PRE 2010 DOCSVillage of Fridley, Minn.
N° 360 Office of INSPECTOR OF BEINGS
fF r
�` "'"`►
Owner a f�
Architect ��� Frid?ey, Minn.,_-�
Lot Block Addition or Sub -Division
A — " A
DESCRIPTION OF BUILDING
Front Depth Height - 1' ,2 Storiesy Manner of
To be used
Permit is hereby
To be
of
Cost 'r,f
the buildindescribed in the above statement. This permit is granted
upon the a press conditio that the pers to whom it is granted, and his agents, employ es and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair d moving of buildings
within the °city limits, and this permit may be revoked at any time upon violation of any f the provisions of said
ordinances.
AGREENIEIU A NTD SWORN STATEMENT
In consideration of the issue and delivery to me by the Intipector of R
the above permit, I hereby agree to do the proposed work in accordance
above set forth and according to the provisions of the ordinances of Fridlej
sworn, I hereby state and say that the facts stated by me and contained in
true as therein stated.
Subscribed and sworn to before nae at Fridley, Minnesota, this
day D. 19 -AZ
of Buildings.
ldings of Fridley of
vith the description
and, being first duly
he above permit are
d
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION -AND
AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE
Furnace Shell & Duct Work $12.00
Replacement of Furnace 7.00
Repairs & Alterations -up to $500.00 7.00
Repairs & Alterations each add. $500.00 4.00
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNER- from 100,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES:
1st 3 Fixtures
Additional Fixtures
Gas Range to 199,000 BTU
AIR CONDITIONING
FAN HEATING SYSTEMS See Fee Schedule
VENTILATING SYSTEMS
ALTERATIONS & REPAIRS
ROUGH INSP.
Date
FINAL INSP.
' Date , q�
APPROVAL FOR PERMIT i� y
$12.00
4.00
7.00
7.00
4.00
TOTAL
S
$12.00
$
4.00
$
7.00
$
6.00
$
$10.00
$
10.00
$
$10.00
$
S
x $ 3.00
x ; 1.00
x $10.00
State Surcharge
TOTAL FEE
REINSPECTION FEE
($10.00)
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
Job Addresst`
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all the
facts and representations stated in this applicationar true and correct.
y, Minn. � , 19 F
Fridley,
OWNER
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
;r — ,
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.`S
DESCRIPTION
HEATING or POWER PLANTS, Steam, 11ot er, Warm Air- No.
Trade Name '�ize No.
Capacity Scj. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
14
Trade Name--— ��! Size No.
Capacity Sq. Ft. EDR BTU " 0 61 HP
Company��i
L' e �✓L-f?� '� 6
Signed By
Tel. No.0 t `
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
$
.AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
$
$10.00
$
GRAVITY WARM AIR:
RATE
TOTAL
Job Address��
Furnace Shell & Duct Work
$12.00
$
Replacement of Furnace
Repairs & Alterations -up to $500.00
7.00
7.00
$
$
Department of Buildings
Repairs & Alterations each add. $500.00
4.00
$
City of Fridley
Tel. #571-3450
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNER- from 100,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES:
The undersigned hereby makes application for a permit for the work herein
$12.00 $ specified agreeing to do all work in strict accordance with the City Cbdes
4.00 $ and rulings of the Department of Buildings, and hereby declares that all the
7.00 $� facts and representations stated in this application
� are true and correct.
7.00 $ y �L� J 1
9
4.00 $ F dle , Minn. .
OWNER -"441 /
$12.00
$
4.00
$
7.00
$
6.00
$
$10.00
$
10.00
$
$10.00
$/0 d9
$
lst 3 Fixtures x $ 3.00
Additional Fixtures x $ 1.00
Gas Range to 199,000 BTU x $10.00
AIR CONDITIONING
FAN HEATING SYSTEMSJ See Fee schedule
VENTILATING SYSTEMS
ALTERATIONS $ REPAIRS
State Surcharge
TOTAL FEE
ROUGH INSP. REINSPECTION FEE
Date ($10.00)
FINAL INSP.
uace
APPROVAL FOR PERMIT
FJND OF BUILDING
USED AS
TO BE COMPLETED ABOUT %G? ___750
ESTIMATED COST
OL - NEW BUILDING PERMIT NO. PERMIT NO. `'/O
$'3. d Q DESCRIPTION OF FURNACE/BURNER
$ HEATING or POWER PLANTS, Steam, Hot Water, arm Air No.
$ Trade Name Size No. 6 48 I'M A M f3
$ Capacity Sq. Ft. EDR49 BTU HP
$
$ .50 Total Connected Load s7 Rind of Fuel
$
BURNER - Trade Name Size No.
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
Capacity Sq. Ft. EDR BTU HP
2Company
Signed By
Tel. No.�'�
07 AI. L-14ndl
•
?r
r
A
PARTIAL RATE.SCHEDULE
b
►.
a C
N
�
aui
TOTAL
1.1=ber Flxtutei
D.
53.00
Water
�-
Future T'_I •tutu Opening
>1
$3.00
$
New Fixture, Old Opening
x
4 -4M
$
Catch Basin•
x
4J
(I.
jy
�
$5.100
1144 ter
100;C00 _BTU to 199,000 BTU
x
510.00
!Aj
M
N
G
b
a
lJ M
W .0
'<
U
x
,�
$
.GAS FITTING FEES; '
`
1 li r u
lit 3 futures
N
-+i
$
.C.1
A
ti
h
_
$
K x
x
W. 00
l7
O
ns
lec
rlrzt $100.00
t
v
;�c
$1,00
$ ��•
u as
$ .50
TOTAL FEE
5 lo.50
'lit
,-71
I ) re
- (RJ Future Connection Opening
Connected with Sewor
1.1 - !low Fix[uro, Old Opening
Hater
Job Addreaa 6L23 Pierce Street
Department of Buildinga
' City of Fridley I
Tol, N571-3450
Tho undersigned hereby make■ application fora permit for the war
specified agruoing•to do all work in strict accordance with the C1
and rulings of the Oepartmont of Buildings, and hereby declares th
the faotu and repraoontationi stated in this application aro true
11-21-77
' Fridley, Ki,,
OWNER STANLEY DUBANOSKI
KIND OF BUILDING frame -
USEO AS
TO BE COMPLETED ABOUT .11-28-77
ESTIMATED COSI' 20•00
OLD - HCH BUILDING PERMIT N0, �� NEfyIIT N0. �%• e2
• Compan
Signed Dy'
MINNEMAUGGASCO
•
Tol. No.
ROUGH INSP.
Data
FINDL INSP.
Dato '
APPROVAL FOR PERMIT
MINIMUM FEB FOR ANY PLUMBING PERMIT 29 $7.50
PARTIAL RATE.SCHEDULE
P MLBING FIXTURE RATES; NO,
RATE
TOTAL
1.1=ber Flxtutei
X
53.00
�-
Future T'_I •tutu Opening
>1
$3.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin•
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.100
$
100;C00 _BTU to 199,000 BTU
x
510.00
$
Nater Sofcancr
x
47,90
�`
$
' New Ground Run Old Building
x
$5,00
$
Elecc.rlc Hater Heater -
x
$5,00
$
.GAS FITTING FEES; '
lit 3 futures
x
43,00
$
1..iditlonal rlxturee �
x
$1,00
_
$
:Cas Range to 199,000 BTU
x
W. 00
�r
$ ��
REPAIRS d ALTERATIONS
'
rlrzt $100.00
$5.00
$
each ked. $100.00 Or traction
$1,00
$ ��•
State Surcharge
$ .50
TOTAL FEE
5 lo.50
Job Addreaa 6L23 Pierce Street
Department of Buildinga
' City of Fridley I
Tol, N571-3450
Tho undersigned hereby make■ application fora permit for the war
specified agruoing•to do all work in strict accordance with the C1
and rulings of the Oepartmont of Buildings, and hereby declares th
the faotu and repraoontationi stated in this application aro true
11-21-77
' Fridley, Ki,,
OWNER STANLEY DUBANOSKI
KIND OF BUILDING frame -
USEO AS
TO BE COMPLETED ABOUT .11-28-77
ESTIMATED COSI' 20•00
OLD - HCH BUILDING PERMIT N0, �� NEfyIIT N0. �%• e2
• Compan
Signed Dy'
MINNEMAUGGASCO
•
Tol. No.
ROUGH INSP.
Data
FINDL INSP.
Dato '
APPROVAL FOR PERMIT
MINIMUM FEB FOR ANY PLUMBING PERMIT 29 $7.50
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 65432
TELEPHONE ( 612)671-3460
H & W Electric
2516 - 37th Avenue N.E.
Minneapolis, MN 55418
Re: Air Conditioner at 6423 Pierce Street N.E.
Dear Sirs:
An inspection of the above address noted the low voltage conductors
from the house to the air conditioning unit have to be replaced with .
a wire approved for outdoor use such.as U.F. or run in a raceway,
Please contact me when this is completed so a reinspection cari be
made.
Thank you,
LECNARD EICHMILLER
Electrical Inspector
LE/mh
97-83-h16051 CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS PITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
m
Future Fixture Opening
x
$2.00
v
New Fixture, Old Opening
x
$2.00
$
Water
es
e
Catch Basin
°
$5.00
$
e •.c+
A
a
$
av
c,
W
g
' Water Softener
Heater
a
d
A
x
$5.00
a
Electric Water Heater
u
$5.00
u
be
'0
1st 3 fixtures
x
'$3.00
$
Additional Fixtures
x
$1.00
S
Gas Range to 199,000 VM
x
$10.00
$
REPAIRS F ALTERATIONS
80
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
m
$ .50
o
TOTAL FEE
ro��ro
m
v
a
w
o
W
S
14
o w
4
to
q
w
u w
O
as
lec
1st
2nd
3rd
4 th
(R) - Future Connection Opening
Connected with Sewer
M . New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
,
Catch Basin
x
$5.00
$
Water Heater - to 99,000 STa
x
$5.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
' Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
x
'$3.00
$
Additional Fixtures
x
$1.00
S
Gas Range to 199,000 VM
x
$10.00
$
REPAIRS F ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
s 8,00
REINSPECTION FEE
($10.00)
Job Address 6423 Pierce Street
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 7-27-78 , 19
OWNER DUBANOSKI
KIND OF BUILDING frame
USED AS res,
TO BE COMPLETED ABOUT $-3-78
ESTIMATED COST 20.00
/ [1i
OLD - NEW BUILDING PERMIT NO. PERMIT N0.
.� . _
Company
INNEGASCO
Signed By
Tel. No.
ROUGH INSP.
Date
e'
FINAL INSP. /I
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SIIRS3iARGE
M
SUBJECT
City of Fridley
2 7 3 2 3
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
L
r PROTECTIVE INSPECTION SEC.c�,fd�/��J
I
I
NUMBER
REV
DATE
PAGE Of
APPROVED BY
I
/"'10� CITY HALL FRIDLEY 55432
-.•.�
L 612-571-3450
910-F15
8/20/98
JOB ADDRESS 6423 Pierce Street NE
1 LEGAL
LOT NO. pt. 15
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
P.1380
lAud. Sub. NO. 88
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Clara J. Dubanski
55412 571-4298
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
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
6 DESCRIBE WORK
Reroof house and garage 1 Tear-off
CHANGEOFUSEFROM 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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$1417
.71
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.
$48.50
Fire. SC $1.42
PLAN CHECK FEEX.63
EE
URE OF CONTRA�RGENT ID EI
� vS,GNATURE
EN R
BL INSP
V LID THIS IS UR R IT
DATE
NER dID 1
M
NEV4 [ l
ADDN [ ]
ALTER [ ]
�( ConstructionAddress:
Legal Description: _
Effective 1/1/98
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
x Owner Name &Address: ���,��� �� (� �` Tel.
Contractor: ��,� �_ d� MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E%IPROVEMENT
LIVING AREA:
Length
Width
Height
GARAGE AREA:
Length
Width
Height
DECK AREA:
Length
Width
Hgt/Gro)und
OTHER:
$
Park Fee
$
Construction Type:
Tel. #
Sq. Ft.
Sq. Ft.
3q. Ft.
Estimated Cost: $ /0 � J
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
x DATE: O APPLICANT: Tel.
CITY USE ONLY
Permit Fee
$ v ��
Fire Surcharge
$ ��-
State Surcharge
$ `� l
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
h
CITY OF FRIDLEY PERMIT N( 2004-00457
6431 UNIVERSITY AVENUE NE —
FRMLEY, MN 55432 DATE ISSUED: 04/07/2004 '
572-36U4 YAA: ( 763) 571-llif"/
ADDRESS : 6423 PIERCE ST NE
PIN : 133024310021
LEGAL DESC : AUD SUB NO 088
: LOT 15 BLOCK 0
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
DISCONNECT WELL AND CONNECT TO CITY WATER
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0
# GAS DRYERS 0 # GAS RANGES 0
# OF NEW FIXTURES 1 # WATER TRMT APPLIANCES 0
APPLICANT
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
15.00
0.00
RAZA, ALI
6423 PIERCE ST NE
PLBG FIXTURES (EXIST OPENINGS)
0.00
FRIDLEY, MN 55432
WATER TREATMENT APPLIANCE
0.00
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
0.00
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
0.00
0.00
0.00
OWNER
RAZA, ALI
6423 PIERCE ST NE
STATE SURCHARGE, PLBG FLAT
0.50
FRIDLEY, MN 55432
TOTAL
15.50
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 co tt ct. n or -the performance of construction.
Applicant Date
Bldg Insp Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
[j
CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
(763) 572-3604, FAX (763) 571-1287
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
i > Wash :::: Floor �.�.,
:.:.....:::<.: €<>.=1ttt...... C#x:::::::>' Auto.
..�,`;:;;;;;:; Gas ;�::::::::: Water Heater
Stories Urinal r
Showe Tray ': Drain
:.
...�.... '.I�..... ttlE�>>:: 1=�?tf'<�..... Washer :�:`;..::..�> Ran ::'���:�::;:<:::::
.................... ................. ................ ...................... �19e ::<::»:: Gas Elec
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
NO. RATE TOTAL
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
� 2-3 Picrzcc s?' N£
JOB ADDRESS
$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
$10.00 and rulings of the Building Division, and hereby declares that all the facts
$10.00 and representations stated in this application are true and correct.
$10.00
$10.00 DATE: Pr 2 l u , 20061
$10.00
$35.00 OWNER
$35.00
$35.00 BUILDING USED AS J
$10.00
$10.00 ESTIMATED COST PERMIT NO. 0�00'1-00 ys l
$15.00
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
PLUMBING COMPANY
Q
SIGNED BY TEL N0.
Approved By Rough -In Date Final Date A/ -
MINIMUM
`MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
$ 1,43 ,SC) 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 IBACK SIDE
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing 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 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)
HEATING CO:
Signed By: Date
4
CITY OF FRIDLEY PE NO 2004-00499 ;l
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 04/14/2004
572-3bU4 N'AX: (763) 571-1287
ADDRESS : 6423 PIERCE ST NE
PIN : 133024310021
LEGAL DESC : AUD SUB NO 088
: LOT 15 BLOCK 0
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 250.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE
2000 INTERNATIONAL RESIDENTIAL CODE. REPLACE FRONT STEPS
APPLICANT BUILDING PERMIT FEE
RAZA, ALI FIRE SURCHARGE
6423 PIERCE ST NE STATE SURCHARGE, VALUE
FRIDLEY, MN 55432 TOTAL
OWNER
RAZA, ALI
6423 PIERCE ST 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 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 provisions of any other state or local law
regulating coetruction or the pyforpance of construction.
Bldg Insp Dath(14[61.
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
23.50
0.25
0.50
24.25
NEW [ ] CITY OF FRIDLEY
ADDN [ J 6431 University Ave NE, Fridley, MN 55432
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 4% Ie C S& �i i d
Legal Description:
Owner Name & Address:
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
Tel. #
Contractor. (D la)v\�� v MN LICENSE #
Address: 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: $Cp
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
DATE: APPLICANT: 9., <,l Yv"�. r� ca Tel. # S
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$3_ SC7 Fee Schedule on Reverse Side
$ 65% of Permit Fee
$S� .001 of Permit Valuation (1/10th%)
$ RSSCj $.50/$1,000 Valuation
$ $1350 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 [ ]
$ . Z STIPULATIONS:
PLUMBING
• - COMMERCIAL APPLICATION
City of Fridley
Permit Number
Received By
Date Received
`
DATE �l — 2 YOUR E-MAIL ADDRESS
SITE ADDRESS I /�� o �rr� �> :Z7
TENANT
SUITE NO.
NAME ,11-- P<,/ Zn
I
PROPERTY OWNER/
!�
ADDRESS /3 0 CLJ
S^•
TENANT
,.
CITY
STATE eJ ZIP
PHONE # — r-
NAME
LICENSE #
ADDRESS
CONTRACTOR
CITY
STATE ZIP
PHONE #
FAX
PERMIT TYPE
❑ INSTITUTIONAL ❑ MULTI -FAMILY ❑
SWIMMING POOL
❑ TOWNHOUSE ❑ COMMERCIAL/INDUSTRIAL ❑
OTHER
TYPE OF WORK
❑ NEW ❑
REPLACEMENT ❑
ALTJREMODEL
DETAILED DESCRIPTION OF WORK
12
FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
FEES BASED ON $10 PER FIXTURE, EXCEPT WHERE NOTED
URINAL
CLOTHES WASH FLOOR DRAINS
RPZ VALVE/ ($15)
WATER HEATER ($35)
DISHWASHER GAS PIPING
BACKFLOW PREY.
DRINKING FOUNTAIN GREASE TRAP
ROOF DRAINS
G
WATER METER
FAUCET KITCHEN SINK
SHOWER
WATER PIPING
WATER SOFTENER ($35)
FLAMMABLE WASTE LAUNDRY TRAY
SLOP SINK
TANK LAVATORY
SWIMMING POOL
WATER CLOSET
,700
Permit Fee $ x� Minim: $35.00
Plan Review $
Surcharge $ $.50 on permits less than $1,000
Total Due $ �� [� Make Checks Payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT - NOT VALID UNTIL PROCESSED
1 hereby apply for a plumbing permit and I acknowledge that the Information above Is complete and accurate; that the work will be in conformance with the
ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a
permit and work Is not to start without a permit; that the work will be In accordance with the approved plan in the case of all work which requires review and
approval of plans.
NAME OF APPLICANT �� �`/�7Zo� DATE�`�
SIGNATURE OF APPLICANT
OF FRIDLEY COMMUNITY DEVELOPMENT DEPART/
6431 UNIVERSITY AVENUE NE, FRIDLEY, MN 55432
(763) 572-3604
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3602 or Fax (763) 502-4977
Water and Sewer Permit Application
❑ New Connection
❑ Existing
Date: eq
Job Address:
[]Utility Line Repair/Relocation
❑Water and Sewer Connection
v
Name of Applicant (Plumber): c�yi1 1�
v
Name of Property Owner:
Existing Structure Permit #
Permit Type: Sewer Fee:
Water Fee:
Meter Fee:
Repair Fee:
Relocation:
State Surcharge:
SAC Charge:
Special Assessment Fee:
Total: $
Applicant Signature:
Inspector approval:
Water Meter Repair — Weekend & Holidays
$125/hour
Water Connections Permit
$50
Sewer Connections Permit
$50
ection Fee for Water/Sewer Line Repair
$40
Special Assessments
See Engineering
Cost of Water Meter
See Utility Billing
SAC Char e
$1450
State Surcharge
$ .50
Water Tap
See En ' eerin
04/04/05
-
a'YF6
Reference No. 601-05-0458 AeQU _
a
Service Reg6ested s`uut fei off 8/16/05 Tie
Department Public Yorks Division hater
Location of Service need
Owner or Agent of Property
6423 Pierce St HE
Milton Figueroa
Name of Citizen Phone: (H)
Address
s
Details of Request
Phone: (H) 612-501-4706
Homeowner has a water leak & needs the water shut off @ the street ASAP.
Homeowner did get a permit from the inspections department. Please shut off ASAP. Please
set up an inspection for work being done so that the water can be turned on again when
the work is complete b
Request Taken By:
Department k, c
Jean
Person responsible for request T, 0%115 Title �"V
Action taken (include date & communication with citizen)
n
Me 4- ✓ vA ��Z a; ff Pte►
'tom
Date Cleared
Signature of person clearing request
Citizen
/ No
Building
$ , a
BUILDING
Permit No.: 7
Inspections
$
RESIDENTIAL APPLICATION
Received By -
y763-572-3604
763 -572-3604
$ _(
CITY OF FRIDLEY
Date Rec'
DATE Zy 7.C»� YOUR E-MAIL ADDRESS � -�'��_ lbTMAIG.
Cs1
SITE ADDRESS
$
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
Sewer Main Charge
PROPERTY OWNER/
NAME: M/LYJn1 fr1 Moo f �Ox 4,yly,4
$ t CI of
ADDRESS: `I7,F9 fi7A7l/C0A-) 9 A/E CITY 6(A/NE
STATE IP Sf Y.7
TENANT
PHONE:
CONTRACTOR
NAME: Nt=l a119.0r-,& ir3r�� f�S� C0ti7-Aq Cr, N 6 A/C
SUBMIT A COPY OF
STATE LICENSE # X326 7r/ EXP DATE '31200c XVWEA A 1
YOUR STATE LICENSE
RESS: f0®/ (/,q(EC c24�S CITY VA/�4/f A0GNTS STATE_ZIP SS/ 2-7
WITH APPLICATION
PHONE S/ g-gSZI FAX 6Jl 6Yr
PROPERTY TYPENGLE
F Y/NEW CONSTRUCTION SIZE
iA
WO FAMILY/NEW CONSTRUCT STORIES
PERMIT TYPE
DDITION GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF❑ J�RAIN TILE
nn
[3DECK ❑ SIDING OTHER�r
❑ SWIMMING POOL
nfA
TYPE OF WORK:
❑ WW ❑ ADDITION
ANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:G.r1 4���� '�'—�'? �'" D� � �!£�. S /A-CJZCL
SIZE OF IMPROVEMENT LENGTH WIDTH
q Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS /
3. Energy Calculations
IN EXISTING OPENINGS 6dYes
❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF -B4 S�Gm e 1r
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED G69;0SS NUMBER OF WINDOWS l
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 31 200. OCCUPANCY TYPE
Permit Fee
$ , a
Plan Review
$
Fire Surcharge
$
Surcharge
$
License Surcharge
$ _(
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$ t CI of
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= 8x$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which re3�7
ew and approval of plans. CMA Ge'�
SIGNATURE OF APPLICANT PRINT NAME60410-f GAegC/A ATE � - 2-11 � %�D �
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATE V -D'-)L_ YOUR E-MAIL ADDRESS
SITE ADDRESS &42 - Lev✓Cc '
THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR
PROPERTY
NAME:
OWNER/
ZZ/��
ADDRESS:(r Z S CITY f '2 STA i t�v� IP f
TENANT
PHONE:
CONTRACTOR
NAME; '
STATE LICENSE # EXP DATE
`P -
SUBMIT A COPY OF
YOUR STATE
ADDRESS: 7_6lD - CITY STATEIP
LICENSE WITH
PHONE 6212 "e% q 'f G dFAX
APPLICATION
PERMIT TYPE
)SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK A�/
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This.should-reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor Z D0 0- x .05 = _.�n
T,FOR3' JECTS WHERE LABOR EXCEEDS1500 7FEES ARE BASED ON $10.00 PER EXCEPT WHERENOTED .:FD0_UR-ESs•d�ICATE TOTAL
R EACH BELOW) / �
BATH SWK/1.AV FLOOR DRAINS S R _WATER PIPING
SI
_
BATHTUB GAS PIPING mw cmlic&jz) I1V .ING POOL _ WATER SOFTNER ($35)
_ _
_ CLOTHES WASHER �TCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
V LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
—DISHWASHER
WATER METER _ OTHER
r �..
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
State Surcharge = $ .50
Total = $ (�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requ' es a ew and approval of plans.
4DATE
SIGNATURE OF APPLICANT PRINT N
„ ar a
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
BUILDING
Permit No.
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date:,%
' 200
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE —0"(YOUR
E-MAIL ADDRESS
SITE ADDRESS ro V 3
Let `--- X/C
THIS APPLICANT IS: ❑ OWNER ' CONTRACTOR
PROPERTY OWNER/
NAME: '-/ car Ex ve
TENANT
ADDRESS: i!�Y.9? ,a e-ne S¢ X1i' CITY F"'71'ri
STATEg/ ZIP
PHONE:
NAME: lit
ADDRESS: o ct CITY
iZlk STA ZIP'
CONTRACTOR
SUBMIT A COPY OF
PHONE G' % �8 - FAX eS
YOUR STATE LICENSE
STATE LICENSE # o2Cijl �D(�� EXP DATE
O
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYNEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: A,-roa F
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFINGHOUSE ONLY
SQUARES ' ❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
NUMBER OF _
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
1. Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
IN
G THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$�
$
$ ,
$��
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
-ft +6 ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks savable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the Minnesota Construc ion Codes; that I u rstand 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 accordan a approved p n the c._ of all work which requires review and approval of plans.
SIGNATURE OF APPLIC ' PRINT NAME(S� ii�e DATE - &rQ
MITM• by. Lil l/1r1AA �°