AF - 34872�
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City of Fridley, Minn.
BUILDING PERIVIIT
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N° 1011 �
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Ad�re� �. a � den W�,� �T �. Ad� �� ^�-n=a�rr�e3.rRFei�� ----
LOCATION OF BUILDIIdG
lvo. ��`�1L— siaeet ? � aen wav �T.,. T. _ �art of I�ot
Lot 2 _ Slock 3 Additton or Sub-Divisian .�-+J-wells Rivex Heighta _'?� �,�G_ 2
Corner Lot ._ Inside Lot X. �tback Sideyard
sewer IIevattam .�4.°� . 67 , &.53�}.2
Top of Footing
DESCRIPTION OF BUILDING
To be vaed as:
Dwelling �t �pt De� �,25! xe��t .2.G? .r sqt. Ft. _.8q.ar ca Ft 218q.�.
�ttaeh�d GarageFromt —24'-- Depth �.22! i�eight _10' Sti• Fw �?-8— Cu. Fi -�2$,Q—
Type of Canstructton Fr�-me. F�t. Cost —��.T;�DA� To be C�npleted duly�:, �—.�—
SE4ilER LOCATION: 64� South of Manhole �' Deep
WgTER LOCATION: 75' South of Manhole
In camsideration oP the issuance to me of a pernnit to camsiruct the buildt� descrii�ed abrn►e I agree to do
the F�P� work ffi acxordance with the descrlption above Porth aad a ce wi e�l provIsions of
o�inanc�es of the dty of Fridley. �/,� 9
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$100.�0 Sewer Connection Ch�. _
Ia �msdderatton of the payment of a fee of $� �- o� :�t fs Ilereby granted tc1�0 s T.i � wa.l l
to canstruct the buildfug or adc7ition aa dacribed above. Thispermit i8 granted nEwn
the expr� condit[an that theperson to whom it is granted and his agents. emPloyees an� workmen, ffi all work
dane in, ara�md arnd upan said bnil� or any thereo� ahall c�offia�m ia aII r�pects 1� the orainaaces of
ara m
Fridley, P2innesota lxa+ion, on„ atteration, maintenance, repair aaa. movin� of builain,�s
wi�� dty limits��i� � permit may be revoked at any ti�ne upa� vlolatian oP a�► of the p�ovlslona of eaid
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Hank Muhic Building Official
aonc�
11d. penadr aoe. no� �er t6s e�trn�, � ter �rMee. Pu�e. e� �, •w�n� er .rah. e. .oro te .e.
da B� 1� ior aparab p�tb hr t6�s (t�m.
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APPLICATION FOR BIIILDING PII�MIT
CZTY OF FHIDLEY, P�IINNffiOTg
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a� i S� c� �1��.�4 o�,�i,�o �s 5
LOCATION OF BITILDII�G
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LOT �.... BLOCg � ADDITION UE SIIBDIFISION,��C� �
CQR'� LOT INSIDE LOT�i ,_SEI'BA�E 3IDEXABD
_ SE� EI,EV�TI01� TOP OF FOQTING
Applioant attech to thie form Two Certifioatee of 3urveay of �t and
groposed building location drawn on th6s3 Certificates.
D�r:RIPTION OF �IIIaDING
To Be IIeed Ae: �
�o�.t 3 � nept� �' � ���nt ��
Square feet 6�� Cubic Feet ���;�_
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Front Depth„� �_Hei�ht y�=
�quare feet + Cubic Feet � `� �` �
Type of Construction � 1' Estimated Coet � I���
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To Be Completed �`,.x�u �, 1 ci
The uadersigned hereb��akes applioation for a permit for the work
herein epecified� agreeing to do all work in Btrict aacordance with the
City of F'ridley Ordinanoee and rulin�e of th� Depastment of Building�a.
and hereby deolarea that all the fe.cts and in�rreeen�ationa stated in
this applicatian ase true ,�nd correate ^ �_
DATE
(3ehedule of Fee Coete csan be fourid on the 8everee Sideo)
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�UILDING PF,RNIIT FEP SC�ULE
SF�CTION 2o The Inepeator of Buildings ehall, before iaeuirig peraits
for the- erection of any building or +structure, or for �.ny addition to any
ex3.etin�'- struat�a�e -c� _building, or for any alteration or repaire to R,ny
eaisting buildiag or structure, upon application thereforea require the
pe.yment_b�r the a�plioant-for auah psrmit of feee to the amount herein
below set forth anc3 in the manner herein p�ovided to-wit:
IIniform Buildix� Code o Type 1, 2, 8a 4-=10 75 for each one thoueand.
aubio feet, or fraction thereof, in auch�cubiaal c�ntente. Type 3� 5-
_�le5o for each one.thouesad cubia feete _.
For the purpoee of computing fees.for building permite, the cubical
coriteute of any building or addition to a uniform he' t throughout by
multiplying the ground area covered from a point eis�6) inches below
the �loor line of the baeement or the cellar to the average height of
�he upper aurfaae or to the average height of the roof surface of the
main gable of a pitahed roof.
�ox re�aiacs or e,ltere.tionas to an euisting structure, the fee ehall be
at the rate of $3.00 per each iive hundred dollars (=500.00) or
fraction thQreof in the cost of all proposed worke
In no caee sha.11 the fee charged for an�r permit ae set forth in Section
2 be le�s tnan 85000a
NSSSI) Coanectiorr Charg�ee based on location - Area 1 or 2.
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E7�TERIOR ENVELOPE AVERAGE "U" COM�UTATIONS
(to be snbmitted with building permit applications)
Oae or two f ami ly dwe 11 ing�_ Contra ctor � - S k1
All other construction Site Address
Dat• �' �Z=�7% Phone Other�� �'�1-1- `�OZ
�� .�, . _..__
LINEAL FT. OF
EXPOSED WALL Cs�C�•O X IS •�4' FT, ABOVE GRADE= °�ZD .�°6
TOTAL EXPOSED WALL AREA SQ. FT. �
OPAQUE WALL CONSTRUCTION: "U" value x area
� Q�� Ga�K Pa�•K— ��U�tp,pi x sq.
Detail ��C=2��o� '��'U" o.o x Sq.
reference �� - \�—�'"U"o. � x sq.
from _�• o �2rr.. ,4�i.�-""U"o��2 _x sq.
attached ��U�' x sq.
sheets ��v ��--- x sq .
._....._
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��
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�� t� nU n_'_" X 8 q.
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f t• OZ•- a G�' i`�6
f t . _�—�
f t. C�� 59 = 3�
ft.�i•2> _ �h.�
ft. _
ft. _
ft. _
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ft• �-SCo = 3�5�
f t. bo . � _��� O
ft. �
ft. _
ft. -
ft. _
DOORS :"U" va lue x area -('u�,�n,
MBke &' type 3° • �'U"�o.� � x#q. ft. 2v.v l a l.�Z
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u n _" , i�U ii � � -----
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TOTALS °�ZO ,5°b Sq.Ft. I1�.02 (U)(A)
TOTAL (U)(A) VALUES DIVIDED BY ���' � _�,115167 AVG, "U"
TOTAL WALL AREA c�� ...,,�a ���. d, �-�
�
ROOF/CEILING : .�r � �
TOTAL AREA: sq. ft.
' o.ogz
Det8i1 GEtL► r•t L.. d` � "U"�x sq."� f t. 44( .d = I� .52 (U) (A)
reference —lo o m�]. "U" o� x sq. ft. 4�,0 = z. (U)(A)
..� ._ _
from nUn x sq. ft. _-zo.�,-z �U)iA)
attached E«..�NC.. Z "U" ��x sq. ft. Z3 = kz.g3 (U)(A}
she�t8 1o/c, �'tt �'U��U.O x sq. ft. 2G.Co = i�L? {U)(A)
, z4�.o �a.ss�
� TOTAIS Sq.Ft._ (U)(A)
TOTAL (U) (A} VALUES DIVIDED BY Zo• g� = AVG. "U" �` �� a�o�
TOTAL �OOF/CEILING AREA 4ait� � '���°�' ¢
" �Z-� c�, i
TOTAL ENVELOPE CALCULATION METHOD ( 4�SS '' D�bS�� �V �' •,� V'` .--
DESIGN: Z��•�
WALIS = 0,1 � x TOTAL �+TALL AREA =.
ROOF/ = S•05 X TOTAL ROOF/CEZLING AREA =
CEILING '
ACTUAL:
WALLS x a
ROOF/CEILING x �
ACTUAL -� DESIGN
��� ,%
� r,
.
�
TOTAL
. .. . _ .�. _ ,� ._....�.�....._.�._....
. a
� �'' � �-; ��?7 -- o0 2.
`' FRAMING:ADJUSTMENT FOR OPAQUE WALL
�� 1� 16", O.C. CONSTAUCTION
' �-7� 24t' 0. C.
`.:FOUNDAT ON
;; WALL , .
�
UNDERSiDE O
�
�i
- ROOF/CEILIN
� •�• J�_
ROOF/CE;
1
?_ .
3
4
5
6
7
8
9
10
12
I2
13`
I4
15
16
17
18
19
20
21
°
R-VALUE;
,
;:�:,
�.;-
;.
,.
��U�• o� o�
.
z2 22 INTERIOR AIR FILM 0.92
2 3 ,_._.._, �..... '..
za . 24
2 5 T OR A R I '�`�`
.
. TOTAL R �
uUn
..
z 26 EXTEFtIOR AIR FILM ST' 0 6-
z7 ?..7 O'� w 1d� 2.2 1� 22.00
? � � �� p.
29 IKTERIOR A R F�LM .
29 TOTAL R,��? 3�a 1
rtUt� cg�, p,42�!'
w ��� ,
.
30 EXTERIQR AIR FILM 0.17
s�
31 .� , . _�
32 ,'!�_�o��n �Ksv� 4.i�
�,
� 33 1" p�. o� sy7 a.
� 34AR PAC L .
� � 35 3��Zn ,f. �►ativ�.' Il•oo
36 �� �. �
37 37 OR A
TOTAL R- �=
ptT� . d S
SUBJECT P � �
City of Fridley 1432
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T.
i i. RECfIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� �ti. ------�
r � � PROTECTIVE INSPECTION SEC.
1 � �
�` /���1 � CITY HALL FRIDLE� 55432 NUbIBER REV. DATE � PAOE OF APPROVED BY �
L••«'�'� ,•� 812-580-3450
910-F15 8/25/77 � �
JOB ADDRESS 7580 Alden Way N.E.
1 LE(iAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 2 3 Elwell's Rinersida Heights Plat 2 SMEET
2 PROPERTY OWNER MAIL ADDflESS ZIP PHONE
R�ert J. McAc]am 7580 Aldeu Way N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSf NO.
.S�@
4 ARCHITECTORDESIONER MAlLADDRE3S ZIP PHONE 610ENSEaVO.
5 ENdINEER MAILADDRESS ZIP PHONE LICENSENO.
B USE OF BUILDINO
Residential
7 CLASS OF WORK
0 NEW Q ADDITION ❑ ALTERATION 0 REPAIR � MOdE ❑ REMOVE
8 DE3CRt8E WORK
Construct a 16' x 28' Addition onto dhrelling
9 CHANdE OF USE FROM TO •
STIPULATIONS
Owner to provide copy of plans within 10 days for City files.
D F.QR WfR�f�G, V'�ARNIHG
SEPERATE PERMITS REQIN� _ Be�ore. chg�in� c�lt l�ca1 ut�Itttes
HEATING� PlUM81N�G AND SlGNS. '� TEI.EPHat�E-�L�Ci�tC-GAS�tc.
.. � REQl3�R�� �Y ��
SEPARATE PERMITS ARE RE4UIRED FOR EIECTRICAL, PLUMBING, HEATIN(i, TMPE OF CONS7. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOO� Fr�ffi�-'
THIB PERMIT BECOMES NULL AND VOID IF WORK- OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAY3, OA IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 4�8 12�5�
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMIN�D THIS APPLICATION l STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINAIdCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE (3RANTINO OF A PERMIT $22, 265 5�.1..�.3
DOES fdOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW Rf(iULATIN CON-
STRUCTIO OR THE RFORMANCE OF CONSTRU N. $SO.I.S NONE
� PLAN CHECK FEE TOTAL FEE
. , ��^ ?% $12 e 54 $73.85
SIGNATUREOFCON RORAUTH IZEDnGENr IDATEI WHEN PROPERLY VALIDRTEO THIS IS YOUR PERfiAIT
k�
_ _
S�ONATURE OF OWNERIIF CWNER BUILOER� IDATEI e BLDG iNSP DA7E
7
�
.�
�
�
ccaA�o �' COTNL i� -
� � 4,�h�.61:!:c AVE '. ` � �� � a� � ���� • NArMOMO� A ►i4$Cq
. . . �"1 A t I F !y �ili � �L ✓ �'�
v �+►�` I,A\U �l'H\'F:l'()K.� ' �7or v :��� ��. '
bR � �.�,�
8L'Q18'fEBED IIIdDE$ LAWB OF STATE OP ffi1XNE80TA
LICEH8ED BY OADI�ANCR OF CI?Y OP MINI�TEApp7.Ig
6917 (dahn 4�r. \. ' r�.99.�. ,
�i�nnrapoJi., llinn� w��a �'�t2A
' - ,s. l..�!�tAL C..)M6:N�N
...�: .; -_,�,.pAFM,r�: �urbeporg �erttficate _ � .:.-:k� r.,A.� �a .�.� . ,,
..` �t� c��tt�NG 'ANG :4k�,;.....r, rxrt.:�.,�� , •,,
b+E.'pn�(?L,•�'� AREA
surv�er Pari: T--- ....._�
� � . e�r � n+c.
��/A�p �54g -
�
Lat 2, 31ock 3,
"�lseil�s Riverside iiai�hts Plat 2
, ,.�•,.. �;rf � •.Ve •nd .o��ecl reprofenfa-
' ' , �. �� � "d�'•�� o( 1he •bore described
' b` ��•�9� s^d •iti�lp eneroavb.
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._.._. __._____. _
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. IAT SUR EYS CQ111P.�2YY _. _ _. _ _.
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• 1 1 � +�
,' � APPLICATION FOR RESIDEMTIAL BUIE.DING PERF�IITS
�NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
, I , � �i � _ :
�OWtdER: vc � BUILDER:
. Address: �� ���� Address: �_'
� �
0
. �.:_ ��yo ���t:
Tel. No.:
_ ``tl� ` ��� _ _
I,OT: __ � BIACY.: � 11DDITION: ��,,.o� � � � �� ,
CORNER LOT: INSIDE I,OT: _� g�gA�; SIDEYARUS /�� ���� �
f
Applicant attach 'to this fozm �vo Certificates of Survey of Lot and proposed
building location drawn on these Certificates. .
DESCRIPTION OF BUILDING
To Be Used As: • �� /
� De th : ,�
��s (v�/ Front: p �' � � Height: �
Square Feet: �_ y�j Cubie Feet: !� ,S`��
Front: Depth: � Height:
e
� Square Feet: Cubic Feet:
Type of Construction: ��`�� � Est3mated Cost: $ �
Zb Be Cc�mpl.eted: li°li�.� � . . � °�� ��'�•
Alt. A Alt. B � �
Proposed Driveway Width I£ 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 inforn�ation.
'�— �
nA�: �'''��3—%% sic�p,�:
Stipulations:
1. ��-� �`�`�`�'`��,:�,:,
,�Q-�/I��-
C !/ U �,�r � S)
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- � B�IILDItdG PERt�7IT FE� SCH�DULE � ,
'� shall, bcfore issui.ng pc�its for the erection
CC��� p� I3uildir�ys t0 Y�{isting buildinq or stru��a.�re.
� addit�on an U OA aPP�icatic;n
or fer atiY bui�.clinq or structure. P ount
�stxucturc, �isting �it o£ �ees to tihe 2m►.
,on or rcpairs to anY
� by �� applicant for such p�
the PaYr°�' e manner herein provideci to-wit: .
►rth and in �
• -- ., ,.�n �,�bic feet..
6ingle Fam11Y ��e3 and Garages s �' . ��, -. -
hcent of buildin9 Pe�l� fee.
p; (Concrete Curb Streets Onlyilacement o� �oncrete curb and
Removal and rD iveway widtl� Plus 6 feet x$1�.75
Alterriate A� gu�ter only;
! oval. and replacement of aoncrete roabhawa�
A].ternate B: R�n► � foot wide aPP 40
gutter and install a 3 Wi�� P�us 6£eet x$15•
• g inch depth; Driveway .
' ADDITIONAL F 4 IO �
� � , rmits.
the cubical contents o£ any
-; �omputing fees for building Pe �e ground area coverea flom a
� -�on, is determined by mu].tiplying t� cellar to the
u��=�7 inches below the f1o°r line of the basemehe ght of the roof surface
point si.x (6) er surface or to the averag
average heights of the upp
of the main g�le of a pitched roof .
airs or alterations to an exi.sting structure,
the fee shall be at the rate
For rep 500.00) or fraction thereof in the cost
I pf $3.00 �er each five hundred dollars ($
' of all propased work. ,
ed for any Permit as set forth in 5ection 2 be less
In-no case shall the fee charg �
than $7.50 plus $.50 state surcharge.
. EV RLF:CeT1�iJ OF FOU�nATI(}N _ �
NOTE: Pexmits for construction�will be issued a minimuma structureSand of�thet�e
of application to allow for proper review of the pro�
construci:ion site. '
A Certificate of Survey of the lot, showinq the location of the foundation oncc: it
has been constructed will be required before proceeding with the framing.
.
, � � :\
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
sai.d stru�ture shall not be aised or occupied until a Certificate.of Occupancy has
been issued. • .
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SUBJECT PE . �,
City of Fridley 217 9 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
i i. NO.
� • COMMUNITY DEVELOPMENT OIV. � � � �
' j L �"��',
r � � PROTECTIVE INSPECTION SEC.
1 i �
� �"'1 � CITY HALL FRIDLE� SS43P NUMBER REV. OATE PAGE OF APPROVED BY
�'""'� � ,�� 612-571-3450 910-Ft 5 4/16/�3 / /
JOB AODRESS 7580 Alden l�Tay NE
t LEGAL �OT NO. BLOCK TRACT OH ADOITION SEE ATTACHED
DESCR. 2 3 Elatells River Heights Plat 2 SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHOPIE
Robert McAdam 7580 Alden Way NE 571-9692
3 CONTRACTOR MAII ADDRESS � Z�P PHONE LICENSE NO.
Landmark Inc. 7580 Alden Way NE 571�09�.7. 1125
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS 21P PFIONE LICENSE NO.
6 USE OF BUILDING
R@�alC�iPSl't18�.
7 CIASS OF WORK
O NEW � ADDITION � ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reside, k�..tchen xeulQd.el; . �loox'ing; sheetrack.
9 CHANt3E OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY 6ROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOH ELECTRICAL, PLUMBIN(i, HEATINd,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES 1VULL AND VOID IF WORK OR CONSTRUCTION ZONINd SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS 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 OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $lO QO:O� $S a OQ
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r
DOES NOT PRESUME TO GIVE AUTHORITY TO YIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $117.OQ �''lx@ .SC $�.O..00
STRUCTIO OR THE PERFORMANCE OF CONST ION.
,� PLAN CHECK FEE TOTAL FEE
'� 13cense SC .$5, QO $137 L OQ
SIGNATURE OF C RACT - R AUTHOFiIZED AGENT (OATEI EN P OP LY V ID D THIS IS YOUR PERMIT/y
� b � // _ / �
S�GNATUREOFOWNERiiFpWNERBWLDERi �DATEi " DG �NSP ria7E
� Cl
ADDN [ ]
ALTER [ ]
Construction Address:
Legal I�cription: _
Owuer Name & ' dd
Contractor:
Address: %�/.�'
LIVING AREA:
GARAGE A1rEA:
DECK AREA:
OTHER:
err�r oF ��Y
SINGLE FAMIGY AND DUPLEXES R-1 AND R 2
Building Permit Application
Effeetive 1l1/93
���q z
- � �� Tel. # �/`��'�
�' � � , - MN LICENSE # %/s2,�
Tel. # o �,�...0 �9'%
Ad�+ch to this ap�ilication, a Certific� of Survey of the
lot, with the propased construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT '
Length ,,�e� Width � Height � Sq. Ft. _����
L,ength � Width Height Sq. Ft
�� Width . HgtlGround Sq. Ft.
, � <, sJ� - r i . ��.e�.,9 - �-1-i `t°�% �. U Ca.1l �.� - �GnD.�'I�itJCo
Comer Lot j] Iaside Lot Fi. Yd Setback Side Yard Setbacks
Type of Consttvction: Estimat,ed Cost: $ /�� O�- G�
Approx. Completion Date: ��/ °°-�� .
(Cost on Back)
Driveway Curb Cut �dth N�ded: Ft + 6 Ft =. Ft x$ _$,
�
DATE: �%� "��' APPLICANT: ,.� � '=� Tet. # /��/
CITY iJSE UNLY
c�
Permit Fee $ � r 7
Fire Surcharge $ ���—
State Surcharge $ 5 `°°i
SAC Charge $
License Surcharge $ �
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIUATS:
$ /.3 % �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOti�%)
$.50/S1,a10 Valuation
$750 per SAC Unit
$5.� (State Licensed Residential Contractors)
Alt "A" or Alt_ "B" Above .
F� Determine�i bY Engineering
Agreement Ne�essary [ ] Not Nece.ssary [ ]
. . BUII.DIN(i PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pe�mits for die �ion of aay building or stiuc,t�re,
or for airy addition to a�y existing bailding or stcucb�re, or for any alt,�ation or repair to any existing
bnilding or stivcture, upon aPPlicatioa the�efore, r�oquire d�e �Ym� �?Y � aPPlic�ant for such permit
of fees to the amouat henein below s� forth and in the a�anaar h�+ein pmvided to-wiC
TOTAL VALUE
$1 to $500 -
$501
i��
$15 (Minimum Fee is $15 pins s�nr,�rge)
to �$Z,O� �$15 for first $�0 pins $2 for each ad�ditio�l $100 or
frac�ion thereof, �to and including $2,000
$2,001 to $?5,000
$25;001 �o $50,000 '
$50,001 to $1�,000
$100,001� to $500,000
$500,001 to $1,000,0��
$1,(�4,001 and up
. $45 for first $2,000 plus $9 for �each �dditional $1;000
or frac�ion thereof, to and including $25,000
. $252 �fot �f�rst� $25,(�0 pl�s $6.50 for each additional $1;000
� or fiar,tion �eof, to. and idcluding $50,000
$4,14.50 for first $50,0� plus $4.50 for �ch additional
$1,000 or fraction the,reof; to .and including $t00,0�
$b39.50 for 5r� $i�,000 plus �$3.50 for e�ach additional �
$1,000 or fcaction th�eof, to and iacluding -$500,000
$2039.� for the ftrst $500,OOQ plus $3 f� each additional
�1,000 or fraction thereof, tu and including $1,�Q,000
$3539.SU for the first �1,OQ0,000 plus $2 for each additional
$1,000 or frac�ion �th�eof -
DRIVEWAY DEPRESSION ESCROW
(Concrete � Curb Stre�ts Only)
Alternate "A": Removal and replaceme� of curb and gutter only - Driveway width plus �6 fe� times
$13.50. " .
Alteanate "B": Removal and replaceme� of curb and gutter and in�tall a 3 foot wide.
.approach witfi 6 iach depth - Driveway wi�fi plus 6 feet times $15.75.
VERiFICATION OF FOUNDATION
Permits for coastruction will be issved a minimum of 24 hours from the time of application to allow
for proper review of die proposed struc�ttue and of tt� coastruction site. .
A Certificat;e of Survey of the 1�, showing the location of the foundation once it has it t�s been
coa�tructed will be required before pmc�eding with the framing. .
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CHIlVINEY AND STACB 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 BTTJ's connected
C�
7.
�'.�
Has total heating BTU's of
%'es()No()
All other BTU's
TOTAL BTU's
Has a liner been provided for water heater Yes () No ()
�
Has combustion air been provided for wa[er heater Yes () No ()
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
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°�'HE BELOW MUST BE FILLED IN WHEN REPWCING FUEL BURNING APPLIANCES OR THE
APPLICATION 1MLL BE RETURNED
r�n�• ;enn� ��n�T��/Ff�'T' pl�l�! GTnR AI�!D COMBl1STlON AIR VFRIFICATI�N
�@n � la _in0 anin_� 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 plastiGPVC and meets all current codes and manufacturer
specafications including s"¢ing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the c�rrent codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
'�'�e �,ci�tina cembuehen air is sized and installed to meet the Cul7ent Codes
and manufadurer's specifications.
Wh@n �Ulf@d t0 �ne+all a n�w comti�etien aic it will be sized and installed
to meet the current codes and manufacturers specifications.
When in����r,aa n_w ver�iin0yy� m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
speafications. This does inGude AGA-GAMA Category I Central Fumace
Verrting Tables for fan assisted and natural draft appliances.
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()
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes( )No( )
! � • . � . � ' . � • • 11 11 • � ' � . � • ' � • � � ' M � � • /11 . • �
Appliance #1 Type BTU Input Fan Assisted or Nat
AppGance #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
' 1 1•► �- r•-
HEATING CO:
Signed By. - Date :
_
_
CITYOF
ERiDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 23, 2004
Mr. David Yonce
7580 Alden Way NE
Fridley, NIN 55432
Re: Final Inspection at 7580 Alden Way NE
Contractor: Roger Wiley Inc.
Dear Mr. Yonce:
A plumbing permit was issued on September 17, 2�3 to install a backflow preventer at
your address. According to 5ection 4715.28� of the State Plumbing Code, a final
inspection shall be conducted on the work authorized by this permit. As of this date the
final inspection has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 da.ys and if we do
not hear from you within this time to set up the inspection, the permit will be marked "no
inspection called for by homeowner after notification" and expire the permit.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
�incerelv_
DJ/mh
SuB�ECT
City of Fridley
AT TME TOP OF TNE TW�NS g U I L D I N G P E R M I T
�
� �
� ��
� ; y _���� � COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 . �
� i /'�'1 � CITY MALL FRIOLE� SS�32 NUMBEP t1EV W►TE
�"""� � �'' 763-571-3450 s� aF� s 10 / 14/03
J08 ADDRESS ��g0 Alden Way NE
t LEGAL �OT NO. BLOCK TRACT Oii ADDITION
oescR. 2 3 Elwells River Heights Plat 2
2 PROPERTY OWNER MAIL AOORES$ Z�P
Laura Yonce 7580 A1den Way NE
3 CONTRACTOF MAIL ADORESS Z�P
Renewal By Andersen 1920 Co Rd C W, Roseville, MN 55113
e ARCFIITECT OR DESIGNER MAIL ADDRESS Z�P
S EN(iINEER
8 USE OF BUILDING
Residential
7 CLASS OF WORK
8 DESCRIBE WORK
Reulace 3
MAIL
❑ NEW O ADDITION 0 ALTERATION
tio doors within exis
9 CHANOE Of USE FROM
TO
� REPAIR
/
IT NO.�
33971
RECEIPT NO.
��.�.J
Or AVVnOvEO er
/
SEE ATTACHEO
8MEET
763-574-0676
PMONE LICENSE NO
651-264-4777 20130983
PMONE LICENSE NO.
PMONE LICENSE NO
O MOVE 0 REMOVE
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelZing
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
. �� �.
tpA ���f•.iz�5',
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:?
t �� � ��� . . .
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+.. ...'. 4.
SEPARATE PERMITS ARE RECUIRED FOR ELECTiiICAL, PLUMBING, NEATING, �
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHOR12ED IS NOT COMMENCED WITNIN 80 OAYS. OR IF CONSTpUCT10N
OA WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 OAYS AT
ANY TIME AFTEp WORK IS COMMENCED. NO. DWLG. l
I HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINEO THIS APPLICATION 1
AND KNOW TME SAME TO BE TpUE AND COflRECT. ALl PROVISIONS Of LAW$ yp�UAT10N
AND OROINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIED
WI7H WMETMEfi SPECIFIED MEREIN Oii NOT. TME GRANTING Of A PERMIT �S f 741
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OH CANCEL TME pERMIT FEE
PROV�SIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON- �125 . LS
STRUCTION OR TME PERfOiiMANCE OF CONSTRUCTION
S�GNAtUpE Of CON'AAGTOp OR nUTMOp�2ED eGENT
IDATEi
�OAT i
STALLS
SC $5.00
a
CU FT
GARAGES
�2.8%
iAC CNARGE
Fire SC $5.74
fOTALFEE
$138.86 ,
LOAO
�[ ]
ADDN
ALTER
��
[l
Construction Address:
Legal Description: _
� Effective 5/10/99
CI1'Y OF F'RIDLEY
SINGLE FAMII,Y AND DUpL�EXE.S R i AND R 2
��� � ^ BIJILDING PERMIT APPLICATION
,�
Owner Name & Address • I f 11. q, j1.�, � (�,'� ( �P , Tel. #��,R� ' �j I �i- � �,.9� ��
Contractor:; �i�ex�wa� '�u A���x . � � MN iICEI�SE # o'ib 1309 B
Address:_j9a� C.Ot�n�'t�0o►d C.. W�,�,��'�,�';�-.u�lk.� Y1c1� 55L1�_Tel. #(�`�I•al�(•�(}}�-
Attach� to� this appl�cation, �� Cer[ificate� of Survey. ii�-�e �
lot, witfi th�'progiisec��consi�ictina� dravv�i�on it to scale.
. ,
. . DESC�.�1'J OF �-�.i)�E11�iVT. �. . � '
LIVING AREA:
GARAGE ABEA:
DECg AREA:
OTHER:
Construction Type:
Length
I.ength
Length
��.� �--�-� ° `��1—��
Driveway C�irb C`ut Width Needed:
DATE: I�J �.� �.�
Permit Fee
Fire Surcliazge '
State Su,rcharge
SAC Charge
Lie�nse Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPLTL,ATIONS:
Wisith Height Sq. Ft.
Width Height Sq. Ft.
Wicitti � Hgt/Ground Sq. Ft.
'J C�J�i�`� \ rJ I i t,�. P k�t � i-, �r,.-_ ���P r ��::, ,-.
� �
Estimated Cost: $ � �� `� � � �
Ft. + 6 Ft = _ Ft x $_ � = $ .
� 1�.S.a�
� �y
$ o`� �6
$
�_�.�°°
$
$
$
$
� ����
T�. # 95a •3�,s•c�o4�-
CITY USE ONi.Y
Fee Sch e � �
edul on Reverse Side
.001 of Psrmit Valuation (1/lOth%)
$.50/$1,OOQ Valuation
$1050 per SAC Unit
$5.00 (State I.�cEns,�d Residential Cou�ractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�es q
_ `
ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 iJNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX:
: 7580 ALDEN WAY NE
: 103024120019
: ELWELLS RIVERSIDE HGHTS PL2
: LOT 2 BLOCK 3
: BUII..DING
: RESIDENTIAL
: ADDITION/ALTERATION
E�711� � ��t;�ll
PERMIT O.: 2004-00�
DATE ISSUED: OS/18/2004
VALUATION : $ 300.00
NOTE: SEE NOTATIONS ON PLAN.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317 OF Tf�
2000 INTERNATIONAL RESIDENTIAL CODE. BATH REMODEL -REPLACE WATER DAMAGED FRAMING ALONG
EXTERIOR WALL.
APPLICAN'd'
YONCE DAVID & ALOI LAURA
7580 ALDEN WAY NE
FRIDLEY, MN 55432
OWNER
YONCE DAVID & ALOI LAURA
7580 ALDEN WAY NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances goveming this type of wor�
will be complied with whether specified herein or no� The
granting of a permit does not presume to give suthority to
violate or cancel the provisions of any other state or local law
regu�lating co�uc�on o�he performance of construrth'o�,.
Bldg Insp.
BUII..DING PERMIT FEE
FIRE SURCHARGE
STATESURCHARGE,VALUE
TOTAL
�y � � �
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
23.50
0.30
0.50
24.30
NEW
ADDN
ALTER
Il
I]
�
CITY OF FRIDLEY
6431 Universit�r Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�� ���i �
Effective 4/1/2004
(763) 572-3604 Bldg Insp �
(763) 571-1287 F � � �
O��
Construction Address: %5$� �) lde� �U� , Fi� �l�v . inN �SY3 �
Legal Description: S�„ �Q �,�, � �� 1/a>rr �
Owner Name & Address: �Ja v P r�l Yon �� c� r��r ss s�� Tei. # Z,� �- S7�-ai 7�
Contractor. MN LICENSE #
Address: Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width HgUGround Sq. Ft
gcr d��► ►'�e e�Yl •- %r�o �� X .� � �-�%° �' . .3%r s �1' �
Construction Type: �e�B �r ��-� o�t Estimated Cost: $� , .3 0 0= o �
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: s P g��/ APPLICANT: ��'�i� YQj''c�e Tei. #?(3�S"7�-G'G�G �N�
6S► —s�z �s� C�j
Eall (763) 572-3604 for Permit Fees if mailing in applicatlon. Fax to 763-571-1287 if using credit carr! and we will call
you for card number. '
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ �. ��
$
$ ��D
� s ��
$
$
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
TOTAL $ ��I , �� STIPULATIONS:
BUII.DING PERNIIT FEE SCHEDULE
Official shall, before issuinS Permits for the erection of any buildin8 or stru�ture, or for any
The Cluef Building building or
addition to any existing building or structure, or for any alteradon or repair to any exisl3ng
stru�ture, upon application therefore, require the payment by the applicant for such permit of fa;s to the amount
herein below set forth and in the manner herein provided to-wit:
�� .
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,0�
$100,001 to $500,000
$500,001 to $1,000,0�
$1,000,�1 and up
FEES
$23.50
$23.50 for first $500 plus $3.OS for each additional $1� or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.OQ for each additional $1,�0
or fraction thereof, to and including $25,�
$391.25 for first $25,000 plus $10.10 for each additional $1,OOQ
or fraction thereof, to and including $50,000
$643.75 for first $50,0� plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fiaction thereof, to and including $5�,000
$3,233.75 for the first $500,000 plus $4.75 for each add.itional
$1,�0 or fracdon thereof, to and including $1,000,�0
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete C�rb 5treets Only)
Removal and replacement of curb and gutter on1Y - driveway width plus 6 feet, times the annuallY determined
rate
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the �°ns��tion site.
VERIFICATION OF FOUNDATION before
A Certificate of Survey of the lot, showin the location of the existing foundation will be required
proc�ding with the framing. New Houses Onlv
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX:
: 7580 ALDEN WAY NE
: 103024120019
: ELWELLS RNERSIDE HGHTS PL2
: LOT 2 BLOCK 3
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
�
PERM N0.:200400733
DATE ISSUED: OS/18/2004 �.
VALUATION : $ 0.00
NOTE: COMBUSTION AIlt SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. CHANGE THREE FIXTURES
IN BATHROOM ALTERATION.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS)
# GAS DRYERS
# OF NEW FIXTURES
/;\���ICN\�Y�
YONCE DAVID & ALOI LAURA
7580 ALDEN WAY NE
FRIDLEY, MN 55432
OWNER
YONCE DAVID & ALOI LAURA
7580 ALDEN WAY NE
FRIDLEY, MN 55432
0 # GAS WATER HEATERS
0 # GAS RANGES
3 # WATER TRMT APPLIANCES
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I ha.ve read and examined this
application and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or no� The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or locallaw
regulating consttuc ion or the performance of construction.
Appli Date
Bl �iA�—� Da� � , �'
� �P
PLBG PERNIIT 11�II1VIlViUM FEE
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (EXIST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0
0.00
30.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.50
30.50
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THE BELOW MUST 8E FlI.LEp �W WHEN REpLqCINO FUEL BURNING APPLIANCFS OR THE
APPUCATION WILL BE RETURNED ��` ' -.
' . i • :T
COMMnN VFIUT �MT �!n�F�TAR eNi� �`AMl31ICTIAI� OIR t�RIF7 � ATf[�R �.� `�;
. " _
Wh@t1 rp la�i i�i ° �
-1�-=�0 9^--�Y�^_a fi�=, the undersigned hereby verifies that �e
venting has been examined and is free from rust, deteriora�on, obsbucdons,
and is securely supported and firestop�d where r�uired. Yes () No ()
The venting system is plastic/PVC and meets all cx�rrent c�cles and manufac�urer
specifications induding sizing, length, number of elbows and tem�inaati�on. Yes () No ()
The undersigned also verfies that the replacement unit is a listed assembly
and meets the current codes and manufadurers specifica�ons. This does
include AGA-GAMA Category I Central Fumace Ventlng Tables for fan
assisted and natural draft �ppliances. •
The eY��r��A _omti����., s�, �S $�� and installed to meet the current c�des
and manufacturers speafications.
Wh@11 �2qUlf@d t0 Inc4a11 a npw eemhuctinn 9irFit yyj�� b@ SIZ@d 811d �nStB��@Ci
to meet the current codes and manufadurers spec�fice�ons.
Wher1 inctallin� a new v_e�tin���� �e undersigned hereby verff(es that
�t is a listed assembly and meets the cument codes and manufac:tuurer's
specifications. This does indude AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
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 ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
� � • . 1 / : : � � • 11 11 • � ' • . � � - � • � � = M • �1 • �11 . � �
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type __ _ 6TU Input F�n A�isted�af �t _
Appliance�#3fiype -- BTU Input Fan Assisted or Nat
Total Appliances ` Total Btu Input
Common Vent Type Vent Height Diameter inches
,
Appliance #1 Vent Connector He(ght ft Length ft Oiameter in Type
Appliance #2 Vent Conneaor Height ft length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length _ft Diameter in Type
��\i��r• ► . _ . . _
HEATING CO:
Signed By: 08te :
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ADDRESS
i� i�l
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 r'AX:
: 7580 ALDEN WAY NE
: 103024120019
: ELWELLS RNERSIDE HGHTS PL2
: LOT 2 BLOCK 3
: PLUMBING
: RESIDENTIAL
: AUDITION/ALTERATION
571-1257
PERNIIT N 2004-00786 � �
._��
DATE ISSUED: 05/27/2004 0
VALUATION : $ 500.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL GAS WATER
, HEATER
�# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS)
# GAS DRYERS
# OF NEW FIXTURES
APPLICANT
NORTHWOODS MECHATTICAL
BOX 1085
FOREST LAKE, MN 55025-
(651) 257-4951
� `.I_��_ �
YONCE DAVID & ALOI LAiJRA
7580 ALDEN WAY NE
FRIDLEY, MN 55432
0 # GAS WATER HEATERS
0 # GAS RANGES
0 # WATER TRMT APPLIANCES
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced. �
I hereby certify that I have read and examined this
application and know the same to be true and conect. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or no� The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or locallaw
regul 'a��uc�pn or the performance of construction.
Bldg
PLBG PERNIIT 1�RINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (E3�ST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 6161
�
SEPARATE PERMITS REQUIltED FOR WORK OTi�R THAN DESCRIBED ABOVE.
1
0
0
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.00
0.50
35.50
Building -
Inspec�ions
763-572-3604
763-502-4977 FAX
dAT7:
From: 6127221021 Page: ?l3 Date: 8/7/2008 4:08:21 PM
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