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PRE 2010 DOCSVillage of Fridley, Minn. BUILDING PERMIT Date: 'Z .. �,.(.� -... Owner Address ......�.' 1740 Builder.............................................. Address............................................. OCA ON OF BUILDING No . ............. Street ....... ................... Part of Lot ..... Lot .... �.... Block ...... /......... Addition or Sub-Divisio��.. Corner Lot ........... Inside Lot ... Y ..... Setback ..� /. Sideyard ... /0.1. o� / .............. DESCRIPTION OF BUILDING be Used as: « ,a Front /16 . Depth .. Height ........ Sq. Ft. Cu. Ft. ........ Fro t ........ Depth ....y.jj. Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction f . !-!P✓2_ .. Est. Cost. [,l �� .1-�.... To be Completed .................. i In consideration of the issuance to me of a permit to construct the building described above, I agree to do troposed work in accordance with the description above set forth and in compliance with all provisions of dinances of the village of Fridley. consideration of the payment of a fee of $AQr. 0. permit is hereby granted to . . ........ to construct the building or addition as described above. This permit is giVanted 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 at any time upon violation of any of the provisions of said ordinances. ,--% . Building Inspector R NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. City of Fridley, Minae BUILDING PERMIT Date: _ _.. '4""_.. c 16. 4e R Owner: _. ... — Builder AddressAddress�p......._.... lvo..._ s I tOF BUILDING jW l meet _� ✓# ..A_ -f7.._.......__..__._.._ Part Lot ...... __ Block ...... .... .ay.+"......................... Addition or Sub -Di _ Corner Lot .........................._........ Inside Lot ....._......................_........ aback ...: .....Sidey d -- ._ .. ... /....._.......- -- .............. i`.rT ..._...... SewerElevation ............. ................. -._............._............._......._...---•-••----...........::.'Fo ation Elevation.............................................................. ......... ......... DESCRIPTION OF BUILDING To u _...:......._.... .._.....R... Front g ...._.. Depth -.i .._.. Height ..14......... Sq. Ft. ..$490 Cu. Ft. J..� .................... _.............. ....................... Front ...................... Depth ................... Height ...................- Sq. Ft. ...................... Cu. Ft. ..... _................. ar D Type of Construction ....I.-eI11E,�!..... Est. Co .......�.Q.._'"''�"To be Completed .......................... -- -• "cUTHCJ R2E Vs�;L � {z)RIVATE LAND COVENANTS ANZ f2UILDING REST::;TIONS. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of$.I' ...................... 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. At 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 within the city limits and this permit may be revoked at any time upon viol ati f any of the provisions of said ordinances. 7. Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. "._.-0 QN0.4 0 - - Owners N Address APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, M:MMOTA LOCATION OF No.,Street. �,,j a t of Lot Lot 6 — Block ZS' Addition or Sub.Div. Corner Lot Inside Lot " ut Back Side -Yard _ SEWER ELEVATION /4OUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUIIDING To be used as: FrontDepth Height Sq. Ft. Cu. Ft.�,. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and correct. � ^ (A Schedule of Fee costs can be found on the Rever.Ve Side.) I - i i 7 I f � I I I I I I 1 � t 1 1 I I ' � I I II I I ---- -- -, - ,- - - -r-- - --- - -� I I I �I -- J- --- -- - -1 -- - C I I 1 I I 1 I I � I - - -- I - - -- i I - - I -- � �`-- I r i I I -I- I 1 1 i I I I i I I1 tL�_ I I _ - --- � - y-- 1 I i }II� I LJ - -- -- I CITY OF FRIDLEY INSPECTION DIV. Effective On January 1. 1997 6431 University Ave NE Fridley. MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 iueRic Nr iMRFR nc ciy-n iRFS Tn RE INSTALLED ON EACH FLOOR Water Stories Closet Bath Urinal Tub Shower Sink Wash Tray Drink. Floor Catch Auto. Fount. Drain Basin Washer lAppl- Gas Gas Misc.. Water Heater Range FixL.. Gas Elec Basement The undersigned hereby makes application for a permit for the work herein Old Opening. New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 Floor 1 Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Floor 2 $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank Floor 3 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 Floor 4 Water Heater ' * $10.00 Building Used As Gas Range" $10.00 �� 2,./ ,vZ PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS ell New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening. New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division. and hereby declares that all the fads Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 Water Heater ' * $10.00 Building Used As Gas Range" $10.00 Gas Dryer** $10.00 Estimated CostPERMIT NO. J Back Flow Preventer Required ( )Yes () No L,��•�y.e1� $15.00 PLUMBING COMPANY �� O� Type Reinspection Fee $42.00/Hr TEL N0. SIGNEDeft!ugh-ln ALL OTHERS AND/OR REPAIRS AND ALTERATIONS tl a 1.5% of Value of Fixture or Appliance Final Date Approved By Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TnTal FF $ PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 to -/2-36U4 F'AX: (763) 571-1257 ADDRESS : 4526 3RD ST NE PIN : 263024330090 LEGAL DESC : REAR BL 13,14 & 15 PLYMOUTH : LOT 5 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT N�6.: 2004-00847 DATE ISSUED: 06/08/2004 r VALUATION : $ 11,780.00 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 REPLACE FURNACE (WARM AIR, ICP, 75,000 BTUS) AND AN AIR CONDITIONER. # A/C UNITS 1 # FURNACES # GAS DRYERS APPLICANT HOME ENERGY CENTER 15200 25 AVE N #128 PLYMOUTH, MN 55447 (763)476-1990 OWNER MAI XICH V & NGUYEN BE TU T 4526 3RD ST NE FRIDLEY, MN 55421 0 # GAS RANGES 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 wort 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 HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 54550 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 1 0 0.00 35.00 0.00 0.00 25.00 0.50 60.50 CITYO.F FRIDLEY BUILDING INSPECTIO 6431 University Ave NE ` Fridley, MN 55432 763-572-3604 FAX 763-571-1287 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 All 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 opq Effective 4/1/2004 ICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION IGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Total )0 $ $10.00 $ $10.00 $ JOB ADDRESS 4SZlo 'Ayl� n `c Owner Do-vidA A �• r V'41kk --e Building Used As % ESTIMATED COST 11,-1 (30 • 00 PERMIT NO DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units_ I Circle One (Steam) (Hot Water) "" Trade Name k a CI W PV -167 Size No. $25.00 $ 26700 BTU=ISThbO HP EDR Fuel ka4 GA, Total Connected Load $ Burner Trade Name Size No. BTU HP EDR Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/IndustriaVInstitu nal State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR 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 representationsssttated inn tth(��p_ LI'clition are true and correct. $ 6a HEATING CO 15200 25TH AVE. NEN#128 PtYMOUM, MN 55447 $ fO0.6o Sign Tel #e(o') •x}7(0.1RgU FAX #—1b3,4"llc • 1143 Date S• \?)• oLl *Air Conditioners can not be placed in side yard withoutaritten approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION 0 REPLACEMENT FURNACE 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. rurrpnt nnriac Yes qj) wo When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes X 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 W..4cm BTU Input,?4LC00 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 1 Common Vent Type �V Vent HeightDiameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type AL, 1p"'11 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: e Signed By: Date: 0 , CITY OF FRIDLEY PERMIT NO.: 2004-00809 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 06/02/2004 572-3604 t'AX: (763) 571-1287 ADDRESS : 4526 3RD ST NE PIN : 263024330090 LEGAL DESC : REAR BL 13,14 & 15 PLYMOUTH : LOT 5 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. REPLACE FURNACE AND AIR CONDITIONER. # INSPECTIONS 1 APPLICANT HARRISON ELECTRIC INC 3440 KILMER LANE N PLYMOUTH, MN 55441- .@A%11 ._ MAI XICH V & NGUYEN BE TU T 4526 3RD 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 worl 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, ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 027592 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building $ BUILDING Plan Review Permit No.: Inspections Surcharge RESIDENTIAL APPLICATION (.0005) times the total job valuation — Minimum $.50 Received By: 763-572-3604 .001 x Permit Valuation (1/10%) CITY OF FRIDLEY $ Date Rec'd: DATE q I 1j,1�S YOUR E-MAIL ADDRESS $1450 per SAC Unit (Plans to MWCC for determination) SrrE ADDREss 'N.16 S"—" SF N ft + 6 ft = ft x $20 = $ THIS APPLICANT IS: ❑ OWNER CONTRACTOR $450 Conservation Plan Review PROPERTY OWNER/ NAME: 0919 I(LI Fee Determined by Engineering ADDRESS- ffab l JI P F CITY STATE ZIP TENANT Total Due PHONE: �6.. L T . �l 1 Make checks payable to: City of Fridley Attach Stipulations CONTRACTOR NAM[E: K534 eQ �P o6p STATE LICENSE # EXP DATE 1115112"6 `� `% / t3�� STATE' d$IP SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: 41 — CITY WITH APPLICATION [�O PHONE �-I°0"':?FAX IVU :Z L7' "5 PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF❑ DRAIN TILE [3 DECK 13 SIDING OTHER ❑ SWDANGNG POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 31MCD SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2• Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑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 FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 4o 6 OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 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 c of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application fora 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 whic view and_ approval of plans. SIGNATURE OF APPLICANT PRINT NAME DATE I 0/71�ri-�r 7/-/3(57 City of Fridley PzMiL- -4t� 21006—U) / t� 6431 University Ave NE Fridley MN 55432 (763) 572-3602 or Fax (763) 502-4977 _ CE Water and Sewer Permit Application New Connection tility Line Repair/Rel )cation Existing Water and Sewer Connection Date: Job Address 6 3-?�5rf r Name of Applicant (Plumber): Zfrr Name of Property Owner: A /I Existing Structure Permit # Permit Type: Sewer Fee: Water Fee: Meter Fee: Repair Fee: Relocation: State Surcharge: SAC Charge: Special Assessment Fee: 7 Applicant Signature Inspector approval; Water Meter Repair — Weekend & Holidays $125/hour Water Connections Permit $50 Sewer Connections Permit - $50- 50Ins ection Fee for Water/Sewer Line Repair Inspection $40 Special Assessments See Engineering Cost of Water Meter See Utility Billing SAC Charge $1550 State Surcharge $ .50 Water Tap See Engineering 04/04/05