PRE 2010 DOCSBUILDING PERMIT
i
Village of Frid , A V 4 U U y � ... I�y� inn.
Date
Builder
Owner .. ... ....
07 Address Address
LOCA ,[ON OF BUILDING
NO. Sheet$.. ..,a�,. Pari of Lot
Lot ................Block •....... Addition or Sub -Division ......... ..............................
Corner Lot ......... Inside Lot ............. Setback ......... Sideyard '..
.� ."
DESCRIPTION OF BUILDING`
To be Used as:
Front ,/ : Depth Height �' ( ,� Sq. Ft...... .. Cu. Ft,
Ali
...
.......... Front .... Depth ........ Height ... Sq. Ft.... .. Cu. Ft........ .
Type of Constructao Est Cost ....: ... To beCompleted
p
it
I,
II i
IIIS �
in considerationof the issuance to me of a permit to construct the building described above, I agree to do
the proposed work I i1 accordance with the description above set forth and in compliance with all provisions of
ordinances of the vil 111age of Fridley.
•�d '
In clOnside of the payment of a fee of $. . ; permit is hereby grants a ¢ ...... .
to 7. iconstruct the building addition as described aboves • s • ted upon`
s do that the person to whom it is granted and his agents, employees and workmen, in all work
done ` , around and upon said building, or any part thereof, shall conform in, all respects to the ordinances of
Fridley, Minnesota z" 6garding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits i,rd this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.,
siding Inspector
NOTICE:
This permitc oes not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. �e sure to see the Building :Inspector for separate permits for these items.
SUBJECT
City of Fridley
inl
AT THE TOP OF THE TWINS
BUILDING PERMIT
rp
0.
COMMUNITY DEVELOPMENT DIV.
r v PROTECTIVE INSPECTION SEC.
IF� /
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF APPROVED BY
612-571-3450
910-F15
4/4/83
JOB ADDRESS 6190 Trinity Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
2
1 Sylvan Hills Plat 2 SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Gordon Miller 6190 Trinity Drive N.E. 571-8114
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Franzen Construction Co. 4250 - 5th Street N.E. 788-4091
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
Alteration in Bath .
9 CHANGE OF USE FROM TO
STIPULATIONS
PERMITS REQUIRED FOR VIFI<:.
ATE
,EPER
PLUNKING AND SIGN
-EATING,
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
]
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
$1,470
$.73
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
F ANY OTHER STATE OR LOCAL LAW REGULATING CON-
THE PERFORMANCE OF CONSTRUCTION.
$25.00
PLAN CHECK FEE
TOTALFEE
�--�
Ezss'
25.73
E OF CONTRACTOR ORAUTHORI D GENT (DATE)
WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
BLDG INS TE
OF OWNER OF OWNER BUILDER) (DATE)
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATION F014 RESIDENTIAL 6UILDIi1G PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: ® J aaa A4 le ►r
ADDP.ESS: _ /iD
TEL NO: J -e'
• STRECT NO: '�/' lq6
6UI LDER : ��.
ADDRESS:
TEL NO: ? F i- - Lo i (
Construction Location
STREET: 7-t a
LOT: HLOCKs ADDITION: j t PLA e -
Corner Lot: Inside Lots /Ir Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOR OF CONSTRUCTION
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Constructions '0'6'g r e 4e.® �r Estimated Cost:
Tb Be Cbr.-pleted:
A it. A Al t. B
proposed Driveway 'Width If New Opening Is Desired: $ S
SEE REVERSE SIDE OF SHEET
Tile undersigned hereby makes application for a permit for the %..,ork herein specified,
agreeing to do,all work In strict accordance with the City of Fridley Ordinances and
rulings of the Delyirtment of Buildings, and hereby declares that all the facts and
representrtiens stated in this application are true and correct.
Stipulations:
SIGNATDAE:
IV), q �
0
BUILDING PERMIT FEE SCHEDULE
The Inspector of buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any
existing building or structure, or for any alteration or repairs
to any existing building or structure, upon application therefore,
require the payment by the applicant for such permit of fees to the
amount herein below set forth and in the manner herein provided to -wit:
TOTAL VALUATION FEES
$1.00 to $500.00 $20.00 Minimum Fee $15.00 plus surcharge
$501 to $2,000 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$2,001 to $25,000 $32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000
$25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$50, 001 to $100,000 $283.00 for the first $50, 000 plus $3.00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$100,001 and up $443.00 for the first $100,000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN CHECK: 25 percent of building permit fee
DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only
Alternate "A": Removial and replacement of curb and gutter only
Driveway width plus 6 feet x $13.50
Alternate •H": Removal and replacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x $15.75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
ey
e
a•
a
S
U
a,
x
w
e
a
water
a
Me
6y
Heater
c0
Q
4
u
3
C7
lec
lot
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(�) - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixture& •
Future Fixtures
Old Opening, New -Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Nater Treating Appliance
Hot Water Beater
Gas Range
Gas Dryer
V
NO.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
Is of Value of Fixture or Appliance
Reinspection Fee $
(515.00)
a
RATE
$ 5.00
$ 3.50
$ 1.50
$ 4.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
TOTAL
$_/'S7,®o
bttective Aug. 1, i9bi
p jam`
r�
Job Address �
Department of Buildings
City of Fridley
Tel. 0571-3450
The undersigned hereby,makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Bu.' Wings. and hereby declares that all
the facts and representations stated in this applicat ar a and Tor t
Fridley, Nn. , 19
OWNER /n i / // P,Y�il i
KIND OP BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMATED DOST 1
OLD - NiW BUILDING PERMIV'NO. PERMIT NO.
Company
Signed By
Tel. No.
ROUGH INSF
FINAL INSF
APPROVAL F
`{-t1 -$ �-')
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
]j®IR C�V AAIR C N6ONDITIONIN3 HOUSE HEATING TEST RECORD
AND ELECTRIC, INC.
ADDRESS 61?6 7,*-1w�
OCCUPANT r
HEAT LOSS DATE HTG. INST. d & ,
SOLD BY P m9 Q-A--
Electrical Work By w►P ine A"a
TYPE OF HEAT GA FA . ' HW STEAM_, SPACE HTR.®
.� AS DESIGN
MAKE
Model
Serial 97 V12 WY
INPUT s �
THERMOSTA
Valve
Limit
Limit Setting
Fan Setting
Pilot Type
Pilot Make_
Pilot Model
Pilot Timing
L. W. Cut Off
PressureA I c 4
Percent CO, f1
Input CFH Percent O,
Stack Temp. - Percent C; =,-
Form 23S
APT. FLOOR CITY et � SUBURB
OWNER1
INSTALLED BY
Gas Una By • ®"
UNIT HTR.® OTHER
CONVERSION
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model
®.
Vent Stas
KIND OF LINER
SIZE NONE tr®
Draft Hood .k
Regulator
Fitters Size le, e ,�'
Number
Chimney Looatlon Inside
Outside
Chimney Construction Af
=
Smoke Bomb Wiring A.
Draft Test Tag
Door Pressure Lighting Inst.
Date Tested 41� -A -
Company Testing" a
Name of Tester
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1995
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 61 16
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
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
TOTAL FEE
Burner Trade Name
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.
HEATING COMPANY
Size No.
HP EDR
BLAINE HTG, A/C & ELECT. INC
13562 CENTRAL AVE. N.E.
®Alnvw .... �a---
Signed By Tel No.
a
Approved ByR` GGA' Rough—In Date Fina{ Date 3
13
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
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 ar
rulings of the Building Division, and hereby declares that all the facts and
$ 20.00
$
representations stated in this application are true and correct.
1995
$10.00
$
d®
OWNER b"1
$10.00
$
BUILDING USED AS OtGU��
$10.00
$
ESTIMATED COST I im PERMIT NO._ ?E
$10.00
$
nFSQB,12 IQN OF FURNACE AND OR BURNER
$
No. of Heating Units_ Circle One (Steam) (Hot Water) arm
Trade Name Tho & Size No. /U ULG M 01?
BTU 7HP EDR
$
Fuel /U A -r Com, i0r5 Total Connected Load to% 00
State Surcharge
TOTAL FEE
Burner Trade Name
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.
HEATING COMPANY
Size No.
HP EDR
BLAINE HTG, A/C & ELECT. INC
13562 CENTRAL AVE. N.E.
®Alnvw .... �a---
Signed By Tel No.
a
Approved ByR` GGA' Rough—In Date Fina{ Date 3
13
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
CHIMNEY 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
( )
S.
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 hater Yes ( ) No ( }
8. Has combustion air been provided for water heaver Yes ( ) No ( )
Remarks:
11 174 W III Z
HEATING CO:
Signed By:
Date:
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
g U I L ®I N G
PERMIT
P "�
27 4 6 7
1 ,
COMMUNITY DEVELOPMENT DIV.
r 1 v PROTECTIVE INSPECTION SEC.
,'� CITY HALL FRIDLEY 55432
L J` 612-571-3450
-RECEIPT NO.
NUMBER
910-F15
REV
DATE
8 31 98
PAGE OF
APPROVED BY
JOB ADDRESS
6190 Trinit Drive NE
1 LEGAL
DESCR.
LOT NO.
2
BLOCK
2
TRACT OR ADDITION
ISylvan Hills Plat 2
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Gordy Miller
571-8114
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
All Am. Roofing & Remodeling 4112 97th Ln NE Blali3e MN
55014 786-6676
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO,
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION 2a REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 19 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State 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
AUTHORIZED IS NOT COMMENCED WITHIN SO DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
VALUATION
SURTAX
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
1584
$.79
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-
STR CTION OR THE PERFSWAAWCE OF CONSTRUCTION.
$51.25
Fire SC. $1.58
AL ' f `9
TUBE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
PLAN CHECK FEE
icense 5.005
TOTAL FEE
.62
P PER
0 INSP
LIDAT /IS iS UR /PEE
BATE
SIGNATURE OF OWNERUF OWNER SUILDERI (DATEi
CATO@fi 11dCl'EIPT
OPER: TUROK OC
DRANER: 1
DATE: 8/31/98 00
RECEIPT: 0005624
DESCRIPTION [ITY
AMOUNT TP
TN
PEMITS—BUILDING 1
$51.Fs BP
CK
FIRE SURCHAR6'E F 1
$1.58 FS
CK
SURTAX 1
$.79 SU
CK
LICENSE SURCHAR6 1
$5.00 H8
CK
ALL P14ERICAN ROOFING/iDEL
8P #27467, 6190 TRINITY DR
TIME: 14:3:11
TOTAL CHECK
$58.62
Effective 1/1/98
CITY OF FRIDLEY
11LY AND DUPLEXES R-1 AND R-2 Ab I
)ING PERMIT APPLICATION I
a`
kA
I _e ,r Tel. #
MN LICENSE # Sl C, o
Tel. # -?ts(v X674
iplication, a Certificate of Survey of the
posed construction drawn on it to scale.
IIPTION OF BIPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
_ Width Hgt/Ground Seq. Ft.
v, -e re; -n V /9 _7a . � t _�
(:'
Construction Type: Estimated Cost: $ A �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: I— 3t-4 YS
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
APPLICANT: o Tel. #.
CITY USE ONLY
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
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 [ ]
-7cd-c, —(,47
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to -wit:
TOTAL VALUE FEES
$1 to $500 $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.