PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
4
Date: ' �"'�• ,
Owner: _ Builder
Address Address �r
� r
L C ION F BUILDING
No. ' Street . �. � 1!_s � -- Part OUt
Lot _ Block Addition or Sub -Division p{
Corner Lot Inside Lot —o"" � Setback Sideyard ,�+'r ? , safe
Sewer Elevation _. Foundation Elevation
DESCRIPTION OF BUILDING
To U 11#
r Front Depth Height 90 Sq. Ft. Cu. Ft r
Fron Depth Height Sq. Ft. "__� __�__ Cu. Ft.
Type of Construction � Est.. Co `f= o 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 ye=t
in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Mitmesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violain of any of the provisions of said
ordinances. .., : A
Building Inspector
NOTICE:
fhb perm* don not cover the comMvddon, I dWbftn for wkhl& plMhtne, an hoattng, ower or water. Be sure to am
the WHO* inspector for operate permits for thea hems.
OWNER'S NAME
ADDRESS
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
ADDRESS
LOCATION OF BUILDING
No. Street
Part of Lot
Lot Blockdation or Subdivision�� i t�
Ad_ '.
(!/
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;
Type
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft.
Cu. Ft.
of Construction Estimated Cost
To be Completed
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 '7 / StGNATtgm
(schedule of Fee Costs can be found on the Reverse Side).
1 •�
MONTH CI 3 �r
DATE
DAY
CONTRACTOR CALL-TIliE INSPECTION & ADDRESS TD4E
1) I _ A /, lam- ��---,e!.!
/�� �� - • ri 1.
� �� C • �
� :l � ��� f !Y ° ! �i �
� ''
I
/
r
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S . NAME—Asd&Tcf (y14L LIIV BUILDER .04AI &A
ADDRESS/I" W..E. % ?�'/�YE ADDRESS FA'/riLfY
LOCATION OF BUILDING
NO. 13X1 STREET 7t VA0 Ye
LOT 9 BLOCK 3 ADDITION OR SUBDIVISION .00A0J-
CORNER LOT INSIDE LOTl,400' _SETBACK SIDEYARD J
SEWER ELEVATION TOP OF FOOTING
Applicant attaoh to this form Two Certificates of Survey of Lot and
proposed building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be.:Used As:.
I
�ant..T�_ Front yy'� �%� Depth %` Height /d ,
Square feet P -CR Cubic Feet
From Depth
Square feet Cubic Feet
Height
Type of Construction .tf4/q a Estimated Cost ZJ-Oo2-r-
To Be Completed /�f #/ dM ® �—
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 J�—-�''di SIGNATURE Gf/ G1i /*Ad"
(Schedule of Fee Costs
can be found on the Reverse Side.)
0 c " • 1 0 rl
otillY
Load Plotinl'17Y C87S -Hi y -045 N I f
Land Surveymy uWdIVI& 3 2.
So;/ -s Teshity EINGINEERING1 INC. 111,7ne:w `7
ctvll I'Municipal RhRt 44066
En9i�teerin9 E%) lneer-s Sur veYO rs
fez! D. L. AVAI-)�Q SOVA BLD.R.
LOT
ANOKA. 4�O'Jtll'lry
Scale:
Ooenc4es Iron
Obcd I
-ed re -e P 5Wvey 401be bcvnc,'0P;e5 0�'ihc O&W Ck5c
a h-ze erred cort p m,,71afi',,i ,
�q me
.Y
e ewcroo:blneals, li cny, {rcpt or oa sad land. As -svry�ycd
SU3U128AJJ R46INFERIN5, IN%'--.
PI
SUBJECT
P
City of Fridley
1500'7
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
®�
1 �
i
' /'••1 CITY HALL FRIDLEY 55432
NUMBER'
REV.
DATE
PAGE OF
APPROVED BY
"•• �'J 612-560-3450
910-F15
11/7/78
JOB ADDRESS 1351 - 75th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
g
3
Don's 5th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jeff Cook 1351 - 75th 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 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct metal asbestos chimney for woodburning stove
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE FERMI r5 REQUIRED
FOR WIRING;
HEATING, PLUMBING
AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Metal
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
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.
$1,000
$'50
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-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEETOTAL
FEE
sh 00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN P PERL V ID S IS YOUR PERMIT
- SP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
PI
• I CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PE1214ITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OVINER: JANai.TEFF COOK—* BUILDER: $',A / -on E
• Address: 1351 Awe NC Address:
Tel. No.:
No. 13 SI Street: AV h" N
LOT: BLOCK.: ADDITION:
CORNER LOT: INSIDE IAT: SETBACK.: SIDEYARDS:
Applicant attach to this form 7Wo Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRI FTION OF BUILDING ,
To Be Used As -.U -
1J�b Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: Estimated Cost: $ !Q QQ. ®d
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
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: SIGNATURE:
Stipulations:
SUBJECT PER
City of Fridley_
194
AT THE TOP OF THE TWINS
BUILDING PERMIT
I `y _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 � �
`
,.� CITY HALL FRIDLEY. 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
---.
L •,` 612-571-3450
910-F15
14/29/88
JOB ADDRESS 1351 - 75th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
3
Don's 5th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jeff Cook 1351 - 75th Avenue N.E. 786-4651
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 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION X7 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (2.6 squares)
9 CHANGE OF USE FROM TO
STIPULATIONS Roof can be 2nd layer but not 3rd. Install ridged galvanized valleys.
On all new roofs or tear-offs and replacement roofs,
State Code requires that 2 layers of 15 Ib. felt,
mopped together, be installed to a point 24 inches
up from exterior wall line, or the use of other
approved underlayment membrane.
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
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
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
$1300
$, 65
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-
$22.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$22.65
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
aye
,WHEN PROPERLY V ID TED THIS IS YOUR E MIT
o� a
Iff SIG TURE OF OWNER OF OWNER BUILDERI I ID EI
/QATE
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: 1561 `751-- AycntAe N•L,
Legal Description: Lo+ q Block 3, -Dares I 5' Addi fiokh --
Owner Name & Address: a1reff C C.aok-, asl 72- pNf- Ne Tel. #
Contractor: Tel. #
Address:
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.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: roo-f ks� �� sti wires
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: Estimated Cost: $ 1�
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: q g APPLICANT: ca"ez /J - b0k' Tel
CITY USE ONLY
Permit Fee $a- U Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ $•50/$1,000 Valuation
SAC Charge $ $ 5,5Q per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ �S
STIPULATIONS:
M
M
0
�a
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR DOWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1267
Residential
Furnace Shell and Duct Work, Burner
Also Replacement Furnace
(Side Vent . Fill Out Back)
Gas PiRing (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
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
a Commercial/Industrlal
1.25° of Value of Appliance or Work
o Slate Surcharge
u TOTAL FEE
0
MINIMUM FEE FOR ANY_HEATIMG/_
o -,
�s
M REINSPECTION FEE $47,00/Hr
N
L'Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective January 1, 2003
JOB ADDRESS _ 1351 1 ?4- 4'v 1C ,6c? f
OWNER
TOTAL
BUILDING USED AS ,-Nes-1-
ESTIMATED COST. PERMIT NO. p1�
$
DESPTjON OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hol Water) Warm Air)
$ Trade Name Size No.
BTU HP ®�2 EDR
$� Fuel- Total Connected Load
Burner Trade Name Size No.
$ BTU HP EOR
$ 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
1 .50 rulings of the Building Division, and hereby declares that all the facts and
$ S—U representations stated in this application are true and correct.
DATE a" 3 7—,o 3
HEATING CO Z,7'?'fie C
Signed Z,2 A404 44 TEL # 4-/d . 3 f-9
FAX # 741 3 ® 313-0313
Approved By _ _ Rough -in Date` Final Date
FED -10-2003 00:11 FROM CITY OF FRIDLEY TO 3230313 P.07='07
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
_AC__MMA VM CONNF-CTAR AWn C -IMAI ICTIQN AIR MIFIC:OTIAI�U
When _nie6na a=aviOfejta. 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 k1 No( )
The venting system is plastiGPVC and meets all current nodes and manufacturer
flans including sift, length, number of elbows and temrination. Yes ( u No �
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cement codes and manufacturer's specifications. This does
include AGA-GAMA Calory I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes (4 No( )
The is sized and installed to meet the current codes
and manufacturet's specifications. Yes (4 No( )
When required to ' will be sed and installed
to meet the current codes and manufacturers specifications. Yes (1 No ( )
When mawaspMm the undersigned hereby verifies, that
it is a listed assembly and meets to currem codes and manufacturer's
sp t`ications. This does indude AGA -,AMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes N No( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separ W* as per current codes. Yes (4 No ( )
4nsli�� anm T4q=An��VXdGCk mjW Vaal and Vent f_annacinr InfaCmadan
Appliance #1 Type F-&4 A-) BTU Input 7 gqs oliiieo
orNat
Applarm #2 Type BTU Input r Nat
Appilance 03 Type BTU Input Fan Assisted or Nat,_
Total Appliances Total Btu Input
Common Vent Type Vent Height �m �� Dlameter�Inches
AppPwm #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appy 03 Vent Connector Height ft Length It Diameter in Type _
HEATING CO: a
111111111111 1
TOTRL P.07
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
((JSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
BUILDING
Plan Review
Permit No.:
3uilding
Inspections
$
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604
License Surcharge
CITY OF FRIDLEY
�� ��(� $5.00 (State Licensed Residential Contractors)
Date Rec'd:
)ATE //- /
YOUR E-MAIL ADDRESS
Curb Cut Escrow
•ITE ADDRESS S%
7S P4 �✓-�
Erosion Control
$
$450 Conservation Plan Review
Park Fee
'HIS APPLICANT IS:
❑ OWNER EXONTRACTOR
Sewer Main Charge
PROPERTY OWNER/
NA1vIE. 3e? 7 Cc��lC
Total Due
ADDRESS: 13 -TI Arir.: CITY
STATE ZIP
TENANT
PHONE: 7Gs 3'- 78W %%T%
CONTRACTOR
NAME: '5y'hs% Ex�e„�i� fS
STATE LICENSE # moa Y t R EXP DATE,&,Y-- `-DG
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: G'iy �'�td`"� S �c CITY
,- "Ole _ STATE/1�ZiP 5)-y%)
WITH APPLICATION
PHONE��� .3-7u `�� FAX
SINGLE FAMILY/NEW CONSTRUCTION SIZE
PROPERTY TYPE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH PROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMM[ING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR M -REMODELING
DESCRIBE WORK BEING DONE: 7' /4 r- ��'i °" &fit e
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
itOOFING ❑ HOUSE ONLY
gUMBER OF SQUARES a� O.HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
3ARAGES
❑ ATTACHED GARAGE
2q
1.
2.
Existing Floor Plan
Proposed floor plan
?ROPOSED SIZE:
�q ❑ DETACHED GARAGE
3.
List of structural members to be used
'ROPOSED HEIGHT:
>IDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
:3 Vinyl
❑soffit
ADDITIONS. & PORCHES SUBMIT:
:3 Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
:1 Other
❑ Fascia
and proposed project
2.
Two sets of construction plans
WE41)OWS
3.
Energy Calculations
N EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
JR FOR NEW OPENINGS -DESCRIBE SIZE OF
DPENING CHANGES & r
TYPE OF WINDOW TO BE INSTALLED YPOD ' NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
((JSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
i. .001 x Permit Valuation (1/10%)
License Surcharge
$
�� ��(� $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
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; that the work will be in accordance with the approved
plan in the case of all work which requir s review and approval of plans.
SIGNATURE OF APPLICANTT PRINT NAME�Z/1✓//.S C ��f J^ DATE �� 7-