PRE 2010 DOCSBUILDING
PERMIT
Village of Fridley, Minn.
No 2521
Date ......
Owner 4
p Builder ... ................... ..
Address ..' ...... Address ... Z-01-0............. .
!Ir.00ATION OF BUILDING
No. ... ? .. Street ..: sG! > .. ` ............. P ,
art of Lot
Lot ............... Block . ............. Addition or Sub -Division .. ..............................
Corner Lot .....•.... Inside Lot .... ... Setback ............ Sideyard ...Z.4.. .. " ... .
I
DESCRIPTION OF BUILDING
To be Used as: j
... ... . , Front "'�. Depth . Height Sq. Ft.. " Cu. Ft. ........
.. Front .... Depth ........ Height ......... Sq. Ft......... Cu. Ft. .......
Type of Constructign .,° Est Cost ....:,r ................. To be Completed ..
r.
In consideratii
the proposed work
ordinances of the 1
i of the issuance to me of a permit to construct the building;:! above, I agree to do
n accordance with the description above set forth and in compliance with all provisions of
Rage of Fridley.
AST "ts,.+Zl`ws, w ..
�In. consider i'o 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 conditiot that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around anupon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota egarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
4 ' . .��.�. �°. Building Inspector
NOTICE:
This permit Ooes not cover the construction, installation or alteration for :wiring, plumbing, gas heating,
sewer or water. a sure to see the Building Inspector for separate permits for these Items.
Eff
CI I I OF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE: N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
March 19, 1990
Owner/Occupant
6301 Van Buren Street N.E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 6301 Van Buren Street N.E.
Dear Owner/Occupant:
The City of Fridley has established a City Code for the purpose of
promoting a pleasant and attractive suburban environment. A recent
inspection of the property at 6301 Van Buren Street N.E. revealed
that not all Code requirements are presently being met. Listed
below is an item which does not comply with the City Code:
1. Observed numerous bags of solid waste at curbside. Fridley
City Code 113 requires that all solid waste must be kept in
secured containers. In addition, these containers must be
stored so as not to be visible from the public right-of-way
except on the collection date.
Your prompt attention in correcting this situation would greatly
assist us in helping make Fridley a better place to live. An
inspection will be conducted. on or about April 2, 1990, to
determine compliance.
If you have questions or would like to discuss this, please contact
me at 572-3595. Thank you for your cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
C-90-129
F OF
CINOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
April 2, 1996
Nikki Black
6301 Van Buren Street N.E.
Fridley, MN 55432
RE: In -Home Business
Dear Ms. Black:
This letter is to confirm our telephone conversation of Monday, April 1, 1996. The City
of Fridley does not require a business license for any business established within the
City of Fridley corporate boundaries. In-home businesses, however, must comply with
the stipulations listed in the home occupation ordinance (copy attached for your
information). From our telephone conversation, it sounds like your proposed in-home
business will comply with the City of Fridley's home occupation ordinance.
I hope this information is helpful. If you have further questions, please feel free to
contact me at 572-3593.
Sincerely,
Michele McPherson
Planning Assistant
C-96-59
SUBJECT
City ®f Fridley
26523
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r L PROTECTIVE INSPECTION SEC.
[st
NUMBER
REV
DATEPAGE
7-9-98
OF
APPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910415
JOB ADDRESS 6301 Van Buren Street
1 LEGAL
LOT NO.
16
BLOCK
6
TRACT OR ADDITION
Florence Park Addn to Fridley
SEE ATTACHED
SHEET
DESCR.
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
David & Nikki Black 6301 Van Buren Street
572-0157
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Same as above
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 US OF III LDING
I es1WLOIN fl
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION X1 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof garage, windows, and siding (woodframe)
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
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 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
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VAL�IATIQ�f�
SURTA
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
yS2,�FU0
$f.20
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 FEE
TOT FEE
8.35
Si TUBE OF CON' TOR OR AUTHO ED AGENT �DATE�
EN OP VALID
INSP
THIS IS YOUR PERMI
riATE
SIGNATURE OF OWNER �iF OWNER BUILDERi iDATEi
NEW [ ]
ADDN [ ]
ALTER [ l
ConstructionAddress:
Legal Description: _
Owner Name & Add
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AIREA:
OTHER:
Effective 1/1/98
CITY..OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
' Ve 21 .
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Leneth Width Hgt/Ground Sq. Ft.
Construction Type: Estimated Cost: $ 2, Lf ®0
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: - Ft.' `+ 6 Ft = Ft x $ _ $
DATE:
v ��APPLICANT: Tela #/ %' `� s7
e
TOTAL $ �8�
STIPULATIONS:
CITY USE ONLY
Permit Fee
$`7, ��
Fee Schedule on Reverse Side
Fire Surcharge
$
..001 of Permit Valuation (1/10th%)
State Surcharge
$ 1,,,2C)
$.50/$1,000 Valuation
SAC Charge
$
$1000 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 [ ]
e
TOTAL $ �8�
STIPULATIONS:
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
$1 to $500
$501 to $2,000
FEES
$21 (Minimum Fee is $21 plus surcharge)
$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
$1009001 to $500,000 $887.25 for fust $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.
CITY OF FRIDLEY INSPECTION DIViSION,
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell .and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25, of Value of Appliance or Work
Rate TOTAL
$ 30.00 $
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
R
N99
OWN
Effective On January 1, 2000
BUILDING USED AS ha'2// t
ESTIMATED COST
PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units f Circle One (Steam) (Hot Water) arm Air
$ Trade Name/J e 0 0 Size No.
BTU �Q HP EDR
$ Fuel � �,t, S Total Connected Load 4=e
Burner Trade Name Size No.
$ BTU HP EDR
$ 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
$ DATE
` t i
HEATING CO
J/✓
Signe �� TEL
Approved By Rough -In Date Final Datel_.L_peLo'
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required.
Yes) No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meetsthe current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes VVNo ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes �) No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications.
Yes k) No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes 0 No ( )
Is the common vent and vent connectors sized and installed correctly after ,Al
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type -P'4V'�1 er Z BTU Input ,U 600 Fan Assisted or Nat /
Appliance #2 Type fxAg �BTU Input -6)j2ya Fan Assisted or Nat (�
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances _� Total Btu Input C7 iii'
® r/
Common Vent TypeVent Height Diameter cs inches
Appliance #1 Vent Connector Height _,3 ft Length _ft Diameter in Type C
Appliance,#2 Vent Connector Height _ -L__ft Length ft Diameter min Type (f
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
_ '
P/
9
SUBJECT
PERMIT.
City of Fridley
0625
AT THE TOP OF THE TWINS
UIL®IA IG DEDA AIT
BUILDING
�
NO.
-------COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIOLEY 5532
NUMBER
REV
DATE
PAGE O:
APPROVED Br
L , ` 612-571-3450
910-F15
1 / 12/00
f'
10B ADDRESS 6301 Van Buren Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
16
6
Florence Park Addn to Fridley SHEET
I
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Nikki Black 6301 Van Buren Street NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Steve Bodinski Construction 2215 135 In NW, Andover, MN 55304 754-8917
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
20019069
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION 1 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install sheetrock over paneling in upper level; install plywood subfloor over
5/8" partical board (Insulation and roof vents by others)
9 CHANGEOFUSEFROM TO
STIPULATIONS
Submit revised venting/insulation plan after approval by Energy Center.
SEPARATE PERWS
REQUIRED FOR:
WIRING,HEATING
SIGNS
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 1 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
@@
$3,000
$1.50
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 NY OT HERS ATE OR LOCAL LAW REGULATING CON.
$83.25
Fire SC $3.00
TRUCTION OR E OF CONSTRUCTION
PLAN CHECK FEE
TOTALF§41
�-
License $5.00 A$
5
ZS9N A TURE OF CONTRACTOR OR AUTHORIZED AGENT tOATE-
N P PERILYV&CIDATED T SIS YOUR PERMIT
8*04 „o •� gATE
S-GNATURE OF OWNEROF OWNER BURDERj iDATEi
9
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �q' Q _ L is e u rrA 71®
Legal Description:
Owner l
Contract
Address
Tel. #
MN LICENSE #�D�j
Tel. # !l'! t 7/�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Types ' Pt✓ % ldiroWl. Estimated Cost: $ ®O®
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: --11— 00
Permit Fee
$
• a �—
Fire Surcharge
$
3, o®
State Surcharge
$
A -SS
SAC Charge
$
License Surcharge
$
-Co
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%)
$.501$1,000 Valuation
5@ 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
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,00 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 orfraction thereof, to and including $100,000
$993.75 for.first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 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 $15.50.
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 $23.25.
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.
CITY OF FRIDLEY PERMIT N .-:200 00515
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 04/15/2004
572-3604 FAX: (763) 571-1287
ADDRESS : 6301 VAN BUREN ST NE
PIN : 143024410104
LEGAL DESC : FLORENCE PARK ADD
: LOT 16 BLOCK 6
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AIR CONDITIONER
# A/C UNITS
# FURNACES
# GAS RANGES
APPLICANT
SHARP HEATING & AC INC
7221 UNIVERSITY AVE
FRIDLEY, MN 55432-
(763) 572-0459
OWNER
GUTZ, DAVE
6301 VAN BUREN ST NE
FRIDLEY, MN 55432
1 VALUE OF APPL OR WORK 0
0 # GAS DRYERS 0
0
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating cons •uction or the performance of construction.
Applicant Date
Bldg Insp Da e4 «l0tt
HEATING PERMIT MINIMUM FEE
0.00
FURNACE SHELL/DUCT WORK
0.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
25.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
0.50
TOTAL
25.50
PAID WITH CHECK # 14324
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY BUILDING INSPECTION
6431UniversityAve NE
A01
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS (QG0 I \) 0 n 13 L1 A I; a
Fee Total
Owner -I LCA .n.'Q col.�z.
$35.00 $ Building Used As
$10.00 $ ESTIMATED COST PERMIT NO
$10.00 $
$10.00 $
$25.00 $
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
DESCRIPTION OF FURNACE AND BURNE
4 eft leatt fg"Q 15 Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel
Burner Trade Name
BTU
Total Connected Load
M
Size No.
EDR
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 Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ •50 HEATING CO
sQ s�ao(4�
$= Signed Tel #
FAX # Date 14 l �� lALf
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
=n
Approved by Rough -in Date Final Date 0-1t-
,i
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When installing anew venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height
Diameter inches
Appliance #1 Vent Connector Height
ft Length
ft Diameter. in Type
Appliance #2 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By: �
763-572-3604
CITY OF FRIDLEY
Date Rec'd: '�3 /5 '0%
DATE T 7 YOUR E-MAIL ADDRESS
SITE ADDR SS Sw.. G GtS DwHG✓ David Gutz
THIS APPLICANT IS: ❑ OWNER CONTRACTOR 6301 Van Buren Street Northeas
PROPERTY Nom: Fridley, MN 55432
OWNER/ ADDRESS: 7632278516 TATE ZIP
TENANT
PHONE:
CONTRACTOR NAME: NORBLOM PLUM—
SUBMIT A COPY OF STATE LICENS 12-13 EXP DATE
YOUR STATE ADDRESS: 2905 G AR'S� F1 E 0 D AVE. @ nCrrY STATE ZIP
LICENSE WITH PHOS °
APPLICATION M1191qEAP0LM;A 55408
PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW KREPLACEMENT
DETAILED DESCRIPTION OF WORK t
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This.should_reflect only -the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
'FOR -PROJECTS WHERE LABOR EXCEEDS$500;-FEES ARE BASED ON $10.00 PER FIXTURE; EXCEPT MMRE•NO:T.ED t'RKr-U?ES,, (DMICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/IAV _FLOOR DRAINS _ SHOWER _ WATER PIPING
_
BATHTUB _GAS PIPING (�+'mcin Lima) ^ SWIMMING POOL WATER SOFTNER ($35)
�_
�_ CLOTHES WASHER KITCHEN SINK _ WATER CLOSET BACKFLOW PREV. ($15)
_
_-LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_DISHWASHER
WATER METER OTHER
y kY
KIM' u"i,;C •`>`s
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15:00 = $_�_
Number of fixtures @ $35.00 x $35.00 =
TOTAL DUE $
State Surcharge = $ .50
Total S0
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an ap on for a permit and work is not to start without a permit; that the work will be in accordance with the
'
approved plan in the case o 1 ork w requires review and approval of plans.
,( %
SIGNATURE OF APPLICAN PRINT NAME JC /(/O//J/d!y% DATE
_3/11/07_
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763=572-3604
FAX: 763-502-4977
Building
BUILDING
Permit No.: 33
Inspections
RESIDENTIAL APPLICATION
Received By:
72007
763-572-3604
CITY OF FRIDLEY
D'4U
DATE " Z - O YOUR E-MAIL ADDRESSSITE
ADDRESS ADDRESS L �) 01 Vq' `J, .Si "6-
eTHIS
THISAPPLICANT IS:
❑ OWNER (CONTRACTOR
PROPERTY OWNER/
NAME: 10AI-fog f- XI141cOELLL Gyz
TENANT
ADDRESS: 4 3U! y�4AI 6v✓ e - S% x t CITY
STATE ZIP
PHONE: t,812 - q 3(0 - & ("� T
CONTRACTOR
NAME: �jid t=STI•v <} j- x 2 :e r o2 S
STATE LICENSE # 4pq 7 ® EXP DATE ?✓ " 3 % ' v
P4.— SSS!/
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: Z22 C'itap 120 CITY S,
STATE"'MP
WITH APPLICATION
PHONE b-71 - 2 S/ - 0-7 I® FAX (P S l- Z S f- 6),P/&
PROPERTY TYPE
ErSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH�B� F ❑ DRAIN TILE
❑ DECK ING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
ENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: 1 E4 -P— 0r� Xtra 1 2001= t igz s (ter
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING � J ' -ZH 5(0 ❑ HOUSE ONLY
NUMBER OF SQUARES
I ❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
I.
2•
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
PROPOSED HEIGHT•
❑ DETACHED GARAGE
I I I _',(�
V
3.
List of structural members to be used
ING1
FOR NEW
CONSTRUCTION INCLUDING DECKS,
inyI
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
Aluminum
11 Other
❑ Trim
�% / f� ❑ Fascia
1.
Site Plan/Survey showing the existing structures
and proposed project
WINDOWS
/1
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ Hi 13? OCCUPANCY TYPE
Permit Fee $ 251. y1. d 5 See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ 3 .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge t{� $ $1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $21 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due Make checks navable to: Citv of Fridlev Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowl ge th a information above is complete and accurate, that the work will be in
conformance with the ordinances and codes th ity of ey and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a p t work is to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whic ew royal of plans.
SIGNATURE OF APPLICANT PRINT NAME ICY l �� 1�� DATE