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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.