PRE 2010 DOCSCity of Fridley, Minn.
BURDING PERMIT
N��* 6104
Date:
Owner: Builder
Address Address
ILDING
Partnf Tnt.
NO. Street
Lot Block At --/Addition or Sub -Division
g4PF
Comer Inside Lot Setback Sideyard Yr If
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
w0be
t Del
Uft Front Depth Height Jta Sq. Ft. Cu. Ft.
V Cu. FL
Depth Ft.
f nstructi
Type o Est. f,4ifoobe Completed
tructi �Wff
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 �Jl provisions of
ordinaac�s of the city of Fridley.
In consideration of the payment of a fee of $ of 77 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
mart thereof, shall conform in all respects to the ordinances of
c
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any #me,u viol
ordinances. e_" . of any of the provisions of said
NOTICE: I
peperm[!don not cover the construction, installation for Wirike, phnnhing, gas hosting, sewer or Be core to see
the Building Inspector for separate pwndh for then hem
III
TW er.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builder J644
Address Address r i — e_s4 C4—
LOCATION OF BUILDING
No. DL 3a Street fic-c— CF�e_K dk4Fart of Lot
Lot 13 Block Addition or SubdivisionG�azl�
�� Side -Yard /� d
Corner Lot Inside de Lot�_Setbacic f�
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 as
De g
Front pth2 �.� Hei ht
Sq. Ft. %200 Cu. Ft.
*.4.04 Front y Depth 22— Height
Sq. Ft. c Cu. Ft.
Type of Construction Estimated Cost d f
To be Completed /® �� zo f 4V2_
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department"of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE SIGNATURE �7
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for Plumbing and Gas Fitting Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
rn
Z
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Z
4y
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O
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qdq
WU'
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NU'
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•
F
•
N
WATER HTR.
-
GASF
TOTAL
Base
Signe
Number Fixtures ....... ..............
x
$1.50
sZ
47.
Future Fixture Opening ...............
x
1.20
�
%
x
1st
$
Business Phone No
)
f
3.25
$
Water Heater (Up to 200,000 BTU) ......�
x
2.00
$�
ROUGH
New Ground Run Old Bldg . ............
x
3.25
$
2nd
FINAL
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
C
$
Additional Fixtures ....................
x
.50
$
3rd
Gas Range to 200,000 BTU ..............
x
2.00
$
_
4th
• Future Connection Openings I
e New Fixture, Old Openings I
11
Connected with
Sewer
Ceasp°°1 �
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all, work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are t;R6 and correct.
Owner �'
Kind of Building
Used as
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE -�`— 42 20
To be completed about "
PARTIAL RATE
SCHEDULE
Estimated Cost, $
Old ew Building Permit No Permi N
l 0 . o
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Signe
Number Fixtures ....... ..............
x
$1.50
sZ
47.
Future Fixture Opening ...............
x
1.20
�
New Fixture Old Opening ..............
x
1.00
$
Business Phone No
Catch Basin ...... .....................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......�
x
2.00
$�
ROUGH
New Ground Run Old Bldg . ............
x
3.25
$
FINAL
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
C
$
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE -�`— 42 20
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 ............ 8.00 $
each add. 80,000 BTU ....................... 2.00 $ r/
Replacement of Furnace 5.00 $
Repairs & Alterations—up to $500.00 ......... :....... 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
P 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 $
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 r `
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTL
1st 3 Fixtures x $1.50 $ V
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
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470 Q�
Locaffon ? 3 A(?_A� / -^v
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 ar true and correct.
//�� Fri y, Minn—
n.
inn 19� Y
l In Y n 1
Owner
Kind of BL/ding
Used as
To be completed about/ '� //f 4
a--� '
Estimated Cost, $ / v 0
Old New. uilding Permit No.
DESCRIPTION OF WORK
HEATING or PLANTS—Ste Hot Wa�WarmAir—N
Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load—� D r� Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU A.P.
(REMARKS -OVER)
RAY N. WELTER HEATING CO.
Signed 4637 CHICAGO AVE.
By MINNEAPOUS 7. MINN659TA
<z zM Business Phone No6
1 —.0, C00- lei 4(
"A-ft"F &A INSPECTIONS 75 e Y1
�es—N�ID 1,9 11 -- ;7 . - -F, I I
I F11 )::?'- R Room I Length /0 Width' /-- -&Heistht 9; Insulation
Windows and boors—Crackage and Area
/
Ff A ACXJSIAL 4V
Width Height Lineal ft. Area
or I No. of
No. of pane pane lights of crack sq. It.
0
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft:
-7-
Coef.
Btu
Infiltration
Coef. Btu
Infiltration
Glass
0
Glass
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall
6 ct
Exp. wall '1-1,rkf 4
.0 -9 se ,0d
Net exp. wall
Int. wall
t�
tt a
Ceiling i) -
Geik g fdKAfto ,ft" -0, 4�k-"
Floor
Floor 41. �, y I/
8'
Total Btu.
Required sq. ft. E.P.R. or sq. ins. W.A. Leader area
Room I LenittV Width'' Height-'.,'
Windows and Doors—Crackage and Area
/
Ff A ACXJSIAL 4V
Width Height No f Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
!E
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft:
-7-
Coef.
Btu
Infiltration
Coef. Btu
Infiltration
Glass
0
Glass
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall V o,!P'!-x �9
F1.1 k1i I f,# -Jo Room I Length tr Width
Exp. wall '1-1,rkf 4
.0 -9 se ,0d
Net exp. wall
Net exp. wall
,4M. wall Qge;,.,*6P
tt a
Int. wall
Geik g fdKAfto ,ft" -0, 4�k-"
Ceiling 7-0
Floor 41. �, y I/
8'
Floor
Floor
7,
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W:A. Leader area z
�l■ Saar•2t
Roof Floor Kind How Applied!,
"IVeAefg -9 *'11'e gif
I F1.1 .le /,wijZs& Room I I en-th N''Width -71!%Height
Windows and Doors—Crackage and Area
W AULAI
Ff A ACXJSIAL 4V
Windows and, Doors—Crackage and Area
6
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft:
-7-
lCoef..
Btu
Infiltration
Coef. Btu
Infiltration
9, wr
0
Glass
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
5,01
F1.1 k1i I f,# -Jo Room I Length tr Width
Exp. wall '1-1,rkf 4
.0 -9 se ,0d
Windows and Doors—Crackage and Area
Net exp. wall
,4M. wall Qge;,.,*6P
Net exp. wall
Int. wall
C.40
Geik g fdKAfto ,ft" -0, 4�k-"
44V A7
Floor 41. �, y I/
Infiltration
Roof Floor Kind How Applied!,
"IVeAefg -9 *'11'e gif
I F1.1 .le /,wijZs& Room I I en-th N''Width -71!%Height
Windows and Doors—Crackage and Area
V OV
Width Height I No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Glass v z4
66
Exp. wall t74T —k -W
lCoef..
Btu
Infiltration
Int. wall
9, wr
Glass
/t! S -Z
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
5,01
F1.1 k1i I f,# -Jo Room I Length tr Width
Exp. wall 4f
Height
Windows and Doors—Crackage and Area
Net exp. wall
Int. wall
C.40
/0
Ceiling
Btu
Infiltration
T27 —4 T
Floor
4` 7 -
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
X.1;Fj7�e- #�#_ Room I Length f.. "' Width Hefightru
Windows and Doors—Crackage and Area
Width Height No of Lineal, t. Area I
No. I of pane or pane llg�ts of crack sq. ft. �OA
S -a !7 1 1 irct 1 91
Infiltration I S- f
V OV
/V
Glass v z4
66
Exp. wall t74T —k -W
Net exp. wall I.-
A= 0
Int. wall
Ceiling ff
/t! S -Z
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
dz-
F1.1 k1i I f,# -Jo Room I Length tr Width
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
C.40
Btu
Infiltration
Glass
Exp. wall 4p; X
Net exp. wall
Total Btu.
Int, wall
Required sq. ft. E.D.Rr`or sq ills. W.A." 2
Le' d are
' C Floing
or
Total Btu. Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area J—y t r Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
r p•
Permit Fee $............................
APPLICATION FOR MECHANICAL WARM AIR IfEATING PERMIT
No. P--••--------------------
Dateof issuance------------------------------------------------------- 196 ...... Location .................................. ............................. ...................
Minneapolis, Minn ........................................ -........ 196......
Inspector of Buildings
The undersigned hereby makes application for a permit for the installation, alteration or repair of
a heatin_9, air conditioning or ventilating system, device or equipment, as herein, specified, a��reeing to do
all such work in strict accordance with the City Ordinances and ruling's of the Det,an•tment o/ Inspections
and the specifications set forth in this application as approved and filed in the Drp arta wnt of Inspections.
Owner----...--•-------•-------------•-•-•--.......-------------------•-•-----•-----------....Address of Owner ...... -----•---•---•------•---- ..........................
Kindof Buildings------------------------------------------------------------------.How occupied ............. ---•------------------------- ---------•----•---•••------
Work to be started. -------------------------------------------------- 196.----. Work to be completed --------------------------- -------••-••r 196------
Estimated Cost$---------- '--------------------------------------------------- Old — New Buildings Permit "r'------------------------- _.................
DESCRIPTION OF WORK
Note: Insert the word install, add, alter, or repair, according to which is,to be done. Under "Remarks," itemize removals, if any, and
alterations to equipment.
.................. ............................. Mechanical Warm Air Heating Plants—Furnaces ......... ............. ...........................................
Make-------------------------------------------------------------------------------------------------------------- Size -•----•-----•-------------------------------------------------------------
Connectedload•---•-•-•--•-'------------------------•----•---•---...................--•••-----...........Capacity ...........'-•------•----------••••--•---•-•---••--••......••--
Air Conditioning System: "Summer — Winter All T'ear,-------- -------------------•------------------------------------------------------------
Make------------------------------------------------------------------------------------------ --Capacity....................................... Cf nn,.........---•-•---......•--••-...
.................•---•............................................................................... ••--•.....••---•...........----•.........-•-...-----•----••-•-•------•--- ...........................
VentilatingSystem: .Make------------------------------------------------------------------ Capacity ................................ Cfm.......... -•----•---•-•----•--
......................•---......-•----------.............----......-•--•---....--••••-'------•-------------••----------•---'--------........................................................ •-•-••---
Remarks: -------------------------------------- •--------•-----------•---•------•---- --•--................................................. =...................................................
.............. ......... --------------•----•--'---.................---...-••--•......---••----••-----.--•----•••------•.---•-------•.................................................. ,--............
----------------------•---------------------------'---•............................•••---••--•-•••--•• •----•••--'••'••••-•--•---•--•----••----•••-••----•--•----•••----•--••---•-------•-•-••-•-••---•••---
=-----------------------••-----------•--'--•-'-•-•-•-••------•---•--------•----.....-----••---- -•--.._.....---................................................... ................................
Signed---•,-------------------------------------------------------------------•----------------
By........................................................................................
Approved................................................................... 196--.... Address-------------------------------•----------------- -----------------
--.. Telephone ----------------------------- ----------------------•--------------
Inspector.
---...---•-•--...•--------••--•••-...-•-----------••'--•-------------•---•-•--•-----••---------•--------•--'--•----•----................................... .......................................
............................................................. ------.................. ------------•••--••••----....•---•...----•-••----•--'•-....-•••-=----•-....-•••••'•-••...........•••---..........
........................................................ ••-•----••••-••••••-•............•••-•'---•'---••••--••••......------....... =......-•••••-•--.........•----•............................
D-20 4.400.3
SUBJECT
P
City of Fridley
2011
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�
L J\ 612-571-3450
910-F15
9/19/89
JOB ADDRESS 230 Rice Creek Boulevard N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
4
Rice Creek Plaza North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Lynn Hansen 230 Rice Creek Boulevard N.E.
571-9431
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑k REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (2nd Layer)
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd layer but not 3rd.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
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
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
$1 r 250
$.63
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$31,00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$31.63
S
GNATURE OFC NT CTOR OR AUTHORIZED AGENT (DATEI
WHEN PROPERLY VA DATED THIS IS YOUR PERMIT
TORE OF OVVNEIKF OWN R BUILDER) (DATEI
BLDG INSP
D TE
NEW [ ] 1 Effective 5/1/88
ADLN R-1 AND I-2
AZT [ ] Building Permit Application
Construction Address: _ p� 3 A C,e CVv 6< 6 jU A /i 6 d 4), AAj 5syr -L—
legal
Legal Description
Owner Name & Address: J1r1 ti 1 M L,) � I ivo 14-0 N s ew Tel. # 37 "yzo
Contractor: S Tel
Attach to this application, a Certificate of Survey of the
lat, with the proposed construction drawn on it to sole.
Ir1VIM AM: Length Width Height Sq. Ft.
GARAGE AMM: length Width Height Sq. Ft.
DECK AREA: Length Width Hqt/Gmund Sq. Ft.
9yL, aw�z SCS o o z ��
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
ZYpe of Construction: Fes- a Estimated Cost:
Approx. Cmanpletion Date: _3,-> d re ,, S
Proposed Driveway Width If NewIs Desired: Ft. $ $
Width + 6' See Back Page
DATE: h'9 APPIZa r: Tel.
�57y-35��
CITY USE CB�Y
Permit Fee $_ 2], ()b
State Surcharge $ (�
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL,
SrIPUTATICNS
��
Fee Schedule on Reverse Side
$.50/$1,000 valuation
$575 per SAC Unit
Alt. "A" or Alt. 'B" Above
Fee Determined by RgineeriM
Agreemmt Necessary [ ] Not Necessary [ ]
125-® 11-1
:E�60 . /Z)
Qx 2
3�,aa
SUBJECT
P
City ®f Fridley
20802,
AT THE TOP OF THE TWINS
BUILDING PERMIT
REC
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
C�
NUMBER
REV
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
JDATE
5/3/91
JOB ADDRESS 230 Rice Creek Blvd NE
1 LEGAL
LOT N0.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
13
4
Rice. Creek Plaza: North SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lynn Hansen 230 Rice Creek. Blvd NE 571-9431
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.
B USE OF BUILDING
Residential
7 CLASS OF WORK
[:j NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct. a 12t x 16" Shed (I.92s,f)
9 CHANGE OF USE FROM TO
STIPULATIONS Special Use Permit #S;P 90-17 approved by. Countil 11/5/1990, Any
materials which.could cause potential water contamination such.as fertilizers
gasoline, oil, pesticides, etc,, shall not be stored in the shed.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED 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 80 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
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
$900
$.50
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-
$23.00
Fire SC $.90
`STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
15=9= $24.40
1IGNATURE OF CONT RACTOR OR AUTHORIZED AGENT ID'A7TEI
EN PROPERLY VAL TED THIS IS YOUR PERMIT
•
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
BLDG INSP ATE
N7 Effective 1/1/91
ADEN [ ] R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address: 30 k, d e (!Lea 9%ted,
Zagal Description: L f 13, /3/o ck q,/F' �e dl-, �/� Za No . 61 dd�
Owner Name & Address: ��� �• n s ei S a 1 %°� 6 Tel.
Contractor:
Attach to this application, a Certificate of Survey of the
lot, with the proposed cmwtn=tion drawn on it to scale.
3TVIlrz ARES: Iength Width � Height Sq. Ft.
GULAM AREA: Leith Width Height Sq. Ft.
DDCR AREA: Tp*th Width Hgt/Gro nd Sq. Ft.
opt: S-kt-a a e shc!�Ol /I d by I L I 1i el. V
QV_`" Y&VA u
Corner Lot [ ] Inside Int [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: t kJ 0 bb e- A VV,9-- Estimated Cost: $ g 00 0 0 0
Approx. Cmpletion Date: SLk V, q
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: � � v� � �! APPIZaW: Tel. # 5 7 ! -q q v l
t.i 57 q -3 T(,
Permit Fee $ ��- 00
Fire Surcharge $ �%
State Surcharge $ ��
-A.0 C,a ge
Driveway Escrow $
Park Fee $
Sewer Main ChargeTOM s,
$
STIPULATIONS:
QTY tm my
Fee Schedule on Reverse Side
.001 x Permit Valuation (1/10th �)
$.50/$1,000 Valuation
$650 per SAC tltit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
n g
Agreement Necessary [ ] Not Necessary [ ]
EXHIBIT A
r k /
lmd 6873 -1?ffvy *cY All.
Soils ksl
ENGINEERING, !NC.
cM,/1, �Po/ -Qim/
Fn yineerS Sur o yars
certifica'te of 5urveI " for R)CE CREEK QLAZAN
1� Zoo
8
AV
� � � err• rd/ / °
4
A
O� �c* Storage Shed Location
t.
L DT
ISC4 ,
RILE CREEK PLAZA
NDRTH �AODIT►O
N
/%nrrby C,&-qy 'Ybll� l5r5 is o inx and =41Z Cl n7Xr-'1140f;ll ja sr�y effx b�►�dori�s 'fir ad.rc o�suirb� !aw', r�
hl =07 , &X�*'/ "-5l9[ 0�a-V MIX , �r,,J, fan or w7s.%d 167d. As s4�yed by rfe Ak .cby
rl v
17 A� SUB UR5" ENGINEERM7 , INC.
-4 bv0 m °s &-
C+
t —_ - - _ �•��
NO.
SUBJECT
City ®f Fridley
26071
AT THE TOP OF THE TWINS
BUILDING EMIT
r
IPT NO.
_ COMMUNITY DEVELOPMENT DIV.
�` ........
7'
d PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE Of
APPROVED BY
CITY HALL FRIDLEY 55432
L J` S 612-571-3450
910-F15
5/20/98
JOB ADDRESS 230 Rice Creek Blvd NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
4
Rice Creek Plaza North Addition
SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP
PHONE
Lynn Hansen 230 Rice Creek Blvd NE
571-9431
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Panelcraft of MN 3118 SnellingAve S, M ls., MN 55406
721-6628 2179
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION I� REPAIR.
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House; Soffit/Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Install building wrap and call for inspection of same. Install soffit
ventilation to f%O comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY
GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
1 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
$5,000
$2.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW
$99.75
Fire SC $5.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
Lice se SC $5.00
$112.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY IDATED THIS IS YOUR PERMIT
LDG NSP
)ATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NO.
N L W ( L'►►CCUVe 1/1/94
ADDN (( CITY OF [,RIDLEY
A1�1'ER ( SINGLE FAMILY AND DUPLEXES R-1 AND R-2 /l1
Building Permit Application
Construction Address: 9,�30 'W 1 r p Creelc' 151v—__.—
Legal Description:
Owner Naive & Address: _1_ ��� � f� Tel. /lqL
Contractor: MN MN LICENSE //3Z
Address: f % _�ine_' lino Ate. S Tel. 1!
Attach to this a lication, a Certificate or Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK ARCA: Len Width Hgt/Ground
OTHER:
Corner Lot [ I Inside Lot Ft. Yd Setback
Type of Construction:
Approx. Completion Date:
Side Yard Setbacks
Sy. Ft.
Sq. Ft.-
Sq.
t.Sq. Ft.
Estimated Cost: $ ®o
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + G Ft = ht x $
_ _ $
DATE:
APPLICANT:
Tel• // -
JDU 4 07J�
CITY USE ONLY
Permit Fee
$__
Fee Schedule on Reverse Side
hire Surcharge
$���
.001. of Permit Valuation (1/10tH )
State Surcharge
$2i..S�
$.50/$1,000 Valuation
SAC Charge
$--- ..�
4fft per SAC Unit
License Surcharge
$ 64>
$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 I I Not Necessary
I
a'�5-
• TOTAL
$ .
STIPULATIONS:
. , -
CITY OF FRIDLEY INSPECTION DIVISION � Effective On.January 1, 2001
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,�6
76972.3604 REFRIGERALIV
TION AND AIR CON
RATE SCHEDULE
Residential Rate TOTAL
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 $J
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work $
Commercial/Industrial .
1.25% of Value of Appliance or Work $
State Surcharge $ 50
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.
DI I IONING SYSTEMS ANDDEVICES
JOB ADDRESS 930 71'(-e
OWN
BUILDING USED AS�
ESTIMATED COST ��(��'® PERMIT.NO.®�
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One` (Steam) (Hot Water)arm Air
Trade Name 7"��y7� Size No. fS'�,d�O
BTU S'di cr6 0 HP EDR
Fuel _atx f C-745 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
rulings of the Building;Division, and hereby declares that all the facts and
representations stated in this. application are true and correct.'
DATE D�
HEATING CO Y M twvt�AC
Signe g TEL # '? -q )
Approved By Rough -In Date Final Date 4?0
BACK SIDE MUST FE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTIONtAIR VERIFICATION
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 NorN
( )
When installina 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 RNo ( )
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)
r
FMIII &2166j�
HOUSE HEATING
PERMrr#
TEST RECORD
CITY I
OWNER OCC
INSTALLED BY inEmmus
ELECTRICAL WORK BY
TYPE OF HEAT GA _ FA& HW_ STEAM SPACE HTR. UNIT HTR. OTHER
�^ GSC DiRRY tN
MAKE Y I AJY L� B
MODEL'I~LZ
CONTROLS
KIND OF LINER SIZE NONE
FILTERS SIZE _� �® NUMBER
PRESSURE v3 PERCENT CO2
INPUT CFH PERCENT 02 f 710
SERIAL Z- 3
INPUT(BTU) ac G 00
COMPANY TESTING
NAME OF TESTER `�
R
Pwieview
Fire Surmharge
Suroharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fec
Sewer Main Charge
BUILDING
'QRSIDENTIA.Ld APPLICATION
OF F' LEY
z
(Z
M
p-
Received By:
Date Recd:
ITSa
c
b , / N
S
� l Sa{} per fin-
S- Itt6ft
$450 Conservation Plan Review
$ Fee Determined by Engineering
v Agreetrnt npcvs sargr ( ) Ron Naceseary { )
TM IS AN APPLIt:AnoN FOR A PERMIT -NOT VALID UNTIL PROCESSEi)
1 hereby apply fch' a building permit and I acknowl that ntvrmation above is complete and accurate: that the work will be in
cwtformartce with the ardlrtanacw arrd codes of F ' and wM the minnesula Co�nstrmthn Godes; that I understand this is not a
permit but only ao application f tic is t start without a permit; that the work will be In aoeoxdance with the approved
plan in the case of&II work wh G et oval of plans.
SIGNATURE UFltPi�L1C ,PRtNTNAME ��` ^.u+•
DATE?
-td wdSb:t7l'c 9T 'unc ZBZttiL� 9�: `ON `bJ RaipFad JO hITO: WDM4
Ir
a
0
i�
o c°
r
U
Pwieview
Fire Surmharge
Suroharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fec
Sewer Main Charge
BUILDING
'QRSIDENTIA.Ld APPLICATION
OF F' LEY
z
(Z
M
p-
Received By:
Date Recd:
ITSa
c
b , / N
S
� l Sa{} per fin-
S- Itt6ft
$450 Conservation Plan Review
$ Fee Determined by Engineering
v Agreetrnt npcvs sargr ( ) Ron Naceseary { )
TM IS AN APPLIt:AnoN FOR A PERMIT -NOT VALID UNTIL PROCESSEi)
1 hereby apply fch' a building permit and I acknowl that ntvrmation above is complete and accurate: that the work will be in
cwtformartce with the ardlrtanacw arrd codes of F ' and wM the minnesula Co�nstrmthn Godes; that I understand this is not a
permit but only ao application f tic is t start without a permit; that the work will be In aoeoxdance with the approved
plan in the case of&II work wh G et oval of plans.
SIGNATURE UFltPi�L1C ,PRtNTNAME ��` ^.u+•
DATE?
-td wdSb:t7l'c 9T 'unc ZBZttiL� 9�: `ON `bJ RaipFad JO hITO: WDM4
Building
PLUMBING
Permit No.:aX 9%33
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
763-502--4977 FAX
EFFECTIVE 1-1-08
{�, y L
DATE ,.J a 0 -' e) V -( YOUR E-MAIL ADDRESS L S
SITE ADDRESS o i L .sem 1i, 73 f v A A) E rJ 4 S V3;2_
-3
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY
NAME: L Y O tJ D 1 N 5 e AJ
ADDRESS: N F_ CITY F L i ,d l -P Y STATQ!�*IPZ�2��
OWNER/
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
ADDRESS: CITY STATE ZIP
INSURANCE
PHONE FAX
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW XREPLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 16B.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 = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW). MINIMUM FEE $15.50.
BATH SINKILAV DRAINS SHOWER _ WATER PIPING
_ _FLOOR _
_ BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
_ _
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
—
WATER METER —OTHER
f�
Permit Fee $ Number of fixtures @ $10.00 x $10.00= $
Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ OR Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
(MINIMUM $15.50) (MINIMUM $15.50) Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
I
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
a permit but only an app 'cation for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan—in, he ase of rk which requires review and approval of plans.
SIGNATURE OF APPLICANT � PRINT NAME / IJ tJ `✓ - // a N56 �I DATE
'i r
APPROVED BY DATE
�/. -.�7'„Yi� �..�,.,�„ T .�� • , a .,, y Aa :�iJ
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
BUILDING
Permit No. -o
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Da
763-502-4977 FAX
EFFECTIVE 1-1-09
y�
DATE I I
YOUR E-MAIL ADDRESS 4 °6 � 1
owes to iw -rie 6
STYE ADDRESS aW
V26EC
THIS APPLICANT IS:
❑ OWNER WCONTRACTOR
PROPERTY OWNER/
NAME: 00bAX&-o
ADDRES�-SQ30 P� OCa �� VAI CITY i
l�Jl E�
STATEMAJZIP 5J J
TENANT
a
PHONE: ! (P3 - S% I
CONTRACTOR
NAME: O S .
o
ID
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # �� � Y, EXP DATE
`7
31
p►�
AND CERTIFICATE OF
ADDRESS: �Y� FNt.I 7
CITY
Iea) 4kSTATEev(
INSURANCE
PHONE — S ' k� FAX
_
®�
PROPERTY TYPE
`4 SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED JkWINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:❑
NEW HOME CONSTRUCTION ❑ ADDITION
,aMAINTENN^ANCE/REPAIR ❑ REMODELING
� � l
DESCRIBE WORK BEING DONE: J 1-x®1,) 5 [ 0 exu-nocx OWWO
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:NUMBER
OF SQUARES
❑ HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS %Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
�®
TYPE OF WINDOW TO BE INSTALLED
kgUA 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 $
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due -bli
r NLS"
$ IVT ds See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ .0005 x Permit Valuation Minimum $.50
$ 5 ®® $5.00 (State Licensed Residential Contractors)
$ $2000 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
�$ Agreement necessary ( ) Non Necessary ( )
$ 1 k Make checks Aavable to: Citv of Fridlev Attac
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 on site; that the work will be in accordance with the
approved plan in the case of/all
�work
lwhich requires review a aka proval of plana.
,t '
SIGNATURE OF APPLICANT lL / i(LK.T } T—G, PRINT NAME aA(1AGC E / DATE II
PLEASE NOTE: SEPARATE PERMITS ARE RE-QU RED FOR CTRICA:/AND MECHANICAL WORK
Building MECHANICAL Permit No.:;2b -fiobl)
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY nate Rec'd:
763-502-4977 FAX
DATE R V 4 t g Z:> 10 YOUR E-MAIL ADDRESS 1— 14A P S e 1�Q S ra W; ' y
SITE ADDRESS .2 .23 ® pc ; e sL C.1• _s-LjLLt 1n I u4 OE e L.e A I -e Y Ma J 59 H 3;L
THIS APPLICANT IS: OWNER 000NTRACTOR
PROPERTY NAME: I , 'q
OWNER/ ADDRESSa23 D Ri Lsa. C 10�. E' (3 l vA- M CITY r- i
TENANT �� Y STATE�IP �y a
PHONE:7&3-+57 J-- 13 q3 l
CONTRACTOR COMPANY NAME:
SUBMIT A COPY OF CONTACT PERSON:
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE SINGLE FAMILY 11 TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK.• NEW O REPLACEMENT D(ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK Ray.avR- c1)(►S'ii,�� Egai �31-- YIIuT�►-` �� Aad
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALCIS PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: Z: z>'t u 1 MODEL& rAO t' D 1/ T� SIZE/BTU �ZL')5 00 0 NTLI
MFG:
MODEL:
MFG: MODEL:
A/C $25.00 IF®ARE LP ACE (GAS) $15.00
,AIR TO AIR EXCHANGEER $15 —_FIREPLACE (WOOD) $35.00
BOILER $35.00 _FURNACE $35.00
-CHIMNEY LINER $10.00 _ GAS DRYER $10.00
_DUCT WORK $10.00 P_GAS PIPING $10.00
SIZE/BTU
SIZE/BTU
_GAS RANGE/OVEN $10.00
_NEW GAS GRILL $10.00
XGAS 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 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 41 work which requires review and approval of plans.
SIGNATURE OF APPLICANT ���,. �1 -, PRINT NAME L-Y)3M , Oa /O Se �,J DAM '8 D& I a D f b
APPROVAL INSPECTORS SIGNATURE
y + W,
11 - City of Fridley
Building Inspections Department
(9 6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977