PRE 2010 DOCSI�
SUBJECTRM
.
City of Fridley
14121
AT THE TOP OF THE TWINS
BUILDING P E R M I
"
r
• COMMUNITY DEVELOPMENT DIV.
V;;t�
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
6/1/77
JOB ADDRESS 4638 2�i Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5�6
11
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Carroll L. Jensen 4638 - 2-1 Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Miles Garages 4500 Lyndale Avenue North 588-9750.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Ek ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 11.2' x 22' Addition to back of garage
9 CHANGE QF USE FROM TO
STIPULATIONS Side yard variance of 4' approved May 101 1977
PERMITS REQUIRED FOR WMING6 W"we
SEpER>�i''E P
P'LUM6ING AND SIGNS. Baton 1 call local utilltiee
HEATING, TEI.IMM.• ELECTRIC -GAS Etc.
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Wood Frame
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.
$1F953
$.98
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-
$10.56
STRUCTION OR TOI PERFOMqNCE O CONSTRUCTION.
a
`- �7
PLAN CHECK FEE
TOTAL FEE
$11.54
9IGNKTLKEOFCONTRACTORORAUTHORIZEDAGEN (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
/I/( � L a ejnjv,- 6—/-77
BLDG. INSP DAT
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
I�
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER:,e�12 �fSL L _ ( fllc� t/S BUILDER: e✓c � F _<
�� �� � 'el o G 4Ytvi' /-I.bq 700
Address: � Address r._ .
Tel. No.:
No.: 6!L,30 Street; �� S7_
Z66 7 -
LOT: 15 6 BLOCK: ADDITION: ;L(,/ /,, el(Ll 9 A6,0/(l.
CORNER LOT: INSIDE IAT: '� SETBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: ,/ ®i41 ® Depth: Height: �1
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: _ O(OLL F�W Estimated Cost: $ & � 6 ®
To Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
r
�► C�'sr i/�i
Stipulations:
.
susdEcr
PERM
City of Fridley
15141
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
ECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 �
NUMBER
REV. -
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-560-3450
910-F15
4/23/79
JOB ADDRESS 4638 - 211 Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5,6
11
Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
C. L. Jensen 4638 - 2h Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Richard Hastings Co 6331 Riverview Terrace N.E., Fridley 5602610
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
RnN8 Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
a
8 DESCRIBE WORK
Install ccmbina.tiOn windows arid. aluminon trim
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPERATE PERMITS
REQUIRED FO
R WIRINGWIRING.
HEAT'NG/ PLUMBING
AND SIGX15
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.
$900
$.50
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
ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON -
RUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$7.50
e
PLAN CHECK FEE
TOTAL FEE
I
63
$8.00
SIGNATURE OF CONTRACTOR OR AUTHORQ' ED AGENT (DATE)
WHEN PROPER VALIDATEgD THIS IS YOUR PERMIT
BLDG. INSP D E
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
tNEW, ALTERATIONS, ADDITIONS,' OR REPAIRS)
OWNER: .. BUILDER:
Address: .Y . �� �- Address: 6 3 3%• �°�' � cis
Tel. No.:
No. j Street:
LOT: BLOCK: ADDITION:
a -
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach 'to this form Two Certificates of Survey of Lot and proposed
• building location drawn on these Certificates.
DESCRIPTION OF BUILDING j
To Be Used As:
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction:�. .� �•,� Estimated Cost: $ o r�
Tb Be Completed: 5-// s ) r
-,--- Alt. A Alt. B
Proposed Driveway Width if New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that.all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: .�,� � �` SIGNATURE: �zi
r
Stipulations:
qso
CD
�.
- - r
�r ray` February 2,
8 4i
:r
COTY OF FRIDLEY
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 5.5432
TELEPHONE
1981
Mr. Carroll L. Jenson
4638 2� Street N.E.
Fridley, MN 55421
a
�r Re:. Electrical Permit For 4638 - 2•1i Street N.E.
Dear Mr. Jenson:
(812)571-3450
Per your request on January 30, 1981, we state the following information;
Elect. Per.
Issued
Work Done
Final Date
#11,925
4/4/77
150 Amp Service Installed
8/1/78
#13,301
8/16/79.
Wiring Furnace
4/4/80
#13,680
4/25/80
Wiring Air Conditioner
4/30/80
Please feel free to contact this office if any further information is
needed on the above noted electrical permits.
Sincerely,
LEONARD EICHMILLER
Electrical Inspector
LE/mh
7
SUBJECT
PER
City of Fridley
16 103
AT THE TOP OF THE TWINS
BUILDING P E R M I T
rp
RECEIPT NO
'COMMUNITY DEVELOPMENT DIV.
L
r ; PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
FPAGE OF
APPROVED BY
612-571-3450
910-F15
4/3/81
JOB ADDRESS 4638 - 231 Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
5,6
11
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Carroll L. Jenson 4638 - 211 Street N.E. 560-7588
3 CONTRACTOR MAIL ADDRESS 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
8 DESCRIBE WORK
Construct a 161.x 3G' Deck.and Patio Door
9 CHANGE OF USE FROM TO
STIPULATIONS
V=utilitit,
ink call local GAS Ur.
.
•,��EG�RIC
LP
SEpEpA
HEATImullpL,uMp� �EQtl1f E� FOR
W"ry%wo
ANO
soNSr
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
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
$900
$.50
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-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$8. GO
S 'IATUREOFCONTRACTOR 0 THO�R,IZEDAGENT (DATE)
WHEN PROPER D THIS IS YOUR PERMIT
//�/VALIDAT
I D TE
IGNATURE OF OWNER (IF OAPfrR BUILDER)
7
CITY OF FRIDLEY
APPLICATIOJ FOR RESIDtNTIAL BUILDING PEMITS
(New, Alterations, Additions, or Repairs)
01l14ER: �e�� L� L� �' BUILDER:
ADDRESS: 3� ^ ��,�. %. ADDRESS:
TEL NO:� � ® % �' � TEL NO:
Construction Location '
STREET NO: _ STREET:
LOT: BLOCK: 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.
DESCRIPTIO14 OF CONSTRUCTION
M C Front: Depth: Height:
Square. Feet_: Cubic Feet:
�1 Front: Depth: Height:
Square - Feet: Cubic feet:
Type of Construction: M A- Estimated Cost: $ Cc ,
To Be Ocrapleted: M0 Y� �
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $
SEE REVERSE SIDE OF SHEET
Ilia undersigned hereby makes application for a permit for the vork'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
. rapresentat�i/ons stated :n this application are true and correct.
DATE: �� 3 / SIGNATURE:
Stipulations:
S
,r. i
e
e, UBURBAN
Ll; NOINEERINO
Y." r r: ,t ll:.nr.tlxrt F.npin::rur[ � �• d l r..rnX � !.•: •;d i;,,r:�rn# � Lund P:unw:#
Certificate ®f Survey f®r .
a
3
- 1---,0 5 ; --
li✓�.'C'U(f]✓
I
11 )
$ r M
?j
4 7'-
11 ;°arn Ot6c. 5116066
I1 6815 Hiyr ;, y No 65 N E.
;i PA u,neapo�:. M,nnrent,, 55432
Iroutn Othoe 8006510
r' 1101 Cttf R" -Al
%!---t.r 55331
ic- � s0 Q
Lo I'S K
TD
�0U T I� .
1 hereby certify that this is o tress and correct representation of a survey of the boundaries of the above
described land, and of the location of III buildin s, therepn, and all visible encroachments, if any, from or on
said land. As surveyed by me this l�°day of r J A. D. 19_Z7 '
SILMURBAN ENGINEERING, INC.
Engineers Syrveyois
by �l J
J
% V_ e'. cf•..�
- f
NA
III E&NO.
City of Fridley
2 9 �5 9
AT THE TOP OF THE TWINS
BUILDING PERMIT
i COMMUNITY DEVELOPMENT DIY.
; >r _
r � PROTECTIVE INSPECTION SEC.
1
1 . �
NUMBS4
REV
DATE
PAGE OF
APPROVED OY
1 t CITY HALL FRIDLEY 55432
"'j
612-571-3450
910415
7/12/99
JOB ADDRESS 4638 2 1 2 Street . NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
oEscR.
5, 6
11
IPlymouth Addn.
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Carroll Jenson 572-8950-
72-895 .3
3CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
CMS Home Improvements 4633 2 1gig-1g6n
2015(1()69
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
D NEW D ADDITION ❑ ALTERATION ®C REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house 11 S Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$961
$.5O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
7
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•
$38.75
Fire SC $.96
STRUFORCCONSTRUCTION
CTION THE P MANriE/p'
a
G
PLAN CHECK FEE
Licens $5V
TOTAL EE
$4 .21
SSG NATURE O CyJyrTRA . OA OR AUTHORIZED AGENT iDATE�
EN�RO&VArZHISLIDA
B, ..
I flPf RMITS,GNATURE
gAtE
OF OWNERof OWNER BU0.DERI iDATE- -
NA
NEW[ ]
ADDN [ ]
ALTER [ ]
Construction Address:
Legal Description:
Effective 5/10/99
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUELDING PERMIT APPLICATION
f-7T-ir FI -6. �
Owner Name & Address: I�V rro I J�05t>n Tel.
Contractor: (f M S 40)„z nWreW, PUAII MN LICENSE #
Address: �33 P�� 5-� %U,j!�e rrid%k S z/'o" 1 Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EM PROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width _ Hgt/Gjr`ound Sq. Ft.
OTHER: it_t�c� s
Construction Type: �-P,)P 4�o
1-91/1
&r j Estimated Cost: $ � �� �/-
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: /� y'� APPLICANT:��
"'- Tel.
CITY USE ONLY
Permit Fee
$ ��^
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
_'ITY OF FRIDLEY INSPECTION DIVISION Effective On May 10, 1999
5431 University Ave NE -
=ridley, MN 55432 APPLICATION "FUR POWER PLANTS AND HEATING, COOLING, VENTILATION,
372-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge $ .50
-- TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes ar
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
261$ RAPIDS BOULLVAJO
C N RAPIDS. MN 55433
HEATING 12 757-5040
Signedi
Approved Byy
FILI. OUT BACK SIDE
Rough -In Date Final Date (U,UUOd
N �7
JOB ADDRESS �S _
RATE SCHEDULE
OWNER1
Residential
Date
TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS
Also Replacement Furnace
$ 30.00
$ i
(Side Vent . Fill Out Back)
ESTfMATED COST `1 PERMIT N0.
Gas Piping (Needed with new furnace,
$ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range.
$ 10.00
$
Heating Circle One (Hot Water) arm Ai
No. of nits(Steam)
Gas Dryer
$ 10.00
$
Trade Name Size No. Im Dl' -O
BTU -JCC HP EDR
'Air Conditioning - All Sizes
$ 25.00
$
Fuel_ - h Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge $ .50
-- TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes ar
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
261$ RAPIDS BOULLVAJO
C N RAPIDS. MN 55433
HEATING 12 757-5040
Signedi
Approved Byy
FILI. OUT BACK SIDE
Rough -In Date Final Date (U,UUOd
6 Has total heating BTU's of %G� 000
All other BTU's 0/����/j��
TOTAL BTU's
7. Has a liner been provided for water heater Yes ) No ( )
8. Has combustion air been provided for water heater Yes ) No ( )
Remarks:
HEATING CO:
Signed By:
Date:
DEPENDABLE IND=
2619 COONID
COON RAP
(6 12) 757,64
f-0
INC. �
/new
35-�
C-MMNEY AND STACK VERIFICATION
.. The
undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes ( No
( )
2.
Is free from rust or deterioration
//7/t" 'Yes (. ). No
( )
3.
Has no foreign objects lodged within
Yes O No
( )
4.
Is securely supported
Yes ). No
( )
5.
Meets all current Code requirements for size
'
and total BTU's connected
Yes ) No
( )
6 Has total heating BTU's of %G� 000
All other BTU's 0/����/j��
TOTAL BTU's
7. Has a liner been provided for water heater Yes ) No ( )
8. Has combustion air been provided for water heater Yes ) No ( )
Remarks:
HEATING CO:
Signed By:
Date:
DEPENDABLE IND=
2619 COONID
COON RAP
(6 12) 757,64
f-0
INC. �
/new
35-�
SO ' d -1d.L01
Frirmut certified by ACOA to meet all requirements of Manual J Form
s0.%SGJ'd WES TZ2 ZT9 W4Id S3-1yS Tt:ET TOOZ-LO-d3S
96 2 Job#
M
MANUAL l: 7th Ed. itIGFTI'-J: 3. G.li-� S1N12076
NainB of Room Entire Houao
Runrdng Ft apoml Wall 112.0 Ft.
Roota Dimensions, FL o.0 t,
Celir gs. Ft Condit 00100 12.0 d
Zone:
WHOLE HOUSE
112.0 Ft.
2s. a x 30.0 Ft
12.0 heaticeel
Entire House
I
2
3
4
Ft.
x FL
X
�
Ft.
TVP1; ON C81 HTM
E"OSim NO, Htg Clg
.Arca
Length
gtult
Htg C1g
Area
Length
stub
Htg Clg
Area
Lengih
Btub
Htg Clg
At" BOA
Ungtli Htg
Clg
a 12C 8,3
ExPoled b 14A 46.9
Walls and c M111.5
d 0.0
2.4
9,8
0.0
0.o0.4f6
1344
224
336
sss«
tss•
rens
ssss
ssss
♦e«s
1344 •Rrs
224 srss
433Partitions
*rsr
ssvt
s•ws
sssr
srss
tsse
ssss
*r•t
r•••
rrrR
WindM wda 2A 43.7
Glass Doors b O,p
Heating o p_0
d 0.0
a 0.0
f 0.0
°•
••
**
10
°•
120
ap
p
0
p
p
3244
0
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p
sss$244
rss•
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Appl• Q 1200 1
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Frirmut certified by ACOA to meet all requirements of Manual J Form
s0.%SGJ'd WES TZ2 ZT9 W4Id S3-1yS Tt:ET TOOZ-LO-d3S
,ITY OF FRIDLEY INSPECTION DIV.
3431 University Ave NE
Fridley, MN 55432
163-572-3604
Floor 1
Floor 2
Flexor 3
Floor 4
PLUMBING FIXTURE RATES:
APPLICATION FOR PLUMBING AND GAS FITiINIP PERMIT
NO. RATE TOTAL
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gasp*
Gas Rarer"
Gas Dryer"
Back Flow Preventer Required ( )Yes {) No
Type
$ 7.00
4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00 evl>
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS'
1.5% of Value of Fixture or Appliance 20' UU
State Surcharge..;
Effective On Jan 1, 2001
JOB ADDRESS- /2_ i i0:
Water Heater
Gas Elec
E.:rf
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
aria ruiir'Os of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
-.200(
-Owner :Lf /yS If A/
Building Used As �i.✓ �� ��/� •'✓
Estimated Cost �b i,PERMIT NO. 6:z -
-PLUMBINGA
SIGNED BY �� TEL N0. `"73 S7'� f
Approved ByaL Rough-ln bate _____•— Final ®ate `/0 -�'y'd 1
i'PLUS THE , 1.
COMBUSTION
• PROVIDED• 14 6_A.
• • • ON
fzl: NUMBER OF FIXTURES T -O BE INSTALLED ON EACH FLOOR
✓-.;
{
;::r:...
Wash : YJ Floor
: �, " Auto.
> } h+t�ii?.
3dower
t}v., <oj �:in. Pti
Tra Y-:'` Drain
'•':{':�'rn
:Washer"
v
:i.'.:..
}t.vy��.}}v: •: is r
xi': •• .✓: • f
�iti:�ii ?:5.; •`.'rA`:
.:fin:
.......:.;
• �3; -
:::::%�:}3'%:•.'•� ��
... FBF
...•✓.,..,. •:: h
.......:. S ?�•::`. '
� ^.`:
`.•.:.qty:: _
:)r".'-=:?•;
r
r t'
. }l iC,..1,:..-'•
:n✓
i`J{•t::•'•1?v is}Sj;f�:;�:;..
'41':i}ti�fyr.;:
NO. RATE TOTAL
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gasp*
Gas Rarer"
Gas Dryer"
Back Flow Preventer Required ( )Yes {) No
Type
$ 7.00
4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00 evl>
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS'
1.5% of Value of Fixture or Appliance 20' UU
State Surcharge..;
Effective On Jan 1, 2001
JOB ADDRESS- /2_ i i0:
Water Heater
Gas Elec
E.:rf
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
aria ruiir'Os of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
-.200(
-Owner :Lf /yS If A/
Building Used As �i.✓ �� ��/� •'✓
Estimated Cost �b i,PERMIT NO. 6:z -
-PLUMBINGA
SIGNED BY �� TEL N0. `"73 S7'� f
Approved ByaL Rough-ln bate _____•— Final ®ate `/0 -�'y'd 1
i'PLUS THE , 1.
COMBUSTION
• PROVIDED• 14 6_A.
• • • ON
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes (} No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specificatlons 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
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes { } No ( }
When'requiredto SSmbusti®fin air, it -will- bgsized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a neva venting system, the undersigned hereby verifies that
d 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 Net
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
. t�aift fl Vent Connector height ft Length ft Diameter �,in Type - ..
Appllar�ce #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS- (Describe) -
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:03232006
(763)572-3604FAX: (763)502-4977
Permit #2006-00448
4638 2 1/2 ST NE
ADDRESS:
PIN:263024330035
LEGAL DESC:UNAVAILABLE
:LOT BLOCK
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:ROOFING/SIDING
VALUATION:$2,400.00
NOTE: VINAL RESIDE GARAGE ONLY.
BUILDING PERMIT FEE83.25
APPLICANT
FIRE SURCHARGE2.40
NORLING EXTERIORS INC (20098700)
STATE SURCHARGE, BLDG VALUE1.20
341 79TH WAY
LICENSE SURCHARGE5.00
FRIDLEY, MN 55432
TOTAL 91.85
(763) 784-8936
Payment(s)
Minnesota State License #: BC20098700
CHECK7701882791.85
OWNER
JENSON CARROLL L
4638 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________
3/23/06
Bldg Insp____________________________Date ________
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
ISSUED:03/23/2006
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2006-00448
4638 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330035NORLING EXTERIORS INC (20098700)
LEGAL DESC:UNAVAILABLE341 79TH WAY
:FRIDLEY, MN 55432
PERMIT TYPE:BUILDING
PROPERTY TYPE:RESIDENTIAL(763) 784-8936
CONSTRUCTION TYPE:ROOFING/SIDING
:
VALUATION$2,400.00
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
FINAL03/29/06PDAVE
WEATHER BARRIER/FLASHING03/29/06PDAVE
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
Inspections
763-572-3604
DATE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER tC16NTRACTOR
PROPERTY OWNER/ I NAME: C Alk -PN
TENANT ADDRESS: q(
PHONE:
CONTRACTOR
Permit N
Received By:
Date Rec'd:
SUBMIT A COPY OF
STATE LICENSE # 36 9-00
T6 7®6 EXP DATE Xn
YOUR. STATE LICENSE
ADDRESS: ci fit
CITY�%1 _STATE±✓ -,=7-
WITH APPLICATION
PHONE .7(0 W-
U FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
' .0005 x Permit Valuation Minimum $.50
❑ TWO FAMILY/NEW CONSTRUCTI N STORIES
PERMIT TYPE
❑ ADDITION
GARAGE/SHED ❑ WINDOWS
$
❑ BASEMENT FINISH
❑)RiOF ❑ DRAIN TILE
$
❑ DECK
JZ SIDING ❑ OTHER
$
$450 Conservation Plan Review
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW
❑ ADDITION
$
❑ MAINTENANCEWiPAIR
❑ REMODELING
DESCRIBE WORK BEING DONE: U4 -5; h- 6ftL4S,e--
- Make checks payable to: City of Fridley Attach Stipulations
SIZE OF IMPROVEMENT,
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SID G
rayl
❑ Aluminum
❑ Other
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
� n
ascia
WIDTH j HEIGHT Sq. Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ Q -00 OCCUPANCY TYPE
Permit Fee
$ ,��Gkr5'
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
a. LP .001 times the total job valuation
Surcharge
$
' .0005 x Permit Valuation Minimum $.50
License Surcharge
$j
c $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
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 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; that the work will be in accordance with the approved
plan in the case of all wo �Iwhiic�ch requires review and approval of plans.
SIGNATURE OF APPLICANT Y� T NAME R� �yK�� DATF_o