AF - 47578sua�ecr PERMIT NO.
City of Fridley ° 13223
AT T1iE TOP OF THE TWINS g U I L D 1 N G P E R M I T
� ,,:.
; ;, RECEIPT NO:,� .`
� `L _.�_ COMMUNITY DEVELOPMENT DIV. `
r � � PROTECTIVE INSPECTION SEC. /7 �/�C��¢
1 � � / O 'f
' 1 �'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE Of APPROVED BY
�---•� � �'' stiz-sso-saso
910-F15 9/24/75 � �
108 ADDRESS 574 Janesville Street N.E. '
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 41, 42, 4 F Riverview Heiqhts Addition SHEET
2 PflOPERTY OWNER MAIL ADDRESS ZIP PHONE
A. L. Williams Contstruction 947 - 86th Avenue N.W.
3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
�I NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 26' x 40' Dwelling and a% 20' x 22' Garage
9 CHANGE QF USE FROM TO
STIPULATIONS
Provide a hard surface drivewa�. Provide a verifying survey before
capping. Provide sod in the front and side yards.
SEWER LOCATION (Approx. 9' Deep) 147' S.W. of Manhole (Inv. 846.73)
Wye Elev: 839.24
Top of Footing: 842.74 Minimum
WATER IACATION: 10' N.E. of Sewer Service ;�; �������
"Be#Dr� dig�ing°call local�'i�i�ties
� i'E,LEP�iQN� - ELECTRIC - Ga5 �.tc.
�.�PERATE PERMITS REQUIRED FOR t�IFti�tC REQU�RED BY LAW
H��1����A PL�IMBIN� Af�1J S1GNS.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FYdIII@
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 PERI00 OF 120 DAYS AT R-�. ZO4O + 440 20, 892+4400
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 TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT $31 � SSO. OO I.S. %S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR HE PE FOR�v1ANCE OF CONSTRUCTION. � 546.75 $325.00
� PLAN CHECK FEE TOTAL FEE
s
� � — $387.50
'Si NATUREOFCONiRACTORORAUTHORIZEDAGENT Ion7E� WHEN PROPERLY VALIDAT�ED THIS IS YOUR PERMIT
• �_C'vl�CJ �/'a '�s..�
SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG iNSP f1ATE
AI'1'LIC�TION 1�OR R}:STll]�N'1'IAL, ALTEIZ/�TION,
OR Al)llITTON 13UILDING I'L'12MIT
CITY OF FRIllLL1', I�ITNNESOTA
OWNER' S NAME : y� / �. �%,L��jfs�BUILD�R: ✓ � /�f /�
ADDRESS :���` O b�Gc-� �I%_ W ADDRESS : ,� %� G`? I
�
N0 : . - S TR�ET : � ` > � � ; � `.,� ;, j ! :: c. :' ✓ T ,
LOT : T / � �{�- S/,,� BLOCK : � ADDIT ION : /I - I v �' � i� / � �cJ /r- �/ TS
CORNER LOT: INSIDE LOT: � SETBACK:�� SIDEYARD:_�i yL ��
Applicant attach to this fozm �ao Certificates �f S±txvey of Lot and proposed
building location drawn on these Cextificates.
�ESCRIPTION OF BUILDING
To Be Used As:
� ' � Front: Depth: Height:� � �
Square Feet • O Q Cubic Feet • "`J �,, !�/
• _..�____.T.
��A �- Fxont : � p Dentli :� � �7 HQight : �f
Square Feet; �� D Cubic reet: �%, `�!� Q
� ��ii
�ype of Construction: ���/�f �= Estimated Ccst: S Q,J a
To Be Completed: �� � ` � � r ,�,�,r
. 3/� �° . °° -
.
The undersigned hereby makes application for a permi� for the work herein
specified, agreeing to do all worlc in st'rict accordance with the City of
Fridley Ordinances and rulings oi the D�partment of Bu.ildings, and hereby
declares tliat all the facts and representations stateu in this appiir_ation
are true and correct.
� :
DATE: 9' � �' %S— SIGNATUItE • 1
(See Reverse Side Fox Additional Informatian.)
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' A��licaf�c� �v� PDcr���� �,�� ��.s �i������ Pe�i�
_ ne�. of sla�. Phor• �ro-ssso
• D£SCRIPTION OF V10IiP: " � � '
Loca
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Num`�e:. Kusd as�d Locr2!oa oi F!xlute� ,
� ` '" �w.,TC� Nr�. ' City o! Fridley:
a .N yf , W � . .
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� y � g�.`y'�< 7 7� 7 W r N ws cuc. ' The undersigned hereby makes apDUcation for a permit for thr worY herei
��) � � S� 3 .'z. ,s � o� � � o S 2 � 3 u u.■ o$
specified, a6reeing to do all wo: k ia strict accordance with the Ci� OrCinana
99�t n n � and ruIing of the Department ot Buildings, and hereby declares that all the tacl
and represrntations stated in this aDplicatios� are true and eorrect
��"' � �' , Fridley� biinn.�2�X -----, 19��
1 ;3 � •
Lp��:��--� ,
3.d Ownec ��,3 �
4th Kind of Buifding
• lFutuz♦ CanaocSSoa:Gponir.qs Conaac:3d wita .
Seaes � Used as
•. 2{�. Fiaturo. 01d 4'Denin4+ Cce:.pool � ' .
� : To be completed about .
PARTIAL RAT� S�HEDULE ESt;m3cea cos�, s
. . Old w. uiiding Permit No. L.��-r�..�.'�' P.rmit No. � i�(-�
pLQMEI?IG FIXTURE RJ17ES: N0. RATE TOTAL � i
,,� ,
' NU.MZifT 'hKZLCCS •�••s••��������w � X.�ij�.Q� s � •� p � . �'1�Cd .
�
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fl�ture flxtuce O�,cning s � � � � �'� c� � • .��. X �Jl.•� s�� • $� ��fi�,lf, �w �� -•
tiew Fixture OId C�erung.. ...: ...• x 51.50 ;�--_ Businrss P'h�ne No -
.
CatcS F3astn . . . . . . . . . . . . . . . . . . . . x 5325 S
' Wat�r iiratrr 'L'p to 99.000 !3TLT�•••• x R3.00 i �� ��, " .
_ ROUf3H
::ew Gro�nd R�n �ltl Fi'.dg. . . . .•. .-, . x 53.25 S
Ei.r.tric �J•�•r FT�etAr. . . . . : . . . • . . . . _._. s S2.Cc'� s�.._.._ FINAL 3 ^ 1 � �4 '
�l ; s^I7TING FEEB: � NO. RAT'L�: TOiAL /
� 13� �3 �1Xt11ieS • • • • • • � �• • � � • � • • � �.• �� x �TZ.� � . . r� � � . . , . . . .
Additianal F'ixturea .. . . . . . ... . .... x = .75 'S -
Gas RanYt to 199�000 HTU . . ... . . . . .. . . ; x S5.Q0 6.-------
REP,1►IRS �c Az.TER1►TIOxS-A�f.r so Cod� .50 State Surcha'rqe
. . Descri�ifon : . . . . . . . . . .. . . . .. . . . ... . . . ... . . . . ... . ... . .3
, TOTAL FEE 5.�.+.�� ' .
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�1g��tcu#�cn �or F��� s�n� i���at�ge �tc��ng, �/���it����4 �::,�r����stia� a��
� l�i� Ca�������in� ������ a�� ��v�� .� � .
PART1�4i. RATE SCi-�EDEILE �
_,.. _
G=iTiYIT7 �IIiP.r: �n: � �T� � �'o�Ra..
FUra�cc She1I a 1'r�ct �Yor� .. ..: ..... ..$30.�0 $
Rrplaccrncnt of e`urnNr , , . . . . 6.p� '�
� P.cpairc �r Al!crations---up to 5500.Q0 6.pp *�
Repairs Q r'.l�crations each add. 5500.00 , gp� $
TfiiCii Wl�.'iy2 �3 .
�:rnace S2�elI L'c 'L`tici F7a-� tc i�,G�Q BTU .. .
� rsG� sdd. 60.000 II'i'IT . ........ . .
RepIsccr.�cnt of Ftirnace • . .
Rt;.�irs & Alte*aLon.s—up to $500.04 .
Ite;,a3rs & httcrations cach add. +500.00
, SZ'EA:�S cr i-30T �di F:T%4 EYSTEM
• i1�rr.ace Shell 3: Lines—to 400 aQ. it. F.DR Stcsirs
il�rnace Shcll & Linc�--to 640 sq. ft. EDR fiot WsLes
Each add .00 sq. fl. EnR Steam
' F..�ch add. 320 sq. 12. EDR Hot Weter .
.:$I0.00 s � ��'�'
3.:rJ �
. $.00 3
6.00 � - -
s.co : s
?2o.x s
20.� S. .
�.tkl �r. -- --
v.VV l�+r�.�w�� �
OIL 3DRAi£R—ta 3;gal, per hour , 6.t10 �, �
' over 3 gal. prr hour—See Fee Sct�edule '.� '. �
GA.S L•T,i1.�R (up to '�,f�3 $Tin . 6.0� ;,_,�,_ •
... _ .
a.•sr 1�?.(.'�J F�TII 3ar Feo 3cliodvle •. ' .
G�:S FFTTINC e c:£u': • IQO itls.T£ TOT1�aL
Ist 3 F�xtures :' x$� ��'J S�
Addi•,ionai �9;.ttires . x .TS �_�.. _ •
� Gas Ran;;c tb I£':3.Gt� _. _ x�f 6.� $ _. ,
n�� cc:.r�r.Q:�:�:�
FA3: H�IaTiI'i� SYs2'E.aQ
'C': i:iZl.�iT2: "..3 i'il'i�TLI+3
RL%.:i.�`i I�':.: b Fz.:Pi.I:4S
�GUr:i
.�"'a._iiFi %/-:l Z-? �
Statie Surchaxge , .54 �
f�_� •
�� �q 2c�su:.1N ..,._�:.
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Dvpt. of 311r„�. P'h�no °�J-?�7�
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City oi r�'Yidlc�y: . . '
• T.�e �ir.c?crsi,�nc*<i herebv makes applicatt�n for a�czmit ior thc a�or:t ncrc;.z
specxiied. a�:c�eing to do a!I vror:s in strict. accordance with L�e City O:d!��r.ce�
and rulir.g oP thr D�ya;tm�nt of IIuildinQs, ,s.;; hereby d:ci:re� +��t aI] t�e tac�
and re�rt:sPntatiuns s?afed in this applieation �tre tn;e ar�1 c�-rcct.
I�i�id)ey, A'uan ���� 2Q�:
Cywner�ldd� �f-.�:,G�� �1�:�r-K�•� �
+ `'�
Kind of Bui�din� � - - . '
T�S�f'f� 2�s �(� -
To be compteted about,_�l�t!-' � rY — l S-
Es4im�ted Cas� S - ��`� ,
Old ew 8tziidirtg Permit No. Pasmit No. V��C!
it��.`e�.�..*rit+ir��ii �{' ��LY.�i
�iEl.TING o: PO��t IaI.P�R^T^ -5bc���zs, �oY F'w�r, R'r.rai Air—No
'irade Name 5L-� 2to= Hf��.i,T-i-
Ca�acity /d,��� �q. S't. E.D.R BTU iI.F3
Tul�I Connect�d 1L��d ..��v.�c��— P�..^3 0: itis
�URJ�a;�..^a — `�'scir �?n�s� 5ize 'I�Fo
CnDaciiy _ `�c3. �'4. �.D.i. Si'J �
� x AE. � $�,_'3'O
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HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceili�g Roof Floor Kind How Applied
Yes—No Yes—No 19_
J Fl.� ' Room � Length / Width Height FI.� Room Length / Width / Height
Windows an oors—Crackage and Area Windows and Doors--Crackage and Area
�Vidth elght No. ot Ltneal ft. Area Wldth Ae16ht No. ot Lineal tt. Araa
No. ot pane of pane lights ot crack eq. ft. . No. of Dane o[ Dane lights oL crack sQ. tt.
3 - � . o. � a.br l � �� / .
,
�2 J�o. /l�
Coef. Bcu Coef. Btu
Infiltration 3 �
Glass 3
Exp. wall
Net exp. wall �
Int. wall
Ceiling J � x .� X /
Floor �� � �
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. I.eader area
FI.� Room � Length Width f/ Height
Windows and Doors—Crackage and Area
Wldth Helght No. o[ Llneal tt. Area
No. of pane o[ pane IlQhts ol crack �q. tt.
� ` �
/ ,
Coef. Btu
In6ltration 3 l
Glasa s
Exp. wall / X
Net exp. wall �
Int. wall
Ceiling ) � � �
Floor �� /,y/ )
Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
' FI. Room � Length Width f Height
Windows and Doora—Crackage and Area
Wldth Aefght No. ot Llneal tt. Area
No. ot Dans ot pane Ilghts ot crack sQ. tt.
� i / <
Coef. Btu
In6ltration �� ,
Glaaa ,
Exp. wall
Net exp. wall
Int. wall
Ceilin8 t I
Floor � � �
Tbtal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area
�
Infiltration o�� ! D
Glaaa G
Eap. wall l �.
Net eap. wall l ` / %S
Int. wall
Ceiling � lj � �
Floor � � 7 �
Total Btu. s'yy�
FI.I Room I I.ength Width � Height y
yVindows and Doora--Crackage and Area
Width Helght No. ot Lfneal [t. Area
No. o[ pane ot pane llehts o[ crack sQ. tt.
/� / ,3 ►
ef. tu
Infiltration / . 3 _ � S/3
Net exp. wall
Int. wall
Ceiling � �
Floor a�
Total Btu.
G
1
1
Required aq. ft. E.D.R. or aq. iris. W.A. L.eader area
FI.� Room I Length � Width /
Windowa and Doora—Crackage and Area
Wldth Hef[ht No. ot Llneal [t. Area
No. ot oane ot Dana Ileht� o[ crack �a. tc_
Infiltration
Glasa
Exp. wall 1 �
Net exp. wall
Int. wall
Ceiling C� �
Floor � �
Total Btu.
aq. ft. E.D.R. or aq. ies. WA. I.eade� area
Btu
CITY OF FRIDLEY
APPI.ICATION FOR PWMBING AND GAS FITTING PEfi�11T
qN T N A U • 1( y WJCI•C
Y N �1 h N (+ C�[ V N � y� q�.. 0. 4. a M�ater
M N C L� � Y G C C ) O U�-�+ �.c �g U � v
wu a" ii i� a �i c" a°. a t�., u a'� �' s 3 � 3 0:as •lec
!rt
2nd
lyd
�th
(R) � iLWr� Conn�ction Oponinq Conn�et�d with Sewer
(•) � ww ►t:wr•, ole ap•ninq wacar
RATE SCNEDULE
PLUMBiNG FIXTURE RATES:
w.� ri:eur..
futur• /�stur��
Old Op�ninq, N�M listur•
���t Di�p�n��s
�lov Ott ��sln
C�tch ���ln
R�In N�t�r L��d�r
Mydc�ullc V�1��
Su�p or R�c�ivinp Ta�k
M�c�r Tr��ttnq Appll�nc�
Not M�t�r N��t�r
G�• R�nq•
G�a Dry�r
N0.
�
—�,
�-.__-�,
RATE
g 5. 00
S 3.50
S 1.50
S �.00
g 5. 00
S 5.00
S 5.00
S 5.00
S 5.00
i 7.00
s 5.00
S 10.00
S 10.00
TOTAL
5
S
S
S
S
5
S
S
S
S
S
S
i
6ack Flor Prw�nbr IrQuared. .. Yes ( 1 tw 1 ) .
�'P� S s. uo S
Effective tday l, 199� ���'� /
��(/
Job Addcess s ��� Y-t5 ;�j�'LGl7,(.�
Departnent of Buildinqs
C►ty uf Fridley
T�i. rs�i-��so
The undcryiqnrd hcreby nakes application for � p�r�it [or th� wrk h�raln
speclEied agreei�q to do all work in stcict �ccos+d�nc� vlth tA� City Cod�•
and rulinqa of the Departaent oE 8utldlnqs, �nd h�r�by d�clar�• that �11
che facta and repzesentationa s u t�d !n chl• appllcitlon ar� ttv� and oorr�ct
Frldi�y, Mn.
19
OWN6R � � _
K[ND OP BUII�ING �� ''�'��IU-E ��T N. E.
FRt�EY , `,�.'�+i32 —
useo As _� H 7�-8959 _ N 48$-666$ ,_
'N BE COMPLETEO 11BOUT IO ��
ESTIlY1TED C06T _� �D U . O'()
/; �
OLD - NEiI B�lIILDING PEPMIR NO. PLIIMIT N0. %(,� C'_ c' ;�%C
..
• � �i
• � r •�-�a1� � ► a ! ; +� 1
- - = •�:
:yi �rK
/ `�� .
i
RWC:N 1NSP.
Date
. ���� �
FINAL INSP. � , �
<� _
`a,
11PPROAIAL POR PERMIT � �
ALL OTHERS AW�/OR R6PAIRS ANO ALTERATIUNS
t• o[ V�lu• ot Flstus• or Appli�nce s !11NllfUy Ft:f•: FOR ANY PLUMBING PERMIT IS s15.00
�LUS THE S.SO STATE 5URCHAHCE
State Surcha[ye S. .SU �
Nu►ns��ect on F�� S ' sa
(515,00) TOTAL FEE � S ,
��_ _.._..
,. - .
SuBJECT � P I NO.
c;ty of Fridley 3 0144
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
' ` RECEIPT NO.
� �
� ; v _ COMMUNITV DEVELOPMENT DIV. /
r � � PROTECTIVE INSPECTION SEC. ��/(�
l-___ A'��'��;,� CITY NA�� FFiIOIE� SS�$Z NUMBER REV DATE PAGE O� APPROVEO 8Y
t �� 612-571-3450 9t0-Ft5 8/31/99 / /
JOB ADORESS
574 Janesville Street NE
t LEGAL LOT NO. BIOCK TRACT Oii ADOITION SEE ATTACHEO
DESCii. L} 1, 42 , 43 F Riverview He i hts sMeer
2 PiiOPERTY OWNER MAIL A�DRESS 21P PMONE
Ro er Johnson
3 CONTRACTOii MAIL AODRESS ZIP PMONE LICENSE NO
D& B Home Im rovement 4901 105th Ln NE Circle Pines 55014 784-0922 7773
� ApCNITECT OR DESIGNER MAtL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII A�DfiESS 21P PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW ❑ ADDITION O ALTERATION �x REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (25 Sq) Tear-off
8 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE Of CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPAFlA7E PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONS7pUCT10N 20NING SO. fT CU fT.
AUTHOR12ED IS NOT COMMENCED WITHiN fi0 DAYS. OA If CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO fOR A PER100 OF 120 OAYS AT
ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREEI PARKING
1 NEREBY CERTIFV THAT 1 HAVE READ ANO EXAMINEO TMIS APP�ICATION STA��S GAiiAGES
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF �AW$ VALUATION SUiiTAX
AND OROINANCES GOVERNING THIS TVPE OF WORK WI�L B COMPLIEO �21HS �L.O9
WITN WMETHEA SPECIFIEO HEREIN OFl NOT. TME GRANTI A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIA O CANCEL THE pEqMIT FEE SAC CMAqGE
ROVISIONS OF AN THER STATE OR L R ULATING CON•
S CTI q`T OfiMANCE CO TF T �83. ZS F1 SC �2. 19
PLAN GNECK F TOT � FEE
,�� L' se C $5 $ 1.53
i N4TU�7E CON7FA(; p�UTM GENt �O�TE� � MEN PR VAU E TMIS I U fi IT
v
S�GHaiUQE O� OwHEp��� OWNEpBU�IDEp� �01fEi BtD �ti5o ��<<f
.. - �
NEW L ]
ADDN [ ]
ALTER [ ]
Construction Address:
Legal Description: �
Effective 5/10/99
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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Owner Name & Address: �' �� � } Tel. #
Contractor: � ? MN LICENSE # ` �
_. . _
Address: �j _ � � � Tel. # ��`�- � ,�
Attach to this applicati�n, a Certificate-of Survey of: the Ss���i
lot, with the proposed �construc�on drawn o� it to seale.
LNING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
DESCRIPT�ON OF i1VIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. �t.
�gth Wid � Hgt/Ground`� Sq. Ft.
F /i � i � � � �' �:5.. .i� / r.4�% �� � ��
i - (�
Q✓
Construction Type: Estimated Cost: $ �ll�S �
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
� �
DATE: � ` � APPLICANT: ' � Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
L:cense Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$� �s
� o? �9
� l'-v}
$
� _ �o� .
$
$
$
$
$ ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuarion
$1450 per SAC Unit
$5.00 (State Licensed Residential Contrac�o�s)
Alt. "A" or Alt. "B" Above
$450.00 Conservadon Plan Review
Fee Determined by Engineering
Agreement Necessary [ � Not Necessary [ ]
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
� _..__ �--"�,,.
PERMTT 2004-01137 ;
�___--� .
DATE ISSUED: 07/19/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 574 JANESVILLE ST NE
PIN : 033024230230
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERNIISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AIR CONDITIONER.
# A/C IJNITS 1 # FURNACES � 0
# GAS DRYERS 0 # GAS RANGES 0
VALUE (FOR MINIMUM CALC) 2800
APPLICANT HEATING PERMIT MINIMUM FEE 0.40
OWENS COMPANIES INC FURNACE SHELL/DUCT WORK 0.00
930 E 80 ST GAS RANGE FEE 0.00
BLOOMINGTON, MN 55420-1499 GAS DRYER FEE 0.00
(952) 854-3800 AIR CONDITIONING FEE 25.00
STATE SURCHARGE, MECH FLAT 0.50
TOTAL 25.50
OWNER PAID WITH CHECK # 07082
JOHNSON ROGER A& JEAN L
574 JANESVILLE ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes nu11 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
regulatin struction or the performance of construction.
Applicant Date
Bldg Insp Date� �i,
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY ((3�ff FRIDLEY BUILDING INSPECTION
r
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
�-� ��0 3
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Fee Tota
JOB ADDRESS .�`Z� � Gv1�5 V��\ e �v �� ��i L~
Owner �o �� � O���d�
$35.00 $ Building Used As \`2S� (1e_v1 � �
$10.00 $ ESTIMATED COST o� l� �` O�) PERMIT NO _������� �
$10.00 $
Gas Dryer $10.00 $
*Air Conditioning - All Sizes • $25.00 $�� V
All Other Repairs or Alterations (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
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
DESCRIPTION OF FURNACE AND BURNER
# of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size 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 8uilding Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ � HEATING CO C'�v: e.�� �-c��MS)G�1� �`� , S.p� �
$ a�
S.S� Signed ,��,,,.. ��r�w.An Tel# 15a�`��`�\">`��(i
*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
FAX# Gsa- �s�- `3i�s� Date %` �1 —O`�
A roved b � Rou h-in Date Final Date ` r D
Pp Y g
ADDRESS
PIN
LEGAL DESC
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
571-36U4 1+'AX:
: 574 JANESVILLE ST NE
: 033024230230
: UNAVAILABLE
: LOT BLOCK
571-t"12f7
PERMIT NO.: 2Q04-01527
DATE ISSUED: 09/O1/2004
����
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL FURNACE AND AIR
CONDITIONER.
# INSPECTIONS 1
RT ELECTRIC INC
8700 171 AVE NW
RAMSEY, MN 55303
APPLICANT ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 6616
OWNER
JOHNSON ROGER A& JEAN L
574 JANESVILLE 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
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.50
20.50
Building BUILDING Permit No.:01U U�( I���
Inspections RESIDENTIAL APPLICATION Received By:l"�� '
763-572-3604 CITY OF FRIDLEY ����
763-502-4977 FAX EFFECTIVE 8-19-09
DATE \�—��'C Y/O�UR E-MAIL ADDRESS
SITE ADDRESS �� 1 �'� `� szt� � �Ls. � 'r u• � }.{ /�^!\)
THIS APPLICANT IS: ❑ OWNER �15;QNTRAC'I'OR�
PROPERTY OWNER/ NAME: c� � �
TENANT ADDRESS: S1 �< < �i �"Y�
r��• � lJ , l� CITY STATE IP
PHONE: (
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # EXP DATE 3" 1�-' l�
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: -I� S-l�^ h�c rrJ �.},�JCa ��CITY �' STATE y� IP_�
INSURANCE PHONE � � � � - �I FAX
PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTTON SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION p GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ,B ROOF ❑ DRAIN TILE
❑ DECK A SIDING ❑ OTHER
❑ SW[MMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF 1MPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor pian
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
O Aluminum ❑ Trim 1• Site Pian/Survey showing the existing sductures
❑ Other ❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
iN EXISTING OPENINGS�'es ONo LOCATTON OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF �i �pr MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS •
ALL FE�;S AKE BASLD ON VALUATlON,1NCLUDING THE COS"T OF LABOR AND MA"1'ER1AL5:
USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ <9 ��-�.• L�D OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surohazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$ 1�
$ SU
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks payable to: City of Fridley
THIS IS AN APPLICAT[ON FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I acknowledge 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 applicatio 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 II ork which req ires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME ���� �Y�� DATE I 1' I�p^ a�