PRE 2010 DOCS3
a
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
,IESIDEN;TIAL
Furnace Shell and Duct Mork,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
• Air Conditioning tall si )
RATE TOTAL
$ 20.00
$
$ 10.00
S
$ 10.00
S
S 10.00
$
All Others/Repairs and Alterations
1• of value of Appliance or Mork
COMERCIAL/INDUSTRIAL
1• of Value of Appliance or Mork
$ 10.00 $ ®b. lob
State Surcharge
Reinspection Fee 015.00)
Rough Insp.
Date
Final Insp.
Date
Approval for Permit 1
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCRARGE
Attach stack verification form with replacrsrnt furnace permits
*Air Canditio►mra can tint be placed in cid,- yard without
written pi-ruission free adjoining nntgldwor.
effective Aug. 1. 19RI
Job Address 71 1p
Department of Buildings, 6411 University Ave. M.B., Fridley. NN 55432
City of Fridley
Tel. 1571-1450
The undersigned hereby waked 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 aro true and correct.
Fridley. Minn.
OOMER lad�
KIND OF BUILDING
USED AS
To BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACd/BURNER
HEATING or POWER PLANTS, Stens, not Nater. Warm Air- No.
TTade Nave also No.
Capacity Sq. Ft. 0014 BTU ® NP
total Connected toad Kind of Feel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EOR _ BTU ® MP
Company
Sinned By A
Tel. Nn.
10
VP_
6`bida.,Jl.va „i. ��j
01
SUBJECT
P
City of Fridley
19079
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
! _
r PROTECTIVE INSPECTION SEC.
I �
`
, CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L j
612-571-3450
910-F15
17/21/87
JOB ADDRESS 7120 Riverview Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
2
RiverwQod Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Larry Johnson 7120'Riverview Terrace N.E.
572-;0451
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Inter City .Builders 1633 - 5th. Street N,W, , New Brighton 633-738'9-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
R NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22r x 22' Detached Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide a hard surface driveway.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PL MBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK R 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 �HIS APPLICATION
1
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND .ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$3.48
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$6,950
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW EGULATING CON-
$62.50
UCTION OR THE PERFORMANCE OF CONSTRUCTION.
AN CHECK FEE
TOTAL FEE
�. —T—
$65.98
7KATUbrFCONTRACTORORAUTHORIZEDAGENT (DA* � �> ti
WHEN PROPERLY
V I ATED THIS IS YOUR PERMIT
2 It
SiGNATURE OF OWNERIIF OWNER BUILDER)
(DATE)
BLDG INSP
ATE
01
NEW [ ]
City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: /d%% �d id -e r -1/i °' s 'E� r' c
Legal Description:
Owner Name & Address:
r roc Jd Tel. # 2 .a S
Contractor: /circ - a. L Tel. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height _ _.— Sq. Ft.
GARAGE AREA: Length `2 �- Width :;?`z- Height 'K Sq. Ft. �
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot VT Ft. Yd. Setback "3'Side Yard Setback 4___�
to
Type of Construction:Estimated Cost: $ (o
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
PPTel. la
DATE: .1vL I7` APPLICANT:
TY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ ?9 $.50/$1,000 Valuation
SAC Charge $ $525 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
„ _ Agreement Necessary [ ] Not Necessary [ ]
CI"IYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
June 24, 1988
Mr. Joe Shun
Inter City Builders
1633 - 5th Street N.W.
New Brighton, M(J 55112
Re: Garage Slab at 7120 Riverview Terrace N.E., Fridley, MST
Dear Mr. Shun:
As you know there is a very serious problem with the garage slab at 7120
Riverview Terrace N.E. This was first brought to your attention the early
part of March, 1988: you then stated that you and the concrete supplier would
investigate the complaint and would do what was necessary to rectify the
problem.
A second inspection prompted by the homeowners, Barb and Larry Johnson, was
conducted on June 23, 1988 and it is obvious that nothing has been done to
date to correct the problem. More flaking has taken place and the concrete
under the flaked areas is suspect and may be unsound making the skin patch
method unacceptable until after a professional testing agency has taken some
test borings to determine the present condition of the concrete slab.
There is also the prablem of a depression in the slab along the northerly
wall just west of the service door. It is very critical that this prdblem be
corrected as soon as possible so the bomeowners can couplete their sidewalk
and driveway construction.
Please let ne know by July 8, 1988 what your intentions are and give me a
time schedule of your corrective plans for City approval. Failure to reply
to this request will result in our turning this matter aver to the City
Attorney for his consideration.
Your cooperation in this matter will be greatly appreciated. If you have any
questions concerning this matter, please call me at 571-3450. r
• .r
Sincerely,
aJ4000
DARREL G. CLARK
Chief Building Official
EGC/mh
CC: Mr. & Mrs. Johnson
7120 Riverview Terrace N.E.
July 28, 1988
Mr. Joe Shun
Inter City Builders
1633 5th Street N.W.
New Brighton, MN 55112
Re: Garage Slab at 7120 Riverview Terrace
Dear Mr. Shun:
In a telephone conversation on July 1, 1988 you asked us to
decide what we wanted done with the garage slab you put in last
summer. As you know, the slab has two serious problems:
considerable scaling over much of the garage floor and a large
depression in the slab along the north wall of the garage. We
regret the delay in this reply, but we were waiting for an estimate
from a professional testing agency that could take test borings to
determine the present condition of the slab and make recommendations
regarding concrete repair.
Twice you have suggested that you would patch the scaled areas.
We have rejected this solution because of the large amount of
scaling that has occurred, including the apron, and the drainage
problem. We have consulted with several concrete contractors and
two major concrete testing companies. It is their general consensus
that patching will probably not be an adequate solution because of
the depression in the slab. The water that stands in the depression
not only aggravates the scaling problem, but is a serious safety
hazard in the winter. We understand that there are two options
available to us. First, removal and replacement of the entire
slab. This solution obviously would take care of any problems
caused by the original slab.
Second, we have been advised that a 2-3" layer of concrete over
the entire slab would be an appropriate repair if done correctly. A
disadvantage of this solution is the loss of two inches of height on
the garage and service doors.
Given the information we have at the present, we plan to go
ahead with the second option: 2-3" of concrete over the slab. If
this is done, we will not feel it necessary to employ the service of
a testing agency. We have an estimate for the repair from a
concrete company that will do the work if you are unable to do it
yourself. In our telephone conversation you indicated your
preference to do the repair work yourself. This would be fine with
us. We assume that you would provide us with a work contract
including some of the following details:
1. Preparation of the slab
.grinding and thorough cleaning of all scaled areas
.appropriate cleaning (acid etching) of undamaged areas to
ensure adhesion to the new layer
2. Use of a specified cement mixture appropriate for a 2-3" layer
3. A concrete layer which might reach a depth of 3" in the
northwest corner of the garage to ensure good drainage
4. Shortening of garage doors and trim
5. The usual guarantee of standard workmanship
Since we want an asphalt driveway and sidewalk constructed early
this fall we need the garage slab repaired in August. We would
appreciate your attention to this matter. Please let us know by
August 5, 1988, what you intend to do now that we have informed you
of our wishes.
Sincerely,
Ojv"004L�
Barb and Lary Johnson
cc: Darrel Clark
Thomas D. McCormick of
Philbrook and McCormick
F�
SUBJECT
PER NO.
City of Fridley
1_ 19804
AT THE TOP OF THE TWINS
BUILDING /PERMIT
r
CEIPT NO.
�
' COMMUNITY DEVELOPMENT DIV.
may_------
r � � PROTECTIVE INSPECTION SEC.
�
I CITY HALL FRIDLEY 55432
NUMBER
REV,
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
3/14/89
10B ADDRESS 7120 Riverview Terrace N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
2
Rsverwood Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHO E
Lary Johnson 7120 Riverview Terrace N.E. 5�2-0451
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 ❑ ADDITION C:k ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Remodel basement (frame & sheetrock) rec. room, study, laundry, bath - close off
tuck under garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Bedroom.must have egress window. Provide fire detectors on both levels of dwelling
Provide combustion air to furnace room. Use treated bottom plates. Provide power
vents to rooms without windows. .
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
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
$1.25
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,500
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.
$54.00
PLAN CHECK FEE
TOTAL FEE
,
$55.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
W N PROP LI A THIS IS YOUR PERMIT
)NSP /OAT
SIGNATURE OF OWNER OF OWNER BUILDER) (DATE)
F�
NEW [ ]
ADEN [ ] R-1 AND R-2
ALTER [ B13-lding Permit Application
A Construction Address: /�� � Vew'i efc)
Legal Description:
Effective 5/1/88
Owner Name & Address: G A9eX 6 1-0, P/I -7®,VK AUa� tod �� r- Tel. #
Contractor: ��C� Tel. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Lr4M AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTfIEIt: �Bv�t o�B � ��Se�rt � n� re�a C2?7 � S/a e �dv�sS� (rer- v avavt �.� �L 1Cf�se,_ �-rte
r
Corner Lot [ ] Inside Lot Dd Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ 2i 5o®
Approx. Completion Date:May 11 , tg s l
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
DATE: ?/ M57
Width + 6' See Back Page
APPLICANT: 4W�e— Tel. #
Permit Fee $ 4PI t'® Fee Schedule on Reverse Side
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $575 per SAC Unit
Driveway Escrow $ Alt. "A" or Alt. 'B" Above
Park Fee $ Fee Determined by Engineering
Sewer Main charge $ Agreement Necessary [ ] Not Necessary [ ]
TIAL
ihmgi
STIPUTATIONS %/� + //� / t\
,/ All 83dtcw�svS -to Dat7l t5 dYt C�9ss —IM4�r fwd
U 1[/
s
[awwd�,
kc�sitY ,/ Clue—aZ e�+�Jy $m $ucit 2 �!4rzuJ
CO
®�a �! �l/��
PrL°VimkS�y '�lcG�d—tcra�6r LVAr:2. VAgep��� ' ��
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
� � �� �� Uel V �2� �u� J J'�"3 C C�✓
RESIDENTIAL
RATE
TOTAL
Job Address
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $
20.00
$
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. her;( 33 19 �
L'AK-Y --fo 1-fo5DiJ
All Others/Repairs and Alterations
OWNER
18 of Value of Appliance or Work
$
i
n� /e&4f f ve W- [_
'COMMEGRCIAL]/INDUSTRIIAAL
KIND OF BUILDING
USED AS
P" ' 1,
1% of Value of Appliance or Work
$
TO BE COMPLETED ABOUT
ESTIMATED COST
State Surcharge
$ .50
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
TOTAL FLE
$
Reinspection Fee ($15.00)
DESCRIPTION OF FURNACE/BURNER
Rough Insp.
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Date
Trade Name Size No.
Final Insp.
Date
Capacity Sq. Ft. EDR BTU HP
Approval for Permit
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
'Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS $1
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard
written permission from adjoining neighbor.
Company /
Signed By
Tel. No. &/ ��?"��� S 5 �Z
)ut back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1.
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
If 1/ �/
SUBJECT
PERMIT hI.O. - -,
city of Fridley
T 2 1 4 51
AT THE TOP OF THE TWINS
BUILDING PERMIT
_ COMMUNITY DEVELOPMENT DIV.
i0 PROTECTIVE INSPECTION SEC.
/"►1 CITY HALL FRIDLE`1 55432
NUMBER
REV.
GATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/21/92
JOB ADDRESS 7120 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
2
Riverwood Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lary Johnson 7120 Riverview Terrace NE 572-0451
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 [2 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Remove Garage Door from Attached Garage and Replace with Two Windows & 1 Entry Do
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations, on plan
SEPARATE PERMITS,REQUIRED FOR
WIRING HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. 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
$2,000
$1.00
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-
$45.00
Fire SC $2.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$48.00
SIGNATU O NTRACT gORAUT ' iIZEDAGENT DATE)HEN
PRO ERLY VALIDATED THIS IS YOUR PE MIT
K
SIGNATU Of OW R IIF, ER BUILDER)
Fi§P fIATE
If 1/ �/
NEW [ ] Effective 3/1192
ADDN (] CITY OF FRIDLEY
ALTER(] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 7/z0 ' /v ew a e'� �"eolx C -e
Legal Description:
Owner Name & Address: s-&,— -5� -e, Tel. # 67Z
Contractor: /Vlt.� 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/G ound
Sq. Ft.
OTHER:
/foot
° 12�-j1Ae-�/nS��
Corner Lot [ J Inside Lot (j Ft.
Yd Setback Side Yard
Setbacks
Type of Construction: (`®Se ® z4,-' lwh -rte ,5 6se, Estimated Cost: $
2 ®®®
Approx. Completion
Date: 527L
J q,1
(Cost on Back)
Driveway Curb Cut
Width Needed:
Ft. + 6 Ft = Ft x $
= $
���� ��� lei'?APPLICANT:
Tei. # S72 ® q/
DATE:
CITY USE ONLY
Permit Fee
$ �® ®0
Fee Schedule on Reverse Side
Fire Surcharge
$ Z< 0 0
.001 of Permit ValuatiQaa�l/3
State Surcharge
$ ®>
$.50/$1,000 Valuation
SAC Charge
$
$700 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway . Escrow
$
Alt. "A" or Alt. "B" Above
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary (] Not Necessary [ ]
o
TOTAL
$
STIPULATIONS:
F 1 4
F �
NLI1. � � (
�yY
� "A
�\
,p � iY i /� �+�+ Tom' R„
z\V?�G•74��t�
! ., ,,'YMY If1•
,.,{
u��wAh�����A.wA��,\1 U, ir, S':
q
YEAR BUILT 8
SS_
YEAR BUILT CLA55
ONDITION EFFECTIVE AGE
ATTACHED D
BASM'T L-- FRONT SIDE BACK
£iz NO. STORIES
FOUNDATION
FLOOR
OPEN SCREENED GLAZED ti's
BY BY
EXTERIOR
FOUNDATION �17W FLOOR
ROOF
EXTERIOR
I
INTERIOR
ROOF
O.H. DOORS
INTERIOR
ELECTRICITY
m rB(��Z A �ll�P9,01�E�1ANTS_
-
;'Y14�2�
.. +
a6pa,v
YEAR BUILT
CLASS
DRIVEWAY ^ _ �y
FOUNDATION
FLOOR
r o W 0 W Pfl o P^ R 9 D TO
EXTERIOR
b O / 4/0% , XfS
ROOF
340
�-
INTERIOR
L/
RESIDENCE
:�.lo
LiX/ =
32 Sp
XZ4'2— If x
X
2 -SI
X =
3 x x ega=
x=
••• x =
90
X =
2f/ X/d = 2�f ® X =
X =
X = X =
X =
x = x =
• ,.� ,� .. � �/�c:',y� -T �; � �.
,p.,�0
P Z.3i. Y'k3 d,� �a3A �, Yi,A
BUILT INS
J }
RANGE -OVEN
/ HOOD -FAN
'
t
J �t .
IV
DISHWASHER ✓ & Q g0 8a
GARBAGE DISP.4.
€ # i
f fd
- FIREPLACES DO gS14060
3- FIXTURE BATH / '� S S p
2 - FIXTURE BATH
t
a
i
CERAMIC TILE
VANITY
#
Y d
y •r
CARPET • YARDS G S
INTERCOM
' e
;
E
a
AIR CONDITIONER+
WALKOUT
.. 2 4 0 a s 3 s' 2wa
8wP>7•« /axis
S� /axlt� 564
oc't Y ,
SUBJECT
PE, .,0.
City of Fridley
2 2 7
AT THE TOP OF THE TWINS
BUILDING PERMIT( ------
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
a° PROTECTIVE INSPECTION SEC.
69
CITY HALL FRIDLEY 55432
IL
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
---- Jl-� �'' 612-571-3450
910-F15
7/1$/94
JOB ADDRESS 7120 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
2
1 Riverwood Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lary Johnson 7120 Riverview Terrace NE 572-0451
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.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 5 3/4' Deck; a 19' x 4.5' Deck; and remove existing deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
�� x e. 0.//, WARNING
7 before digging 4911 for
ZIr — �0 ` 10—P-1'7 X11 utility ioations
454.0002
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 1 HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS I 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
$13-988
$.99
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-
$45.00
Fire SC $1.99.
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
•
$47.98
SIGN T OF CONT ACTOR AUTHORIZED AGENT ttDATEEj
WHE PERLY LID ED THIS IS YOUR PERMIT
IGN RE F OWN IF OWNER BUILDERI IDATEI •i
y BLDG INSP ()ATE
NEW Effective 1/ 1 /94
ADDN (( CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 ANDA -2 7`3
Building Permit Application
Construction Address: 7 lav R ive_r l ve-,�, -re_ rrac,-_
Legal Description:
Owner Name & Address: Lar ok Aga,, Tel. # 5-72 - 0 151
Contractor: OnJL -- 0 w v%e4- MN LICENSE #
Address: " Tel. #
Attach 'to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it. scale.
DESCRIPTION OF. IIVIPROVI IWNT.
LIVING AREA: Length V�idth '� Height Sq. Ft
GARAGE AREA: Length Width _ Height..8 Sq.Ft. .90
DECK AREA-: Length. i �- : Width . Hgt/Ground Sq. Ft.'
OTHER: i.evvl®J e- !L -g
Corner Lot [ j Inside Lo Ft: Yd S ack Side Yard Setbacks
Type of Construction: Y, Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft — Ft x $ _ $
DATE: 7112 APPLICANT: Tel. #
CITY USE ONLY
Permit Fee $ q,�:; ' 00 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 $ �
f 4
STIPULATIONS:
SUBJECT
City of Fridley
2 9 994
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
_jWj7
NUMBER
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
1 612-571-3450
910-F15
4/13/99
JOB ADDRESS
7120 Riverview Terrace NE
9 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
2
Riverwood Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Larry Johnson 7120 Riverview Terrace NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Top Gun Inc 5014 Parrish Ave NE Rogers, MN 55374 428-4559 20155030
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 0 ADDITION ❑ ALTERATION REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Reroof House & Garage (34 Sq) Tear-off
9 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.
Permit Inspection Cards
. Will Be Mailed
To Homeowner To Post
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
$2,914
$1.46
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-
$74.75
Fire SC $2.91
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$84.12
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY LIGATED THIS IS YOUR PERMIT
.!
.•`BL ,NSP �� gATE
S-GNATURE OF OWNER IIF OWNER BUILDER, 'DATE'
MAR -25-1999 16:14 FROM CITY OF FRIDLEY TO 4288826 P.01i02
NEW ( ] Effective 1/1/99
ADDN [ ] CITY OF FRMLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 a(�
BUILDING PERMIT APPLICATION c
ConstructionAddress: I L)
Legal Description:
Owner Name & Address:
`712.0
Contractor: T0F GUN, INC. 5m4 PARR NE MN LICENSE # j ®1 5 5 ®3
Address: U Tel. 1/ '-i 2g — LtS07
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF mpROVEMENT
LIVING AREA: Length Width Height, Sq. it.
GARAGE AREA: Length Width Height Sq. Ft.
DECK; AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: Estim13 aed Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + b Ft a Ft x $ $
DATE: i ��R APPLICANT: rr
Y Tel.
CITY USF Q ,V
Permit Fee $ v7S—Fee Schedule on Reverse Side
Fire Surcharge $--,2.9-1 .001 of Permit Valuation (1/I t %)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1050 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 $ 6 �. -
STIPULATIONS:
CI;. Y' OF FRIDLEY INSPECTION DIV. q,,�t 06 Effective On Jan 1, 2000
fz431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
NO. RATE TOTAL JOB ADDRESS
S
New Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the. Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
'7 �7
_ C , 20 c7f,�
Sump/Receiving Tank
$ 7.00
/
JA-v-,,
Water Treating Appliance
$10.00
Owner5G'�r_j
Water Heater -Electric
$ 7.00
Water Heater - Gas**
$10.00
Building Used As
Gas Range**
$10.00
Gas Dryer**
$10.00
Estimated Cost PERMIT NO. l
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY
Reinspection Fee $47.00/Hr
SIGNED BY TEL N0. 2ka
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved By Rough -In Date Final Date
State Surcharge
$ .50
TOTAL FEE$ 10.S0 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
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 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 :
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
May 25, 2001
Mr. Lary Johnson
7120 Riverview Terrace NE
Fridley, MN 55432
Re: Final Inspection at 7120 Riverview Terrace NE
Contractor: Shiloah Water Co
Dear Mr. Johnson:
A plumbing permit was issued on July 28, 2000 to install a water softener at your address.
According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted
on the plumbing authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the State Plumbing Code. 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 expire the permit and
no further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
1. v /.J�i
Inspector a
DJ/mh
FRIDLEY INSPECTION D1ViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
753.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
R n' I
tMepiacement
hell and Duct Work, Burner -
Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
Mir Conditio ing - All Sizes
1 thers/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
JOB ADDRESS_
Effective On January 1, 2001
OWNER 'k")Z> 6
Rate TOTAL
BUILDING USED AS
$ 30.00 $
ESTIMATED COST PERMIT NO. /5- `7
$ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating U its____ Circle One (Steam) (Hot Water) W rm Air)
$ 10.00 $ Trade Name _� t Size No.
BTU �'� vyc:;, HP EDR
$ 25.00 Fuel Total Connected Load �Mocac_T 'r 5
z.
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.
'Z 1
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 7/,;�
HEATING CO
Signed
Approved ByRough-In Date
BACK SIDE MUST BE FILLED IN ON V
AND COMBUSTION AIR VERIFICATION
TEL # AJ-VJ�-7797
Final Da
J
JT SIZE, VENT CONNE ORS
COMMON VENj-
,%1-.`ONNEC -Z AND COTABU`TiON AIR VERIFICA1 a -ON
Wr on Lipja, an In jLex n 11 f
_ _qg -
jflj�e, the �
!dersigned herebyverifies that the
venting [,! ',,,een exam
:d ar
°s free fron
-ist, deterioration, obstructions,
and is se-_% .,.Iy support
l and
;,.stopped
ire required. Yes t�No (
,.. �
Thcveff ig ystern is I
�Uclf
'and me
all dUrrent code:: and manufacturer
spccificat.'on7, including
-ing,
-fgth, numL
of elbows and to urination. Yes 0�No (
Thu und(.�rsiLired also v,
ifies 1
1 the replo,
ment unit is a li,;.' A assembly
aric'mec's 11-. current c
les t:;
'manufact�
vrs specifications This does
inclideAGA-GAMACa
gory
'entralFur
e Venting Tablef- for fan
assisted anti natural drr
appli
,es.
Yes VNu
Thcexlsflnq,combust, :sized and ' talled to meat thu current codes
anc manufacWrees spo- licatir -0. Yes (�No
W an required to instv'
^ nv!
ombustk
jr, RC.A.111 be siz;
' and installed
to i �ieet t; s current cod�
dl
and
-Anufacture
specifications.
Yes (/No(
V, en in: 'Affing a new
nth,
-3ystem, U
undcrsigned hc.
:by verifies that
it = a Ifs—tod assembly &
rnee
the curren -
codec and man,_1
!:;turers
sp :cificak)ns. This do(
Xkit
AGA-GAi
', Category I Cc-
-al Furnace
Vc rating T-ibles for fan,
>istec
3d natural..
',-raft appliances.
Yes M"No
If: the co° .1mon vent ai :ent inectors c d and install!_,d rrectiy after
ar -ippliai ice has been : illove, from the c; 11mon vent and v =need
s 'aratel', as per currei code: Yes MINO
Applia.f T
A! -and Sixes
Appliance #1 Type
Appliance 12 Type _W. U
Ap!Aanc�-_ 43 Type
Total. :opliances
;L- Total
,mmc -.1 Vent 1 Vent Connector Infoirmation
InPL',: (Fp® Iin Assists r Nat
lnp�.: Man Assisted o(M DD
�
InPU Fan Assisted or Nat
InPLI
00
C( --.!,no., lent Type
V,, Heig!c�l-
j4. Diameter
inches
Arj lianc4
'.1 Vent Coni --tor '
ght
Lengi,
—4
--ft 3liameter in
Type dr,
Ap, Aiancc-
.1,72 Vent Com, i.Aorf
;ght_
Lengi;
a—ft ,Aameter ,5 in
Type
Apl-Tia=
13Vent Coni .torl-:qht_
LencjP
_--ft Aameter in
Type
A! 'ZRA' -,,ONS: (Desc--, j!!L,.
HEA :# -ING 11-0:
Signed By. Data:
P
UiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
June 22, 2004
Mr. Larry Johnson
7120 Riverview Terrace NE
Fridley, MN 55432
Re: Final Inspection at 7120 Riverview Terrace NE
Contractor: Air Mechanical Inc.
Dear Mr. Johnson:
A mechanical permit was issued on July 25, 2003 to install a furnace and an air
conditioner at your address. According to the 1991 Uniform Mechanical Code a final
inspection shall be conducted on the work authorized by this permit. As of this date the
inspection has 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 the permit will be expired.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
...... ...� ............. �� v.. ... ... . .�.✓��. I .Wle Wl
r nrs ►5 AN APPLIQ AM FORA PERMIT - NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acimow ledge that the Inbrmation above is complete and actinate: that L work will X18 in eotlf0imance with
the ordinances and codes of the CJty of Fridley and with the N5nnesOtet Construction Codes: that I understand this is not a permit big 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 ab work which
requires review and approval of P173.
NAME OF APPLICANT DATE
Please print
SIGNATURE OF APPUCANT�
TOTAL P.01
3el
'Hddd ✓ 6
PLUMBING
I RESIDENTIAL APPLICATION
V Received y
City of Fridley
Data Received
it REd
APR
NOTE: IF PROPERTY IS NOT OWNERIOCCUPIM A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
DATE YOUR IE -MAIL AD SS
SITE ADDRESS t s b
THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR
NAME _ Ki Nor ob s [Tr-�L
PROPERTY OWNER!
TENANT
ADDRESS — ^�
CIN STATE
ZIP
PHONE
NAME LICENSE #
CONTRACTORADDRESS
IsaR
CITY 141 9L4 STATE MK) 2FP S�
PHONE # O.�S-_ FAX#
PERMIT TYPESINGLE
FAMILY TWO FAMILY
TOWNHOUSE
TYPE OF WORK
❑ NEW � REPLACEMENT
//
DETAILED DESCRIPTION OF WORK
FETES ARE BASED ON $10.00 PIER FIXTURE, EXCEPT WHERE NOTED
FDRURE9: (INDICATE TOTAL NUMBER OF EACH)
13ATH MK/LAV FLOOR DRAM SHOWER
WATER PIPING
RATHTUB GAS PIPING (Need Cly Ferree) SVY®fltiilNG POOL
WATER SOFrW1ER (gs5)
-_CLOTHES WASHER KITCHEN SINK WATER CLOSkT
BACKFLOW PRE1/. ($15)
DISHWASHER LAUNDRY TRAY � &wATER HTR (no)
FOR IRRIGATION
WATER METER
OTHER
Permit Fee $ MINIMUM: $15.00 or 5% of cost of the Improvement-wtvichever is
Ilan Review $ greater on Work less than $300
Surcharge $ .50
TOTAL DUE $ Make checks payable to: City of Fridley
r nrs ►5 AN APPLIQ AM FORA PERMIT - NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acimow ledge that the Inbrmation above is complete and actinate: that L work will X18 in eotlf0imance with
the ordinances and codes of the CJty of Fridley and with the N5nnesOtet Construction Codes: that I understand this is not a permit big 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 ab work which
requires review and approval of P173.
NAME OF APPLICANT DATE
Please print
SIGNATURE OF APPUCANT�
TOTAL P.01
3el
Building
PLUMBING
Permit No.
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: '
763-502-4977 FAX
EFFECTIVE 2-19-09
DATE 2_1'2;'7 1001
YOUR E-MAIL ADDRESS ntt4�qnn
SITE ADDRESS '71,1c)
R`tguyiezj TZYM A -
THIS APPLICANT IS:
❑ OWNER 4CONTRACTOR
PROPERTY
NAME:wnoy 8tx)
OWNER/
+�
qa -r -a(t CITY ;rwim
ADDRESS: -712.0 fi � f
_STATE ZIP__95_q3 Z
TENANT
PHONE:
CONTRACTOR
NAME: A.67 ALWeY+-S t
,
STATE LICENSE # 059 Gi 6 ' Em J EXP DATE
P2-131 l2oe�q
SUBMIT A COPY OF
YOUR STATE
a
(550 3 64 6 EXP DATE
� 70tyl
LICENSE., BOND AND
CERTIFICATE OF
STATE BOND #
ADDRESS: -M -7E5 0- ° RA CITY 60045&10
STATF.-MAIZIP �JCJC�S
TNSURANCE
< _ _
PHONE (05 t s *73T- OSW FAX_ iP51=773 e
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW (REPLACEMENT
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK Ba�kAnnheN VZAUt 4 -in ftQj-*
-AwhycS an
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
I BATH SINK/LAV
_FLOOR DRAINS _ SHOWER
_ WATER PIPING
l BATHTUB
_ GAS PIPING (NEED CITY LTC) _ SWIMMING POOL
—WATER SOFTNER ($35)
CLOTHES WASHER
_ KITCHEN SINK I WATER CLOSET
—BACK 1; LOW PREY. ($15)
_
DISHWASHER
_ LAUNDRY TRAY _WATER HEATER ($35)
FOR IRRIGATION
WATER METER
_ OTHER
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977