PRE 2010 DOCSCity of Fridley, Minn. r`
BUILDING PERMIT N° /A 4833
`-
Date:
Owner: mss......_: Builder _. . ......... .... _...... _..._..____..__.__._._..... __ ___....W_ ------- _.._.... __----
e
Address _..... _00_ . , Address ....... ........ .... .._._...---._...___.._...._.__......_........ _ .... _----------- _.......
_._....
LOCATI N OF BUIPING
�......No..14 ...Street Par
t o t .............
_ ?s
__..
Lot ......... Block .......... ..........._......._....... Addition or Sub aDivisiogr"i'�"�. !....-=
Corner Lot ._ ........................ Inside Lot ...... . ......... Setback .---. # ........ _........ Sideyard ....._ , ...... .......... .
SewerElevation............................................................. ............... _.......... _........ Foundation Elevation ........ .......................................... _......... _...................
DESCRIPTION OF BUILDING
To be)Used as f We
Cu. Ft,
;�.+.....i�J:
Front-+" -.. Depth ..... Height _.. Sq. Ft.ad
....._.. Depth ..... _ ght ......_.. Sq. Ft. Cu. Ft ... .....
..:_: :....�...-----...----- Front _ �.
of Construction .... :' e. Est. Cos .. .. �o be Completed ................
j 4 j�
c�
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
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 any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be, revoked at any time upon violation of-V#ny of the provisions of said
ordinances.
yr uilding .Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector' for separate permits for these items.
4
APPLICATION! FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Net
Builder_
Address.] " ddress �;� % t�✓:�.°.s �'�`�r,
LOCATION OF BUILDING
No.Str""est' _ -Part of'Lat
Lot _' Block . 3 Addition or Sub. Div. i'te,� ��sic,�A�?A
Corner Lot Inside Lot .1t 1 y Set Back _..3..�
Applicant"&tt&ch to this form Certificate of Survey of Let.and proposed
buildingloe tion.
DESCRIPTION OF BUILDIN
To be used as
e �
Front _ Depth._Height _.
Sq. Ft. `� Cu. Ft. i
Front Depth 'eight �-
Sq. Ft. ..'.^ Cu: Ft. .
Type of Construction i -l4• .� Estimated Cost
To be `completed A4y.► I /9(.-o
The undersi6ied:hereby makes application -for a permit for the work
herein spdcified, 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..
Date Signature
(A Schedule of Fee Costs can be found on th .Reverse Side)
Application for Power Plants and Heeling, Coding, 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. 60,000 BTU ....................... .................. 2.00 $ _
Replacement of Furnace ............................. P.00 $
Repairs & Alterations—up to $500.00 5.00 $
Repairs & Alterations each add. $500.00 .......:....... 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
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 TOTAL
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL
ROUGH
FINAL
Dept. of Bldgs. Phone SII. 4-7470 n
Location ofvL2 J ( /C'
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.
Fr' ey, �� 19
Owner
Kind of Bding
/X � n
Used as
To be completed about
Estimated Cost, $ '!b
O —Ne Building Permit No.
Permit No.
DESCRIPTION OF WORK
HEATING or POAVER PLANTS—,Steam, Hot
�Wa , Warm No
Trade Nam 6 p- - Q due- Size No
Capacity Sq. Ft. E.D.R- BTU H.P.
Total Connected Load `�� `rG Kind. of Fuel
BURNER — Trade Name Size No
Capacity.
(REMARKS—OVER)
Sq. Ft. E.D.R BTU H.P.
RAY N. WELTER H EATI N G CO.
4637 CHICAGO AVE.
Sign ed—M i N N E tt8 i ; ioltfdi ��
By 7
42 2M 7-59 Business Phone No �✓ '�
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK �_
Number. Kind and Location of Fixtures Locatio
N
NO. RATE TOTAL
Number Fixtures ......................
Z
Future Fixture Opening ................
i`�'"
YZ�
x 1.00 $
�paZ_
�TF3-ZNu
Water Heater (Up to 200,000 BTU) ......
,a
w
u
Z
•R
•
WATER HTR.
x $1.50 $ �- 5
Additional Fixtures ....................
x .50 $
Gas Range to 200,000 BTU ..............
'�
Z
Fp'�z'
Z
a
90
N
GAS
ELEC.
02
Base
1st
%
f
2nd
_
3rd
4th
• Future Connection Openings
Connected withI
Sewer
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ......................
C(gS�J
x $1.50 $
Future Fixture Opening ................
'= x 1.20 $ '
New Fixture Old Opening ..............
x 1.00 $
Catch Basin ............................
x 3.25 $
Water Heater (Up to 200,000 BTU) ......
x 2.00 $
New Ground Run Old Bldg . ............
x 3.25 $
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................Z
x $1.50 $ �- 5
Additional Fixtures ....................
x .50 $
Gas Range to 200,000 BTU ..............
x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE
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 reby declares that all the facts
and representations stated in this application true d correct.
A
Owner 6c.�
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit
ROUGH
FINAL
.QMW42 2M 7-59
k
SUBJECT
P -
City of Fridley
--`
28564
AT 0 THE TWINS
BUILDING
PERMIT
O
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
7�-
61 PROTECTIVE
1 ; �
CITY HALL FRIDLEY 55432
'•j
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
11/12198
IDB ADDRESS
267 Rice creek Boulevard
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DEscR.
15
3
Rice Creek Plaza North Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Virginia Evens
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Peak Roofing 11506 S. Oakvale Minnetonka 5530 938-8150
20045301
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 ) REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (24 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
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 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
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2056
$1.03
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CMA E
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON.
STRUCTION OR PERFORMANCE OF CONSTRUCTION
74..75
Fir SC 2.06
�T/HHEE�
G
PLAN CHECK FEE
TOT FEE
L c
.84
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI
04EN
JWTHIS IS rQkJ PE
V
S-GNATURE OF OWNER,IF OWNER BUILOERI IDATEI
INSP
r'ArE
NEW 4 ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ; ®`' '_ � /.
Legal Description:
Owner Name & Address:,
�; �, e
CITY USE ONLY
Tel. #
Contractor: �_��
�� �.'
Fire Surcharge
MN LICENSE #
Address: //S 0
State Surcharge
$ A o3
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
�2c0ys730 /
539- 9f s -o
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/ round Sq. Ft.
OTHER: ( nC`7 59
�� U,/ d U S �
Construction Type: ��e ®� iL��ti Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE:
APPLICANT: �' � &- C— Tel. # % ? fls CD
TOTAL
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ Sr
Fee Schedule on Reverse Side
Fire Surcharge
$ Oto
.001 of Permit Valuation (1/10th%)
State Surcharge
$ A o3
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ Sr ®D
$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:
CITY OF FRIDLEY INSPECTION DIV.
3431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On Jan 1, 2000
PLUMBING FIXTURE RATES: NO. RATE
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 $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL
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 Pluilding Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
EVENS, VIRGINIA
267 RICE CREEK BOULEVARD N.E. '2003
FRIDLEY, MN 55432 C� 3
Owner (763) 574-9593 3
�J �l �f.7
Building Used As _ �`e6k:Qg;�N Com.
�
Estimated Cost PERMIT NO. A
B
-/S
PLUMBING COMPANY ®i��L� LU% AjCr C�}
SIGNED BYTE N0. Z - O
Approved By Rough -In Date Final Date--®�
.50
MINIMUM rtC MIS ANT I'L.tJINISIN141t iAb I,tKMI1 15 520
TOTAL FEE $20.550 PLUS THE 5.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
MARK NUMBER OF
FIXTURES
TO BE INSTALLED ON EACH FLOOR
Stories
..........................Unna
......................Shower
5....-----.......Tra
Wash
F
tttt-<: =<:::: Floor :>•::::> Auto.
Drain Washer
.->::>::::>::>:::
..
.::..:::;:;:
Gas :��:«::::::: Water Hea ter
Rana Gas Elec
BasementI
><>
:l.- vv.• .nv.:..•:...: y::
Floor 1
I
F o0 r2
Floor 3
.. ...
Floor 4
PLUMBING FIXTURE RATES: NO. RATE
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 $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL
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 Pluilding Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
EVENS, VIRGINIA
267 RICE CREEK BOULEVARD N.E. '2003
FRIDLEY, MN 55432 C� 3
Owner (763) 574-9593 3
�J �l �f.7
Building Used As _ �`e6k:Qg;�N Com.
�
Estimated Cost PERMIT NO. A
B
-/S
PLUMBING COMPANY ®i��L� LU% AjCr C�}
SIGNED BYTE N0. Z - O
Approved By Rough -In Date Final Date--®�
.50
MINIMUM rtC MIS ANT I'L.tJINISIN141t iAb I,tKMI1 15 520
TOTAL FEE $20.550 PLUS THE 5.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
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 O 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 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( ) No (
Appllance 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:
Date
Signed By:
CIlYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
June 8, 2004
Ms. Virginia Evens
267 Rice Creek Blvd NE
Fridley, MN 55432
Re: Final Inspection at 267 Rice Creek Blvd NE, Fridley
Contractor: Norblom Plumbing
Dear Ms. Evens:
A plumbing permit was issued on May 1, 2003 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 work authorized by this permit. As of this date the inspection has not
been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the 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 mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
Building
BUILDING
Permit No..
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604CITY
OF FRIDLEY
Date Rec'd: C`
DATE A �f / ���
YOUR -MAIL ADDRESS
SITE ADDRESS 426l 2 4/
a L f tit° rk B11"',
THIS APPLICANT IS:
❑ OWNER 'CONTRACTOR
PROPERTY OWNER/
NAME: VIraw
ADDRESS:(/,,&2 `� f6?tey lam_ %�� /� e64@Vl-Y
STATE ZIP, e7,/,3
TENANT
PHONE: ��l �j - 5-7V 1 J
CONTRACTOR
NAME:
STATE LICEN A
SUBMIT A COPY OF
YOUR STATE LICENSE
ADD S: CITY
STATE ZIP
WITH APPLICATION
IP golnUaWAX '
PROPERTY TYPE
❑ SINGLE FAMILYNEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH PROOF 0 DRAIN TILE
❑ DECK ❑ SIDING O OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE-- ��
re?
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES
J3eHOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ DETACHED GARAGE
3.
List of structural members to be used
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 $ C)C) OCCUPANCY TYPE
Permit Fee $o See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
H
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+68= ffx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
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 anodes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for Hermit 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 'uire vie d pproval of plans. > �j
SIGNATURE OF APPLICANT �' PRINT NAME.P. DATE / ��%