PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 3787
Date: ....! ...�. /✓'... 677 ......... .
owner ....................................... Builder '........... ..........
Address...................................... Address ............... ..........................
LOCATION OF BUILDING
No. ... (Ff :..! .. Street ........�. . e .. Part o Lot .............. .......... .
Lot ..0....... Block .................. Addition or Sub -Division ce~..... .. .. .. ... .
Corner Lot ............ Inside Lot J\ ......... Setback . Sideyard z. . �:........ .
DESCRIPTION OF BUILDING
T he Us as.
.0�rG�G ... .... Front , 7 /..`� Depth jOr q Height �/, '. ® 7 Sq. FtCu Ft.
........ ......
.................... Front JAI :9 Depth -9.1
Height /. .'.. Sq. Ft. CtL Ft.3 Om
Type of Construction ................... Est. Cost... f57'--'-T� be Completed ..................
In consideration of the issuance to me of a permit to construct the building desribed 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 $.q/.. , 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 with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
17 . Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
City of Fridley, Minn. N° 7633
BUILDING PERMIT
Date: June 2, 1965
Owner: LeRoy Hewitt Builder Quality Homes, Inc
Address 763 Mississippi St, N. E. Address 3701 Fremont Ave- No.
LOCATION OF BUILDING
No. 763 street Mississippi Street N. E• part of Lot
Lot 2 Block Addition or Sub -Division Clover Leaf Addition
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. n Cu. n
Front Depth Height Sq. Ft. Cu. n
Type of Construction Fast. Cost _ ft2jt 607 *00 To be Completed
Storm damage repair
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 aboveset orth and in�,coz pltan7 with aft provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to.QUity HOME,
1ne' to construct the building or addition as described above. This permit is granted upon
the express condf
that the person to whom it is granted and his agents, employees and workmen, 9n all work
ti
done in, around upon said building, or any part thereof, shall conform in all respects to the ordinances gof
Fridley, BRinneaoet;ardita :city land this
Allen Jensen Building Inspector
NOTICE:
M penelt den net rarer thn eenatraatten, haftWon foe whinq, pbunbinB, go Matted, www w water. Be son to we
thn BUM* ingaator for apwate pafmtb for than thea.
i
OWNER'S
ADDRESS
APPLICATION FOR I PERMIT
CITY OF. FRnM, NN SOTA
LOCATION OF BUNG
No, Street Par of Lot .
Lot , Block Addit.ibir or Subdlvisien
Corner Lot Inside Lot _ek Side -Yard
SEWER ELEVATIQN FOUNDATION EU ATION
Applicant attach to thi9 form, Two Certificates of Survey of Lot and proposed builder
ing location drewn on these O2ttificates.
DESCRIPTION OF BtTILDING
Tia be used as:
proaC Depth Height
Sq. Ft.
Cu. Ft.
_ yront Depth Height,_
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work it strict accordance with the City of Fridley Ordinances and
rulings ®*f the Departmeat'of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
�tU .of Pee Costs can be found on the Reverse Side).
Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU .................... —
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
RATE TOTAL
8.00
5.00 $
5.00 $
2.50 $
8.00
$
2.00
$
5.00
$
5.00
$
2.50
$
Dept. of Bldgs. Phone 560-3480
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
Fridley,
19 4�c
STEAM or HOT WATER SYSTEM To be completed about
Furnace Shell &Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Estimated Cost, $ �
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $/
Old—New. Building Permit No. �-�L" Permit No. --,3
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water ..... ...... .... 2.50 $
DESCRIPTION OF WORK
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 $ c�
ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH
FINAL
HEATING or POWER PLANTS --,Steam, Hot Water, Warm Air—No
Trade Na—p Size No
Capacity Sq. Ft. E.D.R O 1262'2 BTU H.P.
Total Connected Load Kind of Fuel
BURNER —Trade Name_ Size No
Capacity Sq. Ft. E.D.R- '�'� BTU H.P.
(REMARKS -OVER)
Signe �
By __
4.42 Business Phone No m �
SUBJECT
PERMIT
City of Fridley
15.829
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECE
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 / -1 CITY HALL FRIDLEY 55432
'.j
NUMBER
REV,
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
17/15/80
JOB ADDRESS 763 Mlssissl ppi Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
1 Clover Leaf Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dennis Smolich 763 Mississippi Street N.E. 571-5381
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548
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
X
8 DESCRIBE WORK
Install aluminian siding d trim & gutters - Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd 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.
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
1 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
$7,000
$3.50
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-
$42.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$45.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
i I) Oe6 �
BLDG INSP DAT
SIGNATUREOF OWNER(IF OWNER BUILDER)- IDATEI
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL_ BUILDING PERMITS "
(flew, Alterations, Additions, or Repairs)
OWNER: tj a S �lyl d , C /4 BUILDER: Z--� �l {� `J 6 /`/ � S6 A
yy���� �% ADDRESS: o?S l �► i R� e- dV
ADDRESS: 3 /�1 P Sr s S.
TEL NO: S71-� 3 TEL NO:
STRIMT NO : .L -3 STREET:
Construction Location
r
LOT: BLOCK: ADDITION:
Corner Lot: Inside. Lot: Setback.: _ Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth: Height:
Squane. Feet:_ Cabic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
Type of Construction:
�i ®s Estimated Cost: $ 74
✓ �% LG A A-0 C,
`ib Be Oampleted:
Alt. A Ali. 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 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 corre
DATE: '% - ( s ° v • SIGNATUr.L :
Stipulations:
SUBJECT
N O.
City of Fridley
2 1 0 4 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECE
COMMUNITY DEVELOPMENT DIV.
_
v PROTECTIVE INSPECTION SEC.
'1115-91)
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED By
612-571-3450
910-F15
9/3/91
JOS ADDRESS 763 Mississippi Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
1
Clover Leaf Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dennis/Carol Smolich 763 Mississippi St NE 571-5381
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Reitler Bldg Systems 21789, Oldfield Ave N, Scandia, MN 55073 433-5802
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 ❑ ALTERATION fel REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Kitchen Remodel
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations, on plan.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
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
$5,60Q
$2.80
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$81.00
Fire SC $5.60,
ST ON OR THE PERFORMANCE F CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
9.40
EN PROPERL V LI E IS IS UR PERMIT
NATURED CONTRACT RORAUTFIORIZEDAGENT (PAT
G NSP I DATE
SiGNATURE OF OWNER OF OWNER BUILDER) )DATEi
MW [ ] Effective 1,/1/91
AM4 [ ] 1-1 AMID A-2
AMER [ ] Building Permit Application
crostructicn Address:
t —«
Owner Name & Address: eA/ Ni S 'f 6A Pe / Si» a /rcZ Tel. $ a %/- 53f/
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed r - stru tics drawn an it to sole.
LIVnG AM: Length Width Height sq. Ft.
:GUMM AM: Length Width height sq. Ft.
MOM ARF2,: length Width Hgt/Greu;ri Sq. Ft.
MMM: Tie.
Oarner Lct [ ] Inside lotFt. Yd Setback Side Yard Setbacks
Type of Cmstnicticn: Estimated Oust: $
Approx. Gmppleticn Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DMM: / APPLICANT: cv 'lel. #
QTY WE C LY
Permit Fee $ .00 Flee Sdadule on Reverse Side
Fire Surdharge $ .001 x Permit Valuation (1/10th $)
State Surcharge $ Ci $.50/$1,000 Valuation
SAC Charge $ $650 per SAC Unit
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determined by ,rt; r Tri Tri
Sewer Main Charge $,- Agreement Necessary [ ] Not wry [ ]
To7w s81YO
U=CNS: SSC. ��•O V
I 'u/. YO
4.
M
6400
AA Q — %&(V
4V(Z 34
6rloo'
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Watgr Bath
Wash Drink.. Floor Catch::; Auto. Gas Gas Mise. Water Heater
Stories Closet Urinal Tub Shower Sink.« Trav Fount..> Drain Basin Washer Auol.., Range F�xt. Gas. Elec
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
NO. RATE TOTAL JOB ADDR
New Fixtures -3 $ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas
$10.00
Gas Range
$10.00
Gas Dryer
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance _
C The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
State Surcharge .50
Owner
y
i
Z--7-. 1991
Building Used As A02 -4-'I 5-71 - 53-$/
Estimated Cost 410 19' O'DPERMIT NO. ® �`�o
PLUMBING COMPANY
SIGNED BY� /d Z_04F::2��L NO..�7
Approved By ( Rough -in Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
TOTAL FEE $�' PLUS THE $.50 STATE SURCHARGE
MIT NO.
sue�Ecr
R
City of Fridley
26779
AT THE TOP OF THE TWINS
BUILDING P E R
M I T
r
RECEIPT NO.
1 �• COMMUNITY DEVELOPMENT DIV.
VV �����-I
PROTECTIVE INSPECTION SEC.
415/
r � �
1 . �
,91
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
ti'"-'11.� •'�
612-571-3450
910-F15
7/23/98
J08 ADDRESS
763 Mississippi St NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
Clover Leaf Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Dennis Smolich
571-5381
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Milton Johnson Company 52 LowryAve E is -
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 ❑ ALTERATION rA REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof 24 S Tear-off; Sidingrear trim re air
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
Call for building wrap inspection beforecovering.
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 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 PERFORMA E OF CONSTRUCTION.
74.75
Fire SC $2.00
r
PLAN CHECK FEE
TOTAL FEE
7�-�_ V
`
License SC 5.00
82.75
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPER ALIDATED THIS IS YOUR PERMIT
Bl G INSP
DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
MIT NO.
NEW [ 1
ADDN [ CITY OF FRIDLEY
ALTER �_ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 763 Mississippi St. N.E.
Legal Description:
Owner Name & Address: Dennis Smolich (same)
Contractor: Milton Johnson Company
Address: 525 Lowry Ave. N.E., Mpls. 55418
Effective 1/l/97
1111
9 60'
Tel. # 571-5381
MN LICENSE # 2083
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
781-9548
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Hgt/Ground Sq. Ft.
OTHER:
-------------
Construction Type. Tear -off re -roof Estimated Cost: $ .7 , 6 0 0.0 0 �(
siding repair, trim repair(FeeSchedule on Back)
Driveway Curb Cut .Width .Needed: Ft. + 6 Ft Ft x $ - - $
DATE: APPLICANT: o Tel. 781-9548
;TIPULATIONS:
N
M
CITY USE ONLY
Permit Fee
$ % . ��
Fee Schedule on Reverse Side
%sire Surcharge
$ 00
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 400
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$ ,� (��
$5.00 (State Licensed Residential Contractors)
3riveway 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
$ 0o�
;TIPULATIONS:
N
M
CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1998
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS -7 to 3 PA 155 i S S i
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, Burner - 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 correct.
(Side Vent - Fill Out Back) 01 - (Lv ,1998
Gas Piping (Needed with new furnace) $10.00 $
OWNER Dt h Irl. l S S ir-n 0 l I C�1
Gas Range
Gas Dryer
$10.00 $
$10.00 $
*Air Conditioning - All Sizes $ 25.00
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE,
50
$ � 5.50
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
BUILDING USED AS L) t I'19
ESTIMATED COST L) 0 � 0 U PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name
BTU HP
Size No.
EDR
Fuel Total Connected Load
Burner Trade Name
BTU
HP
Size No.
EDR
RUM Hfc3.717CMIECT- W.
i af4affR LAVE N I
MOM MN 55304
HEATING P
Signed By el No.
Approved By Rough -In Date Final Date
FILL OUT BACK SIDE FOR.STACK VERIFICATION ON
REPLACEMENT FURNACE
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHDJNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
Has been -carefully examined
Yes O
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 heater
Yes (
) No ( )
8.
Has combustion air been provided for water heater
Yes (
) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
From: City of Fridley To: 7637542908 Page: 4/4 Date: 411612009 11:00:10 AM
Bu11dim-
Inspections
76375.72-3604-
763-502-497" PAX j
DATE -11 A-1 i
SITE
`ISITE ADDRESS
HIS APPLICANT 1S:
PLUMBING
SIDENT kL APPS... ICATI®1N1
EFFECTIVE 2-19-09
DOWNER
YOUR E-NIA1L ADDRESS
�iltlS L' 11H a i NAME:1"Iyllb J/r IG '
OWNER/ :" DURESS: �7 i [5il S51 �lf� S- 1-4e CITY 1� ► v�,�W STATE /� 'e, / ZIP SS Z
PHONE:�'y
CONTRACTOR NAME:TZA& Q+'1 eIlalro►jl * C6'
SUBMIT A COPY OF T'
YOUR STATE STATE LICENSE EXP DATE
LICENSE, BOND AND STATE BONDit 1 ,. EXP DATE
cDA
CERTIFICATE OF ADDRESS: CEMP 1 P 94104/1 � g e t-�l CITY I'J STATE&&_GIP Jar ,/Z j
INSURANCE PHONEFAX
PERMIT TYPE SINGLE FAMILY D TWO FAMILY D TOWNHOUSE
TYPE OF WORK: 1 D NEW
))(REPLACEMENT
DETAILED DESCRIPTION OF WORK Ln';b[I ftiinn pf (W 1A(&1 enL W- AE&
FEES ARE BASED ON $10.00 PER FIXTURE EXCEPT WHERE NOTED. FIXTURES: ('INDICATE TOTAL NUMBER
OF EACH BELOW). MINIMUM FEE
$35.50.
DRAINS
_WATER PIPING
_BATHSINK/LAV
_FLOOR
PIPING (NEED CITY LIC)
_SHOWER
POOL
_ WATER SOFTN ER ($35)
_BATHTUB
WASHER
_GAS
SINK
_SWIMMING
WATER CLOSET
PREV. ($15)
_CLOTHES
_KITCHEN
LAUNDRY TRAY
WATER HEATER ($35)
_BACKFLOW
FOR IRRIGATION
—DISHWASHER
_
WATER METER
OTHER
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case �of all work which requires review and approval of plans.
SIGNATUREOF APPLICANT PRINTNAME -1I�4la 1v�
DATE
pu.F. SI-:* (�T S:E:PA1tATE.PERMITS A::It:E..tlEflli:tttET .:FQR:t3i ltLt3iNO :EI,Et Tl`1C.4t : l�tD i9EE HAI �tE Vit;:; . R
City of Fridley
Building Inspections .3epartment
6431 University Avenue NE, Fridley, TMN 55432
763-572-3604
FAX-: 763-502-4977
Building
Inspections
763-572-3604
763-502-4977 FAX
SrrB ADDRESS / ce =
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING DOI
SIZE OF IMPROVEMENT
BUILDING
RESIDENTIAL APPLICATION.
CITY OF FRIDLEY
EFFECTIVE 1-1-08
_ YOUR &MAIL DRESS
VCONTRACTO
cm
PHONE Lim /) K W_
STATE LICENSE # 17
LE FAMILyM9WQ9N6fffKTION
FAMILY/NEW CONSTRUCITON
O BASEMENT ASH DROOP
D DECK O SIDING
O HOME CONSTRUCTION O EMAINTENANCE/REPAIR O REMODELING
FAX _ C' ( St) 1
EXP DATE
ZE
'ORIES
VINDOWS
O DRAIN TILE
O OTHER
oa.`�
PermitNo.-) 001,('U()
Received By:
Date Rec'd:
N
ROOFING
O HOUSE ONLY
zig
NUMBER OF SQUARES
O HOUSE & GARAGE
BASEMENT
REMOD dN0
GARAGES
PROPOSED SIZE:
OATTACHEDGARAGE
O DETACHED GARAGE
I-
.2.
Existing Floor Plan
Proposed floor plan
PROPOSED HEIGHT:
/ L _ /yj
3.
List of structural members to be used
SIDING
O Vinyl
[ a.-,
OSoffit /t,✓w
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADAPTIONS&P(MAM er1R>L�
OAlumrO�
"
O Tru. SL lrcLL-�
O _ Fascia / — 3� vK
I.
Site Plan/Survey showing the existing structures
and proposed project
V4NDOWS
/ — .8 Fi tz 6 L" - A -r" .'
5L. a
2.
3'
Two sets of construction plans
IN EXISTING OPENINGS OYes ONo
OR FOR NEW OPENINGS
LATIOI�J OF WS �— d."
-r
lar@' Calculations
-DESCRIBE SIZE OF
/L) / /3eZL
OPENING CHANGES &
/— A �, , / � _ -
TYPE OF. WINDOW TO BE INSTALLED
ER OF WINDOWS
ALL FEES ARE BASED ON VALLTATIAN- nvrr.rxrinvr• qrUV r r%a . v .1sAr
.
COTAL JOB VAIA
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
1997 UBC FEE SCHEDULE)
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Mmilnum $.50
•$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
$+6ft= ftx$21=$
$450 Conservation Plan Review
4i Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ 14 N . ! cl� Make checks payable to• City of Fr cuoy Attach
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and aownate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the hfiru mote. Construction Codes; that I understand this is not a permit but only an application for a pennit and work is not to start without a
permit on site; that the work will be in ce with the approvedplaA in the. case of all work which re=-1'ew
'd of plans.
SIGNATURE OF PL PRINT NAME�► DA7'l3� • 3-,/1
APPROVED
. . •