PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: L
IL
Owner: d
Address Address —
LO ION OF BUILDING
No. Street v `"?' _ �__ Part of.
Lot _ Block ____ Addition or Sub -Division
Corner Lot _ _ _ Inside Lot_ Setback Sidey '"__
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
TAei1 as) ,,+
" = Front - Depth Height a�- Sq. Ft.1_4612Cu. Ft VIZ +
Front _ _ Depth Height _ ___ Sq. Ft. Cu. Ft.
Type of Construction% -WIN— Eat, Dost , To be Completed —
1,000p,
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
ordinance of twork
he in of Fridley with the description above set forth and in compliance with all provisions of
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
within the city limits and this permit may be revoked at anyon y�io�f any of the provisions of said
ordinances.'
Building Inspector
NOTICE:
This permit does not cover the construction, hntailation for wiring, plomhing, gas heating, Bower or water. Be sure to an
the Building Inspector for separate permits for these hens.
Application for Power Plants and Heating. eating, Cooling, Ventilation. Refngeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470
GRAVITY WARM AIR: RATE TOTAL Locatio
Furnace Shell & Duct Work .......................... 8.00 $ loor
Replacement of Furnace ............................. 5.00 $
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
Repairs & Alterations—up to $500.00 .................. 5.00 $ specified, agreeing to do all work in strict accordance with the City Ordinances
Repairs & Alterations each add. $500.00" " " " " ' 2.50 $ and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
,Repairs & Alterations each add. $500.00 ......... I .... 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .....
8.00 $
Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ...
8.00 $
Each add. 200 sq. ft. EDR Steam ......................
2.50 $
Each add. 320 sq. ft. EDR Hot Water ..................
2.50 $
OIL BURNER—to 3 gal. per hour 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $�
GAS FITTING FEES: NO RATE TgTAL
1st 3 Fixtures ...................... x $1.50 $ �/
Additional Fixtures x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING '-®
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
51 ALTERATIONS & REPAIRS TOTAL FEE $
r ROUGH
FINAL
Owner
Kind ot Building —y
Used as i1
To be completed about
, Aunn. AUG 13 7009 , 19 —
13
00
Estimated Cost, $47/�i
jqj&jLRew. wilding Permit No. ��`� 4 Permit No. ':74099
DESCRIPTION OF WORK
HEATING , Warm Air—No-
Trade Nam Size No- 2 s o�
Capacity f/S Ft. wR 0" BTIJ H.P.
Total Connected Load 4kind of Fuel
BURNER — Trade Name dzszz SizeNo
Capacity Sq. Ft. E.D �BTU H.P.
tl GEO. SED WICK HTG. & AIR-COND. CO
® d 1001 Xenia Av. S.
l Minneapolis 16, Minn.
Signe" 54614
By
48 2M Business Phon No
(REMARKS -OVER)
le
u• DS6c 7�� ? & & Mlv O00 6qa o'I(.' S � �� � �GPd1��J�o � Vie/� v� � � �,c9 � •
8
HEAT LOSS CALCtJL.ATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
Yes—No Yes—No 19_
1 F11 t 1 0 ' jVjfRoom I Length j ' Width J, f Height ' II I F1.1 S A CA RoomI Length 9 C Width ;- 6, Height
Total Btu.
Kequlred sq. rt. L.U.K. or sq. ms. W.A. Leader area 1
n L•i II I r _ _-.t . tar 1.1 .�'' rr. •_.. 2`.�
Width 10
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq, ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Windows and Doors—Crackage and Area
Width Height No. of Lineal f . Area
No. of pane of pan,,eJ lights of crack - sq. ft.
y S'
Fifa'
41
Infiltration
Exp. wall
Glass"
ICoef.1
Btu
Infiltration
Glassj`ry
3 R
3
Exp. wall 2_% x
<e-v�
Exp. wall
Int. wall
Net exp. wall
r`
e z
Net exp. wall
Int. wall
•' «�r
4a
Int. wall
Floor Z
Ceiling .
1
j ,
Floor ,12- aC
Floor
Total Btu.
Kequlred sq. rt. L.U.K. or sq. ms. W.A. Leader area 1
n L•i II I r _ _-.t . tar 1.1 .�'' rr. •_.. 2`.�
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
1 F1.1 0 g ;m r.>no Room I Length g I_ Width ! i Height
Windows and Doors—Crackage and Area
Width 10
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq, ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
�` & •'tij N
Fifa'
41
Infiltration
Exp. wall
Glass"
Coef.1
Btu
Infiltration
3 R
3
Exp. wall 2_% x
Floor
Glass
Int. wall
Net exp. wall
r`
e z
Exp. wall g
Int. wall
'
4a
Net exp. wall
Floor Z
Int, wall
1
j ,
Floor ,12- aC
Ceiling
Floor
fi "► 1�
1 ' •
;E�
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
1 F1.1 0 g ;m r.>no Room I Length g I_ Width ! i Height
Windows and Doors—Crackage and Area
Width 10
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq, ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
.y m ,f e'
Width HeightNo• of Lineal ft. Area
No. of ps,ne� of pane lights of crack sq. ft.
Coef.
iCoef.1
Btu
Infiltration
Exp. wall
Glass"
9 A
Glass
Exp. wall j U X h
3 R
3
Exp. wall 2_% x
Floor
370 "
Int. wall
Net exp. wall
r`
Ceiling
a"`"—
Int. wall
Floor
4a
Ceiling �
Floor Z
1
j ,
[: Total Btu.
ft. E.D.R. or so. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width 10
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq, ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of craAck sq. ft.
3 ;,pio N
Width HeightNo• of Lineal ft. Area
No. of ps,ne� of pane lights of crack sq. ft.
Coef.
Btu
Infiltration
Exp. wall
Glass"
Btu
Infiltration
Exp. wall j U X h
3 R
3
Net exp. wall
Floor
370 "
Int. wall
Exp. wall
Ceiling
Net exp. wall+
Floor
4a
Total Btu. ' S
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 F1.I " � gj�ji Room I Length 1 .:)�
Width 10
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq, ft.
Height 15
Windows and Doors—Crackage and Area
Width HeightNo• of Lineal ft. Area
No. of ps,ne� of pane lights of crack sq. ft.
"'� < �L
Glass
Exp. wall
Coef.
Btu
Infiltration
Int. wall
3 R
3
Glass
Floor
Exp. wall
Net exp. wall+
Int. wall
Ceiling
Floor ,12- aC
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq, ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
«r�i�>�d.v 3c�� owe d �g Al a.. -(0.,v
Ddb 7 • s ^..� / 06 OF 00&x3' �� •�
�il'� �a�
HEAT LOSS C CU� �+ � LAT101S DEPARTMENT OF BUILDINGS M gNEAPOLIS. MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
WindowsI10 Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
Yes—No Yes—19_
l F1.1 r_ d u d "t..,Room I Length 0 6 Heiaht Y II a FU r ,% -, L -a Room I Lenizth yY 6p Width 4!7-, 4, Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Coef.
Coef.1
Coef.
Coef.1
Btu
Infiltration
Glass
Int. wall
�•p
Ceiling
Glass
� r r, ,
Glass
4---z
1 (
�.� �,
-1.;
a ;�
,;z
Exp. wall Is
Net exp. wall
Ceiling
I„ 6
Net exp. wall
.
Int. wall
Int. wall
Ceiling
Ceiling
to
!
. 1 G
Floor
Lt. VF-
Total Btu.' ' �; 3
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
4 F1.1 4 i _ i) i 4 Room I Length i d.. (z Width 9 64 Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Coef.
Coef.1
Coef.
Btu
Infiltrationr`
l'
Glass
Int. wall
�•p
Ceiling
Glass
”
4---z
1 (
Exp. wall
Oj "
Net exp. wall
Int. wall
Net exp. wall
Ceiling
I„ 6
i r`
.
Int. wall
Ceiling
Floor
to
!
. 1 G
Total Btu. I z:z
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I FI.1 i i i'4 Room I Length a -s_ Width l Height '
Windows and Doors—Cracks a and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Width Height No. of'Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Coef.
Coef.1
Btu
Infiltration
l'
Glass
Int. wall
Glass,
Ceiling
Exp. wall r lcJ ye'
”
Exp. wall
Net exp. wag°
Int. wall
Net exp. wall
Int. wall
Floor
Ceiling
-i
Floor
Total litu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Exp. wall
Net exp. wall
Glass
Int. wall
Ceiling
Exp. wall r lcJ ye'
”
Net exp. wag°
Int. wall
Ceiling
Floor
-i
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 -0
FI_I Rnnm I Length Width Heitaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No: of Lineal ft. Area
No. of pane Of pane llghte of crack Area
ft
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
suslEcr
PERMIT NO.___
City of Fridley
"12
AT THE TOP OF THE TWINS
BUILDING P E R M I T
r
�
RE
� 11 � __��__ � COMMUNITY DEVELOPMENT DIV.
J INSPECTION
PROTECTIVE SEC.
,
�•� 7
1 t �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
812-580-3450
910-F15
6/7/73
JOB ADDRESS 5908 - 4th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
l
Holly Terrace SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Richard Hodges 5908 - 4th Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
State Wide Construction 42211 Excelsior Boulevard
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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBEWORK Construct 221 x 221 Garage
9 CHANGE OF USE FROM TO
STIPULATIONS provide hard surface driveway
SEPERATE PERMITS REQUIRED FOR MIRING;
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
R-1
484
4840
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.
$2 192.5.E 1. lO
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-
$9.00
STRUCTION OR TE P R ORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$10.10 '
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HEN PROPERLY VALID
TH IS YOUR PERMIT
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
BLDG. )NSP DATE
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME:__��� BUILDER:_ --'�� ZcJJ.c�e C�-w�l`
ADDRESS: S � � 8 r1/,c�. � el /
ADDRESS: `y n `,
NO:. 6� 7 0 8 STREET: g I_
LOT 'S' —BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: v 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:
Front: Depth: a a Height:Cj
Square Feet: � Cubic Feet: 4)Front: --Depth: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $
r
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: _ Co - 7- e73 SIGNATURE:
(See Reverse Side For Additional Information.)
r
LOCATI Or!—_
DSSCRtptO AS
SIN
m
I
11 ��
i
.qcl/ O/.t/�.•JG /p.4'.AG'EG S
CERTIFICATE 0?a LOCATION OF BUILDTITG
I hereby certify that on / _ CERTIFYCA� OF �U:tFEY
this survey, plan, t n art u' aS r 117 19 � I hereby certify that on 19
P prepared h} me or ttrdFr thk cumey. 1,1ian, or report wa:; prepared by rr4 or Und;r
my direct supervision and that I am a duly he;istered Land to}• din -rt supervision and that I am a duly itr;istered Ltnd 4
Surveyonunder the laws of the ;ate of 3linnesota. Surveyor under the lags of the State of Min;-t'sota.
r~ JOHN J. PYAN. W7C.;r 7'GFFl7 SURVEYOR. No. 4489— —
/ PAUL J. �;RANE. RCGISTr-RED SURVEYOR, No. 44.19 �
.• s
r
t
STUC/O �1j
�O 11
11 ��
i
.qcl/ O/.t/�.•JG /p.4'.AG'EG S
CERTIFICATE 0?a LOCATION OF BUILDTITG
I hereby certify that on / _ CERTIFYCA� OF �U:tFEY
this survey, plan, t n art u' aS r 117 19 � I hereby certify that on 19
P prepared h} me or ttrdFr thk cumey. 1,1ian, or report wa:; prepared by rr4 or Und;r
my direct supervision and that I am a duly he;istered Land to}• din -rt supervision and that I am a duly itr;istered Ltnd 4
Surveyonunder the laws of the ;ate of 3linnesota. Surveyor under the lags of the State of Min;-t'sota.
r~ JOHN J. PYAN. W7C.;r 7'GFFl7 SURVEYOR. No. 4489— —
/ PAUL J. �;RANE. RCGISTr-RED SURVEYOR, No. 44.19 �
.• s
City. of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
MIT NO.
26559
t
I ,
r r.
i COMMUNITY DEVELOPMENT DIV.
r I v PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
612-571-3450
O
L//
//`�
NUMBER
9/0 -Ft 5
REV
DATE
17/13/98
PAGE OF
APPROVED BY
JOB ADDRESS
5908 t t
1 LEGAL
DESCR.
LOT NO.
5
BLOCK
TRACT OR ADDITION
lHolly Terrace
SEE ATTACHED
SHEET
2 PROPERTYOWNER MAIL ADDRESS
Lean Ohn stad
ZIP PHONE
571-3798
3 CONTRACTOR MAIL ADDRESS
din
ZIP PHONE LICENSE NO.
4 ARCHITECT OR DESA NER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20010277
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION X] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 35 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with STate Building Code.
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
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
2919
SURTAX
$1.46
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVI IONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
ST C ION OR THE PERFORMANCE F CONSTRUCTION.
74.75
@
Fire SC $2.92
PLAN CHECK FEE
Licens 5.00
TOTAL E
8 .13
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
N P OPE
I BLDG NSI
V ALIDAT I$ I$ YOUR PERMIT
QA TE
SIGNATURE OF OWNERUF OWNER BUILDERI IDATEI
NEW [ J Effective 1/1/9$
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION 5
ConstructionAddress: 5 �G8 �/ S �• �Lr
Legal Description:
Owner Name & Address: If -,f Al Uhn Tel.
Contractor: %r���s�, �� �� '- Pv; MN LICENSE# OoJoa77
Address: l Fl `t 7 l���s �-e l3 `v,�� Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlAPROVEMENT
LIVING AREA:
Length
Width Height Sq. Ft.
GARAGE AREA:
Length
Width Height Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground Sq. Ft.
OTHER:
d -
Estimated Cost: $
Construction Type: ��ss � 7�-0 �--
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: 7-13 ' APPLICANT:
PTel. #
CITY USE ONLY
'ermit Fee
$ , ���
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 1 •lo
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ - 0 6
$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 [ J
TOTAL
$ '� /3
STIPULATIONS:
CITY OF FRIDLEY
r 6431 UNIVERSITY AVENUE NE
FRIDIXY. MN 55432
PERMIT NO.: 2004-02299
DATE ISSUED: 12/20/2004
572-3604 FAX: (763) 571-1287 le -0 (a 7
ADDRESS
5910 4 ST NE
PIN
233024240110
LEGAL DESC
HOLLY TERRACE
LOT 5 BLOCK 1
PERMIT TYPE
HEATING
PROPERTY TYPE
: MULTI DWELL
CONSTRUCTION TYPE
: ADDITION/ALTERATION
VALUATION
: $ 2,600.00
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.
APPLICANT
KLINE CORPORATION PRACTICAL SYSTEM
4342B SHADY OAK RD
HOPKINS, MN 55343
(952)933-1868
OWNER
LAVONNEJOHNSON
5908 4TH 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
regulates' *struction or the performance of cons] ctio .
Anrrlicant �9 Date I
Bldg
HEATING PERMIT FEE, COMM 35.00
STATE SURCHARGE, OTHER 0.50
TOTAL 35.50
PAID WITH CHECK # VISA
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
u
CITY OF FRIDLEY BUILDING INSPECTION
Effective 4/1/2004
6431 University Ave NE
Fridley, MN 55432
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
m
7s&572-3604 FAX 763-5711287
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
m
JOB ADDRESS5910
U
RATE SCHEDULE
Fie Z4ta!
J(
V e. �1 5��
m
Residential
Owner
3
Furnace Shell and Duct Work, Burner &
Ji d t r'hl
also Replacement Furnace
$35.00 $
Building Used As
Gas Piping (New Fumace, Fireplace, Insert)
$10.00 $
ESTIMATED COST.. Q� �^ PERMIT NO
Gas Range
$10.00 $
DESCRIPTION OF FURNACE AND BURNER
Gas Dryer
$10.00 $
# of Heating Uni Circle One (Steam) (Hot Water) arm Ai
Trade Name Size No.
*Air Conditioning - All Sizes
$25.00 $
BTU tt4'� NP EDR
Fuel Total Connected Load
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
$
BurnerTrade Name Size No.
Minimum Fee $15.00 for Residential or 5% of cost of
BTU HP EDR
Improvement whichever is greater
The undersigned hereby makes application for a permit for the work herein
Commercial/Industrialjlnstitutional
specified agreeing to do all work In strict accordance with the City Codes
1.25% of Value of Appliance or Work (List on Back)
$
and rulings of the Building Division, and hereby declares that all the facts
Minimum Fee $35.00 for Commercial/industriaVinstituUonal
and representations stated in this application are true and correct.
0
Une
State Surcharge
$
HEATING CO DBA: Practical Systems
cW„
TOTAL FEE
$
�342B Shady Oak Road
sign d
Hopkins, MN 55343
ru
REINSPECTION FEE $50.00/HOUR
FAX # 952-933-1868
*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 Rougivin Date Final Date ru
ru
NEW [ j CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: ol— ► \�
Legal Description:
Owner Name & Address:S�=i�b �-\Tel. # -3,Z-0
Contractor. MN LICENSE f5 -Z—
Address:
SAddress: S:Ic1 \;Z�-4 �� S'� �,� 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: g ---
Construction Type: Estimated Cost: $ S�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
DATE:(—( APPLICANITel. #�"'-3 -S--) Z'3 9r')z
Call (763) 572-3604 for Permit Fees if mailing in applia lon. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
lei If1l-&izKolkiI WAM
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 [ ]
TOTAL $ � R STIPULATIONS: