PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn.
Date ................
OwnerI`r« ..:..1 .... �...'0!...
Address ....... "/.' .
Builder ..... ,,, _q06 "$ "..�. .......................
Address.......................................
LOCATION OF BUILDING
No.4 fZ.A- Street ............................ Part of Lot .......................
Lot ....... .I?.. Block ....../........ Addition or Sub -Division �/� � �.............
Corner Lot .......j,.... Inside Lot ............ Setback ............ Sideyard ..........................
To be Used as:
d", ... I
Type of
In consideratic
the proposed work
ordinances of the i
DESCRIPTION OF BUILDING
Front . Jj# . Depth. ILI.. Height %s�! ... Sq. Ft. .l AST Cu. Ft........ .
Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft. ........
1 �� .. Est. Cost /.Y -74v. .00 ........ To be Completed ......................
i of the issuance to me of a permit to construct the building described above, I agree to do
n accordance with the description above set forth and in compliance with all provisions of
Ilage of Fridley.
�jwWeratlo of the paymentof a fee of $.. 1�:.. , permit is hereby granted to... .... to construct the building or addition as described above. This permit is granted upon
e diti l n that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around an 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 limi and this permit may be revoked at any time upon violation of ,any of the provisions of said
ordinances.
Y.: 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.
•
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N? 7201
IF
• City oFridley, Y, Mian..•
idle
BUILDING PERMIT
�I
is �►�►L1
i�
z/,!ff
!V,
BUILDING
� Part of Lot
Lot _ _ _ Block Addition or Sub -Division .__ _
Corner Lot — Inside Lot ._. Setback _ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To as:
Front Depth Height M Sq. Ft. A Cu. Fty74s_
Fro Depth Height Sq. Ft. Cu. Ft.
Type of Construction _ Est.. Cos ,. — M 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 se forth and
the city of Fridley. pliance with all provisions of
ordinances of
In consideration of the payment of a fee of -C , 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 any time upon violation of any of the provisions of said
ordinances. _ m 1-n
NOTICE:
Ab psrndt doss not cover the construction, hutalisdon for wtrlm plumbing, gas heating, sewer or water. Be sure to soe
the Building hupo for for separate pormhs for thea hems.
Ar4Fy
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME �� BUILDER u
i
ADDRESS -- `.., ADDRESS �'�,`-�
S
LOCATION OF BUILDING _
No. Street Part, .,of Lot
Lot Block Addition .or Subdivision -
Corner 1 at Inside Lot Setback Side -Yard t "
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey.of,Lot.and proposed build-
ing location drawn, on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front
Depth Height
Sq. Ft.
��
' Cu. Ft. .
Front
Depth Height
Sq. Ft.
Cu. Ft.
Type of Cons'truct'ion
�
r7//Lia
Estimated Cost_
To be Completedr'.,,6
7 ' e� +
6
The undersigned hereby makes application fora permit for the.work herein,s.pe'cified,
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.
i
DATE_.%`' SIGNATURE
Schedule of Fee Costs can be found on the Reverse Side).
O . W
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•
•
Date:
June 9, 1965
City ®f Fridley, Minn.
BUILDING PERMIT
N'° '7819
owner: Robert C. Kelly Bider Ider City Garage Builders'
Address 6230 7th Street N. Be Address _ 5 %, 10 Mph Mie. 33
LOCATION OF BUILDING
No. 6230 street 7th Street N. E. Part of Lot
Lot ____6Block 1 Addition or Sub -Division Uplands,Add.
Corner Lot _ Inside Lot Setback Sideyard
Sewer Mevation Foundation Elevation
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 01,655,00 To be Completed
Storm damage repair
In consideration of the issuance to me of a permit to construct the building described above I agree to do
pro O the I accordance with the description above set fridley.north and i mpliance with Z provisions of
In consideration of the payment of a fee of $10.00 , permit is hereby granted to Inter City Gare
Wilders 1 . 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 ling location, construction, alteration, maintenance, repair and moving of buildings
wiord�anthe
city 11m1ts � this permit may be revoked at any time upon violation of any of the provisions of said
NOTICE:
111ds permb den net oswr the condmcflw, kmaN Lien for wkb& plumbing, gas hedM& sower or water. Be sun to no
tho Buihiing homer for sopume pwaft for thea Nana.
. - a
OWNER'S
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY,. MINNESOTA
- 7,P-4 r
"LOCATION OF BUILDING
No. p�. �(� Street �. Part of Lot
LOTS BLOCK ADDITION OR SUBDIVISION /
Corner Lot Inside LOT Setback Side Ya d
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; t n
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft'. Cu. Ft.
Type of Construction_ n� Estimated Coat
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 Buildingss and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE b aL- � SIGNATURE ..moi
(Schedule of Fee Costs can be found J/he Reverse Side).
SUBJECT
O.
City of Fridley
16 0 7 4
AT THE TOP OF THE TWINS
BUILDING PERMIT
' '
R
COMMUNITY DEVELOPMENT DIV.
t PROTECTIVE INSPECTION SEC.
t . i
CJS
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
---- ��•---;,;
L J\ 612-571-3450
910-F15
�/�S�.91
JOB ADDRESS 6230 7th Street N.E.
1 LEGALLOT
NO.
6
BLOCK
1
TRACT OR ADDITION SEE ATTACHED
Upland Addition SHEET
DESCR.
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert C. Kelly 6230 7th Street N.E. 571-1534
3 CONTRACTOR MAIL ADDRESS ZIP PHONE ILICENSE NO.
Heritage Builders 409 Main Street N.E. 922-1757
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
residential
7 CLASS OF WORK
❑ NEW C� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
rnnqtrijrt t hy t additinn
9 CHANGE OF USE FROM TO
STIPULATIONS
FOR #NG.
PERM REQUIRED
PER
',VERATE
AND SIGH
SEATING, PLUMBM(i
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
WOOd
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
168
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
5
2.60
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
X200.00
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.
PLAN CHECK FEE
TOTAL FEE
8.25
43.85
IG ATUREOFCONTRACTORORAUT IZ AGENT IDATEI
EN PROPjrRLY V ATED THIS IS YOUR P RMI
LDG INSP DATE
SIGNATURE OF OWNER IIF OW ER SUILDERI IDATEI
CITY OF FRIDLEY
APPLICA'riai FOft RESIDEP-ITIAL BUILDING PEW41TS
• (New, Al aerations, Additions, or Repairs)
• OWNER: li BUILDL-*
ADDRESS: 6,? --3D A) e Z ADDRESS: //D i
TEL N0: %� l-S� TEL NO:
Construction Location
STRIMT NO: �b STREET:
LOT: � BLOCK: % ADDITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of. Survey of lot and
propoaed'building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
01
• Front: �� Depth: Height:
Square.Feet: Cubic Feet: _
Front: Depth: Height:
Square - Feet: Cubic feet: _
Od .
Type of Construction: Estimated Cost: $
To lie Cbrapleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
?pie 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 arg true and correct.
DATE: B- -:)- k <9/ SIGNATURE: <
Stipulations:
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PE IT NO.
City of Fridley
� 16susdEcr
4 91
AT THE TOP OF THE TWINS
BUILDING PERMIT`
RECEIPT NO.
........ COMMUNITY DEVELOPMENT DIV.
-L/3
r PROTECTIVE INSPECTION SEC.
1
{�
/•"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
3/2/82
JOB ADDRESS 6230 - 7th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
1
Upland 1st Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert Kelly 6230 - 7th Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Heritage Builders 409 Maple Avenue N.E. 922-1757
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 ❑ MOVE ❑ REMOVE
S DESCRIBE WORK
Install Majestic WMR 36 Freestanding fireplace
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide products of combustion alarms if not now present.
FOR �tl6>rf��?t��
9E.A��'Iaf G, PLUMBING
AND S GN
NS.
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
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
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2,000
$1.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW RE@ULATING CON-
$32.50
ST UCTION P44.jHE PERFOR NCE OF CONSTRU ION
PLAN CHECK FEE
TOTAL FEE
e-,�,'? — �--�"
$33.50
SIGNATURE OFCACTOR OR AUTHORI AGENT (DATE)
WHEN PROPER VALIDATED THIS IS YOUR PERMIT
%
BLDG INSP 00T E
SIGNATURE OF OWNER( IF OWNER BUILDERi (DATE)
1
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PER14ITS
(New, Alterations, Additions, or Repairs)
OWNER: T /fc-L L BUILDER: �f L�� � T/� _4 � � L r-2 Arf
ADDRESS: _ 4, SL 3 a — 7 $' j ADDRESS: �fy q—t/�i'C [� _ C ,v,(3,
TEL NO: TEL NO: _ c2,,t' .2 — /7j-7
Construction Location
STREET NO: STREET:
LOT: BLOCK: ADDITION: t'-'x4A4-o'O c
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
r�
DESCRIPTION OF CONSTRUCTION
lla Front: Depth: Height:
Square. Feet: Cubic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
Type of Construction: /NSTEL,L ad �C_j_e,.�9Q�L= Estimated Cost: $ the--ia due
oi= /-<CoT,4 r j_
Tb Be Cbripleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ ' $
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the tvrk'herein specified,
agreeing to do,all work in strict accordance with the City of rridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are trAWand correct.
DATE: 0-2— SIGNATURE: —77" §�` `L�
Stipulations:
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S
SUBJECT
PECR
City of Fridley
019989
AT THE TOP OF THE TWINS
g U I L D I N G
P E R M I T
RECEI
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
90
r PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
' 612-571-3450
910-F15
7/11/89
JOB ADDRESS 6230 - 7th Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6T
1
Upland 1st Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert Kelly 6230 - 7th.Street N.E.
571-1534
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
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 DESCRIBE WORK
Construct a 121 x 101 Shed in Rear Yard
9 CHANGEOFUSEFROM TO
STIPULATIONS
Shed must be securely anchored to ground.
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
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
$1,200
$.60
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.
PLAN CHECK FEE
TOTAL FEE
$29.60
SIGNATURE OF CONTRACTO OR AUTHORIZED AGENT (DATE)
i
WHEN PROPERLY VA DATED THIS IS YOUR PERMIT
2/ ilk
45A�TUREOF
OWNER 11F OWNER BUILDS 1 IDATEI
BLDG INSP
ATE
NEW Effective 5/1/88
ADL [ ] R-1 AND R-2
ALTS [ ] Building Permit Application
Construction Address: �p 2✓ C� ?'' l- S -f -
Legal Description:
Owner Name & Address: Rr) a la c , Q - V -E L -L y Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVMG AREA: Length Width height Sq. Ft.
QN1AGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
Oma: gwaj oe 1 9 "
Corner Lot [ ] Inside Lot [y] Ft. Yd Setback Side Yard Setbacks
Type of Construction: P" m F, ccj a,,_3> Estimated Cost:
Approx. CcWletion Date: 2/-3-/ k-2
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
DAM: '?/��a
Width + 6' See Back Page
APPLICANT': 2Tel.
CITY USE ONLY
Permit Fee $ 9, no
State Surcharge 60
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
$ L9. 66
STIPUTATIOM :
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engiraming
Agreement Necessary [ ] Not Necessary [ ]
.. f
suedEcr0
of Fridley
7PECity
0
9 4 8AT
THE TOP OF THE TWINS
BUILDING
PERMIT
r
RE
� • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
� �
I �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910-F15
I
7/19/91
10B.ADDRESS 6230 - 7th. Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
6
1
Upland Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Robert Kelly 6230 - 7th. Street NE
571-1534
3 CONTRACTOR MAIL ADDRESS
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 ❑ ADDITION ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Soffit/Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
S0. 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
$600
$'50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SACCHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$ 17.00
Fire SC $.60
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$18.10
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WN PROP
ALI TED THIS IS YOUR PERMIT
BLDG INSP
OA E
SIGNATURE OF OWNER II OW NER BUILD RI IDATEI
MW [ j Effective 1,/1,/91
ADM [ j R-1 AMID R-2
ALTER Building Permit Application
/ 1�
Cm tructian Address: Lw � & / 1 ( • � ( �
legal Description: L-.OAC, V,,W L- 1
Owner Name i Address: �-PsZ� C ` `�S _Tel . # 5' �i 1 ��
Attach to this application, a Certificate of M vey of the
lot, with the proposed rms xuction drawn on it to scale.
LTVIIG AREA: Length Width Height Sq. Ft.
ORRAM AREA: length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Gr=d Sq. Ft.
o►nMR: Sn FF c ( Fr AS -C i A, ALPM L° n LL P -2—A -GL
Corner Lot [ j Inside Lot
Type of Mian:
[j
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $
Approx. Ccmpletion Date: !> / R /
Proposed Driveway Width If New opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: `� �' -9 APPLICANT:Q".e4k'Del. # 5D /s 3-f
Permit Fee $ l 9, c C'
Fire Surcharge $ LoC
State Surcharge $ G
SAC MuVe $
Driveway Escrow $
Park Fee $
Sewer Main Qharge $
Fee Schedule an Reverse Side
.001 x Permit Valuation (1/10th $)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by^
Agh�e®ent Necessary [ ] Not Necessary [
m
SUBJECT
R
City of Fridley
4 s� 0'
P, AT THE TOP OF THE TWINS
D[ D� A I T
-BUILDING
r CR'v1 I
RECEIPT NO.
Ir
COMMUNITY DEVELOPMENT DIV.
~
L✓
r PROTECTIVE INSPECTION SEC.
� ,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
"1 CITY HALL FRIDLEY 55432
�.j
612-571-3450
910-F15
10/28/96
JOB ADDRESS 6230 7 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
6
1
Upland Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert/Irma Kelly 6230 7 Street NE
571-1534
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Integrity Construction 19015 Co Rd 44, Clearwater MN 55320 558-2692 20006605
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 ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Remove fireplace and two flanking windows - Install
new bow window and reside
front of dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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 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
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
$2.10
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$4,200
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-
ire SC $4.20
STRUCTION OR THE PERFO MANCE O CONSTRUCTION
$99.75
4
PLAN CHECK E
TAL FEE
`
L e SC
5.00
$111.05
SI NATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
H N P
FLY V LI ED THIS IS ERMIT
f
DG INS
FIAT
SIGNATURE OF OWNERoF OWNER BUILDERI IDATEI
m
NEW [ ] ective 3/1/96
ADDN L ] CITY OF FRIDLEY
ALTER [.]/ SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application (�
ConstructionAddress: 6
Legal Description:
Owner Name & Address: ��--� l Tel. #
Contractor: Z' ,�-t e �� ; -��, r; N -aka \ Q�s MN LICENSE # GCC) S
Address: 9 o k S -�� y� C 1-e ��cc M Tel. # 3 zo 55 ?- Z G 7 T
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: GeWe�je
F:rev\a \.\,:A A45 _
L 5 i o�
• �c�o,c�-�-®F No,.._S�, it�3+o.\\ h2�J�ov�1 vJ�l�cio„J S.�d►'n�
Comer Lot [ ] Inside Lot [ ] Ft. Yd
Setback Side Yard Setbacks
Type of Construction:
Estimated Cost: $ 44 a
C�=
Approx. Completion Date: AJo-4, -5
L!j C .
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: IC -5 — z:5q �, APPLICANT:
- - - Tel. # 3 Zo -SSS -ZG i z --
MY
CITY USE ONLY
Permit Fee $ ®,
Fee Schedule on Reverse Side
Fire Surcharge $ zo
.001 of Permit Valuation (1/10th%)
State Surcharge $
$.50/$1,000 Valuation
SAC Charge $
$900 per SAC Unit
License Surcharge $ -
$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 $ ®5
STI]PULATIONS:
_ _
N ha�3
SUBJECT
City of Fridley
2 7 616
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
1 �
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
1 I
NUMBER
REVT9/8/98
ATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
JOB ADDRESS 6230 7th St NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1
Upland Addition
SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP
PHONE
Robert C. Kelly 6230 7th St NE 55432
571-1534
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
New Haven Construction 4208 83rd Ave N Brooklyn Park 55443
566-5225 20077950
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 Cj REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Rwmjdx" $ xft&xxJff Reroof house & garage (34SQ) 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
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
$2,835.00
$1.41
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 L CAL LAW REGULATING CON-
$74.75
1' re SC $2.83
STRUC ON OR THE PERFORMANCE OF C STRUCTION.
PLAN CHECK FEE
TO FEE
Lice e SC $5 0
$83.99
$IGNATU EOF CONTRA TOR OR AUTHORIZED AGENT IDATEI
P V VALID THI$ 1 U
��HE
((//„/((”//))
=RSIGNATURE
OF OWNER IIF OWNER BUILDER) IDATEI
OG INSP
TATE
Hug 26 98 06:53a
NEW [
ADDN [ j
ALTER [ 1
Kerri
566-7183
CITY OF FMLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: (� s7 �e G� /me -
Legal Description:
Owner Name & Address: 4e Z,30
Contractor: 6a �tn ees!�4'09�
Address: 312z:P-e S&rd 'A?11er2 me
p.5
Effective 1/1/98
Tel. # .552/ 3
MN LICENSE # 206 77 9S'®
Tel.# S&kZ217
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IIVIPROVFMENT
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:
�-,eit r - -f-
sero o ' 70' Estimated Cost: $
Driveway Curb Cut
Width Needed:
(Fee Schedule on Back)
Ft. -6. 6 Ft = Ft x $ = $
DATE: 'Z S' S APPLICANT: 4 'd� Tel. # .S3� (o rSZ
IT'Y SE ONLY
Permit Fee
$ f %S4�
Fee Schedule on Reverse Side
Fire Surcharge
$ �- °
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ S On-
$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:
9
01
SUBJE&
PEO.
City of Fridley
' 57���EdD THE TWINS
BUILDING
PERMIT
2 8 3 6 9
RECEIP
` • _ COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
;'j CITY HALL FRIDLEY 55432
l 612-571-3450
�`�
NUMBS I
9t 0415
pEv
DATE
10/22/98
PAGE OF
APPROVED BY
JOB ADDRESS
6230 7th Street NE
1 LEGALLOT
DESCR.
NO.
6
BLOCK
1
TRACT OR ADDITION
1 Upland Addition
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert & Irma Kell
571-1534
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Panelcraft of MN 3118 Snelling Ave S Xpls MN 55406
721-66281
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 jEk ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Awnings
9 CHANGEOFUSEFROM TO
STIPULATIONS
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
1 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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
VALUATION
SURTAX
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
735
.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$29.25
Fire SC .73
PLAN CHECK FEE
TOTAL FEE
T4nnnse SIC $5,0N35.48
SIGNATURE OF CON'aACTOR OR AUTHORIZED AGENT iDA TES
- WHEN PROPERL V LIDAT D THIS IS YOUR PERMIT�/Jy',(r
BLO NSP
C
SIA IE
S-GNA LURE OF OW NEA dF OwNEp BU4 DERi 'DATE,
01
i� L W I
ADDN' I'I CI'T'Y OF I-RIDLEY
AL'I'Elt I I SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
eistruction Acid ress:
Legal Description: ___
630 - ,
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI-IEIt:
W---1IE
UIWIVe 1/1194
d -? 336
a3 3(6 1 b
Tel. //
MN LICENSE //-/
--
Attachio this application, a (`ertificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sy. Ft.
Length Width Height Sy. Ft.-
Length
t.Length Width Hgt/Ground Sq. Ft.
Corner Lot Inside Lot Ft. Yd Setback Side Yard Setbacks
T e of Construction: c �� ., s Estimated Cost: $ -7 3 S.
I4rox. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + G lit = Int x $ _ _ $
DATE: APPLICANT: Tel. #
Permit lee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
101'OTAL
STIPULATIONS:
$ e:12 9 ss
$
CITY USE ouu-
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/ 10th l )
$.50/$1,000 Valuation
$800 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 I I Not Necessary I I
7Z/-lo%z�
1�
SuBjECTPE
.
City of Fridley
3 3-8 7 2'
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
`
RECEIPT NO.
• _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
49&
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432NUMBER
763-571-3450
910415
9/ 11103
1OB ADDRESS 6230 7 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
1
Upland Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert Kelly 6230 7 Street NE 763-571-1534
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Renewal By Andersen 1920 Co Rd C W, Roseville, MN 55113 651-264-4777 20130983
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 IR REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace 9 windows within existing openings
9 CHANGE OF USE FROM TO
1100111
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
Pfau it inspection ceras
Will a Wiled
To Homeowner To Post
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
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 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
1 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
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$5,885
$2.94
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-
Fire SC $5.89
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$125.25
ANC EC K FEE
TOTAL FEE
Lic a SC $5.00
$139.0
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT iOATE.
W EN PROP LY VALIDATED THIS'
UR P RMIT
_Le
I
SIGNATURE OF OWNER,1F OWNER BU[LDERi iDATEi
SP
6rAtE
1�
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FANMY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:" �Q�Ab
Legal Description:
Owner Name & Address:
Tel. I,)), h-1 � b
i
Contractor:; 1=.0—Zai 131M MN LICENSE # oi01309 B ?,
Address: is a Com imcg C. W� �:' ,oScu� tk , t�11� SS ll2 Tel. /# (c5l •°1144 • �f '�'
Attach. to- this application, a- Certificate of Survey of -the
lot, with the proposed -construction drawn on it to scale.
DESCRIFUON OF ROVENI,ENT .
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hat/Ground Sd. Ft.
Estimated Cost: $` t),
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: .p APPLICANT: Tel. # 11b •34,5•Wq
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]
IF
CITY OF ERIDLEY BUILDING INSPECTION
v
9 3431 University Ave NE
9=ridley, MN 55432
L
763-572-3604 FAX 763-571-1287
9
D
n RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (Ne%v Furnace, Fireplace, Insert)
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Fee Tota
$35.00 $315-
$10.00
35,
$10.00 $
JOBADDRESS Coa_J 0
Owner _P,,&Coer k k
Building Used As e5 11 9 -e- Y1e 'e -
ESTIMATED COST AU0$Ob.O0 PERMIT NO
Gas Range $10.00
$
DESCRIPTION OF FURNACE AND BURNER
Gas Dryer $10,00
$
# of Heating Units ( Circle One (Steam) (Hot Water (Warm Air)
Trade Name Care ; r_r Sfs MV 9 (:) o0 Size No.
*Air Conditioning -All Sizes $25.00
$ a5, oa
BTU Lab l DOO HP EDR
COXr : e -r 31;TX A d QLA a +o n
, t��. as. Total Connected Load
Fuel Cer
All Other Repairs or Alterations (List on Back)
r 1% of Value of Applianoe or Work
$
Burner Trade Name Size No.
A
Minimum Fee $15.00 for Residential or 5% of cost of
BTU HP EOR
Y improvement whichever is greater on work less than $300.00
The undersigned hereby makes application for a permit for the work herein
5 Commercial/industrial/Institutional
specified agreeing to do all work in strict accordance with the City Codes
r 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/industriaVinsiitutional
and representations stated in this application are true and correct.
CENTERPOINT ENERGY
Y State Surcharge
.50
HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304
1a
TOTAL FEE
$ W -so
Signed �Te! # 763-757-6202
�
v
REINSPECTION FEE $50.00/HOUR
FAX # 763-757-6701 Date � " oO'
m*Air Conditioners can not be placed in side yard without written approval
ri from adjoining property owner - copy to City
N
ry
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
IL
Q Approved by Rough -in Date Final Date
F0, d lt1101
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verges 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 (y) 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 existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes (� No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturees specifications.
Yes k) No( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA 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 ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type �,Jy nc&& BTU Input Coo Fan Assisted or Nat �Ah
Appliance #2 TypeJ,A�L .Je J&& BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances . Total Btu Input 100 912
etq,,0M
Common Vent Type �j Ci Vent Height 1 Diameter _ inches
91—
Appliance #1 Vent Connector Height ft Length ft Diameter_in Type C)
Appliance #2 Vent Connector Height _3_ft Length _,3:5_Lft Diameterin Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
CENTERPOINT ENERGY
HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304
Signed By: L`Date
n a d-
Z0/Z0'rl T01,91SL 01 A31GINA d0 A110 WONq S7: TT b00Z—LZ—Nc4H