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ROMAN
ROAD
I hereby oertify that the above is a survey of Late One (1) through Twenty (20). Block
CAWON 1S .SUWJT MANOR SOM AMMRON, Anoka County, Minnesota. showing the
location of the houses on said lots.
As surveyed by me this 18th day of April 1955 A. D.
signeq
Minnesota Rep1rtration No. 2584
�i
City of ]Fridley, Alinn.
BU11 DING PERMIT
Date:
Owner: Builder
Address _ __ _ Address
LOCATION A- F
No.Street -
Lot __. ___ Block:Addition or
Corner Lot _ _ _ . _ Inside Lot _ -..-XUtbach
Sewer Elevation _ _ _ _ _ _ Fa
N° a63)
Pari of Lot
Sideyard
Elevation _._.._....
DESCRIPTION OF BUILDING
dont Depth t Height Sq. Ft. Cu. >-
_ _
Depth Height Sq. Ft. Cu. Ft. _
Type of ConstructionP_ _ Est. 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 wori anen, 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 tiae,upo lation of any of the provisions of said
ordinances. ��` tai
Building Inspector
NOTICE: -
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
4
Address
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDTEY, MINNESOTA
LOCATION OF BUILDING
No. 0"I Street Part of Lot
Lot.�
Block J Addition or Subdivision J .�
Corner Lot Inside Lot i--- Setback Side -Yard
SEWER. ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
DESCRIPTION OF BUILDING
y�f
lit -Death /e /-/- Height
Sq. Ft. Cu. Ft. 1,7�
Front Depth Height
Sq. Ft. Cu. Ft.
ch
Type of Construction � ��� �, °6� Estimated Cost a
To be Completed
0
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.
DATE Aef 2 '� /� SIGNATURE e
(A Schedule of Fee Costs can be found on the Reverse Side.)
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
m ra
*Air Conditioning='AlOizes
A r
All Others/Repairs & Ntprations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective On March 1, 1996
JOBADDRESS �4qAq 9QM2DRd NE��
The undersigned hereby makes application for a permit for the work herein
Rate TOTAL 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
$ 30.00 representations stated in this application are true and correct.
$10.00 $ ,1996
OWNER
$10.00 $
BUILDING USED AS W
$10.00 $
ESTIMATED COST PERMIT NO.
$ 25.00 M
DESCRIPTION OF FURNACE AND OR BURNER
State Surcharge
TOTAL FEE
$ No. of Heatin Units Circle One (Steam) (Hot Water) arm Air
Trade Name Size No. i nA d(®0
BTU HP EDR
$ Fuel Total Connected Load
$ .50 Burner Trade Name Size No.
BTU HP EDR
BLAINE WG. A1C & ELECT. INC.
HEATING OMPANX 13552 CENTRAL AVE. N.E.
9 �111KA i. sm"
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.
Si ned Tel No.
Approved By Rough -In Date Final Date. /�0-�—%6
FILL OUT BACK SIDE FR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHMMY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been Laofully examined Yes No ( )
2. Is free
3. Has no
Cm
or deterioration
objects lodged within
Yes k No ( )
Yes () No
Yes No ( )
5. Meets all cuf 'rent Code requirements for size
and 'total BTU's connected Yes N No ( )
6 HV tart ,eating BTU's of 000 g Z 9,e, Q v Q-
All other BTU's �� ®�® at- H` r—
TOTAL BTU's
7. Has a liner been provided for water heater Yes W No { )
8. Has combustion air been provided for water heater Yes ?'-4
No
( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
BLAINE HT9. A/C a ELECT. INC.
13562 CENTRAL AVE. N.E.
ANOKA, MN 55304
01
SUBJECT
City of Fridley
26230
AT THE TOP OF THE TWINS
BUILDING
PER/ I T
f
o ,
YAA '
C,EI
i _ COMMUNITY DEVELOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
I . I
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
�'--' %j 612-571-3450
910415
6/12/98
JOB ADDRESS 4929 Roman Road NE
1 LEGAL
LOT NO.
BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
3 Carlson's Summit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Donald/Esther Chizek 4929 Roman Road NE
572-8681
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
North Central Builders Inc 7401 42 Ave N, New Hope, MN 55427 533-6168 3763
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House, Soffit & Fascia; Trim
9 CHANGE OF USE FROM TO
STIPULATIONS
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 80 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
$9,000
�y��
$4.50
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-
$149.75
_11.00
Fire SC
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEETO
L FEE
Licens C $5
0
1$168.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
HEN
EL,6G Ip
Y VALID TD THIS IS YOUR PERMIT
70SIGNATURE
DATE
OF OWNER uF OWNER BUILDER) IDATEI
01
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: - t
Legal Description:
Owner Name & Address:
Contractor:
Address: 421AI— .414A,
Effective 1/1/98
Tel. #
MN LICENSE #
jtr Tel. # ,,653 - b 1� 9
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:
Construction Type:P9o� $//te -,a Lwy%. 6W&Xstimated Cost: $ ®®D,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: b• g APPLICANT: ,%4+'N� Tel. # ,63-S- blkf
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
$1000 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 [ ]
Y