PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: --
Owner: _ g' r� Builder
Address
Address
N° 5290
� K/J
LOCATIONOF�.BL�IWIING
No. _ Street 'd—�� 1224f,
:. Part�af Tot
Lot __ Block Addition ord ub-Division
--ter---
Corner Lot — Inside Lot Setback t Sideyard t
Sewer Elevation ____ Foundation Elevation _
DESCRIPTION OF BUILDING
To Used Front Depth '~-A - eight ,E_ Sq. F't. , . Cu. Fi,_`
Front Depth Hent D Sq. Ft. ca. Ft. 0
q r
Type of nstruction .,.a—Est cost .[`�, '' -� _ To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
Z
prwork in accordance with the description above set forth and in compliance with all provisions of
ordinancxs ooposed f the city of Fridley. �r
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, Mnnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time u n violatipa of any of the provisions of said
ordinances. _ r
:• �� Building Inspector,
NOTICE:
This, permit does not cover the construction, installation for wiring, plumbing, Baa heating, Sewer or water. Be sure to am
the Building Inspector for separate permits for these items,
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
e
Owner I s Name_,Builder
Address
:�z_Ro
LOCATION OF BUILDING
No. Street�� �,�2 s®•r� 6Z/fC/ Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot z Setback 2-!�- Side -Yard /0
SEM ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
GG `ate Front / Depth2 - - G Height
Sq. Ft. Cu. Ft.
Front A/ Denth Heikht 1
Sq. Ft. Cu. Ft.
Type of Construction Z=� —t Estimated Cost
To be Completed "/ / i/
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�a plication are true and correct.
DATE // ��� / SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
IVillage of Brooklyn Center
Application for Plumbing and Gas Flitting Permit
Dept. of Bldgs. Phone JU. 8-461
DESCRIPTION OF WORK � � /y�l—�'
Number, Kind and Location of Fixtures Location.
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: � RATE TOTAL
l �8QNumber Fixtures ............... x �1,2g6,• $ ,
Future Fixture Opening ............. J- x $�
New Fixture Old Opening ........... x .80 $
Catch Basin ........................ x 3.25 $
Electric Water Heater ............... x 2.00 $
New Ground Run Old Bldg. ......... x 2.25 $
Sump or Receiving Tank ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 5 Fixtures ...................... x
Additional Fixtures ................. x .25 $
Gas Range to 200,000 BTU .......... x 1.10 $
Gas Range 200,000 to 400,000 BTU .... x 4.00 $
Gas Water Heater x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description.............................................$
TOTAL FEE $ �T
I
r
The undersigned hereby makes aj5plication for a permit for the work herein
specified, agreeing to do all work in strict accordance with the Village Ordinances
and ruling of the Department of Buildings, an reby declares that all the facts
and representations stated in this application e e and correct.
Owner -®` '`''� %z� 195._
Kind of Buildings' 195_
Used as
To be completed about
Estimated Cost, $
Old New Building Permit No.
e �—
ByCl
1 1 2M 4-57 Business Phone No kj - q
-Ii-6 r .
.n
�
CR
I✓uR
W
U'
Z
WATER HTR.
GAS
ELEC.
m
Q
u'
u�1
< a
v�
Z
�a
a
F
N
Cn
3
w
3❑❑
m
C7 6
(9
C9 0
Base
1st
J
/
2nd
3rd
4th
• Future Connection Openings
Connected with
• New Fixture. Old Openings
Sewer ElCesspool
El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: � RATE TOTAL
l �8QNumber Fixtures ............... x �1,2g6,• $ ,
Future Fixture Opening ............. J- x $�
New Fixture Old Opening ........... x .80 $
Catch Basin ........................ x 3.25 $
Electric Water Heater ............... x 2.00 $
New Ground Run Old Bldg. ......... x 2.25 $
Sump or Receiving Tank ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 5 Fixtures ...................... x
Additional Fixtures ................. x .25 $
Gas Range to 200,000 BTU .......... x 1.10 $
Gas Range 200,000 to 400,000 BTU .... x 4.00 $
Gas Water Heater x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description.............................................$
TOTAL FEE $ �T
I
r
The undersigned hereby makes aj5plication for a permit for the work herein
specified, agreeing to do all work in strict accordance with the Village Ordinances
and ruling of the Department of Buildings, an reby declares that all the facts
and representations stated in this application e e and correct.
Owner -®` '`''� %z� 195._
Kind of Buildings' 195_
Used as
To be completed about
Estimated Cost, $
Old New Building Permit No.
e �—
ByCl
1 1 2M 4-57 Business Phone No kj - q
-Ii-6 r .
Applicatioe for Power Plants and Heating, Coding. Ventilation, AeMgerafion and
Air Conditioning Systenns and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
1.
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 ............ 8.00 $
each add. 60,000 BTU ... .................. 2.00 $
Replacement of Furnace x.00 $
Repairs & Alterations—up to $500.00 ................ 5.00 $
Repairs & Alterations each add. $500.00 .......... I..... 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam....... 8.00 $_Z1_0
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) ....................... 5.00 $
GAS FITTING FEES:
NO RATE
1st 3 Fixtures ......................
x $1.50
�TOTAL
.$
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
Y'
ROUGH
FINAL-
Dept. of Bldgs. Phone SU, 4-7470
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, 19
Owner
Kind of Building
Used as i
To be completed about
Estimated Cost, $ �b
Old ew Building Permit No. ' Q Permit No.
DESCRIPTION OF WORK
a
HEATING or POWER PLANTS- Steam, Hot Water, Warm AirNo
Trade Name
Capacity Sq.' Ft. E.D.R ��9/i - BTU H.P.
Total Connected Load— Kind of Fuel
BURNER. — Trade Name Size No
Capacity Sq. Ft. E.D.R I BTU H.P.
(REMARKS—OVER)
Signed
By -
42
y r ,
f
4 z 2M 7.59 Business Pho�
City of Fridley, Minn.. N9 9389
BUILDING PERMIT
Date: August 8, 1967
Owner: Robert A. Minish Builder L. W. Samuelson
Address 331 Pgarson Way Address 7800 East River Road
LOCATION OF BUILDING
No. 331 Street Peass on Way part of Lot
Lot — 3 Block 3 Addition or Sub_Division ._ Pearson's Craigway Estates
Corner Lot __ Inside Lot --Setback Setback _.._......_._ Sideyard —
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Alterations Front __ Depth Height _ Sq. Ft Cu. Ft
Front Depth Height _ _ Sq. Ft Cu. Ft
Type of Construction Remodel Basementj;st, Cost — 2000 _ To be Completed Sept. 1, 1967
In consideration of the issuance to me of a permit to constru un d cribed a I agree to do
the proposed work in accordance with the description above set f pliance all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 12.00 , permit is hereby granted to L . W .
Samuelson 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 buil�g�
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of Bald
ordinances.
CLARENCE BELISLE Building Inepactor
NOTICE:
We pom* does not cover t6 construction, Installation for wiring, plumbing, gas heating, cower or water. Be sure to no
the Building Inspector for separate permits for these Items.
OWNER'S NAME
ADDRESS
APrLICIV-Pirl'i FOR BIJ I LDING -!!. iT
CM -1 Oi F rv"'.iJ '3Y,, MI K' iESOTA
ADDRESS ;7
LOCATION Or BUILDING
N0.' -2�L I STREET �,��2so �J �✓ PART OF LOT
LOT ` j _ BLOCK 2 ADDITION OR SUBDIVISION
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 Certificates.
DESCRIPTION OF BUILDING
To Be Used Ad:
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. j� Cu. Ft._
Type of Construction ��odEL Estimated Cost o �oe
&5ri-t�JT
To Be Completed -7
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 he facts
and representations stated in this application are t nd orrec
DATE SIGNATURE -
(Schedule of Fee Costs can be found on the Reverse Side). '
.��
5
�� ��,v.✓ ��
City of Fridley, Minn. 1 7 0
6431 University Ave. N. E., Minneapolis; Minn. 55432
BUILDING PERMIT
Date: September2, .8.1972
�
_�_
• Robert - i • -- . Samuelson Construction
Address 331 Pe rson Way N.E. Address _ 7 800 East
• : •
LOCATION OF BUILDING
No. 331 _ Street Pearson Way N.E. Part of Lot
Lot ___.?_ Block_.___ Addition or Sub_Division Pearson's Craigway Estates 2nd
Corner Lot ___._ __ Inside Lot X Setback 3551 Sideyard t
Sewer Elevation — Foundation Elevation _.
DESCRIPTION OF BUILDING
To be Used as:
Saxege_......______ Front _121 Depth 2Q' Height __10' _ Sq. Ft. - 2401 Cu. Ft. 2400
_
Family 7 v _Room — Front -2.6' Depth 12'8' Height Sq. Ft. Cu. Fi.
Type of Construction Frame Est, Cost 0.385.48 _ To be Completed Dias. 1, 1972
Stipulation: Provide a one hour fire wall between garage and living area.
In consideration of the issuance to me of a permit to construct a buil g above _I agree tg do
the proposed work .in accordance with the description above set fo � ' co li with provisions of
ordinances of the city of Fridley.
2.69 State Surcharge
In consideration of the payment of a fee of $12. oo , permit is hereby granted to L. W• Samuelson Const.
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 ordin4nces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
}githin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
o
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OW -M IS NAME : ,Z&,F&r //�%<s►C/� � BUILDER: G
e � e.eis q
ADDRESS: Af,4a-,e0A-/ /44ADDRESS:
No:-:- aa/ STREET:
LOT; 3 BLOCK: ADDITION: f' oyee'le -1
CORNER LOT: INSIDE LOT: SETBACK: 3 , SIDEYARDo
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front: /Z- Depth: Z ® Height:
Square Feet: Z �d Cubic Feet:
"He
Front: Depth: l Z -� Height:
Square Feet; Cubic Feet:
Type of Construction: wizWI-ezE Estimated Cost: $
R
To Be Completed: / E
The undersigned hereby makes application for a permit for the -wp;rk h4wein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and heV07
declares that all the facts and repress:
are true and correct.
IyATR; / Z
7-7 Z— SIGNATURE
(See Reverse Side For Additional Information.)
0
im
LE
A,,
and Planning
land Surveying
Soils Testing
Civil Engineering
Municipal Engineering
Mortgage
J
UQnOtF; vv-mmaje-, G v Ts llt'/
Eo.ceyrlen �
eJf�/�'tt Gt�'Cl1l6873 Highway No. 65 N. E.
�tJlrJO1909 ' i19P P�jjG'e Minnpolis
aS5432
(/ Telephone 784-6066
Engineers & Surveyors Area Code 612
Loan Survey for Qobor + Minish
l
i
r
. �nGk.
This is a true c z.:, .-,rrect representation of a survey of the boundaries of the IanZ above described and of th-,
location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is
made only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is
understood and agreed no monum nts h ve been laced for the purpose of establishing lot lines or boundary
corners, Dated this 0 do of e L A. D. 1Vr.
SUBURBAN ENGINEERING, INC.
Engineer Sury y rb ;
X53 br L� i '� % `r_ , _�
Application for Peww PhLIft OWHea ft C®ol nq, Vendlatte. Re/Eiget�a� aed
Air Cottditioeieg S�sWom and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE
TOTAL
Furnace Shell & Duct Work .......... .....
.. $10.00
$
Replacement of Furnace ... . ...... ........
6.00
$
Repairs & Alterations -up to $500.00
6.00
$
Repairs & Alterations each add. $500.00
3.00
MECIiL WARM AM "
D
Furnace Shell & Duct Woirk to 120,000 BTU ... ..
..$10.00
$
each add. 60,000 BTU ....................
.. 3.W
i
Replacement of hii7 ace
... 6.00
Repairs & Alte'rations--up to $500.00
6.00
$
Repairs & Alterations each add. $500.00
&W
$
STEAM or HOT WATER' SYSTEM
Furnace Shell & Lines-t_o. 400 sq. ft. EDR Steam $10.00 $.
Furnace Shell & Line -to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR.Ateam 3.00
Each add. 320 sq, it. EDR Hot Water 3.00 $_
OIL BURNER -to 3 gal, per hour 6,00 $
over 3 gal...per hpur--See Fee Schedule
GAS BURNER (up to 199,000 BTU)
... 6.00
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures' x$ z00 $ '9L
Additional Fixtures x .7 $
- - Gas Range to 199/000 I � i�X$ 6.00 $ ® 0
o- IO
FAN HEATING SYSTEM S� Fee
VENTILATING SYSTEM
ALTERATIONS & REPAIRS o TOTAL FEE
Dept. of Bldm rivere M-3490
City of Fridley:
The undersigned hereby makes application for a permit for the work hereir
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,
Owner
—a
Kind of Building
M
Used as
-Z;& �- - > �c s��--rr, I L
To be completed about _-� �L� 3 0- 7-3
� G -V
Estimated Cost, $_._ r���_.t� U(J _
Old -New. Building Permit No. Permit No. � -141
DPSiCRIPTION OF WORK
HEATING or POWER PLANTS -Steam, Hot Water, arm Air No
Trade Name give Ne4� -'3 :P
Capacity Sq. Ft. E.D.R BTU gp
Total Connected Load Kind of Fue l/,
BURNER - Trade Name size No
Capacity Sq. Ft. E.D.R BTU HIP.
ROUGH-
FINAL-2/D-
OUGH
FINAL /D- / / - �-)
(REMARKS—OYER)
F"'-- mmmm,
Applicatia� for Power P1=ts and Heating, CooiingE Ventilations Re%igerafion and
10 Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIA:
IIATZ TOTAL
Furnace Shell & Duct Work ................
.. $10.00 $
Replacement of Furnace ....
6.00 $
Repairs & Alterations—up to $500,00
600 $
Repairs & Alterations each add. $800.00
3.00 $—__
MECH. WARM AIA
Furnace Shell & Duct Work to 120,000 BTU ........ ..$10.00 I
each add. 60,000 BTU .................... .. 3.00 ;
Replacement of Furnace .. ... 6.00 $�
Repairs & Alterations—up to $500.00 .. 6.00 $
Repairs & Alterations each add. $500.00 &00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam g,()() $__
Each add. 320 sq. ft. EDR Hot Water 3.00 $—
OIL BURNER—to 3 gal. per hour 6,0D $ _
over 3 gal. per hour --See Fee Schedule
GAS BURNER (up to 198,000 BTU) ... ...... 6.00 $
over 189,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTA
1st 3 Fixturesx$ . 37
00 $
Additional Fixtures a .76 $
Gas Range to 199,000 s$ 5.00
$
AIR CONDITIONING
T
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM 1 $
ALTERATIONS & REPAIRS TOTAL FEE $ J �s
ROUGH
FWAL
Dept. of Bldgs. Phone W-3480
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 ordinancej
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_ /Z��� 18� Z-
Owner
Kind of
Used as
To be completed about
c�
Estimated Cost,
Building Permit No,
Permit No.
DESCRIPTION OF WORK
HEATING PO PLANTS --Steam, Hot Water, arm Air o �_
Trade Name Si. MIL2
Capacity Sq. Ft. E.D.R- Z /a D U U BTU ^� H.P. -
Total Connected Load dAX; �� Kind of
BURNER —61
Trade Nsn+e Size No
capaci Sq. 1R. E.DR BTU RP.
(REMARKS—OVER)
MEMO TO: Nasim-Qureshi, City Engineer
w,
MEMO FROM: Darrel Clark, Community Development Administrator
MEMO DATE: March 19, 1973
RE: Rusty Water
Robert Minish has asked me why he has had'rusty�water for
such a long time and what we are doing to correct the problem.
His home address is 331 Pearson Way N.E., and His phone
number at home is 786-2616, and at work 335-9331.
Apparently he has asked before and he feels he is not
getting the.correct information and is not satisfied that we
are trying to correct the problOm.
He requested an answer in -writing.
A A-Cft'I'llD
Darrel Clark
DC/de
i
Number Fixtures
x
$2.00 $
Future Fixtures
x
$1.50
New Fixture -Old Open.
x
$1.50
Catch Basin
x
$3.25 _
Water Heater -99,000 BTU
x
$3.00
Ground Run Old Bldg.
x
$3.25
Elec. Water Heater
x
$2.00
Gas Fitting Fees:
1st 3 Fixtures x $2.00
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
See
Description: Code
State Surcharge .50
TOTAL FEE $
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 Tulin,
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
application fre true_aand correct.
'Signa
, P
d Is
GrY Or FRIDLEY INSPECTION DIV.
6431 University Ave NE
Effective On January 1, 1993
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS C
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and
Fumace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Fumace $ 20.00 $ G representations stated in this application are true and correct.
,1993
Gas Piping (Needed with new furnace) $10.00
$
._
•
OWNER!!
i,� V' ��A�P 1'�. � N) SAl
Gas Range $ 10.00
$
BUILDING USED AS Ve-s11br- -
Gas Dryer $10.00
$
ESTIMATED COST ^� PERMIT NO.
*Air Conditioning — Ali Sizes $10.00
$
•
DESCRIPTION QF FURNACE ANQ OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heating Units 1 Circle One (Steam) (Hot Wate(Warm
Air)
Trade Name ein 6 Size No.
Commercial/industrial
BTUHP EDR
1% of Value of Appliance or Work
$
Fuel L) 4:2 Total Connected Load
State Surcharge
$ ,50
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE,
Oj?j)
HEATING COMPANY
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILA 1 N
REFRIGERATIONIAIR CONDITIONING PERMIT IS $16.00
Signed By Tel No.�-,��
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
Approved By Rough—In Date Final Date
*Air Conditioners can not be placed In a side yard without
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
W__
r
CSIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
.1.
Has been carefully examined
Yes
(
)
No
(
i.
2.
Is free from rust or -deterioration
Yes
(
)
No
(
)
3.
Has no foreign objects lodged within
Yes
(
)
No
(
)
4.
Is securely supported
Yes
(-)
No
(
)
5.
Meets all current Code requirements for
size -and total BTU's connected
Yes
(
)
No
(
)
6.
Has total heating BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Bein4 Done:
HEATING COMPANY
Signed' By
Date
7201 WEST LAKE STREET
C R ON S T R 0 M SST. LOUIS P RK, MN 55426 Job Name ` I �1 M �—���
O HEATING AND AIR CONDITIONING, INC. 920-3800
D �b HEAT LOSS CALCULATIONS Job Address
V
S.. ..
Weatherstrips A.Construction No. I Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No I Yes—No 19—
M-1 Room Length a! Width I 1 Heiaht II F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width HeightNo. of Lineal ft. Area
No. of pane of pane Ilghts of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
7 I
Coef.1 Btu
Infiltration
Coef.1
Btu
Infiltration
L14 91-
GJass
Exp. wall
Int. wall
Ceiling
Net exp. wall
Floor
Int. wall QtSA
Ceiling
Floor
ZS s
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
F1.1 Room I Length Width Height
Windows and Doors—.Crackage and Area
Width HeightNo. of Lineal ft. Area
No. of pane of pane Ilghts of crack sq. ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
F1.1 Rnom I Length Width Height
Windows and Doors--Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane Ilghts of crack sq. ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
`Floor
-mal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Craekage and Area
Width I Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef-I Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceding
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Craekage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Iot. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. itis. W.A. Leader area
F1.1 Rtnm I Length Width Heiaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack w. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
1 otal t3tu.
Required'sq. ft. E.D.R. otitis. WA. Leader area
SUBJECT
ERMIT NO.City
of Fridley
25722'
AT THE TOP OF THE TWINS
BUILDING
PERMIT
ti
RECEIPT NO.
V------- COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC.
-
e
� -11 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
12/9/97
JOB ADDRESS 331 Pearson Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
3
Pearson's Craigway Estates 2nd SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert Minish 331 Pearson Way NE
571-6162
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Milton Johnson Roofing 525 Lowry Ave NE, Minneapolis, MN 55418 781-9548
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
2083
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
.6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑X REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (30 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State
Building Code.
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
MOT.
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
$2,502
$1' 25
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-
$74.75
Fire SC $2.50
STRUCTION OR THE PERFORM ANC CONSTRUCTION
OF
PLAN CHECK FEE
TOTALFEE
License SC
$5.00
$83.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY /` IDATED THIS IS YOUR PERMIT
�
BLD INSP
12-104-1
FATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 331 Pearson Way N.E.
Legal Description:
Owner Name & Address: Robert Minish
Contractor: Milton Johnson Company
Effective 1/1/97
Tel. # 571-6162
MN LICENSE # 2 0 8 3
1 P
(04
Address: 525 Lowry Ave. N.E. Tel. # 781-9548
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:
Construction Type:
Tear -off (House & Garage) Estimated Cost: $ 90 n -� 220
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: IL-LI4/ 9 7
APPLICANT: ' � Tel. #
CITY USE ONLY
Permit Fee
$ 'N d%�
Fee Schedule on Reverse Side
Fire Surcharge
$
c'
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$
S < 60
$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
$
8j.'Qy
STIPULATIONS:
781-9548
.,-
�aZ�� A8 /
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE -
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
5/2.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
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.
JOB ADDRESS ��gl I���
Effective On January 1, 2000
L_
OWNER
TOTAL
BUILDING USED AS �(
ESTIMATED COST ��O i� c PERMIT NO.
$
DESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating Units Circle One (Steam) (Hot Water) M rm ir)
$ Trade Name ` TV- 4N G Size No. CP • 75 --
BTU HP EDR
$ Fuel Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ 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.
12 DATE -i Lol _0
H EATIJ�0 �� 5--
Sig ed u EL # a �8�
Approved By Rough -In Date Final Date '9-13-00
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new venting system, 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
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input
Fan Assisted
or Nat
Appliance #2 Type
BTU Input
Fan Assisted
or Nat
Appliance #3 Type
BTU Input
Fan Assisted
or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height
Diameter
inches
Appliance #1 Vent Connector Height
ft Length
ft Diameter
in Type
Appliance #2 Vent Connector Height
ft Length
ft Diameter
in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter
in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date:
A
.ITY OF FRIDLEY INSPECTION DIV.
431 University Ave NE
ridley, MN 55432
y' 763) 572-3604
r
M
�i
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
-r-
Effective On Jan •i. 2000
ARK NUMBER OF
FIXTURES
TO BE INSTALLED
ON EACH FLOOR
.:
specified agreeing to do all work in strict accordance with the city codes
.w.•p[•%ii
, x4%
Xaa
Wash
i%%x<
Floor <% Auto' Gas€ Water Heater
A`vxe
Stories '
— 9 /-00. 20()0
tYA) k
riR'XiP'
Tray
.X%^?`%^: %4C4xJx)
•][d:X:. ';�]D4v%��t'
'{i%%^%(_-.: •t�'":; .s�
:vF•' Av -
Range Din Washer Gas Elec
$ 7.00
$10.00
r
$10,00
$10.00
:•icio�'. Y...eoc:Y
' ).%:C.}^.{.::vK9w-Y.'
Basement •<I[7'
bi
. %�'•^�`:�%
. tiX•�R4
R%^:w:>w:'••:-�•I:CGroiC%NGXji::.F
Xry)�`:'-%).fi>:4ri
Y x
-
-iC >jty,
ri:{CC %.....?i'.. 0..x.4.
:xaaw)%•%>.:b`:•.::• xiwz.).: �:::a;i<:%
..Y..4{ - wit:Y:;f:-!::�:::: '-i:
J y J:. /
t.'..:%
�F..Jx:Y%?Y;%v
){:�4
NL GC%%..^Y-Yd
43•:%4'�C:v �q%a{vim
d _
Floor I
�_lJ•%�a.
..a{._.. ..:4-
,:,. ;l..:..
::::: aX{�t%-i&
a-t3.ac%�a`itdw%%H.
b:?%:%5:.�?:a>.<:..:5 ...x:%•>
Floor 2 k.c......
...�-K<
.s:;:x%di.R&: z...
:Rs6%:r:.:•�_ ;r:;....;?.: �6%::
.:-x��:
:�%vi ...:. �.:{.'•:•i::;
��•..K)
w<�
v%Jt.%vti'y'X2
'v%%:uPYdu."8a'a'Rxa
�Xt��:O:f �::fi is{U'•:�i:: is?x.:;: y;:'le:::J.:�i -
lJ.
Floo
:..
,......
•,'•':%:...
..z: .x
:r%w:;.r..ory<x,".•ri ?:
X:S.>Nz: :X.:'c: -
lSX:XCj:x?x•x:
viS%':.
Floo r 4
Q^%....
:"`•
..Y<.: -a.
HR'R%.•
GC•:i;':; :...: .ri4_rvri
IWw •ix-
_ i::l i�r$:ii:. <C�::
'; Y.'!J -
LUMBING FIXTURE RATES:
0
~ ew Fixtures
-Id Opening, New Fixture
eer Dispenser
low Off Basin
atch Basin
;- ain Water Leader
W
eump/Receiving Tank
Ly later Treating Appliance
u- later Heater -Electric
0
_ later Heater - Gas'"
as Range"
as Dryer" _
ick Flow Preventer Required ( )Yes i) No
LL Tv qe
111
einspection Fee $47.00/Hr
�+
ILL OTHERS AND/OR REPAIRS AND ALT
1.5% of Value of Fixture or Appliance
8
rte, State Surcharge
IL TOTAL F
1
RATE TOTAL
JOB ADDRESS 3 3/ - ��a rSos� GJ CL
$ 7.00
The undersigned hereby makes application for a permit for the work herein
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
$ 5.00
and rulings of the Building Division, and heteby declares that all the facts
$ 7.00
and representations stated in this application are true and correct.
$ 7.00
$ 7.00
— 9 /-00. 20()0
$ 7.00
$10.00
Owner --)%.6e-r e7 5 h
$ 7.00
$10.00
Building Used As
$10,00
$10.00
Estimated Cost , �� �• O� _ PERMIT NO
$15.00 PLUMBING COMPA )9/1" A
TIONS
SIGNED BY gli _ Ta No _7U
ao. co
Approved 54
Rough -1n Date _ Final Date ILU•%
.50
$-.90-.60
0-.60
OMBUSTION AIR SHALL BE PROVIDED PO UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
r AM
CIiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
May 25, 2001
Mr. Robert Minish
331 Pearson Way NE
Fridley, MN 55432
Re: Final Inspection at 331 Pearson Way NE
Contractor: Mike Larson Plumbing
Dear Mr. Minish:
A plumbing permit was issued on September 18, 2000 to install a water heater at your address.
According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted
on the plumbing authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the State Plumbing Code. We will keep your permit open for another 30 days and if
we do not hear from you within this time to set up the inspection, we will expire the permit and
no further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DAVE NSEN
Buil' g Inspector
DJ/mh
.A
; QTY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572-3604 REFRIGERATION AND AIR CONDITIONING - -----
RATE SCHEDULE
Residential Rate
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace, $ 10.00
but not replacement)
Gas Range $ 10.00
Gas Dryer $ 10.00
*Air Conditioning - All Sizes $ 25.00
All Others/Repairs & Alterations (LIST ON BACK)
117o of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
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.
TOTAL
$_—
JOB Al
OWNE
1,111114
Effective On January 1, 2001
ESTIMATED COST n PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating nits Circle One (Steam) (Hot Water (Warm Air)
$ Trade Name Size No. I
BTU_(j HP EDR
s
$ �� Fuel ' Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ 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.
In DATE Z. Oi-,
Signed
Approved
Rough -In Date
Final
IAND COMBUST OI�AER VERIDF CA�IONENT SIZE, VENT CONNECTORS
ER
rl
4
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
4No(
and is securely supported and firestopped where required.
YeX )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
Ye No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Ye No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturers specifications.
Ye No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Ye;1-1" 0 ( )
When installing a new venting system, 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
Venting Tables for fan assisted and natural draft appliances.
Ye��o ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes A No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type rix-- o," BTU Input *M&
an Assiste r Nat
Appliance #2 Type BTU Input Fan Assisted or Nat --
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
- rt
Common Vent Type - Vent Height Diameter inches
r�
Appliance #1 Vent Connector Height --;, ft Length ft Diameter in Type -6-vwl-
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe) --
HEATING CO: �r
Signed By:Date
02/07/2002 14:51 7637128785 SUB IT CONTRACTORS PAGE 01
'=fflt VAN
M.,C_AtVDLM=-
Job N
HEAT LOSS
+70 F INSIDE
�10 F QUTSIODE..
90 F TEMP: Dik'F.
HEAT -GAIN
+75.F WSME
+29 F OUTSIDE
20 F TEMP. DIFF.
{�'r;''l�r if' n'iso 9�8
�� �.
Building
$
BUILDING
Permit No.: --� 00 S
$
Fire Surcharge
$
Inspections
Surcharge
RESIDENTIAL APPLICATION
Received By:
763-572=3604
$
CITY OF FRIDLEY
Date'R p: o
DATE
YOUR E-MAIL ADDRESS
Curb Cut Escrow
SITE ADDRESS 4/ ewi
Erosion Control
$
THIS APPLICANT IS:
❑ OWNER MrCCONTRACTOR
PROPERTY OWNER/
NAME: Ae.00E4 A-0flIVISAK
ADDRESS: � ��//�SD� L� e ` CITY 14.4
STAT)�r%LIP �SX��
TENANT
PHONE: 3J372/ - 6P 1 ,4-
CONTRACTOR
NAME:
STATE LICENSE # 19C ---205"Z3 Z EXP DATE
7 CITY STATI?"IP
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:
WITH APPLICATION
PHONE / !S FAX cg 7 2�
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED 151WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
BECK SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: I-lez° t ,®',C�
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S . Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDINGK
V �1��
FOR NEW CONSTRUCTION INCLUDING DECKS,
[3 Vinyl
❑ Aluminum
Ersoffit
®'Trim ®—c a �
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing strucdues
,.W Other /�
-
f ascia
and proposed project.
2. Two sets of construction plans
WIlVDOWS
IN EXISTING OPENINGS Kcs ❑No LOCATION OF WINDOWS
3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALle FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
Lg -jSINGE 1997 U�B�.0 FEE SCHEDULE)
TOTAL JOB VALUATION $, -� �J OCCUPANCY_ TYPE
Permit Fee
$
L4`?a,10 5
Plan Review
$
Fire Surcharge
$
Surcharge
$
,4
License Surcharge
$
5100
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$�jd.
5
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
fit + 6 fit = ft x $21 = $
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks savable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which r quires r iew and approval of plans. �� '?4've)4 /u" -tee
SIGNATURE OF APPLICANT PRINT NAME �G.S l7 -2/1ke DATE
Building
BUILDING
Permit No.2L,027
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-e
CITY OF FRIDLEY
Date Rec'd:
'Me a'3604
c I
0 S S
C6-n&
DATE
YOUR E-MAIL ADDRESS ep \(A.*\C( kA t
Mt .
SITE ADDRESS 331 Par
SITE
-
License Surcharge
THIS APPLICANT IS:
❑ OWNER OfONTRACTOR
SAC Charge
PROPERTY OWNER/
NAME: ri l G,
Curb Cut Escrow
TENANT
ADDRESS: 33) Pear-SOn CITY rr►—d kAi STATMAkIP STy3Z
Erosion Control
PHONE:
$450 Conservation Plan Review
CONTRACTOR
NAME: — S S i I t CLAIcL G '-JI e,-S
Fee Determined by Engineering
STATE LICENSE #30tj EXP DATE
$
Agreement necessary ( ) Non Necessary ( )
SUBNIIT A COPY OF
YOUR STATE LICENSE
ADDRESS: IAR 0.S�CCX `FO CITY C
vOve 5TAT> ,�
WTTHAPPLICATION
PHONE ' I- - FAXI-y -oma®QTS
FOR A PERMIT -NOT VALID UNTIL PROCESSED
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
a TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGFJSHED ❑ WINDOWS
• BASEMENT FINISH IIROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWINIMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR REMODELLING
►'�e h' re DESCRIBE WORK BEING DONE: I /rr2)G,L'-2 roo iqq
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Scl. Ft.
ROOFING'/ ❑ HOUSE ONLY
NUMBER OF SQUARES �24
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2•
3.
Proposed floor plan
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS.
& PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING 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
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ '.Z G'-iJ
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC 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
$ "�
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION
FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work ich� �yI requires review and approval of plans. n!
SIGNATURE OF APPLICM kbb ' i/1(�C/ PRINT NAIyIEi/1t PJt 1%16/ � V f[�L DATE
` T