PRE 2010 DOCSCity of Fridley, Mnu.
BUR DING PERMIT N® 7132
Date: 7 �? — 4 y
Owner: Builder _
Address Address
�/ LOCATION BU LDING
No. ��1= L Street `4':� �%�Part of Lot
Lot _ ___ Block "lArlAffion or Sub -Division
Corner Lot — Inside Lot Setback -.�� Sideyard
Sewer Elevation ff 7 a _ mon Elevation 7 2 ' % P -
7'0e ,, r--rl`J&
DESCRIPTION OF BUILDING
TA Used
Front Depth _ Height Sq. Ft! �� cu. Ft.
Front DepthHeight Sq. Ft. cu. Ft.
Type of etion- Est.� �_ To be completed
In consideration of the issuance to me of a permit to co �uljll%g Bove I agree todo
work in accordance with the description above se orth with a'll 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
?ids permM does not cover the const. citon, hotaWen for wirks plw*ing, gas hoattag, sower or water. Be ams to see
the BulMh* hopeclor for separate permits for these Mems.
APPLICATION FOR BUILDING PENN
CITY OF FRIKEY, MINNESOTA
Address
LOCATION OF BUILDING
No. :a 5�Street Part of Lot,+
001,
Lot if Block 1 Addition or Subdivisio
Corner Lot Inside Lot Setback --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 sed as:
��� �.l�O c��j/�/���A� Front l /� Denth 9 S —� Heieht F� /
Sq. Ft. Cu. Ft.
l
FrontDepth , 4, Height s
Sq. Ft. CT Cu. Ft.
Type of Construction6. l 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 declaresthat the facts and pr�ntations
stated in this appl,°ca.tion,are true and correct. iy
(A Schedule of Fee Costs can be found on the Reverse Side.)
r
i
Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and "
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................ 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50
MECH. WARM AIR
Furnace Shell & Duct Work to 170,000 BTU ............ 8.00 $ A�
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
NO RATE TOTAL
1st 3 Fixtures ...................
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .....
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ..
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ ~/
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
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
$�
ROUGH
FINAL
Dept. of Bldgs. Phone SII 4-7470
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.
Owner
Kind of Building
Used as'�
To be completed about
Estimated Cost, $
Old New wilding Permit No.ermit No.
DESCRIPTION OF WORK
HEATING or PO PLANTS --Steam, Hot Water,arm Air o
Trade Name & C"� Size No.
Capacity Sq. Ft. E.D.R 40 0 -3t -d BTU H.P.
Total Connected Load of Fuel
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
sem. AY N. WELTER HEATING CN. WELTER HEATING CD,
4637 CHICAGO AVE.
By
ag
<z zM Business Phone No
City of Fridley
Application for Plumbing and Gas Fitting Porn*
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
II
C
cc
u
o�
Zr
u�f
y Z
�G
a
I
w
�U' �a
Z
Z
•
•
WATER HTR.
GAS
ELEC.
Base
%
/Q
1st
2nd
3rd
4th
• Future Connection Openings
e New Fixture, Old Openings
I
Connected with
Sewer �
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $— !2,� e-)
Future Fixture Opening ................ x 1.20 $ 40
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heater (Up to 200,000 BTU) ...... x 2.00 $
New Ground Run Old Bldg . ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ..........................—� x $1.50 $ L -5-d
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
� REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ ,
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. / 1�
Fridley, Minn—��� 1 19(e—
Kind of Building
Used as
To be completed about
Estimated Cost, $® -
Old—,New,. Building Permit No Permit No.
Signe
By
Business Phone No m �� &e9l
ROUGH ('15 ' 1 Y � d '
FINAL
42 2M
City of Fridley, Minn.
BUILDING PERMIT N® 7459
owner: Chester Anderson Builder Suburban Realty Co.
Address 7351 Xa=zy Igne Address Anakax Him, ..
LOCATION OF BUILDING
No. 7351 Street Memory Iane Part of Lot
Lot — 2 w __ Block 1 Addition or Sub -Division . Xelodp Manor 2nd Addition
Corner Lot Inside Lot Setback r._ Sideyard
Sewer Elevation
To be Used as:
Foundation Elevation
DESCRIPTION OF BUILDING
Front _ _ Depth Height _ _ Sq. Ft Cu. Ft
Front Depth Height Sq. Ft Cu. n
Type of Construction Frame Est Cost _ __ To be Completed
Dwelling , Masting Repair "un
In consideration of the issuance to me of a permit to co a building descril,�ed above I agree to do
the proposed work in accordance with the description above Orth and in com ce with a'il provisions of
ordinances of the city of Fridley.
Xz-
In consideration of the payment of a fee of $ 5• , permit is hereby granted toIW6urban
Realty Coo 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
d
Fone in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
ridley, Minnesota regarding location, construction, alteration, maintenance, repair sad moving of buildings
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _
NOTICE:
'Ibis peneit does not corer the construction, hutandlon for vArlm plumbing, gas boding, sewer or wafer. Be sire to son
the Building Inspector for separNe pernih for these home.
r
OWNER'S N .4 e
'APPLICATION FOR MOING PERMIT
CITY OF FRIDLEY; &MMOTA
/
ADDRESS rp / Al 49:-- ADDRESS ������ "w
LOCATION OF RIDING,
No, � 7 Str"set !'// �' `� �/ �?/� Part of Lot,
Lot Block Additions or Subdivision 1
Corner Lot Inside Lot _Seek Side -Yard.
SEWER ELE'V'ATION - . FOUNDATION ELVA17ON
Applicant attach.to thi9 form, Two Certificates of, Survey of Lot and -proposed"b i:.-
ing ,lbcatiori ,drAwn on these CA-rtificates ..
DESCRIPTION OF BOILD ING
fe be used as:
proal Depth Height_.
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost ®le
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work ift 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. '
SIGNATURE
jSchedale.of Fee Costs can be found on the Reverse Side).
�,, 3°Ll q
A 3mmenclal/Industrial
1.25% of Value of Appliance or Work
U
E
$
State Surcharge
TOTAL FEE $�
INlif M FEE FOR ANY HEATING/COOLING/VENTILATM
EFRiGERATIOWAIR CONDITIONING PERMIT IS $25.00
LUS THE $.50 STATE SURCHARGE
a =INSPECTION FEE $47.00/Hr
ED
i dr Conditioners can not be placed in a side yard without
dtten permission from adjoining property owner.
N
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated In this application are true and correct.
HEATING CO
BLAINE HTGi. A/C ELi:W ,, 16-- I a&
13582 CENTRAL AVE. N.E.
ANOKA, MN 55304
Signed ' ` er, L # 75
V
Approved By Rough -In Date Final Date 1,2-10 61
D COMBUSTION AIR VERIFICATION
L i
TY OF FRIDLEY INSPECTION DIViSIONY
Flfective On Januar 1, 2001
N 131 University Ave NE
idley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
m 13.572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
RM SCBE LE
So
R
rD-i :sidential
Rate TOTAL
OWNER v'�
=urnace Shell and Dud Work, Burner •
n
"�
BUILDING USED AS
_
�
llso Repiacemeni Furnace
$ 30.OQ $
Z � 0 nO
[ C.
PERMIT NO. L'<
(Side Vent . Fill Out Back)
ESTIMATED COST
aas Piping (Needed with new furnace,
$10.00 $
but not replacement)
DESCRIPTION OEFURNACEAND
OR BURNER
gas Rare
$ 10.00 $
'sas
$ 10.00 $
No. of Healing 1.11 its Circle One (Steam) (Hot Water) arm '
Trade Name Size No. P�� C7
Dryer
BTU UZfD HP
MR
Air Conditioning • All Sizes
$ 25.00 $
Fuel 4, �? Total Connected Load_
III Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
196 of Value of Appliance or Work
$
BTU HP
EDR
A 3mmenclal/Industrial
1.25% of Value of Appliance or Work
U
E
$
State Surcharge
TOTAL FEE $�
INlif M FEE FOR ANY HEATING/COOLING/VENTILATM
EFRiGERATIOWAIR CONDITIONING PERMIT IS $25.00
LUS THE $.50 STATE SURCHARGE
a =INSPECTION FEE $47.00/Hr
ED
i dr Conditioners can not be placed in a side yard without
dtten permission from adjoining property owner.
N
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated In this application are true and correct.
HEATING CO
BLAINE HTGi. A/C ELi:W ,, 16-- I a&
13582 CENTRAL AVE. N.E.
ANOKA, MN 55304
Signed ' ` er, L # 75
V
Approved By Rough -In Date Final Date 1,2-10 61
D COMBUSTION AIR VERIFICATION
n
SEP -20-2001 1453 FROM CITY OF FRIDLEY TO 7576701 P. 02/02
COMMON VENT, VENT CONNECTOR AND -COMBUSTION AIR V91RIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and Is securely supported and frestopped where required. Yes No( )
The venting system Is piasddPVC 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 manufacturers specifications. This does
Include AGA LAMA Category I Central Furnace Venting Tablas for fan /f
assisted and natural draft appliances. Yes,) No ( )
The existing combustion air is sized and installed to meet the current codes 4
and manufacturer's specifications. YeSM No( )
When required to Install a new combustion air, it will be sized and Installed `
to meet the current odes and manufacturer's specifications. Yes No ( )
When instailinsr a new ventinai system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specfcations. 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( )
ApPtiance Type and $ize/Common (Vent and Vent Connector information
Appliance #1 Type T 12rVaf )- BTU Input l l' 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 U .'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)
BLAINE HTG.'rV-U ELECT.,
13562 NOKA, MN 55304CENTRAL AVE. N.E. .
HEATING CO:
Signed By: en. Date:
TOTAL P.02
Cf1YOP
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
November 9, 2001
Mary Carlson
7351 Memory Lane
Fridley, MN 55432
Re: Final Inspection at 7351 Memory Lane
Contractor: Blaine Heating A/C Electric, Inc.
Dear Ms. Carlson:
A mechanical permit was issued on October 23, 2001, to install a furnace at your address.
According to section 305 (a) of the 1991 Uniform Mechanical Code, a final inspection shall be
conducted on the mechanical work authorized by this permit. As of this date, no inspection has
been called for.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Mechanical Code. We will keep your permit open for another 30 days and if we
do not hear from you within this time to set up the inspection, we will expire the permit and no
further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK Nl IMRFR ()F FIXTI IRFC Tn RF [M-QTAI 1 Gn nki =Ann r1 nn0
Effective On Jan 1, 2000
PLUMBING FIXTURE RATES: NO.
CR • 1
JOB ADDRESS 541YE ff -S dWL)16 e_
R•
� _ t
R F
• -
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
® � R
?
�®
Blow Off Basin
$ 7.00
.and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
7351 MEMORY LANE 20 D Z
Sump/Receiving Tank
$ 7.00
FRIDLEY, MN 55432
Water Treating Appliance
$10.00
Owner (763) 717-1391
Water Heater -Electric
$ 7.00
Water Heater- Gas*' _�
$10.00
Building Used As�al��1lY Cel
Gas Range**
Gas Dryer**
$10.00
$10.00
A
Estimated Cost PERMIT NO. C /
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY__ d0F,=M ?_.() A1_
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
JOB ADDRESS 541YE ff -S dWL)16 e_
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
$ 7.00
7351 MEMORY LANE 20 D Z
Sump/Receiving Tank
$ 7.00
FRIDLEY, MN 55432
Water Treating Appliance
$10.00
Owner (763) 717-1391
Water Heater -Electric
$ 7.00
Water Heater- Gas*' _�
$10.00
Building Used As�al��1lY Cel
Gas Range**
Gas Dryer**
$10.00
$10.00
A
Estimated Cost PERMIT NO. C /
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY__ d0F,=M ?_.() A1_
Reinspection Fee $47.00/Hr SIGNED BY TEL N0. Z` Z o
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved By Rough -in Date Final Date -i /
State Surcharge $ .50
MINIMUM F ANY PLUMBINGIGAS PERMIT IS $20 00
TOTAL FEE $ 0. 510 PLUS THE $.SQ SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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.
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.
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
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()
Yes ( ) No ( )
Yes ( ) No ( )
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 :
SUBJECT
P --NQ,
City of Fridley
32605
AT THE TOP OF THE TWINS
BUILDING
PERMIT
'
r
COMMUNITY DEVELOPMENT DIV.
RECEIPT NO
PROTECTIVE INSPECTION SEC.
�
I
NUMBER
RE"
OATE
PAGE Of
APPROVED BY
f 1 CITY HALL FRIDLEY U432
.J
612-571-3450
910-F15
15/16/02
JOB ADDRESS 7351 Memory Lane NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
Melody Manor 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mary Carlson 7351 Memory Lane NE
763-717-1391
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Stevens Company 10650 Co Rd 81, Maple Grove MN 55369 763-315-6622
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 IR REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with
the State Building Code.
LIMI Inspection Cards
Will 8e Mailed
To Mom' inner 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 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
@
$2,358
$1.18
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-
Fire SC. $2.36
STRUCTION$83.25 OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
Licens SC $5 0
$91.79
S-GNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATE,
HE PR E Y VALIDAT 0 THIS IS YOUR PERMIT
8 G TiATE
S-GNATURE OF OWNER,'F OWNER BUILDER) 1DATE�
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: % 3 51 040 JP Y ZA • X, --e ,
Legal Description:
Owner Name & Address: 0 AR y �A�P�So Tel. #_
Contractor: S21�'>J�'ills �o MN LICENSE #
Address:/ d 6 50 61y Rid � ��j� „�%'% Tel. #_ ZZ—
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
SS-jto-
Atta'�
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 1 Hgt/Ground Sq. Ft
0
Construction Type: It�1 � O ' - c�0 � Estimated Cost: $ '7 X43'58
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: -3 QZ APPLICA S;t �C"d`ZZ%/ �� Tel. # 31 2z—
CITY
Z
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
a�
$ 3. Fee Schedule on Reverse Side
$ a. .001 of Permit Valuation (1/10th%)
$ l . / $.50/$1,000 Valuation
$ $1100 per SAC Unit
$ ° J $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 [ ]
NSW
A D I)
ALTER L j
Construction Address:
I
CRY OI' PPMLEY
SINGLE FAMILY AND DUPLEXES RA AND R-2
BUILDING PERMIT APPLICATION
51 M'P40 0 Y ZAT Al - Le
Ef cfw 11112000
(763) 572.3604 Bldg Insp
Legal Description:
Owner Name & Address: , A �� e S0 __ Tel fir% -lam!/
Contractor5�'FVfAfS Ag' MN LICENSES
Address: 1_C51050 r V PC; 0 T.I. # - V
Attach to this application, a Certificate of Surwy of the
lot, with the proposed construction drawn on it to scale_
DESCRIPTION OF IMPROVLMlNT
LMNG AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height 8q. Ft
DECK AREA: Length Width HgVGround Sq. Ft
OTHER: - -
Construction Type: -ri4.f- DeP ,0 oe-ebpP Estimated Cost: s
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x 5 9 $
DATE: -� `� ��Z APPLICA Tel. ## �
CITY USIA QNLY - Call (763) 578.3604 for Permit Fees if marling In application
a�
Permit Fee $ 3. Fee. Schedule on Reverse Side
Fire Surcharge $ 3 .001 of Permit Valuation (1/10th%)
State Surcharge $ 1, ' $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ ` 4 $5.00 (State Ucensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt 'S" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ Not Necessary [ l
TOTAL 3
STIPULATIONS:
TOTAL P.01
INSPECTION REPORT
CITY OF FRIDLEY MINNESOTA
(763) 572-3604 AA
A ,
ADDRESS ��%
OWNER
If no corrections are listed above. appy
violation of the ordinance if you do not
corrections as called for.
qac*� -LBZT TLS £9L
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/rl,-hereby given to proceed. You will be.indo proper Inspections and make d�
/S - OILS
LBZT TLS £9L-
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