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PRE 2010 DOCS• City of Fridley, Minn. BUILDING PERMIT Date: June 2s 1965 � G>?,P5e,-S N° '7683 Owner: Robert OLee Buildpr sitssel Co Address 495 66Ave. Address 1850 Como Aye. ft - Paul - LOCATION OF BUILDING 495 66th. Avenue N. E. No. street Part of Lot Lot _ Block Addition or Sub -Division Corner Lot Inside Lot Setback Sideyard Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost $975.00 _ To be completed •New Garage n �J Dett• Gar. 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 aft provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $'� , permit is hereby granted to Sussel CO. 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 wo ithi the city limits and this permit may be revoked at any time upon violation of any of the provisions of said Men Jensen Building Inspector NOTICE: This permit does not cover the conrtrucdon, Installation for wiring, piing, gas hating, sewer or water. Be run to ea the Building Wpeeter for apnaM permits for these Nems. APPLICATION FOR BUILDING PERMT CITY OF FRIDLEY, MINNESOTA OWNER'S NAND®Ate e BUILDER ADDRESS_ 1/9a`-- 64, '. L' A e ADDRESS %j.§,e Co A-pq u IV& e LOCATION OF BUILDING No*Street Part of Lotr LOT BLOCK ADDITION OR SUBDIVISION Corner Lot. Inslde-LOT Setback .%de -Yard SEWEI ELEVATION :; t: FOUNDATION ELEVATION 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; ©e1.1114 Front /6 Depth0 .3 --Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost L775 ,To be completedo The undersigned hereby makes application fora 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. f:. OATE,t. f ��a.,�—�. SIGNATURE ,,¢SLAV (Schedule of Fee Costs.:can be found on the Reverse Side). M LOT NAME SIZE +k ZZr BLOCK ADDRESS VALUE - - " ADD'N. AREA TYPE j"1� h t-LlOLE. F FMk\MF- . SEE OwluE2 t"o2 EX4GT L.OGd.TI O�.i ® 5gua.ma W rH Hoose ® em le c tc. eon E N/Ere. ea 2 c F,, %- / Q .SEE_ OWuErt Please advise the sto—cumer bore starting the job of the approximate amount of extra fill and extra concrete and get the OK to go ahead. Whenthejob is completed, notify the owner and also Marilee of the exact amount of extras used. o►VtE514 Co Ili atJtr 22 0 SUBJECT City of Fridley 16 5.8 4 AT THE TOP OF THE TWINS BUILDING PERMIT i � ECEIPT NO. ' COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. '-•-1 CITY HALLFRIDLEY 55432 ,�� NUMBER REV. DATE PAGE OF APPROVED BY -•--11.� 612-571-3450 910-F15 5/17/82 JOB ADDRESS 495 66th Ave. N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 1 2 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Rodney Middlestedt 495 66th Ave. N.E. Fridley 55432 571-4253 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Covert Construction 1276 W. County Rd. B Roseville 55113 631-0189 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 IV ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 20' X 28' sseoond story addtion. 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. good Frame 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 $10.15 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $20,300.00 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- STRUCTIO THE PERFORMANCE OF CONSTRUCTION. $146.50 cam® PLAN CHECK FEE TAL FEE / % $3 .6 $193.28 WHEN ROPER kY V LI A OUR PERMIT SGNATURE OF CONTRACTOR OR AUTHORIZED ENT (DATE) MTI SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) BLDG INSP nA7E CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PEFU41TS (New, Alterations, Additions, or Repairs) �,.ir OWNER: gd.PA�:C/=7<f;3 /t/S ADDRESS: Al2�L 6 6 7'2�U�i ADDRESS: Ca ;TP "Ef" TEL NO: S-7/ TEL NO: Construction Location STREET NO: STREET: 6�C- LOT: . BLOCK: .2. ADDITION: ! 7/772TW C,!t� Corner Lot: j/ 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 /VP _ � Front: o�Q' Depth: ° Height: la Square Feet: Cubic Feet: Front: Depth: Height: Square -Feet.- Cubic Feet: 5740K o •out � a®� J Type of Construction: 4b Be Cbripleted: 3 10aA/ % f J Estimated Cost: A , QO Alt. A Alt. 8 Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET The undersigned hereby makes application for a permit for the herein specified, agreeing to co.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. a— DATE: A)WY/�; ���..� SIGNATURE: Stipulations: p I q4 .,5b PC 36,t La i i Ur 1'r�iL r'y APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION. REFRIGERATION AND S� AIR 1 CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE $ $10.00 ' GRAVITY WARN! AIR: RATE TOTAL Job Address ZI?5 to (t � �,�' /`E• C Furnace Shell & Duct Work $12.00 7.00 $ $ ' Replace—nt of Furnace Repairs & Alterations -up to $500.00 7.00 $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STFAI�f OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 1990999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: The undersigned hereby makes application for a permit for the work herein $12.00 -$ specified agreeing to do all work in strict accordance with the City Codes 4.00 S and rulings of the Department of Buildings, and hereby declares that all the 7.00 $T facts and representations stated in this application are true and correct. 7.00 $ yL 4.00 $ Fridley, Minn. OWNER $'12.00 $ 4.00 S� 7.00 $ 6.00 $ $10.00 $ 10.00 $ $10.00 $_/D aj 1st 3 Fixtures x $ 3.00 Additional Fixtures X $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS State Surcharge TOTAL FEE ROUGH INSP. Date FINAL INSP. 7 -- 7— Date Date APPROVAL FOR PERMIT REINSPECTION FEE (.810.00) MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE KIND OF USED AS TO BE CO ESTIMATED COST �a OLD BUILDING PERMIT NO. PERMIT NO. 8" 2 DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air-- lav/�l N'do./ Trade Name Size No. V II CapacityWo,_ Sq. Ft. EDR BTU HP Total Connected Load 3,�� �i Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company c Signed By / Tel. No. -22;7- /363 0 CITY OF _ FRIDLEY APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND STACK VERIFICATION THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM. LOCATION 1195"' 6/� Al 9 . DATE OWNER ` ADDRESS C The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined �"� 2. Is free from rust or deterioration c, 3. No foreign objects are lodged within 4. That it is securely supported c/ 5. That it meets all current Code requirements for size and total BTU connected 6. Total Heating BTU Zo® 0-0 All Other BTU TOTAL REMARKS SIGNED Licensee by Address —Q 6s0 64,kz . gaoa OLV Telephone -a?7- /363 HEATING PERMIT # Fridley City License # CITY OF FRIDLEY APPLICATION FOR PLUNBING AND GAS FITTING PEFMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture orAppliance Reinspection Fee $ ($1S. DO) RATE $ 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 7.00 $ 5.00 $ 10.00 $ 10.00 State Surcharge TOTAL FEE TOTAL S $ /0- .50 0- .50 s /-00 &azective Aug. 1, 19bi Job Address / v Department of Buildings City of Fridley Tel. 9571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 19� OWNER _ l� U i S A! / Q� ;�/�%/ 4 5 141L�� RIND OF BUILDING USED ASo TO BE COMPLETED ABOUT H 6 - ESTIMATED -ESTIMATED COST J D 0 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company / Signed By Tel. No. 571- 9/293 ROUGH /2S3 ROUGH INSP. Date FINAL INSP. a% lzl—e� ' Date APPROVAL/ FOR PERMIT ,�-t yo MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE M a A A m a C -[+ M oo 10 m w�� eu 3 c� w m e' Water Heater 1ec lat 2nd ' r 3rd 4th (R) - Future Connection Opening (*) - New Fixture, Old Opening Connected with Sewer Water RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture orAppliance Reinspection Fee $ ($1S. DO) RATE $ 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 7.00 $ 5.00 $ 10.00 $ 10.00 State Surcharge TOTAL FEE TOTAL S $ /0- .50 0- .50 s /-00 &azective Aug. 1, 19bi Job Address / v Department of Buildings City of Fridley Tel. 9571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 19� OWNER _ l� U i S A! / Q� ;�/�%/ 4 5 141L�� RIND OF BUILDING USED ASo TO BE COMPLETED ABOUT H 6 - ESTIMATED -ESTIMATED COST J D 0 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company / Signed By Tel. No. 571- 9/293 ROUGH /2S3 ROUGH INSP. Date FINAL INSP. a% lzl—e� ' Date APPROVAL/ FOR PERMIT ,�-t yo MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE SUBJECT AMIT NO. City of Fridley G 18705 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RE COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. I�a1 1 i i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j 612-571-3450 910-F15 10/16/86 JOB ADDRESS 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. rL i . SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE q z 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. tr i J-) C-v`. 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE T. OCCUP CY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZO ING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION w OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT V 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 I. 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 4 NATURE OF CONTRACTOR OR ALFTHORIZED.A ENT f (DATE) W EN PRO EA A D ED THIS IS YOUR PERMIT StGNATUR OF OWNER IIF OWNER BUILDER' IDATEI DG 'NSP gaTE 4-4 -, 7 . - • e__rTr- i � �-+-� y -'T!' -7-'!-•i - --�-}���-�--1 �t � - _-"'Y'E`T_-.- �1�..—� -77-7,41 -- �r. ±_"r _'_-!- _`-_ '1_ - � T_ �S i. .-_..-{-+- t -r- $_TIS t- + t-•1 r :tel _.Y-1-i--t''j -• ' _y_ -� a.e +• - "� _•_-_'---r , t- -yM� ��} ^'-t i _._._._ . -1-'- y-�-i--1-� +- -:--•. .ice �.r•PsexP aaR•-~+-.-.�_�} .-i. } _._. _-♦--?-���_» -i ;--1-.; .i , 1 _ — mss.:.} _ _ -, _. _ ........ � y - rt - -' � .- . _« .:-�- +' __.� � �: •-'- - 1 �. « �' 1 { 1 _.ter' ,t--._ '•f-"_� _.ry,-. i r- I ! 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ILM.-:�J � '-�Tya 1 1 1 ♦ 1 1 L ♦ �-1-. _ I I ' _ __ _-....r_�._._� P ' I--1�-•-t�.�_ - .� r-- -' �^ '+-T--•-++STT'{- ' �.-._ ♦ L. a..� - «-L 1 , I I � � I I ,T- t•- . NEW [ ] ADDh . [ ] ALTER. ( ] Construction Address: Legal Description City of Fridley rR-1 AND R-2 Building Permit Application `N Effective 4/1/61 Owner Npme i Address: D �"� � o Tel. �� 7-eContractor: S 2 Tel. i Address: Attach to this application, a Certificate of Survey of the lot, With the proposed construction drawn on it to scale. DESCRIPTIOR OF 114PROVEMEh'T LIVING AREA- Length Width Height _.�_ Sq. Ft. #W'0A/0 N it � _ Sq. Ft. GARAGE ASA: Length Width DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd. Setback Side Yard Setback Estimated Cost: 1 � Alt. A Alt P Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: U APPLICAFT: Tel. # CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 3 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Residential APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer ik *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effective On March 1, 1996 JOB ADDRESS ��� /v /ZJ c -- Nom/ State Surcharge TOTAL FEE F? 50 $ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. No. of Heating nits Circle One (Steam) (Hot Water) (Warm Air) Trade Name `r/rn r1 /L 4— Size No. BTU.24-gyn_ HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDP Heating and Air Condifionie,n 4854 Central Ave. i`,°L HEATING CO ANY ColuynLia [J1,i.- ,k s 72)572-0459 Signed By L Tel No. Approved By FILL OUT BACK SIDE REPLACEMENT FURL Rough -In Date STACK VERIFICATION ON Final Date 29- The undersigned hereby makes application for a permit for the work herein Rate TOTAL 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 $ 30.00 $ representations stated in this application are true and correct. �- ,1996 -> $ 10.00 $ rYI % / d ' � OWNER / C 6 i/ -S $ 10.00 $ _1*1C1g�f BUILDING USED AS 74%,v✓., $ 10.00 $ ESTIMATED COST �o�®� PERMIT NO. )rZ2 1 $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER State Surcharge TOTAL FEE F? 50 $ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. No. of Heating nits Circle One (Steam) (Hot Water) (Warm Air) Trade Name `r/rn r1 /L 4— Size No. BTU.24-gyn_ HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDP Heating and Air Condifionie,n 4854 Central Ave. i`,°L HEATING CO ANY ColuynLia [J1,i.- ,k s 72)572-0459 Signed By L Tel No. Approved By FILL OUT BACK SIDE REPLACEMENT FURL Rough -In Date STACK VERIFICATION ON Final Date 29- Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHDdNEY 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 Being Done: HEATING CO: Signed By: Date: SUBJECT City of Fridley (�P2 6 41 1 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPq NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. NUMBER REV DATE 6/29/98 PAGE OF APPROVED BY 0-1 CITY HALL FRIDLEY 55432 I.J 612-571-3450 910-F15 JOB ADDRESS 495 66th Avenue 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP Rod Middlestedt, 495 66th Avenue, Fridley 55432 571-4253 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. ffl#q'f/9V9/cy /1f9fgff/#48' OWNER 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 (tear -off) 24 Squares 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must meet 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 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 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 $29001'60 $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- @ $74.75 Fire SC $2.00 OR THE PERFORMANCE 4F CONST CTION. PLAN CHECK FEE Licen $5 0 M2.75 L FEE �' " �U,s/�=Lwoffi� - �' SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATEI EN R BL INSP V VALI T HIS IS YOUR PER BATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY. OF FRIDLEY ALTER [ ] SINGLE FAMELY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: � T ��- re D `/ 61 �(-� AL Legal Description: p Owner Name & Address: �Q fl Tel. # �7�— �a 3 Contractor: P R e �` r P e ,� a� Al MN LICENSE # Address:. Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEWNT LIVING AREA: Length �j Width Height 2 - Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: �i�M1 - 0 �f - jz'60-F Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: - a 9- la - APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ ZY� Fee Schedule on Reverse Side ';'J3 $ 200 .001 of Permit Valuation (1/10th%) $ / • O o $.50/$1,000 Valuation / $ $1000 per SAC Unit `' G $ $5.00 (State Licensed Residential Contractors) $ S : Oo Alt. "A" or Alt. 'B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ J $ 2, '7 5� ?`1 a,� Building BUILDING Permit NO.' Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: -1 DATE ��-i�1� 't--��'��:Z�'-" YOUR E-MAIL ADDRESS SITEADDRESS c THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY OWNER/ NAME: TENANT \ ADDRESS: CITY - \ G STATEt�UP-55�A,'j� PHONE: 'Nvs.5 )— CONTRACTOR N STATE LICENSE # DATE\^ \ ®� SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS :®\p U�� S CITY '„�\STA,�\1ZIP WITH APPLICATION PHONEFAX 'J PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE 0 ADDITION 0 GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK WIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: 0 NEW ❑ ADDITION ANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE0 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2• Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: IDING FOR NEW CONSTRUCTION INCLUDING DECKS, `♦�VirryI ❑Soffit ADDITIONS. & PORCHES SUBMIT: ' Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed protect 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS []Yes❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING TOTAL JOB VALUATION S'3 0 997W. 1 U�.B•C FEE SCHEDULE) TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: City of Fridley Attach 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. i SIGNATURE OF APP CANT 0\ RINT NAME��Pe �{� �'r DATE '� S