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PRE 2010 DOCSDate: / L C TV FUILDING No. Street �y Part of Lot Lot Addition or Sub- 'on . ,�,-------- Corner Lot _ Inside Lot �`� Setback ..._ _ Y Sid d Sewer Elevation Pbundation Elevation DESCRIPTION OF BUILDING To �L Depth Height Sq. Ft. Cu. Ft.2260 Front Depth Height _ �__ Sq. Ft. _ _ Cu. Ft. Type of Construction _. Est. Ce# To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. r Y 12 a A In consideration of the payment of a fee of $ permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or anypart thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding lavation, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon vioof any of the provisions of said ordinance=s. Building Inspector NOTICE this permit does not corer the construction, fiutallallon for wWng, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these hems. _tea, APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER ° S 17AT^.E ® BUILDER ADDRESS ADDRESS LOCATION OF BUIL ING No. I z __z Street art of Lot Lot _Block Addition or Subdivision Corner Lot— _Inside Lot - o- , backZ'22'j ..-®Side-Yard 11A SEWER ELEVATION MUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these.Certificates. DESCRIPTION OF BUILDING To be a f� Front�Depth Height _;2=.Z _ Sq. Ft. 3Cu. Ft.�' Front Depth Height Sq. Ft Cu. Ft _ Type of Construction Estimated Co. To be\Completed 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... S TONATUTRE (Schedule of Fee Costs can be found on the Reverse Side). SUBJECT PERMIT City of Fridley 12623 AT THE TOP, OF THE TWINS BUILDING PERMIT r RECEIPT • COMMUNITY DEVELOPMENT DIV. INSPECTION S r PROTECTIVE SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE _ OF APPROVED BY 612-560-3450 910-F15 7/2/74 JOB ADDRESS 4725 - 21-2 Street N.E. 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 21,23 7 I Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE George Dahly 4725 - A Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION [Z ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof structure 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt 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 1 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $600.00 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $5.00 PLAN CHECK FEE TOTAL FEE 5.50 SIGNATURE OF CONTRAC R OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT oo�� % BLDG. INSP DATE SIGNATURE OF OWNER IIF OWNERB ER) 1 TEI APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: CJI�� BUILDER: ADDRESS: � �-�' � � � // - ADDRESS: NO:. STREET: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: L' SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. r DESCRIPTION OF BUILDING To Be Used As: R � /ti -G Front Square Feet: Depth: Height: Front: Depth: Cubic Feet: Height: Square Feet; Cubic Feet: `` Type of Construction: f�2/ Estimated Cost: $ C� Q� To Be Completed: 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. DATE: /� SIGNATURE: 4f - (See Reverse Side For Additional Information.) V�l?Wt �J- 'g�;06 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 Future Fixture Opening x b+ $ Water x m $ Catch Basin x $5.00 E Water Heater - to 99,000 BTU x $5.00 $ 41 a w $ Water Softener Heater .0/i $ Nye x $5.00 $ Electric Water Heater xR� y a� 1p+ .0 C ani 1st 3 fixtures $4 '$3.00 $ Additional Fixtures x $1.00 $ .5° x ,OY� $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction2.00 r. U $ State Surcharge y 3 Q w° vii w0 w 4 3 O as lec 1st 2nd 3rd 4th Lt (P.) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x '$3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction2.00 S $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address L� r { Xz- -,& A A-- Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all I the facts and representations stated in this application are true and correct OWNER KIND O Fridley, Mn. / ' -7 ,19 USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. i Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SU^E �i SUBJECT city of Fridley0 0 7 AT THE TOP OF THE TWINS gUIL®I RMITeT6 No COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. / 7� ( NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/30/98 JOB ADDRESS 4725 2 1/2 Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21-23 7 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Robinson 4727 2 1/2 Street NE 572-8977 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Viking Home Improvement 4832 2 1/2 Street NE, Fridley, MN 55421 572-1820 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 4772 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION [j REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Soffit & Fascia 9 CHANGE OF USE FROM TO STIPULATIONS Install soffit ventilation to meet the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,450 $.73 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- $48.50 Fire SC $1.45 STRUC N OR T PE RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE �/ III-n.3®��°�21G ��° License SC $5.00 $55.68 SIGNATU EOF ONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERL 4BLD INSPo VALIDATED THIS IS YOUR PERMIT % T1ATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI �i NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY dA ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: tl7 Z f q /, si A ,r— Legal Description: Owner Name &Address: Tn t 1?.o /3.z^./.S QA) �/°% a'7 %Z s>, M, F> Tel. # 6 -?2,-P;7"7 Contractor: r — ®A . MN LICENSE # V772- Address: 772Address: V lq 3 ,7, Tel. # 0 2 /P, Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length �— Width Hgt/Ground Sq. Ft. OTHER: „47.*c.T�A _ --- Construction Type: Cojex so Fr-.rrr 46r 7_4 torrho olO stimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: #ArG 3o Y? APPLICANT: � T� tL L o -.a-A)S,' e✓ Tel. #.S'7 2 TOTAL $� n. D STIPULATIONS: CITY USE ONLY Permit Fee $ < S Fee Schedule on Reverse Side Fire Surcharge $ A�^ .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 00 $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 $� n. D STIPULATIONS: "- Y.ION all/. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR f—iii "Ai r•- s" '.;,.- PLUMBING FIXTURE RATES New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** NO. RATE Gas Range*" Gas Dryer** _ Back Flow Preventer Required ( )Yes () No Type Reinspection Fee $47.00/Hr $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS `'r �Z- t & 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. /0 - G 7 , 20 ® 2=, Ownerm :. S `7f 3— �1A-�, 71 /� Building Used As Estimated Cost (&00, PERMIT NO. PLUMBING COMPANY� �vytcic.6, SIGNED BY TEL N0. w FAX # p Approved By Rough -In Date Final Date 50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 $ =L>, PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. ks ? 0 -env( � /I- a COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When reIn acin8 an _xic inn furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The taxi -sting rnmi, ,conn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a naw nnmhunfinn airs it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a new venting nyystem, 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 #1 Type 1i0.4 seQ BTU Input Fan Assisted 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 V' - slwt b EATING CO: /�� c - Signed By: Date: City of Fridley SUBJECT 3 71.9 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 r� ��/// NUMBER REV DATE PAGE OF APPROVED BY ----I CITY HALL FRIDLEY 55432 'J 763-571-3450 910-F15 8/11/03 10B ADDRESS 4725 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21-23 7 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Robinson 4725 2 1/2 Street NE 763-572-8977 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO US Restoration 93 W Little Canada Rd, Little Canada, MN 55117 651-765-9785 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE N0, 20325484 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION IR REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof & Reside Garage 9 CHANGE OF USE FROM TO STIPULATIONS Underla-yment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 @ $1.70 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,400 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 - $97.25 Fire SC $3.40 TR CTION OR THE PERFORMANCE OF CONSTRUCTION r ° 63 PLAN CHECK FE TOTAL FEE i'L nse C $5.00 1 $107.35 S; , TORE OF CONTRACTOR OR AUTHORIZER AGENT JDATEr PROPERLY VALIDATED THIS IS YO R PER IT NE, NgP rjATE S,GNATURE OF OWNERof OWNER BUiLDERI tDATEi h, NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: I � �T Legal Description: Owner Name & Address: Contractor. U 5 t Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: O k6 I tk Tel. # 761-1-72-122 MN LICENSE # Tel.#,�.� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length o Width L2 Height_ Sq. Ft. Length:�qTT7/47x H ound Sq. Ft. r+4 6 L Construction Type: Estimated Cost: $ ��%o Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: v APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ , c�S— Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ �. `�% 0 $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $ CC $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ Ing, 3�� V 6 CITY OF FRMLEY PERMIT NO.: 2004-02054 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 11/16/2004 763 572-3604 FAX: 763 571-1287 ADDRESS : 4725 2 ST NE PIN : 263024320087 LEGAL DESC : UNAVAILABLE LOT BLOCK PERMIT TYPE HEATING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. VALUE OF APPL OR WORK 0 # FURNACES I # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 300 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 35.00 RIVER CITY SHEET METAL 9928 BLUEBIRD ST NW GAS RANGE FEE 0.00 COON RAPIDS, MN 55433- GAS DRYER FEE 0.00 (763) 754-2199 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL PAID WITH CHECK # 13953 35.50 OWNER BONCHER TIMOTHY J 4725 2ND ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of 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 anyo r state or local law regulating construct' or the erform of construction. Applicant Date Bldg Insp DateI6 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULI; Res dentia) Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer Effective 4/1,/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES fe-0 Tial $35.00 $; -00 $10.00 $ $10.00 $ *Air Condltloning -All Sizes $25.00 All Other Repairs or Alterations (List on Back) J.% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $500.00 t,,ommercia Industria/Institutional 1.25% ol"Velue of Appliance or Work (List on Back) $ Minimum --Fee $35.00 for Commercial/Industrial/institutional State Surcharge TOTAL FEE $ate $ifs REINSPECTION FEE $50.00/HOUR *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 / V JOB ADDRESS �7XS` I-Alnet S� J1J — Owner Y1-2 S 6�'7 0e9Ye�. Building Used AsTDW t.L-L_ I 0 r_ ESTIMATED COST. PERMIT NO r J r r '�: :►� yt 0 of Heating Uni ` Circle One (Steam) (Hot Water) Warr» Air Trade Name/ft�d/� 9a-ol Size No. BTU J HP EDR Fuel Total Connected Load Burner Trade Name 8TU 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. River City Sheet Metal, Inc. HEATING 00 Signed Fridley, MN 5 , 4J32 . (763) 754-2199 Fax (763) 754-2908 FAX # Date Approved by Rough -in Date Final Date MECHAIv 11:AL rer1111L GNU.. Building Inspections RESIDENTIAL APPLICATION Received B 200 763-572-3604 CITY OF FMDLEY 763-502-4977 FAX EFFECI71vE 1-1-08 � % \ r C-4:ZV YOUR E-MAIL ADPRESS SITE ADDRESS \ i r Y\ r THIS APPLICANT IS: ❑ OWNER PROPERTY NAME:-- OWNER/ AME:=OWNER/ ADDRES TENANT CONTRACTOR COMPANY NAME: NOTE: CONTACT PERSON: SEPARATE CITY EXP DATE _ STAr(y� �ZI LICENSES ARE STATE LICENSE # REQUIRED FOR GAS. ADDRESS: \ ` �� AND HVAC.FAX SUBMIT COPY OF BOND PHONE AND INSURANCE �iGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE PERMIT TYPE NEW %p ACEMENT 0 ALTERATION/REMODEL TYPE OF WORK: � {#. DE AILED DESCRIPTION OF WORK is for PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up so ��s00, whichever uldreflect only a er, t thlabor improvement, OR installation or rep ) lacement of a residential fixture, the fixtur. x.OS Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor _— KATE TOTAL FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED.TU OF EACH BELOW) MODEL: SIZE/BTU Equipment Installed MFC: MODEL: MPG: — MODEL: SIZEBTU MFG: GAS RANGEIOVEN $10.00 /�C $� FIREPLACE (GAS) $15.00 —GAS GAS GRILL $10.00 �L. ::=ACE (WOOD) $35.00 _GAS UNIT HTR $10.00 _AIR TO AIR EXCHANGEER Ms =ACE $35.00 POOL HEATER $35.00 _BOILER $35'00 _GAS DRYER $10.00 —VENTILATOR $15.00 _CHIMNEY LINER $10.00 _GAS PIPING $10.00 DUCT WORK. $10.00 PERMIT FEE FOR PROJECTS OVER $500 PERMIT FEE PROJECTS FOR UNDER $500 Number of fixtures @ $10.00 x$_— Permit Fee $ - Number of fixtures @ $15.00 x $15.00 = Surcharge$— 50 OR Number of fixtures @ $25.00 x $25.00 = _— TOTAL DUE $� Number of fixtures @ $35.00 x $35.00 = State Surcharge MINIMUM $15.50 Total MINIMUM $15.50 THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED the application for a permit and work is not to I hereby apply for a mechanical permit and e acknowledge nesotConstruction Codes; that �Ivunderstand this �s not a permit abut onlyapproval apPk will � m conformance with the ordinances r v =th ll work which uires review approval of plans.�.��and codes of the City of Fridley and wi1start without a permit that the work wil t accordance withA T NAME-ffMA. V&U . SIGNATURE OF APPLICAN DATE -- APPROVED BY 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