AF - 43529BUILDING PERMIT
Village of Fridley, 10![inn. N° 2 5 3'7
� �
Date �. �� �:`:�.�.: �. � .......................
Owner , _ : �'`�t�.������. .�� �?�":� . . . . Builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address ��:�i'�r���..'r�.'�r....�...�:�;�: :��.�:� Address .........................................
LOCAT[ON OF BUILDING
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No. ..�.�`'f��....... Street �,.�:�=,�.����:•c-�Cc,....�� ........... Part of Lot .......................
Lot . . . . ��'. .4°� . . . . . . Block . . : .��.^. . . . . . . . . . . Addition or Sub-Division .�"'��°::���#: : : ��}.�{s,e�. �i"�1"���?'�'+�
Corner Lot ............ Inside Lot ............ Setback ���.�.... Sideyard ���� �'.�:if:�...........
DESCRIPTION OP BUILDING
To be Used as:
,, �.'
�,u e����� . .. . Front . �����„ Depth ;�r.�: . . Height . .. .. .. ..
� � -
.................... Front ........ Depth ........ Height . ......
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Type of Construction �y��-.R:« �#�L� . . Es�t. Cos • �'. :�� . . . . . . . . . . . . .
�
Sq. Ft. . � :� :� . � Cu. Ft. . . . . . . . .
Sq. Ft. ........ Cu. F't. ........
To be Completed � . ��.'`r�"°" ��:': . .
In consideration 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 provisions of
ordinances of the village of F'ridley.
�•;r�J��,��;,�+Cr,��J'�1' ,�'�'�.+:"�:. :�s"�t:....
• �'
In consideration of the payment of a fee of $. ..�.Sr�. . , permit is hereby granted to . . . . . .. . . .. .. . . . . . . .. . . .
. . . . . . . . . . . . . . . . . . . . to construct the buiiding or ad dition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worlmien, in all work
done in, around and npon said building, or any part thereof, shall conform in all respects to the ordinances of
�ridley, Minnesot�. regarding loca.tion, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. , . �,
.� �f ��� � ��
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. ��'�.�' r �,'�'��.r�-:� .�Y.�:` Building Inspector
NOTICE:
This permit does not cover 4he construction, installatiors or aiteratian fo� wiring, plumbing� gas heating,
sewer or water. Be sure to see the Building tnspector for separate permits for_these_items.
_�
�
City of Fridley S�B�E�T • o_" 7 j 7 6�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� i O.
� `v ______ COMMUNITY DEVELOPMENT DIV. � � � !
r j � PROTECTIVE INSPECTION SEC. `
� _ ; -�
� �'��1 � CITY HALL FRIDLEV 55432 NUMBER REV. OATE PAGE OF APPROV D BY
�'"""� � ,�� 612-571-3450 910-F15 10/24/84 / /
JOB ADDRESS 1110 Gardena Averrue N.E.
LOT NO. BLOCK TRACT OR ADDITION
1 LEGAL 44 4 Parkview Manor SHEETTACHED
DESCR.
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
R�bert Gunville 1110 Gaxdena Avenue N.E. 574�1421
3 CONTRACTOR MAILADDRESS ZIP PHONE �ICENSENO.
Mi.lton L. Johnson Co. , 2513 Central Avenue N. E. , Mpls. , 55418 781-9548
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
Same
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USEOFBUILDING
Residential
7 CLASS OF WORK
❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
x
8 DESCRIBE WORK
Tnstall �lat roof �
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I. 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 $3 OQO ySl. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OT STAT OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERF RM N F CONSTR CTION. yS`3S. �JO
PLAN CHECK FEE TOTAL FEE
� � ;. ,.� %� � � � �`9r�. 00
SIGNATURE FCONTRAC OR Ia�aurHOaiZEOnGENT lo TEi WHEN PROPERLY UDATED THIS IS YOUR PERMIT
. � ' -_'
SiGNATURE OF OWNER IIF OWNER BUILDERI IDATEI LDG INSP ATE
G
CITY OF FRIDLCY Effective Aug. 1, �9e1
AI'PLICATI�J FOf� RCSIDLf�TI/ti_ BUILDIUG PCiti4ITS
(N�►�. A1 ter�tions, Addi Lions, or Repa i rs )
O�JNER: Robert Gunville QUILDER: �'iilton L. Juhnson Co,
ADDRESS: 1110 Gardenia Ave N.�. pDDRCSS: 2513 Central N.E. Mpls, �'Zn. 5541
TEL 1�0: 574-1�.21 - TEL tJ�: 781-9548
Construction Location
• STJt]�T NO: 1110 gT�; Gardenia Ave l� .�.
�
LOT: HLOQC: ADAITION:
Corner Lat: Insiiie Lotc Sctback: Sicieyards:
Ap�licant attach to this form Lwo Certificates of S�rvey of lot and
pzoposed building locatian 8rawn on certificates to scale.
DESCRiPTIOid OF COt•JSTRUCTIOr�
Front: Depth : Height:
Square.Feet: Qibic Feet:
Front: Depth: Height:
Squar.e FePt: Cvbic I�eet:
Rype of Cor,struction : �lat Ro O f
Zb Be Cbr.�pleted: 60 days
Estiunated Cost: $ 3, 000.00
Alt. A Alt. B
proposed Drivc��ay kiath If New Openinq Is Desire8: $� $
� , , SE� I�VER;E SIDE OF SHEET ,
7sie undersigned hereby mal:e� application fer a permit for the ��ork� herein specified,
agreeing to c�o ,all vork fi, strict accordance �ith the City of Fridley► Osdinances and
rulings of the De�rtmc�t ef DuilBings, ana hereby declare hat all the facts and
represr�tatio sta ed in this application are true and co t.
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D.'17'�: SIGNATIII�: �' �°�- ��-�
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Stfpulations:
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BUSI,DING PERMIT FEE SCHEDULE
The Inspector of buildinqs shall, before 3ssuing permits for the
erection of any building or structuze, or for any addition to any
bxistinq building cr structure, or for any alteration or zepairs
to any eaistinq building or structure, npon application therefore,
require the payment by the applicant f or such permit of fees to the
amount bezeia below set forth and in the manner herein provided to-wit:
TOTAL VAI�7ATI�iT
51.00 t+D 5500.00
5501 m $2,000
S2,001 te $25,000
$25,001 to S50,000
550,001 to $100,000
FEES
510.00 Minimum Fee $15.00 plus surcharge
510.00 for the first 5500 plus $1.50 for each
additional $100 or fraction thereof, to and
inclnding $2,000
$32.50 for the first 52,000 plus 56.00 for each
additional $1,000 or fraction thereof, to and
3ncluding $25,000
5170.50 for the first $25,000 plus S4.50 for
each additional $1,000 or fraction thereof, to
arid including $50, 000
S283.00 for tlze first S50, 000 plus $3. 00 for
each additional S1,000 or fraction thereof, to
and including $100.000
$100,001 anci up $443.00 for the first $100,000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN CHECR: 25 percent of building pezmit fee
DRIt7F�AY DEPRESSION ESQtOW: Concrete Qirb Streets Only
Alternate "A"x Aemoveal and replacem�nt of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B": Rsnoval and replacemerit�of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x S15.75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunwn of 24 hours froau 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, shawinq the location of the fouridation once it
has been vonstructed will be reguired before proceeding with the fzamiriq.
�_ _ ,
HOUSE HEATING TEST RECORD �Q--���,
AD�RESS _•-� APT. FLOOR CITY SUBURB
OCNPANT OMINER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
El�ehical Work' Br Gas Lfn� Br
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
MAKE
Mod�l .
Swio I .
INPUT
THERMOSTAT
Va Ive
Limit
Limit S�Hi�g _
Fan Setting _
Pilot Typs —
Pilot Maks —
Pilot Model —
Pilot Timing —
L.W. Cut Off _
GAS DESIGN
CONVERSION
MAKE OF BURNER
Mod�l
Abx. BTU RatinO
MAKE OF FURNACE
Mod•1
CONTROLS
— Hsot Plup V�nt Sizs
KIND OF LINER SIZE NONE
Droh Hood Rpuloror
Fi lt�rs Sis� ' ' Nu�r
Chfmrar Loeation (nsid� Outsid�
Chimnsy Construetion
Smok� Bomb _
D►aft
Door Pressurs
Prossure P�reent CO� Dats Tssted _
Input CFH P�re�nt O� Companr Tssting
Staek Temp. Perc�nt CO Nams of TsaNr _
Fwm 235
Wirinq
J�st Tay
LiqF�tin9 Inst.
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,' NOTE: �1 through �8 required when using a side vent furnace.
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�_s 1l,�i.l' _-*�! � i �= �_' � I �_ ... .y � s
The unc�rsigneci hereby verifi� that the existing chima�y or stack:
1. Has b�en carefully examined
2. Is free from rtls�t or deterioration
3.
4.
S.
6
7.
8.
Has no foreign objects lodged within
Is securely supported
Meetc all cinrent Code re.quirements for s�ize
a�d totai BTU's conn�
Has tot�al heating BTI7's of
All other BT�T's
TOTAI. BTU's
Has a li�r b�n p�vvided for water hea�r
Has combustion air b�en provided frn w�r heater
_ . , _ .
Remarks:
Yes{)No()
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HE�►TING CO:
Signed By:
Date:
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i�F,AT L�c,�S
WEI ��1�#1/�pi
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waU
;�a. waU
F�oor _
To1a1 Stu.
Reyuired sy. h. �.D.K. or �q.'
Fl.� isoom Lei
•Wiado�+n •ad Lkor.--Cl•e
wia�a aa..� N•. e�
fi0. ef a et e� ! dti
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_ •7 r� rJ r Z.-^
wall
Total 81u.
Rcquired sq. Ie, l
Fl.j
Window� and
In6ltutiaa
:+��N
Eit{t. M/a��
Ne� cxv. w
�nt, M/au
��
�Cl�lhg
floor
Te�al $tu.
DEPARiMENT OF INSPECTION
ii8�{tfYC:loo �7•
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oi p. 6a.. WA.
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q�med �4. E1. E.D.R. or p. ius. WA. leadet .rea
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7.1 R�oom I I.so.tl� Wid�h
Qrindo.w .od Daor�—C.sacit��e �nd Aes�
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lu�e �d A�e�
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