PRE 2010 DOCSDate
Owner
Address /Z e ( .
BUILDING PERMIT
Village of Fridley, Minn.
NO 2960
7
Builder . ...
Address
// LO ATIO OF BUILDING
No. .4..... Street .. .. .. ..................... Part of Lot .... .
.�� . .��
Lot ................ Block ................ Addition or Sub -Division ...//... ' ....
01
Corner Lot ............ Inside Lot .....�... Setback ..... Sideyard % � n. ® '
To be Used as:
Type of Construction
DESCRIPTION OF BUILDING
Fronto ,/ ® r
..®... Depth ..... . Height. C� Sq. Ft. /..��. Cu. Ft........ .
Front Depth Height ......... Sq. Ft. . ® Cu. Ft. ... .
Est Cost.. �. y .®. . ®...... To be Completed .............. .
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 village of Fridley.
In consideration of the payment of a fee of$.. / . .. , permit is hereby granted to
....................... to construct the building o; addition as described above. This pis 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
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.
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas
sewer or water. Be sure to see the Building Inspector for separate permits for these Items. ?,
City of Fridley
SUBJECT
2 2 718
AT THE TOP OF THE TWINS
BUILDING PERMIT
i?
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
�)
r PROTECTIVE INSPECTION SEC.
�� CEJ(
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i "1 CITY HALL FRIDLEY 55432
�""'�'� ".J 612-571-3450
910-F15
7/14/94
JOB ADDRESS 1163 Norton Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
oescR.
SHEET
Auditor's Subdivision #89
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert/Jean Rosecrans 1163 Norton Avenue NE 571-5536
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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 a REPAIR ❑ MOVE ❑ REMOVE
%
8 DESCRIBE WORK
Reroof Dwelling (15 Sq) Tear-off; gutters
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must meet the state building code. Install smoke
detectors adjacent to sleeping areas and in basement.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,125
$.56
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$29.00
Fire SC $1.25.
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$30.81
SIGN RE 9F CONTRACTOR OR AUT R1�' D AGENT IDATEI
R RLY V LIDATED THIS IS YOUR PERMIT 0
GATE
SIGNATURE OF OWNER OF OWNER BUILDERI ID TEI - "
BLDG WSp
NEW j J
ADDN {�
ALTER
ConstructionAddr ,
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Owner Name & Address: �B�—,ter �c,�, � s ��t �,✓s S. .,ng . Tel. #
Contractor: Q w we . MN LICENSE #
Effective 1/ 1/94
Address: . 59—+E e-9-sTel. #
,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.
OTHER: Z12� 1<�A-* _ - �/
Corner Lot ( ] Inside Lot (] Ft. Yd Setback Side Yard Setbacks
Type of Construction: _ f Estimated Cost: $ 075 ?S–
Approx.
SApprox. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft x = $
DATE:
APPLICANT.
e . Tel. # �'/- ��6�36
CITY USE ONLY
Permit Fee
$
�! �' �'
Fee Schedule on Reverse Side
Fire Surcharge
$
/ . ?
.001 of Permit Valuation ( 1 / 10th %)
State Surcharge
$-
$.50/$1,000 Valuation
SAC Charge
$
$800 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 Necessary ( ]
TOTAL
$
STIPULATIONS:
SUBJECT
.
City of Fridley
WRECKING
33787
AT THE TOP OF THE TWINS
I all nit In P E R M I T
f
RE EIPT NCh
COMMUNITY DEVELOPMENT DIV.
r - PROTECTIVE INSPECTION SEC.
1 . �
NUMBER
REV
DATE
PAGE OF
APPR VED BY
---1 CITY HALL FRIDLEY 55432
763-571-3450
910-F15
8/11/03
JOB ADDRESS 1163 Norton Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
Pt lot 4
Aud. Sub. #89 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Michael 9814 P{n Oak Ave, Brooklyn Park, MN 612-636-8156
.luaire
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
PY0 Group Inc PO Box 43243, Brooklyn Park, MN 55443 612-636-8156 20139308
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 ❑ REPAIR ❑ MOVE REMOVE
X
8 DESCRIBE WORK
Wreck House & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
All demolition debris, including foundation & slab, shall be removed from site.
Firal water meter reading needed and entrance to remove water meter.
SEPARATE PERMITS ARE REOUIRED 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$26.25
Credit
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
t
PLAN CHECK FEE
TOTALFEE
v Q .3
$26.25
iGNATURE OF CONT+ C R OR AUTHORIZED AGENT tDATE, er,
EN PROPERLY VALIDATED THIS IS Y RPER IT
1�1
TFIR
_
t`
Y�
G INSP DATE
S-GNATURE OF OWNER OF OWNER BUILDER) IDATEI
Effective 1/1/03
CITY OF FRIDLEY MOVING [ ] WRECKING W PERMIT APPLICATION
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 FAX (763) 571-1287
Job Address: x y
w n 1. 1 ael
Legal Description: —amt IZA � A' a WE -r• nuu �,-�ufw• --
Owner & Address: 11ile,G+ae1 �luQ��`P 9�1� ��%� •l un1Dk� 1h� Tel. #k2 -Z,4 -81J&
Contractor: �/Y17 (7K.oUP _Tel. #6/Z-�3G-,'��Slo
Address • >< 32 3 S!j l n f'&4 State License # 201393Ob
DESCRIP711W& BUILDING /7280
HOUSE: Length _ Width Height Sq. Ft. Cu. Ft. ? -
GARAGE:Length --F=� Width Height _ Sq. Ft. 3&0 Cu. Ft. TT
OTHER: Length Width Height Sq. Ft. Cu. Ft.
Estimated Cost $
Approx. Completion Date
Water Bill Paid: Yes [VJ or Collect [$
Moving Route:
SignatureA11, t I�t
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to
do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State Code
which requires any water well on the property to be sealed by a State licensed water well driller, and hereby
declares that all facts and representations stated in this application are true and correct. ALL DEMOLITON
DEBRIS INCLUDING FOUNDATION & SLAB SHALL BE REMOVED FROM SITE.
v Jo O
Date S• nature
Moving Wrecldng
Principle building into Fridley .... $300.00 For each 1,000 cubic feet or fraction ...... $1.25
Accessory building into Fridley ... $ 42.00 For structures which would be impractical to
Through or within the City ...... $ 20.00 cube, the fee shall be based on the total cost
Move a building out of City ...... $ 20.00 of wrecking at the rate of $6.00 for each $500.00
or fraction.
PE 1%W FEE: o?(� - a'� MINIMUM $20.00
STIPULATIONS:
sueJEcr
P_ER11A1 i
City of Fridley
�
AT THE TOP OF THE TWINS
BUILDING PERMIT (33821'
i �
IPT
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
OTE
PAGE OF
APPROVEDBr
1 1 CITY HALL FRIDLEY 55432
910-F15
8/22/03
JOB ADDRESS 1163, 1165, 1167, 1169, 1171, 1173 Norton Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
E 120' Lf L
t 4 & W 70
of Lot 5, Auditor's Sub. #89
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Michael Juaire 9814 Pin Oak Ave, Brooklyn Park, MN 55443
612-636-8156
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
PMJ Group Inc PO Box 43243, Brookljm Park MN 55443
612-636-8156
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
6 Unit Townhouse Building
7 CLASS OF WORK
{� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
X
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 6 Unit Townhouse Building with Garaizes
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Paid Park Fee of $9,000.00.
Two SAC Credits
from homes removed from site.
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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
6 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
$791,576
$395.79
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$4,620.75
Fire SC $791.58
PLAN CHECK F
TOTAL EE
,908.12 + PF
GAEOF COI
LIOATTURO VEN O
IS IS Yo JR 69 IT
SIGNATURE O� OwNER � F OWNER BUILDER, IDATE.
gip I
g6rE
7
CITY OF FRIDLEY Effective 1/1/2003
6431 University Ave NE R-3, COMMERCIAL & INDUSTRIAL
Fridley, MN 55432 BUILDING PERMIT APPLICATION
(763) 572-3604 FAX (763) 571-1287
116-365; /14-7/ 11447, /Mi 11,93
CONSTRUCTION ADDRESS /A(3 It Zoning
Legal ast 1 ZD -%F. of Lot 4- ,t- Asf 7D -H. Of Id 91AJ Nw A. 8
Owner & Address ffiljWel ,(erre . ftd &&k1,4 &J4 -, ly6) Tel# (612 )0-9IS-
CONTRACTOR & ADDRESS PmQ6WP ,;!!?C. Tel# ( 2. ) 0-1964
PD 13a X 432,3 i � kly� �°a�c, MA) s� 3
Architect
Reg.# Engineer Reg.#
BUILDING CONSTRUCTION
TYPE OF WORK J,New [] Addition [] Alteration -Describe
to urvi r Tom tkm E U.uc..D )•u C,
a- f� 32 / /'.;t
M. AREA: Length 2Wi dth �
' ► n;� Height Sq. Ft. &) 4 Ux;--
2 AREA: Length 3 Grhrt Width Uhf Height Sq. Ft. WUP+"F
6A4A&9+++E* AREA: Length .IT,7 Width 9.5 � un.i'Hei ght Sq. Ft. ZGl/1i4-
APPLICANT2Aj4;4!j
U''`' Tel Date 3
VALUATION
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) — '
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ l 7 9/,5 7
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE
Building Use Construction
Air Conditioning []Yes []No Fire
Performance Bond Amount $
Permit Fee
Plan Check
Fire Surcharge
�J State Surcharge
�CPE!lis SAC Charge
Erosion Control
Park Fee
Spec. Assessments
Curb Cut Escrow
TOTAL
$ 1,&00.75
Type Occupancy Group
Protection Provided []Yes []No
See Reverse for Schedule Received
PERMIT FEES
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See
.001 x Permit Valuation (1/10th %)
$.50/$1,000 Valuation (See Sched.
$1275 per SAC Unit (Plans to MWCC
$450.00 Conservation Plan Review
Fee Determined By Engineering
[]Yes []No
Reverse Side
for > $1 Million)
for determination)
Agreement Necessary [] Not Necessary []
feet x $17.00/foot
ATTACH STIPULATIONS
MNcheck COMPLIANCE REPORT
Minnesota Energy Code
MNcheck Software Version 3.0
COUNTY: Anoka
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Multifamily
DATE: 8-8-2003
COMPLIANCE: PASSES
Permit #
Checked by/Date
Required UA = 1385
Your Home = 783
43.4% Better Than Cale
Area or
Cavity
Cont.
Glazing/Door
Perimeter
R -Value
R -Value
U -Value
UA
CEILINGS
5400
44.0
44.0
65
WALLS: Wood Frame, 16" O.C.
5664
19.0
19.0
193
GLAZING: Windows or Doors, Above Grade
846
0.320
271
DOORS
120
0.130
16
SLAB FLOORS: Unheated, 48.0" insul.
348
10.0
238
HVAC EQUIPMENT: Furnace, 85.0 AFUE
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,
specifications, and other calculations submitted with the permit application. The proposed building has been designed
to meet the requirements of the Minnesota Energy Code.
Builder/Designer. Date 7 03
G! 6 Y ur- !-MIULt=Y INW'LU i 1UN Uiv.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
PLUMBING FIXTURE RATES
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
C�tihl4 Floor Cat
Wash s Auto.s�S; Gas MlSC Water Heater
...:. <.:Q1;ItI
:.: Sli>E> Tray Washer A Range
Shower Gas Elec
NO. RATE TOTAL JOB ADDRESS IW-) IV b UiU j R
New Fixtures
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
and representations stated in this application are true and correct.
Catch Basin
Rain Water Leader
9 �'� 20_
Sump/Receiving Tank
�'1 YUU
Water Treating Appliance
Owner
Water Heater -Electric
Water Heater - Gas"
Building Used As
Gas Range**
Estimated Cost PERMIT NO. 1��93
Gas Dryer**
Back Flow Preventer Required ( )Yes
() No
Type
1
$ 7.00
The undersigned hereby makes application for a permit for the work herein
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
$ 7.00
and representations stated in this application are true and correct.
$ 7.00
$ 7.00
9 �'� 20_
$ 7.00
�'1 YUU
$10.00
Owner
$ 7.00
$10.00
Building Used As
$10.00
$10.00
Estimated Cost PERMIT NO. 1��93
$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
PLUMBING COMPANY
IGNED BY
-1 GNUS
Approved By Rough -In Date_
$ .50
North AvwO Pl,RK&Uv\,g, Iwc.
22590 Ruvu R%vergLvd.
,st. Fra VLZc g, MN 55070
103-�53-33J�3�
Final Date o�
MINIMUM FEE F611 ANY PLUMBING/GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A, COMMON VENT INFO ON BACK SIDE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE Signed L�, CTEL # -Ito-3'qqW 'F()r71
FAX # rl(D 3 -LM - HoLo
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without Approved Byl��L Rough -In Date, Final Date
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Effective January 2003
:ITY OF FRIDLE. ,NSPECTION DIViSION
431 University Ave NE
ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
'AX (763) 571-1287
JJ � f
I tO3 ND(t0r )Ave,
JOB ADDRESS
RATE SCHEDULE
OWNERTmT (71 Il I�iC..12
tesidential Rate
TOTAL
S��"1 I
Furnace Shell and Duct Work, Burner -
�1
o.
BUILDING USED AS—PLP
C7--,
Also Replacement Furnace $ 30.00
Vent Fill Out Back)
$ VO
/�
ESTIMATED COST �tl1LJ' PERMIT N0. %o
7!z/
(Side -
I O O�
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units,_Circle One (Steam) (Hot Water) Warm Ai
Gas Dryer $ 10.00
$
Trade Name VQVK Size No.
* Air Conditioning - All Sizes $ 25.00
$ 2 U®
BTU HP EDR
Fuel Total Connected Load (4,060
All Others/Repairs & Alterations (LIST ON BACK)
-00
Burner Trade Name Size No.
1% of Value of Appliance or Work
$ tQS ----
BTU HP tDR
,ommercial/Industrial
1.25% of Value of Appliance or Work
$
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 an
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE
$ ws-_
10'1-03
DATE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE Signed L�, CTEL # -Ito-3'qqW 'F()r71
FAX # rl(D 3 -LM - HoLo
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without Approved Byl��L Rough -In Date, Final Date
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When re I�_inn an evistinnfi ranr_E±, 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 K) 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 i-nmhi istinn air is sized and installed to meet the current codes
and manufacturer's specifications. Yes) No( )
When required to install a new cnmhiistinn air. it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes No( )
When jpsalling a new venting--ygam, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA 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 #1 Type FA r-LLY1 IQ.CE, BTU Input W006 an Assiste r Nat
Appliance #2 Type BTU Input Fan ssisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances �_ Total Btu Input_ 0 0((0
Common Vent Type C (;SSS Vent Height rr Diameter inches
Appliance #1 Vent Connector Height 2 ft Length 4 ft Diameter L4 in Type 1 le Kfa i i A" hm I tir o
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height l ft Length ft Diameter in Type M
,EATING CO: t'Aj r
Signed By: Date: Ii�' j'y 3
CITY OF FRI Y INSPECTION DIViSION Effective Oi ivary 1, 2002
6431 Univers[Ly Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICESr
JOB ADDRESSp3 N VfW
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)+0f ArgJge,
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/ Industrial
1.25/0 of Value of Appliance or Work
OWNER `��� 6–YO UL0
Rate TOTAL
BUILDING USED AS
$ 30.00 $ r� 00
ESTIMATED COST O U PERMIT NO.—
$10.00
O.$10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ 10.00 $ Trade Name Size No.
BTU HP EDR
$ 25.00 $ Fuel Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE 11 '12-03
HEATING CO � `I -
*-(-Signed Ui77� TEL #-7b `tq t-71
FAX #
Approved By Rough -In Date Final 2?U01
CINOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
May 13, 2004
PMJ Group Inc
PO Box 43243
Brooklyn Park, MN 55443
Re: Final Inspections at 1163, 1165, 1167, 1169, 1171, 1173 Norton Avenue NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on December 11, 2003 of the new townhouse construction at
the above noted addresses. The inspection noted that the construction has been completed in
accordance with the approved plans and is approved for occupancy.
If you have any questions on this matter, please feel free to contact me at 763-572-3603.
Sincerely,