PRE 2010 DOCSV7
City of Fridley, Minn. N° .9147
BUILDING PERMIT
• Date: 28 Febbnary 1967
Owner: Clemron Inc Builder
Address 701 Columbia Blvd. NE Address 701 Columbi,,a Blvd,
No. 1360 Street
LOCATION OF BUILDING
53rd Avenue NE part of Lot
Lot 1 Block 2
Corner Lot — x Inside Lot
Addition or Sub -Division Horizon Heights
_.._ Setback 35' _ Sideyard 35' & 32'
Sewer Elevation ___ ____ --- Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Residential..__ Front 40' Depth 25' Height 20' Sq. Ft. 1000 Cu, Ft. 20 000
At t . _ Snap _ _ — Front _ 2Q' Depth 23' Height __10'_.__ Sq. Ft. _46 0 _ cu. Ft. 4,600
Type of Construction Frame Est. Cost21z000_ _ _ To be Completed July 1967
SEWER Location: 8' S. of Manhole - 23' lead
• WATER Location: 18' S. of Manhole
Top Footing: 1,009
•
In consideration of the issuance to me of a permit to c7'/Oth
the building described ve, I agree to do
the proposed work in accordance with the description above andin��p phance all provisions of
ordinances of the city of Fridley. I/. / _-
In consideration of the payment of a fee of $_ ._2 ._0.0_ .., permit is hereby, granted to Cl emrou, Inc.
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.
CLARENCE BELISLE
Building Inspector
NOTICE:
Tide permit does not cover the construction, installation for wiring, plumbing, gas heating, sewor or water. Be am to sae
the Building Inspector for separate permits for these tome.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER
LOCATION OF BUILDING
NO e STREET PART OF LOT
P
LOT / BLOCK ADDITION OR SUBDIVISION,
CORNER LOT_&�,—INSIDE LOT SETBACK; _/� SIDE -YARD' =li P�2
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;
Front /_ p _Deptho1S� CO Height Z U
Sq. Ft. Cu. Ft. ::. e\
Front �(� %� Depth.2iZZ 1:2_Seight Ir,)
Sq. Ft. �6 Cu. Ft.
Type of Construction s WEstimated Cost",
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 ::�' 4
(Schedule of Fee Costs can be found on the Reverse Side).
of .
\ tE�
Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ' ........ .
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .....
1 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
Each add. 200 sq. ft. EDR Steam ......................
Each add. 320 sq. ft. EDR Hot Water ................. .
C-
OIL BURNER—to 3 gal. per hour ...................... .
over 3 gal. per hour—See Fee Schedule
8.00 $
2.00
$
5.00
$
5.00
$
2.50
$
8.00
$
8.00
$
2.50
$
2.50
$
5.00 $
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$ ✓
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
TOTAL FEE
$ °�
ROUGH
FINAL
Dept. of Bldgs. Phone 560-3480
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application a✓rreej true and correct
/Rldley,
Owner -
Kind of Building/%4�✓a't-P
Used as
To be completed about
cf a
Estimated Cost, $
Permit No.
S
Permit No. &F-3 6
DESCRIPTI/PX OF WORK
HEATING or P R PLANTS—St m, Hot Wate Warm Air /No
Trade Nam o Size No_ G+ �/ �d ✓�
r
Capacity. Sq. Ft. E.D.R BTIJ— /a / H.P.
Total Connected Load Z/ �-, 6 � -2, Kind of Fuel/I&/- 41 -IL-1 J
BURNER — Trade Name Size No
Capacity.
(REMARKS—OVER)
Sq. Ft. E.D.R BTU H.P.
RAY N. WELVER HEATINM C®-
ed
4637 CHICAGO AVE.
M1NftEAR0113 7 b4JulNC-8®TA
42 Business Phone No- le le �
I
WAt LOSS CALCULATIONS
71- th t' A.S.H.V.g
DEPARTPI= OF 1�URDINGS
a ePS Ylps _ Guide Construction No.
Iowa Poors Reference I Out. Wall Int. Wall Ceiling Roof Floor
-1Va er—No 19—. ,
1-1 / - .. - Ranni Lenoth rl - - Width J A __' Height °, II F1.1
Windows and Dooors—Crackage and Area !
1 4
Width
No. of pain.
llelght
of Pane
PJ o. o[
lights
Llneel ft.
of crack
Area
aq. ft.
Area
eq. ft.
Class
c
' f✓' Ery t -r
Earp. wall
Net enp. wmH
i
int. wall
Ceiling
Floor
Total Btu.
Coef.
Btu
lnfiltration;
a
Coef.
Btu
Glass
Fzp. wall
+ `;"
_
Net exp. wall
Glass
Earp. wall - - -
sd•t.,_
Int. wall ¢ 4j o A t z %
717 r)
y
3
Ceiling
Floor
Int. wall
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Ceiling e'
M.l , Room l Lenath r" / Width `f Height d: ,
Windows and Doors—Crackag aced Area
1 4
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
eq. ft.
Class
c
' f✓' Ery t -r
Earp. wall
Net enp. wmH
i
int. wall
Ceiling
Floor
Total Btu.
Coef.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Infiltration
a
Coef.
Btu
Infiltration
+ `;"
d
Glass
Earp. wall - - -
sd•t.,_
w
Net exp. wall
�AA
3
Int. wall J
Int. wall
Ceiling
Ceiling e'
!
,
r'
Floor
Total Btu.
.{!o
Required sq. ft. E.D.R. or sq. ins. T.A. Leader area
I %�
boons I Lenatth d WiM ` H�ighl f'
\71indo'm and Doors—Crackage'and Area - --
width Height No. of Lineal ft. Area
No.-- of pane of pane llghte of crack aq. ft.
c-' ' ,•� � _ 3 moi+ .. :� �¢:
,IIi
1 4
No.
Width
of pane
Height
of pane
Coef.
Btu
Infiltration
Class
c
' f✓' Ery t -r
Earp. wall
Net enp. wmH
i
int. wall
Ceiling
Floor
Total Btu.
Coef.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Infiltration
IZ
Insulation
Kind How Applied
"d
R- nm I I rnatlt .. \with ,��s .: HeinhteX
Windows and Doors--Craekage and Area
1 4
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
eV
y
r
Coef.
Btu
Infiltration
a
Coef.
Btu
Infiltration
+ `;"
d
Glass
sd•t.,_
w
Eaup. wall
3
Int. wall J
Net esp. wall
Int. wall
Ceiling
Ceilingell
!
,
Floor
Floor
'dotal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leslder arra
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
`
I M I ` ' Rnnm I Leniath '". Width `l7 -,- 67emftt 0 _
Windows and Doors--Crackage and Area
1 4
No.
Width
of pane
height
of prone
No. of
lights
Llneal ft.
of crack
Area
eq, ft,
y
Coef.
Btu
Infiltration
a
Coef.
to
Infiltration
Eap. wall ply v
Glass,
sd•t.,_
w
Enp. wall
3
Int. wall J
Net eap. wall
Ceiling
Int. wall
!
,
Floor
Ceiling
'dotal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leslder arra
Floor
Total Btu.
A
Required sq. ft. E.D.R. or sq. ins. VIA. Deader area
ESI -I Reim . I LenrAh width a `f � Heig ht
i t d�.e.s. � 4'� t`
T/indom and Deorc--Crackage and Area
1 4
TYldth
Lao. of pane
"0113htnLineal
of paneof
ft.
crack
Area
eq. 4t.
Coef.
Btu
Infiltration
a
9reJia
C)_ 1 n.Q
Eap. wall ply v
Net exp. walD
3
Int. wall J
Ceiling
,
Floor
'dotal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leslder arra
C I T Y O F F R I D L E Y
6431 University Ave. N. E.
Fridley, Minnesota 55421
August 5, 1968
Johnsville Electric
13.80 109th Ave. N. E.
Minneapolis, Minnesota
RE: PERM SHORTAGE
53r -d Avenue N. .
Gentlemen:
Your permit for the above captioned address was short
the following:
R W $3.80
We would appreciate it if you would kindly give this
matter your preferred attention. When sending in the above amount,
kindly place it on a regular Minnesota State Affidavit so that we
may properly process this permit.
Thank you.
Yours very truly,
LEONARD EICHMILLER
Electrical Inspector
City of Fridley
LE :bks
SUBJECT
PE5M4
City of Fridley
10. "
14531
AT THE TOP OF THE TWINS
PERMIT
BUILDING
RECEIPT NO.
tr _--- --COMMUNITY DEVELOPMENT DIV.
,
INSPECTION
r � PROTECTIVE SEC.
9
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
12/22/77
JOB ADDRESS 1360 - 53rd Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
2
1 Horizon Heights
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Edward J. Alfuth 1360 - 53rd Avenue N.E.
3 CONTRACTOR MAILADDRESS
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 ❑X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install free standing stove
9 CHANGE OF USE FROM TO
STIPULATIONS
SEERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS.
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$800
$.50
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.
$7.50
PLAN CHECK FEE
TOTAL FEE
$8. 00
SI URE OFCONTRAC RORAUTHORIZEDAGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
ZZ
'
BLDG 'NSP
�1v�
462-22 `/:L_
"DATE
SI NATURE 006WNER (IF OWWR BUILDER) (DA30E)
• CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWI4ER: Ga Zy �c ti Cf �• 1-4'& fiv BUILDER:
Address: Address:
Tel. No.:
No..
LOT:
CORNER LOT:
Street: /
BLOCK: -2-ADDITION : l7D Z u !/ 9h TS .
INSIDE LOT: SETBACK.: SIDEYARDS:
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:
�He :o Front: Depth:
gyp,/ Q Square Feet: Cubic Feet:
Front:
Depth:
Height:
Height:
Square Feet: Cubic Feet:
. d
Type of Construction: Estimated Cost: $
To Be Completed: ('Z 2 2 — 'j
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for additional information.
DATE:2= LZr-°� SIGNATURE:
Stipulations:
PME CWA t.f
St) ; v
, .-A
lJ
SUBJECT
ERMIT
City of Fridley
o 15475
AT THE TOP OF THE TWINS
BUILDING P E R M I T
_
rp
R EIPT NO.
1 b ______ COMMUNITY DEVELOPMENT DIV.
ZT o 3
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/24/79
JOB ADDRESS 1360 - 53rd Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
2
hortzon heights SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Edward Alfuth- 1360 - 53rd Avenue N.E. 571-1005.
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
Construct a 1511 x 20.11 Addition to rear of structure
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRIKC4
HEATING, PLUMBING AND SIGNS.
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
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
$1,900
$.95
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-
$12.00
NONE
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$ 3.00
$15.95
SIG NATURE OF CONTRACTORRAUT:,,, DACE IDATEI���y.
WHEN VAWDATED THIS IS YOUR PERMIT
/PROPERLY
VSIGNATURE
OF OWNER IIF OW U OER ID TE)
BLDG INSP ATE
lJ
CITY OF. FRIDLEY
APPLICATION FOR RESIDCNTIAL BUILDING PERMITS
' (New, Alterations, Additions, or Repairs)
OWNER: = -`lya; cl. r'(,�c% T-1-1
ADDRESS:
TEL NO: 3_%/
BUILDER:
ADDRESS:
TEL N0:
Construction Location
d
STREET NO: �° (�/C� STREET: 3 ��� %���� �,
; i V�41y
.
LOT: J -BLOCK: ADDITION:
A) hP,
/% /_1 T��
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
D P6 Ok r�L AJ r Front: / Depth: "Lo
Height:.
1,%.JJ)f CIL Square. Feet: Cubic Feet:
Front: Depth:
Height:
Square - Feet: Cubic Feet:
Type of Construction: Estimated
Cost: $
00
•-
Tb Be Completed: {��� /_6
Alt. A
Alt. B
Proposed Driveway Width If New Opening Is Desired:
$
$
SEE REVERSE SIDE
OF SHEET .
11he 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
reDresenta42J.ons stated in this application are true and correct.
DATE: SIGNATURE:.
Stipulations:
1
SUBJECT
PE
City of Fridley
?.5 9
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
39 /
r � �
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/15/97
JOB ADDRESS 1360 53 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
2
Horizon Heights
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Clair Tettmer 1360 53 Avenue NE
571-7687
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Panelcraft of MN 3118 Snelling Ave S, Mpls., MN 55406
721-6628 2179
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 O ALTERATION j7 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House; Soffit/Fascia/Trim
9 CHANGE OF USE FROM TO
STIPULATIONS
Install ventilation in soffit to meet the State
Building Code.
Install building wrap and have inspection of same unless manufacturer's
specifications state it is not required.
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
1
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
$10,108
@
$505
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
License SC $5.00
$194.91
SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY LI
o
f BLD(Y INSP
DATED THIS IS YOUR PERMIT
r
f)A7E
_
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
1
ADDN CITY OF FRIDLEY
AL'TEIt SINGLE FAMILY AND DUPLEXES R -I AND R-2
Building Permit Application
Construction Address:
Legal Description: ___
Owner Name & ddr
Contractor: Q/%7
- Address:(0
1540e S3�'� �v.��c�cc WE'
Ulecllve 1/1/94
-AS-6,77
/ Tel. /1 11-71" W
7 —
MN LICENSE /i!n,jM
✓g el. #%� �p
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
t.DECK AREA: Length Width Hgt/Ground Sq. Ft.
- OTHER:
'Corner Lot Inside Lot Ft. Yd �Setback Side Yard Setbacks
'Type of Construclion:/�%�q�is/��j�llflYa/Estimated Cost: $ /40"/l%�•O0
Approx. Completion Date:/
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + G Ft = Ft x $ __ _ $
DATE: Wf-7 APPLICANT: ��/t.t Tel. // �0/92p
TOTAL $lf,41. ?Z -
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$_
.001 of Permit Valuation (1/10th!)
Suite Surcharge
$_,50�_
$.50/$1,000 Valuation
SAC Charge
$!
$800 per SAC Unit
License Surcharge
$
SOa
$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 I I Not Necessary
TOTAL $lf,41. ?Z -
STIPULATIONS:
CITY OF FRIDLEY INSPECT ION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On Jan 1, 2002
rz
11IL11IT, 1-3Ik1[H;1KA01 :6 7111 III*]
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () Nc
Type
Reinspection Fee $47.00/Hr
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
TOTAL JOB AD
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
20�
Owner
Building Used -
Estimated Cost PERMIT NO.
PLUMBING COMPANY^ C
SIGNED BY
6A0 ®U FAX#
50
$40.9'6
Approved By b f J Rough -In Date
TEL N0.
Final Date
COMBUSTION AIR 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
CnMMnN VFNT_ VFNT MKINF MR AND CQMR11STION AIR <IFRIFI CATION
When rala _ing an exh ing fitranca, 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 manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The PAstong comb ictinn air is sized and installed to meet the current codes
and manufacturers specifications. Yes( ) No( )
When required to install a new come action air�it will be sized and installed
to meet the current codes and manufacturers specifications. Yes( ) No( )
When ins ailing a new venting nystam, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
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 #1 Type
Appliance #2 Type
Appliance #3 Type
Total Appliances
_ BTU Input
_ BTU Input
_ BTU Input
Total Btu Input
Common Vent Type Vent Height
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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 :