PRE 2010 DOCSCity ' of Fridley, Minn.
BUILDING PERMIT
Date: ...?%�%®..24a..?-9* ...................
Owner .......................................
Address ......................................
N® 3980
Builder .....AMP .BQnMn........................
Address .............................................
LOCATION OF BUILDING
No... ..... Street .....P4W.A.M. X4VA1,. I.......... Part of Lot ...............................
Lot ...7........ Block ....... 5 ......... Addition or Sub -Division .. Brno�Cdow . T8�x ca, . 3fitl Ad t .
Corner Lot ...........
Inside Lot ............ Setback : 35 9w ....Sideyard ...10 10 a
.................
DESCRIPTION OF BUILDING
To be Used as:
. Dvaling........ Front 41W. . Depth 2PP . Height 19!M. sq. Ft. 1034.. cu. Ft. ..� . .
.................... Front ........ Depth ........ cH��e[Light ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction ................... Est. Cost. t?.*76'%4900...... To be Completed ...................
In consideration of the issuance to me of a permit to construct the b g de bed above, I agree to do
the proposed work in accordance with the description above set forth co ante with all 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 ft is granted and his agents, employees and workmen, in an 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.
. ........... Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wlring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
Date:
Owner:
Address
City of Fridley, Minn..
BUILDING PERMIT
N° 5233
Builder
Address f --
N LOCAiON OF DING
No. _ Street?.�_y P q Lot
Lot _ �.._ Block Addition or Sub-Divisi
10F 14
Corner Lot Inside Lot RMackideyard
Sewer Elevation tion Elevation
DESCRIPTION OF BUILDING
To ,1�&i U was:
Front Depth Height Sq. Ft. Cu. Ft'�W
Fr Depth H ght —V..vr Sq. Ft.
Type of Construction :�,. � Est. Co _ To be Completed
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 ail provisions of
gr =ce s 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, reppair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation f any of the provisions of said
ordinances .rte Vii''? Y
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDIEY, MINNESOTA
LOCATION OF BUILDING
No. .0/0 Street Part of Lot
Lot Block >- Addition or Subdivisio
Corner Lot Inside Lot Setback Side -Yard
SEM ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
Sq. Ft. c27 a X 2 i Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction 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 declares that all the facts and representations
stated in this plication are true and correct.
DATE _ _ SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
01
SUBJECT
PE O.
City of Fridley
15 9 41
AT THE TOP OF THE TWINS
BUILDING PERMIT
t
CEIPT NO
�
' • COMMUNITY DEVELOPMENT DIV.
r PROTECTVE INSPECTION SEC.
1 � i
' S CITY HALL FRIDLEY 55432
1.j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
19/22/80
JOB ADDRESS 810 Pandora Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
7
5
$rookview Terrace 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS Drive ZIP PHONE
Duane Losness 810 Pandora MICURK N.E. 571-6029
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 12' x 8' Addition to Garage
9 CHANGE QF USE FROM TO
STIPULATIONS
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$850
$•50
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.
$7.50
PLAN CHECK FEE
TOTAL FEE
$8.00
SIGNATUREOF ONTRACTOR OR AUTHORIZED AGENT (DATE) _
w
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
Si NATUREOF OWNER (IF OWNER BUILDERi (DATE)
BLDG INSP DA7
01
CITY OF FRIDLEY
APPLICATION FOR RESIDLNTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OV114ER: _ PBA- & Lm _j'_0 l ivy g 5
ADDRESS: 8/0 '4A&0_n4.A 121?- lL4—:
TEL N0: % & - 6 G A f
BUILDER:
ADDRESS:
TEL 140: .
Construction Location
STRMT NO:
STREET:
Al ®Q ✓t' //
�� �4L- .�I��� -
LOT.: .' �
BLOCK:
ADDITION:
� ��� , 3 2A
Corner Lot:
Inside Lot:
�/ Setback:
Sideyards:
Applicant
attach to this
form two Certificates of
Survey of lot and
proposed
building Jocation drawn on certificates
to scale.
DESCRIPTION OF CONSTRUCTION
�T/o�rBFront: Height: 46`
Squane Feet: Cubic Feet:
Front: Depth: _ Height:
Square -Feet: Cubic Feet:
Type of Construction: Estimated Cost: $
10106
To Be completed:
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 work'hereinspecified,
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
represent<.tions stated in this :-1pplication are true and correct.
DATE: g U SIGNATURE: �✓ -�s �
Stipulations:SO
nn -
-1.
FO OT11A G 4' DEEP ,
ALL FOOTING MA'TL.
IS QRE.SSURF.TREATED,
13� 2XIO'S ONFEN DVJ\-CH
ENDS COVERED TOP
BOTTO K (3Y S % NGL
ZX\O. S\DES ARE
COVERED WMA S/8
DO®R T\rk\C,I� PLYWOOD
COVERED WIT" POLY
A'DD1T10N S1�EA�'1NG.
00 FOOT1MG IS MTG.ON
I AA-�CKSED._.
GARNGE
22�
t)UANE LOSNqESS
S 10 PN\AD.OR ADR tllE
SUBJECT
P MIT NO.
City of Fridley
15940
AT THE TOP OF THE TWINS
BUILDING P E R M I T
r
�CEIPT
N
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/22/80
JOB ADDRESS 810 Pandora Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
5
Brookvi.eW Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Duane Losness 810 RXNXU Pandora Drive N.E. 581-6029
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct an 18' x 24' Addition to Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
SIEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS. WARNING
Before diggng call local
utilities
TELEPHONE - ELECTRIC
- GAS Etc.
REQUIRED BY LAW
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 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
$16� 0�0
$8. 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-
$96.00
NONE
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$24.00
$128.00
_
SIGNATURE OF NTRACTOR OR AUTHORIZE AGENT
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�(DD-AATEIE
QLSI
BLDG INSP DATE
NATURE OP XtINER OF OWNER BUI DERI IDATE1
CITY OF FRIDLEY
APPLICATI94 FOR RESIDENTIAL BUILDING PER4ITS
(New, Alterations, Additions, or Repairs)
OWNER: DL A AI E I a5 BUILDER:
ADDRESS: / ® F4,V Po t2,4 12/2• IV ADDRESS:
TEL NO: $' 7 /— ®� 9 TEL NO:
Construction Location
STRICT NO: (j STREET: /� 4/ P 0 of 4/ � /�!• L^
LOT: BLOCK: �� ADDITION : /? ef i/ TE i R < 3
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 E 0 e4 14.)* /41
Front: Depth: Height: G--
Squane.Feet:� Cubic Feet: 40
Front: Depth: Height:
Square - Feet: Cubic Feet:
Type of Construction: CE M e "I' T 0 L 6 C/� 4- Estimated Cost: $ ,
To Be Completed: 44 d} :�/
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the work•herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of -the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: � - / 7 SIGNATURE: 'O.A
Stipulations:
pa4,00
Ty .W
C
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Job Address Sole
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. &64-1-1 , 19 �a
OWNER
KIND OF BUILDIN/GJ�
USED AS
17
m>1
TO BE COMPLETED ABOUT "
PARTIAL RATE
u,
ro
U
K
d
Water
a1
m
m
ao
TOTAL
OLD - NEW BUILDING PERMIT NO. PER14IT NO.
H
e c+
m
A
4-)
k
Ra
W
$2.00
$
Heater
o
-H
L is
u
C
m
q!
C
E
.0
m
C
..a
m
yC�
E
=
•.+ ro
?C 4.1
C C
$4
C
3
},
O
m
4 CC
U •.�
ro
O .0
LL
U
x
N
C
$
Water Heater - to 99,000 BTU
C
$5.00
$
m
— o
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
m
$7.00
�
Aj
v
y
'r u
$4
C)
ro
A
$5.00
•.1
rn
b
3
Sd O
❑w
4
w
-4
w
ro ro
vCQ
C ro
C3
ro
ro
i
as
lee
—jZ
INSP. V-1
1st 3 fixtures
x
$3.00
$
Date
Additional Fixtures
x
$1.00
$
1st
APPROVAL FOR PERMIT
Gas Range to 199,OCO ETU
x
$10.00
$
REPAIRS & ALTERATIONS
2nd
First $100.00
$5.0Q
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING RMIT IS $7.50
PLUS $.50 S ATE SURCHARGE
State Surcharge
$ ..�5/0
3rd
TOTAL FEE
l
V �/
$ •
REINSPECTION FEE
4 `z
i
(R) = Future Connection Opening
Connected with Sewer
(*) = New F xture, Old Opening
Water
Job Address Sole
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. &64-1-1 , 19 �a
OWNER
KIND OF BUILDIN/GJ�
USED AS
17
TO BE COMPLETED ABOUT "
PARTIAL RATE
SCHEDULE
ESTIMATED COST
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
OLD - NEW BUILDING PERMIT NO. PER14IT NO.
Rim er Fixtures
x
$3.00
$ _
F`ature Fixture Opening
x
$2.00
$
Company
New Fixture, Old Opening
x
$2.00
$
Signed By
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
Tel. No. s°j 7/
— o
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
ROUGH INSP.
Electric Water Heater
x
$5.00
$
Date
GAS FITTING FEES:"FINAL
—jZ
INSP. V-1
1st 3 fixtures
x
$3.00
$
Date
Additional Fixtures
x
$1.00
$
APPROVAL FOR PERMIT
Gas Range to 199,OCO ETU
x
$10.00
$
REPAIRS & ALTERATIONS
First $100.00
$5.0Q
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING RMIT IS $7.50
PLUS $.50 S ATE SURCHARGE
State Surcharge
$ ..�5/0
TOTAL FEE
l
V �/
$ •
REINSPECTION FEE
($10.00)
n
F
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 5543-1
�pq,
fi
3 ;June 30, 1980
� .0810 Pandora Drive N.E.
e hj
Mr. Duane E. Losness
`y! j
Fridley, MN 55432
d�
TELEPHONE ( 612)571-3450
Re: Machine Shop Home Occupation at 810 Pandora Drive N.E.
Dear Mr. Losness:
it was brought to -the City's attention and confirmed by an on-site
inspection on June 26, 1980 that you were operating a machine shop home
occupation out of the west half of the detached garage.
Although the City.does permit certain home occupations, it should always
be remembered that the purpose of a residential area Is to provide a
living setting away from the noise, clutter, or traffic of a commercial
district. Therefore, please read the following section of the Fridley
City Zoning Code which defines a.home occupation.
Section 205.02 defines a home occupation as, "Any gainful occupation or
profession engaged in by the occupant of a dwelling at or from the dwelling
when carried -on within a dwelling unit and not in an accessory building,
e.g. garage, and which. is. clearly incidental and secondary to the residential
use of the premises and does not change the character thereof, provided
that no signs other than those normally utilized in a residential district
are!present, no stock in trade is stored outside the building, over the
counter sales are not involved, and entrance to the home occupation is
gained from within the structure. Such use includes professional offices,
minor repair services, photo or art studios, dressmaking, or teaching and
similar uses; however, a home occupation shall not be interpreted to include
tourist homes, restaurants, or similar uses. Teaching shall be limited to
four (4) students at any given time. No home occupation shall be permitted
that results in the need for more than two (2) parking spaces at any given
time in addition to spaces required by the occupant (family). Occupations
requiring the hiring of employees other than members of the immediate
family shall not qualify as home occupations."
A reinspection will be conducted on or about July 21, 1980 to determine
compliance with the above listed section of the City Code. We are
confident in your cooperation on this matter and if any questions or
problems arise, please feel free to contact me at 571-3450.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1997
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
New Fixtures
$ 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 6,0
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance ®, oO
State Surcharge $ .50
TOTAL FEE $116.6
�
•_ ADDRESS DrDE. IN
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.
I
Owner 4®S /U E
1997
Building Used As
Estimated Cost f-q�, °D PERMIT NO.
PLUMBING COMPANY
SIGNED BY TEL NO.
Approved By Rough—In Date 3is. Final Date
M
STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
SUBJECT
PERMIT NO.
City of Fridley
275931,
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECE
I
COMMUNITY DEVELOPMENT DIV.
1
PROTECTIVE INSPECTION SEC.
r
i
NUMBER
REV
DATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
9/4/98
JOB ADDRESS 810 Pandora Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
5
1 Brookview TErrace - 3rd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Losness
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Viking Home Improvement Co. 4832 2 1972-IR20
4772
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 jj REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 33 S 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
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2828
$1.41
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-
STRUCV N OR THE PE O MANCE OF CONS RUCTION
$74.75
Fire SC $2.83
PLAN CHECK FEE
TOTAL FEE
License S
(GNAT RE OF CONTRACTOR OFt AUTHORIZED AGENT IDATEI
WHEN PROPERL ALIDATED THIS IS YOURPpjERMIT
BkAG INSP
GATE
S.GNATURE OF OWNER 0F OWNER BUILDERI IDATEI
NEW . F ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: j Li fl -. ,P o4 f) (; , fd . /E .
Legal Description:
Owner Name & Address: l d S.qF_ s s Tel. #
Contractor: MN LICENSE #
Address: -�2, % sT A) Tel. # S7Z—/82-o
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BIPROVEMENT
LIVING AREA:
Length Width
Height
Sq. Ft.
GARAGE AREA:
Length Width
Height.
Sq. Ft.
DECK AREA:
Length Width
Hgt/Ground
Sq. Ft.
OTHER:
3J f
Park Fee
$
Construction Type:
Estimated Cost: $�y
(Fee Schedule on
Back)
Driveway Curb Cut
Width Needed: Ft. + 6 Ft =
Ft x $
= $
DATE: APPLICANT: Tel. #
CITY USE ONLY
Permit Fee
$
Fire Surcharge
$ c�s
State Surcharge
$ L /
SAC Charge
$
License Surcharge
$ G�
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL
STIPULATIONS:
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
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX: (763)571-1287
ADDRESS : 810 PANDORA DR NE
PIN : 143024110098
LEGAL DESC : BROOKVIEW TERRACE 3RD ADD
: LOT 7 BLOCK 5
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT O.: 20041-00353 >>
L
DATE ISSUED: 03/18/2004
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
REPLACE FURNACE (WARM AIR, CARRIER, 70,000 BTU'S) AND AIR CONDITIONER
# A/C UNITS 1 VALUE OF APPL OR WORK
#FURNACES
# GAS RANGES
APPLICANT
CENTERPOINT ENERGYMIlNNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
(763)757-6202
OWNER
LOSNESS ANNA
810 PANDORA DR NE
FRIDLEY, MN 55432
1 # GAS DRYERS
0
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 wort
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 construction or the performance of construction.
ADnlicaff-, n Date
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 5425
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
5400
0
0.00
30.00
0.00
0.00
25.00
0.00
0.50
55.50
V_
'")F F&IDLEY INSPECTION DIViSION
6 1 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective January 1, 2003
&/;54q
GIS- _�4 5q,�_
JOB ADDRESS ] 10 QZ'rJo ✓ -1) L
OWNER /47 h L oski e S
TOTAL
BUI, LDING USED AS
ESTIMATED COST PERMIT NO.-,, ��r'< 0�25,53
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_L Circle One (Steam) (Hot WateC(\Wa m Air)
$ Trade Name C'�, ✓%��� Size No. � e
BTU -76,000 HP EDR
$ 025, 00 Fuel /V_4. was Total Connected Load
Burner Trade Name Size No.
$ B�QTTUU�� HP EDR
(_,rr-itfY 30 p -rk- X6,? -V X14,
$ 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
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
$ SS.So
DATE /S 0
CenterPoint Energy Minnegasco
HEATING C013562 Central Ave NE, Anoka, MN 55304
Signed ks- rt 763-757=6202
FAX # 763-757-6701 C---)
S
Approved By�:)L Rough -In Date Final Date . d
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
r` THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
furance, the undersigned hereby verifies that the
When Tania .:ten : an AX SAID�o
venting has been examined and is free from rust, deterioration, obstructions,
and firestopped where required.
Yes (x) No ( )
and is securely supported
The venting system is plastic/PVC and meets all current codes and manufacturer
of elbows. and termination.
Yes x) No ( )
specifications including sizing, length, number
The undersigned also verifies that the replacement unit is a listed assembly
fFumurees specifications.
and meets the current codes anCentral ace Venting Tables for fan
include AGA-GAMA Category I
Yes
Yes (x) No ( )
assisted and natural draft appliances.
.metayis sized and installed to meet the current codes
Yes) No ( )
and manufacturers specifications.
When required to ire* " a w cembus ion air_ it will be sized and installed
and manufacturer's specifications.
Yes No( )
to most the current codes
When justallia , 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 Yes f) No( )
Venting Tables for fan assisted and natural draft appliances.
insta
led
Is the common vent and vent connectors sized as been removed from the commonvent alnd vented Yes
after
an appliance h Yes (x) No ( )
separately as per current codes.
mai'icn
Appliance Al Type
J L 'r -4 Input" Fan Assisted or Nat
an Assiste 01
Appliance #2 Type gid, �� /j,,, /&,-- BTU Input �j � Fan Assisted or Nat
Appliance #3 Type - BTU Input
Total Appliances Total Btu Input
Vent Height --P0 Diameter � inches
Common Vent Type
Appliance #1 Vent Connector Height 3� ftft Length _ Diameter 5/, in Type
Appliance #2 Vent Connector Height ! ft Length _ft Diameter in Type
Appliance #3 Vent Connector Height _ ft Length ft Diameter in Type
HEATING CO: CenterPoint FnergyMi-n.aeSa,sse
13562 Central Ave NE, Anoka, MN 55304
Y:
Signed B Date
!
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 k'AX: (763)571-1287
PERMIT NO.: 2004-00354 13 A
DATE ISSUED: 03/18/2004
ADDRESS : 810 PANDORA DR NE
PIN : 143024110098
LEGAL DESC : BROOKVIEW TERRACE 3RD ADD
: LOT 7 BLOCK 5
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
REPLACE FURNACE AND AIR CONDITIONER
# INSPECTIONS
APPLICANT
CENTERPOINT ENERGY/MINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
(763)757-6202
LOSNESS ANNA
810 PANDORA DR NE
FRIDLEY, MN 55432
1
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 construction or the performance of construction.
Applicant Date
Bldg Insp Date,
ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 5425
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.50
20.50
Building
Permit Fee
BUILDING
See Back Page for Fee Schedule
permit No.: tro UP
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION�eJL
$ -7 .001 times the total job valuation
4
763-572-3604CITY
16 CJ .0005 x Permit Valuation Minimum $.50
License Surcharge
$
S C} 0 $5.00 (State Licensed Residential Contractors)
SAC Charge
$
OF FRIDLEY
Curb Cut Escrow
Date Rec'd:
7G3-502-44977977 FAX
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
EFFECTIVE 1-1-09
Sewer Main Charge
$
DATE
YOUR E-MAIL ADDRESS
$
SITE ADDRESS
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: lrl�)�N n �—�� -S
TENANT
ADDRESS _'3 1 t� :Rc�N�QrQ C -Q, Dr _ CITY
STAT*\kN"IIP
PHONE:1(O�
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS: ® CITY
'STATF'
INSURANCE
PHONE FAX
PROPERTY TYP
GLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STOems
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHEDOWS
13 BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ M INTENANC PAIR ❑ MODELII iG
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDFFIONS_ & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing srructures
❑ Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy
IN
IN EXISTING OPENINN es ❑No LOCATION OF WINDOWS
OR FOR NEW OPEN S -DESCRIBE SIZE OF
OPENING CHANGES &
l
&04NUMBER
TYPE OF WINDOW TO BE INSTALLED 1 OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
ING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ -7 .001 times the total job valuation
Surcharge
$
16 CJ .0005 x Permit Valuation Minimum $.50
License Surcharge
$
S C} 0 $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans'to N1WCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
1,10CID Make checks payable to: City�of Fridley Attach Stiaulations
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 Contraction Codes; that I understand this is not a
permit but only an applicationfor a permit and work is not Wstart without a permit on site; that the work will be in accordance with the
approved plan in the c of all ork w requires review pp r al of plans. t JJ
SIGNATURE OF APPLICA NAME ,W eSe4 'DATE