AF - 47632SUBJECT R .
City of Fridley o 19586
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � ECEIPT N
� � ____ COMMUNITY DEVEIOPMENT OIV. _
r �~ � PROTECTIVE INSPECTION SEC. a 9��S
� �
1 ' /"'1 � CITY HAL� FRIDLE� SS4$2 NUMBER REV. OATE � PAGE OF APPROVED BV
�.---'�•� �•� 612-571-3450 910-F15 7/7/88 / /
JOB ADDRESS 5750 Jefferson Street N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1� Prt. 2 4 AC�i3ittS Street Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
B.B.A. Enterprises Inc. 6540 East River Road #132, Fridley, MN 55432
3 CONTRACTOR MAIL ADDRESS � ZIP PHONE LICENSE NO.
�e 571�7159
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
X NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCR�BE WORK
Canstruct a 44' x 34' Dwelling and a 24' x 20' Gaxage
SEPARATE PE
9 CHANGE OF USE FROM W�R��V.E2, HEAT[NG, PLllMgtl�G AND S�
STIPULATIONS provide City with copy of verifying survey before capping. Provide sod
in the front and side yards. Provide a hard surface driveway. Paid $750.00 Park Fee.
See notations on plan.
SEWER LOCATION: (Approx. 12' Deep in Street}: 41' S. of M.H. (Inv. 865.76)
WYE ELEV: 865.92 TOP OF FOOTING: 868.92 Minimum
WATER LOCATION: 9' South of Sewer Service.
THE CITY. QF FRI;DLEY DOES NQ� 1N�RNl��
ACCURACY OF Ul'tLITY lOCATtC}NS R{up E��A IONS. TELEPNOiVE ! EI��C�I�iIG' ��f�l$ �Lt�,
THIS DATA IS FOR it�[FORAt[�tT►p� pURPOSES ON�Y, W
AND PERSONS USfNG THES [lE[F'ORN{qT�ON SHOUL REC�UIR�C� g I LAW
VERI�Y IT ON THE $�'E. �
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAVS, OR IF CONSTRUCTION
OR WORK IS SUSPEN�ED OR ABAN�ONED FOR A PERIOD OF 120 DAYS AT
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 �AWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED $83 �700 $�}1.HS
WIT ETHER SPECIFIED HEREIN OR NOT. THE GFANTING OF A PERMIT
ES NO PRESUME TO GIVE AU HORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIO S OF ANY OTHER ST TE OR LOCAL LAW REGULATING coN- 567.50 $550.00
STRUCTIO OR THE PERFORMA C OF CONSTRUCTION. �
PLAN CHECK FEE TOTAL FEE
_ '� -� � N/A 1,159,35 + PF
si NA aEOFC C o EDAGENr IDAT r WHEN PROPERLY V DATED THIS IS VOUR P RMIT
�
SiGNATUREOFOWNERIIFOWNE BUILDEAI IDATEI BLDG INSP � nFT
r �
l� � �
AL"DN [ ]
ALZER [ 7
Clty Ot FY1C�l.E'y
R-1 AI�ID R-2
Builcling �rmit Appl icati�
EEfective 5/L88
Gbnstructian Address: S'?�v 3c-�-��2�oN Sr- NE.
Legal Descripticn:_ �R2c� L � ��o,- � �- Q,,,� �� l�-� -z � (� � o c�c � � .an�u.s � �n o,�e�
Owner Nane & Address: R��� R� ��,,. t• 1 u�z.. �. # 57 t-'7 �� 1
Gbritractor: _ '�, E� . �. �.,.� . ( �rz.. 20� �2. � � FFc ��7L �el. # s�, - �,s�i
� r� ,
A�r2SS! � �
� 1"3 z� --� ;z, � o c. �v 1�' l�, • 5
� Attach to this appl ication, a Certif iaate a� btirvey o� the
lat, with the proposoed oonstruction dra�m on it to scale.
DESQtIPPION QF IM�RWH�TP
, ,
LIVit� ARFA: Length �� Width �� � y iieic�ht �
3 �
• I+ength � � a'�.�n Widt.t: �9 � � r2 � ��t s ,
" �a
��BBC�. Length � width Hgt /Groina
St,�. Pt. �Z7�
s�. Pt. ' �ra� � I�
9q. Pt.
��
4�rrer Lot [] Inside Lat [� Ft. �$',Setback 3 S Sic7e Yard Setb�cks � �' � S�
�pe a� Gbnstructian: �R� F.�timated Cost: S �-�
Approx. cbmpletion D�ate :_ �� t 5� �S gS 3,�O �.
Pro sed Drivew Width If New ��?t' �t. A A1t. B
p� ay Opening Is Desired: S S
Widkh + 6'� See Back Page
T]ATE : 4-�, �- Sr 5' APPLI�IJP: �('a Fl .�.:, . Iv-z.- /(Z.ocs�, L E��' �� Tel. # S; � �-'� � S i
(�TY OSE QiLY
Pe=mit i�ee
State surc3�arge
SAC �arge
Driveway F.�scrav
P�rk Fpe
Se�rer !lain Q�arge
�
sr��s:
k�-,,��� C
S �Jf `�li . SU
S_ � 1, 4��
S 'SSo.vO
$_ :.. . �3f ixf.�i...
S `7 So, ob
S ~��
���) �.��
Piee Schedule � Reverse Side
5.50/81,000 Valuation
5550 per SA�C Unit
Al� '�i" or Alt. '�" Above
Flee Determined by @lgir�eering
Agreenent Neaessary [ ] Nat Neaessary [ ]
m
_�
+ '
,
STRUCTURAL WOOD CORPORATION
1175 EAST HIGHWAY 36 ■ ST. PAUL, MINNESOTA 55109 ■ PHONE (612) 484-0281
, , ,";
° �� SU
� , ,
� . . _ _ . ___ __
, _ _ r_
� _ f i.
E :
� �
; ; �
.
z , � , : . : _ � � �_ _�
. �
s __� F _ f _ _ _ _o- _ _ �_ e t . _ : : � . � _, � � __� m� _-- _ _�
�s�c.�r�
Y :`�ti
.
2
a
�
)
�� !r��a� x�4.�g� -�� ��..�
z. � iac, i �c �rx.res � z
�
� � „ �XtEi�l�it �'NM`ELOME A�MOE "f!" �11TAT!!MI
O�HE R : ,
s�r . ' ' "� � :
� aon�ss: T. ��.�:� �,��� :
- � . ,.� � :,: :�. ` �
CONTRACTOR: .�, ���: ��� ��� � � °���t� �
.,.����.:, r � >� � �
.�:�.
��alir� �+ti�c�� � *
���� ��. � ���� � � Y Y � fi�� � r� . .
�' »,� . . �.x�s� :�'�� �� _-� ' .
1. TOTAL EXPO�EIf �.l. ��, � � � -�'
.�s.s.. '�� �� � �i
��, ��, 5
2 . TAtAL ROf��/t� i E� IN� , � ' � � �_ - � M� � � �
_ ��� ir.r'�ir�a s. a � � � ;,�1�-.•i�11" � +�
3. TOTAL E�tPOSEQ i�AL.I iA�� ��� t �
, t
� T�:t��� . �� .�� ^ a;. -r , ti ,� . Y �� r,� "a"�€ y�r�'�s�ii� t� < „N, �3 �,� ; � y�� x�'� .� � � ,. �� ' , z ` s� "
�i�� � T ��r� -� 1W;� E ���-�. ' `x`� � � � �� �� tJ9ssx� � � i'
rrr�r�iii �
��
a ) TOte i �+�Irt i �►tt�ii► �� t ' ������� �.. -
r, � J1
+�+�rrrwirwY�Y `����� i i � r � �� �� � p ^ � �/j
. � �� �rrrYiY11W1���f11�Y�� � . .. � � .F � / ..
. . . . ��Yr ��� _
��Y�IY �."�����i t � A �'����~ �� �I�.�,,r� � .:. �,,�� ao'. y.�� ` �Wla 'Lt -
` . .. . . .. ,r!�! .1��f'j'k�t��r.- y_;�' .
�1ti '
b) Tota r � dodr ��ea „ �q �� � +�� � ,�
.......
. °�'�� �, t �. ������� � � .�?
c) total s1 idfRq q:�.s!=x�'�x '' ;�,: _ � , � ��.�� � ..�� ��' � g=: �: _ .�� � -��,�
�:, �
�...r..,,,r�,,,,,,,,, q 1is'��.:► .. t s "� ��++o.�,rr,t�li � �t . �� �t V` "� � �' �" ` �: �Ti+ j �.
- . •��+i��i�iYMM�iYi Y Yr� �" .�?ip�3'f�wa.�s. ��w4a�,l.{?.""r�""r,'��,'° � ,r
. �
' f►�i� �^= � , ; " �r.........rr.r
.,...r.,,,+.,4,r+.., • � c � � �. �ik ,.k d: � f t'.� t1�11 ::
" - � �:.ii.+i�i++.rrrMr� . �f'!�& ,.�� w��?�,�,.i�.�""'
, . . , . '� �.. .. ,. . .
. ,�3K9 , - ��Irty -
,�: � To t a i f i tep l�e'� �hl! � t ie� .w."`_ �q f ti i� `N�'� �-'""'_ ��.,�,,.,""-'
�.�.�..�.......
.;4 e� Tbt�i 1���'. `�t►�N111H� MtN `. ._
3 r
A � ; �. � +; r � �,�
( v!1"�r+�i�' �t!'1'� . . . . . . i . ..: ' �q rt! x �'tl'� ; �a�'� �: .�, ��j L
f) Totai r+�t +urli ar�� ii�w� y rs �•�-.-•...�•� °:��
� �� ��
t asut�t�t'� J�e�: �,..'� �q �� � � '�'' � ��� �. �j �--.,�� ����
_ f � �bi11' � .'. �r , . , .�r�,; � � r _ ; .IGIE��� �Y � .
� � ' —„-�.�,.�+.�,:. ,� �
q� to�.� ���► ����� ��.�... � � ���2�Z- .� � � �.�..1..... � � _ `
�r ,�..,,.,.,...........F �q #� itt� if!' . ..:,��� . ,: � : r ,
Tatat tawirtiett+ei� _ �,
��
4
� ��ea (��+tpos+�d � ��
��....�..�.,.
. �� ,: j ,, . -: � C! � �:.
� �
h) Totat iou�datlot� ,�.,,.�,,,,� . . " � �� . ; ,
a . � ��i � �
� ` � �--�..�� ' �z
MIA�i1 arl��.���������►�� , �`'f( � ��� :; f, i� ; : �.
-�-�.�.,�...�� w�i.�.�..�riw� s-�
�� Tot�t wet fet�t�lat�oh ; " �`°� , . � �' ������ , ``� � . '
,� � . � ' �� t r� � :x�- .. ��,���
;,/) w
i �ea d1�iV'e q i�ld�. �•�� r i`s • V� p f I 1' :
� � x � �.����. U:... �,�._...�._; �+ ► : f
j' � 'N!1'1� a� thra i y ;+� 'Z +�
1f ltear �'� i�t the i�� �!*. sr 1�it! �n ��`iii�i �;.� �pr I�w iwet �I�,,�wl�i� �a�s
2 riCAR 1. i60t� A and 0. .
_ , ,.
. , ;:�� ��-. �. ���Z,� ��,
,.,m. •;�� ;^�, ,�� , � ,� t .
� �.. .. i: ? � :!4 f � . �.:'V� ytil k �f �" ������. �
, , .,: . . , . ,.
�
� . � - . . ..� . _
�'
. . . � ' :4 ��' � ' .
�
,
.. . n. . ., , :�. �. ,, . _ •� �' + "
.. � . � . . � . ` '� � ', . . . . _ .,Fr�,x x.S7`1�1a�`�.il J3 ^ �r n.;_' . . ... Y �i'„�...
G. T�TAL fXa05f:p �ra�iii't�tt:lrtr� ��C�'�t�t�1�S� ' .., ,
thtat ��cp�la� � ;� .{. ,��� `�
�: � �
roa4��'ce t t iruq 1���M.� � , � .�. , �� r � �� #� z ; � � � �
. � 1 � r y`�� '� r,7�f.�e �, msxasr*'�nv.y,«..� a- . € y "�S : rtRy� : ne wi �c '�^"�+ -� � ,�.
. .. � ��I ���,/ 7����� ���'iY6��>1�i .'{� � �� � �?�� � � ykg���q'�� :.,. ,�,���� � fL�`;�:
.�at'�++�'iC a �. ;s�n'��� . +M��Ir71�ll�i� %� �r �
, F
. _ � : � � tPt y 18;'. y 5d ? `v � ��.
k� rori�i �����'��� ���i1� , � ,
(yy�� �� � " �`j�f��`��` �y�i n s, ; �' "' �� t<,. � � ,.».�, i� t
. . � � . ��� �F����R ��� � � r ��� ' �7�� ��I ` lf ���: �.,. 5 d � #► � �,� Y R�3 ..
..
i i! ii i 1. �' . , r' '� �
... ... : ' .�
. ' . ^s ��1U�� s1'!,���
'�� �0��� ' iR� ���11����`� ty`..` 1 {� y+�`wh � tS Y'e41'; 4 . �� • � �� L 4����
. � ���'�i� � � �� ��� � i �°�- � t ��, f L' � ��� ,' � � ,�,�� ..:#r;�1 'y'�� �.�`v;�+'
� .� :
. _ °� � � �'° ,� `" . ' . . � � �t
a. �� � �
�� ���,: ���� ��� � � _, �
I f t o t a 1 o f db 1�` t li+� sa�wie i�� �, .�` '�ii� �tiaA �7 . yew Ita�r! �i� tt� i1i���i� �::=
' "ICAR 1.16008 A :� 0. , ..;.,:
�.;_ � � x
� �+� �- � /' ,' � ���.: r
� �������r,������.� �.��,�. ,z���.
,
�„ ` � � �?`,�
� `�"� � � a �� . .,�R r�. � ,,. � � �.s -wx. � C
. . � . . . _ .�t.q . _ . . . . F }°
-�.��T1Ai�°�u�Lnl�� ` ��. � ��
��� �3�.,
� : �
�. . H � �r 3 . : ; �.
To uc i t t ze th� t�►t�►�' eNVei� `fyst+�an n�thod � ch�t v�iu�s l��t�rbl 1�1Wld �� l�ii srrM� �` yy
of t tems N3 and !►4 shel l ndt !�e greater ths� the sua� o� i,�s _#�� �w+d +��: -: .. ��
1. � : �� ���°�� . � � > ., � �
� .
, _
:, �
. � � - .� „N.�, ,.
� _� �:. ,.. _
�• . '� �.���,�.,,,.y '�.�4. � ' � � t i .�"'�ii .�'. ..
, ,_' ��.;. . .: . � ` .. � „ -
� . ..t.. . :. ,�, . ,
� ...._ �s, ..< "��-- � ...�..�:'YU.'ua.i�'i.:.,..��,.. ���. � .
. . � . . .. . - .,a- xY�. . . . . . .
.. . ��y . .� .._ r p F1 e;� �t R . .. �.k.t p, �'_.j' y � m � ��yf
. . ^,�'aM< 5+ �' . `: RM - +�Y
. . �.�'�,�#M.55t � 4,��3�, a�i�i� '� � „i" i� .��y�,+'�
a Ri= rg�
. - '° �r.�, �s r.r, y���t y�., f= .
�. �
� � � •:�'''.��.ru �;N.�.,,, �� s � �� �, , �;.�, ��_
$ ;,,,
. �s.� y .:
, . -
� �
, a. .
'..�,.�..�&:; �'�� �, :�r.
. �,
,. . � , , �. . .
� �`. i' �
� . � . . � .. . � � t+;:t �;.A fi✓ '�S . " �" i k."'y�'� °'•: � ..
r t�
, ,.�
�,'�rsa°'«b K � nk +
�� �� �:a��� �
:�� R 1`. 1 F 1�� C Il fi t� d� M �. �� ;
. �i � vr .w .w1 ir . ++i► r .� . � � � �. , b y � 'T . L""Y .
I hereby �eewttf� �#r�t t kaw c�ltui�rt+�d ti+ae "U" t���ors ��',�`� '- : ,�> �; ,t.: . ; � ,-
vstues heretn �nd that �Me ;:but idine� hero .desctilHr+� �t� or �x�f ,���t���.� , ,� „ �
of Mi�nesot:r L�h��e�y: Ca���v�a!•iar llt�. - ., :. . � „r ._ . . .....�..�., y `
. �,:�� :�� - � �
�
� qnaturs
. . � ;+•, , � H.<° �S, `"'� w�s'� f c . � ° '� � '� ; °�'`�� �d��x `�+ : �� 's ;;�,.
. . . . . � .� . . x � :�S?-`?'7 �'; °:? t �:h
. . . . . • -� . .
� : � mr��• ...
ti . � `� E1+i te;
♦ ;k �
. . � . . . . . � . . ' .,`ds. � ��, r`a � ( 4 �
�1
��
C
I"J
E
�..�s�
M1S�RUCT i ON
�AMING SECTION:
�MLL SEtT10N �INSULATEO�
-----{1 I�t��lor �Ir /1'
�--_.{2 "
----�3 �� t cn
U � 1/U • _,,,d.
u•tnt•�
�-
RIM JOIST SECTIQN:
� 1 Interto� atr tli� A.RA
2 S'- Tns +L*_im 1�
.�--- : 3 l�r ! �ood
�� -� M ?5 /3� 1�i1 �-t tie 2�06
S �
6 Exte� o� a r in .
FOUNOATION INSULATIOM REQUIREO: `�
Min. R-5 on entire Nall OR `� • 1/It •�`,�t
Mi�. R-10 do�m to frost aepth .
fOUNDATION S£CTION:
1 Inte�lo� •fr ft1� A,RA
2 tvro . „
3
� Exte► o� a r w .
�S
i�
._
� u • � ��R • ._:�i
SIAI! ON GMOE
Unl�ted Stabs: .-.
Min1� R ='�.2� "
.-
. . � : : ' p � •'. •. . 4'' �
��d � � 1�_.�'� �� _ •� �.•.i�r�
�
�
H
a
VENTEO �
• 5.
� . :� �
C����i�� �� � i " 1 "�'��1�. � ,.,
i �+�i�r�s�r �tr fltw ��
2 " P Sr' .. .,
�
� Ext�r o� • r w �t �. !
TAL • �_
u • t�� - �
,.
CE f t 11M l�RI1M I IN� SECT 1 dll s
1
�
M
�
, ,�` .. li � tIR • .�b
w F
CE 1 L 1 Nli SE'T 1011 � 1 NSUl,AT`�`b� i'
1• int��to� �ir fi1� A.R1
2 ...�._.�
3 -
M xter or a � w st .
.
—
- @ +� lllt � •
�.....
f . �
�t
t� i� rMr, �rwrii� 'sECVieN: • ,
1• tnte�io� air�tilw A.R1
� �.��
3 �
� xter o� a �� � st .
S ac so t MooA
�-���� � �-�
,
. I U' • t l/R • ,..,,,,,,.
�, .
.;
, .
��
1 .Inslde alr.f�i�� :, _� ___A.lCt
j��� � _�
� � -� -��i . ' � ��1i�b1�
S Ut! • f . lu .
OAL R�
��
.- ._
. ; U+ I/R�
, �
� P°I�!r h
�r
CITY OF FRIDLEY
APPLiCATION FOR PWMBING AND GAS FITTING PERMIT
m a e u -.Ui .-i ..ki p, Water
� +� � � �C H�.�C1 ro � Q ul ro N a u' Heater
�p � � +� ,�� .�G R C 3 la .0 � 6O6a W �S � M
a� .-�I H � qro +�i A H O.�C .� b N y N b � ro� �
rn u D oa ai m 3 � w m w U m 4 3 c� � c7 o as lec
� T �
lst � �"
�
2nd Z J "
3rd f
4th ,
(R) = Future Connection Opening Connected with Sewer
(*) � New Fixture, Old Openinq Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixturea
Future Fixturea
Old Openinq, New FiYture
Beer Diapenser
Blow Off Sasin
Catch easin
Rain Water Leader
Hydraulic Valve
Sump or Receivinq Tank
qater Treatinq Appliance
Hot iiater Heater
Gas Range
Gas Dryer
N0.
� i
�
—L
�
RATE
$ 5. 00
S 3.50
S 1. 50
S 4.00
g 5. 00
g 5.00
S 5.00
S 5.00
S 5.00
s �.00
$ 5.00
$ 10.00
$ 10. 00
Back Flaw preventer pequired. .. Yes ( I �( )
�e S 5.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
18 of Value of Fixture or Appliance
lLeinspection Fee $ State Surcharqe
($15.00) TOTAL FEE
TOTAL
S'_��` dl�
S
S
S
S
S
S
S
S
S 60
S .00
S
S
S
S
S .50
S �� so
Effective Date May 1. 1988
Job Address �� o �e 1 1� IL- � jj r.J
Department of Buildings
City of Fridley
Tel. N571-3450
The undersigned hereby makes application for a permit for the work herein
specified aqreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildinqs, and hereby declazes that all
the facts and representations stated in this application are true and correct
Fridley, Mn. _ g � / � ly ��
«�R �o �`; r �- L ,�..f�t.o .�
KIND OF BUILDING �Q� ��j �Q
USED AS
TO BE COI�LETED ABOUT � t'�_t' ��
ESTIMATED COST _ ��[j� � ••a
OLD - NEW HUILDING PERMIT NO. PERMIT NO. ��%� v
f
��nY � � v ( G c} `�d ,� S � • r��[+�
siq�ed By � �lp� �
��. �. '7 8 � O 5' S�S�
ROUQi INSP.
Date
FINAL ItJSP. � � ���
��
APPRaNAL FOR PERMIT / �
�1INIHUM FEE FOR ANY PLUMBING PERMIT IS E15.00
PLUS THE $.50 ST?1TE SURCHARGE
RESIDEhTIAL
CITY OF FRIDLEY Effect�ve oate May l, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATIQN AND
AIR COND1TlONING SYSTEMS AND DEVICES
RATE SCHEDULE
` RATE TO'PAL
Furnace Shell and Duct Work,
Burner (Also repl�ement furnace)
Gas Pipinq
(pipinq needed wlth new furnace)
Gas Ranqe
Gas Dryer
• Air Conditioninq (all sizesl
All Others/Repairs and Alterations
18 of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
li of Value of Appliance or Work
S 20. oa S��o, 06
S l0.00 S /���
$ 10.00 $
$ 10.00 $
$ 10.00 $
State Surcharqe
i������1='
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp. .� -�.- p /
Date
Approval for Permit /�
MINIMUM FEE FOR ANY HEATING PERMIT IS �15.00�
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard withouL
written pc=mission frm► adjoining reighbor.
S
S
S .50
�
s �O . S�b
Job Address j �J� �_�����I'� �/� � ���
Department of Buildinqs, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Tel. $571-3450
The undersigned hereby makes application for a permit for t�►e work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulinqs of the Departyaent of Huildings, and hereby declares that all the
facta and representations stated in this application are true and.correct.
/ �� � �-.
Fr dley, Minn. �1 � , 19 t°
-T
OWNER G�,vYL/1 C � �-19--�� �
U - " `' � 'I /
KIND OF BUILDING /� 1'�.� LJC�-'P,F' ,( _� Y7��
r�
USED AS
TO BE COMPLETEI
ESTIMATED COST
OLD - NEW HUILDING PERMIT NO. PERMIT NO. y���
DESCRIPTION OF FURNACE/BURNER
HEATING or P�IER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name
Capacity
Total Connected Load
Size No.
Sq. Ft. EDR BTU
Kind of Fuel
HP
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
, .
'/;
oompany l'l' -
Siqned By ' ', '^-
Tel. No. L ���iv 7 �7
Fill out back side for stack verification on replacement furnaces
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE � fU
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
_ _ YOUR E-MAIL ADDRESS I 1� �'G�
❑ OWNER CONTRACTOP
NAME: S S S Y1
ADDRESS:� �� C'Y
PHONE: (9� a- � � �' d �%
COMPANY NAME: � CCL
CONqT�A,CT.� ,P�E�RSON: t_.QQ �
STA'1'� LIC�I�E # � �3 � �� l �`
ADDRESS: ���5� c'�T..-�C4'
PHONE
SINGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY
Permit No..'�I��C �b 131
Received By�
Dat��d� � IC� � �
r �
s,� ci� 1 -C�.,
L
rL-Q
EXP DATE g � c'-�" � Ci
�AX � 'w�ITY O �
❑ TOWNHOUSE
� ALTERATTON/REMODEL
.� A�v, n � o � ..� i- ,
STATE ��ZIP �JS �
�
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVi�
PROVIDE HEAT LOSS CALC'S PER MANUA 2006 ASHRAE HANDBOOK c,� �
EquipmentInstalled MFG: h� � MODEL:RU �`-��5 ,.''""1SIZE/BTU � v �
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
_A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 t�-FCJRNACE $35.00 GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $I5.00
I{Ttt�iber of %t�itre�` � $14.90 �.$1±0:44 � $ . " �:x g��� � ` � < _ ` ��.
�.'; � `� _ �� ' '.�
� . 1
� �, �,� = . ., ��= �-.� . �t���, �, .
Number of fixtures @$15.00 x 515.00 =$
Number of fixtures @ $25.00 x $25.00 = $
�? O
Number of fixtures @ $35.00 � x $35.00 = $ �
State Surcharge = $ .50
-� S�
(MINIMUM FEE $35.50) Total = $ ! �� �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
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 ity of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applicati n for a " it d work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all rk ic res review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME L PP- C �'�-L DATE � lD
APPROVAL INSPECTORS SIGNA drE� � DATE
PLEASE NOT�: SEP ` TS ARE RE UIItET3 FOR BUII.DiNG, $I,ECTRICAL ANT) �CI�A1�i1�A'�-. �URK
�'$-uilding Inspections Departmen�.
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
�