AF - 47372Date
Owner
Addres
�
BUILDING PERMIT
�
Village of Fridley, Minn. N� 2 q 41
..� .... ��.�� / ��s-�� .............
. . . . . . . . . . . . . . . :". . . . aZ�c.�� . . . . . Builder . . . . . . . . . . . . . . . . . . .`�. . �r��''"_ • •�".'ar. . . . . . .
s �O. � l. �. . : �!�'GQ:�I✓r���:�:!;�. Address . . . . . . . . . . . . . . . . . . . . . . . . . .
� LOC TION O� BUILDING
No. . � f �. . . . . Street . . � Z'� . .�� :i1�!�� . . . . . . . . . . . . . . P r f
� • �, , • � t O LOt . . . . . . . . . . . . .
.�
Lot . .. . �..1... .... .. . Block . . .. ..� . .. .. . Addition or Sub-Division .. . .. .. .. .. . . .. . .. .. . .. .. .... . .
/ �� /j�
Corner Lot . . . .. . . . . . . . Inside Lot . .. ��. . .. . . . Setback . ��j . . . Sideyard . � �����" " /r •!. Q.��i,;r°J�l"'
To be Used as:
,
....... . �...
....................
Type of Construction
DES�CRIPTION OF BUILDING
Front �� . Depth . !": ..! . . Eieight c������ Sq. Ft. .`�..1 �Cu. Ft. . . . . . . . .
. Depth . .. . . . . . Height . . . . . . Sq. Ft. . . . .. . . . Cu. F't. . . . .. . . .
./3 : ;►�� �-�r_�_ -�...�
Es� Cost . �, . � . . . . . . To be Completed . . . .� . .-4'—�-
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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 Friflley.
s �
In consideration of the payment of a fee of $.l��s!"pernut is hereby granted to ....... .. ... .........
. . . . . . . . . . . . . . . . . . . . . . . to construct the building or ad dition as described above. This permit is granted upon
the express condition that the person to whotn it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in ali respects to the ordinances of
Fridley, Minnesota regarding location, 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, r a _.--�
•�_,�a;r.z,�• •�ing Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiriry��mbing, gas heating,
sewer or water. Be sura to see the Building Inspector for separate permits for thes�e items.
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City of Fridley, Minn.
BUILDING PERMIT N� 6 8 0 0
� . ..
♦ � � � � �� ��
Date: _. / ____._� _.. � � __.. ._..
Owner: . .� .. ... . . ._ Builder _.. �. .._ . ..._...�_..._.._...._.._.._.._.�_.._
��
�
Address
Address
CATIO BUILDlNG
No. . ...�� _.. Street _ .... .... /���_.. _..�._. ... . b•.:ar�-.... Part t ....._....._..... __. _._._
� - f J �--���--t.-�,._,9..__._-
Lot ....._.._..� .........__ Blo _.___..._._.�w.�..r.�--•-- Addition or Su - i ' 'on ... . /���i
/
Corner Lot ____._._._.._ Inaide Lot ..___.../� ._..._..._ C�l�ack ... ........._.._. . Sideyard _.....�..._..__ _.. �
Sewer Elevatiaai _._..__.._.._� .._.. _._..___._ Foundation IIevation ....�___.._.._...._._._.:._.__
DESCRIPTION OF BUILDING
T V �_. ..1. F�ont _.,f'--••�-• DePth _. �.,�.. ..�- Height ...1.ld . Sq. F'� ,!'��.L� Cu. Ft �-�.� -
_.....__..___. __�..._. �__.._._ DePth _._._ eight .��..._ Sq. F't. _.�_.�.._ Ctl. Ft
Type of Construction _ .._._. �:-�± .�� .'�. Est. Co��.�"".. ..'...! ._ To be Completed _.�..
In consideration of the issuance to me of a permit to construct the building deacribed above, I agree to do
the propo8ed work in accordance with the description above set forth and in compliance with all pro�visions of
ordinanoes of the city of Fridley.
��-� ••,�-- _-
a�
In car�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 Sranted upoz►
the express condition that the person to whom ft is granted and his agents, employees and workmen, fn all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances o�
FrldleY, Minnesota regarding location, construction, alteration, maintenance, repair and moving of bufldings
within the dty limits and this permit may be revoked at ar�y time upo�► violation of any of the provisioa�s of said
ordinaacea �� �-.
Buiiding Inspecta�
NOTICE:
iMs p�emb do�s nof eowr �lu eonshuelka. installallon for wtri�y. P�+�W Y� ti�pY. s�w�r or wabr. d� wn to s»
1M dotWioO In�etor for apKaN p�nails for tl�� fqms.
APP'L7.CATIQI�T FOR BUILDIIJG PERMIT
CITi� OF FRTALEY, MIt�NESOTA .
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LOCATION OF BITxL'DING �
No. ��10 Street ���, ��/E Part of Lot�_
Lot 7 Block ,4' Add.ition or Subdivision � ,� �
Corner Lot Inside Lot '�� Setback � '�""`�� Side-Yard ,� �
SEWLR ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawa on theae Certificates.
DESCRIPTION OF BUILDING
To b�e��as ;
r Front �� Depth �''�'� Height � d
Sq. Ft. Cu. Ft.
Front Depth Aeight
Sq. Ft . Cu . Ft .
Type of Constructian " Estimated Cost
To be Completed �o �' '
The undersigned hereby makes application for a permit for the work herein apecified,
agreeing to do all work in strict accordance with the City of Fridley Ordinance8 an3
rulings of the Departmeat of Buildings, and hereby declares that all the facts and
representations stated in this apglicatiou are true aad correct.
DA���I S � SIGNATUR� �,Nyf.�ci �/y�C�C
'7i '_"'
(Schedule of Fee Costs can be fouad oa the Reverse Side).
`� ' ' •
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•
Caty of Fridley, Minn.
BUILDING PERMIT
��; Ju#�e 2,,` 91 65
� ������
�1T° '7647
Ow►�er: Don pl.�er Builder _.._ ��_��1�i�d��
Aaa� 631� daekson Street �T. E. aaaress � 33:�� g' �en� r.�e �fio_ i�� __
LOC�►TION OF BUILDING
Na _. b�� Street �C$SOA S�t'�O� N. L• ._.� _ Part o! Lot
Iat _._.._...�_.._._..._ Block ___�_____ Additiar► or Sub-Div3sia� C�'�� ��•
Cor�r Lot ._ .�.._ Inside Lot ._._. Setback ..—_ Sideyard
Sewer IIevatiaa _.__.� ...._ Fo�mdatias Elevatiaai
To be Uaed as:
Froat
Front
7j►pe of Caostructi�
DESCRIPTION OF BUILDING
DePth Height Sq. F`t.
DeP� Height Sq. Ft.
� Est, Co�t —.�- _ To be Canpleted
Cu. Ft
Cu. F't
• StOrm �affis.ge Repair
•
Ea ca�sideral3on o! the iss�anoe to me of a pernait to construct the building deBCrlbed abave, I agi++ee to do
th� P�'oPoeed w�ork in a�ordance wlth the descriptian sbove set and in oarnplianceY � all pro�visfons'o[
az+dineaoes of the cit,y of E�Iclley.
In caosiclerat[oa af the paymeat o! a fee of a l�•� , permit is hereby Sranl�d to I,9GH8�'d F'i'e�d
to c�oastruet the buildin8 or addition as deacribed above. Thispermi t is granted upon
the exprees condition that the person to whom it is granted and his agents, employees and war�lm�en, in all wark
daue in. sroand and upon said buildin8, ��Y Pert thereof, shall c�onfo�m in all respects to the o�linaaoes o�
Fridlei'. Min�ta re8ardi�►S locatiaa� ca�structio�, alterati�, maintenanoe, repair and mo'�►�S' � buildinga
wiwi�� dty limits and this pe�rtnit may be revoked at aqy bme upon violati� oi any of the P�visfons ot said
�171.eII �TenSOII Bt�il�in8 InsPectoc
NOTICE:
7Uk p�h dea �ot eevw flw oe�k�, t�alwl[N hr wM�Y. P�+�W YM hwNyr �ar x wM�r. !� a� te �
flw /rildip b��elee for s�p�rah p�s ter tr� ih�s.
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A.PP'LICATION FOR ZNG PERMIT
CITY OF FRII3L�Y, '�iNN�SOTA
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OidN�R' � NAME t� C•-�-ci ,£��uhi BUII.DER
�.ui7i�i•SS . � .� ��C�j �X/G'v[ �fi3O,f-��� l .�. / �y . . AYD1�iiSS ����.r� � �., ... � ,. ;PL-..: .
,T
� � �
� LOC4TION OF E�ZiJG . �
No. St�eet Part of I,at•.: -:
Lot � Block_��_Addit�.o�r or Subdivision �� � �� �\�.
�
Cor�aer Lot Inside ioE _._,,;�etbf�k Side-Yard
SBi+IER E�.E'�1AT14N FOUNDATION ELLV'Al'ION .
Applieant attach to thi� forw,Two Certificates af. Survey of Lot;and propoaed:,'bui#.d�:.�
ing location d��wn on these �e�tificates.
DESCRIPTION OF BUILDING
� �Tv be us ed �s :
� YY1 s-{ `�.:. ^
�'rcraC Depth. He3ght: . �.:
.. �
9q. FL. Cu. Ft. ..
r t
Front Depth Height
�t�. Ft. Cu. Ft. � , .
Type af Coastructioa 1.� s ,� V'�
_ _ ,J�-{ ..c� E$timated Cost � ��� .
4
_,�.•b�. �o�mpl.eted !`<. ,��,;s,�,� \� % _ - - / ?/ ,
._-� �— -__••_---�
The undersi�ne� hereby makes applieation for a permit.€or the work herein �peei��td, '
agreeing Co do all work ii� strict accordancz with the City of Fridley Ordiasnces and
rulings e� tke Departmeat� of Buildings, and hereby declares that a1I the f8ets and-"
representations stated in this application are true and correct.
�Scheduie.+of Fee Costs can be fouad on the Reverae Side).
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Sue�ecr P .
c�ty of Fr�a�ey 9os9
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AT THE TOP OF THE TWINS g U I L D I N G P E R M i T
; � RECEIPT NO.
COMMUNITV OEVEIOPMENT DIV. / ' /^�
r � V � PROTECTIVE INSPECTION SEC. L� /
l•-_-�; �'��;'� CITY MALL FRIDIE� SS13Z NVMBEN pEV OATfi PAGE OP APVROVEO BY
� � 612-571-3450 910-F15 3/26/99 / /
JOB AOORESS 6310 Jackson Street NE
1 IEGAI LOT NO. BLOCK TRACT Oii AOOITION SEE ATTACMEO
oesca. � g Christie Addition SMEET
2 PiiOPERTY OWNER MAIL AOOR�S$ 21P PHONE
Stanislaw Lewicki 6310 Jackson Street NE 586-0514
3 CONTRACIOR MAIL ADDRESS ZIP PMONE UCENSE NO
Heart Home Im rovement 3015 37 Ave S M ls. MN 55406 237-5664 20169074
� AiiCMITECT OR OESIGNER MAIL AODRESS ZIP PMONE UCENSE NO.
5 ENGINEER MA14 AODRE$S Z�P PMONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WOqK
O NEW ❑ ADOITION � ALTERATIpN � REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof House & Gara e(22 S) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUGTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARA7E PERMITS ARE REQUIRE� FOR ELECTAICAI, PLLMB�NG. MEATING.
VEN7ILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID If WOFK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHORIZED IS NOT COMMENCEO VyITNIN 60 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 pAVS A7 �
ANV TIME AFTER WOpK IS COMMENCED. NO DWIG. UNITS OFFSTREE7 PARNING
I MEREBV CERTIFV THAT I MAVE REA� AND EXAMIN�O THIS APP�.ICATION 1 S7A��S GAiiAGES
AND KNOW THE SAME Tp BE TqUE AND COPRECT. A�L PROVISIONS OF LAWS VALUATION SURTAX
ANO OROINANCES GOVERNING TMIS TVPE OF WpRK WI�L QE COMP�IE�
WITM WNETHER SPECIFIEO HEREIN OR NOT. TME GRANTING OF A PERMIT �1�HHS �.94
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CAMCEL THE PERMITFEE SACCNAR E
PiiOVISI NS Of Y OTHER STATE OR LOCAI LAW REGULATING coN� �59.SO �1. Fire SC
STRUCT OR P E CONSTRUCTION
� PIAN CMECK f EE TOTA
Lic C $5.0 67.32
- � UAE OF CON'AAC O OA A pa� EO �GENT �•TE� . MEN ROP 10 MI I ,0/ �/ IT
/
$�GN47UQE O� O�NNEp ��� 0 p BU4DEAi iDAiE� . � «0 Bl �NS� � ����E
NEW [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY �
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION ��i ,�(��
� �
ConstructionAddress: ���� � �1� i�.�� I� - �� �
Legal Description:
Owner Name & Address: �1� lS L.� ..� Tel. #l�l 2- �, �, �bL�l�
Contractor: �«.,� 1.p�9 [ a D_��,az.-r �� ��'Y�.O�.�N LICENSE # z�q�'Z�
�vr
Address: � � S i� l.S Jl� . Tel. #� l 2- 2 3"� S'li' S�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height � Sq. Ft.
DECK AREA: Length Width Hgt/Ground 5q. Ft.
OTI�R: '��j�4.� � l'� �} L� i��� Z.Z- SC�. I�.r�..s.�. ��l�•�►Lo�.
O
Construction Type: Estimated Cost: $. � �� O S
(Fee Schedule on BackJ
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: Z APPLICANT: �--�--�. Tel. #�( 2- 2J �`I e�4
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
���Y��
STIPULATIONS:
$ �9 S a
$ .�
$ `i
$
$ �" o 0
$
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50i$1,000 Valuation
$1050 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 [ ] Not Necessary [ ]
$ � � • ��
f
���,�� HEATING HOUSE HEATING TEST RECORD
AIR CONDITIONING
AND ELECTRIC. INC.
ADDRESS CQ31 a �A� IC S�`1 S� N4" APT. FLOOR CITY F �`i �II�y SUBURB
OCC"UPANT L'tu++C�i OWNER
HEAT LOSS DATE HTG. INST. �—� S'% Y'
SOLD BY . a� �i INSTALLED BY °� w'� £
Electrical Work By i3��� 4 Q� ���o gy �; A 4,
TYPE OF HEAT GA FA �/ HW STEAM_ SPACE HTR._ UNR HTR._ OTHER
GAS DESIGN
MAKE arX*'�T
Model 3SS nl �� �^! �l a, 0�id
Seriai SR�'g �.27q2 •
INPUT--(i0�1AD
CONTROLS
THERMOS7AT S+t4+"S Haat Plug
Valve _ � �' � QeJt�
Limit _ �r•; aCed
Limit Setting � �Q
FanSetting � w1e
Pilot Type � U r
Pilot Make ► K t
Pilot Model %!y
Pilot Timing _ �� � 5" �'
L. W. Cut Oft
Pressuro `�, �p Pareant CO= �'
Input CFH Percent O! �'
Stack Temp. 11 a Parcent CO �
Form 235
CONVERSION
MAKE OF BURNER
Modal
Max. BTU Rating
MAKE OF FURNACE
Model
voMS�� 2''pvc,
KIND OF LINER � g�� S'` NONE
Dratt Hood Regulator
Finars Sia .1 GX?S X � Numbar �
Chimnay Location Insida Outsida
Chimnay Constructlon i�
Smoka Bomb Wtring
DnR Tast Tag
Door Praaaura Lighting Inst.
Data Testad � � S'�l'�i
Company Tasting '�' � E
Nama of Taster �
. *
CITY OF FRIDLEY INSPECTION DI�SION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
ResideMial Rate
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace $ 30.00
(Side Vent — =Fill Out Back)
Gas Piping (Needed with new fumace, $10.00
but not replacement)
Gas Range ; $10.00
Gas Dryer ; $1A.00
*A' Conditioning - All Sizes ' $ 25.00
�r �a�.t 5sD �1r�►x ��-�f - � �
All Others/Repairs & Alterations (LIST ON BACln
1% of Value�of Appliance or Work
Commercial/I ndustrial
1.25� of Value of Appliance or Work
State Surcharge
TOTAL FEE
TOTAL
$�
$
$
$
� 2-�`b�
$
$
$ .50
$�5•�
MINIMUM FEE FOR ANY HEATING/CAOLJNGNENTILATION
REFRIGERAl10N/Aip CONDITIONING PERMIT IS $25.00
PLUS THE $.50 SrtATE� SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effecti��e On January 1, 1999
JOB ADDRESS L�,31 D�1 GtC%�i) ST �•
The undersigned hereby makes application for a permit forthe 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 appiication are true and correet. f c��� �
� ' � �- � ,1�98
OWNER � I �il/Y1 ��U I �,�`-f
BUILDING USED AS ��� l' I{'1 C�
ESTIMATED COST -''rj �D(� • DU PERMIT N0. `�
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units � Circle One (Steam) (Hot Water) (�ra��l
T�ade Name �r Size No. �,�SYYY{..V a 3 U�D �
BTU LP (3 t t� U FiP EDR
Fuel lu Ot� .�t 5 Totat Connected Load
�
6urner Trade Name Siza No.
BTU HP EDR
BLAINE HTG. A;C �I.ECT.; iNC •
13562 CENTRALAVE. hI.E.
NF4TINf; f'Y)MP�,IV ANOKA, MN 55304'
Tel Na � �� �[f1�0�U
Approved By%�" r= Rough—In Date Final Date '� �/'9�
FILL OUT BACK SIDE FOR STACK VERIFlCATION ON REPIACEMENT FURNACE ��'�
CHIlVINEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1: Has been cazefully examined Yes (� No ()
2. Is free from rust or deterioration
3. Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for size
and total 1�TiJ's co�ected
6 Has total heating BTU's of (p %� ,� f� 2�
,
All other BTU's L-{ D� U U-?'
TOTAL BTU's �(J J� _[, U U
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
Yes (� No ( )
Yes(�)NoO
Yes � No ( )
Yes (� No ( )
Yes � No ( )
Yes �. No ( )
List ALTERATIONS Bein�ne:
HEATING CO:
Signed By:
Date:
BLAINE HTC�. A,C ELECT., iNC:.
13562 CENTRAL A1iE. N.E.
ANOKA, MN 553�4
.
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