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PRE2010 DOCS BUILDING PERMIT Village of Fridley, Minn. No 2903 Date . �..►.............,.1.. ......... ..... Owner .........r.... ......... Builder .. M/ .l.�,l�...... Address I: A Address .. 00.7. ..... LOCATION OF BUILDING No. .... ..?GL`�'ia.j Street .... ... ............... Part of Lot ....................... Lot Q74 3.0.... Block ...�........... Addition or Sub-Division ...�. �4 .,,. Corner Lot ...(.,.�.... Inside Lot ............ Setback Sideyard ... .............. DESCRIPTION OF BUILDING To bbe, Used as: �l Front 3.asp.. Depth .4.Z..Height Sq. Ft .. Cu. Ft. ........ Front ........ Depth ........Height ......... Sq. Ft. ........ Cu. Ft, ........ Type of Construction .............. Est. Cost ... �f.Q.�v�J........ To be Completed .3/M. ,-1. ...... `1 ` C 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 village of Fridley. .. .... ... In consideration of the payment of a fee of $..... .. mit is hereby granted to ...... to to construct the building or addition as described above. This permit is granted upon,) the express c ition 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 partraan o , sh 11 conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, ation, aint a e, r,� it and moving of buildings with- in the village limits and this permit may be revokedy tim up v' Oof a of the provisions of said ordinances. !�_4:�_40�uilding Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. • �Tom_.____:.;_. ._._____aa.-.�.r._�.-`-`-___�-._-.-_ ICAJION FOR PUMBI NG AND GAS F1NitiG ('t:tL•;I r J �96 - 6j� 97-8L,-879001 w _, I 1 tlatcr Job Adlrtss H Ir/,r C I zo :i w 3z s') e ti .. Cll'y cl rrldi,y < sl s. C cs aecl Tel. !15)1-3•.50 _1— _I�� i-_._.-___,�..1 1 I I I Thal-cuidorsignc.'. I::rcly s specified a, r _ ;:kcd {pllue.„ •:r c , crc:t C:.r tA3 .+t:rk Leretr. _ I 3 tctt:� tJ d„• t.. work 1^ S.r:. 't .:=:r.,sc�e rltt• CLa I and rulin. s of Lt,. city J u:e.rccrcnt of B,:i:�ir _••, ",.,cry ":c:iare, ttet nl 010 facLir o.cd CGI'LJSJPLALIOtid ]C]lad it1i. y -co t.yo cndy.ra., ::c. CUNCR t � 1+.t.att C...rJ1C.:tiJG .coir 1• (�..��— +t C3-'GC , UILG...,, ! G{ Sta,er KIND Or II � ''• ~-r,c. t 14tc.re, Gl1 O{:cc Water + --- + USLD AS TO DC C�'11i'LEitu t r'.'�.T�J'•. _ _ ._�C ► ESTINATLO COS-, a!I .. _ I I t. ;itG n-.TCS :iu. RATE TOT:.[. . COL IIL'F! BUSLGIa; [LL:tf: :� .. 1 .ccs x 53.G0 S — ae• ll.t.aLe, :.1J v{au.l:., x c2.t:0 $ `_� ._',(:::r.}' L7� at,b t+asln �l.n � �Q�Q .acaa vaatcr - to yi,C30 6I.1 x SS.GC ? r 16.4,0JO LIU to 1i �:0 !:r == 1iJ• dater %..!tenet +cr t.ca..anJ Pur, Old b.41.11rq x 55.00 $ ' --- ROUGH IUSP, 1, aectll� N.tcr ►Icatee < SS.00 S Data _ 5 Li t IIt;G t•f:ES: �_ �g ' 1�. ,it t lr.cucc• x 5 .00 $ Data 0_' x S1.G0 ; was N.••I• W 1S9,i.0u 62U x 510.00 $ AH'ROVAL li.it f•ClU:Ii '� 1'.II"i L ALTiRAT16;15 �lOu.0:, S5.o0 cl.c, as7, 11 ,r.du c fra $2.G3 S 1`1II1IHU11 I'LL l..n lll't ILfC: .IP i5 S:.:J FLUS $ 'p �;�7C GUkL)U.hr1: SL-Lp S..c_r.argc 5 `r.� L 5 06 r City of Fridley KE sueJECT 18905 O. AT THE TOP OF THE TWINS BUILDING PERMIT � EIPT NO. • _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBERREV, DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/27/87 / / JOB ADDRESS 290 61st Avenue N.E. 1 LEGAL LOT NO. BLOCK I TRACT OR ADDITION SEE ATTACHED DescR. 29,30 5 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Dold 6110. Star Lane N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. RUXX Richard Hastings: Contr. 6331 Riverview Terrace N.E. 574-9966 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 6 USE OF BUILDING Tri-Flex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION .Q REPAIR ❑ MOVE D REMOVE 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS 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 3 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 $2 OOO $1.0.0 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 P OVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S TION OR THE PERFORMANCE OF CONSTRUCTION. $32..50 PLAN CHECK FEE TOTALFEE $33.50 SIGNATURE OF CONTRACTOR OR AUTHORIZE AGENT IDATEI ,. HEN PROPERLY VA ATED THIS IS YOUR PERMIT � SIGNATURE OF OWNER 0F OWNER BUILDER) IDATEI BLDG iNSPU ATE NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ Building Permit Application Construction Address: Z 0 6/ N uc 6 a`7/ 3 ?ZD 5 Legal Description: oz3-o 18Lo, jg" ,gxDC' f?X-+2K 4C—( Owner Name & Address: Dol C) ///0 StA,Z L IV Tel. # Contractor: e 4/4 z b dA S 'L n(CS _Tel. # Address: S,j K z %" g vi''j T� i2 • 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: Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: KE Z'0 C r' Estimated Cost: $ Z©o(n� 0 o Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: L 7 ? APPLICANT: Tel. CITY USE ONLY Permit Fee $ �Z Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ 1- C) $.50/$1,000 Valuation SAC Charge $ $525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ �d STIPULATIONS: Y • Lill Ur1 )tl liLtr APPLICATION FOR PLUMBING AND GAS FIT?$'1G PERiIT. ur ._ -. :. _ • U - x -_Y, Nater 3C-1 X'+I.ress 4071 • a w 7^ e II �- - c.... c +--- HeaterDeP4 ' u .+ -� N u L Y _ .e:c of Buildings Q ` • :II ' � U J N J S r • .. o L v City cf Fridley s a +. La r. vmit o as lec Tel. $571-3450 + ± 7!-e un+crsigned hereby sakes arPlication for a Pe=ft for the writ herein specr:ted agreeing to do all work in strict accords m wtth the City Cod s 1st _ ani rslings of the Department of Buildings, and herety declares that all the facts and representations stated in thls-application are true and correct -- 2rr3 ! -.- -- cc'77�� 3r.1 Fridley, +in. :z "� . 19 4th L - - - Car!:T (A) s Future Connection Opening Connected with Sever K1'- .=F BU I L,D I NG- (•) o Iiea Fixture, Old Opening Nater USP— AS - - - TO rr C�)X2LETEO ABOUT 'u- RATE JLr;[ ' E PLUMBING FIXTURE RATES: NO. RATE TOTAL ti_,i BUILDING PER,41T NO. PERLIT Na. Fh lQ New fixtures $ 5,00 $ Future Fixtures S 3,50 S Cc=pa,Iy v Old Opening, Now Fixture S 1.50 $ - Signed By -- Bear Dispenser '- S 4.00 ' S p� - OL Stow Off Basin S 5.00 $ - Tel. No. 'y� _I Catch Basin S 5-10 $ Rain NrC.r Leader _ S 5.n0 $ Hydraulic Valve S 5,00 $ Date Susip or Receiving Tank S 5.00 S Maser Treating Appliance $ 7,00 $ FINA:. INS P. Hot Nater heater S 5.00 $ Cat Gas Range $ 10.00 S Cat Dryer S 10.00 S Fr=_; F07i PEryI ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1e of Valu* of Fixture or Appliance RelnajXCtlOn Fee S State Surcharge S 50 SI5. TOTAL FEE $I,;,3 •'1IN:'!:'`i FEE FOR ANY PLUmUli:t: PER.41T IS $10.3-D ( 00) PLUS HE S.50 STATE SURCHAkGE City of Fridley SUBJECT AT THE TOP OF THE TWINS BUILDING P E R M) 475 g 'r ' RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. I /-'-1 CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED By 612-571-3450 910-F15 11/6/96 JOB ADDRESS 290 61 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 29,30 5 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Dold 6110 Star Lane NE, Fridley 571-3127 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ron Williams Construction 600 Janesville NE, Fridley, MN 55432 784-6497 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 2350 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Apartment (3-Plex) 7 CLASS OF WORK ❑ NEW ❑ ADDITION CK ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace living room window 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST, OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 3 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- TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $34.75 Fire SC $1.00 PLAN CHECK FEE TOTALFEE A &-21 /111 2L"—O—L�- N/A j X $36.25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI PA P LY VALIDAT D THIS IS YOUR PERMIT <24 SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI G INSP GATE Prepaid Plan Check $ Effective 3/1/96 Estimated Cost $ MY OF FRU" Receipt # _ R3,CJOPMM CIAL&INDL6 ML BUIIDP G PEPM[r APPIKABON Construction Address v� �G— / S/ ��/� Zoning Legal Description Owner & Address S i A/10,Z- .��y e 'i? die Tel.#_�_-71•-_? CONTRACTOR & ADDRESS" oy w1 1/i`,41x S e U.,1 q y-. Architect & Address Reg.# Engineer & Address Reg.# TYPE OF WORK [] New [] Addition id Alteration -Describe Poo)"L 10 Applicant Signature, X4 Tel #7?4-4,07 Date BUIMIM DIMENSICNS Length Width Height Sq. Ft. # of Stories OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. CT= AREA: Length Width Height Sq. Ft. VALID, aN Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ AG/lG / Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE Building Use Construction Type Occupancy Group Air Conditioning []Yes []No Fire Protection Provided []Yes []No Performance Bond Amount $ See Reverse for Schedule Received ❑Yes []No Permit Fee $ �� r/�. See Fee Schedule on Reverse Side Plan Check $ — In Excess of Prepaid Amount - See Reverse Side Fire Surcharge $ / �> .001 x Permit Valuation (1/10th o) State Surcharge $ $.50/$1,000 Valuation (See Sched. for > $1 Million) SAC Charge $ $900 per SAC Unit (Plans to MWCC for determination) Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined By Engineering Spec. Assessments $ Agreement Necessary [] Not Necessary [] Driveway Escrow $ feet x $13.50/foot TOM $ CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS Q / 3 �e��L IVF RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - 3�60 rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $x$80 $30'M representations stated in this application are true and correct. (Side Vent- Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ OWNER 0 U/- 0 Gas Range $ 10.00 $ BUILDING USED AS ,�1 Gas Dryer $ 10.00 $ J1�d ESTIMATED COST y j. Q d PERMITNO. *Air Conditioning - All Sizes $Ztft-.w Uel 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) (Warm Air Trade Name Size No. Commercial/Industrial BTU 1/_ p o o HP EDR 1%of Value of Appliance or Work $ Fuel ( 5 Total Connected Load 2i'dry e State Surcharge x50 Burner Trade Name Size No. BTU HP _ EDR TOTAL FEE HEATING COMPANY � MINIMUM_FEE_F__OR_ANY HEATINGLOOLING/VENTILATIO�N REFRIGERATION/AIR CONDITIONING_PERMIT_IS$15.00 Signed By AZA Tel No,,I, PLUS THE_$.SJ_STATE SURCHARGE REINSPECTION FEE $30.00 Approved By Rough-In.Date Final Date *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK DE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE; #1 through #8 required when using a side vent furnace. 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 lodged within Yes O 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 ( ) Re ks: G List ALTERATIONS teeing Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS (fir ® 2 3 RATE SCHEDULE The undersigned hereby makes application for a permit for the work 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 $ pO representations stated in this application are true and correct. (Side Vent — Fill Out Back) ,19 Gas Piping (Needed with new furnace) $ 10.00 $ OWNER�yg 1 .1y/. Q Gas Range $ 10.00 $ ��- BUILDING USED AS Gas Dryer $ 10.00 $ el ESTIMATED COST_ _ 0 6 PERMIT NO. *Air Conditioning — All Sizes $25.00 $ Od 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 WaterK2arm Airy Trade Name ['A,- P;j,�:_,e Size No. Commercial/Industrial BTU 5 '0' d a HP EDR 1.25% of Value of Appliance or Work $ Fuel (,A 5 Total Connected Load a State Surcharge .50 Burner Trade Name Size No, BTU HP EDR TOTAL FEE HEATING COMP Y � er/df MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONIIVG PERMIT IS $25.00 Signe By Tel No.4/.�? PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE$42.00/Hr Approved ByRough—In Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FO STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNA E - s CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes O No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes O 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 ( ) Re rk : r r c List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIV, Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS.AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE' The undersigned hereby makes application for a permit for the work 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 $ Q.�O representations stated in this application are true and correct (Side Vent - Fill Out Back) 47 Gas Piping (Needed with new furnace) $ 10,00 $ , OWNER � ,� [)p,, D Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $ 10,00 $ . ESTIMATED COST_./ !/d PERMIT N0, *Air Conditioning - All Sizes $ 25,00 $ . 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 `eq 0, C-,e Size No, Commercial/Industrial BTUHP _EDR 1,25%of Value of Appliance or Work $ Fuel ra _; Total Connected Load app State Surcharge 50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE � � � • MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION HEATING COMP YAuh a REFRIGERATI.QJNAIR CONDITIONING PERMIT IS $25.00 Signed By el No,,�/,,2- PLUS THE 50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By _ Rough-In Date Final Date�L-5/-a// "Air Conditioners can not be placed in a side yard without FILL OUT FLACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner, REPLACEMENT FURNACE CHBINEY 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 lodged 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 ( ) Re arks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: SUBJECT City of Fridley 30 557 AT THE TOP OF THE TWINS BUILDING I L D I N G D[D � A I f r C R'v, RECEIPT NO. l a3 V....... COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 5/19/00 / / JOB ADDRESS 290 - 61ST AVENUE NE & 6071 073 RD STREET NE (Tri-plex) 1 LEGALLOT NO. BLOCK TRACT OR ADDI SEE ATTACHED DESCR. 29,30 5 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Dold 6110 Star Lane NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contr 6331 Riverview Ter NE, Fridley, Mn 55432 763-574-9966 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 4051 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof Building (35 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 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 3 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 $5,559 $2.78 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 TOT FEE 5- /Fov LicensC $5.00 $/38.59 SIGNATURE OF CON'RACTOR OR AUT ORiZEO AGENT TDA TEi HE PROPE ALIDA THIS IS Y UR PER T _ SIGNATURE OF OWNER,if OWNER BUILDERS -,DATE- 8 G NSP DATE NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763)572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 S� BUILDING PERMIT APPLICATION n P Construction Address: Z o -74— 7 3 S"-e/ S i • Legal Description: Owner Name &Address: -T C rz y Dr, L E f/o StA�- C ey, Tel.# Contractor: Z"c_A-Z D �JA sf �(K �' S MN LICENSE# © f Address: 6, 9 3 i u r iZ J 'k� (� ' 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. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: S S Construction Type: /ICAZ 6 fi� "A� Estimated Cost: $ .> Driveway Curb Cut Wdth Needed: Ft. +6 Ft= Ft x $ _$ DATE: :521?' ve) APPLICANT: � f � Tel.# CITY USE ONLY- Call(763)572-3604 for Permit Fees if mailing in application Permit Fee ����'^ Fee Schedule on Reverse Side Fire Surcharge $ S S .001 of Permit Valuation (1/10th%) State Surcharge $ 76 / $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ `GSC $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: 1