PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERM"
N° 79' 1 Office of INSPECTOR OF BU 1A)INGS
owne
Architect
Builder
Fridley, Minn.,AeL
n LO A�]�jTTONOF BUILDING
No. / Street Part of Lot
ti^r
Lot y`� -4- .+� f dock �� Addition or Sub -Division
DESCRIPTION OF BUILDING
Front *" Depth s"r' a, Height Stories L—Manner of Construction
R
To be used as To be completed Estimated Cost
Permit is hereby granted to k i•`,_,c-..�.:e,-,,
the building`^ described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, 'I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit- are
true as therein stated.
Subscribed and sworn to before me at Fridley,
day of - A.D. 19-2.2
is
Minnesota, _ this
LJ
SUBJECT
PEAMIT NOS
City of Fridley
AT THE TOP OF THE TWINS
?
BUILDING
PERMIT
3 2 7 71
r
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r � PROTECTIVE
1 � �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i A CITY HALL FRIDLEY 55432
;"';•�
--_.
L J�
612-571-3450
910415
7/11/02
JOB ADDRESS 4703 3rd St NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DEscR.
16-17
8
Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Michael Riley, 4703 3rd St, Fridley, MN X= 55421
763-572-8855
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Michael Riley, Same as above
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
g❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE - ❑ REMOVE
8 DESCRIBE WORK
Re-roof (tear-off) house - 14 squares
8 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
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 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
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
$1,501.00
$.75
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-
Fire SC $1.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
.$57.05
PLAN CHECK FEE
TOTAL FEE
$59.30
SiGN4JURE OF CONTRACTOR OR AUTHORIZED AGENT iDATE
\WJAN PROPERLY VALIDATED THIS IS�YO%UR ERMIT
NATURE OF OW NER iF BTJW ERi i0 iEi
L0 iNSP
r�ATE
NEW [ J CITY OF FRIDLEY Effective 1/1/2002
ADDN (] 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Addre
Legal Description:
Owner Name & Address:
Contractor.
Tel. # LA 3 9,�9'
SAW ---MN LICENSE#
Address: `" Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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 Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ 56 f.
Lj
DATE: -7 Ll 9- APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763- 71-1287 if using credit card and we will
call you for card number.
TOTAL $ -INL% STIPULATIONS:
% � v
CITY USE ONLY -
Permit Fee
$7. Ca
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1200 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*Engineenng
Sewer Main Charge .
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ -INL% STIPULATIONS:
% � v
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK N1 IMRFR C)F PIXTHRFS TO HF INSTALLED ON EACH FLOOR
Effective On Jan 1, 2003
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**
Gas Range"
NO
Gas Dryer**'
Back Flow Preventer Required ( )Yes () No
I_
RATE
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $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
TOTAL JOB ADD
11
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
Building Used
Estimated Cost
PERMIT NO.�8
20 Q
PLUMBING COMPANY
SIGNED BY e TEL N0.
Approved By Rough -In Date Final Date
$ .50
MINIMUM FE FOR ANY PLUMBING/
PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON
ON CK SI E
:::a :::
€1':::
Wash ::::::: Floor%:
:::::::.
Auto...:::..:.....
:::::>::::> Gas
:> Water Heater
i::
Urinal
Shower
Tray Drain
.....Wa
she
Ran a:..:::.....�.
..... Gas EI
ecStories
ment
Basement
Floor 1
Floor
Floor 3
I
F oor 4
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**
Gas Range"
NO
Gas Dryer**'
Back Flow Preventer Required ( )Yes () No
I_
RATE
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $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
TOTAL JOB ADD
11
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
Building Used
Estimated Cost
PERMIT NO.�8
20 Q
PLUMBING COMPANY
SIGNED BY e TEL N0.
Approved By Rough -In Date Final Date
$ .50
MINIMUM FE FOR ANY PLUMBING/
PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON
ON CK SI E
;'THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When ra acini n PAsting 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 plastictPVC 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 exi_c�ting nnmhnsfinn air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to install a now nnmhuntinn airs it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When Install"nn a new venting Sygqgrn, 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
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
HEATING CO:
Signed By: Date:
MINIMUM FEE FOR ANY HEATING/COOLINGIVENTILATION
REERIGERATION/AIR CONDITIONING PERMIT IS 125_00
PLUS THE S,50 STATE $URCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
HEATING CO - Sharp Htg & AC ^_
Signed TEL #
FAX # 763-572-464
Approved By D;:� Rough -In Date
763-572-0459_
Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
L11ectiva Jaltuary 1, ;UU.3
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND
HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571.1287
JOB ADDRESS7(���'s:�_�
RATE SCHEDULE
OWNERi )"o-�_.
Residential Rate
TOTAL
p "
Furnace Shell and Duct Work, Burner -
BUILDING USED ASa,�---
Also Replacement Furnace $ 30.00
(Side Vent - Fill Out Back)
ESTIMATED COST gQ PERMIT NO.
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units Circle One (Steam (Hot Water) arm Air
Gas Dryer $ 10.00
$
Trade Name �0Qdon ay No. G - -?17 D&o-_Y
BTU 66 000 HP EDR
*Air Conditioning - All Sizes $ 25.00
$
Fuel_ GCLS 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
$
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
State Surcharge
$ .$0
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE
$3o.50
DATE //- (0-0?
MINIMUM FEE FOR ANY HEATING/COOLINGIVENTILATION
REERIGERATION/AIR CONDITIONING PERMIT IS 125_00
PLUS THE S,50 STATE $URCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
HEATING CO - Sharp Htg & AC ^_
Signed TEL #
FAX # 763-572-464
Approved By D;:� Rough -In Date
763-572-0459_
Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON IMWT., <EW1 C ONNCIOR AND r`US110111 AIRS 11 81EI
When reIArina aaA srietin fR�^anre, the undersigned hereby verifies that the
A TION
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and frestopped where required.
Yes () No ( )
The venting system is plastictPVC 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 (,l No ( }
The exi�li cQMhtjfitjQp air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes () No ( }
When required to install _ambiistinn air it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes () No ( }
When installinga nps�n,�� , tam, 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.
An01i� ani Si'�!C_emrr�nn Vint
Yes( ) No ( }
�n�4 C`nnnprt�rsr nfnr�atinn
#1 Type BTU Input Fan Assisted or Nat
#2 Type BTU input Fan Assisted or
Nat
#3 Type BTU Input Fan Assisted or
Nat
Appliances Total Btu Input
F
Vent Type Vent Height Diameter
inches
#1 Vent Connector Height ft Length ft Diameter in
Type
#2 Vent Connector Height ft Length ft Diameter in
Type
#3 Vent Connector Height ft Length ft Diameter in
Type
00
HEATING CO: Sharip Hta & Ac
Signed By: Date 03