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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: -�► "" _ r Owner: �� Builder - Address _ Address_ ---- LOMF BUILDING No. Street" - _-- Part of t _ Lot _ i '__ Block _ ; Addition or Sub -Division Corner Lot �__- - Inside Lot - Afpo Setback Sideyard �� Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To U UVJ#':_ Front ' Depth Height -*140- Sq. Ft.4 Cu. Ft. a ft O Fron Depth Height — Sq. Ft. Cu. Ft. Type of Construction ^ Est- Cost 'W � 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 $_;,dam _ , permit is hereby granted tor. to construct the building or addition as described above. This permit is granted upon the express conditionthat person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon the 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 , ` "1,„+'j : -') Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sun to no the Bulhitng Inspector for separate permits for these items. 0 4Q10.4 0 APPLICATION FOR BUILDING PSUM CITY OF FRIDLEY, MINNESOTA Address LOCATION OF BUILDING No. 0 Street ,5 of Lot,_,._,.,,,,,_, r Lot 9� �e Block /� Addition or Subdivision --"/ � a Corner Lot Inside Lot Setback Side -Yard , ZO SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Sq. Ft. Cu. Ft. 3 gQ-,Z Front Depth Height Sq. Ft. Cu. Ft. UG Type of Construction Estimated 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 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. ` DAM zi 1� — C� SIGNATURE % (A Schedule of Fee Costs can be found on the Reverse Side.) Xe�L",(j Appr j I Y - `���,� inspector J. Application for Power Plants and Healing. Cooling. Ventilation. lefrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 80,000 BTU ......................... 2.00 $ Replacement of Furnace ............................. .0.00 $ Repairs & Alterations—up to $500.00 ... ............ 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam....... 8.00 $ p Furnace Shell &Line—to 640 sq. ft. EDR 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 c� GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ �- GAS FITTING FEES: NO RATE TOTAL 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 $ 6' ALTERATIONS & REPAIRS TOTAL F$E ROUGH FINAL Dept. of Bldgs. Phone SII. 4-7470 Location -6-4/,e) City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City 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. Fridley, 11 in4�", 19O°L Owner Kind of ez , Used as To be completed about'L�� Estimated Cost, $ Old—New. Building Permit No. / U Permit No. r = DESCRIPTION OF WORK HEATING or POWER PLANTS—Ste Hot Wat 'r Yarm Air—No Trade Name- Size No Capacity ® Sq, Ft. E.D.R_ ` sTU H.P. Total Connected LoadT_'� R �� Kind of Fuel ��• BURNER — Trade Name SizeNo- i A Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signe ,42 2M 7.59 Business Phone No QTY OF FRIDIffir KHROOM ADDRESS AND LEGAL DESCRIPTION: `�`` z /0 MWCONTRACT PORMSER: 6 r 2"' CONSTRUCTION DATE: f - v - & / ADDITIONS: CERTIFICATE OF OCCUPANCY ISSUED: YES NO DATE A. ZONING ACTION: ORDINANCE N0: B. SPECIAL USE PERMIT(S): # C. IDT SPLIT(S): # D. VACATION (S) # ORDINANCE NO: E. VARIANCES APPEALS COMMISSION: APPROVED DISAPPROVED DATE NO. CITY COUNCIL: APPROVED DISAPPROVED DATE NO. F. EASEMENTS: REQ'D DEPT RDC'D Bikeway/walkway Street right-of-way Utility Drainage Alley Other (Specify) G. LICENSE(S) (List): Date of Renewal: S. STIPULATIONS (List): DATE REQUIRED DATE COMPLETED I. MISCELLANEOUS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR ?I:..... .. ..... anal Wash . Shower :f�l'�.''� Tra :'': ::: :..�G:::::�:�:::. )=i'�<:,.:.:;�:•. Floor Drain irw�. "•:..•'I���.. t�:::.:::: G::.:•.::<::.,:... Auto. ...��.........: Washe Gas Range Water Heater Gas ElecSton'es Basement >< : Floor 1 Floor 2 Floor loo 3 Floor 4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas"" NO. RATE Gas Range" 11 /,coo Dryer'" I Back Flow Preventer Required Wes () No Type_Lg,L'A44 ®O 9, t4 60 $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 TOTAL JOB ADDRESS 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. $15.00 '00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance lS-00 State Surcharge S .50 Owner X L k v. r� 2 Building Used As__q `L aC Estimated Cost 47 645, PERMIT NO. PLUMBING SIGNED BY Approved By OC+ - 11 , 1999 ✓0 N14 ". ,-,,Q -d TEL NO. / 0 'O:A Rough -In Date Final Date TOTAL FEE $ PLUS THE 5.50 STATE SURCHARGE p3o, SD "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. SUBJECT PERMIT NO. City of Fridley 32293 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. UMBER REV DATE PAGE OF APPROVED BY ,•� CITY HALL FRIDLEV 55432 L 612-571-3450 910415 11/1/01 JOB ADDRESS 5420 5th Street 1 LEGAL LOT NO. I BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 10 & 11 11 Hamilton's Addition to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rinehart Kurtz, 5420 5th Street, Fridley, MN 55432 612-741-9225 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO T i Roofing, 50 118th N, Blaine, MN 763-755-1444 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO BC 20271874 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Dwelling 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION )7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re -roof (24 squares) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with State Building Code. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OFCO ST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 ISE COMPLIED $1.29 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,573.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCA1, LAW REGULATING CON. Fire SC $2.57 TRUC OR THE PERFORMANCE OF CO TRUCTI N $83 Z5 PLAN CHECK FEE TOTALF icens C $5.0 $92,.Al Si NA UREOFCON• ACTORTHORIZEDAGENT IDATE� O 4 MEN O E ALIDATE T IS IS YQUD PEF3MIT S.GNATURE OF OWNER dF OWNER BUILDERI .DATE, BL INSP gAtE NEW [ ] Effective 1/1/2001 ADDN (] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER (j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: I I u S j�= Legal Description: % (A r 0.'1Owner Name & Address: i h -e AA el 4-� (� � f z Tel. # &IZ- 7 Z-.5- Contractor EtL R n v MN LICENSE # E <f - Zo-Z74? ?51 Address: S—C? /1,F r i't -3 Tel. # %� S y y 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 Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type: r -e c) d Estimated Cost: $ c;l Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ h --r DATE: / / D I APPLICANT: Tel.# ?5�` lYy cy CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ B3 - � Fee Schedule on Reverse Side Fire Surcharge $ ,�_Sr% .001 of Permit Valuation (1/10th%) State Surcharge $ /, $.50/$1,000 Valuation SAC Charge $ _ $1150 per SAC Unit License Surcharge $ , DJ $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 S -' /� STIPULATIONS: