PRE 2010 DOCSIj Village of Fridley,101inn.
�I BUILDING PERMIT
N° 11:0
Office of INSPECTOR OF BUILDINGS
Fridley, Minn., ���-" ¢''�� . � ° 19— �
LOCATION OF BUILDING
t I!, Street e Part of Lot
Front
To be used
Permit is hereby
the building_
upon the express c
the work done in,
nances of Fridley,
within the city lin
ordinances.
Block Addition or Sub -Division
"'°" "DESCRIPTION DESCRIPTION F BUILDING
Height Stories "" Manner of Construction w '^A,
To be completed '" Estimated Cost d 66 , .r"9
to to
described in the above statement. This permit is granted
3ition that the person to whom it is granted, and his agents, employees and workmen, in all
found and upon said building, or any part thereof, shall conform in all respects to the ordi-
[inn., regarding the construction, alteration, maintenance, repair and moving of buildings
i, and this permit may be revoked atany time upon violation of any of the provisions of said
c (T
It 1 - " Vj Ao�i" ��Inspector of Buildings.
AGREENMNT 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 aid according to the provisions of the ordinances, of Fridley, and, being first duly
sworn, I hereby sate and say that the facts stated by me and coptained in the above permit are
true as therein st-Lted. 41
Subscribed and i (torn to before me at Fridley,' Minnesota, this—
day o D. 194
r.
<..
0 0
e
' Application for Power Plants and Healing, Cooling. Ventiiation, .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 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
.each add. 60,000 BTU ..... . .................. 2.00 $
Replacement of Furnace .............................. §.00 $
Repairs & Alterations—up to $500.00 ...:a ............ 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR 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 See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS &REPAIRS TOTAL FEE
ROUGH
FINAL
Dept. of Bldgs. Phone SU. 4-7470
Location
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 application are true and correct.
Owner
Kind of _
Used as
To be completed about
Estimated Cost, $ 1,2?�:D G
Old ew uilding Permit No. ! Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS -Ste Hot Water arm Air—No�
Trade Namt.No "�
0
Capacity 90 ® Sq. Ft. EMM BTU H.P.
Total Connected Load 2::r Kind of Fue:
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
WMILM'.,
4 Z zM 7_59 Business Phone No- i --K `�
(REMARKS—OVER) �'�
M%W–
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS `�EAPOeS. MINN.
Aleatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows Doors Refert#nce Out. Wall Int. Wall Ceiling Ro1 _jof Floor Kind How Applied
Yes I Yes—No 19�.
!d P1 I ER.,..,,, I I a.,�il, * �V;,Ith /l I-IP;oht I II Fl I ..� 1 Rmm I Lenath_ Width Height
Wlndows'an Doors—Cracka'ge and Area
- ----- "
Width Height No. of Lineal ft. Area
No. of pane of pane lights j', of crack sq. ft.
Width Height No. of
No. of'`pane of Dane It ht
Lineal It. Area
of crack aq. ft.
/ / 4
Coef. Btu
Infiltration
Q 41d 0
Glass
lee
Exp. wall
Net exp. wall
f }
Int. wall
Q
Ceiling
Glass
Floor
Windows and Doors—Crackage and Area
- ----- "
Width Height No. of ILineal ft. Area
No. of pane of pane lights I of crack eq. ft.
Width Height No. of
No. of'`pane of Dane It ht
Lineal It. Area
of crack aq. ft.
Coef.1 Btu
Infiltration
Glass
lee
Exp. wall
Net exp. wall
f }
Int. wall
Q
Ceiling
Glass
Floor
Total Btu. Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area R q. ft. E.D.R. or sq. ins. W.A. Leader area
�( Fl.l Bim, Room I Len0h i -3 Width 9 Height A7 W FI , -%.'/C Room I Length ___9 J _Width 44 Height
Win ows and Doors—Cracknge and Area
- ----- "
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
Width Height No. of
No. of'`pane of Dane It ht
Lineal It. Area
of crack aq. ft.
Coef. Btu
Infiltration
Glass
lee
Exp. wall
Net exp. wall
f }
Int. wall
Q
Ceiling
Glass
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ VVI:_l.L r J Ll -:—L. Cy
. I* _ �... i -- .. •- -
Windows and Doors—Crackilge and Area
- ----- "
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No. of
No. of'`pane of Dane It ht
Lineal It. Area
of crack aq. ft.
Coef. Btu
Infiltration
Glass
lee
Exp. wall
Net exp. wall
Infiltration
Int. wall
Q
Ceiling
Glass
Floor
Total Btu.
sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows a12
Doors—Crackage and Area
Width Height No. of
No. of'`pane of Dane It ht
Lineal It. Area
of crack aq. ft.
Al
Coef. Btu
Infiltration
Q
D
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Fader area
0.1 / Room I Length 1!6 Width
Windows -and Doors—Crackage and Area
Wldth Helght No. of Lineal ft. Area
No. of pane of Dane lights of crack sq.ft.
Height
Coef. Btu
Infiltration W,6 U 0.
Glass
Exp. wall
Net exp. wall 99 16 9 91e
Int. wall
Ceiling
Floor /
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. leader area I
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MILAN.
Weatherstrips A.S.H.V.E. Construction No.
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof
Yes—No Yes—No 19�
',R FLI s=,r' 7 Room I Lencith ;i Width /% Heiaht X II f FI.I
Windows and Doors—Cracka,ige and Area
Width Height I No. of Lineal ft. Area
No. of an of pane lights of crack sq, ft.
e
Coef. Btu
Infiltration
44 0 -
za e
Glass
D �®
Exp. wall
10
Net exp. wall
29,0
Int. wall
B
Ceiling
129
Floor
Total Btu.
Re . t. E.D.R. or sq. ins. W.A. Leader area
)VV Room I Length __.Pj_1 Width Height -0
Windows and Doors—Crack4ge and Area
Width Height No. of Lineal ft. Area
No. of pane [ of pane tights of crack eq. ft.
Coef. Btu
Infiltration
Glass /
44 0 -
za e
Exp. wall
D �®
Net exp. wall
Int. wall
10
Ceiling
29,0
Floor
B
Total Btu. I /
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
♦ FI_I Y Room I Lenlrth /.R Width -3 Height S
Windows and Doors—Crack2ge and Area
Width Height No. of Lineal ft. Area
No. of pane of pane Ilghts of crack eq. ft.
Coef. Btu
Infiltration
Glass
D �®
Exp. wall
Net exp. wall
29,0
Int. wall
B
Ceiling
129
Floor
Total `$tu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 _4j' e
Insulation
Floor — Kind How At
' _-7; Room I Length /,/ Width 4
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
go
Net exp. wall
Int. wall
Ceiling
B
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.l Room I Length Width '
Windows and Doors—Crackage and Area
Width Height No. of Llneat tt. Area
No. of pane of pane Itghts of crack sq. ft.
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
RS4uijf#s . E.D.R. or sq. iris. W.A. Leader area
F . oom I Length idth
Windows a d Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights I of crack sq. ft.
I I I I I I Coef.l Btu
Infiltration
Glass
Exp. wall
Net exp. wall 9
Int. wall
Ceiling
Floor
Total Btu. ®�
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
II
�.. HEAT LOSS LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, MINN.
Weatherstrips A.S.HV•E. Construction No. Insulation
Guide
Windows Doors Reference Out. Wall jInt.Wall, I Ceiling.j Roof Floor Kind How Applied
Yes—No I Yes—No 19—i— I I I I
.,
9 —
♦ FI -1 X, .,A j Room I Lenf th /d? Width 6Y Heistht II o' Fl. �., 7� ,.Room I Length Width Height
Windows and Doors—Crackage
and Area
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack sq. ft.
p
t
Btu
jCoef.
Infiltration
Coef. Btu
Infiltration
0
Exp. wall
Glass
Net exp. wall P
Exp. wall
Ceiling
Net exp. wall
Floor U.
�®
Int. wall
Ceiling
Ceiling
/
Floor
10
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
CII _ 1/ .* 0.,.....11 —4L j o W;AtL, e --2 14.;.1,M
Win ows and Doors—Crack' ge and Area
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
-r
p
t
Btu
jCoef.
Infiltration
GlassLo
0
Exp. wall
Glass
Net exp. wall P
Int. wall
Ceiling
I IWJe
Floor U.
�®
Total Btu. i L
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
i FI_I . Rnnm ILenatth A— Width 9' Heiaht V
Win ows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No* of pane of pane lights of crack sq. ft.
-r
p
t
Coef.1 Btu
Infiltration
Coef. Btu
Glass
Exp. wall
Glass
Net exp. wall
Int. wall
Ceiling
Net exp. wall
Floor
�®
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane ►Ig is of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane 11B s of crack I sq. ft.
vm
t
Coef. Btu
Coef.
Coef. Btu
Infiltration
d
Glass
Glass
Exp. wall
Exp. wall
Net exp. wall
Net exp. wall
e),
�®
Int. wall
Ceiling
Ceiling
Floor 4al�'
10
Floor
Total Btu. C�
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
M-1 .d. °.A Room I Lenath Width fl" Heights
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane 11B s of crack I sq. ft.
O �
Coef. Btu
Coef.
Btu
Infiltration
Exp. wall
Glass
�o
Exp. wall
Ceiling
Net exp. wall
e),
Int. wall
Ceiling
Floor 4al�'
Q!
Total Btu.
Required sq. ft. E.D.R. or sq. ifis. W.A. Leader area
FLI Rnnm I Lenath Width Height
Windows 'and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
City of Fridley, Minnie
BUILDING PERMIT
Date:
Owner: _._ _..._.. _,.._.. _ .. _ 1 _.. ..... ._._....
Address.
Builder....
_............. ..... ..._._..._.---._--.._.__._.-.
Address.....
...... ....._.......... .-,l< .... _.................... _..................... _.......
LOCATION OF BUILDING
No. 1....-.. Street-'y,•'..._��-....._......._..._........ _ Part of Lot
Lot.:._._.:................ Block _.__.....:........_-..._.._.... -Division _.. _ ....-........_......_........
Setback ... _.
Addition or u ,�+ �r
Corner Lot .........................._........ Inside Lot ............. YJ _...._........ Sideyard ....._. a..t� ....................................._.._.......
Sewer Elevation ............................. -.... .............. ....................... _.... ........................ Foundation Elevation .......................... ............ _....... -
DESCRIPTION OF BUILDING
To be Used as:
_ p
_...__... _...:........ Front _:^ .. ,.._.. Depth - --.. Height ..... Sq. Ft..„ „�.Cu.
..... .............. _...................................... Front ...................... Depth ...................._ Height .................. Sq. Ft. ...................... Cu. Ft. ......................
of Construction ..4 ... ..ar................. To be Completed ... ................ ___--_-----................
Type of Est. Cos ....
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 $... .., 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 time upon violatin* of any of the provisions of said
ordinances. — A A
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas he�sOwpyq j�yty�1Be sure to see
the Building Inspector for separate permits for these items. X � ON
a 1 O OF APRIVATELAND COWO MNO
BUILDINtSTRICTIONS.
}
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name
Builder
Address -'Toll --410 A117 Address --- -
LOCATION OF BUILDING
No. 21. Street _S7— Al 47 - P4rt of Lot _ZZ,.__
I,ot sock . / 1 Addition or Sub.Div. -dazu.A.ra d(-�:
Corner Lot_Inside Lot_,,Set Back _ Side -Yard_
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
�/Ozz-v,/L6�940nt
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. _ Cu. Ft,
Type of Construction Estimated Cost
To be completed,, --, - / / — 6 .. .
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 ell the facts and representa-
tions stated in this application are true and correct. - ---
�A - 1A-0-MMmss;.
(A Schedule of Fee costs can be found on the ReverseSide.)
Approve y inspector
61�
Application for Power Punts 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 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
.each add. 60,000 BTU ... � � .................. 2.00 $
Replacement of Furnace ............................. .§.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. IDR 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 $�0'0
I
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... �x $1.50 $ _
Additional Fixtures ................. 2E!x .50 $
Gas Range to 200,000 BTU ........:.. x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FFE $ _
Dept. of Bldgs. Phone SQ 4-7470
Location
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 application true and correct.
Fridley, AUnn—19 O
Owner
Kind of Building -
Used as — S�
To be completed about %fto
Estimated Cost, $
Old-jj& Building Permit No.Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size
Capacity.
Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Signe�z/"
By co
42 4N1 -59 Business Phone
inry Tn,s.}t!7.q•...M r. f•'iA..;...� ri..�...-eb'1 [.� ..,,i �r�.�^:»�+!r-�•..� e. r�.. @1 M1'.'J�.. �!,� 8' r o... -.gin =+
Y'�+, (: asa.�'..� "a S :n �sW b �.,... ...+ 4..a <.rl ti�..'v.•.,.., ... �„� '•k. ri diili�� i6 �'L'aL aa•3t.a►+ai i�Q trawra��vai L�+a 6.a•� �mtJ
�7 ^.d"air r. ilia S•L.'�r'nai:: � cu-`� i:b 0 cS.d D zF Yv'.a._-3
PARTIAL RATE SCHEDULE
GRAFITT WARM AM: RA17W TOTAL
iwaace Shell & Duct Work $10.00
Rey'acemrnt of Furnace 6.00 $
P.rpa:-c & Altorat.Uns- -up to S500.00 6;* S
Repairs & A:tera;cors each add. S500.00 300 $
MCIL WARM AM
itarrace Shell & Duct Work to 120,000 BTU 11000 $
esch add. 60,000 BTU 3.tXJ S
RepiscYnent of Furnace
6.40 S
Re -,airs & Ahp ations---up to $500.00 6.00 $
Repairs & Alterations each add. $500.00 3.00 $
STEAM oz HOT MATER SYSTEM
Pir-ace Shell & Lines- to CM sq. ft TDR Stearn 510.00 $
FL•rnace Shell & Line --to 640 sq ft. EDR lint Water 1000 S.
Each add 200 sq. ft. EDR Steam -4 nn $
Eads add. 320 sq. ft EDR Hot Water 3.00 S
OIL BUFNEF.-to 3 gal. per hour 6.00 S
over 3 gal, per hour --See Fee Schedule
GAS BURNIM (up to 159,000 BTL') 5.00 $_e2=
vrer 159,000 b''TV See roe Sehoduls
GAS FITTING FTE3: No TATE TOTAL
Ist 3 nxtures x$ 200 $
Additional Fixtures x .76
Ga3 Rare to 138.0+00 a$ 8.00 $
AIR CO3Mr:IONI`17.G'
rAA F---ATL-.G gTaTi�-1
FF3sTMILTILZ3 fST57=2
ALTZRR770P3 & REPA123
State Surcharge .50
Sao FOG Sac% -44o
TOTAL 7 $ Jr
City of Fridley:
The undersigned hereby makes application for a p,-rmit for the work ?Bert
spectfied arrrre:cg to de all x•ork in strict accordance with the City Ord!na:.c
and ruling of the Deva: trn(-nt cif Buildings. and hereby declares that an the fat
and rep rs.-sPntaduns stated in this appbcation are true and correct.
r-,dlry, Ptinn .7 9
F
Owner
Kind of Building 14,11,A42n4
4
d 61 A/% A "
used as
To he compie:ed about v
Estimated Cost:, S �
OO d Ivew. Building Permit No Permit No.
E�-MY-27770:1 OF WO11M
HF,ATTNG or POWER PLANT_—Bream, Hot Water, Warm Air—No
-�
Trade Name - Size Ydo�
Capacity_. _. ^ Sq. In E.D.R BTU EL
Total Connected Load—_�—/ Alnd of /
BURNER — Trude Name_ / �� �� Size 140 l0
Capacity Sq. IFL. EDA- BTU -
taxcaAaxa-*W*
-M
y r,
_ � r�
l
mr.ki
SUBJECT
of Fridley
15516
AT THE TOP OF THE TWINS
JPERMITNOrCity
BUILDING PERMEIPT
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
����
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF APPROVED BY
612-571-3450
910-F15
10/15/791
JOB ADDRESS
5419 - 4th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
18, Pt. 19
18
Hamilton's Addn. to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Larry Noble 7381 Jackson Street N.E. 784-4711
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 ❑
X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 42' x 20' 4 -stall garage
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRING,
HEAVING, PLUMBING AND SIGNS. WAI NSNa
-E:.
local : �_'
Before digging call
- EES C I , :,c - .:.
TELEPHONE
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$7,030
$3.51
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$33.60
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$37.11
SiGNTURf..OF CONCTOR OR AUTHORIZEDA ENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
.74
7
l
BLDG INSP JOATE
U OF OWNER IIF OYrNER BUILDER( (DATE)
• CITY OF. FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: BUILDER:
ADDRESS: '73 $f ADDRESS:
TEL NO: 7gEe- 47 / / TEL NO: '
Construction Location
STREET NO: % STREET: Th `•`
•
LOT: 1gr �,gt7®F BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: ° Depth:. 2_0 Height:
Squane. Feet: 9440 Cubic Feet: w
Front: Depth: Height:
Square - Feet: Cubic Feet:
Type of Construction: '4 Estimated Cost:
. T .- �•.. ?030:
9b Be Completed: ze -- gr 7�
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET .
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: ��� / �— - SIGNATURE:
r
Stipulations:
3. b�
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
N
PLUMBING FIXTURE RATES: NO.
RATE
mq
New Fixtures
g
5.00
U
Future Fixtures
M
W
S
Water
0
1.50
S
Beer Dispenser
e
4.00
$
Blow Off Basin
g
5.00
e
N
a
w
g
Rain slater Leader
Heater
5.00
5
Hydraulic Valve
$
5.00
S
or Receiving Tank
:star
S
5.00
S
Water Treating Appliance
g
7.00
5
Not Water Heater
S
5.00
S
Gas Range
~
O
A
�qq
.S
c
S
� 7
O
H
N
� m
u�q�
m
C
NU
D
N
yc
O
qqm
U
4
qN
O
as
lec
pl
Al
S
f.0.
1AW
ql
l7
t7
RAAA-
1st
2nd
3rd
4th19
(R) - Future Connection Opening
Connected with Sewer
V) - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
New Fixtures
g
5.00
$
Future Fixtures
g
3.50
S
Old Opening, New Fixture
$
1.50
S
Beer Dispenser
S
4.00
$
Blow Off Basin
g
5.00
$
Catch Basin
g
5.00
g
Rain slater Leader
$
5.00
5
Hydraulic Valve
$
5.00
S
or Receiving Tank
:star
S
5.00
S
Water Treating Appliance
g
7.00
5
Not Water Heater
S
5.00
S
Gas Range
g
10.00
S
Gas Dryer
S
10.00
S
Back Flow P�nr1e'vvQeencrter Required. Yes Y --
,
No ( )
Type �S v re— �r (� w.1 S 5.uo
`/tigaT'on sySY�r�+
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $ State Surcharge
($15.00) TOTAL FEE
S
�00
S e
S 50
Effective Hay 1, 1990.
Job Address -_ ? L/ � ( ( P, �5o
Department of Buildings
City of Fridley
Tel. 1571-3450
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
eeftrue and cocorrect
Fridley, Mn.
OWNER E7 14 n h fL-- e-lr%
KIND OF BUILDING ..7 ikal& I yM -r'lY &,%
USED AS K e -s u
TO BE COMPLETED AUT
ESTIMATED COST (�+®1 ��
OLD - NEW BUILDING PERMIT NO. PERMIT NO. /CSS/ 9
Company v cc—
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP. 49 -/6 — 19LI�2
Date
APPROVAL FOR PERMIT
!1ININUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE S.50 STATE SURCHARGE
SUBJECT
City of Fridley
2 7 4 4 3
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
O
COMMUNITY DEVELOPMENT DIV.
_
PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
8 28/98
JOB ADDRESS
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DescR.
118,Pt. 19
11
Hamilton's Addn. to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
John Jenson 6070 6th St NE FridleyMN
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Brent Darr Construction
-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and arae 24 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2001
1.00
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 PERKORMANCE OF CONSTRUCTION.
74.75
Fire SC 2.00
PLAN CHECK FEE
TO L FEE
c c-5.0
82.75
SIGNATURE OF CONT RACTORORAUTHORIZED AGENT IDATEI
N
VALI D THIS IS PERMIT
-
011A
SIGNATURE OF OWNER of OWNER BUILDERI IDATEI
BLD INSP
NEW', I ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 0!9
BUILDING PERMIT APPLICATION
ConstructionAddress: 5q I q q T� 5 f /1/
Legal Description:
Owner Name & Address: JOA,,
J e ,, 5 ) (170 6fA 5t /VE P4 nel. #
Contractor: h ai v,- cot-, e f C -U c ov MN LICENSE #
Address: 2441 S 510 � Tel. # 61 �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA:
Length
Width Height Sq. Ft.
GARAGE AREA:
Length
Width Height Sq. Ft.
DECK AREA:
Len
Wi th Hgt/Ground Sq. Ft.
OTHER:
i2 C1 CjF 57-S", -PEI�,✓--
Construction Type:
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
BATE: " 01���
APPLICANT:
� Tel.
CITY USE ONLY
Permit Fee
$
S`
Fee Schedule on Reverse Side
Fire Surcharge
$
U Ca
.001 of Permit Valuation (1/10th%)
State Surcharge
$
1, U
$.501$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
0 U
$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
$
�� '?s
. STIPULATIONS:
CITY (W: FRIDLEY INSPECTION DIV.
6451 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2000
PLUMBING FIXTURE RATES: NO.
RATE TOTAt
JOB -ADDRESS 54)VC i -S 6LAOSE�_
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 facts
Blow Off Basin
$ 7.00
and representations stated in this application are true and correct
Catch Basin
$ 7.00
��j
Rain Water Leader
$ 7.00
JENSEN, JONELE 71 .20 CO .
Sump/Receiving Tank
$ 7.00
5419 4TH STREET NORTHEAST
Water Treating Appliance -
$10.00
(763) 5 2 93VIN 55421
(763)572-9935
Water Heater -Electric
$ 7.00
Water Heater - Gas"_
$10.00
Building Used As�a17 Cit
Gas Range"
Gas Dryer"
$10.00
$10.00
l -� n
Estimated Cost PERMIT NO. o'- 8/ /
/
Back Flow Preventer Required ( )Yes O No
Type
$15.00
�/�
PLUMBING COMPANY B�� / LQ *?aAj (4
Ji S'?
Reinspection Fee $47.00/Hr
SIGNED BY TEL NO.&Z—RV-
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved By Rough -In Date Final Date
State Surcharge
$ .50
TOTAL FEE
$2a.550
PLUS THE 5.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-& COMMON VENT INFO ON BACK SIDE
GNOE
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
September 18, 2000
Jonele Jensen
5419 4 Street NE
Fridley, MN 55421
Re: Final Inspection at 5419 4 Street NE
Contractor: Norblom Plumbing Co.
Dear Ms. Jensen:
A plumbing permit was issued on April 18, 2000, for the above noted address,
to install a gas water heater. According to section 4715.2800 of the State
Plumbing Code, a final inspection shall be conducted on the plumbing authorized
by this permit. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we will expire the permit and any inspections on this
installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
dAV�NSEN
BuilVg Inspector
CITY-OF FRIDLEY INSPECTION DIVISION
00
6431 University Ave NE q'P
Effective On May 10, 1999
'Fridley, MN 55432 APPLICATION FOR POWER PLANTS
AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
A�
JOB ADDRESS 15't- /UZ
RATE SCHEDULE
11I
Residential Rate
TOTAL
OWNER
Furnace Shell and Duct Work; Burner -
BUILDING USED AS
Also Replacement Furnace $ 30.00
(Side Vent - Fill Out Back)
ESTIMATED COST cJ��i� PERMIT NO. A J(Y7
Gas Piping (Needed with new furnace, $ 10.00
$�
but not replacement)
Gas Range
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00
$�__
Gas Dryer $ 10.00
$
No. 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 Others/Repairs & Alterations (LIST ON BACK)
oG
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
$ .50
rulings of the Building Division, and hereby declares that all the facts'and
TOTAL FEE
�G
�!
representations stated in,this application are'true and correct. -
$
MINIMUM FEE FOR ANY HEAT-ING/COOLING/VENTILATION
/&ING
HEATING CO /,��
E GE TION/AIR CONDITION PERMIT IS $25.00
PLUS THE $.50 STATE SURC ARGE
Signed DATE
REINSPECTION FEE $47.00/Hr
(4 t,2
"Air Conditioners can not be placed in a side yard without
Approved B Rough-In Date Final D
written permission from adjoining property owner.
\
FILL OUT BACK SIDE FO STACK VERIFICATInN nN RFpt Ar%PUPKiT rI IonVAf%r
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHItii I EY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or
stack:
1.
Has been carefully examined
Yes
O No ( )
2.
Is free from rust or deterioration -
Yes
O No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
4.
Is securely supported-
Yes
O No ( )
5.
Meets all -current Code requirements for size
and to -al BTU's connected
Yes ()
No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Ries ()
No ( )
8.
Has combustion air been provided for water heater
Yes ()
No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CCIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
February 11, 2002
Eleanor Jenson
5419 4`h Street NE
Fridley, MN 55432
Re: Final Inspection at 5419 0 Street NE
Contractor: Reliant Energy-Minnegasco-Blaine Heating
Dear Ms. Jenson:
A mechanical permit was issued on September 26, 2000, to hook up a range at your address.
According to the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the
work authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Code. We will keep your permit open for another 30 days and if we do not hear
from you within this time to set up the inspection, we will mark the permit "no inspection called
for" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/ls
CIlYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
February 18, 2002
Barry Jensen
8001 Garfield Street NE
Spring Lake Park, MN 55432
Re: Final Inspection at 5419 4th Street NE, Fridley, MN
Contractors: Reliant Energy-Minnegaso-Blaine Heating
Dear Mr. Jensen:
Mechanical permits were issued on September 26, 2000, to hook up a range at 5419 0 Street.
According to the 1991 Uniform Mechanical Code, final inspections shall be conducted on the
work authorized by these permits. As of this date, no inspections have been called for.
The permit fees that were paid covers the inspections to make sure the work was completed
according to the Codes. We will keep your permits open for another 30 days and if we do not
hear from you within this time to set up the inspection, we will mark the permits "no inspection
called for" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/ls
r`
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
February 11, 2002.
Elean <MN
on
5419 4�'NE
Fridl ,5432
Re: Final Inspection at 5419 4 h Street NE
Contractor: Reliant Energy-Minnegasco-Blaine Heating
Dear Ms. Jenson:
A mechanical permit was issued on September 26, 2000, to hook up a range at your address.
According to the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the
work authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Code. We will keep your permit open for another 30 days and if we do not hear
from you within this time to set up the inspection, we will mark the permit "no inspection called
for" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/ls
CITY OF FRIDLEY INSPECTION DIV. '�/iL� Effective April 1, 2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
(763) 572-3604, FAX (763) 571-1287
nneot[ nII IRAPS:0 nG MYTI IRFC Tn RF INGTAI 11=n ON FAr.W FI OOR
Stories .��:���
���
Urinal '�'..:::::. Shower
��
::. ':� :
Wash
Tr
:>::::
:I::::::::.
.;: `....:.;_:
<�
i��......
FloorI'#::::
Drain
�:.::::::..
Auto. �::;::::::::
Washer .. I
... �..:::::.::
Gas
Ran a
:: > water Heater
:::::...
`' Gas e
EI c
Base ment `'r*
I
F o0 r1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
NO. RATE TOTAL JOB ADDRESS
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance _
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.00
Ir -
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 tpa and orrect.
DATE: , 2�
OWNER
BUILDING USED
ESTIMATED COST PERMIT NO.
$15.00 PLUMBING
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
SIGNED BY
Approved By
Rough -In Date Final Date
$ .50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE
't
FILL IN COMPLETELY FOR REPLACEMENT FUEL BUFkNING 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 terminatidn.
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;
spec cations. This does include AGA-GAMA Category I Central Fumice
Vinting 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 Tctal Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter. in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
Building
PLUMBING
Permit No.; 067-o I L41
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
DaQKDdAUG 5 20Q
DATE �( il 7 YOUR E-MAIL ADDRESS
SITE ADDRESS 5411 9 S i Al C
THIS APPLICANT IS: ❑ OWNER L r_ONTRACTOR
PROPERTY
NAME:
OWNER/
ADDRESS: R001 G A A F, E L 0 1T CITY S P& I ,J 6 G.4 k e STATEf'1'J ZIP
TENANT
PHONE: � L 3 - -)17_r _ .D Y1'p F4A0,L
CONTRACTOR
NAME:
SUBMIT A COPY OF
STATE LICENSE # 51 y 4 Terry Overacker Plumbing, Inc
YOUR STATE
ADDRESS: 502 E Main St _STATE ZIP
LICENSE WITH
PHONE Anoka, MN 55303 --
APPLICATION
❑ SINGLE FAMILY Tom@ FAMILY ❑ TOWNHOUSE
PERYMT TYPE
TYPE OF WORK:
❑ NEW JO REPLACEMENT
DETAILED DESCRIPTION OF WORK�.�
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
_ BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
_ _
—BATHTUB —GAS PIPING fns cnrucw _ SWIMMING POOL _ WATER SOFTNER ($35)
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15)
_
—DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
.'�FR1V�I�';'FES:�EfDR=P�tfl�C'I�C3�ER'$500�`-
Permit Fee $ 55--. (1 u Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ 9,' . Sti Number of fixtures @ $35.00 x $35.00 = $
i State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and.codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
/
SIGNATURE OF APPLICANT PRINT NAME �09 L 4C -Z c: -J 6L DATE `FJ d 3
;PLEASE N.OTi . 5' .. fi P _:._._ .AREIIItEI7t?R BI,ID G, ELE+CZICAI A1D 1CIiANICAL YOitK :,
City of Fridley
Building Inspectionns Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977