PRE 2010 DOCSCity of Fridley, Minn.
BUILDING' PERMIT S0 4 09
Date:
Owner: _ .. .. .t.__. Builder
Address ✓
._ Address _ .... .._..._ ..._ _ _-..._-_..._.......
OC TIO1 OF BUILDING
No....,..::..: Street .......... Part of Lot _....
Lot ...... ...................... _........ : Block .....___.... --------- ........................... Addition or Sub -Division ..... ........... ..................
Corner Lot ................................. Inside Lot ........................... Setback ----- ---------_-----.................. Sideyard
Sewer Elevation ..... .............. _.._......__.._..._._......._...._____----------.--..._..._. Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
L' -¢r- ---..._ nt ...6 - Depth a�.._.-:,P''..._.. Height .�...i�.�......_.. Sq. Ft..�.,�.. Cu. F't.�_..�'-
---------------.............. _................ _..... Front......._. Height ...................... Sq. Ft. _..._............... Cu. Ft. ..... .............
....
Type of ConstructionEst. Cost _............... ......... To be Completed ..... ............. _............ ..........
......
,�,UaHt
71-119_ f
'E yid®
1C�lti Cor ir1ONS.
W .UIL ii lu RE'S- FJ
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$'7� - `""'"' ......., 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. .A.n "I i
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 hems.
4
Owners N
Address
No.
APPLICATION FOR BUILDING PERMIT
IOTA
of Lot
Lot Block Addition or Sub.Div.
Corner LotInside Lot_____ Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used s
LL
ont Depth Height._.
Sq. Ft.
Front Depth Height
Sq. Ft. Cu. Ft,
Type of
Tstlmated Cost - L::f�6
To be completed
The undersigned hereby makes application fora 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 mares tall the facts and represen -
tions :7din this application are true and cor t.. -
DATE / .� 6 C� SIGRA�URE
(A Schedule of Fee costs can be found on t6 Reverse Side.)
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City of Fridley, Minn.
BUILDING PERMIT
ado 7c/
N° 7015
L ONF B ILDING
No. _ Street —a _ Part f Lo
Lot Addition or Sub -Division
Corner Lot Inside Lot — Setback __ Sideyard_—
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To
Front Depth Height �G,f Sq. Ft Cu. Ft
Fro t Depth Height _ Sq. Ft ____ cu. Ft.
Type of Construction Est. -/ � _ 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 abov set forth and compliance with all provisions of
ordinanc:ea of the city of Fridley. �'/�j �
In consideration of the payment of a fee of $tel , 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 vio of oln of any of the provisions said
ordinances. A A % 1
NOTICE:
ibb permit don not cavae the construction, instailarion for wbfng, plumbing, gas boning, server or water. Be vera to we
tbo Buiblbrg laspeder for aparare permits for then item.
APPLICATION FOR BUILDING PEPR
b :
CITY OF FRIDLEY, MINNESOTA,-,,
LOCATION OF. BUILDING
No. Street .,Fa t of. Lot
Lot_ Block. /r Addition or Subdivision
Corner Lot Inside Lot rSetback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Twq.Gertificates 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.,.,f Cu. kit:
Front Depth Height
Sq-. int. Cu.. Ft,
Type of.Constructiea7 C
d i
Estmate:oat: �,
- o�
To be Completed_
The undersigned hereby makes application fora -permit for the, work torein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings'of the Department -9f Buildings, and hereby declares that:all the facts and
representations stated in this applicati�n'amp true and correct'.
jSchedule of Fee Costs can be found on the Reverse Side).
P
r
52-84-x915.51
City of Fridley
Appiication for Plumbing and C%n Ruing Perndit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK 137 N E 49th Ave
Number, Kind and Location of Fixtures L°cation
pp
x $2.00
$
Future Fixture Opening ................
x $1.50
12
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ............................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
U0'
Z
•
•
WATER HTR.
$
Electric Water Heater
Base
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
In,,qt
Gas
Additional Fixtures ....................
P
$
Gas Range to 199,000 BTU ..............
x $5.00
$
Gas Dryer
1
5.00
REPAIRS & ALTERATIONS—Refer to Code
1st
2nd
3rd
4th
• Future Connection Openings
e New Fixture, Old Openings I
Connected with
Sewer ❑
Cesspool Ej
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ....... ..............
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ............................
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
x $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$
Additional Fixtures ....................
x$.75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
Gas Dryer
1
5.00
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ 5.00
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn 12-6-68 19_
Owner R Markwaod
Kind of Building frame
Used as res
To be completed about 12-1
Estimated Cost, It 10.00
Old—New. Building Pe t q � Pe
� =.1 � '. ,'.ter✓.I���l�`' .
Signed - -
By APANKAPOUS GAS CA
Business Phone No
ROUGH
FINAL I/^ 2 S'- 7 �j
42
01�
SUBJECT
PER
City of Fridley
o 1231'7
AT THE TOP OF THE TWINS
BUILDING PERMIT
•
RE
�
--COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 i
� CITY HALL FRIDLEY 55432
NUMBER'
REV.
DATE
PAGE OF
APPROVED BY
--'- • •'� 612-560-3450
910-F15
9/13/73
JOB ADDRESS 137 - 49th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
1
1 Carlson's Summit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Regina Markwood 137 - 49th Avenue N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
North Central Builders 4716 - 42nd Avenue North 533-6168
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION [X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK Reside dwelling with steel siding
9 CHANGEQFUSEFROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Steel
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
$2,850
1.43
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-
18.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
&�/�
ji
PLAN CHECK FEE
TOTALF41L�P-4/
SIGNATURE O ONTRACTOR OR AUTHORIZED AGENT - IDATEIWHE
PROPERLY VALI TE T IS UR PERM
7
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG. INSP DATE 1'
01�
APPLICATION FOR RESIDENTIAL, ALTERAT1,0N,
OR ADDITION BUILDING PERMIT
CI'T'Y OF I -RI DLI. Y, MINNESO'T'A
OWNER'S NAME: Jeq,T� f'?arlkweb d BUILDER: A4,--16 C -e. J. -al /3L!,(c1ed-5
ADDRESS: 13 7^ ADDRESS: g716 - V2_1.j ue Idea gP Sz% i Z
N0;
STREET:
—
LOT: BLOCK:
ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
buildirig location drawn on these Certificates. !'
DESCRIPTION OF BUILDING
To Be Used As:
%ee S, Cir&!5= .,v,7 Front:
0 5 S T.ee I
Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
®u
Type of Construction: Estimated Cost:
To Be Completed: ®cr/S, /T73_
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in st7tict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that .ill the facts and representations stated in this application
are true and corrt•ct.
DATE: 7--/4-73 73 S IC;,NATURE
(See Reverse Side For Additional Information.)
a ,
a
CITY OF FRIDLEY
53-9),-991)'051 APPLICATION FOR PWMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: N0,
RATE
a
homer Fixtures
x
$3.00
S
Future Fixture Opening
si
a
$
Water
x
$2.00
$
Catch Basin
x
$S.00
E
m
oo
Q
m
row
x
$10.00
$
Water Softener
Heater
i.
,�i
J m
.ei
. C
x
m
"�
$
Electric Water Heater -
•o+
$5.00
S
,iG�
N
H
m
m
x
$3.00
S
Additional Fixtures
x
$1.00
$
.Gas Range to 199,000 BTU
x
$10.00
S
b
+'
U
<
$5.00
o
as
lec
a
v
State Surcharge
ct0o
$ .50
N
S
a w
icvi
w
ti
R
1st
on
ectl
SnLnpA
2nd
3rd
r(R)- Future Connection Opening
Connected with Sewer
- New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: N0,
RATE
TOTAL
homer Fixtures
x
$3.00
S
Future Fixture Opening
si
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$S.00
$
Water Heater - to 99,000 BTU,
x
$5.00
$
100;000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.90
$
New Ground Run Old Building
x
$S.00
$
Electric Water Heater -
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
x
$3.00
S
Additional Fixtures
x
$1.00
$
.Gas Range to 199,000 BTU
x
$10.00
S
REPAIRS $ ALTERATIONS
First $100.00
$5.00
S
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
$ B.00
REINSPECTION FEE
($10.00)
Job Address 137 49 Xve . NE
Department of Buildings
City of Fridley
Tel. 9571-3450
The undersigned hereby makes application for a permit for the work herei
specified agreeing -to do all work in strict accordance with the City Codei
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and cors
Fridley, M.•►. 12-9-76 , 19
OWNER !RALPH M.ARMTOOD
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 12-16-76
ESTIMATED COST 10.00
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
. Company
Signed By
casco
Tel. No.
ROUGH INSP.
Date
FINAL INSP. 11-Y- 7 7
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
HOUSE HEATING TEST RECORD
ADDRESS 137 '�E. 49 Ave, APT. FLOOR CITY SUBURBFridle y
OCCUPANT Ralph W. Markwood OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY Minnegasco INSTALLED BY
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. _UNIT H OTHER
GAS DESIGN
MAKE Autocrat MAKE OF BURNER_
Model W12«N7-50 Model
Serial 7�!`Max. BTU Rating —
INPUT 12M MAKE OF FURNACE
CONVERSION
Model
CONTROLS _
THERMOSTAT eat Plug Vent Sian
Valve KIND OF LINER SIZE NONE
Limb' Draft Hood Regularor
Limit Setting
Filters Size Number
Fan Setting Chimney Location Inside Outside
Pilot Type Chimney Construction
Pilot Make
Pilot Model / Smoke Bomb Wiring
Pilot Timing Draft Test Tag
L.W. Cut Off Door Pressure Lighting Inst.
Pressure— —Percent CO Date Tested
Input CFH ��®� Percent 02 Company Testing'
Stack Temp. Percent CO Name of Tester��
Foran -235
AH';- I Cj% rION FOR PLJJMD!NG AND GAS F1T11116
N IN
ti0.
RAT
f" Ilua,:,cL II -%WCaa
x
a in ;Cjawl
f;; IVLu[r..F1aCUra Gl.rning
x
$2.00
lied f lAULer Old Oper.l:.,
x
$2,00
se- h" �Iterl— rfe
I'
13-TMI
X
—
Wate[ lieatnr - Lo 95,000 6111
On
$5.00
WS.!
_ L ,35'OOq BT
i
x
$10.00
Natur S.,fLenar
x
$7.00
!: if. G[uun,l Run Old BaLld
I lr7
x
$5.00
ElccLL1,: Nater iLnaLnr
x
$5.00
with
I,LULe Cu nncctlon Cjv.r,I l ! C- .r.ecLnd
V
cw Ii9LULa, Old Opining
I
x
$3,00
A.1,tILIonal fl. Lures
PART IiiL Ril, i CL �t
'''hLU�Iti1NI; I•IXTUkE RATES;
ti0.
RAT
f" Ilua,:,cL II -%WCaa
x
53.00
f;; IVLu[r..F1aCUra Gl.rning
x
$2.00
lied f lAULer Old Oper.l:.,
x
$2,00
�J, C1L,.11 Babin
X
$5.00
Wate[ lieatnr - Lo 95,000 6111
a
$5.00
' 1u0,000 BIL to 159,030 BTU
x
$10.00
Natur S.,fLenar
x
$7.00
!: if. G[uun,l Run Old BaLld
I lr7
x
$5.00
ElccLL1,: Nater iLnaLnr
x
$5.00
As FI I r1t;G FEE5;
1st I tIALures
x
$3,00
A.1,tILIonal fl. Lures
L.aa I,.,,.a to 159,OOu BTU
X
$1.0,00
tEl',1f it 4 ALTERATIGNS
j100.00
$5.00
ea n e,f.l. S1JJ.u0 oc !racoon
$2,00
5LALa Surcharge
Tort.L LU:
hJrL151•L':.TIGN FITC
a ltater
o.
lieatnr
I C ;us .1e
sewer
Water
TOTAL,
$
$
Job Addrrss 13-7 49 Ave. NE
Department Gf 6u1•ldlgg>a
City of Pridl.y
Tel. 0571-3.150
The undarslgrnad harety reakee applica[:o❑ f,.r s -4rTLLL C: r th4 work hernln
Specified agrtcing La d 'all work in strict t: crJancn wltt-, the City CGde;n
and rulings of the Oef:arLment of Baildtngs, and ereL; dez1 arei. tt.at ell
010 fact❑ 0 -id r 1rua ntaLlons etatud jr, tn1a �t,,.jcuticn aro tkuo and .true
Frldlny, ttr,. 12-10-79 15
OWNER Markwood
KIND OF IIU1L'u1t;,i frame
USED AS res.
TO BE COMPLETED i.I,:;U r 12-17-79
A ESTIriATLD Cosi 1140.00
OLD - tv-1 uunr,11:i I'LI,mir tic.
Campany o�
signed By .SCO
ral, Ila. -
ROUGII INSp.
Data
FILIAL INSP,
Data
AI'I'RUVAL• FOR FElaill, ,
MIIIIMUII I'L'L I't111 111Y PLUIiullfu FL:fu;IP IS 67.50 PLUS 5.50 S'011! 6UWU.ItGr
HOUSE 'HEATING TEST RECORD
ADDRESS ' 1'3r p 49 ADe • APT. FLOOR CITY SUBURB Fridley
OCCUPANTRail='fh mirkwood OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY Minnegasco INSTALLED BY ov e7e-
Electrical Work By Gas Line By e-
TYPE OF HEAT GA FA HW STEAM SPACE HTR. x UNIT HTR. OTHER
GAS DESIGN
MAKE Perfection MAKE OF BURNER _
Model WSVo,135 T -M Model
Serial 57- Max. BTU Rating —
INP C ! G MAKE OF FURNACE
Model
�j CONTROLS
THERMO A� Heat Plug Vent Size
Valve KIND OF LINER
CONVERSION
SIZE NONE
Limit Draft Hood Regularor _
Limit Setting Filters Size Number_
Fan Setting Chimney Location Inside
Pilot Type Chimney Construction
Pilot Make 05
Pilot Model Smoke Bomb Wiring —
Pilot Timing j t" Draft Test Tag
L.W. Cut Off Door Pressure /A-7—? Lighting Inst.
Pressure " -4'` Percent CO2 Date Tested
Input CFH ? Percent 02 Company Testing C
Stack Temp. Percent CO Name of Tester
Outside
Form 235
SUBJECT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
`L ....... COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
---•� �r���,,,
j 612-571-3450
910-F15
6/23/81
JOB ADDRESS 137 - 49th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
1
CarlsonrS Suffinit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Regina Markwood 137 - 49th Avenue N.E. 560-5512
3 CONTRACTOR MAIL ADDRESS ZIP PHONE . LICENSE NO.
Viking Home linprovement Co. 4832 - 2'h Street N.E. 572-1820
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Structure and add Roof Vents
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be. 2nd but not 3rd roof. Install ridged galvanized valleys.
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
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
$1,20Q
$.60
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 REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$9.60
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG )NSP r)ArTE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI ^-
CITY OF FRIDLEY -
APPLICATIM FM RESIDb,1TIn1- BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
ADDRESS:
TEL NO:Z-
- STREET NO: /� 1
BUILDER:
ADDRESS:
TEL NO: % 2, —1-rO
Construction Location
STREET:
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
Front:
Square -Feet:
Depth: Height:
Cubic Feet:
Front: Depth: Height:
.
Square - Feet: Cubic Feet:
�®
Type of Construction: fe Ag f- �(�� � S Estimated Cost: $ oZ ®
Rb Be (orpleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE 10VERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the t:,ork"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
represen z 'on stated in this application a true and correct.
D,7TE• SIGN2ITUF.E
Stipulations:
I
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Building
MECHANICAL
permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By mLAO
763-572-3604
AA. 1
CITY OF FRIDLEY
.
763-502-49n77 FAX
EFPECTIVE2-19-00
DATE ����- YOURS -MAIL ADDRESS��f1P14��� 1'E, . Gl7CYi
L-�—
SITE ADDRESS
THIS APPLICANT IS: 0 OWNER 11 60NTRACTOR
PROPERTY
NAME: I
OWNER/
ADDRESS: -i LAVIP CITY \��.1 STATiMA7L1 �L 1 1
TENANT
PHONE:
CONTRACTOR
COMPANY NAME: %�.
SUBMIlT A COPY OF
CONTACT PERSON:
YOUR STATE
LICENSE WITHj�
STATE LICENSE N EXP DATE
Y\IZ CITY � STATdMiKIP�_�
APPLICATION
ADDRESS:
PHON� FAX�Q� �9�
PERMIT TYPE
VINGLE, FAMILY 0 TWO FAMILY O TOWNHOUSE
TYPE OF WORKS
0 NEW 2 REPLACEMENT ❑ ALTRRATION/KEMODEL
DETAILED DESCRIPTION OF W RK w1�fZ'i
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE, TOTAL NUMBER OF EACH BELOW)
Equipnmt Installed MFG: MODEL: SIZE/ATU
MODEL:C-I�rn,�,r-��� SIZEB�TU
MFG:11
h��
MFG:LM.. � MODEL: C \%A. SIZE/BTU avo
A_A/C $25.00 FIREPLACE (GAS) $15.00 OAS RANOE/OVGN $10,00
_AIR TO AIR EXCHANGEER$15 _FI REPLACE(WOOD)$35.00 NEWGASGRILL$10.00
BOILER$35.00 I FURNACE$35.00 _,,,, OAS UNIT HTR $10.00
CHIMNFLY LINER $10.00 CAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of fixtures cr S 10.00. x $10.00 $
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures Qa $25.00 , x $25.00 _ $
Number of fixtures (a) $35.00 _„.,�_ . x $35.00 — $
State Surcharge = $ .50
IN IM UM FEE $35.50 Total = $�
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 or in ces and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only appl ion for a pe and work is not to start without a permit; that the work will be in accordance with the
approved plan in the of w which q it a approval of PIPS.
r
SIGNATURE OF API'LICA NT NAME ATE
PLEASE NOTE: SEPARATE PE ITS RE REQUIRED FOR BUILDING ELCCTRI.0 AND MECHANICAL, WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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