AF - 46968sue�ecr P MIl`NO.
City of Fridley 14861 �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
r
; � R PT
� • COMMUNITY DEVELOPMENT DIV.
, �,; ----- -9a
r � � PROTECTIVE INSPECTION SEC.
1 i
'4 ' r"�1 � CITY HAIL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""'�' ,'� 612-560-3450
910-F15 8/17/78 � �
JOB ADDRESS 5821 Arthur Str�.t N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. Pt,. of 39 �_E3S. S. ��� & N. ZQ��� �it1C�. SLlb. #92 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Donald L. Moore 2121 University Avenue N.E. 789-9876/788-9572
3 CONTRACTOR MAIL AOORESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS E��`��P Cjr����lpf� �LICENS;Ni�
«� ,-Eku R ;� n
6 USE OF BUILDINCa S
Residential �
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCR�BE WORK
Construct a 44' x 28' Dwelling and a 38' x 3Q' Garage
9 CHANGE QF USE FROM TO
STIPbLATIONS provi.de a hard surface driveway. Provide sod in the front and side
yards. Provide a verifying survey before capping. Provide combustion air
to the furnace area. Provide shop drawings and desiqn load calculations
for garage area before footing inspection.
SEWER IACATION: (Approx. 9' Deep In Street) 185' N. of Manhole (Inv. 950.00)
WYE ELEV: 955.62 TOP OF FOOTING: 958.92 Miniru�n
WATER LOCATION: Approx. 10' N. of Sewer Service
DRIVEWAY DEPRESSION COST: 16' + 6' x$14.50 =$319.00 ����
TH� CttY O� I�IptEY DOES �iOT GUARANTEE ti!! �@fOm dt$�if1$ C8N IOCfj utiiit� i
�+ccuR�cir aF un�rnr �outroNS �r,o �v�t,ok�, TELEPHOAE - ELECiRIC - GAS E.
�'h11S DATA IS FOR INFORMAiiON PURPOSES ONLY ANU � � � � � � �; � � : �r� LJ�1
�ERSONS USNVG R SNOULD VEWFY TtiE NVFQIllW�ltlpM
ON rni SrtE �
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FrBCIe
THIS PERMIT BECOMES NULL AND VOID IF WOfiK 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 1232 +1140 46,688 Tota
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHEfi SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT $79�0%S $39.54
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- c.
STRUCTtON OR THE PERFORMANCE OF CONSTRUCTION. � y��.HC. %S q4OO. OO
PLAN CHECK FEE 707AL FEE
46.69 $672.98
SIGNATUREOFCONiRACTOl70RAUTHORI2EDAGENT IDATEI t �WHEN PRO ERLY VALIDATED THIS IS YOUR PERMIT
� �� .........Q �1 � �tv.�,Q � I\��� _ c� ..-) c�-� c� -'l�
SiGNATUREOFOWNERIIF NERBUILDERI � c I�AfEI BLDG. WSP nATE
�
. . cz�rY o�= �=lZIULCY . � '_
' /�P('LI Ci1T1 Ui� FOR RLS I llf:tvT I/1L BU I LD 1 �1G PERI'f I 7S ,
' tf'�Lw� nLTLR/iT'I UfJS, �L}llI T I UNS, OR RE!'/�I l2S )
�
OWI��R: � ������ ���Q`� JlUTLll3�R: ����`�
. l�ddre�.s: c���.� �'\.1�V�'�cC��� �� ��T+ddress:
a..�.,�� �.. is `�4�``'� °��2i�� ` �.�� �5��
��02 � � �T��2C- � ��'-`
J�o. : Street :
�'� So�� °�ll i�'v.1 � O`C- '�
LOT:�l�� }3LOCK: ADDITIOP�: � Cj ��
GOktt•diR �,OT: It1SIDE IAT: SLTBJ�CY.: SZDL•'Y11RDS:
Rppli.ca;�t attach 'L-o L-his form Tao Cert-iiicates of Survey of Lot and proposed
bu�.lding locatian dra�m on these Certificates. .
D�SCRI PT10('d OF $UI LDI �G
.,
To Be Used 11s: '
� e� f Z� �
�•��1� Front: ���^ Depth: ��] � Height: -
Square Feet: -��3 � Cubic Feet: �J S o2 g0 r
1 i l
�-�Y I9cont: _�� Dep�h: �d� Height: � D
� Square I'eet: !� . � Cubic I'eet: '
7'ype o� ConstrucL-ion: � Esi:imated Cost: $�p. ��
To Be Completed: �"' x '�
f Alt. A A].t. R
Prdposed Driveway Zti'idth If New Opening Is Desired _ 1� $ $
(S�T: ]2EVERSE STD� OF SiiEET)
�he undersigned hereb�� r.zai��,es appli�ai.ion for a permit for the work herein
s��ecified, agzeeing to do all c.ork in strict accordance �aith the City of
Fx�dley Ordinances and rul.inys of the Dep�.rtmei�t of }:,uildings, and hcreby
c�ecl.ares L•rat all the facts and re��resent��ians �tated iz� i:his application
are true and correct. Sec reverse side for aclditional ini'ozmation.
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NOTE : USE 12°6 OF OPAQUE WALL AItEA FOR x'
FRAME CONSTRUCTION CONSTRUCTIOiV (R) VALtTE - �``: "�
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WALL SECTION - Tf+�R'N G�i�°ri�l�=' �%�"I.e' kJ�'i+►LL PAGE , . �
NQTE: USE 12X OF OPAQUE WALL AREA FOR ='r/,�a" /.�v/l T%�J iTiS� 3/� N�ir/, ,�• �
FRAME CONSTRUCTION CONSTRUCTION (R) VALt7E � �
FIG. #11�PLAN VIEW
FiG. �l�"SECTION
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WALL SECTION — PAGE
NOTE: USE 12% OF OPAQUE WALL AREA FOR
FRAME CONSTRUCTION CONSTRUCTION (K) VALUE
,
- I-. - � 1. Interior air film 0.68
2 � --
� � �j ' -----`
� � --- 4 4 -- --- - —
� 5 5 '-- --------
�� —__ � b. I:xterior air film_ _ �•17
T�TAL (R)
FIG. IP1 PLAN VIEW "P"= 1/R=
- � 1. Interior rjir f ilm 0.68
- � +- � - —
� - - 3 ' -- ----- ---
_ a 4
__y 5 ------------
� E�. Exterior air film 0.17
_ � - ------ TOTA L i R )
FIG. Ill SECTION "1'"= 1 /R=
r
FIG. ;F1
�� �- COTiB. "11"=( . 1 �' X )+( .88 X
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FIG. �t���SECTION
F1G. �t3 SECTION
�
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2 .— — ----
3 . --- _ _
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— --. __ ---- --------- -
5.
6. Exteriur air film 0.17
--- -- - I'O Tf1L ( R )
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-' - -- - ---
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i.
6. Exterior air film __ 0.17
T�TtIL (R) � �>"
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2.
3. Exterior air film 0.17
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us� .o�
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3•
4.
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R
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C�U".( X )+( X ��e. _
� CITY OF FRIDLEY � � .
APPLICATION FOR PLUMBING AND GAS �:fiTING P�RMIt
o� >, en ' u K e� water
e� a; d+ �� u c� m a � aa w � Heater
r� u .-1 M H�� n f� N rd S+ p�
k s n G .0 �-�i � .r �� 3 � U� O.JC a U C�i �
v, ' i � � s� � 3 Q 4°• b[i g � w� d? � � c� o as lec
\ \ \ • a. \
is� \ `.
2n3
3r�
4 t�
(R) = FLture Connection Openinq Connected with Sewer
(') = New Fzxture, Old openinq Water
PAftTIAL RATE SCHEDULE . '
PLUAffsING FIXTURE RATES: N0. RATE TOTAL
h^.u��r Fixtures �� x S3.00 $�'' � 6b .
Fvture F�cture Opening � x 52.00 S .Ub
Nsw Fixture, Old Opening •� x $2.00 � $
Catch Basin x $5.00 $
Water Heater - to 99,000 BN �_ x $5.00 $ S•c50
lOG,000 BTU to I99,000 STU x$1D.00 S
' kater Sof tener x $7.00 $ .
New Ground Run Old Building x $5.00 $
Electric Water Heater x $5.00 $
GAS FITTINC FEES: • ..
. lst 3 fixtures �_ x'$3.00 S �•�"
Additional Fixtures x 51.00 $
Gas Ranqe to 199,000 BTO x ST0.00 $
REPa1RS F, ALTERATIONS
First $100.00 $5.0� S
each add. 5100.00 or fzactton S2.00 $
State Surctiarqe $ .50
, ToTAL FEE S S.S�
u
Job Address = ���`� ��� `� v � ��� ;
Depaztment of Buildings
City of Frid2ey .�
Tel. #571-3450 .
The undersiqned hereby makea application !or e permit !or ihn wrk heze3a
specified agreeing to do nll work in atrict accozdance with tha City Codes
and rulinqs of the Department of Suildfngs, and hereby declares that all
the facts and representations stated in thia �pplication are true and oorreCL
Fridley� Mn. �a"� c��— � 19� �
OWNER � �'O
KZND OF BUILDZNG n Q�VllL� �
i
USED AS �
TO BE COMPLETED AHOUT '
ESTIMATED COST ,
OLD NEW UILDSNG PBRMZT NO. PERMIT NO. ����� �
Company �� �,�� �- �'��
Siqned Sy h� �— �.4 � � .
Te2. No.
ROiJGH INSP.
DatB
FINAL ZNSP.
� � Ddte
APPROVAL FOR PERMIT ��GC1�G.1
MINIMUM FE8 FOR ANY PLtIMBING PERMIT 2S $7. S0 pypg a.50 STJ1'L'E SfJ�71RGE
REZNSPECTZdN FEE •
(510.00)
0
�
0
0
crYY �or- r-iilv�cY .
• APf'L1C�TT01� FOR R�SI;)[�t�TI/1L BU1LDI��G ('EIZt�1ITS . g��3�
' �I�L"W, nLTLR/1TIUPJS, nL�UIT10tJS, OR REPAI{2S) �
OWtI�R: �ntiS �-LbJ /�"�UO,E'_� � �uzz,nr•.��: : - ' .
r�aax�ss: ' naarc�s: �
� Tel. No.
No. : ���- � Street : QJ) �yt .�t 11� � ll � Q � .
LOT: �' D �,,,_,_ BIACY.: ADDITZON : ( .�1 � v�% . � . ���
�
COi2I�IER LOT: INSID� IAT: SLTF3ACY.: SIU�YARDS:
Ap�lica'r�t attach 'to L-his form Z��o Certii-icates of Survey of Lot and proposed
buS.Iding loeai:ion dra�m on these Certificates. �
To Be Used As:
DESCRI PTIOf�d OF BUI LDI �G
. '.
Front: Depth: ' Height: -
Square Feet: Cubic k'eet: �
I�ront: � Depth: Height:
� Square reet: G11bic Feet: �
Type of Gbnstruction: Estimated Cost: $
Zb IIe Completed: ' Alt. A Alt. B
Proposed Driveway WidL-h If New Opening Is Desired $ $
(SEr R�VERSE SIDE OF SHEET)
The undersigned hereby mal:es application for a permit for the work l�erein
specified, agrecing to do all �aork in strict accordance with the City of
Fxidley Ordinances and rulings of the Department oi- Buildings, and hereby
declares i:hat all tlic facts and representatians stated i�l L-his applicaLion
are true and corrcct. See reverse side £ar aclditional ini'ozmation.
DATE: SIGNATUF.E: � ,r---e.�� �'''t_ ��•�
Stipulations: ��l�.l J�.C9J ��.���-SSl U�IJ �Se�!(-�C� -'
�� D r T � c� N A t-- '�
C
/ `� � X ��/�. .� C� _
���,� d
. . •
��i"l� C.,i� FRit3lLEY
6431 UNIVERSITY AVENUE N.E., FRIDLEY. MINNESOTA 55432
TELEPH.ONE ( 612y5T1-3450
�ch 25, 198D!
Donald L. Moore
:1 Arthur Street N.E.
.dley, NII�i 55432
Re: Final Inspection at 5821 Arth.ur S�reet N.E.
Dear Mr. Moore:
A final inspection was made on March 20, 1980 of the above address
and the following iterns were noted which must be completed before
the structure can be finaled out;
1. Provide sod in the front and si.de yards by June 15, 1980.
2. Provide a hard surface drive�tay by June 15, 1980.
3. Post address munbers on structure by April 15, 19a0.
4. Install vapor barrier on lower level walls by April 35, 1980.
We will expect the above items to be completed by the scheduled dates
when reinspections will be made to determine compli.ance. If you have
any questions on these items, please contact me at 571-3450.
Sincerely,
DARRET� G. CLARK
Chief Building Official
DGC/mh
' :�
�� .
, �.
�.
�
: . ;.
4 "�3"
'�
,,
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June 11, 1981
� CITY OF FRIDLEY
8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TEIEPHONE ( 612)571-3450
Mr. Donald Moore
5821 Arthur Street N.E.
Fridley, P�I 55432 •
Re: Completion of Sod & Driveway at 5821 Axthur Street N.E.
(�' II1AL NOTICE ).
Dear Mr. Moore:
u
An on-site inspection was made on June 11, 1981 to determine if the sod
and driveway had been campleted at your address. This inspection noted
� that neither had been ccenpleted.
We have written you on two previous occasions and extended your
co�tpletion dates twice. You had requested that the last campletion date
be May l, 1981.
The City and your neighbors have been toZerant to the condition of your
yard to this point, however with.respect to the City Code and your
neighbors, progress towards completion must now take place.
We will expect the required improvements to be completed by July 6, 1981
when a reinspection will again iie made to determine compliance. Your
cooperatian will be appreciated and if you have any questions on this
matter, please feel free to contact me at 571-3450.
Sineerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
�
June 17, 1980
� t :OTI� C�� F�IDLEY
6431 UNIVERSITY AVENUE M.E., FRtDLEY, MINNESOTA 55432
TELEPHONE ( 6i2)571-3450
Mr. Donald L. rioore
_
5821 Arthur Street N.E.
Fridley, MN 55432
Re: Final Inspection at 5821 Arthur Street N.E.
Dear Mr. Moore:
A final reins,pection was made on June 16, 1980 to determine compliance
, with our letter sent to you on March 25, 1980. It was noted that the
following items are still in need of completion before the structure
can be finaled out; ,
l. Provide sod in the front and side yards.
2. Provide a hard surface driveway.
We will expect the above items to be completed by July I5, 1980 when
a reinspection will again be made to determine compliance. If you
have any questions on these it�ns, please contact me at 571-3450.
Sincerely,
.
DARREL G. CLARK .
Chief Building Official
DGC/mh
� I ��
���
G� �'�'�, i. � S �l
�
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�
sue�etT ER I____
City of Fridley A �
AT THE TOP OF TNE TWINS g �� L D I N G P E R M I T 3' 6� �
� _ ---
� ` RECEIPT�
� • COMMUNITY DEVEIOPMENT DIV.
� ; L��'��� , � �
r � � PROTEC7IVE INSPECTION SEC.
� . .
� � /'�'1 � CITY NALL FRIOIE� SS132 NUMBER REV DATE PAGE Of AOPROVEO 8Y
�'""'�" �'' 612-571-3450 9t0-F15 2/5/O1 / /
JOB ADDRESS 5821 Arthur Street NE
1 IEGAL ��T NO. BLOCK TFACT Oii AODITION SEE ATTACHEO
oesca. Pt 39 Auditor's Sub. �i�92 SHEET
2 PFOPERTV OWNER MAIL ADDRESS ZIP PMONE
Donald Moore 5821 Arthur Street NE 763-574-1828
3 CONTRACTOR MAIL ADDRESS ZIP PMONE IICENSE NO
Lamere Concrete & Masonry 714 18 1/2 Ave NE, Mpls., MN 55418 612-834-1118 3588
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE IICENSE NO.
5 ENGINEER MAIL AODRESS 21P PHONE IICENSE NO
6 USE OF BU�IDING
Residential
7 CIASS OF WORK
O NEW C� AOOITION O ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 12', Two Story, Addition to Dwelling; Construct an 8' x 15' Deck;
remove existing ec . ition znc u es two irep aces
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Call Gopher State before digging.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
WARNING
SEPARATE ��RI�1`i� Before digging cali for
REQUtRED FOR: all utility locations
WIRING, t�EATfNG 454-0002
PLUMB�NG EANQ S1G�" RE�UIRED BY LAW
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOFi ELECTfiICAL. PLUMBING, MEATING.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK Ofi CONSTRUCTION 20NING SO. fT CU FT.
AUTHORIZEO IS NOT COMMENCED N/ITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FpR A PERI00 OF 120 OAYS A7
ANV TIME AfTER WOFK IS COMMENCED. NO DWLG. UN17S OffSTREET PARKING
I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION Z STA��S GARAGES
AND KNOW THE SAME TO BE TRUE ANO COFiFiECT. ALL PROVISIONS OF LAWS VALUATION SURTAI(
ANO ORDINANCES GOVERNING 7HIS TYPE OF WORK WILI BE COMPLIED (�8�SOO ' �Z�+.ZS
WITH WMETMEA SPECIFIEO HEREIN Of± NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OFi CANCEL THE PEFMIT f EE SAC CHAFG
PROVISIO S Of ANV OTHER $TATE OR LOCAL LAW REGULATING coN- �633.65 Fire S ��F8.5�
STRUCT pR ?HE PERFORMANCE OF CONSTRUCTION
{, f/ PLAN CHECK f TOiA� F E
�� 01 p?/S/U �
Lice S $5.0 $7 1.40
$�GNATUQE OF CQN"RACTOQ OA AU�MOQ�ZEO AGENi iD��� * �- MEN FO E 110ATE S IS �� P�MI��
s
r
S�GtiaiuAE O� OwaEQ ��% OWNEQ Bu�LOEQi �D• � ii g�p �i� rE
� �
�� �►����
�
NEW [ ] �U� Effective 1/��f260'I`%—
ADDN �c]. CITY OF FRIDLEY (763) 572-3. � Bldg In��
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION ,r.'` � �
Construction Address: S 8 a � �-t f-�-hu v S�" N� �+.� � E� � h �S`�/��
Legal Description: Lc� �- ��I �cA c,( i�--o r �c� �, � a
Owner Name & Address: 1�na1 c� ,YY�oor e_ �� n� e �4c�Ic���ssTel. #%�03 S�'-1 18�8
Contractor: �---G w,�Y c�•� Ye -�� c� s�c,.- MN UCENSE #
Address: "-7 I'-1 I`a y l-�� e� E +(�'},o� s►'�'1 r SS�1 g Tel. #(n t a� 3`�l i���
� �a 4�� o� � o
Attach to this application, a Certificate of Sunrey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width HgUGround Sq. Ft.
� S �-o r --� 6� �'C�� 4C�tC�� �d n –f' � !'� /l � ;r� � }j � �.1"
���%2C��' %J �� . c.-%G' � � ��L,C G� � �( �.S �
Construction Type: S'� ��k �., 1�- Estimated Cost: $ �'� � S� ��
-- ��'f � 6� —
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: .3 � 1 APPLICANT: �2.c�,c..p �.!�_ — Tel. # (� l� a 3y > > � 8
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $�9 3��� S Fee Schedule on Reverse Side
Fire Surcharge $ •SC� .001 of Permit Valuation (1/10th%)
State Surcharge $ ��1 , �5 $.50/$1,000 Valuation
SAC Charge $ f� $1150 per SAC Unit
License Surcharge $ � �� $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
E:
$ � , 'y
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
!•
:f
_ _ . a , . , _. . ., , ,�, .
. . . ,�X .5�5.[:. � ;P". :°,�;,a.;y , . .
\7 /
CEF�TIF"1CATE OF SURVEY
JAM ES L. KURTH
LAND SURVEYOR
42a1 N.B. 5TH STREET
COL.UMBIA HEIGHTS SS427 788-3004
1 HSRE�Y CERTIFY THAT THIS SURVEY, PLAN, OR REPORT WAS Pit6PARED BY ME OR UNDER MY DIRECT SUPERVISION
AND THAT 1 AM A DULY REGIETERED LAND SURVEYOR UNDER THE LAWS OF THE STATE OF MINNESOTA.
. ^^1 �
; .-�-. � �J„'�.., F�" � DA T E � 4 � ;1 � � � �
. .°°+�+'9"^i4� AT� Y .
� V
�' ...�.-� .�.u.,� SCALE 1"= �:� �
MtNNE TA; REGISTRATION NO. 5332 '� �= IRON MONUMENT
'f $" ��' 1 }��C�E4Z �P �
s
� ( �t? �
i � 1 �-=����` Novs�. �cxA-Troki
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Lot 39, Auditors Subdivision No. 92, Anoka Caun�y, Minne ota
except the south 90 feet and e�cept the north 200 feet
Su�g � 4ee.—s o l:.�+e»,'�r-� : o'C '� �.a � n e�r �„* ,
L .� --
, _
-
;ITY OF FRIDLEY INSPEC�1 iUN DIV.
A3t University Ave NE �
�ridiey, MN 55432 ��'°�
'63-572-3604 MARK N
Urina!
Floor 1
Floor 2
Floor 3
FII oor 4
PLUMBING FIXTURE RATES:
Shower
APPLICATION FOR PLUMBtNG AND GAS FITTING PERMIT
OF FIXTURES TO BE INSTALLED ON EACH FLOOR
x� Floor �':� ::V:::n; Auto.
_; Wash �f���:;`�;,���;:: ��� � ::
�pr� .:: . �S: '�Y:"'
'�...� Trav �n�>y:€�::�::: Drain ��i5ii�.::�` Washer
NO. RATE TOTAL
New Fixtures �
Old Opening, New Fixture
Beer Dispenser ..�----
Btow Oif Basin �--
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas"
Gas Range"
Gas Dryer"
Back Flow Preventer Required ()Yes () No
�YPe
$ 7.00 � � �
$ 4.00 _
$ 5.00
$ 7.00 _
$ 7.00 _
$ 7.00 _
$ 7.00
$10.00
$ �.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00IHr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS ���
1.5% of Value of Fixture o� Appliance �=
/
JOB AO�RESS � � 2 J �
E4�ective 4n Jan 1, 2001
Gas
Gas IElec
t1 l2 5 �- _t„� ,£-
�
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do al! work in sirict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application a�e true and correct.
�, �, I � , Zo oj
Owner
Buitding Used
� �1�"t�`� %�.�-�r�'.
T-- � - ���,� )
Estimated Cost /�� . � PERMIT NO. � �� �`�
PLUMBING CON�PANY �` U � Y , ��} � �' �" U � �� 1 I �!: �% —
SIGNED BY
Approved 8y
�,� TEL N0.
_ Rough-In Date _ Final Date �� �,)
State Surcharge �--�4 ��•;•• r« ��R AtvY PLllh�BIhGIGAS PERMIT IS '
TOTAL FEE $ U,�" _, J� p� US THE S 50 STATE SllRGHARGE
COMBUSTION AIR SHALI BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacins� an existin� furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely suppo�ted and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets a!I 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 cuRent codes and manufacturers specifications. This does
incfude AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances. Yes () No ()
The existing combustion air is sized and installed to meet ths cur�ent codes
and manufacturers specifications. Yes O No O
When required to install a new combustion air, it will be sized and installed
to meet the cunent codes and manufacturers specifications. Yes () No ()
When installins� a new ventin� svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () 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 cuRent codes. Yes () No ()
AePtiance Tvpe and Size/Common Vent and Vent Connector Information
/ —'�
. �
Appliance #1 Type �`' � BTU Input 2S Fan Assisted r Nat �
Appliance #2 Type BTU Input T— Fan Assisted or at
Appliance #3 Type BTU Input Fan Assisted or Nat
Tota) Appliances Totat 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 Connecto� Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�631572-3604 FAX: (7631571-1287
: 5821 ARTHLJR ST NE
: 243024140027
: UNAVAILABLE
: LOT BLOCK
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
PERMIT NO.: 2004-01789 � ��'
DATE ISSUED: 10/OS/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
OWNER
MOORE DONALD L& SHIRLIE K
5821 ARTHUR ST 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 wark is suspended ar 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 governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating consmzction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 118132
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.50
20.50