PRE 2010 DOCSCity of Fridley, NUn.n.
BUILDING PERMIT N95 s 7 4
Date: _ r="�. ip
G K",
Owner: Builder - – �-
Address Address --.
.!DCeTION OF BUILDING
No. street _ _ Part oTots
Block _ Addition or Sub -Di 'on1 01
.
Corner Lot Inside Lot 4pback Sideyard
Sewer Elevation _ _ _ Fo dation Elevation _
DESCRIPTION OF BUILDING
To. as:
Front Depth Height Sq. Ft. Cu.,3
Fro Depth ei t Sq. Ft. - Cu. Ft. W_
Type of Construction _ Est, t _ To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration, of the payment of a fee of $ fe 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
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
�
Inspector
NOTICE.-
This
OTICE:This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner ° s
Name
t' S' �&Wgr
Builder
6�'d We. ®
AoV 1&, C �
Address�`��
Addresses
LOCATION OF BUILDING
No. 1/ 7.33 Street Zee✓W S �- P)"e Part of Lot /&A X
Lot .2 3 Block 1�' Addition or Subdivision
Corner Lot Inside Lot X Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
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 a •
4-'q 4? �gv Front ®o( Depth -2 1 Height
Sq• Ft, 3�®2-,. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of ConstructionEstimated Cost e``
To be Completed 7 �-
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE - 7— SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
CITY OF FRIDLEY INSPECTION
6431 University Ave NE
Fridley, MN 55432
(763) 572.3604
RATE SCHEDULE
DIViSION
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
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 q1733 33 2-f%d S-1— ° X • E
OWNER Na7 malt'1 C0J/_;/7S_
Rate TOTAL n
�� � BUILDING USED AS
$ 30.00 $ P
ESTIMATED COST deo' PERMIT NO. A_
$ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units f Circle One (Steam) (Hot Water) arm Air)
$ 10.00 $ Trade Name Size No. a 17'7 TO V
g56c) BTU VS p HP EDR
$ 25.00 $ Fuel ,"-2 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.
$ .50
$ 5(5, 5_0
Burner Trade Nam
BTU
Size No
HP
CLJ (/ 2 A"
_ 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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE C�2
HEATING C T olud4
Signed TEL #
FAX # 033 7
Approved By Rough -In Date Final Date
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
GQMMON V NTS VENT CnNNFGTnR AND COMBUSTION AIR V RIFT ATIQN
When re la _ing an LaAs ing 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 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 ins alling_a new venting-gyctem, 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 :
NEW , [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER JjJ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
f BUILDING PERMIT APPLICATION
Construction Address: 3.; Z" &/ 57- tu e
Legal Description:
Owner Name & Address: Gnco/s ,4L Cal- , 1, Tel. # 7,53--���
Contractor: .1 c 44' r MN LICENSE # 21 �
Address: /000 S 17'4 41-Q 1�7 G C/rP57Z7 z- � c- 11 Tel. #41
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:
Construction Type: �e �Cc®� Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = FU $
DATE: APPLICANT:
Call (763) 572-3604 for Permit Fees if
you for card number.
Permit Fee
P
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Tel. #
application. Fax to 763-571-1287 If using credit card and we will call
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: