PRE 2010 DOCSW. " ...,
&..A 400 Village ®f Fridley, Minn.
BUILDING PERMIT
N° 1'733
Builder..............................................
Address.............................................
C ® S1 3LO ATION OF BUILDING
No . ............. Street ........ ®a..!K...................... Part of Lot ........
... ... ... ....
Lot ....... Block / . Addition or Sub -Division
Corner Lot .. ..... Inside Lot Setback —:3S' i.. Sideyard ...... ,/40"5 .............
"DESCRIPTION OF BUILDING
e Used as:
�sP D
Front .., Depth Q.... Height .l Sq. Ft. ........ Cu. Ft. ........ r
7 f`v
.. Fr t ........ Depth...
He t Sq. Ft. ........ Cu. Ft. ........ 5 r
4`
Type of Construe ............ Est. Cost To be Completed ..................
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 descriptio above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
... 1.. .................
In nsideration of the payment of a fee of $/ 41 ., 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, alidr tion, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revokes at any time upon violation of any of the provisions of said
ordinances.
E
........... ..y � ... 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.
City of Fridley-
SUBJECT
RM I
��-
l- 5
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
• COMMUNITY DEVELOPMENT DIV.
�L ------
� PROTECTIVE INSPECTION SEC.
t✓ �
®/�fr✓
7 ; �
/--n CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
6/3/76
JOB ADDRESS 990xxXX 251 45th Avenue N. E. #% ® IV. Aid.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
8
1
Rearrangement of Plymouth SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Ralph Erickson 4507 2 1/2 Street N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Sussel 1850 Como St. Paul
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
EC NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a detached garage 24' x 30'
9 CHANGEQFUSEFROM TO
STIPULATIONS. 4
NOTIFY THE FRIDLEY CNGR.DIVISION
1. Garage to be 45.25 feet from house REGARDING CURB
REMOVAL AND REPLACEMENT
2. Provide a hard surface driveway AT DRIVEWAY, OPENINGS.
PERMITS REQUIRED FOR WIRING#
F P ERATE
PLUMBING AND SIGNS
HEATING,
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
wood frame
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
720
7,200
ANY TIME AFTER WORK IS COMMENCED,
NO. DWLG. UNITS
OFFSTREET PARKING
'HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS, GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$5,328
2,66
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU ION OR THE PERFORMANCE OF CONSTRUCTION.
13.50
PLAN CHECK FEE
TOTAL FEE
fo
6
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
OEN PROPER Y ALIDATED THIS IS YOUR PER . IT
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG )NSP DATE
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME: , „ ! >_ �� BUILDER:-
ADDRESS.: _- Off' r' ADDRESS:
f STREET:
LOT: 0 BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificatcs of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
U
Front: Depth: Height: 16
Square Feet: �%�L Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: -�y� X Estimated Cast:
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stxict 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
true and correct. 1
SIGNATURE •
Reverse Side Side For Additional Information.)
w
SUBJECT
PER
City of Fridley
r 15 8 0
AT THE TOP OF THE TWINS
BUILDING P E R M I T
i
• _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J\ 612-571-3450
910-F15
6/30/80
JOB ADDRESS
4507 - 21g Street N.E.
1 LEGAL
LOT NO.
BLOCK
RACT OR ADDITION SEE ATTACHED
DESCR.
8
1
rRearr.of Blks .13 14,15 Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ralph Erickson 4507 - 22 Street N.E. 560-7946
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Viking Home Improvement Co. 4832 - 21S60-1794
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
al
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house
9 CHANGE OF USE FROM TO
r
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
I
ISTALLS I 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
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.
' I
PLAN CHECK FEE
TOTAL FEE
L ? (�- 30 t- to
$8.00
SIG ATUREOFCONTRACTORORAUTHORIZEDAGENT (DA IEl
WHENVALIDATED THIS IS YOUR PERMIT
Is
1�gqPROPERLY
LC...
BLDG INSP f)A E
SIGNATURE OF OWNER(IF OWNER BUILDER) (DATE)
w
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(Neer, Alterations, Additions, or Repairs)
OWNER:99-1p�j
_ J�
ADDRESS: V 6`7 2� S 1 V
TEL N0:
ADDRESS:
TEL NO: C1
Construction Location
13TR3 s T NO: �-f 5�(J STREET:
LOT: . BLOCK: ADDITION: ��1��f� J(�1 �S ,LJ, 1'1.
i //l ULk_
41-40Corner Lot: Inside Lot: Setback: Sideya.rds:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to. scale.
DESCRIPTION OF CONSTRUCTION
Front:
Squane. Feet:_
Depth : Height:
Cubic Feet:
Fr, it: Depth: Height:
Square - Feet: Cubic Feet:
Type of Construction: ZEstimated Cost: $ A
To Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is.Desired: $ $
SEE REVERSE 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
/57
representations stated in this application are true and correct.
�� �e�6,
DATE: SIGNATURE:
Stipulations:
00
e
• •
SUBJECT P
City of Fridley
16 9.0
AT THE TOP OF THE TWINS
PERMIT
BUILDINGr
r �
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
r �
= CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF APPROVED BY
612-571-3450
910-F15
12/22/82
I �
JOB ADDRESS 4507 - 211 Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
1
Rearrange. 13,14,15 Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ralph Erickson 4507 - 23i Street N.E. 572-1558
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Viking Home Improvement 4832 - 2k Street N.E. 572-1820
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
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Install aluminum siding and trim
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
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
$4,000
33 $2.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
1
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PIROIONS NY OTHER STATE OR LOCAL LAW REGULATING CON-
$44.50
TR CTIO R E PE FOR NCE ON UCTION.
3
PLAN CHECK FEE
TOTALFEE
$46.50
N' r
IGNATURE OF CO RACTOROR U O EDAGENT (DATE)
WHEN PROPES.LY VALIDATED THIS IS YOUR PERMIT
BLI IOAT
SIGNATURE OF OWNER I IF OWNER BUILDERI IDATEI
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATION FOR RESIDENTIAL BUILDIIIG PERMITS
(New, Alterations. Additions. or Repairs)
OWNER: "-��o b�
ADDRESS: _ �� �1- �� ' .7-.
TEL 110: I' x'70 - /���
BUILDER:
ADDRESS: St.
TEL NO: -18au
Construction Location
STR=T NO: STJUMT:
LOT: BLOCK: % _ ADDITIONa
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:
Square Feet:
Depth: Height:
Dibic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Rape of Construction: _ Aub 'I -n "0a�m Estimated Cost: 5 �
Rb Be Completed:
Alt. A Alt. 8
Proposed Driveway 'Width If New Opening Is Desired:
SEE REVERSE SIDE OF SHEET
The undersi ned here makes application for •
9 by PP permit for the work herein specified,
agreeing to do ,all Work LT, strict accordance with the City of Fridley Ordinances and
rulings of the DeLx%rtmcnt of Buildings, and hereby declares that all the facts and
representations stated in this application ar"true and correct,
D,ZTE: D&:�—%�. � --SIGNATUIE:
Stipulations:
P.
SUBJECT
City of Fridley
2899 5
AT THE TOP OF THE TWINS
BUILDING PERMIT
r ,
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
SEC
r PROTECTIVE INSPECTION
I
= CITY HALL FRIDLEY 55432
NUMBERREV
DATE
PAGE OF
APPROVED BV
612-571-3450
910-F15
3/10/99
JOB ADDRESS 4507 2 1/2 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
8
1
Rearrangement of Plymouth Blocks 13,14, 1,1§IEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Amy Rogers 4507 2 1/2 Street NE
571-5079
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Sela Roofing & Remodeling Inc 4100 Excelsior Blvd, St
Louis Park, MN 55416
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO
823-8046 1050
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW 0 ADDITION 0 ALTERATION Cj REPAIR
O MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof House & Garage (24 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS 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
WITH WHE ER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,056
$1.03
DOES NC RESU TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHA E
PRO V I N F OTHER STATE OR LOCAL LAW REGULATING CON-
ST C 0 ANCE OF CONST TION
$74.75
Fir SC $2.06
PLAN CHECK FEE
TOTA EE
Li S $5
$ .84
►UAE OFCON'RACTORORAUTHORIZEDAGENT IDATEI
EN RO V LI
A T IS IS.MDUR R RMIj
Blp INSP
L GATE J
S-GNATURE OF OWNEROF OWNER BUILDER, IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY /�
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �lO
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address: , 14v-. y Av:f� Tel. # e�-/ Z- 5' i/ - P2,9
I
SEL A I100FINU & FIRMOUBLIN®, NC.
Contractor: ��v�•c, „�„ BLVD. MN LICENSE
Address: ST. LOUIS PARK, MN 55416 Tel. # 10'OL-12-3 '-,?DV6
0 #000 1050
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA:
Length
Width Height Sq. Ft.
GARAGE AREA:
Length
Width Height Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground Sq. Ft.
OTHER:
f -�
Construction e.
(d
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: '"� ! APPLICANT:
Tel.
CITY USE ONLY
Permit Fee
$ . ��
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /, Q_j
$.50/$1,000 Valuation
SAC Charge
$
$1000 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:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBFR OF FIXTIIRFR TO RF INIRTAi I Fn nN FAr`H FI nnR
Effective On Jan 1, 2000
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 50PE tS 6W&3'6 -I2_
New Fixtures
M��MIOTMM
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas*"_
$10.00
Gas Range"
$10.00
Gas Dryer**
$10.00
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 50PE tS 6W&3'6 -I2_
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas*"_
$10.00
Gas Range"
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes ( ) No
Type $15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
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; §,wilding Division, and hereby declares that all the facts
.and representations stated in this application are true and correct
ROGERS, THOMAS/AMY
4507 2ND 1/2 STREET NORTHEAST 3 20 ®off
FRIDLEY, MN 55421 —
(763)571-5079
Owner
Building Used As��1�>� Cs�
00
Estimated Cost PERMIT NO. / V L
PLUMBING COMPANY /L.()A) C
SIGNED BY TEL N0. Z"
Approved By Rough -In Date Final Date
MINIMUM rrr- r"K ANY PLUMMING/GAS PERMIT IS 52
TOTAL FEE PLUS THE 5.50 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 durance, 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 O 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 Mn
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 manufacture's specifications. Yes () No ( )
When installina 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 cur ent 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
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:11302006
(763)572-3604FAX: (763)502-4977
Permit #2006-02423
4507 2 1/2 ST NE
ADDRESS:
PIN:263024330093
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH
:LOT 8 BLOCK 1
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:REPLACEMENT
VALUATION:$300.00
NOTE: VALVE REPLACEMENT
PLUMBING PERMIT FEE15.00
APPLICANT
STATE SURCHARGE, PLBG FLAT0.50
JUBILEE HOME SOLUTIONS OF MN
TOTAL 15.50
700 PRIOR AVE N
Payment(s)
ST PAUL, MN 55104-
CHECKCC4115615.50
(651) 645-5040
Minnesota State License #: 005509PM
OWNER
ROGERS THOMAS F JR & AMY I
4507 2 1/2 ST NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction authorized
is not commenced witin 180 days or if construction or work is
suspended or abandoned for a period of 180 days at any time after
work is commenced.
I hereby certify that I have read and examined this application
and know the same to be true and correct. All provisions of laws
and ordinances governing this type of work will be complied with
whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any
other state or local law regulating construction or the performance of
construction.
Applicant____________________________Date________
Bldg Insp____________________________Date ________
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
ISSUED:11/30/2006
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2006-02423
4507 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330093JUBILEE HOME SOLUTIONS OF MN
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH700 PRIOR AVE N
:LOT 8 BLOCK 1ST PAUL, MN 55104-
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL(651) 645-5040
CONSTRUCTION TYPE:REPLACEMENT
:
VALUATION$300.00
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
PLUMBING FINAL
EXPIRED. NO FINAL INSPECTION SCHEDULED.
EXPIRED PERMIT05/30/07OTHR
INSPECTION COMMENTS:
IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL
WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT.
THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE.
From: unknown Page: 2/2 Date: 11/2812006 11 10:24 AM
fr
Building
PLUMBING]Permit
No.:
Inspections
RESIDENTIAL APPLICATION
Received ey:
763-572-3604
CITY OF FMLEY
Date lzec1d;—(I
/
DATE 1 YOUR B- Al ADDRESS
SITE ADDRRSS r
THIS APPLICANT IS: Q <)WNER )N'fRA(`rOR
PROPewry
NAME:
OWNER/
TENANT
ADDRESS: CrrY
CONTRAC'rf)R
NA M13 .s, ,a ' 1 . , F(_� l7
STATE LICENs>: s ExP NATE
ADDRESS: CITY STAiI�
stir3Mrr A COPY OF
YQIJR
STATE
LICENSE WITH
PHONE ' 4!7 3==; �- FAX
APPLICA11ON
PERMIT TYPE
SINGLE FAMILY O TWO FAMILY O TOWNHOUSE
TYPZ ( WORK.
0 NIAV �F.PI.ACPAENT
DETAILED DESCRIPTION OF WOR� _ . r�yt�
PER MS 1613.665 the permit fee is a nalaimum of $1.4.00 or 5% of tilt total cost up to $500.00, whichever is greater, for tie
Improvement, installation or replacement of a residential fixture, excluding the fixtuiia. (`Phis should reflect only the cost of labor)
Labor cost under $300 - $15.00. Labor cost bctwc® $300 to $500 = cost of labor X.05 a
FOR PROJEC'ral WHERE LABOR EXCEEDb $500, FEES ARE BASED ON $1000 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES. (INDICATE WTAL
NUMSER R OF FACH IIELOW)
BATH$IVKILAV PLOORDRAINS (SHOWER WATER PIPING
---
HATkffLM _ iaAS PIPING (Nswcw7ac") SWIMMrNG POOL WATER SOFT= (S35)
CLO!fflB WAWEk KITCHEN SINK 7 WATER CLOSET _BACiSFLOW (REV. (Sir)
_
_ DISHWASIER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER _ OTKER
....r. �,4'P `
y . •n . '�" Tt L . ry TSh••q L G
Permit Fee $ / -' Number of fixtures @ $10.00 x $10.00 - $
surehim .50 Number of fixtures @ $15.00 x $15.00 - $
TOTAL DUE $ _ Number of fixtures (a $35.00 _ x $35.00 - $
State Surcharge - $--.A
Total M $
THIS IS AN APPLICATION POR A PERMIT -NOT VAUD UNTIL PROCRRSED
I hereby apply for a building permit and I acknowledge that the infprmation 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 1 understand this is
not a permit but only an appl' on Fora permit and work is not to start without a permit: that the work will be In accordance with the
approved plan in the esse o w hick requires review and approvalof plans.
' PRINT S A {7p�-LDATK 1t lam
SIGNATUREOF APPLICANM N
City of Fridley
Building Inspections Department,
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FLAX: 763-5024977
i
(ft