AF - 38018�
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City of Fridley, Mi.nn.
BUILDING PERMIT
Da�; Oct. 2, 1968
Owuer: Homedale Blders .
B�� S ame
Addresa 5217 Wayzata Blvd. �,g�s Same
.�'�'� � 7
�o ��s�
LOCATION OF BUILDING
No. 74'4'�_ Street Concerto Curve _ p� of Lot
Lot � __ Biock 2 Additlon or 5ub-Division ____Melody Manor 3rd Addn..
Coraer Lot � Inaide Lot X Setback 35 � .�_ Sideyard 10 �
Sewer IIevation ____ $$� • 29 �����x 883 • 29
Tou of Footin.�
DESCRIPTION OF BUILDING
To be Used as:
Dwelling �t ____46' �p� 24' f 28aHeight ....._ 20� �, F.t, 1152 �� 23, 040
Garage Front 16� Depth 24� ITetght 10� Sq. Ft 384' �, �, 3840
Type of Construction Frame ���$19, 000.00 _ To be Completed
SEWER LOCATION -
WATER LOCATION-
50' East of Manhole
60' East of Manhole
In consideral3on oP the issuance to me of a germit to construct the building described above I agree to do
the proposed work in accordance with the descrlpt3on abov �ae� forth and in compliance with a�l proviio of
oidinances of the dty of Frldley. / f� �i �s �i� �
$100.00 Sewer Connection Charge �
�
In consfderatton of the payment of a fee of $ 40. OA ��{t is hereby granted to �Omedale Bldess .
to conatruct the building or adclition as described above. Thispe rmit ia granted upon
the express condition that the pensfln to whom ft ie granted and hia agent�, employees and worlflnen, in all work
done in, around and u�n said building, or anypa� thereof, sY►all conform in all respects to the orainaacee of
Fridley� Minnesota regarding location, conatruct�on, alteratlon, maintenance, repair and moviag of buildinga
wituin the dty ]imit� and thia permit may be revoked at any time upon violation of oE the provisions of said
ordinanc�s. �
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� NOTICE:
'Ihb ps�it d� ae� eovsr fhs eomtrn�toa, 6ulaU�Hen fer �rtrtee, plambieg, pn 6uHoA, uw�r or wafsr. 8� am to as
tha Bnildiu8 lasp�etoe for aparaM parmita fer �6a� it�na.
.. .
APP�ICATION FOR BUIIsDINC PERMIT
� ITY OF FRIDL��C 9 MINIV�SOTA
OWN�ti �� NAl� BUII�ER �,�,�
A�DDRF�5S AUD�S .S�v�
LCCAT�O�T OF B�II�II�TC
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. . - - ' - -� ��'�/".f � �_,/__ _ . ._ I'�- -= ' � --- . . - - - -
LO'T � BLOCK ,�, A�DITIOlV O�i. StTB�IVI�IO � �,��
�OR�'ER LGT I�I�IDE I,OT�S�'I'BAi:I� �-� SI�E'� / � °'
S�ER ELE`�ATIOP�
TOP OP �'OCTI?��
Apg�li�a.nt atitiach to thz� �'o�. T-��o �'e?�ti.�i �ates o�° S�vey oi Lot ar�.
p�o�o�s�d. buzld�.r.:g lo�atio� cLra�. o�? �hes:: �cr°ti�°icat�� o
7F,S��R.IF'I' i ON C��' BL�II.��NG
To Be ����. A� m
,/ Fro�t ��pth H�ight ��
�quare ieet • ��,� � Cubzc FE�t :� �_ ��= --
� F�ont /�p De�th � � Height / �
� "f
Square beet � � `� �:ubi� Fe�t �' _ � '_
/ ���� ��
Type oi Construction ,��'��'s�l�. Est�.mated Cost /� �
To Be Completed �ey—��� /.� �
� � ��-
The undersig:n.ed he�eby ma.k�s application for a permit iox �he �vo�k
he�ei�. specii°i�d9 agxeeing to dc� all work ita �trict accoraance r�itih thP
City o� Fridley Ordinarbce� a.nd rulit2g� oi th� Departnent oW�' Build�..g� 9
and hereby d.eclares that alI the �acts at�d rep�°e�er.tatioi�a �tat�d it�
thi� application axe true z�:�.d co�reeta
DATE %�� �—' C( i3 ��C?�TATIIRE ��i9��'" i�������0�
(SehEdule o�° Fee Cost� car� be fouc�d on the Reve��e Side� .-.s� �_�
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BUII,DING PEftMIT FEE SCHED�I,E
SECTION 2o The In�pector of Buildings �hall, �aefore issu�g per�it�
for the esection of any building o� �truetur�, o?� for any addi�tion to a.�y
existing �tructuz°e or build.i.ngy or f or ax�y �.lte�ation o_r rep�„ir� to any
exiating building or st�uctu�e9 upon ap�Zi;;at�on th�refosF:, �er�uirE the
pa,yu�ent by the �.ppli�ant for 8uch permit of f�es to the amo-u�t he�ei��
below �et io�°th and in the ma.,�ner he�ein provid�d to�wit:
Uniio�m Buildir�. Codea Typ� 19 2, & 4-$1075 fbr each one thous�.z�d
cubic feet, or fraction thereofe �.n sucr cubical c�nt�ntso Type 3 8e 5�
$1050 for eaeh one thousatad eubie �eeto
For the purpose oi computin.g iees ior buildi.ng permits9 the cubical
contenta of any buil3ing or addition to a uniform height throughout by
multiplying the ground area covered from a point six (6� inches below
the floor lin.e of the basement or the cellar to the average height of
the upper auriace o� to the average height o�° the roof �uriace of the
ma.�.n gable of a pitehed roof o
For repairs ox° alteration� to ax� existi.ng �tructu�e, the fee ah�,ll be
at the �ate oi $3000 per each iive hundred dollars ($500a00) or
fraction thereof in the cost of all p�oposed worko
In no case sha11 the fee �ha�ged f°or any p�rmit as aet forth i,� Section
2 be lesa than $50000
NSSSD Connectiox�. Cha,�ges ba�ed oxa looation - Area 1 c�r 2 0
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HOUSE HEATING TEST RECORD
ADDRESS_���� � �
,, APT. F-OOR CI S BUR /�'�
OCCUPA�v�} OWNER ��_;s��t���
HEAT L-a55 DATE HTG. INST. ^-AS C0. METER BAD #
SOLD BY INSTALLED BY � �-��
Electrical Work By Gaa Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. _
f,� GA5,-0�SIC�A��� �� .
MAKE � �=`�" %� �=a �-�`�/� � � %" �°-"� ''�-��''.�r MAKE OF BURNER _
Modal � � �� �`.� '!� [,°° � �� Model
Serial .� �+ ���� %���� �� � Max. BTU Rating —
UNiT HTR. OTHER
CONVERSION
INPUT f� �^�� MAKE OF FURNACE
Model
CONTROLS Er
THERMOSTAT a������'Heat Plug Vent Size
Yalve f - °? KIND OF UNER 'k" + > � . ^�'SIZE�NONE
Limit ��� �' ��� � Droft Hood Reguloror
Limit Setting -�--�°`'�' Filters Size Number
Fan Setting ��'S'� �'''/`�,`� Chimney Loeation Inslde `�°` Outside
Pilot Type "" —
Pilot Make ��=s- �. °<`'
Pilot Modal � � � �- *� �
Pilot Timing � ��-� -
Chimney Construeiion
Smoke Bomb Wiring +� �°°
Draft � ��'" Test Tag
L.W. Cut Off Do r Pressure Lighting Inst. �-
Prossure �� � Pe�.c CO � �� � `� A ate�ted �' - -
� /,;
Input CFH �� c' P�e � "�.' A �� pany Testi�g ` ��s'' � . � _ -
Staek Temp. _�,�_� Percent CO ��F��' Mame of Toster '
Form 235
�
STATE OF MINNESOTA
D<rARTMtNT OF NUMAN aERVICEB
444 LARAYETTE ROAD
ST. rA�1L. MINN680TA ss101
� �8-86
Date
Citv of Fridlev
2oning Authority
6431 Universitv AVe. N.E.
Street Address
Fridlev, MN 55432
City State Zip Code
RE: ZONIATG NOTIFICATION OF APPLICATION FOR LICENSURE
Subject: ,�
Name of Day Care Home Applicant
�� �D �(�o--r���-�
Street Address
� �����
City Sta e Zip Code
���'1�° ���ik� �C%-�"
D6S-2722 (9-85)
pz-oz�zz-oa
/D —/� �� ��
Type of License:
Family Day Care _�_
Group Family Day Care
Licensed Capacity ( �
Phone No. � �� � �� `�U
This is to inform you that we are in receipt
licensure under Minnesota Rules, parts 9502.0300
Rule 2), Family Day Care and Group Family Day Care
this license is subject to compliance with the
Statutes, Sections 245.781 to 245.812 and 252.28,
the Public Welfare Licensing Act and the rules of
Services.
of an application for
to 9502.0445 (formerly
Standards. Issuance of
provisions of Minnesota
subdivision 2� known as
the Department of Human
You should note that under Minnesota Statutes� Section 245.812, Subvision
3� a licensed day care facility serving 12 or fewer persons shall be
considered a permitted single family residential use of property for the
purposes of zoning. Subdivision 4 of the same section indicates that a
licensed day care facility serving from 13 through 16 persons shall be
considered a permitted multi-family residential use of property for
purposes of zoning.
If we do not hear from you within
will consider the above-mentioned
your local zoning code.
Sincerely,
Licensi g Worke �
Street Address
30 days after receipt of this letter, we
day care home to be in compliance with
COMMUNITY HFALTH & SOCIAL
SERVICES DEPARTMENT
COUNTY OF ANOKA
COURTHOUSE, FOURTH FLOOR
Name o A ency Organization
City State Zip Code
AN E�UAL OPPORTUNITY EMPLOYER
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When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions, Yes No ()
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets all current codes and manufacturer Yes No
specfications including sizing, length, number of elbows and termination. ( � ��
The undersigned aiso 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 Yes �No (;
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the cuRe�t codes
and manufacturers specifications.
When required to install a new combustion air, it will be sized and installed
to meet the cuRent codes and manufacturers specifications.
Yes (� No (
Yes (�/S No ( )
When installing a new venting s sy tem, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturer's
specifications. T�� fan ass sted a d natu a dAaft appliancesentral Fumace Yes () No ()
Venting Tables for
Is the common vent n� e�o ed f om the ommonv ent alnd ent dtly after
an appliance has bee Yes (�No ()
separately as per current codes.
A liance T e and SizelCommon Vent and Vent Connector Information
' ce #1 T e BTU Input 0'00 Fan Assisted or Nat �
Applian YP BTU Input fJ, J'r�'/ Fan Assisted or Nat �
Appliance #2 Type �����°%� � -
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances �_ Total Btu Input /��_
Common Vent Type Vent Height,i�= Diameter �_ inches
Appliance #1 Vent Connector Height �ft Length = Diameter � in Type
Appliance #2 Vent Connector Height �ft Length .,,,�_ft Diameter �in Type
Appliance #3 Vent Connector Height = ft Length = Diameter in Type
ALTERATIONS: Describe
¢ � G ���
HEATING CO: GU �cQ � 3- ZG -�/
Date :
Signed By:
Building PLUMBING Permit Ivo.: � Uc.��
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date xec'd: %-' -
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS v
THIS APPLICANT IS: ❑ OWNER [�ONTRACTOR
PROPERTY NAME: � +e
OWNER/ ADDRESS: V CITY STATE��IP S��Ca'
TENANT
PHONE:
CONTRACTOR NAME: �T Ce i� � �I (.�fM�T��j. � TitPr'b"�� -'
SUBMIT A COPY OF STATE LICENSE # J EXP DATE �(
YOUR STATE ADDRESS: CITY �f�-��,, � STATE V�I t,�IP�D�
LICENSE WITH PHONE ��- �-� �= �7C3-�,� FAX - E� --
APPLICATION
PERNIIT TYPE `�SINGLE FAMILY � TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � �W ��PLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS Wf�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPI' WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVi�
BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
_ BATHTUB GAS PIPING p✓� cr�rtrcE,vsE} SWIMMING POOL WATER SOFTNER ($35)
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS)
_ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
_ WATER METER OTHER
;�?'��.����"�E �?�t.�}���r�{��.' '�!� 'ER.F �'iS(i(i ;.„s s,: , ' 1>FkfiI1?I'['T' �E� �Q�t �'R'C.�J�C`� f.���'. �$� :
Permit Fee $ Number of fixt�ures @$10.00 x$10.00 =$
Surchar e .50 Number of fixtures a�$15.00 __ x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$
State Surchazge = $ .50
Tota1= $ , �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the cas a work which re '� review and approval of plans.
SIGNATURE OF APPLI ANT i� PRINT NAME��� l/ l�n DATE Z
. n, _ ,
' `�' . . �*��TC?�";� ,�E. A�`�.�, F ...Y'' .. - . . ��`�� t:7�1�� �C)R.,��*�?�N{ar E�}��;'i`1�ICt�il,,:d��II ..;. "., �"�r��!Ri�:`. ,� �''.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977