PRE 2010 DOCS*City oFridley, f FMinn.
BUILDING PERMIT N® 4 4 3 0
Date: %
s.7.`......-•-------- ..._..-�---"�.._®._._.._.._ __-------------------......
Owner: om.----pl.0.e
............ Builder ............................ ?.................. .......................
® j
.....Address ...... .t id-vL_.. Address /
qq 1 LO TION OF BUILDING
No.....�D. .�(�D. Street . 6._3... 5 --Way. .............. . ...................................-. Part of Lot ...._....-...........-
Lot ._ ® .%.[_........ Block....../4........................ ...._.... Addition or Sub -Division ...rX.-.1-(L--1 td..._..�/_�..®......_--------
s/
Corner Lot ... ....... k!!7........... Inside Lot ......_.................._.._. _.. Setback ...........��... ................ Sideyard .........,�� �._�� -----.......---..._...........
Sewer Elevation ............1?.. ...... .-.._............................ _...................... Foundation Elevation ........... rJ............3.------................-----
DESCRIPTION OF BUILDING
To beUsed as:Dp) elliP'j'I f ..�./ ,
.0.Q(I1e.....��?..�1 �t `Front 4...... Depth ......'1....�.... Height ..... ...1....... Sq. Ft./CU.. �� (O.. Cu. F .3�`�j /�/
F.0._h ... .)2 t*' L. Front ,/..d'�....._... Depth ..... ..�.. Height ....�._9... Sq. Ft. ... .. Cu. F........................
Type of Construction.........i'.-...e........... .. Est. Cost To To 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 above set forth din C77"11ance with all provisions of
ordinances of the city of Fridley. ,7 ,%
Ct
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
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. ii „el -'l
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 items.
4
ti
4 - 'elj- 7'a
CITY OF FRIDLEY INSPECTION DIV,
Effective On January 1, 1993
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
JOB ADDRESS
The undersigned hareby makes application for a permit for tho work herein
Residential Rate
TOTAL
specified agreeing to do all work In strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner —
rulings of the Build!ng Division, and hereby declares that all the facts and
Also Replacement Furnace 20.00
$
representations stated in this application are true and correct,
®Z. ,1993
Gas Piping (Needed with new furnace) 1$10.00
$
OWNER_L�.
Gas Range $ 10,00
$
BUILDING USED AS_®G
Gas Dryer $ 10,00
$
_
ESTIMATED COST PERMIT NO.
*AIr Conditioning — Ail Sizes $10,00
$
�--•
DESCRIPTION OF FURNACE ANg OR SURIJER
All 01hers/Repairs.& Afteratlons (LIST ON BACK)
1%<<zf Value of Appliance or Work
4
$
No, of Heating Un I s / Circle One (Steam) (Hot Water) arm Air
Trade Nam_ Size No./-
Commercial/Industrial
BTUIHP EDR
' -
1 % of Value of Appliance or Work
$
Fuel Total Connected Load
State Surchzrge
$ ,50
Burner Trade Name ,Cly Size No.
�o
BTU ®f,2 HP EDR_
TOTAL FEE
$
S E D GWI C K
HEATING COMPANY HEATING & AIR CONDITIONING M
MINIMUM FEE FOR ANY HEATING/COOLINGPJENTILATION
8910 JWERIWOR &IINNEAPOUB, 5542Q-2853
REFRIGERATIONIAIR CONDITIONING PERMIT' IS 115.00
Signed B el No. 881.=
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
Approved By �-- Rough—In Date Final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner,
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
4P e -
P Coy
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
Yes No
( )
2.. Is free from rust or deterioration
Yes ( No
( )
3. Has no foreign objects lodged within
Yes (1X No
( )
4. Is securely supported
Yes ( No
( )
5. Meets all current Code requirements for
size and total BTU's connected Yes No ( )
6. Has total heating BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
OCUUMLON
HEATING A AIR cnNDITIONING rn
8910 WENTWORTH AVE. SO. � -
MINNEAPOLIS, MN 55420-2853
HEATING COMPANY 881.9000
Signed By
Date
<u� _ li d, `Sx.e �. ..ty: ��L :w'e• -.. ,g.-� � '��u� 'Jtis�.-.ri -.caM---4_'��a .
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOB NO.7
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (612) 881-9000 TEST RECORD
ADDRESS CITY r " ° leJ
OCCUPANT (JJ A �� 0 OT A, OWNER Wa /7Z
SOLD BY �GvOC INSTALLED BY _ S ��S fs. /C �� y
MAKE B Ct3a w MODEL 3/ 9 614 Lf/ 0 z i 6 .5 0
SERIAL N0.313 5 14®/ Cl INPUT SO
,000
THERMOSTAT tmhu4C 9a4eir
VALVE Bahr t !AQV
LIMIT 3 f.. QN
LIMIT SETTING 8 o a
FAN SETTING :;�/ n+ e J QA -1
PILOT TYPE F ec'td It G
IGNITION MODEL 54,Vtn 4 /
PILOT TIMING �tr r4,',4 Td n�
PRESSURE 3 - S LU/fr PERCENT CO2 S
VENT SIZE 41
TYPE OF LINER Veit
LINER SIZE -S
FILTERS: SIZE /Z6r25 1r I NUMBER
WIRING-S-Pcfc. Cy %C ®i
TEST TAG
LIGHTING INST. V
DATt TESTED (� S' 93
INPUT CFH J ®
PERCENT OZ
(.96
COMPANY TESTING S -C1
Cf (✓f'@ lZ
STACK TEMP. y3 d
PERCENT CO
® 919
NAME OF TESTER M - ��
Gru Iu
FORM 235 (REV. 1189) FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY CITY
SUBJEt7
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT/e29235
i
`COMMUNITY DEVELOPMENT DIV.
L_
r � � PROTECTIVE INSPECTION SEC..
(/
CITY HALL FRIDLEY 53432
�j
NUMBER
REV
DATE
vAGE OF
APPROVED BY
612-571-3450
010415
4/16/99
JOB ADDRESS 90-100 63 1/2 Way NE
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
10,11
16
Fridley Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Walter Doelz 2218 W 82 St, Bloomington MN 55431 884-5070
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Dave Lane 33025 Jewel Ct, Chisa o City, MN 55013 257-7200 2081
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Duplex
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Duplex (20 Sq) Tear-off
9 CHANGEOFUSEFROM 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.
Permit Inspection Cards
Will Be an
To Homeowner To Post
SEPARATE PERMITS ARE REOUIRED 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
2
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
$1,714
@
$.86
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.
$56.75
Fire C $1.71
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL F
-,<� , //
$5YA2
SIGNATURE OF CON TRACTOR OR AUTHORIZED AGENT IDATEI
P VALIDAT IS IS Y U PER
kQ
SIGNATURE OF OWNER 16 OWNER BUILDERI IDATE.
SF' rSIA E
04/16/1999 11:41 612-257-3681
hFR-1�- ; �:;�•ra
Arw
ADDN (:
ALTER0
LANGE INS. AGENCY
IN
CITY OF FRILEY
SINGLE FAMILY AND DUPLEM R-1 AND R-2
BUILDING PERMI T a' APPLICATION
PAGE 02
P.01/04 d
F"frective 1/1/99
Constructio M Z
Legal Description:............M7Sr�--~--�'__G1_,,,.�,�?..�'
..Owner Name ' Address:Te(..4- 6,,
DENY-- ----
Address -03
Attach to this application, a Certificate of Survey of trP.
lox, with the proposed construction drawn on it to scale.
DESCRI MON OF MPROVEMEN T°
MMG AREA,. I�ng� ....._�...._...- Width _... _ _...___ tict�ht ... _. Sq- Pt. � ..
GARAGE AMA:. Length .... - , v- .._ _ Width �. � height _..._�_� Sq. -Ft:
_ Width _ Iigt/Ground � Ft.
DECK AR1�.A.- .-thy .. 4� � _.._._...
;onstruction Type: ,., �-`' � ._ �_._......_._... _.... Estimated Cost. S
-.
Back)
Driveway Curb -Cut Width Necded: _ F<,. + b Ft — Ft x S _.._.......
_..__
DATE:..T � I .:._.,,.. .A►PiPLICANT .�� .-- �'�- _ . °i'et. #���'
°.?ennit Fee
St
.
Fee Schedule on Reverse Side
=ire Surcharge'S__..�......_L�.
,�-.,--
l.n.
sm of Permit Valuation {J/Ift9)
'state Surcharge
A..._....�..-_
_ _
MOISLOW Valuation
).AC Charge
per SAC Uni;
.,)cense Surcharge
r7 _ _
$5.00 (State Ucemwd ResictertW Contra Fors)
3riveway Escrow
S
Alt. "A" or AIt. "$" Above
;rasion Control
$450.00 Coivservation Flan Review
"ark Fee
�
.,..._.
Fee Determined by Engineering
;ewer Main ChargeW
.,_..._ ..._„_....__
A're+ementiec;_ssary i a Itrut Nesxsary ; j
TOTAL
S,,�
'
`
, rIPULATIONS :
�if o„t
�,,,F
.>
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK Nt]MRFR OF FIXTURES TO BE INSTALLED ON EACH FLOOR
E.ttective On Jan 1, ZU03
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS �G l �/ �! ✓.
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 () No
Type
$ 7.00
The undersigned hereby makes application for a permit for the work herein
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
$ 7.00
and representations stated in this application are true and correct.
$ 7.00
$ 7.00
J
$ 7.00
$10.00
Owner
$ 7.00
$10.00
Building Used As
$10.00
J JJ
DC)
$10.00
Estimated Cost PERMIT NO. /
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $ 0.S-6
PLUMBING COMPANY -
SIGNED BY TEL NO.-7d-
Approved
O.-7d- �i✓ (�
A roved B v:)—k Rough -In Date Final Date
PP Y
MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
COMBUSTION 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
rQMMQN VFNT, VENT r.QNNFCTQR AND COMB IISTION AIR VFRIFICATION
When repla .inn an _xin inaf uri anre, 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 Pxtina rnmeiistinn air is sized and installed to meet the current codes
and manufacturers specifications. Yes( ) No( )
When required to one+all a now rnmhustinn air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When inn allinn a n _w ventingrzyStam, 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
BTU Input
Fan Assisted 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
Vent Height
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