PRE 2010 DOCSDate r
Owner
Address
BUILDING PERMIT
Village of Fridley, Minn. N? 2267
kmsil ........... `..................
No. ...$�...
Lot ....... li A ....
Corner Lot ... $ ...
To be Used as:
.' ,)111..--��.� . .
...................
Type of
In consideration
the proposed work i
ordinances of the vi]
Builder....... .......................
.......................
Address.........................................
4LOCATION OF BUILDING
. ► .r`
Street... ...................... Part of Lot ....,.,,..,., .�.L........... .
j Block .. ./........... Addition or Sub -Division . �1r''.�r!"���°� ...* .... , , . , ,
f... Inside Lot . �"". ` ...... Setback SW! Sideyard ... ��` �+ ..............
DESCRIPTION OF BUILDING
Front : l.% — Depth . 4 +fit :4'lieight *9Sq. Ft......... Cu. Ft. ........
Front ........ Depth ........ Height ........ Sq. Ft:........ Cu. Ft........ .
Aso
Est. Cost -A ": 00 ............. To be Completed
if the issuance to me of a permit to construct the building described above, I agree to do
accordance with the description above set forth and in compliance with all provisions of
.ge of Fridley.
_ ...................
,%%��In_ oo eration �f the payment of a fee of $.. �i .. , permit is hereby granted to r�.'(4CA41..�......
)!'r:'... , ... to construct the building or addition as described above. This permit is granted upon
the express conditiothat 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 uviolation of any of the provisions of said
ordinances.
* F V.Aguilding Inspector
NOTICE: Ji
This permit dies 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.
0
Village of Fridley, Minn. N° 2331
Date ..: s.............................
0 0
..��! ..ABuilder ."� ... �. ...................... .
Owner il¢lj *.(A 444. ,
Address ....... ..... Address ......................................
LOCATION OF BUILDING
No... fes':' : f .... Street 40 ................. Part of Lot ....... ............ .
�� ..... Addition or Sub -Division Lot .... ........... Block.. .:..,,�,,,,.....
Corner Lot .... A ..... Inside Lot ....... I .... Setback J41*ow.. Sideyard /tf **4.w.;':"`........... .
To be Used as:
Type of
DESCRIPTION OF BUILDING
Front '�l' Depth Height ... Sq. Ft. Cu. k'i... ... .
ff:
Front ...... Depth ......... Height ......... Sq. Ft.... ... Cu. Ft........ .
...
�.l... Est. Costes...:..;.. To be Completed
T'
In consideration 4 if 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 viII go of Fridley.
...........................................
aider the payment of a fee of $. %" permit is hereby granted to . ..... ..........
to Construct the building, or' ad dition as described above. This permit is granted upon
the express co clition t the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and n said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota r g location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits w id this permit may be revoked at any time u nvio n of any of the provisions of said
ordinances.
r
. , . Building Inspector
NOTICE: 1-
This permit does not oover the construction, Installation" or alteration for wiring, plumbing, gas heating,
sewer or water. Bc sure to see the Building Inspector for separate permits for these Items.
City of Fridley, Minn.
BUILDING PERMIT N?57s
• ..rrr.r+'Builder
a
Address
Address
,r+ LO ION OF BUILDING
No. , Street G - �''. ___ _ Part of Lot
,�.
Lot _ _ J .__ Block Addition or Sub- ivisi7i _
Corner Lot _ Inside Lot Setback _ _ _ Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
Toe as:
Front Depth _.;— Height Sq. Ft. Cu. Ft.
Depth Height Sq. Ft. Cu. Ft.
Type of Construction _ . i P Ft. • 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.
A
4I
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 whorh 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 any time upon violation of any of the provisions of said
ordinances. _ .4
Building Inspector
NOTICE
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
- J 4 -- - -"
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
owner's Name Builder
Address �. 0
No.
LOCATION OF BUILDING
4- ZLy-
U
art of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
To be used as:
DESCRIPTION OF BUILDING
pront1�. Depth -2 -1 -Height l
Sq. Ft. � ,�Pu. Ft. 3
Front -„_Depth Height
Sq. Ft. Cu. Ft.
Type of Construction 2---/.� Estimated Cost
To be
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 ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correct. 1�,
DATE 9 — % sIGNATUl2E
ZZ��
(Schedule of Fee Costs can be found on the Reverse side).
•
n
LJ
City of Fridley, Minn..
BUILDING PERMIT
Date: July 20, 1965
Owner: ARDEN L. EBERT Builder GENERAl CONTRACTOR
Address 6011 — 6th St. N.E. Address
Fridley* Minnesota
LOCATION OF BUILDING
No. 6032 Street 6TH STREET N. E. _ Part of Lot
Lot 10 _ Block 1 Addition or Sub -Division _ Bonney Addition
Corner Lot , Inside Lot Z Setback 35 Sideyard
Sewer Elevation _ Foundation Elevation
N° 8244
DESCRIPTION OF BUILDING
To be Used as:
Front — Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost $15,000900 To be Completed
REPAIRS DUE TO STORM DAMAGE
REQUEST FRONT S'TBACK VARIANCE OF 35 to 32 ft on GARAGE
APPROVED BY COUNCIL ON JULY 199 1965
In consideration of the issuance to me of a permit to construct the building described above I agree to do
theproposed work in accordance with the description above set forth and in compliance with a'll provisions of
ordinances of the city of Fridley. —�,..
In consideration of the payment of a fee of 1 10.00 , permit is hereby granted to SEN L. EBERT
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 �gg location, construction, alteration, maintenance, repair and moving of buildings
within the city limitsns permit may be revoked at any time upon violation of any of the provisions of sJd
ordinance.
ALIEN G. ffiVSEN Buildmng inspector
NOTICE
Se pun* den not ewer the condroc8oe, intelhdlen for Wbing, plumbing, gn henthl% rawer er water. Be sun to ne
the Bugdh* l gmftr for sepm to pormifs for thea hoar.
V � `
82APPLICATION FOR BUILDINO„PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME A 13 C R 7—BUILDER
ADDRESS 1�, ® l( e t �� ADDRESS
// LOCATION OF BUILDING
No.. 40*STREt PART OF LOT
LOT ) BLOCK ADDITION OR SUBDIVISION'
CORNER LOT INSIDE LOT 1, SETBACK S SIDE -YARD
SEWER ELEVATION FOUNDATION ELEVATION
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: S �' �� 4D
Type of Construction
To be completed -
Front Depth Height,
Sq. Ft.
Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Estimated Coste'l , J6�
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_ SIGNATURE
1
(Schedule of Fee Costs can be found on the Reverse Side).
c. 7—
NEW [kj Effective 8/16/90
ADAN [ ] R-1 AND R-2 . 3-1 (0 cc)
ALTER [ ] Building Permit Application
dll
Construction Address: (f �� I lQ G�/� , G
Leal Description: `` /
Name & Address: ��l�i� ( ZZ: �L L n L�ll/� Tei. # J ��
Contractor: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed constriction drawn on it to scale.
0
LTVn G AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Bgt/Ground Sq. Ft.
07HER:
Corner Lot [ ] Inside Lot [ ]
Type of Construction:
1t' Date•
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $
Approx. Ccanp a ion
Proposed Driveway Width If NewDesired: Ft. $ IM'. $
Ri + 6 See Bac Pa 1 7 / /S
,DATE: APPLSCANr: Tel. #
Permit Fee
$
Fire Surcharge
$
State Surcharge
$
SAC amrge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Charge $
TOTAL $
CITY USE ONLY
Fee Schedule on Reverse Side
.001 x Permit valuation (1/10th �)
$.50/$1,000 valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
PE
City of Fridley
200
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
• _____ COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
1 � ,
i " ,`� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED UT
•-_. ��
L 612-571-3450
910-F15
8/18/89
JOB ADDRESS 6011 - 6th. Street N.E.
1 LEGAL
LOT NO.BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
10.
1
Bonny Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Leslie Coleman 6011 - 6th Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Richard Hastings Roofing 6331 Riverview Terrace N.E. 574-9966
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 3 REPAIR ❑MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling 18 Squares.).
9 CHANGEOFUSEFROM TO
STIPULATIONS
Roof can he 2nd layer N11IEN but not 3rd. Install ridged galvanized
valleys.
On all new roofs or trfr-RffS a~� ren!a�ement roofs,
State Code requires th J 2 1,-'CTC cf 15 IIJ. felt,
mopped together, fe ins'.alled to a point ?_'1 inches
up from e,:terior V12T line, or the use of other
underiayment membrane.
approved
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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$900
$.50
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-
$23.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$23.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY V LIDATED THIS IS YOUR PERMIT
BLDG )NSP /
qAT
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ]
ADCN [ )
ALTER [ )
R-1 AND R-2
Building Permit Application
Effective 5/1/88
Construction Address: L E z t r'e C. o L 4/V 6 0/( � rA X571• N - S,
Legal Description:
Owner Name & Address: L g s j i r` <-o L cm ,a ,yam Tel. �
Contractor: R, c,4 A j2,0 4A 5t ; N c S Tel. # 5 I 9wz
Address: 1331 'R i V E 2 u t E Lj -rE& .
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
1zqr9!9MgTT OF err
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Lex h Width Hgt/Ground Sq. Ft.
oma:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard SP
tbacks
Hype of Construction: i, E Ttoo F Estimated Cost: $'� ,
Approx. Completion Date: 9/> s jr i IE
S
F.
Proposed Driveway Width If New opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE:
V—/ 8 �y APPLSCANT: p - Tp1. #_ 572 j! '-qF W
Permit Fee $ QL1, ou
State 3urrharge
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Qurzrge $
To►rAL $'�u
b'rIPOIATIONS:
G'LTY USE OIaY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by
NAY [ ] Not Nary [ ]
966.00
s76c,—
SUBJECT
P NO•
City of Fridley
27362
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
1 ,
O
' • COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
-1d
r
7
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 58432
612-571-3450
910-F15
18/24/98
JOB ADDRESS
6011 6th Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
1U
1
Bonn
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Les Coleman
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Premium Roofiniz 6S71-3971
20097688
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 3g REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 18 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
I 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
1501
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.FireASC
$1.50
PLAN CHECK FEE
Licen e C
5.00
T07A EE
5 0
®
90
SiG—TURE OF CON � RACTOR OR AUTHORIZED AGENT (DATEI
EN 7PRPER
9L S
LIDAT
$ I$ y��q�R P R
OATS
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW L ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ��%� ���_ ✓��
Legal Description:
Owner Name & Address: Ze!!��ZcA, I i A,) Tel. #
Contractor: /'re;'�MICe.��� MN LICENSE#
Address:'�lo b'C,a G 4 ��,V �z�/U� 2� Tel. # , Si/ -3 r
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:
Construction Type: POU ►= / V�,
Estimated Cost: $ ,'l'� IS -6
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: 9 --)L `/ -q 5� APPLICANT: Tel.
CITY USE ONLY
Permit Fee
$
�� o?S�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ PJS
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
. Ulf
$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
$
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2003
k Y/ t/7
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
6612 ' 4 cw
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
JOB ADDRESS
>/
New Fixtures
$ 7.00
The undersigned hereby makes application for a p rmit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Water Leader
$ 7.00
�� 20d-
0dSumRain
p/Receiving Tank
Sump/Receiving
$ 7.00
Water Treating Appliance
$10.00
Owner
Water Heater -Electric
7
$ 7.00
geg
Water Heater - Gas**
$10.00
Building Used As
Gas Range**
$10.00
) 2
Gas Dryer**
$10.00
Estimated Cost PERMIT NO.
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPAN
Reinspection Fee $47.00/Hr
SIGNED BY TEL N0._ i
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved By Rough -In Date Final Date
State Surcharge
$ .50
411
MINIMUM FEE ANY PLUMBING/GAS PERMIT IS $20.00
TOTAL FEE
$ C22 s4
PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
rpMMQN VFNT- VENT rYINNFC_TQR AND COMBUSTION AIR VFRIFICATION
When ralarin n As in0 furan _ _, 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 ( )
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 () No ( )
The Px1 ting rnmhi ichnn aor is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to ennfaIl a now cnmbuction airrit will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When in ming a naw y _ntingyystam, 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( )No(
)
A*r urian Tyne and S07P/Gammon Vent and Vent Cannertgr Information
Appliance #1 Type
Appliance #2 Type
Appliance #3 Type
Total Appliances
_ BTU Input
— BTU Input
_ BTU Input
Total Btu Input
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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
HEATING CO:
Signed By: Date :
//-)--70
Building
iaaac. Drag" v11 V AJULIKILVAP INN Ul711vW THE COST OF LABOR AND MAITMA1 C:
BUILDING
(USIM THE 1997 UBC FEE SCHEDULE)
TPermit No.:
Inspections
OCCUPANCY TYPE
RESIDENTIAL APPLICATION.
$
Received By:
763-572-3604
$
65% of Budding Permit Fee
Fire Surcharge
$
3.56 .001 times the total job valuation
Surcharge
CITY OF FRIDLEY
7a .0005 x Permit Valuation Minimum $.50
License Surcharge
763-502-4977 FAX
S • D 0 •$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Curt Escrow
EFFECTIVE 1-1-08
ft + 6 ft = .ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
DATE
' l 1 6 YOUR E-MAIL ADD
Sewer Main Charge
SITE ADDRESS
��
Total Due
THIS APPLICANT IS:
❑ OWNER NTRACTOR
PROPERTY OWNER/
N
TENANT
ADDRESS:// O J CITY
STATIN' os
PHONE.7(o3 eO R —D
CONTRACTOR
ADDRESS: � •ASD/
SUBMIT A COPY OFPHONE
�e SO � —o`tCB FAX
YOUR STAT$ LICENSE
STATE LICENSE #—___Z % EXP DATE
D
PROPERTY TYPE
1NGLE FAMILY SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED EVWINDOWS
❑ BASEY2M FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SW &,CNG POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
0'1 aIN'TENANCEIREPAIR ❑ REMODELING
"DESCRIBE WORK BEING DONE: _. PW
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFIN
0 HOUSE ONLY
NUMBER F SQUARES
❑ HOUSE & GARAGE
BASEMUM
REMODELING SUBMTf
GARAGES
❑ GARAGE
1.
.ATTACHED 2.
Ex isting Floor Plan
Proposed floor plan
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ DETACHED GARAGE
3.
List of structural members to be used
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
AI)_DD
XS z onyr•vne ertas rrr.
❑ Aluminum
❑ Trim
I.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fasciaand
— � �
2.
proposed project
Two
WINDOWS i — YV\ �.�,,
IN EXISTING OPENINGS Pfes
3.
sets of construction plans
Energy Calculations
❑No LOCATION OF WINDOWS r
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS
A i i IMMIC a WW r A..-
�...a. ,•.., •.�
iaaac. Drag" v11 V AJULIKILVAP INN Ul711vW THE COST OF LABOR AND MAITMA1 C:
TOTAL JOB VALUATION $ 3,500
(USIM THE 1997 UBC FEE SCHEDULE)
OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Budding Permit Fee
Fire Surcharge
$
3.56 .001 times the total job valuation
Surcharge
$
7a .0005 x Permit Valuation Minimum $.50
License Surcharge
$
S • D 0 •$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Curt Escrow
$
ft + 6 ft = .ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$i:Z&Agreement
necessary ( ) Non Necessary ( )
Total Due
$
Make checks payable.to: City of Fridley Attach Stduuu lations
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I 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 Fri and with a Construction Codes; thall understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the wr be' rcla th the ap, rove pan the case of all work which review d f p
SIGNATURE OF APP PRINT NAME V l/L DATE1V"./
A3U 11
APPROVED BY
DATE