PRE 2010 DOCSiG
VMage ®f Fridleyq Minim.
BUHMING PERX[T
N? 202 Office of INSPECTOR OF BUMI)INGS
Own Ti
er lo
ArchitectFridley, Minn., 19
�j
Builder
LOCATION OF BUILDING
NO.
Street. Part of Lot
Lot II, Block_ Addition or Sub -Division
:L,4'
&MTION1 OF BUILDING
-2
Front- 'Depth Height --
—f Stories/ Manner of Construction
To be used as
To be completed
46L
5Estimated Cost --;
—77
Permit Is hereby Olanted to ',,J -.- ' I,,'! I ' to Lam" I I
the bull
ding described in the above statement. This permit Is granted
upon the express c'Inditlon that the p4,"pon to whom It is granted, and his agents, employees and workmen, in an
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.
L—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 perm description
#, I hereby agree to do the proposed work in accordance with the de c ption
above set forth land 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 and contained in the above permit are
true as therein Mated.
Subscribed and sworn to before me at Fridley, Minnesota, this
day A.D. 19-s #.
City of Fridley, Minn.
BUILDING PERMIT
Date: May 17, 1967
Owner: Dongl d RM Crooks Builder
Address 5 910 2nd St. N.E. Address
B.& K Builders
V° 9248
5727 Knox Ave. North
LOCATION OF BUILDING
No. 5910 Stmt 2nd Street N. E. ____ part of Lot
Lot _ _ _ ___ Block
Corner Lot --- Inside Lot
Sewer Elevation
Addition or Sub -Division
Setback --- Sideyard
____ Foundation Elevation ._._....—
DESCRIPTION OF BUILDING
To be Used as:
Reshingle Rood Front _ _ Depth _ freight — Sq. Ft. Cu. Ft.
Front Depth freight _ _ Sq. Ft. CtL Ft.
Type of Construction _ Roofing Est. Cost Q 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 ail provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 5.00 permit is hereby granted to B & R Builders
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 peons of said
ordinances.
CLARENCE BELISLE Building Inspector
NOTICE:
This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or water. Be sun to see
the Building inspector for separate permits for these hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME ° BUILDER .,s�•'�c� G�'���✓ _
ADDRESS 2-2� ADDRESS
LOCATION OF BUILDING
NO. STREET PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDE -YARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form two certificates of survey of lot and proposed
building location drawn on these two certificates.
'DESCRIPTION OF BUILDING
To be Used as:
-- Front
Depth Height
Sq. Ft. Cu. Ft.
Front
Depth
Height.
Sq. Ft. Cu. Ft.
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 strict accordance with the City of Fridley 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 i — SIGNATURE ���ei �� 1•`� <--�%'
(Schedule of Fee Costs can be found on the Reverse Side).
e
MECHANICAL WARM AIR:
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU $12.00 $ specified agreeing to do all work in strict accordance with the City Codes %
each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the
Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct.
Repairs & Alterations -up to $500.00 7.00 $
Repairs & Alterations each add. $500.00 4.00 $ Fridley, n. , 19t791,"
SMA.M OR -HOT WATER SYSTEM: OWNER v
Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING
each addn. 50,000 BTU 4.00 $
Boiler only up to 100,000 BTU 7.00 $ 100 USED AS
each addn. 50,000 BTU 6.00 $
TO BE COMPLETED ABOUT oZ GJ Z d
OIL BURNER- to 3 gal. per hour $10.00 $��
each add. 3 gal. per hour 10.00 $ ESTIMATED COST
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $-6. PLDNEW BUILDING PERMIT NO. PERMIT NO. 4
8
(over 199,999 BTU see Fee Schedule) $
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $ 19- DESCRIPTION OF FURNACE/BURNER
Additional Fixtures x $ 1.00 $
Gas Range to 199,000 BTU x $10.00- $ HEATING or POWER PLANTS, Ste `19E
Wat , Warm Air- No.
AIR CONDITIONING $ Trade Name Size No. ;2-,3 -L9'
FAN HEATING SYSTEMSSee Fee
Sc$ hedule $
VENTILATING SYSTEMS Capacity o2 �� Sq. Ft. EDF BTU HP
ALTERATIONS REPAIRS $
State Surcharge %� .50 Total Connected Load ...5 � � Kind of Fuel `
TOTAL FEE
BURNER - Trade Name Size No.
ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP
Date ($10.00)
Company4 V7"
14
FINAL INSP.
Date Signed By
APPROVAL FOR PERMIT / Tel. No. 2 Wk
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS
AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
_
GRAVITY WARM AIR:
RATE
TOTAL Job Address
Furnace Shell & Duct Work
$12.00
$
Replacement of Furnace
Repairs & Alterations -up to $500.00
7.00
7.00
$
$
Department of Buildings
Repairs & Alterations each add. $500.00
4.00
$
City of Fridley
Tel. #571-3450
MECHANICAL WARM AIR:
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU $12.00 $ specified agreeing to do all work in strict accordance with the City Codes %
each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the
Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct.
Repairs & Alterations -up to $500.00 7.00 $
Repairs & Alterations each add. $500.00 4.00 $ Fridley, n. , 19t791,"
SMA.M OR -HOT WATER SYSTEM: OWNER v
Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING
each addn. 50,000 BTU 4.00 $
Boiler only up to 100,000 BTU 7.00 $ 100 USED AS
each addn. 50,000 BTU 6.00 $
TO BE COMPLETED ABOUT oZ GJ Z d
OIL BURNER- to 3 gal. per hour $10.00 $��
each add. 3 gal. per hour 10.00 $ ESTIMATED COST
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $-6. PLDNEW BUILDING PERMIT NO. PERMIT NO. 4
8
(over 199,999 BTU see Fee Schedule) $
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $ 19- DESCRIPTION OF FURNACE/BURNER
Additional Fixtures x $ 1.00 $
Gas Range to 199,000 BTU x $10.00- $ HEATING or POWER PLANTS, Ste `19E
Wat , Warm Air- No.
AIR CONDITIONING $ Trade Name Size No. ;2-,3 -L9'
FAN HEATING SYSTEMSSee Fee
Sc$ hedule $
VENTILATING SYSTEMS Capacity o2 �� Sq. Ft. EDF BTU HP
ALTERATIONS REPAIRS $
State Surcharge %� .50 Total Connected Load ...5 � � Kind of Fuel `
TOTAL FEE
BURNER - Trade Name Size No.
ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP
Date ($10.00)
Company4 V7"
14
FINAL INSP.
Date Signed By
APPROVAL FOR PERMIT / Tel. No. 2 Wk
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
NAME
H T G. C O N T R. ADDRESS
DATE
NAME
`� O B [ADDRESS r
FL.
ROOM LENGTity R
WIDTH
y HEIGHT
FL.
ROOM LENGTH f
ROOM LENGTH WIDTH
HEIGHT
WINDOWS AND DOORS-CRACKAGE AND AREA
ROOM
WINDOWS AND DOORS-CRACKAGE AND AREA
WIDTH HEIGHT
NO. WIDTH HEIGHT No. OF LINEAL FT AREA
' LIGGHTS OF CRACK SO. FT
NO. WIDTH HEIGHT NO. OF LINEAL FT. AREA
LIGHTS OF CRACK S0. FT
WINDOWS AND DOORS-CRACKAGE AND AREA
NO. WIDTH HEIGHT N0. OF LINEAL FT. AREA
LIGHTS OF CRACK SO. FT.
,,3
COEF.
BTU.
COEF. BTU.
COEF. BTU
a
COEF. BTU
INFILTRATION
INFILTRATION
INFILTRATION
�2
GLASS
GLASS
GLASS
EXP. WALL
EXP. WALL
EXP. WALL
EXP. WALL
NET EXP. WALL'
NET EXP. WALL
! 7i
NET EXP. WALL
NET EXP. WALL
CEILING
CEILING'
FLOOR
CEILIN.G
FLOOR
TOTAL BTU.
TOTAL BTU.
FL.
ROOM LENGTH f
WIDTH
/ 71 HEIGHT
FL.
ROOM
LENGTH
WIDTH HEIGHT
WINDOWS AND DOORS-CRACKAGE AND AREA
NO. WIDTH HEIGHT NO. OF LINEAL FT. AREA
LIGHTS OF CRACK SO. FT.
3o7 rlo 2 1,5-
-2-
S-2-� 1- O
WINDOWS AND DOORS-CRACKAGE AND AREA
NO. WIDTH HEIGHT N0. OF LINEAL FT. AREA
LIGHTS OF CRACK SO. FT.
COEF.
BTU.
COEF. BTU.
INFILTRATION
a
INFILTRATION
GLASS
�2
GLASS
EXP. WALL
l�,
EXP. WALL
NET EXP. WALL'
! 7i
NET EXP. WALL
CEILING
o,-®
CEILING
FLOOR
®
�oZ Q
FLOOR
TOTAL BTU.
TOTAL BTU.
FL.
ROOM LENGTH
WIDTH
HEIGHT Z
FL.
ROOM
LENGTH
WIDTH HEIGHT
WINDOWS AND DOORS-CRACKAGE AND AREA
WINDOWS AND
N0. WIDTH
DOORS•CRACKAGE AND AREA
HEIGHT IN JLINEAL
L�GHTS OF CRACK
SO RFT.
N0. I WIDTH I HEIGHT LOF
�GHTS OF CRAEA
CK SQR F7.
COEF. BTU. I I I I I COEF. BTU.
INFILTRATION INFILTRATION
GLASS
EXP. WALL
NET EXP. WALL
CEILING
FLOOR
TOTAL BTU.
TOTAL E.D.R. STEAM
GLASS
EXP. WALL
NET EXP. WALL
CEILING
FLOOR
TOTAL BTU.
TOTAL BTU. HEAT LOSS
HEATING UNIT
TOTAL SQ. FT. H.W.
0
CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION4 P�.. DATE A— 0
e
OWNER ADDRESSJLJe — ,,2
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
Z. Is free from rust or deterioration
3. No foreign objects are lodged within - s
4. That it is securely supported l�
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU /
All Other BTU
TOTAL
REMARKS ZdA, 9
HEATING PERMIT #
SIGNED
Address
Telephone % ,y F --
Fridley City License #
moi,. ea:uva euay. �., i�oi
CITY OF FRIDLEY
APPLICATION FOR PWMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$ 5.00
,�
14
$
a
water
01 W
��
€`]
S 4.00
$
b
E
b
e
$ 5.00
m
a) M
14
p,
-1
w
$ 5.00
$
Heater
Rain Water Leader
$ 5.00
$
Hydraulic Valve
$ 5.00
$
Sump or Receiving Tank
�a
W
Water Treating Appliance
$ 7.00
$
s
Hot Water Heater
ii
$ 5.00
m
m
o
$ 10.00
g
+y
Gas Dryer
V
9
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
lec
U)
u
W
Appliance
m
ow
to
w
c�c
w3
u�
os
($15.00)
TOTAL
FEE
$
/0. SD
1st
2nd
3rd
4th
(R) a Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$ 5.00
Future Fixtures
$ 3.50
$
Old Opening, New Fixture
$ 1.50
$
Beer Dispenser
S 4.00
$
Blow Off Basin
$ 5.00
$
Catch Basin
$ 5.00
$
Rain Water Leader
$ 5.00
$
Hydraulic Valve
$ 5.00
$
Sump or Receiving Tank
$ 5.00
$
Water Treating Appliance
$ 7.00
$
Hot Water Heater
$ 5.00
$
Gas Range
$ 10.00
$
Gas Dryer
$ 10.00
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or
Appliance
$
State Surcharge
$
.50
Reinspection Fee $
($15.00)
TOTAL
FEE
$
/0. SD
Job Address —af2/,0
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn.
OWNER XV Ae�) 1"/ 441 JC
RIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT Ile-, /Y2
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. 82 r79'
ROUGH INSP.
Date
Company
Signed By �>
Tel. No. �-
FINAL INSP.
Date
APPROVAL FOR PERMIT 44
MINIMUM FE ANY PLUMBING PERMIT I $10.00
PLUS THE .50 TATE SURCHARGE
SUBJECTP
NO.
City of Fridley
16 9 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
RE
�
-------- COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
t ,
t . ,
i-__- A CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�r���,•�
612-571-3450
910-F15
2/8/83
JOB ADDRESS 5910 2nd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
13-15
9
1 Hyde Park SHEET
2 PROPERTY OWNER. MAIL ADDRESS ZIP PHONE
Wintnn Rnhwpdnor 5910 2nd Street N.E. 574-1278
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
The Balluff Company 10920 Wayzata Blvd. 541-9910
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
residenttial
7 CLASS OF WORK
❑ NEW CX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
18 x 10 solarium hetween house and attached qarage
9 CHANGE QF USE FROM TO
STIPULATIONS
1. Provide frost footing is none exists.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
wood fram
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
180
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
7500.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
3.75
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
68.50
PLAN CHECK FEE TOTAL FEE
3 IA 89.38
SIGN TURE OF CONTRASTOR ORAUTHO ZED AGE (DATE)
WHENROP RLY V I T THIS IS YOUR PERMIT
.,BLDG INSP DATE
GNATURE OF OWNER OF OWNER BUILDER! IDATEI A,,.
CITY Of FRIDLEY Effective Aug. 1, 1981
APPLICATICH FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions,, or Repairs)
OWNER: moi, i-td7T-V' r 1.45 ®tom
ADDRESS: /-.16
TEL M0: w7l— Z-7.
BUILDER: _ 7—Mg C ca.
ADDRESS: !a 9,;�,O— l—, yz47,sq C�LvIJ,
TEL 110: 5 L11- 2d?/0
Construction Location
• STRECT NO: % C7 STREET: J
IAT: /3 '-O BLOCK: ` ADDITION:_c
Corner Lot: Inside Lot: �� Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
s DESCRIPTION OF CONSTRUCTION
Front: p Depth: Heights
t
Square Feet: d' Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
'type of Construction: _ Estimated Cost: $ 7c5 a®,
Rb Be Completed: 6, 0 17!2��
Alt. A Alt. B
Proposed Driveway Width If Now Opening Is Desired: $ ' $
SEE REVERSE SIDE OF SHEET
Zi:e undersigned hereby makes application fox 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 DeLxlrtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true d correct.
DATE: TA -v, 10, SIGNATUM:
Stipulations:
c' Cod.SV
3n
V.n
f
�:� �C.rr� �r ..
♦/
J
SUBJECT
N
City ®f Fridley
6
268 51
AT THE TOP OF THE TWINS
BUILDING PERMIT(
r
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
R
r � PROTECTIVE
NUMBER
REv
DATE
PAGE OF
APPROVED BY
CITY HALL FRIOLEV 55432
612-571-3450
910-F15
7/28/98
JOB ADDRESS
5910 2nd St
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1311 15
9
H de Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Sharon Hanson 5910 2nd St NE
571-8668
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION IV REPAIR
O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (30 S Tear -off; reside house and garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
Call for building wrap inspection before covering.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK 1S COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
1 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
4500
$2.25
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.
$99.75
Fiw SC $4.50
PLAN CHECK FEE
TOT EE
06.50
OFC Ni O THORIZEDAGENT )DAT
N P IDA THIS IS UR PERMIT
VSIGNATURE
2PIO
I ~BLDG SP
�1ATE
Si NATUREOF OWNEROF OWNER BUILDER) ID EI
J
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLEIDTPLC�D R-2
BUILDINGING PERMIAPPATIONjQ ls'!�I
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:
VAt-1
0='A
FjffYA
Tel. #
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE -AREA: Length
DECK AREA: �jLength
OTHER:2S
Constructi Type:
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Estimated Cost: $ /` — -q - ArexIA'�(_5,
(Fee Schedule on Back) '/�5-0 0
Driveway Curb Cut Width Needed:
Ft. 6 Ft = Ft x $ _ $
DATE: '� a8
APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee $
��
Fee Schedule on Reverse Side
Fire Surcharge $
�i S-0
.001 of Permit Valuation (1/10th%)
State Surcharge $
�2S
$.50/$1,000 Valuation
SAC Charge $
$1000 per SAC Unit
License Surcharge $
$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
STIPULATIONS:
Building BUILDING Pest No.: z �����
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd:
DATE `P I �(� -- - YOUR E-MAIL ADDRESS
SITE ADDRESS '�'-q 10 2y Si-, M
THIS APPLICANT IS: ❑ OWNER %CONTRACTOR
PROPERTY OWNER/ Nom: } n s®?
TENANT ADDRESS: '<Ckri e. CITY STATE—ZIP
PHONE: /'
CONTRACTOR NAME: P��-11 ® aV%L1 D.-1
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
STATE LICENSE #RA L EXP DATE a
ADDRESS: V CITY,
PHONE /..cry_ /-`7i —jinn FAX :Z5 R i
PROPERTY TYPE A
PERMIT TYPE
TYPE OF WORK:
❑ BASEMENT FINISH
❑ DECK
❑ NEW
❑ MAR
DESCRIBE WORK BEING
..,T7E OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES —
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TvnF nF WINDOW TO BE INSTALLED
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 140, 000 P> OCCUPANCY TYPE
❑ GARAG
❑ ROOF
❑ SIDING
❑ SWIMM
M
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF
SIZE
STORIES
❑ WINDOWS
❑ DRAIN TILE
❑ OTHER
a li
WIDTH I ` -.& HEIGHT
wmffl�]"
Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$�/al
$
$�
$
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$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires re iew and approval of plans.
SIGNATURE OF APPLICANT N11k _ ^%' PRINT NAME ---YD f- %A )%--DATE � \> Q7
From: City of Fridley To: 7634346464 Page: 213 Date: 2/2/2009 9:28:43 AM
Building
MECHANICAL
Permit No.40WO
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Da e dFEB 0 4 20
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE Feb. 2, 2009 YOUR E-MAIL ADDRESS
SITE ADDRESS 5 910 2nd S t . ply
THIS APPLICANT IS: D OWNER DICONTRACTOR
PROPERTY
NAME: Sharon Hanson
ADDRESS: 5 910 2nd St. NE CITY F i r d 1 e y STATE N 5 5 4 3 2
OWNER/
TENANT
_GIP
PHONE: 763-571-86ti$
CONTRACTOR
COMPANYNAME: Anderson Burner Service, Inc.
NOTE:
SEPARATE CITY
Howard or Di
CONTACT PERSON:
STATELICENSE# 55-200208 EXP DATE 17-19-nq
LICENSES ARE
FOR GAS
REQAN D HVAC..
ANll
ADDRESS -17535
Chisholm S tN E CIT)i a m a1�L
Lke STAIN Z�5 3 0 4_ 4
SUBMIT COPY OF BOND
PHONE 763-434-6464 FAX same
AND INSURANCE
PERMIT TYPE
1:SINGLE FAMILY 11TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW XEJ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK reel are Pxi ci-i ng nat gas boil e -r-
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
OR
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: Burnham MODELP204BHWNS SIZE/BTU 96,000
MFG: MODEL: SIZEIBTU
MFG: MODEL: SIZE/BTU
A/C $25.00 _FIREPLACE ('GAS) $15.00 _GAS RANGE/OVEN $10.00
AI R TO AIR EXCHANGEER $15 ( WOOD) $35.00 NEW GAS GRILL $10.00
-FIREPLACE
:XBOILER $35.00 RNA CE $35.00 _GAS UNIT HTR $10.00
_FU
LINER $10.00 DRY ER $10.00 _POOL HEATER $35.00
_CHIMNEY _GAS
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
E>PRE.-> I$:F1al+iD11R: Sfl0 »::::::::<><»><»
............................................................................................................................................................................................................................
::>::»:::<>»::::><:;>:s >:Plll
Permit Fee $ 35 .00
Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50
Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $
OR Number of fixtures @, $25.00 x $25.00 = $
_
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
MINIMUM $15.50
MINIMUM $15.50 Total ,60
THIS IS AN APPLICATION FORA PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical permit and 1 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 wit ons es• tat understand this is not a permit but only an application for a permit and work is not to
start without a permit; that the will be in accord az t the i plan' the case of all work which requires review and approval of plans.
SIGNATURE / PRINT NAME Howard Anderson DATE -?-2-0q
APPROVED BY DAT
.. ..
.,>�I~I...
?+�€.>'�[is1�1�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
56