AF - 37987�
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City of Fridley, inn
BUILDING PERMIT
��: April 8, 1969
N° 10169
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p�r; Eu�ene Koza� g�der Clemron, Znc .
�� A�,� 4411 Central Ave . N. E.
LOCATION OF BUILDING
No. 7409 g�t Concerto Curve �. p� of Lot
� 11 _ Block 3 Addition or Sub-Divisfon . Melody Manor 3rd Addn.
Coraer Lot — Inside Lot —. X Setback 35 � � Sideyard 11 � 11 �
Sewer IIevatian — 874.0 877.0
Top of Footing
DESCRIPTION OF BUILDING
To � v�a as:
Dwelling �t 60� Depth 26 � Height � 20'gq. �, 1360 �, �
Garage Front 20� Depth 21 � I-�eight 10�� Sq. Ft 420 G�. Ft
Type of Construction F��e �� �_ 27, 000. 00 __ To be Completed
SEWER LOGA.TIOIQ - 4' S. W. of Ma.nhole
WATER LOCATION - 8' N. Eo of Manhole
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In conaideration of the issuance to aie of a germit to construct the building descrlbed above I agree tm do
th� proposed work ffi aceordance with the descriplion above set Porth and�in compliance wlth a'll provlsfons of
or�inanc�a oY the dty oP Fridley. � / J
In conafderai3on of fhe payment of a fee of $�+6 . 00 , p�t is hereby graated to Clemron, Inc .
to construct the building or addition as described above. This �ermit is granted upon
the express condil3on that the person to whom ft fs granted aad his agents, employees and worl�en, in all work
done in, around and upon eaid building, or anypart thereof, st�all �nform in all reapects to the ordinaac:e� oP
Frldley� Minnesota regarding locat3on, constructton, alteration, maintenance� repair and moving oE bufldings
w.��l,th7d_in,,_the dty ]imfts and thia permit may be revoked at any time upon violatfon of a�y of the Pravisions oP said
Va'�a�aaaY�. 9
Clarence Belisle
! ��
NOTIC�
'hds permtt dea net eorer ths eonslrnetioe, ieshllatlon Po� �rtring, plumbing, ea hsaNng, anne er w�tar. B� wre to see
tlre Bnlldios le:pseto� fo� a►perm parmM� fo� fhess ttNm.
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APPLICATION FOR BIIII,DINC PIIZMIT
CZTY OF F'HIDLEY, MINNESOTA
Oi�i �S NAME Eugene gozak BUILDHt Clemron, Inc.
�� �DDRESS l�.11 Central Ave . N.E.
LOCATION OF HiTILDING
N0. 7I�09 STREE7� Concerto
LOT 11 BLOCK 3 AUDITION OR SIIBDISiISION M. M. 3rd.
COR\'F� LOT INSIDE LOT X SETB�.t;� 35 SIDEXARD 11-11
SEk1ER ELE„PATION TOP OF FOCTING - 5 t
Applicant attach to thie foru� Two �srtificates of SurvQy of I,ot and
proposed building location drs,wn on thee� Certificatese
DESCRIF'I'ION OF B'QILDING
To Be Used Ae: Swne as 7l�Ol Caneerto
Residenee Front 60 Dapth 26 Height 8
�quare feet 1360 Cubic Feet
Gar�.�e Front 20 Depth 2l Height 9
Square � Eet �{.20 Cubic Feet
Type of Construction FPBme Estimated Coet � 27�000.00
To Be Completed 7-1-69
The undersigned hereby makes application for a permit for the work
herein apecified, e,greeing to do all work in etrict aocordance with the
City of Fridley Ordinances and ruli.ngs of th� Department oi Building�e,
and hereby declarea that all the facts and z�:;�r�eer.tations statEd in
thie applieation are true and correcto �1
DATE �
�_7_�4 ,
(Schedule of Fee Coete cau be fourid on the Rever e' eo)
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BIIILDING PII�MIT F'EE SC�UL�
SECTION 2o The Inspector of Buildings ehs.11, before iasuir�g pernita
for the erection of any building or etructure, or for �.ny addition to any
exieting structure or building9 or for any alteration or repaire to say
esieting 'buiZding or structure9 upon application therefore, �equire the
9 a payment by the applicant for such permit of fees to the amount heretn
below set forth and in the manner herein provided to-wit:
IIniform Buildin�' Codes Type 19 2, & 4-�1a75 for each one thoueaad
cubio feet, or fraction thereof, in such c�bical c�ntente. Type 3� 5-
�10 50 fo� c�ach, one thousand cubic feet e
For the purpose of- computing fees for building permite, the cubical
contente of any buildin� or addition to a uniform height throughout by
multiplying the ground area covered from a point eix (6) inches below
the �'loor line of the basement or the cellar to the average height of
the upper aurface or to the avere.�e hei�ht of the roof aurface of the
main �able of a pitched roof. �
For xepa,i�s or alteratiox�s to an exiatizi� struct�are, the fee ehall. be
at the rate of $3.00 per each iive hundred doilars (�500.00) or
fracti.on thereof in the coet of all proposed worko
In no case sha.11 the fee cha,rged for any permit ae eet forth in Section
2 be le�s thsxi $5000�
NSSSD Coxir�,ection Charges based on location - Area 1 or 2.
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� � HO�E HEATING TEST RECORD �
AE?pRE�S�T��� ��"��� �°�'�``� APT.—�� R ITY SUBURB `'�"��� i?
OCGii�ANT OWNER C.=� . �
HEAT LOSS DATE HTG. INST. GAS CO. METER BADG #
SOLD BY INSTALLED BY � - ��
Eleetrical Work By Gaa Line By �
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT H . OTHER �
MAKE .�'���..�r►zF_���5 �SIG� �L' _ CONVERSION
T— � t�� MAKE OF BURNER
Model � % � � Model
Serial �� � �] � � � � Max. BTU Rating .
INPUT ` �-� > �''� MAKE OF FURNACE
Model
CONTROLS � i �
THERAAO�S�TAT � H t Plug Vent Size �
Valve � ' � ��'�'r"`�� KIND OF LINER ' '�' � SIZ � NONE •
Limit ����'�d� � t, � �� �� _ Dra$ Hood RegulaTOr
Limit Setting �'� e Filters Size ��`'�, X 1 M��� �
Fan Setting ��� Chimoey Location In,r1side Outaide
Pilot TY� Chimney Construction �/--� ����ap
Pilot Maka �
Pilot Model Smoke Bomb Wiring �� _
Rilot Timing ��`��� Draft ��� Test Ta ��
9
L.W. Cut Off Door Pressure_ Lighting Inst. �� �'�y
Prossure � � � Pereent CO "' Data Tested �–j � � �
2
Input CFH ��� Pereent O �� � Company Testing -� --
Staek Temp. "� �/�—Pereenf CO2 LA o� Name of Teater -
Form 235
C
City of Fridley
� 4T TM£ TOP OR TME TN�IN4
,
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r r..-------, COMMtlNITY pEV[1.0�MENT QiV,
1 � � MOT�CTIVR IMtI�CTlpp OtIT,
�` � �.--- i GTY M/U.L s1110L�tl �MR
1..._.J`.� �.� N3-s�o-sNo
53-8t�-s-9�5.51
i��EGT
PLUMBI�Vr, PERf�IT APPLICATI��J
Job Address '��'�A '
7�09 N. E �oncerto �urve
ner Ad
Eugene J. Kozak
Contractor A
RVIiNiVEGASCO
Kind of Building Use
�'a�
Comp etion Date .cr
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�3� fd1A�QL1EifTE AV�NII�
. MPLS., lVIIi+IfV,
Res.
���
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. lo,00
Plumbing Fixture Rates: N0. RATE TOTAL
Number Fixtures x $2.00 �_
Future F�tures x $1.50
New Fixture-Old Open, x $1.50
Catch Bastn x $3.25
Water Heater-99,000 BTU x $3.00
Ground Run Old B1dg. x$3.25
E1ec. Water Heater x $2.00
Gas Fitting Fees:
lat 3 Fixturea x $2.00
. �,
Additional Fixtures x $ .75
Gas Range-199,000 BTU x $5.00
� Repairs � Alterationa
See
Deacription; Install Gas Grill �ode 5•�
State Surchar�e .50
C:�� _ °4�" ��;�,r:_�,,�e�=:,= -,�;.: I
� TOTAL FEE $ 5.50
!The underaigned hereby makea application for a pera�it
f�r Che work herein apecified� agreeing to do all work .
in atrict accordance w ith the City Ordinancea and rulin
of the Department af 8uildinga, and hereby declare that
a11'the tacta and repreaentations atated in this
application are trus and correct.
.. V� P �� � /� �'D°i,v
"'Signature � ��{��q�;=� Date ,
.
t
.
SUBJECT P
City of Fridley _ 19463
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T,
r
i � RECEIPT NO.
� `L ___�_ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC.
�
1 � ,
' � /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""'� � ,�� 612-571-3450 910-F15 5/11/88 / /
10B ADDRESS �409 Concerto Curve N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 11 3 Melody Manor 3rd Ad.dition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Patrick Harmon 7409 Concerto Curve N.E. 784-6776
3 CONTRACTOR MAILA�DRESS Z�P PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
B USE OF BUILDING '
Residential
7 CLASS OF WORK
O NEW C� ADDITION ❑ ALTERATION ❑ REPA�R ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 24' x 12' �ck
8 CHANOE OF USE FROM ' TO
STI PU LATION S
See notations on pla.n
��������
Before di;;gin,� ca11 local utilitl��
TcLEPHONE - E�ECTRiC - ��� ��.
SF��1��T� �'���6TS REQUIR�� F�R f���UlRED BY l,a�°
���'.°S��G, H�A �I�G, PLIJM�B�G A�D SlGeJS.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINCi, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIN(3 SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO 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 1. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND,OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,650 5.83
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEFiMIT
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. �2�•OO
LAN CHECK FEE TOTAL FEE
$2 9 . 83
SIGNATUREOFCONTRACTORO AUTHOf±12EDAGENT IDATE� HEN PROPERLY V L� ATED TM S IS YOUR PF�RMIT
�'% � � p � 'L � �
�
iGNATUREOFOWNERU O NERBUILDER� IDATEI BLOG �N'P p7E
�1 �� City of Fridley EEfec�ive 5/L88
� � � R-1 AND R-2
ALTER [ ]
�,;�ding Permit Application
�
�nstructian Address: � f� C��'l�Pr� ����'r/'
r �� Description-
Owr�er NaQne & Address : �19-i72 �C.�� Tf-�%� G�'1 ��h � Te1. � !g y - � �7�
Contractor: ��� ll(P T�. �
Address:
Attach to this appl ication, a Certif icate aF Stiirvey of the
lat, with the proposoed construction drawn on it to scale.
L�S(RIPPION OF IM�RWII�NP
Li�1�G AREA: Length Width �eight 3q. Ft.
c�1�,GE 1�R�: Length Width Height 9q. I�t.
DECK ARFA: Len h Z�� � Width I Z� ,� U
9t Hgt/Gro�md � Sq. Ft. �
.�:.
� V' �
� � '� i ,a�r�
Gbrr�er Lot [] Inside Lot ]' Ft.
�ipe af Construction:
Approx. Completion Date: �
_ Side Yard Setbacks
Estimateol Cost : S� ��
Alt. A Alt. B
Proposed Drivavay Width If New Opening Is Desired: S �
Width + 6' See Back Page
DATE : �/ Co APPLICADTr • �
AeLmit E�ee
State Surcharge
SAC Cl�arge
Driveway Escrvw
Park F�ee
Sewer Main Qlarge
Tor�
STIP[]I,A�ION.S:
$ �
S 9 ��
�
$
S
� .:
�;° �o
s � � `� -.
Tel. # 7� �� %�o
(�TY OSE 0l�Y
F1ee Schedule on Reverse Side
5.50/51,000 Valuation
5550 per SAC Unit
Alt. '�" or Ait. '�" Above
F�e Determired by Ehgir�eering
Agreenerit Neoessary [ ] Nat Neoessary [ ]
r w
J��
���� ����
��� ,;-� �
•_ 1 �. �. ' �+;�v 4 �� `«:i�� 1
The Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for any �dition 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 applicarit for such permit of fees to the amount
herein belaw set forth and in the manner herein pravided to-wit:
TOTAL VALUE
E��
S1 to 5500 S15 (Minimt�n Fee is S15 plus surcharge) '
$501 to 52,000 S15 for first 5500 plus S2 for each additional 5100 or fraction
thereof, to and including $2,000
52,001 to �25,000 S45 for first �2,000 plus $9 for each additional �1,000 or
f raction thereof, to and inclucling 525, 000
525, 001 to 550, 000 5252 for first $25, 000 plus 56.50 for each additio�a7. $1, 000 or
fraction thereof, to and including 550,000
550, 001 to 5100, 000 $414.50 for f irst 550, 000 plus 54.50 for each ac�itianal $1, 000
or fraction thereof, to and incl�3ing 5100, 000
5100, 001 to 5500, 000 $ 639.50 for f irst 5100, 000 plus $3.50 for each additional $1, 000
or fraction thereof, to and including 5500,000
5500,001 to 51,000,000 52039.50 for the first 5500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including 51,000,000
51,000,001 a�d up 53539.50 for the first �1,000,000 plus S2 for each additional
$1, 000 or f raction thereof
D�VE'N� DEPRF�GTnN F�Y'R(Ti�7
(Concrete Curb Streets Only)
Alternate "A": Remwal and replaoement o�' curb and gutter only - Driveway width plus 6
feet times 513.50.
Alternate "B": Renavai and replaoeme.nt of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75. � °
'� <::
T T�A�flN OF` F�DL�AmTON
.
Permits for construction will,.'t�e,�i�su.��d``a' min�.�hum of 24 hours f rom the time of
a icatian to allaw for �'� � ��
F� � proper xevi��t�;of� the,proposed structure and of the oonstruction
site. � .. -
• �, :i,�p..� .
A Certif icate of Siuvey of the �].p�i; sfiaaing the location of the foundation once it has
been o�nstructed will be required before proveeding with the fraQning.
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V
CT'[ININEY AND STACR VERIFICATION
The undersigned hereby verifies that the . existing chimney or stack:
1. Has been carefully examined � Yes () No ()
2. Is free from nist or deterioration Yes () No ()
�3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
��
C�
Meets all current Code requirements for size
and [otal BTU's connected
Has total heating BTiJ's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarl:s:
List ALTERATIONS Bein� Done:
HEATING CO:
Signed By:
Date:
Yes ( ) N� ( )
Yes ( ) No ( )
Yes ( ) No ( }
s�e�ee. PE .
Cit of Fridley ' 2 8 6 0
� 572d����F TME TWINS gu ILDING PERMIT
� � RECEIPT NO.
� �� _� COMMUNITY DEVELOPMENT OIV. ���
r � � PROTECTIVE INSPECTION SEC.
�
� i �
� �"'1 � CITY HALL FRIOLEy SS1�2 NUMBEB REV OATB PAGE Oi ApPROVEO BY
�----� • •�� 612-571-345p 910-F15 � �
11 17 98
J08 ADDRESS
7409 Concerto Curve
t LEGAL ��7 NO. 9LOCK TRACT OR AODITION
SEE ATTACNED
DESCR. li 3 Melod Manor 3rd Addition SHEET
2 PROPERTY OWNER MAIL AOOR�S$ ZIP PNONE
Pat & Victoria Harmon
3 CONTRACTOR MAIL ADORESS ZIP PHONE UCENSE NO
Plumbline Builders 7 Ninth Ave N. Ho ins
4 ARCNITECT OR DESIGNER MAIL AODRESS ZIP PMONE IICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PHONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION � ALTERATION O REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Remodel bathroom
9 CHANGE Of USE FROM TO
STIPULATIONS '
See notations on plan.
Smoke detectors on all levels, adjacent to and in all sleeping rooms.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING, TYPE OF CONST. pCCUPANCY GROUP OCCUPANCV �OAD
VENTILATING OR AIR CONDITIONING.
7HIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTpUCTION 20NING SO. F7 CU FT
AUTHORIZEO IS NOT COMMENCED Y�1ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WOfiK IS SUSPENDED OR ABANQONEO FOR A PERIOD OF 120 DAYS AT '
ANY TIME AFTER WOfiK IS COMMENCED. ' NO. OW�G. UNITS OFFSTREET PARKING
1 HEREBY CER7IFV 7HAT I HAVE REAO AND EXAMINED THIS APP�,ICATION STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CO�iRECT. ALL PROVISIONS OF �AWg yp�UATION SURTAX
AND ORDINANCES GOVEqNING TNIS TYPE OF WORK WILI �E COMPLIED
WITH WHETHER SPECIFIED MEREIN OR NOT. TME GRANTING OF A pERM1T $3935 $1.9J
DOES NOT P TO GIVE AUTMOf11TY TO VIOIATE OR CAMCEI THE pERMtT FEE SAC CHARGE
PROVISIONS OF A OTMER STATE OR LOCAI LAW REGULATING CON•
STRUCTIO O T OR NCE OF CONSTRUC710N $8],25 Fire SL' �3.9�F
PLAN GMECK FEE TOiAL fEE
�� -�� License SC 5.00 98.16
G nr aEOFC N'AACTOpOA4UTMpF12E00GENT iO�iE� WNEN PROPE:1 ALIOATED TMIS IS �OUR PEAMIT
� �
�— j �
S�GNAlU�7E O� OWNEp��c pyyNEp Bui�DEp� IO�IE� ' Bl �NSP � f�p(E
t
NEW
ADDN
ALTER
` � J
[l
[l
CITY OF FRIDLEY-
SINGLE FAMILY AND DUPI:EXES R-1_AND R-2
BUILDING PERMIT APPLICATION � �
Effective 1 / 1 /98
_ -� ������!`��-- .
ConstructionAddress: f �}(� q ���'Q � �%�
Legal Description:
Owner Name & Address: �(A�- ��I 10� i-�C�,�rWib1� Tel. #
Contractor: �� l�l�D� I�,� � 1� dC� � MN LICENSE #�°1 �]
Address: 7 i� I �� f}VQ, (�T_ �j��l Yl , �I� �5 �3�%� Tel. # (QIZ-933 -�l �'3
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width HgdGround Sq. Ft.
YP �J ' Dt�YYI �Qi�OC�� I ���
Construction T e: Estimated Cost: $(.,Q, �}3� ,U� �� i��
(Fee Schedule on Back) " �� '�J�;��-`�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
��
DATE: (� � APPLICANT: s Tel. !� (pjZ-�33-��9�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ , G��
$ f�
$ o�
$
$ ,�', �'
$
$
CITY USE ONLY
Fee Schedule on Reverse Side
.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 [ ]
$ / 0 '�
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sue�etT NO. �
City of Fridley 3 07 8 6�
AT THE TOP OF THE TWINS � � I L D 1 N G P E R M I T
r
� ` RECEIPT NO.
� `y � ��� COMMUNITY DEVEIOPMENT OIV. I �}��
r � • � PqOTECTIVE INSPECTION SEC. � ��
1 = �
� �"'1 � CIfY MALI FRIOLE� SSI$2 NUMBEF REV D�TE v�GE OF �iaaOVEO Br
��--�� � �'' 612-57�-3460 s�aF�S 4/5/00 / /
�oe nooaess 7409 Concerto Curve NE
1 LEGAL �07 NO. BLOCK TNACT OR ADDITION SEE ATTACMED
DESCR. 1]. 3 Melody Manor 3rd Addition SNEET
2 PiiOPERTY OWNER MAIL ADDRES$ 21P PMONE
Victoria/Pat Harmon 7409 Concerto Curve NE
3 CONTqACTOR MAIL ADORESS Z�P PMONE LICENSE NO
Deschane Remodeling 49 13 Ave SW, New Brighton, MN 55112 651-633-7705
4 ARCHITECT OR DESIGNER MAIL ADOFiE3S 21P PMONE LICENSE NO.
20172664
5 ENGINEER MAIL ADDFESS , tIP PMONE LICENSE NO
8 USE OF BUIl01NG
Residential
7 CLASS OF WOFiK
O NEW �l ADDITION ❑ ALTERATION O REPAIR O MOVE O REMOVE
8 OESCRIBE WOpK
Construct a 15' x 14' Porch Addition and a 3' x 14' Deck and a 10' x 12' Deck
9 CHANdEOFUSEFROM TO
STIPULATIONS
See notations on plan.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
���► � � � �E REQU REDEFORI��
��f�r� �igg�r�� ��II fo� WIRING HEATING
�II �rtitity Iocati�n� p�U11�I�IN� AND SI�,�1�
454-0002
RE�USR�� �� �A�`'
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV IOAD
SEPARATE PERMITS ARE REOUIRED FOH ELECTfiICAL, PLUMBING, HEATINfi,
VENTILATING Oii AIF CONOITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SG. FT CU fT.
AUTMORIZED IS NOT COMMENCEO VtIITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOO OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DW4G. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED TMIS APPLICATIpN 1 STALLS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORfiECT. ALL PROVISIONS OF LAWS VALUATION SUR7AX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMP�IEO 16 � SOO � �S . 2S
WITH WHETHER SPECIFIEO MEREIN OR NOT. TNE GRANTING OF A PERMIT �
OOES N07 PRESUME TO GIVE AUTMORITY TO VIOLATE 01i CANCEL TNE pEqMtT fEE SAC GMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• �2.�9 � 2S Fire SC �p LC) . SO
TRUCTI R TME PERFORMA CE OF CONSTRUCTION
�PLAN CHECKFEE TOTALfEE
�s'O� License SC $5.00 $309.00
S�GNATUAEOFCON'AACTOaOp1UTMOp�IEDAGENT iO�TE� WME pOPERLV VALIDATED THIS IS VOUR PEAMIT
L,/ � `�
S�GNAtUAE O� OWNEA��� OWNEp9U�LDEA� iD�TE� G�NS� � ���Tt
NEVi/ [ ]
ADDN []
ALTER [ ]
Construction Address:
�g�,�
b Effective 1/1/2000
CITY OF FRIDLEY �(763) 572-3604 BI�g Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 : ,�'�� ��.'
BUILDING PERMIT APPLICATION �� ,�� � lr� C
d�L � ,�� �
�Oi ���, � .� �� C��� .�-���-
Legal Description:
Owner Name 8� Address: _ l,J w L-��" � � �. �'� °�° ��� :� �� Tel. #
Contractor: � SL �, � ' � MN LICENSE # ���'%2�(0�_
Address: � � � � � � � � � .e,cJ � (���a,ti.i Tel. # � 5 E - � � 3 `� � ��
�'3,7��
J�,�c�
LMNG �:
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 ��'I e Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length � Width `� ` Hgt/Ground Sq. Ft
OTHER: �� � �O� �
Construction Type: �.�' �� ��e � � � � Estimated Cost: $ � I �� � � � `°""
Gay� t33Se � on Vz �.e ��n,—
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 3 21 D APPLICANT: �� Tel. #�� 3`�� 1���
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ �q��J�' Fee Schedule on Reverse Side
Fire Surcharge $ �(p .SD .001 of Permit Valuation (1/10th%)
State Surcharge $ ��. � S~ $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$
$1100 per SAC Unit
$ 5'� 60 $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
Park Fee $
Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
� �� .�
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 $2,0�
$2,Q01 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,(�1 to $500,00q
$500,001 to $1,000,000
$1,000,�1 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$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 additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $1Q0,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or &action thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,(}00
$5,608.75 for the first $1,OOO,WO plus $3.15 for ea.ch additional
$1,(�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only) •
Alternate °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 faot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applica.tion to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Si�rvey of the lot, showing the location of the foundation once it has it has l�en constructed will
be required before proceeding with the framing. New Houses Onlv
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When repiacina an existina 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 plastiGPVC 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 cuRent codes and manufacturer's speciflcations. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installing a new venting svstem, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent 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 ()
Aqpliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 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
ALTERAT'IONS: (Describel
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57Z-36U4 FAX:
: 7409 CONCERTO CRV NE
: 113024130083
: MELODY MANOR 3RD ADD
: LOT 11 BLOCK 3
: BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : RESIDING
�.�rr �a r�t;�r�
PERM�� 0`�.:2004-00711 ;
_ "�__i _� '-
DATE ISSUED: OS/18/2004
VALUATION : $ 7,892.00
NOTE: PER R703, 2000 INTERNATIONAL RESIDENTIAL CODE, REQUIltES THAT A WEATHER RESISTIVE BARRIER BE
PLACED OVER EXTERIOR SHEATHING TO PROTECT TI� INTERIOR WALL COVERING. EXCEPTIONS FOR THIS
PROVISION WOULD BE IF SHEATHIl�TG IS AN APPROVED WEATI�RPROOF PANEL OR WI�N TI� SIDING IS AN
APPROVED WEATI�R BARRIER VINYL SIDING IS NOT A WEATI�RPROOF COVERING UNLESS TI�
MANUFACTURER STATES THIS IN TI�IR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE
COVERING OR TAKE PICTURES. RESIDE HOUSE; REPLACE 4 BASEMENT WINDOWS WITHIN EXISTING OPENINGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
NORTH CENTRAL BUII.,DERS 1NC-20265918
740142 AVE N
NEW HOPE, MN 55427-1219
(763)533-6168
OWNER
HARMON VICTORIA
7409 CONCERTO CRV NE
FRIDLEY, MN 55432
BUII..DING PERNIIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALLTE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 20336
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
applicarion and l�ow the same to be true and correct. All
provisions of laws and ordinances goveming this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Bldg
�
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
153.25
7.89
3.95
5.00
170.09
�� a�3 �
MH1'-13-���4 �1�:'�3 FF.'Oh1 t:I T`r' CiF FR I ULE`r' TU y��6c11 P.O1/02
m
N� �) CiTY dF FRIDLEY Effective 4/1/2004
AD�N ( J 8431 Univers�t}r Ave NE, F�idley, MN 55432 (763) 5T2-3604 81dg Insp
ALTER ( j SINGL� FAMILY AND OUpLEXES R-1 AND fi-Z (763j 571-1Z87 Fax
�U{LDING PERMfT APPLICA710N
� /� �����-�� �7/l
Construction Address: 7 �%� p_ C:D N C�i� TD � u� �E
Legal Deacriptian: ..`_- -- - - - ----
Own�r Name & Addtess 1�1 CT D���ry� �/U -�-/�i E Tel. # 7� 3- 7� y- 6�77�
���cant�ctor. No,e r� �iv r,��� �ui� � --- nnN uc�NSE #1'a-� ��� � S �i/�''
�Address:�� / �%�` N/� ��"�u� o,�I"ff - • �cc''4V�p �!�l�V 55y�7 TeJ. # %L�-3- 533 -�/fo�
Attach �to this application, a Certificate of Survey of the
bt, with the proposed construction drawn Qn it to scale.
DESCRIPTIQN OF IMPROVEMENT
l.MNG AREA: Length � Width ------ Height __ Sq. Ft
GARAGE AREA: Length Width _ Height Sq. F�,
DECK AR��►: �ength Width HgVGround Sq. Ft
OTHER:
Constn�ction Type: � �M� - ._ Estimated Cost: $�7 ,� -"
'�Oy9CE y��g�ETh�NT �I,v�o�5 r,� tXlST/�r D� NI�j
Q�i�ev���°�Urb`Cut �117'idth Need"�cci� ` F�: + � F{ -- ` Ft .
. „.
, x: $ ., . <, _�
_ . . �..
_ .� ,
,. :
� . ,.
,
;,- - _:� . -,, �
� DATE: i ,�� APPLICAAIT: �1- ---`�E� ,_�n... . , Tel.l1��3 �J '�
Call (763) 572,3604 fvr P�rmit Fees if mailing in ap�il' ation. Fax ta B-571-12$7 if using credit card and we will call
you far card number.
Perm� Fee
Plan Review
Fire Surcharge
�tate Surcharge
SAC Ch�rge
Lir�nse Sur�harge
Curb Cut Escrow
Erosion Cantrol
Park Fee
Sewer Main �harge
� �� ��A
�
$ � c �'
� �.`�.��
e �
$
$ � ,G�
,�
�
CITY USE ONLY -
Fee Schedule on R�verse Side
���
65°/a of Permit Fee
.001 of Permit Valuatian (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State LicPnsed R,esir�enti�l Contractors1
A(t. "A" or /�It. "B" Above
� $450.p0 Gonservation Pl�n Review
� F�e i7etermined by Engine�ring
$ � Ar�reement Necessary [ ] Not Necessary [
TpTAL $ �.�, �,��
S71pUlATIONS:
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