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� here�ir certify that this is o,irue and corre�t repr��e,pip�iai+l� af a'surx��r �� tlta bq,y�tiMriss' of the pbove ',
� d.�s#ri�ed, Imttsl� nnd nf the� Iqcorion. of al buitdinga��th .e�n� dnd e�li +�#diWe' enc�qere#��►e�11s, ii -any� fw,om or' on `
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la�d Planning �i,L�u%��n 6875 Highway No.65 N.E.
land Surveying • • (� Minneapol{s�
so�is Testing ��Yt�Zj�P_ el-�y2f�'j •�iZC� Minn. 55434
Civil Engineering Telephone 784-6066
Municipal Engineering Engineers & Surveyors Area Code 61�
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Mortgage Loan Survey for�;N�rz�� C. ��Ha,rr � vti�., �1�G,
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e ouNTY oF �.�� o �.
This is a true and correct representation of a survey of the boundaries o/ the lartd qbove described and oi 1he
location oi all buitdings� if any� thereon� and all visible encroo<hmente, if any� }rom or on soid land. This su�vey is
_ made only in connecfion wifh a mor►gage loon now bei�g plated on the property ond no liability is assumed
_ except to the holder of such morlgoge or any other interest wcquired by the reason o1 suth mortgoge. It is
u�derstood and agreed no monuments hova been ploced for the p�rpose of astablishing lot lines or boundary
cornera. Dated this 15'�"dar of O�r�;,�6crA.0. 19�.
SUBURBAN ENGINEERING, INC.
Engineera �r�, Sur ey rs
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City of Fridley, Minn..
BUILDING PERMIT
Da�: December l, 1970
p��; Charles Johanson,Inc. g��. Same
Ad� 580-69th Avenue N.E. Address
��/� o �
. ��� _ .
��' 109 4
__%%'.
LOCATION OF BUILDING
No. 275 Str�et Craigbrook Way N.E. p� of Lot
Lot 20 _ Block 6 Addition or Sub-Division Pearson's Craigway Est. 2nd.
Corner Lot , Inaide Lot x Setback 35 � � Sideyard 12 �
Sewer IIevation
Foundal3on IIevation
DESCRIPTION OF BUILDING
To be Used as: 24' ! 41'
Dwellin� �t 26' �p� 30' Height 20 � Sq. Ft, 1764' �� 35, 280'
Fi9ont Depth ITefght Sq. Ft C,u. Ft.
Type of Construction Frame �� $40� 000 To be Completed
WATER LOCATION:171' East of Alanhole at Alden Aay - Service to property line.
SEWER LOCATION: 161' East of Manhole at Alden Way - Sexvice 24' long.
Prov ide Hard Surface Driveway. Verify location of basement with survey before
framing is started.
In consideration of the issuance to me of a germit to construct the building d bed above I agree to do
the proposed work in accordance with the d�script3on above set fo�th a�d in p ce with afl provisions of
ordinancxs of the dty oP Frldley. : �%/ /" .y �
�
In coasfderation of the payment of a fee oE $ 66.00 � p�t ���, �� to Charles Johan.son
to construct the building or addition as de,sc�ibed above. This �rmit is granted upon
the eapress condition that the perafln to whom it fa granted aad his agents, employees an�� workmen, fn all work
done in, around and upon eaid building, or anypart thereo$ sk�all conform in all respecta to the ordinances of
Frldley, Minnesota reg ��ng location, construction, alteral3on, ma3ntenance, repair and mov7ng of builc�tngs
within the dtY ]imits and tY�s permit may be revoked at a,r�y time upon violation of any of the provlaiona oi said
ordinancea
�
CLARENCE BELI 4�
NOTIC�
��, -'�jb Peredt doa eef ewse t6s co�lruetioe, leslaUaftoe foe �vGtee, plum6ing, gas 6eaHag, �rr�r er watsr. B� sure to sss
` 1he Butldie8 lespseto� far �psrate perm(b f�o� thass itfm�.
�1 ��
APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
owx�R's r1AMEC�'ARLES E. JQH�►NSON INC. BUILDER: ��'���LES E. J�HAN�OIV INC�
e .
AnDRESS: �ridley, fl�innesafa 55432 ADDRESS: ��'idley, M�noe�^�'c� 5��-32
,-� f
N0 : . ,-� ��— � STREET : � � � e4 / � � �i 6 � f�' G-�.J �
LOT : � BLOCK: � ADDITION : p�'q R-� e r� C`� R�► �� �t.^ �� }' , ��T � �i.���
CORNER LOT: INSIDE LOT:� 1� SETBACK: � S SIDEYARD; ) 2-
Applicant attach to this form �o Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As : �.. �• X �/ �
� � �S P Front : � � k � � :
�, - � Depth: �`"' Height: � r�`+
F Square Feet: � C ��°�` Cubic Feet:� ��„ �`� t��
�>
Front: �pth: Height•
Square Feet; Cubic Feet:
Type of Constructioa: Estimated Cost:_� �`p ���
To Be Completed:
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in �tfict accordance with the City of
Fridley Ordinaaces and rulings of the Department of Buildings, and hereby
declares that all the facts and representationa stated in this application
are true and correct.
7
L1ATE: � _ � � �. ` m��� SIGNATURE •, � � ..� � � � v�
(See Reverse Side For Additional Information.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings sha11, before isauing pennits 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 application therefore, require the payment by the
applicant for such permit of feea to the amount herein below set forth and in
the manner herein provided to-wit:
UNIFORM BUILDING CODE: Type 1, 2� 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents: �rpe 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, ia determined 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 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 a.11 proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: 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 coastruction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceedint� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy qf any structure for which a building permit has been
issued; and said atructure shall not be used or occup�ed until a Certificate
of Occupaacy has been isaued. •
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sue�ecr PERM ___
City of Fridley 21417
AT THE TOP OP THE TWINS g U I L D I N G P E R M I T
r
� �
COMMUNITY DEVELOPMENT DIV. , (/ r �
' � V ��'�� , �
r � � PROTECTIVE INSPECTION SEC. �����' �
i� _ �
.--• A�'�',•� CITY HALL FRIDLEV 55432 NUMBER REY. DATE PAGE OF APPROVED BY
i �� 612-571-3450 910-F15 6/24/92 / / �--
JOB ADDRESS 2 �5 Craigbrook Way NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 20 6 Pearson � s Crai a Estates 2nd SHEET
2 PROPERTVOWNER MAILAODRESS ZIP PHONE
Jan/George Dean 275 Crai brook Wa 71-
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Peachtree Construction lhc Pq B.ax 34152 B1 ' 755-1925 1910
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �] ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 12�4�' x 14�4" Screen �oxch. Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
�ee nQtatipns on pl�,n.
waR�����
Before d�gging call for
all utili#y iocations
4�4-0002 �
REQUfR�D�..�1( t.�tW,
TYPE OF CONST. OCCUPANCY OROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORFiECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOqK WILL BE COMPLIED $2 � 724 $1. 36
WITH WHETHER SPECIf1ED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO IVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIO F ANY OT ER STATE O LOCA LAW REGULATING coN- $54. OO Fire SC y�2 .%2
TRUCTI R THE PERF RMAN O CONS UCTION.
PLAN CHECKFEE TOTALFEE
License SC $5.00 $63.08
SIGNATU OFC NTRACTORORAUTHORIZEDAGENT IDATEI HEN . OP LY VAL AT �� THIS IS Y��O^^UR PERMIT
R � � � � � �
�/.- ` J
� +�--
SiGNATURE OF OWNER iIF OWNEP BUILDERI IDATEi DG �NSp fJpTE
NEW [ ]
ADDN [ J
ALTER [,C],
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: � % �
f' (� ��� r e� v J'� �...� G..
Effective 3/ l l�2
i
Lega1 Description: .� A�,,� Co �- Z o � � oL �o eG �so � sC �� .5...,a��s�c,�,2h
/ -�----
Owner Name & Address: ��„ � �r � e o �--� �. � e_c� „ ( S a ..,�.� _ � Tel. # S % % - 7 �3 � Z-
Contractor: � 2 c. c�-�'K �- �o � s-�- ��,. ���.. �� �. MN LICENSE # O� v I� I c�
Address: {�- O � o � 3 �-/ �.� Z � �G.•:• a. �"5 /•� Tel. � %SS - � �i Z �
Attach to this application, a Cerdficaie of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: I.ength Width Height Sq. Ft.
GARAGB AREA: Length Width Height Sq. Ft.
DBCK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: SC �-- e e � i�- a �' C h L. = I Z � ` j �� W � I �1 � '� '� /a - /p �
���.�-�"
Corner I.ot [] Inside I.ot �C] Ft. Yd Setback Side Yard Setbacks
Type of Constivction: �,J o o��- �� ��.. Estimated Cost: $ �'
Approx. Completion Date: 27.��-°—° -
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x$ _$
DATE: � � �1 �i Z APPLICANT: TeI: . # % � � - 1 � 2 S�
. <. .
CITY USE ONLY � �
Permit Fee $�s Q. D
Fire Surcharge $ � � ? Z
State Surcharge S l � ✓ �o
SAC Charge $ ------�
License Surcharge $ � � �
Driveway Escrow $ `—"�
Park Fee $ '`--'
Sewer M�in Charge $ `--'
TOTAL $ � 3 0 � �
STIPULATiONS:
Fee Sch�ule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Contra.ctors�
Alt. "A" or Alt. "B" Above
Fee Determined by Engin�ring
Agreement N�essary [ l Not Necessary [ l
�
� : ��,�.�,�.�� ��� , - —�-�,
�� �.a , -
� 1�� �. � �_ � f, �J �'i �� I
� � �
BUII,DING PERNIIT FEE SCHEDULE
The Cluef 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 auy alteration or repair to any existing
building or structure, upon application therefore, require the paymern by the applicant for such permit
of fe�,s to the amount herein below set forth and io the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,4T00
$2,001 to $25,0�
$25,001 to $50,0�
�$SQ,U01 to , $100,000
$lIX},�1 ,tA $SW,�
s , . ,
$500,�1 to �1,0�,�
$1,�,001 and up
FEFS
$15 (Minimum F� is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $10(? or
fiac,tion thereof, to and including $2,000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction ther�f, to and including $25,U00
$252 for first $25,000 pl�s �.50 for each additional $1,000
or fraction thereof, to and including $SO,ODO
$414.50 for first $SO,OOU plus $4.50 for each additianal
$1,000 or fraction ther�f, to and including $100,�
$639.50 for first $100,(�0 plus $3.50 for �ch additional
$1,� or fraction thereof, to aad including $500,000
$2039.50 for the first $500,000 plus $3 for each additional
$1,0� or fraction ther�f, to and including $1,(�0,000
$3539.50 for the first $1,�,000 plus $2 for each add.itional
$1,000 or fraction �thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Slreets Only)
Alteraate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 fe.et times
$13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approa.ch with 6 inch depth - Driveway width plus ° 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construcbion will be issued a minimum of 24 hours froIIe the time of application to allow
for proper review of the proposed structure and of the constivction site.
A Certificate of Survey of the lot; showing the location of the foundation once it has it has been
consttucted will be r�uir� before proceeding with �he framing.
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City of Fridley 217 8 7 `
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� �
� � •
COMMUNITY OEVELOPMENT DIV. /
r i v � PROTECTIVE INSPECTION SEC. / l��
� 1 /"'1 � CITY HALL FRIDLE� 55432 NUMBEP REV OATE PAGE OF APPROVED BY
�""'� � �'' 612-571-3450 910-F15 4/9/93 / /
JOB ADDRESS 2'75 Craigbrook Way NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2p 6 Pearson�s Crai,gway Esta.tes 2nd SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Jan/George Dea.n 275 Cxai.gIarook W�.y NE 571-7852
3 CONTRACTOR MAIL ADDRESS Z�P PHONE L.ICENSE NO.
Peach.tree Construction Inc PO Box 49152, Bla,ine MN 755-1925 1910
4 AFiCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER N�A�LADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroa� Ds�ell'ing (30 Squares) Tear-•o��
9 CHANGE OF USE FROM TO
STIPULATIONS ,
Underlayznent must comply wi.th the State �uilding Code.
SEPARATE PEHMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS 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 yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1'� 62O $" 81
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIO OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT OR THE P RFOR NCE OF CONSTRUCTION. S37.00 Fire SC $l. GZ
% PLAN CHECKFEE TOTALFEE
� � Jr 'a License SC $5�00 $44.43
SIGNA i7E OF NTRACTOR OR AUTHORIZED AGENT I ATE� HEN PRQP V L �T THIS IS YOUR PERMIT
" "� �'�Z `�.3
S�GNAiURE OF OWNEA �.�F OWNEA BUiLDERi �DATE� ` 8 G�NSP qFiE
.. . . . ... . .� ........ . . . ....�. . .._,.........,.,.......,.. ..,..,.,..�.................,., �.K. .�... ....�......>.> .:,i>o..a....�:-.aav. ..•..�.�x.�;:..�.u:..::,-zca:.ax>o.�:n>:.....•c•.x. . . .ni�.>..y_. i. i_.:�?.�..e.w... ..,:•.�,... ...
NEW [] Effe�tive 1/1/93 �'�� o Z
ADDN [ ] CTfY OF FRIDLEY
ALTER [] SINGLE FAMIGY AND DUP'LEXES R-1 AND R-2
Building Pernut Application
Construction Address: � % S � �'- � � a� � �- o u � l,,' � �/
� �
Legal Description: Lo -i-' Z�' ���o c. k � i'�e� ,- �o r• s C e-- a. ���, �e y z
, ,
Owner Name & Address: .� a ., c�- �� � � � � �c, � Tel. # S 7J - ?�S z..
Contractor: �� ���,e, �,.� s°i� c� u� ,'�• � MN LICENSE # O/ 9/ o
Address: f-�O �,x �-I q.� S Z 1�`c� ► ti� Tel. # 7 S S-) �l � S
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:
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width . Hgt/ . ound
�Q. �oo �r' � p 5
Comer I.ot [] Inside Lot [ j
Type of Construction:
Approx. Completion Date:
Ft. Yd Setback
Sq. Ft_
Sq. Ft.
Sc�. Ft.
Side Yard Setbacks
Estimated Cost: $
(Cost on Back)
Driveway Curb Cut Width Nceded_ Ft. + 6 Ft = Ft x$ _$ l�i Z�
I�ATE: ���i 3 APPLICANT: (� Tel. # i SS —1 q��
Permit Fee $ � Q(�
Fire Surcharge $ G �
State Surcharge $ �
SAC Charge $
License Surcharge $ � a �
Driveway Escrow $ —�
� F� � .�
Sewer Main Charge $ �
TOTAL $
STIPULATIONS:
�ITY USE QNLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
�.50/Si,(?00 Valuation
$750 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt "A" or Alt. "B" Above .
Fee Determined by Engineering
Agreement Ne�essary [ ] Not N�e,ssary [ ]
_ �,
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure,
or for a�► addition to any existing baildiag or sbructure, or for any alteration or repair to any existing
building or st�ucture, upon application therefore, require the pay�n�t by the applicant for such permit
of fe�s to the amount heaein below set forth and an the manaer herein provided to-wit
TOTAL VALUE
$1 to $S00
$SOl to �$2,0�
$2,001 to $25,000
$?.5;001 to $50,000 '
$50,001 to $100,OW
,
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEFS
$15 (NCnimum Fee is $15 plus sarcharge)
$15 for first $S00 plas $2 for each additional $100 or
fraction thereof, �tm aad including $2,000 �
$45 for first $2,000 plus $9 for each additioaal $1;000
or fraction thereof, to and including $25,000
$252 �for �first� $25,000 ples $6.50 for e,ach additional $1;000
or fra.ction thereof, to and including $50,000
$414.50 for first $50,OQ0 plus $4.50 for each additional
$1,000 or fractioa thereof, to . and including $100,OQ0
$639.50 for first $1�,OQ0 plus $3.50 for each additi.onal
$1,000 or ftaction th�eof, to and including �$500,000
$2039.50 for the f�st $5�,000 plus $3 for each addit[onal
$1,000 or fraction thaeof, to and including $1,�O,OUO
$3539.50 for the first $1,�0,000 plus $Z for each additional
$1,OU0 or fraction thereof �
DRI`iEWAY DEPRESSION ESCROW
(Concrete C%rb Streets Only)
Alternate "A" : Removal aad replacement of curb and gut#,er only - Driveway width plus 6 feet times
$13.50. �
Alternate "B" : Removal and replacement of curb and gutter and i�istall a 3 foot wide .
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for consti�uctioa 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 Ce�rtificate of Survey of the lot, showing the location of the foundation once it has it has been
constructed will be required before proc�eding with the framing.
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COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinct 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 plastic/PVC 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 current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina 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 installina 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 coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
Appliance Tvpe 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 Heiaht 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: (Describe)
�! ��; � ��� �i� /� ^� �-� �- 1� r� � � �i � � �•c,u� �, ,�r��
� ���
HEATING CO:
Signed By
SUPERI�R wCiHf6'�,��TO�S� l:�C.
2142F:�AVENUENO. �
CI�Y5T�1.. MN b�
� Date Q «�a�
Building
Inspections
763-572-3604
sr[� �nDtt�ss ,�
,
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLE�
Permit No:
. _ - - . : W\1L
� �r� ��:. �.
• - . � � • � i��. • � � r � � _► _� � .�� .� r � � �
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR
George Dean
P�w�� N�� ' 275 Craigbrook Way Northeast
�N� '�'�D�s: Fridley,lVlN 55432 �ATE zrr.
• PHOr�: __7635717852
CONTRACTOR
SUBMTf A CpPY OF
YOUR STATE
LICENSE WITH ,
APPLICATION
PERMIT TYPE
TYPE OF WORK:
STATE LICENSE # sa, �
ADDRESS• �/� �t�
PHONE % - y03 Fp}t
]�SINGLE FAMILY ❑ TWO FAMILY
�-
❑ NEW
DETAILED DESCRIPTION OF WORK
E7� DATE
�REPLACFMENT
�
� O TOWNfiOUSE
�.�rn s'sYv9'
PER MS 16B.665 the pennit fee is a minimum of $15.00 or 5°/a 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.shouldreflect only.the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
•FOR�ROJECI'S WI��RE LABOR IXCEEDS$300;�EES ARE BASED ON $10.00 PER FIXTURE,"EXCEP�3':�V[�RENQ'L�,,:RIZCT[�Eg;.,(A�DIC�ATE TO�TAL
NUMBER OF EACH BELOVi� •
_ BATH SWK/I.AV FLOOR DRAINS SHOWER WATER PIPIIVG
_ BATHTUB _ GAS PIPWG (rvEeoCrirucFrvsE) SWD�RMIIVG POOL WATER SOFfNER ($35)
_ CLOTE�S WASHER _ KITCHEN SWK WATER CLOSET BACKFT.OV✓ PREV. ($15�
_DISHWASHER =LAUNDRY'i`Re1Y ,LWATER HEATER ($35� FOR IRRIGATiON
_ WATER MEfER OTHER
Permit Fee $ Number of fixtures @$10.00 x$10,00 =$
Surchar e .50 Number of fixtures @$15.00 x$15�:00 =$
ITAi DUE $ Number of fixtures @$35.00 � x$35.U0 =$ 3S Oo
� � � � State Surcharge = $ .50
Total ° $ 3�. S�
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the informarion above is complete and accurate; that the work will be in
conformarnce 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 applic n 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 case �� wb'� r�uires review and approval of plans. �
SIGNATURE OF APPLICANT
NAME Je.'� /YOI��IDN�1 DATE I � Ub
City of Fridley
�uilding Inspections Department ,
6431 University Avenue NE, �ridley, MN 55432
763-572-3604
FAX: 763-502-4977