PRE 2010 DOCSCity of Fridley, Minn.
BUHDING PERMIT N?( OC20
Date:
07
Builder
Address Address
C
LO 0% 11 TI BUILDING
C
NO. Street Part_ Q
fT +
Lot z
Block lition or Sub-P!V11 �on�
Setback Sideyard
cornerrot- Bl Inside 14,
Sewer Elevation Foundation Elevation
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 ;J1 provisions of
ordinances of the city of Fridley.
.A
In consideration of the payment of a fee Of $'— (0- !!E'-7permit is hereby granted to
, to construct the building or addition as described above. This permit Is granted upon
the express condition that the person all or
building,
to whom It Is granted and his agents, employees and workmen, in 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 ups viodewW any of the provisions of said
ordinances.
Building Inspector
NOTICE:
Sk permit don not cover the construction, huftildlen for Wirlm phnnising, On heating, sewer or water. Be sure to M
the Building Inspeder for uparaft permits for these fteum
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owneris
xame_,��. uiide,ijv
AddresS/
e�O1, - -
LOCATION OF BUILDING
NO. Part of Lot
Lot Block . Addition or Subdivisiov' ,04 awt
Corner Lot Inside Lot -4 --setback Side -Yard
SE?7ER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
DESCRIPTION OF BUILDING
To be used as
LIZ -1 Front_.:6(�Depth c�Fl Height
Sq. Ft. Cu. Ft.
FrontDepth Height
Sq.. Ft. Cu. Ft
Type of Construction,Estimated Cost 4LL
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 of Fridley Ordinances and ruling of the Department of Build-
ings, and,hereby declares that all the facts and representations
statedlin this application are true and correct. ,7
DATE SIGNATURKd
(S ed a of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for Plumbing and Gas Fitting Permit
a
Dept. of Bldgs. Phone SU 4-7
DESCRIPTION OF WORK {�
Number, Kind and Location of Fixtures Locatio v
qq
G1 '
3d
RATE
P
yy,,
Z
n
3�
Y
o�
K
C Z
Qp_
LLo
Z
V
ilii
O Z
a3
�U�
w
(79
U'
Z
�O
•
F
p
N
WATER HTR.
GAS
ELEC
Base `
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
f
2.00
$
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
1st
RATE
TOTAL
1st 3 Fixtures ..........................
x
$1.50
$ /IJV
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
t
4th
• Future Connection Openings
New Fixture, Old Openings
Connected with
Sewer
Cesspool El
PARTIAL RATE SCHEDULE
�JA38ING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures .......................
x
$1.50
$
Future Fixture Opening ................
x
1.20
$
- New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE
TOTAL
1st 3 Fixtures ..........................
x
$1.50
$ /IJV
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $�T
J
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn -
Owner Ila - e ® lQ
Kind of Building " 6 z
Used as / C S / d P --Z C -C--
To be completed about �� �� L
Estimated Cost, ®a 0.
Old Ne . Building Permit No Gw Permit No.
Signe
pl&d
By
Business Phone No----
ROUGH
o.
ROUGH 6
FINAL
.OEW42 2M
77
Application for Power Plants and Heating. Cooling. Vt-.__ilation. Refrigeration 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 $ c
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 xOTA�
1st 3 Fixtures ...................... x $1.50 $ (/
Additional Fixtures x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH
FINAL
Dept. of Bldgs. Phope_ SU 4-7470
City of Fridley:
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.
Fridley, Minn 19
Owner -
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old ew. 'lding Permit No. 0,7%-10 Permit No.—�
DESCRIPTION OF WORK
HEATING or POWER PLANTS—,Steam, Hot Water, Warm Air—No
Trade Name y Size No-d"?-'40-22-4—
Capacity-
od ?-'40-22-4—
Capacity- BTU H.P.
Total Connected Load Kind of Fue
BURNER — Trade Name Size No
Capacity. Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
Signed
By p ''A
M 17 . B�.�i, I __1179
42 2M Business Phone No-
Windows
and Doors-Crackage
No.
and Area
Compliments of North Central Public Service Co.,
No.
Width Height
of pane of pane
No. of
lights
Lineal ft.
of craack
Area
sq. ft.
CITY
Area
sq. ft.
HAAT LOSS CALCULATIONS
v`
VIILLAGE
DEPARTMENT OF BUILDI S
Coef. Btu
Infiltration
Weatherstrips
A.5.H.V.E.
Construction No.
Insulation
Guide
Net exp. wall
®� a
Coef.
Btu
Windows Doors
I Reference
Out. Wall
Int. Wall
Ceiling
Roof
0
Floor
Kind
Haw Applied
Y o Yeo
19........ 11
Exp. wall `L� f®e goo
I
d
t
j
Int. wall
6�
id `.
/Fl. { ti Room I LengthWidth / _ Height
{{
Fl.
Room Length
Width Height
Windows
and Doors-Crackage
No.
and Area
Area
sq. ft.
No.
Width Height
of pane of pane
No. of
lights
Lineal ft.
of craack
Area
sq. ft.
Lineal ft
of crack
Area
sq. ft.
Area
sq. ft.
v`
o
Coef. Btu
Infiltration
-M Q
—
Glass
Exp. wall
Net exp. wall
®� a
Coef.
Btu
Infiltration
e
TO
"Yo
3 2dfO
Glass
0
Infiltration
a� 6
Exp. wall .^
y0
Exp. wall `L� f®e goo
Net exp, wall
d
4)
j
Int. wall
Int. wall
`6
Int. wall
Ceiling
Floor
Floor
S
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Total Btu.
Fl. I,I Length a t�Width Heigh_
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I I/
/Fl. I Ci/-1c..e Room I Length �;' Width /_2- Height p>
Windows and Doors-Crackage and Area
and
No.
Width Height No. of Lineal ft.
of pane of pane lights of crack
Area
sq. ft.
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft
of crack
Area
sq. ft.
Area
sq. ft.
o
Coef. Btu
Infiltration
-M Q
—
Glass
Exp. wall
Net exp. wall
®� a
Int. wall
Ceiling
TO
6
Floor
loe,
0
Total Btu.y
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. I F %3i O Room I Length 1 s Width j 2� Height ep
Windows
and
Doors-Crackage
and Area
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft
of crack
Area
sq. ft.
Area
sq. ft.
o
i
cs' 4
Coef. Btu
Infiltration
Btu
Infiltration
a� 6
Glass
y0
Exp. wall `L� f®e goo
14 rD
Net exp. wall
Net
Net exp. wall
! (�
Int. wall
`6
Int. wall
Ceiling
Floor
Y'
S
Total Btu. C
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows
and
Doors-Crackage
and Area
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
i
cs' 4
Coef.
Btu
Infiltration
y0
Glass
Exp. wall0467/-r-
46j .:
14 rD
Net
Net exp. wall
AV
A)
`6
Int. wall
Ceiling
Floor
Total Btu.
Required s. ft. E.D.R. or sq. ins. W.A. Leader area7ri9ik
Y'
I Fl. I Room I Length sy Width oo Height ;;�
Windows
and
Doors-Crackage
and Area
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Coef.
Btu
Infiltration
y0
Glass
14 rD
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
04b 7OF
Fl. I,I Length a t�Width Heigh_
Windows
and
rs-Crackage
and Area
1.
/® Ll
No,
Width
of pane
Height
of pane
No. of
lights
Lineal t.
of crack
Area
sq. ft.
a
Coef.
Btu
Infiltration
d'57 ?-a
Glace
7
—i%
��
Exp. wall
Net exp. wall
Int. wall
Ceiling
FloorVA-47
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Compliments of North Central Public Service Co.,
TWAT LOSS CALCULATIONS TOWN
DEPARTMENT OF BUILDINGS VILLAGE
Weatherstrips A.S.HNZ Construction No. Insulation
Guide
WindowsI Doors Reference Out. Wall I Int. Wall Ceiling Roof I Floor Kind I How Applied
Yes—No Yes—No 19........ II
FL
I
oom I Length
Width Height
and Area
Fl. I
Room I Length Width
Windows nd
Doors—Crackage and AVArea
Lineal ft.
of crack
® 377
Windows and
Doors—Crackage and Area
No.
oPVpat a
of pane
lights
of crack
®
Int, wall
No.
I oPWidth
pi ane
o epane
lights
Lineal
P cerackt
sq ft.
4P
'4 .6
Total Btu.v
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. I Room I Length Width Height
Coef.
Btu T
Infiltration
Coef.
Btu
Glass
Infiltration
M
Windows
I
I yee
I
and Area
J`
Coef. Btu
Infiltration
No. of
lights
Lineal ft.
of crack
® 377
Glass
Area
sq. ft.
-P aA.$'
Exp. wall a
Net exp. wall
®
Int, wall
Ceiling
Floor
4P
'4 .6
Total Btu.v
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. I Room I Length Width Height
M
Windows
and Doors—Crackage
Doors—Crackage
and Area
and Area
No.
Width Height
of pane of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Area
sq. ft.
Area
sq. ft.
Coef.
Btu T
Infiltration
Coef.
Btu
Glass
Infiltration
Exp, wall
Glass
Glass
Net exp. wall
Exp. wall
Exp. wall
Int. wall
Net exp. wall
Net exp. wail
Ceiling
Int. wall
Int. wall
Floor
Ceiling
Ceiling
Total Btu.
Floor
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. I Room I Length Width Height
Windows
and
Doors—Crackage
and Area
and Area
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft
of crack
Area
sq. ft.
Area
sq. ft.
Coef.
Btu
Infiltration
Infiltration
Glass
Glass
Exp. wall
Exp. wall
Net exp. wall
Net exp. wail
Int. wall
Int. wall
Ceiling
Ceiling
Floor
Floor
Total Btu.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Height
Btu
Infiltration I
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
Fl. I Room I Length Width Height
Windows and
Doors—Crackage
Doors—Crackage
and Area
and Area
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
I of crack
Area
sq. ft.
Area
sq. ft.
Coef.
Btu
Infiltration
Infiltration
Glass
Glass
Exp, wall
Exp. wall
Net exp. wall
Net exp. wail
Int. wall
Int. wall
Ceiling
Ceiling
Floor
Floor
Total Btu.
Total Btu.
II Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
Fl. I Room I Length Width Height
Windows
and
Doors—Crackage
and Area
No.
Width
of pane
Height
of pan.
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Coef.
Btu
Infiltration
Glass
Exp. wall
Net exp. wail
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I {
I hereby certify that the above is a true and correct plat of a survey oft
Lot 5, Block 2s PARKVIEW OAKS FIRST ADDITION, t1noka County, Minnesota.
As surveyed by me this 10th day of July 1962 A.D.
Dsota Regi.tratil
No.
INDUSTRIAL
C E COULTER
PLATTING
BUSINESS
CITY *LOTS
• . �
LAND SURVEYOR
FARM SURVEYS
LAKESHORE
TOPOGRAPHIC MAPPING
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
JUDICIAL
LICENSED SY ORDINANCES OF CITY OF MINNEAPOLIS
3300 LYINDALE AVE. SO. MINNEAPOLIS
8. K!,NN.
V TAYLOR 4-0370
*urbepor'm; Certificate
61
LY
0 LO
0
r �A r
6
l
GU
zc 21.33
I
P, n
�
S .g n-' tin �•
l I
4
i
f
ti:lti �J{d
I hereby certify that the above is a true and correct plat of a survey oft
Lot 5, Block 2s PARKVIEW OAKS FIRST ADDITION, t1noka County, Minnesota.
As surveyed by me this 10th day of July 1962 A.D.
Dsota Regi.tratil
No.
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
RATE
TOTAL
Job Address
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $
20.00
o
$
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Gas Piping $
10.00
$
Tel. #571-3450
(piping needed with new furnace)
Gas Range $
10.00
$
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
Gas Dryer $
10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
* Air Conditioning (all sizes) $
10.00
$
Fridley, Minn. co-' 19��
All Others/Repairs and Alterations
OWNER
18 of Value of Appliance or Work
$
KIND OF BUILDING
AS
COMMERCIAL/INDUSTRIAL
USED
18 of Value of Appliance or Work
$
TO BE COMPLETED ABOUT
ESTIMATED COST
State Surcharge
$ .50
/D
�%
OLD - NEW BUILDING PERMIT NO. PERMIT NO. ll n
TOTAL FEE
$
Reinspection Fee ($15.00)
$
DESCRIPTION OF FURNACE/BURNER
Rough Insp.
Date
Final Insp.
Da
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air -No.
Trade Name Q( \e6 Size No. J'�s����C
Capacity Sq. Ft. EDR BTU Lp��qgHP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Fill out back side for stack. verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
I.
Has been carefully examined
Yes (,)
No
2.
Is free from rust or deterioration
Yes ( )
No
3.
Has no foreign objects lodged within
Yes ( )
No
4.
Is securely supported
Yes ( )
No
5.
Meets all current Code requirements for size and
total BTU connected
Yes ( )
No
6.
Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Date
SUBJECT
PEfwtm0,-._
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
\ 9�
`
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
j-------
r PROTECTIVE INSPECTION SEC.
75V
CITY HALL FRIDLEY 55432
�.j
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/10/95
JOB ADDRESS 5561 Regis Trail NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
1 Parkview Oaks 1st Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Harold OBert 5561 Regis Trail NE
574-1465
3 CONTRACTOR MAILADDRESS
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 C.l ADDITION ❑ ALTERATION El REPAIR
1X�
O MOVE El REMOVE
8 DESCRIBE WORK
Construct a 10' x 12' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
ANING
Before digging..call for
all utulty ..t}oc�ations,
REQUARED BY-LAW
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
]
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
$978
$.50
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.
$25.00
Fire SC. $.98
PLAN CHECK FEE
TOTAL FEE
$26.48
SIGNATURE OF CONTRACTOR ORAUTHORIZED AGENT (DATEI
WHEN PRO
LY VALIDATED THIS IS YOUR PERMIT
OG INSP
1&axmK
I ri• E
SIGNATURE OF OWNER IIF OWNER BUILDERI iDATEi
NEW
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building. Permit Application
fJ�5_Construction Address:? 116 % S / /l I_
Legal Description:
Owner: Name &. Address:
Contractor:
Address: .
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effective 1/ 1/95
MN.LICENSE #
Tef. #
Attach to •#his application, a Certificate ' of Survey of the
lot, .with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Lengthf j� ! Width Hgt/Ground e Sq. Ft. % *L -V
Comer Lot [ ] Inside Lot [ 1
Type of Construction:
Approx. Completion Date: _
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $
Driveway Curb Cut Width Needed: _
DATE: APPLICANT:
(Cost on Back)
Ft. + 6 Ft = Ft x $ _ $
Tel. #
TOTAL $
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ ,72 '
Fee Schedule on Reverse Side
Fire Surcharge
$ 4
.001 of Permit Valuation (1/10th%)
State Surcharge
$ Ra
$.50/$1,000 Valuation
SAC Charge
$
$850 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:
Building
PLUMBING
Permit No.: too AL I
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
gain
763-502-4977 FAX
I EFFECTIVE 7-1-2010
DATEL� CvYOUR E-MAIL ADDRESS
SITE ADD SS rrn�'- P ,r
THIS APPLICANT IS: 1 ❑ OWNER 66CONTRACTOR
PROPERTY
NAME:"0 rl ey, ,Q ;—
OWNER/
ADDRESS: CITY STATE ZIP
TENANT
PHONE: 6 y�
1101
CONTRACTOR
NAME: e 'w U74"-' „
SUBMIT A COPY OF
STATE LICENSE # ,f -o<ajf-V EXP DATE ✓°� <�
YOUR STATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
ADDRESS: 3 71( CITY STATE ZIPfr,74-
INSURANCE
PHONE 1e,3 --d,(7 - +W- FAX
PERMIT TYPE
V, SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
[3 NEW eREPLACEMENT
DETAILED DESCRIPTION OF WORK i.�.u� /��•r e u,s�e
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
SINKILAV FLOOR DRAINS SHOWER _ WATER PIPING
—BATH _
GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
—BATHTUB _ _ _
CLOTHES WASHER KITCHEN SINK_ WATER CLOSET _ BACKFLOW PREV. ($15)
_ _
—DISHWASHER LAUNDRY TRAY -ZWATER HEATER ($35) FOR IRRIGATION
_
WATER METER OTHER
� �$ i � - {�3- 4 '.E a � \ )" 1 � � `.� � f $ 7 ? 3 .:.£`a' £ F � 5,,. '`5 3Y'�,z5 �� �'n 1 3 ,� � �o� •!$
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THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I 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 on site; that the work will be in accordance
with the approved plan in the c of ll work wh' h r quires review and approval of vl
SIGNATURE OF APPLICANT .�"rv/ of, r%`e -0 PRINT NAMES `^�'A�?/1c.� DATE
rlWil
APPROVAL INSPECTORS SIGNATURE
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.�a
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building MECHANICAL Permit No.: Wn
Inspections RESIDENTIAL APPLICATION Received sy: ff�bzA
763-572-3604 D d•
CITY OF FRIDLEY
763-502-4977 FAX
EFFECTIVE 7-1-2010
'- � y �y�
I
DATE . I �/� i - _ YOUR E-MAIL ADDRESS 1. Ob
(q�
SrrE ADDRESS��`—Iv,�-1
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: 1 b 1 1%. ® .p2r-j-
OWNER/
TENANT
ADDRESS:551-c V - CITY �iZI ®1�_ U STAT'} IVZIP a
PHONE:I 5I- L613 49
CONTRACTOR
cOMPANY NAME:
CONTACT PERSON: V I S S L (.I (I l /I
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
re L N
ADDRESS: I?JrJ_1 1 SOWS ln.,t A_ T,� C1TY D} Utft1�11 STATEN'
APPLICATION
'
PHONE � LP?? Lj,)- QCy--I� FAX -I ` (A) I` C) l
PERNIIT TYPE
L�4INGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK V1S J'jq 0 NJ IM hUnJUL
l,ll(1 k i`_
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALLS PER MANU ASHRAE HANDBOOK. f1
Equipment Installed MFG.Y M (p D IQ ® SIZFJBTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_C11 ER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00
�CHIIVINEY LINIIt $10.00 GAS DRYER $10.00 POOL HEATER $35.00
_DUCT WORK $10.00 GAS PIPING $10.00 VENT LATOR $15.00
Number of fixtures @ $10.00 x $10.00 = $
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
++
Number of fixtures @ $35.00 N x $35.00 = $
State Surcharge = $ 5.00
FEE $40.00 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 w rk which require review and approval of pia
SIGNATURE OF APPLICANT PRINT NAMT DATE%
_
-11 l
APPROVAL INSPECTORS SIGNATURE DATE S
PLEASE NOTE: SEPARATEPftM1q7S ARE REQUIRED FOR BUILDING ELECTRICAL AND MECHANICAL WORK
v City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977