PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: .------•--.._`_'...... Q ........ /... . ....---...------...
Owner:
Address.
N? 4297
Builder 41, - --------- .......... . _...
Address................. - .... .............. _......... .......... __------ ------------- ___ - -
�f LO TION OF B IL�DING
No........__°...7/Street ....._...... - ���r i....._ ._.. _.......y..... e'1� P rt of t ......................... - - - ..... .........
r/' e
Lot ........ _0-- ... Block ..... ........ .....7 ............................. Addition or Sub -Division ... ................... . .... .... _ A..............
Corner Lot K................. �- c �► c `w
......... Inside Lot ....................................... Setback .�,F...._�..�C�........ Side ard................................ __
Sewer Elevation ........................•----............-----------....................------------..........---•-•... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as
G�
�o
..............
........._..................... Front -. Depth .........�..� Height7.-'® Sq. Ft. _9..®_! -Cu. Ft _.....�
_.............................-.......-.............. Front ........................ Depth ...................... Height ........................ Sq. Ft. ..... _................. Cu. Ft. .................... ...
Type of Construction........................................................... Est. Cost.........�)� 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.
In consideration of the payment of a fee of $....J .., permit is hereby granted
...._... ............ ...... .-------........................_....--- 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:
This permit does not 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 PERMIT
.CITY OF FRIDLEY., MINNESOTA
Owners Name Builder - --
Address _. Address
LOCATION OF BUILDING
No. Street Part of Lot
Lot Block Addition or Sub.Div.�
Cornski Loi nside ,Lot Set Baas �' Side -Yard
SEWER ELEVATIOWL FOUNDATION SET iVATION
Applica.nt.attach to this form Certificate of Survey of Lot and proposed building
loca.ti6' .*
t DESCRIPTION OF BUILDING
To be used as:
. - • ...Font • Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction 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 strict accordance with the City Ordinances and ruling of
the Department of._Buildingsj- and,hereby declares that all the facts and representa-
tions stated �in thisapplication are. true and correct.
DATE SIGNATURE
(A Schedule of Fee costs can be found on the ..evdrse Side.)
R114PING -?ERM;T FEE SCHEWLE..
'
Section 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 building or structure,,or for any alterations or repairs to
lr
-i��ln--'W!Idifig'-b.'t'-�;'tructure , up= application- therefor I requ , e
any ex is` g -
the payment by the applicant for such permit of fees to the amount
-the manner- herein --provided--to-wit c.-
2.1 For any such permit for the *bkeb.t-i(in.�of: sing' -fireproof building.,
other than a garage, warehouse, factory or, grain elevator, or for the
any.. fttbprodf: addition, for similar occupancy, to any
-:
existing building shall be at the rate of $1.40 for each one th6iiiirid
-fra-.ation! thereof, in 6;u&.. cubical contentsi-,:n
f.Qr. the. erection'.-af any. fireproof garage,, ware-
'''
house factory or grain elevator, -or or the erection ofany fireproof
'-`baT.
_.addition, ....for- simil �6ccd�)&ncy , to : &hy,.qxisting building shall -at:th shall P
rate of .25for each one thousand cubic feet, classified as 'ffireproof"
by',sectibri.-:-'592::6f- thb Minn&pdl-is Building-G-6dei--:
HOUSES
2.3 For any such permit for -the'erec ion of any non -fireproof building
other than a garage, warehouse, factory or grain elevator, or any
non -fireproof addition, for similar occupancy, to any existing builaihg.'
Permit $1.00 for each one thoupand-cubic feet.
GARAGES
2./+ For any such permit for the erectioTr-ef -any'non--;fireproof - garage..,• • po
warehouse,:fAqtq,ry or grain elevator, or for the erection ' ' of any non-
........ . "addition -----for -.sintliLr occupancy -i- to-- any existing building --or
for each such building or addition. Ninety Cents for each one
thousand cubic feet or fraction thersof-i---i-n-the dubidal.-eontents-ther.eof.
with a minimum of V.OQ...,
For the purpose of computing fees for building permits the cubical
— ------- 66fttetts' '6f any" -building or addition to. -a- uniform hei ht - throughout by -
I lying_..the,ground area covered from a.,p .point six 6) indhes below
multJ oi
,p the
ave-rageheight, of - h& -
base t'' cellar t6,
pen., qr..
_,,j -per,. o, a pitched t the' 'Might roof surface .611 thd maih•
pur ace or o , e average
gable '-f r'o6 f
2.5 For repairs or alterations to an existing structure, the fee shall
-each -Five Hundred Dollars 4500.00•)-, ..or..
fraction thereof �n 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
AT THE TOP OF THE TWINS
SUBJECT
BUILDING PERMIT
ERMIT
12676
r
COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
612-560-3450
ECEIPT NO.
NUMBER
910-F15
REV.
DATE
PAGE OF
APPROVED BY
JOB ADDRESS 7471 Van Buren Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
30
1 Sha.ffers Sub. NO. 1 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Tri -CO Builders 7955 Van Buren Street 55432 633-4681
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQ.UiRO FOR i1YIRING,
MEATI'ING;. ,PLU.MBING AND SIGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
aff:f(RN'T00tt
Rj fUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. &
end wall
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
1,000.00
.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
6.00
PLAN CHECK FEE
TOTALFEE
6.50
Sj�NATUREO TRACT RAUT IZEDAGENT .(DATEI
-'+ HEN PROPERLY V 1D � HIS IS YOUR PERMIT
✓''
IGNATU OFO E VWNE73bUILDE A 1
BLDG INSP. ME r'
Ae r
4
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: BUILDER: -
ADDRESS: ADDRESS: -
NO:. ;� 7 STREET
LOT: 3 0 BLOCK:
CORNER LOT: _INSIDE LOT: SETBACK: t SIDEYARD:C�`
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As
DESCRIPTION OF BUILDING
Front Depth: Height:_
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Flet:
Type of Construction: a 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 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 : fl
(See %Werse Side For Additional Information.
If
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 k
-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.
,CE.RTIFICATE 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.
CITY OF FRIDLEY INSPECTION DIV.
Effective On March 1, 1996
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
J
l/
JOB ADDRESS /
RATE SCHEDULE
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
Furnace Shell and Duct Work, Burner –
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00
$�
representations stated in this application are true and correct.
(Side Vent – Fill Out Back)
— _ 99 6
Gas Piping (Needed with new furnace) $10.00
$
OWNER&,(6df B ?� `� Y ' ®C 2 7
-0,
Gas Range - $10.00
$
-
BUILDING USED dwpo
Gas Dryer $10.00
$
ESTIMATED COST � PERMIT N0.
*Air Conditioning – AlUSizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alt6rations (LIST ON BACK)
11% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Y Size No. B0 1919 LOW
Commercial/Industrial
BTU HP EDR
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
$„_.50
Burner Trade Name Size No.
TOTAL FEE
BTU HP EDR
�.�0
BLAINE HTG. A/C & ELECT. INC.
HEATING OMPAN 13662 CENTRAL AVE. N.E.
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
A, MR 00JU4
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
Signed Tel No. /25�J�®
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
ApprovJBy�Rough–In DateFinal Date
*Air Conditioners can not be placed in a side yard without
FILLOUTBASTACK VERIFICATION ON
written permission from adjoining property owner.
REPLACEMENT FURNACE
CEMWNEY AND STACK VERIFICATION
The undersigned hereby ver'if'ies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of � ®® o
All other BTU's grzI OL -10
TOTAL BTU's �Z Q
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
Yes No ( )
Yes N No ( )
Yes ( ) No
Yes No ( )
Yes >eNo ( )
Yes ( ) No " 71� 7"' 4—
Yes-
Yes No ( )
List ALTERATIONS Being Done:
9
HEATING CO:
Signed By:
Date:
BLAINE HiQ. A/C & ELECT. INC.
13562 CENTRAL AVE. N.E.
ANOKA, MN 55304
SUBJECT
City ®f Fridley
2660 2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
1 7
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.17
P _
r 1
1 � �
NUMBER
REV
DATE
PAGE OF
APPROVED 8Y
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7 i4 98
JOB ADDRESS
7471 Van Buren St. NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
30
1 4
Shaffer's Subdivision No. 1 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Barbara Nieswaa
784-0627
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Stock Roofing, Inc. 289 Liberty St.780-3561
3112
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK ❑ NEIN ❑ ADDITION ❑ ALTERATION TJ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House and Garage 22 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the 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 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 I HAVE READ AND EXAMINED THIS APPLICATION
i
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
$1,834.80
.92
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVI IONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
ST T ON OR THE PERF MA CE OF CONSTRUCTION.
rj9, rjQ
ire SC 1.83
PLAN CHECK FEE
TOTA EE
A ' I CA"�
Licens 5.00
.25
SIGNATURE OF CONT ACTOR OR AUTHORIZED AGENT (DATE)
EN OP
BLD I. _
ALIDAT D HIS IS YOUR PERMIT
..n i
QATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY,.OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION Z
ConstructionAddress:
Legal Description:
Owner Name & Address: Tel.
Contractor: c ®� ¢ Q%� r MN LICENSE # 4 4
Address• r �� �-® ��� �� - IFY__� lz� 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: (.� �� /, V 3 % h
0
Construction Type: Estimated Cost: $
(Fee Schedule" on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: P I q -c APPLICANT: Tel. # (1 �
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ J, .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1000 per SAC Unit
License Surcharge $ o $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:
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 "fust $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 DIV. WT
3431 University Ave NE ��
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTl1RF19 TO RF INSTAI 1 Fr) ON FAr.14 FI OrIR
Effective On Jan 1, 2000
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**
NO. RATE TOTAL JOB ADDRESS_ NNIF Jts
-j--
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
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
and rulings of the Building Division, and hereby declares that all the facts
.and representations stated in this application are true and correct.
ANDERSON, CARESSE 2-7 , 20 ®1
7471 VAN BUREN STREET N.E.
FRIDLEY, MN 55432
Owner _ (763) 783-3959
Building Used As '�S-61flA24 C
00
Estimated Cost PERMIT NO.
PLUMBING COMPANYdo'=MPLO!✓����i
Reinspection Fee $47.00/Hr SIGNED BY _ TEL N0. Z - O
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
• Approved By Rough -In Date Final Date � c�dSCd�•
State Surcharge $ .50
- MINIMUM FEE R ANY PLUM13INGIGAS PERMIT IS $20.00
TOTAL FEE $20-50 PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
<�
Wash
rfl:_ Floor ==�<� Auto.
::
Gas
�:<r::
Water Heater
Stories ��
:•: Show
Urinal Shower
Tray
::: Z:
Drain Washer
�';��=� =<i��'
�:.:.:<::.
Range
�~
Gas Elec
...............:..
...............
..:.......::::::.
<.: :.
..:............:..::.:.. .i��€�:;�:.
.....
en
Basem t
ii'rTiY:i�
Floor 1
:i
Floor 2
Floor 3
Floor
....'.4...v.... �.-1
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**
NO. RATE TOTAL JOB ADDRESS_ NNIF Jts
-j--
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
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
and rulings of the Building Division, and hereby declares that all the facts
.and representations stated in this application are true and correct.
ANDERSON, CARESSE 2-7 , 20 ®1
7471 VAN BUREN STREET N.E.
FRIDLEY, MN 55432
Owner _ (763) 783-3959
Building Used As '�S-61flA24 C
00
Estimated Cost PERMIT NO.
PLUMBING COMPANYdo'=MPLO!✓����i
Reinspection Fee $47.00/Hr SIGNED BY _ TEL N0. Z - O
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
• Approved By Rough -In Date Final Date � c�dSCd�•
State Surcharge $ .50
- MINIMUM FEE R ANY PLUM13INGIGAS PERMIT IS $20.00
TOTAL FEE $20-50 PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
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 ventingsystem is plastic/PVC and meets all current codes and manufacturer
specifications :including sizing, length, number of elbows and termination. Yes O 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 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 () 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)
O
HEATING Cb:
Signed By: Date;
1
U7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
January 11, 2002
Ms. Caresse Anderson
7471 Van Buren St NE
Fridley, MN 55432
Re: Final Inspection at 7471 Van Buren St NE
Contractor: Norblom Plumbing
Dear Ms. Anderson:
A plumbing permit was issued on July 12, 2001 to install a water heater at your
address. According to Section 4715.2800 of the State Plumbing Code, a final
inspection shall be conducted on the work authorized by this permit. As of this date,
no final inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was
completed according to the Code. We will keep your permit open for another 30
days and if we do not hear from you within this time to set up the inspection, we will
mark the permit "no inspection called for" and take no further action.
To set up the inspection or to have any questions answered, please contact the
Building Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
S,
sue iEti
PER
City ®f Fridley
3211
AT THE TOP OF THE TWINS
BUILDING PERMIT
� .
CEIPT N '
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r : PROTECTIVE
� e
l ��' ,•� CITY HALL FRIDLEY 55432
L j\�
NUMBER
REV
DATE
8/28/01
PAGE OF
APPROVED BY
.��-
612-571-3450
910-F15
JOB ADDRESS 7471 Van Buren Street
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
30
4
Shaffer's Subdivision N0. 1 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Caresse Anderson, 7471 Van Buren St, Fridley, NN 55432 763-783-3959
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Home Depot Installed Sales, 3200 Cobb Galleria Pkway, Atlanta, GA 30339
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
763-542-8826 20268257
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
jJ NEW O ADDITION 0 ALTERATION 0 REPAIR 0 MOVE O REMOVE
8 DESCRIBE WORK
New windows (3)
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulking
& flashing for all exterior openings.
SEPARATE PERMITS ARE REOUIRED 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
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 09 COMPLIED
$2,292.00
$1.15
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
TOTAL FEE
ice a $5 00
$91.69
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI
W EN OPERLY VALIDATED THIS IS YOUR RMIT,.
jjAll
A
/QAIE
S-GNATURE OF OWNEAOF OWNER BUILDER, IDATEI
:in
9L INSo
S,
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FREDLEY
ALTER [ ] SINGLE FAAfILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 1 \)c3.vice�C�.�
Legal Description:
Owner.Name & Address:
Contractor:.
r
Address:
A
la
Tel. #4 +13'9
H*e4 MN LICENSE #
3200 Cobb Galleria Pkwy., Ste. #200 Tel. #
Atlanta, GA 30339
763-542-8826 ►urvey.of the
BC -20268257 )n it to scale.
DESC. ON OF IMPROVENWNT.,
LIVING AREA:
Length
Width Height
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA.:
Length
Width Hgt/CGround
Sq. Ft.
OTHER:
Jke%vn t m r n
► , ;,v�, A nA , %o=- .: r, \ rveq., n
e.. ;,,kAf..: ,R
Construction Type:
Estimated Cost: $ �,9a
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$®�5
Sewer Main Charge $
\�..� ..._r. �►','.i►,� Alf►, • •
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "E" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary I ]
T®TAI., $ �I•(���
STRULATIONS: ��Vj07,
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 amoun..herein
below set forth and in the manner herein provided -to -wit: `
TOTAL, VALUE FEES
$1 to $500 $23.50
$501 to $2,000 $23.50_ for first $500 t plus $3.05 for each additional $100 or
fraction thereof, to and•_including;.$2,000
$2,001 to $25,000 _... $:69,25 for first $2., plus. $14.00_fbr each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof,. to and: including $50,000
$50,001 to $100,000 $643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to -$500,000 $993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $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
$1,000,001 and up $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.
CATION 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.