PRE 2010 DOCS0
City of Fridley, Minn.
BUILDING PERMIT
N® 7443
Date: e��Ca�I
r
Owner: ' - a tee✓ elder
Address Address
ION F BU LDING
No. Street.� ey
Part -10 Lo
Lot Block Ad on or Sub -Division
Corner Lot Inside Lot _ Setback , _ Sideyard '
Sewer Elevation e-5 2 • -*9-� _1m9MKonXqy#tion LES
DESCRIPTION OF BUILDING
,
Front Depth �c' �+
U% `
it Depth AA4LWHeight sq. Ft. CU. Ft 49W
y7-ype Of .;7 be Completed
In consideration of the issuance to me of a permit to construct tb buil scHbed ab to do
the proposed work in accordance with the description above set font mpliance �{ pro ons of
ordinances of the city of Fridley. _ o _ � l
In consideration of the payment of a fee of $,j '? .5 ,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 permit may be revoked at any time upon violwt of any of the provisionsof said
ordinances. ��
NOTICE:
Yids perm& doss not cover the constructim, dalagMen for whhm piumbine, pas heating, serer or Wats,. Be ere to as
the BuihBng inspector for separate permit for these &sem.
APPLICATION FOR BUILDING PEPMET
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER
ADDRESS
ADDRESS
LOCATION OF BUILDING
No. Street Fart of Lot��
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION. FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
To be used as:
DESCRIPTION OF BUILDING
Front raapth Height
Sq. Ft. Cu. Ft.
Front Depth
Height
Sq. Ft. Cu. Ft._
Type of Construction Estimated Cost
To be Compietedi
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 S
T
('Schedule of Fee Costs can be found on
Reverse Side).
SUBJECT
PE --
City of Fridley
214 5 7
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
1 ,
T NO.
COMMUNITY DEVELOPMENT DIV.
1 L PROTECTIVE INSPECTION SEC.
!�
r 1 �
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/2 4/92
JOB ADDRESS 49 66th Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
18
4
Edgewater Gardens SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Hollen 49 66th Way NE 574-7415
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Citywide Home Improvement 1005 W Broadway, Mpls 55411 529-2489 3013
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 DA REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (26 Squares) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be 2nd layer but not 3rd.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 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
l
STALLS I 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
$1,378
$.69
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-
$33.00
Fire SC $1.38.
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
License SC $5.00
$40.07
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEIHE
P PE L VA ATED THIS IS YOUR PERMIT
-F2-.
BLDG INSP DATE
S,GNATUREOF OWNER 0F OWNERBUILDERI IDATEI
ADDN [ ]
ALTER [
raffecelve J1142 .
CITY OF PRIDL13Y
SINGIX FAMILY AND DUPLEXES R -I AND R-2
Building Permit Application .S
-q 4k
Construction Address: e 1
Legal Description: Y& T —a2
Owner Name & Address: IL1� "� L('%�. Tel. #..�-2yzf
Contractor:
MN LICENSE # � '1 _3
Address: ., r .. Tel. �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OP IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height . Sq. Ft.
DECK AREA: Length Width Hgt/Cffomd _ Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot I J Ft. Yd Setback Side Yard Setbacks
v
Type of Construction: mated Cost: $_ /
Approx. Completion Date: _
(Cost: on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Pt x $. _ = $_
�Q(
DATE: APPLICANT: �� j _ Tel. # L
L
Permit Fee
$
3J fo
Fire Surcharge
$_-
State Surcharge
$—.,,,,
L2
SAC Charge
$
License Surcharge
$'.
6e)
Driveway Fscrow
$
Park 11"
$
Sewer Main Charge $
TOTAL
. STIFUl.ATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / 10th %)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State 1.1censed Residential Contractors)
Alt_ "A" or Alt. "B" Move
Fee Determined by Engineering
Agreement Necessary I ] Not Nececary i
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADD
a
Effective On January 1, 2001
iA-)14 V jJIF-
RATE SCHEDULE
OWNER ��ere"$
Residential
Rate
TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS
Also Replacement Furnace
$ 30.00
$
C
��y U
(Side Vent - Fill Out Back)
ESTIMATED COST PERMIT N0.
Gas Piping (Needed with new furnace,
$ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Range
Gas Range
$ 10.00
$
J
No. Heating UnitsCircle One (Steam) (Hot Water) (Warm Air)
of .—L
s D
Garyer
$ 10.00
$
Trade Name Size No.
BTU . �'� HP EDR
*Air Conditioning - All Sizes
$ 25.00
$
Fuel ,rr/� Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ .50
$ 21�-' Sb
Burner Trade Name Size No.
BTU HP EDR
eyf
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE 169 _2-Y-0(
HEATING COr� ���Dcr. �sL®��G.►✓�
Signed �� TEL#
HL.Jr'
Approved By "\ Rough -In Date Final Date nfcA'� 01
BACK SIDE MUST 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 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 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
A
CITY OF FRIDLEY INSPECTION DIVISION
6431 UniversityAveNE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Full Out Back)
Gas Piping (Needed with new furnace,
but nor replacement)
Gas Range
Gas Dryer
Effective on January 1, 2000
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Rate Total
$ 30.00 $'
$ 10.00 $
$ 10.00 $
$ 10.00 $
*Air Conditioning -All Sizes $ 25.00 $
All Others/Repairs & Alterations (LIST ON PAGE TWO)
1 % of Value of Appliance of Work $
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTALFEE
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$
$ 3V150
JOBADDRESS
49 66TH WAY NE Fridley MN 55432
OWNER Kermit Hollen
BUILDINGUSEDAS residence
ESTIMATED COST 4500 PERMIT NO. / 4-/
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units 1 Check One: Steam ❑ Hot Water ❑ Warm Air 21
Trade Name Rheem Size No.
BTu 75,000 HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
— rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
.50
Date 01/18/2001
— HEATINGCO MMCA: Bonfe's Heating & Air Servic
SIGNED
TP -L# 6512287
Rough -in Date / Final Date `�J /C�� ✓
FILL OUT PAGE TWO FOR STACKVERIFICATION ON REPLACEMENT FURNACE
A.
COMMON VENT, VENT CONNECTORAND COMBUSTION AIR VERIFICATION
When replacing 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 ❑t/ No ❑
The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing,
length, number of elbows and termination. Yes a 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 Fumace Venting Tables for fan
assisted and natural draft appliances. Yes ❑✓ No ❑
Alterations: (Describe)
<Desc>
HFATINGCO: MMM�CA: Bonfe's Heating & Air Servic
Signed By: _"AW
Date: 01/18/2001
Yes ❑✓
No ❑
The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications.
When required to Install a new combustion air, it will be sized and insalled. To meet the current codes and
Yes ❑✓
No❑
maufactures specifications.
When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the
current codes and manufacture's specifications. This does include AGA-GAMA Category I Central Furnace Venting
Yes ❑✓
No ❑
Tables for fan assisted and natural draft appliances.
Is the coomon vent and vent connectors sized and installed correctly after an appliance has been removed from the
21
coomon vent and vented separately as per current codes.
Yes
No❑
Appliance #1 Type Rheem Furance BTU Input 75,000 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 It Length ft Diameter in Type
Appliance #3 Vent Connector Height It Length ft Diameter in Type
Alterations: (Describe)
<Desc>
HFATINGCO: MMM�CA: Bonfe's Heating & Air Servic
Signed By: _"AW
Date: 01/18/2001
Ira 720 Dubuque Ave., South San Francisco, Ca. 94080 Permit
Government Services: 888-330-1777 Application
8-.4 t 6 ir G IS Fax: 877-846-5888
I Mail
TO: Fridley
Building
6431 University Ave NE
Fridley
MN 55432
Phone: 7635713604
Fax: 7635711287
Permit Handling Instructions
Mail
The approved permit will be mailed to you.
Additional Comments
Contractor Information
Company: MMCA: Bonfe's Heating & Air Servic Worker's Comp Carrier: aaaaa
Address: 505 Randolph Ave. Worker's Comp: 11111 Exp. 01/01/2002
City: St. Paul State Contractor's License: 11111 Exp. 01/01/2002
State / zip: MN 55102 License Class / Type:
Exp.
Phone: 6512287140
Exp.
Fax: 6512810358
Business License #: Exp.
Email: sroft(ftonfes.com
Credit Card Number. Visa: El
Expiration Date: Mastercard: 11
Card Holder Name: Other: E]
Homeowner Name: Homeowner Phone Number:
Project Address: 49 66TH WAY NE Fridley MN 55432
Valuation:
Job Description:
Residential 0 Commercial 0 Paper
rates
Payment: YES Attachments: WC SCL SASE AA 0 CBL CCA E]
Permit Type: Check Agent Authorization: ORGE] NOT. 1:1
On
Permit ID: 7292-9 AA Type:
IC
UiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
October 17, 2001
Mr. Kermit Hollen
49 66 Way NE
Fridley, MN 55432
Re: Final Inspection at 49 66 Way NE
Contractor: Bonfe's Heating & Air Service
Dear Mr. Hollen:
A mechanical permit was issued on January 31, 2001 to install a furnace at your address.
According to section 305 (a) of the 1991 Uniform Mechanical Code, a final inspection shall be
conducted on the mechanical work authorized by this permit. As of this date, no inspection has
been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Mechanical Code. 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 expire the permit and no
further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner —
Aiso Replacement Furnace $ 30.00 $
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00 $
Gas Dryer $ 10.Q0 $
*Air Conditioning — All Sizes $ 25.00 $
All Others/Repairs & Alterations (LIST ON BACK)
I% of Value of Appiiance or Work $
Commercial/Industrial s
1.25% of Value of Appliance or Work $
State Surcharge .50
TOTAL FEE 515
MINIMUM FEE FOR' ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
Effective On August 1, 1995
JOB ADDRESS '
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
OWNER �%✓�✓,'i� �G���� ---
BUILDING USED AS
ESTIMATED COST �� PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units _ Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
FuelTotal Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
Signed By
Approved By
CZIV7��I, 1 1*-1-114�.
, �W/75✓ O°y
igh—In Date Final Date
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
Remarks:
List ALTERATION B ag Done: ,
HEATING CO:
Signed By:
Date:
CHIMNEY 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 Dodged 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 ALTERATION B ag Done: ,
HEATING CO:
Signed By:
Date:
CITY OF FRIQLEY INSPECTION DIV. �� _.. QU J 3 Effective April 1, 2004
6431 Unh-,,aftity Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT j n
(763) 572-3604, FAX (763) 571-1287
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
*41'1 4q 25�6 GJA e
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
JOB ADDRESS
New Fixtures
$10.00
-f °
The undersigned hereby makes application fnr a permit for the work herein
Old Opening, New Fixture t
$10.00
1
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$10.00
and representations stated in this application are true and correct.
Catch Basin
$10.00
/ /� C
""
Rain Water Leader
$10.00
DATE: a3 *C IY , 20 S�
Sump/Receiving Tank
$10.00
Water Treating Appliance
$35.00
OWNER
Water Heater -Electric
$35.00
!�
Water Heater - Gas**
$35.00
BUILDING USED AS L� 9S IDE^/ e C—
Gas Range**
$10.00
Gas Dryer**
$10.00
'#
ESTIMATED COST PERMIT NO.
Back Flow Preventer Required ( )Yes () No
// //
Plrti 2 rp!d 4,M
Type
$15.00
PLUMBING COMPANY
Reinspection Fee $50.00/Hr
SIGNED BY4nTEL N0.«1 ill 755
6f
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
Approved By Rough -In Date Final Date
State Surcharge
$ .50
MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
TOTAL FEE
$_I& - b
OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300
'AUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE
i
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing 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
Appliance #2 Type
specifications including sizing, length, number of elbows and terminatidn.
Yes () No( )
The undersigned also verifies that the replacement unit is a listed assembly
BTU Input
and meets the current codes and manufacturer's specifications. This does
Total Appliances
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes () No( )
Tie existing combustion air is sized and installed to meet the current codes
Appliance #1 Vent Connector Height
and manufacturer's specifications.
Yes () No( )
When required to install a new combustion air, it will be sized and installed
ft Length
to meet the current codes and manufacturer's specifications.
Yes () No ( )
When installing a new venting system, the undersigned hereby verif€es that
ft Diameter in Type
it is a listed assembly and meets the current codes and manufacturer's',
specifications. This does include AGA-GAMA Category I Central Fumice
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 :
NEW [ ]
ADDN []
ALTER [
Construction Address:
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432 (763) 72.34 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (76 3) ,717 Fax
BUILDING PERMIT APPLICATION
moi- 66 -r4 WA %I N, &
Legal Description:
Owner Name & Address: 1<&X141 'T °� 1�%J qo e-,4 Tel. # '763 S 7`f — 74- 5
Contractor: MN LICENSE # 66 - v? 050 984)6
Address: /36 / CR EAK pAAAe- 4.n/ - clg i DL M J Tel. # 76 5 - Z 2G - '78 7 0
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
r
Length Width 8 Height % ' Sq. Ft. '6 1'
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
o®
Construction Type -' -i%+' Estimated Cost:
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
DATE: ' �45 /® 5 APPLICANT: J04 PW® t� °�� Tel. # %6 3 "'' '� ! 7� 7
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.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ 7.7,3)
$ 66
$ 07. S6
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 [ ]
STIPULATIONS:
NEW, [ J CITY OF FRIDLEY Effective 1/1/2003
-ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: Z/ 1114 6b
51
Legal Description: -
Owner Name & Addres^^s__:1�,,2A lYv J-1 Tel. #�(�3' Ste// 7
Contractor: Il l L�� �(�J MN LICENSE #
Address: 5558 A'(� 657- Y3Tel. # 95Z ' 9355' ?&6"?
0+ %5Z ' 9.35' ' 15-W
Attach to this application, a Certificate of Survey of thl b
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: LAngthWidth Hgt/Ground Sq. Ft.
.�� /�
OTHER: Oh.e ( � how
Construction Type:/67�Estimated Cost: $
010
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
�7
DATE: V I ZU APPLICANT:9R('
-VP& Tel. 451 -qJJ --9
Call (763) 572-3604 for Permit Fees if mailing in app kation. Fax to 763-571-1287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
CITY USE ONLY -
TOTAL $ / 49• ar
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,+700 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
Buildin g
BUILDING
Permit No.:'
d .-
Inspections- -
RESIDENTIAL APPLICATION
Received By:
763-5724604
CITY OF FRIDLEY
Date Rec'd:
DATE
U YOUR E -MAI DRESS
C n m
SITE ADDRESS
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: CITY
STATE ZIP
PHONE:
CONTRACTOR
NAME q
SUBMIT A COPY OF
STATE LICENSE # A173 EXP DATE
ATALT07 ATA/T07mW
YOUR STATE LICENSE
ADDRESS: SSSS ZA `/V -
CITY STATE—ZIP
WITH APPLICATION
PHONE 9S2 . 935 • qWe 9 FAX -?SZ • 9.R5. 95-zlq
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
Q ADDITION ❑ GARAGE/SHED
WS
O BASEMENT FINISH ❑ ROOF
DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ W ❑ ADDITION
I>dMANTEIJANCEREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: AP IN
!S O
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq -Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Ahiminum
❑ Trim
I. Site Plan/Survey showing the existing struct m
❑ Other
❑ Fascia
and proposed project
2. Two sets of construction plans
yy"OWS
IN EXISTING OPENINGS Yes
❑No LOCATION OFWS
3. Energy Calculations
OR FOR NEW OPENNGS-DESCRIBE SIZE OF A !
OPENING CHANGES &
IV
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS J
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING -1,010 7O OCCUPANCY .B.0 FEESCHEDULE)
TOTAL JOB VALUATION STYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ 10
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 vavable 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
pennit but only an application for 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 whic equves r w v of plans. �I ' /� I_ ( G% (n
SIGNATURE OF APPLICANT - PRINT NAME_- V /� DATE l `lam