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I hereby certify that the above to a survey of Lots, One (1) through Twenty (20), Block r
Three 0)..com;xNI:,.Sm*uT MANOR CouTH ADDITION. Anoka County, Minmeote, shoving the ;wy,
location of the houses on said lots. ,...F
As surveyed by we this 18th day of April 195$ Signed.
t+ wwsots Hegict�n No. 2584
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CITY OF FRIDLEY INSPECTION DIV.
Effective On March 1, 1996
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
2`7/ &)1'41frJ
JOB ADDRESS !
RATE SCHEOULE
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
X Furnace Shell and Duct Work, Burner —
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00
$C` C'C'
representations stated In this application are true and correct.
(Side Vent — Fill Out Back)
/ Al' 1996
Gas Piping (Needed with new furnace) $ 10.00
$
OWNER_,��/�
Gas Range $ 10.00
$
�S
BUILDING USED AS C
Gas Dryer $ 10.00
$
ESTIMATED COST ®® PERMIT NO. 1,2
K *Air Conditioning — All Sizes $ 25.00
$ C>,e�
p_,,F„§CR,IPTION OF FUBNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heatingnits Circle One (Steam) (Hot Water) (Warm Air)
Trade Size No.
Commercial/Industrial
BTU '7;rcCb HP EDR
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
.50
Burner Trade Name Size No.
TOTAL FEE
� �. ��`
BTU HP EDR
°'�`v�'r�
HEATING COWNY �.
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
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.
Signed
Tel No.
Approved By/ Rough—In Date Final Date .Z —/ —k
FILL OUT BACK SID OR STACK VERIFICATION ON
REPLACEMENT FUR ACE
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CEMNEY AND STACK 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
7.
Has a liner 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:
SUBJECT t
City of Fridley
31220'
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
SEC.®�
r E PROTECTIVE INSPECTION
F ,
I _ ----Ti CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
�J 612-571-3450
910-F15
7/18/00
!OB ADDRESS 4941 Roman Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DEscR.
6
3
Carlson's Summit Manor South Addition $MEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Rolland Pogreba 4941 Roman Road NE
572-8691
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER AIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION] REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Reside House and replace windows
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comp y with the State Building Code.
Provide smoke detectors in all sleeping rooms and on
all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform 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 BO 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
$39800
$1.90
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FE
TOTAL FEE
102.95
OF CONTRACTOR OR AUTHORIZED AGENT IDATEi
EPRO
VALID T THIS I OUR MIITT�
/SIGNATURE
FOWNE
S.GNATURE pF OWNER SOLDERI [DATE,DG
-N P
BATE
NEW []
ADDN [ I CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Addre
Legal Description:
Owner Name & Ad
.3/Qa0
Effective 1/1/2000
(763) 572-3604 Bldg Insp
Contractor: '444zk� - MN LICENSE #
Address: Tel. #
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 7-U Width 6 ` Height Sq. Ft /® V®
GARAGE AREA: Length . 6 e Width / P Height % Sq. Ft. .Z $6
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER:
Construction Type:ld/ls>I- Q ®I�iS ! C� 1Estimated Cost: $ t�
W
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ .
DATE: " O ® APPLICANT: A Tel. # S Z ?V'71
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ r Fee Schedule on Reverse Side
Fire Surcharge $ , .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ $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: