PRE 2010 DOCSCity of Fridley
SUBJECT
P
15 516
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
COMMUNITY DEVELOPMENT DIV.
7� 33
r i PROTECTIVE INSPECTION SEC.
7 3
I---5 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATEP
AGE OF
APPROVED BY
612-571-3450
910-F15
10/15/79
�
JOB ADDRESS
5241 Pierce Street N.E.
1 LEGAL
LOT NO.
BLOCK
T RACT OR ADDITION SEE ATTACHED
DESCR.
16
1
Marion Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Bob Johnson Construction Inc. 16521 Nowthen Blvd. 753-4254
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS SEPERATE PERMITS REQUIREDONFOR WPM
6 USE OF BUILDING HEATING, PLUMBING AND SIGNS.
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
t x 221
9 CHANGE OF USE FROM TO
STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side
yards. Provide City with copy of verifying survey before. capping.
SEWER LOCATION: (Approx. 14' Deep In Street) 119' N. of M.H. (N. Inv. 1013.5
WYE ELEV: 1013.98 TOP OF FOOTING: 1016.98 Minimum
WATER LOCATION: Approx. 188' N. of Center line of Culdesac.
DRIVEWAY DEPRESSION ESCROW: N/A
WARNING
Services may not be extended to property line.
digging call local utilifiNes
THE CITY OF FRIDLEY ROES NOT GUARANTEE TMEBefore
TELEPHONE -ELECTRIC -GAS Etc
ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS.
THS DATA 15 FOR INFORMATION PURPOSES ONLY AND REQUIRED BY LAW
PERSONS USING R SHOULD VERIFY THE INFORMATION
ON THE SITL
TYPE OF CONST,
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Wood Frame
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$45,050
$22.52
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
OES NOT PRESU E IVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
ROVISIONS OFA OT ER STATE OR LOCAL LAW REGULATING CON -
$122.40
$425.00
RU 10 PE O MANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$30.60
$600.52
SIGNATURE TRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
i
BLDG INSP 0AT
SIGNATUREOF OWNERIIF OWNERBUILDERI (DATE)
01
CITY OF. FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(flew, Alterations, Additions, or Repairs)
6
OWNER: %3t�S' .�I� ISS®� c -e& z //v BUILDER:
ADDRESS: IC-�I &&,7Ar F ADDRESS:
TEL NO: c TEL NO:
Construction Location
STREET NO :STREET: ?l �� C�
LOT: -BLOCK: ADDITION: 9 / 1,4P_t &)
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
LA_s CC— to Depth: • 6�6 Height: oi0
Squane.Feet: Cubic Feet:
l�r`}72�Co� Front: Depth: �a Height:
Square - Feet: Cubic Feet:
Type of Construction: Estimated Cost: $
xb Be Completed:
Alt. A Alt. B
1
Proposed Driveway Width .If New Opening Is Desired: /(0 $ $
SEE REVERSE SIDE OF SHEET
.Mie undersigned hereby makes application for a permit for the work -'herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are trilm and correct.
e
DATE: �® ( SIGNATURE:. _
Stipulations:
30, GOL
0 o. SO
SZ -40
I Sr F••e 4(,K Z8 o 1289 V M c IS, SU c-�►�r-.
GAME 2-t vz W4 `k #a r-- e,w *T,
S01600 It q
mn x G.y%l = 8Z9�(.7Z
12 s% x ZS.*S,9 =
�g `( k 4, osl ,08
t, a,4f. iz ,u _ 4 .00O• oa
Qlic,(LAg v- 3o. 4 K I r 127 -.yo
C4.
'tic 4S.0r VA
SAS L m—)
C000. S`t.�
{" k 1 J:
(J� A 'E S ��L .® K U R tl fill
' Lh+(?� i1G fel- � t�J W �tY Lti. � ®� , : •
4002JEfF£RSON ST. N.H.
COLUMBIA HEIGHTS 65421.788.8759.;
R 11=SS? C1' WTIPV WHAT THIS SUVkVMV* PLAN 9H PM -PO T, WAS PREPARED DY MR OR UNDER MY DIRECT CUPMVIGI
A"D 4"A7 1 AM A !?IJUY 1=1379AUD LAND PIjRVSVQCC'61 AD= THS LAWS OPP TH3 STATE OFDATE
MINtdSSOTA. � � :
�r
SO
SCALE I
• M1.
M9��S�SO . A REGISTRATION. ION a!® 533 o .=IRON MONUME�'�CS�4'�A
f it 7
j h'
Pt\k
MFRS
- N •: �5�Jrf e
l3�•93 `` f 4 �;
A
r• .e i '
e +
C ,4
cy t
o :
lit �. !" � _ . c �'•r<
4_,/.f „ -td �• - /1 fb� i t o{,{�f` V s l
Q� U `�
•: ,, t d � { f e �:
GUAR o
T 1 ti
�Y bays
r OF F :Ic+>.�oc�iIONS AND : �z� H I tL
+ y..
ABY ®f UTllif't.
j,poSES ONLY
F®�TtJP tiAT�EJ�'„ ;
A 15 FOR IN jtE INrOR
flA►USING SHOULD
p� RSOPS NERIFY
d
'
ON 7tiE SITE.
J
F ' L
1
Tr �u��yy per- ���M1�r.,',
Lot 16, Block 1, Marfan Hills, Anoka County, Minnesota a
• r,
r'
t
t lak
4�
_•i�ir.
t�
!/lC CSS Z7V/ Y ZZ,,ld ? A�, �x ,cam
70 7
/98 / /V, eF 'Aw
6,ve G,iF ct-'z (J sx C .
CITY OF FRIDLEY
APPLICATION FOR PWMBI•NG AND GAS FITTING PERMIT
' PARTIAL RATE SCHEDULE
e
NO.
RATE
>1
W
x
ro
$
U
x
$2.00
d
New Fixture, Old Opening
Water
a
$
Catch Basin
x
$5.00
$
4
.a f3
m
N
b w
w
w
Water Softener
x
Heater
$
c
A
$5.00
$
Electric Water Heater
x
4i
t
$S+
4C
R
1st 3 fixtures
I x
$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,006 BTU
x
$7:0.00
a
REPAIRS & ALTERATIONS
First $100.00
d
$S.OQ
m
each add. $100.00 or fraatioa
$2.00
$
State Surcharge
N
$ .50
'
N O
~ p
41 p
N
N
N
y
U
G
ur
A
S
o w
v$c`�
.=1
t�
o
as
lec
lst
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(*) - New Fixture, Old Opening
Water
' PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
N --ber Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
�_ x
$5.00
100,000 BTU to 199,000 BTU
x
$10.00
$'
Water Softener
x
$7.00
$
New Ground Run Old Buildizq
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
I x
$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,006 BTU
x
$7:0.00
$
REPAIRS & ALTERATIONS
First $100.00
$S.OQ
$
each add. $100.00 or fraatioa
$2.00
$
State Surcharge
$ .50
'
TOTAL FEE
REINSPECTION FEE
($10.00)
Job Address i/ /% �L tfL' V l
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 roprosontations stated in this ap ication are true and correct
Fridley, Mn. , 192-L
OWNER�t-
KIND OF BUILDING 5ia--e
USED As
TO BE COMPLETED ABOUT �� p
ESTIMATED COST _ G� CJ O
OLD - NEW BUILDI= PERMIT NO. PERMIT NO..
Company c- C e
Signed BY
Tel. No. •hl 6 .�
ROUGH INSP.
Date
FINAL INSP. 6 -17
Date
APPROVAL FOR PERMIT !
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SUr=vLRGE
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$ .00
specified agreeing to do all work in strict accordance with the City Codes
AIR
CONDITIONING SYSTF14S AND DEVICES
PARTIAL RATE SCHEDULE
and rulings of the Department of Buildings, and hereby declares that all the
*Replacement of Furnace
7.00
GRAVITY WARM AIR:
RATE
TOTAL
Job Address
Furnace Shell & Duct Work
$12.00
$
* Replacement of Furnace
7.00
$
Repairs & Alterations -up to $500.00
7.00
$
Department of Buildings
Repairs & Alterations each add. $500.00
4.00
$
City of Fridley
$
Boiler only up to 100,000 BTU
Tel. #571-3450
MECHANICAL WARM AIR:
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
*Attached stack verification form
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$ .00
specified agreeing to do all work in strict accordance with the City Codes
each add. 50,000 BTU
4.00
$
and rulings of the Department of Buildings, and hereby declares that all the
*Replacement of Furnace
7.00
$
facts and representations stated in this application are true and correct.
Repairs & Alterations -up to $500.00
7.00
4.00
$
$
— 19ff
Repairs & Alterations each add. $500.00
Fridley, Minn. ,
STEAM OR HOT WATER SYSTEM:
OWNER
Boiler & Lines up to 100,000 BTU
$12.00
$
KIND OF BUILDING
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
USED AS
each addn: 50,000 BTU
6.00
$
I —3
. TO BE COMPLETED ABOUT `
OIL BURNER- to 3 gal. per hour
$10.00
$
O®
each add. 3 gal. per hour
10.00
$
/ A
ESTIMATED COST /�"
GAS. BURNER- from 100,000 BTU to 199,999 BTU
$10.00
$
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
(over 199,999 BTU see Fee Schedule)
$
GAS FITTING FEES:
1st 3 Fixtures x
$ 3.00
$9.00
DESCRIPTION OF FURNACE/BURNER
Additional Fixtures x
$ 1.00
$
Gas Range to 199,000 BTU x
$10.00
$
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. '
AIR CONDITIONING
$
Trade Name Size No. QB�tGA w 0A(n 1007
FAN HEATING SYSTEMS
$
rN/q0+
See Fee Schedule
VENTILATING SYSTEMS
S
ALTERATIONS $ REPAIRS
$
Capacity S Ft. EDR BTU HP
p y q'
State Surcharge
$ .50
Total Connected Load Kind of Fuel
TOTAL FEE
$�
BURNER - Trade Name Size No.
ROUGH INSP. REINSPECTION FEE
Capacity Sq. Ft. EDR BTU HP
Date ($10.00)
001
FINAL INSP.
Company Q
Date
-
Signed By
APPROVAL FOR PERMIT 46
` (,eR o®
Tel. No. /S /
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
*Attached stack verification form
= IMH 11 W,4111
..
8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
June 24, 1981
k
Mr. Bob Johnson
Bob Johnson Construction Inc.
_ 16521 Northen Boulevard
Anoka, MN 55303
Re: 5241 Pierce Street N.E., Fridley, MN
Dear Mr. Johnson:
In response to a request to investigate a water leakage problem at 5241
Pierce Street N.E. by the owner, Mr. Robert Wachsmuth., we made a field
inspection on June 22, 1981.
We were informed by the owner that during the rains of the weekend of
June 13th, they experienced water leaking in along the front wall of the
basement and also through the ceiling bell w. the.: fxont step and landing.
Mr. Wachsmuth reported that he.called you about this problem and he'
indicated that he was concerned that you were. not going to solve the*
leakage problem.
Would you please get in touch with -the owner and resolve -the. situation.
Your cooperation in this matter will be appreciated and if we can be of
any assistance, please feel free to contact me at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
CC: Mr. Robert Wachsmuth
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
U ��
JOB ADDRESS -2 !% /U<�
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 Furnace $ 30.00
$ '40.00
representations stated in this application are true and correct.
(Side Vent - Fill Out Back)
l 3D- 1998
Gas Piping (Needed with new fumace) $10.00
$
�rnUe 4- RC141c ��n-, s7--aI.-,
OWNER
Gas Range $10.00
$
BUILDING USED AS
Gas Dryer $10.00
$
ESTIMATED COST � Z �� � PERMIT NO.1-3111
*Air Conditioning - All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) Warm Ai
Trade Name 14.,-.-T-- Size No.
Commercial/Industrial
BTU `7SS n HP EDR
1.25% of Value of Appliance or Work
$
Fuer 1 Total Connected Load
State Surcharge
x.50
Bumer Trade Name Size No.
BTU HP EDR
TOTAL FEE
HEATING COM
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
/
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
Signed By Tel No. Y�7`22'?6
PLUS THE $.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
FILLOUT BACKSIDE FOR S CK VERIFICATION ON
written permission from adjoining property owner.
REPLACEMENT FURNACE
Remarks: k
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
v � �, �,v►, J4 ewe'• .N -�-
3-i?v-,?r
CHIMNEY 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 ()
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
7.
Has a liner been provided for water heater,
Yes ()
No ( )
8.
Has combustion air been provided for water heater
Yes No ( )
Remarks: k
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
v � �, �,v►, J4 ewe'• .N -�-
3-i?v-,?r
����. ,� .ti� 4`'�--.tet rh.;, �, �'r,q �a�,a;;>��d"�,.;�p��+i�a.,,?'1s ,. �,,�,,:i ,xr°.. "�,.r,;a�',�-d�;ia�_. ,�a:.� Y,-:;.-, �?° .:+��.ya,..-:, .� ✓ � „
L.� w
HOUSE HEATING TEST RECORD
GAS DESIGN
Make k"
I Make urner
Model IVTC r iSa I Model `
Serial /. 9 -7'� 7 4� 1'3'6 Z Max. BTU Rating
Input -73" `',3,3 g' i e1 Make of Fur Ace
CONTROLS
Thermostat Heat Plug Vent Size
Valve Kind of Liner Size None
Limit Draft Hood F�>e , r� Regulator
Limit Setting Filters: Size r t ^ Number
Fan Setting ,i Chimney Location Inside Outside
Pilot Type- Chimney Construction 7` '
Pilot Make
Pilot Model °'°� Smoke Bomb Wiring
Pilot Taming Draft Test Tag
I -M. Cut Off Door Pressure Lighting Inst.
Pressure Percent CO2 Date Tested 30 -911
Input CFH1 Percent 02 0 Company Testing
Stack Temp. r� Percent CO Name of Tester i`>
(0rsatt Test) z
Address
�+ `'
Apt. Floor
City Suburb
Occupant
Owner
Heat Loss
Date Heating Installed
"30 L6
Sold By
Installed By�"�"
Electrical Work By
�� "f �s C /e,. i ,
Gas Line By t er --j
Type of Heat GA
FAHW
Steam Space Htr.
Unit Htr. Other
GAS DESIGN
Make k"
I Make urner
Model IVTC r iSa I Model `
Serial /. 9 -7'� 7 4� 1'3'6 Z Max. BTU Rating
Input -73" `',3,3 g' i e1 Make of Fur Ace
CONTROLS
Thermostat Heat Plug Vent Size
Valve Kind of Liner Size None
Limit Draft Hood F�>e , r� Regulator
Limit Setting Filters: Size r t ^ Number
Fan Setting ,i Chimney Location Inside Outside
Pilot Type- Chimney Construction 7` '
Pilot Make
Pilot Model °'°� Smoke Bomb Wiring
Pilot Taming Draft Test Tag
I -M. Cut Off Door Pressure Lighting Inst.
Pressure Percent CO2 Date Tested 30 -911
Input CFH1 Percent 02 0 Company Testing
Stack Temp. r� Percent CO Name of Tester i`>
' CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On January 1, 1999
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS
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 - dv
State Surcharge $ .50
TOTAL FEE $A Sb
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.
1999
Owner
Building Used As
Estimated Cost PERMIT NO.
MRMWOFWAM
PLUMBING COMPANYc„W,.,, &_�W,,2 j, ■,,,
SIGNED BY ' TEL N0. �Zf' O
/ a
Approved By Rough—In Date Final Date
PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
I
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
October 9, 2000
David Holmstrom
5241 Pierce Street NE
Fridley, MN 55421
Re: Final Inspection at 5241 Pierce Street NE
Contractor: Mr. Rooter of Anoka Co.
Dear Mr. Holmstrom:
A plumbing permit was issued on May 10, 1999, for the above noted address,
to install a gas water heater. 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.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we will expire the permit and any inspections on this
installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
A, SEN
i .•Inspector
01
SUBJECT
City of Fridley3�7f
AT THE TOP OF THE TWINS
BUILDING PERMIT
O
1 1
COMMUNITY DEVELOPMENT DIV.
_i��®�
f -____
PROTECTIVE INSPECTION SEC.
�� 2
p
i � "' �'; CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
AOPROVEO By
.--•
L 612-571-3450
910-F15
3/30/01
JOB ADDRESS 5241 Pierce Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
OESCR.
16
1
1 Marian Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dave Holmstrom 5241 Pierce Street NE 763-571-0762
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
American Building Contractors Inc 12247 Nicollet Ave S, Burnsville, MN 55337
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
952-707-6959 20169383
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW O ADDITION 0 ALTERATION REPAIR O MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof House & Garage (25 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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 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
$2,557
$1.28
WITH WHETH R SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT ESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROV SION OF ANY OTHER STATE OR LOCAL LAW REGULATING CON.
$$3 25
Fire C $2.56
STR TION OR THE PERFORMANCE OF CONS UCTION
PLAN CHECK FEE
TOTA FEE
Lcien $5.00
X92.09
SIG RE OF CON -PA TOR R AUTHORiZEO AGENT iOATE�
VALID TE THIS IS Y R E MI�
jii
kl��WHE_PROP
P �/yj E
SIGNATURE OF OWNERpF OWNER BURDERi IDATEj
01
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: P1 ML
Legal Description:
Owner Name & Address: l� �Iplo� r� - � �i M, ST N'F- Tel. #60.5);:)n I - ®'l ca
Contractor: AWPi(19 n B14 li� &Itmct"W DY., MN LICENSE #o -IDI A A3
Address: (b) Ult—� PN C, Sal hO-MV l la., M0 �% 55 532 Tel. #LC�0�5-20yjjyj—(&q!5j
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:
P1am
0-k LA Q
Construction Type: QiMbUC RM Q& Estimated Cost: $_
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE:
APPLICANT:
I l l Q
Tel.
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
,
SAC Charge
$
$1050 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:
Building
1 1 MECHANICAL
Permit No.: baa �, r
Inspections 0�_
RESIDENTIAL APPLICATION
Received By
N
763-572-3604
CITY OF FRIDLEY
REGIleAl L 2007
DATE YO�IIUR E-MAIL ADDRESS
`0�
SITE ADDRESS S I 1 (� S T ME
nL
THIS APPLICANT IS: ❑ OWNER ]CONTRACTOR
PROPERTY
NAME: � C, -,Q 1 6 k r,-\ -A rcr'1
OWNER/
TENANT
`
ADDRESS: t5 c4 l l L�O�C�_ ST flgiry F"t_ L. �-�e -f sTATEA/VzIP aj
PHONE: —1('07, - G -I l - 0-1 G,2—
CONTRACTOR
COMPANY NAME: CENTERPOINT ENERGY
CONTACT PERSON: JOANN 7INKEN
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: 9320 EVERGREEN BLVD STE Brry''COON-RAPIDS sTATENIN zIP55433
APPLICATION
PHONE 763 — 757 -- 6202 FAX 763--757-6701
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW VREPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK Z`cam - : eL t N� (- MCI t l O 0 e_r`
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)I
Equipment Installed MFG: r t- i tr MODEL: s���d�b SIZE/BTU ` L 1'Ol�►S
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
_LAIC $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
NEW
TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
_AIR
_BOILER $35.00 _FURNACE $35.00 UNIT HTR $10.00
LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY
$110..00 GAS PIPING $10.00 —VENTILATOR $15.00
�p_L�DUCT.WORK
+v.LJ^_�4�•tVaElrk L7l�.�•},L'Rj,'.:�3i:t'�'�`�#,tia,
y'
�dLL';'�?5.si a;ftY'�''�i wlv$ psi ^` k+} , . P.�;..f `iyiA,4��.DS Vt�.1
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50
Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $
Number of fixtures @ $25.00 % x$25.00=$ �S`z5
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $ oZ j SO
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 requires review and approval of plans.
,,rr
�' & z -2 D
SIGNATURE OF APPLICANT A, vT NAME ROGER HOFFHEIN DATE
a;PLLA , �{. 0E.1 1, t
City of Fridley
Building Inspections- Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.