PRE 2010 DOCSVillage ®f Fridley, Minn.
N? 223
Office of INSPECTOR OF BUILDINGS
. o b,
Owners;�rv°� r.
Architect
i+
Builder
li
n
Fridley, Minn.,'
LOCA ON OF BUILDING
No. r �� Street—,"Lt", ' Part of Lot
Lot Block Addition or Sub -Division
Front , . Q Depth
To be used
Im
DESCRIPTION OF BUILDING
�� Stories 2 Manner of Construction :2n>�
To be completed + Estimated Cost
QJ
Permit i hereby gran q
8 ted t0 k..�v. f�..d ,-��"4`€ a. y vk•'"i<r%��"?^c'�i��:W 4', t0
aap�
the building- described in the above statement. This permit is granted
upon the express condition that the A' rson 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 limits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances..
" uc<<aF Inspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration 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 state and say that the facts stated by me an4# contained in the, bove ;permit are
true as therein stated.
f
R r�
a`� r
k"
Subscribed and sworn to before me at Fridley, Minnesota, this
a
day of�
City of Fridley, Minn.
BUILDING PERMIT N? 3717
Date: ... r. .... .. ............
owner?73.. F'rl� ..... Builder .... . l' .....................
Address ..:..... Address .............................................
�i .ATs� OF BUILDING
No.Street :................. Part of Lo ...............
.. . ........
Lot .... P...... Block ..../.......... Addition or Sub -Division .8.. . ......... .........
Corner Lot ............ Inside Lot ..?<........ Setback ............ S14e urd ...........................
DESCRIPTION OF BUILDING
To be Used as:
.................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
.................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction ................... Alit. 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. /C
.. ... ?s.? ........
,,��_
In consideration of the payment of a fee of $. j ..... . , 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 revolted at any time upon violation of any of the provisions of said
ordinances. A 7
NOTICE:
This permit does not cover the construction, Instateion or alteration 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 NBui3.der
Address Address
LOCATION OF BUILDING
No. Street, of Lot
Lot ..r Block. Addition.or Sub. Div..
Corner Lot Inside Lot Set Back
Applicant attach to this form Certificate of Survey of Let and proposed
building location.
DESCRIPTION OF BUILDING
To be used as
Front Depth Height
Sq. Ft. Cu. Ft.
Front ..._____._ Depth Height
Sq. Ft. Cu. Ft./l
Type of Construction Estimated Ce
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
r
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 P Signature
(A Schedule of Fee Costs can be found on the Reverse Side)
JRi'
A y
- �O�
�)_A,-?-a3
City of Fridley, Minn. 0 10708
BUIMING PERMIT
Date: Flinn 17,. 1970
Owners Norman Roseth Builder Miles Garages
Address _453 -2 -2nd Street N.E. Address 4500 Lyndale Avenue North
No. 4532 Street 2nd Street N.E. Part of Lot
Lot_ Block 13 Addition or Sub -Division . Plymouth Addition
Corner. Lot . Inside Lot X Setback 15' T_ Sideyard 4'
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Gavage Front _ 20'__ Depth Z2' Height 10' Sq, Ft, 440' CIL Ft. 4400'
Front Depth Height -- Sq. Ft. Cu. Ft.
Type of Construction `Frame Est. Cost _ $1, 600.00 _ To be Completed 60 days
Provide Hardsurfaced Driveway
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.
P
In consideration of the payment of a fee of $_ 9. dd ., permit is hereby granted to Miles Garages
thto construct the building or addition as described above. This permit is granted upon
e 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, I�tinnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
wi city limits and this permit may be revoked at any time urn violation of any of the provisitons of said
2
NO'T'ICE:
'Ills permh does not cover the construction, instalhaion for whb& plumbing, gas heating, sower or water. Be sure to we
the Building Inspector for separate permits for these hams.
1
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: ?i/ 4,41 /�7P'5 r�BUILDER :
ADDRESS:, f/J_ f7f! II SDRESS •
NO • �' y. �� STREET:
L( ��tlll �- OCK:� ADDITION •
CORNER LOT: INSIDE LOT: /f SETBACK : S I DEYARD
-�-- -—
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
i��..
DESCRIPTION OF BUILDING
Front: Depth: Height ;
Square Feet: Cubic Feet: 0 G
Front: Depth: Height:
Square Feet; Cubic Feet:
r
Type of Construction: ti�/%� Estimated Cost:=
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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 Inf�rI tion.)
u -o
i "
City. of Fridley, Minn. 11- 5 2
6431 University Ave. N. E., Minneapolis, Minn. 55432
BU11DENG PERMIT
Date:June 20, 1972
owner: .._. Norman Roseth Builder , Sane
Address _._._.-4332 2nd qt*rept- N E. Address qa-me
No. X4532 _ Street
LOCATION OF BUILDING
2nd Street N.E. part of Lot
Lot - 6.7 _ Block — 173 Addition or Sub -Division _ Plymniitb Addition
Corner Lot ______.._. _ _.Inside Lot - X Setback Sideyard
Sewer Elevation _ _ _ Foundation Elevation _..._.
DESCRIPTION OF BUILDING
To be Used as:
Raside House __— Front . Depth Height Sq. Ft. Cu. Ft..
Front Depth Height Sq. Ft. — Cu. Ft.
Type of Construction Aluminum Est, Cost — $685.00 To be Completed Arg _ 197
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 Wpr&vidons of
ordinances of the city of Fridley. \
.50 State Surcharge
In consideration of the payment of a fee of S b . no , permit is hereby granted to Norman Roseth
to construct the building or addition as described above. This permit is granted upon
the express condition that fhe person to whom it is granted and his agents, employees and workmen, in. aII Work
done in, around and upon said building, or any part thereof, shall conform int all respects •to the ordin�,nc:es of
Fridley, Minnesota regarding -location, construction, alteration, maintenance, repair and moving of buildings
epithin the city limits and this permit may be revoked a t any time upon violation of an�of the provisions of said
ordinances.
01!
CLARENCE BELISL
NOTICE:
This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or water. Be sure to as
the Building Inspector for separate permits for these items.
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME :9✓,UILDER:
01
ADDRESS: q gajj%�ADDRESS:
F
NO:. STREET
LOT; ± BLOCK: -/,3 ADDITION:T"= aziz--
CORNER LOT: INSIDE LOT: � SETBACK: SIDEYARDi
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; In
Square Feet; Cubic Feet: dd
Type of Construction: Estimated Cost:
To Be Completed:
The undersigned hereby makes application for a permit for tbe,w9rk heroin
specified, agreeing to do all work in sttict accordance with the city 9f
Fridley Ordinances and rulings of the Department of BuLldingso and hereby
declares that all the facts and representations stated in this appliq4tim
are true and correct.
(See Reverse Side For Additional information.)
01
SUBJECT
MIT
City of Fridley
12600
AT THE TOP OF THE TWINS
BUILDING PERM I T
r
_ COMMUNITY DEVELOPMENT DIV.
L
INSPECTION SEC.
r PROTECTIVE
,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
I CITY HALL FRIDLEY 55432
612-560-3450
910-F15
6/17/74
JOB ADDRESS
4532 2nd Street E
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
Fi 7
13
SHEET
Plymitth Additinn
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Norman Roseth 4532 2nd Street N -P--
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS.
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
ZON Ghal
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
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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$180.00
.50
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.
$5.00
PLAN CHECK FEE
TOTALFEE
4�
$5.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIOI4R PERMIT
SIGM JRE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG: )NSP DA
01
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME l%? ��.✓ ✓� ILDER:
ADDRESS: `J�✓ p� ��ADDRESS:
NO:.`{5-3 a STREET:
�
LOT: 7 BLOCK: Z3 ADDITION
CORNER LOT: 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:
.Zgt±�-�Zzont: Depth: Height:
tl
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: r Estimated Cost:
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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.)
0-0
0.0i C
G
.9 .
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY i AZI AIR:
Furnace Shell & Duct Work
# Replacement of Furnace
Repairs & alterations -up to $500.00
Repairs & Alterations each add. $500.00
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
*Replacement of Furnace
Re:airs & alterations -up to $500.00
Repairs & Alterations each add. $500,00
STLA`•I O.T.' IDT I':aTER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each adds. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
RATE TOTAL gob Address %z—_ 3
$1,00 $
7,00 $
7.00 $ Department of 134t1angs
4,00 $ City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
$12.00 specified agreeing to do all work in strict accordance with the City Codes
4.00 $ and rulings of the Department of Buildings, and hereby declares that all the
7.00 $ facts and representations stated in this application are true and correct.
7,00 $
440 $ Fridley, Minn. . 19
q12. PO
4.00
7• AA
P. -AA
$. Q -AA
• ;A! AA
GAS BURNER- from 100,000 BTU to l�s.ggq RTR S?A•AA
{over 199,999 BTU see Fee Sc4equlej
GAS FITTING FEES: -
1st 3 Fixtures x $ 4:AA
A23itional Fixtures x $ ;:AA
Gas 'range to 199,00Q BTU
AIR CONDITIONING
FAX HEATING SYSTEMS See Fee Schedule
VENTILATING SYSTEMS
ALT£R TIONS 4 REPAIRS
State Surcharge
TOTAL FEE
RDUGHH INSP.
Date
FI:iAL INS?. a q —
Date ,
APPROVAL FOR PERMIT to
REINSPECTION FEE
U10.00)
yZ-%TD";:: FEE FOR ANY HEATING PERMIT IS $7.50 pLUS . $. 50 STATE SURCHARGE
*Attached stack verification form
KIND pF BUILDING
pSEP AB Ir"C751 I
TA PP. PPOR QTR ?�4RT
PR - NR PATRTNG PF.F-ITT M. PERHTT N0.
pEsORTPTTPIJ PF FURNACE/&UMER
#IB n1w AI: PQ?XR PW. TSr pt -r- f #IQt-lam A No.
Trade Name :C-6,010AIJ Stze No
Capaoity 000— Sq. Ft. EDA 'BTU. I•�'�
`.� Kind of Fuel
Total Connected Load &
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company 046 4 AA +
_ o
Signed (;
Tel. No. 7rT�
•
SUBJECT - r -
I N .,
City of Fridley
31834
AT THE TOP OF THE TWINS
?-,_
B U I L D I NG PERMIT
f
COMMUNITY DEVELOPMENTDIY.
INSPECTION
� PROTECTIVE INSPECTION SEC.
f �
E �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
_
CITY HALL FRIDLEY 55432
612-571-3450
9t4-F15
5/18/01
JOB ADDRESS 4532 2 Street NE ..
I LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
Sj 6 & 7
13
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS IIP PHONE
Jon Okerstrom 4532 2 Street NE 571-4061
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Midwest Roofing 7395 Mark St, Greenfield, MN 55357 763-416-4804 20010277
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK 0 NEW_
O ADDITION O ALTERATION REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House (12 Sq) 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,
TYPI` OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
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 QE COMPLIED
$1,227
$.61
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-
$47.90
Fire SC $1.23
TRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TO IL FEE
Lice C $5 0
$54.74
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATEi
HE PR P VALI THIS IS YOUR P MIT
iN R - BATE
SIGNATURE OF OWNER.IF OWNER BUILDERI (DATE,
I
NEW [ ] Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: . �MCA
Legal Description:
Owner Name & Address: O i P -r S'i'd y',N Tel. # -'-ns11 - HD b l
Contractor. iikvx,61 Poo En MN LICENSE t ()'�-17
Address: ': °J) /-k- S1' GfearWd[ / AA1 553S-7 Tel. # lb3 -Ll l b-404
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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.
0
Construction Type: too Estimated Cost: $ e %Z2 /
r7
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: ^ 1 'Q + APPLICANT: _ _ Gr � 6e (w ``S Tel. # -1 0 - 9 `b ` "t P O -I
CITY USE ONLY -
Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee
$
® Fee Schedule on Reverse Side
Fire Surcharge
$ % �.�' .001 of Permit Valuation (1/10th%)
State Surcharge
$
/ $.50/$1,000 Valuation
SAC Charge
$
$1150 per SAC Unit
License Surcharge
$-CSO
_
$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 $A-1 �G
STIPULATIONS:
( OON 1kC---
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
Effective On January 1, 2002
JOB ADDRESS L45�� ,11 �/1
OWNER �� ls1�t�U)�iV�Y�
Rate TOTAL
BUILDING USED AS ; � -t Z
$ 30.00 $ _
ESTIMATED COST I`J '�® PERMIT NO.
$ 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 $'5000 Fuel Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
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.
$ .50
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true end
nd correct.
DATE G -Y
HEATING CO DEPENDABLE INDOOR AIR QUALITY, I
26!9 e60F4 RAPIDS i
COON RAPIDS. MN 654a
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When reIn acing an existing f uran . the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes() No()
The existing comhustinn air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new enmhustinn 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 #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
HEATING CO:
Signed By: Date:
3uilding
BUILDING
Permit No.:
rnspccfioiis
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: 9, I
)ATE 'U Y
YOUR E-MAIL ADDRESS
;ITE ADDRESS
—SFa---e A1 q-
1-0 APPLICANT IS:
iKbWNER ❑CONTRACTOR
PROPERTY OWNER!
NAME: D, Ar. d c — I �h�, r ate✓ erg t
ADDRESS: L 4S -�' TY vet ( e,
STATE IP rLI Z'
TENANT
PHONE: rI Cn 3, !�-O )- I G ct'2--
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
O TWO FAMILYNEW CONSTRUCTION STORIES
PERMIT TYPE
O ADDITION O GARAGEISHED I9 WINDOWS
0 BASEMENT FINISH O ROOF O DRAIN TILE
O DECK 0 SIDING O OTHER
0 SWB041NGPOOL
TYPE OF WORK:
0 NEW 0 ADDITION
0 MAINTENANCE/REPAIR 0 REMODELING
DESCRIBE WORK BEING DONE: Ir" 4,-((
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
0 HOUSE ONLY
NUMBER OF SQUARES
0 HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
0 ATTACHED GARAGE
1. Existing Floor Plan
2• Proposed floor plan
PROPOSED SIZE:
0 DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
O Vinyl
OSofft
ADDITIONS, & PORCHES SUBMIT:
O Aluminum
0 Trim
I. Site Plan/Survey showing the existing structures
0 Other
0 Fascia
and proposed project.
Two sets of construction plans
WINDOWS2.
3. Energy Calculations
IN EXISTING OPENINGS 12Y/es
ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &t
TYPE OF WWDOW TO BE INSTALLED c?luw-+ eA�- NUMBER OF WINDOWS 1 L
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 3 ► 20 0, a3 OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: Citv of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all wor requir! s v w and approval of plans. ((�� a �i
SIGNATURE OF APPLICANT PRINT NAME D vk, - - 0v-,) d" ( DATE �S- - o
SOki
CIWOF
HUDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
1, D 0 P C& U. understand that the State of Minnesota
requires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a specific exemption from the licensing requirements. As
the owner of the property at WS2 ;z�- V J�,Jq-- , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Nam
Date_ 5? -3 1-()(,
Building
$ ',) .(pyS'
BUILDING
Plan Review
Permit No.: -6/1
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
.001 times the total job valuation
Received ByOA4f'
763-572-3604
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ no
G 0'6 ZUU9
SAC Charge
$
CITY OF FRIDLEY
Curb Cut Escrow
D LRQcP
763-502-4977 FAX
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
EFFECTIVE 1-I-09
Sewer Main Charge
$
DATE � ` b (
YOUR E-MAIL ADDRESS
$ 3 Q JCA
SITE ADDRESS 1:5 3,;x,
a ST N,6
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: DL)ANiE OLkAOA%t,,
TENANT
ADDRESS: 4Jf 3Z a10✓10 Sr NG CITY F+:.! O §! '" STATE /k ^4IP a -
PHONE: &'S — SCux— /0 a
CONTRACTOR
A/
NAME: AAAr- eeAvs r Rt;c Tt%jo
SUBMIT A COPY OF
STATE LICENSE # b 364( / 3 EXP DATE
3 — 3
YOUR STATE LICENSE
AND CERTIFICATE OF
a2b
ADDRESS: kV b $9 7 8M AV' CITY at/
44 CIA STATI1" 1 A -}LIP 1_63 3
INSURANCE
PHONE d —717 — 02 / 7 FAX ,3.20 "
• .23/
PROPERTY TYPE
;MINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH PWOOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
)&MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: RAA, —t�r-P ¢ or— 4,A eArL-rAE� d AJ I- y
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING s ❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES V
❑ HOUSE & GARAGE
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
I .
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS []Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING THE 19 7 .B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ , 6"0 OCCUPANCY TYPE
Permit Fee
$ ',) .(pyS'
See Back Page for Fee Schedule "3Q(
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ '1
.001 times the total job valuation
Surcharge
$ 50
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ no
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ 3 Q JCA
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application fora a it and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of al requires review and approval of plans. ®�,,
SIGNATURE OF APPLICANT PRINT NAMETt> AV -d f� `Ov uJ lrl DATE 0 ��
Building
71�� BUILDING
Permit No..
Inspections
$
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
WE"D9-
763-502-49>77 FAX
EFFECTIVE 1-1-09
DATE �`� (�
YOUR E-MAIL ADDRESS
SITE ADDRESS 7;;Z: rf_ IN
THIS APPLICANT IS:
❑ OWNER J'3EONTRACTORR
PROPERTY OWNER/
NAME: 1 A f,.) (0 K0 Q0A R L
ADDRESS: q � —''O S % CITY %^�l�De�g" % STATE,"IP
TENANT
PHONE: '2 4 3A —
CONTRACTOR
NAME: tS /6-2-1 t
STATE LICENSE # �0(, 90 C( 13 EXP DATE —3'— 3/-/o
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: d n=t
r.
CITY Al IL <4 STATWAtIR. 3C
INSURANCE
PHONE - '-02 517 FAX
- /7 3 '"'
PROPERTY TYPE
�INGLE FAMILY/NEW CONSTRUCTION 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
IAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: "O p-p /'Oz— e} i
d N
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
,OUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
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 S Q
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �"�/ A b. CAD OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential. Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a_gprmit and work is not to start without a permit on'site; that the work will be in accordance with the
approved plan in the case of all w ' re es review and approval of plans.
9 %
SIGNATURE OF APPLICANT _ �_ __ PRINT NAME J _ '.hj DATE
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential. Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a_gprmit and work is not to start without a permit on'site; that the work will be in accordance with the
approved plan in the case of all w ' re es review and approval of plans.
9 %
SIGNATURE OF APPLICANT _ �_ __ PRINT NAME J _ '.hj DATE