PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERMIT
Date:.............. .. .......
e'
Owner�Ai Y .�rr' � ✓� .`
Address
r
Builder ... .p.�....... y�. ..... ....
Address .. �?..�. 1 -.!.rs ....... -,�' Y✓/
e� % LOC/j ION UILDING
No.! .1 . Street ... �� .! . a!4'" ..... Part of Lot
Lot .. A4....... Block ,.... J./.......... Addition or Sub -Division . ... ��- . .......... .
Corner Lot ........... Inside Lot ........... Setback ........... Si eyard .............................
DESCRIPTION OF BUILDING
To be lised%as:
��rr �
71/.... Front 3 .e�.`. Depth l4. / . Height Awo Sq. Ft.c� . / Cu. Ft. ....... .
..................... F t ........ Depth ........ Height /.�®�.. Sq. Ft. ........ ,yC,u`._ F't. ........
Type of Construction Est. Cost ./ ®! ..... To be Completed .0.'7 ..
e `iI
A
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 village of Fridley.
In consideration of the payment of a fee of $./!., permit is hereby granted to%1'
......................... to construct the building or addition' as described above. This permit is granted upd'n
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 village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
a
•(� • �r°! Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring um , gas heating, -`
sewer or water. Be sure to see the Building Inspector for separate permits for th " items.
i
City of Fridley, Minn.
BURDING PERMY17 N° 3923
- 7Date: ....�..... �.. ..� .....
Owner Builder ..or.e. ...........
Address ................................... Address .............................................
LO��C/�A��TI ONS%�BUILDING I LD I N G
.. . �,'•1.:. .Part of Lo .. .. ........ .
A
.. .. ..
Lot .C? 6 ..... Block .. A ............. Addition or Sub -Division . . .
Corner Lot ............ Inside Lot ..4n ....... Setback ............ 040yard .............
DESCRIPTION OF BUILDING
be
Us
as:
.. ...
Front �� .. De .�. � -Height Ft.CUL Ft.
............ ..... Front ........ Depth ........ Heiig``ht ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction ................... Fst. Cost... 7,S .. `.�� To be Completed ...................
in consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $.. permit Is hereby granted to ...................
............. ............ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done In, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
SUBJECT
PERMIT -.
City of Fridley
ori825 1
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
REC O.
`L ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
?
r PROTECTIVE
id
/
i �'� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
---.�
L 612-571-3450
910-F15
10/16/85
JOB ADDRESS 5947 - 211 Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2627
11
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Alfred/Pat Gabel 5947 -- 21� Street N.E.
571-1288
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
S acne
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 Cj ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Rooting can be 2nd layer but not 3rd. Install ridged galvanized valleys.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Asphalt
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 BE COMPLIED
$500
$.5O
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
ANY OTHER STATE LOCAL LAW EGULATING CON-
PROVISIONS CON-
$15.00
STRUCTION ORFTHE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$15.50
NATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
.. HEN RQ
Y ALI ED THIS IS YOUR PERMIT
BLDG INSP
�aTE
,?77SIGNATURE OF OWNER IIF OWNERB LDERI IDATEI
NEW [ ] City of Fridley Effective 4/1/84
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: 69AII7 a
Legal Description: Ln' 5 0?(— �'� -
Owner Name
Contractor
Address
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
Length Width Height
Length -)
Width Hgt/Ground
. # .5,71 — 1o7,B[Q
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: Estimated Cost: $
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired:
DATE: /fo APPLICANT:
CITY USE ONLY
Alt. A Alt B
$ $
See Back Page for Explanation
Tel. #
v
Permit Fee $ Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $425 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS:
w • •
m
rJ
9
SUBJECT
PER=.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
` COMMUNITY DEVELOPMENT DIV.
L_ -____
r PROTECTIVE INSPECTION SEC.
t �
`
CITY HALL FRIDLEY 55432
NUMBER
REV.
BATE
OF
APPROVED BY
L 612-571-3450
910-F15
6/15/88
;GE
/
JOB ADDRESS 5947 - 211 Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
26 27
11
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Patricia Gabel 5947 - 2h Street N.E.
571-1288
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS
ZIP PHONE LICENSE NO,
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION) REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Fire Repairs to Deck and side of House
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan
WARNING SEPARATE PERMITS REQUIRED FOR
Before digging call local utilities WIRING, HEATING,
PLUMBING AND SIGN.
TELEPHONE - ELECTRIC.- GAS Etc.
RMUIREb'SY LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE 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.
1
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
$850
$� rJQ
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
6.
$23.50
sl TURE OFCON iRACTOR ORAUTHORIZEO qENT IDATEI
WHEN PROPERLY (DATED HIS IS YOUR P RMIT
B OG INSP
QAT
iGNATURE OF OWNER 0F OWNE BUILDER( IDA I
rJ
9
NEW [ ]
ADDN [ ]
ALTER [ ]
Construction Address
City of Fridley
R-1 AND R-2
Building Permit Application
EEfective 5/1/88
legal Description: a4 /--)7 Owner Name & Address : Zai �- _ Tel. #
Contractor: Tel. #
Address:
Attach to this application, a Certif icate of Survey of the
lot, with the proposoed construction drawn on it to scale.
DESCRIPPION OF II+ PROVEME2V
LIVING AREA: Length Width Height Sq. Ft.
GUAGE • Length Width Height Sul. Ft. '
DECK AREA: Length Width a Hgt/Ground Sq. Ft.
�t ��- ilk
Corner Lot [ ] Inside Lot lam, Ft. Yd Setback Side Yard Setbacks
D�
Type of Construction: Estimated Cost: $ e?16'D
Approx. Completion Date:
90 � 6 _rev f`930. Lfo
Proposed Driveway Width If New Opening Is Desired: $_
Width + 6'
DATE: APPLICANT.
MY USE Y
Alt. A Alt. B
$
See Back Page
Tel. #
Permit Fee $ e Fee Schedule on Reverse Side
State Surcharge $.50/$1,000 valuation
SAC Charge $ $550 per SAC Unit
Driveway Escrow
Park Fee
Sewer !lain Charg
TOTAL
A M ULATIOHS:
Alt. "A" or Alt. "B" Above
Fie Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
1
®�
g e-,
L��ti
C� 1
7,
00 t)OkAlL ;rn OIL %"- -V'l
I
3'.sTr;
RMIT NO..,S
City of Fridley
sue1ECT
,
27523
2 7 5 2 3BUILDING
AT THE TOP OF THE TWINS
PERMIT
COMMUNITY DEVELOPMENT DIV.
1 v PROTECTIVE INSPECTION SEC.
r
u/vim
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
9/2/1198
JOB ADDRESS
5947 2 1 2 Street NE
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
262.27
11
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Pat Gabel
-
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 O ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and shed 21 S 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 80 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
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
$1799
.90
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.
$56.75
Fire SC $1.80
PLAN CHECK FEE
TOTAL F
_,'07
- A
59 45
S TUR OF CON, RA TO R�AUTHORIZGENT IDATEI
P PE LIDATED S IS YO PERMIT
L�
BLDiNSP
BATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ]
Width
Height
Effective 1/1/98
ADDN '[ ]
Width
CITY OF FRIDLEY
Sq. Ft.
ALTER [ ]
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Hgt/Ground
Sq. Ft.
BUILDING PERMIT APPLICATION
I<G C/
Me)
5_�/�
J�
ConstructionAddress:
�?
Ay
Legal Description:
Owner Name & Address: 7W
Tel. #
Contractor: 6
4?" -r N Ile e
MN LICENSE
#
Address: - ;f� 7 y Tel.
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:
I<G C/
Me)
5_�/�
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
r d
Estimated Cost: $
(Fee Schedule on Back)
Ft x $ = $
DATE: % - APPLICANT: Tel. #
CITY USE ONLY
Permit Fee $ 56, .S
Fire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
(763) 572-3604 FAX: (763) 571-1287
5947 2 1/2 ST NE
233024220120
UNAVAILABLE
: LOT BLOCK
HEATING
RESIDENTIAL
ADDITION/ALTERATION
PERMIT NO.: 2005-00037
DATE ISSUED: 01/07/2005
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
VALUE OF APPL OR WORK 0 # FURNACES I
# GAS DRYERS 0 # GAS RANGES 0
VALUE (FOR MINIMUM CALC) 2500
APPLICANT
BONFES PLUMBING & HEATING
505 RANDOLPH AVE
ST PAUL, MN 55102
OWNER
GABEL PATRICIA
5947 2 1/2 ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Bldg Day/ -/o
HEATING PERMIT MINIMUM FEE
0.00
FURNACE SHELL/DUCT WORK
35.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
0.50
GAS PIPING FEE
10.00
TOTAL
45.50
PAID WITH CHECK # 4335
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of,
Improvement whichever is greater
Fee
$35.00
$10.00
JOB ADDRESS _957(V-7 Z '/,?— -54-r V) t
Total
Owner Pa-t-ne---te Cu -bo --A
$10.00 $
Building Used As
C0
ESTIMATED COST ZPERMIT NO
DESCRIPTION OF FURNACE AND BURNER
$10.00 $ # of Heating Units_ Circle One (Steam)=HotWater (Warm Air)
Trade Name " 4-G"1 Size No.
$25.00 $ BTU 7 HP EDR
Fuel Total Connected Load
$ Burner Trade Name Size No.
BTU HP EDR
Co m mercia I/I nd ustria I/I nstitutiona I
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/IndustriaVinstitutional
State Surcharge`
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
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 Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ HEATING 0 fz`S 10 l
�7
�!
$/_ Sign Tel #7 Z�F'
_SOFAX# CEJ ' `�o Date
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Approved by Rough -in Date Final Date
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING 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. Ye l� 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�4 No( )
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes14 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 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�•v 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
I
HEATING CO: � /� ►-C �'
Signed By: Date:
Building
BUILDING
Permit No.: a200,19-ga3D�
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATE O 2 DEG 0 S YOUR E-MAIL ADDRESS
SITE ADDRESS X9 4-?
2 /Z SI-
ITHIS
THISAPPLICANT IS:
O OWNER BICONTRACTOR
PROPERTY OWNER/
NAME: A4. (r,alOVa
ADDRESS: X 9 ¢7 Z Yz S CITY �K/�L�°
STATEM ZIP SS4 3Z
TENANT
PHONE: 7G 3 S'71 /Z B8
CONTRACTOR
NAME: ce- J:Ee-T-a h-
M AG�
STATE LICENSE N Z db, 7Z / 3 EXP DA E �
44. A4vi� STATE ZIP
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS.Ara S'8 2a A 4 Awe- w CITY
WITH APPLICATION
PHONE (g<1 409 8¢ FAX
PROPERTY TYPE
Jff SINGLE FAMILY/NEW CONSTRUCTION SIZE
O TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
O ADDITION O GARAGE/SHED O WINDOWS
O BASEMENT FINISH O ROOF O DRAIN TILE
O DECK O SIDING MOTHER
O SWIMMING POOL
TYPE OF WORK:
0 NEW O ADDITION
A9 MAINTENANCE/REPAIR O REMODELING
DESCRIBE WORK BEING DONE: 96ft rt— Oo rSTLvcg u,4,a f= --j
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING -
8 HOUSE ONLY
NUMBER OF SQUARES Z
99_ O HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
O ATTACHED GARAGE
I.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
O DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT*
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS.
O Vinyl
0sotTit
ADDITIONS.
& PORCHES SUBMIT:
O Aluminum
O Trim
1.
Site PlaWSurvey showing the atisting structures
O Other
O Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
IN EXISTING OPENINGS []Yes
CINo LOCATION OF WINDOWS
3.
Epergy Calculations
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 $ 15,000 OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Surcharge $ (.0005) times the total job valuation — Minimum $.50
Fire Surcharge $ .001 x Permit Valuation (1/10%) S
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for deter' ation)
Curb Cut Escrow $ ft + 6 ft = ft x $20 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due • $ 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 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 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
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in the case of all work which requires revi�eww and pproval of plans.
ATURE OF APPLICANT � A4 rr 46 �.�s,.�.. PItINT NAME %FoP-w« .-r. #4:g9SATE d Z Dee 6 c