that the wo�ill be in accordanc�v��
SIGNATURE OF
OCCUPANCY TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$1825 per SAC Unit (Plans to MWCC for determination)
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
ft+6ft= ftx$21=$
Make c6ecks payable to: City of Fridley Attach Stipulations
ATION OR A PERMIT-NOT VALID UNTIL PROCESSED
rmatio above is complete and accurate; that the work will be in conformance with the ordinances and codes
that 1 nderstand this is not a permit but only an application for a permit and work is not to starc without a
pl in the case of all work which requires review and approval of plans.
PRINT NAME �I���/�/�� %I��� DATBS/ ,3'U�
. . . . • � : .'L'�Lyl�i������ - - � .
Page 2- Building commerciaUIndustrial Application
BUILDING PERMIT FEE SCHEDULE
PERFORMANCE BOND POLICIES
When a building permit is issaed for a commerci�l, industrial or multiple dwelling residential
project which requires outside improvements, a Performance Bond or a Letter of Credit shall be
submitted to the City. The bond will cover all outside improvements, including but not limited
to landscaping, irrigation, curbing, blacktopping, screening fences, lighting, water & sanitary
sewer services, and storm drainage systems.
Calculation of bond amounts will be determined by the building permit values. The bond
amount will be 3% of the building permit value up to a$2 million dollar project or a
$60,000 bond. Actual amounts will be rounded to the nearest $100. The City reserves the right
to require greater or lesser bond amounts based on unusual circumstances. Projects with no
outside improvements generally will not require a bond.
Bonds must remain open until the project is fully completed. Reproducible "as-built" drawings
of a11 exterior underground utilities must be submitted to the City Engineering Department
before the project is considered complete and the bond released. All bonds will be held over one
winter and through the next growing season to insure the survival of all landscape installations.
The City will then inspect these properties in August of the year following the initial planting.
Bonds may then be released in October of that year if all improvements are satisfactorily
completed.
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Faz: 763-502-4977