PRE 2010 DOCSBUILDING PERMIT
Village of
Date •""•` A. .......................
Owner-4_4c�j _` %oft,
Fridley, Minn. N? 2520
Builder...........................................
Addressiaai ..... Address .........................................
LOCATION OF BUILDING
No. 70 f ........ Street ... di..l• .......... Part of Lot .......................
Lot ................ Block ................ Addition or Sub -Division ........................................
r
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard r �:. Atp.C, .............
I 1i DESCRIPTION OF BUILDING
To be Used as:
...... ............epth ........ Height ......
....
.......... Fro -at ........ Dep1th ........ Height- .........
Type of Construction .............. Est Cost ' /%f +'� ..........
Sq. Ft......... Cu. Ft, ........
Sq. Ft......... Cu. Ft. ........
To be Completed,,.?-
&-
ompleted
&- A li ,, &o,,,, (i
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 withrovisio f
ordinances of the village of Fridley.
... ..... �. ....
.......
onsideration of the payment of a fee of $.. * .'.. , permit' fs ereby granted to fir,
..........
..... to construct the building or, addition as described above. I ermit is granted upon
'4�-exp'i'ress condition that the person to whom it' is granted and his agents, employees and workmen, in all work
done in, around and upon said building, orlany part, thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
r7. Building 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.
673
City, of Fridley, Minn.. 17 5 6
6431 University Ave. N.E., Minneapolis, Minn. 55,132
BUILDING PERMIT
nate: _ netnher 24, 1972
: _ Pagel Skater Builder Miles Garages
Address ---7.21 Marigold Terrace N _E _ Address 4500 Lynda1 a &Ven apt= _North
LOCATION OF BUILDING
No. 721 Street - Marigold Terrace N.E. _._. Part of Lot
Lot 13 Block 3 Addition or Sub -Division Donngy's Lakyiew Manor Addition
Corner Lot Inside Lot Setback Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Caraae Front 20' Depth 22' Height 10' sq. Ft. _.._440' CtL p, 4400'
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction - Wand Frame Est, Cost $1,99-1.20 991.90 To be Completed 2 months
Stipulation: Provide a hard surface driveway.
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
Ordinances of the city of Fridley.
1.00 State Surcharge
r
In consideration of the payment of a fee of $ 8.50 , permit is hereby granted to Mrs Skabra 1-
____
,�
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordinances of
I;'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
� e city limits and this permit may be revoked at any time upon violation of an of the provisions ofPAR
said
- InspectoP
CLARENCE BELISLE S
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, Bas hosting, sewer or water. Be sure to
thaJBuilding Inspector for separate permits for these items, j
0.
APPLICATION FOR RESIDENTIAL, ALTERATION#
OR ADDITION BUILDING PERMIT
CITY OF FR.IDLEYs MINNRSOTA
OWM' S NAGE: P A LU E L �g K A B 8 i Bun=: M 1 L-- ES C A R.ijG
ADDRESS : _7).l m A.A�.a oL. i i ACr—g- ADs S : �F s o c
Vol �-� S��t ►� (moi ��-01_� ► a � ac -C
un;
��pp��p�qq�e e2r pT �/7�/ • 4 1r nq ■ ■^'^��g++R7 ,g
un; I J BLOCKI �I�A�3�f�i�ON; 17(J(v49 LI`��EU��: � e�Y�0'j 0
F%�i>b a I � ®ail
CORNER LOT: LOT; SETBACK: SIDEYARD:
Affj-Lg=t attach to, thU fo=_Vo Certificates of SurvpZ of Lot and proposed
UAj4ftg 14mation drWn on the" Certificates.
VESCRIPTION of BUILDING
Vo Be ume 4 As: &p R n C C
ns�pth: 2 a Height • l
square Feet-; `'rya Cupric Foeti.kI L) 0 c)
Front: Depth; Height:
Squares Feet; Cubic Feet:
TyfC of C0nstruetiom1 LUOQ, A ML Estimated Cost: $ l o D 0 0
To se feted; �1_ fo 0 !y t h -E
The underviSned hereby s application for. a permit for the work herein
spealfied,, agreeing to do all work im sttict accordance with the CAty of
TvAdley ordl es =d zuttW pf the Department: of Bui Wings, andhereby
lareas i all the facts and representations stated la this application
axe to =4 correct,
VATS; t o - � w - - i SIMATM:
(See Rweype Side Fog Addt tlanal Information-)
97 =$1-1819001, , '
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Job Address 72L MARIGOLD TERRACE
Department of Buildings
City of Fridley
Tel. $571-3450
The undersigned hereby makes application for a permit for the work here
specified agreeing -to do all work in strict accordance with the City Code
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and cot
Fridley, Mn. 2-18-77 , 19
OWNERT
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 2-25-77.
ESTIMATED COST 10200
OLD - NEW BUILDING PERMIT N0.` PERMIT NO.
a(J c��.5���cf` � ���c9•cuK..
Company
MINNEGASCO
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
Class "Y' S1_1rC!1ar-': 710-
WAtor
Heater
0 J° •''
1
0 as ler
vi 3 a F°.
1sc can ec ringag
2ad
13rd
4th
Lj
(R) • future Connection Opening
Connected
with Sewer
(•) • New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
N0,
RATE
TOTAL
Numbs; Fixtures �
,_,
x
$3.00
$__
Future Fixture Openingx
$2.00
$
Now Fixture, Old Opening
x
$2.00
$
Gatch Basin
x
$5.00
$
`Hater Heater - to 99,000 BTU,
x
$5.00
$
100;000 BTU to 199,000 BTU
__
x
$10.00
$
Water Softener
__„
x
$7.40
$ �_
Ne -,j Ground - Run Old Building
_, ,,,_
x
$5.00
$ �_
.Electric Water Heater -
___
x
$5.00
$ �_
GAS FITTI\G FEES: ,
1st 3 fixtures
__
x
$3.00
$
Additional Fixtures
x
$1.00
$
.Gas Range to 199,000 BTU
__
x
$10.00
$
REPAIRS $ ALTERATIONS
First $100.00
$5.00
$2.00
$
$
each add. $100.00 or fraction
State Surcharge
$ 50
$ .• 8000
TOTAL FEE
REINSPECTION FEE
($30.00)
'
Job Address 72L MARIGOLD TERRACE
Department of Buildings
City of Fridley
Tel. $571-3450
The undersigned hereby makes application for a permit for the work here
specified agreeing -to do all work in strict accordance with the City Code
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and cot
Fridley, Mn. 2-18-77 , 19
OWNERT
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 2-25-77.
ESTIMATED COST 10200
OLD - NEW BUILDING PERMIT N0.` PERMIT NO.
a(J c��.5���cf` � ���c9•cuK..
Company
MINNEGASCO
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
Class "Y' S1_1rC!1ar-': 710-
SUBJECT
PE O.
City of Fridley
®1481
AT THE TOP OF THE TWINS
D[ R A A I T
PERMI
�
BUILDING
I
ECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
g
r SEC.
�`
T !/ 6
1 . �
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�.J 612-560-3450
910-F15
7/24/78
JOB ADDRESS 721 Marigold Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
3
Donnay's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Pawel Skabrat 721 Marigold Terrace
3 CONTRACTOR MAILADDRESS
ZIP PHONE LICENSE NO.
Bernick Roofing Co. Route #1, Delano, MN
972-2826
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
'
7 CLASS OF WORK
ElNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE 11F&MOVE
X
B DESCRIBE WORK
Install aluminum soffit and/ facia
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$700
$.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$8.00
SIG 'TUR ONTRACTORORAUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDA ED THIS IS YOUR PERMIT
BLDG INSP
OATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESI ENTIAL BUILDING PENMITS
(N.EW, ALTERATIONIS, ADDITIONS, OR REPAIRS)
OWNER:
Address:
No.: Street:
LOT:
BUILDER:
Address: c`_ ��1f�1Ci 34
Tel. No.: /e�-o2C�o2C,
BLOCK: ADDITION:
CORNER LOT: INSIDE TAT: SETBACK: SIDLYARDS:
Applicant attach to this form TWo Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front:
Square Feet:
Depth: Height:
Cubic Feet:
'Front: Depth: Height:
.
Square Feet: Cubic Feet:
Type of Construction: Out 0- Estimated Cost: $ I3(-)
To Be Completed: ( W
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
Are true and correct. See reverse side for additional information.
DATE: 7/_��1 SIGNATURE:
/. VU
Stipulations:
u
SUBJECT
City of Fridley
';
```� 75Or747
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
L -�---
_ COMMUNITY DEVELOPMENT DIV.���
r ; PROTECTIVE INSPECTION SEC
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
5/12/97
JOB ADDRESS 721 Marigold Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
3
DonnayTs Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Pawel Skabrat 721 Marigold Terrace NE
571-6213
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Quarve Contracting 8427 Center Dr NE, Spring Lake Park MN
55432 785-1472
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6016
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION j] REPAIR
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House & Garage (23 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
@ 1 897
$
$.94
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-
$59.50
Fire SC $1.90
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$5.00
$67.34
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT MATEI
WHEN PROPERLY V IDATED THIS IS YOUR PERMIT
(f{�%d-4-7
BLDG NSP
FATE
SIGNATURE OF OWNER,iF OWNER BUILDER) (DATE)
NEW [ ] Effective 1 / 1 /97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2//�
BUILDING PERMIT APPLICATION `t
ConstructionAddress: ` N 1 M al -L4 �dd � G[
Legal Description:
Owner Name & Address: Ah !/,fief Seabraf Tel. # 6`71 - 6-11 Q 3
Contractor: Q(x A /nkU� Oo!J i P4 C Illy C MN LICENSE # 60 / (,
Address: ?qal 5nbl . tJ S/zInQ We /' n GY-k Tel. # '7P51,-'1 Ll 7Z
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length
Length
Length
-7-ear oFr 4
Width Height
Width Height
Width Hgt/Ground
-roo- �
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: �00Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
EO,/9-7j,
yDATE: �% Ci'7 APPLICANTz�'4y buAey� ,v�,�Tel. # ��5-/���
TOTAL $ V7.4
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ / . o
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$ 5-a0
$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 $ V7.4
STIPULATIONS:
sueJEtr
� j
RMIT NO.
City of Fridley
30601
AT THE TOP OF THE TWINS
BUILDING
P EN I T
r
i
RECEIPTNO.
_ COMMUNITY DEVELOPMENT DIV.
� PROTECTIVE INSPECTION SEC.
9
'7q
r I
/% G
1
NUMBER
REV
DATE
12/22/90
PAGE OF
APPROVED BY
I"9 CITY HALL FRIDLEY 53432
612-571-3450
910-F15
JOB ADDRESS 721 Marigold TERRACE NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
3
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP ! PHONE
Pawal Skabrat 721 Marigold Terrace NE 571-6213
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
North Central Builders Inc 7401 42 Ave N,
New Hope MN 55427-1219 533-6168 3763
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR] ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Home; Soffit/Fascia; Trim
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Call for building wrap inspection
before coverino. Install soffit
ventilation to meet the State Building Code.
'
permit 189P6 C "WO
Will 8'0 w1sll®d
osonot To ®st
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
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
1
STALLfi 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
$ 12,158
$6.07
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOFEE
.00Licens
246 .48
SIGN A TURE OF CONCRACTORORAUTMORIZED AGENT IDATO
EN ROPE IDA T HIS IS YYCIUR EERRMIT
S-GNATURE OF OWNER,IF OWNER BI ILDERI MATE,
MILDINSR ���
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMELY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �® ��
Construction Address: 92
Legal Description:
Owner Name & Address: J�A�I my's - ?MV NL ! IK&NAT K`AlmE POD. Tel. # bA13
Contractor: W.V4 c Ekff�I,� I I- �� (I �a , MN LICENSE # 3%b-3
Address: 9Q It��EI N1 Y41 5.qa1'j49 Tel. # 533 —61 bS
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIONT 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:
iDE
MME Sot�LT' , E]aoN ! 'TFArn
Construction Type:
9P,�1\A 0 Q &L
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: ° -Cluj APPLICANT:
ar&J�QL�L
Tel. # 53- Imo/
CITY USE ONLY
Permit Fee
$ P Z • Z'
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ Lo.
$.50/$1,000 Valuation
SAC Charge
$
$1050 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
$
Fee Determined by Engineering
Sewer Main Charge
$
[ ]
Agreement Necessary [ ] Not NecessaryYAO
TOTAL
$ lv�
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2000
PLUMBING FIXTURE RATES:
New Fixtures
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**
NO. RATE
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
TOTAL JOB ADDRESS 72-1 // Iarig'Ie T Aft -
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.
20&
Owner Aq'w') n
Building Used As /
Estimated Cost - PERMIT NO.
OTER OF ANOKA COUNTY
PLUMBING COMPANY 6250 Industry Ave. N. #114 }
Reinspection Fee $47.00/Hr SIGNED BY 421-6140 TEL N0.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS D 421 -61'8 -FAX
1.5% of Value of Fixture or Appliance
Approved By
2ough-In Date Final Date _
State Surcharge $ .50 MINIMUM FEE 4FR- ANY PLUMBINGIGAS PERMIT IS S2(
TOTAL FEE $ o PLUS THE 9.50 &TATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
R,
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing 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 plastic/PVC and meets all 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 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 ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new ventina system, 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 current codes. Yes( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #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 iii, TYPIQ
Appliance #2 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter "° ih Type
ALTERATIONS: (Describe)
-0
HEATING CO:
Signed By: Date :
From: City of Fridley To: 7637816681 Page: 2/4 Date: 5/27/200912:30:38 P /,o e199?
Building MECHANICAL Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Recd- �` �b
763-502-4977 FAX EFFECTIVE 2-19-09
DATE
YOUR E-MAIL ADDRESS
I
SITE ADDRESS
O`, ER
)NTKACTOR
PROPERTY
NAME:
OWNER/
ADDRESS:
CITY
STATEMOZII 3
TENAT
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PHONE:
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CONTR"XCTOR
COMPANY NAME:
CONTACT PERSON:
SLB'Iv1IT A COPY OF
YOL R STATE
STATE LICENSE 7�
P DATE
LICENSE WITH
ADDRESS: l�
_
CITY
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STAT ' LI �C
APPLICATION
PHONE -
AXT / T- 7P / `P/
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PERMIT TYPE ? NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF NVORK: ❑ NEW PEPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORKAwtd.�& W—AWNA'ez�
EES ARE BASED ON 510.00 PER FIXTURE ,,EXCEJ'HERE NOTED. FIXTURES: VQICA'1"H TOTAL VU�IBNROFEACH BELOW)
L:liiirment Installed MFG:(M/tea_ MODEL: SILEiBTU4!S;l j_
Y
MFG:
MODEL.
SIZE/BTU
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977