PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: ... ................. .......
.�. t Builder
Address ".5.7 ., .. f ..�. ,� Address
N® 3181
9 �f
LOCATION OF BUILDING
No. . �. J. � . Street ,1. ..�![ : �' :®. ... Part of Lot .........
...... ..... ..
Lot ..... � 1.. Block .... ............ Addition or Sub -Division ....................
0
Corner Lot ....... .. Inside Lot ............ Setback .... Sideyard .... ../ ....... ..... • i
DESCRIPTION OF BUILDING
be Used as:
... ! ... Front ........ Depth .Height .....9. Sq. Ft.T.. Cu, Ft. ........
0 01- ....... Front . � I .. Depth 4 f'lieight . b .. Sq. Ft. ?! CILL Ft. ........
0'
Type of Construction ................... Est. Cost. S ,�4Q% Q — tvOn .. 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 forth an in compliance with all provisions of
ordinances of the city of Fridley.
.�
. SdF•+ ".� �f.
y . v.. Vii:" -s" �c
6�
O ?! -
In consideration of the payment of a fee of $./a -� permit is hereby granted to .7k ...A—
......................... 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.
e ,
A�V.�4.. ding 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.
m
01,
SUBJECT
PERM N
City of Fridley
13248
AT THE TOP OF THE TWINS
BUILDING PERMIT
Ir
REC .
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
SEC.
1 . ,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
' _ /''•1 CITY HALL FRIDLEY 55432
�•"' %J
612-560-3450
910-F15
JOB ADDRESS
1 LEGAL
LOT NO.
BLOCKANU
TRACTOR ADDITION SEE ATTACHED
DESCR.
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lawrence Podan .695 57th Avenue N.E.
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 (X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Add two feet to existing porch and change this to living area 13' x 18'
9 CHANGEOFUSEFROM TO
STIPULATIONS
AGR�tRO°�
PERMIT REJQUiRED
SEPERATE AND SIGNS -
HEA TING, PI-Ut%BING
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
wood frame
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
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,
$ 3'oOQ
1.50
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.
PLAN CHECK FEE
TOTALFEE
19.50
SIGNATUREOFCO FACT R THORIZEDAGENT (DATE)
N PROPER Y V D TED T I IS Y�)OU PERM T
1
41
�(.� % S
S ATURE OF OWNER II NER BUILD (DATE)
bATE '
m
01,
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'SN (� b BUILDER:
ADDRESS : U- l �� S7ADDRESS :Irr`-��
NO:. L e2 STREET
LOT: —BLOCK: -
ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two. Certificates of Survey of Lot and propose
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
ro`
1� ►�
Front: Depth : Height:
Jl�� Square Feet: Cubic Feet:
cl[l ,'�6C_oLe:f Front: _Depth: li�Height:
Square Feet; Cubic Feet:
Type of Construction: W 06� � �1 G7 Estimated Cost: $ Com( /q_W?AL
To Be Completed: � � 1, n -I s -
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: / � �STGNATU
(See Reverse Side For Additional Information.)
97-8b-h16o5i CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PER4It
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Dumber Fixtures
x
$3.00
m
Future Fixture Opening
x
$2.00
v
New Fixture, Old Opening
si
n
$
Water
a
+'
M
Water Heater - to 99,000 BTU
x
$5.00
N
h
0u1
$10.00
$
ro
a
w
$
New Ground Pian Old Building
Hester
.1
O
Is
x
n
C
$
GAS FITTING FEES:
.[i
�C( u
a!
14
y
G
N
d
'$3.00
$
Additional Fixtures
x
$1.00
O
O
+�
$10.00
W
�a
C.
N
•M "�
O
O
.0
1 4
i[�j
43 N
I
W
N
k
0
$
v
" v
a
m
ani
-W3
$ 8.00
o w°
h
w
u w
Q 3
O
as
lel
lst
gr
11
2nd
3rd
4 th
(R) - Future Connection Opening
Connected with Sewer
f") - New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Dumber Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water softener
x
$7.00
$
New Ground Pian Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
x
'$3.00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS & ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .5o
TOTAL FEE
$ 8.00
Rr-'"ITEC-TTOH FL••E
Job Address 695 57 Ave. NE'
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 application are true and correct
Fridley, Mn. 6-19-78 , 19
OWNER MORRIS
KIND OF BUILDING frame
USED AS res -
TO BE COMPLETED ABOUT 6-26-78
ESTIMATED COST 20.00
OLD - NEW BUILDING PERMIT NO. PERMIT NO. C
Company
MIN14EGASCO
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT 20�4 Y
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.S0 pLUS $.SO STATE SURE
SUBJECT
P NO.
City of Fridley
18400
AT THE TOP OF THE TWINS
BUILDING
PERMIT
ECEIPT NO.
1 • COMMUNITY DEVELOPMENT DIV.
r i PROTECTIVE INSPECTION SEC.
d
1 i
iL CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
----� �----,
j 612-571-3450
910-F15
4/25/86
JOB ADDRESS 695 - 57th Avenue N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
18
9
Donnay' s Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Tom Morris Same
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Richard Hastings Contractor 6331 Riverview Terrace
N.E., Fridley 574-9966
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 Ck ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Soffit & Facia
9 CHANGEOFUSEFROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Aluminum
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
S0. 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
$1,300
$.65
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.
$22.00
CHECK
LAN CHECK FEE
TOTAL FEE
Ake �S
$22.50
SIGNATURE OFCONTRACTOR O UTHORIZEDAGENT ID TEI
HEN PROPERLY ALIDATED T IS IS YOUR''ERMIT
NW
LDG )NSP
Ij
�J
OA/E
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] City of Fridley Effective 4/1/86
ADDN...[ _] / R-1 AND R-2
ALTER. [LAY Building Permit Application
Construction Address: (�`t�S S77`X
Legal Description: X07` 13Er�Caek l ta�,S/,4y r5 L��ke +Jf AAaA/o P
Owner Name & Address:
I itllale� S Tel. #
?' 1 C_ - 4 °ftv Tel. # ,S7 " Flo
Contractor: C
Address: 633 adZ0 Lo - P_
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height Sq: Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: / Lunn, So Fri -r *1 IFS Estimated Cost: $ Q ®D • [i� %
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE:
2~5 Z,5,6 APPLICANT:- %U
U Tel . # S 7 A M4K
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ cam.y j
$ �,so
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$475 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
AW
CIiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
October 25, 1990
Thomas Morris
695 - 57th Avenue N.E.
Fridley, MN 55432
RE: Property at 695 - 57th Avenue N.E.
Dear Mr. Morris:
On July 1, 1990, the City of Fridley began a new program called
Systematic Code Enforcement. This program is designed to provide
fair and equitable code enforcement, improve the City's appearance,
and maintain property values by creating a more attractive suburban
environment. Under this program, all properties in the City will
be inspected approximately once each year to ensure that they are
in compliance with the Fridley City Code.
A recent inspection of your property revealed that not all Code
requirements are presently being met. Listed below are item(s)
which do not comply with the Code:
1. Discontinue outside storage of brush and wood located at the
northeast corner of your property. (Fridley City Code does
permit the storage of stacked firewood in the side or rear
yard.)
Your prompt attention in correcting this problem would help us in
our effort to improve the City. A reinspection will be conducted
on or about November 12, 1990, at which time compliance is
anticipated. Please call me at 572-3595 if you have questions or
wish to discuss this further. Thanks for your cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
C-90-904
1
SUBJECT
PE .. . _
City of Fridley
21115
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
COMMUNITY DEVELOPMENT DIV./
_
Tr PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
GATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/18/91
JOB ADDRESS 695 - 57th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
18
9
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Thomas Morris 695 - 57th.Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Twin City Storm Sash.Co.. 10825 Greenbrier Rd, Minnetonka 546-8160
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 jo ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install bay window and siding plus fas.cia & soffit
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
SQ. 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
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
$10.4`298
$5.15
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$126, 00
Fire SC $10.30
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$141.45
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
W k' N PROPERLY V TI IS IS YOUR PERMIT
yj
BLPG INSP DATE
S,GNATUREOFOWNER oFOWNER BUILDER) IDATEI
1
NEW [ ] Effective 1/1/91
ADDN [ ] CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Legal Description:
Owner Name & Address:--t)-Ometz, 1-Y1®2q,t_S Tel. #
Contractor: `"1+J C i1Z ,oma Tel. #{�
Address: 1607-T C9'n-K1Z r-3 CSMA -Kn (2ca /h "CnfUeS dW
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 Fkt 1. �, ..� �,:� c.a �-Q-,� d- ►�,
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback _
Type of Construction: Fyt&w%. .
Approx. Completion Date: `mac -Q
Side Yard Setbacks
Estimated Cost. $ 1 Q 2513.0 Q
(cm m Buk)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT: Tel. #
Permit Fee $ 1 of (0, 00
Fire Surcharge $ Co. ?)a
State Surcharge $ <1_
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary ( ]
SUBJECT
City of Fridley
21158
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE O.
_ COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
PAGE OF
APPROVED BY
612-571-3450
910-F15
JDATE
11/19/91
JOB ADDRESS 695 - 57th Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
18
9
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
'Phomas Morris 695 - 57th. Avenue NE 571-5189
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Twin City Storm Sash Co Inc. 10825 Greenbrier Rd, Mtka 55343 546-8160
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 I� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replacement Windows
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
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
$365.00 $.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-
$15.00 Fire SC $ .37
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$15.87
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN OPERLY D 7S IS YOUR
^PERMIT
LDG INS DATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW ( ] Effective 1/1/91
ADDN (] CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address:
Legal Description:
Owner Name & Address: Tel. 7
Contractor: Tel. #
TWIN CITY STORM SASH CO., INC.
Address: 10=1 GREMPRIFR RO- A -D
WTtS NA &% d&, tificxte 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: A
Corner Lot [ ] Inside Lot [) Ft. Yd Setback _
Type of Construction:
Approx. Completion Date:
Side Yard Setbacks
Estimated Cost: $
(Con - ■a)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT: Z`//�> Tel. #
Sewer Main Charge S
TOTAL
STIPULATIONS:
s b�Si
Fee Schedwle an Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/51,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
��t Fee
Fire Surcharge
� 6 6�
$
State
Surcharge
$
SAC
Charge
$
Driveway Escrow
$
Park
Fee
$
Sewer Main Charge S
TOTAL
STIPULATIONS:
s b�Si
Fee Schedwle an Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/51,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES /� '
JOB ADDRESS '7-S 5 7` A G
RATE SCHEDULE
OWNER___t7,-.%_i /'IAIT; c
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $56-61)
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $5 0
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
BUILDING USED AS ie_S
ESTIMATED COST �?D-DO PERMIT NO. 'L /-S
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units—L— Circle One (Steam) (Hot Water) arm Air
Trade Name C &rH ce Size No.
BTU 70, nrm HP VJ
EDR
Fuel, Total Connected Load_ 30 , oen
Burner Trade Name Size No.
BTU HP EDR
$ 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
$ Ic .5D representations stated in this application are true and correct.
�� DATE 10.4-00
HEATING Get G n/G
Signed TEL # 1& V rfi
Approved By Rough -In Date Final Date /%"3-uo
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existina furance, 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.
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.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
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( )
Yesv) No ( )
Yesy) No( )
Yes (A 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 Y) 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 M No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type.. ,��,._ BTU Input — an Assis 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 ak 'Vent Height /Z Diameter 5 inches
Appliance #1 Vent Connector Height Z- ft Length ft Diameter in Type e_
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: 'T(lr ,�. �rJ( ( (6Alt 1J4,1 G
Signed By: Date: (0 �� QUO