PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn. N? 2761
Date �!� �".,tr� S . .....................
Owner A:� ............. Builder ...........................................
Address��.............. Address .........................................
LOCATION OF BUILDING
No. ...... Street.. !r ...-;v " ........ Part of Lot .......................
Lot ....AJ........ Block ....� ......... Addition or Sub -Division .L ... ......................
Corner Lot ............ Inside Lot .... ` ..... Setback c' Sideyard /0.%~. �. ..............
DESCRIPTION OF BUILDING
To be Used as:
...... .... Front sJ6 .... Depth 1-� ... Height 1.46 .4 .... Sq. Ft.Cu. Ft........ .
.................... Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft.........
00
Type of Construction' .... Est. Cost . f �-�� ................ To be Completed
Construction's.... .7 .�.
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 an in compliance with all provisions of
ordinances of the village of Fridley.
... .... ............................ c
�consideration of the payment of a fee of $ �.�' . , permit is hereby granted to
Lr64 ......... to construct the building or ad dition 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. /A i n
...... 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.
•
City of Fridley, Minn.
BUILDING PERMIT
Dater �..:........... .......
Address
•
N® 3316
Builder ..........................:.................
Address .............................................
LOCATION nF BUILDING
�..^Q
No.�. `. Street . �. ... ........ ....... Part of t
Lot .. ... Block ...... i ......... Addition or Sub -Division .... 1.... .
Corner Lot ............ Inside Lot ... Aow%.... Setback .... Sideyard ........
DESCRIPTION OF BUILDING
TbAe Used as:
Ir ........... .......
f(�'
Front ..� .. Depth Height
De
... 0„ ..
*2
Sq. Ft. � Cu. Ft. ...... . /T
....................
Type of Construction-;�'R.
Front ........ Depth ....... VelHeight
-Shist. Cost.... . ®®o.,
. .
.
Sq. Ft......... XU, Ft.........
To be Completed 2 �z
if f-
azu'-�t� # % ie--� / X-
p��� e
In consid tion of the ce to _ f a permit to construct the building desribed above, I agree to do
the propose work in accord ce 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- .�f..... Z.,
......................... 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 of the provisions of said
ordinances.
Buildintt Insaecbor
NOTICE:
This permlt 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 Fridley, Nina- N° 7737
BUILDING PERMIT Lj
Date: June 4, 1965
per: Frank 0wato Bider M=U S. Si lVis
Address 548 63rd Avenue N. E. Address 6020 4�ood Rd.
LOCATION OF BUILDING
No. 548 street 63rd Avenue N. E. Part of Lot
Lot 21 _ Block 9 Addition or Sub -Division Christie Addition
Corner Lot Inside Lot _ __ Setback ____ Sideyard
Sewer Elevation ` Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost . __ To be Completed
Storm Damage Repair
In consideration of the issuance to me of a permit to construct th building described above I agree to do
the proposed work in accordance with the description above set fo and in compliance with ea'II provisions of
ordinances of the city of Fridley.
A
In consideration of the payment of a fee of $29&M-, permit is hereby granted to 4110mas S. 5 3ads
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 oP
Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings
� city ]imits� permit may be revoked at any time upon violation of any of the provisions of said
Allen Jensen Big r
NOTICES
M peemh dens sol dewy the eoesteud im, histaUatien for whim& phsmbteg, gn hathlg, nwer or water. Be euss to as
the Building legadtw for aparats pwn& for thea hens.
APPLICATION FOR"BUILDING PERMIT
CITY OF FRIM&- MINNESOTA
A
OWNER'S NAME BUIL°DE,
ADDRESSf�v �.. G _ADDREss+�
LOCATION OF BUILDING
No. Street' 'Past of Lot
..�
LOT BLOCK L7 ADDITION OR SUBDIVISION
Corner Lot`'lnsi'de SOT. ` Setback Side =lard`
SEWER ELEVATION POUNDATI0* ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location draws on these Certificates.
DESCRIPTION OF'BUILDING
To be used as:'
Front Dept `��Height
Sq. Ft. Cu. Ft.
'Front Depth Height'
Sq. Ft. Cu. Ft.'
r: Type of Construction Estiadated. Cost
To be•ccmpleted .
Therundersigned hereby makes application for a permit for the work here"in specified,
agresing,to do all Vork in'strict accordance with the City of.Fridley Ordinances
and rulings of the Department of Buildings; and hereby declares that all the facts
and, represe tations stated'in this application ar true -and 'correct. '
DATE �� SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
Proposal
Proposal No.
FROM 01111111111110 i- Di.1Tie
Sheet No.
6020 Yynmloild bad.
Date
Nils-, idM., 55422 544-3919
Proposal Submitted To
Work To Be Performed At
NamA, lkw* 0MU
Street same
StreetW 63M Am. N. E.
City State
City
Date of Plans
Architect
Stat e'
Telephone Number
'
We hereby propose to furnish all the materials and perform all the labor necessary for the completion of
Doom; replace frog '='Mung tram & 22e tion fit bIlAfts
rwron ti cabinet doors.
r ;. ire loons, re pe, redgeorate entire hoc" vitt the eacetll,
I"= .
re ase k1tahme
DW; replace `
oars;se g ova & oubi=+stione or parts thereof.in
z repUos.
QM9e; replace.
09;ee ase board, Effl2gr & clean soffit.
e or ftol=Ung MW addine
All ma rial is guaranteed to be as sfied, and the abgveork to be ormed in accordance with the drawings
and.gici cations sukmitte for above work and co leted in a substantial workmanlike manner for the sum of
�7Z thousand 270th hundred di�f�ty
and no/1i0 — — --- — — — — — — — Dollars ($6v47040 I.
with payments to be made as follows:
Total amunt due on ooa,,pletion.
Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary insurance upon above ork. Workmen's Corqpensation cmcl :Public
Liability Insurance on above work to be taken out by GMtirafaltOr
Respectfully submitted
Per
Note — This proposal may be withdrawn by us if not accepted within ton days
ACCEPTANCE OF PROPOSAL
'The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the .4ork`os
specified. Payment will be made as outlined above.
Accepted Fridley, Ktm. Signature—
Date Signature.,., i r/,/,J/•rte � /+/(jjli./'Kiri L1
TOPS FORM 3450 • • •
lr
t � UTHO 1110.
4 l;Ail
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773>
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S;'KM
ADDRESS 5� �� ADDRESS /vim A,?e-
s
/ p LOCATION OF BUILDIN
No.�7 0
/ 5otreet �/_ dart - •f Let
LOTS BLOCKADDITION OR SUBDIVISION
Corner Lot inside LOTSSetback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
.To be used as;
DESCRIPTION OF BUILDING
Front Depth Height
I
Sq. Ft.. Cu. Ft.
Front Depth Height
Sq. Ft.. Cu. Ft.
Type of Construction Estimated Cost'
eelny�
To be completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work to;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 Xrue and correct:
e
a
SIGNATURK
(Schedule'of Fee Costs can be found on the Reverse Side).
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SUBJECT
PE 0.
City of Fridley
18171
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
�
RE
`L _ COMMUNITY DEVELOPMENT DIV.
/ ^19
r PROTECTIVE INSPECTION SEC.
OV 3
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/22/85
JOB ADDRESS 548 - 63rd Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
21
9
Christie Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Frank Owato 548 - 63rd Avenue N.E.
571.3362
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Reliable Builders, Inc. 10.543 Pierce Street N.E., Blaine, 786-8358
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 j7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Adding a 35' x 16.' Addition over Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATF
_WIRING,
HEA 7I;vIG,L
���.
I,'�I,�E®
�i1VG
ASD 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
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
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
$ 24 7OO
$12.35
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-
S U TION OR THE PERFORMANCE CONSTRUCTION.
$170.50
PAN CHECK FEE
TOTAL FEE
r
$ 42.63
$225.48
SIGNATURE OF CONTRACTOR OR AUTHOPftZE0 AGENT (DATE)
WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
n
BLDG )NSP
J[
OJ^
qAT
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
I
NEW [ ]
ADDN. [ ]
ALTER. [ ]
Construction Address:_
Legal Description: Z'�
Amer Name & Address:, J
Contractor: r&_l« (,
City of Fridley
R-1 AND R-2
Building Permit Application
Effective 4/1/84
Tel. #Tel. #
� ll
Address • /6 J' y3 do e PC S • �V lo�� -
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 3S Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: C uQ
q,� Z
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback
Type of Construction: l�Oy�T p
Approx. Completion Date:
Side Yard Setback
Estimated Cost: $
oy,76(J
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
``�� <rC ' �� ,� -.ZZ,�Tel. # 2 DATE• APPLICANT•
,tom,
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
]STING
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SUBJECT
MIT NO.
City of Fridley
2701
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
CEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
��
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/3/98
JOB ADDRESS
548 63 Ave NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR,
21
9
Christie Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Betty Moon
571-7361
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Midwest Roofing. Siding,
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
416-4804 20010277
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE
9 DESCRIBE WORK
Reroof house and shed (27 S Tear-off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with
State Building Code.
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
MOT.
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2251
$1.12
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.
$74.75
Fire SC $2.25
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$83.12
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY V DATED THIS IS YOUR PERMIT
�®
BLD INSR DATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
SEP -25--1937 14:05
NEW $
ADON
ALTER[ }
G I Tf OF ISI DLEY
bid will i"e VA41lfM
CMV OF MDMY
SMLZ FAMMY AM DUPU&) &'S R-1 AND R-2
BUIL OINO PMS A MCATLO q
CvuKr=dc"s: 5qs 6,3rcA,
Saar Nam & As1:
Common M,)rb ip.o-4
W
Cff=tive 111197
_� ��
wift Sq. FL
GARAGE AREA: LMSM W-Mh
ill
DECK
y
OnSWURCOM Type..—L=
scheatiao on
ay Cutb Cut V446 Made&
ATFA — ...� APPUCANT6 Td.
��. V 77-
-or Main Charge
'ui..MIONS:
Z.S Fft samkAw an Anwm rue
SPSO Per SAC Urdt
_ $S.00 (State)
Alt "Ap or t& IV H,bove
. •$4MOD Comorva&n Jim Rovfcw
Agmmmd Bury Not N=Mary r I
I
SUBJECT
PERMIT NO..
City of Fridley
2 9 0
AT THE TOP OF THE TWINS
BUILDING
PERMIT
`v ----� COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
_LT[
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
3/25/99
JOB ADDRESS
548 63 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
21
9
Christie Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert Harry 548 63 Avenue NE
571-6385
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Town & Country Roofing 7910 12 Ave S Bloomington,
MN 55425 854-9365
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
20091282
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK ❑
❑ NEW ❑ ADDITION ❑ ALTERATION X REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof House & Garage 27 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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 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
$ 1.16
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,313
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
$74.75
F SC $2.31
OR TtJE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEET
Licen SC
$5 0
A FEE
$83.22
lul-tj ell!
".11
SIGNATURE OF CONTRACTOR AUTHOR EE0 AGENT F IDA E.
HE PR
Y D ' THIS IS DUR
S-GNATURE OF OWNEAOF OWNER BUILDER, IDATEI
B G INS
BATE
I
Mar -19-99 11:23A
NEW [ l
ADDN [ ]
ALTER [ ]
ConstructtonAddress:,1
Legal Description.-I;—R)&
Owner Name & Address:
Contractor: COW V
Address: 19)/) /c'�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
P.09
Effective 1/1/98
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Tel. # X5"-2/ — 4,3S6'
MN LICENSE # oPLOC-) 9/o28`oZ.�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Construction Type: 3z e- - (Oy Estimated Cost: $
Sq. Ft.
Sq. Ft.
Sq. Ft.
a�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 3 W APPLICANT: Tel. #
. ; -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
NEW [ l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 4 F- j A-t),e5 of l=;g /'YI 3 a
Legal Description:
Owner Name & Address: ern %ed fYY lob ref d40.- camel. #/-
Contractor: r MN LICENSE #
Address: Tel. #
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:
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: N Ft. +, 'Ft = Ft x $ _ $ f DV, S-0
XDATE: ID -1 r-Oy APPLICANT: � lel Tel.
CITY USE ONLY - Call (763) 572-3604 for Permit Fees If mailing In application
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ $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 [ ] Not Nee sary [ ]
TOTAL $ (1
gY
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING` SYSTEMS AND DEVICES
JOB ADDRESS iET y 4l0
Effective On January 1, 2002
n)E
RATE SCHEDULE
OWNER
Residential Rate TOTAL.
Furnace Shell and Duct Work, Burner - BUILDING USED AS ry S
Also Replacement Furnace $ 30.00 $315 -1911-1`
(Side Vent Fill Out Back)ESTIMATED COST PERMIT N0;
Gas Piping (Needed with new furnace, $ 10.00 $
but not replacement) DESCRIPTION OF FURNACE AND OR 131 RNER
Gas Range $ 10.00 $ i=
No. of Heating U 'ts_�_�
cle One (Steam) (Hof Water. ar ir)
Gas Dryer $ 10.00 $ Tradea�ne Size No.� r C�=
BTU HP EDR-
*Air Conditioning - All Sizes $ 25.00 $ Fuel °�S Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)' Burner Trade Name Size No.
1% of Value of Appliance or Work $ BTU HP EDR °
Commercial/Industrial
1.25% of Value of Appliance or Work $ 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
State Surcharge $ .50 rulings of the Building Division, and hereby declares that •all'the facts and
representations stated in this application are true and correct.
TOTAL .FEE STANDARD HEATING & AIR (IING CO.
410 WEST LAKE DATE
MINNEAPOLIS, MN 55408-2998
812-8242656
MINIMUM FEE FOR ANY HEATING/CO.OLING/VENTILATION HEATING CO
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE Signed #
FAX # l i 23
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not.be placed in a side yard without Approved B Rough -In Date Fin `
PP Y g al Dat „
written permission from adjoining property owner:4 t�
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT'F I
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VENT, VFNT CONNFCTnR AND COMBLISTION AIR VFRIFICATIC)N
When re In acing an - Asting;furance, the undersigned hereby verifies that the
venting has_%een ex n7 ned and: is free from rust, detehoratiorli-obstructions, -
"i.
and is securely supported:and firestopped where required. - Yes (W. )
The venting system is plastictPVC 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 manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances. Yes (L ' No ( )
The exictrng _nmh jstion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes (LYINo ( )
When required to install a now _omhus ion amt will be sized and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When ins+allin,9e a new venting cy5tem, the undersigned hereby verifies that
itis 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 (4 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 (q No ( )
Appliance #1 Type rC"E- BTU Input 9F, 0.0 D Fan Assisted or Nat FR
-
Appliance #2 Type Wim- N-,�L BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat -
Total Appliances Total Btu `Input coo
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft
Appliance #2 Vent Connector Height ft
Appliance #3 Vent Connector Height ft
Al -rF:0eT1nn1c- frigsa..wksi Gz
Length ft
Length ft
Length ft
,..SCI
Diameter in
Diameter in
Diameter in
Type B�
Type 6yld�r—
Type
HEATING CO: D -
Signed By: Date 0,
V
HEATING CO: D -
Signed By: Date 0,
NEW []
ADDN []
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
-P
�
�' 4 S1—
AV -57—
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763) 5714287 Fax
Legal Description:
Owner Name & Address: Tel. #
Contractor. TWIN CM =tIOiS/ABC SD= MN LICENSE # 2535
Address: 9060 ZACHARY LANE N #108 MAPLE GROVE, MN 55369. Tel.# 763-425-4737
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:
Construction Type:i�QDU� 7� �T€stimated Cost: $ �� ���
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: ° i APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-5714287 If using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control.
Park Fee
Sewer Main Charge
C�3 � �'i�F-� ��1►1A�
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [
TOTAL $ S -' ! STIPULATIONS: