PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 6555
Date:
Owner: ¢� Builder
Address -_ Address
LO. _TIO OF BUILDING
Street 4 el
Lot ' __ Block _____ _ Addition or Sub- vision .
Corner Lot Inside Lot 1-=— Setback L -r _ Sideyard g
Sewer Elevation
Foundation Elevation
� Tto'11ZDESCRIPTION OF BUILDING
To ' Used
Front Depth 4 Height Sq. Ft. Cu. Ft.
Front ,Depth /jam htt ��Sq. Ft. Cu. Ft.
Type of coon . __ -- Fst. ,1��/� To be Completed
In consideration of the issuance to me of a permit to cons the ding descri, ' e I agree to do
the proposed work in accordance with the description above set rth in compligh- a'll provisions of
ordinances oP the city of Fridley. ! i?
In consideration of the payment of a fee of $� permit is hereby
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 anypart thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of builA8ngs
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of saad
ordinances. n, /l !1
NOTICE:
Uls permit doss not cover the construction, insmWen for WWng, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these Henn.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
0607M:' S NAME le BUILDER �d `
ADDRESS ADDRESS 3 13
LOCATION OF BUILDING `
No. Street Part of Lot
Lo` J Block Addition or Subdivision
Corner Lot Inside Lot Setback 3 J Side Yard
SEWER ELEVATION FOUNDATION ELEVATION �S %
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. FC . CU. Ft.
Type of Construction Bstimated 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 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 aAd correct.
(Schedule of Fee Costs can be found.on the Reverse Side).
City of Fridley
Application for Plumbing and Cas Fitting Permit
Dept. of Bldgs. Phone SII 4.7
DESCRIPTION OF WORK / .
Number. Kind and Location of Fixtures Location 4 o
U' WATER HTR . . .
City of Fridley: �✓
VC
Z~L
e2r��8CZ
tZ
OZ
,
C7
Z
•
•
GAS
ELEG
Base
1st
2nd
,
3rd
4th
• Future Connection Openings
e New Fixture, Old Openings I
Connected with Sewer
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $—,1--2- e-0
Future Fixture Opening ................ x 1.20 $
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 $ ' S- 0)
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ...............................................$
TOTAL FEE
5
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 applicatio are true and correct.
Fridley, Minn 19
43
Owner - 'f iz -6
Kind of
Used as
-ro ne completes anout
Estimated Cost, $
Old New ding Permit
ROUGH
FINAL
4e
By
Business Phone
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
�G
I
uu��6SS
Y rF�-
Z
8
Z7
S� L<�w,
Ignd
w
Ig
Z
•
R
•
N
WATER HTR.
GAS
ELEG
c
<�
U a3
< 3
aS
C�'1 0
Base
Ljf
Z
Ist
2nd
3rd
_
4th
• Future Connection Openings
Connected with
* New Fixture, Old Openings
Sewer
Cesspool 0
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: RATE
Number Fixtures x $1.50
Future Fixture Opening 9;? --x 1.20
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
TOTAL
$
$
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 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE %� O
City of Fridley: 6 -7 ? -�3
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.
Fridley, AMnn _, 19Aj
Owner /
Kind of Building
Used as
v
To be completed about
Estimated Cost,
Old New d
ROUGH
FINAL
d2 2M
City of Fridley, Minn. N° 8285
BUILDING PERMIT
Date: July 290 1965
Owner: RON DeVRUEBDT Builder L. W. SAMUELSON CONST.
Address _.. 6783 Overton Drive Address 7800 E. River Road
Fridley, Minnesota Fridley, Minnesota
LOCATION OF BUILDING
No. 6783 street OVERTON DRIVE Part of Lot
Lot 3 Block l Addition or Sub -Division Medowlands 2nd Addition
Corner Lot — Inside Lot Setback Sideyard
Sewer Elevation ____ — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front _____ Depth Height Sq. Ft. Cu. Ft
Front Depth Height Sq. Ft Cu. Ft
Type of Construction Est Cost $7.9815160 To be Completed
Repairs - Storm Damage
�i
In consideration of the issuance to me of a permit to construct ding bed above I to do
the proposed work In accordance with the description above set fo in pliance with 21- ons of
ordinances of the city of Fridley. /
r;
In consideration of the payment of a fee ofl$0 • � , permit is hereby granted to L. W. SAMUELSON CONST
to construct the building or addition as described above. This permit is granted upon
the eFy
ess condition that the person to whom it is granted and his agents, employees an workmen, in aII work
donearound and upon saidWillinthe d olimits and 1pcation, construction, alteration, maintenance, repatr visionba o said
orthi nceg. ty permit may be revoked at any time upon violation of
ALIEN G. JENSEN Building r
NOTICES
This pan* den net nwr the conshvetien, hufallatbn for wkht& phmbb& gn howb& sewer or wda. Be wn to see
the Betiding Wgwd r ter opmb pwmth ter these Hexa.
No'._ ' 6183 Street OVA. r' a0 LL Dr, Part of Lo
LOT BLOCK _ADDITION OR SUBDIVISION
Corner Lot., _Iaside LOTS Setback Side -Yard �.
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location -drawn on these Certificates.
DESCRIPTION OF."SUILDING
To be` used as:
dwelling Front Depth Height
Sq. -Ft. Cu. Ft.
Front Depth* Height
Sq. Ft. Cu: Ft.
Type of Construction -PM _ Estimated CostPis.6D
To. be completed a gonia •a . ra n c c3 h7'a ,
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 trM6 an co ct.
DATE __jUj. 'I X65 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side)-.
City of Fridley, Minn. 0 10973
BUILDING PERMIT
Date: _ARril 6, 1971
Owner: Ronald DeVriedt Builder Floodmaster Eng.
Address ----6U3 Ovexton nriuP Address 1545 Selby Avenue
LOCATION OF BUILDING
No. - 6783 Street _ Overton Drive N.E. _ _ part of Lot
Lot W3'__ Block 1 Addition or Sub -Division . Meadowlands 2nd Addition
Corner Lot __ Inside Lot —?KSetback --- Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Alterations Front r Depth Height __ Sq. Ft Cu. Ft
Front Depth _ _ Height _ _ Sq. Ft. Cu. Ft.
Type of Construction Frame Est, Cost . 960.00 To be Completed 1 month
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 Z provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 6.00,permit is hereby granted to Floodmaster Eng.
or addition as described above. This permit is granted upon
the express condition that to
construct o whom ibuilding granted and his gents, �Plall respects to the�ordinanoEs of
done in, around and upon said building, or any � thereof, shall conform in
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upon violation of aay of the provisions of said
ordinances.
Inspector
CLARENCE BELL
NOTICE:
This permit does not cover the construction, InskWon for wiring, Plumbing, gn heating, sewer or water. Be sore to we
the Building Inspector for separate permits for these Items.
ry
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME : Z..N (U BUILDER:
ADDRESS:/, 71 ADDRESS: / S q S
c
NO:. & 78_ STREET: el r►,e� _ � �,,_e
LOT: 3 BLOCK: / ADDITION 59U-"'
CORNER LOT: INSIDE LOT:_SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
aa�g g Front • Depth • Height
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: 114 Estimated Cost: $ &0' 0 Q
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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:*, / ' �o - SIGNATURE:A:
(See Reverse Side For Additional Information.)
SUBJECT
Pr16
City of Fridley
o 71
AT THE TOP OF THE TWINS
B U I L D I N G P E R M I T
r
REC
�
11 Lu _ COMMUNITY DEVELOPMENT DIV.
y�3 D
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/20/8
JOB ADDRESS 6783 Overton Drive N.E.
1 LEGALLOT
NO.
3
BLOCK
1
TRACT OR ADDITION SEE ATTACHED
Meadowlands 2nd Addition
DESCR.
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
DeVriendt 6783 Overton Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Richard Hastings 6331 Riverview Terrace N.E. 574-9966
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 ❑ REPAIR ❑ MOVE ❑ REMOVE
El
8 DESCRIBE WORK
Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS Will.be tearing off roof and reroofing. Install galvanized valleys
where needed.
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
1
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$2,000
$1.00
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-
$32.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
`e4Z -' a c 84
$33.50
SIGNATURE OF CONTRACTOR OR AUT RIZED AGENT (DATE)
WHEN PROPER VALIDATED THIS IS YOUR PERMIT
V�
BLDG INSP r) TE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIC14 FOR RESIDENTIRL BUILDING PERMITS
(REw, Alterations. Additions. or Repairs)
OWNER: , p 6' U,Z I BUILDER: /Z e c A A R 0 - Ag s -, `-f tiC s
ADDRESS: , "7 S oie ADDRESS:
TEL 90: TEL NO: 5-7
Construction Location
- STRE T NO: 4793 STREET: U ✓ S lZ t o ry I' Z,
LOT: 3 BLOCK: `LADDITION: AAS -4.1c, 61,Vo S . 2-/V./ Ag
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:
Square Feet. Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: 7t -egg o FF C too o !' Estimated Costa s a oo o " o p
To Be Obrapleted: zZi ® f � a
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired:
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the �;ork herein specified,
agreeing to do -all Work in strict accordance with the City of Fridley Ordinances and
rulings of the DeZkirtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: j/20 ''Z SIGNATIJIM:
Stipulations:
0
CITYOF
FRlDLEY
FRlDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRlDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
April 25, 1994
Ronald Devriendt
6783 Overton Drive N.E.
Fridley, MN 55432
RE: Home Occupations
Dear Mr. Devriendt:
In the zoning district where you live, home occupations are
permitted as an accessory use, provided that certain criteria are
met. I have enclosed a copy of this City Code section for your
review.
Recently we received information suggesting that you may be
operating a retail business (ongoing garage sale) out of your
residence which is not in conformance with the restrictions. If
this is correct, please comply with the City Code by discontinuing
this activity immediately.
Feel free to call me at 572-3595 if you have questions or wish to
discuss this further. Thanks for your cooperation!
Sincerely,
Steven Barg
Planning Assistant
SB:ls
CE -94-156
CITY OF FRIDLEY INSPECTION DIVISION
Effective On January 1, 1999
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
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
Fumace Shell and Duct Work, Bumer -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Fumace $ 80.E
$
representations stated in this application are true and correct.
(Side Vent -Fill Out Back)
Gas Piping (Needed with new fumace, $10.00
$
but not replacement)
OWNER -j
Gas Range, $10.00
$
BUILDING USED AS �
Gas Dryer $10.00
$
�, � C� � )l
ESTIMATED COST . PERMIT N0.
*Air Conditioning - All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% bf Value of Appliance or Work
$
9
No. of Heating Units I Circle One (Steam) (Hot Water) li �armA-
TradeName 7 V4. Size No. A)—f ;)60 `7S
Commercial/Industrial
BTU_ -75,0 ®(D HP °Z EDR
1.25% of Value of Appliance or Work
$
Fuel_ N3 Total Connected Load
State Surcharge
$ .50
Bumer Trade Name Size No.
TOTAL FEE
30. w
BTU HP EDR
$
HEATINJMW A tr
MINIMUM FEE FOR ANY HEATING/COOUNG/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
Signed Tel No. `l5PLUS
THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
Approvgh-In Date Final Date
*Air Conditioners can not be placed in a side yard without
FILL OUT BACK SIDE FOR STAG VERIFICATION ON REPLACEMENT FURNACE
written permission from adjoining property owner.
CHIMNEY 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 Yew 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 1115� J 0 0
All other BTU's 7A , ® ® 0
TOTAL BTU's , `� . Q Q p
T�
7. Has a liner been provided for water heater Yes Z-� No ( )
8. Has combustion air been provided for water heater Yes)A) No ( )
Remar*—R>,
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
.r.
I
CfiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
August 9, 2000
Ron DeVriendt
6783 Overton Drive NE
Fridley, MN 55432
Re: Final Inspection at 6783 Overton Drive NE
Contractor: Quality Air, Inc.
Dear Mr. DeVriendt:
A mechanical permit was issued on April 9, 1999 for the property located at
6783 Overton Drive NE for a furnace. 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 (763) 572-3603.
Sincerely,
DAVE�JE�pSEN
Build g spector
f /
SUBJECT
P
City of Fridley
�L!29341"'
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBERREV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/29/99
10B ADDRESS 6783 Overton Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
1
1 Meadowlands 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ron De Vriendt 6783 Overton Drive NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Richard Hastings Co 6331 Riverview Ter NE, Fridley, MN 55432 574-9966
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
4051
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Partial reroof (13 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS ARE REOUIREO 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) HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS
GARAGES
AND KNOW THE SAME TO IBE 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
$1,114
$.56
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 PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEETOTAL
E
IV
L _, C
$5.
$46.9
SIGNATURE OF CON7AACTO. ORCAUT.ORIIED AGENT 1 ATE,
EN 41RO
zrr
ALIDAT HIS IS O P IT
SGNATURE OF OYVNER,IF OWNER BUILDER, IDATE,
9ljr INSP
pA 1E
f /
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION v�#�—
ConstructionAddress: 4,?Y3 otjeg %� � 'A
Legal Description:
Owner Name & Address: C2 1,e (D� 1%�e`� i�s�� Tel. #
Contractor: �� cGj r2 �f Si �V6 S MN LICENSE # y05
Address: E 3_� kc U'94 0; C-1., f'E- ft— Tel. # S? Y'—??ee
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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
Length
Width
Length
Width
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
Construction Type: ?A? L 7��g Of'r7- lz� IZIrRcz-t Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $
DATE: L APPLICANT:.y�� Tel. #
Permit Fee
Fire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$ (�U
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ �Z �o
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
CITY OF FRIDLEY PERMIT NO.: 2004-02011
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED:
10/28/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 6783 OVERTON DR NE
PIN : 133024230042
LEGAL DESC : MEADOWLANDS 2ND ADD
: LOT 3 BLOCK 1
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL GAS
WATER
HEATER.
# NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS
0
# OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC)
200
APPLICANT
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
0.00
0.00
H P PIPEWORKS
3670 DODD RD STE 100
PLBG FIXTURES (EXIST OPENINGS)
0.00
EAGAN, MN 55123-
WATER HEATER - GAS
35.00
(651) 365-1340
STATE SURCHARGE, PLBG FLAT
0.50
TOTAL
35.50
PAID WITH CHECK # 10084
OWNER
DEVRIENDT RONALD E
6783 OVERTON DR 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
regulating cons tion or the performance of cons ction
App Date
Bldg Insp Dat
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Building
Inspections Cog
7.63-572-3604
'%--I-c,(.
SITE ADDRESS _ P
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
0 OWNER 11CONTRACTOR
PHONE: –1 I. -, - '5-7 1 - S % S -3
CONTRACTOR I COMPANY
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNUT TYPE
TYPE OF WORK:
CONTACT PERSON:
STATE LICENSE #
,7r : , r. a, :4 DL i
EXP DATE
Permit No.:
Received By:
Date Rec'd: r'
ATEMZIP15SU3.2
ADDRESS: 13562 CENTRAL AVE NE CITY ANOKA STATE AlN 55304
PHONE 763-757-6202 FAX 763-757-6701
,,SINGLE FAMILY 0 TWO FAMILY
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK 2 ,n 51 CL -1
0 TOWNHOUSE
❑ ALTERATION/REMODEL
awl„ AN
e
PER MS 16B.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)MFG: � r f •E'er MODEL: a� 1 � SIZE/BTUSIZE/BTU
a _+Gn
Equipment Installed MODEL:
MFG:
MFG; MODEL: SIZE/BTU
_A/C $25.00 _FIREPLACE (GAS) $15.00 —GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 _FURNACE $35.00 GAS UNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 VENTILATOR $15.00
POOL HEATER $35.00
DUCT WORK $10.00 _GAS PIPING $10.00
Permit Fee $ Number of fixtures @ $10.00 x $10.00
_
Permit Fee $ 50 Number of fixtures @ $15.00 x $15.00 = $
SurchTOTAL DUE $ Number of fixtures @ $25.00 _1 x $25.00 = $ a5 ,00
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $ 2-S SS6
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 work which requires review and approval of plans. G
SIGNATURE OF APPLICf� � . ° ` PRINT NAME R®GER HOFFHEIIi+1 DATE D ` G�
SIGNATURE OF APPLIC�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
'74z_�'7'7_1A04
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