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AF - 47689BUII,DII�TG PERMIT Village of Fridley, Mi_n.n. N� 211 � • �. ' Date � �.�c:j.l�:............ ............ Owner .���� �': ''.'r';!�!: . . . . . �'�. �-'. . 6. . . . . . . . . . . Builder . .� :..•!e�' p'`.�r".`""� . . . . . . . . . . . . . . . . . . . . . . . . . . . �,_ � Address . +�,;; � . '�.�`. .��. �`�'.': . . � ��. . .�,t : �',/: . .�a�� Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LOCATION OF BUILDiNG ,.; � �f � ;� No. ... �.�. � ... Street .r l.�t�C��C�f.�.. . �.-�.. . Part of Lot . .. . . ...... ...... . .. .f � ��j / � „ ... Loi ..... .,.��...... Block . �`s�r. ..... Addition or Sub-Division ..�if(...�:je��''.�.'..b!':��^:"_C _.... Corner Lot . . . . . . . . . . . . Inside Lot . . .�. . . . . . . Setback , �.; ~�,!�� Sideyard .�'.�ti. :'.�ff�4, , , , , , , , , , , , , , DES�RIPTIOI�! OF BUILD{NG To be Used as: . . � f D"�" �`�: i' . '. . . .,d,r'�. . p " ' :� g % .�iw'. . . . Sq. Ft. . . . . . . . . Cu. F't. . . . . . . . . �5,; (,. Yc.: Front �. . De th . . ��. . Hei ht • �'� �"'.�.�... ' . . '°`.`� Front �,�,, . Depth . .� � . . Height . . . . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . . 1�`� .�"4� .s r 11�� . ,� Type of onstruction ;�� . �,{;, t ,,: . . Est Cost �3. �. . . . . .�,,. . . . . . . . . . To be Completed �F.:��.,�.-: �. � .� � ��F �t�'� ,...,-1��+L�� ^ ,,.�,,���,. i�t• �,��c r.� � �,ti�r�'" f In consideration rrf the i�ssuance 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 �'ridley. � `� �� � / 1 � � consideration of the payment of a fee of $. ��. .., permit is hereby granted to ��,�� ��,�,r/: ,, • r!.'.,. .�,/ . . . . . . . . . . . . . . . to construct the building or ad dition as described above. s pe t � ia �anted upon the express condition that the person to whom it is granted and his agents, employees and worlunen, in all work done in, around and upon said building, or any part thereof, shall conform in all 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. j. ' ��� /7 � y �h�. �, P t �:. r .�' v ,�y�,,,� . �rz{ „�,. . .. . . . .,�. . :� 1C. e�1l; '�J.A�1111f11T3g ZYLSp@CiOT NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspectbr for separate permits for these items. �. �, � .� sue�ecT IT NO. City of Fridley � 16 3 7 7 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r ; � RECEIPT NO. � ' COMMUNITY DEVEIOPMENT DIV. �� � � � �: — • r � � PROTECTIVE INSPECTION SEC. l� � � -_-_ A �����,,, CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV i' � � 612-571-3450 910-F15 9/10/81 � � JOB ADDRESS 6370 Jefferson Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 4 Christie Aeldition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Richard Ht. Blooau 6370 Jefferson Street N.E. 571-2377 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Elk Si ' & Oonstructi.�n 13977 - 91s.t Street N.E. Elk River 441-4877 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENOINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X S DESCRIBE WORK IriS'�31 S. � CZ � 9 CHANGE pF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. S'�EP.1 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED 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 LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2/��Q $�'.24 • 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 O THE PERFORMANCE OF CONSTRUCTION. $3SsSO asi�� ' ��/� PLAN CHECK FEE TOTAL FEE � `�� $39.74 SIGNATUREOFCONiRACTOROR UT OR�2EDAGEN IDATEt WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT SIGNATURE OP OWNER �IF OWNER BUILDERI IDATEI -'r �°_� BLDG �NSP � DAT CITY 0� FRIDLCY Effective Aug. 1, 1981 APPLICIITIQ,J FOft RCSIDEi�TI1lL QUILDIt1G PEfL'�ITTS (�de►•l, Alter.�tions, Additions, or Repairs) OtJCdER: �iG��/�Yi7 P�� ,�/a�IYI I3UILDER: ��,� ���(���f�� � G c�t/S�— T.. ADDRESS: J�.3 �[� � c/—'F�f�.�'c�iY l�l� ADDRCSS: /.�i 7� ��s,�N� ��li�'[ �°1��� TEL N0: .r-'7 1�3 7� TEL ��d0: ca(�c� ��7,� _ 7s°� =��'� :g_ Consi:ruction Location STRI�T NO : lOJ �(� STFtEET: c� ���SON LOT: . � SLOQC : � ADDITION : C�Ft,�! S j / �., � D {� Corner Lot: Insicle Lot: SetbacY.: Sideyards: Ap�licant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIOid OF COP�STRUCTIOPd �S � Front: Depth: Height: Square. Feet: Qibic Fcet: Front: Depth: Height: Square� Feet: Cubic I'eet: ���� 7�y,pe of Construction : - ` - _ � Zb 8e Q�r,�pleted: EstimaL-ed Cost: $ ,���0 • � v Alt. A Alt. B Proposed Drive��ay Width If New Opening Is Desired: $' $ SE� REVERSE SIDE OF SHEET ZRie undersigned hereby ma}:es application for a permit for the work�herein specified, agreeing to c� .all work ir� strict accordance with the City of I'ridley Ordinances �azd rulings of tlle De�-trl�t�n� of Buildings, and hereby declares that all the facts and rapres�ntations stated in this application axe true and correct. DI,T�: %y - %O �- c�� SIGNnTUFtE : Stipulations: � g . �� �. � �. ��. �� BUILDI•NG PERNlIT FEE SCHEDULE The Inspector of buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any bxisting buildinq or structure, or for any alteration or repairs to any e$isting building or structure, upon application therefore, require the payment by the applicant f or such permit of fees to the � amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUATION $1.00 t� $500.00 $501 t�o $2, 000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 FEES $10.00 Minimum Fee $15.00 plus surcharge $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000 $32.50 for the first $2,000 plus $6.00 for each additional $�,000 or fraction thereof, to and including $25,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 and up $443.00 for the first $100,000 plus $2.50 for each. additional $1,000 or fraction thereof PLAN CI�Qt: 25 percent of building peYmit fee DRIVF�TAY D�EPRESSION ESCROW: Concrete C�rb Streets Only Alternate "A": Removeal and replacement of curb and gutter only Driveway width plus 6 feet x$13.50 Alternate "B": R�oval and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth Driveway width plus 6 feet x$15.75 VERIFICATION OF F4UNDATI�ON Permits for construction will be issued a mini.minn of 24 hours fro�n the time of application to allow for proper review of the pro,posed structure and di the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceed3ng with. the framing. * � � D m �'�* � z � o N 7 � � a, m co n -. _« ,-i 3• � o N_ � Z y � � m ,� � m 3 � � -0 V � O p � O .� _' � QR n N � � O �• � � (D y � n- o CD � � . � Q . � 0 c � D -� � 0 < m a � O C O�C' � � m � D N �� �i -� m r � � . -� � �. :� d"_ . . . , � : _ _ !�i �� � � � . 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S � n � � Z i �mv o��-°;. m fD m � D � �p ,..r _' n � G Y�t —� n� � =� � (n c�p � m y rn c�D p_ � o N' Q- C!1 D Z �� Z� � � ° � � o m � � � inA . . � �- � .� . .. p a mv z ... . p ... . � . c� � rn ' o � �N n � � � Q rr � 3.. _.%n . � C. Z. .. . � . � � � ..�+ . .. **' _ O.. �� o �� �.o . . p� Z . a �� �- - � �- cu:=�... • � - ��� s .. .v. � mc?�D � .,- : _ � � o _ __ N o � _ ._� ^{ �, - Q ? 3 � �D � � � � C. � �. 7 � � � r v_ Z � C � m � � � v c 0 � � '6 � S � � � T � n W O' W -f F-+ cn =� C � V � �v��•-n WZcp � rn � o � v'�c m � W < -< ' N m Z z� rn� m n -i 0 Z � C N a � � z '� r �� � O � Z m .,, �O �� O � Z � 2 � v aD �Z . Q N G Z � .� v o �Dr��l Z W Z -� 3 D '� Z � �n cn m p � 3r N Z L� vm � r°n � _� < (J N � � 0 � ? � � � � � m n .+ --- _---� _ 0 < m 0 _ . ` � � c d � � � N O O N THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED �OMM(]N VFNT, VFNT CnNNECT�R AND C(�ME3l1STInN AIR VFRIFI(:ATI(�N � When r� �n acing an _xie in8 f�ranr_e, 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. The unde�signed 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 Fumace Venting Tables for fan assisted and natural draft appliances. The pY��+��A ceme�,.;t�en ��r is sized and installed to meet the current codes and manufacturers specifications. V1/hen required to inst��� a npw _emhu�en air�,it will be sized and installed to meet the current codes and manufacturers specifications. Yes �j�j No ( l� Yes (�`� No ( ) Yes � No ( ) Yes (� No ( ) WhEf1 inctalline a new ��entina e�c�t�, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does inGude 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 () � • • . � ' • ' . � • - • 11 11 • � - � . � • ' / • � � ' M • � • �11 . 1 • � Appliance #1 Type ,� � BTU Input f�T Fan Assisted or Nat � a�" Appliance #2 Type BTU Input - Fan Assisted or Nat '� Appliance #3 Type BTU Input Fan Assisted or Nat o a ppliances -- — --- . "Total B�u Inpuf - - - - - Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ��� r - � r.► .- ..- 7356? CENT�iL AVE. �N.E. HEATING CO: _ . ANOKA MW 55304 Signed By: -C�aden. � • �v�-�-- Date : � �' ��� -��- HEATING AIR CONDITIONIIVG AND LECTRIC, INC. ADDRESS � �— OCCUPANT � � HEAT LOSS DA,7`E HTG.BIA�ST. SOLD BY e�s �e h! `h��eo Elecuical Work By � 1 � TYPE OF HEAT GA FA � HW STEAM SPACE HTR. � _ ► _ � 9 � , t+ � ,% _/ V�_,� i.�.� ��i. � , iy�������1���:�� �' � i . � i�-.r3 � "� � ��4'Z�iL., CONTROL3 ., , � �, �' 61OUSE HEATING TESi FiECORD � APT. FLOOR CITY SUBURB OWNER INSTALLED BY � `�:°e P� Gas Line By / 1 1 UNfT HTR. OTHER �f V@nt S'tZB KIND OF LINER -- Draft�fiood _ C«•12V'I���3[•721 SIZE �' NONE Regulator Filters Size Itc�J� :J-S x 1 Number Chimney Location Inside �,,� o Outside Heat Plug ^ Chimney Consvuction Limit Setti � � � Fan Settin Pilot Type .� Pilot Make �- Pilot Nbdel PilotTiming e%� 1°C L.W. Cut Ott Pressure �_ � � s � • Peraent COz Input CFH�� .�� � Percent OZ �� o Stack Temp. �� Percent CO S-i�'��%� Smoke Bomb wring Draft !� %� Test Tag Door Pressure Lighdng Inst. Date Tested � �`�- Company Testing � Name of Tester Pressure Peroent COZ Input CFH Peroent OZ Stack Temp. Percent CO From: Cityof Fridley To: 651-982-4587 Page: 4l5 Date: 7/2712006 3:37:06 PM Builcling BUILDING P��t No.: �d�`� � �' ' ° Inspections itESIDENTIAL APPLICATI4N Received By: 763-572-3604 � CITY OF FRIl)LEY __ � vate R.ec'd:��.� SITE .�T' DRESS �Q�L�_(� ��f� THIS APPLICANT IS: ❑ GWNEIt PROPERTY OVVNER/ N��: TENANT �pD�ss: CONTRACTOR SUBMIT A COPY OF YOL'R STATE LICENSE VeTIH APPLICATION PROPERTY TYPE I � �1__;i�l��t� �'���1 YOURE-MAII. ADDRESS �• :� I�.�.r.�--. rl�i L�SrI� � ; �i � - = /� — ' � � ' �%"�� ✓�.� � . . i, � .� r . ❑ BASELIENT FII�IISH .�gOF ❑ DECK � SIDING ❑ S4\'IM.MING TYPE OF `'VORK: I 4 ��' S.z�' _��T't�1�'(�.�.._ U r�.� Is C EXP DATE J�'� �%P �__CITY �.��� %QZ��� stzE sTOx�s ❑ v+�Il•1DOW5 ❑ DRAIN TILE ❑ OTHER �� STA'f�/� _�� — -- ---_ ----r-- ----- DESCRIBE WGRK BEING I�ONE: - SIZE OF IIvIPRC��'E_LIENT ENGTH WIDTH HEIGHT RO�FING � ❑ HOU3E ONLY TE�Z}���` Ft. NUA4BER OF SQUARE3� _ ❑ HOUSE &(3ARAC�E HASEMENT REMQDELI�TC� SU$MTT: GARAGES ❑ A1°TACHED GARAGE 1. Er.isting Floor Flan PROPOS� SIZE: ❑ DETACHED GARAGE 2, Proposed flouC plan PROPOSFA HEIGHT: 3. List of structural members to be used SIDING FOR NEVV CONSTRUCTION INCLLTDING DECRS. ❑ Virryl OSnffit ADDITIOKS_ � PORCHES SUBMIT: ❑ Alumimiea ❑ Trim 1. 3ite PIan/Snrvey shoa ing the existing structures ❑ Ottier O Fascia and proposed project. y��Dy�� 2. ltvu sets of conswcKion p!ans IN EX[STII�Q OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energ} Calculatiot�s OR FOR NEW C�PENINGS-DESCR[BE SIZE OF OPENING CHANGF� & TYPE OF U4'NDOW TO BE INSTALLED NUMBER OF WA��OWS ALL FEES ARE BASED O�T �ALLATION, INCLUDpNG THE COST OF LABOR AVD MATERLt1LS: (USING "E 99 T; C FEE SCHEDULE) TOTAL JOB VALUATION S� _ •�� .00CL'P.�11TC�' TYPE Pamut Fae $ �� ,��' See Back Page for Fae Schedule Plan Review $ 65% of Build'a�g Permit Fea Fire Surcharge �}�' .OGl times tha tota.l job �aluatian Surcharge $ �.� .0005 x Permit Valuation I�iinimum $.50 License Surcharga $ �.� �S.OU (State Licensed Residential Conttactora) 5AC Charge $ __ ___ ___ __ $1550 per SAC IJnit tPlens to M�ti'CC for determination) f'urb Cttt Escrodv $ i{ + 6 ft= ft x$21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Datarminad by Enginaering 5ewer Main Charga $ Agreemant necessary ( i Non Necessary ( j Total Due $ � ,� Malce checks payable to: Cityo uf Fridley 4ttach Sdpalations THI5 I3 AN APPLICATION FOR A PERyIIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that tha information aboye ia complete and accurate; that the wark will be in conformance vPihh tha ordinances and codes of thz City of Fridley �d with the l�Zinnesota Construction Codes; that I understand this is not a parmit but only an application for a parmit and evork ia not to start without a permit; that the work will be in accordance evith tha appro�ed plan in the case of all work w i equiras re�iaw and a val of plana. SIGNATURE OF APPLICANT _ ! �__ ���-L—PRfNT AAME __ DATE ------ —7— From. Ciry of Fridley To: 651-982-4587 Page 2- Building Residential Application Page: 5!5 Date: 7127I2006 3:37:05 PM BUILDING PERIVIIT FEE S(;HEDLTLE The Chief Building Official shall, before issuing permits for the erection of any building ar stnicture, ar for any addition to any existing building or structure, or for any alteration ur repair to any eaisting building or structure, upon application therefore, require the payment b}� the applicant for such permit of fees to the amount herein belo�a� set forth and in the manner herein provided to-wit: � TOTAL VALL� ---T FEES -� �$1 to $500 $23.50 (Vlinimum. Fee is $23.50 plus swchargz) $501 to $2,000 �23r50 for 18` $SGO plus $3.05 for each additional $1 UO or fiaction, to and includin $2,000 $2,G01 to $25,000 $69.25 for 1" $2,000 plus $14 for each additional $1,000 or fraction, to and � includ'm $$25,000 � $25,001 to SSO,OOG $391.25 for 1"$25,000 plus $10.10 for each additional S1,G00 or fraction, , to and includin SSO:OOU $50,001 to S1011,000 $643.75 for 1°� $50,000 plus $7 for each additional $] ,000 or fraction to and � ir.cludm $100,000 $100,001 to $SOO,UOcI $993.75 for 1$100,000 plus $5.60 for each additional S1,000 or fraction to and includin $500,000 $500,001 to $1,U0(1,000 $3,233.75 for the 1�$SU0,0�)4 plus $4.15 for each additional �1,UC10 or fraction to and includin $1,000,000 I$1,000,001 and up $5,608.75 for the 1"$1,000;000 plus $3.1 S for each additional $1,0(m or fraction VERIFIC:�TION OF FOUNDATIOn Permits f�r construction will be issued a minimuin of 24 hours from the time of application to allow for proper review of proposed shucture and of the construction site. A Certificate of Survey of the lot, show-ing the location of the existing foundation witl be required before proceeding with the &aming. New I€ouses Onlv City of Fridley Building Inspec�ions Departinent 6431 University Avenue NE Fridley, MN 55432 763-372-3644 Fax: 763-502-4977