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PRE 2010 DOCSVillage of Fridley, Minn. ® 1374 BUILDING PERMIT Date: -c'�� . .... .-.. ... .... . Owner':, 3 . ........................... Builder ... .. .. .. . Address«''........ .'I; ........:.................. Address: ii 40CATI(�N OF BUILDING Street t a(I".. v' .. .... Pa o �.ot ............................. r.. � Lot ./* ........ Toch :......:... Addition or Sub -Division r"-- ... L.. -^'a'. ... .. V Corner Lot ........ Inside Lot .. ... Setback ..,... Sideyard ��....�.............. DESCRIPTION OF BUILDING To be Used as: : ..:` 1. Front Depth Height ........ Sq. Ft. .... Cu. Ft. .... Front ........ Depth .. Height ... Sq. Ft. ........ Cu. Ft. ........ Type of Construction-°rn . Est. Cost Z4 . "' .... To be Completed ... .... . Ij II II!, i' In consideration I;of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. In consideration of the payment of a fee of $�; V, permit is hereby granted to ' fear ..... .. ...... ... to construct the building or addition as described above. This -�ermit is granted upon the express conditionAhat the person.to whom it is granted and his agents, employees and workmen, in all work done in, around and 41pon 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 with- in the village limits a�nd this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector NOTICE: I F This permit dries not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see uilding Inspector for separate permits for/ -�e items. City of Fridley, Minn. BUELDING PERMIT N® 3922 Date: ... . .................................. Owner ....................................... Builder .... .. .. 0; Address...................................... Address ............................................. ATION OF BUILDING No. .. ... Street ... ..... ..r....c....a......... Part of Lot ............................... Lot ............ Block ................... Addition or Sub -Division ....................................... Corner Lot ............ Inside Lot ............ Setback ..... Sideyard ...... .. ..... ....... ... ........ ... DESCRIPTION OF BUILDING T s as: a �/� . �..� Front ` �:. �. Depth 0?, Y �� eHeight/C) . A. Sq. Fm�. F�1. Cu. Ft. %�. Y/. . ................ Front ........ Depth ........ .Height .. Sq. Ft. ........ Ca. Ft. Type of Construction ................... Est. Cost... // ....... To be Completed ................... In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $...�......... permit is hereby granted to ................... ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. B Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to 'see the Building Inspector for separate permits for these Items. � Q ADDP.V,S S k$. VALUATIUM T",'PE ............................... .................... . .................... .... .................. ...... .................... I .......................... ....... ........ ....... Property Line r- — — — — ,i 9iA-V to L--iiK-- - - - --m SUBJECT -RMI T City of Fridley®12685 -PE AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ?a90 1 1 � ; CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L---- • •�� 612-560-3450 910-1715 8/17/74 I JOB ADDRPlank Kozlak 4512 2nd Street N.E. 1 LEGAL LOT NO. TRACT OR ADDITION SEE ATTACHED DESCR., 1 [BLOCK 3 Rearrangement of Blocks 13-15 PlymodtftT addn 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Kozlak .4512 2nd Street N.E. 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 EK ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE QF USE FROM TO STIPULATIONS 1. Provide roof for 40 # XXXX live load SEP5RATE PERMITS REQUIRED FOR WIRlNd, NEATIN�, PLUMBING NO SII" TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. lber lass 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 FORA 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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. 5.00 PLAN CHECK FEE TOTAL FEE5.50 .50 SIGNATURELFCONTRACTOROR WHORIZEDAGENT (DATE) 7A- EN OPERLY VALIDATE T IS YO R PERMIT .SIGNATURE OF OWNER 11F OWNER BUILDER) (DATE) DG. INSP. - DATE' APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : `` d n /<', &X a /L BUILDER: ADDRESS : �.5 %� — �S T, %y, ADDRESS: NO:. STREET: LOT: BLOCK: ADDITION :T -ri o CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front:, Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: • Type of Construction: �Q- I�-� o� l Estimated Cost: $ �SJU o, of F�A � To Be Completed: Qi/ 0 h y. The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. A DATE: D 4 SIGNATURE: (See Reverse Side For Additional Information.) I (i. w Ea U) iv ft P) rt (D to 91 I 1� I po CR z 0 0 0 to V 0 C r— m w CA ca :a 0 F4 0 9 9 9 8 8 8 8 r � ir r r 1, r 1, r r r r r z 0 0 0 to V 0 C r— m w SUBJECT City of Fridley ® 14691 AT THE TOP OF THE TWINS BUILDING PERM r i RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 5' 1 � = CITY HALL FRIDLEY 55432 NUMBER REV._- DATE PAGE OF APPROVED BY 612-560-3450 910-F15 5/11/78 JOB ADDRESS 4512 - 2nd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 1 Rearrang. of Blks. 13-15, Plymouth SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Kozlak 4512 - 2nd Street N.E. 560-9149 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof dwellincr 9 CHANGE OF USE FROM TO STIPULATIONS 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 $900 $.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- $7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $8.00 SIGNA UREOFCO�NT�RRAAC;ORO AU HORIZE AGE (DATE) HEN PROPER V/A,LIIID�ATE�Dq THIS IS YOUR ,/� ALDG INSP �PERMIT //��/'�{ DATE GN TURE OF OWNER((( I FO ER BU DERI (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUJLDING PERMITS (WEw, ALTERAT' i oNS, ADDITION -3, OR REPAIRS) MIME; Z BUILDER: P"fr Address: �/� Address: . Tel. No. I-Im LOT: I COMILR LOT: Street: BLOCK: ADDITION: e & . Q F 2Le�'-g-a INSIDE LOT: SETBACK: SIDEYARDS: Applicaht attach to this fo n Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: cQ Q.� Estimated Cost: `$ 9(XY To Br- Completed: _ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE kEVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings., and hereby declares that all the facts and representations stated in this application are true and correct. See reverse side for additional inj;ormaj�ion,,. DATE: S-(1-01 SIGNATURE Stipulations: r SUBJECT PER City of Fridley " ! -15-497 AT THE TOP OF THE TWINS B I I L D I I� I i� D C D M I T BUILDING r �"CR RECEI COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ��� � `1 � L ��-�� �CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450. 910-F15 9/28/79 / / JOB ADDRESS 4512 - 2nd Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 1 3 Rearrangement of Blocks 13,14,15, PlyMutffET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Frank Kozlak 4512 - 2nd Street N.E 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Nedegaard Construction Co., Inc. 3903 Foss Road, St. Anthony 560-0070 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 11 Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10' x 20' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Variancee approved on front .yard setback to 25 feet on 9/18/79. SEPERATE PERMITS REQUIRED FOR WIRING,- HEATING, PLUMBING LAND SIGNS. WARNIIN Before dIIWng call local utilitio :%J 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 $3,650 $1..83 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- R THE PERFO CE F CONSTRUCTION. �` 4. 00 NONE PLAN CHECK FEE TOTALFEE USIGNATU 6.00 $31.83 E OF CONTRACTOR OR AUTHORIZED AGENT IDA EI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT ']Ii4') h P -0 1 - LU� 9Y.,6/92— BLDG WSP DAT SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF. FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: „F hAIK KOF141� , BUILDER: ���� „� CVIV__9 cla 3wal ADDRESS: J43 Q- _'R&"9d` ADDRESS: 3cW_5 ® yolyr TEL N0: TEL NO: 5&0—oo ,® Construction Location STREET NO: STREET: AJP LOT: -BLOCK: ADDITION: ✓�9 Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Height: >o� Squane. Feet: Cubic Feet: Front: Depth: Height: Square - Peet: Cubic Feet: Type of Construction: Estimated Cost: $ a Tb Be Completed: - _ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ ' $ SEE REVERSE SIDE OF SHEET . .7he undersigned hereby makes application for a permit for the work'herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: �o�•/�%�% SIGNATURE: Stipulations: ° C ' . A�& _...........__._...__ r I L. -7-M-1 NEDEGAARD CONSTRUCTION 3903 FOSS ROAD • ST. ANTHONY, MINNESOTA 55421 Request for Variance for Frank Kozlak 4512 - 2nd. Street Fridley, Minnesota Proposed Addition 10'X20' 1 1 COMPANY PHONE 560.0070 August 29, 1979 IVR0 PoSjPD A P D r -rr©ov WTMOow NVs:w �Ro�vT SfcoP)v srREET INC.. SUBJECT P IT NO. City of Fridley'T AT THE TOP OF THE TWINS BUILDING PERMIT r RE PT NO. COMMUNITY DEVELOPMENT DIV. I ; tr ______ PROTECTIVE INSPECTION SEC. NUMBER REv OATSPAGE OF APPROVED By CITY HALL FRIDLEV 55432 612-571-3450 910-F15 9/10/978 JOB ADDRESS 4512 2nd St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 Rearrangement of Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim & Tara Jackson Same 571-5146 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. PTL Contracting 2526 N Ferry t Anoka 55303 323-7400 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 lb REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage 23S Tear -off 9 CHANGE OF USE FROM 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 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 $10,833.00 $.99 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- CON- $62.25 Fire SC $1.97 STRUCTION OR THE FORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTA EE ®Lice SC $5 0 $70.21 ;PKATURE tl (DAA1 - ENP PER A "00 BLD INSP DA D HIS IS R PER IT DATE SIGNATURE OF OWNER OF OWNER BUILDERI (DATE, NEW [ ] Effective 8/1/95 ADDN [ ] CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -7&96 Building Permit Application Construction Address: �—lv�;. Legal Description: Owner Name &Address. /A ,f Tel. # J7 l .�p V4 Contractor:MN LICENSE # _�2V�l Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: 3 Tel. # � 3 ?Veev Attach ,to this 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. Length Width Hgt/Ground Sq. Ft. Comer Lot [ ] Inside Lot [ ] Ft. Yd SetoWk Type of Construction: Approx. Completion Date: Driveway Curb Cut Width Needed: DATE: APPLICANT: Side Yard Setbacks Estimated Cost: $ e11 3� _ (Cost on Back) Ft. + 6 Ft = Ft x $ Tel. # TOTAL $ __70 STIPULATIONS: CITY USE ONLY Permit Fee $ 62, Fee Schedule on Reverse Side Fire Surcharge $ ® .001 of Permit Valuation (1/10th%) State Surcharge $ $.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 $ $450.0 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ __70 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURtS TO BE INSTALLED ON EACH FLOOR `; Wash tvl:`: :::«:>::::: Floor Auto. Stories »> Urinal Shower . �•`��°`'fi m ..<� Washer �.'�':��:;:.: Basement 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 Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas`* Gas Range*` NO. RATE M Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Effective On Jan 1, 2000 Gas Heater Elec TOTAL JOB ADDRESS WIZ 0"o 5T, � I. e�& Cl State Surcharge $ .50 TOTAL FEE $ 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. ,20C>� Owner ��� Building Used As Estimated Cost PERMIT NO. PLUMBING 1 SIGNED BY Approved By���� Rough -In Date Final Date /6� A U 6 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE a__ t 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: CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1999 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work, Bumer — Also Replacement Furnace $ 30.00 $ (Side Vent — Fill Out Back) Gas Piping deeded with new furnace, $10.00 $ but not replacement) Gas Range $10.00 $ Gas Drygr $10.00 $ *Air Conditioning — All Sizes $ 25.00 $ da G/%-R4Z, 's`cz 9T® -a Ptda_y All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE, REINSPECTION FEE $42.00/Hr ,,Air Conditioners can not be placed in a side yard without writtep permission from adjoining property owner. 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 cr. X998 � , OWNER i4 CJ BUILDING USED AS ESTIMATED COST 2-75 o d PERMIT NO. c2 DESCRIPTION o2 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One Trade Name BTU HP (Steam) (Hot Water) (Warm Air) _ Size No. EDR Fuel _ Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMPANY �E3(QE&iI /;�L_ )4EK1,r�c *A�� Signed By Tel No. S/ ApprovedBy Rough—In Date Final Date ! 0 d 0 STACK VERIFICA 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's cc-nnected Yes () No ( l 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: .90 A1, "EMN01 & AIR, 'Ne' 1515 East 41 St StWt, Suite Am Minneapolis, MN 0725 M 01700-1 RN Yes () No ( ) Yes O No ( ) rJAM GNOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 September 25, 2000 Mr. Jim Jackson 4512 2 Street NE Fridley, MN 55421 Re: Final Inspection at 4512 2 Street NE Contractor: Residential Heating & Air Dear Mr. Jackson: A mechanical permit was issued on June 9, 2000 for the property located at 4512 2 Street NE for an air conditioner installation. According to Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical system. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (612) 572-3603. DJ/mh 5,���i5aAiM '_ITY OF FRIDLEY INSPECTION DIViSION Effective On May 10, 1999 5431 University Ave NE =ridley, MN 55432 APPLICATION •FAR POWER PLANTS AND HEATING, COOLING, VENTILATION, 372.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS y�� �s+ ME _ RATE SCHEDULE OWNER-- lesidential Rate TOTAL Furnace Shell and Duct Work, Burner - 30.00. $� �, BUILDING USED AS Also Replacement Furnace $ . `-7 ILI C7 ESTIMATED COST tO Ob Cy-D PERMIT NO. (Side Vent . Fill Out Back) . Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range. $ 10.00 $ No. of Heating Units I Circle Cne (Steam) (Hot Water)arm ir. Gas Dryer $ 10.00 $ Trade Na ) iDj Size No. 5V IC 00 BTU 7i HP EDR "Air Conditioning - All Sizes $ 25.00 $ Fuel_ _ Total Connected Load J All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge $ .50 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. 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 ar rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. HEATING RAPIDS, Ill 55433 Approved By Rough -In Date Final Date '` 6 Has total heating BT'U's of /,��, ado All other BTU's -- TOTAL BTU's 7. Has a liner been provided for water heater Yes No ( ) 8. Has combustion air been provided for water heater Yes No ( ) Remarks:. a AV DEPENDABLE INDOORAtRQUALIM INC. 9 COON S BOULEVARD _ COON RAP 55433 HEATING CO: (612) 75 Signed By: Date: CELIAMY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined z. 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 requirementsfor size and total BTU's connected Yes ( No ( ) 6 Has total heating BT'U's of /,��, ado All other BTU's -- TOTAL BTU's 7. Has a liner been provided for water heater Yes No ( ) 8. Has combustion air been provided for water heater Yes No ( ) Remarks:. a AV DEPENDABLE INDOORAtRQUALIM INC. 9 COON S BOULEVARD _ COON RAP 55433 HEATING CO: (612) 75 Signed By: Date: CITY OF FRIDLEY PERMIT NO.: 200400699 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/13/2004 572-36U4 YAX: (763) 571-1287 ADDRESS : 4512 2ND ST NE PIN : 263024330117 LEGAL DESC : REAR BL 13,14 & 15 PLYMOUTH : LOT 1 BLOCK 3 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SERVICE AND 11 CIRCUITS TO GARAGE. APPLICANT RED HORSE INC 6540 LUCIA LANE NE FRIDLEY, MN 55432 OWNER JACKSON JAMES A & TARA R 4512 2ND ST NE FRIDLEY, MN 55421 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. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MAX (RESI) 85.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 85.50 PAID WITH CHECK # 2168 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT NO.: 2004-00700 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/13/2004 572-3604 FAX: (763)571-1287 ADDRESS : 4512 2ND ST NE PIN : 263024330117 LEGAL DESC : REAR BL 13,14 & 15 PLYMOUTH : LOT 1 BLOCK 3 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL TWO SERVICES AND 8 CIRCUITS IN DWELLING. APPLICANT RED HORSE INC 6540 LUCIA LANE NE FRIDLEY, MN 55432 JACKSON JAMES A & TARA R 4512 2ND ST NE FRIDLEY, MN 55421 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 atter 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 wort 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. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MAX (RESI) 85.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 85.50 PAID WITH CHECK # 2168 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.