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: