PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N° 3111
Date: .. ... ..........................
Owner . ' Builder .........
........
Addres ....9 . �.'. � ... Address ...... r? ./.., :.. r. ......... .
�ON OF BUILDING
®... Street 10-� ................................ Part of Lot ......
Lot .... �..... Block .../.......... Addition or Sub -Divisign ... .... ....o`'!'.. .
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...............
DESCRIPTION OF BUILDING
To be Used as-
. ... Front Depth �.� Height /e4A�OZ Sq. Ft Q" Cu. Ft. ........
Type of Construction
7? -3
........ Depth ... Height .....8,* Sq. Ft. ........ OCu. Ft.
Est. Cost �/). . To be Completed . �?
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set orth and in compli a with all provisions of
ordinances of the city of Fridley.
....... ..... .....
In consideration of the payment of a fee of $..4J ......., 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
.� uildin
g 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.
City of Frill
BUILDING
Date:/ .. "" -
le.-
Owner:�r�= #
ey,
PE 1 N
Builder
Address % Address
L TION OF BUILDING,
Z
No. ! �y Street ee P of t
i
Lot Block z d Addition or Sr
Corner Lot Inside Loth (,*back Sideyard
Sewer Elevation ____ Foundation Elevation
DESCRIPTION OF BUILDING
To V
Front Depth Height Sq. 1!'t. �V_"''`"` Cu. Fti`7'_`�
Depth eight sq. Ft. Ca. Ft.
Type of Construction _ - ;Est fi!��-~T° be Completed
IF
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 $ "�� , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
ress condition that the person to whom it is granted and his agents, employees and workmen, in all work
:nj,d
, around and upon said building, or any p� thereof, shall oaffiorm in all respects to the ordinances of
Minnesota regarding location, conatruct[on, alteration, maintenance, repair and moving of buildings
the city ]units and flue permit may be revoked at any time upon violation of any of the provisions of said
ces. _ _ .�"'"►
Inspector
NOTICE:
rah perp it don not cover the construction, kaft tlon !.er wMk& phimblov, on hootbe, rawer or welor. Be sure to roe
the BuIkUne Inspector for separate permits for those home.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Residential
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs CAIterations (LIST ON BACK)
1 % of Value of Appliance or Work
Com mercial/1 nd uatriaP
1.25% of Value of Aance or Work
J 0
o_a
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
Effective On August 1, 1995
JOB ADDRESS (/�`tzt� c� ! 4V& N�
The undersigned hereby makes application for a permit for the work herein
TOTAL 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
$_;3D. 00 representations stated in this application are true and correct.
5' ,1995
L,
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING_ PERMIT_ IS $25,00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
OWNERZ-
BUILDING USED AS �L{Jr4l �t i2�
ESTIMATED COST I �O , PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units 1 Circle One (St
Trade Name 8 tv Dnk
BTU HP
am) (Hot Water)arm Air
Size No. V ®7n
EDR
Fuel Total Connected Load
Burner Trade Name
BTU
HP
Size No.
EDR
BLAINE HTG. A/C & ELECT. ING
HEATING COMPANY 13562 CENTRAL AVE. N.E.
AW
Signed By
Approved
FILL OUT BACK SIDE"FOR
REPLACEMENT FURNACE
Tel No. 517 -00 -too
STACK VERIFICATION ON
Final Date
i4qY-
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes
No ( )
2.
Is free frofnist or deterioration
Yes
No ( )
3.
� pp
1" fo�e> tf objects lodged within
Yes
No .( )
4.
Is. securely', --supported
Yes (y)
No ( )
5.
Meets all current Code requirements for size
W total BTU's connected
Yes
No ( )
6
Has tgtal heating BTU's of :200 0oO
All other' BTU's
TOTAL BTU's 1 y �Z ®� cy _
7.
Has a liner been provided for water heater
Yes (,A
Noki ( )
8.
Has combustion air been provided for water heater
Yes ()Q
No
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
BLAINE HTO. AIC & ELECT. INC.
13562 CENTRAL AVE. N.E.
ANOKA, MN 55304 r%rJ✓� _�o� C�t�
W s.�1M
sueJEcrMIT
City of Fridley
27 04 3
AT THE TOP OF THE TWINS
?`
BUILDING PERMIT
r
:
—Rlr E T FT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
P��
r
-/(/
1 �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
�
I Ti CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/7/98
JOB ADDRESS 640 57 Ave NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
10
Donna ' s Lakeview SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Richard Shultz
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Four Seasons Roofing and Re
795-9410
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20138780
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION MX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (23 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with
State Building Code.
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
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 1 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1918 .96
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE SAC CHARGE
PROVNS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S 7RU TI N 5R T ERF0 MANCE OF CONSTRUCTION.
$62.25 Fire SC $1.92
PLAN CHECK FEE AL FEE
7$.70.13
Licens 5.
'IGNATURE OF CO kACTOR OR AUTHORIZED AGENT IDATEI
N R P VALI D THIS IS YOU PERMIT
I
r �
, fy.A Iw5w gaTE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] ,;.t !� ,� Cl h'� OF FRIDLEY.. ; .. .
V.
ALTER [ ] SINGLE FAMI�X-AND DUPLEXES. R-1 AND R4 d�I
�B�TII,DI�1a,_PV=T APPq$� MiOpQ, + �i'ty; • C'tt�'! i
ConstructionAddress. ! f Y'S9'?:�Is: d ,:, t� .:k,;•
rat!j..:J'ttl�:•k�'. r'{.. .. .,ti- ... �J Y� °��.}'+'.k ', r•i .r tP b1.1. r.
Legal Description:
Owner Name & Address: #i
Owner
Contractor: rU U ( S e�.s CM 5 ? d-�i +na n(��i�d , t. n� l r' MN LICENSE �#
:address: IN3 d u h t u e.�5�► :W Aum Alm' Fr ► cl t�
Tel.
Attach to.this"application/,iw Certificate.of 4$urvey of the
,Ott witlirtt `� r poswd con'struction.drgwn oA."it,to. scale.
~r� DESCRII'TION, OF 1WROVEMENT
•:,,. .i 1 , Y r.•a
LIVING AREA: Length. Width Height Sq. Ft.
GARAGE AREA: Length . Width . Height Sq, Ft.'
DECK AREA:
ngth �," . Width' Hgt/Ground ;Sq. Ft.
OTHER: IL
IN
Construction Type: ��'$/�+ Estimated Cost: $`
(Fee Schedule, on
Driveway Curb Cut Width Needed: '�"' '�g Ft:' +` 6 Ft = Ft x
V.�t�Ys , r . 1`r 4x ,p
DATE: APPLICANTr ;Tel:` # r rte, , old
rct+*ri i<, .
y �'s�-, 'b r ,• TT �(] �r'.Mr r., h }�'.¢� fn" ,tet..
. `%!a{t6�� �Ja.0 r.V MY��7L• �� �V��.., 0��+. Fwl i v�•�'�y',.:,�+3 1 5 •��c t "' . �:.
• a' 'r}tc• t r-r,r"tatii ; a { S i,
• " •'��'�'y•i '� w >j.'����»Ar ..�:L1 �'}� ;� ,•
Permit Fee $' Fee Schedule. on Reverse Side
h r i n
Fire Surcharge • 3 • •
$ �, . • VV -Ti Valuation.(1/10th%)
•ri.�j,4 ��" � S 4' � '� /Ira
State Surcharge $ $.50/$x;000 Valuation
SAC$] er}`SAC Unit
,i�.r )MY '•i ,,�-Sd .M'a•,�t '..• .d e'..e,1 8 J °�� " �'
License Surcharge $ �5:00(Stat�S .Licensed. Resldeti�l Co "` '"
tr
..:.
ckA,y �N ,r .�,• • •"yN ••
Driveway Escrow $ t' t� RIMf#444,r A=° vrVU
� `. ,t%t 5 � x, N'•�"�_ �'i; • • ' �'. ��.' k r � . ' �', s��+�'y�'F �e5t�✓, ,..'
Erosion Control r $ ° 4� k OOAarrV4tion,P1
i.' •�dl.....r v; E S 5��'t" 1 flit/ .
,t.
v 4;
Park FeeDetermined by Engineering . ►: , , �'V, P�
Sewer Mairi Charge $ `" `h�Agrement :Necessary . [r.] .:Not: Necessary 4 z
..:.
TOTAL.,.
t
STIPULATIONS:
'tG"N' ..* +y��. L r "' ..••
t�y9%" +�� Wrri n•' .. '•' t. 'N !r�' per ri',
��.� l�� �x 4�t�' �y' ..,�1 11��.� .!i'i'i 4-•
; t t ! rim✓ r.,�. d y- . �, vo
A6
Building°
M^t� URA1N IUAL
`.`..` .
Inspections
RESIDENTIAL APPLICATION
Received :-Zi
Date Rec'd: /0-�
7.63-572-3604
CITY OF FRIDLEY
DATE `-1 ® YOUR E-MAIL ADDRESS
SITE ADDRESS V Ne
THIS APPLICANT IS: O OWNER CONTRACTOR
PROPERTY
OWNER/
NALg; 0.f v 179
iD �� - V e CITY EEII_:_ms__;STATEMj4ZIP,SS��
TENANT
ADDRESS:
PHONE: -16-6-S 1 US45
CONTRACTOR
COMPANY NAME: CENTERPOINT ENERGY
SUBMIT A COPY OF
CONTACT PERSON: JOANN ZINKEN
YOUR STATE
LICENSE WITH
STATE LICENSE # EXP DATE
ADDRESS: 13562 CENTRAL. AVE NE CITY ANOKA STATE MNZIP 55304
APPLICATION
PHONE 763-757-6202 FAX 763-757-6701
9
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
PERmrr TYPE
o NEW )REPLACEMENT ❑ ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK 0-
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: ONDICATE TOTAL
NUMBER OF EACH BELOW) u J� MODEL: U Nva U907AZ SIZE/BTU " 10r1
MFG:
Equipment Installed SIZE/BTU
MFG: MODEL:
MFG: MODEL: SIZE/BTU
A/C $25.00_FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 —FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
UNIT HTR $10.00
_BOILER $35.00 _FURNACE $35.00 —GAS
_CH [MNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
VENTILATOR $15.00
DUCT WORK $10.00 _GAS PIPING $10.00
,0.
Permit Fee $ Number of fixtures @ $10-00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 1 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $_25�tSy
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLIC PRINT NAME ROGER HOFMIN DATE
ut��I 7a1 � f �'I',�1'j`iI4 g ,. A ` a.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS XEXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or PropaneUGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation .
a_ Per MN Energy Code 7670 or 7672
6. Duct Design Per RMC 1346. 0603.2
.a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations