PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: _ `.6March 1967
Owner: Andrew J. Donnay Builder
Address 914 Thomas Ave.. S t . Paul Address
Same
LOCATION OF BUILDING
No. 174._.— Street ..— Pearson Way NEPart of Lot
'949�-7
N° 9150
Lot — 12 .._.___ Block 6 Addition or Sub-DivisionPearson's Craigway Estates 2nd
Corner Lot — X Inside Lot _ Setback __ Sideyard __ 17
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Double Bungalow Front _32__._ Depth 50__— Height 24 Sq. Ft. 1600 Cu, Ft 32, 000
Garage— Front 22 Depth 22 Height 100 Sq. Ft. 4,84 Cu. Ft. 4. 840
Type of�Construction Frame Est. Cost 16_, ono _.._ _ __ To be Completed 1 June 1967
Sewer:�,,ll' West of Manhole
Water: 20' West of Manhole
Top of footing: 848.5'
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. A n /A
In consideration of the payment of a fee of $ _1 I 87 -vu ., permit is hereby granted to aauurcw
.00
J. Donny to construct the building or addition as described above. This permit is granted upon
the express condition that theperson 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.
CLARENCE BELISLE Biding Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, wwor or water. Be sure to ase
the Building hapestor for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER
ADDRESS - ADDRESS
II&LOCATION OF BUILDING
NO. /J STREET ' a , � .-�'� �°L/ AN PART OF LOT
LOT _JA BLOCK �� ADDITION OR SUBD SIGN '"
CORNER LOT INSIDE LOT SETBACK SIDE -YARD ZZ
U
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used, AJ:
DESCRIPTION OF BUILDING
'� npnth ,1 Rei aht A441,, 2
Sq. Ft. Alo" Cu. Ft.—
Fran
t
t._Front Depth Height
410
Sq. Ft. Cu. Ft.
Type of Construction _ Estimated Cost
To Be Completed Cdr l
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 deelgres that a1L the facts
and representations stated in this application are true and correct.
DATE ,J�-�
(Schedule of Fee Costs can be found on the Reverse Side).
To
560-3450
Cit
Cyof.
�1�
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55421
Mr. A9xdrew Donnay
914 Thomas Avenue
St. Paul, Minnesota
Re: 174 Pearson Way
Dear Sir:
September 14, 1967
On June 29, 1967, a red tag was posted on your double bungalow
at 174 Pearson Way N. E. Single wall construction is not permitted in
the garage unless the west wall is covered with 5/8" sheet rock and the
balance of the garage is covered with approved sheathing. A second red tag
was posted Tuesday, September 12, 1967. In 15 days (September 28,•1967)
the City Attorney will be advised to hold the owner in violation. He will
then take steps to gain compliance.
Your prompt cooperation would be appreciated. Thank you.
Yours very truly,
M-ARENCE BELISLE
Building Inspector
City of Fridley
CB/bks
Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00
Replacement of Furnace ............................. 5.00
Repairs & Alterations—up to $500.00 ................ 5.00
Repairs & Alterations each add. $500.00 ............... 2.50
NECK. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ......� 8.00
each add. 60,000 BTU 2.00
Replacement of Furnace 5.00
Repairs & Alterations—up to $500.00 ................. 5.00
Repairs & Alterations each add. $500.00 .............. 2.50
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00
Each add. 200 sq. ft. EDR Steam ...................... 2.50
yBach add. 320 sq. ft. EDR Hot Water .................. 2.50
OIL BURNER—to 3 gal. per hour 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) .......A— . (9)...... 5.00 $ Z Q • 01
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
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
$ 121S EV
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4.7470
City of Fridley:
" 6 /e,
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 application are true and correct.
Fridley, Minn !q—�� 1947
Owner
Kind of Building �
ing ���
Used as lJdi�w ,e //r n fa
To be completed about
Estimated Cost, $
Oldew. Building Permit No. — Permit No.
Q a e_v DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm No
Trade Name AAre n c4A STA,OC&A W Size No_ a G IS�®
Capacity. q. Ft. E.D.R. ®0C' BTU—Ing- H.P.
Total Connected Load .73A. 9916.3 C4 - S 0 �e Kind of Fuel �� _ 62 C
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Signe : AND AIR CONDITIONING aNch
440 .EXCELSIOR BLVD. MINNEWULJO
By 92a-3900;:��Fk.
42 2M Business Phone No
(REMARKS -OVER)
Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ......I' p 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam ..... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) .......est... ..... 5.00 $ 1 O • ehn
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 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
$
See Fee Schedule
$
TOTAL FEE $
Dept. of Bldgs. Phone SU 4-7470
-2��
)0 CA d �P
�� i��^ sr, r..F c+A-► GL arc
City of Fridley:
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 application are true and correct.
Fridley, Minn_ T - �' y 19 &V,
Owner e,L. L� ¢ o f: (�° rzL t. o .
Kind of Building
Used as .lJu-� �'`� ✓eO u �►%� �zj4 le�w!
To be completed about
�d/
Estimated Cost, $ 1gby
Old—�ewNBuilding Permit No. Permit No.
r.._
DESCRIPTION OF WORK
HEATING or POWER PLANTS --Steam, Hot Waters Warm Ar��-No
/► r' �
Trade Name?:"'0F'roCci'-J Size No-
Capacity 164 - - Sq. Ft. E.D.R Q BTU_j�-* • A.P.
Total Connected Load 6y 0-4 . 10 cep Kind of Fuel AKL 14
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Signed 1411AT4"S A QMOlg4V.,.:....ey,
4.@ LULSICR ®LVO. MINNEAPL^moi:
By... AAA 2�fP1R C s D
T�J'"SG7"�r craC
<Z 2M Business Phone No
(REMARKS -OVER)
CRONSTROMS HTG. & AIR COND., I iC. Job Nam `
D-56 "10 Excelsior Boulevard, Minneapolis 16, Minn. ^9
Ze NEAT LOSS CALCULATIONS Job AddressI r
A.S.H.V.E.
Weatherstrips, Guide Construction No. I Insulation
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof FloorI Kind How Applied
Yes—No Yes—No 19—
i:►J .......:�,� Room I Lenlfth Width i S~Heisfht d` II Fl. Room I Length We v -Height
endows arm
Doors—Crackage and Area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. fL
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
v
qF
Coef. Btu
Coef. Btp
�..
Infiltration r3
Coef.
Btu
Infiltration
Glass
Exp. wall
Glass
Net exp. wall
/O O
Exp. wall
Exp. wall
Ceiling
% 0
Floor
Net exp. wall
X F'
/70
7®.
2-o
Int. wall
Ceiling
Ceiling
i1c,
Ceiling
g-0
Floor
Floor
Total Btu. 01 V f
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
r►.1 -noom I a.eugmr --e- naqui
® aaoiguL p
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. fL
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Coef. Btp
Coef. Ptu
Infiltration r3
Infiltration
Glass
"b
Exp. wall
Glass
Net exp. wall
/O O
Int. wall
Exp. wall
Ceiling
% 0
Floor
Net's . wall6. f"Y
Total Btu. 151, O
Required sq. ft. E.D. . or aq. ins. WA. Leader area
Fl. 1J Room I Length i® t Width 4 Heiaht
Windows and Doors—Crackage and Area
f
O
Width Height No. of Llneal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. fL
t�
Coef. Btu
Coef. Btp
Coef.1
s , Btu
Infiltration
Glass
'b Q
Glass
Ceiling
'.0
Net exp. walla S- 4 Vr -.16C
Exp. wall
_
Int. wall
Net exp. w
Net's . wall6. f"Y
"7
/70
7
Int. wall,,,
Ceiling
Ceiling
i1c,
jrT
g-0
Floor
' Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
f
O
Width Height No. of Llneal ft. Area
No. of pane of pane lights of crack sq. ft.
Y y 5
t�
Coef. Btu
Coef. Btp
Infiltration
Infiltration
TOT
Glass
'b Q
Exp. wall
Ceiling
'.0
Net exp. walla S- 4 Vr -.16C
BF J,
Int. wall
Net exp. w
, 4--k ! _ fw
Ceiling . 51- /a• C,
Cl
Int. wall
Floor
Total Btu. I &V
Required sq. ft. E.D.R. or !g. ins. W.A. Leader area
F7_ V linen I Eenth Width Height
Windows and Doors---Crackage and Area
f
O
V
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
t�
Coef. Btu
Coef.
Infiltration
3
Glass
Ceiling
'.0
Exp. wall
Net exp. w
, 4--k ! _ fw
/Q3
Cl
Int. wall
Ceiling
S + 1)
f
5-0
Floor
Total Btu. ,j" JNW U
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
F7.1 Rtnm 1 Lenath Width Heisfht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. -of pane of pane lights of crack eq, tL
Coef. Btu
Infiltration
Glass %
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total 13tu.
Required sq. ft. E.D.R. or sq. ins. WA. Lrader area
SUBJECT
City of Fridley
9442
AT THE TOP OF THE TWINS
BUILDING
PERMIT
COMMUNITY DEVELOPMENT DIV.
R 6 �O.
f PROTECTIVE INSPECTION SEC.
I CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/10/99
JOB ADDRESS 174-176 Pearson Way NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DES CR.
12
6
Pearson's Craigway Estates 2nd Addn SHEET
I
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Vic Daml 1
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
K & K Roofing 9401 McCamus Rd. Brookston, MN 55709
624-2805 20094111
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Duplex
7 CLASS OF WORK
p
❑ NEW ❑ ADDITION ❑ ALTERATION X REPAIR 0 MOVE ❑ REMOVE
S DESCRIBE WORK DU lex
Reroof
X59" & Garage (32 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 REQUIRED 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 BO 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
2
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
$2,742
$1,37
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
r
PLAN CHECK FAL
FEE
%
Lic S $5
7$92.36
SIGNATU OF CO AC TOR OR AUTHORIZED AGENT IDATEI
WHE P
INSV-
Y A THIS 14.XQyR � iMIT
F�
MATE
SIGNATURE OF OWNEPoF OWNER BUILDERI IDATEIOG
NEW[ ] Effective 5/10/99
ADDN [ J CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 171-/- / 74, "5e
Legal Description:
Owner Name & Address:('/"C'd Tel. # 7 RZ/- S-3 7
Contractor: 14 1) MN LICENSE #
Address: �9yGI �'7� �m Lrs W A.yCA42L:1 Tel. # aO09t//I /
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width _
GARAGE AREA: Length Width _
DECK AREA: Len Width
OTHER: ;2 7
e
Height
Sq. Ft. .
Height
Sq. Ft.
Hgt/Ground
Sq. Ft.
J—� 5-
/CAW -),C
Construction Type: Re Estimated Cost: $ ^����-� o2
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $
E99
DATE: /p Q APPLICANT:
7� i�c✓r���� Tel. # .21k- �49e/-.2,Fa—
CITY USE ONLY
Permit Fee
$ �3-�S�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 1,312
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ 57- c)0
$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 [ J Not Necessary [ ]
TOTAL
$ -�
STIPULATIONS:
SUBJECT
,
City of Fridley
32724
AT THE TOP OF THE TWINS
BUILDING
PER M
O.
i
F • _ COMMUNITY DEVELOPMENT O
r 1 � PROTECTIVE INSPECTION SEC..
NUMBERDATE
171
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
6/24/02
JOB ADDRESS 174-176 Pearson Way NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
12
6 1
Pearson's Craigway Estates 2nd Addn SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Victor Daml
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Rite Way Waterproofing 448 Lilac St, Lino Lakes, MN 55014 651-786-0550 Cit
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential Duplex
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Q REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install interior basement drain tile system
9 CHANGE OF USE FROM TO
STIPULATIONS
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 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 OWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1 ISTALLS
GARAGES
AND KNOW TME 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
$2,495
$1.25
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 FEE
TOTAL FEE
City c nse
11
$87.00
SIGNATURE OF CON TRACTOR OR AUTHORIZED AGENT IDAiEI
HE PR
LY VALI&TED THIS ISyy,OUR
_
JIFOG INSP
CPERMIT
4
GATE
S-GNATURE OF OWNEROF OWNER BUILOEAI tOATEI
NEW [ ]
ADDN [ ]
ALTER j>Q
Construction Address:
Legal Description: Di e
Owner Name & Address:
CITY OF FRIDLEY Effective 1/1/2002
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Tel. # 7u3 - -7g(/ - 53/7
Contractor. Rite -Way Waterproofing MN LICENSE#
Address: 448 Lilac Street, Lino Lakes MN 55014 Tel.# 651-786-0550
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: Tnteri ter Ratpmpnt Drain Tilt- System
Construction Type: Estimated Cost: $
Dnvevay Curb Cut Width Needed Ft + 6 Ft Ft x $ $
DATE: Co -! 1 - n�;) APPLICANT. A
Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
lkq
STIPULATIONS:
Building MECHANICAL Permit No.: -0 6
Inspections RESIDENTIAL APPLICATION Received By: '.�§
763-572-3604 CITY OF FRIDLEY DRMICT 2
763-502-4977 FAX EFFECTIVE 2-19-09
SITE ADDRESS V
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
❑ OWNER
YOUR E-MAIL ADDRESS
CONTRACTOR
COMPANY NAME:
V cc s.
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
STATE LICENSE # bV\VA
EXP DATE
LICENSE WITH
ADDRESS.
APPLICATION
PHONE �tSl �%�- r���-i-
FAX 11I l -
PERMIT TYPE AsINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK. ❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF
TEWLI'5511W
FEES ARE BASED ON $10.00 PER FIXTURE EXCEPT WHERE NOTED. FIXTURES: NDIC T Al,NUMBER OF EACH B L W)
Equipment Installed MFG: I b1� MODEL:
/� f y[j' J�, SIZFJBTU h
MFG: U ( MODEL:l7 b i Vnio'3t#8-®rtV SIZEt TU 06 6
A/C $25.00
_AIR TO AIR EXCHANGEER $15
_BOILER $35.00
_CHIMNEY LINER $10.00
DUCT WORK $10.00
MFG: MODEL:
_FIREPLACE (GAS) $15.00
_FIREPLACE (WOOD) $35.00
FURNACE $35.00 'K
_GAS DRYER $10.00
GAS PIPING $10.00
SIZEIBTU
_GAS RANGEIOVEN $10.00
NEW GAS GRILL $10.00
_GAS UNIT HTR $10.00
_POOL HEATER $35.00
VENTILATOR $15.00
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 applica 'on 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 al ork which re e and approval of p
�
SIGNATURE OF APPLICANT PRINT NAME kjbYA7i3 p.. DATE , 0- 20' 0 c
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977