PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 4284
Date: /"
--
Owner: .......................... .............. -............. -....... ...... _._._...__------------ ---- Builder
Cger.jj.–
Address...-_......._...._......._.._......._.__.._.__._... _ _.— _._._._..._.._ Address ........ . ........................
LOCATIO OF BUILDING
No.... r PJ..... .... Street ... � �� . .------ ........ -.............. Part of Lot ..................
Lot . _.. .?............. Block....._.....�............. ................. Addition or Sub -Division✓: . .. ........• ... .
Corner Lot .................................... Inside Lot ....................................... Setback ..... _............. ............... ........ Sideyard
Sewer Elevation .........---•-----•-•............................------------......-------------•----................. Foundation Elevation ..................
DESCRIPTION OF BUILDING
To be Used as:
1 J f v Depth.:l.�/' f 'Height
>f- -`' Front 7_. � ' H /.......' 10 Sq. Ft. /..Q.. ..t! Cu. Ft. 1.9
vy� �.__...._..
................ ........ Front .'P s Depth Height ..10...7_® Sq. Ft...cti.J_.. Cu. Ft.47(:)
Type of Construction ........................... ......................... ...... Est. Cost ....*70
....I9 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 fort d �Coan'e with all provisions of
ordinances of the city of Fridley.c�------....--- ..! -._------..._'_�.,
. _. ..._ _ _ _ ..
In consideration of the payment of a fee of $.c�� .., permit is hereby granted to....._ ............. ..............
... _.................. .... -................ _............._........ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within 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 for wiring, plumbing, gas heating, sewer or wafer. Be sure to see
the Building Inspector for separate permits for these items.
e
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner s-..�1ame == ' r_' " ' Builder 7 .
Address] -,Address
LOCATION OF BUILDING
No. Street_ Part of Lot
Lot - Block 7 Addition or Sub.Div.ZL.n peg
Corner Lot -Inside Lot 1_ Set Back �' Side -Yard I' d
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach:to this form Certificate of Survey of Lot and proposed building
loca.tioh,.
DESCRIPTION OF BUILDING.
To be used as: ,
' Fik0nt - - Depth - -Height
�r;
Sq. Ft. ��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 representa-
tions stated in this application are t_ue and corrpet.
DATE', �` SIGNATURE
(A Schedule of Fee costs can be foimd on the Reverse Side.) i
r
sueJEcr
IT NO.
City of Fridley
2 0 6 2 4
AT THE TOP OF THE TWINS
BUILDING PERMIT
F?
R .
t
COMMUNITY DEVELOPMENT DIV.
3
PROTECTIVE INSPECTION SEC.
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
i
�.� CITY HALL FRIDLEY 55432
_-►- �i"'
L 612-571-3450
910415
10/10/90
JOB ADDRESS 881 Pandora Drive N,E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
29
4
B.rookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Gerald/Sandra Kos.kiniemi 881 Pandora Drive N,E. 571-5274
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 261 x 10 Addition to Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Install smokedetectors dor all M sleeping
rooms. Provide at least one egress window-in eadh-bedroom,
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 60 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
$22,326
$11,16
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$234.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
ire SC $22,32
$267,48
ATUREOFCONTRACTO OR AUTHORIZED AGENT IDATEI
xsz
WHEN PROPERLY LIDATED THIS IS YOUR PER�yMIT
b® ezz t�
BLDG INSP rlAT4
SIGNATURE OF OWN ROFOWNER BUILDERI IDAT 1
NEW [ ] Effective 8/16/90
ADEN [ j R-1 AND R-2
ALTER [ ] Q Building Permit Application
Construction Address: D I C9.�v� AQ i�ty�� L� A , " ji z
Legal Description: ce-" ate/ S -to- L- q- Q. l x djL "-L" 0
Owner Name & Address: � �_�_ S C', 0 4 - Tel. # .57 ' S -a 7 `!4
Contractor: `Ko -r. Tel. # 571- 35 / �4
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
UESCR=CK OF I RENM
LIVM AREA: Tp*rjth Width Height Sq. Ft.
G RAM AREA: Length Width — Height Sq. Ft.
DECK AREA: Length — Width - Hgt/Ground Sq. Ft.
07M:
Corner Lot [ ] Inside Lot [ nFt. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $� �a� .3'/ 64W
Approx. Completion Date: L Q-�
Proposed Driveway Width If NewOpening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: D APPISCANT: � 7 d -L
If JF
16 / b
Permit Fee D C
Fire Surcharge�-
State Surcharge
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL A , �'("9, y n
CITY USE ONLY
Fee Schedule on Reverse Side
.001 x Permit Valuation (1/10th �)
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by EWineering
Agreement Necessary [ ] Not Neceyssary . [ ]
S'1IPULATIONs : 1 C)
Zoom,
land Planning (4a&tr6aliL J 70 Asilsiff, Jt. Aff
Land Surveying MianeoPolis 'll,
Soils Teshq ENGINEERING, INC.
Ciw 16. municipal StInfet 4-0066
b7j/ . neermq —Engineers Sur vey0r%5
certificate ® survey C
!;i
j
//A"&JitAy 7*14 *15 Is .0 +wd warred repm5wifffim 47fe survey eft &wnder4s e& 46ore Asc"kd land, and
qfh lw4&a ;�,ffff hmildm9s, hmw, mda# risible mava&bm&drj&�. {an or wssid land. As surveyed by me tki-- day
A.O.
SUB URBAN ENGINEERING , INC.
Engineers Fr Surveyors
7C
m
CITY OF FRIDLEY
APPLICATION FOR PWMBING AND GAS FITTING PERMIT
Effective May 1, 1990
Job Addressy l Lp C) 0 gpt
Department of Buildings
City of Fridley
Tel. 1571-3450
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 correctFridley. Mn. 0219 19,e
OWNER 0.5 K ! N t `
KIND OF BUILDING
USED AS
y
RATE SCHEDULE
a4
ESTIMATED COST
PLUMBING FIXTURE RATES: NO.
u
TOTAL
K
v
Wdter
NO.
0
New Fixtures
g 5.00
c
a
Future Fixtures
$ 3.50
a
s w
nQ'
�'
S
S
Heater
Beer Dispenser
$ 4.00
$
Tel.
-7 O
Blow Off Basin
$ 5.00
6
No.
c.
Catch Basin
t
6
pT
Rain Mater Leader
w
a
rJ
Hydraulic valve
$ 5.00
C
c
a
g
u
t
Date
u
Suep or Receiving Tank
w
$
Water Treating Appliance
S 7.00
$
.
FINAL INSP. G
not Water Heater
$ 5.00
6
Date
a
u
$
a
A
a
A
c4°.
0
w
u��i
( )
��
ii
o
s
1ec
a"
It of Value of Fixture or Appliance
pp
6�
!11NIN114 FEE FOR ANY PLUMBING
PERMIT IS $15.00
PLUS THE $.50 STWE SURCHARGE
State Surcharye
Re►ns(w►ction Fee S
(615.001 TOTAL
FEE
S `�
lot
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sever
10) - New Fixture, Old Opening
Water
Effective May 1, 1990
Job Addressy l Lp C) 0 gpt
Department of Buildings
City of Fridley
Tel. 1571-3450
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 correctFridley. Mn. 0219 19,e
OWNER 0.5 K ! N t `
KIND OF BUILDING
USED AS
'PO BE COMPLETED ABOUT
RATE SCHEDULE
ESTIMATED COST
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
OLD - NEW BUILDING PERMIT
(�
NO.
PERMIT NO. l
New Fixtures
g 5.00
Future Fixtures
$ 3.50
S
Company
(U /
Old Opening. New Fixture
$ 1.50
S
Signed By
Beer Dispenser
$ 4.00
$
Tel.
-7 O
Blow Off Basin
$ 5.00
6
No.
d /
Catch Basin
S 5.00
6
Rain Mater Leader
S 5.00
$
Hydraulic valve
$ 5.00
ROUGH INSP.
$
Date
Suep or Receiving Tank
$ 5.00
$
Water Treating Appliance
S 7.00
$
.
FINAL INSP. G
not Water Heater
$ 5.00
6
Date
Gas Range
$ 10.00
$
Gas Dryer
$ 10.00
6
APPROVAL FOR PERMIT
Back Flow Preventer Required. . . Yes ( 1 NO
( )
Type
$ S. UO
6
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
pp
6�
!11NIN114 FEE FOR ANY PLUMBING
PERMIT IS $15.00
PLUS THE $.50 STWE SURCHARGE
State Surcharye
Re►ns(w►ction Fee S
(615.001 TOTAL
FEE
S `�
y
SUBJECT
MI
of Fridley
28730
?City
AT THE TOP OF THE TWINS
BUILDING
PERMIT
16.572-_30O4
� •v __��_ MUMITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 . �
l� 7
CITY HALL FRIDLEY 53432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1 612-571-3450
910-F15
12/8/98
JOB ADDRESS
881 Pandora Drive NE
T LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
29
I 4
I Brookview Terrace, 3rd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jenny & Sandy Roskiniemi
571-5274
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Rick's Roofing & Siding 183 Cleveland Ave SE New Brighton 55112 633-6395 3566
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 O ALTERATION VA REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (27 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED 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 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
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
2313
$1.07
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
$74.75
Fire SC $2.14
PLAN CHECK FEE
TOTAL FEE
e
5
82.96
SIGNATURE OF CONTRACTOR OR AUTHORIZEO AGENT (DATE,
WHEN PROPERLY - LIDAT D THIS IS YOUR PERMIT
B�0 �NSo -
MATE
S-GNATURE OF OWNER of OWNER BIULDERI iDATE,
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 0� 1 0 "
Legal Description: E l? X4,1111
Owner Name & Address:
Contractor: �,'c
Address:
hot -t 5eo7A
vi Z
Effective 1/1/98
V*2-730
lC /1 r' el. # S 714 :;Pj
MN LICE'NSE # -75:-66
J°'S//.,2 Tel. # (O.� j ' C. 77—
lle,elgn d
Xttach to this application, a Certificate of.Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVENIENT
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:
Estimated Cost: $ Q7 st;F
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + t = t x $ _ $
DATE: 1<9 _ � " 1 8,
APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee
$
% 7.5�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
/.07
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
-5-.00
$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
$
y o� , %
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIVISION
Effective On January 1, 1998
6431 University Ave NE
Fridley, ant 55432 APPUCATION FOR
POWER PANTS AND HEATING, COOLING, VENTILATION,
572-3504 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residertial Rate
TOTAL
gwAed agreeing to do all work in strict ac=danoe with the City Colles and
Furnace Shell and Duct Work, Burner —
rulings of the Building Division, and hereby declares that all the kcts and
Also Replacement Furnace $ 30.00
$
representations stated in the application are true and correct.
(Side Vent - Fill Out Balt)
,1998
Gas Piping (Needed with new furnace) $10.00
$
..
OWNER
Gas Range $10.00
$
BUILDING US ME AS
Gas Dryer $10.00
$
ESTIMATEDCOST /4,5!)1.0D PERMITNO.�
*Air Conditioning — All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alleratlons {LIST ON BACK)
1% of Value of Appliance or Work �-U^
No. of beating Units Circle One (Steam) (Hat Water) (Warm Air)
Trade Name Size No.
Commercialnndustrial
BTU HP EDR
1.25% of Value of Appliance or Mork
$
Fuel Total Connected Load
State Surcharge
$ .50
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
S� 50
HEATING COMPANY�We_ C i cin
MINIMUM FEE FOR ANY HEATINGICO UNGfi"TILATION
GERATION/AIR CONDITIONING POUT IS W.00
Signed
PLUS THE t.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
Approved By Rough—in Date Final Date
*Air
Conditioners can not be placed in a side yard without
FILL OUT BACK SIDE FOR STA VERIFICATION ON
wnttenn permission from adjoining property owner.
REPLACEMENT FURNACE
CHMMY AND STACK 'VEMCATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
Yes ()
No
No
( )
2. Is fry from rust. or deterioration
Yes (
)
No
( )
3. Has no foreign objects lodged within
Yes ()
No
( )
4. Is securely supported
5. Meets. all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of
All other BT'U's
TOTAL BTU's
7. Has a liner been provided for water heater
S. Has combustion air been provided for water heater
Remarks.
HEATING CO:
Signed By:
Date:
I
_CS
Yes ()No()
Yes ( ) No ( )
Yes
No
Yes (
)
No
( )
9
SUBJECT
City of Fridley(`2
9 61
AT THE TOP OF THE TWINS
BUILDING PERMIT
-REVEIPT NO.
i ♦V _��--�; COMMUNITY DEVELOPMENT DIV.
SEC.
L/
f PROTECTIVE INSPECTION
CITY HALL FRIDLEY 55132
NUMBERDATE
REV
PAGE OF
APPROVED BY
612-571-3450
910415
6/3/99
JOB ADDRESS 881 Pandora Drive NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
29
4
1 Brookview Terrace 3rd
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Gerry & Sandy Koskiniemi
571-5274
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Renewal by Andersen 350 73rd Ave NE Fridley 5502-4777
2004n63n
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 ®X REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
11 Window inserts; 1 Full frame window
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels
of the dwelling per Sec. 310.9.1.2, 1999 U.B.C.
SEPARATE PERMITS ARE REQUIRED 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 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$13,845
$6.92
TO TO OR
DOES NOT PROVISIONS
IESTATE
ELCON�
PERMIT FEE
SAC CHARGE $13.84
OFUME
ORITY
ANY OTHER LOCAL AWTE
REGULATING
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$237.25
Fire SC 18Xg
PLAN CHECK FEE
TOTA E
Licens $5.0v
I$W.01
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT (DATE,
EN ROP ALIDA E HIS Is UR P I
9l ,NSo
r �
pAtE
SIGNATURE OF OWNER„F OWNER BUILDER, (DATE,
9
Prepaid Plan Check $
Estimated Cost $
Receipt #
CITY OF FRIDLEY
R-3, COMMERCIAL & INDUSTRIAL
BUILDING PERAM APPLICATION
Effective 1/1/99
3
Construction Address '66 f. rt, fr;d i- u mv0 Zomig
Legal
Owner & Address G S Cindt, . b SK i 11 i-cw►, (50Zn-k 0-2 6,6ZY_ Tel# Sid -sa y
OaITRACDOR & ADDRESS x,356 _ g V d You.YI�F ;rf c� �-e �► Tel#
Architect Reg.# Engineer Reg.#
TYPE OF WORK
BUILDING CONSTRUCTION
[] Addition
IJ Alteration -Describe
OFC. AREA: Length Width Height Sq. Ft.
WHSE AREA: Length Width Height Sq. Ft.
OTTER AREA: Lexxjth Width Height Sq. Ft.
APPLICANT Tel # R" '7 Date s/ate l Cc9
VALUATION
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ )
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TML VALUE
Building Use Construction Type Occupancy Group
Air Conditioning [] Yes [] No Fire Protection Provided (]Yes (]No
Performance Bond Amount $ See Reverse for Schedule Received []Yes' []No
Permit Fee
Plan Check
Fire Surcharge
State Surcharge
SAC Charge
Erosion Control
Park Fee
$ 5• 00
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit valuation (1/10th o)
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1050 per SAC Unit (Plans to MKCC for determination)
$450.00 Conservation Plan Review
Fee Determined By �g i nri ng
Spec. Assessments $ Agreement Necessary [] Not Necessary []
Driveway Escrow $ feet x $13.50/foot
T07RL $
-� ATTACH STIPULATIONS
CITY OF FRIDLEY INSPECTION DIV. I I I
6431 University Ave NE 14
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572=3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On January 1, 1999
3-7
I
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS FWdOM Dr' N
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
.
State Surcharge $ .50
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.
g— ' , 1999
Owner 6MIJ 1 1
Building Used As
Estimated Cos<26_0�_
PERMIT NO.,��
PLUMBING COMPA 1 f- w S q3T�lli
SIGNED BY TEL N0. 'q5! — ` (7,6
Approved By
Rough—In Date Final Date
TOTAL FEE $lo,6d PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
From: 952 8814491 Page: 2/3 Date: 5/6/200912:20:00 PM
From: City of Fddlev To: 9528914401 Pane: 915 Date: 515120091:41:22 PM
Building , t)
q 4 , MECHANICAL
Pemilt NO.: �
Impectivns
RESIDENTIAL APPLICATION
RecaLvmdL
763-572-3604
CITY OF FRIDLEY
baMed:
763-5024977 PAX
IA+PECTIVB2-IM
DATE " Off YOUR E-MAIL ADDRESS
SITEADDRESS Q DR.r
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: Ile
OWNER/
ADDRESS; t CITY STA LIPK��
PHONH• bA•--T f7_I ' jJ 9 %Y
CONTRACTOR
COMPANY NAME: --
SUBMIT A COPY OF
CONTAcgfii j K_HFATiNG & AIR CONDITIONING LLC
YOUR STATE
smu LICENSE 0, 8.910 Wentworth Ave. SDATE
LICENSE WITH
ADDIWS: Minnaapds MW 5542 CITY STATE GIP_ -_
APPLICATION
PHONE (95) Hal -9.0.0 x
PERMIT T)TE
'*INCLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK,
❑ NEW AREPLACHMENT O ALThiRATION/REMODHL
DETAILED DFISCRIPTION OF WORK '(.p_.� +
FEES ARE BASED M $10.00 PER FIXTURL+, EXCL+PT WHERLI NOTED. FIXTURES: (LNDICATL TOTAL NUMBER OF EACH BELOW)
Egdpimnt laWled MFG: MODEL, SILEMTU
MFG: MODEL: SIZWBTU
Ml -G: MODEL: SIZE/BTU
YA/C$25.00 l+1RliYLAC1:(OAS)$15.00 PASRANGHIOVENSKOF —
�
AIRTO AIR EXCHANOEER$15 FIREPLACE (WOOD)$35.00 NEW OAS GRILL$ 10.00
BOILER $35.00 FURNACE $35.00 CTAS UNIT HTR $10.00
CHIMNEY LINER$10.00 _GAS DRYb'R$10,00 =POOL HEATER $95.00
DUC r WO= $10.00 _GAS PIPING $ID.00 VENTILATO1t $15.00
ME
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'<'u<i1�•u�u g�
. }:i i� n,.,.,'�`�'it?X``,«
um
,.
Id,,r
I'll, I .. 1
THIS 1S AN APPLICATION FORA PHRMIT NOT VALID UNTIL PROCESSED
I haroby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will bo in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that l unders. Wd ihi 4q
not a porn,it but only an application for a permit and work is not to start with ut a porinit; that the work will be in arxordanco with the
approved plan in tho cake of a work which requires re low and approval Grp s.
,
SICNATUREOFAPPLICA RINTNA V +otATE Lam/ -D:5-16
�W • • +C' ' � � ° '�'• .JlbtA " '�c3:tiA��4)i4kixi
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763•-5723604 FAX. 763-542-4977
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