PRE 2010 DOCSCity of Fridley, Blinn.
BUILDING PERMIT
Date:
Owner: ' _ Builder.
Address Address
e-,4i
TI�V OFF-�NG
No. _� ,,,, Street � � -6 _ Part t
Lot +.__ Block Addition or Sub -Division
Corner Lot _ Inside Lot _ SetbackSideyard
----
+�
Sewer Elevation ...... Foundation Elevation
DESCRIPTION OF BUILDING
To WUsed
•�. i :/. c Front `-" Depth Height lC r _ Sq. Ft. Cu. Ft.
t Depth Height
� Sq. Ft. Cu. Ft.
Type of Construction`; � , �' � Est. ,-_ —r 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 $ , 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
�n� city limits and this permit may be revoked at any time upon violatAon of any of the provisions of said
- -'
' ` Building Inspector
s �[. g
a
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for thews homy
APPLICATION FOR BUILDING PERMIT
CJTY OF FRIDLEY, M7[N WOTA
Owner' 9 Name /f%�i'�2�✓ Builder _ L�� %�2G"J
Address J f�L�� L Address /�2
LOCATION OF BUILDING
No. Street_, Part of Lot
Lot Block Addition or Subdivisio
Corner Lot Inside Lot j / Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front ,� Depth Height �-
Sq. Ft. � Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
_ems
Type of Constructions-- Estimated CostO-V
To be Completed • A
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinpres, and ruling of
the Department of Buildi�ng�s, and hereby declares that all the ets and representations
stated in -this applicat- n are true and correct.
DABS ` SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
A
City of Fridley, Minn.
BUILDING PERMIT
Date: June 7,* 1965
W? '7'763
Owner: AUan Peterson Builder Rand Builder's
Address 565 67th Avenue N. E. Address 5243, 6th Stiml N, rho
LOCATION OF BUILDING
No. 565 Street 67th Ayemm N. E. Part of Lot
Lot 9 _ Block 1 Addition or Sub -Division Rice Creek Terrace, Plate 4
Corner Lot — Inside Lot Setback Sideyard
Sewer Elevation
To be Used as:
Type of Construction
Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft.
Front Depth Height Sq. Ft.
Est. cost . _ 81.5..__ To be completed
• Storm damage repair
•
Ca. Ft.
Cu. Ft.
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 ail provisions of
ordinances of the city of Fridley.
�1�...4.
In consideration of the payment of a fee of permit is hereby granted to Rand Builde= I
to construct the building or addition as described above. This permit is granted upoa,
the express condition that the person to whom it 3s granted asci his agents, employees and worlmnen, ffi all work
done in, around and upon said building, or any part thereof, shall coffiorm is all respects to the ordinances of
Fridley, Mizmesota location, construction, alteration, maintenance, repair and moving of buildings
wiordtinan city ]units and permit may be revoked at antiy time upon violation of any of the provisions of said
Allen Jensen Building Iw4pectov
NOTICE:
Ub pent dos not corer the construction, hahDadon for wirieg, phimbing, gas hee8ng, ower w wdw. Be sun to me
the BWMIng Impator for aparah pwmhs for thea Umm
APPLICATION FOR BUILDING PERMIT
CITY ' OF FRIDLEY, mnmsOTA
I
ADDRESS_��� " Ca `� "� ADDRESS
..t
LOCATION OF BUILDING
No. Street Part of Lot
LOT BLOCK ADDITION OR SUBDIVISION& (2tCX7_-eAAo
Corner Lot Inside LOT Setback Side -Yard
SE6JER ELEVATION 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:
Front Depth Height,
S%. Ft. Cu. Ft.
Front Depth ,Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost �I o m ° 44_�_4.
To be completed
The undersigned hereby makes application for 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 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
CITY OF FRIDLEY INSPECTION DIVISION
e� Qj� act U ' So�
J
\ �'A'Qj S ,� Effective On January 1, 1999
-6431 University Ave NE
Fridley, MN 55432 APPUCA71ON FOR POWER PLANTS
AND HEATING, COOLING, VENTILATION,
572-3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
(1 f n
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the wo herein
Residential
Rate TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner —
®
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
$ 30.00 $
representations stated in this application are true and correct.
(Side Vent —Fill Out Back)
b bb
,19
Gas Piping (Needed with new furnace,
$10.00 $ 1 .
but not replacement)
OWNER 1f Y) P
Gas Range
$10.00 $
BUILDING USED AS
Gas Dryer
$10.00 $
/
ESTIMATED COST ���y �� PERMITNO.
*Air Conditioning — All Sizes
$ 25.00 OS
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 Air)
Trade Name Size No.
Commercial/Industrial
BTU �, �, i� _ HP EDR
1.250/a of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
TOTAL FEE
$ .50
$US S v
MINIMUM FEE FOR ANY HEATING/COOUNG/VENTILATION
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.
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY KpENDA&E MOOR AIR QUALITY, INO,
1108. 543!�
Signed ByM., MTel No .
L\ c�-
Approved By Rough—In Date Final Dat
CEaM NEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack
L 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 Q) No ( )
6 Has total heating BTU's of 0�90
All other BTU's
TOTAL BTU's i 12 , S Oo
7. Has a liner been provided for water heater Yes (A No ( )
8. Has combustion air been provided for water heater Yes ()6) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
f
GNOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
October 17, 2001
Mr. Jeff Palmer
565 67 Avenue NE
Fridley, MN 55432
Re: Final Inspection at 565 67 Avenue NE
Contractor: Dependable Indoor Air Quality Inc.
Dear Mr. Palmer:
A mechanical permit was issued on June 3, 1999 to install a furnace and air conditioner 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.
Building
DJ/mh
City of Fridley
SUBJECT
P
2 9477
AT THE TOP OF THE TWINS
?
BUILDING
PERMIT
r
I
RECEIPT N O.
COMMUNITY DEVELOPMENT DIV.
: SEC.
DA
r � PROTECTIVE INSPECTION
I 1 �
I �•__1 CITY HALL FRIDLEY 55432
ti_._.11: '•�
(/r`
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
90415
1A 5/17/991
1
JOB ADDRESS 565 67th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
g
1
Rice Creek Terrace Plat 4
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Jeff Palmer
HWUR 323-3019
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Ace RRRfjggxA Const. 6017 167th Ave NW Ramsey MN 55303
20001884 88888889
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
S ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION 0 ALTERATION REPAIR
0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof house and garage (26 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OF CONST
OCCUPANCY GROUP
OCCUPANCYLOAD
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
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
$2228
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
Fire SC. $2.23
PLAN CHECK FEE
TOTAL FEE
c e SC $5.00
$91.59
SIGNATURE OFCONTRACTOR ORAUT14ORIZEDAGENT IDA Tt,
M p ERLY VA (DATED THIS I YOUR PERMIT
-
S.GNATURE
s
OF OWNERJF OWNER BUILDER. IDATEI
BLDG (NSP
GATE
NEW[ ] Effective 5/10/99 /1
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 5 �,�C UC- J\J, f _
Legal Description:
Owner Name &Address: Tel. #
Contractor: 4u L�� �fvGT��ia MN LICEN #
Address: b b 11 l ���- q "c 1U v ) W� �_ 55 Tel. #
Attach to this application, a Certificate of Survey of the — -- - --
'a lot, with the proposed construction drawn on it to scale. �� OC
a
c(� DESCRIPTION OF IMPROVEMENT 2, J
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 =
DATE:
APPLICANT:
Estimated Cost: $�6 Ido„ 4--
�.0070 8
_Ft x $ _ $
Tel. #
TOTAL
STIPULATIONS:
$ qi.6 '
CITY USE ONLY
Permit Fee
$ ��, o'?
Fee Schedule on Reverse Side
Fire Surcharge
$ 0`,1. 9 3
.001 of Permit Valuation (1/10th%)
State Surcharge
$ %, / /
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ 5 -,Ob
$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
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$ qi.6 '