PRE 2010 DOCS0 P
Village of Fridley, Minn.
BUILDING PERMIT ° 17 5 7
Date: .......... ^.... .� �.... f
Owner....................................... Builder ....... ...... .. ........
Address...................................... Address ..............................................
LO5�Al10W BUILDING
.... i.. ......... Part of Lot
Lot .... 1. ..... Block ... .� ........... Addition or Sub -Division ...... .. !L.. .........
Corner Lot ........... Inside Lot ... �... Setback .. '.... Sideyard ....Zoe ....................
DESCRIPTION OF BUILDING
li
To be as:
e
} T be Used
.
Front . A3 ;L .
Depth
Height
Sq. Ft. �, 3iZ! Cu. Ft. ........
.....................
Front ........
Depth ........
Height ........
Sq. Ft. ........ Cu. Ft. ........
Type of Construction
........
Est. Cost ....:
.) �.
j-00
=.....
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 village 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 village limits and this permit may bevoked at any time upon violation of any of the provisions of said
ordinances.
1"} 1116�... Building Inspector
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.
C .s .
SUBJECT
RM
City of Fridley
3042BUILDING
AT THE TOP OF THE TWINS
PERMIT�RECEIPT
r
i.
NO.
�y - --COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 �
;
1IL1 �'-'1 CITY HALL FRIDLEY 55432
A
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L' -" 612-560-3450
910-F15
6-93-25
JOB ADDRESS
7557 - 4TH STREET N.E. FRIDLEY MINNESOTA
1 LEGAL
LOT NO.
BLOCK
TR ACT OR ADDITION SEE ATTACHED
DESCR.
18
1
OSBORNE MANOR SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
JERRY LARSON, 7557 - 4TH STREET N.E., FRIDLEY, MINNESOTA
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.
6 USE OF BUILDING
RESIDENCE
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
CONSTRUCT DETACHED GARAGE 24 x 24 x 10
9 CHANGE OF USE FROM TO
STIPULATIONS
PROVIDE HARD SURFACED DRIVEWAY
WARNING
Before digging call local utilitles
TELEPHONE - ELECTRIC - GAS Etc.
foR
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. I
PRANE
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
576
5,760
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
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.
$1.95
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$4,262.40
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-
$10.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$11.95
SIGNAT REOF CONTRACTOROUTHORIZED AGENT (DATE)
WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
_
�> / L JUNE 23, 1975
SIGNA' WNE O L E I (DATE)
BLDG INSP DATE i
C .s .
APPLICATION FOR RESIDENTIAL., ALT1:Rr1TI0N,
OR ADDITION.BUILDING PERMIT
CITY OF -FRIDLLY, MINNESOTA
OI•: f" ER ` S NAME: Q 1A L & R.,SQK_i BUILDER: n (_l3 10!E jR
ADDRESS: �.5� % s� ��
ADDRESS:
Ido :
STREET., ,
LOT:_BLOCK: % ADDITION: ;s k C9 Q vk\)�_�Pwloo
CORir'ER LOT: INSIDE LOT: ✓ SETBACK:: SIDEYARD :
Applicant attach to this form T7o Certificates of Survev.of Lot. and.propose
building location drawn on these Certiiicateso
DESCRIPTION OF BUILDING
To Be Used As:
tr,b Front: p2 "Y Depth : Height: �__0
Square Feet : `�-76 Cubic . Feet : 6 d
Front: Depth: Height:
Square Feet, Cubic Feet:
Type of Cons truction . Estimated Cost: $ , a '2 ' /0"o
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 rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: 76 SIGNATUM: W LA A I
(See Reverse Side For Additional Information.)'
City of Fridley
SUBJECT
�® 148
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO
i 6 - _____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBERREV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
8/10/78
JOB ADDRESS 7557 - 4th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
1
Osborne Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerry D. Larson 7557 - 4th Street N.E. 784-6169
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
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 0A ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 14' x 10' Addition & Reside House
9 CHANGE OF USE FROM TO
,r
STIPULATIONS Provide preformed valleys. %yly-A// Install triple glaze window or
triple glaze glass door to meet energy requirements. Insulate ceiling to R-30
Minimum. Provide City with copy of truss design by Sept. 15, 1978.
WAR�i� G
® ore diggrng Cell local
SEPERATE PERMI*TS REQUIRED FOR WIRING, utlllti�
�' rEEEPHONE- EL�"CTt;tC
HEATING, PLUMBING AND SIGNS. P Ir � � a >. •GAS Etc.
� , ,
LAW
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
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
'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
$10,000
$5.00
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-
$7.84
NONE
STRUCTI N OR THE PERFORMANCE F CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
•(DATE)
$1.96
$14.80
S NATURE Of ONTRACTORORAUTHORIZED AGENT
1\
PROP RLY VALIDATE THIS IS YOUR PERMIT
tti8 %` ® / 7
cWHEN
SIU 1
BLDG INSP DATE
SIGNATU OF OWNER (IF OWNER BUILDER( V (ATE)
U
f
CITY of FRIDLEY
APPLICATION FOR RESI ENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER= J3UILUER: vS�L w
Address: 7 ,? 57` . Iv. z- Address: -;Zle�
Tel. No.:Y
No. Street: ✓�i �
LOT: J J3Iocn / ADDITION: x5,00&1VC I- #A/D/C
CORNER LOT: INSIDE IAT: ✓ SBTBACY.: SIDEYARDS:
Applicant attach 'to this form T`ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING j
To Be Used As:
,0,&Nn/iNG Xeo/7 Front: %�!� Depth: •/O Height: /
Square Feet: / yd Cubic Feet: l�lp d
/1 Z�✓d�i / %`� r
4e—af.W 1adDWtxlS - epth• Heigl,t:
• Square Feet:
Type of Construction: t-7 6d n 7z�e±!Zjr- Estimated Cost: $ lv av-g
oto Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
ir
ecified, agreeing to do all work in strict accordance with the City of
idley Ordinances and rulings of the Department of Buildings, and hereby
clares that all the facts and representations stated in this application
Q true and correct. See reverse siddlfor additional information.
DATE: / 7X- SIGNATURE:
%Sy
Stipulations: . � d*4jr4z/ du04 a-oft�dAw
ILA
SEPARATE ITEMS TO BE SUBTRACTED
(Non -insulated frame items)
K-Iewc �i;K - �t' IV
U4 707A`,
- -- .-- - - ✓ �y ---�
A. Concrete block exposed above ground in square footage / �_ g Z '
(Note: A minimum of 6" exposed block required by Code)
B. Rim joist area - usually 10/12 inches x perimeter in 2� �/ l,6 8
feet
C.
Window area in
concrete blocks above ground in square
Z
v,
re-40,
footage
1i
D.
Fireplace area
(from floor to header) in square feet
E. -Sliding
glass
door area
'��
✓
F.
Door area
G.
Window area
H.
Total Area Of
Subtractions
(Enter On Line `Below)
s
I.
Overall wall areas
(From ground
to top plate all around building or AddzJ
J. Less Subtractions for windows, etc. (#H)
K. Net area remaining
L. Net area x 10% = Frame area
M. Net area x 90% = Insulated area
N. Total ceiling area
O. Ceiling area x 10% = Frame area
P. Ceiling area x 90% = Insulated area
IF f -4 -t G
LqO
/N,
Z
7Zi70L
,oW4-A
/o, y
3a �
I,
'SII .•..
j p��• FoVihEO VI•W
#R^!G To M,, Tc
i
t l,v
r I
_ %/(p�X 'Ad P7,1S0M/TE .J q&,p
I � ! �/N� ' NEte.► ,�ppiTie.✓ Y gX /SiriH �Yc�e
�
' THIS PLAN MOT � � � • BE MAINTAINED ANS - -----�------_- ��-------�-•--
i
ACCESSIBLE ON 1-H�
CONSTRUCTION SITS;
Vida 'a 4-i
/ob PIN
voce L,4,
FOR WA
MA.
a.
WPOR OA
�PS!'y�bFc,9rf
PR FOLINDA
I Pim, J•C/j
1/
DC CA
N
tXSJST/NG !C'/rC� I
xl?,: EN
7
I lg" m1N. DISTANL" d
BOTTOM OF FLOOR! JOIST.
AND FLOOR &PRO lD
jq
ANGC!.ScAl GLiOC�
_vN►r-?mss[,
- - 7�rPo� �C�,t�L� • - c>20y IG'6" c�wrcr� F.C00% ,7oisT
4 i i
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PER41T
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
y.
Nv
Number Fixtures
X
$3.00
s0
$ 1,
.
4
• 0
$
Water
01
$2.00
dl
�
Iii
N
CCi
�+aei
tll
Li
$
+�
Ca
w
�
1001,000 BTU to 199,000 BTU
Heater
Heater
$10.00
JO
a
x
$7.00
_
$
N
x
$5.00
$
Electric Water Heater
x
$5.00
$
d
p
iJ
N
o
N
L N
e
g
o
kec
CA
u
y
w
N
w
u w
a r
i�
3as
lst
2nd
3rd
4 th
(P.) - Future Connection Opening
Connected with Sewer
V) - New Fixture, old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Number Fixtures
X
$3.00
s0
$ 1,
Future Fixture Opening
'x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
�
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
1001,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
_
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
l.st 3 fixtures x '$3.00 $
Additional Fixtures x $1.00 $
Gas Range to 199,000 BTU x $10.00 $
REPAIRS $ ALTERATIONS
First $100.00 $5.00 $
each add. $100.00 or fractions $2.00 S
State Surcharge $ 50
d
TOTAL FEE $
' .--
REINSPECTION FEE
(510.00)
Job Address
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 apy ication are true and correct
idley, Mn. , 19'�x-
OWNER v v
KIND OF BUILDING
USED AS V"
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company .
Signed By p S "�f
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
• Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT 76DP
LUS $.50 STATS SIIItOMM=
SUBJECT
PERMIT NO.
City of Fridley
222 4 8
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
OF
APPROVED BY
IL"'".114-1- 11F I'J 612-571-3450
910-F15
JOWTEPAGE
11/24/93
JOB ADDRESS 7557 4 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
18
l
Osborne Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Jerry/Diane Larson 7557 4 Street NE
784-6169
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Exterior Design Service 6391 Monroe Street NE
571-3220 3237
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 ❑ ALTERATION REPAIR
O MOVE ❑ REMOVE
O
8 DESCRIBE WORK
Reside Dwelling
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide smoke detectors as per UBC 1210 adjacent to all sleeping areas
and in basement,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS
GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$4 Q00
$2,00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
f
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVIS SOF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$63, 0.0.
Fire SC $4.00.
TR TI N O THE P RF MANCE 9F CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC
$5.00
$74.00
SIGNATURE OF CO TRACOR AUTHORIZED AGENT (DATE)
T R
WHEN
ER VALIDATED THIS IS YOUR PERMIT
G I
1<2
DATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ l
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address:
Legal Description:
Owner Name & Address:
Contra
Address:
Effective 5/26/93
cion: MN L CEI 9t #3 x 37
ZO
Tel. �.1 ",?,o;I
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
7ioth Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ l Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks.
Type of Construction: Estimated Cost: $ !!! a a, e01 el
Approx. Completion Date: j - -/,r—
Driveway Curb Cut Width Needed:
Ft. + 6 Ft =
(Cost on Back)
Ft x $
DATE: APPLICANT4"
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ CQ Fee Schedule on Reverse Side
$_ p .001 of Permit Valuation (1/10th%)
$ n o $.50/$1,000 Valuation
$ $750 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ Conservation Plan Review $450.00
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$�GOC STIPULATIONS:
Tel. #5l�
SUBJECT
P
City of Fridley
26960
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
COMMUNITY DEVELOPMENT DIV.
1 L INSPECTION SEC.
No
r PROTECTIVE
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/3/98
JOB ADDRESS
7557 4 St NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
18
1
1 Osborne Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jerr Larson 7557 4 St
784-6169
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 ❑ ALTERATION R] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 23 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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
MOT.
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
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
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.
162.25
Fire
Sc $1.91
PLAN CHECK FEE
TOTAL FEE
SIGNATURE OF CONTRACTOR UTIHORiZED AGENT MATEi
ENROP VALIDAT D THIS IS YOUR T
�J'PER
�
SIGN REO NER0F NER BUILDERi IDATEi
B G iNSP
DATE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 .8P,4
BUILDING PERMIT APPLICATION
ConstmctionAddress: ��5 7
Legal Description:
Owner Name & Address: 5-e af2_S! Z_k:;�so /I Tel. # 6,Q- -AV- &16
Contractor: MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft. �—
OTHER: iz aAa.440 +I�Pv3e, l01WAov` A,,,,Te hof
Construction Type: J2Q 1' Estimated Cost: $ �� / (0)
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel.
CITY SE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
1
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 [ ]
A
Effective January 1, 2003
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
FAX (763) 571-1287
JOB ADDRESS
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
Rate TOTAL
$ 30.00 $ C
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $_
State Surcharge
TOTAL FEE
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.
'. ]'►`l'
BUILDING USED ASS�C4�
ESTIMATED COST
PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_ Circle One (Steam) (Hot Water) (Warm Ai)
Trade Name klj Xc6OvezSize No.
BTU C/, CXDCr HP ` EDR
Fuel eLS Total Connected Load 11 -i P 5
Burner Trade Name -L-15u-'a-" A Size No. VA
BTU HP 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 :�12/ 03
S� HEATING CO ` J� 14Qc&' 1�
Signed TEL #1��4°�
FAX # G -Sr; T.)J
Approved By Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When as la _in0 an exictingf ii rannp, 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 (Pr
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. P Yes O No ( )
The existing comb is+inn air is sized and installed to meet the current codes
and manufacturer's specifications. . Yes ('-j'No ( )
When required to install a now cnmhustinn air.,jt will be sized and installed
to meet the current codes and manufacturer's specifications. Yes �/fNo ( )
When Installing a naw wanting 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 dNo (
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 IF\.) BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Ac P -i Fan Assisted or Nat VI t '-
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input 2-e
Common Vent Type NVA& k— Vent Height—_ Diameter --�: Pr inches
Appliance #1 Vent Connector Height�ft Length ft Diameterin Type
Appliance #2 Vent Connector Height 4 ft Length =ft Diameter _min Type z
Appliance #3 Vent Connector Height ft Length ft Diameter in Type _
HEATING CO: -�- �A0 t;4 Ir�
Signed By:Date :'? c) P�