AF - 42665City of Fridley, inn
BUILDING P�RMIT N° 5 4 3 0
Date: "' '�-+f�'
,a�
Owaer: ��„�.�l� � . Builder
Address ...._ Address
� � �.O ION BU L NG
No. �Street ��, _ ,� �.. Part Lot —
Lot �' ' y.. Block :A.dditfon or Sub-Divlsio �.��"�� � �____
�._._'�'_ � �t ,
Coraer Lot _�Inafde Lot Setback �,,,�� Sideyard ��,
Sewer IIevatfon Foundation IIevation '
DESCRIPTION OF BUILDING
To vsed � �- �
��� '_ Front Depth '��€..� Height � S4. Ft �P�. -°�"'� Cu. Ft ���a��
l�� .
1�. t Depth ght "�..�. Sq. Fi. Cu. Ft
�� �,�r,�
Type of Coastructi� r� F�st. Cost� � To be Completed
In considera.tion of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all proviaions of
qrdinances of the city of Fridley. � .
In considerat3on of the payment of a fee of �.��'� � permit is hereby granfi,ed to
to construct the building or addition as described above. This permit is granted u�n
�he egpress conditaton that the person to whom it is granted and his agents, employees and wor�en, in all work
done in, around and upon said building, or any► part thereof, shall conform in all respects to the ordinancea of
�rYdley, Minnesota regarding location, construction, alteration, maintenance� repair and moving of buildings
within the city limits and this permit may be revoked at any time upon viola any of the pmvlsions of eaid
ordinancea �..�,� �
Building Inspector
NO'fIC�
Thts psrmii doea not wver f6s �ens�rueNon, Mataqadon for vrtring, Plumbtnp, gaa headne, aswer oe watsr. 8e wro fo ass
ths Buildieg laspedor for separate pa�its for �6we hsms. _
_,, "•a !!` 4 � �— �.
�,. _
�PPLICgTION FaR BIIILDING PE�iNlI'P
CITY �' FRIDLEY, MINNE,SOTA
t Builder �'-� � ^- � ° "J �� �
Owner s Alame '
/ddress, � � 1/ �2 s�r I � � � � e � � ,
ldclresa - -
. LOCATION OF BIIILDIl�TG
No. ���� 8treet e Part of Lot
Lot s `� ° � S B1ock 5� Addition or 3u�livis3on � � � � �' � �'
Corner Lot ✓ Inside Lot Setback �� Side-Yard /��
SEWER ELEVgTION FOUI1mATI0N EI�IiATI�N
�@pplicant attach to this form Certificate of Survey of Lot and proposed buildin�
loca.tion.
DESCRIPTION OF BIIILDING
To be used as: � /
� � S i �-� _ 1 � �ont � ti Depth � y Height �
Sq. Ft. / �' �' � Cu. Ft. � � � d� � ,
Front__ Depth Height
Sq. Ft. Cu. Ft.
Type of Construction � �'`�_ `� '�- Eatimated Cost /� �' �' �
�__.__
To be Completed �@ � � �° � --
The undersigaed hereby makes application for a permit for the work here3n spec3fied,
agreeing to do all work in strict accordance with the City ardiraances and rulin� oi
the Department of Buildings, and hereby declares that all the facts and representations
atatad in thi.s applica.tion are true and correct.
D1�TE , SIC�TATURE �
(A Schedule of Fee Ccsta can be found on the Reverse Side.)
__' �"'1 n
. r
BUII�DIiJG PERMIT FEE SCHEDIII�
Section 2. The Insgector of Bu3ldings ahall, before issuing any perm3t for the
erection of ang building.or. structure, or for arr�r addit3on to eny existing build-
ing or atructure, or for �.n.y alterations or repairs to ang e�.at3ng bu3lding or
st.ructure, upon applicat3on therefor, require the pe,�►ment by the applicant for
such permit of feea to the amount herein be�.ow aet forth and 3n the mesuter herain
provided to--wit:
2.1. For ang such permit for the erection of ang fire-.proof building, other thaa
a garage, warehouse, factory or �,I'B,�A -8I898'�OT� or for the erect3on of any fi.re-
proof addition, for aimilar occupea�og, to any exist3ng building shall 'be at the
rate of �1.4A for each one thousand cubic f�et, or fraction thereof, 3n such
cubical contents.
2.2. For an�► auch permit for the erection of any fireproof gare.ge, warehouee,
factory or gra3n elevator,'or for the erection of any.fireproof addition, for.
sim3lar occupancy, to any e�cisting building shall be at the rate of �7..25 for
each one thousand cub3c feet, classified as '�f3reproof" by Section 502 of the
Minneapolis Building Code.
HO,USFS
2.3. For any such permit for the
tha.n a garage, warehouae, facto
addition, for similar occupan�y,
each one thousand cubia feet.
GAR`
erection of a�► nor�fireproof building other
ry or grain elevator, or any nor�-fireproof
to any exiating building. Permit �7..00 for
2.4. For any such permit i�or the erection of an�+ norr�fireproof garage, waxehouse,
factory or grain elevator, or for the erection of any non-fireproof addition, for
simil.ar occupancy, to any exiating building or for each such building or addition.
Ninety Cents for ea.ch one thousand cubic feet or f'raction thereof, in tha cubical
con�ents thereof �rith a minimtm� of $I�.00,
For the pvrpose of computiug fees for building permits the cubical contents of any
buildi.ng or addition to a un3form height throughout by multipl�ring the �round area
covered from a point aix (6) inches below the floor line of the basement or cel3ar
to the average height of the upper surface or to the average height of ihe xoof
surface of the ma3n gable of a pitched roof. �
2.5. For repairs or alterations to an existing structure, the fee ahall b� at the
rate of �3.00 for each Five Hu�dred DolTaxs (�500.00), or fY�action thereof 3n the
aost of al.l proposed work.
2.6. In no case shall the fee charged for any permit as aet forth in Sect3on 2 be
leas than �4.Q0.
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H,�AT.L�S5 CA[.CULATIONS �� 3 DEPARTMENT aF �UILDINGS � 6 ROSEVIL�..E,,�N
�eatherstrips A.S.H.V.E. Construction No. .,_ Tasulation ' m
Guide - - - -
Windows --@dors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applie�
�_..
Yes—No ' Yes—No 19_
¢' Fi.� �'`,��� ,�. : Roo:n � Length /'�°,1, Width �� HeiBht +'`` ,� FI•� 1����, Room � I,ength ��;�Width
Windows and Doors—Crackage �n Area Window and Doors—Crackage aa Area
�Vldth " Helght No. ot Llaeal It. Area Wldth Haight No. at Llneal tt. Area
_No. ot pane o[ Dane lighte ot crack aq. tt. No. ot Dane ot Dane Ilghte ot crack aQ. [t.
Btu
Infi(tration P
Glass �.�
F�cp. wall `" ��
Net ezp. wall _ - - -
lnt. wsll
Ceiling �
FJoor �
Total Btu.
Required sq. ft. E.D.i. or sq. ins. W.A. Leader area
Fl.� �'��_.�- i�oom � Length � Width %'�� Height
Windows and Doors—Crackage and Area
Wldth Helght No. o[ Lineal tt. Area
No. o[ Dgne ot Fana 116hte ot crack eq. tt.
�
Infilcration
Glass
Exp. wal!
Net ezp. wall
Int. wa4
Ceiling
Floor
Total Btu.
CO�f.� BiU
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
� Fl.� ���t�-'��, Room � Length ,��d/ Width
Windows and Doors—Crackage and Area
Wldth Helght No. ot Lineal tt. Area
No. ot pane o[ Dane Ilghte ot crack eq, tt.
Bcu
Infiltration
Glass
Exp. wall
Net exp. wall
lnt. wall
Ceiling
Floor
Total Btu.
Requir�d sq. ft. E.D.R. or sq. ins. W.l�. L.eader arca
��•��•�.:� � . .�
� �
1
Coef. Bta
' In6ltration j g=„�I i.� �B- � ��
C)ass e°
Facp. wall �
__ 'l�et eap. wrall --- — '�'
Int. wa[l
Ceiling - �.�
Floor t��
Total Btu.
Ftequired sq. ft. E.D.R. or sv. ins. WA. Leader area
Fi.lm ;�. Room ( Length �,,�,t�' • Width �
' Windows a Doors—Crackage and Area '
� Wf�th Helght No. ot Llneal [t. Area
No. ot Dane ot pane Ilghte ot crack aq. ft.
I �' �'C � �� �'" ��` �/eC'
Infiltzation � E
Glass /
'I Exn. wau
Net_eap. wall _
'� Int. wall � '� '
�
' Ceiling �'
I Floor
' Total Btuo
�
'I ftequired aq. ft. ED.R. or sq. ins. W.A. L.eader area
Ft.� ' �_,� ,.' :"�.`"`�E�om I Length � "� Width / p
Windows and Dooro--Crackage and Area
WI�}th Helght No. of Llneul [t. Area
No: ot pane ot Dane tlghte ot crack ep. tt.
�P �� � � 6 r !�
Coef.l Btu
Infiltration l � g �°J ' `'�t
Glass q ��, ,�-j
Eap. wall � �
Net eap. wall ` ``°
.,a
Int.-wafl _ ;� L . � _
Ceiling �,d'�- ' �
Floor �
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.l�. Leader area
�.°.,.. _+
City of Fridley, Mirm..
6431 Univeraity Ave. N. E., Miuneapolis, Minn. 55432
BUILDING PERMIT
DBte: - Nov mb r i 1 g] 1- --
p��; _ Roy T. Holma.n B�� Same
Address _.�5.9SL E7: idl�� S tree t N. E Ad��s Same
i - �/
r �� ' .
LOCATION OF BUiLDING
No. �.�Q4..� Street Fridley Street N.E. p� op �t
Lot lL�s 7.5 Block 5. _.— Addition or Sub�Div3sion nak [:rove Addi t; on
Coraer Lot ._?� Inside Lot Setback °?S � Sideyard �S ` F��s1a � uSE
Sewer Elevaiion —_ Foundal3on Elevation _.._.
DESCRIPTION OF BUILDING
To t�e vsea as:
Detac ed G xage �n� 26' �p�, 24' Height 10' gq, �, 624' �, �, 6240'
--____ Front Depth Aeight Sq. Ft Cu. Ffi.
TypQ og ����� Frame �, �� ��2, 733 To be Completed Janua 1, 1972
Stipulations: Provide a hard surface drive. Elevation to be 12" above centerline of
existing finished Miasissippi Street as per City Engineer Nov. 2, 1971.
In consideration�,of the issuance to me of a permit to constru�,i�e building described above, I agree tg do
fihe proPosed work in accordance with the description above set�.Ror,ih and in ��apli�2� with all prov3sions oY
Ord�ances of the ci of Fridle . /�/ .,.
�
1.37 Sta
In consideration of the payment of a fee of $�12.,_Q�_, permit is hereby granted to �������
R�v_�1man _ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, 3n all work
done in, around and upon said building, or any part thereof, shall conform in a]1 res�cts •to the ordinanCes oi
Zs'ridley, Nlinnesota regarding location, construction, alteration, maintenance, regair and mov3ng of bu�diIIgs
�i� th�e� city limits and this permit may be revoked at any time upon violation oE any of the provi�tons of s8id
�
�� Btrlldin8 Inspect�
HANK MUHICIi �
NOTICE:
This permit does naf eover the eonsfruetion, installa4ioe ffor wiring, plum6ing, 8as heating, �xrar oe water. Be snre to s�
fhs Building Inspeeto� fo� separate permifs for theae fitema. ,
B. H. BRADLEY
CIVIL ENOiN6BR AND 8t7RVEYOR
9829 - 84TX AYHNUE BOUTH
MINNBAPOLIB, MINN880TA 06008
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AP.PLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME :�� / ��ym,�� BUILDER • �� �
AnDx��s : �'sL�� i.��� .� !y�-� ann�ss • �� � �
_
' NO : . G �c+� o S TREET : ��/2 /.fJ � L=� � % �t/. L— .
I,0'�:I��/S BLOCK: � ADDITION: ��� ��m��
CORNER L(rr: �1—� INSIDE LOT: SETBACR: SIDEYARD;
�ppliGant attach to thia form �ao Certificatea of Surveq of �,ot and psoposed
'buildin$ locatioa� d�awa on theae Certificates.
�E�C�2IPTION OF BUILDING
To Be Ueed A�:
�E! - ��Q��� F�ont ; 2- � Depth • ..'� Height : `�'
Square Feet: �� Cubic Feet: iv � 7` �
Fxontt Depth: Height:
Squaze Feet; Cubic Feet:
Z�►pe of Conetruction; �i�D9��L.� Estimated Coet: $����� '`
a .a�e
To �e completea$ G�' / / /7 � � � �
� i �' _. .
� � ,_ -
�e unde�ceigaed hereby mnkes applicatinn for a�ezmit �or the work hereiu `�
epec�fied, agreei.ng to do a11 Mo�k in sttict �ccvrdaucs wl.tii tile Cl��y of c�'� � `�
�'�ridley Osdinaaces and suliqgs of the Department of Buildings, and heraby -
decl.�ree that all the fact� and repreaentatioas etated in this application' `�
are true aad correct.
r r -
AATE: / f �� / SIGNATiJRB: '
(See xeverae Sida For Additioaal Imformation.9 �
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� � � � � � � p ��
�'�.� � � . � � � -�` � ;��= °'�,� � • � ' ,��` p, � �e ��! ' � � 7 � , ,.�
j�,�= � ���, ��. - �--- ��. .�'� `_ � � l� � �i� .� �� �r� ,� G-�. ,�� b� _ �:�
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� ��+W � 3 i . � i � ' r _ ,- ,
. R�° �� �4 �r� I?Ar '3v.a
,� _ -- - - � ,� � � ¢�' -. %�r`9, � �- �`i,�f '�� � � / ��`�
��- � ; O � �,�.... / / ,� , � � /
,
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for Y.he
exection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
buildiag or structure, upon applicatioa therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the u�anaer herein provided to-wit:
UNIFORM BUILDING CODE: 1j►pe 1, 2� 4-$2.15 for each one thousand cubic
fee�, or fraction thereof, in such cubical contenta. 1j►pe 3� 5-$1.85 for
each oae thousand cubic feet.
ADDITIONAL INFORMATION
Fo7r the purpose of computing fees for building peanita, the cubical contents
of a,uy building or addition, ia determined by multiplying the ground area
covsxed from a point six (6) inches below the floor line of the basement
o� the cellar to the average heights of the upper surfac� or to the average�
hei�t o£ the roof surface of the main gable of a pitched roof.
Foa xepairs or alterations to an exi�ting 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 all propoaed work.
Ia no case sha1X the fee charged for aay pemnit as �et forth in Section 2 be
leae th�n $5.00.
� -=' �._
V�RIFICATION OF FOUNDATION
NOTE: Pe�te fvr aonstsuctioa will be issued a miai�m of 24 houxa Eram the
�i�e of application, to allow-for proper review of the proposed stxuctuxe �tnd
of the coastsuctiop site.
A Ce�ti�ied Survey of the lot, ehawing the location of the foundation, ouce it
hsa been canstructed, will be required before proceedin�t with the framing.
CERTIFICATE OF OCCUPANCY
Appiicatio�n for a Certificate of Occupancy sha11 be made teq (10) days prior
to t�e use or oceupaacy of any atsucture for which a buildiag peYmit hae beea
issued; and eaid etsucture shall aot be used or occup�ed until a CeztiiicaCe
o£ Occupaucy has been isaued.
.*
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SUBJECI PERMIT NO.
City of Fridley 2 0 8 6 9
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� � I .
COMMUNITY DEVEIOPMENT DIV.
� � v------� �� `�= �`'= �
r i � PROTECTIVE INSPECTION SEC.
i . �
� � r'�'1 � CITY HALL FRIDLE� 55432 NUAABER REV. DATE PAGE OF APPROVED BY
�'"""� � �'� 612-571-3450 9t0-F15 6/11/91 � �
JOB AQ.�RESS 65Q0 Fr,i.dley 5treet NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 14�,1.5 5 Oak Grove Additian SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Glen Kendall 6500 Fridley Street NE 574-9154
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Sela Roofing & Remodeling INc. 3233 Henne in Ave S M ls 55408 -
4 AHCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof �� Dwelling (18 Squares)
9 CHANGEQFUSEFROM TO
STIPULATIONS Mu.st �ollow S.tate Code �or iee and water shield.
�0 �N new toofs fl� #eat•offs and replacement roofs,
�tate Code r�qW�rQS that � I�yers of 15 fb, feit,
mopp�ed tilbe��eC, �e ins#all�d to a point 2� inches
up from er.ter;or wal! line; or the use of other
�pptoved underiayment membrane.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTHUCTION
OR WORK IS SUSPENOE� 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 EXAMINEO 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 $��6 .}` aSO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATiNG CON- 2rjeOO �''1,1;C.' SC yS`e��i
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECKFEE TOTALfEE
� �� c ��l���� � y l /-� $26.44
��� �;
SIGNATURE OF CONTRACTOP OR AUTMORIZED AGENT IOATEI WHE . PRO ER A ID / ED TNIS IS YOUR PERMIT
'
SiGNATUFEOFOWNERpFOWNERBUILDERi �OATE� - SP aiE
�. 1 i i �i r r r•:: i i �� i I t L� F_ 1�-�• � 1-1 ��: ;' � �. I" r._+ 1 _{ � 1 t 1 f+ �� .� 1 i� � r' . Ll �: .` [�
� [J
� [ ]
�r�t � )
..: � . �.. - I
l�l At�ID R-2
Building Pex'mit Applicatian
�'i �,�'�i°, � �� • ' � %°�'/�%
�
Effective 1/1/91
I�gal Descripticn: D� S l�, /S �. S i ��-� �,eOv� �/��/,
� ��'7�t �'- % co �Z�v �rrc� /�y S�'
cxrner Name & Addr� : ( -7��d°J ` ` - ✓� c� f� '�.1. � �� �-�' ��J�/
,� ,�
oaa�txa�t+or: �lCc _ ✓7 �C� �/�i � i✓�6'l��G��� � � s , Tal . � � �"��f �
Aaa��: �3Z� � �%�� ���� �� ��� f'� 1� �S `�� ci
a
Att�di to this appli�a►tian� a Caertificate of S�rvey c�f �chhe
lot, with the pra�o�ext constzvc.tic�-i dra�wn an it to scale.
C� ��
LIY,II+'� 7U�,: Ler�gth Widt� � Heic�it Sq. Ft .
c�►RAr� AI�i►: ierrjfih Width Height Sq. Ft.
I� A�: IPr,�th Width � Hgt/Grau�d Sq. Fk.
�R:
Carner Iot [] Incide Ir�t [} Ft. Yd S�tbr3cJc 5ic9e Yan3 Setba�
Rj►pe of C�ion: c.�o�� -� _�..���,�1" Fsti�mated C�ost: ��
��pprox. C7�leticsi Date:
Pro�osE,d Driveway Width Zf N�w Opening Is D�ired: F'�. $ $
�
, Wit�th + G' S�e BaC3c Page
L�'E; C� `�'� A�I.SC.�riI': ��(,�� 6 ,� x�el. # c�� i��`� �P
�t F� $ �� . oa
Fir� �rge S � 9 �
State S�uYi�arge $ , � D
SAC ci�arge $
Driveway Escraw $
�ark Fee $
Sew�r Main Ct�ar�ge $
� Y•
�71 li1JJ.l111� :
$ a�. �
� ,_
�J-1
��� .,`��
�
w� ��-+- • i�
Fee S�le an R�ver�e Side
.00l x Pe�t v�luation �1/loth �)
$,50/$1,dd0 Valuatiori
$650 pea� SAC Unit
Alt. "A" �D]� ,Aat. "B" Ai'xlve
�ee Detrermi.tierd by �gineerirr3 •
� �� C ] � �� [ ]
�
` �
NEW [ ]
ADDN [ ]
ALTER [ ]
�-�Const�uction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Perrnit Application
�
�
Effective 3/ i/92
Lega1 Description:
i1 Owner Name & Address: .� °o-�-� d-��.c,�eQc�.��. Tel. #�7� �/�y
Contractor:
Address:
MN LICENSE #
Tel. #
Attach to this applica.tion, a Certificate of Survey of the
lot, with the proposed construcdon drawn on it to scale.
DESCRIPTION OF IIVIPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
�� t
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimat� Cost: $
Approx. Completion Date: ,
;� ' (Cost on Back)
�Driveway Curb Cut Width Ne�ed: �� Ft. + ,;� Ft = �i' Ft x $ � �� �� _ $
DATE: g'' G% ��
Permit Fee $
Fire Surcharge $
State Surcharge $
SAC Charge $.
License Surcharge $.
Driveway Escrow $_
Park F� $,
Sewer Main Charge $.
TOTAL
STIPULATIONS:
$
Tel. # � �����7`
CITY USE ONLY
Fce Schedule on Reverse Side
.001 of Pemut Valuation (1/lOth%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Not Necessary [ l
_------- __ ,
BUII.DING PERMIT FEE SCHEDULE
The Cluef Building Official shall, before issuing �rmits for the erectioa of any building or structure,
or for any addition to any existing building or sbructure, or for any alteration or repair to azry existing
building or shvcture, upon appGcation 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 $25,0�
$25,001 to $50,0�
$50,001 to $1�,000
$10(?,001 to $S�,Q00
$500,�1 to $1,000,000
$1,�0,001 and up
FEES
$15 (Minimum Fee is $ i5 plus surcharge)
$15 for first $500 plus $2 for each additioaal $100 or
fraction ther�f, to and including $2,000
$45 for first $2,00� plus $9 for each additional $1,OQ0
or fraction ther�f, to and including $25,000
$252 for first $25,� plus $6.50 for each additional $1,000
or fraction ther�f, to and including $50,000
$414.50 for first $50,� plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,�0
$639.50 for first $i00,�0 plus $3.50 for each additional
$1,(�0 or fraction thereof, to and including $500,000
$2039.50 for the first $500,000 plus $3 for each additional
$1,�0 or fraction thereof, to and including $1,0OO,OW
$3539.50 fvr the first $1,�,000 plus $2 for each additional
$1,000 or fra.ction �thereof
DRIVEWAY DEPRE.SSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus b f�t times
$13.50.
Alteinate °B": Removal and repla.cement of curb and gutxer and install a 3 foot wide
appr�ch with 6 iach depth - Driveway width plus 6 feet times � 15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issu� 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 locadon of the foundation once it has it has been
constiructed will be required before proceeding with the framing.
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COMMON_VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacina an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely suppo�ted 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 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 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 specfications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installing a new ventina svstem, the undersigned hereby ve '�'ies that
it 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. 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 ()
A�pliance TYpe 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 Totaf 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: (Desc�ibe)
HEATING CO:
Signed By: Date :
�
_
CIIYOF
FR[DLEY
FRIDLEY MUMCIPAL CENTER • 6431 LTNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
January 25, 2002
Mr. Glen Kendall
6500 Fridley Street NE
Fridley, MN 55432
Re: Fina1 Inspection at 6500 Fridley Street NE
Contractor: R A Johnson & Son
Dear Mr. Kendall:
A plumbing pemut was issued on October 16, 2000 to install a water heater at your
address. According to Section 4715.2800 of the State Plumbing Code, a final
inspection shall be conducted on the work authorized by this permit. As of this date,
no final inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was
completed according to the Code. We will keep your permit open for another 30
days and if we do not hear from you within this time to set up the inspection, we will
mark the permit "no inspection ca11� for" and take no fiirther action.
To set up the inspection or to have any questions answered, please contact the
Building Inspection Division at (763) 572-3604.
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