PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERWr
N? 829 Ofi'ice of INSPECTOR OF BUII.DINGS
C
owner
Architect Fridley, Minn., - + 19 • . _
Builder
LOCATIOIJ OF BUILDING
No. ` Street yam+' r 'f jf Part of Lot
Lot / `* Block %w1 Addition or Sub -Division
DESCRIPTION OF BUILDING
Front Depth ? Height Stories Manner of Constriction
To be used as s To be completed . Estimated Cost, fi
�.i
Permit is hereby granted to
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.
Inspector of Buildings.
4
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, Minnesota, this
day of A.D. 19--r--
is
9
•
City of Fridley, Minn..
BUILDING PERMIT N? 6931
Date: /
Owner:
Address
O ION OF BUILDING
No. Street -� Part of Lot
Lot ---- __ Block ___ _ Addition or Sub -Division .__
Corner Lot , Inside Lot Setback — Sideyard
Sewer Elevation -- Foundation Elevation
DESCRIPTION OF BUILDING
6nbe Used :
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Constructio EstCost /- `� be Completed
In consideration of the issuance to me of a permit to construct the building des 'bed above, I agree to do
the proposed work in accordance with the description above se7 and in co m cewith provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $4 , 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
within the city limits and this permit may be revoked at any p,m violation of any of the provisions of said
ordinance&
Building Inspector
NOTICE:
TIS permit does not cover the construction, haftWon for whin& phnnbing, gee hating, sower or water. Be core to see
tin BWhUng hapeetor for separate permih for these Nene.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S
ADDRESS
LOCATION OF BUILDING
No. Stta t � ,- - Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant, attach to.this,form Two Certificates of Survey -of Lot and proposed•build-
ing location drawn_oh these Certificates.
DESCRIPTION OF BUILDING
To be used as:
AAWt Depth Height
Sq. Ft. • Cu o It .. .
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 of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all.the facts and
representation's stated in this application are true and correct.
Schedule of Fee Casts can be found on the Reverse Side).
i
f�
Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 g
MECIL WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................ x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470
q IL
i�
City of Fridley: '
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 representations stated in this applicati r� a true and correct.
OA Fridley, Minn_ �/ 3 1
Owner
Kind of Building /
Used as
To be completed about
l
Estimated Cost, $d , ® y LL
Ol ew Building Permit No. &;k J Permit No. oZ 16 Q�
DESCRIPTION OF WORK
HEATING or POWER PLANTS—.Steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fuel
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
$
See Fee Schedule X2
TOTAL FEE $_; 4 , Signe
By %
ZQ 42 IM Business Phone
NO
(REMARKS -OVER)
Cify of Fridley
52-84-879.01 Applicafto for Plug wd Gat Fhlg Foran
Dept. of Bldoa. Phone 980-3490
DESCRIPTION OF WORK LO=6=4820 NE 3 St.
Number, Kind and Location of Fixtures
• Future Connae!!oa Openings
+
Now Fixture, Old Openings Sower
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................
x $2.00
8111MMMMMMMM11
Future Fixture Opening ...........
x $1.50
$
New Fixture Old Opening ..........
x $1.50
$
Catch Basin ....................
x $3.25
$
peplaceranpe
Wdter Heater Up to 99.000 BTU) ....
1 x $3,00
$ 3.00
New Ground Run Old Bldg. ........
x $3.25
$
Electric Water Heater ..............
x $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
MEEMMONMENEEMEMMMI
• Future Connae!!oa Openings
+
Now Fixture, Old Openings Sower
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................
x $2.00
$
Future Fixture Opening ...........
x $1.50
$
New Fixture Old Opening ..........
x $1.50
$
Catch Basin ....................
x $3.25
$
peplaceranpe
Wdter Heater Up to 99.000 BTU) ....
1 x $3,00
$ 3.00
New Ground Run Old Bldg. ........
x $3.25
$
Electric Water Heater ..............
x $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures x $2.00 $
Additional Fixtures .................. x $ .76 $
Gas Range to 199,000 BTU.. . x $5.00 $
- .0
REPAIRS 8: ALTERATIONS --Refer to Cwe
Description ..............................................
TOTAL FFE $ •�
City of Fridley:
The .undersigned hereby makes application for a permit for the- work herei
specified, agreeing to do 811 work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that alI the fact
and representations stated in this application are true and correct
Fridley, Minn June 30, 1971 19_
Owner M Szczich
Kind of Building fr.
Used as res •
To be completed about July 5
Estimated Cost, $ 10.00
Old—New. Building Permit No. �APermit No.
Signe MINNEAPOLI GA$�/%/
L
Business Phone,
ROUGH
Nif(` NEGA5Z0
53-84-s-915.51 _
C!iy of Frldlay
Applicolicn for PIv.�ing Old G.M. PC
Dept. of Bldg*. Phone M-3450
DESCRIPTION 07 8701: Ltoeu N:E.- 3rd Street
Number, Kind and Loce.'ion of Fixtures
~
r�
oO
N N
�7x0
y
u
t�fa
N
:
Uz
O
/
e
N
WATER NTR.
7G-S
ELEG
t
Ini to
as
Grill
Futuz. ConaocLszu Opoaings"`""`�`•'� ��
SSo-war o
INew Flxtura. Old Openings Cesspool 0
PARTIAL RATE SCHEDULE
UMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ........ • . • • • . • x $2.00 $.--
Future Fixture Opening ........... x $1.50 S -•
New Fixture Old Opening.......... x $1.50 $-----
Catch Basin .................... x $3.25 $
Water Iieater 'Up to 99.000 BTU). • • • x $3.00 S
New Ground Run Old Bldg. .... •.. •.. x $3.25 $
Electric Water Heater...... ........ a $2.00 $
!lS FITTING FEES: NO. RATE TOTAL
Ist 3 Fixtures x $2.00 $
Additional Fixtures .............. x S .75 $
Gas Range to 199.000 BTU ........... x $5.00 b
City of Fridley:
The undersigned hereby makes application for a permit for the- work here
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct,
Fridley, M--
5-13-75
Owner Matthew J. Szeozech
Kind.of Building Frame
Used as Res.
To be completed about 5-20-75
Estimated Cost, $ 10.00
Old --New. Building Permit No. Permit
Signed
By MINEGASCO --
Business Phone No
ROUGH
FINAL '/3 -12(
MAIRS Sr ALTERAMONS—Roto: to Code .50 State Surcharge
Install Gas Grill 5.00
•Description •••••..••.w•.....•..•...••.••••.••••••�
50
• TOTAL FEE i—mrd=�litcha�ge�®¢
utast -
E
CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL ` RATE
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00
Gas Piping $ 10.00
(piping needed with new furnace)
Gas Range $ 10.00
Gas Dryer $ 10.00
* Air Conditioning (all sizes) $ 10.00
All Others/Repairs and Alterations
1% of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp. /` e eu)
Date
Approval for Permit
VOW -%0
$ .50
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
Job Address /06-6' — Z!)o f'L 1')
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Minn. 9 19y
OWNER 0
` ) zc2.Ir�
KIND OF BUIL-DING
p��(
USED AS E J( LJ'C :(W'\ 0,
TO BE COMPLETED ABOUT i t( rx Q)I
ESTIMATED COST y L J J /
OLD - NEW BUILDING PERMIT NO. PERMIT NO. ( D17�J
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Bot Water, Warm Air- No.
(� � _y--,_�fr(o1r750C/U
Trade Name Tj�-K ► �� Size No. �1VCJ(J
Capacity Sq. Ft. EDR' BTU HP
Total Connected Load Q,,�/Kind of Fuel�`I
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company Mr)r--14,N ►awi
Signed By / LJL�/%� .(. i
r
Fill out back side for stack verification on replacement furnaces
CHIM14EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1.
Has been carefully examined
Yes
No
2.
Is free from rust or deterioration
Yes
No ( 1
3.
Has no foreign objects lodged within
Yes
No ( )
4.
Is securely supported
Yes
No ( )
5.
Meets all current Code requirements for size and
total BTU connected
Yes
No ( )
6.
Has Total heating BTU's of j �, Loo
All other BTU's
TOTAL
Company • A►ir
Signed Byi.1�$. ��
Da te
I�: , • - -
r
.'a
suB�Etr
P jo
City of Fridley
30711
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
r • _ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
� .
I CITY HALL FRIDLEY 55432
NUMBERREV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/24/99
10B ADDRESS
4820 3rd Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
11 12
2
Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Matthew Szczech
572-888
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Vikin_g Home I. Co. 4832 2 1/2 5572-JR20
4772
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
❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and arae 21 Sq) 1:ggU-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
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 HEREIN OR NOT. THE GRANTING OF A PERMIT
1835
.92
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
66.20
Fire 1.84
PLAN CHECK FE
TOTAL E
��-�j—�' _ g'-2f`
Licens C 5.0
7 .96
SIGNATURE ON'RACTOR OR AUTHORIZED AGE Nr iDATEi
EN P P
ISI R PERMIT
;rLIDATE
S-GNATURE OF OWNEROF OWNER BUILDERS IDATEI
xBLOC INSv -
gitE
NEW [ ] 4 Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 I1 `
BUILDING PERMIT APPLICATION �C
Construction. Address: `l8 20 J? P-0 n.; 'V. E
Legal Description:
Owner Name & Address: A 0 77#Ew .Sz e z E c ft Tel. # _�- 7 2 -APr �
Contractor: art<.t...c, Ho p-ar C e . MN LICENSE #gi y 7 Z
Address: 50r43,2 o?%i s r-. I✓. let 55gj( Tel. #
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:
A-t4e f'- fie d vo F
Estimated Cost: $ Q2 / O
y �
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $ _ $
DATE: 1'2 y- S 3
APPLICANT:
Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
P
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BF INSTALLED ON EACH FI OOR
Effective On Jan 1, 2000
f� •• iso
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
$ 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
TOTAL
State Surcharge $ .50
TOTAL FEE $ M -�
.JOB ADDRESS _fMOS -te, du31.� ry
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 Puilding Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
AL SIOLIFFY, EDGAR
4820 3RD STREET NORTHEAST
FRIDLEY, MN 55421
Owner (763) 571-4718
0131 .20 03
Building Used As_3�61�%J C�
Estimated Cost0 PERMIT NO.
00 3e)'7 0
PLUMBING COMPANY�_ &/Qr�.wI-A PLUMwjr, C.t�
SIGNED BY/�---- TEL N0. Z" O
Approved By , Rough -In Date Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
�;_F1,71
F
Mill M rT M_F
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
$ 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
TOTAL
State Surcharge $ .50
TOTAL FEE $ M -�
.JOB ADDRESS _fMOS -te, du31.� ry
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 Puilding Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
AL SIOLIFFY, EDGAR
4820 3RD STREET NORTHEAST
FRIDLEY, MN 55421
Owner (763) 571-4718
0131 .20 03
Building Used As_3�61�%J C�
Estimated Cost0 PERMIT NO.
00 3e)'7 0
PLUMBING COMPANY�_ &/Qr�.wI-A PLUMwjr, C.t�
SIGNED BY/�---- TEL N0. Z" O
Approved By , Rough -In Date Final Date
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 O 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 :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 YAX:
: 4820 3RD ST NE
: 263024320018
PLYMOUTH
LOT 11 BLOCK 2
HEATING
RESIDENTIAL
ADDITION/ALTERATION
571-1287
_..-------.—.__
PERMTT O.: 2004-00952 '
DATE ISSUED: 06/21/2004
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 DRYER WITH 1/2" COPPER, FLEX CONNECTOR AND SHUT-OFF VALVE.
# A/C UNITS 0 VALUE OF APPL OR WORK 177
# FURNACES 0 # GAS DRYERS 0
# GAS RANGES 0
APPLICANT
CENTERPOINT ENERGY/MINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
.'1 /LR
EDGAR AL-SIOUFFY
4820 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 Wncel the provisions of any other state or local law
regulatingstructf'on or the performance of construction.
Applicant ' Date - 1
Bldg Insp.
HEATING PERMIT MINIMUM FEE
15.00
FURNACE SHELL/DUCT WORK
0.00
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
15.50
PAID WITH CHECK # 1011069
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
340 C)
CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004
6431 University Ave NE
Fridley, MN 554x2 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS L '5
RATE SCHEDULE Fee Total
Residential Owner
Furnace Shell and Duct Work, Burner &
also Replacement Furnace $35.00 $ = Building Used As 16,C_' /kJ
Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST PERMIT NO
Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER
Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
*Air Conditioning- All Sizes $25.00 $ BTU HP EDR
Fuel Total Connected Load
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work $ Burner Trade Name Size No.
Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR
Improvement whichever is greater on work less than $300.00
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
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 representations stated in this application are true and correct.
$ 5�
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
HEATING
/ XZ/
13�a �%
FAX # 41/?- 3)J- .5� ) Date
�%6
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Approved by hd 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 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
$ Y51 - 5-
BUILDING
Permit No.:
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By: t_
763=572-3604CITY
Surcharge
OF FRIDLEY
DatJ :JUN 2,5 2008
763-502-4977 FAX
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
EFFECTIVEEFFECTIVE 1-1-08
Curb Cut Escrow
DATE it w �?
7S YOUR E-MAIL ADDRESS
Erosion Control
SITE ADDRESS
_
Park Fee
THIS APPLICANT IS:
OWNER OCONTRACTOR
Sewer Main Charge
PROPERTY OWNER/
NAME:
Total Due
ADDRESS: tK �Q St tV e— CITY a '
STATE ZIP„5�_&,9,_
TENANT
PHONE:
NAME:
ADDRESS: CITY
STATE ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE FAX
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
PROPERTY TYPE
91 SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF O DRAIN TILE
❑ DECK 'WIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
,1?r20AINTENANCE/REPAIR O REMODELING
DESCRIBE WORK BEING DONE: N i5 -w S �. n" Cis
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
O HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used,
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
I.
Site Plan/Survey showing the existing structures
❑ Aluminum
❑ Trim
and proposed project.
O Other
[I Fascia
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
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 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ rte. 7"�1 Y / , OCCUPANCY TYPE.
Permit Fee
$ Y51 - 5-
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ !) o •
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 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. �, �p
SIGNATURE OF APPLICANT 7 PRINT NAME )E/ ,7ejOn�DATE6�b_
APPROVED BY DATE
0
C11YoF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I,
understand that the State of Minnesota
requires that all residential build in contractors, remodelers and roofers obtain a state
license unless they qualify for a,sscific em tion from -the licensing requirements. As
the owner of the property at ^ e L - �TJUc- -,� , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. 1 hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
I LW�Wm 211 W-- Z Z � I I Z
Building
BUILDING
Permit No.: 90
Inspections
RESIDENTIAL APPLICATION
Received Bye
763-572-3604
CITY OF FRIDLEY
C/ . G /
DJEMN O V S 610
DATE l 3l.0 YOUR E-1AIL ADDRESSC��0 7 g eD p (ff
a j U I LL S. t o rn
SITE ADDRESS ji 6 i2 0 3 r s- YrO . b /Y
.001 x Permit Valuation (1/10%)
THIS APPLICANT IS: ❑ OWNER VCONTRACTOR
$
PROPERTY OWNER/
NAME: -7 1 co n
;AC Charge
TENANT
ADDRESS: Y 92 a 3 P d CITY � rc'1 r r STATE ZIP '56(/P/
$1450 per SAC Unit (Plans to MWCC for determination)
PHONE: 7 L 3 I 6V-7 .a� l
$
CONTRACTOR
NAME: J THD At- Home Services, Inc.' d o d t 4D
E(d i t J O n 4 S
$
sTATE LIc 2690 Cumberland Pkwy, Ste 300 g Sa 13
Ys - G b y 7
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS Cumberland Office Park CITY
STATE ZIP
WITH APPLICATION
PHONE Atlanta, GA 30339-3913
'e SINGLE Lic# 20268257 Ph. 763/542-8826.E
$
PROPERTY TYPE
Agreement necessary ( ) Non Necessary ( )
❑ TWO FA _ .ORIES
$
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
-0 MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �/ W / CIAO /
1 4 D.4fI 1
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
JARAGES ❑ATTACHED GARAGE
I.
2.
Existing Floor Plan
Proposed floor plan
?ROPOSED SIZE: 13DETACHED GARAGE
3.
List of structural members to be used
?ROPOSED HEIGHT:
3IDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
:1 Vinyl ❑Soffit
ADDITIONS. & PORCHES SUBMIT:
I Aluminum ❑ Trim
I.
Site Plan/Survey showing the existing structures
:1 Other ❑ Fascia
and proposed project
WINDOWS
2.
Two sets of construction plans
N EXISTING OPENINGS 13 -Yes ❑No I Ji ATJ01 J OF YNROWS
(, BaS/
3.
Energy Calculations
)R FOR NEW OPENINGS -DESCRIBE SIZE OF + ,A . Ila , inin a�
)PENING CHANGES & W- DM140 #i
l
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 $ 9P l 0 OCCUPANCY TYPE
'ermit Fee
$
See Back Page for Fee Schedule
'Ian Review
$
65% of Building Permit Fee
>urcharge
$
C/ . G /
(.0005) times the total job valuation — Minimum $.50
'ire Surcharge
$
9"? J
.001 x Permit Valuation (1/10%)
,icense Surcharge
$
$ . 0 V
$5.00 (State Licensed Residential Contractors)
;AC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
zb Cu! Escrow
$
n ' 6 f: _ ;> $20 = $
,rosion Control
$
$450 Conservation Plan Review
'ark Fee
$
Fee Determined by Engineering
:ewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
'otal Due
$
RbO, 07
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
onformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
ermit but only an application for a permit and or is not to start without a permit; that the work will be in accordance with the approved
Ian in the case of all work which requires revi BA approval of plans. M /�
IGNATURE OF APPLICANT/ ii�'� PRINT NAME/ • 1 �.P 1 DATE