PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N 4958'.
Date:----._.`.`.'d_:�"..� ..�...._.._._...._......_..___
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Owner: ...�...�.�•-------------- - =---�--- - _..� Budder ..4••••••�..�...__.�_.._ '.:. -: � - ...�..... �_......_ ��
Address........................ ..--_. + __ _. __. _ _ .. Address.--------.............-----.._....__....._._._._._._..._----•-----------._............................
A L TIO OF OUILDING
rr f,.
No.... _ Street - _... _. ...�.........t�� . of _..- _ ...__...._ ..._...._....
Lot ................ ............. Block ....._......-�--.--..- .............. Addition or Sub -Division ...
.- - ---------------.._......_.........--
Corner Lot . ............................ Inside Lot ....._.-------- Setback .....,,-..y c.....__..._........ Sideyard .-�+"---•.�`..._........... - ...... .............. _...........
SewerElevation .......... -.......... ............ ....................... .._............._....................... Foundation Elevation .................... -............. .............. .................... ........................ _..
DESCRIPTION OF BUILDING
To be ed
-.. Depth ... Height ....✓..... Sq. Ft.. Cu.Ft.
.� .. .. _.:. .. ...� Front ---•�- - ---• -- •- --- x"`....
.................... ....................... _.............. , Fro -
t ....._•-----....._.. Depth ...... ...... ...--......................
He ht ........ Sq. Ft.Cu. Ft. ..... _.................
Type of Construction--.-.`,-,-""",-*- .......... Est. Cos .. `; ................ 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. I
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 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 end moving of buildings
within the city limits and this permit may be revoked at any m Nation of any of the provisions of said
Ordinances. ,#'
_"_ding Inspector
NOTICE:
This permit doesnot 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.
APPLICATION FOR BUILDING PES
CITY OF FRIDIEY, MINNESOTA
Owner's Name Builder
Address ,� ,.--� AddressF.�.
LOCATION OF BUILDING
No.
of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SMIEfi ELEVATION FOUNDATION ELEVATION
Applicant attach to this form. Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction rte, 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 that all the facts and representations
stated in this application are true and correct.
DATE SIGNATURE -
(A A sem_
(A Schedule of Fee Costs can be found on the Reverse Side.)
IfPOO,l ' ; I ,�4 04 +N buil f
SSection 2. The Inspector of Buildings shall, before issuing any permit for the
erection of any building or structure, or for any addition to any existing build-.
ing or structure, or for any alterations or repairs to any Existing building or
structure, upon application therefor, 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:
2.1. For any such permit for the erection of any fire -proof building, other than
a garage, warehouse, factory or grain elevator, or for the erection of any fire-
proof addition, for similar occupancy, to any existing building shell be at the
rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such
cubical contents.
2.2. For any such permit for the erection of any fireproof garage, warehouse,
factory or grain elevator, or for the erection of any fireproof addition, for
similar occupancy, to any existing building shall be at the rate of 01.25 for
each one thousand cubic feet, classified as "fireproof" by Section 502 of the
Minneapolis Building Code.
H0'USES
2.3. For any such permit for the
than a garage, warehouse, factory
addition, for similar occupancy,
each one thousand cubic feet.
GARAGES
erection of any non -fireproof building other
or grain elevator, or any non -fireproof
to any existing building. Permit $i.00 for
2.4. For any such permit for the erection of any non -fireproof garage, warehouse,
factory or grain elevator, or for the erection of any non fireproof addition, for
similar occupancy, to any existing building or for each such building or addition.
Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical
contents thereof with a minimum of $4.00.
For the purpose of computing fees for building permits the cubical contents of any
building or addition to a uniform, height throughout by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement or cellar
to the average height of the upper surface or to the average height of the roof
surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 for each Five Hundred Dollars ($500.00), or fraction thereof in the
cost of all proposed work.
2.6. In no case shall the fee charged for any permit as set forth in Section 2 be
less than $4.00.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1993
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas
Gas Range
NO
1
Gas Dryer
Back Flow Preventer Required�w 'es () No
Type F�T jj0,L_v=
RATE TOTAL JOB ADDRESS e-� -77v- y Tit ">a. A) giz_
$ 7.00 The undersigned hereby makes application for a permit for the work herein
$ 4.00 specified agreeing to do all work In strict accordance with the city codes
$ 5.00 and rulings of the Building Division, and hereby declares that all the facts
$ 7.00 and representations stated in this application are true and correct.
$ 7.00
$7.00�� 19
$ 7.00
$10.00
$ 7.00
$10.00 ®ao®®
$10.00
$10.00
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
Owner mb a c.
Building Used As l.ras I C., M
�-
Estimated Cost 46pa PERMIT NO.
a, 2IGNED BY TEL NO.s
1�4 V W F T
Approved By 1 Rough -In Date Final Date
-
$ .50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
HEATING
AIR CONDITIONING HOUSE HEATING TEST RECORD
81AIANEAND ELECTRIC, INC.
ADDRESSI Y!
OCCUPANT atr Cei
HEAT LOSS DATE HTG. INST.
SOLD BY
Electrical Work B'le%' "&
TYPE OF HEAT GA FA 2S HW STEAM® SPACE HTR.®
GAS DESIGN
MAKE � /
Model C "9oz d
Serial %2Sd 7
INPUT 4 &=
THERMOSTAT �% 1, �&
Valve U/'
CONTROLS
7 Heat Plug
Limit
Ji2
J-YelnGa
Limit Setting
/7,9
Fan Setting
T'rn
Pilot Type
Pilot Make
Pilot Model
/
Pilot Timing'
-G
L. W. Cut Off
Pressure
Percent CO, .S fj
Input CFH
8
Percent 0, 9
Stack Temp.
8
Percent CO
Form 235
APT. FLOOR CITY f� SUBURB
OWNER S 3c
INSTALLED BY
Gas Line By
UNIT HTR. OTHER
CONVERSION
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model
Vent Size
KIND OF LINER G SIZE S NONE
Draft Hood Regulator
Filters Size I Number
Chimney Location Inside %i Outside
Chimney Construction
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Lighting Inst.
Date Tested
Company Testing
Name of Tester _
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1993
6431 Unilersity Ave NE
FridieD M-�O'55432 APPLICATION
FOR POWER
PLANTS AND HEATING, COOLING, VENTILATION,
512-3604 REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS & A q 6 1 171/ f ��
RAMSCHEDULE
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
Fumace Shell and Duct Work, Burner —
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$ 20.00
$ go.
representations stated in this application are true and correct.
6 Y ,199
Gas Piping (Needed with new furnace)
$10.00
$
OWNER_ �_ (� � � L�- 4N)
Gas Range
$ .10.00
$
BUILDING USED AS �� f e,e-,
Gas Dryer
$ 10,00
$
ESTIMATED COST PERMIT NO.
*Air Conditioning — Alt Sizes
$10,00
$ jb-ft
DESCRIPTION OF FURNAQE AbIQOR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) arm Air
Trade Name IkiT Size No.--sg5C.A0gZ®i
Commercial/industrial
BTU 151 O HP EDR
1% of Value of Appliance or Work
$
Fuel ULM Total Connected Load
State Surcharge X50
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATIONIAIR CONDITIONING PERMIT IS 115.00
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.
Burner Trade Name Size No.
BTU HP EDR
BLAINE HTG, A/C & ELECT. INC.
13562 CENTRAL AVE. N.E.
HEATING COMPANY ANOKA, MN 55304
Signed By Tel No, %59 — 60
Approved By6;�F Rough—In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ( j
2. Is free from rust or deterioration Yes No ( )
3. Has no foreign objects lodged within Yes V) No ( )
4. Is securely supported Yes VK) No ( )
5. Meets all current Code requirements for
size ai, d- total BTU's connected Yes ) No ( )
6. Has total heating BTU's of
All other.BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
BLAINE HTC, A/C & ELECT. INC.
13562 CENTRAL AVE. N.E.
HEATING COMPANY ANOKA, MN 55304
Signed By d4klt.�;
Date q1
t
a
SUBJECT
T"N6,_.-.
City ®f Fridley
2 7 2 5
AT THE TOP OF THE TWINS
B U I L ®I N G P E
M I T
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
I v c PROTECTIVE INSPECTION SEC.62
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L 612-571-3450
910-F15
8/18/98
JOB ADDRESS
6240 rinity T)-rivp NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
3
Sylvan Hills Plat 3
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Doug Buckman
571-0698
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Premium Roofing 6680 Lucia Ln NE #11 Fridley, MN 55432571-3973
20097688
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
O NEW ❑ ADDITION ❑ ALTERATION (Ex REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (23 Sq) 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
ZONING
SO. 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
$191$
.96
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.
$62.25
Fire SC $1.92
PLAN CHECK FEE
TOTAL FE
-�
License 5.00
70.
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
rP pER V
BLDGFINSP jr
DATED I$ Y UR PERM
Z
MATE
SIGNATURE OF OWNERoF OWNER BUILDERI IDATEI
a
PHEW ~ [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY 1
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1�1
BUILDING PERMIT APPLICATION � X03
ConstructionAddress: 6-� 90 mtl ," 7 i
Legal Description: (L4 �� ;�- ��%-r-�
Owner Name & Address: Dor, j Z)c-,4,.a.,11 Tel.
Contractor: �� j/L:�� If��5a-ate MN LICENSE #r
Address: 1,51 // 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 Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: 7�1�i= /./ •C' r �'---�3 �`z ) ALA?, -/) ��
Construction Type: �a�a v� Estimated Cost: $ _ / 916
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $
M9
DATE: APPLICANT:Tel. #�/ 0
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 9a -1.P3
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 [ ]
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.