PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N® 7160
Date: �-
Owner: Builder
Address Address
LOCATION—OF
No. z� Street ��� � Y4C- of Lot
Block �� Addition or Sub- vision .
Corner Lot __—, Inside /Lot Setback � �_ Sideyard � � L5
Sewer Elevation' 7 -� mon IIevation e7 -A2,
DESCRIPTION OF" BUILDING
Tit Used
Front Depth Height L6 Sq. Ft. A cu. Ft.
ZFro Depth Height Sq. Ft. . Cu. Ft. l
Type of ction Est. =--;—`'Fo be Completed
In consideration of the issuance to me of a permit to co the buildhtg descri�r':,Ip=g do
the propoced work in accordance with the description above fo in com of
ordinances of the city of Fridley.
In consideration of the payment of a fee of �, is hereby granted to
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, orany part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constructaton, alteratlon, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violatigs�, of any of the Provisions of said
ordinances. rte. _ n Y
NOTICE
'fhb pennh does not corer the construcHon, hrstAMon for vririaa, phrmbbrg, gas hesdng, sevar or water. Be sure to we
the BWMIng hrsputor for sepm to permits for thus hens.
APPLICATION FOR BUII+DING PERMIT
CITY OF FR.IDIEY, MINNESOTA
CLEMRON, INC.-
Owner
NC:owner IsName Builder G NFRA CONjRACT(lRS
3619 Benjamin St. N. E.
Address Address Uinneapo!is 'a, Alan
1612"1 Alll_�Iffl
No. 2� / Street �� Part of Lot
Lot S Block z Addition or Subdivision
Corner Lot Inside Lot_ Setbackd'�� Side-Yar
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be Completed
DESCRIPTION OF BUILDING
Sq. Ft. //% S Cu. Ft.
s i
Sq. Ft. Cu. Ft.
FAX
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 that all the facts and repre tation
stated in this appligAtion areArue and correct. �'"-� _ _, j,1s
/4
_
ME"
(A Schedule of Fee Costs can be found on the Reverse Side.)
Land Pla piny
Land SLCWY�?y
Sods Teshi?9
Owl & Mmopul
Enymeenfly
n
a
6875-Rfhj ay 065 A[E.
Minnpu�a�s 7l,
ENGINEERING, INC..
sUnsef 440"
-�- En yineers ti Sur veyors
certificate of
surTe few - E it M DEYELOPWiF.Ni CO.
NOTE ,r
1, Elevoi(one SIlown are eropofza +V
2, Fi�tii• Cleor• tl. 2.9 f�. eboy¢ yrwetd
49 hemse cowners .
Cperitrg 71.'1 �
el. g,5.o
O DENOTES IRON ~! DENnE5 DRAINAGE 4 UTILITY TASEMENT
LOT s BLOCK 11 MELODY MANOR 2 -SR ADDITION
(Anoka Coun}X
/ �dy C'!4wy flid flni is o /rae aid awmel rep"" dahm ore surrey oC#jr dv+�s q'!Ar abow shod fad, aid
of k ora/f ftadls , l/rrean , wd ed risible waverhmm is , tf mj, fmv or m sod /mad. As sww yal 6y me f/vs dwj
-
�' Ao r i I A -D. SUB URBAN ENCWNEERIN6 , INC.
s /fr Sar a
SCALE 1"- 30'
Date: May 16, 1972
Owner: J. J. Reis
City of Fridley, Mian..
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Builder Quality Construction Co.
Address -.`7321 Memory Lane N.E. Address 2001 E. 04th St. Mpls
LOCATION OF BUILDING
No. __..7321 Street ` Memory Lane part of Lot
Lot »5 . _ _ Block — 1 _. Addition or Sub -Division Melody Manor 2nd
Corner Lot Inside Lot x Setback . Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Residing_____ Front Depth Height Sq. FL Cu. FL
Front Depth Height Sq. Ft. Cu. FL
Type of Construction Steel Est. Cost _ 1,980. To be Completed 1 month
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 pli with a'll provisions of
ordYnances of the city of Fridley. �•
In consideration of the payment of a fee of $ 12.00 permit is hereby granted to Qualtty
Construction Co. T
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 ordinanos Of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildlIIgB
W *thin ancese. city limits and this permit may be revoked at any time upon violation of any of the provisions of Said
664'�e " Building Inspector
Clarence Belisle
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to a"
the Building inspector for separate permits for these items.
.!
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME:e_J . tJ ' ` S BUILDER : ` �', �1 / T �1 sC�S
ADDRESS: �� �/ `� i%l fr' i' �✓� /fl ADDRESS : , l �'� �` ! �,; ,�
NO • . �oZ STREET: 1 C1,
LOT: BLOCK: l
CORNER LOT: INSIDE LOT: V
.1.
TION : O_tW azn_ J oZn�
SETBACK: SIDEYARD•
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:
Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: ',Q�> Estimated Cost: $ / 9s�
To Be Completed: fn 6_La
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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.
DATE: /"L� `�o, /� �� SIGNATURE: M4
(See Reverse Side For Additional Information.)
SUBJECT
P
City of Fridley
0718 61
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i
•
• COMMUNITY DEVELOPMENT DIV.
�----y---
r i PROTECTIVE INSPECTION SEC.
d -9Y
/"--1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
,'j 612-571-3450
910-F15
6/12/85
JOB ADDRESS 7321 Memory Lane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
1
Melody Manor 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Connie Ahrens 7321 Memory Lane N.E.
535-5101
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Covenant Construction Co. 7716 - 67th Avenue North., Brooklyn Park 55428
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
535-5101
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION Q ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd layer but not 3rd layer. Install ridged galvanized
valleys.
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
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$11788
$.89
WITH WHETHER SPEQUED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT P E TO IVE A RITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
t3 OVISIO NY ER S ATE R LOCAL LAW REGULATING CON-
$29.50
ST N THE R RM NCE F CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$30.39
ATURE C RORAUTHORIZEDAGENT (DATE)
WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
I
BLDG INSP
c
GATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW [ ]
ADDN. [ ]
ALTER. [ ]
Construction Addro
Legal Description
City of Fridley Effective 4/1/84
�R-1 AND R-2
Building Permit Application
Owner Name & Address: ;gzol'e,-e S Tel. 4 S-sS—S10�
Contractor
Address
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft. 1
OTHER: Cz� ll el" -ed-
Corner Lot [ ] Inside Lot Ft. Yd. Setback Side Yard Setback
Type of Construction: Estimated Cost: $ %
Approx. Completion Date: -��-�-
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desi $ $
See Back Page for Explanation
DATE: �� "'��57- APPLICANT; L Tel.
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
* Air Conditioning (all sizes)
All Others/Repairs and Alterations
l% of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
RATE
TOTAL
Job Address 7321 Memory Lane
$ 20.00
$ 20.00
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
KIND OF BUILDING
City of Fridley
$ 10.00
$
Tel. #571-3450
$ 10.00
$
The undersigned hereby makes application for a permit for the work herein
$ 10.00
$
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
$ 10.00
$
Fridley, Minn. August 17, 19 89.
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp.
Da e
Approval for Permit
DESCRIPTION OF FURNACE/BURNER
*REPLACING FURNACE WITH HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. one
ONE CARRIER 58SS08OBC Trade Name Carrier Size No. 58SS080BC
NAT. GAS FURNACE AND ONE
CARRIER 49BG HUMIDIFIER Capacity Sq. Ft. EDR BTU 80,-00 HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
Attach stack verification form with. replacement furnace permits
*Air Conditioners can not be placed in side yard without
written permission frau adjoining neighbor.
Company , Dependable Heating and A/C
Signed By
Tel. No. 757-5040
OWNER Connie Ahrens
$
Frame
KIND OF BUILDING
USED AS Residential
$
TO BE COMPLETED ABOUT
ESTIMATED COST $1700.00
$ .50
20.50
OLD - NEW BUILDING PERMIT NO. PERMIT NO. !
DESCRIPTION OF FURNACE/BURNER
*REPLACING FURNACE WITH HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. one
ONE CARRIER 58SS08OBC Trade Name Carrier Size No. 58SS080BC
NAT. GAS FURNACE AND ONE
CARRIER 49BG HUMIDIFIER Capacity Sq. Ft. EDR BTU 80,-00 HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
Attach stack verification form with. replacement furnace permits
*Air Conditioners can not be placed in side yard without
written permission frau adjoining neighbor.
Company , Dependable Heating and A/C
Signed By
Tel. No. 757-5040
City of Fridley
AT THE TOP OF THE TWINS
SUBJECTIT
BUILDING PERMIT
NO.
27290
r
`y �_���_ COMMUNITY DEVELOPMENT DIV.
r i PROTECTIVE INSPECTION SEC.
` _-_- ��"'f;•� CITY HALL FRIDLEY 55432
L 612-571-3450
RECEIPT NO.
�� $/S
NUMBER
910-F15
REV
DATE
8/lg/98
PAGE OF
/ /
APPROVED BY
JOB ADDRESS
7321 Memor Lane NE
1 LEGAL
DESCR.
LOT NO.
5
BLOCK
1
TRACTOR ADDITION SEE ATTACHED
Melody Manor 2nd Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP PHONE
Connie Ahrens
-
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Golden Hatchet Roof497-4006
20003158
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 IRx REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (23 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
VALUATION
SURTAX
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1918.20
.96
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-
STRUCTIO OR THE PE ORMANCE OFC STRUCTION.
/ �
4A
$62.25
Fire SC 1.92
PLAN CHECK FEE
TO L FEE
70.13
/��/ �I�y
vie
Licen 5.0
SIGNATURE OF CONTRACTORORAUTN ED AGENT IDATEI
EN ROP VALIDAT/-THIS I�Sj/,,JJR I
gL INSP 1C�• DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
J
NEV4 [ l
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 73,2 / /:AZ v ":*w
III/
Effective 1/1/98
Legal Description:
Owner Name & Address: C�l/1�%��iG-t Tel.
Contractor: Z®A? 7c-4 e-7— /-'/!U® y__ MN LICENSE #,,qC-t90-315"Y
Address:/-` 0� /� o
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EVIPROVEMENT
Tel. # 7 Z �7 oA
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: l ���� Estimated Cost: $ I D . 26
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT:,ZZI�5�� Tel.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY
$ • 2 5 Fee Schedule on Reverse Side
$ 1- t 2 .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ OCA $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 $ D - l
STIPULATIONS:
SUBJECT - I
TNO. '
City of Fridley
11884
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
' • COMMUNITY DEVELOPMENT DIV.
-' >r ------
PROTECTIVE INSPECTION SEC.
` 36U
672
r � �
eat(
'56?
� CITY HALL FRIDLEY 55432
NUMBER
NEv
DATE
PA GE Of
APPROVED BY
L J` 612-571-3450
910415
6/7/01
/ /
JOB ADDRESS 7321 Memory Lane NE
I LEGALLOT
NO.
BLOCK
TR ACT OR ADDITION SEE ATTACHED
DESCR.
5
1
Melody Manor 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Connie Ahrens 7321 Memory Lane NE 763-784-1785
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Renewal By Anderson 350 73 Avenue NE, Fridley, MN 55432 763-502-4777
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
20130983
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION Q REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace patio door within existing opening
9 CHANGE OF USE FROM TO
STIPULATIONS
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. Caulk
and flash all exterior openings.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
TYPE OFCONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,319
$1.16
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-
$83.25
Fire
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
SC $2.32
PLAN CHECK FEE
TOT FEE
LicenseAC $5.00
$91.73
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
EN ROP LY ALIDATE THIS IS YOUR PERMIT
• ��q
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
Bl INSP - TE
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLES R-1 AND R-2
BUILDING PERMIT APPLICATION
Constriction Address : , 4 -3;t k
Legal Description:
Owner Name & Address: (It Tel. #3 •U • I�• %S
Contractor:; RENEWAL BY ANDERSON MN LICENSE #
350 -73RD AVE. NE.
Address: FRIDLEY, MN. Tel. #
Attac. 763/5024777 arvey of the
lot, d LICENSE# 20130983 ,n it to scale.
LPRNG AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: \_ rrnA „ I. UL ' A ... C,.
Construction Type: Estimated Cost: $ D 311/0
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $ = $
DATE: S -nU2Se .®1 APPLICANT: Tel. #%Sa�• 345 • U-04 I
CITY USE ONLY
Permit Fee $ %I • a 5 Fee Schedule on Reverse Side
Fire Surcharge $ 2 . 3 a, .001 of Permit Valuation (1/10th%)
State Surcharge $ . ► LA $.50/$1,000 Valuation
SAC Charge $ $1050 per SAC Unit
License Surcharge $ 0_Cp $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, $
S
TIPLTI.ATIONS:
•0 l
CITY OF FRIDLEY INSPECTION DIV.
;431 University Ave NE
=ridley, Mha 55432
763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004 S Jo
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (� 1j�0
MARK NUMBER OF FIXTURES TO BE INSTALLED
ON EACH FLOOR
)Id Opening, New Fixture
$10.00
..:..
': Urinal
i. •:F:
:..<-
.Shower
Wash Ei<:::::r:< Floors::.:=:
T ra �:.��•�' � Drain
�
Auto.
�1�1'����. Washer
&:r
-�`-�.Ir'`.
��
Gas
Ran a
<. Water Heater
is Gas Elec
Sto ries
Basemen t<.``<
$10.00
Nater Treating Appliance
$35.00
Nater Heater -Electric
$35.00
Nater Heater - Gas**
$35.00
Floor 1
$10.00
Sas Dryer**
$10.00
Sack Flow Preventer Required ( )Yes () No
Type
$15.00
Floor 2
:::}i:i:::
:t:::k'.:'i::%:
Floor 3
Floor 4
?3,; � 1 1vOn(D it
3LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS at.S OW Al d -
Jew Fixtures
$10.00
)Id Opening, New Fixture
$10.00
3eer Dispenser
$10.00
Now Off Basin
$10.00
;atch Basin
$10.00
lain Water Leader
$10.00
Sump/Receiving Tank
$10.00
Nater Treating Appliance
$35.00
Nater Heater -Electric
$35.00
Nater Heater - Gas**
$35.00
Sas Range**
$10.00
Sas Dryer**
$10.00
Sack Flow Preventer Required ( )Yes () No
Type
$15.00
leinspeclion Fee $50.00/Hr
4LL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge $ __6D
TOTAL FEE $ �S
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city odes
and rulings of the Buildina Division. and hPrphv ri—Lgres that all the fads
and repres AHENS, CONSTANCE and correct.
7321 MEMORY LANE NORTHEAST
FRIDLEY, MN 55432 Lot 23 Oq
(763) 784-1785 ' 20
OWNER
BUILDING USED AS I'SI d11evice
ESTIMATED COST q6PERMIT NO.
� '�`
PLUMBING COMPANY O f' b ` a'VA wvv, bz
SIGNED BYWJ11 TEL N0. "l012 $Z%- 0,33
Approved By Rough -In Date Final Date
OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A, **PROVIDE COMMON VENT INFO ON BACK SIDE
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existing furnace, 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 existinsa 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 Installinsa a new venting 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 in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 PAX: ( 763) 5 71-IZ57
PERMIT NO.: 04-01050 •
DATE ISSUED. 07/07/2004
ADDRESS :
7321 MEMORY IN NE
PIN :
113024130005
LEGAL DESC :
MELODY MANOR 2ND ADD
:
LOT 5 BLOCK 1
PERMIT TYPE :
PLUMBING
PROPERTY TYPE :
RESIDENTIAL
CONSTRUCTION TYPE :
ADDITION/ALTERATION
VALUATION :
$ 0.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
TOTAL
# ELEC WATER HEATERS
0 # NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS
1 # GAS DRYERS 0
# GAS RANGES
0 # OF NEW FIXTURES 0
VALUE (FOR MINIMUM CALC) 400 # WATER TRMT APPLIANCES 0
APPLICANT
NORBLOM PLUMBING CO
2905 GARFIELD AVE S
MINNEAPOLIS, MN 55408-2173
(612)827-4033
F JAI_
AHRENS CONSTANCE H
7321 MEMORY LN 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 governing this type of worl
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 constrpction or the performance of construction.
Bldg InspDate::� L-1 Lo I
PLBG PERMIT MINIMUM FEE
0.00
PLBG FIXTURES (NEW OPENINGS)
0.00
PLBG FIXTURES (EXIST OPENINGS)
0.00
WATER TREATMENT APPLIANCE
0.00
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
35.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
STATE SURCHARGE, PLBG FLAT
0.50
TOTAL
35.50
PAID WITH CHECK # 28580
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Building MECHANICAL Permit No::
InspectionsRESIDENTIAL APPLICATION Received Bt
763-572-3604 CITY OF FRIDLEY Da d: � F
763-502-4977 F
EFFECTIVE -19-09
DATE �� YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: n O vc0frtm
PROPERTY NAME:
OWNER/ ADDRESS. CITY STA
TENANT — —
CONTRACTOR COMPANY NAME: Standard Heating & Pur CorxltUontng
SUBMIT A COPY OF CONTACT PERSON:. 130 121yrriouth Ave, itie Not di
Minneapolis, MN 55411 34 45
YOUR STATE STATE LICENSE # 612--824,2M DATE
LICENSE WITH ADDRESS: CITY STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE IASINGLE FAMILY ❑ TWO FAMILY
❑ TOWNHOUSE
ITYPE OF WORK: I ❑ NEW _x2EPLACEME7NT ❑ ALTERATION/REMODEL I
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed
MFG: MODEL:
MFG4+./
SIZE/BTU
MODEL:
SIZE/BTUl
�/
MFG: MODEL:
SIZEMTU
/5A/C $25.00
FIREPLACE (GAS) $15.00
GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15
FIREPLACE (WOOD) $35.00
NEW
NEW GAS GRILL $10.00
BOILER $35.00
FURNACE $35.00
UNIT HTR $10.00
CIIIMNEY LINER $10.00
_GAS DRYER $10.00
POOL HEATER $35.00
DUCT WORK $10.00
_GAS PIPING $10.00
VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMrT-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 N Imnesota Construction Codes; that I understand this is
not a permit but only p tion for a t work is not to start with t a permit; that the will be in acro ance with the
approved plan in the o whi iilre ew and approval of p
SIGNATURE OF AP C NAME
-► City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
-1 NEW HOMES/ADDITIONS )(EXISTING HOME LJ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel tither than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW 11OMES
4. Heat loss & cooling load per room
a. Required on new Construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and mare -up air calculations.