PRE 2010 DOCSCity of Fridley, NHnn.
BUH DING PERMIT N°
Date: .021 '"" gtlei
!,F
44
Owner: Builder t 0–,t --
Address
Address
LO TION BUILDING
No.Street 3 rf _� Par Lot ,
Lot � _""WL__Block — �� Addition or Sub -Division
;;;� 5VI
Corner Lot _ Inside Lot Setback _ Sideyard
Sewer Elevation r_ _ _ Foundation Elevation
DESCRIPTION OF BUILDING
To Used
0
Front Depth Height yy Sq. Ft. Cu. Ft .
Fro Depth Height .146— Sq. Ft Cu. Ft
o construction EstYCANTo be Completed —
Type !� r
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 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 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 buildings
within the city limits and this permit may be revoked at any time upon viola"f any of the provisions of said
ordinances. _ ,"?
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 Ioopector for separate permits for then items.
=J-�i
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDIEY, KDRWOTA
CLEMIRON, INC.
Owner's Name Builder rz j -mg A7_ r°QN CT®RS
2500 22nd Ave. N. Es
Address Address M„n„bnpn1in I R, Minn. _
LOCATION OF BUILDING
No. �if Biel Street �%�/,-��� _._Part of Lot r
� erc
Lot Addition or Subdivision
v
Corner Lot Inside Lot Setback j 3 Side -Yard /e
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUIIDING
To be used as:
41
Front '�_-Depth _�Height L �
Sq. Ft. Cu. Ft.
—Front_/ Depth tee' / Height ,r
Sq. Ft. _!gx Cu. Ft.
Type of Construction Estimated Cost//�.17 14FI-7Z9
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 r e tions
stated in this applieson are rue and correct.
DATE SIGNA
(A Schedule of Fee Costs can be found on the Reverse Side.)
a 0 74PY
City of Fridley, Minn. N° 8504
BUILDING PERMIT
Date: OCTOBER 4, 1965
Owner: WILLIAM J. HENGSTLER Builder SAME
Address 840 Pandora Drive N. E. Address
Fridley 32, Minnesota
LOCATION OF BUILDING
No. 840 Street Pandora Drive N. E. Part of Lot
Lot 4 _ Block 5 Addition or Sub -Division Brookview Terrace, 3rd Addn.
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 Leight Sq. Ft Cu. Ft
Type of Construction Est. Cost " 1 000 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 above set forth and in compliance with 21 provisions of
ordinances of the city of Fridley. v
In consideration of the payment of a fee of1- —0- 00 , permit is hereby granted to W31LUM J
HENGSTLE 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, s ��ce, °of i build�in-
Fridley, Minnesota regarding location, conatructton, on, ge
within the city Iimtts � We permit may be revoked at any time upon violation oY any of the provisions oY said
ordinances.
ALLEN G. :JENSEN
NOTIC@S
M pone& don not aewr the cowevedon, kdaWm for Wbhi& pbmbieo, On hedh* two or wabr. Be am to as
the BQOdieo hmpftr for ap"de pwft for thw &oma.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME UILDER 1."����°��� A?
ADDRESS l4 C 47z" dy i''o a 0 C ADDRESS Seg. 2yN. -,C- ,
LOCATION OF BUILDING
NO, (�' it/ e STREET . Ce -' j' V' P 'A,�J PART OF LOT
LOT _4BLOCK ADDITION OR SUBDIVISION °To��t'o" recTt'rIr AC e
CORNER LOT INSIDE LOT 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 Certificates4
DESCRIPTION OF BUILDING
To be used as:
Front. Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
�Sq. Ft. Cu. Ft.
Type of Construction �'_/1__"'7_/7,) ✓w �� �� Estimated Cost /, 4,1 0
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 and correct.
DATE Ocd �� . / �%f� SIGNATUR %/(f 1�)'171. 17 ill'/-'�
(Schedule of Fee Costs can be found on the Reverse Side).
i
r
97-8t,lU6051
CITY OF FRIDLEY '
APPLICATION FOR PLUMBING AND GAS FITTING PtWIT
Job Address 840 Pandora Drive '•
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 repro sjentations stated in this application are true and correct
Fridley, Mn. 3-23-79 , 19
OWNER Hengstler ,
KIND OF BUILDING frame '
USED AS res. '
• r
TO BE COMPLETED ABOUT 3-30-79
PARTIAL RATE SCHEDULE
ESTIMATED COST 30.00
PLUMBING FIXTURE RATES: No.,
U
RATE
TOTAL
OLD - NEW BUILDING PERMIT. NO. PERMIT NO.•
ftusber Fixtures
Water
$3.00
$
Future Fixture opening
x
$2.00
$
company
' "IrdPd6el�
flew Fixture, Old Opening
x
$2.00
$
Heater
Signed By .
u
x
$5.00
C
hW
Water Neater • to 99,000 BTU
x
•$5.00
$
Tel. No.
d
R
$10.00
$
m
Water Softener
x
lec
$
flew Ground Run Old Building
x
$5.00
$
ROUGH INSP.
1A o
9
8
,C
A h
j m
H
o
'
U
a
oo
ai
vi'
.�
o tv
a
w
U oa
R
x'
•$3400
$
Date ,
1
as
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
S
APPROVAL FOR PERMIT
REPAIRS $ ALTERATIONS
,
First $100.00
$5.00
$
'
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATS S4Rj=MU6E
State Surcharge
$ .5o
i
TOTAL FEE
$ 8.00
'.
•
a
REINSPECTION FEE
'
�d
.5
;R) --Future Connection Opening
Connected with Sewer
(0) - New Fixture, Old Opening
Water
Job Address 840 Pandora Drive '•
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 repro sjentations stated in this application are true and correct
Fridley, Mn. 3-23-79 , 19
OWNER Hengstler ,
KIND OF BUILDING frame '
USED AS res. '
• r
TO BE COMPLETED ABOUT 3-30-79
PARTIAL RATE SCHEDULE
ESTIMATED COST 30.00
PLUMBING FIXTURE RATES: No.,
RATE
TOTAL
OLD - NEW BUILDING PERMIT. NO. PERMIT NO.•
ftusber Fixtures
x
$3.00
$
Future Fixture opening
x
$2.00
$
company
' "IrdPd6el�
flew Fixture, Old Opening
x
$2.00
$
Signed By .
Catch Basin
x
$5.00
$
Water Neater • to 99,000 BTU
x
•$5.00
$
Tel. No.
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
flew Ground Run Old Building
x
$5.00
$
ROUGH INSP.
Electric Water Heater
x
$5.00
•� $
Date .•
'
CAS FITTING FEES:
N NSP
FI AL I .
lst 3 fixtures
x'
•$3400
$
Date ,
1
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
S
APPROVAL FOR PERMIT
REPAIRS $ ALTERATIONS
,
First $100.00
$5.00
$
'
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATS S4Rj=MU6E
State Surcharge
$ .5o
i
TOTAL FEE
$ 8.00
'.
•
a
REINSPECTION FEE
'
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING P E R M I T
PE
:65q 7
r
' '
• _____ COMMUNITY DEVELOPMENT DIV.
t✓ PROTECTIVE INSPECTION SEC.®
1 /-'•1 CITY HALL FRIDLEY 55432
612-571-3450
R
NUMBER
910-F15
REV.
DATE
4/22/82
PAGE OF
APPROVED BY
JOB ADDRESS 840 Pandora Drive N.E.
1 LEGAL
DESCR.
LOT NO.
4
BLOCK
5
TRACT OR ADDITION SEE ATTACHED
Brookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Judith Hengstler 840 Pandora Drive N.E. 571-3229
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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 Z ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRINCz
HEATING, S'LU IL';iNG A140 SIGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Cedar
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
$600
$.5O
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.
$15.00
PLAN CHECK FEE
TOTAL F�E50
NATURE OF CONiRACTO 0 A ORI2ED AGENT ATE)
WHEN PROPERLY LIDATED THYYIS IS YOUR PERMIT
(�
/U
BLDG iNSP 0-
TUR OF OWNERI ER U LDE i (DATE)
OW
LJ
u
01
SUBJECT
PE
City of Fridley
165437
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE
'
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J\ 612-571-3450
910-F15
4/22/82
JOB ADDRESS 840 Pandora Drive N.E.
1 LEGAL
LOT N0.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
4
5
Brookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Judith Hengstler 840 Pandora Drive N.E. 571-3229
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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 11 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PE'RMTS REQUIRED FOR WfRINCi,,
HEATING, PLUM'11_301G AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Cedar
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$6Q0
$•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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$15.00
PLAN CHECK FEE
TOTAL Fg 50
O A ORIZED AGENT 1 ATEI
WHEN PROPERLY LI DATED THIS IS YOUR PERMIT
�TURE.OF.CONNET.RACTO
ZT
BLDG iNSP DA E
F WS OW ER U LDE i IDATEI
u
01
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PEIV41TS
(New, Alterations, Additions, or Repairs)
OWNER: i
�f^
ADDRESS: (�
TEL R0: �J?�
BUILDER: \v �e //j'1 r6r\-
ADDRESS:
-
ADDRESS:
TEL NO:
Construction Location
STRIIIaT NO: V G STREET: . Pana -o (CA
IAT: BLOCK:ADDITION: ®� (J �� ! ff(a-Ce,
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.
RE -SL4� �V-QSC Front:
DESCRIPTION OF CONSTRUCTION
Depth:
Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square -Peet: Cubic Feet:
Type of Construction: Q ed a d^ Estimated Cost: $ D v i o®
'lb Be Mmpleted:
Alt. A Alt. H
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 applica
DATE: r oZ SIGNATUIE:
Stipulations:
�/ v
SUBJECT
City of Fridley
=4�2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
�•
COMMUNITY DEVELOPMENT DIV.
______
1 v
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 5$432
612-571-3450
910415
8/31/98
J08 ADDRESS
840 Pandora Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
5
1 Brookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Judith Hen stler
571-3229
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Owner
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
8 DESCRIBE WORK
Reroof house and garage 20 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
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
1668
.83
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.
$54.00
Fire SC $1.66
PLAN CHECK FEE
TOTAL FEE
56.49
SATUREOFCONTRACT OR THORiZEDAGENT DATEi
WHEN PROPE VA IDATED THIS IS YOUR PERMIT
i TURE OF OWNE qF N I D Ri iDATEi
OG INSP
T)ATE
�/ v
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:o r 0,4
I /
Legal Description: ` d'� (� c c S�AL i �ewrae e 3rd rl[k1
Owner Name & Address: Tel. # / r —(32Zq
Contractor: MN LICENSE #
Address: [ s Tel. # -
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E%IPROVEMENT
LIVING AREA: Length -- Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Width Hgt/Ground �Sq. Ft.
OTHER:
Construction Type: �o , Estimated Cost:
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 0 6 APPLICANT: -TU� t. -[6 C AJ J Sr L F-✓' Tel. # S 7 1
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ S 00
Fee Schedule on Reverse Side
Fire Surcharge
$ /, (,,i6,
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 83
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway 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
$ 6.
STIPULATIONS:
suejEct
PERMIT NO.
City of Fridley
2 8127
AT THE TOP OF THE TWINS
PERMIT
572-3604
BUILDING
RECEIPTNO.
_ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
�//j
r � � PROTECTIVE
NUMBER
REV
DATE
PAGE OF
APPROVED By
i � CITY HALL FRIDLEY 55432
l 612-571-3450
910415
10/7/98
JOB ADDRESS
840 Pandora Drive NE
1 LEGALLOT
NO.
BLOCK
ACT OR ADDITION
TB
SEE ATTACHED
DESCR.
4
5
rookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Judith Hen stler
571-3229
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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
O NEW O ADDITION ❑ ALTERATION 1& REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside house and garage; Facia
9 CHANGEOFUSEFROM TO
STIPULATIONS
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. `
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
1200
.60
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
$40.25
1
Fire 1.20
PLAN CHECK FEE
TOTAL
4 .05
ATURE OF CONTR O Op AUTHORIZED AGENT iDATE,
NI OP
LI ATE IS IS YOUR PERMIT
pN IF E E , DATE,
E O W
A, n .NSA -
riArE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:
Tel. #_
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Effective 1/1//98
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: (i C I°�� Estimated Cost: $ i2,00
(Fe
00
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: /,"? IAc APPLICANT: Alf Tel. # 3-7_/'-
I " �L6
STIPULATIONS:
CITY USE ONLY
Permit Fee
/
$
Fee Schedule on Reverse Side
Fire Surcharge
$ %, a0
.001 of Permit Valuation (1/10th%)
State Surcharge
$ (off
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway 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
$
STIPULATIONS:
MINIMUM FEE FOR ANY HEATINGICOOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By_
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR
written permission from adjoining property owner. REPLACEMENT FURNACE
Tel No,:—
Rough —In
o Rough—In Date Final bate r
VERIFICATION ON�� `�'
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
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
$__3_D _-O v
representations stated in this application are true and correct.
'�)2c
(Side Vent — Fill Out Back)
3 ,1998
Gas Piping (Needed with new furnace) $10.00
$
OWNER \.kD i -T JA )i E tV (QST LF-
EGas
GasRange $10.00
$
BUILDING USED AS > e s \ 172 nC t:
Gas Dryer $10.00
$
ESTIMATED COST \%00. 06 PERMIT NO. I�
*Air Conditioning — All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
a
1 % of Value Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water, �armDA[r
Trade Name ��rn ,P �T A IR-- Size No. �o o
Commercial/Industrial
BTU -7s-06c HP EDR
1.2596 of Value of Appliance or Work
$
Fuel &2 d T ,4s Total Connected Load
State Surcharge
$ .50
Burner Trade Name Size No.
BTU HP EDR
RIV CTT7ZREErVrrALJNC.
TOTAL FEE
10105 LINNET ST. NW
HEATING COMPANY COON RAPIDS, MN 55433
MINIMUM FEE FOR ANY HEATINGICOOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By_
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR
written permission from adjoining property owner. REPLACEMENT FURNACE
Tel No,:—
Rough —In
o Rough—In Date Final bate r
VERIFICATION ON�� `�'
4
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
RIVER CITY SHEET METAL, ANG,
10105 LINNET ST NW
/,,z -,7-- ZL
o
CHUMMY 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
Yes No
( )
3.
Has no foreign objects lodged within
Yes (Jj No
( )
4.
Is securely supported
Yes (✓f 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:
RIVER CITY SHEET METAL, ANG,
10105 LINNET ST NW
/,,z -,7-- ZL
o