PRE 2010 DOCSI
Village of Fridley, Minn.
SIDING PFJtM"
N° 26'3
Office of INSPECTOR OF BUHMINGS
s
Architect
P Fridley, Minn., 18.E
Builder
a
OC TION OF I UILDING
No.
Street Part of Lot
Lot
it
Block Ad tion or Sub -D on
i
DESCRIPTION OF BUILDING
1i�IiI �
Front Depth Height Stories Manner of Construction--
onstruction
To
To be used
!i To be comple ed F1- t !' Estimate cj Cost / rte€
ox
I
Permit is hereby
ted to to
7
the buildln
escri in the above statement. This permit is granted
upon the express co
'dition that the person tJ whom it is granteand his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, 3 regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limit
, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Easpector of Buildings.
I'
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of. Fridley of
the above permit; I hereby agree to do the proposed work in accordance with the description
above set forth;" according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby tate and say that the facts stated by me and contained in the above permit are
true as therein stated..
Subscribed and'Isworn to before me at Fridley, Minnesota!; th' V
day --r o �,� . t- � 1— .D. 19 s
N° 2
Village of Eri.dley,11' m.
BUILDING PERXrF
Office of INSPECTOR OF BUiiLBMNGS
19---.D
Fridley, Fridley, Minn.
LOCATION nOF BUILDING
���� ,�
�_ a street Part of Lot
Block Addition or sub -Division
OF BUILDING
Front Depth ^'- Height stories / Manner of Construction
ar,t i Estima ed Cost
To be used as �';a� To be completed - �,
Permit is hereby gaIlted to—L'
y
the building �� `„' ` * described in the above statement. This permit is granted
upon the express c clition that, the ierson to Ivhom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Man., regarding the 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.
V- !— inspector of Buildings.
In consider
the above perr
above set forty
sworn, I herebi
true as therein
Subscribed
AGREEMENT AND SWORN STATEMENT
>n of the issue and delivery to me by the Inspector of Buildings of -Fridley of
I hereby agree to do the proposed work in accordance with the description
d according to the provisions of the ordinances of Fridley, and, being first duly
ate and say that the facts stated by me and contained in the above permit are
sworn to before me at Fridley,
day of A.D. 19
I
�I
II
I'
it
II
Minnesota, ,:th a
is
Application for Power Plants and Healing. Coding, Ventilation, -Reh igeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace 6.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam_ ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $ C
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE c
ROUGH
—
A
f INAL
Dept. of Bldgs. Phone SII, 4-7470
Location 43 ye " to ��r� , au, Z). 60°
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, Aunn
Owner
Kind of Building ,
Used as
To be completed about
Estimated Cost, $
Old' New. Building Permit No. Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. E.D.R. BTU H.P.
Total Connected Load Ila �� Kind of Fuel
BURNER — Trade Name . '!� Size No-
Capacity,
o Capacity X5 b Cri5'20 Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Sign CC��
By
4 z 2M 7.59 Business Phone No- v'
STATE OF MINNESOTA DEPARTMENT OF {HEALTH
ABANDONED WELL RECORD
I. �� 1�L1 MINNESOTA UNIQUE WELL N0. 1
(leave blank if not known)
County Rama Anoka
Township Rases
Tmmship RurNRange
Number
Soction No.
Fraction
4. WELL DEPTH (completed)
Date sealed
Brian Peterson
N
H
Al bof %
313 Plastic 60 Stainless Steei
in. to ft.
HARDNESS OF
3. FORMATION LOS COLOR FORMATION FROM TO
Fridley
30
21'
13
h''W "E
84 +t•
9/20/89
s
W
® Open tote from ft. to ® ft.
Numerical Street Address and City of Well Location or Distance from Road
S. DRILLING !METHOD (if known)
Intersection
0 Cable tool 40 Reverse 7® Driven 1613 On
1340 64th Ave. NE
a® Rai law Rod go Air C Bared 110
30 Rotary 60 Jetted U Pmmr Auger
11. WELLHEAD COMPLETION
1® Pitless Adapter 40 Found Buried
Show exact location of well
(in section grid with °K°) Sketch map of well location
6. OBSTRUCTIONS
M oL,p UAM L
Well obstructod ® Too ® Ifo
W
MEN=
7® Air Conditioning 11I
2. PROPERTY OWNER'S NAME
®®M
S. CASING(S)
property address indicated above
10 Black 40 Tkroaded 7[3
Brian Peterson
6200 Dupont Ave. N.
%GRIT. 13Welded
Brooklyn Center, IN.
313 Plastic 60 Stainless Steei
in. to ft.
HARDNESS OF
3. FORMATION LOS COLOR FORMATION FROM TO
Obstructions removed ® Yes ® No If obstructions cannot be
® removed. contact KOH
E A kefaro $asling.
IPJ1. USE T �. 1 Domestic 413 Monitoring I0 Heat Loop
I 213 Irrigation 50 Public go Industry
1 30 Test Well 60 lumicipal IC Commercial
a� L wi�=��
7® Air Conditioning 11I
2. PROPERTY OWNER'S NAME
Mailing Address if different than
S. CASING(S)
property address indicated above
10 Black 40 Tkroaded 7[3
Brian Peterson
6200 Dupont Ave. N.
%GRIT. 13Welded
Brooklyn Center, IN.
313 Plastic 60 Stainless Steei
in. to ft.
HARDNESS OF
3. FORMATION LOS COLOR FORMATION FROM TO
If not known. indicate formation
log from new well or nearby rail.
in. to ft.
2. SCREEN
® Screened wall from ® ft. to ft.
(If known)
® Open tote from ft. to ® ft.
10. STATIC WATER LEVEL
ft. ® below ❑ above
land surface Date Measured
11. WELLHEAD COMPLETION
1® Pitless Adapter 40 Found Buried
Basement offset e0
Wali Pit
16. REMARKS. ELEVATION. SOURCE OF
DATA - CASINGS REMOVED. CASINGS PERFORATED. ETC.
12. GROUTING INFORMATION
Neat Cement 20 Bentonite 30
2" well, 84 ft.
la" from house
•
deep
Grout meterialP,mt.]and1romQ—to-Uft. cu. yea
_ 2, -bags
13. MEANEST SOURCES OF CONTAMINATION
feet direction type
Well disinfected before staling? ® Yes
14. PUMP I rRemoved ® Not Present
Type: 1Q Submersible 30 L.S. Turbine 0 Reciprocating
Jet 40 Centrifugal 6J3
-
15. EXISTING WELLS (Please sketch locations of abandoned and
active wells in remarks sect on or an back.)
Other unused wells) on property? ® Yes JKNo
Abandoned: [❑ Permanent [3 Temporary ® Rot sealed
17. WATER WELL CONTRACTORS CERTIFICATION
This well was sealed under my jurisdiction and this report
is true to the best of my knowledge and belief.
LicenWe ,rasa Mame License No
Inc.02484
Addrssa l r
Signal Date 9/20/89
Oats
Now of Driller
OFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer)
ZNPURT.1Wp'!a PZ219 WXW J»
MINIMUM FEE FOR ANY HEATING/COOU-NGIVENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00 1
*Air Conditioners can not be placed in a side yard without
whaen permission from adjoining property owner.
HEATING COMPANY M0459 #ez4'''' j * A tz
Signed By cP *� Tel No. 536.-0667
Approved BYaLZ Rough -in Date Final Date .121.-
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
-7to3?
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1,199y
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 �!31-/0-
ICRATE
RATESCHEDULE
The undersigned hereby makes application for a permit for the 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 Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 20.00
$ �
representations stated In this application are true and correct.
(Side Vent - Fill Out Back)
/ a
Gas Piping (Needed with new furnace) $10.00
$
S A A gw nJ Q A /" rSEy
OWNER
Gas Range $10.00
$
BUILDING USED AS
Gas Dryer $10.00
$
ESTIMATED COST & Y600, CSU PERMIT NO.
*Air Conditioning - All Sizes $10.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
%
Units Circle One Water) arm Ai
1% of Value of Appliance or Work J)�
$ a 0
No. of Heating (Steam) (Hot
Trade Name Size No. -5 FIs t1?Q6011Y'
Commercial/Industrial
BTU & d> ® HP EDR
I% of Value of Appliance or Work
$
Fuel IV A% Total Connected Load
State Surcharge
.60
Bumer Trade Name Size No.
BTU HP EDR
TOTAL FEE
q5 5-0
MINIMUM FEE FOR ANY HEATING/COOU-NGIVENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00 1
*Air Conditioners can not be placed in a side yard without
whaen permission from adjoining property owner.
HEATING COMPANY M0459 #ez4'''' j * A tz
Signed By cP *� Tel No. 536.-0667
Approved BYaLZ Rough -in Date Final Date .121.-
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
CHIMM _MM AN. ► STACK i. Y__ : M..:..YM
The ►► ► vied hereby verifiesthat ►i existing ► iui
1.
Has been carefully examined
Yes (,No
( )
2.
Is free from rust or deterioration
Yes (4No
( )
3.
Has no foreign objects lodged within
Yes( -�'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 �-
7. Has a liner been provided for water heater Yes ( ) No (�}
8. Has combustion air been provided for water heater Yes ( ) No (-�-
Remarks: w /L �✓�/.'r�/iZ� ,s PIOC
all
List ALTERATIONSftfg
HEATING CO:
Signed By:
Date:
5r9,5-
HOUSE UZATING TEST ttt:coRn
ADDRGS_ !,3 YO T i4Vf- APT. FLOOR _ CtTy _SUBURB_"
OCCUPANT <A iJ Q�Av�S 4- OWNER '
HEAT LOSS DATE I1TC. INST.
SOLI) By. at STALLED IIY_____G — --
4bcCC:lca-l. Mork BY, Cas Linc By __ •'
UNIT 11TR.• OTHER
TYPE OF IIL•'AT: GA Fr �lII1� STF.1�J•t S�'�ICT± IITR. ..._.�� .
•
CAS Dtszcrr Cownslox•
14AKL' OF. BURNER
5Tm uP0(oy t1, q. Modcl
Max. BTU Ratin .
INPUT�O�.00(� tllli.L Or FU RCE .
Noacl r• -
C011TROLS
THERrlu:,i.� �i7_Ileat P1uR Vent Size 7 I V c
valva KIND OF L::14r tSIZE NONE
Limit —1*1e •-,a ,sem Draft Hood Rcrulator
Limit Sctting /7t� Filters; Siee I �O I Number•% _
Fan Setting' SO Ssx- Chimney Location: 'Inzidc Outside
Pilot Type 'k-15--TCiii=cy Construction,
Pilot Make* 4-
Pilot Model Smoka Bomb Wirinf,
Yllo t iimin(I -� Draf t Test Tar
L.W. Cut Off Door Preasure LiEhting Inst.__,
Pressure a. 5 percent co • 1-1 Date Tea tcd -
Input CFtt t QI o o Pcrccnt 0Z _ Company Tcatinr
2
Stack Temp.- Pcrccnt CO !e Name of Tcs ter o _ •
ri
SUBJECT
RMIT NO.
of Fridley
� � �
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
If?City
�
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/24/96
JOB ADDRESS 1340 64 Avenue NE
I LEGAL
LOT NO.BLOCK
TRACTOR ADDITION
SEE ATTACHED
DEscR.
Pt 15,16
2
Spring Valley Addition
I
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ramsey 1340 64 Avenue NE
574-4465
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Ricks Roofing & Siding 77 2 St SE, New Brighton MN
633-6395
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 a
❑ NEW ❑ ADDITION El ALTERATION x REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (14 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
1
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE DCO ECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINA S GOVERNING T S TYP OF WORK WILL BE COMPLIED
$1,155
$.58
WITH WHETR SPECIFIED HEREI OR THE GRANTING OF A PERMIT
DOES NOT RE UME TO GIVE THO Y TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PRO OF ANY OTHER 5 TE LOCAL LAW REGULATING CON-
$40.25
Fire SC $1.15
CTOR THE PERFOR CE ONSTRUCTION
PLAN CHECK FEE
TOT FEE
Li ens SC
$5 0
$46.98
OOF //I NA7
E PROP
VALIDAT D THIS IS YPUR PERMIT 00/
iGNATU E OF OWNER OF OWNER BUILDERi iDATEi
WDG 1N5
70
9AT
ri
zl tl i/
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: �® (o t-% �� tkE r Z C
Legal Description: g P �' (�A t Gwl"� A4.5' bS"16
Effective 3/1/96
F-,?, -6l�
Owner Name & Address: atn S v Tel. # S-- %
Contractor: I S� / MN LICENSE #
Address: 77 a7� d S/ 5i-- Rk1!c ka= Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: /1 7 Estimated Cost: $ v / / 5 ;
Approx. Completion Date:
(Cost on Back) f
Driveway Curb Cut Width Needed: Ft. + 6 Fte= Ft x $ _ $
DATE: - 9�APPLICANT: �Ud� Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$900 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 [ ]
SUBJECT
P
City of Fridley
2 5 38 6
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
' ,
I
RECEIPT
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
i
NUMBER
REV
DATEPAGE
8/19/97
OF
APPROVED 8V
= CITY HALL FRIDLEY 55432
612-571-3450
910415
JOB ADDRESS 1340 64 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Pt 15,16
2
Spring Valle
Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Sharon Ramsey 1340 64 Avenue NE
574-9332
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Murphy Bros 1613 93 Ln NE, Blaine MN
55449 780-3262 3416
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 C ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 27' x 12' Addition to House
9 CHANGE OF USE FROM
TO
STIPULATIONS See notations on plan.
oftsm
WARNING
Before digging call for
all utility locations
454.0002
REQUIRED BY LAW
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
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
$17,798
$8.90
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-
$262.25
Fire SC $17.80
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$293.95
TURE (:)FQ0jTRACTOR OR AUTHORIZED AGENT $DA EI
EN PROPERLY ALIDATED THIS IS YOUR PERMIT
��;e a
$NSP GATE
_
SIGNATURE OF OWNER OF OWNER BUILDER$ IDATEI IBLDG
NEW
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AN R>2
BUILDING PERMIT APPLICATION
N
ConstructionAddress:
Legal Description: i 0 F /S (/� r G2)�',�l '21 cS � o k-)��
Owner Name & Address:Tel # 74 -S37
Contractor:/( Ups MN LICENSE # --Sr$
Address: _ ) I 9-1kb Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWPROVEMENT
LIVING AREA: Length � ;_ Width 2,7_ Height I STeW-Y Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.�'�0 7�
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type:— Tim s' Estimated Cost: $
(Wee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ftx $ _ $
DATE: -4-9-7 APPLICANT: 1b Tel.
�62' Z5- CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge ��, $ J147acr .001 of Permit Valuation (1/10th%)
State Surcharge X,10 $__,&:r $.50/$1,000 Valuation
SAC Charge $ /� $950 per SAC Unit
License Surcharge
Driveway Escrow $ .
Erosion Control $
Park Fee $
Sewer Main Charge $
STIPULATIONS
$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 [ ]
v !n"Iraces Monument.
Description:
The Fast 114.00' of Lot 15 and
the East 114.00' of Lot 16 -
Block 2 - Spring Valley Addition
Fridley, Minnesota
/ Ftr'C:I�TFRF.D LAND SURVF.l
Actual Foundation
Location
AV E.
N. E.
116
/3
14
64
o
/ Ftr'C:I�TFRF.D LAND SURVF.l
Actual Foundation
Location
AV E.
N. E.
116
/3
14
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Rath Wash Eink .. ;Floor Ouch Auto.
Urinal Tub ,; Shower Sink Tray Fouhi Drain Baan Washer
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 7.00 7 0�
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas**
$10.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance 70, D V
State Surcharge .50
TOTAL FEE $$"U
JOB ADDRESS_
Effective On January 1, 1997
Gas Mise Water Heater
Range Fust,..... ; Gas E I eec
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 Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Building Used As
3 1997
S"7y- 9 3 2Z
Estimated Cost _ 7 S PERMIT NO.
PLUMBING COMPANY�iif
SIGNED BY ��G?' �G'L �/ TEL N0.
Approved By Rough—In Date Final Date
MINIMUM FEE F R ANY PLUMBING GAS PERMIT IS $20.00
PLUS THE'$.SO STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.
U
SUBJECTW
N -a-
city of Fridley
3 9 7 6
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r?
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1
1
NUMBERREV
DATE
PAGE OF
APPROV BY
i -�-1 - CITY HALL FRIDLEY 55432
763-571-3450
910-F15
10/16/03
JOB ADDRESS 1340 64 Avenue NE
1 LEGAL
LOT NO.
I
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
rt 15,16
Z
Spring Valley Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Sharyn Ramsey 1340 64 Avenue NE
763-574-9322
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Sussel Corp 654 Transfer Rd, St Paul,
MN 55114 651-645-0331 1934
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 0 ADDITION 0 ALTERATION 0 REPAIR O MOVE 0 REMOVE
8 DESCRIBE WORK
Construct a 22' x 20' Garage; Remove existing 20' x 14' Single Garage
9 CHANGE OF USE FROM
TO
STIPULATIONS
010011111
See notations on pian. Provide
a hard surface driveway.
Before digging call t0�
all utility locations
4540002
F0) BY LAW
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 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
@@
@@
$7.00
WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT
$14,000
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-
Fire SC $14.00
CONSTRUCTION
$237.25
yx:aT-
LAN CHECK FEE
TOTAL FEE
�// ®
Li nsk SC $5.00
1 $263.25
SIGNATURE OF CON7AAC0 AUTHORIZED AGENT IDATEI
EN PR P RLY VALIDATED THIS IS YOPF PE MIT
$�GNA LURE OF OWNER SIC OWNER BUIIDERI (DATE.
G INS fI �E
U
NEW CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax �(
BUILDING PERMIT APPLICATION
Construction Address: ),:?��i U�
Legal Description:
Owner Name & Address:
Tel. # "'% e 3 , :G7'10- � 9 3-'Z
Contractor. MN LICENSE #
Address: (,2 S 91.0.5-2 09 � �7- Q�v�� ms`s 1 I � Tel. # z.5! X03.3 1
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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 Sq. Ft.
Length Z. Z Width Height I I Sq. Ft. 4<16
c �-
47�8f��D
Construction Type: Estimated Cost: $ i -4 ,mxnb
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: CL ),®3 APPLICANT: Tel.
Call (763) 572-3604 for Permit Fees if mailing in applicatio / ax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ 7 ��
$ ab
$
$ r
TOTAL $ ,'G 3 - Z
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [
• #3650
--® Ms. Sharyn Ramsey
iffe! INS 5% 1340 64th Ave. NE
AM Fridley, MN 55432
654TRANSFER ROAD, suITE 1s13 H763-574-9322
ST. PAUL, UIN 55114
Permit b 4 4 20x22 Det. Allbilt W/Conc.
Legal Description 9/24/03 Dennis Jamot
Lot: 03
Blk
Add'n
vaiuR Builders License 97 934
Type Const.._.
SLAB:
ZBY SUSSEL
❑ BY Owner Approx.-
01n
pprox. ❑In
2 -STARTING POINTS ONLY _ _ . ... _
dE:
4E:
—SIZE
-- _
x
ONE ROW BLOCK 4 SIDES
� lo cks• y Sussel
❑Wtr.proof: ❑By Own. ❑By Sus
❑Backfill: ❑By Own. ❑BY Sussel
n `
„ X
OVERHEAD DOOR M.0.16'3"
Maintains' total Wall Height
OR
SERVICE DOOR M O 41"
Including Blocks
❑ Maintain B' all Height on
Top of Blocks
Block Size flop course) -
--
Q B �'6 0 4_
Wall Height other than 8'x_ _
e
❑
C
Ia
11 ACCESS
❑ Good ❑ Fair ❑ Poor
MIn/N 1 A OC r3 'C IIII 1r AI C -
DIRECTION
SUS SEL G GE S
�12
ROOF: ( ABLE REVERSE GABLE HIP
EAVE OVERHANG:
d
RAKE OVERHANG: +-
SEAL DOWN SHINGLES WITH PLYWOOD OR
WAFERBOARD ROOF SHEATHING AND 15 LB. FELT.
Roof Sheathing
Seal Down Shingles
\ / Ice and Water Protection
Trim
Manufactured Trusses 2" x 4" Dbt rrlple _► 1" x 4"
Top Plate Sub Fascia
NOTE: Fascia
Soffit
1) Roof approved by Minnesota State Buliding Dept. as meeting Minnesota State
Code Requirements of 40# snow load. 3/4" Cove
ons ra es ,
ru
RAFTERS: Trusses @ 24" O.C. 2" x 4" Studs
STUDS: 2" x 4" 16" O.C.
�j I U 4—Siding
WALL SHEATHING: j
SIDING: v' +V -..j ✓
OVERHEAD DOOR HEADER: Double Tx 12' or 2 - Micro Lams x
a
2"x 4" studs
2"x6"
Treated Bottom Plate
Sill Sealer 1 n
1 Row 6" Concrete Blocks
1/2" x 7" Anchor Bolt
W/140 -8w `1113
Tb slab
2" x 4" Treated Bottom Plate
SLAB: NOMINAL 4" RE .INFORCED CONCRETE °f Above Grade
_. _._._._._.._. _._._._._._._._._._._._._._._._._._ .................... j
811 I Grade
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