PRE 2010 DOCSI
* City oFridley, F , Minn 0
BUILDING PERMIT N° 4029
Date. _2 (9 ...... ...... . ......... ...................
Jl.. _......------
Owner: - ..aC......_.__------ ......_.................... Builder .... ... .......-...._..._....................................... ........... _........__
Address.............. .... ......... _.._................. _......... ............. ._... --- ... _................ Address........-............._............._............._.............._......_......._......._.._..._......._......._._...
LOCATION OF BUILDING
No. .......... Street ............... .._.............. Part of Lot ......
Lot....................................... Block ..... ........ ..... -................................ Addition or Sub -Division ....._ .............................
Corner Lot .................................... Inside Lot ....................................... Setback ............................................. Sideyard
Sewer Elevation ................................... .............. -.............. ...................................... Foundation Elevation ..................
DESCRIPTION OF BUILDING
�Tyo be Used as: ��//' �/�°
Fronto-._ ~Depth RQ:!7 Height t4.7' Sq. Ft. 7-------P�--.A Cu. Ft. .1.._..1........�®
............................................................ Front ........................ Depth ...................._.. Height ........................ Sq. Ft. ..... _................. Cu. Ft......_............._..
Type of Construction...................._............................... Est. Cost... 1-3.Q.10 ...... .: � 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. A
In consideration of the payment of a fee of $..."/ permit is hereby granted to .....................................................
....._.............................................................. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. I�—
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
4
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK — `
Number, Kind and Location of Fixtures I'O�O� •
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ......................
x $1.50
$
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
Z
Z
�_
i„
O
J
W
=�
l7
?
w
Water Heater (Up to 200,000 BTU) ......
N
WATER HTR.
GAS
ELEG
'^
3.25
j
m
VI
3
LL
LL O
U
3
U� G
U
O
Base
1st
2nd
_
3rd
_
4th
• Future Connection Openings
Connected withI Sewer �
New .Fixture, Old Openings
Cesspool E]
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ......................
x $1.50
$
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
$
New Ground Run Old Bldg . ............
__ x
3.25
$ \d,
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
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 co t.
Fridley, .Minn
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old——Building Permit No Permit No. �!
/ 6
Signed/
�`L
By
Business Phone No
ROUGH
FINAL
Description ............
....................................
TOTAL FEE • '�- as 2M 7.s9
V
SUBJECT
PERrii30-1�8
City of Fridley
AT THE TOP OF THE TWINS
PERMIT®
r
BUILDING
RECEIPT NO.
`______ COMMUNITY DEVELOPMENT DIV.
L
l�
%C/
r PROTECTIVE INSPECTION SEC.
((lJ (p
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-560-3450
910-F15
6-13-75
JOB ADDRESS
502 - 66TH AVENUE N.E., FRIDLEY, MINNESOTA
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
4
RIS CREEK TERRACE PLAT
2 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
JEROME M. KLEES, 502 - 66TH AVENUE N.E., FRIDLEY MINNESOTA
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 j] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
row-STRUCT STORAGE SHED
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.
Mon
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
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERM T FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
A
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
EN V LI TED THS IS YOUR PERMIT
BLDG INSP
ERPROPERLY
E
SIGNATURE OF OWNER IIF OW U DERI (DATE)
V
-APPLICATION FOR RESIDL'NTIAL., ALTERATION,
OR ADDITION -BUILDING PERMIT
CITY OF-FRIDLEY, MINNESOTA
OWNER ° S WUME.: � UILDER
ADDRESS:,¢�,�ADDRESS :
NO:. 5 STREET:
LOT: BLOCK: ADDITION:
CORNER LOT: V INSIDE LOT: SETBACK:
IDEYARD• '
Applicant attach to this form. n -yo Certificates of Survey of Lotand propose'
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: Depth: Ion T Height: � �T•
Square Feet: Lo Cubic.Feet• -7 0
Front: Depth: sleight:
.Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $ 2
To Be Completed: Z5
The undersigned hereby makes applicatian 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:
6 3 - 7 SIGNATURE: i
(See Reverse Side For Additional Infion.)'
4-V
sue.IEcr
PE N0.
City of Fridley
® 1451'7
AT THE TOP) OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
`L ____�_� COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 �
i /•••1 CITY HALL FRIDLEY 55432
�•-••'�'� <J
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
812-580-3450
910-F15
12/6/77
JOB ADDRESS 502 - 66th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
4
Rice Creek Terrace Plat 2 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Kle' th Avenue N.E.
3 C TRACTOR NIL ADDRESS ZIP PHONE LICENSE NO.
Oak-Vik Construction 7891 Firwood Way N.E 571-5779
4 RCHITECT OR DESIGNER AIL ADDRESS / ZIP PHONE LICENSE NO.
5 ENGINEERL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING y%
Residential
7 CLASS OF WORK
❑ NEW E� ADDITIO ❑ ALKATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 14' x 24' Addition to. Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS Provide truss design by December 15, 1977. Provide floor plans
and scale elevations and section through by December 15, 1977.
- ..�VARNIG
S RAIT PERMITS REQUIRED OR WIRI Before digging call Ioca1 Ufiilifi�gs
HEATING, PLUMBING AND SIGNS. TELEPHONE -- ELECTRIC - GAS Ete'.
REQUIRED ®E/LAW"'
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
336
6720
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.
$5.15
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$10,300
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 OE PERFORMANCE OF CONSTRUCTION.
$26.88
PLAN CHECK FEE
TOTALFEE
W.,E±w �0! P/',
6.728
$38.75
'BMNATURE OF CONTR R AUTHORIZED AGENT (DATE)
WHEN PROPE LY VALIDATED THIS IS YOUR PERMIT
/C:?I 40 -
BLDG. INSP DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
• CITY OF FRIDLEY
' APPLICATION FOR RESIllENTIAL IIUILDING PERMITS
I rv' (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
`OWNER: BUILDER:
• Address: Address:
Tel. No.: �/ - 2
No.: Street: ( � (��. A) (—C
LOT: Cp BLOCK: ADDITION:
CORNER LOT: _ ' INSIDE IAT: SETBACK: SIDEYARDS:
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:
"USE- flo 13AJ -Front: �'� Depth: a'� � Height: .20 ,
Square Feet: Cubic Feet: _6 74 0
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: Estimated Cost: $
To Be Completed: 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
at'declares
that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: J - % SIGNATURE:V4
Stipulations:
#00,101A- 7t2g 61 P
.�, :jP-P,Ji v6- F "'tX f 0+F1
30,
C2G � 88
3
4 �
ENERGY CONSERVATION SUPPLEMENT TO BUILDING PERMIT APPLICATION
PLANNING AND INSPECTION DEPARTMENT
CITY OF FRIDLEY, MINNESOTA
This supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE
AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING
OFFICIAL can determine that submitted plans comply with the ENERGY CONSERVATION
DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S
responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA
in the plans; submit product specifications, if needed to support the "R" and."U"
factors used; and to assure construction is per approved plans.
JOB LOCATION:
OWNER/CONTRACTOR:
ADDRESS: �f��"� �+���i� PHONE:��
A. Determine the Total Exposed Wall Area as follows:
1. Total wall window area
2. Total door area
3. Total sliding glass door area
4. Total fireplace wall area
S. Total wall framing area(average 100)
6. Total net wall area above floor(average 90%)
7. Total rim joist area
Subtotal: Total exposed wall area above floor
8. Total foundation window area
9. Total net foundation area above grade
Subtotal: Total exposed foundation area
GRAND TOTAL EXPOSED WALL AREA
r
rl
B. Multiply the GRAND TOTAL EXPOSED WALL AREA X .17 = Item I
C. Determine the Total Exposed Roof/Ceiling Area as follows:
10. Total skylight area
11. Total roof/ceiling framing area (10%)
12. Total net insulated roof/ceiling area
GRAND TOTAL EXPOSED ROOF/CEILING AREA
D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 =
•
E�. Determine the "U"
value of
each segment
(1-9) and multiply by the area as
follows:
1. _
X
stuff
2.
X
"U"
_
3.
4. J�2
X
X
"U"
fluff
_
5. ��
X
stuff
6.
7. ��—
X
X
nun
"u"
8.
X
"U"
9. S/
X
"U"
_
ADD 1-9 FOR TOTAL WALL SEGMENTS
F.
ITEM III ��-
Determine the "U" value of each segment (10-12) and multiply by the area as
follows:
10. X "U" _
11. X "U" _
12. X "U" _
ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS =
ITEM IV
G. If Item III is the same as, or less than Item I, you have met the intent
of State Building Code 6006 (c) 2.
H. If Item IV is the same as, or less than Item II, you.have met the intent
of State Building Code 6006 (c) 1.
I. Add Item I + Item II =
J. Add Item III + Item IV =
K. If the sum of Items III and IV are less than.Items I and II, you have met the
intent of the Code for Notal envelope system.
The undersigned, as applicant for a building permit, hereby affirms the above
information has been prepared and submitted by himself or under his direction,
hereby acknowledges the information to be correct and accurate; and hereby
presents the information with required plans' in support of the building permit
application.
By: DATE: 1'1.
1��
/6
0
slG�.
t'v
GENERAL CONTRACTORS
- CARROL L-OAKVUC __ --- - - -- - ,_,_. - _ _ _. COMMERCIAL • RESIDi6NTI"
2
Cy vato40
li
m'
..?,K I iIc"'og
moi' -
CeNp
s/44
a
1%
ch..
04121"s
City of Fridley
146SUBJECTPERMI
38
AT THE TOP OF THE TWINS
PERMIT
BUILDING
RECEIPT NO
• COMMUNITY DEVELOPMENT DIV.
------.
r � � PROTECTIVE INSPECTION SEC.
y
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
812-580-3450
910-F15
4/17/78
JOB ADDRESS 502 - 66th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
6
4
Rice Creek Terrace Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jerry Kleis 502 - 66th Avenue N.E.
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
John J. Scanlon 487 Mount Curve Blvd.
698-7297
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 CR ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Complete construction of addition and reroof entire dwelling
9 CHANGE OF USE FROM TO
-STIPULATIONS
Schedule meeting with inspector on job site before continuing with work.
SE-PERATE , PERMITS REQUIRED FOR WIRING,
MEATINGo PLUMBING AND SIGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
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
$6,000
$3.00
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.
$36.00
PLAN CHECK FEE
TOTAL FEE
F
$39.00
SIGNATUREOF 6ONTFMCTOR OR AUTHORIZED AGENT IDA
PRO RRLY VALIDATED THIS IS YOUR PERMIT
••HEN
BLDG INSP
DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE)
° CITY OF FRI DLEY -
° APPLICATIO d FOR RLSI;ai rdtlAi_ PUI(_DING PERMITS
�I'uLl1, ALTERAi I viJs> ADUI T I OI,S, OR REPAIRS)
01r11I1ER: � •C rlS '-S�r-5;"y
Address: foe � 6' �Iv� � � Addre_"' : Gf � 7 / � !'vim BLv AO
Tel. No.:
No. Street:
LOT: BLOCK: L�_ ADDITION: f►��'� C ����'c T�'RRAI� P��
COMER LOT: (,/ INSIDE LOT: SET13ACK: SIDI:YARDS:
Applicant- attach 'to this form qN o Certificate`of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
rotiST�uCT�ver� vG /4K2�
Front: Depth:
Square Feet: Cubic Feet:
Height:
Front: Depth: Height:
Square Peet: Cubic Feet:
Type of Construction: Estimated Cost: $
To Be Completed: Alt, A Alt. B
ado
Proposed Driveway 11idth If New Opening Is Desired 0%
(SEE REVERSE SIDE OF SHEET)
The undersimled 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 licreby
declares that all the facts and representations stated in 'this application
are true and correct. See reverse side for additional information.
DATE: �j! /// / �` SIGNATvi'.F.:
Stipulations:
670oL�, ,�
SUBJECT
1YERMIT NO
City of Fridley2
_.-
5 4 9 8
AT THE TOP OF THE TWINS
BUILDING
PERMII(�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV./
PROTECTIVE INSPECTION SEC.
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L J` 612-571-3450
910-F15
9/12/97
JOB ADDRESS 502 66 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
6
4
Rice Creek Terrace Plat
2 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jacqueline Frogh 502 66 Avenue NE
571-7782
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO,
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace windows
9 CHANGE OF USE FROM TO
STIPULATIONS
Smoke detectors to be installed to meet the State Building Code.
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
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
@@
$•50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
`P1,000
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-
75
Fre SC $1.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$34 •
PLAN CHECK FE
TO AL FEE
$36.25
IGNATURE OF CONTRACTOR OR A THORIZE GENT IDATEI
EN R P
VALID T TFj1S IS OUR PER
O
@LD INSv
r
4ATE
iGNATU E OF OWNER OF OWNER BUILD I (DATE)
NEW
ADDN
ALTER
ConstructionAddress:
Legal Description:
Owner Name & Addr,
Contractor:
Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
lIZ
Effective 1/1/97
"
Tel. # —57/— 7 zE2_
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 Width Hgt/Ground Sq. Ft.
OTHER: '
Construction Type:
Driveway Curb Cut .Width Needed: Ft. + 6 Ft =
Estimated Cost: $
(Fee Schedule on Back)
_Ft x $ _ $
DATE: 111 7 APPLICANT: Tel. # -5-7/- % 7,F-2—
CITY
,'-2—
CITY USE ONLY
Permit Fee
$y
Fee Schedule on Reverse Side
` 4/a /3&7L- 7w
Fire Surcharge
$ /
.001 of Permit Valuation (1/10th%)
�f
State Surcharge
$
$.50/$1,000 Valuation
i SCJ��icG
SAC e Char
g
'..;cense
$
$950 per SAC Unit
Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
-$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
;ewer Main Charge
$
Agreement Necessary [ ] Not Necessary
( ]
TOTAL
$ , Z
xil'ULATIONS:
SUBJECT
P
City of Fridley
31380
AT THE TOP OF THE TWINS
B I I I L D I A I %�' D C R
A A
t
v ' v V r C
'v,
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
1 � � PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/11/00
JOB ADDRESS 502 66 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
4
Rice Creek Terrace Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jackie Frogh 502 66 Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Richard Hastings Contractor 6331 Riverview Ter NE, Fridley,
MN 55432 4051
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO
574-9966
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION I j REPAIR
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House & Garage (21 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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 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 xx
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
$2,147
$1.07
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
$83.25
Fi SC $2.15
%
PLAN CHECK FEE
TO FEE
d 4= -TCC e�
Licens $5.091/91.47
SIGNATURE OF CONTRACTOR O UTHORIZED AGENT OATE-EN
ROP VALIDATED
HIS IS UR PE MMIIjT(�
- BL 'Ih$D
FiAtE
S,GNATURE OF OWNEAtIF OWNER BUILOE RI IDATEI
exp,H 3/3,?0'
NEW [ ] Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: So z 4 6 :rA ,
Legal Description:
Owner Name & Address:-a-AcC'i—om �" lZ v� Tel. #
Contractor: Z, C-44,12. ID 4A S 1tr t.F 6 5 MN LICENSE # YQ S1
Address: 633 I 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. FL
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �/ S
Construction Type: ]-,'A Z BFF z;(?f ?--oo F Estimated Cost: $ ?I'7 2
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: 9111 20 0 APPLICANT: Tel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing In application
Permit Fee $ i �r Fee Schedule on Reverse Side
Fire Surcharge $ /S� .001 of Permit Valuation (1/10th%)
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$ /-O% $.50/$1,000 Valuation
$1100 per SAC Unit
$ D� $5.00 (State Licensed Residential Contractors)
"A" or Alt. "B" Above
$450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$
CITY OF FRIDLEY�INSPECTION DIVISION I D 116[0 D )ar
6431 University Ave NE
Fridley, MN 55432- APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement furnace
(Side Vent - Fill: Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/Alit CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE; SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners cannot be placed in a side yard without
written permission from adjoining property owner.
TOTAL
JOB A
Cl'i'p
Effective On January 1, 2001
jj�
BUILDING USED AS IX'S t cv("ii —
ESTIMATED COST �l PERMIT.NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warn--Pdr)
Trade Name Size No. -:Z, �'Sy
BTU HP EDR
Fuel `c r Notal Connected Load
Burner trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and corr ct.
DATE 0
STANDARD HEATING & AIR CONDITIONING GO.
HEATING CO 410 WEST LAKE STREET
MINNEAPOLIS, MN bMUU-2998
Signe 612-824- #
Approved By Rough -In Date Final Dat , (�
c
BACK SIDE MUS1, BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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 plastid/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 existing 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 venting 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
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date
GAS WORK ORDER�,�b., .;�
1082 Payne Ave. STANDARD 410 W. Lake St.
St. Paul, MN 55101 Minneapolis, MN 55408
651/772-2449 b H EAT I N 09 612/824-2656
& AIR CONDITIONING
A Blue Doe Service Co. EQUIPMENT INFORMATION
LAST � /- FIRST C o
ADDRESS 'Q -�— 44 -0% z -
CITY �'� �a le 4� ZIP 5-s--/?, Z -
HM PH WK PH
TECH & DATE / 16 -c.:,/
TYPE
4 6t7
MAKE
METERED INPU�_ao Cfh CHIMNEY TYPE
MODEL
LIMIT SETTING /�0;6 ° FLUE SIZE C, �- in.
SERIAL
7
INPUT
�° 0TOTAL CHIMNEY INPUT 14O btuh
17
ORSAT TEST RECORD
CO2 6, %
METERED INPU�_ao Cfh CHIMNEY TYPE
02 %
LIMIT SETTING /�0;6 ° FLUE SIZE C, �- in.
CO %
PILOT OUTAGE sec CONNECTOR SIZE a' in.
NET STACK TEMP
�° 0TOTAL CHIMNEY INPUT 14O btuh
f
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
March 14, 2003
Ms. Jacquie Frogh
502 66 Avenue NE
Fridley, MN 55432
Re: Final Inspection at 502 66 Avenue NE
Contractor: Standard Heating & Air Conditioning Co
Dear Ms. Frogh:
A mechanical permit was issued on October 18, 2001 to install a furnace at your address.
According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on
the work authorized by this permit. As of this date the inspection has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh