PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N®
_.
Date: .....__10
_._._..._...._.._.........�
...._............._............_...._... � ... -..................
Owner:
Address
4191
Builde ' -
•---... ......_..... ,.._....._.._..__�....t_._.. � Address ... ..._......... .................... --•---..... -......... -..............
-- - -- - - - - _
Ja&8 ' 'J_ LOCATI N OF BUILDING
r
No. Street Street _..._....... ..-• .._r.. --•-----.. Part of Lot .................... _........ ......
�
Lot ............ ._....... Block ....../ ............... _............. Addition or Sub -Division . ..
.-- - --
.G.r �, e
41-
Corner Lot .................................... Inside Lot...X............................ Setback . .. .._..'....�..... Sideyard ..... .........� ......_. ............. -.._.......
Sewer Elevation ...... ............. _............. _.......................... -............ ...... .............. _. Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
.- .... Front Depth . � .-- .. S . Ft.... 4? Cu. Ft. �,.. � � 0
.............._.. Height .. ......c �� q
P'
.... ............................. .......................... Front ..... ................. Depth ...................-//.. Height ....................-... Sq. Ft. ..-.._................. Cu. Ft. ..... .........
...._..
Type of Construction........................................................... Est. Cost..l...l�:��....... _ ®...0.. To be Completed ..... .............. _......................
In consideration of the issuance to me of a permit to construche building described abov , to do
the proposed wank in accordance with the description above set fo in compliance with all sons of
ordinances of the city of Fridley. `4k
In consideration of the payment of a fee of $X .., permit is hereby granted to...............................................
.......... ................... .................... _..._...._........ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _ �•
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure- to-sm
the Building Inspector for separate permits for these items.
City of Frill -ley
Permit No.
AT TK TOP OF THE TWINS
r'
Furnace Shell & Duct Work to 120,000 BTU ......
. ..$10.00
$-Z-'!-' U 0
i 11;1-.--_-__,
HEATING PERMIT APPLICATION
' . ' ' ' 3.UO
CONNIVdITY DEVIL SENT ®IV.
Replacement of Furnace .. . ..
..... 6.00
$
MOTICTIYE IWa-$CTI0q DaPT.
Repairs & Alterations—up to $500.00
6.00$
6 i �evo1 CITY HALL FRIDLEY DGQ2
l.es..J s/ 'md ala"801.'86fia®
Repairs & Alterations each add. $560.00
3.00
$
mx4zER
REV.,
®dYE
BY
910-F17A
1 0
2/15/73
IPAGEOftAV'PR0VEa
1 1
800
Job Address
nerd
r ss
Phone
�
Co or
A r ss
Phone
o x '
Kind of uilding
Use
Comp etion Date
Estimate�( ost
%V=Zt V _ a a a+a 491"x14 ft z x3:
Furnace Shell & Duct Worla ...
Replacement of Furnace
Repairs & Alterations—up to $500.00
Repairs & Alterations each add. $500.00
NAYIE TOTAL Heating/Power Plants #
"810.00 $ ' Steam Hot Water Warm Air
6.00 $
Trade Name
6.00-- Q
3.00 $_- -____ Size No. c�0 f�r�J
I CI -L WAMI AM `-,
Capac! ty U O Sq. r t
Furnace Shell & Duct Work to 120,000 BTU ......
. ..$10.00
$-Z-'!-' U 0
HDR BTU Ton.
each add. 60'000 BTU . ' ' ' ' ' "' ' ' ' ' ' .
' . ' ' ' 3.UO
Total Connected Load
Replacement of Furnace .. . ..
..... 6.00
$
Repairs & Alterations—up to $500.00
6.00$
Kind of Fuer --
Repairs & Alterations each add. $560.00
3.00
$
Burner
STEAM or &IGS° WATER SYSTEM
Furnace Shell & Lanes—to 400 sq. ft. FMR Steam $10.00
Furnace Shell & Line to 640 sq. ft. EDR Hot Water 10.00
Each add. 200 sq. ft. EDR Steam %.On
Each Gadd. 320 sq. ft. EDR Hot Water 3.00
OIL BURNER—to 3 gal. per hour
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 1�3,0W BTU)
over 1S-9,046 Fi'.1'i1 See Fee Bchedulq
Trade Name
Size No.
$ - - Capacity
$ HDR BTU
&00 $ 's-' ® O
GAS &'IiI rl?.7G FEES: ES: NO RATE TOTAL
1st 3 Fixtures X5 200 $ 010 O
Additional natures x .75 $
Gas Range to 199,C x5 5, $ _
50 State Surcharge
'AIA Cob DYTIONIvG 'a I/ ;'--0 � $ g
TAN IMATIPIG ZY� 4 SCQ Fee seht:drja
VENTILATING SYSTZvj �
ALTERATIONS & REPAIRS
ROUCI 3
�e�
11'iFelAL / ��' ion
TOTAL r= $ -2'Z. S-0
to
Sq.Ft
Ton,
_3
e3
mf MGASCO
53-84-s-915.51
City of Fridley
Applice,ian for Plumbing and Gas MSN'in g Pe It
Dept. of Bldga. Phone 360-3450
DESCRIPTION OF WORM 1268 Skywood Lame N.E.
Number, Kind and Locr'±an of Fixtures Lo=
Futuzo Connactku Openings Cozmactod with
E®was []
Xaw Fixture. Old Openings Cccspool E]
PARTIAL RATE SCHEDULE
.UMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................ ___. x $2.00 $
Future Fixture Opening ............ x $1.50 S _.
New Fixture Old Opening.......... x $1.50 $_---
Catch Basin .................... x $3.25 $
Water Heater 'Up to 99.000 BTU) • • • •
x $3.00
$
> New Ground Run Old Bldg.......:.
x $3.25
c o
Electric Westar Heater. ........
N
ui
o s
o!
3
O
I
u
U a
i
4i
u$
7
N
WATER NTN.
GAS
ELM•�
x
Gas Range to 199.000 BTU ...........
x $5.00
S
In tal
1 1as
og
3
_
i
Futuzo Connactku Openings Cozmactod with
E®was []
Xaw Fixture. Old Openings Cccspool E]
PARTIAL RATE SCHEDULE
.UMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................ ___. x $2.00 $
Future Fixture Opening ............ x $1.50 S _.
New Fixture Old Opening.......... x $1.50 $_---
Catch Basin .................... x $3.25 $
Water Heater 'Up to 99.000 BTU) • • • •
x $3.00
$
> New Ground Run Old Bldg.......:.
x $3.25
$
Electric Westar Heater. ........
a $2.00
$
AS FITTING FEES:
NO. RATE TOTAL
Ist 3 Fixtures ............ • • • • • •
x $2.00
$ .
Additional Fixtures ...............
x S.75
$
Gas Range to 199.000 BTU ...........
x $5.00
S
City of Fridley:
The undersigned hereby makes application for a permit for the- work her ei
specified, agreeing to do all work In strict accordance with the Citi 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 5-15-75 19.
Owner Ytn Ho Lee
Kind. of Building Frame-
Used as Res,
To be completed about 5-22-75
Estimated Cost, $ 10.00
40
Old--`ir. IIuilding Permit No.
Signed .�..�.'
By MINNEGASCO _-
Business Phone No
ROUGH
FINAL -10-760
EPAIRS & ALTERATIONS --Beier to Code .50 State Surcharge
Description
� Install Gaslog 5.00
.......... w. � .. ° .. r..................
T AL FEE $ 5.50.
'Class
SUBJECT
PERMIT ..
City of Fridley
0
AT THE TOP OF THE TWINS
DCRvIT.
BUILDING
Ir
i.
I�IEEIP .
COMMUNITY DEVELOPMENT DIV.
�
r ! PROTECTIVE INSPECTION SEC.
! I , CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
11/26/73
Jos ADDRESS 1268 XXM Skywood Lane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
Beverly Hills Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Yun Ho Lee 1268 Skywood Lane N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Ron Scholl 1508 Ferndale Avenue
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING Residential
7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK Deck & Alterations
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WILING,
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITSARE 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
I
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.
$3000
1,50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
f
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-
$18.00
STRU I NOR THE PERF RMAN�CSCTION.
Vm,,r,4( �/d �L ��
PLAN CHECK FEE
T�TA1�FE 50
IGNATURE OF CONT A TOR OR AUTHORIZED AGENT (DATE)
HEN PROPERLY VALIDATED T YOUR PERMIT
#: SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
G. INSP OATE
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR Ai)DITION BUILDING; PERMIT
CITY OF 1-1:1 DLLY, MINNESOTA
/ I !�:�
OWNER IS NAME: 14D BUILDER: �o--, _
ADDRESS Jal- . ADDRESS
NO;. STREET:
LOT; BLOCK: / ADDITION:A::te-
CORNER LOT: INSIDE LOT:_ SETBACK: SIDEYAFD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
builditig, location drawn on these Certificates.
To Be Used As:
.DESCRIPTION OF BUILDING
Front:
Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: 1Xd4 Estimated Cost: $ 1 �O� ov
To Be Completed: 2 — '2,3
The undersigned hereby makes application for a permit for the work herein,
specified, agreeing to do all work in sttieL accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that. ,ill the facts and representations stated in this application
are true and corrt.c t .
DATE://' SIGNATURE:
(See Reverse Side For Additional Information.)
CITY OFitIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTE14S AND DEVICES
FATE SCHEDULE
RESIDELyTIAL
RATE
TOTAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
$ 20.00
$
\
Gas Piping
$ 10.00
$
(piping needed with new furnace)
Gas Range
$ 10.00
$
Gas Dryer
$ 10.00
$
* Air Conditioning (all sizes)
$ 10.00
$
All Others/Repairs and Alterations
1% of Value of Appliance or Work
$ 15.00
Replace Wall Htr., direct
Vent
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
$_
State Surcharge
$ .50
TOTAL FEE
$15.50
Reinspection Fee ($15.00)
$
Rough Insp.
Date
Final Insp.
Date f�
Approval for Permit 1T
MINIMUM FEE FOR ANYHEATINGPERMIT IS $i!ff.00
PLUS $.50 STATE SURCHARGE
Attach stack verification form with replacement furnace permits
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
1.1 LeUtive Auy. 1, 1 )qI '
Job Address 1268 NE Skywood Lane
Department of Buildings. 6431 University Ave. N.E., Fridley, MN 55432
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, Minn. 22 Feb 89 19_
OWNER
Xun Ho Lee #571,6903
KIND OF BUILDING Fr
USED AS
Res
TO BE COMPLETED ABOUT 22 'Feb
ESTIMATED COST 6()0
OLD - NSKBUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Not Water, Warm Air- No.
Trade Name LSC Direct Vent Wall SAIrNo. LSCa25
Capacity
Total Connected Load
Sq. Ft. EDR BTU HP
Kind of Fuel Nat, Gas
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR , BTU 25,0
el
Company
'Si+jned: By
Tel. No., ® #34.2-536 7
700 %& Llnden Avenue
P. 0. BOX 1165
MinneaP0115, MN 55440.1165
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 k'AX: (763) 571-1287
PERMIT O.: 2004-01697.
DATE ISSUED: 09/29/2004
ADDRESS : 1268 SKYWOOD IN NE
PIN : 243024330017
LEGAL DESC : BEVERLY HILLS
: LOT 4 BLOCK 1
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 0.00
# ELEC WATER HEATERS 0
VALUE OF FIXTURE/APPLIANCE
0
# NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS
I
# GAS DRYERS 0
# GAS RANGES
0
# OF NEW FIXTURES 0
VALUE (FOR MINIMUM CALC)
400
# WATER TRMT APPLIANCES 0
APPLICANT
PLBG PERMIT NIINIIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
0.00
0.00
NORBLOM PLUMBING CO
2905 GARFIELD AVE S
PLBG FIXTURES (EXIST OPENINGS)
0.00
NIINNEAPOLIS, MN 55408-2173
WATER TREATMENT APPLIANCE
0.00
(612) 827-4033
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
35.00
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
0.00
0.00
0.00
OWNER
LEE YUN HO &SOON JHA
1268 SKYWOOD LN NE
STATE SURCHARGE, PLBG FLAT
0.50
FRIDLEY, MN 55421
TOTAL
35.50
PAID WITH CHECK # 29179
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 construction or the performance of construction.
ADDlicant A Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004
6431 University Ave NE 45 j Cl
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT ✓l 1
(763) 572-3604, FAX (763) 571-1287
MARK NIJMRFR nF FIXTI IRFC Tn RG IMQTAI I Cn nal Cee -u C" nno
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas** /
Gas Range'"
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.00
Type $15.00
35-- OZ
•: ADDRESS
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
OWNER
LEE, VUN HO
1268 SKYWOOD LANE NORTHEAST
FRIDLEY, MN 55421
(763)571-6903
'7J23 206 5(
BUILDING USED AS �,e,Sl J e4iC--r—
ESTIMATED COST W O _ PERMIT NO.
PLUMBING COMPANY NO f- U OV
Reinspection Fee $50.00/Hr SIGNED BY
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
Approved By
State Surcharge $ --6D
MINIMUM I
TOTAL FEE $ �S.Sa OF THE IMI
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
TEL NO. �f'olZ) $27—c/o33
Rough -In Date Final Date
"PROVIDE COMMON VENT INFO ON BACK 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( j
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 :