PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date:
Owner: - - , •• ;�= a, s!�� _..__....
Address
Builder _.._. ........ +....... .._.._.....
Address ...., _._._ ... _.W_ _
LOCATION O I DING
Part of Lot ...
No..... f Streetw._ -----___
Lot ... Block ..... _...... ddition or Sub-Divisi n.......�.�-.. s..
Corner Lot ..__......._..._...-._....... Inside Lot .-----------.. Setback ..._,�+� ......._...._..__ Sideyard _ .— . -•
Sewer Elevation ..... . ............................ ........ _.... .............. .............. _.._............. _... Foundation Elevation
DESCRIPTION OF BUILDING
To bq Used as:
i ��"'' /
_. .:_..:. Front . _. ,. Depth .. . _ Height ._ :,. Sq. Ft. _ yr�'_ Cu. Ft. d-9 e
- -.44.4 .... Front . Depth .. .... Hsight
_' Sq. Ft. ....._f — Cu. Ft....
Type o nstruction .....:........�. Est. Co ...... _o 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 city of Fridley.
In consideration of the payment of a fee of $...;?... __:...._.::., permit 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, 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
within the city limits and this permit may be revoked at any time upon violationany of the provisions of said
ordinances. '— ^/?
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name 6 ci. Build4s 'f
Address Address - � � y� A v c
�y LOCATION OF BUILDING
No. Street Part of Lot
Lot !_ Block 13 Addition or Subdivision -2,
Corner Lot Inside Lot „�, Setback -g Side -Yard
SEWER ELEVATION 9' FOUNDATION ELEVATION Z'Z cf ,
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
DESCRIPTION OF BUILDING
Frontepth : ,_Height
Sq. Ft. Cu. Ft.
Front L 3 _Depth a Height
Sq. Ft. Cu. Ft.
Type of Construction "�� �'� ' Estimated Cost /f Q
To be Completed
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 representations
stated in this application are true and correct.
DATE
/ --� e77SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
Application for Power Plants and Heng. Cooling. Ventilation, Reftigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
STEAM or HOT WATER SYSTEM
RATE
TOTAL
8.00
$
5.00
$
5.00
$
2.50
$
8.00
$
2.00
$
5.00
$
5.00
$
2.50
$
Furnace Shell & Lines ---to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOT
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
REMARKS:
$
See Fee Schedule
TOTAL FEE
Dept. of Bldgs. Phone SII 4-7470
City of Fridley: v
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 representations stated in this application are trueand correct.
.4Fridley, 1Vlinn �E G 5,-- 1960
- 195—
Owner Z
Kind of Building
Used as
To be completed about
195-
195-
00
Estimated Cost, $
ding Permit No.�'
DESCRIPTION OF WORN
HEATING , Warm Air—No-
Trade Name Size No
Capacity Sq. Ft. E.D.R G BTU H.P.
Total Connected Load Kind of Fuel.
BURNER — Trade Nam Size No �'A-
Capacity Sq. Ft. E.D.R
1001 Xenia Av. 5.
Minneapolis 16, Minn.
Signed
y
11 POST 1M-12-58 Business Phong'No
'Y a. fly 6 4►"' �., ®�'.^y6.. - fr _ - / '� ._ v-
1)•36
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN.
A.S.H.V.E,
Weatherstrips _ Guide Construction No. Insulation
WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
Yes—No Yes—No 19_
F1.1 Room I Length ; Width Heistht - II F1.1 Room I Length Width ` Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal f : Area
No. of pane of pane lights of crack sq. ft.
el
i •
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int: wall
Ceiling -
i
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length " '._ Width' Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft. -
el
i •
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
i
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane llghta of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor -
Total Btu.
Required sq. ft. E.D.R. or'sq. ins. W.A. leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
Noe of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Lenge Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu. F
Required sq. ft. E.D.R. or sq. iris. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
'50s91
City of Fridley, Minn. N° 8465
BIT.[ D NG PERMIT
Date: SEPTEMBER 17, 1965
Owner: JAMES BRUBAKKEN Builder OLSON COMPANY
Address 6810 naklev Drive N -E- Address 4004 - 4th Avenue South
Fridley 32, Minnesota
LOCATION OF BUILDING
No. 6810 Street Oakley Drive N.E. part of Lot
Lot 12 _ Block 3 Addition or Sub -Division Brookview Terrace, 2nd Addn.
Corner Lot ._ Inside Lot _ _ Setback __._ Sideyard
Sewer Elevation
To be Used as:
Foundation Elevation
DESCRIPTION OF BUILDING
Front - Depth Height . _ Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost _,?,QQO.00 To be Completed
z
REPAIRS DUE TO STORM DAMAGE - REBUILD
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 ab set set forth and in compliance with a'll provisions of
ordinances of the city of Fridley. /_ / . -
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to OLSON COMPANY
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
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving ofbuildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
ALLEN G. JENSEN Building motor
NOTICE:
This permit den sof corer the conairuedw, butallafion for wiring, plumbing, gas heating, sewer or waist. Be saes to no
tiro Building Mgmftr for aoparab p mahs for these Berns.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
/I/r/i2C�l� �_ti r 2 S
OWNER'S NAME, � �' � � ' � BUILDER
ADDRESS ��� .�' / �° C��' ADDRESS C
LOCATION OF BUILDING
NO, STREET PART OF.LOT
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDE -+YARD
SEWER ELEVATION FOUNDATION ELEVATION
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;
LZ f
Depth Height
Fron D p H t
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft.
Type of Construction
To be completed
Cu. Ft.
Estimated Cost / a ,, v
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,
DATE S
(Schedule of Fee Costs can be found on the Reverse Side).
00
SUBJECT
MIT NO.
City of Fridley("�
2 9123
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT -NO.���7
F • ____ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r i PROTECTIVE
F �
_
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/1/99
JOB ADDRESS
6810 Oakley Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
12
3
Brookview Terrace 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Todd Jenko 6810 Oakley Street NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Premium Roofing 6680 Lucia Lane NE Fridley, MN 55432 571-3973 20097688
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
8 DESCRIBE WORK
Reroof House & Garage (24 Sq) Tear -off
8 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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
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
$2,056
$1.03
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-
$74.15
Fire SC 2.06
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
OWOTAL FE
f�-6e �.I�'C �- -
Lice .00
$ 4
SIGNATURE OFCON TRACTOR OR AUTHORIZED AGENT IDATEI
NPR PEAL DATED T S YOU R T
I
BLDG SP RATE
S-GNATURE OF OWNERJF OWNER BUILDER� IDATEI
00
NEW [ ]
ADDN [ l
AT [ ]
Effective 1/1/99
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: A Ve) 0,4& /7- S /
Legal Description: �� F
Owner Name & Address: 7o- a p J_E l ;G Tel. #
Contractor: MN LICENSE#9
Address: 4� 6'� Z 0 l r1/ Tel. #
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:
Construction Type: Estimated Cost: $�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: q - -q 9 APPLICANT: - Tel. #
Permit Fee
$_ S
Fire Surcharge
$ ' 6 C
State Surcharge
$ 1,p3
SAC Charge
$
License Surcharge
$ CSO
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ col'?- :_
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
ERMIT N
City of Fraley
3 802
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RNO.
_ ____ COMMUNITY DEVELOPMENT DIV.
L - PROTECTIVE INSPECTION SEC.
% ��pp
2-oVO4
dAECEIPT q�
■
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/7/01
JOB ADDRESS 6810 Oakley Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
%$ 12
3
Brookview
Terrace 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Todd/Deb Jurek 6810 Oakley Street NE 763-571-0655
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Four Seasons Construction Co Inc PO Box
32033, Fridley, MN 55432 763-786-4039
a ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
2456
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW 7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22' x 101 Living Area Addn; an 8' x 10' Deck; and an 18' x 22' Garage
9 CHANGEOFUSEFROM
TO
STIPULATIONS
See notations on plan.
WAm"NING
Before digging call for
all utility locations
454.0002
REQUIRE® BY LAW
SEPARATE PERMITS ARE REOUIREO 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 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
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
$17.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$35,000
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S CTI R THE PERF MANCE OF CONSTRU
492.25
Fire SC $35.00
u � Al6
PLAN CHECK
TOTA EE
jF
Lice e$5.
549.75
SiG TU C •RACT OR AUTMORI GENT '^ IDATE7
OAT THIS IS V P - 17
S,GN4TUBE OF OW NEA,iF OWNER BUILDER, BOATF
VOG iNSPor- f�ATf
NEW [ ] Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
1/1
Construction Address: a'
Legal Description:
Owner Name & Address:
Tel. # 065 5
Contractor:
Toe", MNLICENSE# R12-,9456
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 aWidth 1D Height Sq. Ft.
GARAGE AREA: Length 125 Width Height Sq. Ft 30/
DECK AREA: Length Width /® Hgt/Ground Sq. Ft _CS (5
OTHER:
Construction Type: 4,'®.A., Estimated Cost: $�360oQ, 0t]
n
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
i'r- 3 ,d3
DATE: 4L -JR ---O/ APPLICANT:
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$� Fee Schedule on Reverse Side
$ 3S, 00 .001 of Permit Valuation (1/10th°)
$ /?7, $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ 00 $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 [ ]
Land Planning
land Survey i J
Soils Testiny
Civil b- Municipal
En5ineermy
ENGINEERING, INC.
i
— Engineers Surveyors
370Mississopj ft. AT..
Minrn gowns ?l,
Minniesota
S14101W40"
certificate of sszrPe �`'� Ai'y�-c A/Yt;✓i ULJ►2
_T
A
/rove
'
r�
---- ?2 C)
`F
v
10' Drive_.
1
,
�
24.0
�.
w
�r0h
/hereby certify that this is a true and
correct representation oV'o sirveyf eft bandor;es o`'& ohow demcrilard /arid, and
of'#je 1whon #Poll b #ldin9s, #xre&7, and o/l risible err wcbments , If & , fnri or 07 "id /and. As 'survey ed hq me Phis-- cby
A:D dui2.
SU6UR8AN ENGINEERING, INC.
E319 leers E- Surre yrs
AY71171
A
r
CITY OF FRIDLEY INSPEC) iUN DIV
6431 University Ave NE
Fridley, MN 55432
763-572-3604
V II APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On Jan 1, 2001
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"
NO. RATE TOTAL
Gas Range"
Gas Dryer"
Back Flow Preventer Required ( )Yes () No
Type
$ 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 7
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance •
State Surcharge $ .50
TOTAL FEE $o? -S. a
JOB ADDRESS
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
7___9 • . 20C2!
Owner
Building Used As
Estimated Cost PERMIT NO. / 3m�y
PLUMBING COMPANY Pipe
SIGNED BY 1114111V jk TEL N0.
03
Approved By Rough -In Date Final Date aim
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
MARK NUMBER OF
FIXTURES TO
BE INSTALLED ON EAUH I-LUUK
�•�
�:::: •�
><Jeitm..<'
Wash
r:.
>?> Floor
i:.::..Auto.
Vis;:::.:?+:?:.:.Gas
i' •%..:.f.::•:::: %�.:
:"Water Heater
y::.a.�:
Gas Elec
Stories
Urinal
u'': Shower
't°... Showt..
:.,,••:'::ll,v+:.
aP:%`
Tra
t><:' Drain
!#�t5t:<N« Washer
-
.v1+.'Y.+ :::;:-.`:1Q::
..;aaP' ?•
�•: +� ::l .
:v fi• :::3•,:
��i
:?
:Pi.: :Y{.P::!i::,:j:: F.
•'{: {Pi,P�a; ...li:
':.. • .: %:.; ...
:{k:!ri8'di:!i�%�;:
i::v�::?? a::a?+//.P
}%�;�v,-$?:1;;::Y�:
..:,L,`:.
Basement
.....'..
:F?:{P:::•.!•':::;idi:
:iYiS'{ :%d;{?;:
yr .,. ..
:ay:%H::6 i!{?.
Floor 1
r:: y
�•- •
�t .
:?a2!
PPY-f:P:.:
......:...:..
i;:i?`T!r•::{••,;.ecy{
`>':Y.:.::.
F:!?y: 'a•,��,::-'.Y:;P;.
'•PXa:O::•i:
Floor 2
itli?•PYk+O:a iiii�::
Floor 3
.:':::::.Pi::Y.}:+••}
�-
:.:•:..::::• :•: ••.-: •. �.
:::: •.ter:: r:. ?•.,{:...
Floor 4
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"
NO. RATE TOTAL
Gas Range"
Gas Dryer"
Back Flow Preventer Required ( )Yes () No
Type
$ 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 7
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance •
State Surcharge $ .50
TOTAL FEE $o? -S. a
JOB ADDRESS
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.
7___9 • . 20C2!
Owner
Building Used As
Estimated Cost PERMIT NO. / 3m�y
PLUMBING COMPANY Pipe
SIGNED BY 1114111V jk TEL N0.
03
Approved By Rough -In Date Final Date aim
COMBUSTION AIR SHALL 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 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 manufacturers 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 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)
HEA71NG CO:
Signed By: Date :
CI7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
February 14, 2003
Mr. & Mrs. Jurek
6810 Oakley Street NE
Fridley, MN 55432
Re: Final Inspection at 6810 Oakley Street NE
Contractor: PMR Mechanical Inc & Pipeworks Inc
Dear Mr. & Mrs. Jurek:
A plumbing permit was issued on July 12, 2001 to install a sink and a mechanical permit
was issued on September 7, 2001 to install gas piping for a fireplace and unit heater and
new supply openings, venting a kitchen hood exhaust and a bath fan at your address.
According to Section 4715.2800 of the State Plumbing Code, and the State Mechanical
Code, final inspections shall be conducted on the work authorized by these permits. As of
this date the inspections have not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
CITY OF FRIDLEY INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572.3604
RATE SCHEDULE
DIViSION C //_CC
A
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
(Abut notleplacemQnttpm
Gas Ranle � *_ ee ",�'ele
Gas Dryer
Effective On January 1, 2001
JOB ADDRESS
nn�� (�olu C_hy'lp_�[
Il
OWNER e -*A" - kkt.E�
Rate TOTAL i
BUILDING USED AS P0�aMcor
$ 30.00 $ >
ESTIMATED COST 1001 0 PERMIT NO.
$ 10.00 $ 0.0'0
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 UO -100
No. of Heating Units
$ 10.00 $ Trade Name
BTU HP
*Air Conditioning - All Sizes $ 25.00 $
All Others/Repairs & Alterations LIST ON BACK) 6q) 5190
1% of Value of Appliance or Wor $
Commercial/Industrial
1.25% of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE $ -
o�S ?®
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.
Fue
Circle One
(Steam) (Hot Water) (Warm Air)
_ Size No.
EDR
Total Connected Loa
Burner Trade Name Size No.
BTU HP EDR
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE A601
HEATII\CO PRC- a
Le
Signed
Approved By /�^ Rough -In Date
BACK SIDE MUSTBE FILLED IN ON V
AND COMBUSTION AIR VERIFICATION
TEL # 412-`721=?&Z&
Final Date
i
VENT CONNECTORS
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 manufacturers 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 manufacturers specifications. Yes () No ( )
When installing 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
It 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
HEATING CO:
Signed By:
auiIding
$ -?SO- us
BUILDING
Permit No.:
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By
763-312-3604
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
CITY OF FRIDLEY
n 'd
763-502-4977 FAX
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
EFFECTIVE 1-1-08
$
DATE
YOUR E-MAIL ADDRESS
$
Fee Determined by Engineering
'C S= N
$
SITE ADDRESS ty n
na�
'$ J u)
Make checks payable to: City of Fridley Attach Stipulations
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: IJt y -el
ADDRESS: O 'e CITY
STATE�W ZIP S
TENANT
a
PHONE:? to a S' 71 0 & S-5'
NAME:
ADDRESS: CITY
STATE ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE FAX
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE 1 _3
V- 0 ®k -AA_
13 TWO FAMILY/NEW CONSTRUCTION STORIES_
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHEDWINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR XREMODELING
DESCRIBE WORK BEING DONE: GLS Y° t l
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS.
& PORCHES SUBMIT:
❑ Vinyl
❑Soffit
I. Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS3.
&
Energy Calculations
IN EXISTING OPENINGS ❑Yes
Jlo LOCATION OF 1 �5 a S e m
KPDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF i=).K ti
OPENING CHANGES &
��
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
r� (USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $1 9 Ku tag OCCUPANCY TYPE
Permit Fee
$ -?SO- us
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
'$ J u)
Make checks payable to: City of Fridley Attach Stipulations
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 MinneFsnstruction Codes; that I unders�ar►d 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 a with ap roved plan in ase of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME DATE
APPROVED BY DATE