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City of Fridley, Minn.
BUILDING PER.MIT
Date: .....__. � _._ �"....�._� �.� ._._..r_____..___._.
Owner:
Address
N° 4028
Builder � ��°��._.... � .._.._.:....__...__._.. �—�� �
Address........_......._...._......._...._...._._..._......__...�....__..._.__...____...__.._----•---
L CATION OF UILDING
No. ���, Street ._ .. ......._._. .--••-----....._.._......_...._.._....: .__...�...�. .�.��,..._.. _._..... Part o Lot •--�._._._._.___..... ...�'_'!��1
Lot.... `�.........._._......-- •---�-�-�------._...--��---��-�--��-�-----.... Addition or Sub-Division .---. ...---:_...._... ..._ _... .._..__._.... ..._.. ..._.._.._........._.._ �
Corner Lot ...-.- ............._�... Inside �..%`.....--.-----......_........ Setlosek ----.��.�. �.~... Sideysrd ..�.Q_..'_...a�..~_.._...__.....__._..Y...
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Sewer IIevation ....._..........�.4...F.._`J._ ....................................._.............. Foundatfon Elevation ..................---�---....._..._...........__............__....._....___..._...._
To be Used as:
�.ei�rt�...�'`s�..._.....
Type of Construction
DESCRIPTION OF �UILDING
/ r �� a�/ � r �+ �7,e—
Front �!....---� Depth�.�.._�....1.. Height _l�'� Sq. Ft. �'��� Cu. F�".�.i��..���
Front .-----.......------.. Depth ....._ ............._.. Height ........�.... Sq. F� ....._...-----...._.. Cu. F'�
........................................................ Est Cost .../..�!.�..l�_�.`.�...--.._°�. To be Completed •-----•-•�---._.._.....
�C.��' G� �� f � �.� �,s �,� � �.�� �
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In considera.tion of the issuance to me of a permit to construct the ding described a.ve, I agree to do
the proposed work in accordance with the descxiption above set f� d in pHance provision of
ordinances of the city of Fridley.
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.�`---- _.. ._ _. _ ...° ...._..._._-- ••---- •�-��---_
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In consideration of the payment of a fee of $�.�---------------_......_..., permit is hereby granted to.------.•-.----.--•-----_---._............._......._..
_.�_._........_.._....--•--------.-•--�---_-.---- to construct the building or addition as described above. This �rmit is granted upon
the express condition that the person to whom it is graated and his agents, employees and worlQnen, in all work
done in, around and upon sa.id building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesoffi regarding location, construction, alteration, maintenance, repair and moving of buildings
within the caty limits and this permit may be revoked at any time upon violation of any of the provIsions of said
ordinances. i �
NOTICE:
Suilding Inspector
,, }� I Thls permh does nof cover fhe wnstrueNon, inatallaHen for wiring, plumbing, gaa heaHng, aewer er warer. es sure te ses
V�i the Building Inspeetor for separate permha for fhese Nems.
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, . BLOGK �, /�ARKf�/E!/y /J�%qNOF't
INOUSTRU4 ' �• E. C O U L T E R
BU8INEBS � �� -
cirr �o�s LAND SURVEYOR
TOPOORAPHIC MAPPINO R@GISTERED UNDER LAWS OF STATE OF MIWNESOTA
LfCENSE'D BY ORGINANCEB OF CITY OF MINNEAPOLIS
3300 LYNDALE AVE. 50. MINNEAPOLIS 8. MINN.
TAYLOR 4•0370
. Su,�vEr {r �IR{//f� E. CARGS0110 � SON
�urbepor'g �lCertificate
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, PLATTIN6
FARM SURVEYS
LAKHBHORE
JUDICIAL
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I hereby certify that the above is a tru� and correct plat of-'a survey of:
That part of Lot Three (3), Block Four (4) lying West of the East Fifty (50)
feet thereof and that part of Lot Four (4), Block Four (4) lying East of
the West Twelve (12� reet thereof, PARKVIEW MANOR ADDITION, Anoka County,
Ntinnesota. � , -r �
As surveyed by me this 24th day of June 1959 A.D.
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Signed ,��Cp, C� ,
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THE BELOW MUST BE FlLLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED '
CnMMON VFNT� VFNT C`_nNN _TC)R AIUD (]MB ISTIOI� �41R VFRIFI _ATinl`
a/VF1en _r� la _ing an pYistinA, ,rar, o, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions, •
4and is securely supported and firestopped where required. �Yes (� No ()
The venting system is piasticlPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and teRnination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
indude AGA-GAMA Category i Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The p�� �,r_art,t�n�,n a�r is si�eztand installed to meef the current codes
and manufacturers speafications.
When required to ir,�tau a r,ew cer�,b �ctien air�,it will be sized and installed
to meet the cuRent codes and manufacturers specifications.
Yes (� No ( )
Yes (� No ( )
4 .
Yes � No ( )
Yes � No ( )
Wh@I1 in�iallin8 a new ventine e�, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
speafications. 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 ()
Annliance T� ne and Si�e/Cemmen t/ n�nd �! _enn c+er Ir�ferm-tien
Appliance #1 Type �j� .I�I�U'A('� BTU Input 7 S, OTrU Fan Assisted or Nat, 6�,( Gt,t
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 Verrt Height Diameter inches
Appliance #1 Vent Connector Height ft�ehgth ft Diameter in Type
Appliance #2 Vent Connedor Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
�
Center Point Energy MGCO
13562 Central Ave NE
HEATING CO: /�oka, MN 553Q4 • .
Signed By: � Date : l�-�� D y
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HEATING
AIR CONDITIONING
AND ELECTRIC� INC.
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ADDRESS
OCCUPANT
HEAT LOSS DA7E HTG. (NST. I �
SOLD BY
Electrical Work By
NPE OF HEAT GA F HW AM SPACE HTR.
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� CONTROLS
THERMOST` qT � Heat Plua
Value V1A
U
Limit Settlna ���
Fan Setp
Pilotafype �
Pilot Make
Pilot AAodel
PUo� Tlmina
L.W. Cut Olf
Preasure � �+..� . Percent COa
Input GFH Per�nt Oa
Stack Temo. �� I� Percent CO
HOUSE HEAYING TEST RECORD
APT. FLOOR CIN SUBURB
OWNER
�
INSTALLED BY s
Gas Line By
UNIT HTR. O HER
CONVERSI�N
Vent Size '7 �` •�
KINp OF LINER SIZE NONE�_
Draft Haod Regulator �� 0%�
Filtera Size �� � Number
Chimney Locadon Inside � Outside
Chimney ConsVUCtion �
Smoke�� b' Wiring
D� �' � Test Tag
Door Pressure Lighong Inst.
Date Tested /
Company Testl �
Name of Tester A
Preasure Percent CO2
Input CFH Percent OZ
Stack Temp. Percent CO
NEW
ADDN
ALTER
���5 - �o��J
[ ] CI1Y OF FRIDLEY
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SIIdGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address:
Contractor. �irti. � �
Address: �?��o f� 3
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
:�
t �r�e e Gtlti /l!
� 7
.� ,.�.�.� �r _ r�� ����,� ��.�,�
Tel. #
MN LICENSE # BG �Z G6 y8 7
Tel. #.�G a— 6 l Y/
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
Length VVidth Height Sq. Ft
Length � Width Hgt/Ground Sq. Ft
� :%%%%�i�i/ I� /
. . .- i -. . ..�
Driveway Curb Cut Width Needed: Ft + 6 t= Ft x� _$
DATE: Z� �� APPLICANT: Tel. # �� � �1��
Call (763) 572-3604 for Permit Fees if mailing in pplication. Fa�c to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewier Main Charge
� l�5 • �5
�
$ � G�
$�� • i
$
$
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Reviewr
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ � � � • _�� STIPULATIONS:
BUII.DING PERMIT FEE SCHEDULE
The Chief 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 any alteradon or repair to any existing building or structure,
upon application 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 $5�
$501 to $2,Q00
$2,�1 to $25,�0
$25,001 to $50,0�
$50,�1 to $100,�
$100,001 to $500,000
$500,(�1 to $1,�0,�
FEES
$23.50
$23.50 for first $5� plus $3.05 for each additional $1(� or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,0�
or fraction thereof, to and including $25,000
$391.25 for first $25,� plus $10.10 for each additional $1,000
or fracdon thereof, to and including $50,�
$643.75 for first $50,000 plus $7.� for each additional
$1, 000 or fraction thereof, to and including $100, Q00
$993.75 for first $100,00Q plus $5.60 for each additional
$1,000 or fraction thereof, to and including $5(�,000
$3,233.75 for the first $500,� plus $4.75 for each addirional
$1, 0� or fraction thereof, to and including $1,0�, 0�
$1,000,001 and up $5,608.75 for the first $1,0(?0,000 plus $3.15 for each addirional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20.�.
VERIFICATION OF FOUNDATION
Permits for consiruction will he issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed stntcture and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Only