AF - 42048� �
City of Fridley, Minn.
BUILDING PERMIT N� s 7 3�
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Date: _.._._ :.. `......�^....L.—�__`.��__ . .._._.�.
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Owner:
�.�%�.__. . .. _ Builder -
. .__L ._._. .__� _.. _ ....._..._..._.._.
•
Address
Address
LOC IO��F UILDING
No. .[.... .......Q--•...._.. Street .....- • -•.1��-�{..•-..�c-...... t_�--•�......_....----.... Part of t .......... ... ..... ....___.. ......_ ._._._..._.._.
Lot .��. � ..._�_%_k?_ Block ._.._.,_..._ ...._...�f••- .............. Addition or Sub-Division .. . ....�...����s.!'�.r.- .��_ .._.��.--_...._...
v°°' � L � � r
CornerLot _.__........_..._......_ Inside Lot ....._.._.._ ........................... Setback -•--.. .��...il.....I_.---••---.. deyard .._..._.._..�.._....._.._.___...._..._..__.__.._�.
Sewer EIevation _._......._._._......_...._...._._..._.._.._..____._....__ .............-......_ Founda.tion Elevation
r DESCRIPTION OF BUILDING
T Use�l
_ . _ Front _�.�..�__. Depth ..��..e.... ...._. Height ... ��....�.1' . Sq. F� �,�� Cu. F�<•i��-°
__._._._._.._....__....._. �� Fro __._..__.._..__ Depth .....__._... . Height ._.._.....�.�, Sq. Ft. ._.___.._...._. Cu. F'� _.._..___—
� y� /�, _
Type of Construction _..._. ..._...���� .�l(�.�..�... Est. C _.�...✓..�5�'.-.-'--...... To be Completed _..._..._.._._._....._..__.__�
In consideration of the fssuancae to me of a, permit to construc e lding described above, I agree to do
th� proposed work in accordance with the description above set f in compliance with provisions of
c�rdinances of the city of Fridley. �
,
In co�sideration of the payment of a fee of ��,�- ., permit is hereby granted to_.+..�.� ._.._..__._
..,.__,._...._..�........_....._.:.._.._.__.._.._. 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 buiiding, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constxuction, alteration, maintenance, repair and movinS of buildings
within the city limits and this permit may be revoked at any time upon vi'g3+�ozrQf any of the provisions of said
ordinancea �a d i'1 / t
Buildin8 �P��
� NOTICE:
71ds p�emit doa not eowr th� eonstruefion, insnilNion fsr widng. Phia�bin9. o�s h�atGig, »w�r or wat�r. B� wn fo �
1h� 6�ildfog Intp�ewr for apant� p�rmfts hr tha� it�ms.
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City of Fridley
Application #or P'lumbing and C�s Fitting Perm�t
Dept. of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK � �
Number, Kind aad Locaiicn of Fixtnres Locafio�_
�n (9 WATER HTR.
F� N � W W = � `
3 l7 � 6� m u� ;� o O ; g � U m < 3 <U' `(9 y+ � O F N GAS ELEC.
, Base � � " �
lst x < < l '�
2nd
3rd
4th
• Fuiure Coanection Openings
* New Fixlure, O!d Openings
PARTIAL RATE SCHEDULE
City of Fridley:
s`���._
l
.-
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this applica a true and corr t.
ridley, Minn. � � , 19 ��
Owner � � �"'�'
Kind of
3ewer � Used as
Cesspool j']
PLIIMBING FIXTURE RATES: NO. RATE Tf)TAL /
.( � �
Number Fixtures . . . . . . . . . . . . . . . . . . . . . . �_ x $1.50 $
Future E`ixture Opening . . . . . �. . . . . . . . . �2_ x 1.20 $ �`-� � d
.
New Fixture Old Opening . . . . . . . . . . . . . . x 1,00 $
Catch Basin ..... .......... ... x 3.25 $
Water Heater (Up to 200,000 BTU) . . . . . .—� x 2.00 $ + �i �
New Ground Run Old Bldg. . . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures .......................... ! x$1.50 $�� h a
Additional Fixtures .. ... ............... x .50 �
Gas Range to 200,000 $TLT . .......... ... x Z.00 �
REPAIRS & ALTERATIONS—Refer !o Code
� \ Description ................................................$
� � TOTAL FEE ��O
To be completed about
Estimated Cost, $
OId Tew. uilding Permit No. �/� Permit No. �
�:,..,,,a �.-
rl � 4 �
ROUGH �v
FINAL
d 2 $ll�
By �.�--�-�+ � —
Business Phune No._� �
�
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` f�P°LICA7IQN FOR �Lll;�it,ItiG AND �7AS �I7TIi�G P�Fv�tIT
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P�;RTIAL RATE SC!�EDULE �
Pi:, ��i\G ciXiUP.E R.r".;.r-.S: ti0. z2ATE
....�._,'�� Fir. =�:res x S3. QO
r.:_..re ri..Yt,.re C?eniag x S2.00
.:a•� .-i:ct..re. Old Coea:ng x 52.00
�tc:z 3�.,_.� x S_.CO
n.�.___ :edLer - :0 9°.G00 ...:J X 5�.00
1C�,G;,� ...^J to �99,000 3�C r, S10.00
i:�:er Sc` �er.e= x $7. 00
::e:a Gro•�:.; y�^ 02� 3ui2d.i:.g x 55.00
==e=._ic +:a=e= :�ca�er x 55.00
G:S cITiI::G F��S:
2s_ 3 :ir.t..-cs x 53.00
_��O:dl ::%'��.=�5 Y. $1.��
Gss R..-ge �o :93,0�0 3TU x 510.00
R:.?:.:RS � :�L1LP�iIO\S
- zst SiG�.GO 55.00
escl a�d. 5=�0.00 or �ractioa a2•00
S�.ate Surcharge
TC::ti:, F��
it£I::S?OC.I0:1 F::�
. {S1v.00) .
ToTnL
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$
$
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5
$ 50
$�0-- v
.'ob Ac?3YCSS �' �C/ � � �rJ �` /1 N 1---
l /
,�I�artmrr;t o° Lsuilui^c,s
Cl`�f OP : T1c�iCj/
TC1. `=.`"i%1-34JO ,
2�hc undersigncc: nereby makes ap�licatiol for a�ez�it foz t'�e M�zk herein
snecificd a�rrcci:rg b c:o a21 «or., in �,.rie= accorZar.cc wit`� L'r.c City Ce��s
and rul.in,� of t::a ^eps: ��c^t o_° �ui�.d:tir,s, ar.d ::ereby �eclares :ha� aI?
tne °acts and re,>resentations sta:ec ia tn:s a��li�at:.on ..re trse ar.d correct
rr'_d.cy, s:.-e.. �Z—� �- — . 19 ��
�S`TyJL'.Z ��...�.��'... /_.�j r � Ly--.�--�.+._---_
;��tiD OF IIJZZ,DZ�G �- 11 � L�
,� / �
US�D AS
TO SE CQ::PI.ETED <'+�O:J�
ESTIv,AT�D COS;
OiD - NEW Btiii.'JiNG P°R`?IT D:O. PE.^�?1IT \O. �/L� /�
Co:npany �.�._�� ,. � �.
Signec 3y �-� -�,-�-.�%�._� �°>. . �___
�el. ho. L / / — �J �5�� �
ROUGH INSP.
Date
FINAL INSP.
Datc
fir r:zov,�L r•o�t ��r�axT
::I:3;.N�:d FEE r^OR A.VY PLGNWItiG PLR�:TT ZS S7. SO
u
- �—_.__� _ _
SUBJECT P . .
City of Fridley 1712
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � REC O.
� ' COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEG �� ���
� �
� � /'��1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
� ----�: `.�
612-571-3450 910-F15 5/9/83 � �
JOB ADDRESS 248 Ely Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
�ESCR. 35,36 11 Spring Brook Park SHEET
2 PROPERTYOWNER MAI�ADDRESS ZIP PHONE
Darrell Neptron 248 Ely Street N.E. 786-1659
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Palmer West Construction Co. 6937 West Palmer Lake Drive 561-9482
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Re siden tial
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 12' x 10' Addition to Dwellin and r f
9 CHANGE QF USE FROM TO
STIPULATIONS
Provide products of eombustion fire alarms on both levels of
existing house. Rc�of can be 2nd layer but not 3rc1 layer. Insta.11ed galvanized
valleys.
� A��idt�� �,;�;�
��e di$g�ng �a11 toca� GAS Etc.
�N�-��EC�R�C- S�PER'A�'E PERIkIltTS REQU1REf� FOR WlRIf�C�
����� gY �-AW H�A�'fNG, PLUMB�NG AND SIGN.S
�EQU�a�o
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTFiUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET 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 VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,750 $2.3H
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE
ROVISIONS OF ANY OTHER STATE Oii LOCAL LAW REGULATING CON-
TR ' OR THE PERFORMANC OF NST CTION. $SO. SO NONE
PLAN CHECKFEE TOTALFEE
��� $12.63 $65.51
Si NATUREOFCO RORAUTHORIZEDAGENT IDATEI 1/uHEN PFOPERLY IDATED THIS IS VOUR PERMIT
! ��
_ _______°y�rC��
SiGNATUREOFOWNERiiFOWNERBUILDER� iDATEI BLDG WSP DnT
�1TY OF fR1DLCY Effeetive �u9. �, 1961
Af PLICJ1Tla� FOk RCSIDCH7IH� 6UlLOl��G PLi�IITS
(Nc+,r, Alterations. Additions. or Repairsj
ON1�FR: �'1�. a �^ e, 1! �e (J -�-r o v1
ADDP.ESS: _ dZ �i� ��� S l� /j% £•
—
Tfl M0: i_p�6 -- /��'�I �
BU11DfR: �a � v+� e v° ''1� e S`� �'o �. s 7�,r �o .
A�Dtttss: �9.3i �- �'c�wr c � � k �r
TEL N0: �'6 � 9 yd' Z
�
� Constrvction Location
. sr�r no : � �/ �' irr�r: ,______�__�' /y �S f. ti � �
LOT: _� 3 S�j-3(� �IAOCs r �� ADAITIO�I s S � R4 1�
--
Corntr Lot: `_ Incide Lot: ��etb�cY.: ^� Sid�yards:
11p�licar�t att�ch tc t)iis fono ts+c Certificates of Stizvey ot lot ar�d
pzoposed builc]ing locatian ezawn on certificates to scale.
OESCRIPTIO�i OF COI�JSTP.UCT10t�
���_'� c`rt � Front: I Z` Depths jQ ` Height: � r
`�� aquart Feets �,'� D _ Cubic Fcet: _�(e �
���� Front: � �_
P BeSght:
J Square Fe�t: W�bic Peet:
12.��c 3�.� � ��5� � � a7�'�
9ype oi tbrstzuction: _ �oo r� ,� c�ic� ��;o � Esti�►attd Cost: : d c�
. -- —_�
1b Be Cbr..plctee: � r/– .� 3 �
111t. 7► 1►1 t. B
Proposea Drivc�+ay icidth If Ne+.+ Openinq Is Desfred: :� j
.._-.--______ � _
, . . SEL REVER;E SIDL OF SHF�T
Z9�e undes�icned ?�ereby ma1;c� aPplic�tion for a per�it icz the �AYk ?�ereir► specffied,
agreeing to da ,all vork ir, ttrict accozd�ce r+ith the City of Fridley Ozdi��ances t,�d
'ruliu9s of the ecl�,,sc�+c�t of nuiiain�s, and ?�ezcby declazes tt,at •11 tl�e fact� ana
zeprese�trtiens stated fn this npplication are true and co:rect.
. �
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sua�ecr P IT N
City of Fridley �� 17 6 4 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � R IPTN
� • COMMUNITY DEVELOPMENT DIV.
' � y- - / ��
r � � PROTECTIVE INSPECTION SEC. ( S(,
� � /'�'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""""�� ,�� 612-571-3450 910-F15 8/6/84 � �
�oe ,n�oaess 248 E1y Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oESCR. 35,36 11 Spring Brook Park SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Darrell Nystran 248 Ely Street N.E. 786-1659
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct an 18' x 20' and a 7' x 10' Decks onto Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
r�rA��r�c
BeforE digging cali local u±ilitie,
TEiEPHONE - ELECtRIC - GAS Efc.
REQU�RED BY LA`d1i
SEPERATE PERMfTS R�C�U1�tED FOR WtRti��.
HEATING. PLUI�I$ING AND S1G�.
TYPE OP CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED 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 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED 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 APPUCATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WII.L BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $25O yfi�..2S
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. �38.SQ None
PLAN CHECKFEE TOTALFEE
$ 9.63 $49.38
uaeOFCON�A ioao AUTHORIZEDAG .T IDATEI WHEN PROPERL VA ATED HIS IS YOUR P RMIT
/ ,i � � �
SI ATUAEOF OWNEAi�F OWNER BU DERI IDATEI BLDG iNSP DA E
NEW [ �
ADDN. [ J
pLTER. I J
Constructlon Addresa:
City of Fridley
�R-1 AAD R-2� .
Building Permit Applieation
�-� � �L
Effective 4/1/84
�
Legal Des�ription:
Owner Name & Address:
��l �'�.� / � /V��I�d � ' Tel . # I �
r --- C
Contractor: -e- � Tel. # /
Address:
.r�--�
LI9IIiG AREA:
GARAGE AREA:
DECK IIREA :
OTHER:
Corner Lot [ ]
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction draWn on it to scale.
Length
Length
Length
DESCRIPTIOp OF IMPROYEMENT
Width Height ____,___ Sq. Ft. �
Width eight Sq. Ft. ______�
!
Width r gt/Ground.�_ Sq. Ft. �
Inside Lot [!�]� Ft. Yd. Setbaek" �� � Sa��� rd Setbaek _
� % L-�nr ��/ Estimated Cost: �
Type of Construction: ,,,�i� - �-� -- '
Approx. Completion Date: ����
Alt. A Alt B
Proposed Drive�ray Width If Ne�r Opening Is Desired: ._ �e Back Page for Explanation
DATE: � '
Permit Fee
Plan Check
State Surcharge
SJIC Cbarge
Parlc Fee
Setirer Irlain. Charge
?OTIIL
STIPULATIONS:
APPLICANT: ��'��� J�`� Tel. #��� ���
CITY IISE ONLY
� ,� Fee Schedule on Reverse Side
; 25� of Building Permit Fee
� �.50/a1,000 Valuation
� ""'r"` �425 per SAC Unit '
� "��` Fee Determined by Engineering
� �,�.r
Agreement Necessary [ ] Not Necessary ( ]
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CITY OF FRIDLEY INSPECTION DIV
6431 University Ave NE
Fridley, MN 55432
572-3604 .
�ATE SCHEpULE
Residential
APPLICATION FOR POWER PLANTS AND HEATING, COOLING� VEN71LATfON,
REFRIGERATION AND AIR CONDITIONING SYS7EM8 AND DEVICES
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back}
Gas Piping (Needed with new furnace)
Gas Rahge �
Gas Dryer
*Air Candit(oning — Ail Sizes
A!I Others/Fiepairs & Alterations (LIST ON BACK)
1% of Value of Applia�ce or Work
Commercial/Indu$t�ia1
125% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $ � • �
$ 10.00 $
$10.00 $
$ 10,00 $
$ 25.00 $
$
$
State �urcharge
TOTAL FEE
.50
$�d.'�V
MINIMUM FE� FOR ANY HEATING[COQLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PI.US THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
Effective On March 1, 1996
JOB ADDFlE5a � N �
The undersigned hereby makes application for a permit for the work herein
specified agreaing to do �il work in strict accordance with the City Codes and
rutings of the Building Division, ancl hereby declares that all the facts and
representations stated in this appiication are true an correct.
_�----
-- — _— 1996
OWNEW ��arr
BUILDING U5ED A5 (�L�'_�,Q�e�
eO
ESTIMATED COST I� O� -` PERMIT N0. j� �� �
D�SCR�PTION OF,,,fURNACE AND OR 6URNER
No. of Heating Units � Circle Ono (Steam) '�Hot Water) arm Air)
Trad� Name 1''UIQII�' Size No. �(p D
BTU� b HP EDR
Fuel QG S Total Connected load
�--- �
Burner 7rade Name Size No.
8TU HP EDR
BLAiNE HTG. A/C 8 ELECT. INC.
13562 CENTRAL AVE. PI.E.
HEA7ING C010PANY nunve us� cc�n�
Tel No. ���%��QadO
Approved By�=�-- Rough—In Date Final Date � �'`'��
0 �, ,/
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR Sl'ACK VERIFICATION ON �v�'
written permission from adjoining property owner. REPLACEMENT FURNACE ,
�=E:.:::':::
�'. ��4-. . ..
r^y`..
CHIl1sNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
2
3.
Has been carefully examined
Is free from rust or deterioration
Has no foreign objects lodged within
4. Is securely supported
5. Me�ets all current Code requirements for size
ancl `total BTLT's connected
�
7.
�
Ha�:total heating BTU's of �`� 00 �
All��is�th� r$TU's ��. o a o
��
TOT'A� BTU's � "Z. Oo v
.�
Has a�"liner been provided for water heater
Has combustion air been provided for water heater
Y�s�No()
Yes � No ( )
Yes ( ) No Q�
Yes � No { )
Yes (j� No ( )
Yes (� No ( )
Yes �f No ( )
Remarks: � �
� �� �1�t s'�- �{-� � � �f /�- (J�-Z-t/�
List ALTERATIONS Bein� Done:
Bl.�INE HTl3. A/C 8 EIECT. IN�
i3562 CENTRAL AVE. N.E.
HEATING CO: ANOKA, MN 55304
Signed By:
Date:
�
6��,�� ~��NG HOUSE HEATING TEST RECORD
AIR CONDITIONIN3
ANO ELECTRIC, INC.
ADDRESS � �- APL F OOR CiTY F� I ale gUBURB
OCCUPANT _ �i�� A �'lJ�� OWNER .C���%—�/�_ i''57��'i(
HEAT LOSS DATE HTG. INST. /� ��
SOLD BY �//rJ� INSTALLED BY /. /��%�%� �
Electrical Work By __ �'/�%/f� ; Qas Un� By l�
TYPE OF HEAT GA FA '�C HW STEAM_ SPACE HTR._ UNR HTR._ OTHER
(iA3 DESICiN � CONVERSION
MAKE MAKE OF BURNER
Model Q ModN
Serial / Max. BTU Aatinp
INPUT IiIAICE OF FURNACE
Model
, � ceuran� c r /
THERMOSTAT
Vatva
Limit
Limit Setting _
Fan Satling ,_
P(lot TYpo ,
Pilot Maka �
Pluy Wnt Siz� _
S KtND OF LINER
DraR Nood
Flft�es 81z� , /�,�
Ch�mn�y Location Iniid�
Chlmn�y Construction
g►� J " NONE
R�pulator
. Numb�r
PUot Model &nok� Bomb Wirinp
Pilot Timing �G- Dnh T�st Tap
L. W. Cut Off Door Pnssun UphUnp Inst.
eun „- Parcant CO, pat� Tqt�d
'H �% � Parc�nt O, Company T�stiny %
P�rcmt CO p�� o} Tp��r e
sue�ecr PER .
City of Fridley � 3 2 9 9 6 "
, , AT THE TOP Of TME TWINS g U I L D I N G P E R M I T R CEIPT N.
r
� �
� • COMMUNITY DEVELOPMENT DIV.
�V'�'��� ,
r � � PfiOTECTIVE INSPECTION SEC.
� �
� � �"'1 � CITY HALI FFIDIE� 55�32 NUMBEA pEV O�iE P�GE OF • PpOVEO Br�
�"'"'��� ,�' 763-571-3450 910-F15 8/19/02 / /
J09 AOORESS 248 Ely Street NE
t LEGAL LOT NO. BLOCK TFACT OR ADDITION SEE ATTACHED
�esca. 35,36 11 S rin Brook Park SHEET
2 PFOPERTY OWNER MAII ADDRESS ZIP PHONE
Dave Schwerdtfeger 248 E1 Street NE 763-783-8142
3 CONTHACTOR MAIL ADORESS 21P PMONE LICENSE NO
Same
a ARCMITECT OR OESIGNER MAIL AOOFESS ZIP PHONE LICENSE NO.
5 ENGtNEER MAIL ADDRESS 21P PHONE IICENSE NO
6 USE OF BUILOING
Residential
7 CLASS Of WORK
❑ NEW O ADDITION O ALTERATION X REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof House (15 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
?YPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR EIECTfiICA�, P�UMBING, HEATING,
VENTI�ATING OR AIR CONOITIONING.
THIS PEFiM1T BECOMES NUIL AND VOIO IF WORK Ofi CONSTRUCTION ZONING S�. FT CU FT
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAVS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOR A PER100 OF 120 DAYS AT
ANV TIME AFTEq WORK IS COMMENCED NO DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIfV THAT I HAVE READ ANO EXAMINEO THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE $AME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO OADINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITM WHETMER SPECIFIED HEREIN OFi NOT THE GRANTING OF A PERMIT �l s6OH �.BO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OA CANCEL THE pERMIT fEE SAC CNAqGE
PROVISIONS OF ANV OTMER STATE OA LOCAL LAW REGULATING CON-
STRUCTION OR TME PERFORMANCE OF CONSTRUCTION �6O.IO Fire SC �I.GI
PLAN CHECK FEE TOTAL FEE
$62.5i
S�GronruaE9 anC a0 u��OQ�ZED�GEHi iO�TE� N PAOPEQLV VA�IOATEO THIS IS YOUR PERMiT
� � ��. U � �
�+n7 E� �� WaEQ�1 ERBWIDEA� iOAiE� BLD o ��°�t
. r �
NEW
ADDN
ALTER
( j CITY OF FRIDLEY EffecWe 1/1/2002
( J 6431 University Ave NE, Fridley, MN 55432 (763) 572�3604 Bidg Insp
[ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPIICATION
Construction Address: c��� � � � �t
Legal Description:
Owner Name & Address: .��1�� 5��-����-�^�c �e-�' Tel. #?Co3 -?g3- � l'� Z
Contractor. MN LICENSE #
Address: Tel. #
LNING AREA:
GARAGE AREA:
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 � Height Sq. Ft Gf �
Length Wdth Height Sq. Ft.
DECK AREA: Length
OTHER:
Wdth HgUGround Sq. Ft
1�
�e.(� cs,� v / O
Construction Type:� ��� Estimated Cost: $ ��-�� 1�O �t5
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
��
g4/ o
F�
DATE: � /Ov APPUCANT: <�� ���C����N Tel. # %� " 783 "c`s�l�Z
Cal) (763) 572-3604 for Pertnit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
l.icense Surcharge
Driveway Escrow
Erosion Control
Partc Fee
Sewer Main Charge
TOTAL
$ lp� , � �
$ -�o�
$ F�d
$
$
$
$
$
$
$ ��. S"�
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ J Not Necessary [
z
STIPULATIONS:
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-36u4 r��:
: 248 ELY ST NE
: 033024420094
: UNAVAILABLE
: LOT 0 BLOCK 0
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
s�i-ii��i
PERMIT NO.: 2004-01782 �a� 1
DATE ISSUED: 10/OS/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS
SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
OWNER
DAVID SCHWERDTFEGER
248 ELY ST NE
FRIDLEY, MN 55432
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 wark is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. T'he
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 ar the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 118132
S�YAKA 1� Y�KMI l'S 1Z�(�UIK�D r'OK WUKK UTHEK THAN ll�SC;lZ1J3�ll A13UV�.
20.00
0.50
20.50
0
Building
Inspections
7. 63-572-3604
MECI�ANICAL
R�SII)ENTIAL A�PLICATIQN
CITY �F FR�LEY
PermitNo.: �Od7
Received By:
D���°�:u
DATE O' a� �� O'7 YOUR E-MAIL ADDRE55
S.ITEADDRESS c��iY I � N � �
THIS APPLICANT IS: ❑ OWNER .�CONTRACTOR '
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
lvruvan.v v � w.r -' - � — • • — - -- �
ADDRESS: ��i� ��N cS�' N�' CITY �Rl �I C.,, STAT�/N ZIPS S.�1�
rxorrE:i63 ° 7�i 3-�� y �
coMP�xY N.v,�: 2c v cr
CONTACT PER�ON: �!J
STATE LICENSE # EXP DATE
p�{— NC=, CITY FO�1tJI t� STATEKe•�ZIp `�I �F3d�
ADDRESS:�a-9U d'�Q.(�l �
Pxot�`163 • �� �' � ( �1 � F,4X
FAMILY ❑ TWO FAMILY
TYPE OF WORK: I❑ NEw �LaCEtvt�r'r
0 TOWNHOUSE
❑ ALTERA110N/REMODEL
DETAILED DESCRIPTION OF WORK�S� � /2t�O�at'tr`+ i'�'�' A/� ("tS�'1���1� L/L
PER MS 16B.665 the perrnit fee is a minimum of $15.40 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 fjxtiues. (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 PROJEG?5 WHERE LABOR EXCE£DS $500, FEES ARE BASED ON $10.00 PER FIX!'URE, EXCEYT W1iERE NOTED• FIXT�JRES: (INDICATE TOTAL
NUMBER OF EACH BELOV� � v MODEL: �a ���`�aZ S�� .s� TO I'�
Equipmcnt Instaqed . M�C'� i2 � MODEL:
NffG: SIZFJBTU
�G; MODEL:
FIREPLACE (GAS) $15.00 . _GAS RANGE/OVEN S10.Qa
�A/C 525.00 riEW GAS GRILL 510.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 ,G� �T HTR $10.00
�BOILER 535.00 FURNACE $35.00
�CHIMNEY LINER $10.00 �GAS DRYER $10.00 POOL HEATER $35.00
'—DUCT WOItK $10.00 GAS PIPING $10.00 VEN'ITL�P►TOR 515.00
_ ,� w.. „».,,��-,x������ � n
11:.�lL"aGr.r�iG1L"WJiG.,trnrLr� +p.�:i�x�a�v�z.s.:,.,r.r.�...��:,....�nc.,,.r. ��yt -:.:.� . �-o:._...... . ..... .... ... ......... .. . . . .
.... . , _. _ ..� .�..
Permit Fee $ � o o Number of fixtures @$10.00 x$10.00 =
Swchar e $��— .50 Number of fixtures Q$15.00 x$15.00 =$
g o Number of fixtures @$25.00 x$25.00 =$
TOTAL DUE $ 3�5 • �
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ _50
Tota] _ $
THIS IS AN APPLICA7'ION FOR A PERM]T-NOT VALID UNTIL PROCESSED
I hereby appIy for a bt�itding 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 case of all work which requires review and approval of plans•
SIGNATURE OF APPLICANT l� �'�.�1.ZJ' 1`�!-� PRINrNAME �l'(S '`�+,��i DATE ` �3 � b'�
Ciiy of �ridley
Building Inspections Department
643I University Avenue NE, Fridley, MN 55432
763-572-3604
FA;�: ?63-502-4977