PRE 2010 DOCSCity of Fridley, Minn. 114 7
6431 University Ave. N.E., Minneapolis, Minn. 55432
BUILDMG PERMIT
Date: - June 5.. 1272
Owner: Lenard Isdahl Builder Amber 8onstruction Inc.
,Address --M-20 Monroe Street N.E. _. Address 6070 Stinson Boulevard
LOCATION OF BUILDING
No.._.._.5$2,Q_._.._ Street ___ _...Monne Sttreet N.E Part of Lot
Lot—__4 __ Block _ _ 8 ___ Addition or Sub -Division Donngy's Lakeview Manor
Corner Lot __. Inside Lot X Setback 35' Sideyard 1 0'
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: ,�
Farni 1 y. Room Addn Front _.4-0 ® / Depth 12 � Height Sq. Ft. 240 Cu. Ft
GaragQ — Front -612" Depth 261 Height Sq. Ft. X421 _ Cu. Ft. - -
Type of Construction _ +, __ Est. Cost 1-1 --.0- To be Completed Sept:. l,r—Lq.0
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work accordant with the description above set and in compliance } all pr ►vit�ione of
ordinances of the cityof Fridley. / 0 /7
In consideration of the payment of a fee of $14 00—, permit is hereby granted to Amber Cons truction
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordingnces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildino
vyithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of odd
ordinances.
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be suns to see
the Building Inspector for separate permits for these items.
•
2
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME : -1,Z &f& f3 7S O AA -t, BUILDER: /9�?,0J/Z &v -q -r I-IV C
ADDRESS ;EFf-2c) zr/laaleya 97%zr£7- A—ADDREss : <, Q C 11V S6Ae
NO:. STREET: Wa n
LOT; BLOCK: ADDITION: /►`_ /' /?/f V kP �g�fG✓�
CORNER -LOT: INSIDE LOT: SETBACK: 5 SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
o Be Used As:
Front: Depth: Height:
Square Feet: Cubic Feet:
r '
Front: & Depth: Z Height:
Square Feet;-- Cubic Feet:
off'
Type of Construction: F�d9L f' -r r-- Estimated Cost: _$ 6,
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict 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: 7 Z- SIGNATURE:
(See Reverse Side For Additional Information.)
a
v
URRALIX T- Una"IKAI*-Wlow I& WIPAS04
LOT SURVEYS CLOW, ANY
UOD �;Alkll-nlcoc-
MIN&IML 4tr, V'A�- Iff!'%ft Kra IM -11,51,42
==rM=
a0ll.vsw XT 4ND293uom ,Vw OT 312VMW�
%arum-mis WIMTnn-M 14
CITIV i"VIM - 4��4--flwjl ;sr
I ti -J;
316ack St
LAKSVIE4 MANOR ADDITION
We a true aid cony rePrduntV'Qn
of a sjjrm-j Li,"-bmr-t�arTes *# the aWve described tared
the locaticm vi v] and vs onamchme". if any,
from or an upid!wr&
Signed
Strveyed bv ut t- 00' LOT SURVEYS COMPANY
V7
.1.
%r
rV
CA
&
316ack St
LAKSVIE4 MANOR ADDITION
We a true aid cony rePrduntV'Qn
of a sjjrm-j Li,"-bmr-t�arTes *# the aWve described tared
the locaticm vi v] and vs onamchme". if any,
from or an upid!wr&
Signed
Strveyed bv ut t- 00' LOT SURVEYS COMPANY
Av a pvnw and HCao - cAir Cca +�!qq:?+-2psa�g, ver' ��` 43, t
as
PARTIAL RATE SCHEDULE Dept. of la1a0s. pliftw
/ )30 -UM
GfRA VI sir WARM AM: MFaTZ TOTAL 1t_nesa4eus� � O O� G t
Furnace Shell & Duct work $10.00 R
City of Mdler:
Replacement of Furnare 6.00
P,cpairc & Altcrat:ons up to ¢500.00 s g The undersigned hereby makes application for a permit for the work herds•
specified agreeing to de all work in strict accordance with the City Ordinaneet
Repair, & Alterations each add. 5500.00 300 $ and ruling of the Depa?tment of Buildings, and hereby declares that all the fee
and represPntatluns stated in this application are true and correct
Nf.LCI-L WARM AXR
Fridley. Minn
FUrnace Shell & Duct Work to 120,000 BTU
.$1000
$
each add. 60,000 BTU
3.W
S
Owner
Replacement of Fluence
6.00
i
Kind of Building
Repairs & Alterations --up to $500.00
6,00
$
Repairs & Alterations each add. $500.00
3.00
$
Used ae
STEAM at Ho°r WATER SYSTEM
To be completed about
Furnace Shell & Lines ---to 400 sq. ft FZR Steam
S10.00
$
Estimated Cost, $
Furnace Shell. & Line—to 640 sq. ft. EDR Hot Water
1000
$.
Id New. Building Permit No. ____ __ _ Permit No.
Each add 209 sq. ft. EPR Steam
A on
;
Each add. 320 sq. ft EDR Hot Water
3.00
$
=CRUMOH or WORK
OIL SUPKEF.—to 3 gal_ per hour 6.00
over 3 gal. per hour ---See ree Schedule
GAS BURNER Cup to 199,000 BTID 5.00 ;
over 199,000 BTU Sae Fee Schedule
GAS FITTING FEES. NO RATE TOTAL
1st 3 fixtures %$ ZOO $
Additional )P Isrtures x .75 S___
Gas Range W I99,0M8 4 s$ M $
Gr _
z ® 11State Surcharge , 50
PAN HEATING GTZT=l S®s Fee
VESITILATWO 9TBTEW
ALTZnATrON5 & REPAIRS TOTAL F=o
1 wAL `2 3 - i.S'
HEA77NG or POWER PIA Steam, Hot Water, Waren Air—No
Trade Size No e1'
Capacity_-__. _ Sq, n E.D.R BTU g,p
Total Connected Load Kind of FUel
BURNER — Trode No Size AFo
Capadty Sq. R )i M R BTU Zai,_
tmaas—oM1
ft
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
-RESIDENTIAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
RATE TOTAL
--UU Xve Aug. 1, 1901
Job Address r
$ 20.00
$
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.
* Air Conditioning (all sizes) $ 10.00
All Others/Repairs and Alterations
1$ of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
$ /'0 D 60 OWNER
RIND OF BUILDING
USED AS
S TO BE COMPLETED ABOUT
State Surcharge $ .50
TOTAL FEE $
Reinspection Fee ($15.00) $--
Rough Insp.
/ Date
Final Insp.,
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCHARGE
Attach stack verification form with replacement furnace permits
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
ESTIMATED COST OLJu
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
BEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name size No.
Capacity Sq. Ft. EDR BTU HP i.
Total Connected road Rind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company
:,�.�� •4
Signed By
Tel. No.
r
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
Back Flow Preventer Required.
Type
$
5.00
$
m
$
1.50
>,
N
$
5.00
$
U
$
k
N
5.00
Water
5.00
$
7.00
$
5.00
$
idc
E
$
M
N
Id
v
p,
W
tP
Heater
bro
m
$4
.�
aN
N
N
ro
N
8
403 N
N0
N
o
En
PO
U
D
m
3
a W
tp
w
u p�
3
as
lec
1st
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
Back Flow Preventer Required.
Type
$
5.00
$
3.50
$
1.50
$
4.00
$
5.00
$
5.00
$
5.00
$
5.00
$
5.00
$
7.00
$
5.00
$
10.00
$
10.00
. Yes ( )
TOTAL
$
No ( )
$ 5.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or Appliance
Reinspection Fee $ State Surcharge
($15.00) TOTAL FEE
Effective Date May 1, 1988
Job Address "02a S11-
4 -
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 application are true and correct
Fridley,
+Mn. , 19
OWNER
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT r- A 6
ESTIMATED COST C�
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
ROUGH INSP.
Date
Company ) /
Signed By �j .rho 2
Tel. No.
FINAL INSP. �,7
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY P
PLUS THE $.50 STATE S
ING PERMIT IS -M-00
SUBJECT
City of Fridley
20356
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
� • COMMUNITY DEVELOPMENT DIV.
w------
r PROTECTIVE INSPECTION SEC.
�
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
I i"'1 CITY HALL FRIDLEY 55432
� �j 612-571-3450
910-F15
5/15/90
JOB ADDRESS 5820 Monroe Street N, E,
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
4
8
Donnay`s: Lakeview Manor Addition SHEET
DESCR.
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Leonard Is.dahl 5820 Monroe Street N,E, 571^3662
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home improvement 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 ❑ ALTERATION Cjj REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo£ Dwelling C17 Squares)
9 CHANGE OF USE FROM TO
STIPULATIONS goof 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
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
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
$850
$150
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
PROVISI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$23 ° OO
STRUCT ON THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$23.50
S NATURE OF CONTRACTOR OR AUTHORIZED AGENT 10 TEI
HIS IS YOUR PERMIT
WHN�=
i IS-/NP2�
iNSP PATE
SIGNATURE OF OWNERJF OWNER BUILDERi IDATEI
NEW [ j CITY OF FRIDLEY Effective 1/1/90
ADM [ ] R-1 AND R-2
ALTS [ ] Building Permit Application
Construction Address: _ `� $O® 11-29we0e s;,-, 'Ioe'
legal ..`. i`." ipotion: '
Lr7M AM:
GNOM XMM:
D�C1C ARES►:
OTIM :
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
arc t1MCK CF n► va�xr
Length Width '_: - Height Sq
. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: _ ,--A. IL Estimated Cost:
Approx. CMpletion Date: ® 70 17
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: APPLSCANr: Tel. #
Permit Fee $ ?3-
state
3.
State surcharge
$ SD
SAC Charge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Charge $
$ a3� -s�D
SM UUMCNS:
CITY USE CMY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreelnerit
Necessary [ ] Not Nary [ ]
V�,
HOUSE HEATING TEST
.. 2:rMas211171 IX•
VVAWAWWWlr
RECORD rAU�
_FLOOR CITY SUBURB
HEAT LOSS DATE HTG. INST.
INSTALLED BY
SOLD BY
Electrical Work' By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR.
GAS DESIGN
MAKE MAKE OF BURNER —
Modal Model
Serial Max. BTU Rating
INPUT MAKE OF FURNACE —
Model
UNIT HTR. OTHER
CONVERSION
CONTROLS II
Vent Size
THERMOSTAT Heat Plug
KIND OF LINER
SIZE NONE
Valve
Draft Hood
u laror
Limit
I(n
Filters Si:
umber
Limit Setting �
Chimney Location
Outside
Fan Setting
(Inside
vile
Pilot Type 0
Chimney Construction T
Pilot Make
Pilot Model
Smoke Bo //��
.ilh
Wiring
Daft
Test Tag
Pilot Timing
Door Pressure
Lighting Inst.
L.W. Cut Off
Pressure Percent CO2
Date Tested
Input CFH �� Percent 0P.2Company
Testing
Stuck Temp. Percent CO
ter
Name of TesA3:�-
Form 235
r ,
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1986
' 6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS
AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING
SYSTEMS AND DEVICES
SCHEDULE
JOB ADDRESS 6920
RATE
r. 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, Bumer —
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace 00.00
$
representations stated In this application are true and correct. I` 19S
(Side Vent — Fill Out Back)
___ ,
e Gas Piping (Needed with new furnace) $10.00
$
),��5 `� � J
OWNER ��11�.���
Gas Range $10.00
$
BUILDING USED AS
Gas Dryer $10.00
ESTIMATED COST �� �•—� PERMIT NO. /
*Air Conditioning All Sizes $J600
$�
All Others/Repairs & Alterations (LIST ON BACK)
DESCRIPTION -OF FU„RIACE AND OR BURNER
1% of Value of Appliance or Work
$
No. of Heating U Its I Circle One (Steam) (Hot Water) arm Air)
_._
Trade Name Mr pSize No.
Commercial/industrial
I
BTU 15a WQ HP EDR
1 % of Value of Appliance or Work
$
Fuel A&L-4% Total Connected Load 5 9,, --
State Surcharge
$,�,60
Bumer Trade Name Size No.
BTU HP EDR
TOTAL FEE
ROYALTON HEATING & COOLING
HEATING COMPANY 4120 -€35TH AVENUE N.
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
BROOKLYN PARK, MN 55443
REFRIGERATION/AIR CONDITION NG PERMIT IS U5.00
Signed By I r LL.
PLUS THE $.50 STATE SURCHARGE°',
y�QC�e�,y- G
6 �
REINSPECTION FEE $30.00
Approved By Rough—in Date Final Date _ L
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
FILL OUT BACK SI E FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
�r.
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes a No ( )
2. Is free from rust or deterioration Yes o No ( )
3. Has no foreign objects lodged within Yes ( ) No (4
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 t/
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No (vf
8. Has combustion air been provided for water Mer Yesgo No
Remarks:
1, ,Z;i It AAM 5,,, C,,/1! /0<
HEATING CO:
Signed By:
Date:
d�
HEAT FOBS CAL
Wa-hsr4t81"
WIAdOwi —pEk
!� —Yrs.
Roos{ I Laoat6
Wia&wr and Doo r—Craakaev *Q Are{
Na, ar 1 Oa a{ apt IIaAu Of ""A,a% + (u
7
Cosi Btu
1a61eratioo
Glaze
Esp. wall
Net eap. waU
lat. wall
Ce1l1A/
Floor
-S'S-"36- f,,-
I
GiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612)
March 5, 1999
Chris Larson
5820 Monroe St NE
Fridley, MN 55432
Re: Final Inspection at 5820 Monroe St NE
Contractor: Royalton Heating & Cooling
Dear Mr. Larson:
A mechanical permit was issued on February 6, 1998 for the property located at 5820 Monroe
St NE fora replacement furnace and air conditioner installation. According to Section 305(a)
of the 1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical
system. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do not hear
from you, we will expire the permit and any inspections on this installation will require a new
permit.
Any questions can be addressed to myself at (612) 572-3603.
Sincerely,
If J io�
RIESCH
Building Inspector
BR/mh
SuBjECT
P MIT NO: ,
City of Fridley
33907
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
I �
NUMBER
NEV
OAT'
PAGE OF
APPROVED BY
CITY HALL FRIDLEV 55432
1 J` 763-571-3450
910415
9/22/03
JOB ADDRESS 5820 Monroe Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
8
Donnay's Lakeview Manor Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Christopher Larson 5820 Monroe Street
NE
763-571-1400
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
d 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 J7 REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with
the 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
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
$29315
$1.16
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$83.25
Fire SC $2.32
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$86.73
SG T j OFCON 'RA uTM iZEDAGENf DATEi
MEN PROPERLY VALIDATED THIS IS YOU
PERMIT
3 /03
S-GNAiURE OF WNE�7 iii OWNEp BU4DER� i0 E,
jkCrG -NSP
4ATE
NEW [ J CITY OF FRIDLEY Effective 1/1/2003
ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 5724604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION.
Construction Address: l4c,,,roe �y
Legal Description:
Owner Name & Address: if A r,-s-le.0 Tel. # i
Contractor. �� MN LICENSE #
Address: Tel. #
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.
Fire Surcharge
GARAGE AREA: Length
Width Height _
Sq. Ft.
$ ,.,�. l ��
DECK AREA: Length
Width Hg Gro nd
.
Sq. FtA 67
/
OTHER:
$
$5.00 (State Licensed Residential Contractors)
Curb Cut Escrow
$
Alt. "A" or Alt. 'B" Above
Erosion Control
$
Construction Type: r��-�,r�
Estimated Cost: $
L
Fee Determined by Engineering
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: !'/Z?- -3 APPLICANT: C—hr, 5 6,04-.1 1) Z -"s -"n Tel.
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
$ .
Fee Schedule on Reverse Side
Fire Surcharge
.001 of Permit Valuation (1/10th%)
State Surcharge
$ ,.,�. l ��
$.50/$1,000 Valuation
SAC Charge
$
$1275 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Curb Cut 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 $ (961 1 V
Building
PLUMBING
Permit No.:'70 -
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: - " -o
DATE -2 0 ® YOUR E-MAIL ADDRESS 4 � S®� to c G . !moo N1
SITE ADDRESS S a 0'q Iro e S T 1 `� E
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY
NAME:
OWNER/
TENANT
ADDRESS: 'S -7Q) ZQ 114 ® /1 tie E CITY STATE/4A)zIP 3
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE ZIP
LICENSE WITH
PHONE FAX
APPLICATION
PERMIT TYPE
TINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
XNEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK Unde2) ,,,V? d
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
_ BATH SINK/LAV _FLOOR DRAINS SHOWER _ WATER PIPING
_
—BATHTUB _ GAS PIPING (NEED cirrrrcmsE) _ SWIMMING POOL WATER SOFTNER ($35)
CLOTHES WASHER—_ KITCHEN SINK _ WATER CLOSET ACKFLOW PREV. ($15)
AOR
—DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) IRRIGATION
WATER METER OTHER
>,_ t;� ^•", ,. -,-...Ali F .. ,::_,... f
�
A.. tit, ,xi S^. S,. `vAha-•4;:`��R.,
Permit Fee $ 00
Number of fixtures @ $10.00 x $10.00 = $
_[5.
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $ �^ .
State Surcharge = $ .50
Total = $
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 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; that the work will be in accordance with the
approved plan in the case of all w r equires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME 126c- S !U eA S C) n DATE (On
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
*,;2ILe1
Building PLUMBING Permit No.: C7C�7
Inspections RESIDENTIAL APPLICATION Received By: 00
763-572-3604 CITY OF FRIDLEY Dat
DATE -7/6/2007 YOUR E-MAIL ADDRESS _RNELSON@HMCC.COM
SITE ADDRESS _5820 Momoe St NE, FRIDLEY, MN 55432
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY
NAME:_ROSS NELSON
OWNER/
ADDRESS: 5820 MONROE ST NE CITY FRIDLEY STATE MN ZIP 55432
TENANT
—
PHONE: 763-571-1159 OR 612-290-2291
CONTRACTOR
NAME
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE ZIP
LICENSE WITH
PHONE FAX
APPLICATION
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK _BATHROOM REMODEL. NEW TUB, TOILET, FAUCETS (SHOWER/SINK) ALL
IN LOCATIONS THAT MATCH EXISTING.
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SRWLAV DRAINS _ SHOWER l WATER PIPING
_FLOOR
1 BATHTUB GAS PIPING Men cnTLicwm) SWIMMING POOL _ WATER SOFTNER ($35)
_ _
CLOTHES WASHER _ KITCHEN SINK l WATER CLOSET _ BACKFLOW PREV. ($15)
_
DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_
WATER METER OTHER
PERMIT FEE PROJECTS FOR UNDER $500
PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $ Number of fixtures @ $10.00 _ x $10.00 = $
Surcharge .50 Number of fixtures @ $15.00 _ x $15.00 = $
TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
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 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; that the work will be in accordance with the
approved plan in the case of a ' h requires review and approval of plans.
s �o /I ''�(Sc�'� —7/G
SIGNATURE OF PRINT NAME S� X DATE / 46 '�
APPLIC
PLEASE NOTE: SEPARATE PERMITS ARE WQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
107