PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT
IIT.
Cj'72
Date: ....._ _ _... _.�..___.__..................... ......
Owner:��Builder ....._......._....._............_.....
ys� q
Address ....� .._. ...... m ..._ Address ........ _...--•- K..
LOCATION BUILDING
No.... .. ...... Street ....._ �" _: � �! ._...._..... Part ofr-Lot
a..........
Lot .............W1...•..__........ Block -•... ........ .....------------- Addition or Sub-Division� .._ _:..._ _ .....:_ Y.. .1 -MI- I'
Corner Lot .................................... Inside Lot ............ " •""_--------- Setback ........... _........ Sideyard --i _ ..............................
Sewer Elevation ... ....................... ...................... .............. ........ ............................ Foundation Elevation
DESCRIPTION OF BUILDING
To Used ash,
.... Front "? .. Depth ...:. Height -.._.. Sq. Ft. , Cu. Ft. .T,�./_.
�ivo
. .�....... Fro ..... Depth eighti Sq. Ft. _ Cu. Ft...._._�'`
Type Construction:...: _....... Est. Cos& ..........•.......... To be Completed .............. .... ...................... - -
CAUTION
THIS PERMIT G()Ej NOT.. .
ION OF ANYA�
BUILDING FAL; I ��IOI!®MS� �NtA�tTS AND
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. o
In consideration of the payment of a fee of $420-7 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, ups Rlation tai any of the provisions of said
ordinances. . , r+" I
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, MIldNF�S0 A
Owners Name Builder
Address
LOCATION OF BUILDING
'Z-7 �&_ I Le) -
No. Street 'L�Part of Lot
Lot Block ,� Addition or Sub.Div, 3 L 6 d��
Corner Lot Inside Lot_L:::—Set Back Side -Yard Z/1,,��,
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot_and proposed building
location.
DESCRIPTION OF BUILDING
To b used a •
Fron Depth �� � Height_+,+,,
Sq. Ft. `�- Cu. Ft.
Front Depth _ Heightt,,,
Sq. Ft. Cu. Ft.,rl
Type of Construction ' �% Estimated Cost
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 Ordinances and ruling of
the Department of Buildings, and hereby declares tat all the facts and representa-
tions ;q_tated in this application are true and cor ect. At
(I Sche66le of Fee costs can be found on the Reverse Side.)
:0 ^- -
57e P S—
City of Fridley, NUmn. N? 7904
BURDING PERMT
Date: June 16, 1965
owner: Mary Herzgk Builder 0 •R • Anderberg Co.
Address 831 Bice Creek Terrace Address 29213 Oakland Aire.
LOCATION OF BUILDING
No. 831 Street Rice Creek `herr. Part of rAt
Lot 6 Block 1 Addition or Sub -Division Btookyiew Terr. 3rd Add,.
Corner Lot _ Inside Lot Setback Sideyard
Sewer Mevation Foundation Mevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Ca. Ft.
Front Depth Freight Sq. Ft. Cu. Ft.
Type of Construction Est. Cost _3 0.•00 Tobe Completed
In consideration of the issuance to me of a permit to construct ding described above I agree tc do
the proposed work in accordance with the description above and compliance with ail provisions of
ordinaaoes of the city of Fridley. � _
In consideration of the payment of a fee of $ 10.00 permit is hereby granted t = erg CO.
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 regardinglocation, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any fi3me upon violation of any of the provisions of said
ordinances.
Allen Jensen Building fpr
NOTICE:
Sh psm b door not em m the eomcdw, lmite� for wbin& pWmbbv8• Bsu b"A& "Ww er water. Be sure to we
the Buiidhm iaspnmr for t pauft pwmih for these hems.
b
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA'"
OWNER'S NAME , U&17 k BttTLDER 0 . R. Anderbera CC)
.,.
ADDRESS 331 Rice Creek Terrace ADDRESS 2923 Oakland Ave.
LOCATION OF BUILDING
No. 331 Street Rice Creek Terra8art of Lot
LOT BLOCR ADDITION OR SUBDIVISION,=�C Imo.
Corner. Lot -Inside LOT Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth, Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. - Cu. Ft.
Type of Construction geroof & misc. repairs Estimated Cost 3,500.00
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 application are true and correct.
DATE 6-15-65
(Schedule of Fee Costs can be found on the Reverse Side).
109
SUBJECT PeMlft NO.
City of Fridley
1712 3
AT THE TOP OF THE TWINS
BUILDING P E R M IKit 1
r
�
.
R O.
• COMMUNITY DEVELOPMENT DIV.
1
r PROTECTIVE INSPECTION SEC.
9` 3 7f
1 ,
NUMBER
REV.
DATE
PAGE OF APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910-F15
5/9/83
JOB ADDRESS .831 Rice Creek Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
6
1
Brookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joseph Beverage 831 Rice Creek Terrace N.E. 571-2935
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
X
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Cedar
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
$3000
$1.50
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 CON-
$38.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$40.00
SIGNATURE OFCONTTRACTgO/RR OR AUTHORIZED AGENT 1DATEI
WHEN PROPERLY nIDATED TH�ISO IS YOUR PERMIT
Z
p
4:t2
LOG WSP f DA
SIG ATU E OF OWNERIIF OWNER BUILDERI IDATEI
CITY OF FRIDLEY Effective Aug, If 1991
APPLICATION F014 RESIDENTM BUILDVIG PEMITS
(New. Alterations. Additions. or Repairs)
OWUER: k'a UV M A*t-- R ►%L 4 , x
ADDRESS: T'3 c -Z I W4 .e c Ar�c:-,
BUI LDER : 5�--•
ADDRESS:
TEL NO: 5 -7 / —'?-93S- TEL NO:
Construction location
• STR= NO: 3 l STrd=: r c -'-s 0�� !c % c
LOT: sI.000: �� ADDITION: l� %W o Ic v 1 C --c- j T,7!�r 3 ,z 0
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this foam two Certificates of Survey of tot and
proposed building location drawn on certificates to scale.
DESCRIPTIOR OF CONSTRUCTION
21 D= Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Peet:
A
Type of Cbrstructim:Air/ Estimated Cost: : Z,`'®u--30oca
Tb Be Cbr-pleted: _ �®
A it. A Al t. 8
proposed DrivOWAY Width If New Opening Is Desired:
SEI: PZVER: E SIDi OF SHEET
Tire undersigned here makes a lication for •
b5' '' PP permit icz the %jork herein specified,
agreeing to do ,all work ii, strict accordance with the City of Fridley Ordinances and
rulia:ys of the Delxlxbncnt of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
6tipulations:
10
SUBJECT
PEN0.
PERMIT
City ®f Fridley
00 4
31
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.y
v PROTECTIVE INSPECTION SEC.
/ A
CITY HALL FRIDLEY 55432
NUMBER
REYDATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/24/90
JOB ADDRESS 831 Rice Creek Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
1
BrOokview Terrace 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joe Beverage 831 Rice. Creek.Terrace.N.E, xxx 571--2935
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Mark Nord Masonry 3868 Jackson Street N.E,, Columbia Heights 55421 788-7928
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 �J ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct new concrete front step
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. 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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
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
$300
$.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-
$15.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
ln\
$15.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY V LIDATED THIS IS YOUR PE IT
'7M
" O of
B DG INSF DATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
10
NEW [ J Effective 1/1/90
ADDN [ ] R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address: % /�. �, lie -e'
Legal Description:
I
� ea,�e�/G
Owner Name & Address: o./4025 �e.� �� ��/ /�� ���� Tel.
Contractor:Z- Tel.
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVIIG AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: ke A,)
Corner Lot [ ] Inside Lot [KJ Ft. Yd Setback Side Yard Setbacks
Type of Construction: 111f 4-5 faLA�� Estimated Cost: $ .3 c
Approx. Completion Date: jj 5
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: - APPLICANT: Tel. # --;W 7 f X
Permit Fee $ `J/ -c // e2
State Surcharge $
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Marge $
STIPUTATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY
APPLICATION FOR PWMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
Ul
New Fistures
$ 5.00
$
Future Fixtures
$ 3.50
$
Old Opening, New Fixture
$ 1.50
$
WdLer
S
.
Blow Off Basin
$ 5.00
$
'
$ 5.00
$
%
a
W
$
Hydraulic valve
Heater
$ 5.00
$
Sump or Receiving Tank
C
$
water Treating Appliance
$ 7.00
�
$ 5.00
$
oSf
$ 10.00
$
Gas Dryer
M
M0
$
Back Flow Preventer Ihquared. .
. Yes ( ) No
C
oi
O
U.N
N cL
UN
cn
C7
Go
a
v
a
State Surcharge
$ .50
Re�napection Fee $
ow
u
TOTAL
FEE
5 % S,7)
'as
lec
w
0
lot
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(•) - Now PLature, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fistures
$ 5.00
$
Future Fixtures
$ 3.50
$
Old Opening, New Fixture
$ 1.50
$
Beer Dispenser
$ 4.00
$
Blow Off Basin
$ 5.00
$
Catch Basin
$ 5.00
$
Bain Water Leader
$ 5.00
$
Hydraulic valve
$ 5.00
$
Sump or Receiving Tank
$ 5.00
$
water Treating Appliance
$ 7.00
$
not water Heater
$ 5.00
$
Gas Range
$ 10.00
$
Gas Dryer
$ 10.00
$
Back Flow Preventer Ihquared. .
. Yes ( ) No
( )
Type
S 5.00
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or
Appliance
5
State Surcharge
$ .50
Re�napection Fee $
(515.00)
TOTAL
FEE
5 % S,7)
Effective Hay 1, 1990
Job Address J I 1 C�� ��� �� A/c--
Department
/c
Department of Buildings
City of Fridley
Tel. 1571-34SO
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. I G( C)C.i . ig % u
OWNER o Ly G
KIND OF BUILDING qq
USED AS 1 cI �cW C
TO BE COMPLETED ABOUT c�/=z�/� t ,J A J
ESTIMATED COST ��i 7a��®�
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP.—��
Date
APPROVAL FOR PERMIT
!11N1M04 FUE FOR ANY PLUMBIN PERMIT IS $15.00
PLUS THE 6.50 ST4TE SURCHARG
;ITY OF FRIDLEY INSPECTION flfViStON Effective On January 1, 2000
5431 University Ave NE
-ridley, MN 55432 APPLICATION FOR POWER PLANTS AND IDEATING, COOLING, VENTILATION,
763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYS'T'EMS AND DEVICES
JOB ADDRESS gni_ __Q1j r- D Q ��1
WE SCHEDULE I—,- .n - - _
3esidential
Furnace Shell and Duct Work, Burner
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping; (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryor
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1.% of Value of Appliance or Work
commercial/Industrial
1.25®70 of Value of Appliance or Work
Rate
State
TOTAL
BUILDING USED AS
$ 30.00
$_
ESTIMATED COSTQA
PERMIT NO.
$10.(94
�
I7ESCRIPiDON
OF FURNACE AN0 OR U NEI1
$ 10.00
No. of Heating Units
Circle One (Steam) (Hot Water) (Warm Air)
$ A,0.00
$e
Trade Name_' _..
_ Size Pio.
nap
BTU
HP _ EDR_
$ 25.00
$
Fuel — _--
oad
Total Connected Load---
State Surcharge
TOTAL_ FEE
4 NIMUM FEE FOR ANY H.D:ATINGI/COOLING/VENTID.ATION
IE 199RRAAYION/IdELCONDITIQU ING MNIT IS $25.00
- LU STHE 5.550 STATE SURCHAIRGE
!E.INSPECTION FEE $47.00/Hr
Air Conditioners can not be placed in a side yard without
mitten permission from adjoining property owner.
Burner Trade Name_ _ Size No.
$ BTU--- HP E.DR,
$ 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
1_ .50 rulings of the Building Division, and hereby declares that all the facts and
$� representations stated in this application are true and correct.
DATE
HEATIN ' 4—
Signed TEL # 42) '�]n
Approved By Rough-ln Date Final Da
?0'd `4d10i
COMMON VENT, VENT CONNECTOR AND COMIiM!2N APB VERIFICATION
When replacing an existing f4rrance 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 plasWPVC and meets all current codes and manufacturer
spec Mentions 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 -LAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes { ) No( )
The ex_19fl t, a ccrnbc_stion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes No ( )
When required to install as neva cornbuVion air, I: will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No { )
When installing a new venting M stern, 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 i me and Size/Cornmon Vent and Vent Conmetor Information
Appliance #1 Type _ �_ BTU Input t=an Assisted or Nat
Appliance #2 Type ETU 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 02 Vent Connector Height ft Length ft Diameter. jn Type
Appliance #3 Vent Connector H1eight ft1L\enngthh ft-�Diam�eter �- inn Type(
Ai_TE f TIONS• (Describe) ' 1 _ I I
HEATING
Signed By:
eo/zo I d 5;09868L 01 A3 -la l ?jd -j0 UI:) W02ld 8S : ZT 0002--ZZ-nON
CITYOF ! `RIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-5711287
RATE SCHEDULE
Resi en
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 55/6 of cost of
improvement whichever is greater
f` cc, !�;_ Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
r�merciai/in ustrial/institutional
:L25% of Value of Appliance or Work (List on Back)
Minimum Fie $.35.00 for Commercial/industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
*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
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
HEATING
Approved
Rough4n Date Final Date
Ow
I
JOB ADDRESS
Fee
Total
'
Owner 3 ::tte�DfA76'-
$35.00
Building Used As
$10.00
$
ESTIMATED COST
PERMIT NO
$10.00
$
DESCRIPTION
OF FURNACE AND
BURNER
$10,00
$
# of Heating Units__,
Circle One (Steam)
(Hot Water) W m Air
Trade Name
Size No.
$25.00
$
BTU
HP
EDR
Fuel
Total Connected Load
$
Sumer Trade Name
Size No
BTU
HP
EDR
r�merciai/in ustrial/institutional
:L25% of Value of Appliance or Work (List on Back)
Minimum Fie $.35.00 for Commercial/industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
*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
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
HEATING
Approved
Rough4n Date Final Date
Ow
I
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 odes 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 1 Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes No ( )
The existinsa 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 { )
Appliance Type and SizelCommon Vent and Vent Connector Information
Appliance #1 T A -)-A P aC -t BTU Inp man Assisted o Nat
pp Type � �-.—
Appliance #2 Type BTU Input I=an Assisted or a
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances. Total Btu Input
to
Common Vent Type C2 'I Vent Height ��� -Diameter inches
Appliance #1 Vent Connector Height C --ft Length --�Lft 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
HEATING CO:
Signed By:
Date: -
Building
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604CITY
OF FRIDLEY
nate Recd:
/
DATE L i
YOUR E-MAIL ADDRESS
SITE ADDRESS131
r-0
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: P
ADDRESS: q31 di — Aff'E TY 'FP—I L4�n4 STATE ✓
TENANT
PHONE:�"J d-2
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
FAMILY SIZE X� Pa si
PROPERTY TYPESINGLE
E3 TWO FAMILY/NEW CONSTRUCTION STORIES
—
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
r„
❑ SWIIvIMIIJG POOL
lY
TYPE OF WORK:)KMAINTEN
❑ NEW ❑ ADDITION
l
ANCE/REPAIR IJREMODELING
DESCRIBE WORK BEING DONE: a c-7- 0 dV w ope 9 -
SIZE OF IMPROVEMENT LENGTH .7 0' WIDTH '�fo
HEIGHTSq. Ft.
ROOFING ❑ HOUSE ONLY
.._
NUMBER OF SQUARES -2-�
�330USE & GARAGE
BASEMENT ING SUBMIT:
1.
Existing Floor Plan
GARAGES
[3 ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ DETACHED GARAGE
�j
3.
List of structural members to be used
SIDING
❑ Vinyl
f _
� ✓w
Soffit
�IWLe,6
FOR NEW CONSTRUCTION INCLUDING DECKS,
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 NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING T 97 .B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ c OCCUPANCY TYPE
Permit Fee L
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due ,
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks Pavable 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 and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires review and approval of plans. t
SIGNATURE OF APPLICANT a�e PRINT NAME 0544A ���� A"1E l Z
Building
BUILDING
Permit No.:
Inspections..
RESIDENTIAL APPLICATION.
Received By:
763-572-3604
CITY OF FRIDLEY
Date AUG M.
763-502-4977 FAX
EFFECTIVE 1.1-08
DATE 2
9 YOUR E-MAIL ADDRESS
SITE ADDRESS .3
Ak. '-n '•
THIS APPLICANT IS:
O OWNER CONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: N CITY
STA1'F�ZIP�
PHON"?'
'
CONTRACTOR
NAME:
ADDRESS:
STA z>P�l
SUBMIT A COPY OF
PHONE I — (p FA7{
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
®I D
PROPERTY TYPE
SINGLE FAMILY Si
O TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
0 ADDITION 0 GARAGEISHED ZVINDOWS
D BASEMENT FINISH 0 ROOF 0 DRAIN TILE
O DECK D SIDING D OTHER
O SWIMMING POOL
TYPE OF WORK:
D NEW HOME CONSTRUCTION 0 ADDITION
XMdAIVTENANCF/REPAIR 0 REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
0 HOUSE ONLY
NUMBER OF SQUARES
17 HOUSE & GARAGE
BASEMMT
REMOD G SUBMIT:
GARAGES
PROPOSED SIZE:
D ATTACHED GARAGE
1.
. 2.
Existing Floor Plan
Proposed floor plan
PROPOSED HEIGHT:
0 DETACHED GARAGE
3.
List of structural members to be used
SSIIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
D Vinyl
DSofflt
ADDTTIONS
& POICIIES SUBMIT.
0 Aluminum
0 Trim
I.
Site PlawSurvey showing the existing structures
D Other
O Fascia
and proposed pmjwt.
4JiND(iwS
2.
Two sets of construction plans
IN EXISTING OPENINGS Aties DNo F OWS
3.
Energy Calculation
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS
TOTAL JOB VALL
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
etc, ne�rw -Ll v—vAliVl\, JAUUULIAky IN W 1OF LABOR AND MATMAi S:
rnuv e % C/g /t1G THE 1997 UBC FEE SCHEDULE)
$ f , "v See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ / . 56 .001 times the total job valuation
_ $ . I .0005 x Permit Valuation Mmimmn $SO
$ -$5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6 ft= ttx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ r,1d.. Agreement necessary ( ) Non Necessary ( )
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 Wormation 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; his is not a permit but only an applicatio for a
permit and work is not to start without a
permit on site; that the work w� be in ac7npg�a
all work which review and 791,
fplan.SIGNATURE OF APPLICANT RINT NAME`DATE'S t Lac
APPROV$D BY DATE