PRE 2010 DOCSCity ®f Fridley, .Minn. N° 8630
BUILDING PERMIT
Date: DECEMBER 14, 1965
Owner: Builder CHARLES JOHANSON
Address - Address 160 Hartman Circle N. E.
Fridley, Minnesota.55432
LOCATION OF BUILDING
No. 425 Street RICE CREEK BOULEVARD Part of Lot
3 1 HOLIDAY HILLS, 2ND ADDITION
Lot Block Addition or Sub -Division ._.u.
Corner Lot de Lot X Setback 35' __._ Sideyarrd, 15'611
Sewer Elevation mon Elevation C2
DESCRIPTION OF BUILDING
To be Used as:
DWELLING Front 58! 8"8" Depth 26 ,eight 24 Sq. Ft. 1, 006 Cu. Ft 24,144
ATT. GARAGE Front 20'4" Depth 22 Height 10 Sq. Ft. __4L8 Cu. 4,480
Type of Construction Frame Est. Cost ,_ X20 000, 00 To be Completed
In consideration of the issuance to me of a permit to const
the proposed work in accordance with the description above set
ordinances of the city of Fridley.
s T / '�� 0✓h°/� o
above,I agree to do
rljh a'll provisions of
In consideration of the payment of a fee of $-19 --00 , permit is herebjgranted to CHARLES
JOHANSON 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, Mirmeaota location, construction, alteration, maintenance, repair and moving of buildings
ordinances.
within the city limits permit may be revoked at any time upon violation of any of the Provisions of said
ALLEN G. JENSEN guilding motor
NOTICES
Ub pom* does not sorer the eonetwedon, hutallatt o for whine, phnn+ine► en hentine, ower or water. Be am to as
the Building Ineped r for aperote pennih Por thea Noma
OWNER'S
ADDRESS
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
r
street � � Z Vo Part of Lot
LOT IC� ADDITION OR SUBDIVISION .o
Corner LotInside LOT Setback Side -yard_
...SEWER ELEVATION FOUNDATION ELEVOk ... ..
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be -fused as,
Front Depths Height'`
Sq. Ft. ,®� Cu. Ft.y—
Fron
pth � .�=- Height
Jt
Sq. Ft._ Cu. Ft.
Type of Construction Estimated Cct ee
i e
To be completed
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 applicati5op are true and/correct.
DATE SIGNATURE.
(Schedule of Fee Costs can be found on the Reverse Side)
Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems 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 $
MECH. WARM AIR '00
Furnace Shell & Duct Work to 170,000 BTU ............ $10.00 $1 o'
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 .............. 3.00 $
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 ...................... 3.00 $
Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $
OIL BURNER—to 3 gal. per hour ........................
6.00
$
over 3 gal. per hour—See Fee Schedule
o®
GAS BURNER (up to 199,000 BTU) .......................
5.00
$i
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE
T OT,iL
U� U
1st 3 Fixtures ..... ................
x$ 2.00
$�
Additional Fixtures .................
x .75
$
Gas Range to 199,000 1 ..........
x$ 5.00
$
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE iZ 0
Dept. of Bldgs. Phone 560-3450
Location `/ - LC (�
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. J
n Fridley, Minn 3 - 2 6 , 19
Owner ( 'AA -42,e A
Kind of Building
Used as
To be completed about
I
Estimated Cost, $ ' ? 0-5—
`
Old New uilding Permit No. ff6 34) Permit No._41a
71a
DESCRIPTION OF WORK
HEATING or POWER PLANTS -Steam, Hot Water,'Warm Air—No
Trade Nam Size No 7®�
Capacity a 3 ® Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fuel XV
BURNER — Trade Nam Size No-
Capacity
o Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
Signed � ��-
By
az Business Phone No-
O>ighw 0
PERMIT for Power Plants and Heating. Cool=
ing, ventilation, Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. o. ! Heating Plants d—z'u to be Ens' --altered—repaired
Make , Size �> X 19 f3 L9.,
Oil fired ; Coal fired—, Gas fired—L; Gas Authorization No.
/?r . /} A< A . r7 . a d/
Remarks
Approved
Final Inspection
19_
Inspector
Permit N® 4679
Fee $
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn.; 177wifew ,19z-
OwneriAc�
Location 3c2 Rr' ,E. CG 46ElC' RL��
Kind of Building �4P19/y
How Occupied i iC11°.L, j t)
Work to be Commenced—, 19—
To be Completed _:&'qfE / ,19z�)-
Estimated Cost, $ Z-kQ
Old -New, Building Permit No.
Permission is hereby granted to to install—erect—use the material and devices described in the
above statement. This permit is granted upon thtf express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifications t fo h in the approved application for this
permit on file in the office of the Inspector of Buildings.
,Inspector of Buildings
42 2M 11-67 V
SUBJECT -
.
City of Fridley
rE3
302
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
L-------- COMMUNITY DEVELOPMENT DIV.
1 PROTECTIVE INSPECTION SEC.
1 �
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
11/5/75
JOB ADDRESS 425 Rice Creek Boulevard
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
1
Holiday Hills 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Gerald R. Maeckelbergh 425 Rice Creek Boulevard
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Chas. Johanson 424 Rice Creek Boulevard
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 EX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a fireplace
9 CHANGE OF USE FROM TO
STIPULATIONS
Per specifications attached.
�'R`�G,
PERMITS gJIRED
SEP ERATE
AND SONS'
HEATMIG, PLUMBING
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Concrete
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
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
$1,500
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.75
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-
$9.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$9.75
tfEIGN"A'TUREOFCR RACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
91�
BLDG. )NSP DATE
SIGNATURE OF OWNER OF OWNERBUILDER)(DATE)
yrs �'' des AIE.
Minrkafvl's3z.
ENGINEERING' Sods Trshi�
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Caf2l�SPF��+� a
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1 tF0vby WN< the tills is ® h -W cars/ er�rtcf pre ,faon d - . d lard As .st r w ycd by
trh 1"Otmin Ord# E►ua Ui t r� r , / sire ed cr5arie�►fs . rs
A.0 SW UIWAN ENONH- ING , IVC.
c.Y _lit~• At1'
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Caf2l�SPF��+� a
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1 tF0vby WN< the tills is ® h -W cars/ er�rtcf pre ,faon d - . d lard As .st r w ycd by
trh 1"Otmin Ord# E►ua Ui t r� r , / sire ed cr5arie�►fs . rs
A.0 SW UIWAN ENONH- ING , IVC.
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•' -APPLICATION FOR RESI'DE'NTIAL., ALTLRATION,
OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
�.�UI
OWNER'S �N�AME: LDER:
ADDRESS q7,6- •7G2 i� �C,ffrJ� ADDRESS :
e
NO:. STREET • �' �2 tC ►�✓ L ��
c ODD
LOT: BLOCK: I ADDITION : �L l D 4 y l C 4,11
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
. i
Applicant attach this fors. Two Certificates...)f Survey of Lot and.propos•ed • '
building location drawn on these Certificates.
r
r
DESCRIPTION OF BUILDING
• i
To Be Used As: '
?L v_t Front: Depth: • Height
Square Feet: Cubic.Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: 60/ye.26Estimated Cost: $ 1500
To Be completed:
The undersigned hereby makes application for permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fiidley 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: _
(See Reverse Side For Additional Information.)'
SUBJECT
PER O.
City ®f Fridley
2076
AT THE TOP OF THE TWINS
BUILDING PERMIT
CEIPT
i tr: -------COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
pp /
r
I
NUMBER
REV.L4/16/91
ATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
JOB ADDRESS 425 Rice Creek Blvd
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
1
Holiday Hills 2nd Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Gerald Maeckelbergh 425 Rice Creek Blvd NE 574^9580
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 IR ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct an 81 x 51 Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
WARNING
Before digging call for
all utility locations
454-0002
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED 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 60 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
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
$500
$.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-
$155o oo
Fixe SC $.50
STR CTION OR THE PERFORMANCE OF CONSTRUCTION,
P CK FEE
TOTAL FEE
$16.00
SI NATURE OF CO�/T�'(�4CTOR RA UTH RIZED AGENT IDA
Ip/f{E IS Y UR PERMIT
C,.J/� J �EjI
�ROPELHIS
iGNa7URE OF OWN R iiF OWNER BULLDERi ID TEI
BLDG iNSP r)aTE
NEW [ ] Effective 1/1/91
ADIN R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address: q7-5- t& " x%13
Legal Descripticn: 3 9bo 'e, ) l bLt DA X 141U., -5j
Owner Name & Address: 6&)ZA'L %/'r �� C � � � C� Tel.. # 5'7 V f SS Q
Contractor: t LV AAG/1 Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIMICK CF MEMM
UMM AREA: Ler:gth Width Height Sq. Ft.
G RAM AREA: length Width Height Sq. Ft.
MOM AREA: Length Width 5- Hgt/M=zn l Lz . Sq. Ft. �y 1::�7-
Corner lot [ ] Inside Iot [ ] Ft. Yd Setback Side Yard Se lacks
Type of Construction: C DA fz, Estimated Cost: $
Approx. Ccerpletion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DAZE:f� I(� t APPLICARr 'Pel. # S% Ii 9 c)
Permit Fee IOU
Fire Surge $ O
State Surcharge $
SAC amrge $
Driveway Escrow $
Park Fee $
Sewer MainCharge
70ML $J—(2 10�
SzzPUTATICNS:
00
CITY USE C�II,Y
Fee Schedule cn Reverse Side
.001 x Permit Valuation (1/10th �)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
0
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Effective On January 1, 1991
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Rate TOTAL
$ 20.00 $
$ 10.00 $
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
*Air Conditioning - All Sizes $ 10.00
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50_
TOTAL FEE - �®
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB
yzS- !� �Cr free k i U�
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 ruling of the Building Division, and hereby declares
that all the facts and representations stated in this application are
true and correct. -F/ ,1991
LID. -Che I
BUILDING USED ASDwe_ Y/ N g
ESTIMATED COST �YO U PERMIT NO.�C
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
6Y��: iC1N HEA7I�JG � ���'l1PaG-''+
HEATING COMP Y 120.85th AvrrUt1
moux, Fa 9v
424-8333
Signed By Tel No.
Approved By Rough -In Date Final Date - 2 _ Y<
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND BTACR 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
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
n
SUBJECT
PERMIT NO.
City of Fridley
23728
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
RECjEI O.
COMMUNITY DEVELOPMENT DIV.
_
>. ______ PROTECTIVE INSPECTION SEC.
3 7;
NUMBER
REVDATE
PAGE OF
APP B
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
JOB ADDRESS 425 RICE CREEK BLVD
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
1
HOLIDAY HILLS 2nd ADDITION
SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP
PHONE
GERALS MAECKELBERGH 425 RICE CREEK BLVD FRIDLEY MN 55432
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
RICHARD HASTINGS 6331 RIVERVIEW TERRACE NE FRIDLEY MN 55432
574-9966
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
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
REROOF TEAR -OFF (23Sq)
9 CHANGE OF USE FROM TO
STIPULATIONS
UNDERLAYMENT MUST MEET 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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS
I 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
1840.00
92
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-
59.50
FIRE SC 1.84
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION,
® �y �y
d
�l C is
PLAN CHECK FEE
TOTAL FEE
67.26
SIGNATURE OF CONTRACTOR O UTHORIZED AGENT (DATE)
WHEN PROPERLY LIDA ED THIS IS YOUR PERMIT
d
BLDGFINSP
`
DATE
_
SIGNATURE OF OWNERUF OWNER BUILDER) IDATEI
NEW [
AD15 [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 8/1/95
3s 77
Construction Address: ` Z 5 � , c E c � P E
Legal Description:
Owner Name & Address: 6,E,?A tel AA A EG k,9 L- 13F2!5 1, Tel. #
Contractor: ? , C-4 a F - dust; n(6 S _ MN LICENSE # y® S/
Address: Tel. # S �(—
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:
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback. Side Yard Setbacks
Type of Construction: °-E A R o Ft= 4- K E R O c, F Estimated Cost: $ _®
Approx. ComDate:
® X �V!�T , (Cost on Back)
Driveway ' th Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: zL-? S APPLICANT: Tel. # S ? c/
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS: _
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,00 Valuation
$850 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION.AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS o� '
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with nowfurpace)
G�e ��
Gas Dryer
*Air Conditioning - All Sizes
Rate TOTAL
$ 30.00.• $
$10.00 $
$10.00 $
$ 25.00 : $
All Others/Repairs & Alterations (LIST ON BACK)
I% 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/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On August 1, 1995
, 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.
/c'Z / 00--' ,1995
BUILDING USED AS
ESTIMATED COST 9-6*7,'�? e) � PERMIT NO.
wagelp-agN OF FURN E AND OR BURNER
• No. of satin nits _ Cirole One (St m) (Hot Water) (Warm A1r)
_Trad6.Name Size No.
BTU • _P HP EDR
Fuel . Total Connected Load
Burner Trade Name Size No.
B.M. ` ' HP EDR
a
HEATING COMPANY
Signed By �et_e_" Tel No. �� % -FV .9 j
Approved By Rough -In Date '9� Final Date '3
FILL OUT BACK SID FOR STACK VERIFICATI00 ON
REPLACEMENT FURNACE
f6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a Inver been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done-
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney
or stack:
1.
Has been carefully examined
Yes ()
No ( )
Z.
Is free from rust or deterioration
Yes ()
No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
4.
U securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes {)
No ( )
f6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a Inver been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done-
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Stories
Basement
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
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
Effective On January 1, 1997
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Beth WashFloorgt>::< Auto Gay Gas EyliC Water Heater
Urinal :TU Shower Sink Tray Fount Drain gmstrf Washer A: 0 Range z� > < Gas Elec
NO.RATE TOTAL JOB ADDRESS7� J �J
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
State Surcharge
TOTAL FEE
The undersigned hereby makes application fora 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.
Owner t✓ 19
Building Used As Sliv
Estimated Cost PERMIT NO.
PLUMBING COMPANY
SIGNED BY "`""'d TEL N0.
Approved By Rough—In Date Final Date (,
$ .50
MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $20.00
$ PLUS THE $.So STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.