PRE 2010 DOCSCity of Fridley
AT THE TOP OF THE TWINS
rL------� COMMUNITY DEVELOMENT DIV.
I FROT(CTIVR r1EF$CT*M 89IT,
i
r.-.` CITY BALL PRIOLCY 5042
Job Address
--?> - 7 -3
owner ->
umbing Coon�trac or
"Ir
Kiindd�of Bui ding
Completion Date
L
acarol I � I I �
'lddrl I I I O
i
i
;4I
0
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t
$U34ECT
Permit No.
PLUMBING PERMIT APPLICATION Ai jL
!-!!Yl 8A 1 0 12/15/73 1 1 1
/?C_
ddress Phone
Address Phone
f/ Use -
1,
Estimated Cost/
1 Plumbing Fixture Rates; NO. RATE TOTAL
! Number Fixtures !� x $2.00�,��
I Future Fixtures x.$1.50 d L
New Fixture -Old Open. x $1.50
1
Catch, Basin x $3.25
Water Heater -99,000 BTU _� x $3.00 ---3, d -e
Ground Run Old Bldg. x $3.25
I Elec. Water Heater x $2.00
jGas Fitting Fees;
1st 3 Fixtures x $2.00
i -
Additional Fixtures x $ .75
i
j Gas Range -199,000 BTU x $5.00
Repairs &-Alterations-Alterations
lDescription; See
Code
IState Surcharge .50
TOTAL FEE $
.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 declare that
all'the facts .and representations stated in this
application are true and correct.
v 9
'Signature ate
r�S/7y
31
SUBJECT
PERMIT NO.
City of Fridley
® 12779
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
16
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
1 ~ PROTECTIVE INSPECTION SEC.
r
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
EAP2PROVEDBY
612-560-3450
910-F15
10/28/74
JOB ADDRESS 1503 - 73zi Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
]
Jiro Lund Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James Lund Construction, Inc. 2417 - 148th Avenue N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USEOFBUILDING
Residential
-F-CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 42' x 24' Dwelling and a 20' x 24' Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS Provide a verifying survey before capping. Provide a hard surface
driveway. City not responsible for street or house grade elevations. No
occupancy permitted until lot recorded.
SEWER LOCATION: 324' W. of Manhole (Inv. 892.99)
Service extended 47' N. of sewer main.
Wye Elev: 894.16
TOP OF FOOTING: 898.16 Minimum
WATER LOCATION: East of sewer service in same trench (extended 46' North of
sewer main)
SEPERATE PERMITS REQUIRED FOR AIRING
HEATING, PLUMBING AND SIGNS.
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
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
19,968 S480
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
1020
+
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
11.92
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$23,847
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-
STRU ION OR THE PERFORMANCE OF CONSTRUCTION.
$46.00
$300.00
PLAN CHECK FEE
TOTAL FEE
-
357.92
IGNATUREOFCONTRACTOR ORAU,1WORIZEDAGENT (DATE)
HPROPERLY VALID D HIS IS YOUR -PERMIT
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG INSP1 DATE
r�S/7y
31
APPLICATION FOR RIiSIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME:_ JAMES LUND CONST., INC. BUILDER: JAMES LUND CONST. INC.
ADDRESS: 2417 148th Ave NE ADDRESS:_2417 148th Ave NE
NO:. 1503 STREET: 73 112 Ave NE
LOT: g BLOCK: 1 ADDITION: .Tim 1.11nd Fstates
E-5.6
CORNER LOT: INSIDE LOT: X SETBACK: 37,6 SIDEYARD:W-12.0
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Single Family Fr0n t: 421 Depth: 7 t Height:
dwelling ®�
Square Feet: Cubic Feet: �
Garage Front: 201 Depth: 2At Height: `
Square Feet; 4Rn-t Cubic Feet:� i
Type of Construction: Frame Estimated Cost: _$ 33.000.00
To Be Completed: 12-23-74L c, i
k�
� G_C
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: 10-23-74 SIGNAT6E:
(See Reverse Side For Additional orma�
tion. 'F 0 ``�
• , ;`
43 . • • � °rte' ` � "`�� ."�2 _ d eT -.A �o-' tj
CERTIFICATE OF SURVEY
FOR: TAMES LUND
74.47
' 4Dmir.me 4 Utility Easement I
g04_S O
S �
10.5 2
%n �. N
N N Proposed }Rouse N
5.
t1_0 62 I 9o95I %
904.5 0
£ R'
S
1
,tri ?(i' 1q I '(go4.0)
(904.;)h9
904.;) ' (904.2)
19.31"
902.E
N
1 f'Q 3 F, olo _ 2 rl V
_ o .
o Denotes iron monument
(900) Denotes Existing Grade
Fq__0_0_j Denotes Proposed Grade
Proposed Top of Foundation- 905,0
Address: 1503 731 Ave. NE
Note: Description invalid un-
til plat is filed
DESCRIPTION: Lot 9, Block 1., Proposed JIM LUND
ESTATES, Anoka County, Minn.
VOWK 1,I hereby certify that this is a true and correct representation of a survey of Job No.
ounfry the boundaries of the above described land and of the location of all buildings, V14
SuweyorJ if any, thereon, and all visible encroachments, if any, from or on said land.
Book —Page
Lan(!.'�urveyiny • Site Planning As surveyed by me this ---�-hday of
- Civil Engineenny / +
8816 70th Av. N. (1 94 at Boone Av. N.) le
Brooklyn Park, MN 55428
Phone 533 7340 Minn. Reg. No. _ 10944 1 40,
a
0 F v, O"p?, '9 7 )
2
-rof OF Fo-erm�o-,-
Z'a
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7-g iiWc H t1- X 0
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1 Y40m)
�, �F Sewer �e��
93 r AvE
560.3450
AMY Of
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE January 16, 1975 FRIDLEY, MINNESOTA 55432:
James Lund Construction, Inc.
2417 - 148th Avenue N.E.
Anoka, Minnesota 55.303
Re: Structural Finals on Homes in
Jim Lund Estates
Dear Mr. Lund:
You have been requesting finals on the homes built in Jim bund Estates.
Upon making these inspections, we have noted that there are no door closers
on the door leading from the dwelling unit to the garage. This is a
requirement of the Building Code and therefore you must install them. Make
sure that they are capable of completely closing the door as some that we
have seen are not capable enough and do not close and latch the door.
This is necessary to keep the integrity of the firewall between the
house and the garage.
We ask for your cooperation in getting these installed on all your
homes prior to your requesting finals and those with people in and already
finaled must be installed on or before February 7, 1975.
Upon your completion of this request, would you please supply us with
the addresses of those installed in the homes that we have already make
finals on so we can reinspect them.
If there are any questions on this matter, please feel free to contact
me at 560-3450.
Sincerely, `
DARREL G. CLARK
Community Development Adm.
DGC/mh
ac nen ft -7 Power Rmb and N Coamig, Tam . asR .0M
r Can � � � ,,. � end Devi92W&M amid
ORAVI'I'Sf WAIS
MATZ TOTAL.
Furnace She_l & Duct Work ... ...
$10.00
Replacement of Furnaces
6.00
Repairs & Alterations—up to $500.00
&00 $
Repairs & Alterations each add. $500.00
300
Furnace Shell &Duct Work to 180,000 BTU .110.00
each add. 60,000 BW . .. ...... 3.110 i
Replacement of Furnace 6.00 s
Repairs & Alterations --up to $500.00 6.00 $
Repairs & Alterations each add. $50x.00 3,00 $
STEAM or HOT WATER SYGTED4
Furnace Shell & Lines—to 400 sq. tt. F.DR Steam 310.00 $
Furnace Shell & Pane --to 640 sq. ft. EDR Hot Water 10.00 $,
Each add 200 sq. ft. EDR Steam 3.nn $
Each add. 320 sq. ft. EDR Hot Water 3.00 $__
OIL BURNER—to 3 gaL per hour 6.00
over 3 gal. per hour—See ree Schedule
CLAS BURNM (up to I%= BM &00 g�
owner 199,000 VM See Fee Schedule
GAS FITTING FZW. NO RATE TOTAL
1st 3 Fixtures X$ 200 $— ._
Additional Inxtures x ,96
Gas Range to I29. as 6.W $
?^, rr ►�s' i 'Y" s :R I'd :f - .
s �`if � �•f� . ..IBR .?: +' as r s.1�t
U161 rs'l;:p
FITpr 1-1—t x.
State Surcharge .50
is" Fes
City of Pitdley:
The undersigned hereby makes application for a permit for the worts her'eW,
specified, ,agreeing to do all work in strict accordance with the City Orditnancer
and ruling of the Department of Buildings, and hereby declares that all t)he fact
and representations stated in this application are true and correct.
Frid,ey, Minn �'_' C I9;�L,
v �
Kind of Building
ne-` /%
Used as
To be completed about, v � /57—
Estimated
7—Estimated Casts $
Oi New. uilding Permit No. _—_ Permit No. (a3i
HEATING or POWER PI.!!N'T��teatn, Not Water, NO
Trade
Trade Name
901,
Capacity—_-- — Sq. Ft. E.D.R- � � O C} BTU % R31 -
Total Connected Load ` -7 3 -6 lily of Fete
BURNER — Trade Name � 2 �� size
Capaci Sq. YL F.DR
r rmr-17vi j1
IAINNEGASCO
53 -8h -s-915.51.
City of Fridley
APPlirat-icn for Plumblisig rz.Md GM N1;i'j Pes t
Dept. of Bldgs. ]'hone 360.3450
DESCRIPTION OF WWI=
Numbar, Kind and Location of Fixtures
1 I;
r
Number Fixtures ................
x $2.00
N�
x $1.50
z•_
''
nO
New Fixture Old Opening..........
pp �=
Oo S�
o
<3
V
Uolt
N
Water Beater fUp to 99.000 BTU) • • • •
°
WATE4 HTR.
New Ground Run Old Bldg.......:.
x 3^ "5
-e
Electric Watar Heater ..............
a $2.00
$
kS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures • ............ • • • • •
x $2.00
$ .
Additional Fixtures ...............
x $ .75
$
Gas Range to 199.000 BTU ...........
1 x $5.00
S 5.00
I
St 11
jRaT.ge
l
_
Future Connection Opaninp 10
.,ower C]
New Fixture. Old Openings Cesspool C]
PARTIAL RATE SCHEDULE
MUSING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................
x $2.00
$
Future Fixture Opening ...... • .. • • •
x $1.50
S _.
New Fixture Old Opening..........
x $1.50
S ---
Catch Basin ....................
x $3.25
$
Water Beater fUp to 99.000 BTU) • • • •
x $3.00
$
New Ground Run Old Bldg.......:.
x 3^ "5
$
Electric Watar Heater ..............
a $2.00
$
kS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures • ............ • • • • •
x $2.00
$ .
Additional Fixtures ...............
x $ .75
$
Gas Range to 199.000 BTU ...........
1 x $5.00
S 5.00
Loom 1503 N. E. 732 Ave.
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, a. -reefing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct'
Fridley, Minn 4-7-75 19!
Owner Le Rohr A. Larson
Kind of Building Frame
Used as 'Res.
To be completed about 4-31-75
Estimated Cost, $ 10 00
S New. Building Permit No. Permit No.
Signe CPQ
By MINK GASCQ
Business Phone No
ROUGH
FINAL - - X-4- 7(,
EPAIRS me ALTERATIONS—Rotor to Code .50 State Surcharge
Description .......................................$
TOTAL F'EE 3 5 _ g0
•Vass -�Y' 'Surcharge .50¢
[E
TO:
ENG NOTIFICATION OF INTENT
Fosterer Family Homes
D94i Care Homes
FROM: ANOKA COUNTY'SOCIAL SERVICE
COUNTY COURT HOUSE
,,.ANOKA
ANOKAD MINNESOTA 559103
APPLICANT: 4 ra
kNamej
X50,715 a,
(Street)
AJGKo"
4W4
city) (State)lg
umber ,of en und9r. TO
0 1 2 3 4 5
C
n
4 5 6 7
N er)
(Numbers- of Natural. -PrescltiDoi Children In Home:
00 2'3 4
(Circle Number)
-irsojuaAw4 3Ln lloopsez,0 1 2 3(V5
(Circle._ r)
0/43 17
4.1 4c -
SUBJECT
PER
City of Fridley
7 6 9 5
AT THE TOP OF THE TWINS
BUILDING PERMIT
_'l
i �
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J\ 612-571-3450
910-F15
9/4/84
10B ADDRESS 1503 73 1/2 Avenue N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
1
1 Jim Lund Estates SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
LeRoy Larson 1503 73 1/2 Avenue N.E. 784-2109
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Gilbertson Const5uction 7704 Riverdale Drive Brooklyn Park 55444 560-6943
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 C ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DES RIVE WORK
0 x 20' addition to an existing attached garage
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERAT"E PERMITS REQUIRED FOR WIRING,
HFATING. PLUMBING, ANn 41GNS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
frame
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
400
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
4484.00
D
2.25
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
--��
52.75
IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
kN PROPERLY VALIDATED THIS IS YQUF PERMIT
BLDG INSP NATE
SIGNATURE OF OWNER 0F OWNER BUILDER) IDATEI
4.1 4c -
NEW [ ] City of Fridley Effective 4/1/84
ADDN.] �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: �� `7��` (V6 -
Legal Description: Z�2 1h ✓ l `�` �'�""T`�-fir
C�v�i
Owner Name & Address: C ��'-� ; Tel. #
# ZLI '
Contractor: ' 1 3
Address: -7 710 jeT � Q fly ' �C�,-,, e '� S3caLe
21
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length
Width
Height Sq.
Ft.
7
GARAGE AREA: Length a r Width
Z `_
Height Sq.
Ft. �
DECK AREA: Length
____ Width
Hgt/Ground Sq.
Ft.
_
OTHER:
Corner Lot [ ] Inside Lot
[ Ft. Yd.
Setback
__ Side Yard
Setback
Type of Construction: c'A—
=
Estimated Cost: $
el cl
av
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: �i APPLICANT: -�� Tel.
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer !lain Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ 15 '0..S 0
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit '
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [,]
,p
V=tc4wLJFm
Comet, SI-Rc3
C, —'6
`:�^
- —. — 4 � e
w -910 tox co tm �
:S'O l -----
i
-T-Lr.}p f�✓�i►RIi- 5.111Ntot�S
i
i
VT It CZ Nom_
1 N
c7CSiS/7N �
�1NcN�� 3047:5 (,' O C
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8X1to
t 4 . r
CITY OF FRIDLEY INSPECTION DIViSION Effective On January ], 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE JOB ADDRESS_ ISD 3— 173 a Age Jycc.
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 CAILILIf
3If9XR pap
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/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
OWN
T
0 1
BUILDING USED AS
ESTIMATED COST kd a . O0 _ PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) arm Air
Trade Name h—A&,PIF Size No. v
BTU isD. QOO HP EDR
Fuel I'r 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.
River City Sheet Il ial. Inf- 7 f od
9928 Bluebird St. N.W.
C
HEATING CO _ nnn Rapids, tN,R' 55433
Signed �� 754-2199 TEL #
L�' V ff &J
Approved By Rough -In Date Final Date 9 -.2('1 -co
503
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.
YesNo ( )
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 manufacturers 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 manufacturers 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 manufacturers
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances.
Yes(K 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 Informatijonn
Appliance #1 Type - vc 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 `"ti.�- ll
Common Vent Type 4-7 VaA Vent Height / T Diameter 6, inches
Appliance #1 Vent Connector Heights ft Length ft Diameter,in Type C—
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
l(
HEATING CO: eat' KPItd
Signed By: Date 7i� 4�
a
Building
BUILDING
Permit No.:��
Inspections
RESIDENTIAL APPLICATION
Received By: A4
763-572-3604
CITY OF FRIDLEY
DatR dM AY
763-502-4977 FAX
EFFECTIVE 1-1-09
—12 - ( r,
"+.
C0�
DATEy
YOUR E-MAIL ADDRESS `QC V� U
—5
SrrE ADDRESS I'Sd 3
_.
n '
�'/2 � 'V c
THIS APPLICANT IS:
❑ OWNER 66ONTRACTOR
PROPERTY OWNER/
NAME: v Sek)
ADDRESS:'0 S " —T-51/2- P V -P— NE CITY -PrZ4 I Ali
STATE VLZIPJ5S (4 3
TENANT
PHONE: -7 US - —('&4 — 7-1 0-1
CONTRACTOR
NAME: M Ild laasC&Q, G, '
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # G p 1 / EXP DATE
3`3�— 1 Z
AND CERTIFICATE OF
ADDRESS: CrrY ®5'5g
�C
STATEIP Z
INSURANCE
q `
PHONE 11 " S FAX
PROPERTY TYPE
&INGI E FAMILY/NEW CONSTRUCTION SIZE
TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FINISH 'MaOOF ❑ DRAIN TILE
❑ DECK SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
I.MAINTENANCE/REPAIR ❑ REMODELING
p
DESCRIBE WORK BEING DONE: Te�;& . ne r c . t J w-iL oA 1S _ I i , t):—! nCU
lVVJ 0001tMl
u
SIZE OF IMPROVEMENT
LENGTH WIDTH HEI HT SQ FT
ROOFING
NUMBER OF SQUARES
❑ HOUSE ONLY
St HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
3C ' 1A ATTACHED GARAGE
1.
2.
Existing Floor Plan
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:
❑ Aluminum ❑ Trim , (�
❑ Other ` k, / CO�MDga7� f� Fascia \ �J'
1.
Site Plan/Survey showing the existing structures
and proposed project.
1
2.
Two sets of construction plans
WINDOWS �O
IN EXISTING OPENINGS Wes ❑No LOCATION QF WINDOW�� 2
OR OPENINGS SIZE OF r V
3.
Energy Calculations
FOR NEW -DESCRIBE W t
OPENING CHANGES &JJ _ ( ®U 2 S " U & I
1 V1(o
TYPE OF WINDOW TO BE INSTALLED
l N�JMEER OF WINDO S
ALL FEES ARE BASED ON VALUXTION, INCLUDING THE COST OF LABOR AND MATERIALS:
G THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ J I S NOCCUPANCY TYPE
Permit Fee $ MA, I . See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ 1 .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $.50
License Surcharge $ 5to $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ AW1 jif 13 Make checks payable to: City of Fridley Attach Stipulations
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 on site; that the work will be in accordance with the
approved plan in the case of alllJnwor�_which require review andapprovalof plans
SIGNATURE OF APPLICANT �X/ Vt l Jl/� L���J�J�'�YI�INT NAME�Qj
1:1;7:1