PRE 2010 DOCSDate:
Owner:
Address
City of Fridley, Minn.
BUILDING PERMIT
/f 9 - � i
N° 4348
DING
No...le��. Street....._ ......_......._. _............ ....r........... '- Part of Lot .............. -.... ............... ............. -...........
-- ...
Lot ...........1--3 ........ Block ...............1 .. / .............................. Addition or Sub-Division.—W-1/4 ............... .. . - �
Corner Lot ................................... Inside Lot ..... ........................... Setback � .'_t_p_............ Sideyardf V..... C?..y........_........................... _...........
Sewer Elevation .. ...................... .................... ..... _..................................................... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
t G a
-- ....._............ Front -® Depth T-- Height 0 Sq. Ft. .74-4_.7 Cu. Ft. /fir... �
......................................................... Front ....................... ... Depth -- ----- ............ Height ........................ Sq. Ft....._.--._.......... Cu. Ft......................
p
Type of Construction ......._ ................................ .. Est. Cost _./ .Y....... . ............. 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 s forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $. .................... 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 upon violation of any of the provisions of said
ordinances.
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.
APPLICATION FOR BUILDING PEMM
CITY OF FRIDLEY, MINNESOTA' .r.
Owners Name Builder
Address Address,
LOCATION OF BUILDING '
No. SNt'w Street nAyooa Part.of-Lot
Lot i 3 Black / Addition or Sub.Div. tI yw- G- .
Corner Lot Inside Lot Back Back.: 3 t Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
' DESCRIPTION OF BUILDING
To be used as:
Front z Depth_f Y Height / fi
Sq. Ft. Cu. Ft.
Front ' i `` Depth Height
Sq. Ft. Cu.. Ft. — J/
Type of Construction Estimated Cost 7 ��
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 in this application are true and correct.,
! (' G ' SIGNATURE
DATE w
(A Schedule of Fee costs can be.found on the Reverse Side.)
City of Fridley
Application for Dumbing and Gas Fitting Permit r
Dept. of Bldgs. Phone SU 4.7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Lova
I�
€g
12
y
zz
`a
pz
�
0O?
J
w
0
Z
z
90
•
R
�
N
WATER HTR.
GAS
TIM
az
�
Base
f
1st
%
2nd
_
3rd
_
4th
• Future Connection Openings
I
Connected with
Sewer
e New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RAI
Number Fixtures ......................I!L x $1.50
Future Fixture Opening ................ x 1.20
New Fixture Old Opening .............. x 1.00
Catch Basin ............................ x 3.25
Water Beater (Up to 200,000 BTL) ...... x 2.00
New Ground Run Old Bldg. x 3.25
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 are true and correct.
,., Fridley, Annn 19 �?'
Owner
Kind of Building
Used as
To be completed about
/d e" a
Estimated Cost, $ G
TOTATOTALOldl!Fluilding Permit No -� Permit No. G�
4
Signe-
$ Bye_"--'�
$ Business Phone
$ ROUGH DEC 21 1959 DEC 2 3 1
FINAL
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ...................... — x $1.50 S
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ...........................
TOTAL FEE $� 42 2M 7-59
City of Fridley, Minn.
BUILDING PERMIT �2C
Date:"
Owner:'=w Builder -
Address Address
OCATION OF BUILDING
No. y Street "RAO, Part of t
Lot_ Block Addition or Sub -Dion
Corner Lot Inside Lot Am!!!!! ' ab2dation,
Sideyard
Sewer Elevation_ _ Elevation
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft. Ca Ft.
t _ Depth Height ^ Sq. Ft. Cu. Ft.
Type of Constructioi_ Est.. To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
Zproposed work in accordance with the description above set forth and in compliance with all provisions of
ttancxs of the city of Fridley.
In consideration of the payment of a fee of It _ , permit its 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 upon viola ' of any of the provisions of said
ordinances..
Building Inspector
NOTICE:
Tbls permit does not cover the construction, batallation for wiring, plumbing, Bas heating, sewer or water. Be sure to we
the 8uildhng Inspector for separate permits for these Items.
_ � I
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builderl�'6'�°
Address Address ,7/19-S
LOCATION OF BUILDING
No. Street Part of Loth ,
Lot � Block Addition or Subdivisi
Corner Lot Inside Lot Setback,.S ide-Yar
SEWER ELEVATION FOUNDATION ELEVATION G
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
DESCRIPTION OF BUILDING
T be used as-
nt � De th
.._ !
Sq. Ft. Ft.
Front Depth ____Ji eight
sq. Ft. Cu. Ft.
Type of Constructio -7i_ Estimated Cost 60To 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 of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that,all the facts and representations
stated in this application are true and correct.
DATE — D - IA , ' SIGNATURE lae4,, � e�
(Schedule of Fee Costs can be found on the Reverse.Side).
SUBJECT
City of Fridley
25644
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
` COMMUNITY DEVELOPMENT DIV.
~
PROTECTIVE INSPECTION SEC.
d, `�
r
i "';•, CITY HALL FRIDLEY 55432
NUMBER
REV
DATEPAGE
OF
APPROVED BY
__--�
L 612-571-3450
910-F15
10/28/97
JOB ADDRESS 5412 Madison Street NE
I LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DEscR.
13
1
Lyndale Builders 4th
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Linda Oslund 5412 Madison Street NE
572-9223
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Same
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 j] REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (14 Sq) Tear -off
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
MOT.
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
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
$1,167
@
$.58
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
40.25
Fire SC $1.17
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTA FEE
$ 2.00
ATUREOFCON.RACT ROR HOR. ED AGENT MATEI
EN ROP
L VALIDA ED HIS IS YOUR PERMIT
/J�
5NATURE
B G INSP
VVV GATE
OF OWNER OF OWNER BUILD IDA I
NEW [ ] Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �57
ConstructionAddress:d �/ (� �� r 3 �� u 1' 4)
Legal Description:
Owner Name & Address: ,� N j A D S Lut d 0 s AAI l.� Tel. # Q a 3
Contractor: S (; L11� MN LICENSE#
Address: S (4 /V1 Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF B PROVEMENT
LIVING AREA: Length
Width
Height
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA:S�
Width
Hgt/Ground
Sq. Ft.
OTHER: I ?1° n
Q)i `' ('-�
11V_ r
CITY USE ONLY
Construction Type:_
Qj, P L q (. C,
0 0 Estimated Cost: $ ll(,, %
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: � `'XPPLICANT:
Tel. #
CITY USE ONLY
Permit Fee
$� , as
Fee Schedule on Reverse Side
Fire Surcharge
$ / , / �/
.001 of Permit Valuation (1/10th%)
State Surcharge
$ ��`;
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$
$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:
%/ 3.2®3
TY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2001
N 131 University Ave NE
m idley. MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING. VENTILATION,
m 13.572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
a
JOB ADDRESSy��
14 RAT'E SCIIEDULE
- D
6 i) 5 &)t
rA :sidential
Rate
TOTAL
OWNER rda C 1
=umace
BUILDING USED AS AeSiear, CG
Shell and Duct Worts, Burner •
—
%Iso Replacement Furnace
$ 30.0.0
$
-D
{Side Vent •Fill Out Back}
ESTIMATED COST .3 LCSL7. O PERMIT NO.
.3as Piping (Needed with new furnace,
$10.0.0
$
but not replacement)
DESCRIPTION OF FURNACE AND OR'I MRNER
Sas Range
$ 10.40
$
I Air
10.00
No. of Healing UN its (Steam) Ho Water arm
Circle One ) ( ) {W )
Trade Name �Ci rri e -r' Size No.
Sas Dryer
$
$
BTU mo _ HP MR
Air Conditioning • All Sizes
$ 25.00
$
Fuel A2ait 6-S Total Connected Load
all Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
A3mnmr+dal/Industrial
W 1.25% of Value of Appliance or Work $
0
State Surcharge
L) TOTAL FEE $ 30•
E
INIIR= FEE FOR ANY HEATINGICOO ING/VENTILATION
EFMGER/ITIOWAIR CONDITIONING PERMIT IS $25.00
LUS THE $.50 STATE SURCHARGE
v
_INSPECTION FEE $47.00/Hr
`i +ir Conditioners can not be placed in a side yard without
ritten permission from adjoining property owner.
n
Ti.
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all Worts in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
HEATIN
Signed
DATE /-9-0 olz
Approved By Rough -in Date Final Date
BACKSIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
SEP -20-2001 1453 FROM CITY OF FRIDLEY TO
7576701 P.02i02
COMMON VENT. nNT CONNECTOR AND COMBUSTION AIR VIPWICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from nest, deterioration, obstructions,
and Is securely supported and fr+estopped where required.
YesKNO ( )
The venting system Is plasticlPVC and meets all current codes and manufacturer
specifications Including sizing, length, number of elbows and termination.
YeSKNo ( )
The undersigned also verifies that the replacement unit Is a listed assembly.
and meets the current codes and manufacturers specifications. This does
Include AGA -LAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
YesXNo ( )
The existing combustion air is sized and installed to most the current codes
and manufacturer's specifications.
Yesx) No ( )
When required to Install a new cmMb rstion air, it will be razed and Installed
to meet the current codes and manufacturers specifications.
Yes'XNo ( )
When Installing a now venting system, the undersigned hereby verifies that
it is a fisted assembly and meats the current codes and manufacturer's
speftations. This does include AGA -LAMA Category I Central Furnace
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 ( )
ADAtiance Tvpp and $izelCommon Vent and Vent Connector tnformatlon
Appliance #I Type L i(M(L BTU Input 4 Fan Assisted
or Nat
Appliance #2 Type BTU Input Fan Assisted
or Not
Appliance #3 Type STU Input Fan Assisted
or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter
inches
Appliance #1 .-nt Connector Height ft Length ti Diameter
In Type �...._
Applenoe #2 went Connector Height ft Length ft Diameter
In Type
Appliance #3 Vent Connector Height ft Length ft Diameter
in Type
ALTERATIONS: (Describe)
HEATING CO: 6IC41
Signed S)r o Date
TOTAL P.02
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Stories
Basement
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Bath Wash IKIra1 Floor Gatch :Auto.
Urinal Tub Shower S;rnk,.; TrayQUEIt„ Drain Ba�.trti Washer
NO. RATE TOTAL
Effective On January 1, 1997
Gas Mise >s Water Heater
Range 1=1Xt......z Gas Elec
e
JOB ADDRESS_ 7'/ 'A r"
New Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7,Op
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Owner �j�✓d s� ® S ( 0 /�
Water Heater —Electric
$ 7.00
Water Heater — Gas** ><
$10.00 10 <v
Building Used As --,5—/,v
Gas Range**
$10.00
Gas Dryer**
$10.00
Estimated Cost � �'% `,,� PERMIT NO.
Back Flow Preventer Required ( )Yes () No
Type_
$15.00 2&4
�` >
PLUMBING COMPANY
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
SIGNED BY
�W tev
Approved By / "ter Rough—In Date
$ .50
$�61'0 PLUS THE $.50 STATE SURCHARGE
TEL N0.
Final Date
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.