PRE 2010 DOCSILDING PERMIT
Village of Fridley, Minn. No
Date 4— -7-*--
-4:?- . � ........... ......... .
Owner ��t•s��r••a.."� ..
Address............ .......... ..........
2456
Builder...........................................
Address.........................................
LO ATION OF BUILDING
No. Street o lFr . ... ... a ` .....Part of Lot .......................
Lot ... J10......... Blocks.. g........... Addition or Sub -Division .......................................
Corner Lot ............ I�►side Lot .� Setback ............ Sideyard ..........................
vc
To be Used as:
1"""r'+'' ...
Frost 190...
.................... Fro�t .......
Type of Construction
In consideration of thessuance to
the proposed work in accor ance with
ordinances of the village of Fridley.
In considera.ation of the payment of a f
to construct the
e express cothat the person to a
done in, around and upon said building, o
Fridley, Minnesota regarding location, cox
in the village limits and this permit may 1
ordinances.
NOTICE:
This permit does not cover the
sewer or water. Be sure to see the
i
RIPTION OF BUILDING
iepth.J� Height . t • .��/ . Sq. Ft......... Cu. Ft. ........
lepth ........ Height ......... Sq. Ft......... Cu. Ft........ .
Co 9 ......... To be Com pleted y. ,
of a permit to construct the building described above, I agree to do
description above set forth and in compliance with all provisions of
'Of $. .,,,.. , permit is hereby granted t�rmit
�uildin( 1r addition as described above. Tranted upon
am it is granted and his agents, employees and workmen, in all work
any part thereof, shall conform in all respects to the ordinances of
truction, alteration, maintenance, repair and moving of buildings with -
revoked at any time upon violation of any of the provisions of said
OF
...... Building Inspector
ion, installation or alteration for wiring, plumbing, gas heating,
Inspector for separate permits for these Items.
ING PERMIT
Village of Fridley, Minn. N° 2455
Date` •+.!.,•, :.................. ......... .
Builder AV
Owner•st . ........................ .
Address .........:. Address ..........................................
LO f ATION OF BUILDING
No. tr;p3 4.. .. Street .. .......... Part of Lot .......................
Lot .......... Block ...J"....... ... Addition or Sub -Division AA_ e�y,e�yl.aW 4*0+„M'.r
Corner Lot ............. Inside Lot .. ... Setback ... ... Sideyard ..........................
To be Used as:
Od/u ....... Front .
.................... Front ........
Type of Construction .... I
In consideration of the issuance to mi
the proposed work in accordance with the
ordinances of the village of Fridley.
PTION OF BUILDING
a
Height .......... Sq. Ft......... Cu. Ft.........
epth ........ Height ......... Sq. Ft......... Cu. Ft........ .
Cost .......... To be Completed ol 4wow ... .
d of a permit to construct the building described above, I agree to do
description above set forth and in compliance with all provisions of
In consideration of the payment of a f of $. &., permit is hereby granted to + ,r .........
to construct the u.ilding dry addition as described above. This permit ie granted upon
e espre •s conMn that the person to w om it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or I 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 bi revoked at any time upon violation of any of the provisions of said
ordinances. _ ,r _1
,.... Building Inspector
NOTICE:
+ This permit does not cover the cons ruction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Buil Ing Inspector for separate permits for these Items.
City of Fridley, Minn.
BUILDING PERMIT
Date: —. April 30, 1968
per: Simon Smith Builder
Same
Address 5730 Madison St. N. E. Address Same T
No. 5730_ street
Lot ._._ 15 —__ Block
N9
�-?-d �7;7
9'705
LOCATION OF BUILDING
Madison St. N. E. _ part of Lot
8 Addition or Sub -Division . Donnay's Lakeview Manor
Corner Lot — Inside Lot x Setback --_ Sideyard
Sewer Elevation _.._ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Attached Garage Front 20' Depth 24' Height 10' Sq. Ft. 480 Cu. Ft. 4800
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction _ _ Frame Est. Cost _ .....la 000 _ To be Completed Sept. 1 1968
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 in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 7.00 , permit is hereby granted to Simon Smith
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 umm violation of any of the provisions of said
ordinances.
Ja Gaste nad, Building Official
NOTICE:
This permit does not cover the construction, installation for whdng, plumbing, gas heating, sewer er wafer. Be Sure to see
the Building Inspector for separate permits for these hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, M=NESOTA
OWNER'S NAMES )IR'ON M l BUILDER_�___� V
�l�%J4IF.t• ...
ADDRESS Z�0 ��/1 d. `�O /v ADDRESS
LOCATION OF BUILDING ,, )
NO STREET
LOT , BLOCK ADDITION OR 900DIVISiCiN__
CORDES LOT INSIDE: LOT SETBACK SIDBYARD, � �_
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING'
To a Us d As
Front Depth . Height
Square feet Cubic Feet_ b ®�
Front Depth Height
Square feet Cubic Feet
Type of Construction Estimated Cost _
To Be Complete 2�_ f 2�
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 rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true a07
n cor ect.
DATE ® SIGNATURE
Schedule of Fee Costs can be found on the Reverse Side).
770
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
ul
m
C'496). U
w
e
ESTIMATED COST O
PLUMBING FIXTURE RATES: NO.
u
ri
»ki
Water
m
e
New Fixtures
$ 5.00
o
E
.i V
m
M
C
ro
0
04
Old Opening, New Fixture
$ 1.50
$
Heater
�
°'
�
ro
�b
°c
g
.0
ro °1
Blow Off Basin
$ 5.00$
u
Tel. No.
Catch Basin
$ 5.00
+�
m
If
U
o
oa
$ 5.00
y
S
i+
a w
Hydraulic Valve
$ 5.00
$
ROUGH INSP.
Sump or Receiving Tank
$ 5.00
$
pate
lec
Water Treating Appliance
$ 7.00
$
Hot Water Heater
5.00
W
w
U r
a 3
U
Date
o
s
$
/
Gas Dryer
$ 10.00
$
APPROVAL FOR PERMIT e
Back Flow Preventer Required. . . Yes ( )
No
Type
( )
1st
$
`
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% Of Value of Fixture or Appliance
$
MINIMUM FEE FOR ANY PLUMBING PERMIT
IS $15.00
PLUS THE $.50 STATE SURCHARGE
2nd
State Surcharge
Reinspection Fee $
$ .50
($15.00) TOTAL
FEE
_
s1� Q
3rd
4th
(R) a Future Connection Opening
Connected with Sewer
(*) a New Fixture, Old Opening
Water
Effective Date May 1, 1988
Job Address f 3 4 41 S o tl i, / v,
S
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 appl cation are true and correct
Fridley, Mn. 861 , 19 8V
OWNER 1 Y)'t O )A S/71
KIND OF BUILDING -::I- r ,E}-,-il 31---
USED
P
USED AS D uj Q I , yt c7
TO BE COMPLETED ABOUT
3a/ Y
RATE SCHEDULE
C'496). U
ESTIMATED COST O
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
OLD - NEW BUILDING PERMIT NO.
PERMIT NO.
New Fixtures
$ 5.00
$
Future Fixtures
$ 3.50
$
Company iL-
A l` , l -p /5
Old Opening, New Fixture
$ 1.50
$
Signed By
Beer Dispenser
$ 4.00
$
Blow Off Basin
$ 5.00$
Tel. No.
Catch Basin
$ 5.00
$
Rain Water Leader
$ 5.00
$
Hydraulic Valve
$ 5.00
$
ROUGH INSP.
Sump or Receiving Tank
$ 5.00
$
pate
Water Treating Appliance
$ 7.00
$
Hot Water Heater
5.00
FINAL INSP.
$
$
Date
Gas Range
$ 10.00
$
/
Gas Dryer
$ 10.00
$
APPROVAL FOR PERMIT e
Back Flow Preventer Required. . . Yes ( )
No
Type
( )
$ 5.00
$
`
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% Of Value of Fixture or Appliance
$
MINIMUM FEE FOR ANY PLUMBING PERMIT
IS $15.00
PLUS THE $.50 STATE SURCHARGE
State Surcharge
Reinspection Fee $
$ .50
($15.00) TOTAL
FEE
_
s1� Q
CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
nV 0 VnWW17"yx T_
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with neer furnace)
Gas Range
Gas Dryer
* Air Conditioning (all sizes)
All Others/Repairs and Alterations
1% of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
.`—Date
Final Insp. "5--f
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 without
written permission from adjoining neighbor.
A
$ .50
KIND OF
USED AS
TO BE COMPLETED ABOUT I .C_ C / L,/
ESTIMATED COST /Jl(o - 00 / /y
OLD - NEW BUILDING PERMIT NO. PERMIT NO. [(OeL
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name/ ( Size No.Lp W, \g n'
Capacity Sq. Ft. EDR BTU %.C/ HP
Total Connected Load /j r p OM+ Kind of Fuel n& -JJ
BURNER - Trade Name Size No. �����t✓
Capacity Sq. Ft. EDR BTU HP
Company 7
Signed ByJ-
Tel. No. /O /
Fill out back side for stack verification on replacement furnaces
�3 �
RATE
TOTAL
Job Address J / 2/i2� ,.� / �
$ 2.0.00.
$o
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
$ 10.00
$
Tel. #571-3450
$ 10.00
$
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
$ 10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
$ 10.00
$
Fridley, Minn. �, 1 (/
>>
OWNER SoOr9l L7-7
$
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
.`—Date
Final Insp. "5--f
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 without
written permission from adjoining neighbor.
A
$ .50
KIND OF
USED AS
TO BE COMPLETED ABOUT I .C_ C / L,/
ESTIMATED COST /Jl(o - 00 / /y
OLD - NEW BUILDING PERMIT NO. PERMIT NO. [(OeL
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name/ ( Size No.Lp W, \g n'
Capacity Sq. Ft. EDR BTU %.C/ HP
Total Connected Load /j r p OM+ Kind of Fuel n& -JJ
BURNER - Trade Name Size No. �����t✓
Capacity Sq. Ft. EDR BTU HP
Company 7
Signed ByJ-
Tel. No. /O /
Fill out back side for stack verification on replacement furnaces
CHIM14EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1.
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
(x)
No ( )
5. Meets all current Code requirements for size.and
total BTU connected Yes No ( )
6. Has Total heating BTU's of r)Q,I�j®D
All other BTU's �), nou
TOTAL , J 0 , 1
1
Signed By �jm
Date
SUBJECT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
L _ PROTECTIVE INSPECTION SEC.
1 S
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
A %.j 612-571-3450
910-F15
4/26/90
JOB ADDRESS 5730. Madison Street N.R.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
13
8
Donnay"s Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Simon Smith 5730 Madison Street N.E. 571-6564
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home Improvement Inc. 7401 Central Avenue N.E. 784-7543
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION Clx REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Cla Sguares:l
9 CHANGE OF USE FROM TO
STIPULATIONS
Roos; can be 2nd layer but not 3rd. Install ridged galvanized valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
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
$950
$.50
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU N OR THE PERFORMANCE OF CONSTRUCTION.
$25.00
PLAN CHECK FEE
TOTALFEE
$25.50
G ATUREOFCONTRACTORORAUTHORIZEDAGENT ;DATE)
WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
BLDG INSP � E
SIGNATURE OF OWNER OF OWNER B U'L.ER1 IDATEI
NEW [ ) CITY OF FRIDLEY Effective 1/1/90
ADDN [ ] 1-1 AND R-2
ALTS [ ] Building Permit Application
Construction Address: "64* tj sst 144F.
Legal Description:
owner Name & Address: - C571;mlo 6 Tel. # 5-71-6525V
Contaactor: c�9 �o�� 7—/�. ZTel. �� 7 4S
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
L1YM AREA:
length Width _-__._...._- - _.._- Height Sq. PC
GNMM XMM: Length Width Height Sq. Ft.
DBCR AREA: Length Width Hgt/Ground Sq. Ft.
07m:
Corner Lot [ ) Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: We-Xeel elm ' � Estimated Cost:
AM=x. Capletion Date: 4 5"� ` `? z5goees
Proposed Driveway Width If New Opening Is Desired: Ft. $ S.
_ W dth + 6' See Hack Page
DATE: APPLICANT: Tel. #
Permit Fee
o n
State Surcharge
$
SAC Charge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Charge $
STT uukTICNS:
CITY OSE aNLY
Fee Schedule on Reverse Side
$.50/$1,000•Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
P NO.
City of Fridley
24616
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r � �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/3/96
JOB ADDRESS 5730 Madison Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
8
1 Donnay's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Smith 5730 Madison Street NE
571-6564
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Protective Home Covering Inc. 9929 Pleasant Ave S
Bloomington 55420
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
884-0123 4164
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Install aluminum soffit & fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Venting to comply with State Building Code.
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
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
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
$2,645
$1.32
DOES NOT PRESUME TO GIVE AUTHORITY T OLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR L C LVILAW REGULATING CON-
STRUCTI OR THE PO N OFC STRUCTION
$74.75
Fire SC $2.65
PLAN CHECK FEE
TOTAL FEE
License SC
$5.00
$83.72
SIGNATURE OF CONT RACTOR OR UTHORI ?AGENT IDATEI
WHEN PROPERLY ALI DATED THIS IS YOUR PERMIT
B1.1t, INSP
C�
OATE�
SIGNATURE OF OWNER 0F OWNER BUILDERI (DATE)
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: _'�� a Nre,1,t .son 'Y 41,
Effective 3/1/96
Legal Description:
Owner Name
�� �-/ ' & Address: �dS � 1 � Tel. # j 65_ T
Contractor: - r6tf L �L o Q w- (QV(Y 1 v\ MN LICENSE #
Address: �(�� plegsoru'A'111-e �S 1_f O Tel. # g8�'C7la
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 - Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: 47_s'ttk Estimated Cost: $
Approx. Completion Date: /®- 4!!Z�4
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. # j?&V --0/
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
�i. (��
.001 of Permit Valuation (1/10th%)
State Surcharge
$
/ •
$.50/$1,000 Valuation
SAC Charge
$
$900 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
$4
STIPULATIONS:
SUBJECT
P O.
City of Fridley
2 6 7 6
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
qzl7q
r
T
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L J` 612-571-3450
910-F15
7/21/98
JOB ADDRESS 5730 Madison St NE
t LEGAL
LOT N0.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
oescR.
13
8
Donna 's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Luba Smith
571-6564
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Four Seasons Roofing & Remodeling
-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20138780
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION A❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (24 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with
State Building Code.
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
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2001
$1.00
DOES NOT PRE E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
ING CO -
PROVISIONS OF NY OT S OR LOCAL LAW RE7z,2
STRUCTIO O HE PERFOR ANCE OF CONSTRUCTION.
$74.75
Fire SC 2.00
PLAN CHECK FEE
TOTAL FEE
®
Licen SC 5.00
82.75
Si ATUREOFCONTRACTORO AUTHORIZEDAGENT iDATEi
HEN PROPERLY/LIDATED THIS IS YOUR PERMIT
le
BLDG i SP
Qpy�
� DA E
DATE
S.GNATUREOFOWNER OFOWNER BUILDERi (DATEi�..
NEW [ ] Effective 1/1/98
ADDN [ ] CI1�Y�OF FRIDLEY .. .
ALTER [ ] SINGLE FAMILY. AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
. 2�'.,1 .31 �.:e�x '.p:�..+... g .. y� .u,kR �1�hf%�� Z.. I°:. ;fit .•. �"��/'[I
ConstructionAddress:
Legal Description:
Owner Name & Address: , 5M L Tel.
Contractor: U V ( 6e4s ort^S Oo;l nj d Rem,,,4 L,,4 l.e -MN LICENSE
Address: '7Gl3 d U vi i U ears ► 43f t/ f A/ L*_' Fr ► A Imo, Tel. # ''7R5-•
Attach to this application;. a Certificate of-$urvey of the
lot, with the proposed: construction drawn on *it to scale.
DESCRIPTION, OF ]MPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width . Height Sq. Ft.
DECK AREA: Len th Width Hgt/Ground Sq. Ft.
OTHER: aL I o G► �+-• 1
Construction Type:.coo Estimated Cost:
(Fee Schedule, on Back).
Driveway Curb Cut Width Needed: Ft., -'+'6 Ft = Ft x $ _ $
DATE:. r%— APPLICANT"
Tel: °
...
.. i , 4. 'N<.(• ffr ',.CITY` USE ONLY_.
r d
Permit Fee
$
S . Fee Schedule. on Reverse Side
Fire Surcharge
$
C) s':001 of Permit` Valuation (1/10th%)
State Surcharge
$ , 6 1.50/$1;000'Valuation
SAC Charge ;,, :..
$ , $1000. per SAC Unit.
rd
'ial Cont�ractr
License Surcharge
$
t � 1.1 t,$5.00''(State. Licensed Resident
Driveway Escrow
$
A '� �` A1; A"'or:AIt:, "B". Above ^ :
W)�
- 'I ��°
s+ ,
Erosion Control
n
$="
$450 00 Conserv tion Plan Review
&
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
'''Agreement Necessary [.j ..Not: Necessary []--,
t
..,
... 8 X17,•}'�. �M M IJ i44i"R'k i4
STIPULATIONS:
i
t `
FFA
SUBJECT
City of Fridley
3=2591
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
16
y ______ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r !
� CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L J` 612-571-3450
910-F15
5/14/02
JOB ADDRESS 5730 Madison Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
13
8
1 Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lubg Smith 5730 Madison Street NE 763-571-6564
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Renewal By Andersen 1920 Co Rd C W, Roseville, MN 55113 651-264-4777 20130983
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
O NEW 0 ADDITION 0 ALTERATION Ij REPAIR 0 MOVE 0 REMOVE
B DESCRIBE WORK
Replace 3 windows within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code.
Permit Insp etion Cards
Will 91'9 Mailed
To Homeowner To Post
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
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
@
$2.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,995
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.
$97.25
Fire SC $4.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
OTAL FEE
License 5.00
$10 .25
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDATEI
N P PER DATED T IS IS YOUR PERMI
S,GNATURE OF OWNERI6 OWNER BUILDERI IDATEI
BlD INSP ATE
FFA
NEW[ ] Effective 5/10/99
ADDN L ] CITY OF FRIDLEY
ALTER [ ] SINGLE FANMY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: N
Legal Description:
Owner Name & Address: �U,�q fM� Tel. #3 •��(• (a, ay
Contractor:;i�w\ 'v► A•exs�-tom MN INCENSE # 0"101?j09�
Address: J9 a i�SGl�N11t,Mr,-) SS Tel. # J5140
. O1h4 • y}}�-
Attach. to this application, a'Certifcate of Survey. of -the
lot, with the :proposed constriction drawn on it to scale.
DESON OF I "—W!' ANT
LIVING AREA:
GARAGE AREA:
DECK AREA:
Construction Type:
Length
Length
Length
Width Height Sq. Ft. _
Width Height Sq. Ft. _
Width Hgt/Ground Sq. Ft. _
q
Estimated Cost: $ 695 6.JV
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: - APPLICANT: Tel. # 95a •34,5•lod4�-
Permit Fee
$ 9+ as -
Fire Surcharge
$ Lj .p
State Surcharge
$ Op
SAC Charge
$
License Surcharge
$ �j • Q
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. 'B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ O
as
STIPULATIONS:
w
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763) 571-1287
PERMIT N .: 2004-01922
DATE ISSUED: 10/19/2004
ADDRESS :
5730 MADISON ST NE
PIN :
233024130072
LEGAL DESC :
DONNAYS LAKEVIEW MANOR ADD
:
LOT 15 BLOCK 8
PERMIT TYPE :
PLUMBING
PROPERTY TYPE :
RESIDENTIAL
CONSTRUCTION TYPE :
ADDITION/ALTERATION
VALUATION :
$ 500.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
TOTAL
# ELEC WATER HEATERS
0 # NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS
1 # GAS DRYERS 0
# GAS RANGES
0 # OF NEW FIXTURES 0
VALUE (FOR MINIMUM CALC) 500 # WATER TRMT APPLIANCES C
APPLICANT
NORTHWOODS MECHANICAL
BOX 1085
FOREST LAKE, MN 55025-
(651)257-4951
OWNER
SMITH LUBA
5730 MADISON 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
reguj�ting co struction or the performance of construction.
Applic Date
Bldg Insp Date l
PLBG PERMIT MINIMUM FEE
0.00
PLBG FIXTURES (NEW OPENINGS)
0.00
PLBG FIXTURES (EXIST OPENINGS)
0.00
WATER TREATMENT APPLIANCE
0.00
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
35.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
STATE SURCHARGE, PLBG FLAT
0.50
TOTAL
35.50
PAID WITH CHECK # 6268
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
TY OFTMDLEY INSPECTION DIV.
•31 University Ave NE
kney, MN 55432
63) 572'AAAA
a
In
m
V
Effective On Jan 1, 2002
APPLICATION FOR PLUMBING AMI? GAS FITTING PERMIT
R 5 37
_UMBING FIXTURE RATES:
NO. RATE TOTAL JOB ADDRESS ,�1IPYiP�i. ASE
0
ewr Fbchrras
Id Opening, New Fo(ture
aer Dispenser
low Off Basin
etch Basin
w ain Water Leader
J
A umpvReceiving Tank
LL later Treating Alliance
o later Heater -Electric
later Heater - Gas''
U gas fie"
ias .
(� ack Flow Preventer Required ( )Yes (} No
Type
1,
$ 7.00
The undersigned hereby makes applcation for a permit for the work herein
$ 4,00
specified ming to do all work In strict aocardarice with the city codes
$ 5.00
and rulings of the BuNng DWislon, and hereby declares that all the facts
$ 7.00
and representations stated In this application are true and correct
$ 7.00
- a0 , 20-0(w
$ 7.00
$ 7.00
$10.00
Owner moi! ry ( --��w d n
$10.00
Buildetp Usk As
$10.00
4-1
$10.00
Estimated Coat 5�r„� P921NT N10.
$15.00 PLUMBING COMPANY.
:ekispection Fee $01imimr
.LL OTHERS AND/OR REPAIRS AND ALTERATIONS �`1
1.5% of Vakw of Fixture or Appliernce D'1L z
C� State Surcharge
g�
L TOTAL FEE $�
FLUS THE IM STATE SURCHARGE
,OMBUSTION AIR SHALL BE PROVIDED PER LLMC SECTION 504(A) AND TABLE 6 A COMMON VENT INFO ON BACK SIDE
CITY OF FRIDLEY PERMIT NO(. 2004-018 v
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 10/14/2004
572-36U4 YAX: (763) 571-1287
ADDRESS : 5730 MADISON ST NE
PIN : 233024130072
LEGAL DESC : DONNAYS LAKEVIEW MANOR ADD
: LOT 15 BLOCK 8
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AN AIR CONDITIONER.
# A/C UNITS 1 VALUE OF APPL OR WORK 0
# FURNACES 0 # GAS DRYERS 0
# GAS RANGES 0 VALUE (FOR MINIMUM CALC) 2000
APPLICANT
SUPERIOR CONTRACTORS INC
612142 AVE N
CRYSTAL, MN 55422
OWNER
SMITH LUBA
5730 MADISON 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 wort
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 pert rmance of construction.
Applicant Date
$ldg Insp
HEATING PERMIT MINIMUM FEE
0.00
FURNACE SHELL/DUCT WORK
0.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
25.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
0.50
TOTAL
25.50
PAID WITH CHECK # 16849
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY BUILDING INSPECTION
• 6431 University Ave NE
ridley, MN 55432
63-572-3604 FAX 763-571-1287
14
RATE SCHEDULE
dentias
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
* A�-s"t&Hexnr—
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
R a#; 4 4 4ffective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 5950 111"4b1 5ID-AJ
Fee Total Owner L)6 A 'TK 17-*
$35.00 $ Building Used As �LgJ
$10.00 $ ESTIMATED COST 0 PERMIT NO A0 0 � O `q 9 8
$10.00 $
$10.00 $
$25.00 $�
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
BTU HP
Size No.
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 Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ '1
50
HEATING CO ��*00" lOg � �5 /PS
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
Tel #
FAX # Date 161-' /°al ` &I!r
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Approved by Rough -in Date Final Date
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, 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 plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No( )
The undersigned 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 Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA 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 ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances
Total Btu Input
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
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :