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City of Fridley, Minn.
BUILDING PERMIT N® 3900
Date: ... -.... /. .. ..............
Owner � ..... .. ...........`�.`:`�"� Builder .........
.. ...................... ...
Address .....� Ll ......................... Address .............................................
oa�� �. _ J� ���ING
No..l... Street ...�/.. .......... ............. Part of Lot ...............................
Lot ............ Block .................. Addition or Sub -Division .....................................'..
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
A% o . . �.. .. .. Front /V DeptbAR- C5 Height 1.. � Sq. F`t WW 2 cu. Ft.
......... Front ........ Depth ........ Height ........ Sq. Ft ........ Cu. Ft. ........
Type of Construction ................... Est. Cost. To " To be Completed ................
In consideration of the issuance to me of a permit to construct the building desribed 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.
.�%010V
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 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
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.
r
SUBJECT
R NO.
City of Fridley
1369
AT THE TOP OF THE TWINS
BUILDING PERMIT
t�ERMIT
EIPT NO.
iCOMMUNITY DEVELOPMENT DIV.
INSPECTION
PROTECTIVE SEC./
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
JOB ADDRESS 4720 - 3rd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
11,12
7
Plymouth Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Kendal Knutson 4720 - 3rd 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
RN Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION 61A ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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.
$350.00
$.5O
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
$8.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)WHEN
P OPERLY VALIDATED THIS IS YOUR PERMIT
1� ��, a ,, �n� S- i -7 �,
�rU t� (9-q-&
BLDG iNSP GATE
SIGNATURE4DF OWNER (IF WVNER BUILDER) IDATE)
r
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER'S NAME : h E N D,,9 L J, k N 0"s o rel BUILDER: X EA/D 6 2 J, K N VT -5 0 Al
ADDRESS: 4'2 3R®, -5 F, N, E7 ADDRESS: 4-72 d
NO:. % Z 0 STREET: 3 R V, -s-11-
LOT:
LOT: 9 I U,12 --BLOCK: `7 ADDITION: P Z Y M '° V T tj !) D .) 9 7/ a rV
CORNER LOT: INSIDE LOT:ETBACK: SIDEYARD:
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:
6 E X 0 OF M O US F-- Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: ,� S P H)9 L l Estimated Cost: $ -3 !9 0,D �av
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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: g - y " 7 E SIGNATURE:
(See Reverse Side For Additional Information.)
J
I
SUBJECT
PERMIT .'
City of Fridley
18785
AT THE TOP OF THE TWINS
BUILDING P E R M I T
r
P.
RECEIPT NO.
•COMMUNITY DEVELOPMENT DIV.
..------,
r � � PROTECTIVE INSPECTION SEC.
3 3
L1 = �
�r---,'� CITY HALL FRIDLEY 55432
1
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
----�
612-571-3450
910-F15
1/27/87
JOB ADDRESS 4720 - 3rd Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
11.,12
7
Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Kendal Knutson 4720 - 3rd Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO,
Season's Four Remodeling Services Inc. 374-3863
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
1830 Glenwood Avenue, Mpls., MN 55405
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 10' Addition to Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
APA r RM
IT-I UU I� _�. A r $
r Iron
y �L�
�ILz'
Before digging call ibcal uti!otqRs ,A � sic
TELEPHONE - ELECTRIC - GAS Etc. '
REQUIRED BY LA ji
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 BO 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
]
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
WITH WHETHER SPECIFIED HEREI OR N4.
.THE GRANTING OF A PERMIT
$19,750
$9.87
DOES NOT PR T VE U O Y TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISION OF AN O ER TA CAL LAW REGULATING CON-
$140.50
None
T UCTIO OR T PE O A E NSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
1 4 —
$185.50
siGN OF CONT ACT RORAUTHORIZEDAGENT IDATEI
t$35.13
WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
BLDG INSP Ijq
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW [ ] City of Fridley Effective 4/1/86
ADDN. t1 J IR -1 AND R-2 1 000
TER. [ ] Building Permit Application
AL )Lka
Construction Addri
Legal Description
Owner Name
& Address: � �L -iii
i(JU � o sc� "'�-20 - d" °
Tel. #
Contractor:
S s�,�`S ���
� A� �� � '�ie�S /.ye.
Tel. # 39.1-38 6-3
Address:
/6,3n LwjUJr0aA
Aj,-1 AA)L-,
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 /0 Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot ] rFt. Yd. Setback Side Yard Setback
Type of Construction: ('Ijao Estimated Cost:
Approx. Completion Date: =
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: l �� APPLICANT: tL_ �ttAQ6d-A _ Tel. 317'1-J6 4J
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS • k%� V__
CITY USE ONLY
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$44 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
I�o7�
®0Cj SZ)
i q®.:
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work $12.00 $
Replacement of Furnace 7.00 $
Repairs & Alterations -up to $500.00 7.00 $
Repairs & Alterations each add. $500.00 4.00 $
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU $12.00 $
each add. 50,000 BTU 4.00 $
*Replacement of Furnace 7.00 $
Repairs & Alterations -up to $500.00 7.00 $
Repairs & Alterations each add. $500.00 4.00 $
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU $12.00 $
each addn. 50,000 BTU 4.00 $
Boiler only up to 100,000 BTU 7.00 $
each addn: 50,000 BTU 6.00 $
OIL BURNER- to 3 gal. per hour $10.00 $
each add. 3 gal, per hour 10.00 $
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $
(over 199,999 BTU see Fee Schedule) $
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $
Additional Fixtures Y. $ 1.00 $
Gas Range to 199,000 BTU x $10,00 $
AIR CONDITIONING
FAN HEATING SYSTEMS Sed Fee Schedule $
VENTILATING SYSTEMS $T
ALTERATIONS & REPAIRS $
State Surcharge $ .50
TOTAL FEE $ t ® (;
ROUGH INSP. REINSPECTION FEE
Date ($10.00)
FINAL INSP. A s 2 P • ?
Date
APPROVAL FOR PERMIT�'�
C
MIN11MUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
*Attached stack verification form
Job Address 4-72o'5.f A e
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 the
facts and representations stated in this application are true and correct.
Fridley, Minn.
OWNER %�E130AL J� N'UTS®&3
KIND OF BUILDING L10000 F A /4" L
USED AS R 01) 10 CN CZ
TO BE COMPLETED ABOUT p 1
ESTIMATED COST -575L)
OLD - NEW BUILDING PERMIT NO.
PERMIT NO. 1) CO3 9
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steno, Hot Water, Warm Air- No.
Trade Name
Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company
Signed By i
Tel. No. 4r 4-700
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$
5.00
® O
$
Future Fixtures
$
3.50
e
Old Opening, Nov Fixture
water
�si
$
.ei
$
4.00
$
Blow Off Basin
.ci
a
$
m
e"
5.00
w
5
$
Heater
$
Hydraulic Valve
$
5.00
$
Sump or Receiving Tank
$
5.00
$
Water Treating Appliance
$
7.00
$
not Water Heater
$
5.00
$
Gas Range
$
10.00
$
Gas Dryer
$ 10.00
$
m
u
o
w
cbi�s
c�
ec
lstr
2nd
X
3rd
4th
(R) - Future Connection Opening
Connected with Bauer
(�) = New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$
5.00
® O
$
Future Fixtures
$
3.50
$
Old Opening, Nov Fixture
$
1.50
$
Beer Dispenser
$
4.00
$
Blow Off Basin
$
5.00
$
Catch Basin
$
5.00
$
Rain Water Leader
$
5.00
$
Hydraulic Valve
$
5.00
$
Sump or Receiving Tank
$
5.00
$
Water Treating Appliance
$
7.00
$
not Water Heater
$
5.00
$
Gas Range
$
10.00
$
Gas Dryer
$ 10.00
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
11 of Value of Fixture or Appliance $
State Surcharge $ .50
Reinspection roe $��
(615.00) TOTAL PER
Effective Aug. 1, 1961
I
Job Address 4--7 Z t3 — 3 )'0D , S7. N, ' ► FOR ),D L y oV
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
the facts and representations stated in this application are true and correct
Fridley, Mn. • 19�
OMMR
T
KIND OF BUILDING MMSOW WOOD IfE A M E
USED AS
TO BE CONPLETED ABOUT
ESTIMATED COST
OLD - HIM BUILDING FROM N0. PERN1T NO.
Company
Signed By
Tel. No. S7 Z
ROUGH INSP.
Date
FINAL INSp.
Date
APPRWAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT 18:$10.00
PLUS THE $.50 STATE SURCHARGE
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$
5.00
a
Future Fixtures
p
3.50
u
Old Opening, New Fixture
x
v
$
Water
S
4.00
S
Blow Off Basin
$
5.00
h
C ro
m
5.00
m
ro w
a
na.
$
Hydraulic Valve
Heater
5.00
$
Sump or Receiving Tank
$
5.00
$
Water Treating Appliance
$
7.00
$
�l r
H
5.00
$ 3: Oa
Gas Range
$
10.00
wpp
0 W
r
L
A
Y
t
C C
3
O
O .UC
U
$ .50
N
($15.00)
TOTAL
tO1
S 16'.lra
w 0
<
C
O O
ti ,0
y
N
c
p
vJ
.Ci
U
w
D
0
qNq
o0
W
b
3
Q 4.
H
.1
1..
S m
4 i
t!
L�
�
O
s
lec
let
2nd
3rd
4th
(R) " Future Connection Opening
Connected with Sewer
(•) - New Fixture. Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$
5.00
$
Future Fixtures
$
3.50
$
Old Opening, New Fixture
$
1.50
$
Beer Dispenser
S
4.00
S
Blow Off Basin
$
5.00
$
Catch Basin
$
5.00
$
Rain Water Leader
$
5.00
$
Hydraulic Valve
$
5.00
$
Sump or Receiving Tank
$
5.00
$
Water Treating Appliance
$
7.00
$
Hot Water Heater
_� $
5.00
$ 3: Oa
Gas Range
$
10.00
$
Gas Dryer
�_ $
10.00
$ 00.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1t of Value of Fixture or
Appliance
$
State Surcharge
$ .50
Reinspection Pee $
($15.00)
TOTAL
FEE
S 16'.lra
Ettective Aug. 1, lyHl
.lob Address -f--1 Z0 3 Ra, ,S?; At I -f
Department of Buildings
City of Fridley
Tel. 0571-3450
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
the facts and representations stated in this application are true and correct
Fridley, Mn. �L i 2 3 , 19'i
OWNER _ I<1vD/�L J, kNV%`so IJ
KIND OF BUILDING WO 0 P t
USED AS D W R -L L f
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT 140.
ROUGH INSP.
Date
Company
Signed By
Tel. No.
FINAL INSP. a
Date
APPROVAL FOR PERMIT
HINIHUM FEE FOR ANY PLUMBING PE
PLUS THE S.50 STATE SURCHARGE
IS $10.00
J
CITY OF
o.. ca a,vr nuy. ,• ,•.n�
FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL
RATE
TOTAL
Job Address L��� - J' P� ,j✓ x/
Furnace Shell and Duct Mork,
Burner (Also replace nt furnace) $
20.00
$J(®a
Department of Buildings, 6411 university hwe. N.E., Fridley, M" SS432
Gas Piping $
10.00
$ /®e
City of Fridley
Tel. 6571-34SO
(piping needed with now furnace)
$
10.00
$
The undersigned hereby malted application for a permit for the work herein
Gas Range
specified agreeinq to do all work in strict accordance with the City Codes
Gas Dryer $
10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
• Air Conditioning (all sizes) $
10.00
$
Fridley, Minn. 19
All Others/Repairs and Alterations
OWNER
11 of Value of Appliance or stork
$
/I�
0 �`2 � � e'
RING OF BUI�L'DING /;�/0
J IAg& F4 M, / D4)e- //i rJG
COlM1ERCIAL/INDUSTRIAL
USED AS
11 of Value of Appliance or Mork
$
To BE COMPLETED ABOUT
ESSTIMATED COST
State Surcharge
$ .50
PERMIT ND. PERMIT NO.
Slid 4 -
OLD -NEM BUILDING
TOTAL FEE
Reinspection Fee ($1S.00)
$
DESCRIPTION OF'FUMACE/BURMCR
Rough Insp.
Date
Final Inep. 16-1-97
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCHARGE
Attach stack verification form with replacement furnace permits
*Air Conditioners can not ln• placed in side yard without
written permission frnn adnotninq nengldx.r.
HEATING or POWER
�� PLAN75, Steam, not Mater, Mass Air- No.
/jY, ya
Trade Name `-i� %'ri/�l✓ else No.
Capacity Sq. Ft. CDR BTU ♦up
p
Total Connected load Rind of Fuel N G
BURNER - Trade Name
Size Mo.
Capacity Sq. Ft. EDR BTU HP
Company �i�G�G9a �iJ //GCi�OJ lI/�� �lVd ccL1
Siqned By /
Tc1. No.
CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHII4NEY AND STACK VERIFICATION
THIS FOR14 MUST ACCOt'PA11Y STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION DATE
OWNER ,L�� ,�.yi��.�a ADDRESS
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are lodged within
4. Ttat it is securely supported
S. That it r:eets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
All Other BTU
TOTAL
REMARKS i -e,
": Z ,
r 1
SIGNED
Licensee
by d�Z�- ,,('
Address -53S4�
Telephone -ZZ�
HEATING PERMIT #
Fridley City License #
SUBJECT
_
City of Fridley
2509-8
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.0
COMMUNITY DEVELOPMENT DIV.
fr
a
r PROTECTIVE INSPECTION SEC
�� ((��
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
'', 612-571-3450
910-F15
5/27/97
JOB ADDRESS 4720 3 Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
11,12
7
Plymouth
I
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Kendal Knutson 4720 3 Street NE
572-8864
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 ❑ ALTERATION Ij REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
REM Reroof Souse & Garage (19 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
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
$1,567
$,78
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
FEE
rTAL
$53.60
SIIGGNNJAAATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
ENP
VALID T D THIS IS YOUR PERMIT
L %
SIGNATURE OF OWNER iI WNER BUILDE I IDATEI
. BLDG NSP
nATE
NEW [ ] Effective i / 1 /97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2� / 2U
BUILDING PERMIT APPLICATION d�
ConstructionAddress::'7 Z o - 3 A D, Z r g-� 1r ]L 9,p 2. E'Y
Legal Description:
Owner Name & Address: K ND -R 2 .3, X N u-rs oN +72 a Tel. # 5 7a -- g g
Contractor: -s !E: L p- MN LICENSE #
wd R 95
Address: 3 ,xA s Tg V F= -T Tel. # 7 $ 9 3 S -t- /
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:
= R= - R `0 o �_
HQ L,sF %4 G A
3RA(h E 1 S
Q U A R E S (_A:Lk�1F�
Construction Type: A S �PN A 1.7 I S Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: .5- Z 7 -- '�) 7 APPLICANT: Tel. # 5- 7 Z •--'9 B fo
STIPULATIONS:
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
$
$950 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
$ S3.&6
STIPULATIONS:
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763)571-1287
ADDRESS : 4720 3 ST NE
PIN : 263024320097
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMITO.: 2004-01531
DATE ISSUED: 09/02/2004
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.
INSTALL A FURNACE (WARM AIR, GOODMAN, 70,000 BTUS)
# A/C UNITS 0 VALUE OF APPL OR WORK 0
# FURNACES 1 # GAS DRYERS 0
# GAS RANGES 0 VALUE (FOR MINIMUM CALC) 2000
APPLICANT
ANDERSON HEATING & AIR COND
4347 CENTRAL AVE NE
COLUMBIA HEIGHTS, MN 55421
OWNER
KNUTSON KENDAL J & ELAYNE O
4720 3RD ST NE
FRIDLEY, MN 55421
r
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
regutirkg,conuction or the performance of construction.
Annlicant\ (jDate
F . IF
HEATING PERMIT MINIMUM FEE
0.00
FURNACE SHELL/DUCT WORK
35.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
0.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
0.50
TOTAL
35.50
PAID WITH CHECK # 24184
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
C
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 DEVICEScc
J�
FAX (763) 571-1287
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)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
JOB ADDRESS UZ
Ettective January 1, 2003
OWNERy[/'
Rate TOTAL
BUILDING USED AS
$ 30.00 $��
ESTIMATED C04(9 0 0D " PERMIT NO.
$ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units Circle One (Steam) ws arm Air
$ 10.00 $ Trade Name Size No.
BTU HP EDR
$ 25.00 $ Fuel Total Connected Load��
Burn ade Name 6DWAO,4 Size No. 61,WV_)Q-J
$ BTU Z V, LUZi HP EDR
State Surcharge
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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
$3c o representations stated in this application are true and correct.
DATE —
HEATING CO d
Signed �p TEL #
FAX # 0
Approved By &Rough In Date Final Date
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
nNNFCTOR AND COMRI IRTIM AIR VFRIFICATIt
KI
,nMMnN VcNT VENT
When imnla ling an taxonhnn fi trance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
Yes � No ( )
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets all current codes and manufacturer
Yes( ) No
specifications including sizing, length, number of elbows and termination.
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.
Yeses No ( )
The px etinn r-nmi> intron air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes () No (NA
When required to i etall a new cnmh"SUnn airs It will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes P) No ( )
When jpctallonn neje yantinAyy=, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes qq 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 1y No( )
,Appli ncp Jyglo and Si7P/Cnmmnn Vent and Vent Cnnnector Information
Appliance #1 Type BTU Input11 r� Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat &zqn
Appliance #3 Type BTU Input _ Fan Assisted or Nat I
Total Appliances Total Btu Input I �. %
iameter I in
Common Vent Type �`� Vent Height IS� D r
Appliance #1 Vent Connector Height c2, ft Length %ft Diameter in Type
Appliance #2 Vent Connector Height _/—ft Length ft Diameterin Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
HEATING CO:
Signed By:IV
_
5
Date: