PRE 2010 DOCS04► .#ft
Date:
Owner
Addres
Village ®f Fridley, Minn.
BUILDING PERMIT
° 1735
Builder..............................................
Address.............................................
LOCATION OF BUILDING
No . ............. Street ........ .................. Part of Lot .............................
Lot .../a....... Block ......../ Addition Addition or Sub-Divisio %�. 1,3'. /.(/ ..Y !.
O If 1p
q��
Corner Lot ........... Inside Lot ........... Setback .�... Sideyard ..../ .......................
DESCRIPTION OF BUILDING
be used as:
P
.... Front ... Depth ..oQ. c)-. Height ........ Sq. Ft. ........ Cu. Ft. ....... .
.............. ...... F ont ........ Depth.. ®® Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction .... Est. Cost )*O?r. �9To 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 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 $x.074.4 ., 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,,lsart thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, cons"ction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may 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 or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
City ®f Fridley, Minn.
BUILDING PERMIT N? 5984'
Date:
Owner: guilder
Address Address
ATION F BUILDING
Pax. L
NO. Street � 6�- '0
Lot Addition or Sub -D'
7.
Comer Lot Inside Lot *tback 4� Sideyard
7f
Sewer Elevation Fo dation Elevation
DESCRIPTION OF BUILDING
To Used as:
Height
Cu.
Front -s Depth 1W Sq. Ft.
DepthHeight Sq. Ft. Cu. Ft.
(04' �f
Type of construction COS,
Est. To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I a to do
the
work In accordance with the description above set forth and In compliance with all provisions Of
or the city of Fridley.
i4,W 1 -
In consideration of the payment of a fee of $ * '"J ""� ., 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, ymaintena� upon violation
repair and moving of buildings
within the city limits, and this permit may be revoked at an . - of any of the provisions of said
ordinances. ,�ation,
.; 14
Building Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these Items.
APPLICATION FOR BUILDING PENT
CITY OF FRIDLEY, MINNESOTA
owner's Name Builder
Address Address
LOCATION OF BUILDING
No.T- 2 :z Street
woe,, Part
of Lot
Lot Block
Addition
or Subdivisior�
el
Corner Lot Inside
Lot
Setback
side -Yard
SEVER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
To be used as:
DESCRIPTION OF BUILDING
Front Depth/Height %®
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type or Construction Estimated Cost
61
To be Completed
The undersigned hereby makes application for a permit for the work
herein specifiers, agreeing to do all work in strict accordance with
the City of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correct.
DATE 4zc� / A/-, SI
(Schedule of Fee Costs can be found on the Reverse Side).
SUBJECT
PE
City of Fridley
61 13
AT THE TOP OF THE TWINS
B U I L D I N G P E R M I T
r
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
5L-73
.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/9/81
JOB ADDRESS 4527 - 2h Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
10
]
Rearr. of alks. 13,14,15, Plymouth SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Ralph jai. Jackson 4527 - 2'h Street N.E. 560-7415
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO,
6 USE OF BUILDING
Res idential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
B DESCRIBE WORK
Install a 9,foot bay, window in living room extends out 18 inches.
Install neat- steps and walk
9 CHANGE OF USE FROM TO
S71PULATIONS
SEPERATE PERMITS REQUIRED FOR WING,
HEATING,. PLUMBING .AND SIGNS.
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
1
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
$4,500
$2.25
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-
$27.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL6jb. 25
SIGNATURE OF CONTRACTOR RAUTHORI DAGENT (DATE)
r WHEN\\ PROPERLY VALIDATED THIS IS YOUR PERMIT
A E
SIGNATUR ATE5
CITY OF FRIDLEY .
APPLICATION FOR RESIDtNTIAL BUILDING PERMITS
Wevi, Mterations, Additions, or Repairs)
01-111ER:
TEL NO:
BUILDER: r -fit
ADDRESS:
TEL 140:
Construction Location
STRIMT NO: �j�. � STREET:
LOT: �[ BLOCK: ADDITION: 4r -r.
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.
DESCRIPTIO14 OF CONSTRUCTION
�sv��ea o,v Ga`v i r'v�
- -- oa Front: Depth: Height:
Squane.Feet: Cubic Feet:
Front: Depth: Height:
.
Square - Feet: Cubic Feet:
e�
Type of Construction: Estimated Cost: $
To $e Completed:
a
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
Mie 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.
D.1Tr:� SICNATUF.E:
Stipulations:
tO °�?d
��.as' w
4i
On
SUBJECT
�
ER
City of Fridley
_ 77 7 4 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
IECEIP
I `L ------- COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r I PROTECTIVE
/
r---1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/27/84
JOB ADDRESS 4527 - 21� Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
10
1 1
Rearrangement of Plymouth B:1. 13,14,15 SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Ralph Jackson 4527 - 2' Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Franzen Construction Co. 4250 5th Street N.E., Columbia Hgts. 7884071
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
Install sliding lass door and add a 131 x 181 Deck
Alumirnim soffit and gutters.
9 CHANGE OF USE FROM TO
STIPULATIONS
FOR WONQ
ERM) -T5 REQUIRED
1:F 11' �
SEPERATE
�4FA+�ItVC. PLl19�iE3lN�°� Before digging call local ufilifics
TELEPHONE -ELECTRIC - GAS RC,
REQUIRED BY LA
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
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
`r2 00�
$l.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
Y
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
P VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON -
$32.50
None
ST UION OR THE PERFORMANCE OF CONSTRUCTION.
'T
el
s_ 1
PLAN CHECK FEE
$8.13
TOTALFEE
$41.63
7-
SIGNATURE OF CONTRACTOR OR AUkHOqIZED AGENT (DATE)
WHEN PROPER VALIDATE THIS IS YOUR PERMIT
•�
SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE)
BLDG WSP D E
On
NEW L 7
ADDN. [ ]
ALTER. L ]
Construction Address:
Legal Description:_._.
Owner Name & Address:
Contractor
Address:_ ?_ S6
City of Fridley
�R-1 AND R-2
Building Permit Application
NO]
I
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Effective 4/1/84
Tel. #
Tel. # -7-�4-4a7
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width r Height / Sq. Ft.
DECK AREA: Length �� ( Width %1� Hgt/Ground_—
_ Sq. Ft. 3
OTHER: d9- , ® o d k4
Corner Lot [ ] Insi a Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: 71411,0 L _ Estimated Cost: $
Approx. Completion Date:
�m®�
A� z� 19��
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: APPLICANT:
Tel.
CITY USE ONLY
Permit Fee $ ?.`s5 Fee Schedule on Reverse Side
Plan Check $ "1 3 25$ of Building Permit Fee
State Surcharge $ 00 $.50/$1,000 Valuation
SAC Charge $ $425 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
ktv
STIPULATIONS:
Effective Date May 1. 1988
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures $ 3.50 $
Old Opening, New Fixture $ 1.50 S
Beer Dispenser $ 4.00 S
Slow Off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader $ 5.00 $
Hydraulic Valve $ 5.00 S
Sump or Receiving Tank $ 5.00 $
Water Treating Appliance $ 7.00 $
Hot Water Heater $ 5.00 $
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Preventer Required. . . Yea ( ) No ( )
Type
S 5.00 $ .
ALL OTHAS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance $
Reinspection Pae $ State Surcharge $ .50
($15.00) TOTAL FEE $ I 0
Job Address
Department of Buildings
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 ereby declares that all
the facts and representations stated in this a catfon a e true and -correct
Fridley, Mn. , 1
OWNER �� /� �I14 (1 1` Sf/ lei
KIND OF BUILDING
'A P!NZ41WAFAS
TO BE COMPLETED ABOUT 004 ESTIMATED COST 90"6 /,-) O
OLD - NEW BUILDING PERMIT NO. PERMIT NO. O-3
company 1 t
Signed By
Tel. No.
ROUGH INSP.
Date
C�
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
U
a
Water
Heater
w
m
be
C
a s
3
M
r
u
w
ami
a
b
w o
s
8
m
a+ In
m
r�
FA
a
ori
14
S
o w
vi
w
U
a� 3
chi
O
as
lec
1st
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(*) - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures $ 3.50 $
Old Opening, New Fixture $ 1.50 S
Beer Dispenser $ 4.00 S
Slow Off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader $ 5.00 $
Hydraulic Valve $ 5.00 S
Sump or Receiving Tank $ 5.00 $
Water Treating Appliance $ 7.00 $
Hot Water Heater $ 5.00 $
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Preventer Required. . . Yea ( ) No ( )
Type
S 5.00 $ .
ALL OTHAS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance $
Reinspection Pae $ State Surcharge $ .50
($15.00) TOTAL FEE $ I 0
Job Address
Department of Buildings
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 ereby declares that all
the facts and representations stated in this a catfon a e true and -correct
Fridley, Mn. , 1
OWNER �� /� �I14 (1 1` Sf/ lei
KIND OF BUILDING
'A P!NZ41WAFAS
TO BE COMPLETED ABOUT 004 ESTIMATED COST 90"6 /,-) O
OLD - NEW BUILDING PERMIT NO. PERMIT NO. O-3
company 1 t
Signed By
Tel. No.
ROUGH INSP.
Date
C�
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:10242008
(763)572-3604FAX: (763)502-4977
Permit #2008-01817
4527 2 1/2 ST NE
ADDRESS:
PIN:263024330095
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH
:LOT 10 BLOCK 1
PERMIT TYPE:HEATING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:FIREPLACE
NOTE: CALL FOR ROUGH IN AND FINAL INSPECTION
FIREPLACE GAS INSERT15.00
APPLICANT
STATE SURCHARGE, MECH FLAT0.50
FIRESIDE HEARTH & HOME
GAS PIPING FEE - MECH10.00
2700 N FAIRVIEW AVE
TOTAL 25.50
ROSEVILLE, MN 55113-
Payment(s)
(651) 633-2561
CHECK80064625.50
Minnesota State License #: 20512060
OWNER
THOMPSON JOHN & CAROLYN A
4527 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:10/24/2008
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2008-01817
4527 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330095FIRESIDE HEARTH & HOME
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH2700 N FAIRVIEW AVE
:LOT 10 BLOCK 1ROSEVILLE, MN 55113-
PERMIT TYPE:HEATING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL(651) 633-2561
CONSTRUCTION TYPE:FIREPLACE
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
GAS PIPING/AIR TEST11/10/08PDAVE
FIREPLACE FINAL11/10/08PDAVE
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.
Building
MECHANICAL
Permit No.-20
Inspections
RESIDENTIAL APPLICATION
Received By: ftF
763-572-3604
CITY OF FRIDLEY
DateKVNICT 2 4 2011(
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE O '? CYOUR E-MAIL ADDRESS
SITE ADDRESS qS' a '? �' z S N.
THIS APPLICANT IS: 0 OWNER CONTRACTOR
PROPERTY
NAME: r, T1% a^— A s a r+
-:3-0
ADDRESS: Y5"2 i At F CITY: o� STATE AZIP .2
OWNER/
TENANT
PHONE:,�.'� 4%Z• %?tlLP
CONTRACTOR
COMPANY NAME:
.
CONTACT PERSO1111Z8 & Home !WAM *QlW hm
NOTE:
SEPARATE CITY
LICENSES ARE
STATE LICENSE#dba EXP DATE
2051
REQUIRED FOR GASI-joeme
N. Falmlim Ave.
ADDRESS: CITY STATE ZIP
AND HVAC.
SUBMIT COPY OF BOND
PHONE ;8118jr9id1 FAX
AND INSURANCE
PERMIT TYPE
XSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
XNEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK S re jP lam g,-, &A s •. e
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
OR
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) ��
Installed MFG: LA4Tie (v MODEL: 71T SIZE/BTU
Equipment
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
$25.00 (GAS) $15.00 _GAS RANGEIOVEN $10.00
_A/C _FIREPLACE
TO AIR EXCHANGEER $15 (WOOD) $35.00 _NEW GAS GRILL $10.00
_AIR _FIREPLACE
$35.00 $35.00 _GAS UNIT HTR $10.00
_BOILER _FURNACE
LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY
WORK $10.00 TGAS PIPING $10.00 VENTILATOR $15.00
_DUCT
5EZ .
Permit Fee $ -� Number of fixtures @ $10.00 x $10.00 $
Surcharge $ 0 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ '� OR Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
MINIMUM $15.50 MINIMUM $15.50 Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances
and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to
start without a permit; that the work will be in accordce with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT .= PRINT NAME ��vrel 155 45 In % c DATE /e ky
APPROVED BY ` C DATE
bm Ew
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
M
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS 0 EXISTING HOME O -MAKE-UP AIR
4 , €�< and7a cArioN Z alit,-wqii
REQUIRED FOR NEW/EXISTING HOMES"m0" M M'seN obipli-.' € ,k,
Qaosteus se' -10:)
.OVA dotal .H 00�S
1. Combustion Air (See note below) Mea "M.fi1hWftvR
a. Oil or solid fuel IMC Chapter 7 with MN Amen nen1si"
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load. per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:10312008
(763)572-3604FAX: (763)502-4977
Permit #2008-01872
4527 2 1/2 ST NE
ADDRESS:
PIN:263024330095
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH
:LOT 10 BLOCK 1
PERMIT TYPE:ELECTRICAL
PROPERTY TYPE:COMMERCIAL
CONSTRUCTION TYPE:ELEC CIRCUITS
NOTE: CALL ROBERT CLAUSON AT 651-777-7885 WEEKDAYS FROM 7-8:30 AM FOR REQUIRED INSPECTIONS.
ELECTRIC PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE
WIRE GAS FIREPLACE.
ELECTRICAL PERMIT FEE35.00
APPLICANT
STATE SURCHARGE, ELEC FLAT0.50
COLLINS ELECTRIC
TOTAL 35.50
278 STATE ST
Payment(s)
ST PAUL, MN 55107-
CHECK01956035.50
(651) 224-2833
Minnesota State License #: CA00406
OWNER
THOMPSON JOHN & CAROLYN A
4527 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:10/31/2008
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2008-01872
4527 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330095COLLINS ELECTRIC
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH278 STATE ST
:LOT 10 BLOCK 1ST PAUL, MN 55107-
PERMIT TYPE:ELECTRICAL
PROPERTY TYPE:COMMERCIAL(651) 224-2833
CONSTRUCTION TYPE:ELEC CIRCUITS
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
ELECTRICAL FINAL11/10/08PBOBC
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.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:10162009
(763)572-3604FAX: (763)502-4977
Permit #2009-01622
4527 2 1/2 ST NE
ADDRESS:
PIN:263024330095
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH
:LOT 10 BLOCK 1
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:WATER HEATER
NOTE: CALL FOR FINAL INSPECTION
COMBUSTION, VENTILATION AND DILUTION AIR PER MN RULES 1346.5304 IFGC STATE AMENDMENTS
MAKEUP AIR PER 1346.0501 IMC STATE AMENDMENTS
VENTING OF EQUIPMENT PER 1346.5503 IFGC STATE AMENDMENTS
CALL FOR FINAL INSPECTION WITHIN 10 DAYS
WATER HEATER FEE35.00
APPLICANT
STATE SURCHARGE, PLBG FLAT0.50
CHAMPION
TOTAL 35.50
3670 DODD RD
Payment(s)
EAGAN, MN 55123-
CHECK1895135.50
(651) 365-1340
Minnesota State License #: 61770-PM
OWNER
THOMPSON JOHN & CAROLYN A
4527 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________
10/16/09
Bldg Insp____________________________Date ________
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
ISSUED:10/16/2009
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2009-01622
4527 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330095CHAMPION
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH3670 DODD RD
:LOT 10 BLOCK 1EAGAN, MN 55123-
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL(651) 365-1340
CONSTRUCTION TYPE:WATER HEATER
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
PLUMBING FINAL10/30/09PRONJ
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.
'1�9 1 Cn�;o
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604CITY
OF FRIDLEYjWWV_16
2009
DATE ®�l YOUR E-MAIL ADDRESS
SITE ADDRESS IV
THIS APPLICANT IS: 0 OWNER a1CONTRACTOR
PROPERTY
OWNER/
Nom:
0' ILi'l cel [ e STATE
syr l
ADDRESS:
-CITYTENAN
_q
PHONE: D� - cSOaZ' 10(0
CONTRACTOR
Nom:
STATE LICENSE # C D �EXP DATE I01 ' ��' Ga
SUBMIT A COPY OF
YOUR STATE
ADDRESS: Champy CITY STATE zip
LICENSE WITH
PHONE 651-365-134OFA
APPLICATION
1
Ea;k' 3g 13
ANN
PERMIT TYPE
SINGLE FAMILY d' A TOWNHOUSE
TYPE OF WORK:
r
o NEW JLREPLACEMENT
DETAILED DESCRIPTION OF WORK V G I1QA'
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $5oo.00, whichever is greater, for
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of
labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of laborby x.05 = is -0-0
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDIC ILTE TOTAL
NUMBER OF EACH BELOW)
—BATH SINKILAV FLOOR DRAINS WATER PIPING
t _SHOWER _
WATER SO
($35)
—BATHTUB _ GAS PIPING MW CUT ) _ SWIMMING POOL _
CLOTHES WASHER KITCHEN SINK WATER CLOSET —BACKFLOW PRE V. ($15)
—DISHWASHER —LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATIO
OTHER
_ WATER METER _
PERMIT FEE PROJECTS FOR UNDER $500 ROE FEE FOR PROJECTS
VER $500.
Permit Fee $ oo Number of fixtures @ $1.0.00 x $10.00 =
Surcharge "50 Number of fixtures @ $15.00 x $15.00 =
TOTAL DUE $ -2-515 ,CICI) Number of fixtures @ $35.00 x $35.00 =
Stats Surcharge=
50
- Total =
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the woi
i will be in
is
conforr ance with the ordinances and codes of the City of Fridley and with the Mmnesota Construction Codes; that I under
mmd this
the
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordai
tce with
approved plan in the case of allwork w h re ew and approval of plans.
1 DATE V �J
SIGNATURE OF APPLICANT NAME
_
PLEASE NOTE: SEPARA .. . EnWS ARE UIRED FOR BUILDING ELECTRICAL AND MECHANICAL
WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
17 A v. P?c2 cA01 Awry