PRE 2010 DOCSBUILDING PERMIT
Village of
Date . . li' . . iM' r. ...........
Owner . . . . ... ... .
Address ........ .................................
Fridley, Minn. N? 2172
Builder...........................................
Address.........................................
p J -gszk i1- _ LOCATION OF BUILDING
QEMEMtnt
+*
No. .. Street ..................... Part of Lot .......................
Lot ...... ... Block .... & ....... Addition or Sub -Division . . . .....
Corner Lot .....: .. Inside Lot ............ Setback .4*, Sideyard..�!i...
To be Used as:
DESCRIPTION OF BUILDING
Front ...V4! Depth Ji -Height
Front ........ Depth ........ Height .........
Type of Construction • �. Est. Cost /vj.4APV ..............
Sq. Ft......... Cu. Ft........ .
Sq. Ft......... Cu. Ft........ .
To be Completed ...................
In consideration of the issuance to we 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.
VA �... 4 ..... V ..
In consideration
Of the payment of a fee of $. M."'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 be revoked at any time upon violation of any of the provisions of said
ordinances.
• ?S' ........ 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.
i
is
•
0 City of Fridley, Minn.
BUILDING PERMIT N° 6469
Date:
Owner: _ Builder
Address Address
/�
/ L O ING
No. AQ / Street a Part of Lot
Lot _Block Addition or Sub-DivisiA
Corner Lot Inside Lot _ _ Setback _1�2z—..... - S eyard _ ,C
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth Height 449!7— Sq. Ft. Cu. Ft
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. CoFZ�y� � ' '�' o be Completed
In consideration of the issuance to me of a permlt to construd the building described above, I agree to do
�k Yra c with the description above seOvid Of ptaccordance
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, re ' and moving of buildings
orrdi�nancthe ces. city limits and this permit may be revoked at any up�Aola 'ono of the provisions of said
NOTICE:
This pernh does net corer the eondrueHon, huhllation for whtng, plumbing, gas heating, rower or water. Be euro to sae
Tho Buihling ingm ter for separate permits for these hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
%,LBUILDER
OWNE R'S NAME
0�
LOCATION OF BUILDING
No. ®l Street I ��`� �, Part of Lot
Lot Block 3 Addition or Subdivision
Corner Lot -4 --Inside tot, Setback_ )� (P Side Yard
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:
Jy� Front e� / Depth Height
Sq. Ft. '5- Cu.. Ft.
Front Depth Height,
Sq. Ft. Cu. Ft. 90,
D�
Type of Construction 7 Estimated Cost 2W
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 9 � SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
0 . 1-..- 16
SUBJECT
P
City of Fridley
o- 16939
AT THE TOP OF THE TWINS
B U I L D I N G P E R M I T
r
ECEIPT NO.
�
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
y
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
13/14/83
JOB ADDRESS 101 45th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
3
1 Rearrangement - Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Thomas M & Audrey M. Stenehjem 101 45th Avenue N.E. 572-1687
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
SAME
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 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construction a 22' by 18' addition
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.
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
396
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
$20,500.00 10.25
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
146.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
3 193.38
SIGAATIIRE OF CONTRACT RA IZEDA NT IDATEI
WH ROP RL VA T THIS IS YOUR PERMIT
-r S
3AB
GN TURE OF OWNER IF OWN R BUILDER) tj IDATEI
BLDG NSP f1ATE
CITY OF FRIDLEY
Effective Aug. 1, 1981
APPLICATION FOR RESIDENTIAL BUILDIIIG PERMITS
(New. Alterations. Additions, or Repairs)
7W6,wo5 9 f 0496-V ,
OWNER: S7 -E" BUILDER:
ADDRESS: _/y/ ��S'='�`i ADDRESS•
TFL Mo: TEL NO:
Construction Location
- STRITT NO: O� STREET: 4n7:— T- (%�c
LOT: BLOCK: ADDITION:
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.
DESCRIPTION OF CONSTRUCTION
r
Front: �z , / Depth: / O Height:
Square Feet: SQ6 Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
®O
Type of Construction: Estimated Cost: S
Tb Be Canpleted: S �
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: S S
. SEE PZVER.iE SIDE OF SHEET
Zile undersigned here makes application for •
9 b1' Pp permit far the work herein specified,
agreeing to do,ail work Im 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.
MATZ: SIGNATUME:
Stipulations:
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Effective Aug. 1. 1991
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL
RATE
TOTAL
Job Address
Furnace Shell and Duct Work,
Burner (Also replacesent furnace) $
20.00
$
Department of Buildings, 6131 University Ave. N.E., Fridley. MN SSI32
City of Fridley
Gas Piping $
10.00
$
Tel. 1571-3150
(piping needed with now furnace)
Gas Range $
10.00
$
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
Gas Dryer $
10.00
S
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this appl/cats are true and correct.
• his Conditioning (all sizes) $
10.00
S
Fridley, Minn.
All others/Repairs and Alterations
OWNER
It of Value of Appliance or Work
S
F
KIND OF BUILDING
COMMERCIAL/INDUSTRIAL
USED AS
It of Value of Appliance at Mork
$
10 BE COMPLETED ABOUT
ESTIMATED COST
State Surcharge
$ .50
OLD - NEW BUILDING PEANIT 6D. PLRMIT 110.
TOTAL !ZE $
Reinspection Fa ($15.00) $
Rough Insp.
Date A ��,
Final Insp. e� C��
Date
Approval for Permit ^ '
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCHARGE
Attach stack verification foe with replacement furnace permits
•Air Conditioners can not be placed in side yard without
written petsission from adjoining neighbor.
DESCRIPTION OF FURNACE/BURMER
HEATING or POWER PLANTS. Steam, Hot dater. Mars Air- No -
Trade Now
size No.
capacity Sq. Ft. EDR BTU NP
'Dotal Connected Load Kind of Fuel
BURNER - Trade Name Size No.
capacity Sq. Ft. EOR BTU MP
Company �r
,
CITY OF FRIDLEY
Effective May 1, 1990
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL
Furnace Shell and Duct Work,
Burner (Also repiacestent furnace)
Gas Piping
(piping needed with new furnace)
Gas Range •
Gas Dryer
RATE TOTAL
$ 20.00
$ 10.00
$ 10.00
$ 14.00
• Air Conditioning (all sizes) S 10.00
All Others/Repairs and Alterations
1• of Value of Appliance or Work
CON14ERCIAL/ INDUSTRIAL
11 of Value of Appliance or Work
State Surcharge
TOTAL FZE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp. Y —/3
Date
Approval for Permit 61,J)_
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining ne►glLLmr.
Job Address 1� �v�Y° J w� f V E
Department of Buildings 6431 University Ave. N.E., Fridley, MN 55432
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 application are true and correct.
Fridley, Minn. //-/& S 19�n
OWNER
KIND C
USED AS
TO BE COMPLETED ABOtfT 4
U
ESTIMATED COST ,500 - &-0 /
I /j NEW BUILDING PERMIT NO. PERMIT NO. l ` (r "
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water,ai Air -
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel ,
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR 8/111 HP
Company , I e qn ;� -- -
Signed By e� 8'7c?/ n p /�Y-Q �J
Tel. No. J �� O / c /
Fill out back side for stack verification on replacement furnaces
CHIM14EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1.
Has
been carefully examined
Yes (,)
2.
Is
free from rust or deterioration
Yes ( )
3.
Has
no foreign objects lodged within
Yes ( )
4.
Is
securely supported
Yes ( )
No ( )
No ( )
No ( )
No ( )
5. Meets all current Code requirements for size and
total BTU connected Yes ( ) No ( )
6. Has
Total
heating
BTUs of
All
other
BTU's
TOTAL
Rema rk s
Company _
Signed By
Da to
Effective May 1, 1990.
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
v
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4 x
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Water
Heater
as
lec
I
1st
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(") - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
Back Flow Preventer Required.
Type
RATE
$ 5.00
S 3.50
S 1.50
S 4.00
S 5.00
S 5.00
S 5.00
S 5.00
S 5.00
S 7.00
S 5.00
S 10.00
S 10.00
Yes ( ) No ( )
_ S 5.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $ State Surcharge
($15.00) TOTAL FEE
TOTAL
S
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 app
tion1are true and correct
Fridley. Mn.V' � , 19 f
OWNER / -/L I'l a -i .0 1 / l.'
i
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT ZOO
ESTIMATED COST 00
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By
Tel. No. .�
ROUGH INSP.
Date
FINAL INSP. // �7 " �;70
Date
APPROVAL FOR PERMIT 0C.;
11INIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 YAX: (763) 571-1287
ADDRESS : 101 45 AVE NE
PIN : 263024330119
LEGAL DESC : REAR BL 13,14 & 15 PLYMOUTH
: LOT 3 BLOCK 3
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-01070 390
DATE ISSUED: 07/12/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL AIR CONDITIONER.
# INSPECTIONS 1
APPLICANT
CENTERPOINT ENERGY/MINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
LANGIEWICZ ALEXANDER & SUSAN
101 45TH AVE NE
FRIDLEY, MN 55421
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 5818
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
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 provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp.
Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
S72 -36U4 1"A.2L:
ADDRESS : 10145 AVE NE
PIN : 263024330119
LEGAL DESC : REAR BL 13,14 & 15 PLYMOUTH
: LOT 3 BLOCK 3
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
571-1287
PERMIT O.: 2004-01071
DATE ISSUED: 07/12/2004
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AIR CONDITIONER.
# A/C UNITS 1 # FURNACES 0
# GAS DRYERS 0 # GAS RANGES 0
VALUE (FOR MINIMUM CALC)
2000
APPLICANT
HEATING PERMIT MINIMUM FEE
0.00
CENTERPOINT ENERGY/1VIINNEGASCO
FURNACE SHELL/DUCT WORK
0.00
13562 CENTRAL AVE NE
GAS RANGE FEE
0.00
ANOKA, MN 55304-
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
25.00
STATE SURCHARGE, MECH FLAT
0.50
TOTAL
25.50
OWNER
PAID WITH CHECK # 5818
LANGIEWICZ ALEXANDER & SUSAN
101 45TH AVE NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws 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 provisions of any other state or local law
re onstruction or the performance of consIctir.
Ann icant 4 Date I
I
Bldg Insp;
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
;ITY OF FRIDLEY BUILDING INSPECTION
v
9 3431 University Ave NE
9=ridley, MN 55432
L
763-5723604 FAX 763-571-1287
1
9
D
n RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
D Gas Range
Gas Dryer
*Air Conditioning -All Sizes
Effective 4/1,/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS D Y `-` AV- �L
es Total /►
Owner At Lr /141 C LJ C Z.� -
$35.00 $ Building Used As �2Si cQp�l C2
$10.00 $ ESTIMATED COST A{ a0- L:3D PERMIT NO ->C�Z �1 09 l
$10.00 $
$10.00 $
$25.00 $–—�
All Other Repairs or Alterations (List on Back)
>- 1% of Value of Appliance or Work $
a Minimum Fee $15.00 for Residential or 5% of cost of
Y improvement whichever is greater on work less than $300.00
i
Commerciallindustrialjlnstitutional
> 1.25% of Value of Appliance or Work (List on Back) $
Minimum Fee $35.00 for Commercial/industriaVinstitutional
YState Surcharge $
1 TOTAL FEE $�
114
REINSPECTION FEE $50.00/HOUR
W *Air Conditioners can not be placed in side yard without written approval
ry from adjoining property owner - copy to City
r�
N
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE.
IL
CC
DESCRIPTION OF FURNACE AND BURNER
ft of Heating Units Circle One (Steam) (Hot Water a
Trade Name _J010114 Size No.
BTU Hp EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
u.'(ir,t
he un ersigned hereby makes app ication for a p t or h wor erein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the B Idin Division, and hereby declares that all the facts
and representationsu" &Ce� eAvm ►d correct.
HEATING CO e NE
"aM- Lake, MN `5&W4
FAX
Tel #
Date'
Approved by (tough -in Date Final Date
z® • d 7alal
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS t
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestppped where required. Yes ()
No ( )
The venting system is plastic/PVC-and meets all current codes and manufacturer
specifications including sizin�, %Vth, number of elbows and termination. Yes ()
No( )
The undersigned also verifiet, t#at the replacement unit is a listed assembly
and meets the current cod gd manufacturer's specifications. This does
include AGA-GAMA Categot'pantraI Furnace Venting Tables for fan
assisted and natural draft apli0ns. Yes ()
No ( )
�4
The existing combustion air is sizdd and installed to meet the current nodes
and manufacturers specifications. Yes ( )
No( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. - Yes ( )
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-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( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
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
ALTERATIONS: (Describe)
HEATING CO: -
Signed By: Date:
F0/FA ' A TWAA21 01 A, iia 1 HA �D Ai T o wnH-I lq? : T T i?00E-2,Z-8dd