PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT 4 s s s
A
Date: ..... _. " `..."'..$.... _. _..._.._..._
P
Owner: --- - ._..:.. .1 .... itz, Builder w..... _.._.._.._.......
_ _._.__.._.___.._.......__ __
Address:_:------_...._.._..__ ..._......_.. _._... _ _. _ __ _ w.. _.._ Address ........ _.�� :...::.:.:::._!•.+'' ^ i......._......_......._......._.._..._.......
r LO ION C
QF ZBUILDING
No. _I.W.—Ilp.......street._.............. Part ,�._...... _._..
Lot Block ....•.............. Block ....._._ _------.................... Addition or Sub -Division tr.e!1....._
..............
,�.,,. "..
Corner Lot... ......................_........ Inside Lot .----_.:.........----_....--- Setback ....._ ...:.:,......_. ...........
Sewer Elevation .................... _.......... ..._.........---._.......................... _..... .....,......... Foundation Elevation
DESCRIPTION OF BUILDING
To b4�.Used as:
�.', Front .....- .,./:/__ Depth ..... Height ..: Sq. Ft. .:.,t� Cu Ftir
. % --------..:... Front ,�f" ---. Depth .... 0� -- eight .... .. Sq. Ft. 7 . Cu. Ft.
of Construction ...."�...... Est. Cost .. p... To be Completed .................... ....................... _........
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 tuneviolation any of the provisions of said
ordinances. ,- , )upon
Building Inspector
NOTICE:
This permit doe's 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
Address
No.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
�.t of Lot
Lot Block Addition or Sub.Div. ¢ �%4f I
s..
-' Corner Lot Inside Lot Set Back / Side- Yard,1 7 Y—
SEWER. ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be ed as:
Front Depth Height!,,, ` . .
Sq. Ft. 1 2I Cu7 7'.. Ft.
Front v Depth Height �� l
S!. Ft., S::24,
Type of
To be
21,
ted Cost
The undersigned hereby makes application for a permit for the work herein specified.,
agreeing to do all work in strict ac,p ordance with the City Ordinances and ruling of
the Department of Buildings, and hez�eby declare tall the facts representa-
tions'stated in this application are true'end orre
DATE ✓® /o ,. SIGNATURE
(A Schedule of Fee costs can be found on th Reverse Side.)
City of Fridley
Application for Plumbing and Gas Fitting Perndt
Dept. of Bldgs. Phone SU_ -4,-7
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
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.
Owner `'v—rte . . v� c ..•��
Kind of Building
Used as
To be completed about
PARTIAL RATE
SCHEDULE
Estimated Cost, $
'8Qz
8�
z
O
J
O
Z
Number Fixtures
•
WATER HTR.
Sig�
....... ..............�
Future Fixture Opening ................
— x 1.20
$ p2?�
y0
x 1.00
$
Catch Basin ............................
�°'
�Z
�a
O
F
N
GAS
ELEC.
New Ground Run Old Bldg . ............
x 3.25
$
ROUGH
FINAL
GAS FITTING FEES:
NO. RATE TOTAL
,�
It /� v
1st 3 Fixtures ..........................
x $1.50
Base
x .50
$
I C/
x 2.00
$
v
1st
2nd
_
3rd
_
4th
' Future Connection Openings
Connected withI
Sewer
New Fixture. Old Openings
Cesspool El
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.
Owner `'v—rte . . v� c ..•��
Kind of Building
Used as
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................
TOTAL $ az 2M 7-59
Business Phone No.
lq_'
c_3
To be completed about
PARTIAL RATE
SCHEDULE
Estimated Cost, $
Old—New. Building Permit No
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures
x $1.50
$
Sig�
....... ..............�
Future Fixture Opening ................
— x 1.20
$ p2?�
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ............................
x 3.25
$
Water Heater (Up to 200,000 BTU) ......
x 2.00
$__�R_
New Ground Run Old Bldg . ............
x 3.25
$
ROUGH
FINAL
GAS FITTING FEES:
NO. RATE TOTAL
,�
It /� v
1st 3 Fixtures ..........................
x $1.50
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................
TOTAL $ az 2M 7-59
Business Phone No.
lq_'
c_3
Application for Power Plants and: Heating, Cooling, Ventilation, .ReirigeraaNk" I 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
t 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
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE
Dept. of Bldgs. Phone SII. 4-7470
Location — P
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.
0 , Minn � 02 19 ,j
Owner v
Kind of
Used as
To completed about c9
Estimated Cost, $ 4
Ol Ne .'Building Permit No. %` !� Permit No. —3
DESCRIPTION OF WORN
HEATING or POWER PLANTS --Ste Hot Wa Warm Ai No
Trade Name c C) Size No /,(; a °�
Capacity Sq. Ft.E.D.R— ZQ BTU H.P.
Total Connected Load Kind of Fu e ", C`
BURNER — Trade Name Size No.
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
RAY N. WELTER HEATING CO,
44637. CHICAGO AVE.
Sign MINNE P@LIS 7, MiNNES(rrA
By
4Z 7M -s9 Business Phone No
D-56 -6f.,W79 G`- �i 4 1-1 #44,
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS NoMbRW MINN.
Windows and Doors—Crackagie. and Area
Coef.
Width Height No. of Lineal ft *Area
No. of pane of pane lights of crack sq. ft.
7am,7
4
Coef. Btu
Class
Coef.
Btu
Infiltration
Net exp. wall
Net exp. wall
Glass
Ceiling ;-i, A'
*?T
Int. wall
Exp. wall
Exp. wall
'1
e
Net exp. wall
Net exp. wall
Floor
x
777 7,7, 77
d,
Int. wall
?
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Ceiling ,j
Floor
Floor
Total Btu. 1 7
Required sq. ft. E.D.R. or sq, ins. W.A. Leader area
Room I Length Width, 1.Height
Windows and Doors—Crackage and Area
Width Height ft. Area
NO. of pane '1,.%Ct,.f Lineal
sq. ft.
4'Fl.l Room I Length', " Height Width Y -1
Windows and Doors—Crackage and Area
Coef.
1 Btu
Infiltration
---------- r A
Coef. Btu
Class
Coef.
Btu
Exp. wall f7
Net exp. wall
Net exp. wall
Glass
Ceiling ;-i, A'
*?T
Int. wall
Exp. wall
Exp. wall
Ceiling
e
Net exp. wall
4
Floor
x
777 7,7, 77
Int. wall
Total Btu.
?
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Ceiling .1"'
4'Fl.l Room I Length', " Height Width Y -1
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane_ lights of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
jft.
---------- r A
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Net exp. wall
Int. wall
Glass
Ceiling ;-i, A'
*?T
Floor
Exp. wall
Exp. wall
Net exp. wall
Net exp. wall
77 �-
777 7,7, 77
Int. wall
Int. wall
Ceiling J,
Ceiling .1"'
Floor
Floor
Total Btu.
I L ACIMIAL
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane_ lights of crack sq. ft.
jft.
---------- r A
Coef. Btu
Infiltration
Glass Z
Infiltration
Exp. wall
Net exp. wall
Int. wall
Ceiling ;-i, A'
*?T
Floor
Exp. wall
Total Btu.
Required sq. ft. E,D.R. or sq. ins. W.A. Leader area
7 R.17,7-7/ Room 1Length ."'t", Width.^Height z'
Windows and Doors—Crackage and Area
Width Height No.of Lineal Area
a
No. of pane of pane lights of crack sq. M
jft.
---------- r A
Coef. Btu
Infiltration
Glass
*?T
Exp. wall
Net exp. wall
77 �-
777 7,7, 77
Int. wall
Ceiling J,
Floor
Total Btu. z,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Z RnninlLength ,.", 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._
z,
---------- r A
Coef. Btu
Infiltration
Glass
*?T
Exp. wall
Net exp. wall
Int. wall.
Ceiling 7
Floor
Total Btu. "4", , !A 7- T-)
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area II Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
SUBJECT
PERMLI
City of Fridley
213 7
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
o
b; COMMUNITY DEVELOPMENT DIV.
/ Ll
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE Of
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/3/92
JOB ADDRESS 440 Rice Creek Terrace NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
4
Rice Creek Terrace Plat
3 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Virgil/Rose Mullins 440 Rice Creek Terrace NE
571-7751
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 ❑
REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 241 x 111 Garage Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway. See notations on plan.
4 lm
Before digging Call for
all utility locations
454=0002
REQUIRED B LA
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 $4,155
$2..08
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-
$72.00
Fixe SC $4,16
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
.
PLAN CHECK FEE
TOTAL FEE
$78.24
AlNATURE C NTRA �UoHORIZEDAGENT (DATE) WH P
E LY A AT ED THIS IS YOUR PERMIT
VSK;N00RE OF 0W NER OF OWNER BUILDER) AT 1 BLOG,IftIr
GATE
NEW [ ]
ADDN [
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/92
Svc"'�,�
Legal Description: �� : BZ. 0Qk �/ � � ���ra A ;c I-
7 0LAT S co
,,� �
is �?
Owner Name &Address: V�� . Tel. #,-577/ -'775-1/
�,, � � � � to ,�/ � ey' �� ��� � � � �-
Contractor: 1��'� 1 Infer' 11_ dA-> S MN LICENSE #
Address: LIC) S / C S- CA. ?1q Tel. #,G-7/ i 7,5 /
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
GARAGE: Length
DECK AREA: Length
OTHER:
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot Ft. Yd Setback Side Yard Setbacks /-7 6 +
Type of Construction: Estimated Cost:
Approx. Completion Date: --ViL V � Ste` at,
(Cosi on Back)
Driveway Curb Cut Width Needed: Q Ft. + 6 Ft = Ft x $ = $.
d
DATE: (,/,)/?Q- APPLICANT: 1� ��� Tel. # 71 % 75-/
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow I
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
$ '7
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ l
it
CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICKnON FOR POWER PLANTS AND HPATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By Rough—In Date Final Date a ' 7•
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
JOB ADDRESS "LdA
t`7 0% ee, �%� � rd_0e, AA5_
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
Furnace Shell and Duct Work, Burner —
rulings'of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00
$_3Q, 00
representations stated in this application ake true and correct.
(Side Vent — Fill Out Back)
oez?. ,1995
Gas Piping (Needed with new furnace) $10.00
$
OWNER �®
Gas Range $10.00
$
—
BUILDING USED AS. �d IA,��� l Lu -
Gas Dryer $10.00
$
ESTIMATED COST PERMIT NO.
*Air Conditioning — All Sizes $ 25.00
$
,,
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs &Alterations (UST ON BACK)
1 % of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) arm Air'
Trdde Name Size No. 35D t� A V03(al)(aD
Commercial/industri�.'_.
BTU (aQ HP EDR
1.26% of Value of Appliance or Work
$
Fuel Total Connected Load
_�-
" State Surcharge
$ .50
Burnar Trade Name Size No.
TOTAL FEE
1 0.60
BTU HP EDR
,
HEATING CO PANY BLAINE HTG. A/C a ELECT. INC,
-1414560 CEEWRAI
MINWUM FEE FOR ANY HEATINGICOOLING/VENTILATION
ANOKA, 55304
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
Signed B Tel No. 0a 5D
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By Rough—In Date Final Date a ' 7•
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
Remarks:
HEATING CO:
Signed By:
Date:
BLAINE HTO. A/C 6 `I.ECT. INL
13562 CENTRAL AVE. N.E.
ANOKA, MN 55304
I ).-(a -44
op
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
W
YesNoYV
( )
.J
2.
Is free front't or deterioration
Yes (
No ( )
3.
Has no' : foreig ;)objects lodged within
Yes ()
No
4.
Is securely sorted
Yes((`�/
No ( )
/
5.
MeetsGill current Code requirements for size
-2 � --lbq � �i•Y 5l�
and total BT s s connected
Yes ()
/.k:c
No
6
Has total -heating BTU's of _ 5 �"� c/r�
Poo
All other BTU's 3 Iia cc 0 -n, c d�
i k it j, (�
TOTAL. BTU's
,N�
.7.
Has a liner been provided for water heater
Yes
No ( )
8.
Has combustion air been provided for water heater
Yes 64
No ( )
Remarks:
HEATING CO:
Signed By:
Date:
BLAINE HTO. A/C 6 `I.ECT. INL
13562 CENTRAL AVE. N.E.
ANOKA, MN 55304
I ).-(a -44
op
owe
I
SUBJE61
City of Fridley
2 9 86'&
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
T NO.
• _ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
9
r I PROTECTIVE
e �
1--�1 CITY HALL FRIDLEY 55432
ti.__.11.' `•�
NUMBER
REV
DATEPAGE
OF
APPROVED BY
612-571-3450
910-F15
7/14/99
JOB ADDRESS 440 Rice Creek Terrace
I LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
7
4
Rice Creek Terrace, Plat 3 SHEET
2 PROPERTY OWNER MAIL ADDRES$
ZIP PHONE
Ron Jacobson
571-7897
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Suburban Exteriors 9701 Penn Ave. S. Ste 107 Bloomington 55431 881-8232 4289
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 house and garage (30 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
b
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
S0. 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
$2622
$1.31
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-
STRUCTION OR THE PERFORMANCE CONSTRUCTION
83.25
Fire SC $2.62
PLAN CHECK FEE
TOTAL FEE
Lice 5.00
$K.18
S ATURE OF CONTRACTOR -6R AUTHORIZED AGENT IDATEI
EN R P
WIOn'
BL G INSR
VALIDAT THIS IS Y R P/ERMIT
.r 75
IZ
( TIAiE
SIGNATURE OF OVVNERIIF OWNER BUTLOERI IDATEI
I
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[ SINGLE FAMELY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: Llq® n ,e,
Legal Description:
Owner Name & Address: U U U Tel. # 5 f- FY9
Contractor: -Ul6u,l MN LICENSE # E- 9
r
Address: `� I I"` v -j -� 7 Tel. # 391 -
Attach
9l -Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: R Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Rx $
ELF
DATE: f7 - 13 - 2E APPLICANT: A &Apv-, . � �; Tel. #_ 8 9-)
e
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/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.0 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
r63) 572-3604 FAX: (763) 571-1287
ADDRESS : 440 RICE CREEK TER NE
PIN : 143024240074
LEGAL DESC : RICE CREEK TERRACE PLAT 3
: LOT 7 BLOCK 4
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERM NO.: 200401063
DATE ISSUED: 07/07/2004
VALUATION : $ 1,500.00
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AN AIR CONDITIONER.
# A/C UNITS 1 VALUE OF APPL OR WORK 0
# FURNACES 0 # GAS DRYERS
# GAS RANGES 0 VALUE (FOR MINIMUM CALC)
APPLICANT
RIVER CITY SHEET METAL INC
9928 BLUEBIRD ST NW
COON RAPIDS, MN 55433
OWNER
KARLA HOESCH
440 RICE CREEK TER NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or th perfo ce of construction.
Applicant zi Date ,
Bldg
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 13402
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
1500
0.00
0.00
0.00
0.00
25.00
0.00
0.50
25.50
„CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
e Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS -q'40 1C.(. z
Fee Total
Owner C-,& Y' Lam_ A o e s c.h
$35.00 $ Building Used As RQS dc,n C e-
$10.00
$10.00 $ ESTIMATED COST )!^Cd'9'D PERMIT NO
R Pr Ytr10- D R Li ':ia}Z -13 9-Lt/v a rrr.-)
$10.00 $ C DESCRIPTION OF FURNACE AND BURNER
$10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
$25.00 $ cAG.yD BTU HP EDR
Fuel Total Connected Load
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
Burner Trade Name
BTU
HP
Size No.
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
$ and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ o HEATING
$ as. SD
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Tel #�ln3- 5AL 2) 9
FAX # Date O 6 Z3 01� Z -J
n 1
17
Approved by Rough -in Date Final Date
4
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes ( ) No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes ( ) No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input Fan Assisted or Nat
Appliance #2 Type
BTU Input Fan Assisted or Nat
Appliance #3 Type
BTU Input Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
STl-36U4 FAX: (763)571-IZ57
ADDRESS 440 RICE CREEK TER NE
PIN 143024240074
LEGAL DESC RICE CREEK TERRACE PLAT 3
LOT 7 BLOCK 4
PERMIT TYPE ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-01068 / „ 71V
DATE ISSUED: 07/12/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL AIR CONDITIONER.
# INSPECTIONS 1
APPLICANT
DEPENDABLE ELECTRIC INC
2619 COON RAPIDS BLVD NW
COON RAPIDS, MN 55433
OWNER
KARLA HOESCH
440 RICE CREEK TER NE
FRIDLEY, MN 55432
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 28587
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp.
Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
N
m
N
a
J
A
LL
0
r
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CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
)& IG u l/l,)� I //fW `f7-) 0 f f0 _L_Z ,)-rice 0 0 1
L'ad&LCL 4A-xc�
PLUMBING FI•XTURE�RATES: NO. RATE TOTAL JOB ADDRESS 'T e Ai,et
New Fixtures
Old Opening, New Fixture I_
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Surrip/Recelving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas"
Gas Range°*
Gas Dryer"
Back Flow Preventer Required ( )Yes (} No
Type
$10.00
$10.00
$10.00
$'10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$'10.00
$15.00
The undersigned hereby makes application for a permit for the work herein
/0.010 specified agreeing to do all work in strict accordanoe 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.
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Applianpe /5.6D
DATE:
OWNER
BUILDING USED AS
ESTIMATED COSTPERMIT NO.
PLUMBING CONY �� I ���
Approved By
State Surcharge $ .50
M1NILOUIYI
TOTAL FEE $__j5.5D OF THE IMI
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
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TEL N0. 959(/ 'S-�
Rough -In Date Final Date
"PROVIDE COMMON VENT INFO ON BACK SIDE
MARK NUMBER OF FIXTURES TO BE INSTALLED
ON EACH FLOOR
Wash
''
Floor
Auto.
x : GaS
Water Heater
Stories
.
Urinal
Shower
Tra
:_
Drain'Washer
: Ran a
Gas Elec
Basement
Floor 1
��'
• J?.� $ �_'-•:
?�
w�q,
� .q
TnSC>'��
�cr•
.aMPaxsax
"xitic.'. • g�Kw<x
�sF6 ax
�af
iit.<aux•y .m
FcYei?>?rXk
Floor 2
Floor 3
Floor 4
•=viao�a
x •fa9'v •ilj
<k�Zzfu:��-•g
ijw:.oT.x�r�SaFi
+���x, �
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)& IG u l/l,)� I //fW `f7-) 0 f f0 _L_Z ,)-rice 0 0 1
L'ad&LCL 4A-xc�
PLUMBING FI•XTURE�RATES: NO. RATE TOTAL JOB ADDRESS 'T e Ai,et
New Fixtures
Old Opening, New Fixture I_
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Surrip/Recelving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas"
Gas Range°*
Gas Dryer"
Back Flow Preventer Required ( )Yes (} No
Type
$10.00
$10.00
$10.00
$'10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$'10.00
$15.00
The undersigned hereby makes application for a permit for the work herein
/0.010 specified agreeing to do all work in strict accordanoe 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.
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Applianpe /5.6D
DATE:
OWNER
BUILDING USED AS
ESTIMATED COSTPERMIT NO.
PLUMBING CONY �� I ���
Approved By
State Surcharge $ .50
M1NILOUIYI
TOTAL FEE $__j5.5D OF THE IMI
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
N
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cc
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TEL N0. 959(/ 'S-�
Rough -In Date Final Date
"PROVIDE COMMON VENT INFO ON BACK SIDE