PRE 2010 DOCS.-40
Date:
Address 0
•
Village of Fridley, Minn.
BUILDING PERMIT
N° 1739
Builder..............................................
Address.............................................
LOCATION OF BUILDING
No...... Street .... �i�.................... Pa Lot ...
Lot ..... �..... Block ... Addition or Sub-Dfvisio1 •� • l �p
Corner Lot �� Inside Lot ... �.. Setback . a�.. Sideyard .. /���................. .
DESCRIPTION OF BUILDING
obe used as: e,
. . .... .... Front , t� ... Depth .. a:1 r Height Sq. Ft. ........ Cu. Ft. ........
............. ....... F nt ........ Depth *4-
-7Height .
�.... .. Sq. Ft. ........ Cu. Ft. ........
Type of Construction Est. Cost . QCC..�. ` °•"•� 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 village of Fridley. ?r%
consideration of the payment of a fee of $1 a�eC .. , permit is hereby granted to ...
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked any time upon violation of any of the provisions of said
ordinances.
...........g,� .. Building Inspector
%�
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
') -
SUBJECT
rms
P O.
City of Fridley
,i. 30
AT THE TOP OF THE TWINS
PERMIT
r
BUILDING
RECEIPT NO.
Z
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
!7/
r 1 � SEC.
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
`
1 "1 CITY HALL FRIDLEY 55432
L----j%" ' "'3 612-560-3450
910-F15
I
I 8/2/78
JOB ADDRESS 4514 - 3rd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
1
Rearrang. of Blocks 13,14,15, Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Richard Golen 4514 - 3t-d Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Skyline Fence Company Route #1, Box 137, Rockford, MN
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
8 DESCRIBE WORK
Reroof structure
9 CHANGEOFUSEFROM TO
STIPULATIONS
Roof can be. second but not third roof. Install ridged galvanized
valleys.
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
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,
$500
$.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 PERFOR NCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$8.00
SIGNATURE OF CONTFKCTORORAUT RIZEDAGENT IDATEIWHEN
P PERLLY THIS IS YOUR PERMIT
,VALIDtTED
`b•- (Cly
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATE)
') -
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIms, ADDITIONS, OR REPAIRS)
OWNER; Ec' k rd . �� /a,, MILDER:
Address: q,C1 �l. 3af Address:
Tel. No.:
LOT:
Street:
BLOCK: ADDITION:
CORNER LOT: I14SIDE LOT: SETBACK: SIDEYARDS:
Applicant attach 'to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Fxont: Depth; Height:
Square Feet: Cubic Feet:
_'Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: p1 C' Estimated Cost: $ JV? •r
To Be Completed: �e�y 4 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 fior additional information.
DATE: %� SIGNATURE: vC�6
Stipulations:
SUBJECT
..PER-M4T NO.
of Fridley41
5
AT THE TOP OF THE TWINS
BUILDING PERMIT
Ir?City
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV
PROTECTIVE INSPECTION SEC.
r i �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATEPAGE
OF
APPROVED BY
' 612-571-3450
910-F15
5/2/96
JOB ADDRESS 4514 3 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
6
]
Rearrangement of Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Richard/Cindy Golen 4514 3 Street NE
572-1560
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Gregory Construction Inc 1703 39 Ave NE, Columbia Heights
55421 788-4359 5171
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
O MOVE ❑ REMOVE
x x
8 DESCRIBE WORK door
Construct an 18' x 10' Deck and install a patio IN M
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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
1STALLS
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
$2,742
$1'31
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-
$74.75
Fire SC $2.74
T UCTION R T PER ORMA CE ONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
4.License
SC $5.00
$83.80
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
PROPERL ALID TED THIS IS YOUR PERMIT
THEN
1 INSIS
nA E
-
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEIBl
NEW [ l
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: -1/ 5 / y 3-6 sd, a e:
Legal Description:
Effective 3/1/96
Owner Name & Address: -P C t A!LA G6I ec\ Tel. # T761-- /scP-o
Contractor: C� t o �r C� s a c ��1-� ®� a- c . MN LICENSE # s / 7
Address: I-703 35°l- A,) QC Tel.# '7;78- 9355
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: Len�th I ' Width l b ` Hgt/Ground _yLL Sq. Ft. 170 X �
OTHER: _��/ SF ,4 L t- ��X to c3 " ���D Qo ,L-
vl /0260• d'v
Corner Lot [ ] Inside Lot [k] Ft. Yd Setback Side Yard Setbacks
Type of Construction: A h.e -T a L-IQ d- Estimated Cost: $
Approx. Completion Date: :i� / S l9 c,
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + Ft = Ft x $ _ $
DATE: 3 APPLICANT: C Tel. # 7
Permit Fee �4, 79- $
Fire Surcharge .2 7,� $ t*
State Surcharge Mi
/ $
SAC Charge $
License Surcharge $ ,
Driveway Escrow $
Erosion Control $
Park Fee $
Sewer Main Charge $
TOTAL
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$900 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: -.
\Z � LhG�✓'d- ,p 1, � v�n-� `� �' . � . .
r g..Ll
i
r
i
,t
K-
ov\
�� P "
• R. C -V C ,: A— ,fie Gvk.cllt:� (-"'t, E �.
Ai 519 3 Sd- n�--
m
10C--,c9e0 C r �vv
24K
a cJoz /12
jJ0
arc r o
SQ`Sue C
��r�c
sueJEGr
PE NO.
City of FraleyC
30083
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
-REC-E—IPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC,
PROTECTIVE
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE Of
APPROVED BY
612-571-3450
910-F/5
81999
JOB ADDRESS
4514 3rd Street NF__
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
OESCR.
6
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
S
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
I�
1
4 ARCHTTECTOR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION ia REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house 15 S Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Permit Inspection Cards
Will Be ,Nailed
To Homeowner To Post
SEPARATE PERMITS ARE REOUIREO 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
1311
6
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
$50.95
PLAN CHECK FEE
TOTA FEE
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI
NO LIOAT HIS IS YOUR P IT
SIGNATURE OF OWNER,IF OWNER BUILDER, (DATE,
81,091'/NSP r)AT E
NEW
ADDN [ ]
ALTER [ ]
ConstriuctionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:
CITY OF FRIDLEY
SINGLE FAMILY: AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
mossy �p3�h�
h�
Tel. #
MN LICENSE
Tel. # .�<���-2��
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
GARAGE AREA: Length Width Height
DECK AREA: Length Width HgVGr,
OTHER:
d
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: /"Estimated Cost: $ ' 1311
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: OC,e� Tel. #
TOTAL $
.::,,f2
STIPULATIONS:
4.
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
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
.::,,f2
STIPULATIONS:
4.
L
SUM.&
PERMI
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
3 0 6 2 8
r
`
O
rrV COMMUNITY DEVELOPMENT DIV.
^J
PROTECTIVE INSPECTION SEC.
�{ /
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
1/14/00
JOB ADDRESS 4514 3 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1
Rearrangement of Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Rick Golen 4514 3 Street NE
572-1560
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Norling Exteriors Inc 341 79 Way NE, Fridley, MN 55432
784-8936 20098700
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
O NEW O ADDITION O ALTERATION REPAIR
O MOVE O REMOVE
8 DESCRIBE WORK
Replace 7 windows within existing openings
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 uniform Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL. PLUMBING. HEATING.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
1 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
$1.20
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,400
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-
ON-
$83.25
Fire SC $2.40
STRUCTI0 OR THE PERFORMANCE OF CONSTRUCTION
STRUCT
PLAN CHECK FEE
TOTAL FEE
X_
Licens SC $5.00
91.85
NATURE OF CONTRACTOR OR AUTHORIZED A NT 4DAtE,
PROP R VALIDATE THIS IS/YOUR PERMIT
kTHE
G oNSp
rTAlt
S-GNATURE OF OWNER of OWNER SU'LOERt tOATE-
L
NEW [ ] Effective 1/1/9S
ADDN [ ] CITY OF FRIDLEY N
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION w� �
ConstructionAddress: ��O'�jo ° �� 5 7 A, f' .
Legal Description:
Owner Name & Address:�,'� �C r e f--) �S�•'r e s 4 6�v� Tel.
Contractor: 1,10 /"/, .-, s' � C- MN LICENSE # ® 9 F %V c�
s
Address: G✓loyy lltle� ltl--- ^Tel. # 6,,d -7.VS'�d'%'
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:
Construction Type: f 9i v��� �� �� e'i tJ, Estimated Cost: $ 9 Y®a _
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $.
DATE: /' Ay' ®19
APPLICANT:
r Tel. # 6, Ad - i�i8-a -? 9 .9/'
CITY USE ONLY
Permit Fee
$ �
Fee Schedule on Reverse Side
Fire Surcharge
$ 17"16
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$ ✓
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ 4?1'
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
17o of Value of Appliance or Work
Commercial/ Industrial
1.25% of Value of Appliance or Work
Effective On January 1, 2000
JOB ADDRESS
OWNER
Rate TOTAL
BUILDING USED AS 5;��
$ 30.00 $
ESTIMATED COST �1139S 07�) PERMIT N0.
$ 10.00 $
DESCRIPTION AF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units_ Circle One (Steam) (Hot Water) (Warm Ai
$ 10.00 $inOD ' Trade Name !_ / Size No.
BTU D HP EDR
$ 25.00 $ Fuel Total Connected Load
State Surcharge
TOTAL FEC
MINIMUM FEE FOR ANY HEATING/COOL.ING/VENTIL.ATION
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.
Burner Trade Name Size No.
$ BTU HP 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
yo representations stated in this application are true and correct.
DATE
HEATIN CO e �c� �`S 6 /Q °,
Signed TEL # o
�V
Approved By Rough -In Date Final Date J/ -
FILL
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
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 ONo ( )
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 r ,KNo ( }
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes Vf 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 (--Y'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 (-4/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 (�o ( )
Appliance Type and Size/Common rent and Vent Connector information
Appliance #1 Type Vi I hn BTU Input Fan Assisted or Nat
Appliance #2 Type BTU inpufi 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) S & - �� Vie-- – Ce "7 7 /
HEATING
Signed By:
IN
SUBJECT
City of Fridley3
1 7 4 0
AT THE TOP OF THE TWINS
?
BUILDING
PERMIT
r
:
RECEIPT NO.
` ------COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
���_360
r PROTECTIVE
I 1 CITY HALL FRIOLEY 55132
ti"--11-� �''
NUMBER__j
REV
DATE
PAGE OF
APPROVEO BY
612-571-3450
910-F15
4/16/01
JOB ADDRESS 4514 3 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
1
Rearrangement of Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Cindy/Rick Golen 4514 3 Street NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Panelcraft of MN Inc 3118 Snelling Ave
S, Mpls., MN 55406 612-721-6628
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
2179
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION CI REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Replace windows within existing openings;
install trim
9 CHANGE OF USE FROM
TO
STIPULATIONS
Provide smoke detectors in all sleeping
rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997
Uniform Building Code. Caulk
and flash all exterior openings.
Permit Inspection Cards
Will Be Mailed
To Homeowner To Post
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
1 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
$5,174
$2.59
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 COW
$12.5.25
Fire SC $5.17
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
T AL FEE
Licens'jw S $5
$138.01
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATE.
EN I Y VA ED THIS IS P ]
iR rl
`BLD .NSP OAtE /
S,GNATURE OF OWNER.IF OWNER BUILDER. (DATE.
NEW [ ] - Effective 1/1/2000
ADDN [ J CITY OF FRIDLEY 612-572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2
BUILDING PERMIT APPLICATION
1.r Construction' Address:
Legal Description:
Contractor:
3rd .ruf
liY"40Tel. #
MN LICENSE # .217 9
s�LTel.#_(p/;.-7A/–%(ooZ 8
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:
Construction Type: /] ehdat;S S�YIm stimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #'6 7Z/-10 2�S
CITY USE ONLY - Call (612) 572-3604 for Permit Fees if mailing in application
Permit Fee $ /PSa r Fee Schedule on Reverse Side
Fire Surcharge $ �S-W .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $_$1 100 per SAC Unit
License Surcharge $ SSD $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:/r �� c�► j2Qi� �ce_—�
C'
CITY OF FRIDLEY INSPECTION DIV.
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
Effective On Jan 1, 2001
PLUMBING FIXTURE RATES: NO.
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**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
RATE TOTAL JOB ADDRESS S 1 L( 3 r IL
$ 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
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
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.
Owner l e'n
Building Used As 140.^ .0
Estimated Cost PERMIT NO. 3/0
PLUMBING COMPANY
SIGNED BY `/ � TEL N01 1 -1�
0.00 /
Approved ByX�6
Rough -In Date Final Date
$ .50
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing 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 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 :
Building
PLUMBING
Permit No. '
Inspections
RESIDENTIAL APPLICATION
Received By:
q-
763-572-36041-0
CITY OF FRIDLEY
Date Recd: '�'
I 19 - f) (�
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS 4 5 19 r Sf Iv E' E f i C[ (e- 4
THIS APPLICANT IS: PWOWNER ❑CONTRACTOR
PROPERTY
NAME: C% n C(H G o I En
OWNER/
ADDRESS: y S 3rd sr. N t,
� CITY Fr i � (ems STATE M QIP Cs Ya,[
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: CITY STATE—ZIP-
TATEZIPLICENSE
LICENSEWITH
PHONE FAX
APPLICATION
PERMIT TYPE
❑ SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW ❑ REPLACEMENT
��rr
DETAILED DESCRIPTION OF WORK Wt i� OJP
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor -x.05=
FOR PROJECTS WHERE LABM EXC-BEDR{$5.W, ARE BASED ON $10.00 PER FDCrURE, EXCEPT WHERE NOTED. FIXTURES: (IlNDICATETOTAE-4
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS SHOWER _ WATER PIPING
_ _FLOOR _
—BATHTUB _ GAS PIPING pvEED cirrrrcENz) SWIMMING POOL _ WATER SOFTNER ($35)
_
_ CLOTHES WASHER _ KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREY. ($15)
_ DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER �COTHER
y
c�
Permit Fee $ IS, .00
Number of fixtures @ $10.00 x$10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
_
State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the 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 work which requires review and approval of plans.
SIGNATURE OF APPLICANT � LZ (pxp,Ie� PRINT NAME �� .� << y G 0 ICK
� K DATE -7-0-06
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977