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AF - 47202N° 7'79 � � Villa�;e of Fridley, Minn. BUILDING PERMIT Office of INSPECTOR OF BUILDINGS `rr�'�. , � , . • � i;. , ._. � L Owner . ,. . .. ,. ..�:.. .. Architect Frid'ey, Minn.,_ Builder LOCATION OF BUILDING , i � . � No. t } � Street r'= �- '..r26�i ;. .. Addition or Sub-Division 1 , ,. i [,�/'7' � 1. .: of 19 ' DESCRIPTION OF BUILDING i , , � / ,.l Front � DeQth �� Height Stories_`� � � S�Ianner of Construction�/ ' `"`f` �` " `'� � � 1 , � <i To be uaed as '" � � � � � �� — To be completed � r �"°� �' � � � � EsUmated Cost ��. �`" -' ; � � . _ r. • . !• •t . _�.. :.t . .:_� { . ... �/p.l.c....a._ �.�- 1� s'-'1 .. L..r(u : - 4- � ' ..�+% �_ _ t+. •/ i �' 1� / !� C _ , .. , � /" .P .ct- . � _ -U f _ �f�-.-. 4 � �.. _ Permit is hereby granted to � . .-r� � c-�...._.«. , . _ . � ' ..� /_ the building "" �� -- described in the above statement. Thie permlt is granted upon the express condition that tLe person to whom It is granted, and his agents, employees and worlmien, fn all the work done ia, around and upon said building, or uny part thereof, ehall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alteration, malntenance, repair and moving of buildings within the city limlts, and thia permit may be revoked at any time upon violatioa of any oY the provisions of said ordinances. r ; / ; , ` , �'� , �`� +e- , ( �.• � <.:- . _ Inspector ,oY Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereb,y agree to do the proposed work in accordance with tlie description above set forth and according to the provisions of the ordinance , of Fri�lley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. _. --- f � ------ Subscribed and sworn to before me at Fridley, Minnesota, this� �� ; � �. . � "� /,' day of ; :.._ -,, , .. (r < A.D. 19 -=: .... � :, . , / ,', -�Ci..-c.-t�. L,�^.. • • i, , . � City of Fridley, Minn. BUILDING PERMIT N° 4 010 G �5 �� .� Date: ......... .................................. ......................................... ._........... �--............... Owner: ��-�'�� .................. Builder ._............. ' . .. ..................................... . ........... ... .... . ..--��---..._........ ........................_............._............._._._.. Address....._ ....................................................................•---._.--�-----............-----�-•---••---... Address ........_..........................................._........---.......:....---....._......._................. ...._........ OCATION OF BUILDING No. .�j- Q/Q/.iG'... Street ...... .... ... .......... ..............._ .................................._..................................... Part of Lot ...... f1..... Lot _._......... - ......._....... Block .........._......- .. ... ........._....... - Addition or Sub-Division ...._-- - - -....... Corner Lot _... Inside Lot ......---......._ .............._.... Setback ..:.................--------............... Sideyaxd Sewer Elevation ............... � ..........:...- ... � ........................................ Foundation Elevation .................. DESCRIPTION OF BUILDING To »e usea as: .�...�..�..�� Front ��.�� Depth �- �..' +Height .��"t D Sq. Ft.�.O.....�. Cu. F� .�8'a�"' ............................_........................_... Front ................ -- Depth --._....._......._.. Hei ht ��... Sq. Ft. ........................ Cu. F't. .......-- .... -- Type of Construction ._. ...J- ...................... -....._ ... Est. Cost....�/...._...�.........:-�.. To be Completed ...................._................................ ��'�',�t..""•` ��" !/ �-�--��C�! �-�f � � l� X o?' a � ,�- �'' t� GR°� �°` In consideration of the issuance to me of a pernut to construct the building described above, I agree to do the proposed wark in accordance with the description above set forth and in compliance wlth all provisions of ordinances of the city of Fridley. /"'1 /! /�� In consideration of the payment of a fee of $....�.`._'-"-......., perx�►it is hereby granted to ...........................................................:... ....._ .................................................................... to construct the building or ddition as described above. This permit is granted upon the express condition that the person to whom it is anted and his agents, employees and workmen, in all work done in, around and upon said building, or any par thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the visions of said ordinances. ., , � ,/ i-� _ � Building Inspector NOTICEe This permit does not eover the eonstruelion, installafion for wiring, plumbing, gas heafing, s�wsr or watsr. B� sur� fo sN � � fhe Building Inspector for separaM psrmits for fhese items. � 4 . � �� . � . . � � . � � � . , . �. �( V. e •M � . . . �:� W .� - � � � . � � � t • � . � � � .. .. � . � . . � �! . . . . . . � � �. � .,. . _.... -;."� ..-- ��, .—. __.: __ ___._ . � - � _ _. __. i j� i � , � t f� , -_.... , . . . .. . .��p ,� . . . .. . , � . . " . , . . . , . . . . % �. � ' . . � . . � . . . . . . � � ;i . . . . .. � I , `�`r � {i f 1; ' �, 1 (j� fl i �� __ __ � � �. � ✓% O r ; � � : � , ;, . � i . '!� ,� � j t- ,. , , j � � j • � ! _ j � i . � � _ V f% ' � . . . . . _ . . � - . � . . _ ... � . " . . . . _z. .' i � � -� � ' ' � + .;. . ! �;� �. ~��c � ` � . . - � ., . . . i . . � . . ,. . . . . . . �� . �., � r` • ' . . - - ,,- �� , _ .. ,: a `� � , �Q . . � .� _ , � - � _ � `� . , �_-.__ i , , . ;� �� . . . . � _ _ __ _ -_ � -� � _ � . , , � �., - _ _ � � . _ � , `� �,� . � . _ r .�:_. - . _ � _ ___ _ _ __� � . ,d._ .- _ , . .. ,...�� '..� ,.:� .� � . � '4� ��' . . ��'.. � . - . . . . . i ' ,. . _ . . . . .. . . % , � .% . �-- ___ __ _ . __ .,_ __�, ' � �, -�� , -- - ------- ��' � t� � � _ 'Z� , , x -�-� I <. . � � . - _- _- - _- .. __. . -__��; � ' � _ : _ `� � , � �� - " . � � , � _. ! • _ . � � � � �.C- .. .. .._ .— � . - _ .. . � : .. . ...__ .. .._ . .... __—. _ _.____ \ � - . ,� . � _. �./ .�� . � .. . " . � ' . ii . - .. . _�. _. ._ _ . _ .. _ . � y �� --�- ✓� _ � � f �. � � � - � . � � � ` �. �� , ,.__ _ __ /� �� City of Fridley � . . . . . Ap�phcafiio�n for Plutnbing and Gas Frtt�ng Perm�t Dep� of 81dgs. Phoae SU 4-7470 DESCRIPTION OF WORK % , ` Number, Kind and Lxatioa of Fixtures LoCSfio�—�Yi '�%F�% �� <�I < I<'I � I Z I� �I� OI � I� �I<�I� �I� 6�� ZI� ZI R I N I WAASTER ELEC. Z �. � O f. m VI 3 F- O LL V1 LL O U m 3(9 � U' Sa U' O Base lst 2nd 3rd 4th ` Future Connection Openings * New Fixture, Old Openings PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATEB: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 200,000 BT'IT) . . . . . . New Ground Run Old Bldg . . . . . . . . . . . . . Sewer � cesspaol rj NO. RATE TOTAL � x $1.50 $ _ x 1.20 $ — x 1.00 $ — x 3.25 $ — x 2.00 $ _ x $.25 $ GAS FITTING FEES: NO. RATE TOTAL ist 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .5Q $ Gas Range to 200,000 BTU . . . . . . . . . . . . . . x 2.U0 $ REPAIRS 8t ALTERATIONS—Refer to Code Description ...... ...................... - $ ...✓ .......... TOTAL FEE $ �"'"� City of Fridley: / l, , . ;, ;j ;/; ;.. �. � The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares bhat all the facts and representations stated in this application are true and correct. Fridley, Minn '' �� "-- f J!� , 19 :� - r Owner ___ r��-�� C�� , lg— � Kind of Building , 19— Used as To be completed abaut Estimated Cost, $ 61e1�New. Building Permit No. � � / 11 POST 1 M-12-58 Sign By � � f � i✓R', i� Business Pho Na. CITY QF FRIDLEY INSPECTION DIV. Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOLIWG, VEN7ILATIDN, 572-3604 REFRIGERATION AND AIR CONDiTIONING SYSTEWIS AND DEVICE5 . Residentiai - Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed wfth new furnace) Gas Range Gas Dryer *Ai� Conditioning - All Sizes AllOthers/Repairs & Alterations (LIST ON BAClq 1% of Value of Appliance or Work Commercial/I ndustrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30,00 $ �o •c� $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ �- v� State:Surcharge TOTAL FEE JOB �4DDRE5u �2 � ��c ry r' G Kc�.�, �'�-�� The undersigned hereby makes application for a permit for the work herein specified agreQinr� to cEo all work in strict �ccordance with the City Codes and rulings nf the �uilding Division, and hereby declares that all the facts and representations statr�d in this application are true nd correct, �--- -_ . Gc � � _,1996 OWNEFI �- �� ,�L�:� l � � � � f .� � l - D g 3 � BUfLDf�JG U�ED AS >`y�ar,�-�2.� ESTIMaTED COST �� o� `J'� PERMIT N0. i� l� ! �i •� • � •' : $ No. of Heating Units % Girale On� (Steam) `Hot Wat (Warm A Trade Narne /��d"7��,.. Size No. c.c BTU��o,� u v v T HP EDR $ Fuel iv r}-� �ra-�' Total Connected �oad �_.__..__�� `S.cS�� MINIMUM FEE F�R ANY HEATIN��QOLIWGNENTILATIOI� REFRIGERATION/AIR CONDITIONING PERMLT IS $25.00 PI.US THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size Nc, BTU HP EDR HEAI"ING COMPANY �Ip-/C�,�. � !v. !�� Signed 8y No. 40.2� - ci�"Y3 Approved By Rough-In Date Final Date ��/�`' � FILL OUT BACK SIDE OR STACK VERIFICATION ON ��? REPLACEMENT FURNACE � � CHIlVINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chirnney or stack: 1. Has been carefully examined Yes �No O 2. Is free from nist or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6 Has total heating BTU's of �D� �� All other BTU's TOTAL BTU's �U� � � � ,� 7. Has a liner been provided for water heater S. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes (�No ( ) Yes (�-'j No ( ) Yes ( �No ( ) Yes ( "�No ( ) Yes()No() Yes (�No ( ) Fv) � , ..,r. . . ._ .., .. ,. ._._ �i i�t9 LJIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMSER OF FIXTIlRES TO BE {NSTALLED ON EACH FLOOR r.tte�tMV� � 1� � �a� � s, �... �. PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB New Fixtures Old Opening, New Fixtu�e Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range*` Gas Dryer"* Back Flow Prev nter Required ()Yes () No Typ� _�, $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 �S a G Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE .50 $�=� 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. , 2(,Y�,�. o '�—�,�,— � Owner Building Used As Estimated Cost PERMIT NO. /�—� �-� r� PLUMBING COMPANY, SIGNED BY r� FAX # Approved By TEL N0.��37�—`�i� Rough-In Date Final Dat �'�. � cL COMBUSTION AIR SHALL BE pROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridiey, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLfCAT10N FOR PLUMBiNG AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2003 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS �� /' /'Z' l�� oG' /�' � New Fixtures 3 Old Opening, New Fixture Beer Dispenser Blow Off 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 Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.�� $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE � ♦I $ .50 $ � S7� 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner /��'V✓' Building Used As �� C� 20� G L/) Estimated Cost 2�UU- � PERMIT NO. �. (`�7 / PLUMBING COMPANY SIGNED Approved By � TEL N0. ��3 � d � Z i Rough-In Date Final Date � � � � COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE Building Inspeciions 763-572=3604 DATE � �/ o ' SITE ADDRESS _�� THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYP'E PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY � OWNER E-MAIL ADDRESS . �� PHONE: %illp v Permit No.: Received By: D��, TE ZtP N.4ME: �i�%' /J' Z � � � G o �l� i. /:-c �' STATE UCENSE # 4�,�9 % EXP DATE �- 3�'� � g ADDRESS: �/ 3�� /f G�/`7�� 7 T� ��LiTY i�cs� STATE �%ZIP�� PHONE TWO FAMII.YMEW ❑ BASEMENT FWISH ❑ ROOF 0 DECK D SIDiNG O SWATMING POOL O MAIIJTENANCE/REPAIR DESCRIBE WORK BEING DONE: /.� SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROP05£D SIZE: PROPOSED HEIGHT: SIDIIVG ❑ Vinyi � Aluminum ' ❑ Oti�er . wnvnows IN EXLSTING OPEMNGS OYes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES 8c TYPE OF WINDOW TO SE INSTALLED� LENGTH ❑ HOUSE ONLY ❑ HOUSE 8c GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE OSoffit O Trim 0 Fascia LACATION OF WINDOWS 30 � �g ��1 ��ti �TORIE,S.�- WINDOWS ❑ DRAW TILE ❑ OTHER � .YOD � G� WID'TH HEIGHT BASEMENT REMODELING SUBMiT: ' 1. Existing Floor Plan 2. Proposed floor ptan 3. List of structural membas to be used Ft. FOR NEW CONSTRUC170N INCLUDING DECKS, ADDITIONS_ dt PORCHES SUBMIT: 1. Site Plan/Survey showing fhe acisting structures � P�� P%f� Z. Two sds of construaion plans 3. Enugy calcu�at;ons ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (LTSING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ fp D, oP OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Gtirb Cut Escrow Erosion Control Park Fee Sewer Main Chazge Total Due $ $ . �� $ 3 •a�� $ � � $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 55.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+68= ftx$21 =$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks aavable to: Citv of Fridlev Attach 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 ail work 'c qu' es re ', and ap val of plans. SIGNATURE OF APPLICANT PRINT NAME �H v L" �N�<SZ�� DA� ,�� ` �/ Building Inspections 763-572-3604 763-502-4977 FAX PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-08 DATE E--��/ � C� O � SITE ADDRESS � � � G �< < THIS APPL]CANT IS: ❑ OWNER � PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF INSURANCE PERMIT TYPE TYPE OF WORK: DETAILED I��SCR 8 (3 % Permit No.: ��' � Received By: �� Date Rec'd: �i YOUR E-MAIL ADDRESS � 1tiJ{1 S� "l 1 C°y �i`"C0`Srt� ��c � s'� STATE LICENSE # �iS `� UU % -' i STATE BOND # g' �✓ B Z{�`I 3� ADDRESS: I � � 3 3 ✓� �✓�_ PHONE � �SINGLE FAMILY O TWO FAMILY ❑ NEW OF S'�' CITY O REPLACEMENT � � �L EXP DATE l��?J I'" � a� � EXP DATE l 2� 31 `'20�� CITY /� r�c�r d� pv STATE�_Z[P S_SI�D FAX ❑ TOWNHOUSE 13�t/ / av PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON �10.00 PER FIXTURE, EXCEPT WHERE NOTED. FiX'fURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINK/LAV FLOOR DRAJNS SHOWER � WATER PIPING BATHTUB � GAS PIPiNG (NEED CITY LIC) SWiMMMG POOL _ WATER SOFTNER ($35) ��LOTHES WASHER KITCHEN SINK _ WATER CLOSET _BACKFLOW PREV. ($IS) DISHWASHER � LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION — — WATER METER _ OTHER Permit Fee TOTAL DUE $15 g Number of fixtures @$10.00 x$] 0.00 =$ .50 Number of fixtures @ $15.00 x $15.00 = $ $ _'�.� OR Number of fixtures @ $35.00 x $35.00 = $ State Succhazge = $ .50 (MlNtIvIUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of a work w i requires review and approval of plans. . SIGNATURE OF APP T PRINT NAME ✓✓ N�-�S d� DATE ��f�� / . A . � �/ / APPROVED City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 DATE