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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: Owner: _.. _iOle _ r der Address Address N�/4987 CATION O U G No. ---. _ Street-�•.•• �' . s Pari orf I , Lot .. ............... Block _..._......"'------.......--- Addition or Sub -Di --- ............. - Corner Lot ......_.............._. ......... Inside Lot .............. .._................. Setback....._..,�..,,�...._...._........ Sidey d....._.....:....__.........._........_---........................... Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To d as:�' 1�:_.. Height ...:".. Sq. Ft.6rCu. FtWl�AbUU _. _ Front ..._..__.._. Depth .. .........----....... .............. .............. .-....... .. Depth .......... He' h ........._._ Sq. Ft. ..................... Cu. Ft. ................. C1 Type of Construction ......:-'..... Est. Cost....,t' _•----....' ..._"''_"..� To be Completed ....---•----....._ .............__. 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 city of Fridley. In consideration of the payment of a fee of $91.1 ................... permit is hereby granted to. ..................................................... ... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom 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 all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time up�oon violation' o%any of the provisions of said ordinances. al.f/ Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. er 4 APPLICATION FOR BUILDING PE%MIT CITY OF FRIDLEY, MIAINESOTA LOCATION OF BUILDING No. 5:S egl Street Jzz/i&of Lot Lot_ Block �— Addition or Sub.Div. Corner Lot, side Lot --'--Set Back Side -Yard SEWER ELEVATION _ FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING Front Depth Height,,,,_,,, Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction �<�-e—Estimated Cost To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated 3n this application are true and cor*ct. ---2 , DATE IGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK CIV Number, Kind and Location of Fixtures Location h n .r1 W TOTAL y� I- Number Fixtures ......................� a ui °uhf Future Fixture Opening ................ w Z Z W �O °7 ` N WATER HTR. GAS ELEG +� 3i7 $ <� Water Heater (Up to 200,000 BTU) ...... x 2.00 3� o� u� LL� V3 �d �gu GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $��_ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code ss Description ................................................ ...................... $ TOTAL FEE Base � l 1st 2nd _ 3rd 4th • Future Connection Openings Connected withI Sewer � New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL �d So Number Fixtures ......................� x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $—A. " New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $��_ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code ss Description ................................................ ...................... $ TOTAL FEE City of Fridley: The undersigned hereby .makes application for a permit for the work herein specified, agreeing to do all work 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 ares tru allgrect. Fridley, Minn. 19_ Owner X1 44- C, A/Y �3L oras Kind of Building �2 Used as Gv. To be completed about Estimated Cost, $ Old—New. Building Permit NoPermit No. Sign e�+I0ND N PLUMBING CO - By Y Business Phone No ROUGH % '-/ - �- / FINAL az 2M 7-59 City of Fridley, Minn. BUILDING PERMIT Date: _ June 21, 1965 Owner: Orville Nelson Builder N° '79'74 Superior Concrete Const. Co or Oriville Nelson Address 5381 Madison St. N. E. Address 5381 Madison St. No E. LOCATION OF BUILDING No. 5381 Street Ma. Bison Street N. E. Part of Lot Lot 1 _ Block 2 Addition or sub -Division _ Temple Terrace, 2nd Add. Corner Lot _ Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost �/�_ _ To be Completed New Det. Garage In moderation of the issuance to me of a permit to construct the building described a e I to do the proposed work in accordance with the description above set forth and in compliance wi ail ons of ordinanc:ea of the city of Fridley. _aG In consideration of the payment of a fee of •00 , permit is hereby granted to Superior Concrete Constr. Coo to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it pisargtranted and his agents, employees and workmen, ffi all work eq Minneso u?X1lem city limita��anpermit may be revoked at any time upon violation of any of the provisions said NOTICE: 766 poemh does not ower the condrueHoe, huhlindw for wh s pimebine, gn hanthm ewer or order. Be erre to sm the BWMbg heostar ter aparafe p wff&s for thea hams. Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificate's. DESCRIPTION OF' BUILDING To be used as Frontes a Depth —Height, fl Sq. Ft. r .'b�� Cu. Ft.._ Front Dept ��Height, Sq. Ft.Cu: Ft.. Type of Construction_ i Estimated Cost To be ' completed' 9,0 The undersigned hereby makes application Ior a permit for the work herein'specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances au& rulings`bf the Department of Buildings, `And `hereby declares that -all the facts and -representations stated'in this'applicat.iori are true and'correct DATE ► a SIGNATURE 'CU (Schedule of Fee Costs, can be found :on%the Reverse Side). 52-84-S915.51 City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK 5381 N E Madison St Number, Kind and Location of Fixtures Location - �+ 0 11 zrz 6z o= nab u�0 0 • u�z `U' F + N WATER HTR. GAS ELEC. 4-; U 1 in 3 D u� LL U< 3 Ua' c (`'J c O Base I Dryer 1st 2nd 3rd 4th • Future Connection Openings Connected with I Sewer E] New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ...... ..................... Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ NO. RATE TOTAL — x $1.50 $ — x 1.20 $ — x 1.00 $ — x 3.25 $ — x 2.00 $ — x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ gas Dryer 1 2.00 REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ 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 of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn 8-30-66 19— Owner Will Swanson Kind of Building frame Used as Vrdo To be completed about 95-66 Estimated Cost, Old—New. Build ROUGH FINAL TOTAL FEE $ 2.00 a 2 Business Phone No SUBJECT PERMIT N City of Fridley O - 2 7 AT THE TOP OF THE TWINS BUILDING PERMIT ECEIPT NO `y ____._ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. `! 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/20/79 JOB ADDRESS 5381 Madison Street N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 1 Temple Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Hassman, Robert W. 5381 Nadison Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE_:' LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct ' x 231 1 3c 12' Dining P om Addition 9 ,CHANGE OF USE FROM TO STIPULATIONS y p TATE PERMITS R%.%Cu 'D FOR 11�iR1 jjEA'nt4G, PLUMBING AND SIGNS. WARWO B-efm Qigenj call Ind utilities TELEPHONE - ELECTRIC - GAS Etc. REQUIRE© BY LISW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 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 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 $12,450 S6.23 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 THE PERFORMANCE F CONSTRUCTION. $75.00 NONE PLAN CHECK FEE TOTAL FEE NT ACTO OR AUTHORIZED AGENT ID I 18-75 WHEN PROPE Y VALIDATED THIS IS YOR PERMIT ('GN$lUREO / - BLDG INSP OAT IG ATURE OF WNE IIF OWNER BUILDERI ID 1 CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PEMITS ' (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: �/ �s� .� zo BUILDER:Address: S-3 p/ .L4 X -r 6 � S7l �� Address: Tel. No.: 0 0 No.Street:- LOT: z BLOCK: ADDITION: CORNER LOT: IN SIZ ,�P LOT: SEMCK: SIDEYARDS: ` ,� Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: � / Front: / Depth: • - Height: If, 1P Square Feet: 2 'z- Cubic Feet: 2 e33, Jv, Front: % Depth: / ti Height: Square Feet: Cubic Feet: 13 v y/ Type of Construction: To Be Completed: Estimated Cost: $ 24 ySd Alt. A Alt_. B Proposed Driveway Width If New Opening Is Desired - $ - $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified. agreeing to do all work in strict accordance with a City of Fridley Ordinances and rulings of the Depa t of Puildin s, and hereby declares that all the facts and represe at' ns state is this application are true and c rrec See reverse sid fo on 'nformation. DATE: / 71'V SIGNATURE: Stipulations: 1Vy 3S�z O'�X' 2S3 = / 1141 -v X128 Oso . POL oo . PLL P.e t,Z3 . 4 0,;-�g a 124ERGY C014SEIZVATIO14 SUPPLEMENT TO BUILDING. PEk14IT APPLICATION 1'I.ANNJN(: AND 114:;1'1171'1014 I�la'Al"1'Mlal'1' CITY OF PRIDLI:Y, M1NNE'SOTA This :supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING O1•'F JCIAL can detcrmi ivi, tliat: :;u1.)initted plans canply with the ENERGY CONSERVATION DESIGN CRITEFdA of the: STATE BUILDING CODE (Section 6000) . It is the APPLICANT'S responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA in the plans; submit product specifications, if needed to support the "R" and "U" factors used; and to assure construcL-ion is per approved plans. JOB LOCATION: - S^_3 Y / .l' o , - r71 - - - OWNER/ (tet/. ./ / .Vs ADDRESS: -5--3 el ;W /• f o •v -r � �.� PHONE: 3,:? % LU- -5-6 A. Determine the Total Exposed Stall Area as follows: 1. Total wall window area 2. Total door area 3. Total sliding glass door area 4. Total fireplace wall area 5. Total wall framing area (average .10 0) 6. Total net wall area above floor(average 90%) 7. Total rim joist area Subtotal: Total exposed wall area above floor £i. Total foundation window area 9. 'Petal net foundation area above grade Subtotal: Total exposed foundation area GRAND TOTAL EXPOSED WALL AREA 3 5 , e RT 31P. / s9101---/ ;7- y Al. o 7'e, e 9. s c5f 71 s /0 344 B. Multiply the GRAND TOTAL EXPOSED WALL AREA X .17 C. Determine the Total Exposed Roof/Ceiling Area as follows: 10. Total skylight area 11. Total roof/ceiling framing area (100) 9 12. Total net insulated roof/ceiling area / GRAND TOTAL EXPOSED ROOF/CEILING AREA `l ?o Item I 175. 3 �� D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 = Item II 2 �/, .- l:. Ik l� rmin�r Uw "U" value of each f.expnilt (1-fj) :ind multiply by the area follows: as 1. x flu" a 2• x "U" a s 9. X "U" _ S. X "U" 6. X "Un o 7. X "U" a. x "Us. _ 9. x "U" _ ADD 1- 9 FOR TOTAL WALI. SEGMENTS = ITEM III F. Determine the "U" value of each segment (10-12) and multiply by the area follows: as 10. X fluff - 11. x "U" 12. x "U" _ ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS - - ITEM IV G. If Itcm III is the same as, or less than Item I, you have met the intent of State Building Code 6006 (c) 2. 11. If Item IV is the same as, or less than Item II, you have met the intent of State Building Code 6006 (c) 1. I. Add Item I + Item II a J. Add Item III + Item IV a K. If the sum of Items III and IV are less than Items I and II, you have met the intent of the Code for total envelope system. The undersigned, as applicant for a building Permit, hereby affirms the above infoimation has been prepared and submitted by himself or under his direction, hereby acknowledges the information to be correct and accurate; and hereby Presents the information with required plans in support of the building permit application. By. DATE: CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures- 3 $ 5.00 $ /S.DCJ Future Fixtures $ 3.50 $ d Water y a°( .ei pp $ E r. -A rd e M m ed w 004 . [•, � $ Heater Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ M Sump or Receiving Tank �g $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range 5 x U $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS u o It of Value of Fixture or ai G g U 3 $ .50 Reinspection Pee $ ,tea s lec FA ($15.00) TOTAL r o� 3� w° Q[ir ru a� t3 7 t`� b lot' 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures- 3 $ 5.00 $ /S.DCJ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser S 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Pee $ TT ($15.00) TOTAL FEE $ Effective Aug. 1, 1981 Job Address -?,P/ Department of Buildings City of Fridley Tel. $571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. - / l , 19,q4 OWNERS KIND OF BUILDIbkG USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - BUILDING PERMIT NO. PERMIT NO. F Company .///" Signed By� Tel. No. S 2 ' �� 7 - ROUGH INSP. Date FINAL INSP. 6 ` 1- -Z- Date Date APPROVAL FOR PERMIT A�4,A MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE Q SUBJECT PERMIl City of Fridley 7 4 9 AT THE TOP OF THE TWINS BUILDING PERM I T i 1 • _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ' /-'-1 CITY HALL FRIDLEY 55432 I'' NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-1715 I 5/11/84 I I JOB ADDRESS 5381 Madison Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Temple Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Bob Hassman 5381 Madison Street N.E. 572-9264 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Salve 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 ❑ NEW ❑ ADDITION QALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish Otf Basement 9 CHANGE OF USE FROM TO STIPULATIONS LEPER TE PERMITS REQUIRED FOR WiRMG a�Ari�r. Pl. IIMFUNr, Anon SIGNS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 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 PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND 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 OF WORK WILL BE COMPLIED $2,000 $1.00 WITHKWHETHEZHEREINNOT. THE GRANTING OF A PERMIT DOERITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROOR LOCAL LAW REGULATING CON- $32.50 STRF CONSTRUCTION. PLAN CHECKFEE TOTAL FEE �/ $33.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT",01(DATE) WHEN PROPERLY LIDATED THIS IS YOUR PERMIT a ��BLDG IN5P D E SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) NEW [ ] City of Fridley Effective 4/1/84 ADDN. [ ] FR -1 AND R-2 ALTER. [tom Building Permit Application Construction Address: g 3 . 's S f Legal Description: Z Property Owner/Address: -rs -�3� ol.� S �✓��Tel. # - 72 -92 ej Contractor: 'C'og- /i Tel. # Address: 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 GARAGE AREA: Length Width DECK AREA: Length Width OTHER: 1�+N aS H nF ;5 5 _ Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: WOO �7p E— Estimated Cost: $ Approx. Completion Date: '2- A o -S Alt. A Alt B Proposed Driveway Width If New Opening Is esired: See Back Page for Explanation DATE: -r1�e� APPLICANT.. r� Tel. Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ 7z.so Fee Schedule on Reverse Side $ 25% of Building Permit Fee $ $.50/$1,000 Valuation $ $425 per SAC Unit $ �� Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] d I., SUBJECT City of Fridley 31301 AT THE TOP OF THE TWINS BUILDING P E R M I T r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. :Rdy NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 8/11/0 JOB ADDRESS 5381 Madison St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 3 2 1 Temple Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bob Hassman 5381 Madison St NE 3 CONTRACTOR Contr. MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings 6331 Riverview Terrace, Fridley, MN 55432 574-9966 4051 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 ❑ NEW ❑ ADDITION ❑ ALTERATION? REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Tear Off and Reroof House and Garage 27 sq 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING 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 1 ISTALLS 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 r WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,360.00 $1.18 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- Fire/SC $2.36 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $83.25 PLAN CHECK FEE EE TOV1.79 ef//f Oct Licens S $5.00// SIGNATURE Of CONTRACTOR OR ALI&ORIZED AGENT r ATEr EN PROPE Y ALIDATED HIS IS Y UR PERAAIT S-GNATURE OF OWNER. -F OWNER BUILDER. iDATE, BL ,Ngo IF OA TIF I., NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 1-3F / 1p ` 5',aAt Legal Description: Owner Name & Address: -6 d A/ Tel. # Contractor: 'r c L A R D Alc S MN LICENSE # q®� f Address: X331 f'lc- iZ Tel.# LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this, application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft Construction Type: 7, � P- Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: C e v APPLICANT:. Tel. # J? �( CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $_ 83-? Fee Schedule on Reverse Side Fire Surcharge $ .2-36 .001 of Permit Valuation (1/10th%) State Surcharge $ 1,140 $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ S700 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. ' i Effective On August 1, 199S 6431 University Ave NE Fridley, MN 55432 APPLICATIONFOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION.AND AIR CONDITIONING SYSTEMS AND DEVICES ; . . . . 41_'_ JOB ADDRESS U/ RATE SCHEDULE ;The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Bumer — CV rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00. representations stated in this application are true and co t. (Side Vent — Fill Out Back).194 Gas Piping (Needed with new furnace) $10.00_ • $ —�� / ✓ OWNER Gas Range $10.00 $ BUILDING USED AS t Gas Dryer $ 10.OJ $ r W ESTIMATED COST_,- PERMIT NO.13 *Air Conditioning — All Sizes $25.00. $ . DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (UST ON BACK) I% of Value of Appliance or Work $ No. of heating Units Circle One (Steam) (Hot Water)arm Air) Trade.Na_me Size No.� J7�, cn Commercial/Industrial . BTU . Z o HP EDR 1.25% of Value of Appliance or Work $ Fuel-4-aZAAA Total Connected Load State Surcharge X50 BurnerTrade Name _J Size No. /%rZ BTU' nJ _ ®iJ' HP EDR TOTAL FEE HEATING COMPANY MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By Rough—In Date Final Date))0- *Air Conditioners can not be placed In a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE CHIMN Y AND TACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: I. Has been carefully examined Yes No ( ) 2. Is free from rust or deterioration Yes) No ( ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes) No ( ) S. Meets all current Code requirements for size l and total BTU's conn-ected Yes ) No ( ) .6 Has total heating BTU's of 1.� Q ' All other BTU's YO 6 TOTAL BTU's 7. Has a liner been provided for water heater Yes f) No ( ) 8. Has combustion air been provided for water heater Yes lic) No ( ) HEATING CO: Signed By: Date: