PRE 2010 DOCSAPACHE DRAIN & SEWER CLEANING CO.
2370 HAMILTON COURT --NEW BRIONTON, MINN. 55112—Phone 781.2027
"Drains flow easy with Apache Service"
AGREEMENT
DATE: 19 '
In consideration of the promise of Apache Drain & Sewer Cleaning Co., hereinafter called "the Com-
pany" to:
D Clean---- feet of - inch main sewer from inside the building on curia
(tenth)
tomer's premises to the main city sewer.
feet of inch inside line
� Clean - (Type of line)
(length)
D Clean Describe other Imes or fixtures to bo cleaned
Q Clean feet of inch line from inside the building on- customer's
(length)
premises to on customer's premises servicing. the premises at,
(Job Address
in accordance with the Conditions .set forth on the
�
reverse side hereof, the uadersign agrees lady th$�,
1
e company the sum of
payable as follows
Special Terms:
APACHE DRAW & SEWER CLEANING CO. ACE '
By Authorized Representative / Customer's Sig *two
Print Name
Billing Address
Owner's Tel. Tenant's. Tel.
In addition to the cleaning services as set forth above, the following described pasts are recommended
and shall be furnished and installed by Company
at an additional charge of S , if authorized below by customer.
Authorizes above parts and installation: Parts and installation not authorized
N 9659
(The reverse side is a part hereof)
(1% per month charge on past due accounts)
inv, No. 3005
GALAXY MECHANICAL CONTRACTOR, INC.
1308 113TH AVENUE N.E'.
BLAINE, MINNESOTA SS434
'FEL:. 612-7S7-2699
Date Sent, 2.1 19 77 f
Mr. 0a -Ten Me-lGon
4624 ?). 5t.
Frielnv. Minn. 55432
O'urchose Order
fob
Number Description Per Unit Total I
i
Plumhi nn to repair setiPr. "265.(10
..
t
4624 Zj St N E
Minneapolis Mn 55421
Sept. 27, f977
Mr. Dick Sabiech, City Engineer
6431 University Live. N E
Fridley, Ma 55432-
Dear
5432Dear Dick Sabiech:
Thank you for the work of the city in cleaning out the drain sewer,
replacing the broken tile, and as of yesterday, the resuf¢facing of
the street in front of our home.
Per our conversating via phone last week, I am enclosing our paid
bills as follows:
Apache Drain & Sewer Cleaning Co. in the amount of $71.75
Gkaxy Mechanical Ccntracbr, Inc. for the digging for the
sewer repair - and they are the ones who contacted the
City of Fridley, and your dept. came immediately. Invoiced for $265.00
Please send us a check for $336.75 for expenses we incurred.
Thank you.
Sincerely
Mrs. Galen J. Nelson
4624 2'* St. N E
Minneapolis, Ma 55421
�1�
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE (612)571-3450
. Octobe& 3, 1977
Mu. Gaf-en J. Netzon
4624 - 2% St eet Noxihea6t
FA i deey, M,i:nnu ota 55421
V eac Mu . Galen:
This is in &egand to you& .tette& o6 Septembe& 27, 1977, addressed to
R.ichand Sobiech, which exp2a.in6 the expenses you ineun&ed bon &epaiA of
you& s ewer tine. May I exp.2cu.n the City's pot ie yy negandi hg these s.ctua-
t�.ons . I j a pni.vate contnacton .ins eaUed to wog on a homeowner's .line,.
at the gime the sewer tine •us uncovered, a City Inspecto& .cis salted beJo&e
the tine is broken. At this time, a determination can be made as to
whethex the tespons.ibility ties with the homeowner on with the. City. _As
to eteaning the homeowne&'s own tine, the City does not assume any &ebony. i-
biti ty. As we have adventused .in the "City Newstetten" .in the past, it is
the dezi e o $ the City that any homeowner having pro btems in thein own
sewe& tine catt the City 4i ust. There ane times when having our .inapecto&
come out to diagnose the p&obtem jon the .individual homeowner can save this
person some money. There might be a poss.ib c t- ty that the City main tine
eoutd be btocked and backing .into the home; a.Pso, he can then make a deter-
mination .i.6 the probtem might be .in the sewer connection between private .
pnopWy and the City tine. In such cases, the City digs up the tine, using
the City cAew.
The City &eee.ived a call J&om Gataxy Meehan.ica2 Contria.ctok, Ineorpo&ated, .in-
6oAming us that they were having some probtems. When we ann i.ved at the site,
we discovered that the p&obtem was the City's &espons.ibi ty. We then helped
the eontna.eto& with the probtem; also, we came back and &emedied the other
pro btem .in the 6t&eet. The City wiQt pick up the hes pa nsibit ty o j a portion
of this bctt .in the amount o4 $265.00, but we cannot pay the bii2 4o& the
s ewer e tean.ing .
May I a.?so state that there shoutd be one hour's tabor deducted 6&om this bitt,
because the contnacton spent an hour digging .in the wrong area. He was .ins-
tructed .to do so by youAAetj, -or. your husband. Ig the contna.cton had contact-
ed the City jo& a tocat.ion, it would have saved time and &educed the mess .in
the yard jnom digging in the wrong ptace. I wilt instruct the Finance Vepant-
ment to .issue you a check 6o& $265.00. I believe this check wi-U &each you
within two weeks to a month, as all checks have to be approved by the City
Counci.t.
Ij there ane any othe& questions, ptease beet 4&ee to cafe me.
S.incerety,
RALPH VOLKMAN
Superintendent
RV:.ik
, ;* rd WA-- U M
o6 Pubt.ic woAk s
Al
SUBJECT
PE
City of Fridley
WRECKING zNG
51728
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
COMMUNITY DEVELOPMENT DIV.
L
INSPECTION SEC.
p
S
r PROTECTIVE
//0 0
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/12/83
JOB ADDRESS 4624.- 232 Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9,10
11
Plymouth. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Galen Nelson 4624 - 2� Street N.E. 572-1598
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
B DESCRIBE WORK
Wreck 12' x 20' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Site to be cleaned of all debris..
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 1 HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$15.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$15.00
SIGN)ATUREOFCONT� CTOR OR AUTHORIZED AGENT (DATE) .r
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
yy
BLDG INSP OPT
Si ATUREO OWNE [IF OWNERS IL RI I (DAT I
Al
Effective Aug. 1, 1981
City of Fridley
w�.IEC.T
Permit No.
AT TNM TOP OR TME TWIN$
L
WRECKING PERMIT APPLICATION
I
Receipt No.
1 -------- COMNVNITY DEVELOPMENT OW,
I} PROTECTIVE 08 ECTION WT.
I
CITY 14ALL /IdOLRY 6941
02-5"-3460 "Loop
EV.
DATE
P"E OP
JAPPROVED BY
Job Address
Legal
Lot No.
Block No.
Tract or Addition
Desc.
1 9 �V /C
//
-
Property Owner Address Phone
G .4 ,L avv ���/U�
Contractor Address Phone
Description
Front
Depth
Height
Sq. Ft.
Cu. Ft.
of Bldg.
/
_k1d
/D
No. of Dwelling Units
Taxes Paid
Tax Receipt No.
Estimated Cost of Wrecking
To Be Complete
w
Utilities to be Notified and date Services Disconnected
Npls. Gas Co. N.S.P. Northwestern Bell Tel. Co.
Engr. Dept. Cust. Bus. Ofc. Bus. Ofc.
372-4850 330-5540 332-4112
Date Date Date
Wrecking Fees: $1.25 for each 1000 cubic feet or fraction
For structures which would be impractical to cube, the fee
shall be based on the total cost of wrecking such structure
at the rate of $6.00 for each $500.00 or fraction.
MINIMM FEE: $15.00 No State surcharge on Wrecking Permits.
Approved By Water & Sewer Department:
All Bills Are Paid Services Are Disconnected
The undersigned hereby makes application for a permit to wreck the building
described above, agreeing to do all work in strict accordance with the City
Ordinances and rulings of the Department of Buildings, and hereby declares that
all facts and representations stated in this application are true and correct.
43
I `a Date
SUBJECT
PER
City of Fridley
1.7286
AT THE TOP OF THE TWINS
BUILDING PERMIT
rp
` .___ COMMUNITY DEVELOPMENT DIV.
L
d � , PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/12/83
JOB ADDRESS 4624 - 2� Street N.E.
1 LEGAL
LOT NO. BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
S 10 11 1
Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Galen Nelson 4624.- 23 Street N.E. 572-1598
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
p
X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 241 x 2W Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway.. Maximum height to be % 14 feet or less.
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
$71176
$3.59
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.
PLAN CHECK FEE
TOTALFEE
$72.09
SIGNATUREOFCONT ACTORORAUTHORIZED AGENT IDATEI
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG !NSP D TE
"SMikATURE WOWNF OWNER B IL R7 IDA EI
CITY OF FRIDLEY
. Effective Aug. 1, 1981
APPLICATIO'1 FOR RESIDENTIAL BUIL01ING PLUMITS
(14evi, Alterations, Additions, or Repairs)
ADDRESS:g i,
BUILDER:
ADDRESS:
TEL 190: 5-7A , 1.6 f TEL 110:
Construction Location
STJt=T HO :7 �o STREET:-
LOT: l� BLOCK: /L� ADDITION:
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 MISTRUCTION
G,q le q G1-' Front: Depth: .2 Jr ,
Height:
Square Feet:Cubic Feet:
Front: Depth:
Height:
Square Fent: Cubic Teet:
"Aype of Construction: %�Cl-U C� � K n rn Estimated Cost: $
4b Be Cbmpleted: % - (J -
Alt. A
Alt. B
Proposed Driveway Width If New Opening Is Desired:
$
$
SEE PEVF:R;E SIDE
OF SHEET
2be undersigned hereby makes applicaticn for a permit fcr the %:ork 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: -ID- % �� SIGNMIS:
Stipulations:
7 '�' o
n yr r ® 6L /-1�C&Lrr
Plr
E-
/ -S -Su— &A Geyer
e-
-4
EAST FLLEVATIQ-�
C--� I V-0, �,. �A,► mut -f �i,.
"U I L_D k Kc- FELT
F O'OTI N Com- `--DEjT--A-_,1
1 7
I
WELL OR BORING LOCATION
"MINNESOTA DEPARTMENT OF HEALTH SMinnesota ealing Nowell and Boring
WELL AND BORING SEALING RECORD Minnesota Unique No.
Minnesota Statutes, Chapter 1031 or W-series No.
H 102021
County Name
AM-KA
(Leave blank If not known)
To s f3
Township No. Range No.
Section No.
Fraction (sm. -9 Ig.)
Date Sealed
Date Well or Boring Constructed
L
31 24
7
.APRIL 05, 1996
Numerical Street Address or Fire Number and City.of Well or Boring Location
4624 = 2 1/2 T
Depth Before Sealing 70 ft.
Original Depth
It.
Show exact location of well or boring Sketch map of well or boring
In section grid with °X°. location, showing propertySingle
lines, roads, and buildings.
N
AQUIFER(S)
Aquifer ElMultiaquBer
STATIC WATER LEVEL
Measured ❑ Estimated
WELLIBORING
_T_ --- --- t
I I
Water Supply Well ❑ Montt. Well
Env. Bore Hole ❑ Other
ft. below
❑ above land surface
Y_ _.(.._ __- _!
W E
CASING TYPES)
4- -�-- --i--
Ya mfle ��y.
JL
Steel ❑ Plastic ❑ Tile ❑ Other
CASING
Diameter Depth Set in oversize hole?
from Jo ft. ❑ Yes Qlo
Annualar space initially grouted?
❑ Yes ❑ No ❑ Unknown
in. from to ft. ❑ Yes ❑ No
❑ Yes ❑ No ❑ Unknown
PROPERTY OWNER'S NAME
GAL `N MUM
in. from to ft. ❑ Yes ❑ No
❑ Yes ❑ No ❑ Unknown
Property owner's mailing address H different than well location address indicated above.
4624 NE 2 1/2 d ��
SCREEWOPEN HOLE
FRIM B 55421
Screen from 67 to 70 ft. Open Hole from
to ft.
OBSTRUCTION/DEBRIS/FILL
❑ Obstruction ❑ Debris ❑ Fill]o Obstruction
-1
Type of Obstruction/Debris/Fill.
WELL OWNER'S NAME
SAME
Well owner's mailing address If different than property owner's address indicatedabove.
Obstruction/Debrialmn removed? ❑ Yes ❑ No
PUMP
Type RECIPROORrING
Removed ❑ Not Present ❑ Other
GEOLOGICAL MATERIAL
COLOR
HARDNESS OF
FORMATION
FROM
TO
If not known, Indicate estimated formation log from nearby well or boring.
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING
001 No Annular Space Exits
Annular space grouted with tremle pipe
AND BORE HOLE:
BROW4
0 lit
GRAVEL 9,
A
Casing Perforation/Removal
In. from to R
ln. from to ft.
❑ Perforated ❑ Removed
❑ Perforated ❑ Removed
CLAY GRAY
fij
T „ P
1
Type of perforator
❑ Other
GROUTING MATERIAL(S)
PIMTLAMR70 SURF
Grouting Material om tgft.
yards bags
from to ft. yards bags
from to ft. yards bags
from to ft. yards bags
REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING
UNSEALED WELLS AND BORINGS
Other unsealed well or boring on property? ❑ Yes ''W.Ao
TiIWIRISEIFOR REGISTERED CONTRACTOR CERTIFIOR71ON
WATER LEVEL L I Z m. L r 1401his
DATE LEVEL - 05-04-40&
well or boring was sealed in accordance with Minnesota Rules, Chapter 4725.
to the best of my knowledge:
The Information contained in this report is
W045DO3.154
No 15 945
��
`s� 1�
Contractor Business Name
Ucense or Reglsha0'on No.
E-32
'2;
°
Autho&ed131 ` re
Date
[77"'k
,
!"Fo 1--3p L
r '�lYl
'P
LOCAL COPY
®�
Mame of Perm Sea)ingWell or Boring
HE -01434-02 ' 1019SR
'J, d46ili
CIN OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, CAN 55432
763-572-3604 FAX 763-571-1287
A
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning -All Sizes ItAelm
yAll Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS "T 6 JLV t1 Im
Fee Total
$35.00 $
$10.00
$
$10.00
$
$10.00
$
$25.00
�®
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
Owner
Building Used As���.�/.%.�
ESTIMATED COST � PERMIT NO
DESCRIPTION OF FURNACE AND BURNER
# of Heating Units Circle One (Steam) (Hot Water)arm Ai;r)�)
Trade Name r Size No �®
BTU `72�. HP EDR
Fuel Total Connected Load
Burner Trade Name
lail<J
HP
Size No.
EDR
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.
$ s ® i HEATING
$ Signed_
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
3���
�'4--t.
FAX # NOV IJ Date
Tel #45�1Tf®d 00
Approved by Rough -in Date Final Date
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( )
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 :
R
w
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
• . • • , • • •
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 -LAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes 0,�' No( )
The existina 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 p 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 11/�i No( )
A►)oliance Tvge and.Size/Common Vent and Vent Connector Information
Appliance #1 Type¢ L��!� „?�'e BTU Input 70 Fan Assisted or Natr�°
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances �� Total Btu Input -7 0/'�
Common Vent Type t3 Vent Height 2-`' Diameter C 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: � buF� � ' " XIN e MY
Signed By: Z Date: �'��
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:04042007
(763)572-3604FAX: (763)502-4977
Permit #2007-00477
4624 2 1/2 ST NE
ADDRESS:
PIN:263024330037
LEGAL DESC:UNAVAILABLE
:LOT 1 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
REPLACE WATER HEATER
WATER HEATER FEE35.00
APPLICANT
STATE SURCHARGE, PLBG FLAT0.50
NORBLOM PLUMBING CO
TOTAL 35.50
2905 GARFIELD AVE S
Payment(s)
MINNEAPOLIS, MN 55408-2173
CHECK3504235.50
(612) 827-4033
Minnesota State License #: 005065PM
OWNER
VAN NELSON, RICHARD
4624 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________
4/4/07
Bldg Insp____________________________Date ________
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
ISSUED:04/04/2007
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2007-00477
4624 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330037NORBLOM PLUMBING CO
LEGAL DESC:UNAVAILABLE2905 GARFIELD AVE S
:LOT 1 BLOCK 1MINNEAPOLIS, MN 55408-2173
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL(612) 827-4033
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 FINAL
EXPIRED. NO REQUEST FOR INSPECTION.
EXPIRED PERMIT12/02/08RONJ
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
PI,UMgINO
Permit No.:
InspectionsRESIDENTTAT.
APPLICATION
Received By: 1
763-572-3.604
Da P R
CITY OF FRIDLEY
DATE YOUR E-MAIL ADDRESS
SITE ADDFASi SA.w+t aS Q. Mee- Galen Nelson
THIS APPLICANT IS: C) OWNER JCONTRACTOR 4624 2 1/2 Street Northeast
PROPERTY NAME: Fridley, MN 55421
OWNER/ ADDRESS: 7635721598 zrn
TENANT
PHONE:
CONTRACTOR NAME: NORBLOM PLUM8--l-N-6-C-0-
INGCO_SUBMIT
SUBMITA COPY OF STATE LICENSE # (6 2)WW � 3
/ ""
YOUR STATE ADDRESS: STATE ZIP
LICENSE WITH PHONE
APPLICATION
PEST TYPE
SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
0 NEW KREPLACEMENT .
DETAILED DESCRIPTION OF WORK Rg6a, "hew- AaAK.....
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_rellect only.the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 tq $500 =cost of labor X.05 =
�•FOR,PROJECTS WHERE LABOR EXCEEDS$500;-TEES ARE BASED ON $10.00 PER FDn URE, EXCEPT-:` MERENDMD-;FECR-'RES:_.(INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/IAV FLOOR DRAINS —SHOWER _ WATER PIPING
_
—BATHTUB �_ GAS PIPING �mcmtjc m) _ SWUVVANG POOL _ WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15)
_ _ _
—DISHWASHER ^LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surchar�_ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $35.00 x $35.00= $JS:W
State Surcharge = $ .50
Total = $ 3S SD
THIS LS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge -thatthe 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 app tion for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case o llwork w ' requires review and approval of plans.
SIGNATURE OF APPLIC PRINT NAME Je{� D/� lOhf'% DATE (4117
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:04102008
(763)572-3604FAX: (763)502-4977
Permit #2008-00406
4624 2 1/2 ST NE
ADDRESS:
PIN:263024330037
LEGAL DESC:UNAVAILABLE
:LOT 1 BLOCK 1
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:WINDOWS/DOORS
VALUATION:$15,123.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R-313.2.1 OF THE
2006 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. CONSTRUCTION IN THE CITY IS
UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY THROUGH FRIDAY AND BETWEEN THE HOURS
OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY LEGAL HOLIDAY UNLESS AN
ALTERNATE WORK HOUR PERMIT HAS FIRST BEEN ISSUED. REPLACE 11 WINDOWS & 1 DOOR W/IN EXISTING OPENINGS.
BUILDING PERMIT FEE265.25
APPLICANT
FIRE SURCHARGE15.12
RENEWAL BY ANDERSEN
STATE SURCHARGE, BLDG VALUE7.56
1920 COUNTY RD C W
LICENSE SURCHARGE5.00
ROSEVILLE, MN 55113
TOTAL 292.93
(651) 264-4777
Payment(s)
Minnesota State License #: 20130983
CHECK9250292.93
OWNER
VAN NELSON, RICHARD
4624 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________
4/10/08
Bldg Insp____________________________Date ________
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
ISSUED:04/10/2008
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2008-00406
4624 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330037RENEWAL BY ANDERSEN
LEGAL DESC:UNAVAILABLE1920 COUNTY RD C W
:LOT 1 BLOCK 1ROSEVILLE, MN 55113
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL(651) 264-4777
CONSTRUCTION TYPE:WINDOWS/DOORS
:
VALUATION$15,123.00
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
PROVIDE SMOKE DETECTOR IN BASEMENT LEVEL.
CALL FOR REINSPECTION.
SMOKE DETECTORS05/29/08FDAVE
WINDOW/DOOR FINAL
OPEN PERMIT LETTER SENT08/06/08POTHR
EXPIRED. NO RESPONSE FROM LETTER.
EXPIRED PERMIT12/11/08RONJ
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
BUILDING
Permit No.:-
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Dat�v�M 0 20i
CITY OF FRIDLEY
DATE �� 1®� OUR E-MAIL ADDRESS LQ5Q�ck�
�(QC. • C CJYY%
SITE ADDRESS i
P I'
`%
\
THIS APPLICANT IS:
13 OWNER CONTRACTOR
PROPERTY OWNER/
NAME:' I C L
TENANT
n
ADDRESS: CITY
STATE_ZIP
PHONE: Q ' 1
NAME:
Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113 t
STATE ZIP
WITH APPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/NEI
PROPERTY TYPE
❑ TWO FAMILY/NEW C 651-264-4777 _
O ADDITION 13GARAGE/SHED WINDOWS
PERMIT TYPE
❑ BASEMENT FINISH O ROOF ❑ DRAIN TILE
❑ DECK O SIDING ❑ OTHER
13 SWIMMING POOL
TYPE OF WORK:
❑ NEW O ADDITION
AINTENANCE/REPAIR O REMODELING
DESCRIBE WORK BEING DONE: `1 i
' IV
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
13 HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGESGAAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2•
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
IN
E3 Vinyl
FOR NEW CONSTRUCTION INCLUDING DECKS,
E3 Aluminum
❑ Other
OSoffit
O Trim
ADDITIONS
1.
& PORCHES SUBMIT:
Site Plan/Survey showing the existing structun
❑ Fascia
and Proposed Project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS DYes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL Jr LES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1"7 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S 15 1 t'a 3 '— t17["C'I IPAN[ V TVPP
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
Al
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be i
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an application for it and work is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work which r uires revi d approval of plans. %�
SIGNATURE OF APPLICANT NT NAME,p1 vj(,� ) Q,CCr. � _1nSo tr`� DATE M it` b
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:09082008
(763)572-3604FAX: (763)502-4977
Permit #2008-01468
4624 2 1/2 ST NE
ADDRESS:
PIN:263024330037
LEGAL DESC:UNAVAILABLE
:LOT 1 BLOCK 1
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:DECK
VALUATION:$4,000.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
CONSTRUCTION IN THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY THROUGH
FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY
LEGAL HOLIDAY UNLESS AN ALTERNATE WORK HOUR PERMIT HAS FIRST BEEN ISSUED.
16X20. TOTAL SQ FT = 288
BUILDING PERMIT FEE97.25
APPLICANT
PLAN CHECK FEE63.21
NELSON GALEN J
FIRE SURCHARGE4.00
4624 2 1/2 ST NE
STATE SURCHARGE, BLDG VALUE2.00
FRIDLEY, MN 55421
TOTAL 166.46
Payment(s)
CHECK2739166.46
OWNER
VAN NELSON, RICHARD
4624 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:09/08/2008
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2008-01468
4624 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330037NELSON GALEN J
LEGAL DESC:UNAVAILABLE4624 2 1/2 ST NE
:LOT 1 BLOCK 1FRIDLEY, MN 55421
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:DECK
:
VALUATION$4,000.00
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
FOOTING09/18/08PDAVE
MAX BEAM OVERHANG = 12''.
ADD ADDITIONAL POST/ FOOTING UNDER OVERSPANED BEAM.
FRAMING10/17/08FDAVE
OPEN PERMIT LETTER SENT01/13/09PMARY
Original failed on 10/17/2008. History:
MAX BEAM OVERHANG = 12''.
FRAMING01/22/09PDAVE
ADD ADDITIONAL POST/ FOOTING UNDER OVERSPANED BEAM.
PROVIDE A GRIPABLE HANDRAIL ON STAIRS WITH 4 OR MORE RISERS.
CALL FOR REINSPECTION.
FINAL01/22/09FDAVE
Call for final handrail.
SITE INSPECTION05/04/09PDAVE
Original failed on 1/22/2009. History:
PROVIDE A GRIPABLE HANDRAIL ON STAIRS WITH 4 OR MORE RISERS.
FINAL08/05/09PDAVE
CALL FOR REINSPECTION.
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
$
BUILDING
Plan Review
Permit No.: X6_01NO?
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
.001 times the total job valuation
Received By:
763-572-3604
CC) .0005 x Permit Valuation Minimum $.50
CITY OF FRIDLEY
$
Date Rec'd-
763-502-4977 FAX
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
EFFECTIVE 1-1-08
$
$450 Conservation Plan Review
DATE
n r
YOUR E-MAIL ADDRESS 1 n Q'W ^� f
8
-7
SITE ADDRESS 41612
�/ tr
7 02 /iZ 5 - ✓�' g•
Agreement necessary ( ) Non Necessary ( )
Total Due
$
60 . Vii" Make checks payable to: City of Fridley Attach Stipulations
THIS APPLICANT IS: C9kOWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: -t- 'r* -D V �_k f_ks a_
ADDRESS: 4AVa y 2/cc//z &A -A - CITY
STATE ZIP 57 y Z�
TENANT
PHONE: ke (Z — Z VO %
NAME:
ADDRESS: CITY
STATE ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE FAX
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
PROPERTY TYPE
Cly -SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES/2-
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION EPADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH La WIDTH ZG '- Zo HEIGHT Z S FT Z CJ
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used,
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS. & PORCHES SUBMIT:
Vinyl
❑ V
❑Soffit
I.
Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
t.
and proposed project
❑ Other
❑ Fascia
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
1 (U G T 1997 UBC FEE SCHEDULE)
'AL JOB VALUATION $ 1� D °'`� Al 0&0 OCCUPANCY TYPE
Permit Fee
$
° s� �� See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
CC) .0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
60 . Vii" Make checks payable to: City of Fridley Attach Stipulations
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 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 on site; that the work will be in accorddanrce th the approved p in the case of all work which requires review and approval of plans. j
SIGNATURE OF APPLICAN� r' lZ� PRINT NAME DATE
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:03042010
(763)572-3604FAX: (763)502-4977
Permit #2010-00220
4624 2 1/2 ST NE
ADDRESS:
PIN:263024330037
LEGAL DESC:UNAVAILABLE
:LOT 1 BLOCK 1
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:BASEMENT FINISH
VALUATION:$8,293.00
NOTE: FINISH BASEMENT WITH OWENS CORNING BASEMENT FINISH SYSTEM.
BUILDING PERMIT FEE167.25
APPLICANT
PLAN CHECK FEE108.71
GREAT LAKES WINDOW & SIDING CO
FIRE SURCHARGE8.29
14650 GLENDA DR
STATE SURCHARGE, BLDG VALUE4.15
APPLE VALLEY, MN 55124
LICENSE SURCHARGE5.00
(952) 891-3400
TOTAL
293.40
Minnesota State License #: 20060427
Payment(s)
CHECK23614293.40
OWNER
VAN NELSON, RICHARD
4624 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:03/04/2010
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2010-00220
4624 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330037GREAT LAKES WINDOW & SIDING CO
LEGAL DESC:UNAVAILABLE14650 GLENDA DR
:LOT 1 BLOCK 1APPLE VALLEY, MN 55124
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL(952) 891-3400
CONSTRUCTION TYPE:BASEMENT FINISH
:
VALUATION$8,293.00
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
ELECTRICAL ROUGH-IN03/02/10PBOBC
NO HEATING RI CALLED FOR, APPEARS OK
HEATING ROUGH-IN03/19/10PDAVE
NO FRAMING CALLED FOR. OWENS SYSTEM APPEARS OK.
FRAMING03/19/10PDAVE
INSULATION03/19/10PDAVE
ELECTRICAL FINAL03/04/10PBOBC
HEATING FINAL03/19/10PDAVE
SMOKE DETECTORS03/19/10PDAVE
CARBON MONOXIDE DETECTOR03/19/10PDAVE
FINAL03/19/10PDAVE
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
BUILDING
Permit No.: 20
Inspections
RESIDENTIAL "PLICATION Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: ®
763-5024977 FAX
11,37, 6-2See Back Page for Fee Schedule
Plan Review
1-1_2D1A
, `7 65% of Building Permit Fee
DATE 0
YOUR E-MAIL ADDRESS
', C9 9 .001 times the total job valuation
SITE ADDRESS z
tj �Z S�_ A)
1,/�.0005 x Permit Valuation Minimum $.50
THIS APPLICANT IS:
0 OWNER CONTRACTOR
` &V $5.00 (State Licensed Residential Contractors)
PROPERTY OWNER/
NANJE. (R CA— t L��,. /J1 /S'„
$2100 per SAC Unit (Plans to MWCC for determination)
TENANT
ADDRESS: CITY
STATE ZIP
Erosion Control
PHONE: 6/2 - fe-T- 2yJ-7
$450 Conservation Plan Review
CONTRACTOR
NAME: �f t4kes fsl.1 -,-v ` d:,1
6,
SUBMIT A COPY OF
STATE LICENSE # 2®®G ®zr2
,+
EXP DATE 0,3/ 4 1 1Ze9 i o
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: / V16 S6 1ev D.,!=
CITY �/� STA
INSURANCE
p
PHONE (!57Z - g'011- 3 17000
FAX 95-Z -'9'7 /
PROPERTY TYPE
GLE FAMQ Y/NEW CONSTRUCTION
SIZE
❑ TWOS FA1VX47REW CONSTRUCTION
STORIES
PERMIT TYPE
O ADDITION 17 GARAGE/SHED
O WINDOWS
BASEMENT FINISH ❑ ROOF
0 DRAIN TILE
17 DECK O SIDING
® OTHER
O SVAAIM NG POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION 0 ADDITION
OM-AINfENANCE/REPAIR )'REMODELING
BEI
DESCRIBE WORK NG DONE: ►�=i'U + 5I a esu e« W jtia ®�yy� S a ie
n
�a /hS �� ✓� �"" ` °� Sjd �+
SIZE OF DAMOVEMENT
LENGTH WlDT1W
HEIGHT J. SQFT
ROOFING
NUMBER OF SQUARES
0 HOUSE ONLY
0 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES
0 ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
17 DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
OSofft
ADDITIONS. & PORCHES SUBMIT:
0 Aluminum
O Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
andlrolosedraj-'
Z Two sets of construction plana
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS OYea ONo LOCATION OF WIDOWS
FOR WINDOWS -PROVIDE U VALUE AND
ORFOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ATERIAL 4:
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS-
(USING
SIN® THE 1997 U B C FEE SCHEDULE)OCCUPANCY
COTAL JOB VALUATION $
Z q TYPE
Permit Fee
$
11,37, 6-2See Back Page for Fee Schedule
Plan Review
$
, `7 65% of Building Permit Fee
Fire Surcharge
$
', C9 9 .001 times the total job valuation
Surcharge
$
1,/�.0005 x Permit Valuation Minimum $.50
License Surcharge
$
` &V $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks payable to: City of Fridley Attad
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 work will be in
conformance with the ordinances and odes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicati fora and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case o all M&c which#oires review and approval of plans. j
SIGNATURE OF APPLIC f PRINT NAME j`/ ^itl p-�! , . a-iZ— DATE �/'<<�/J 0
EF
Soffit: LF Steel Fr ming:
NOTES:
t,
9
LF
_m _
w VN
8 �► t_ 4 s w
i
_
¢
f
^'^�$
AAM)._..,,.
E E
i E
i
�i
i 1
J.—
.......... ..
SCALE: 1/4 = 1 foot 1/4 = 2 feet Measurements and scale are only approximations.
TEC.1 J1\9 CAL
BULLETIN #2
Study Objective
To validate the theory that no vapor retarder should
be used with the Basement Finishing System.
This would be accomplished by obtaining point
moisture condition and combined system moisture
transport data for various vapor retarder
configurations with the system. Of key interest is
the locations in the basement system where
moisture levels are high; the interior humidity and
temperature conditions under which such high
levels are achieved, as well as the interior
temperature and humidity conditions required for
complete moisture removal (wetting/drying cures).
The study was conducted at the University of
Minnesota Foundation Test Facility and began in
November of 1998. The Owens Coming Basement
Finishing System ( R11) was installed with three
vapor retarder configurations:
`r A polyethylene vapor retarder placed between
the insulation and the foundation wall "Exterior
Side Vapor Retarder"
r A polyethylene vapor retarder placed on the
Interior surface (between the insulation and
interior air.) "in -9dor Side Vapor Retarder'
3 "No Vapor Rete der" on 2 of the module
quadrants (opp )sing corners)
From 12198 through 2100, measurements were
taken of: Interior air temperature, humidity ratio,
and barometric pressure, ambient exterior
temperature and humidity ratio, and humidity ratio
measurements at 40 locations within the insulation
(10 per quadrant). Additional data was collected
for: amount of dehumidifier condensate (water)
removed mass of 8 removable sq. ft sections,
electrical energy consumption
Discussion
The environmental conditions were established
to be representative of "typical" MN basement
conditions. Testing began with the basement
module under ideal indoor conditions – 65°F and
low relative humidity (40% RH). Conditions
were later modified to represent a "worst case
scenario"– an unconditioned basement at 56F
and 70% RH. Following is a brief discussion of
each quadrant performance.
University of Minnesota —
Foundation Test Facility:
Evaluation of the RU Basement
Finnshing System
Exterior Side Vapor Retarder:
During the winter months, condensation formed
on the Insulation side of the vapor retarder. -The
amount of condensate was enough nm down
the vapor retarder onto the floor. As the climate
transitioned into spring and summer, water
droplets accumulated on the exterior wallside of
the vapor retarder. In both the heating and
cooling seasons, this vapor retardef
con_fiour_ation was cleariy unacceptable.
mor Sideb-75—por Retarder.
When the vapor retarder was placed on the
interior surface, condensation also accumulated
on the insulation side of the vapor retarder.
Additionally, the insulation panels showed
moisture gain during the spring/summer at levels
that exceeded the drying potential during the
heating season. This cycle would result in the
insulation becoming progressively "wetter" over
me. Thus, the interior va or retarder
corriigurat+_on_was Maccepta ie.
Aro vaporretarder.
The two quadrants with no vapor retarder clearly
showed a "stable wetting/drying annual cycle in
a heated basement" As expected, a more
significant moisture gain was observed in the
panels during the "unconditioned" phase of the
study with no dehumidification. However, the
data also showed the ability of the system to
effectively "dry out" once conditions changed.
This can be extrapolated to conclude ero
valor retarder coriftgurationhas a s able
wetting/drying annual cycle in an approximately
unheated basement as well."
Conclusion
Men insialrmgr the Owens coming
R11 Basement Finishing System a vapor
retarder should NOT be used. The use of a
single vapor retarder, regardless of fte location,
provided a condensation plane where liquid
water formed and remained trapped in the
system.
Additional information regarding this report can
be obtained by contacting Owens Coming at
1 -800 -GET --PINK.
SREPORT=
ESR -1872
Issued May 1, 2007
Thisreport is subject to re-examhWon in one year.
ICC Evaluation Service, Inc. R office a MM walahmrs = M4 wrMft Caffinnda X691 a tM 699WO
www.1cc-es.ora Renal 'ilm • gMRo4 SLft A. `. SSM upMaMM
a tin=ao3Ivuet Roaa.coff&ycWbHbawbaorrs.U08i-PJsr.M5
DIVISION: 09—FINISHES The system is limited to installation over wags of concrete,
Section, 09770 Special Wall Surfaces concretemasonryandexmbngwood-orshmi-framedgypsum
walls. Ail !so ' mectiar�S+ ai ander work must be
REPORT HOLDER: done prior to msfaltaton of the wag panel system. SMIrical
boxes and wiring must be attached to existing wags in
OWENS CORNING SALES, LLC accordance with the applicable code requirements and are
ONE OWENS CORNING PARKWAY subject to approval of the code ofiidal.
TOLEDO, OHIO 43659
(419) 24&8000
www.owenscoming.com
marc.keenan(Mowenscomina.com
EVALUATION SUBJECT.,
BASEMENT FIMSHING SYSTE rfu
1.0 EVALUATION SCOPE
Compliance with the following codes:
a 20061ntemaflonal 8u►7eft Code® (IBC)
a 20061nInmadorml Residential Cade® (IRC)
a BOCA`O Naflonal Buii7ding Code/1g89 (BNBC)
a 1999 Sfanderd But7dmg Code* (SBC)
a 1997 Unt%rm Bullding Code•" (UBC)
Properties evaluated:
a Surface-buming charactehislics
* Flammability characteristics of textile wall coverings
to Interior finish stabiit r at elevated temperatures
2.0 USES
The Owens Coming Basement Finishing Systsm•m is used to
cover existing basement wags.
3.0 DESCRIPTION
The Owens Coming Basement Finishing System m consists
of PVC support heals, snap -m -t im components, base,
battens and covemoldingsandprallydshad glas&flberpanels
(see Figure 1). Panels am prefinished with a 17.6 -ounce (499
gm) polyolefin sheet with Tetlon finish and acrylic baclang.
The panels most the requirements for ciassiflcaton as a
Class A interior wag finish under the IBC and SBC (Class I
under the BNBC and UBC), when tested in accordance with
ASTM E 84. The panel sizes are 48 inches by 94 inches by
2'12 inches (1219 by 2388 by 64 mm). The Pineals are 93112
Inches by 212 inches (2375 mm by 64 mm).
4.1 Fastening lanais to Concrete and Concrete
Masonry Wags:
I-ineaks are attached to concrete or concrete masonry walls
using 31981nch4b4-1'144nch (5 by 32 mm) concrete screws
every 24 inches to 30 inches (610 to 762 mm) on center. The
frim moldings must then be snapped into the Uneals, holding
the panels In place.
4.2 FasteriMgL:mealstoE3dstingWood-orSteel4ramed
Gypsurn:
Hor¢flntal Uneals are attached at every wood stud with 1`14-
Inch-long
'/4inch-tong (31.8 run) drywall screws_ Vertical Pmeals must be
attached with construction adhesive and held in place with
1114 -inch -long (31.8 mm) drywall screws every24 inches to 30
Inches (610 to 762 mm) on center. The vertical heals need
not be alllgned with the studs.
5.0 CONDITIONS OF USE
The Owens Coming BasementftfthingSystarn-m described
in this report compUeswth, orisa suitable aitemafivetowhat
Is specified in, txm codes listed In Section 1.0 ofthis report,
suis dtothefollowing conditions:
5.1 Installation of the Basement Finishing SystemT"' must
be In accordance with this report, the appUwble code
and the manufacturer's published Installation
inst uciions. to the event of a conflict between the
manufacturer's published Installation instructions and
this report, this report governs.
3.2 Concealed electrical, mechanical or plumbing
componentsmustbeinstalled and inspected priorto the
Installation ofthe BasementFinishing System7m to verify
compliance with the applicable code.
5.3 Attachment of the Basement Finishing System m is
limited to concrete, concretsmasonrywalls and existing
wood- or steel framed gypsum wags.
5.4 Concealed spaces must be drattstopped and
freblocked in accordance Valli IBC Section 717, IRC
Section R 502.12, BNBC Section 721, SBC Section
7053 and UBC Section 708.
6.0 EVIDENCE SUBMITTED
4.0 INSTALLATION
6.1 Ma
The Owens Coming Basement Fines %Mbernm murstbe huraactuaer's published Insiagafron instructions.
insiaged in accordance w1h the Owens Cflming published 6.2 Reports of tests in accordance with ASTM E 84 (UBC
installation instructions, the applicable code and this report. Standard 8-1).
�EFQR75 areuattohew='maarrgresM&gaesthd1marany otherah-SWeschinsgrdf+aull}`mldrg=gnWffe11W10beawctlraedaran
endarsearort ajthesnbjert ofthereport ora rernmarerdaltorrJaritr use ?ltenaarro x�rmUy�l+plCCEuatarQionSaroFee Luc. �oraaplfesL auto arty
JmrGr{vorWheraaareria tbirrrporb araslomryp�ut tov�d.bpthereporL
Capy4igH1O2 07 = Pap oft
Page 2 of 2
ESR-4872
6.3 Reports of tests in accordance vuM NFPA 265 (UBC
7.0 W NTWICATION
Standard 8-2). 1
6.4 Reports of lire tests on panel stability at 300T (149'C)
The Owens Corning -Basement ftisfung System-M
components bears labelincilca6ngtheOwens Coming Sales,
far 30 n*urtes.
LLC, name, the product name, the Owens Corning product
6.5 A quality control manual.
code numberand the evaluation report number (ESR-9872
All Molding
Snaps
into Existing Foundation Wall
PVC
Support '.
Grid ,
1 1
t t
1 t
2.5" Glass
Fiber Board ;
Panel with
Facing ;
PVC
t
Cove
' I
PVC Support ;
Molding
Lineal '
(top, boiiom,
vertically
every 48")
PVC
Molding
Vertical
PVC
Batten
Molding
Base
FIGURE 1—OWIVNS GORi3WG SASENIM ' FDRSHING SYSTENw
BASEMENT FINISHING SYSTEM
INNOVARONS FOR LWMG"
DESCRIPTION
The Owens Coming"' Basement Finishing
System is comprised of V*wdgft fiber• &ss
panels, Parc rneals (which replace canverslronai
fizWhV and foamed PVC trim moidmgs
(which replace Vim lumber).The trap moldings
snap into the Me.*. holding the panels in place.
Moldings and wall panels are easily removed to
puede easy access to a home's foundation
walls: Becausetraditionalwood and paper-
based bolding materials are replaced with sur
glass and PVC materials,'the Basement Finishing
System offers inherent resistance to moisture,
mold and mrldew.0The system is covered by
a fifedme limited Varrsfeable warrarttyoc
from Owens Corning.
USES
The Owens Coming`" Basement Finishing
System is an innovative system designed to
insulate and finish basement wails. It inst;kes,
acousdaaliy trews and atedwficaly *ddm
wails in a few smpte steps.The rAberm can be
assWed over both masonry btsuWon wails
and into lm pariitlom walls built with either
wood or melai members.
AVAILABILITY
94" x 48° x 2 1/r Panels
i heals
Trim Molding.
Cave Mdd'mg
Vit Battens
Base Molding
Outside Comer
Casing
ChaSdender
ir Rai
Color Choices:
Panels:' Linen Mist" waven fabric
Trim: Al trim avabbe in White orWoodgrah
In addition, vwdcdi trim available in fabric took
fir orfabric wrapped to match panes.
CODE COMPLIANCE
20080 BOCA Evaluation #21-24
2004 ICC Report #NER-635
Whle rhe and design ofthe Owns Cami-
8115errrern Wd tng S)Cerm reit mold arrd rrrilde,u ft
SYst m can trot preverN or aledift mold Fft ems
' ss�y�r•motdg�a>Iervuea6�tinKxrtt
RF,
» . . !!•3n •- ..__7F 3
SUBMITTAL SHEET
i'rolla -Y
Test Mefted
value
Far Rber Gloss Board
WaterVapor Sorption
ASTM C 1104
<2% by wt @ 120NF
95% RH
Compressive Strength
ASTM C 165
@10% defamation
25 Isr
025% delbrmardon
90 psf
ThenQ Resistance
ASTM C 518
R-11
Normal Det>4 W
ASTM C 303
32 PCF
For gushed Fhwk
Morse Reduction Ca�
ASTM C 423
TypeA Mount
0.95
Surface Burning Characteristics
ASTM E 84+
Class A Flame Spread:5 25
-Meets Class A Bum Rating
Smoke Developed:5 450
htenorTextile Finish Fire C(assrircation
NFPA-286
Meets Acceptance
Criteria
Motd Resistance
ASTM C 1338
Pass
ASTM G 21
Pass
iThe �a oF9xfi pond vreJe detuar5,ed ar acmrtimm W& ASTM E 84.7nr's star►
ckr:I erreastaes and dasutmft properft after Prad,es crasserrb� in r to heat and 8mm under
ccnut fiecl illbOrAtcrY eotwls.13 a fromASiM E 64 trsvrrg rasimot be used to damte or assessthe fire tamed or fire
Ask ofnra2eri k pinducts -assembles %*— $ aU oftse fa:xor5 mr0inent m an me int of the fife hward of
a pa &vbr end use.Vdues are reported to the nearest 5 rating.
DESCRIPTION
BASEMENT FINISHING SYSTEM
INTERIOR WALL PANEL
The Owens Ctmv Bjishing
System is comprised of lightweight fiber glass
panels. PVC finals (which replace conventional
flaming) and foamed PVC trim moldings
(which replacetrim lumbw).-Me Iran moldings
snap into the irneals, holding the parsecs in place.
Moldings and wall Panels are easy removed for
removing or adding waling Bemnuetradl6onal
wood and paper-based buicrmg rna mats are
replaced with fiberglass and PVC materials, the
Baseman Finishing System offers inherent
resistance to moisturei mold and mildew--.
The system is covered by a lifetime limited
bansfe -&e warrant from Owens Coming
USES
The Owens Coming' Basement Finishing
System is an innovative system designed to
fetish basement walls in a few simple steps
while providing acoustical treatment
The interior -wall panel pruddes a CiassA
flame spread rating, meeting the requirements
for the iBC for single and murd-famUyy
rsidences.The anterior panels can be installed
over hUnor partition walls and stakweft built
with either wood or metal members. Panels
may be used on wood framed walkout wails
that are insulated and meet local v )or barrier
code requirements.
AVAILA13ILYTY
94'x4Tx 1511G*Panels
Uneals
Trim So -I tine:
Cove Molding
Vertical Battens
Base Molding
Outside Comer
Casing
Jamb Sd ender
Chair Rail
Color Choices:
Panels: "Linen Mist woven fabric
Trim: AD trim avaifabte in White orWoodgrain.
In addition, vertical trim available in fabric took
finish or fabric wrapped to match panels.
Wltr ** materials and desk afthe Owers e=we
BumaeftWi System refit atold acrd a2ftxthe
System can trot preierst araBeuiate mord ifthe ods
raecemyfor•meigtomhctenWata tmjurba9erri m
"See acarol ncnanry (ar dero3c Griinoriws acrd resaricaons.
0
e
e
SUBMITTAL SHEET
a
0
a
111{ j't
;I: . . . . . . . . . . "I,,,,,!,,,.
. ' w7i:• t' :;•:� • •' 3: is >i•' ?:� •••:i + : .. z "s ••-`- :" `�-i.•' _ : I
PHYSICAL PROPENES
ProlserLy Test Method Yd
For Fffw Glass Board
WaterVapor Sorption ASTM C 1104 t2% by wt @ 120NF,
95% RH
Compressive Strength
@10-5. deformation
25% defomnation
ASTM C 165
min.
25 psf
90 psf
Norma! Density
ASTM C 303
51) PCF
For finished Panek
Noose Reduction Coefficient
ASfM C 423
Type A Mourn
0.75
Surface Bunning Characteristics
-Meets Class A Bum Rating
ASTM E 84+
Class A Rame Spread <_ 25
Smoke Developed:5 450
InteriorTextile Finish Fire Ctassi&cadon
NFPA 286
Mks Acceptance
Criteria
Mold Resistance
ASTM C 1338
ASTM G 21
Pass
Pass
+lire drr eristia ofthe
pznel tvse d�ermared
in ao�rdarrce vrith ASTM E KThis
staridatd rereasues � d the pmpt� of materials products orate � tespoi►se to hs�t alai !fame acidic
cormObd laboratorycorrdt mDara tom A" E 84tesdtig oromt be used to rdesarbe orasft fire ism -ee
risk ofmatertk pro&= or assemlfies when mu Vw!rtg all orthe faaors perm,em to an ammum ofthe fire hm2rd or
a pard darend we.Valurs are reported to the rmvest 5 rating.
SOCA lnternationai EV►aluation Report B
0
A
ai��.�JG..:..ia.� _ •..: �"� r •.�,. �.: -_ attic:,:-; _�?,r
description
OWENS COPA41 NG Basetnent Wall Finishing
SystemTm is analtemativeto conventionalwaIl
framingandgypsum wallboard. TheBasement
Wall Finishing SystemTM c insists of PVC
support lineals, base, batten, ,md cove mold-
ings, and rigid prefinished fiberglass panels.
Panels are prefinished with a fabric coven
Basement Wall Finishing SysteruTM is primar-
ily intended for installation in residential
applications. Refer M Figure I at the encs of
this -report for ill suctions of the Basement
Wall Finishing SystemTw-
The Basement Wall Finishing SystemTm shall
be installed in accordance with the mamafac-
mrer s installation instructions.and this report.
Installation typically consists of either me-
chanical fasteners or adhesive fastening or a
combination of both to the supporting sub-
strate. Thennal resistance (R -value) for the
fiberglass panels is 11 -
Basement Wall Finishing SysteraTM panels
meet the requirements for classification as a
Class I interior finish as tested in accordance
with ASTM B84 and also has demonstrated
that it wilt not spread fire to the edge of the
specimen or cause flashover in the testroomin
accordance with the testing regmii�ments
specified in Section 803.6(2) of the BOCA
Nafional Building Code11999.
o®ndmon of une
This report is limited to applications and
Products as stated herein. BOCA ES intends
that this report be used by.the code official to
determine thatthereport subject complies with
the code requirements specifically addressed,
proldded that this productis installed in accor-
dance with the following conditions:
• OWENS CORNINGBasementWallR=h-
ing SystemTm is intended for finishing walls
m basement applications. Other applications
are outside the scope of this report.
■ The maximum permitted area of the PVC
moldings shall not exceed 10 percent of the
aggregate wall and ceiling are*of the room -
8 Installation of the Basement WAU Famishing.
System"-' shall be in accardance with this
report and the manufacturefs installation
manual.
■ Basement Wall Finishing SystemTu shall be
installed over cast -in-place concrete or
concrete masonry unit walls, or wood or
metal stud framfm& Supporting structural
systems shall conforming to code require-
ments for that system and are outside scope
of this report.
a The electrical wiring in the chase at the
bottom of the Basement Wall Finish Sys-
temT&I shall conform to the requirements of
the code and is outside the scope of this
report.
ftems requiring
vert Mc Mon
Thefollowingimms amreiated to theuse ofthe
report subject, but are not within the scope of
this evaluation. However, these items are related
to the determination of code compliance.
V Concealedeiectrical,mechanic al, orphm ib-
ing components shall be inspected prior to
the installation of the Basement Wall Fm-
isWng SystaniTbi panels to vercfy compli-
ance with related code requirements. Evalu-
ation of these components is outside scope
of this report.
✓ Framing supporting the Basement Wail
Finishing SysternrM shall beinspectedprior
to the installation of the panels to verify
compl mmvihhrelaWdcoderequirements.
Evaluation of this framing is outside scope
of this report -�
Research Report
21,24
MANUFACTURER:
OWENS CORNING
ONE OWENS CORNING PKWY
TOLEDO, OHIO 43859
DMSION 7 —THERMAL AND
MOISTURE PROTECTION
Section 07200 — Insulation
DIVISION 9 — FINISHES
Section 09540 — Special Wail
Surfaces
EVALUAinom SUBJECT
BASEMENT WALL FINISH
SYSTEM*"*
PRINTED AUGUST, 2000
Page 1 of 2
Copyright@2000,
BOCA Evalttadon Services, Inc.
A Participafing Member
of Me NES, Ina
Pmfi 2 of 2
Research Report No. 2124
ittttft�on submitted Product IdON-1:111c Hon
■ htWeXTM Tm&g S3'stmis, RepcatNo 73143, datedApril 17,
2000, containingrescdts of physical testing
a IntcgrexTM Testing Systems, Report No. C423-99065, dated
Angmt 19. 199.9, containing results of physical testing.
s OmegaPointLaboModes,Rep=No.13460-103216a,dated
May 14,1999, conwbingm ahs forfai,-temmgin accordance
with ASTM E84 for rigid M mz&w waft panels used in
Basement Wall Finishing SystemlK
s Omega Point Laboratories, Report No.16218-106644, dated
April 13,2000, contabftgresrtforf=testinginaccordamce
with ASTM E84 for moldings used in Basement Wall Fndsh-
mg gysiem,'°i-
e OmegaPointLahoratoxies. ReportNo.13060-103213x, dated
Stine 7, 1998, and Report No. 13060-104470a, dated March
24,1999, containingrestftforfiretestimgforfn-scaleroom
comer testing in accordance with requirements contained m
Section 803.6 (2) of theBOCANationalBuading Code17999
■ OWENS CORNING ProductLiterature, dated May 1998.
■ OWENS CORNING Submittal Sheet jbr Basement Wall
Frnishing System (BWFS), dated April 2000.
= OWENS CORNING Basement *all Finishing System
Installation Manual; dated January 2000.
applioation for Permit -
To aid in the determination of compliance with this report; the
following represents the minimum level of information to
accompany the application for permit:
x Thelanguage"SeeBOCAEvatuation.Services,Inc. Research
Report No. 2124" or a cop- of this report.
in Ptansiacficatingtheaggmgat�area oftheroomandthearmof
the PVC moldings being used.
■ Plans and specifications of any 6=Wcal, rnechamcal, or
plumbing items bstai%ed within the wall system.
R De -tails; and specifications of the supporting construction tr
which the system is to be applied.
All OWENS COR1WG Basement Wall Fmisbing SystnmsTu
manufactured in accordance with tleis research report shall bear
the followingidendficadon:
■ "See BOCA Evaluadon Services, Inc. Research Report No.
2124."
All MoldiiEtsling
Snaps
1nta Foundation WMI
PVC } = or Interior Partition
Support j
Grid I
2.6"Glass
Fiber Board
Panel with
Facing t
PVC
= Cove
PVC Support
€ MoIcring
Lineal
(top, bottom,
ver6cailly
every 48")
PVC
Molding PVC
Vinic dJj��t-
Batten Molding
Base
Fugate 1*
Sketch of Bassawd Wal{ Flash Sysiemm
Showing'iW1cW Components
'THIS DRAWING tS FOR ii USTRATION PURPOSES ONLY. IT IS NOT
INTEND® FOR USE AS A CONSTRUCTION DOCUMENT FOR THE
PURPOSE OF DESIGN, FABRICATION OR ERECTION.
MO i EVIG TO FAMPORTU80RS_
MWrep=is sabjectto annual mon. Reports that are not certifiedshallnotbemed ori to. To determine the smm of cerdacadon ofthis
report:coatactBOCAEvab ad=Swdces,lac.,orcmmdtthelatesteMonoftheBOCAkW,zationa7Praduct.EvatimdozL&dngpsbUshedperiodically
in theBOCA magaaaieine.
M&xepwt is subject to the conditions &-wdherein and to the spedfic pmdnr4 data and tustreports submitted by de applicantrequesft this report.
Independent test,were=tp 6 id by BOCAEvaluation Services, Inc. and BOCA ES Vacifi' scally does notmake an
h as to an Iia ' Qs or other matter in this Y Y. either expressed or
implied, Y tuna report or as m airy product covered by this report. Evaluation reports are not to be construed as
representing aesthesia or any other aildbutes not specifically addressed nor as an endousment orrecommemcatimi for the use of the report subject. This
dkwld ar includes, but is not limited to, mercbantab ty.
Plea$e contact BOUEvah afioaSwvlces,33z Withany questions you nmyhavegt1ft reporLA+dcfiiionati
have any hiformation on the'performmue of the product desd rtRied herein. which 9� pose coaiactus if yon
eoxdrary ids this report.
4051 West Ftassmoor Rbad - Country Club Hilts, IL 60478-5795_
telePhom (708) 799-2305 • fax (708) 799-0310
e-ntrail: bora-esabocai org • hw. !hitt w bocci arg
A.
0
(> ra Service, Inc.
5203 Leesburg Pike, Suite 600, Falls Church, Virginia 22041-3401 MEAM
Phone: 7031931-2187 www.natevai.ora Fax: 703!939-5505CGDE Lf)I�ftt'Rk
Report No. NER-635
Issued January 1, 2003 .
DIVISION 07 — THERMAL AND MOISTURE PROTECTION
Section 07210 — Building Insulation
DIVISION 09 — FINISHES
Section 09770— Special Wall Surfaces
REPORT HOLDER:
OWENS CORNING
ONE OWENS CORK ,NG PKWY
TOLEDO, OHIO 43669
Page 9 of 3
EVALUATION SUBJECT:
CopyrighM 2003, National Evaluation Service, Inc.
Tira report is lindred to the sprettle product and data and tent reports mthn:ifted by. the appiieant in its application requF:stuig this
rr ur: 1'6 mcicperrclEr:t te.•ts trere per/nrmed big the Matfonal Evaluarian SmIce, Inc. (tl•E'S), and NESspecificallr does nal make am-,
wermantr, either eapm e:f or fmp&4 its it., tun• findmg or other mutter in this report or as to am -product corered bE• flits report_ This
disclaimer ineludets, but i3 nor limited to, merdiantabill _ This report is also subject to the Iimitatfan fisted,Bassin.
Page 2 of 3
National Evaluation Report No. NER-635
NATIONAL
SUBJECT
EVALUATION
BASEMENT WALL FINISH SYSTEMTL*
SERVICE" INC,
CopydgirM 2003
2.0 PROPERTY FOR WHICH EVALUATION IS SOUGHT
Interior finish trim
NES,
3.0 DESCRIPTION
Product Evaluaffon &"na
OWENS CORNING 5�ismunr kwav S.- Item is an aftemative to con-
ventionalwall framing and gypsum wallboard. The Basement Wag Finishing System
consists Of PVC support fineals, base, batten, and cove moldings, and rigid
SI.I11GTt
Preftshad fiberglass; panels. Panels are prefinished with a fabric cover. Basement
.
Wall Finishing System is primarily intended for installation in residential applications.
Basement Wall Finishing System panels meet the requirements for classification
Ze.-PROPERTY FOR WHICIi
as a Class I (Class A) interior Wish.
S "VAL
X ISSGUGHT"
4.0 INSTALLATION
The Basement Wall Finishing System shag be Installed in accordance with the
manufacturers published installation Inttructions, subject to the conditions of this
report. Installation typically consists of using either mechanical fasteners, adhesive
or a combination of both to secure the Basement Wall Finishing System to the
supporting substrate.
6.0-1 WiTIFICATION.'.
5.0 IDENTIFICATION
All OWENS CORNING Basement Wall Finishing System components or packaging
as described in this reportshall bears label indicating the manufacturer's name and
this report number, for field identification.
CONIDMOP!S OF USE
6.0 EVIDENCE SUBMITTED
6.1 Omega Point Laboratories, Report No. 13060-103216a. dated May 14. 1999.
containing results for fire testing in accordance with ASTM E84 for rigid
fiberglass wall panels used in Basement Wall Finishing System.
6.2 Omega Point Laboratories, Report No. 16218-106644, dated April 13, 2000,
containing results far fire testing in accordance with ASTM E84 for moldings
used in Basement Wall Fn -Esping System -
6.3 Omega Point Laboratories, Report No. 13060-103213, dated June 7,1998, and
Report No. 13060-104470a, dated March 24, 1999, containing results far fire
testing for full-scale room comer.
6.4 OWENS CORNING Product Literature, dated May 1998.
6.50WENS CORNING Submittal Sheet for Basement Wall Finishing System
(BWFS), dated April 2000.
'2 W. 3
6.6 OWENS CORNING Basement Wall Finishing System Installation Manuel,
dated January 2000-
7.0 CONDITIONS OF USE
The National Evaluation Service Committee finds that the OWENS CORNING
back to -the NES.hompage Basement Wall Finishing System as described in this report complies with or is a
'e
suitable alternate to that specified in the 2000 Wernatfonal Building Code with the
'
2001 Supplement. the 2000 International Residential Code with the 2001
Supplement, the BOCA National Building Code11999, the 1999 Standard Building
Code, the 1.997 Uniform Building Code, and 1998 Intemadonal One- and Two -
Family Dwelfing Code subject to the following conditions:
Overview
Steel Frame Walls
• Construct full height steel frame
walls
• Studs are attached back-to-back
• Made with 25 ga. 2-1/2" or 1-5/81,
studs
Ceiling & Floor lineals
• Proprietary lineals are attached to
the wall_ By snap- ing the trim into
the lineals, the pa3.els are held in
place.
• Ceiling lineals are used instead of
wall angle for the ceiling grid
io Floor lineals are installed so they
follow the contour of the floor.
Irrs&Aation: 1
Overview
'of Owens Corrin
Confidential Property
iiemadeling systems. LLC x05.1
1jro::•.•�•s•<
tat
Corner Lineal & Panel
• Cut and set panel in place. Snap a
small piece of cove trim into the
ceiling lineal to hold the panel in
place.
• Cut all vertical lineals to .length so
they fit between the floor and
ceiling lineals, NOT overlapping.
Slide the corner lineal up snug to
the panel and check for plumb.
• Use the same procedure on the
other side of the panel and fasten
to stud.
Second Corner pane]
- Cut and set nex° panel in place.
• Slide the vertica lineal up snug to
the panel and fasten to wall.
IIIS Uaiion: 2
Overview
cDadm iai Pfupwy orotvm Corning
6.
Remodeling Syu=M LLC v 05.1
taa
Veriical Lineals and Panels
• Install full --width panels for the rest
of the wail until you reach a door
or corner.
Tnm
• Install horizontal )ase and cove
trim first_
• Then install vertical corner and
batten trim.
Installation: 3
Overviap
---{ conridaw Properly oromns coming
!
Remodeling ysc ¢05.1 ,;� ,,_.--:•� � s ems. rl,.e
FRI
P p
Electric Boxes
Attachment to Concrete Walls
• Use 2-1/2" deep boxes fastened
directly to concrete wall with
concrete screws.
• Attach wire or conduit to wall as
required.
-1
Attachment to Steel Frame Walls
Fasten the box directly. to the stud with a brace as
shown for support betweenfixed (not floating) studs
using sheet metal screws_ This brace is important to
keep the box from twisting. Pictured is a 3-1/4"
deep "Adjust A Box" electric box by Carlon -
Lamson & Sessions with 21.1 cu in volume. A
single screw adjusts the box for the proper depth to
the 1" interior panel.
0
0
Installation: 4
Electsfc Boxes
Confidential Progeny Of (tams COMM
Remodeling systems. LLC v 05.1
opt tot tta�-
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:03102010
(763)572-3604FAX: (763)502-4977
Permit #2010-00272
4624 2 1/2 ST NE
ADDRESS:
PIN:263024330037
LEGAL DESC:UNAVAILABLE
:LOT 1 BLOCK 1
PERMIT TYPE:HEATING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:NEW INSTALLATION
NOTE: INSTALL 2 SUPPLIES AND 1 RETURN IN BASEMENT FINISH.
HEATING PERMIT FEE, FIXTURE-BASED35.00
APPLICANT
STATE SURCHARGE, MECH FIX0.50
ALTA HEATING AND PLUMBING INC
TOTAL 35.50
19260 MUSHTOWN RD
Payment(s)
PRIOR LAKE, MN 55372-
CHECK1720435.50
(952) 440-3779
OWNER
VAN NELSON, RICHARD
4624 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:03/10/2010
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2010-00272
4624 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330037ALTA HEATING AND PLUMBING INC
LEGAL DESC:UNAVAILABLE19260 MUSHTOWN RD
:LOT 1 BLOCK 1PRIOR LAKE, MN 55372-
PERMIT TYPE:HEATING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL(952) 440-3779
CONSTRUCTION TYPE:NEW INSTALLATION
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
NO HEATING FOR CALLED FOR. APPEARS OK.
HEATING ROUGH-IN03/22/10PDAVE
HEATING FINAL03/19/10PDAVE
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 . ' , ' 7
Inspections
RESIDENTIAL APPLICATION
R
I
763-572-3604
CITY OF FRIDLEY
Dat�ec'd
763-502-4977 FAX
EFFECTIVE 1-1-2010
DATE U YOUR E-MAIL ADDRESS
SITE ADD SS 41& A 61` 2 N
THIS APPLICANT IS: ❑ OWNER t�MNTRACTOR
PROPERTY
NAME: R r c k cua .l .i--
ADDRESS: '5? 5 CITY Y =� l e� STATE�/'7IP V
OWNER/
TENANT
PHONE: -
CONTRACTOR
COMPANY NAME: G
SUBMIT A COPY OF
_ k
CONTACT PERSON: Z c�
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: N7A& p 1 7!/IS'G? /C& CITY 1Q-ii-E&VW( STATE�/IIP %
APPLICATION
PHONEg=a -t%q®- 779 FAX q'4�;� -�/ q(j -f -7
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAr�ED DESCRIPTION OF WORK
n ^.
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
$25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
_A/C
TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR
$35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
_BOILER
LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY
_DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR$15.00
Number of fixtures @.$10.00 x $10.00 =
Number of fixtures @ $15.00 x $15.00 =
Number of fixtures @;,P5.0017 x $25,00 $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge,= $ .50
M )SEE$3 ".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 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 applicatio or a permit d work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all w which requ� review and approval of plans.
SIGNATURE OF APPLICANT ' �/LJ PRINT NAMES icer-�Gi (/ vi l�t1TE
APPROVAL INSPECTORS SIGNATURE DATE
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:03112010
(763)572-3604FAX: (763)502-4977
Permit #2010-00276
4624 2 1/2 ST NE
ADDRESS:
PIN:263024330037
LEGAL DESC:UNAVAILABLE
:LOT 1 BLOCK 1
PERMIT TYPE:ELECTRICAL
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:ELEC SERVICES, NEW
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.
BASEMENT REMODEL.
ELECTRICAL PERMIT FEE70.00
APPLICANT
STATE SURCHARGE, ELEC FLAT0.50
KENDRICK ELECTRIC
TOTAL 70.50
14540 PENNOCK AVE
Payment(s)
APPLE VALLEY, MN 55124-
CHECK1177370.50
(952) 432-5036
Minnesota State License #: CA02896
OWNER
VAN NELSON, RICHARD
4624 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:03/11/2010
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2010-00276
4624 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330037KENDRICK ELECTRIC
LEGAL DESC:UNAVAILABLE14540 PENNOCK AVE
:LOT 1 BLOCK 1APPLE VALLEY, MN 55124-
PERMIT TYPE:ELECTRICAL
PROPERTY TYPE:RESIDENTIAL(952) 432-5036
CONSTRUCTION TYPE:ELEC SERVICES, NEW
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
ELECTRICAL ROUGH-IN03/12/10PBOBC
ELECTRICAL FINAL03/16/10PBOBC
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:04272010
(763)572-3604FAX: (763)502-4977
Permit #2010-00570
4624 2 1/2 ST NE
ADDRESS:
PIN:263024330037
LEGAL DESC:UNAVAILABLE
:LOT 1 BLOCK 1
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:BACKFLOW PREVENTOR
NOTE: INSTALL 1'' VIB FOR LAWN IRRIGATION SYSTEM.
PLUMBING FIXTURE FEES35.00
APPLICANT
STATE SURCHARGE, PLBG FLAT0.50
CEDAR PLUMBING
TOTAL 35.50
20612 MONROE STREET
Payment(s)
CEDAR, MN 55011
CHECK1434835.50
(763) 753-3464
Minnesota State License #: PM005550
OWNER
VAN NELSON, RICHARD
4624 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:04/27/2010
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2010-00570
4624 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330037CEDAR PLUMBING
LEGAL DESC:UNAVAILABLE20612 MONROE STREET
:LOT 1 BLOCK 1CEDAR, MN 55011
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL(763) 753-3464
CONSTRUCTION TYPE:BACKFLOW PREVENTOR
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
CHECK MIN HEIGHT ABOVE HIGHEST HEAD.
PLUMBING FINAL06/16/10PDAVE
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.
40`31:e
Building
PLUMBING
Permit NoJO®`�'
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: 027 �Q
763-502-4977 FAX
I EFFECTIVE 1-1-2010
DATE ! I i i 0 YOUR E-MAIL ADDRESS
SITE ADDRESS �� 2 �� �� t/
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: v ')
OWNER/
I
ADDRESS: C"z� fU C CITY "'( `x y STATE ZIP
TENANT
PHONE&2165623 " 2_(j 0 7
CONTRACTOR
NAME: " L &-
SUBMIT A COPY OF
# Z Z 7 DATE Z 3
YOUR STATE
STATE LICENSE EXP
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
it
ADDRESS: i Z/e S CITY STATE {VBUZIP
INSURANCE
PHONE 7 Ste-3�I6L1 FAX 'Z�i� 3e4- 300
PERMIT TYPE
EANGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
REW _ ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
_ BATH SINK/LAV _FLOOR DRAINS SHOWER _ WATER PIPING
_
GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
—BATHTUB _ _
_ CLOTHES WASHER KITCHEN SINK WATER CLOSET ZjdCKFLOW PREY. ($15)
_
_ DISHWASHER _ LAUNDRY TRAY HEATER ($35) FOR IRRIGATION
_WATER
WATER METER OTHER
P' s�
-- .,. r .s �,�^" ^, �+,' U� 'S mr :>d �: s ->sy. ✓ze1J�, z'�"2T X74 k s
N' §��� _ �. - � •xm �' M +-,�S
P'�rv^vk ��� 2
b � � .�„° 3 ,P 4. Y Al
y
S«�
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
Ing 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 appli on fo a pe it and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the a of o which re uires review and approv l ofdI n
u
SIGNATURE OF APPLICA PRINT NAME DATE / l0
x
City .of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977