PRE 2010 DOCSl
Village of Fridley, Yffnn
BUILDEW PERMIT
O
2410 Office of INSPECTOR OF BUILDINGS
Owner,
Architect Fridley, Minn., r, 19_ siva.
i
Builder
l
N 'CATION OF BUILDING
No. Street Part of Lot
711 +) V' y
Lot ° Block Addition or Sub -Division
i" DESCRIPTION OF BUILDING
Front Depll;h Heights Stories_ Manner of Construction '
To be used as i. a ,_. To be completed Estimated Cq�t,
k'
Permit is hereby grantedto
the building described in the above statement. This permit is granted
upon the express condition that the erson to whom it is granted, and his agents, employees and workmen, in all
the work done in, 'around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limas, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. 9
a 5 s a y Inspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consider4lon of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby iistate and say that the facts stated by me and contained in the above permit are
true as therein stated.
Subscribed and sworn to before me at Fridley, Minnesota, this
day of —
DEOCRIPTION OF WORK
Number. Kind and Locadon of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures
x $2,00
$ g b D
Future Fixture Opening ..
x $1.50
$
New Fixture Old Opening
x $1.50
$
Catch Basin ...
WA7ER HTR.
GAS
ELEC
f
x $3.00
New Ground Run Old Bldg.
x $3,26
$
Electric Water Heater
* $2.00
$
GAS FITTING FEES:
NO.
RATE TOTJKL
1st 3 Fixtures ..... .........
!
N
eia
&"
x $ .75
eS
Gas Range to 199,000 BTU ...............
H��
x $5.00
$
C�90
Base
lot
2nd
_
3rd
—
— -
- --
4th
_
' Futuro Connection Openings Conneded with.
+� New Fixture, Old Openingsmel
Cesspoo
I
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures
x $2,00
$ g b D
Future Fixture Opening ..
x $1.50
$
New Fixture Old Opening
x $1.50
$
Catch Basin ...
x $3,25
$
Water Heater (Up to 99,000 BTU)
f
x $3.00
New Ground Run Old Bldg.
x $3,26
$
Electric Water Heater
* $2.00
$
GAS FITTING FEES:
NO.
RATE TOTJKL
1st 3 Fixtures ..... .........
x $200
2,(3
$
Additional Fixtures ..... ..............
x $ .75
$
Gas Range to 199,000 BTU ...............
x $5.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn- / �� t t> /-z 19 %a
Owner
Kind of Building _
T 7
Used as �� - I
To be completed about `!
v
Estimated Cost, $ �C,. 00
Old New. Building Permit No.—_ _ __. _ _Permit No.
Signed
By_
Business Phone No 44 �
ROUGH
FINAL
I;
,i
City of Fridley
Application for Plumbing and Gas FlMng Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OWORK Location 4O .S Valk—
WATER
!� L/ .
Number, Kind and Location of Fixtures
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Y
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Number Fixtures ......................
'�i
$
Y F-
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�p
*
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WATER HTR.
GAS
ELEC.
Base
x $3.00
$
New Ground Run Old Bldg. ............
x $3.25
$
Electric Water Heater
a $2,00
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ...... ...................
/
x $2.00
$--2C:K
Additional Fixtures ....................
1st
$
Gas Range to 199,000 BTU ..............
1
x $5.00
$
/
2nd
_
3rd
4th
• Future Conaectloa Openings I
New Fixture. Old Openings I
1
Connected with
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures ......................
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ............................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg. ............
x $3.25
$
Electric Water Heater
a $2,00
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ...... ...................
/
x $2.00
$--2C:K
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true a d correct.
Fridley, Minn `°� 19�
Owner o X A -�
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No Permit No. /5
Signe t� °
Business Phone
ROUGH
FINAL -_T--/ L— 2 0
Stories
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N® 5154
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original
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Permit r PUABING AND GAS FI
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N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for
Permit
$�� 0
G J
3 U
K
a
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of thisFee
permit.,
4
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Z
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DESCRIPTION OF WORK
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Number, Sind and Location of Fixtures
City of Fridley LA,
, I9
Basement
1St---F--
to
Stories
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2
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b¢
Q z GAS ELEC.
c9
Basement
1St---F--
2nd
3rd
4th
Connected with Sewer -Cesspool Gas Piping for Openings
Permission is hereby granted-AZ(�. tn,i�l� e '--L- to do the plumbing and
gas fitting in the building described in the statement Areto attached, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection Date
Inspector.
42 ria—�.s9-v
Owner -'V -'n Vr,
Location %
Kind of Building
Used as
To be Completed , 19�(�
Estimated Cost $ z,!S--QQ
Old New. Building Permit No.
Date
Inspector of Buildings.
• - - Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
NECK. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. .60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
. Furnace Shell & Lines—to 400 sq. ft. EDR Steam .....
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR, Hot WaterD.
. '&60o
$ I0.00
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
OIL BURNER—to 3 gal. per hour 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) 5.00 $ .J'•0 O
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... �_ x $1.50 $ �•�®
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $_
ALTERATIONS & REPAIRS TOTAL FEE
ROUGH
FINAL %e- —/ r �7/
Dept. of Bldgs. Phone SU 4-7470
Location—,�'Z0.- J 4/f/ R!/.2,e_'V �EE�
City of Fridley:
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.
Fridley, Minn— 18 Z®
Owner
Kind of Building
Used as
To be completed about 6e t 3 Q • 1970
Estimated Cost, $
Old—New. Building Permit No. Permit No. 4111171
DESCRIPTION OF WORE
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No /
Trade Name PfiKFlCe �7l��Y� 512 1) Size No 6
/NP v r
CapaciSq. Ft. E.D.R !R Z D O O BTU H.P.
Total Connected Load�//%%�� O Kind of Fuel 49'4_ `
BURNER — Trade Name,/a'wew;G'fRl Size No. 691f r
1N)P0'.
Capacity Sq. Ft. E.D.R- !22,0o -1 BTU H.P.
(REMARKS—OVER)
Signerl,z < O
By 6�%&adees'G&11 9517 z� �.
- <2 2M Business Phone No- 4a 0 /
Ft.
FL
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Residence
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Locationlov
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TOTAL "HEAT LOSS OF HOUSE o777
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THE SYSTEM -t k
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LINEAR LENGTH aL x l S EQUIVALENTSLENGTH,Or
`� "'°• � `�' '
(include verticals to rooms and at
belief) .
ODESIGN
FLOW RATE c
GPM'.' dTable 1)
4�
DESIGN TEMP. DROP IN LOOP = F. (fable
56°F.i
II)
' IShould trot
exceed
Room Heat Lose
SolWater'
°
Tem P.^ F•'
Ye4lolli
7ompp DruP
Av®rage i; �ab1�1V x'
Wa4er DesiSel `
T®m in Ra4ings
1f� J Item i (Single Seriesi
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04 Room
® Tem eratUPap
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; Eagh Room �`: {@ average '
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GRAND TOTALS
-
ihe, stake a of is aleeeed' T 1•iolteP i'Q(aP 4amperafura aslx4fed %r ¢be tlnstgr
hasp �6�i artruge }ysfvm rcmgeraEutsf bet�reen,20Q
�Liquf�
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Original .
PERMIT for Power P ants and Heating, Coolis
-
ing. Ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of }} % Heating Plants to b installe ltered—repaired
Make(�irY► � �_ �.v� � J. , Size 6 PIn -- 5� ;
Oil fired—,- Coal fired F , Gas fired v ; Gas Authorization No.
Remarks
Approved
Final Inspection
19_
Inspector
Permit AT® - 4'7'7i
Fee
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. , 19-2-fi
Owner / )
Location
Kind of Building��.2,Q/YVI� -
How Occupied
Work to be Commenced—, 19
To be Completed_( 3-0--,19 :2t1
Estimated Cost, $ /c;�S-V.00
)New, Building Permit
Permission is hereby granted to to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that the p son'to dhom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices ein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifications se forth in the approved application for this
permit on file in the office of the Inspector of Buildings. (o�J
Inspector of Buildings
42 2M11 -67V
City of Fridley, Minn.. N. 108
BUH DING PERMIT
Date: September 17,, 1970
Owner: _ Federal Housing Authority guilder C & S Remodelin
Address Address 42-7tb, StrPPt W F.
LOCATION OF BUILDING
No. 6405_ Street Van Buren _____ pal't of Lot
Lot .16 -17 -_ Block 3 Addition or Sub -Division _ Florence Park
Corner Lot Inside Lot _ Setback Sideyard
Sewer Elevation
Foundation Elevation
0 t,
To be Used as:
Remodel Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est, Cost _AM 12,: 00 __ To be Completed _ Sept. 1970
In consideration of the issuance to me of a permit to q64struct the bTIffing described above, I agree to do
the proposed work in accordance with the description abov forth andomwith all provisions of
ordinances of the city of Fridley. N
In consideration of the payment of a fee of It 15. 00 _ .., permit is hereby granted to C & S Remodeling
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 and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
" permit does not cover the construction, tnstallafton for wiring, plumbing, on heeling, sewer or water. Be sore to as
the Building Inspector for separate permits for these Items.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME : e A 11451414BUILDER:
ADDRESS • ADDRESS:
NO:. ® STREET:
LOT: BLOCK: ADDITION•
CORNER LOT: Y, INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: �—
Front• Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Fr"-- IN .e_ Estimated Cost:_$
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stt'ict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: SIGNATURE: �•�
(See Reverse Side For Additional Information.)
J.
BUILDING PERMIT FEE SCHEDULE
SECTION 2. 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:
UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.{
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
'In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: 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 Certified Survey of the lot,.showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE.OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
Building
Job Re
119 9 7
ADDRESS
art
OWNER
•
f
BUILDER
�YVI,L
L.-✓t.�,''
F
DATE q 1107/,IA TYPE
PE IT NO
DESCRIPTION
i
i
'
a
k
INSPECTION RECORD
DATE
REPORT
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k.
COMPLETED & APPROVED
i
o DATE
INSPECTOR
•a
s
SUBJECT
Py
of Fridle
16 6 2 9
AT THE TOP OF THE TWINS
BUILDING P E R M I T
rpCity
EIPT N
�
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 �
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
6/10/82
JOB ADDRESS 6405 Van Buren St. N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
16,17
3
1 Florence Park Add. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Pat Hadke 6405 Van buren St. N.E. Fridley 55432
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Tabor Const. 1800 Central Ave. N.E. M ls. 55418 788-9193
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION CX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Remodel interior and f
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
R-1
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
I 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
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.
q
PLAN CHECK FEE
TOTAL FEE
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALI D T IS IS YOUR PERMIT
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIVA FOR RESIDENTIAL BUILDING PEW41TS
(New, Alterations, Additions, or Repairs)
OWNER:
ADDRESS: i0 7
TEL NO:
BUILDER: i o
ADDRESS:
TEL NO: -5
Construction Location
STRICT NO: STREET: � A Gc,& 9,
LOT: ZBLOCK: ADDITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth: Height:
Square Feet: Cubic Feet:
Front:
Depth: Height:
Square -Feet: Cubic Feet:
_2 Type of Construction:��"� Estimated Cost: $ ®�
'!b 8e CUrapleted: i
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET .
Tile undersigned hereby makes application for a permit for the work -herein specified,
agreeing to do,all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: ��- /� � SIGNATURE:
Stipulations:
� �f a
,—
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
bxisting 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 Ln the manner herein provided to -wit:
TOTAL VALUATION
FEES
$1.00 to $500.00
$10.00 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": Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x $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 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 withthe framing.
1,q I 001W
XMo
?®,Cj
SUBJECT
P NO.
City of Fridley
"142
19870'
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIP�
( • _ _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 i
� ----I CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�.j 612-571-3450
910-F15
5/4/89
JOB ADDRESS 6405 Van Buren Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
16,17
2 TFlorence
Park Addition
SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP PHONE
Shirley Switzer 6405 Van Buren Street N.E.
572-0734
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
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 Ik ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 25' x 61 Addition to Dwelling
9 CHANGEOFUSEFROM TO
STIPULATIONS
Variance approved 9/88. Provide smoke detector in bedroom area.
See notations on plan
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
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$7,450
$3•'73
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
TOTALFEE
$102.73
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HEN RQ
7
BLDG WSP
A ATED THIS IS YOUR PERMIT
` OA E
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
NEW [ J Effective 5/1/88
ADDN [ J R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address:
Legal Description: 110 r FL o 2 Ov r�Y4 K b r
Owner Name & Address: (J I %Z EO�� Tel. #,5-7�? -6 9 .3
Contractor: S f -I AA Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DIST OF IlDVEN�iT
LMM AREA: length � � / Width � / Height Sq. Ft.
GARAGE AREA: length Width Height Sq. Ft.
DECK AREA: length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot k Inside Tat [ ] Ft. Yd Setback / Side Yard Setbacks e
Type of Construction: /QeDab p -MF _ Estimated Cost: $ % 4 c)
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Wi + 6' See Back Page
DATE: - / APPLICANT: &��Tel. # S`7 Q - D % 3
CITY USE ONLY
Permit Fee $ 99 . 0 0
State Surcharge $ ,
SAC Marge $
Driveway Escrow $
Park Fee $
Sewer Main Cuirge $
TOM $ 62.
STIP MATIMS:
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
9 qsb
2.0 6, W- (45- 06
l:;spy a, ;
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:
$1 to $500 $15 Minimum Fee is $15 plus surcharge)
$501 to $2,000 $15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
EPZVEWAY 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.
Permits for construction will be issued a minim m of 24 hours froim 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
Effective Date May 1. 1988
APPLICATION FOR POWER PLANTS
AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
// ,,// //q� ,� / /��f
"7`D � �/ °T� ��� �/V � '/ `'�
RESIDENTIAL
RATE
TOTAL
Job Address (�
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $
20.00
$
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Gas Piping $
10.00
$
Tel. #571-3450
(piping needed with new furnace)
Gas Range $
10.00
$
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
Gas Dryer $
10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Minn. 7 19999
* Air Conditioning (all sizes) $
10.00
$
All Others/Repairs and Alterations
OWNER
�8 of Value of Appliance or Work
$
J-���
KIND OF BUILDI/NG/A
COMMERCIAL/INDUSTRIAL
USED ASZJ
1% of Value of Appliance or Work
$
To BE COMPLETED ABOUT 9 C'
J'o
a;,
ESTIMATED COST
State Surcharge
$ .509
%off
FEE
OLD - NEW BUILDING PERMIT. NO. PERMIT NO.
TOTAL
Reinspection Fee ($15.00)
$
DESCRIPTION OF FURNACE/BURNER
Rough Insp.
Date
Final Insp.
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. % 6E1,qTC-1C,
Trade Name /7�. �T/�a Size No.
Capacity Sq. Ft. EDR BTU HP'
Total Connected Load
BURNER - Trade Name
Kind of Fuel
Size No.
Capacity Sq. Ft. EDR BTU HP
ppCompany
Signed By `
Tel. No. -5-
Fill out back side for stack verification on replacement furnac s
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 ( )
5.
Meets all current Code requirements for size and
total BTU connected
Yes ( )
No ( )
6.
Has Total heating BTU's of
All other BTU's
TOTAL
Remarks
Company
Signed By
Da to
SuII. EtT
PE
City of Fridley2
8 228
51 ® �'E TWINS
BUILDING
PERMIT
RECEIP
`
COMMUNITY DEVELOPMENT DIV.
f i ' PROTECTIVE INSPECTION SEC
CITY HALL FRIDLEY 55452
NUMBERREV
DATE
PAGE OF
APPROVED BY
' 612-571-3450
910415
10/13/98
10B ADDRESS
6405 Van Buren Street E
I LEGAL
LOT NO. BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR.
16 17 3 Florence Pgrk Addn. to f id a SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP PHONE
Laurice Clausen
571-6684
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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
0 NEW 0 ADDITION 0 ALTERATION ]a REPAIR 0 MOVE 0 REMOVE
6 DESCRIBE WORK
Reroof house and garage 13 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
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 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
1114
56
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-
STRU CION OR THE PERFORMANCE OF CONSTRUCTION
Fire 1.11
PLAN CHECK FEE
.
'elTOT/�L�F
SIGNATURE OF CONTRACTOR OR AUTHORIZED A ENT IO EI
ENP OP
LI AT I$ IS YOUR PERMIT
T
LAG///
S,GNATURE O$ OOVNERIIF OWNER SUILDERI IDATEI
BL INSP
q6 E
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -Z
BUILDING PERMIT APPLICATION
ConstructionAddress: �o 41a5 U 4t) 1pape-b Si • /�o E
Legal Description:
Owner Name & Address:
Contractor:Cc
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
xOTHER:
Construction Type:
ka-L jQ;'Le. cktt5efii Tel. # \t;-17/ —
4 �i�.4 MN LICENSE #
Tel. #
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.
Length Width Hgt/Ground Sq. Ft.
CL' -"s ®—/i/ - - 1.6.6 .
-? Driveway Curb Cut Width Needed:
Estimated Cost: $ 11 /'-/,
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT:&uAt c� Tel. # -4 6 8
TOTAL
STIPULATIONS:
$ qLU
CITY USE ONLY
Permit Fee
$ 0• 16
Fee Schedule on Reverse Side
Fire Surcharge
$ 1, 11
.001 of Permit Valuation (1/10th%)
State Surcharge
$ ,. �'(o
$.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 [ ]
TOTAL
STIPULATIONS:
$ qLU
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.
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION
AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
RATE SCHEDULE
OWNERe-r C- e. k14 tttS6-1(-,)
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS K�5 i'�L✓ G
Also Replacement Furnace $ 30.00
(Side Vent - Fill Out Back)
$
ESTIMATED COST PERMIT NO.
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating -,U,nits Circle One (Steam) (Hot Water) (Warm Air)
Gas Dryer $ 10.00
$
Trade Name Size No.
BTU eVv 31—GF HP EDR
*Air Conditioning - All Sizes $ 25.00
$
Fuel "T, ejA5 Total Connected Load
Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
,--,-,All
�,1%-of Value of Appliance or Work _.�
$
BTU HP EDR
Commercial/Indus vial r
1.25% Value App liance'orWo'rk
of of
$
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
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE
$
DATE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
HEA C9 Y mer-
G
REFRIGERATION/AIR
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
S TEL #Z/42
REINSPECTION FEE $47.00/Hr
`'
'eU
*Air Conditioners can not be placed in a side yard without
y Rough -In Date Final Date
Approved By/;
written permission from adjoining property owner.
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. Yeskj*` o ( )
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 (-rNo ( )
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes (-rNo ( )
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 a new venting system, the undersigned hereby verges 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 (,-Y'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 (fNo ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type ,91 I v -r BTU Inputs Fan Assisted N 9 T
Appliance #2 Type r s� exp ileglee BTU Input,3,15ae' Fan Assisted o •�� T
Appliance#3 Type BTU Input Fan Assisted or Nat
Total Appliances 2= Total Btu Input d00,000 79
��•�
Common Vent Type Vent Height ,� a Diameter, inches ry
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
HEATING CO:
Building
BUILDING
$
Permit No.: find
Inspections
RESIDENTIAL APPLICATION
65% of Building Permit Fee
Received By:
763-572-3604
CITY OF FRIDLEY
Surcharge
D 'MAY . 2009
763-502-4977 FAX
License Surcharge
$
��, DO $5.00 (State Licensed Residential Contractors)
SAC Charge
EFFECTIVE 1-1-08
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
DATE lS. I6 --Ci YOUR E-MAJL 4DDRESS
ft + 6 ft = ft x $21= $
SITE ADDRESS D
$
THIS APPLICANT IS: ❑ OWNER NTRACTOR
Park Fee
PROPERTY OWNER/
NAME: Z
Sewer Main Charge
TENANT
ADDRESS: -CITY
STATB%�ZIP ��
$
PHONE: � to 3 - 207 — yl D 4_/
NAME:
CONTRACTOR
ADDRESS:__q1) C
STATii� N z>P b ��
SUBMIT A COPY OF
PHONE b s-1 2zo FAX
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
J7 / a-0 f
PROPERTY TYPE
WSINGLE FAMILY ON SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
ANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
IN EXISTING OPENINGS<Yes ❑No LOCA�IOrT OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF Jr, (1-fJ %lar c.o� 3 Yh /
3.
Energy Calculations
OPENING CHANGES & A i111
TYPE OF WINDOW TO BE INSTALLED 1J tt' NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $ ( 1997 UBC FEE SCHEDULE).110, HEOUPANCY TYPE
Permit Fee
$
14g '7,967 See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
��, DO $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 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
$
/ 's . Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMrr 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 derstand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will be in accor 1h the approved pl case of all work which requires mew and a prov9M, SIGNA PRINT NAME (�l,
APPROVED BY