PRE 2010 DOCSVil�age of Fridley, Minn.
BCU ING PERMIT N® 1916 .
Date:
I
Owner.. V ....................... Builder .... ......... .
Address . I� . ... .. .. .. Address
LOCATION OF BUILDING
No. t S eet i� ° . ®�" :..... Part of 'Lot ......... ........
Lot ... Blok .... Addition or Sub Divisions`.... ...
Corner Lot ..... .... SInside Lot : " ..rSetback ., �r- Sideyard,�:9+t �''
DESCRIPTION OF BUILDING
To be Used as: I
r F14 Z'ront. Depth °1 Height . Sq. Ft Cu. Ft. .
j!ront� Sq. Ft....... Cu. Ft. ........ .
Type of Construction .;t Est. Cost . i'� Q .... To be Completed ... ...... . .... .
}
1.
In consideration of the issuance to me of a. permit to construct the building described above, I; agree to do
the proposed work in a ccordance with the description above set forth and in compliance with : all provisions of
ordinances of the villa of Fridley.
In consideration o ;the payment of a fee. of $.`:' ... ; .., permit is hereby .granted to c:�°'
.........
. ...........to construct the building or addition as described above. This permit is granted upon
the express condition tat'the person to whom it is granted and his agents, employer's and workmen, in all work
done in, around and u n. said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reg ding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits an.1, this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Bei ure to see uilding Inspector for separate permits foc se items.
=:I
i
City of Fridley, NUnm
BUILDING PERMITNo 134
Date:
Owner.
Address _ Address' '
No. 1 Street o_ Part of Lot
Lot _ _ _ _ ._ Block ---Addition ..._._.... Addition or Sub -Division
Corner Lot _ _ _. Inside Lot _ _ Setback _
Sideyard
Sewer Elevation _ ___ Foundation Elevation
DESCRIPTION OF BUILDING
4
;.Front _ Depth Height &L Sq. Fi: ± � ; Cu. Ft
Depth _HHPight Sq. Ft. Cu. Ft.
Type of Construction" a-`° 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
prdinances of the city of Fridley.
�a
In consideration of the payment of a fee of $_ _€a , 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
within the city limits and this permit may be revoked at ,any time upon violation,.ofrauy 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 hems.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name, a r a� % rIAI-Builder ' r ,L�✓�
..,._
Z"
, ✓�
Address Vis/ _ A& S7— 1 % 4- Address
LOCATION OF BUILDING
No. �,,.fart of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot . Setback Side -Yard
SEWER EIEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:. 0
Z��
Front De-oth /6 _Height
--
Sq. Ft.
Cu. Ft.
Front Depth Height
Ft. Cu. Ft.
Type of Constructi n Estimated Cost„
To be Completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department -of Buildings, and hereby declares that all the facts and representations
stated in this application are true and correct.
DATE lv SIGNATURES
,L ��
(A Schedule of Fee Costs can be found on the Reverse Side.)
. - .
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
RESIDENTIAL ` RATE
TOTAL
Job Address
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00
$ a['
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Gas Piping $ 10.00
$
Tei. #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..
* Air Conditioning (all sizes) $ 10.00
$ �b ,��
Fridley, Minn. 'R -�A"",J �19 a
All
A,
1'?1;z So
G��'W
Others/Repairs and Alterations
OWNER ® �/ ,O ALJ
1• of Value of Appliance or Work
$
n
KIND OF BUILDING
COMMERCIAL/INDUSTRIAL
USED AS 100� S •` C
1% of Value of Appliance or Work
$
TO BE COMPLETED ABOUTESTIMATED
COST
State Surcharge
$ .50
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
TOTAL FEE
$
keinspection Fee ($15.00)
$G
DESCRIPTION OF FURNACE/BURNER
Rough Insp.
HEATING POWER PLANTS, steam, Hot Water, Warm Air// No.
Date
or
Final Insp.
Trade Name, Size No. /per®GAO /�%Lr
Date
Capacity -Sq. Ft. EDR BTU HP
Approval for Permit
Total Connected Load Kind of Fuer
BURNER - Trade Name e-si -No.
Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,Company / N S
PLUS $.50 STATE SURCHARGE
Signed By G
Tel. No.
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
Fill out back side for stack verification on replacement furnaces
CHIM14EY 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
Date
CIlYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
April 16, 1992
Ms. Nancy Thompson
851 W. Moore Lake Drive
Fridley MN 55432
Subject: Hold Harmless Agreement
Dear Ms. Thompson:
Enclosed are two copies of a Hold Harmless Agreement to allow the construction of a
2 -foot high retaining wall on the public right-of-way. Please sign both copies in the
presence of a Notary Public. A Notary Public is generally available here at City Hall if
you have difficulty finding one.
Please return both signed copies, with a copy of your Owners Duplicate Certificate of
Title (#55899). After the document is signed by the proper City Officials, it will be
recorded with Anoka County. If you have difficulty in locating your Owners Duplicate
Certificate, contact the Anoka County Registrar's Office.
If you have any questions, please contact myself or Clyde Moravetz at 572-3552.
Sincerely,
�-
ark A. Winson, P. E.
Assistant Public Works Director
MAW:cz
Enclosure (2)
State of Minnesota )
) ss
County of Anoka )
HOLD HARMLESS AGREEMENT
CONSTRUCTION AND MAINTENANCE OF A
2 FOOT RETAINING WALL ON PUBLIC RIGHT-OF-WAY
THIS AGREEMENT made and entered into this day of , 1992, by and
between the City of Fridley, County of Anoka, Minnesota, a Municipal Corporation, hereinafter
referred to as City, and Nancy Ann Thompson, a single person, hereinafter referred to as the
Owner.
WHEREAS, the Owner has requested that the City allow the placement of a 2 -foot retaining wall
on the boulevard abutting the following described property:
LOT 9, BLOCK 3, SHOREWOOD
NOW THEREFORE, it is agreed as follows:
1. The City shall allow the Owner, at Owner's expense, to place a 2 -foot retaining wall across
the boulevard of the above described property.
2. The Owner shall construct above said retaining wall and provide immediate and continued
maintenance of the retaining wall, and property on either side of the wall, and shall eliminate
thereon hazards to safety and conditions of disrepair and unsightliness and shall hold the
City harmless of any liability of damages consequent upon, resulting from, growing out of,
or in any manner connected with the construction or maintenance of the above mentioned
retaining wall.
3. The Owner shall not obstruct or interfere with the use of the existing sidewalk in the
boulevard abutting the above mentioned property.
4. In the event the public right-of-way is required for use by the City and/or public utility
companies, the Owner, at Owner's expense, shall remove and/or -replace said retaining wall.
5. The provisions of this agreement shall be binding upon and enforceable against the parties
hereto, their successors and assigns and all subsequent owners of the property herein
described. An executed copy of this agreement shall be filed with the Anoka County
Recorder's Office and made a part of and be binding upon the above described property.
IN WITNESS THEREOF, the parties have hereunto set their hands this
1992.
Nancy Ann Thompson -Owner, a Single person
This instrument. was drafted by:
City of Fridley
6431 University Avenue N.E.
Fridley, Minnesota 55432
day of
HOLD HARMLESS AGREEMENT
Page 2
State of Minnesota )
) ss
County of Anoka )
On this day of . 1992, before me, a Notary Public within and for the
County of Anoka and the State of Minnesota, personally appeared Nancy Ann Thompson, a single
person, to me known to be the same person described in and who executed the foregoing
instrument, and acknowledged that she executed the same as her free act and deed.
Notary Public
William J. Nee - Mayor
City of Fridley
William W. Burns - City Manager
State of Minnesota )
) ss
County of Anoka )
On this day of , 1992, before me, a Notary Public within and
for said County, personally appeared William J. Nee and William W. Burns, to me personally known,
who being each by me duly sworn they did say that they are respectively the Mayor and the City
Manager of the City of Fridley, the municipal corporation named in'the foregoing instrument, and
that the seal affixed to said instrument is the corporate seal of said municipal corporation, and said
William J. Nee and William W. Burns acknowledged said instrument to be the free act and deed of
said municipal corporation.
Notary Public
NEW [ ] Effective 3/1/92
ADDN [ ] CITY OF FRIDLEY
ALTER[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: /" pore 1.9 17 r
Legal Description:
Owner Name & Address: 1 V A ti l lnn g a s
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Tel. #
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $
Approx. _. CQmp�tion _.Date: '
Driveway Curb Cut Width Need : 9 Ft. + 6 Ft = / SFt x
DATE: Y15 p APPLICANT:U fl
G
Permit Fee
$
Fire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Charge
$
TOTAL
STIPULATIONS:
CITY USE ONLY
(Cost on Back)
$ --,?0� f � �) = $
Fee Schedule on Reverse Sid
.001 of Permit Valuation�_-
$.50/$1,000 Valuation --� ----
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ] I
SUBJECT
0•
®f Fridley
215 � 6
PCity
THE TOP OF THE TWINS
BUILDING N G P E R M I T
,AT
Ir
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r 1
I =
CITY HALL FRIDLEY 55432
NUMBER
REV
GATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/1/92
JOB ADDRESS 851 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
3
Shorewood SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Nancy Thompson 851 West Moore Lake Drive NE 574--1164
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Inter City Builders 773 Torchwood Dr, New Brighton MN 55112 633--7389 6018
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Res iden tia 1
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 241 x 2V Detached Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Special Use Permit approved 9/21/92 for second accessory building.
Stipulations on special use permit approval are: The accessory structure shall be
architecturally compatible. with the. existing dwelling unit; The petitioner shall
provide a hard surface driveway by August 1, 1993.; The accessory structure will not
exceed 14 ,feet in height; The accessory structure may not be used to conduct a home
occupation as defined in Section 205.03.34 of the Fridley Zoning Code.
WARNING
before diggingCall
� call for
SEPARATE PERMITS REQUIRED FOR all utility ► atioms
WIRING, HEATING, PLUMBING AND SIGNS. ,454.0002
RfQUBRED BY LAS/
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$8 310
$4.16
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT P SUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIO OF NY OTHER STATE OR LOCAL LAW REGULATING CON-
$108.00
Fire SC $8.31
STRUCT ON ORT E PERFORMANCE OF NSTRUCTION.
(-')/,
��
0 / L—
PLAN CHECK FEE
License SC $5.00
TOTAL FEE
$125.47
SIGNATURE OFCONTRACTOR OR AUTHORIZED AGENT (DATEIW1W
P PE L V DATED THIS IS YOUR PERM)
DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI)NSP
NEW [ ]
ADDN [ ]
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1192
Legal Description:
ul 4
"- C C� `
Tel. #'�—
Owner Name & Address:
.001 of Permit Valuation (1/10th%)
State Surcharge
$
Contractor:
_
SAC Charge
MN LICENSE #a o 0
Address:
$700 per SAC Unit
Tel.
# 57
$5.00 (State Licensed Residential Contractors)
Attach to.
this application, a Certificate
of Survey of the
Alt. "A" or Alt. "B" Above
Park Fee
lot, with
the proposal construction
drawn on it to scale.
Sewer Main Charge $
DESCRIPTION OF IMPROVEMENT
LIVING AREA:
Length
Width
Height
Sq. Ft.
GARAGE AREA:
Length
Width �-�Z
Height l
Sq. Ft.
DECK AREA:
Length
Width
Hgt/Ground
Sq. Ft.
OTHER:
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Gi Estimated Cost: $ _ (-
Approx. Completion Date:
(Cost op Back)
Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ I = $
DATE: APPLICANT: Tel. Tel. # 63— Y
CITY USE ONLY
Permit Fee
$ : `�'
"- C C� `
Fee Schedule on Reverse Side
Fire Surcharge
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.501$1,000 Valuation M �'
SAC Charge
$
$700 per SAC Unit
License Surcharge
$
0 L
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
CITY COUNCIL
ACTION TAKEN NOTICE
September 24, 1992
Nancy and Patrick Thompson
851 West Moore Lake. Drive N.E.
Fridley, MN 55432
Dear Mrs. and Mr. Thompson:
On September 21, 1992, the Fridley City Council officially approved
your request for a Special Use Permit, SP #92-09, to allow a second
accessory building over 240 square feet, on Lot 9, Block 3,
Shorewood,. generally located. at 851 West Moore Lake Drive N.E.,
with the following stipulations:
1. The accessory structure shall be architecturally compatible
with the existing dwelling unit.
2. The petitioner shall provide a hardsurface driveway by August
1, 1993.
3. The accessory structure may not exceed 14 feet in height.
4. The accessory structure may not be used to conduct a home
occupation as defined in Section 205.03.34 of the Fridley
Zoning Code.
You have one year from the date of City Council action to initiate
construction: If you cannot begin construction in time, you must
submit a letter requesting an extension at least three weeks .prior
to the expiration date.
SUBJECT
City of Fridley
;�
AT THE TOP OF THE TWINS
g U I L D I N G
P E R M I f---
--
r233
`- "--------7
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r I �
II "S CITY HALL FRIDLEY 55432
IIL""�
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/2/95
JOB ADDRESS 851 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
9
3
Shorewood
I
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Nancy Thompson 851 West Moore Lake Drive NE
574-1164
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
James Marinaro Construction 1007 Montclair Ave, Mounds
View MN 55112 785-2954
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONECENSE NO
2002'44
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW 0 ADDITION (i ALTERATION 0 REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Install bathroom in lower level
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan. Provide
smoke detectors adjcent to sleeping areas.
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 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
@
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$4,000
$2.00
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-
$63.00
Fire SC $4.00
STRUC ION OR THE PERFORMANCE OF CONSTRUCTION
%
PLAN CHECK FEE
TOTALFEE
License SC $5.00
$74.00
IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN )ROPERI&Y VAL DATED THIS I�SSYOUR PERMIT
8 G INSP
/ qAT
SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEIp/
NEW [ ] Effective 1/1/95
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: LIJ Moose LQ (<e or
Legal Description:
Owner. Name. & Address;. NO 11 � ,ho lkn� c � � Tel. #
Contractor: aYVi e5 YYl q Y i n a v �� v i �r� �� �o �� 5 MN LICENSE ##.Cx�
Tel.
Address:
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:
Comer Lot [ ] " Inside Lot { ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: ',— m' ed Cost: $ y vac-)
Approx. Completion Date: 6, – 7 5"
(Cost on Back)
Driveway Curb Cut Width Needed: Ft 6 Ft = Ft x `$ _ $
DATE: APPLICANT: Tel. # 7,g S
CITY USE ONLY
Permit Fee
$
, '0,°
Fee Schedule on Reverse Side
Fire Surcharge
$ 41, Oc'
.001 of Permit Valuation (1/10th%)
State Surcharge
$
a. 00
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$
00
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.0 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
T '
rn
rn
rn
71
71 to
rA ;a
rn
E�,o
S2 -
00
2®O
U
0
s
OQ
i
W.W:
DX
i
R V'+
�T1 TTS
m
+ x
�} 9 '14
op
i
�
i
A
i
�
9
s
� o
CITY OF FRIDLEY INSPECTION DIV.
Effective Orr January 1--.1995 . .
6431 University Ave NE
Fridley, MN 55432
APPLICATION FOR PLUMBING AND'GAS FITTING PERMIT
572-3604
MARK
NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Water
Bath
z i
Wash''Floor
i at h Auto. Gad"i"" Gas
Misc
Water. H'eeter
Stories
closet
Urinal
Tub' .
Shower
iri r
Trayko
Drain . Washer A i I :...: Ran a
1=i k, :.,:
Gas . ' Elei:
BasementTH
k
ly
Floor 1
,,4.1
:i I
�
'�
Floor 2
9: P Y IrsIVI
aI 1: i
I,� I
�1 n"
Floor 3,ka
Floor 4
til ,i ; ;
�I im=y. i ..:.cal
P rI'�I I r �1ilq'
L II . _ 4
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
JOB ADDRESS�i/lOd
New Fixtures
$ 7.00
`'"'r
The undersigned hereby-makes application forA•permit.for•the, workherein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all'work in strict aecocdance.wh*h the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and representations stated in this application`are•true and.correct. "
Catch Basin
$ 7,00
r ;
Rain Water Leader
$ 7.00
,1995
Sump/Receiving Tank
$ 7,00
Water Treating Appliance
$10.00
Owner
Water Heater —Electric
$ 7.00
Water Heater — Gas
$10.00
Building Used As'�� IN1 CC
Gas Range
Gas Dryer
$10.00
$10.00
Estimated Cost �a U(s
�� PERMIT N0.' d' %
Back Flow Preventer Required ( )Yes O
No
Type
$5.00
PLUMBING COMPANY_, ( ►r1�mai
Reinspection Fee $30.00
SIGNED BY 6r+.42 1'e " TEL N0. 3
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
Approved B Rough—In Dater Final Date
State Surcharge
,50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT: IS $15.00 ��. j
TOTAL FEE
$ /
PLUS THE $.50 STATE SURCHARGE
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1995
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas
Gas Range
Gas Dryer
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00 The undersigned hereby makes application for a permit for the work herein
$ 4.00 specified agreeing to do all work in strict accordance with the city codes
$ 5.00 and rulings of the Building Division, and hereby declares that all the facts
$ 7.00 and representations stated in this application are true and correct.
$ 7.00
$ 7.00 ,199
$ 7.00
$10.00 Owner
$ 7.00
$10.00 Building Used As
$10.00
$10.00 Estimated Cost PERMIT NO. z/��
$5.00 PLUMBING 1
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge .50
TOTAL FEE A42
SIGNED BY
Approved By 94 Rough—In Date Final Date 0
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
MARK NUMBER
OF FIXTURES
TO BE INSTALLED
ON
EACH FLOOR
We
Beath
_- Wash Floors tch
Auto. has "
Gas Misc L ;Water Heater
Stories
Close ;Urinal
Tull _; Shower
In ;;; Tra
o_:: Drain
gasin�.
Washer
m M
. Ran a Fb�t. Gas Elec
Basement
Q17
n .;
.MOM
4 V 50.
Floor 1
Tism
Floor 2
Floor 3y
'a'TI' if�
rt
7 N i ''
}: N.
Floor 4
a tY
� `I.::
�F_:� -..
i "'{i"�
PLUMBING FIXTURE RATES;
NO. RATE
TOTAL
JOB ADDRESS
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas
Gas Range
Gas Dryer
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00 The undersigned hereby makes application for a permit for the work herein
$ 4.00 specified agreeing to do all work in strict accordance with the city codes
$ 5.00 and rulings of the Building Division, and hereby declares that all the facts
$ 7.00 and representations stated in this application are true and correct.
$ 7.00
$ 7.00 ,199
$ 7.00
$10.00 Owner
$ 7.00
$10.00 Building Used As
$10.00
$10.00 Estimated Cost PERMIT NO. z/��
$5.00 PLUMBING 1
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
State Surcharge .50
TOTAL FEE A42
SIGNED BY
Approved By 94 Rough—In Date Final Date 0
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
SUBJECT
City ®f Fraley
, �r
27321
AT THE TOP OF THE TWINS
BUILDING
PE M I T
r
63 (-�,3
COMMUNITY DEVELOPMENT DIV.
' •PROTECTIVE INSPECTION SEC.
e
NUMBER
REV
DATE
PAGE Of
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/20/98
JOB ADDRESS
851 West Moore Lake Drive
1 LEGAL
LOT NO.
BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
3 1 Shorewood
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Nancv Thompson574-1164
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Nutzmann Bros Constr. 736 1st Ave NW New Brighton MN
55112 628-0128 20043453
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 :RK REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (32 sq) 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 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
$2668
$1.33
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CO IN-
STRUCTION OR THE PERFORMANC OF CONSTRUCTION.
$74.75
Fire SC $2.66
—
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
1$83.74
SIGNATURE OF CONT ;WOR OR AUTHORIZEDAGENT (WATV (ATV
WHEN PROPER
VALII��]jATED THIS IS YOUR PERMIT
B G INSP
�y
�/ I-TA I E
SIGNATURE OF OWNER of OWNER BUILOERI IDATEI
NEVA [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 p ��
BUILDING PERMIT APPLICATION
ConstructionAddress:
�S
Legal Description:
Owner Name & Address: ,1Vf&
Contractor;/V4,47-,---p�q 4
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
N3
,0-9'
1eles— a,
Tel. # 4�s��-�
MN LICENSE #&-,f0r`/ -37
Tel. #�%1�/
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF EUPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: / APPLICANT: Tel.
CITY USE ONLY
Permit Fee
$ /� , S�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 1,33
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ ��' OAD
$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:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
nnACl! All IAAQCD nC CIYT1117CC Tfl RR IAICT01 I Frl r1N Fdi'.H FI r)nR
Stories )�?�:::
Urinal
:::�:::
Shower
�...���.��li:::::>::
Tray
:iu�?t�k'�:
Floor
Dram
.•..•�..I'?i�s
Wash er
�'.. <..::.•........
Gas ;:;:...
Range
Water neater
s Elec
Bas ement:>»>`>
Floor 1
o
FI r2 o
or
Floor 4
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS q l u d e-
New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin $10.00 and representations stated in this application are true and correct.
Catch Basin $10.00 /�
Rain Water Leader $10.00 DATE: 6 0 5— , 20
Sump/Receiving Tank $10.00 �� ' � �
Water Treating Appliance $35.00 OWNER 1 `� C 00 Le -if
Water Heater -Electric $35.00
Water Heater - Gas** $35.00 BUILDING USED AS Cf 114 10
Gas Range** $10.00
Gas Dryer** $10.00 ESTIMATED COST PERMIT NO.
Back Flow Preventer Required ( )Yes () No
Type $15.00 PLUMBING COMPANY
Reinspection Fee $50.00/Hr SIGNED BY A TEL N0.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS _
1.25% of Value of Fixture or Appliance `9
Approved By Rough -In Date Final Date
State Surcharge $ .50
MINIMUM FEE F ANY PLUMBING/GAS PERMIT IS $16.00 or 5% OF COST
TOTAL FEE $s S� OF THE IMPROV ENT WHICHEVER IS GREATER ON WORK LESS THAN $300
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE
k
FILL IN COMPLETELY FOR REPLACEMENT FUEL BUIkNING APPLIANCE PERMITS
COMMON VENT,* VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and terminatidn. Yes () No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No
When installing a new venting system, the undersigned hereby verifles that
it is a listed assembly and meets the current codes and manufacturer's;
specifications. This does include AGA-GAMA Category I Central Fum4ce
V6nting Tables for fan assisted and natural draft appliances. Yes () No ( )
19 the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height
Diameter inches
Appliance #1 Vent Connector Height
ft Length
ft Diameter. in Type
Appliance #2 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :