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City of Fridley .�)''
Application for P`lumbing and Gas Fitfiing Permrt
Dept. of Bldgs. Phone SU 4- 470 !„Q
DESCRIPTION OF WORK l�t� � �
N u m b e r, K i n d a n d L o c a t i o a o f F i x t u r e s L a a h o � �%�
_���1I����=�`�zz���8�z��1zI��o=� .�� �� _
� F m IA 3 F C� N LL� U m � 3 IJ < U� C' IJ O
Ist 1 / 1 1
2nd
3rd
4th _
• Future Co�►�tion Opeaings
* New Ffxture, Old Openiags
PARTIAL RATE SCHEDULE
WATER HTR.
♦ !
f N GAS ELEC.
l
3ewer
Cesspool
PI.UMBING FIXTURE RATE$: NO. RATE TOTAL
Number E`ixtures . . . . . . . . . . . . . . . .. . . . . .,(�— x $1.50 $ < (/ �
Future Fixture Opening ................ � x 1.20 $� !�U
New Fixture Old Opening . . . . . . . . .:. . . . . x 1.00 $
Catch Basin . . . . . . . . . . . . . . . . . . . . . . . . . x 3.25 $
Water Heater (Up to 200,000 BT[J) . . . . . .—�x 2A0 $ � � � �
New Ground Run Old Bldg. . . . . . . . . . . . . x 3.25 $
City of Fridley;
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 o# Buildings, and hereby declares that all the fact
and representations stated in Lhis application are true and correct.
Owner
Kind of Building �%�/`Z�---g'r�f /�
Used as ./��'' ��N / l <--�-�/
a /,�
To be completed about
Estimated Cost, $
%�, -� °L °� ��y
Old—ATew. Building Permit No. `� Permit No. /_/
Signe � t �' �
By
Business Phone No � � � �
ROUGH �' � u — � �
FINAL
GAS FITTING FEES: NO. RATE TOTAL
lat 3 Fixtures .......................... � x$1.50 $ ���1
Additional Fixtures .................... x .50 � "
�, Gas Range to 200,000 BTLT . ............. x 2.00 �
' REPAIRS 8t ALTERATIONS—Refer to Cods
Description .................................. ...........$
TOTAL FEE $.��U a z sM
�
�
• . . . �
City of Fridley, Minn..
�j �; j �_.5
BUILDING PERMIT lv� 6 4 8 9
• -._
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•
f� `� �
Date: _._.,c,,Z ._...:�':.,�i�..__''..�' .�..� _._._.__......____..
Owner: � ���. � �.e�4S..S� Builder _. __. _.. ..._..__..._.._...._..__._�.___.._-•______..M_.._.�
Addre�s .._.__._:.__.._..._...._.__...._....�..�.__.._._._.........__.._...._.._.._._._ Address
/�l �/ ;
L ATION UI ING
No. ...(�t .o�:._,�!__ Street .._._ .. .. ___:.___ .... :.... . _. ..,r_.... o! T.ot _.._._._ .._ _._._..___..._._._...�.
Lot _._._.'��_._...__...._ Slock .._........_.._.<...._.._..__...._._. Addition or Sub-Division .. �._ ._. � ._ %
/
Corner Lat _.__.._...._.._.._.... Inside Lot ....._..__��..._.._. Setback ._ ..�r.�.c'�.___._._ Sideyard ._...M.�� ._...�. _......� - --- -
Sewer Elevation __.___..._.._.._______..._.._.._....__._.._.._.._..______ Foundation Elevation ....._..._._........._._._.. __.w_____..
DESCRIPTION OF BUILDING
TO Vsed w
_._.... Front _... .___._.. Depth _.. _. `
..� ... �� Z .a .I_�. Hefght ..�. �.M. Sq. Ft./�.�Cu. Iy�4��,G..112.,�v'
.. Front .._.�..a.�.� DePth �-(LL-• s ���_ Sq• F� .�.�-�� Ctt. F� �_�....��
_._.. _... _ .. ... . Height ._
Type oP nstruction _��rE-_�.__.._��__� Es� �.,�..�� �._.._`-"�fio be Coanpleted _..___...__._....._..�.____.
In consideration of the issuance to me of a permit to construct the building descxibed above, I agree to do
th� proposed work in accordance with the descriptioa above set forth and ia comphan �'th provisions of
oxdixiances of the city of Fridley. ��
In caaisfderation of the payment of a fee oP $.��....._...._.., permit is hereby granted to.�
to construct the building or addition as described above. This permit is granted upari
the �express condition that the person to whom it is granted and his agents, employees and workmen, in all work
dane in, around and upon said building, or any part thereof, shall oontorm in all respects to the ordinances o�
Fridley, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked a t any time upon viol�.�ie� of aay of the provisions of said
ordinaaoes. /'°� .� ,� / 1
Bt�ilding Inspector
NOTICE:
ihis p�mdf doa not eew� tla eonsMUlioa, inshllNion for wleinti. P��9� Yu h�o, ww�� or wM��. E� sun to s»
tM suiWiog Intp�cbee for »puat� p�rmits for fh� it�ms.
0
A.PPL,ICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME �A/�d�.S �7 . C.�c9 S� BiJILDER
ADDRESS ADDRESS
LOCATION OF BUYI,DII�
No. Street Part of Lot
Lot � $lock / Addition or Subdivision .,_,_"%~,�� ��-xl•e�i
Corner Lot Inside Lot Setback Side-Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawa on these Certifica�es.
DESCRIPTION OF BUILDING
To be used as;
_ ,�o���- Front Depth Height
Sq. Ft. /3A� Cu. Ft.
���,.+ H� f�yo��� Front Depth Height
Sq. Ft . �9.� Cu . Ft .
Type of Construction �,u�-- Estimated Cost '�j�p�
T To be Completed ,��,,� �; 3
'The undersigned hereby makes application for a permit for the work herein speciffPd,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares thet all the facts and
representations atated in this application are true and correct.
DATE' SICNATLIRE
(schedule of Fee Costs can be found on the Reverse Side).
.. < .. .�. . '�'` • . , ' � � ` _ "
� a- �
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f��
�I'
,,�j� ca�on f�or Pawe� P�nnts cau! H
App� ' eoting, Coo�ing. Ventilation. Refric,�ration cr�d
I�� Air Conditioning Systems a�d Device�s
PARTIAL RATE SCHEDULE Dept. af Bldgs. Phoae SU 4-7470
GRAVITY WARM AIR: AATE TOTAL
Furnace Sheli & Duct Work . . . . . . : . . . . . . . . . . . . . . . . . . . 8.00 $
Replacement of Furnace ............................. 5.00 $
R.epairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . : . 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTLT . . . . . . . . . . . .
each add. 6Q,000 BTU .......................
Replacement of Furnace .............................
Repairs & Aiterations—up to $500.Q0 . . . . . . . . . . . . . . . . .
Repairs & Alterations each add. $500.00 .. .. . . ... . . . . .
s.00 $ . 06
a.00 �
5.00 $
5.00 $
2.50 $
STEAM or HOT WATE1i. $YSTEM
. = ---:
Furnace Shell & Lines--ta 400 sq. ft. FDR Steam ...... 8.00 $ -
F�.rnace Shell & Line—to 640 sq, ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 40Q000 BTU) . . . . . . . . . . . ... . .. . . . . . . 5.00 $ .S ��
GAS FITTING FEES:
lst 3 Fixtures ......................
Additional Fixtures .................
NO RATE TOTAL
_ x $1.5d $ � � �
_ x .50 $
Gas Range to 200,000 BTU . . . . . . . . . . . x 2.00 $
AIR CONDITIONING �
FAN HEATING 3Y8TEM See Fee Schedule
VENTILATING SYSTEM �
ALTERATIONS 8c REPAIRS TOTAL FEE $yL 7• �
REM�IRK3:
�
�.
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all wark in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn. � � 2 � , 19�
Owner — 195_
Kind of B ding 195—
Used as .. D./-.��c
To be completed about � �' � � � ` �
OG
Estimated Cast, $_ ��� ��
Old—New. Building Permit No. � / �/
DESCRIPTION OF WORS
I3�ATING or POWER PLANTS—Steam, Hot Water, Warm Air—No.
Trade Name�� �i Size No��3- GL- /.2a
Capacity � �� Sq. Ft. E.D.R. BTU g,p,
Total Connected Loa�� �y� Kind of Fuel �? •
BURNER — Trade Name Size No.
Capacity.
11 pOST 1M-12-58
Sq. Ft. E.D.R. BTLT H.P.
SUPERIOR FURNA3CE CO'
6121 - 42nd AVE. N.
MPLS. 2Z. MINN. • KE 7-8491
Signed
sy �
Business Phone No
t ry � �v
, , ,
� /� � 4
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(—�'i,�'7��`.s� -� c� �.,'%l�r•_£� a-ir•Y�._ 'J`�--, ,. y <��� `�
I1�S6 „z �6 ' `!% iJ� ,
�IEAT �LOSS C�1�CULATIONS DEPARTNIENT OF BUILDINGS j, FRIDLEY, MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor Kind How Applied
Yes—No � Yes—No 19_
FL� .���,.i� Room Length %;� Width `��j;leight ' Fl.� � j�� � hgth Width °�" Height ��
Windows and oors—Crackage and Area Windows and Doors—Crackage and Area �
Nidth elght No. o[ Lineal ft. Area Width � Height No. ot Llneal tt. Area
No. . o[ pane of pane lighta o[ crack nQ. ft. No, ot pane o[ Dane lSghta ot crack aQ, tt.
D � 5"� "" — D G � ' `
3 �+�/'o '-� � / � 1/� / _' � c� / �o � ! � �
i o -
Coef. Btu Coef. Bcu
Infiltration � 21� rl� Infiltration � O
Glass A L'�C� Glaas �D
Exp. wall Eap. wall
Net exp. wall �% D d Net eap. wall ''�� � M � � U
Int. wall Int. wall
Ceiling 1 D Q Ceilin8 ,LJ d
Floor S Floor S `
Total Btu. Total Btu. U
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area �J' Required sq. ft. E.D.R. or aq. ins. W.A. Leader area __ _
F7.r Room � I.ength " "'�-1'CVidth ''
Windows and Doora—Crackage and Area
WId2h Hetght No. o[ Ltneal [t. Area
No. o[ pane o[ pane Ilahts ot crack �q. tt.
/ �',�� %� � %� 1�
� FI.I �i.'s�-ali �o.�,�
Windows and Door
Wldth Heig6t
No. ot eane ot pans
Coef. Btu =
In6ltration �j � � * C.� Infiltration
�a� 1 5D �� � Glaaa
Exp. wall (�
Net exp. wall ' '� j "
Int. wall
Ceiling f ;,�� ,
.Floor
: Total Btu.
Required sq. ft. E.D. . or sq. ins. W.A. Leader area
Fl• �`, f:__ oom � Length 1 w�arh •
Windows and Doora—Crackage and Area
Wldth Helght No. ot Lineal tt. Area
Na. ot nane ot pane IlBhte ot crack sa. tt.
Exp. wall
' O 8 Net ezp. wall
' � Int. wall
O % L� Ceiling
i � / O Floor
Infiltration I � � 3
Glasa j ,�
Exp. wal) �
Net exp. wall ^'
Int. wall
Ceiling
F loor L D ar
Tbtal Btu.
Required aq. ft. E.D.R. or sq. ins. W.A. L.eader area
I Length / f i�-Width
:rackage and Area
Vo. ot Llneal tt. Area
trhts ot crack sa. tt.
aq. k. E.D.R. or aq. ina. Vf/.A. Leader area
( �. ��z�r'ti! � -�-KOOm 1
W dowa and Doors—C
W(dth Hefght N
No. of Dane ot.Dans tl
Btu � 'i
� Inhltration
��c7 Glaaa
F.�cp. wall
� Net exp. wall
Int. wall
_ j p Ceiling
� .r�(j Floor
t� S � T'otal Bm.
��w
and Aroa
�
�
ired sq. ft. E.D.R. or �. ins. WA. L.eader area
% ��r-
�1 0�,
,2. O �, �
���%a
Btu
��
y / v
�vo
sue�ecT P MIT NO.
c�ty of Fr�aley � r� 6 6 9 a
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� ; L _ COMMUNITY DEVELOPMENT DIV. �{
r � � PROTECTIVE INSPECTION SEC. � �!/3
1 � �
' � /���1 � CITY HALL FRIOLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
� '""�� ,�' 612-571-3450 910-F15 / /
7 27/82
JOB ADDRESS 62�1 Jackson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 4 ]. Ix'EII2 HQILY'�7 ACZCIlt10I1 SHEET ..
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James H. Cross 6271 Jackson Street N.E. 57i-2213
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Same
4 ARCHITECT OR DESIGNER MAI� ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUI�DING
Residential
7 CLASS OF WORK
❑ NEW OO� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Cons truct a 2 2' x 24' Attached Garage
9 CHANGE QF USE FROM TO
STIPULATIONS
Special Use Permit and Variance approved by City Council on 7/26/$2
Provide a hard surfaeed driveway.
������
4 � �' SEPERAt7'� PERM�r.7 ��}'�'�'b��
�e�ort diztin� c�;l 1��cai u±i,����s �
Tf.LET�10NE - ElE�tR1C - GI1S EtC. NE�TIIVrs ,r,� n� ���
� �'lUMBlNG AND S�G�gt .
i�EQ�3lRE�p �Y ��
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FL'dItl@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHOfiIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 528
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 VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5,438 $2.72
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ��JC.SO
PLAN CHECK FEE TOTAL PEE
$59.22
siGrvn REOFCONraa OAORtUTH AGENT �oa7Ei �n/f{.FN PROPERLY V IDATED THIS IS VOUR ERMIT F'
GNATURE OF OWNER IIF OW � EI � �" BLDG .INSP �
CITY OF FRIDLCY Effective Auq. 1, 19s1
APPLICIITI��I FOft RCSIDL"i�ITI/li_ I3U1L�IitG PL-(L'�ITS
(t�c�r, Alterations, Additions, or Repairs)
ONJIIER: �sq�1� � ��o�� QUILDER: �",d�G�.
ADDRESS: G�� 7i �i�tG.C�S�/�i'�Ji�/1i/�� ADDitCSS: -
7El. P�O: �/ — ,�___���__ TEL ti0:
Construction Location
• STJiI�T NO : COv`Z %/ STItEET: ��Q (v�.c(� �/�' Y r,r/'—"'��G
IAT: � SLOCK: �1� ADAiTiON: � ,� T7
,--
Corner Lot: Insicie Lot: SctbacY.: Sideyards:
Ap�licant attach to tliis form two Certificates of Slizvey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOf� OF COtdSTP,UCTIOW
Front: oZ� Depth: � Height: �
��'�� � Squane Feet: 5� t�ibic Feet:
_ Front: Depth: Height:
Squar.e� FePt: Cubic I'eet:
Type cf Construction : �_�,0��
Zb Be Wr.�pleted: / ���g�
Estimated Cost: $ � �
Alt. A Alt. B
Proposed Drive�day Width Yf New Openinq Is Desired: $� S
_ , SE� i�VERSE SIDE OF SHEET .
�iie undessigned hereby ma3;e� application for a permit fcr the work� herein specified,
agreeinq to co .all work ir, strict accordanec ��ith the City of Fridley Ordinances and
ruling� of th� De�kzrtment of Buildings, and hereby declares that all the facts and
rcpresen tations stated in this �pplication are true and �orr�t.
D.'iTi: �f —vZ7—�� SIGNATUIi'E:
Stipulations:
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sue�ecr � PERMIT NSZ..._�
c�ty of Fr�aley �� � 2�. 2 4 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i � RECEIPT NO.
� �
� • COMMUNITY DEVELOPMENT DIV. I{/
i LV ����� � 2� % �l
1 � � PROTECTIVE INSPECTION SEC. y.7
� �
�.---�; /'��1,.� CITY�HALL FRIDLE� 55432 NUMBER REV. OATE PAGE OF APPROVEO BV
6]2-571-3450 9t0-F15 3/3Q/�2 / /
JOB ADDRESS 6271 Jackson Street. NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 4 1 TY2ri2 H2riY'y AdClltlOri SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
James H. Cross 6271 Jackson Street NE 571--2213
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILAODRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ AITERATION O REPAIR ❑ MOVE D REMOVE
8 DESCRIBE WORK
Construct a 13'•8'F x 17''4`t' Three Se�son �'ox�cfi. Addition
9 CHANGE OF USE FROM TO
STIPULATIONS See notatipns on �la,n.
� ����
Before diggir�g ca;l #or
ali utility locations
454-0002
R�QUIRED BY LAV�/
TYPE OF CONST. OCCUPANCY CaROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED\FOR ELECTRICAL. PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SU. 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 ANO EXAMINED THIS APPLICATION 1 STALLS GAHAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SUiiTAX
AND OR�INANCES GOVERNING THIS TVPE OF WORK WILL 8E COMPLIED $rJ(47(� $2�']t�
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- $81eQp Fi�e SC y�`�3e4'%
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTAIFEE
$89,21
SiGNATU oF c0 � CTO THORI2ED AGENT - IDATE� EN p p Y VALI AT THIS IS YOUR PERMI
: _.� • ^ � G/ � L/
_ .�f
Si ATURE OF OWNE IF O ILOEAI IDAT I G�NSP DA E
NEW I �
ADDN ,,��
ALTER ( j
Construction Address:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Bailding Permit AppliCation
r
�ffective 3/ 1192
Qwner Name & Address: '�T',�4rrl� r�% ��rZc� SS Tel. # 5'7/ - o�a-13
i
Contractor: o�j���.,. LICENSE #
Address:
TeL �
Attach to this application, a Certificate of Survey of the
lot, with the proposed conslxvction drawn on it to �.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length V�idth HgtlGround Sq. Ft.
OTHER: YD/Z C.t� /�� �,l� �7 � � � �s /3 � � 3 �
�-ND � S �SV� (� jl.�J i,v/�c,c�s' �O oJa,
�era�r Lot � Inside Lot [) Ft. Yd Setback S�de Yard S�cks ��'
Type of Construction: �,2,�� Estimated Cast: $ ��� _..�-
Approx. Completion Date: �"�„r,� i��
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 3-2F�qZ- APPLICANT: TeI. # 4; 7/ �a�,�/3
..
�TY USE ONLY
oD
Permit Fee S� �`' �Fee Schedule on Reverse Side
Fire Surcharge $ �• � 5�� .001 of Permit Valuation (1 / l Oth 90 )
State Surcharge $ 2�� Z�$.50/$1,000 Valuation
SAC Charge $ �_ $700 per SAC Unit
License Surcharge $ `—`- $5.00 (State Licensed Residential Contra.ctors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ ---�` Agreement Necessary [ J Not Necessary [)
�l
TOTAL $
STIPULATIONS:
0
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SUBJECT . PE, L��Q..`..�....
c�ty of Fridley 2 2 0 3 2
' , AT THE TOP OF THE TWINS g � I L D I N G P E R M I T RE .
r
� � COMMUNITY DEVELOPMENT DIV. ����
i •
v PROTECTIVE INSPECTION SEC.
� � "" ,
r , �;
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. OATE PAGE Of APPROVEO BV
�---•� � `.� 612-571-3450 910-F15 8/12/�:3 � /
JOB ADDRESS 6271 Jackson Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 4 1 TY'P.Tl@ Henxy Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Jim Cross 6271 Jackson Street NE 571-2213
3 CONTRACTOR MAILADDRESS Z�P PHONE UCENSENO.
Woods Canstruction Co 7728 Knollwood Dr, Mounds View, MN 786-2321 8737
0 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE UCENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION L� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo� House (_33 S�quaxes� Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must complx with the State Bui,lding Code. �'rovide adequate
attic ventilation; �rovide smake detectors as per UB.0 1210 adjacent to all
sleeping areas. and in ba,sement.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPARATE PEFiMITS ARE REQUIRE� FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT 1 HAVE READ ANO EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED $5r 49Q $2,, 7S
WITH WHETHER SPEC�FIED HEREIN OR NOT. TNE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1TFEE SACCHARGE
PROVISIONS OF ANY OTHEF STATE OR IOCAL LAW REGULATING CON- $81. QO Fire SC $S. 49
ST UCTION OR THE P RMANCE OF CONSTRUCTION.
� I PLAN CHECKFEE TOTALFEE
� % ` �� License 5C $5.Q0 $94.24
S�GNATUREOF iRACTORORAUTHORIZEDAGENT ATEI WH OPE VALIDATED THIS IS VOUR PERMIT
- �- �3 �-
SiGNa7URE OF OWNEA i�F OWNER BUILDERi �DATE� �� BLDG ��NSP paTE
NEW
ADDN
AI.'I'ER
[l
[l
��
Coastruction Address:
Legal Description:
Owner Name 8t Address:
Contractor:
t�rrtidress: _� 7�� �
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
,
Effective 5126/93
.��7�s
� Tel. �J�.�.�.��
MN LiCENSE #J�Z� 7
Tel. # 7��� 02?0�/
At�a,ch to tlus application, a Certificate of Survey of the
lot, with the propa►sed construction drawa an it �o s�cate.
DESCRIPTION OF IMPitOVEMENT
LIVLNG AREt�: I.eaigth Width Height Sq. Ft.
GARAGE AREA: Length Wi�h Height Sq. Ft.
DECK AREA: L�tgt6 �, W�dth �IgtJGr�nd Sci- Ft.
OTHER: .�vr� / �,��f.�i i ✓��'� � rrf. _// 3�,r9r�i ��i.,¢nw�.l,�V .,d�i/i,�
Corner Lot [ l Inside I.ot [� Ft. Yd Setback
T�pe of Construction: ���_��r�i ��� ��i
Approx. Completion Date: aq� (,�'G(���.�
(Gost an Back}
Ft. + 6 Pt = Ft x$
Driveway Curi� Cut Width l�tee�ed:
Side Yard Setbaeks -
Estimated Cost: � .�L � ��0,�---�
�$
i �� � � � •
� / �. .0 � � r / . ��.i.' /// ..f%/ �ri�//�,, � � �.
, _ _ / _
Pe,�rmit Fee
Fire Surc�arge
State Surcharge
SAC Charge
License Sarcharge
Driveway Escrow
Erosion Control
Patk Fee
Sewer Main Charge
TUTAL
� ��, p��
$ �•`�i°
$ � • %S
�
$ .� • ��
$
$
$ �
$
$ -�`�
1! M ' 1 . __
Fee Schedule on Reverse Sick
.001 of Permit Vatuation (U10�%)
�.50/$1,000 Valuation
$�SO per SAC Unit
$5.00 {State Licensed Residential Contractors)
Alt. "A" or Ah. "B" Above
Conservation Plan Review $450.00
Fae i�rmi�ed by Engineering �
Agreemeat Neces�ry [ ] Not Necessary [ ]
STIPULATIONS: �
_ .,,,, t_ ,..
r.�_._ . _.
CITY OF FRIDLEY PERMIT N� 20o4-o�s2s� •
6431 UNIVERSITY AVENUE NE �"� `�
FRIDLEY, MN 55432 DATE ISSUED: 09/01/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 6271 JACKSON ST NE
PIN : 143024440004
LEGAL DESC : IRENE HENRY ADD
: LOT 4 BLOCK 1
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL A FURNACE (WARM AIR, LENNOX, 70,000 BTUS) AND AN AIR CONDITIONER. INSTALL VENTING TO MEET
MANUFACTURER'S AND NFPA CODE REQUIREMENTS.
# A/C LJNITS 1 # FURNACES 1
# GAS DRYERS 0 # GAS RANGES 0
VALUE (FOR MINIMUM CALC) 4500
APPLICANT HEATING PERMIT MINIMUM FEE 0.00
MARSH HEATING & AIR CONDITIONING FURNACE SHELL/DUCT WORK 35.00
6248 LAKELAND AVE N GAS RANGE FEE 0.00
BROOKLYN PARK, MN 55420-2937 GAS DRYER FEE 0.00
(763) 536-0667 AIR CONDITIOrTING FEE 25.00
STATE SURCHARGE, MECH FLAT 0.50
TOTAL 60.50
OWNER PAID WITH CHECK # 70708
CROSS JAMES H & MARCELLA
6271 JACKSON 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 work 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. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of y other state or local law
regulating constructi or the pe ormanc of constructio .
Applicant Date
Bldg Ins D
SEPARATE PERMITS Q IRED FOR WORK OTHER THAN DESCRIBED ABOVE.
��ITI( OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE �}
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Sheil and Duct WorR, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Other Repairs or Aiterations (List on Back)
1°� of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
��l
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
� Total
$35.00 $ 3Jr``�
$10.00 $
$10.00 $
$10.00 $
$25.00 $ ��•°D
�
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
JOBADDRESS b L� � ��I�SOn� S� /��
Owner � `i� C�SS
Building Used As
ESTIMATED COST ���d�' `� PERMIT NO �?C�-'� f����Sr`��
DESCRIPTION OF FURNACE AND BURNER
# of Heating Units � Circle One (Steam) (Hot Water) arm Ai
Trade Name ��K Size No. C� ioa ��'✓36•9��
BTU 7o�D� HP EDR
Fuel .N'�!-T Total Connected Load 3r� o� �
Burner Trade Name Site No.
BTU _ _- HP _ EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
$ and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ HEATING CO M
$�� Signed �
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
� 1��:�-�-q ,�� � %°K.o��,�.,� rG��
Te� # 7d3 `�'s 6 -o �v 7
�
FAx #�f3 —536 �-n ZL 6 �ate g� 7�o Y
Appr
\
r�
Rough-in Date Fnal Date C ��
F �
. FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinst an existin� furnace, 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 plastiGPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No �Q
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 Furnace Venting Tables for fan
assisted and natural draft appliances.
The existins� 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 �j No ( )
Yes (�J No ( )
Yes ( ) No ¢�)
When installin� a new ventin� 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 �
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. �
No ( )
Yes (� No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input �?a�oo� Fa ' r �^' _
Appliance #2 Type �C BTU Input �o� Fan Assisted or ��
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Tatal Btu Input
Common Vent T e � �� '�
yp C �k55 � Vent Height �,_ Diameter �o inches
Appliance #1 Vent Connector Height _�ft Length �� ft Diameter �f ` in Type.� � C_
Appliance #2 Vent Connector Height �' ft Length �f' ft Diameter '�" in Type 15 a-�
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO: � Tt /� �/�'� ��r`�''~�
Signed By: Date : ��3� �6 y
■ � ► �_ ��� •� �
ADDRESS: 6271 Jackson St NE APT: FLOOR: CITY: DATE: I I
OCCUPANT: Jim Cross OWNER: Jim Cross
HEAT LOSS: HEATING INSTALLED BY:Marsh Heati n& Ai r
ELECTRICAL WORK BY: S ark E1 ectri c GAS LINE BY: Marsh Heati n& Ai r Cond . Co
TYPE OF HEAT: GA FA ROOFTOP SPACE HTR UNIT HTR OTHER
GAS DESIGN
MANUFACTURER: Lennox
MODEL:
SERIAL: �
INPUT: 70, 000
CONTROLS
THERMOSTAT: VENT SIZE: � '
VALVE: KIND OF LINER: rj ; , slzE NoNE
LIMIT: DRAFT HOOD: REGULATOR:
LIMIT SETTING: 1�� FILTERS - SIZE: �p NUMBER:
FAN SETTING: CHIMNEY - INSIDE ( OUTSIDE
PILOT TYPE: k C,+e. ' CHIMNEY CONSTRUCTION: � � 4SS
PILOT MAKE:
PtLOT MODEL: ; SMOKE BOMB: ! WIRING: �
�
PILOT TIMING: � �DRAFT: �TEST TAG:
L.W. CUT OFF: I DOOR PRESSURE: i UGHTIN(31NST: '
PRESSURE: " � ' � % CO2 , 1 ; DATE TESTED: �' � J
�
INPUT CFH: <�� I% 02 ,3 ' COMPANY TESTING: G�/r c.�
STACK TEMP: � ! NAME OF TESTER: ,
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57'L-36U4 l+'AX:
: 6271 JACKSON ST NE
: 143024440004
: IRENE HENRY ADD
: LOT 4 BLOCK 1
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-1'L2S7
PERMIT NO.: 2004-01542 ��r��/�
r
DATE ISSUED: 09/07/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL FURNACE AND AIR
CONDITIONER.
# INSPECTIONS 1
APPLICANT
SPARK ELECTRIC
2114 WASHINGTON ST NE
MINNEAPOLIS, MN 55418-
OWNER
CROSS JAMES H & MARCELLA
6271 JACKSON 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 work 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. The
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 or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 40285
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.50
20.50
Building BUILDING Permit No. �� ` � �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY vateR��� ��'�' ��
763-502-4977 FAX EFFEC'ITVE 1-1-2010
DATE �"' /�� d YOUR E-MAIL ADDRESS
si�nnn�ss G���'1 ��ic.�,S� S� - N�
THIS APPLICANT IS: � OWNER �K,`ONTRACTOR
PROPERTY OWNER/ N�: �'� y, � v1',r
TENANT �D�SS: j cr[�r STA'rE Z�
PHONE: Tb3',�"/ " oZ� I
CONTRACTOR NAME: iC.�`S ��o ��i kr S i �{Ui S►. /n L_
SUBMI'T A COPY OF STATE LICENSE #`�S�o 6 � EXP DATE �� 3� � I Z
YOUR STATE LICENSE 4
AND CERTIFICATE OF ADDRESS: �3'�%'r,�fo �Tv�►/S�v. S'�' N� CITY i��l, �/�e. STATF t NZIPSS�° y
INSURANCE PHONE �^ .z 6�- 6�—Z' FAX � 2
PROPERTY TYPE ?�i GLE F Ew coNS�ucTTOrr srzE
❑ W CONSTRUCTION STORIES
PERMIT TYPE ❑ �DITION ❑ GARAGE/SHED ❑ wlt�rnows
0 BASEMENP FIPTISH '�,'ROOF � DRAIN TILE
❑ DECK ❑ SIDING ❑ OTf�R
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCI'ION ❑ ADDTIION
"'�MAIIVTENANCElREPAIlt ❑ REMODELING
DESCRIBE WORK BEING DONE: �2.��" — oC�F� ��I'—ti�
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING C, f(7 ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES "�HOUSE & GARAGE 1. Existu►g Floor Plan
GARAGE� ❑ ATTACHED GARAGE 2. Roposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural membets to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
C7 Vinyl OSoffrt ADDITIONS_ & PORCHES SUBMIT:
❑ Numinum ❑ Trim 1. Site Plan/Survey showing the existing slructures
❑ Other ❑ Fascia and proposed project.
2. Two sets of consuuction plans
WINDOWS 3. Energy Calculations
IN EXISTTNG OPENINGS OYes �IVo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE SITCKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL r'1;1:5 AKI: BASED UN VALUATlON,1N(:LUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
JOB VALUATION $ II, �� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Swcharge
License Surcharge
SAC Charge
Curb Giit Escrow
Erosion Control
Park Fee
Sewer Main Chazge
$�LSZ�`�� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ � .001 times the total job valuation
$ �'� .103 .0005 x Permit Valuarion Minimum $.50
$ �� 5D0 $5.00 (Staxe Licensed Residential Contractors)
$ $2100 per SAC Unit (Plans to MWCC for determinarion)
$ ft+6ft= ftx$24=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$—��� Make checks aavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID LJNTIL PROCESSED
I hereby apply for a building permit and I aeknowledge 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 on site; that the work will be in accordance with the
approved plan in the case of a11 w rk whic requires review and approval of plans.
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SIGNATURE OF APPLICANT �- � PRINT NAME�'e!''b �� ��f DATE /�!
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