PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT No 4 5 5
Date:
Owner: ...
...� _ _. Builder _..._._._......._..._...._. ._._.._.._...____...._.__
Address _.(?r,,C`A
s Address ...._.._......y�'..... .__- .._......._.-._._..._.._._....
� I,OCATI BUILDING
NO. .... ... ............ Street _ , _ ._.:......_ ......,,e..._....._._ Part of Lot _....
Lot ..-- ---------------------- --------- Block ._.._.._......... .............. - .............. ... Addition or Sub -Division _............ ............. ----
Corner Lot ..... . ................... _........ Inside Lot ..... ....................... -........ Setback .... ........................ ............. Sideyard
Sewer Elevation ........... ............ .......... ..._.......... ............. —...... ........ _._ Foundation Elevation
DESCRIPTION OF BUILDING
To yUed�:
_�....:.. Front .,A._.. Depth -.---. Height ...._.. Sq. Ft. Cu. Ft..
.... _............ -............. ........ -.............. Front ... -............ _.. Depth ............. _. Height_..._ .- Sq. Ft ....................... Cu. Ft. _....................
Type of Construction .----..... Est. co;t-z ................... To be Completed ..................................................
-o TE I LAND COVjENANT$.,AVR
RESTRICTIONS,
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. X
In consideration of the payment of a fee of$�._�" '`'�`., 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, re. and moving of buildings
within the city limits and this permit may be revoked at any time onviolation
6. of the 7il
vons of said
ordinances. pp00//
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 PERMIT
CITY OF FRIDLEY., MINNESOTA
Owners Name ,,._. Builderla, v
Address .���Q �� ► �- Address
-LOCATION OF BUILDING
No.: ' Street* _ Part of Let
Lot Block Addition or Sub.'Div.
Corner Lot Inside Lot Set Back
;Applicant attach to this form Certificate of Survey of Lot and proposed
building location.
DESCRIPTION OF BUILDING
fia be.used as
1,4 rl
Front � C° Depth Height `®
Sq. Ft. -/g 0 Cu. Ft. Z/ fo C
Front —Depth Height
Sq. F`t. Cu. Ft....�
Type of Construction
��-�;" Estimated Cost f// 00—" .
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 ef.Buildings, and hereby
declare$ that all*the facts and representations stated in this.applieation
are true and correct.
Date �_T / 9 G ® signature
(A Schedule of Fee Costs can be found on the Reverse Side)
Date:
City of Fridley, Minn. N° 8397
BUILDING PERMIT
Address
OCATION NG
No. Street Part of �--- %
Lot _ Block Addition or Sub -Di on
Corner Lot _ Inside Lot Setback ideyard
Sewer Elevation -- Foundation Elevation
DESCRIPTION OF BUILDING
'�.� %�:��, 'mss..- • I rr�cr,� Depth Hel: I // Sq. i Cu.
o, DepthSq.CIL Ft.
� _ fie.
Type
J� y
I Con C A A I I�y.%Y• 1: /.. 1 1 -Completed
�ff
i
In consideration of the issuance to me of a permit to construct the building des cri hove I agree to do
==Was!
he proposed work in accordance with the description above set fo in complian a�l provisions of
ordinances of the city of Fridley.
n _
cancidera on of the payment of a fee of $--, permit is hereby granted to
construct the building or addition as described above. This permit is granted upon
oaa L titan that the person to whom it is granted and his agents, employees and workmen, in all work.
in, around and upon said building, or any pari thereof, shall conform in all respects to the ordinances of
dleF. Minnceota location, constructCon, alteration, maintenance, repair and moving of buildings
within the dty limita� permit may be revoked at any time upon violation of any of the Provisions of said
ordinanoes.
NOTICE:
7W pwmb den not cover die constraadon, huff a w for wbtne, piambine, on he d m sewer w wafer. Be wro to see
the Balldiee hu" ter for sepmte pwmds for dbess items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
NAME
/
- l
DD' I .� - ADDRESS�
LOCATION OF BUILDING
NO, ?` D STREET &G °Yj PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDE YARD
SEWER ELEVATION FOUNDAtiON ELEVATION
Applicant attach to this ford Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as;
Front�y Depth,2?�Height
Sq. Ft. �Z '�70 Cu. Ft. �
�®
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction C a Jt. CES Q� Estimated Cost � ��o 00
To be completed Al6 J -P127 h -e (r
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 and correct.
DATE
(Schedule df Fee Costs can be found.on the Reverse Side),.
l�s� R•a�..�c��.iu nom:! ri �'� t�:.a�' u�_....-..:� ��o-.�.� ��Pv�.0 ®...:'�� 4� "`A .. �6".'y� ���+a ,F°?,..{`. o,�,�+� °tT� A..,�Ep ^r"�"`s t.'.9+., ry�m+'
L-'�',i \*,�i,'r�uiurw.ur:7 L'a,yr�i.i•� Q,J��,iU.uriJ�J t�.s J'� li✓vbrry.
PARTIAL RATE SCHEDULE
GRAVM WAW-, Ara: 1M' -' `1°t:➢D'"2AL
Fur=ce Shell & Duct Work . $10.00 `�—
Replacement of Furnam 6.00
P.epairs & Alterations -up to 5500.00 600
'Repairs & Alterations each add. 3500.00 3*W $
b=C13. WMMI PM
Furnace Shell & Duct Work to 1241,000 BTU
..$1000
e=h add.. 60,00 BIV . .........
3.OJ $
Replacement of Furnace
6.00 $
,Repaira & Alterations -up to $500.00
6.00 $
Repairs & Alterations each add. $500.00
3.00
STF_1kM or HOT 4'J M P. S'aJ.'F'�'...4
Furnace Shell & Lines -to 400 sq. ft. FDR Steam $10.00 g
Furnace Shell & Line- -to 640 sq. ft. EDR Hot Water 20.00 S.
Each add 200 sq. ft. EDR Steam -4.00 $
Each add. 320 sq. ft. EDR Hot Neater 3.00 $
OIL BURN= -to 3 gal. per hour 6.00 S.
over 3 gal. per hour See ree Schedule
GAS BU'M1o" EER (up to I!..-,0;::1 BTU) 6.00 $
ow;:: 199.M BTU See Fes schodule
GAS FI=HG iF.a: 110 RATE TOTAL
Ist 3 F%xtures x3 103 S
Additlonai Fixtures _ x .78
Gas Range to 1M,M x'S 6.M $
State Surcharge 50
_
AlitCC:D:'S�trBsEe:a
FAX
A. LQF�.,ai��S�lIi.�S � 1�0�LcJ ��i1.g.,c• l�.".o p
Dapt. of Bldg. is &n* -34M
City Of ridley:
The undersigned hereby makes application for a permit for the woraa here;.:
specified. agreeing to do all work in strict accordance with ttie City Ordinarce=
and ruling of the Department of Buildings, and hereby declare. that all the fa��
and representations stated in this application are trye and correct.
Fridle�, Minn 19
C:wner
Kind of Building U
Used as
To be completed about,`
oa
Estimated Cast:, $ XQ 6
�ew. Building Permit No. --- Pormit No.-
HE.4,7ING or POWER. N75--St=m, Hot Water, Warm Air -No
Trade Name Sym No
•Capacity—_-• — Sq. FL E.D.R BTU B.P,
Total Connected r=d bind of stmt
EUR -MR - Trs& Name Size No
Capacity Sq. n F-DIL BTU -
6 -6 -v -
TU
. te��aaeas�-®e�a1
6fJv-Or
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Effective On January 1, 1995
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace .
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/Industrial
I% of Value of Appliance or Work
Rate TOTAL
$ 20.00
$10.00
$10.00
$10.00
$ 10.00
State Surcharge
TOTAL FEE
$
.50
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $,50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB ADDRESS
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 at
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
OWNER_ _T)<:;/`® i�� Q��i1s BSc
BUILDING USED AS
ESTIMATED COST���� PERMIT N0. /
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
Signe B ---z Tel No.f
k:�
Approve Rough—In Date Final
Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
CHIMNEY AND STACK VERISCATION
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 ()
No
( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes(
)
- No
( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water beater Yes ( ) No ( )
8. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks:
HEATING CO:
Signed By:
Date:
SUBJECT
City of Fridley
" :3115:5 2AT
THE TOP OF THE TWINS
BUILDING PERMIT
O.
• ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r PROTECTIVE
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910415
11/9/00
JOB ADDRESS 6340 Madison Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
5
Christie
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Dorothy Jacobsen 6340 Madison Street NE
571-2269
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Window Lite Home Imp. 8400 89 Ave N, Brooklyn Park, MN 55445 425-2227
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
20039258
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION GR REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace three windows
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 inspection Cards
Will Be mailed
To Homeowner 'ou
p- P®st
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
$2,200
$1.10
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-
Fir
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
SC $2.10
PLAN CHECK F
TOT FEE
Lice S $5
1.45
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE,
ENRWE ALID
G INSP
D HIS IS :) A PE 1T _
PATE
SIGNATURE OF OWNEROF OWNER BUILDER, (DATE,
3Q�p 5-9
NEW q[ Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: %.3 +0 nlad ','- S 6rl S+
Legal Description:
Owner Name & Address:
Contractor: 1 I) 'A r r1A, -, U
rrrgm�ffiikm
LIVING AREA:
GARAGE AREA:
DECK AREA:
IVB- lav L A)0
Tel. #,5'11- as & 9
MN LICENSE # 7,003.925-9
8e_Tel. #
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
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: Estimated Cost: $ 0?6Q&), 0 a
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 11 12j c,0 APPLICANT: Tel. #
Permit Fee
$ ql.
Fire Surcharge
$ 1
State Surcharge
$ Lf. 00
SAC Charge
$
License Surcharge
$ 5,00
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 $ TsA
STIPULATIONS: D� ��Y ae
Wj
"r, —We-
v�lo.