PRE 2010 DOCS•
City of Fridley, Minn.
BUILDING PERMIT N® 6735
Date:
oe
Owner Builder r
Address Address
�OCATION�=-DING
No. Street — ,G _ Part f Lot
Lot A tion or Sub -Division .
Corner Lot Inside Lot — � Setback -��_ �_ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
Used A29/109
/�
Front Depth Height Sq. Ft. Cu. F40-
0
Front Depth Hight Sq. Ft. Cu. Ft.
Type of Constru on Est. C� 2 �� o be Completed
In consideration of the issuance to me of a permit to constAuct the building described above, I agree to do
the proposed work in accordance with the description aboveorth and in pliance with all provisions of
ordinances of the city of Fridley. V n /y
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
theexpress 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 � thereof, shall conform in all respects to the ordinances of
7dl
einances.
EW Building Inspector
• NOTICE:
This permit doss not cover the construction, hatalletioe for wiring, plumbing, gas hea8ne, sewer or water. Be sore to see
the Building hopeetor for separate permlta for thus Moms.
APPLICATION FOR BUILDING PERMIT
CITY OF FRiDLEY, MINNESOTA
Owner's Name Builder
Address desa' -
LOCATION OF tMING
No. z/0 Street Part of Lot
Lot Block Addition or Subdivision
P
Corner Lot Inside Lot Setback Side -Yard /®
SES ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
� s
iv
Frontepth
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction '��c' " - - ..Estimated 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. Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representations
stated in this application are true and correct.
nems / / 2 gTr.NATTMV. At,—
(A
(A Schedule of Fee Costs can be found on the Reverse Side.)
w
U /
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK Location 110 - 63z Way
Number. Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIBTU RATES:
<g
3
RATE
��
z�
3F
�O�
c2
10.50
y.
x $1.50
$
w
?
•
•
N
WATER HTR.
GAS
ELEG
Base
$
Catch Basin ............................
x
3.25
$
`Z•00
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg . ............
1st
1
$
1
1
GAS FITTING FEES:
1
is
os
1
1st 3 Fixtures ..........................
x
$1.50
2nd
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
_
3rd
4th
• Future Connection Openings
New Fixture, Old Openings
Connected withI Sewer �
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIBTU RATES:
NO.
RATE
TOTAL
7
10.50
Number Fixtures ......................
x $1.50
$
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
`Z•00
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg . ............
x
3.25
$
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
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$ -
TOTAL FEE $ 14. d0
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 are true and correct.
Fridley, Minn Sept.11 1963
Owner Paul Schwartz const, Co.
Bind of Building Frame
Used as Dwelling
To be completed about Dec. 1 s 63
Estimated Cost, $ 800.00 a ®{
Old—New. Building Permit No Permit No.
Signe STANDARD RUMBING
By-
Busin Phone No We 8 3589
ROUGH
FINAL
az 2M 7-59
APPLICATION FOR HEATING OR POWER PLANT AND SPECIAL DEVICE PERMIT
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ......................... 8.00 $
Replacement of Furnace ............................. 4.00 $
Repairs & Alterations—up to $500.00 ................. 4.00 $
Repairs & Alterations each add. $500.00 ............... 2.00 $
MECH. WARM AIR
Furnace Shell &Duct Work to 120,000 BTU ........... 8.00 $
8.00
each add. 60,000 BTU ........................ 1.00 $
Replacement of Furnace ............................ 4.00 $
Repairs & Alterations—up to $500.00 ................. 4.00 $
Repairs & Alterations each add. $500.00 .............. 2.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.00 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.00 $
OIL BURNER—to 3 gal. per hour ........................ 4.00 $
over 3 gal. per hours—See Fee Schedule
GAS BURNER ............. 4.00 $ 5.00
GAS PIPING (Up to 5 Fixtures) .......................... 1.25 $ 1.50
AIR CONDITIONING 1
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM 5
14.50
gMdARKS: Plan R-1 On File TOTAL FEE $
Dept. of Bldgs. Phone JU. 8-4614
Location 110 - 63-2 Way N. E.
Village of Brooklyn Center:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the Village Ordinances
and ruling of the Department of 1#hildings, and hereby declares that all the facts
and representations sta �dt in this application are true and correct.
Plial Schwartz onstruction Co.
Owner 195—
Kind of Building Fr.
Used as
To be completed about
Estimated Cost, $—
Res.
400.00
10-13-63
Old—New. Building Permit No. a�
DESCRIPTION OF WORK
195T
HEATING or POWER PLANTS—Steam, Hot Water, mi.... Aar No
Trade ame Size No
Westinghouse GUA-1®®
N
Capacity Sq. Ft. E.D R BTU loom H. P.
Total Connected Load 45,631 Bind of FUSA Gas
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D R BTU H. P.
Signed
By FRED VOGT & CO.
HEATING & AIR CONDITIOXIN-3
1 1 3M-3-59 Busine&%MnWNp Leke Si. s:i—$16;9
St. Louis Pork, Minnesota
11
E
City of Fridley, Minn..
BUILDING PERMIT
Date: jolly 1 h' 1 A6A
Owner: Ed. Wilbert Builder Same
Address 110 63-,1- Way N. E. Address Same
LOCATION OF BUILDING
No. 110 Street 63z Way N. E. _ --- Part of Lot
Lot _ 1 ___ Block 2 Addition or Sub.Division . Eva Erickson
Corner Lot —_ x Inside Lot — Setback --- Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
N° 10338
To be Used as:
Garage Front 24' Depth 24 t Height 101 Sq. FL 576 CtL Ft 5760
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost —. $ 10Q_,92___ 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 and in compliance with all provisions of
ordinances of the city of Fridley. &r�
In consideration of the payment of a fee of $ 2 -QQ__., permit is hereby granted to Ed -Wilbert
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 anyrof the provisions of said
ordinances.
inspector
Clarence Belisle
NOTICE:
This perodt does not corer the construction, ins aMen for WLdng, plumbing, gas haadng, sewer or water. Be euro to sae
the Building Inspector for separate permhs for these hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME ��J�� BUILDER
ADDRESS (} — � ADDRESS
LOCATION OF BUILDING
NO. STREET 4, -3 � <�A -.,,, Z%c!�
LOT BLOCK 2 ADDITION OR SUBDIVISION
CORNER LOT .X_ INSIDE LOT SETBACK SIDEYARD,�
SEWER ELEVATION TOP OF FOOTING
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: /a -A—."
Front / Depth y Height
Square feet �r r Cubic Feet?
Front Depth Height
Square feet Cubic Feet
Type of Construction Estimated 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. P
.(Schedule of Fee Costs can be found on the Reverse Side.)
PLEASE REPLY TO SIGNED
FOLD
t
DATE SIGNED
SEND WHITE AND PINK COPIES WITH CARBON INTACT PINK COPY IS RETURNED WITH REPLY.
DETACH THIS COPY - RETAIN FOR ANSWER
REGULA .C�,10NCIL MEETING OF JULY 21, 1969
PAGE 7
of the request with the stipulation that no other sign be allowed on this
pylon, or any additional pylon.
MOTION by Councilman Liebl to grant approval of the sign permit request
for Country Boy Station Store by John Baucom with the stipulation that
no other signs may be added. Seconded by Councilman Samuelson. Upon a
voice vote, all voting aye, Mayor Kirkham declared the motion carried.
REPORT CONCERNING REQUEST TO BUILD A GARAGE ON A PUBLIC EASEMENT: (Mr.
Edward Wilbert, 110 6311 Way)
The City Engineer reported that his department recommended denial because
if there should ever be a break in.the sanitary sewer line, the repairs
would have to be made immediately and would use up the full 20 foot easement.
It would be a time consuming job to take down the superstructure of the
garage and a break in a sanitary sewer line cannot wait. He felt that this
,x would interfere with the health and safety of the citizens.
Councilman Liebl asked if this would go before any of the subcommittees.
\rThe City Engineer said no, as it affects only one person and the. City of
Fridley.
` Councilman Samuelson pointed out that Mr. Wilbert is willing to sign an
\� agreement holding the City harmless if any break should occur. The City
Engineer said that this was not the main problem, but rather the speed with
which the sanitary sewer line would have to be repaired. If it was a storm
sewer, it would be different. He felt that as a matter of Council policy,
this should be discouraged. Councilman Liebl commented that he was in an
unfortunate situation with easements on both sides of his lot. The
storm sewer easement for East River Road runs along the west side of this
house. The City Engineer suggested that the garage could be put behind
the house, as the lot is quite deep.
MOTION by Councilman Liebl to instruct the Administration to advise Mr.
Wilbert that his request cannot be approved, and suggest to him that some
plan whereby the garage could be located behind his house. Seconded by
Councilman Sheridan. Upon a voice vote, all voting aye, Mayor Kirkham
declared the motion carried.
RECEIVING THE MINUTES OF THE LIQUOR STUDY COMMITTEE MEETING OF JULY 8, 1969:
MOTION by Councilman Liebl to receive the Minutes of the Liquor Study Com-
mittee Meeting of July 8, 1969. Seconded by Councilman Sheridan. Upon a
voice vote, all voting aye, Mayor Kirkham declared the motion carried.
RECEIVING THE MINUTES OF THE PLANNING COMMISSION MEETING OF JULY 9, 1969:
1. LOT SPLIT REQUEST: L.S. #69-18, L. GEORGE WELLS: The east 12' of the
north 100' of Lot 8C, Second Revised Auditor's Subdivision #21.
The City Engineer explainted that Mr. Wells' house is on Lot SA and he
also owns 100' of Lot 8B. He would like to retain 12' of Lot C to go with
his house and yard for screening, if the north 100' of Lot C should be sold
in the future. If there should ever be a road between Brookview Drive and
Oakley Drivel there would be a 25' easemerj.. ?9cps9ary aJgpq the easterly
REGULAR COUNCIL MEETING OF JULY 21, 1969
PAGE 8
40
portion of Lot 8A and 8B. Mr. Wells said that he could not see the
relevance of a street dedication with the requested lot split. The City
Engineer said that there should be some sort of a street pattern set.
These are very big lots and there may be a need in the future for a road
either from Brookview Drive or from Mississippi Street, or possibly west
from Oakley Drive. Councilman Samuelson asked if he did not receive a
separate tax statement on the two parcels. Mr. Wells said that he did
up to this year, but this year they were together.
Mr. Wells explained that his house sits so far back on Lot 8A that if Lot
8C should ever be sold, this 12' would be very important to him as screening.
MOTION by Councilman Samuelson to grant the lot split requested by George
Wells (L.S. #69-18). Seconded by Councilman Sheridan. Upon a voice vote,
all voting aye, Mayor Kirkham declared the motion carried.
The City Engineer said that he wanted to point out -that there may be a
possibility of a road going through somewhere in this area, and he wanted
Mr. Wells to be aware of this.
2. KAYE WESTERLAND REZONING REQUEST, ZOA #69-08A: North 824.7 feet of the
west 2% of NE14 of the NE's of Section 13, rezone from R-1 to R -3A.
The City Engineer reported that the previous Council action has been to
set the Public Hearing date for August 11, 1969 for this request.
3. SACRED HEART PARISH: REZONING REQUEST ZOA #69-09: Lots 5, 6, A of
7, Block 10, Hamilton's Addition to Mechanicsville, to rezone from
R-1 to R -3A
MOTION by Councilman Sheridan to set the Public Hearing date for the
rezoning request by Sacred Heart Parish for August 11, 1969. Seconded by
Councilman Samuelson. Upon a voice vote, all voting aye, Mayor Kirkham
declared the motion carried.
4. VACATION REQUEST: SAV #69-03, GREAT NORTHERN RAILWAY COMPANY:
Alley and streets in Block 6, Berlin Addition
MOTION by Councilman Liebl to set the Public Hearing date for the vacation
request for Great Northern Railway for August 11, 1969. Seconded by
Councilman Samuelson. Upon a voice vote, all voting aye, Mayor Kirkham
declared the motion carried.
5. APARTMENT SURVEY IN THE CITY OF FRIDLEY:
The City Engineer reported that the Engineering Department has been taking
care of supplying the Planning Commission with the material and most of
it has already been taken care of. It will take some time to study the
number of school children in relation to apartment dwellers. They are
hoping to have their report done about the first of September.
MOTION by Councilman Liebl to receive the Minutes of the Planning Commission
Meeting of July 9, 1969. Seconded by Councilman Samuelson. Upon a voice
vote, all voting aye, Mayor Kirkham declared the motion carried.
T
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4
SUBJECT: t .�
FOLD
e
A
SEND iNH ,I AND PINK COPIES V
._..r: DATE: a°
4ACT PINK` COPY IS RETUA
A'a"4i
ai> �
f %}'
REPLY. -
COUNCIL MEETING OF JULY 7, 1969
PAGE 28
*41
FNN
D. MR. & MRS. EDWARD WILBERT: REQUEST FOR PERMISSION TO BUILD GARAGE
OVER SEWER EASEMENT:
uncilman Samuelson said that he has conversed with Mr. Wilbert, 110 6A Way
.E. concerning their desire to build a garage. There is a sewer easement
\ where the garage would have to be placed and he told them on the phone that
they would have to assume all responsibility if ever the sewer should have to
be torn up or repaired. They are willing to sign an agreement to this effect,
and hold the City harmless.
MOTION by Councilman Samuelson to receive the communication from Mr. & Mrs.
Edward Wilbert and refer to the Engineering Department for review, and return
to the Meeting of July 21, 1969. Seconded by Councilman Liebl. Upon a voice
vote, all voting aye, Mayor Kirkham declared the motion carried unanimously.
E. CITY OF MINNEAPOLIS: REGARDING PAYMENT OF SPECIAL ASSESSMENTS ON LOT
30, AUDITOR'S SUBDIVISION #39, PARCEL 3460:
Mayor Kirkham read the letter aloud for the City of Minneapolis in which they
explain that they purchased Lot 30, Auditor's Subdivision #39 in 1965 and at
that time there were special assessments of $1464.43 against the property.
At that time, in the Attorney's opinion it would be illegal for a city of the
first class to make payment to another city. Since that time Legislative
amendments have been made and it is now legal to do so and they are willing
to pay that entire amount now, with the understanding that the interest and
penalties which may have accrued since that time will be waived.
MOTION by Councilman Harris to receive the communication from the City of
Minneapolis dated July 1, 1969 and concur. Seconded by Councilman Samuelson.
Upon a voice vote, all voting aye, Mayor Kirkham declared the motion carried
unanimously.
YMCA DISCUSSION:
Councilman Harris reported that he had also received a letter from Mrs. Riese
and felt that some clarification was in order. Since receiving the ruling
of the Attorney General and the City Attorney that the land cannot be given
away, some coverage by the press to that effect should be helpful and that the
City is not going to be doing anything illegal. The City Attorney added that
it will not be necessary to have an appraisal, but that it would have to be a
marketable price.
MOTION by Councilman Harris to authorize the Administration to notify the
YMCA that the West Moore Lake site cannot be given to the YMCA and to invite
the YMCA to consider other sites in Fridley. Seconded by Councilman Sheridan.
Upon a voice vote, all voting aye, Mayor Kirkham declared the motion carried
unanimously.
There followed some discussion on locating the YMCA facility behind the Ice
Arena, however, the City Attorney pointed out that here again the same ruling
would hold, that it would have to be for a marketable price.
ADJOURNMENT:
MOTION by Councilman Liebl to adjourn the Meeting. Seconded by Councilman
REGULAR COUNCIL MEETING OF JULY 7, 1969 PAGE 27
CONSIDERATION OF CHANGES IN PROPOSED ZONING ORDINANCE:
MOTION by Councilman Liebl to receive the information from the City Engineer
on the proposed Zoning Ordinance. Seconded by Councilman Samuelson. Upon a
voice vote, all voting aye, Mayor Kirkham declared the motion carried
unanimously.
CONSIDERATION OF CHANGES IN PROPOSED SIGN ORDINANCE:
MOTION by Councilman Liebl to receive the information from the City Engineer
on the proposed Sign Ordinance. The motion was seconded and upon a voice vote,
all voting aye, Mayor Kirkham declared the motion carried unanimously.
AUTHORIZATION OF CERTIFICATES OF ACHIEVEMENT FOR FOUR MEMBERS OF THE POLICE
DEPARTMENT PISTOL TEAM:
Mayor Kirkham reported that the Fridley Pistol Team placed second in the State
Pistol Shoot in Winona. The competition was against all law enforcement
agencies and the State Conservation Department. He would like to see these
men awarded Certificates of Achievement.
MOTION by Councilman Harris to authorize preparation of Certificates of
Achievement to be presented to: Sergeant Robert Cook, Officer Dallas Nelson,
Officer Kenneth Wilkenson, and Officer Thomas Kennedy. Seconded by Council-
man Sheridan. Upon a voice vote, all voting aye, Mayor Kirkham declared the
motion carried unanimously.
RECEIVING THE MINUTES OF THE LIQUOR STUDY GROUP MEETING OF JUNE 26, 1969:
MOTION by Councilman Liebl to receive the Minutes of the Liquor Study Group
Meeting of June 26, 1969. Seconded by Councilman Samuelson. Upon a voice
vote, all voting aye, Mayor Kirkham declared the motion carried unanimously.
COMMUNICATIONS:
A. KAYE CONSTRUCTION: REQUEST TO BE ON AGENDA JULY 14, 1969:
MOTION by Councilman Samuelson to receive the communication from Kaye Con-
struction Company dated June 12, 1969. The motion was seconded and upon a
voice vote, all voting aye, Mayor Kirkham declared the motion carried
unanimously.
B. BUREAU OF OUTDOOR RECREATION GRANT:
MOTION by Councilman Liebl to receive the communication from the State of
Minnesota, Department of Conservation dated June 23, 1969 and authorize the
City Manager's signature. Seconded by Councilman Samuelson. Upon a voice
vote, all voting aye, Mayor Kirkham declared the motion carried unanimously.
C. JANICE A. RIESE: OPPOSED TO YMCA ON WEST BANK OF MOORE LAKE:
MOTION by Councilman Liebl to receive the communication from Janice A. Riese
dated June 19,1969. Seconded by Councilman Samuelson. Upon a voice vote, all
voting aye, Mayor Kirkham declared the motion carried unanimously.
TO
CITY OF FRIDLEY
6431 UNIVERSITY AVE. N.E.
FRIDLEY, MINNESOTA 55421
PHONE: 560-3450
SUBJECT: DATE:
FOLD 99
J `
PLEASE REPLY
TO —3 SIGNED
(f mlior-1-elo r/
7^ e CG")'mv I" p -m c/
is a- e a- !'i °G "3c
e
DATE 1 ®— SIGNED
SEND WHITE AND PINK COPIES WITH CARBO INTACT PINK COPY IS RETURNED WITH REPLY.
June 20, 1969
Mr. Edward Wilbert
110 - 63 1/2 Way
Fridley, Minn. 55421
RE: 10 Foot Easement on Your best Lot Line
Dear Mr. Wilbert:
On Thursday, June 19, our City survey crew did
make a field survey to determine the location of the
Sanitary Sewer. The Survey shows that the sewer
pipe is located at or very near the property line
Dand at a depth of about 11 feet.
Assuming a break was to occur at this location
and an excavation was to be made for repairs we
could assume that the trench walls would be
approximately on a 1 to 1 slope thereby taking up
the full 20 foot easement.
The survey together with the above assumptions
means that we would be unable to recommend to the
City Council vacation of any portion of the existing
easement, therefore we regret to inform you that
you could not expect to build any structure over
the Westerly 10 feet of your lot.
II would like to thank you for your patience
on this matter and if there is any additional
information you might want please feel free to
contact me.
Yours very truly,
ingineering Assistant
DC/njf
wo", T shall be at the
h e fee
or fraction thereof In the
2.6. In 120 cage shall the fee charged for an,
""S than
Permit as set forth In Section
2
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June 20, 1969
Mr. Edward Wilbert
110 - 63 1/2 Way
Fridley, Minn. 55421
RE: 10 Foot Easement on Your hest Lot Line
Dear Mr. Wilbert:
On Thursday, June 19, our City survey crew did
make a field survey to determine the location of the
Sanitary Sewer. The Survey shows that the sewer
pipe is located. at or very near the property line
Dand at a depth of about 11 feet.
Assuming a break was to occur at this location
and an excavation was to be made for repairs we
could assurie that the trench walls would be
approximately on a l to 1 slope thereby taking up
the full 20 foot easement.
The survey together with the above assumptions
means that we would be unable to recommend to the
City Council vacation of any portion of the existing
easement, therefore we regret to inform you that
you could not expect to build any structure over
the Westerly 10 feet of your lot.
I would 1 il:e to thank you for your patience
on this shatter and if there is any additional
information you might want please feel free to
contact ne.
Yours very truly,
� I)�IZi:1L ' l:-�': iii i''�'•'�c•-:`:�
) nginecrinfg Assistant
DC/ri j f
worl, ijollars (v,�- the
AL, 50 fee shall be at t),,a
2.6. OO)p or Faction
thereof In the
In no c1`13 shall the fee charged for a i I
less than $/
.00•ny Perm
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SUBJECT
"PER O.
City of Fridley
16397
AT THE TOP OF THE TWINS
BUILDING PERMIT
i�
• V _____ COMMUNITY DEVELOPMENT DIV.
� t
r PROTECTVE INSPECTION SEC.
1
l 1;,J CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
OF
APPROVED BY
-_--
L 612-571-3450
910-F15
9/21/81
F;GE
/
JOB ADDRESS 110 63h Wag N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
1 2
Eva Erickson River Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Leslie L. Wi ert 110 631 Way N.E. Fridley 55432
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Owner
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 1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Install
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof Can be the second but not third.
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
R-1
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
$796.19
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
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PRO ER LIDATED THIS IS YO R PERMIT
BLDG )NSP f)ATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDAT-
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIM FOR RESIDbMAL BUILDING PEIVITS
(New, Alterations, Additions*, or Repairs)
OW14ER: L -W* =4 BUILDER:
ADDRESS: l b -3 !%t ADDRESS:
TEL NO: TEL NO:
Construction Location
• STREET �� V STREET:y<STREET NO: '
LOT: BLOCK: 7 ADDITION: tiJr�✓C14
e/®s�
Corner Lot: Insiiie 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
Front: Depth:
Square. Feet: Cubic Feet:
Front:
Height:
Depth: Height:
Square -Feet: Cubic Feet:
i�
Type of Construction: =., ".�) L Estimated Cost:
4b Be Cbmpleted: z_ ��{- 3�� � r, 1
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ * $
SEE PZVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the %pork'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: � � f SIGNATUM: - �,/�, l
Stipulations:
SUBJECT
of Fridley
ERMII..City
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir
i 6 ...... COMMUNITY DEVELOPMENT DIV.
/;
r PROTECT VE INSPECTION SEC.
CITY HALL FRIDLEY 55432
L
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/31/86
JOB ADDRESS 110 - 63h Way N. E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
1
2
Eva Erickson River Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jim Fish 110 - 63' Way N.E.
571-5477
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Pacific Pools & Patio 6922 North 55th Street, Oakdale 55109 770-1313
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
X
8 DESCRIBE WORK
Construct an 18' x 36' In -ground Swimming Pool
9 CHANGE OF USE FROM TO
STIPULATIONS
See letter dated 7/31/86 with stipulations from Building Official.
-SEPARATEZee
F0
y0AeNF�,�'g
ca`
Cmvs.
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$10,000
$5.00
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.
$80.50
PLAN CHECK FEE
TOTALFEE
$85.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY LI DATED THIS IS YOUR PERMIT
,1
!
BLDG INSP
c^%
f
DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATEI
NEW [ ]
ADDN. [ ]
ALTER. [ ]
Construction Address If
Legal Description: Leo
Owner Name & A ress!
Contractor: Cl
Address: .[�2 ,t/C-/
LIVING AREA:
GAR AREA:
DECK AREA:
OTHER:
Corner Lot [
City of Fridley
�R-1 AND R-2
Building Permit Application
(110 K s
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length
Length
Length
Inside Lot [
Width
Width
Width
//l.5
Height
Height
Hgt/Ground
Effective 4/1/86
Tel. #��
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
r i
Ft. Yd. Setback Side Yard Setback
Type of Construction: (,
Approx. Completion Date:
Estimated Cost: $ _/_
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
O
DATE: 77 3� / - APPLICANT: Tel.
G CITY USE ONLY
Permit Fee $ C1^.�Z` Fee Schedule on Reverse Side
Plan Check $ 2% of Building Permit Fee
State Surcharge $ C C, $.50/$1,000 Valuation
SAC Charge $ $475 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS• LjasF5 Voss.�[�� n,>���' Ae,""st��
70^600 NATIONAL ELECTRICAL CODE
680-8. Overhead Conductor Clearances. The folio
win
shall not be placed under existing service -drop conductors or an of
overhead wiring; nor shall such wiring be Installed above the folios of pools
pools and the area extending 10 feet (3.05 m) horizontally from the In Pen
of the walls of the following: (1)
towers, or platforms 1' (2) diving structure; or 3 side
()observation stands,
Exception No. 1: Structures listed in 1
Permitted under utility -owned, -o (� (2%� a (3) above shall be
service drops where such installations provide the following clearances:
maintained supply lines or
A. Clearance in any
' direction to the water
level, edge of water
surface, base of
I diving platform or
permanently -anchored
raft
B. Clearance in any
direction' to the
diving platform or
tower
C, Horizontal limit
of clearance
measured from
inside wall of
the pool.
Insulated supply o► ser-
vlce drop cables, 0-750
volts to ground,
supported on and cabled
together with an eftec-
tively grounded bare
messenger
18 feet
(5.49m)
14 feet
(4.27m)
All other a,PPb
or service drop
conductors
voltage to Ground
0-15 k V 15-50 k V
25 feet 27 feet
(7.62m) (8.23m)
16 feet 18 feet
(4.88m) (5.49m)
This limit shall extend to the outer edg
structures listed in e of the and (2) above but not l
than 10 feet (3.05m), ess
rOOL
4
L
Z- meq wp .c. - "s (000.00), zee shall be a
or fraction thereof t
2•6' In no C2the
ye shall the fee char the
less than w`/.. �. charged for an I ' ( , ,
3' Permit as set_forth in Section
20 be
�•ss•..ga ar.a�,a.
01961 `WO'i 10 hap
•��ova;.r,WGln-a,+nJvIct"Y`2j0A/HAl 062Y At05Y06N.3 d(73�z sr-�
n ��;.ra.�.,vc� vpo lranyxv v jo vov'ted v.�,W
„t. _ • '`'
AV 740
. r�.uv3L•��9!�� dL0 9 � .
�Ct
re
6", 1011 " 'ta a4
C-- o
5odo''d i
IV95
£8 - f
,oys
VIA"
�j Hva3u3W 's 1M3eom
uosz o oazzna �
NOSNHOf 's Amuvs
♦QiiY!(IM 'Oi i110�v9N1i1M
"I Moo sev aoYrz.: !zoos ln4vdwoJ ?'1 awd0p"q, awd :yob h7
Af
• � r a 3• r n n a Y v 1
r � ,
I Copy: OffiC6
2 Copy: Crew Chief
3 Copy: Municipality
4 Copy: Customer
Pacific Pool & Patio
A Minnesota Package Products Company
Brooklyn Center Store
No. St. Paul Store
Burnsville Store
1278 W. Co. Rd. 42
Ridgedale Store
12500 Wayzata Blvd.
4321 - 68th Ave. No.
Brooklyn Center, Mn. 55429.
6922 - 55th St. No.
No. St. Paul, Mn. 55109
Burnsville, Mn. 55337
Minnetonka, Mn. 55343
(560-6442)
(770-1313)
(435-3500)
(541-9180)
CREW CHIEF
[7ATCCOUNTNUMBER
I gi%��o
O ve9L 7 30 -
Equipment Needed
POOL SIZE
DATE
h0@ L7BOb C8ts
HOME PHONE
O Truck
NAME
Ilo & /
y N�.
Fence ❑
STREET
WORK PHONE
�Ri
f�Iitl 5`55�3�
Contract
� G� y
CITY
STATE 21P CODE
7 Back
❑ Cat
0 Snow
Inspections
[J Walls
• Plumbing
❑ Footing
C7 Before Backfill
[J Other
DIRECTIONS
Diagram pool site in relation to
Zxca
s Customer wish to retain any or all dirt from pool
vation: X) -o
Will any obstructions be encountered — syph as trees,
vation from location marked "A" in diagram: � l/
�
Show type and location of slide if applicable: -'e'L '477
for disposal of dirt:
Pacific Pool & Patio recommenas
(As soon as possible following pool
1. Rain gutters adjacent to pool
2. Retaining wall where diagramed _
CUSTOMER ALSO UNDERSTANDS & ACKNOWLEDGES THE FOLLOWING
Some damage may be done to the yard and/or drivewly enter mg and leaving the yard during construction: Intial
r.ustomer assumes responsibility for electrical wiring and grounding of the pool (including permit if required): I ial
CIlYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
July 31, 1986
Pacific Pool & Patio
6922 North 55th Street
Oakdale, Md 55109
Re: Swimming Pool Construction at 110 - 63 1/2 Way N.E., Fridley
Dear Sirs:
This letter is to make clear this department's requirements for the swimming pool
construction at the above address.
1. As indicated, two (2) skimmers approved by the National Sanitation Foundation
will be provided.
2. As indicated, two (2) inlets of approved design for fresh and/or repurified
water will be provided.
3. As indicated, a main drain of approved construction will be provided.
4. The filter and pump shall be approved by the N.S.F. and be of sufficient
capacity to provide a minimum turnover of at least two (2) times in 24 hours.
This department recommends a turnover rate of 6 - 8 hours.
5. A deck of at least three (3) feet wide, measured from the pool waters edge,
shall be provided which extends completely around all private residential pools.
Above ground private residential pools may be provided with decking of a minimum
size of 4 feet by 4 feet at pool entry points and provided that such decking has
the approval of the City.
6. Fencing, or other effective means including but not limited to walls or
buildings, acceptable to the Casty, shall be provided to positively control all
access to public and private residential swimming pools. Fencing shall meet the
following criteria:
(a) The fencing shall prevent the entrance of children and be without hand or
foot holds that would enable a person to climb over it.
(b) The fencing shall be at least 6 feet high and entrances shall be equipped
with self-closing and self -latching gates capable of being locked.
(c) Self-closing and self -latching devices shall be placed at the top of the
gate or -otherwise inaccessible to small children.
(d) The opening between the bottom of the fence and the ground or other
surface small be not more than four inches.
July 31, 1986
Pacific Pool & Patio
Re: 110 - 63 1/2 Way N. E. Page 2
7. An autanatic chlorinator should be provided with a suitable test kit.
8. All electrical and plumbing installations shall be inspected and approved by
_ the City Inspection Department.
9. All overhead electrical lines must be a minimum of 10 feet horizontally from
the pool surface, and 18 feet straight line distance from the waters edge. An
alternative is to bury said lines.
10. 7he pool fill spout must be protected by a vacuum breaker or air -gapped.
11. Suitable safety equipment to include but not limited to a ring buoy and rope
that is 1-1/2 times the pool diameter and shepherds crook pole must be provided
and maintained with the pool at all times.
Furthermore, these and any other requirements must meet the provisions of the
Fridley City Code, Section 115, Swimming Pools. 7he building permit is approved
contingent on final inspections and approval of the City.
If any questions or problems arise from this letter, please feel free to contact
me at 571-3450.
Sincerely,
G. CLARK
Chief Building Official
DGC/mh
CC: Mr. Jim Fish
110 - 63 1/2 Way N. E.
SUBJECT
P
City of Fridley
2036 1
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
1 ,
R
`L __�___ COMMUNITY DEVELOPMENT DIV.
SEC.
( z n
�J J
r � � PROTECTIVE INSPECTION
1 i
CITY HALL FRIDLEV 55432
�"""' �`�
NUMBERREV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/16/90
JOB ADDRESS 110 - 631� Way N.E.
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
2
Eva Erickson River Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James. Fish_ 110 - 631-;,. Way N, E, 571-9477
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.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 161-x 14t Three Season Porch Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan,
WARNING
Before digging call for
all utility locations
454.0002
SEPARATE PERMITS REQUIRED FOR REQUIRED BY LAW
WIRING, HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
S0. 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
$4,900
$2.45
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PL CHECK FEE
TOTALFEE
$74.45
SIGNATURE OF CONTRACTOR OR AUTHORIZEDA T IDATEI
T
WHEN PROPERLYV ID TED THIS IS YOUR PERMI4�zz�
zz
��_I
BLDG INSP D 14E
NATURE OF OWNER tIF OWNER StILOE IDATEi
7 PC
OJJ
W4A.;O F Q*ws#A
><
-A
C 'Mr- R z k
C
-7T
Sk
4D
EWTALnAC;� kJ&t-"—
Co CD'Aj
a P -S
GAX
Ys "IRC41
Iq & A Iq
JAJ C—
Tv
L
A-
-------- ----
n all new Mofs?r tear -offs and
laceilpleirt MumifS,
f 6-
tate COM requi z lay
-
iopped to gethere installed to a point 24 inches
p from exterior tall line, or the use of othW 0 vex //& N
Mb—ft
vmved---u dralayInent W1114"MI
rk
k -Y
tn-U
k U Q�(—g
DOC*J'4e
2.41X le �tpo�,OeA-, r- vtv r1wo
Sk
4D
EWTALnAC;� kJ&t-"—
Co CD'Aj
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Iq & A Iq
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Tv
6 b STATE 21P CODE J
Inspections Contract I bTr
If
l �. A D a y w. g r .7 « ••
o �o t flany,S.' Iohli 1:r
ss 0 eley 7 i
'eq 9"; Pato bene lop►xe.Lt Cott-paeAl toes :• • A % c s 4149. • o U t N
r�4,, AVoL.is so. MIlIA!•6T\
1 �ussoo • soon
HARRY S. JOHNSON
ROBERT 8. MEREDITH
r it 0 N
r
/q'x� f(v
Ld34,- L
Ll
1
;x•;30
ScAL
�i•� l
Lq � i.�y hat t" pt4t. i,a a correct �.�xp sc ctc.Lic�,t o� a 4++.suey oi
• �� r:jc�E2. FUR Fk9CKSON R90£k V jA#r�
NEW [ ] Effective 1/1/90
ADEN R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address: �f cS sa �� lf✓e �' /�
i
Legal Description:
Owner Name & Address: T m ry Z. L f l -f Sig n1 E Tel. #
Contractor: J'ajAj Ef, Tel. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
.S SEASo,v Por,%I nEsTXMON OF IMPROVEN�TP
LTM G AREA: Length Width /!� Height s Sq. Ft. I
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Grp Sq. Ft.
07MM: &qCorner Lot [A Insid � ] `Ft $ d Setback Side Yard Setbacks
Type of Construction: C C)Oo fl it A M Estimated Cost: $
Approx. Completion Date: Y-90CJ
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: APPLSCANT: , Tel. # .3r'71- 9$ 7Z?
CITY USE ONLY
Permit Fee $
State Surcharge $ ,
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Marge $
TOTAL $ q. q.-.)
STIPULATIONS:
�Scr a 0
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
flcea."j
w
4yav
� r 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
RATE SCHEDULE
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
Ali Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
JOB
OWN
Rate TOTAL
$ 30.00 $ 3Q m
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $
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.
$ .50
$�o
lilil
Effective On January 1, 2001
ESTIMATED COST .9LQ� • 00 PERMIT NO. /-00/
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heatingnits Circle One (Steam) (Hot Water) (Warm A
Trade Name ,( ri_k 'Q_V_ _ Size No.
BTU HP EDR --
Fuel Total Connected Load
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
// 1A„ / DATE
HEATING CO
SignedTEL #
Approved By Rough -In Date Final Date Z�
y
BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
.,AMMON VENT, VE;, _';R AND L'Illi®US PION AIR V'"-.- —' CATION
When reA,lacing an axis, 29 f .ince, the -idersigned hereby verifies that the
venting has been examin 3d an s free fror . ust, deterioration, obstructions,
and is securely supporter' and ?stopped, There required. YesA t
The anii.,g system is plp slic/P :� and mei. , all :xrent codes and manufacturer
spec' ",",ons including s Ting, ! :9th, numb it of -;lbcw; and termination. _
The U " i-,csigned also ve hies t> °t the rept: m nt unit is a listed assembly
and n.eet:s the current cc Jes at 'manufac'C specifications. This does
incluc' ;• ACA-GAMA Cat,, gory I )ntral Fur,,.acu Venting Tables for fan
assisi ,�d and natural dra; appli -:es.
r .Isting combustic n air i .sized and ;st ed to meet the current codes
. r� :Manufacturer's spec ;retic
;xr required to install a ney, :ombustic :a wi,'be sized and installed
t , meet the current code : and - .mufacturc.'s sprcific:ations.
Yes 0 No ( )
Yes P )( )
Yes P J( )
Yes P)( )
d'hen installing a now, entin _..wstem, ti ur-Jersi-ned hereby verifies that
is a listed assembly and i mee' '-he currer co(` -3 and manufacturer's
Pecif dations. This doe',, inclu( AGA-GAI SA Category I Central Furnace
I:mtir. Tables for fan a. 3isted , id naturai :Ira: P appli: aces. Yes 1, } ( )
they ,I -mon vent and vent c ,inectors s -,:ed :ynd ir;stalled correctly after
r app�;ance has been rcmove-` ;rom the c Ammon ve:it and vented
,parately as per current code: Yes yQ N ( )
Applianf_e TT and Size, . cr,°-7non Vent and Vent Conn cior Informatio
)pliancv #1 Type � � CTU i:. put 116A y 0 Fan Assisted o"
)plianf ., ##2 Type ETU 1, put Fan Assisted or Nat
)pliance ##3 Type BTU 17 put Fan Assisted or Nat
Tota' Appliances Total Stu, ;gut --4(n. o—c
UOMMoi r Vent Type W -- Hr: ,-Ijht�c M Diameter , inches
Appliam: -;'Al Vent Conn¢ ctor V
ght
Le! gth it Diameter
in Type
Applianr ',�2 Vent Conn,. otor V
ght
t Lei gth _ ft Diameter
in Type !,
AEplianc- 13 Vent Connr ctor i'
ght
t Length ft Diameter
__._,in Type
AL a Eft ° _)MONS: (Descr:.;,a .
FIEATIN 'J'O: _ TnG-
Signed E Date.
City of Fridley Q
6431 University Ave NES 0 I
Fridley MN 55432
(763) 572-3604 or Fax (763) 502-4977
Water and Sewer Permit Application
❑ New Connection []Utility Line Repair/Relocation
❑ Existing ❑Water and Sewer Connection
F
Date:— /
Z/ez-7
Job Address: ho VL
Name of Applicant (Plumber): 6-,,., L✓4 +,-, ��✓
Name of Property Owner: 1?-zn2ja= n a 6^1.e,<—
Existing Structure Permit #
Permit Type: Sewer Fee:
Water Fee: At'
Meter Fee: ,,
Repair Fee: D Od W4L,� 64
Relocation:
State Surcharge: 3`t7
SAC Charge:
Special Assessment Fee:
Total: $ Yo. G 0
Applicant Signature:
Inspector approval:
Pa�,kA -Wt?-O, ax- -
Water Meter Repair – WeekenM Holidays
$125/hour
Water Connections Permit
$50
Sewer Connections Permit
$50
Inspection Fee for Water/Sewer Line Repair
$40
Special Assessments
See Engin erin
Cost of Water Meter
See Utility Billing
SAC Char&e
$1675
State Surcharge
$ .50
Water Tap
See En 'neerin