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City of Fridley, Mian..
BUILDING PERMIT
C -q- 4)(Val
N® '7065
Date:
B
Owner: altdL, Builder A _ ----
Address
Address
l/� O TION PF
BUILDING
No. Street�_F Part of Lot
Lot �__ Block _____ _ — A ._ tion or Sub -Division
Corner Lot _ Imide Lot �� Setback -��� _ Sideyard M A
Sewer Elevation �-3 Femlihdt®n Elevation ?35-' ?5�
T o or- FUa7i.y�
DESCRIPTION OF BUILDING
T Used
Front Depth `I V Height _ Sq. Ft l -G 4 Cu. Ft.��
c:
if
Front Depth Leight Sq. Ft. Cu. Ft.
Type of Construction - 444 a Est. � D 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.
In consideration of the payment of a fee of $ fj permit is hereby granted to
the
to construct the building or addition as described above. This permit is granted upon
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
F
hin the dty limits and this permit may be revoked at any time upon vi9]ation of any of the provisions of said
inances /� w
NOTICE:
Tbb permit does not corer the construction, hntaibtion for wiring, phanbtne, ger heating, cower or water. Be sure to on
the Bulldtng Inspector for separate permlte for than items.
City of Fridley
Application for Plumbing and Gas Fitting Perndt
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
rn
NO. RATE TOTAL
Number Fixtures ......................
x $1.50
$--f"
Future Fixture Opening ................
x 1.20
Y
New Fixture Old Opening ..............
c
Z
g
x 3.25
w
o
a
z
O
•
P
•
N I
WATER HTR.
GAS
ELEG
Base
NO. RATE
9TOTAL
1st 3 Fixtures ..........................
'
-Q
Additional Fixtures ....................
B
$
Gas Range to 200,000 BTU ..............
x 2.00
$
1st
%
2nd
_
3rd
_
4th
• Future Connection Openings
New Fixture, Old Openings
Connected with Sewer �
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ......................
x $1.50
$--f"
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ............................
x 3.25
$
Water Heater (Up to 200,000 BTU)
...... x 2.00
®Q'
$ —R—
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
NO. RATE
9TOTAL
1st 3 Fixtures ..........................
x $1.50
-Q
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE o
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 ag true and correct.
Fridley, Minn.—
iI ���
P
Owner
Kind of Building
Used as
To be completed about
FIA
Estimated Cost, $ la 6a o �®
Ol New Building Permit No / (1�rmit
f> l
ROUGH
FINAL
4 z 2M 7_59
By.
Phone 14
19&Y
(T
City of Fridley, Minn. N' 10752
BUILDING PERMIT
Date: _ July 15, 1970
Owner: Lavern Dornbusch Builder Same
,Address 40 - 64th Way N.E. Address Same
LOCATION OF BUILDING
No. 40 _Street 64th Way N.E. --- Part of Lot
Lot 4 & 5 -_ Block _ _ Addition or Sub•Division . Fri d ey Park✓
Corner Lot — Inside Lot —X Setback — Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front _ 16 Depth __ 24' _ Height _LQ Sq. Ft. 3.84-- Cu. Ft. 3840
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame: Est, cost _ $1400.Dn _ To be completed 7 115 1.71
Provide a hardsurfaced driveway.
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 ah provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $-j. 00 , permit is hereby granted to Lavern E.
DQrnbusch to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construciaton, alteration, maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
NOTICE:
Uls permit does not cover the construction, InslaUaMon for wiring, plumbing, gas heating, sower or water. Be sun to we
the Building Inspector for separate permNa for thus Rena.
9 0
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: 1��' C a'/ . I - A v eN BUILDER:
ADDRESS: --'/0 ,J -19Y ILI F. ADDRESS: Sa.7m E
NO:..- STREET:_ C^ y f/V ttI' , rli.
LOT: - S� BLOCK: /S ADDITION • ✓r K' 1 j7Z t- y 14 R A
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front:° Depth: Height: Q
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: � , Estimated Cost:
To Be Completed: ,Tu L J S
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE:' � �' f S � � SIGNATURE
(See Reverse Side For Additional Information.)
Land Planning ��i �"G�TAi 6875 Nlghway Np.6$ N.E.
Land Surveying • Minneapolis,
Minn.
Soils Tepting �%�Zpi��G�i� rJi✓s Minn. 55431
Civil Engineering Telephone 784-6066
Municipal Engineering Engineers & SUrvey'f re Area Lode -612
Mortgage Loan Survey for � 4 tGRI\l /_ ', , , %
AlAY
i
fix, �F�nn
I c1 M 4(-
I +
0
f cs
IN
.9.5
1
i-0 40
t_
L07-5 '.4- ' 5, BLOCK /5 , F -RI DL Y
,alloK�► cr�uvr°r
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, and all visible encroachments, if any, from or on sold land. This survey is
made only in connection with a mortgage loan now being placed an the property and no liability is assumed
except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is
understood and agreed po monuments have been Placed for the purpose of establishing lot lines or boundary
corners. Dated this day of - %,A1! 1_A. D. 1970.
—r- SUBURBAN 1INGINIMUNG, INC.
L� Engine s Sury
�4 - bye,
c' K/ c. r
SUBJECT
P IT NO.
City of Fridley
® 0120
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIP
L-_ COMMUNITY DEVELOPMENT DIV.���
INSPECTION
r � � PROTECTIVE SEC.
1 . i
CITY HALL FRIDLEY 55432
NUMBERREV.
DATE
PAGE OF
APPROVED BY
612-660-3450
910-F15
JOB ADDRESS
1 LEGALCT
LOT NO.
BLOCK
TRA OR ADDITI N SEE ATTACHED
DESCR.
4 & 5
15
FRIDLEY PARK SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
LAVERN DORMUSHCH 40 - 64TH WAY N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
RESIDENCE
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
RE -ROOF DWELLING
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
SIGNATURE OFCONT TOR OR AUTHORIZED AGENT (DATE)WWHENPRROPERRVVALIDATED
�SIGNATURE
THIS S YOUR PERMIT
INSP DA
OF OWNER IIF OWNER BUILDER) ID TEIBLDG
c' K/ c. r
-APPLICATION FOR RESIDENTIAL,ALTL'RA1'ION,
OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWER' S MID: L A L1c rAJ -00 ,'AJBuS(//BUILDER:
• ADDRESS : 6917-1-1 C✓A y Al, F, ADDRESS:
NO:. o STREET • l� 7` T/� W,9)1 A),
LOT: BLOCK: /S_ ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: _- SIDEYARD:
• I
Applicant attach to this form Txao Certificates.. -if Survey .of L-ot and .proposed • '
building location drawn on these Certificates.
.DESCRIPTION OF BUILDING
To Be Used As:
Front: Depth: Height:
.- Square Feet: Cubic.Feet:
• Front:' Depth: Height:
Square Feet; Cubic Feet':
• ' =V/0, 00
Type of Construction: eE-,eooF VW r1Lrn/L 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.
•
DATE: TUGS 3 / _ SIGNATURE: ae,_e,,, +--�
(See Reverse Side For Additional Information.)'
City of Fridley
SUBJECT
9
931
r-1
AT THE TOP OF THE TWINS
PERMIT
BUILDING
CEIPT
v _����_ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
/j
`� 3a
I � �
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
9/20/78
JOB ADDRESS 40 - 64th Wav E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4-5
15
1 Fridley Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lavern Dornbusch Sae as a560-5729
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
7 CLASS OF WORK
❑ NEW ❑ ADDITION )CI ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Finish basement
9 CHANGE OF USE FROM TO
STIPULATIONS
In bedroom. 5 �
1. Provide escape wi ndVos
�, �Q� �� CPLJG�
2. Mechanical vent if window area is less than 10% of floor.
(3) '--*kIlzo Pea i�x "r—\4L,.%d Guu c rca.,r,C S1��►�`
r ► VL IfIc to L dc" --
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
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$4,000.00
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.
PLAN CHECK FEE
TOTAL FEE
$26.00
GNATURE OF CONTICTOR OR AUTHORIZED AGENT IDATEI
9-20-78
WHEN PROPER VALIDATED THIS IS YOUR PERMIT
9-20-78
BLDG )NSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PE11141TS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: �/y� Pl� Jopdgcjs(�l BUILDER:
Address:*
'10 - Ir? `/ T11 64JAl AIJ-C- Address:
Tel. No.:
No. Street: T'7 (A) ?9 1J -C
•�i�l %� L E / �A
LOT: � BLOCY.: 'ADDITION: ��
CORNER LOT: INSIDE LOT: SETBACK: SIDDYARDS:
Applicant attach 'to this form T<•io Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
�i �✓i S Ji Q �S��Eont: Depth: Height: .
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
• Estimated Cost: $ `7, D D o 0 00
Type of Construction:
To Be Completed: Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEI: REVERSE SIDE OF SHEET)
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 correcct. See reverse side for additional information.
DATE: -a0- 7E, SIGNATURE: -Z�
Stipu ti s: 0 P (16 0% 0 i) OESC C 0-`o S IN C)d j f/J'
/ VJ� q QZlUd �
oI
(C) % o ►�' F�
a6,Od
CITY OF FRIDL EY
APPLICATION FOR PLUMBING AND GAS FITTING PEF44IT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
V)
ro
9,00
o
g
$3.00
m
Future Fixture Opening
Water
y
t�
myy
x
$2.00
$
H
rd
$5.00
$
Water Heater - to 99,000 BTU
c4J
n,
w
100,000 BTU to 199,000 BTU
x
Heater
.�i
N 0
d
A
$7,00
C
New Ground Run Old Building
m
,yp� B
r.
Gl
Spa
.G 9
8 N
Qa,
GAS FITTING FEES:
1a
C
lst 3 fixtures
x
0
0
b
.11
x
$1.00
R
Gas Range to 199,000 BTU
•.a
O
O
+� u`4l
tOrO
of
u�i
'�
oN!
W
U
D
w
W
ai
3
A w°
vii
w
U w
3
Cbl
$
c`�
0Bas
as
lec
P
t
j
/
1st
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
9,00
Number Fixtures
g
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7,00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
lst 3 fixtures
x
$3,00
$
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS $ ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
$
REINSPECTION FEE
($10.00)
Job Address /0 .1117W- T1� W1411
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all +cork in strict accordance with the City Codes
and rulings of the bepartment of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
/ Fridley, Mn. Tp/^/t�Py %% , 197*
OWNER i%U � /P /+� AI RAIt7 tJ S C /y
KIND OF BUILDING W®D%% /C�jjp✓/
USED A5 PLA) F'LL / .✓�
TO BE COMPLETED ABOUT _ TP A/J 0 I y
ESTIMATED COST
OLD )NEW BUILDING PERMIT NO.
ROUGH INSP.
Date
FINAL INSP.
Date
PERMIT NO. rixp
Company r
Signed By R i/-Qyts�
Tel. No. O—.S%.72- fr'
APPROVAL FOR PERMIT r419
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
[�
.__-__'_--_ ��
_-_�
----- ' ) |
| ( �-_J
of Fridley
SUBJECT
o 1547
AT THE TOP OF THE TWINS
BUILDING PERMIT
rpCity
RECEIPT NO.
`y ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
��
r PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/24/79
JOB ADDRESS 40 - 64th_ Way N.E.
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4,5
15
Fridley Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lavern Dornbursh- 40 - 64th Way N.E. 571-3853
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Finish basement and install chimney for free standing fireplace
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, Pi,UMOING MQ
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
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
$2,000
$1.00
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-
$12.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$13.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)WHEN
('�
r PROPER Y VALIDATED THIS IS YOUR PERMIT
SIGNATURE OF OWNER I IF OWNER BUILDER) (DATE)
BLDG IN
• CITY OF FRIDLEY
• APPLICATION FOR RESIDLNTIAL BUILDING PERMITS f
(New, Alterations, Additions, or Repairs) ,
OWNER: EPA/ �� �Pn7 �� S c l-� . BUILDER: - 5.19/j-?&
ADDRESS: L1D — 00 E ADDRESS:
TEL NO: S 71 TEL NO:
-
Construction Location
. - STREET NO: U STREET: (o T� L�J� Y /l% •..<
LOT: BLOCK: l ADDITION: /�2l E P'9 1,C K
Corner Lot: Inside 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
f/nl/ S4 64 SfMIFKgront: Depth: • Height:
Square.Feet: Cubic Feet:
q%Front: Depth: Height:
•
Square - Feet: Cubic Feet:
Type of Construction: Estimated Cost: $ 02, D o o,,,
9b Be Oc)mpleted: / fJ D A) E�/EfI 0 ,C' ole
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET .
The undersigned hereby makes application for a permit for the work -'herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: C/_ - a ?` '75 SIGNATURE:.
Stipulations:
INCIDENT REPORT
FRIDLEY POLICE DEPARTMENT
TH F S
REPORTED BY O I q� 7 y
ISN U0C DISP
ADDRESS PHONE
CFS
INC
ARR
JUV
OFF
PROP
REPLACEMENT VALUE
VALUE OF DAMAGE.
j VALUE RECOVERED.
eo,SUSPECTIS) OR DESCRIPTION TIME OF ARREST
N
2
WITNESSES ADDRESS PHONE DOB
2.
DETAILS OF INCIDENT. ADDITIONAL REPORTS:
DAY
w
DATE REPORTE
�%�
TIME RECEIVED TIME ARRIVED TIM9 COMPLETED
DATE OCCURRED
TIME OCCURRED NRR.
- radio
P - phone
PLACE OF OC URRENC�
RID /
L
A alarm
I in person
NAME O C NICTIM
Y - visual
HOME ADDRESS /
z, �
�D �G
PHONE
M - mail
�)/ ��
5l " � �_ (
T - other
TH F S
REPORTED BY O I q� 7 y
ISN U0C DISP
ADDRESS PHONE
CFS
INC
ARR
JUV
OFF
PROP
REPLACEMENT VALUE
VALUE OF DAMAGE.
j VALUE RECOVERED.
eo,SUSPECTIS) OR DESCRIPTION TIME OF ARREST
N
2
WITNESSES ADDRESS PHONE DOB
2.
DETAILS OF INCIDENT. ADDITIONAL REPORTS:
19
SUBJECT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
22459
i
RECEIPT NO
COMMUNITY DEVELOPMENT DIV.
_
U PROTECTIVE INSPECTION SEC.
r
5 Sd
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
4/28 94
JOB ADDRESS 40 64 Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4,5
15
Fridley Park SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lavern/Betty Dornbusch 40 64 Way NE 571-3853
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
Reroof House & Garage (Tear -off) 21 Squares
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must meet the 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
SQ. 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
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
$1 575
$.79
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-
$37.00
W
Fire SC $1.58
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FAE
$39.37
/ SIGNATURE OF CONTRACTOR OR ORIZED AGENT A (DATE)
WH N P Y VALIDATE THIS IS YO R PERMIT
BLDG IN SATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
19
NEW (( Effective 1/ 1 /94
ADDN CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2d55b
Building Permit Application
Construction Address: ---V0 - `i TN. /0' E- , -- - - - - - --- ---
Legal Description: --- 110-15 -p _ 5(���,��/
Owner Name & Address: )AVER -1- 8,- i TY 3au S'f 4 A-6<1 t Wel. #
Contractor: 6 u3 A) MN LICENSE #
Address: m .E - 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 With gt/Ground Sq. Ft.
OTHER: A -C-
`
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: K ,E -Poor 90 O S.f ,&6 R 06-E Estimated Cost:
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
r 11 Tel. #
DATE: - = APPLICANT:v-�r,L
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ , Ob
Fee Schedule on Reverse Side
$
.001 of Permit Valuation (1/10th%)
$
$.50/$1,000 Valuation
$
$800 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 [ ]
S 393 7
CITY OF FRIDLEY INSPECTION DIV.
Effective On March 1, 1996
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
�'AA�
JOB ADDRESS 4 -/11�� - 1�� Alv�
RATE SCHEDULE
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 -
®'00
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00
$ J7
representations stated In this application are true and correct.
(Side Vent - Fill Out Back)
_-- _ ,1996
Gas Piping (Needed with new furnace) $10.00
$
OWNER
Gas Range - $10.00
$
BUILDING USED AS
Gas Dryer $10.00
$
*Air
i..�N
a4�1ka
ESTIMATED COST PERMIT N0. 4>2
Conditioning - All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water)arm Al
Trade Name Size No. �355'ir� z d
Commercial/Industrial
BTU hQ00D HP EDR
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
.50
Burner Trade Name Size No.
5 TO
BTU HP EDR
TOTAL FEE
HEATING COMPANY BLAINE HTr. A/C & ELECT. INC.
13562 CENTRAL A14E FI.Es
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION ANOKA, MN 55304
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signe y Tel No.d�
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved ByRough-In Date Final Date"/S'
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE R STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
Remarks:
List ALTERATIONS Bein Done:
HEATING CO:
Signed By:
Date:
W.
BLAINE HTG. A/C & ELECT. IN -
13562
13562 CENTRAL AVE. N.E.
ANOKA, MW 55304
CEMWiEY 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 (,�
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:
List ALTERATIONS Bein Done:
HEATING CO:
Signed By:
Date:
W.
BLAINE HTG. A/C & ELECT. IN -
13562
13562 CENTRAL AVE. N.E.
ANOKA, MW 55304
rj
SUBJECT
NO.
City of Fridley
-274 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
10/9/96
10B ADDRESS 40 - 64th Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4, 5
15
Fridley Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Paul & Gudrun Mattson, 40 - 64th Way, Fridley, MN 55432
586-0097
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Paul & Gudrun Mattson (same as above)
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residence
7 CLASS OF WORK
JJ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct deck.
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan VARNING
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 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
$656.00
State SC $.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$26.c50
Fire SC $.65
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$27.65
SIGGN,�ATTURE OF CONTRACTORR-ORR,,AUTHORIZED AGENT
HEN PRAOP/ERLY ALI DATED THIS ISYOUR PERMIT
q /'yIDATEI
Q�P
SIGNATURE OF OWNER IIF OWNER BUIL.ERI IDATEI
BLD INSP
GATE
rj
NEW [ ] Effective 3/1/96
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: yo -- 6 y" W'4 Y
Legal Description: GnT y �tia S, c3G�c�c �S �,e,pc�Y Aka -f -'-
Owner Name & Address: a i, n 1*7 77--So.J Tel. # 5R6 - oo l 7
Contractor:
Address:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length /y Width5 °� Hgt/Ground o g Sq. Ft. `77
OTHER:
Comer Lot (] Inside Lot [ ]
Type of Construction: (e cob
Ft. Yd Setback
Side Yard Setbacks
Estimated Cost: $ j e:�z54� . Ob
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed:
DATE: APPLICANT:
Permit Fee
$ �. SU
Fire Surcharge
$ �o s
State Surcharge
$ , 50
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ .41
STIPULATIONS:
Ft. + 6 Ft = Ft x $
Tel. #
CITY USE ONLY
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
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
rDl
ELAN, FIELD & NOW_AK
SURVEYORS
28Z9 HARRIET AVE.4EN F MINNEAPOLIS, MINNESOTA
CERTIFICATE OF SURVEY
For Z1PCO, INC,
f
...
� A
DESCRIPTIONS
44. 3 �.
5, Block and 4 5
Lots t ,
u Fridley Park.
ij
Scalps I* — 301
r -
i
i
J
We hereby certify that this is a true and correct representation of a survey of
the boundaries of the land above described and of the location ofall building4
if any, thereon, and all visible encroachments, if any, from or on said land.
�„ ..
1964
ry.:G!`�N,_.F i E L D b NOWAK
So
100. h �v 1;
al Apt 0��
Railpost Spacing = 72 in. o.c., Baluster Spacing — 4 in., Toe Spacing = 4 in., Railing Height = 36 in.
Star I: Rise = 6 in., Run = I1 in.
Stair 2: Rise = 6 in., Run =1 I in.
Specification
IS(
r.
dFr
J' r X ` b /l p
* Ask For A Construction Detail Sheet Before You Begin Your Project
ll ovc# SPACING
,1 nv\ S
Y K TO 0A lei
-fe`t�
See the Specification Sheet for More Details
SUBJEeT
PnMIt NO.
City of Fridley
31274
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
i ♦ _____ COMMUNITY DEVELOPMENT DIV.
V
INSPECTION SEC.
� /7-2
r PROTECTIVE
1
NUMBER
REV
DATE
PAGE Of
APPROVED By
CITY HALL FRIDLEY 55432
�.j
612-571-3450
910415
8/2/00
JOB ADDRESS 40 64 Way NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4,5
15
Fridley Park SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
Paul Mattson 40 64 Way NE
586-0097
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Window Lite Home Improvements 8400 89 Ave
N, Brooklyn Park, MN 55445 20039258
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
425-2227
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION? REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Replace 11 windows
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997
Uniform Building Code.
Permit Inspection Cards
Will Be Mailed
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
SQ. 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
$5.40
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$10,800
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-
$195.25
Firo SC $10.80
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOT FEE
Lice C $5.0
$216.45
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATE,
EN PROP V ALID E THIS IS XQUA P MIT
r
S-GNATURE OF OVVNERnF OWNER BUILDER, iDATE,
L IN_ gAif
NEW [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY G
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: n-_L14gA )a -a / c, P(`i a(Lj M—
Legal Description:
Owner Name & Address: AL& (!'1a+(-san �qq-A, LZo-g pf,. Tel. # J-96- DD 9Z
Contractor:() ;�(A) Ll *a & au- O9•Yn �9 r o +� �m�n-F5 MN LICENSE # 0700,3 902 ,P
Address: $��pp - q �'�- ,� /�p . �Br�oK(-, `Pat- mA1,55'W5el. # 5 =baa
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: Q imated Cost: $ Y00, 0 C)
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: �% APPLICANT: am , i A Tel. # 4Z,5-2 2-
Z
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ 195 -"2s -
Park Fee $
Sewer Main Charge $
TOTAL $ 07 . '
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]
STIPULATIONS.
� i.�
CITY OF FRIDLEY BUILDING INSPECTION -SO O'�C Effective 4/1/2004
6431 University Ave NE d ��
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
JOB ADDRESS
Fee Total � � Al
Owner
$35.00 $ Building Used As I el 4 -
$10.00 $ ESTIMATED COST t. �cJ G PERMIT NO
$10.00 $
$10.00 $
*Air Conditioning -AII Sizes $25.00 $
All Other Repairs or Alterations (List on Back)
11/6 of Value of Appliance or Work $
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater on work less than $500.00
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/IndustriaVinstitutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
DESCRIPTION OF FURNACE AND BURNER
# of Heating Un
Trade Name
BTU
Fuel ewe
Burner Trade Name
BTU
_ HP EDR
Total Connected Load
HP
Size No.
EDR
(Warm Air)
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
$
—1r and rulings of the Building Division, and hereby declares that all the facts
d representations stated in this application are true anJd correct.
$ . 50 HEAT G CO
$
-qy _10137'_
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
7402 Washington Avenue
Eden Prairie, MN 55344
941-1044
Tel# ` O9, -d
FAX # Ce ®'� �® Date
�7
/lld--
Approved bbyJ �/J Rough -in Date Final Date
w
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existing furnace, 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 manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new ventina system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () 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 Type and Size/Common Vent and Vent Connector Information
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
®15&, `-!®
HEATING CO:
Signed By:
N c 60 /1.1-Z
Date
Cos-- 006 ,3 0
NEW CITY OF FRIDLEY
p [ ] 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� d-1 61A�� IfA i
Legal Description:
Owner Name & Address: d Tel. # .761 <La
Contractor. 1 Ae MN LICENSE # alb, ,? .5-4 ��
3,-5-1Address: �® 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: & 5 Z ,�2 f Estimated Cost: $ /O, 3 /x , 1:9
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: o' ` APPLICANT: ��/—"1'el. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ q
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 $ STIPULATIONS:
Building
MECHANICAL
Permit No.: ��� - --
Inspections div
RESIDENTIAL APPLICATION
Received By:
7.63-572-3604
CITY OF FRIDLEY
Date Recd: i- -
DATE I - l0' YOUR E-MAILDRESS
SITE ADDRESS 4o I'
THIS APPLICANT IS: 13 OWNER PCO CTOR
PROPERTY
NAME: �PCI-V �G
OWNER/
ADDRESS: O CITY i` r c STATE•MLXIPC
TENANT
PHONE: -1 (-3 - � (o - ®Uq D
CONTRACTOR
COMPANY NAME: CENTERPOINT ENERGY
SUBMIT A COPY OF
CONTACT PERSON: JOANN ZINIMN
YOUR STATE
LICENSE WITH
STATE LICENSE # EXP DATE
ADDRESS: 13562 CENTRAL. AVE HE CITY ANOKA STATE ENZIP 55304
APPLICATIONPHONE
763_757-6202 FAY 763-757-6701
PERMIT TYPE
9
)(SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW XREPLACEMENT ❑ ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK S cxA\ )Lr,
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)14 .2
MFG: C-0- MODEL: aLf K P A 5 SIZEBTU
Equipment Installed
MFG: MODEL: SIZE/BTU T—
MFG: MODEL: SIZEIBTU
FIRLACE (GAS) $15.00 GAS RANGEIOVEN $10.00
1A/C $25.00 —EP
NEW GAS GRILL $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00
-BOILER $35.00 UNIT HTR $10.00
$35.00 _FURNACE —GAS
_CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
VENTILATOR $15.00
DUCT WORK $10.00 GAS PIPING $10.00
mo.. . ,•' R.. 1 '. tlY, ' .t. ".;e... .s 1 i ..ail-, A.}.., �. w
..t
Permit Fee $ Number of fixtures @ $10.00 x $10.00 $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $ 05 , CO
TOTAL DUE $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $ P5 -SO
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLIPRINT NAME ROGER lIOFFHEIN DATE
LAN �
YIVV,1alJ� •.if..":. _ .. _ ....r.w ,...« 1"r.E .-
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
T A tr. •7/'1 Z'fNn AfN"P7
w -
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONSEXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments .
b. Natural Gas or Propane/]FGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346. 0603.2
.a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air, calculations
CenterPoint.
Energy
October 12, 2006
City of Fridley
6431 University Ave NE
Fridley, MN 55432
13562 Central Avenue NE
Anoka, MN 55304
Please cancel the permit and send a refund, if applicable, for the following:
Paul Mattson
40 64th Way NE
Fridley, MN 55432
Permit amount: 25.50 and 20.50
Permit number: 2006-01260 and 2006-01259
The job has been cancelled.
If you have any questions, you may contact me at 763-757-6202.
Thank you,
Katie Schlundt
Administrative Assistant
CenterPoint Energy
13562 Central Ave NE
Anoka, MN 55304
CITY OF FRIDLEY PERMIT NO.: 2006-01260
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 07/10/2006
572-36U4 FAX: (763) 571-1287
REPRINTED ON 10/16/2006
ADDRESS : 40 64 WAY NE
PIN : 153024410024
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : HEATING - FIXTURE BASED
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : AIR CONDITIONING
NOTE: H/O:763-586-0097 CONT: 763-757-6202
INSTALL A/C
CARRIER MODEL: 24APA5 14 SEER 2 TON
# A/C UNITS
APPLICANT
CENTERPOINT ENERGY
13562 CENTRAL AVENUE NE
ANOKA, MN 55303
(763)757-6202
MATTSON PAUL C & GUDRUN
40 64TH WAY NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
1
AIR CONDITIONING FEE 25.00
STATE SURCHARGE, MECH FLAT 0.50
TOTAL 25.50
PAID WITH CHECK # 8109
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY PERMIT NO.: 2006-01259
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 07/10/2006
571-36U4 VAA: ( 763) 571-1Z5_/
REPRINTED ON 10/16/2006
ADDRESS : 40 64 WAY NE
PIN : 153024410024
LEGAL DESC : UNAVAILABLE
LOT BLOCK
PERMIT TYPE ELECTRICAL
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ELEC SERVICES, NEW
NOTE: CALL FOR ROUGH IN AND FINAL INSPECTION
H.O. PHONE #763-586-0097 CONT: 763-757-6202
ELECTRIC PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE
A/C RECONNECT
ENTER ELECTRICAL FEE 20
APPLICANT
CENTERPOINT ENERGY MINNEGASCO
13562 CENTRAL AVE NE
BLAINE, MN 55304-
(763)757-6202
CA01796
OWNER
MATTSON PAUL C & GUDRUN
40 64TH WAY NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date,
ELECTRICAL PERMIT FEE 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 8109
ECOPY
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.