PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: ..J.'--...073 .........
Owner .......................................
Address ......................................
AT® 3725
Builder .. ..43. .........
Address .............................................
,LO�CATIQN OF .BUILDING
No. . 6. !.3 !. Street ... ... Part of Lot .......... .......
.. .
Lot ... .. Block .... / .......... dition or Sub -Division f/. /'- .. 4ej
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard .........................
DESCRIPTION OF BUILDING
To,,be Used as: .,
... ...... Front <.1...4: Depth Height Y!'4 a Sq. Ft. �Jl./. Cu Ft.��.��:(�./
Front ........ Depth ........ Height ........ Sq. Ft. Cu. Ft. .....
Type of Construction ................... lit. Cost./... To be Completed ...................
In consideration of the issuance to me of a permit to construct the building desribed 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 . $./► . �, permit is hereby granted to ...................
......................... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. .011 _I ---
,;l......... Building Inspector
NOTICE: NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector foi.separate permits for these Items.
City of Fridley, Minn- N? 7644
MUDING PERAUT
Date: June 29 1965
owner: Amold Ku-bWzBuilder Q. Elson Peterson Const.
Address 6747. Wmhindga St. N. E. Address 29-W 3.32 nd. Ave. N X. Anoka,$-ximo
LOCATION OF BUILDING
No. 6717 street Washington Street N. E. Part of Lot
Lot 14 _ Block 1 Addition or Sub -Division Rice .Creek Terrace Plat is
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost i-00 To be Completed
Storm Damage Repair
In consideration of the issuance to me of a permit to construct the building described above I agree to do
tho proposed work in accordance with the description above set0fo , in ce with ;J1 provisions of
cfrdinances of
the city of Fridley.
In consideration of the payment of a fee of It 10. W , permit is hereby granted to -Q. Eldon Peterson,
Const, to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it gis granted and his agents, employees and workmen, in all work
done ces of
ey, around and urn said location,
o attic oconstru�ct�fon, alteration maintenance, shall mrein all pair and moving to the 000f�buildings
within � city limits regarding permit may be revoked at any time upon violation of any of the provisions of said
Men Jensen Building Inspector
NOTICE
lhhi pert deft not emrer the candmd1w, hwhMdlan for wiring, plumhiag, gas hearing, aver or water. Be som to see
the Buildieg MgwMr for separate permhs for thea items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME
LOCATION OF BUILDING
No. 6 T4 7. Street 7Q Part of' Lot
�.�
LOT BLACK ADDITION OR SUBDIVISION G AT
Corner Lot. Inside.LOT Se6ack Side -Yard -
SEWER ELEVATION
ide-Yard
SEWER'ELEVATION FOUNDATION ELEVATION --
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 Hi eight.
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
00a
Type of Costs,truction estimated Cost
To be completed
The undersigned hereby makes application.for,je� emit .for the work herein specified,
agreeing to do all work iri'strict'Accordance .with the City of. Fridley _,Ordinances
and rulings of the Department of Buil'dings,, and hereby .declares that all the. facts
-and representations stated in this application are true and correct.
4 /
DATE C)Awff SIGNATURE:-
(Schedule of Fee Costs can be found on the Reverse Side).
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®'d®� ,�/�L tgtbuildor e -
j ing or
fkkw&nt for
r herein
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C ing,.
s�on
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a rate
,r
�uildin
gt
Omer mans garage, warenouse, factory or grain elevator, or any non -fireproof
addition, for similar occupancy, to any existing building - permit $1.00 for each
one thousand cubic feet.
GARAGES
L.4. For any such permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non -fireproof
addition, for similar occupancy, to any existing building or for each such
building or addition - ninety cents ($0.90) for each one thousand cubic feet
or fraction thereof, in the cubical contents thereof with the minimum of $4.00.
For the pu pose of computing fees for building permits, the cubical contents
of any bui ding or addition to.a uniform height throughout by multiplying the
ground are covered from a point six (6) inches below the floor line of the
basement or cellar to the average height of the upper surface or to the average
height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee shall
be at theeste of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in�the cost of all proposed work.
2.6. In no case shall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
••.��\�•1� vI��M�\. •ice vii
MYIrICN by Councilman Schneider to adopt the agenda with the above addition.
Seconded by ODuncilman Goodspeed. Upon a voice vote, all voting aye, Mayor
Nee declared the motion carried unanimously.
OPEN FUMM, v VISITORS*
7here was no response frcmthe audience under this item of business.
i, * .; 1►.
$750,000 INDUSTRIAL 1 M1 ; I?1>t, :E1/E1EE W. a: Mel.
MMCN by Councilman Fitzpatrick to waive the reading of the public hearing
notice and open the public hearing. Seconded try O:>uncilman Schneider. Upon
a voice vote, all voting aye, Mayor Nee declared the motion carried
unanimously and the public hearing opened at 8:02 p. m.
Mr. Inman, City Clerk, stated this is a request by Gerald Paschke for the
issuance of a $750,000 industrial development revenue bond to construct a
30,000 square foot office/warehouse facility on the east side of Main Street
between 79th and 81st Avenues.
Mr. Inman stated it is proposed the annual payroll generated f rom
construction of this facility would be $700,000 and would add 30 new jobs in
the City. He stated the facility would also increase the taxable value of
the land. He stated staff has reviewed the documents and would recommend
approval.
Councilman Goodspeed asked haw much industrial revenue bonds the City can
issue this year. W. Inman stated the City can allocate approximately $8.1
million. He stated if these bonds were issued, the balance would be about
$2 million. He further stated he didn't feel the City would have a problem
in increasing their allocation if there was a large project at the end of
the year.
No persons in the audience spoke regarding this proposed bond issue.
M rICN by Councilman Schneider to close the public hearing. Seconded by
Councilman Goodspeed. Upon a voice vote, all voting aye, Mayor Nee declared
the motion carried unanimously and the public hearing closed at 8:05 p.m.
XMCN by Councilman Fitzpatrick to waive the reading of the public hearing
notice and open the public hearing. Seconded by Councilman Schneider. Upon
a voice vote, all voting aye, Mayor Nee declared the motion carried
unanimously and the public hearing opened at 8:05 pm.
Mr. Flora, Public Works Director, stated this is a request to vacate a
-2-
I DIM I, eve)WITA-10FI:
drainage and utility easement on Washington Street between 7th Street and
68th Avenue. He stated the vacation is requested in order to construct a
garage and install a driveway on the rear of the lot at 6747 Washington
Street.
W. Flora stated all the utility companies have been contacted and they have
no problems with the vacation of this easement.
Mr. Flora stated the Planning Om mission recommended approval with three
stipulations, as follows: (1) a drainage plan be coordinated with and
approved by Engineering staff prior to the Council. meeting; (2) the neighbor
to the north provide a letter agreeing to the reduced driveway setback and
drainage plan; and (3) a new 10 foot drainage and utility easement be
provided on the southerly ten feet of the lot.
The petitioner, Mr. Ruhnly, presented a drainage plan and a letter from the
property owner to the north indicating he had no objection to the extension
of the driveway or to the drainage. No person spoke regarding this proposed
vacation request.
MDTICN by Councilman Goodspeed to close the public hearing. Seconded by
Councilman Schneider. Upon a voice vote, all voting aye, Mayor Nee declared
the motion carried unanimously and the public hearing closed at 8:09 p.m.
MOTION by Counclman Goodspeed to approve vacation request, SAV #85-02, with
the stipulation that a new 10 foot drainage and utility easement be provided
on the southerly ten feet of the lot. Seconded by Councilman Fitzpatrick.
Upon a voice vote, all voting aye, Mayor Nee declared the motion carried
unanimously.
NEW BUSINP'_R.S
4. RECE VIN THE !S OF THE CABLE TELEVISION AMSORY MMMISSION ME9C, OF
APRIL 18, 1985
MDTION by Councilman Schneider to receive the minutes of the Cable
Television Advisory Commission Meeting of April 18, 1985. Seconded by
Councilman Fitzpatrick. Upon a voice vote, all voting aye, Mayor Nee
declared the motion carried unanimously.
5.
Mr. Flora, Public Works Director, stated the County has purchased property
on which the sign is located and have asked FMC to reduce the size to 144
square feet. He stated the existing sign is approximately 448 square feet.
Mr. Flora stated FMC is a unique manufacturing facility, partly owned and
operated by the Navy and partly by FMC. He stated this directional sign
would clarify FDIC ownership and safely direct southbound traffic to the
proper entrance. He stated the facility averages 120 visitors and 65
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SUBJECT -
City of Fridley
�FPERM
7l 7V 2
AT THE TOP OF THE TWINS
g U I L D I N G PERMIT
r
�
RECEIPT
• COMMUNITY DEVELOPMENT DIV.
r I PROTECTIVE INSPECTION SEC.
CA
1 - --1 CITY HALL FRIDLEY 55432
� f %'J
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/8/85
JOB ADDRESS 6747 Washington Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
14/ Pt. 1
1
Rice Creek Terrace MIX Plat 4 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Arnold Kuhnly 6747 Washington Street N.E. 571-1248
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 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 22' x 22' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Vacation of Easement along North side of lot (-to be dedicated along
South side of Lot) approved by Council on 5/6/85
SEPARATE PERMIT
WARNING WIRING, HEATING,gR�F���PE® FOR
b3' e'�JuYNG AND SIGNS.
Before digging call local utilities
TELEPHONE - ELECTRIC - GAS Etc,
REQUIRED BY LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
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 BE COMPLIED
$5,899
$2.95
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 CDN-
$56.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$59.45
5�1 UREOFCONTRACTOR OR ARTHORIZEDAG DATE)
WHEN PROPERLY ALIDATED THIS IS YOUR PEg�MIT
�✓
CJ '.
ZI i NATURED OWNER (IF O �R BUI D RI AT
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01
NEN City of Fridley Effective 4/1/84
ADDN.. [ ] �R-1 AND R-2 ]
ALTER. [ ] Building Permit Application
Construction Address
Legal Description:
Owner Name & Address:
Contractor
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
r
OTHER:
S
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Lengtho�
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Tel. #�T,;V--/yd'
Tel. #
- 6 "i
Sq. Ft.
Sq. Ft.�
Sq. Ft.
Corner Lot [ ] Inside Lot " Ft. Yd. Setback Side Yard Setback
Type of Construction: _01Y_a "7 v Estimated Cost: $
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $
See Back Page for Explanation
DATE:%LCA— APPLICANT:2�g Y Tel. If T71�-2�e
CITY USE ONLY
Permit Fee. $ Fee Schedule on Reverse Side
Plan Check $25% of Building Permit Fee
State Surcharge $ 9s—
$.50/$1,000 Valuation
SAC Charge $ $425 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary
TOTAL $ [ ]
STIPULATIONS:,
AI C A-i7o � OF / 04a-4
Cr/J�_- or Lv %a
QWt akfm bread.
InividGil'to CArpofitt�0$ { iii/ �i 6L7�;-a�
-_--� Nlirittesbta i)hiiorm 8on.eyanabs. B
G'Q titll O f '
rkr (Revised 19`61
Tbis; 3nbenture. #r.& this...................Ath.......... ...... day of ........................ May. ............................ ., 19...85...I
between... AU9.1.d...M......Wn1.Y....and.....Mair..garet...M.....Au.hnly...Oius.band...and...W.i.fe.)........................................................
of the County of. ...... Anoka..............................................................and State of ...... Ki.nneSQta.............................................. ............. .,
part...i.es. of the first part, and .... Ci. ty.... o.f.... Fri.dl.ey.................................................................................................................................
... .................................. ......................................................................................................................................................................... _..........................................
i
a corporation under the laws of the State of. ... Mi.nnesota .................................................., party of the second part,
Witneggetb, That the said part............ of the first part, in consideration of the sum of
... Pie ..d.Q.U.a.r..... U.1.A.01... and -other ... uahabl.e... consi.der..ati.an...................................................................DOLL.4RS, !
to............................................................in hand paid by the said party of the second part, the receipt whereof is
hereby acknowledged, do............ hereby (,want, Bargain, Quitclaim, and Convey unto the said party of
the second part, its successors and assigns, Forever, all the tract...... or parcel...... of land lying and being
in the County of ....... Anoka ..............................................................and State of Minnesota, described as follows, to -wit. j
A drainage and utility easement described as follows:
The South 10 feet of Lot 14, Block 1, Rice Creek Terrace Plat 4.
The City of Fridley hereby accepts this easement for
drainage and utility purposes,
.�r
Sidney Inman - City C erk
No State Deed Tax Required,
To 3gabe anb to Jbolb the Oallle, Together with, all the hereditaments and appurtenances there-
unto belonging or in anywise appertaining, to the said party of the second part, its successors and assigns..
Forever.
din Tevitnonr Wbereof, The said part i es of the first part ha ve.... hereunto set... their ..............
hands the day and year first abor-e rcritten.
4
i
�/
.......2 ....................... ......
. . .. ....... 2z _� -�
`../1..... ..........'.: ...............
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
e
JOB ADDRESS Ll % co n .e
RATE SCHEDULE
Li
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 ar
Furnace Shell and Duct Work, Burner —
c) ®
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 20.00
$,®,
representations stated in this application are true and correct.
(Side Vent — Fill Out Back)
1995.
Gas Piping (Needed with new furnace) $10.00
OWNER
Gas Range $10.00
$
,
BUILDING USED AS
Gas Dryer $10.00
$
ESTIMATED COST PERMIT N0.
*Air Conditioning -Ali Sizes $10.00
®
$ .� e �
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Ropairs & Alterations (LIST ON BACK)
r : ,.;
1% of ValuO.,�sf Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water arm A'
F�
Trade Name (`�, Size No.
Commerci4Adustrial
BTU %HP EDR
I% of Value of'Appliance or Work
$
Fuel v Total Connected Load V
State Surchargea0
Burner Trade Nam Size No. c)
f�
`$
®
BTU HP EDR
TOTAL FEE
�-J
s
HEAT COMPANY At ®K
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
-.
Signed Tel No. / I'
PLUS THE $.50 STATE SURCHARGE
"�7"�
REINSPECTION FEE $30.00
Approved
pp B Rough—In Date final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
CC. MNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes(
)
No
{
)
2.
Is free fro�'rust or deterioration
Yes ()
No
No
(
)
3.
Has no foreign objects lodged within
Yes ()
No
(
}
4.
Is securely supported
Yes {
}
No
(
)
5.
Mom all current Code requirements for size
and total BTU's connected
Yes (
}
-No
(
)
6 Has total heating BTU's of
All other 0W, 's
TOTAL Bid's
7.
Has a liner been provided for water heater
Yes (
)
No
( }
8.
Has combustion air been provided for water heater
Yes (
)
No
( )
HEATING CO:
Signed By:
Date:
O
SUBJECT-PERMIT
NO.
City of Fridley
C
5 ,
2695
AT THE TOP OF THE TWINS
BUILDING
RERMIT
t
-
RECEIPT ON/�
COMMUNITY DEVELOPMENT DIV.
I ~ e PROTECTIVE INSPECTION SEC.
r
7
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
�•"'� �'' 612-571-3450
910-F15
8/3/98
JOB ADDRESS hin tont
6747a 5
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
14
1
1 Rice Creek Terrace Plat
4 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bob Schmitt
572-0634
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
A-Line Const 6171 189 Ln NW Anoka 55303 -
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 It REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 26 S Tear-off
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
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
216$
$1.08
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 ION OR E OF CONSTRUCTION.
74.75
Fire Sc 2.16
PLAN CHECK FEE
TO AL FEE
��
Licens
5
2
SIGNATf O ONT ACTO OR AUTHORIZED AGENT (DATEI
EN O
L VALIDA
THIS IS R 5RM
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
BLD INS
OATS
O
NEW [ J
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: C� S )-
Legal Description:
Effective 1/1/98
Owner Name & Address: L Tel. #
Contractor: - L�'�. C z �\s L_ MN LICENSE # DCS Q-z-�S D -7_�-_�
Address: ��, '� ( J �3Tel. #i
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlAPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAG9 AREA: Length Width Height Sq. Ft.
DECK AREA: Len 7e_
Hgt/Ground Sq. Ft.
OTHER: 61
Construction Type -e D Estimated Cost: $ C'iCT�U /l
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: ' —� = APPLICANT: Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ % `�
Fee Schedule on Reverse Side
Fire Surcharge
$ 1
.001 of Permit Valuation (1/10th%)
State Surcharge
$ t C`.
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ . 00
$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 [ J
TOTAL
$
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 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
JOB ADDRESS
Effective On January 1, 2002
&7
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.
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 C l
HEATING COB L� (W4_*V_t_
Signed
FAX �.
Approved By
Rough -In Date
TEL
Final Date
OWNER
Rate
TOTAL
BUILDING USED AS
$ 30.00
$
ESTIMATED COST
PERMIT N0. 1,5111
$ 10.00
$
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00
$
No. of Heating Units
Circle One (Steam) (Hot Water) (Warm Air)
$ 10.00
$
Trade Name
Size No.
BTU
HP EDR
$ 25.00
$�
Fuel
Total Connected Load
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.
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 C l
HEATING COB L� (W4_*V_t_
Signed
FAX �.
Approved By
Rough -In Date
TEL
Final Date
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL!BE RETURNED
COMMON VENT, VENT CONNECTOR AND QQMR11STION AIR VFRIFI .ATION
When re In acing 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 meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes( ) No( )
The pxia+ing cnmb ,$ inn air is sized and installed to meet the current codes
and manufacturers specifications. Yes( ) No( )
When required to install a new cnmbiictinn air.itwill 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 #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 onnetor Height
ft Length
ft Diameter in Type
HEATING CO:
Signed By: Date: