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PRE 2010 DOCSApplication for Power Plants and Heating. Cooling. Ventiiation..Refrigeration and 77 — Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone -1SU, 4-7470 _ GRAVITY WARM AIR: RATE TOTAL, Location T_s S 7 . Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ City of Fridley: Re airs &Alterations—u The undersigned hereby makes application for a permit for the work herein P P to $ 500.00 ......... ......... 5.00 $ specified, agreeing to do all work in strict accordance with the City Ordinances Repairs & Alterations each add. $500.00 ............... 2.50 $ and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ .each add. 60,000 BTU ....................... 2.00 $ _ Replacement of Furnace . 0.00 $ 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. IDR 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 BTL) ....................... 5.00 ®E $ 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 Fridley, 7V�inn. , 18 _ Owner I Q Q 4 4J Q O M i3i d., 0 S, Kind of Building Ej Used as u a To be completed about e o Estimated Cost, $ f 0 Old New Building Permit No� Z/— Permit No. r DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, �Alr_o_ Trade Name L F M Aj O,�c Size H% Q v L– i g '0 050 Capacity— A 000 Sq. Ft. E.D.R BTU H.P. Total Connected Load �� 'i�0 2-5�°/Ogi-d of Fuel BURNER —Trade Name Size No— Cap city. o Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signe a z 2M 7-59 Bu PSA 4810 �3(=10R BLVD. MINNEAPOLIS .16, MINN. @1111$: 0-0547 City of Fridley, Mi BUILDING PERMIT N° (!!8:1). Date: Owner: Builder a 'e FXWMMe. A — Address ____ Address . J*Y LO TI. NY BUILDING No. Streets . r Part Lot r Lot _ Block Addition or Sub-Divi�on:+�1�y���' T _ Corner Lot — Inside Lots Setback _ _ _ Sideyard .__. Sewer Elevation Foundation Elevation DESCRIPTION .OF BUILDING Te4Used Front Depth Height Sq. Ft.. &I'M Ft. ZOO Depth Heights �a Sq. Ft. Cu. Ft. Type of Constructions Est. CostM.,ro be Completed 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. so In consideration of the payment of a fee of $4�11� , permit is hereby granted to.— to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and, this permit may be revoked at any time upon violation of any of the provisions of said ordinances. / ll Building Inspector NOTICE: This permit does not ,cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 6. 1-- ---s 'APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA owner's Narike,,i ...cam'/` � uilderz-� Address s LOCATION OF BUILDING No. street ���► Part o L t Lot .._,_.__•_Block Ad ition or Su%�~~� division Corner Lot Inside Lot Ad._,____Setback-If.LSide_yard � sEGdER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and Proposed building location. DESCRIPTION of • BUILDING , To be used ass FronttDepth rama,vua. Jd sq. Ft. 1!2ee,01 aCu. Ft. G Front Depth Height sq. Ft. Cu. TYPe of Construct To be Ft. Costj The undersigned hereby makes application for a pe herein specified, agreeing rmit for the work to do all work in strict accordance with the City of Fridley Ordinances and ruling of the Department of Build= ings, dad hereby declares that all the facts and representations stated in this application are true and correct. DATEaZ, SIGNATURE CZ 4�/ � --- - ®® (schedule of Fee Costs can be found on the Reverse Side). 0 • n City of Fridley, Mian.. BUILDING PERMIT Date: June 10, 1965 a�;Vqy N° '7845 Owner: R. L. Percy Builder Bch instruction many Address 5$ E 40 — 5$42 4th Street N. . Address 7709 451 Aven 3a KQ. Doublas 5040 LOCATION OF BUILDING No. 5042 - Street 4th St. N. E. Part of Lot Lot 4 _ Bloek 4 Addition cr Sub -Division 13ennca t Pa.l mp-r, Add. Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Costf6, 0004,E _ To be Completed Storm Damage Repair Double Bung. 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 con ce with aII provisions of ordinanoEs of the city of Fridley. / . ' In consideration of the payment of a fee of $ 10,QQ , permit is hereby granted tpKt,cj1��rct.r_ nn 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 g location, construction, alteration, maintenance, repair and roving of buildings w� city limit Uns permit may be revoked at any time upon violation of any of the provisions of said ordinances. Allen Jensen Building inspector ICE: fhb permb don net emer the eendruedw, hWaibdon for wiring, plumbing, on hearing, seam or mater. Be sues to me the Building Ingmftr for apmft parmib for thea times. 0 OWNER'S NAME G f ADDRESS =�'60 C � y Ze:- APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING No.� �� Street -Z 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 building location drawn on these Certificates. To be used as: DESCRIPTION OFBUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction 4Ge4__t__ 1timated Cost a u 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 representations stated in this application are true and correct. DATES SIGNATURE d y 4LT y (Schedule of Fee Costs tan be found on the Reverse Sid. X City of Fridley, Minn.. 6431 University Ave. N.E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: November 16, 1972 Owner: _ James Larson B Sam Address . .5.44.0 - 14th Street N.E. Ad Same LOCATIOW',OF BUILDING No. —514A-- street 4th5treet N.E `Part of Lot Lot _ 4. __ _:__ Block —___ 4Addition or. Sub -Division \. neit Corner Lot Inside Lot X Setback Sewer Elevation To be Used as: garage Front Front Type of Construction _ _Bona 5CEPTION OF BUILDING Depth Height 162,'/Sq. Ft. _624' Cu. Ft. 4,94.0 � Depth Height(--- Sq., Ft. Cu. Ft. Est. Cost ; $2y § ;'�7Z ` To be Completed 1- 8-r Stipulations: Const ction is not to contin�e beyond the slab until the easements assuring access to the ew garage are obtaixied and submitted to City Hall. Provide a�ard surface driveway. ATE PERMITS REQUIRED FOR VMI In considers n of the issuance to a of a permit 'o TSE tl%bi�3Tdiii W O agree to do the proposed work accordance with th description above set forth and in compliance with all provisions of ordinances of the city Fridley. -1.41 State Surcharge In consideration of the payment of a fee of $ ` 12. LID , permit is hereby granted to James Larson 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 bu5�lding, 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 violation of any of the provisions of Said ordinances. Building Inspector CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to as the Building Inspector for separate permits for these hems. A1qW APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY Of FRIDLEYv MINN9SOTA OWMIS Nm: lm� Z�� BUILDER: ADIMESS: 'A" ADMW.SS:- ,5'( o -d� 7 7°C LOT; BLOCK: AIMITIONt CORM LOT: TMIME LOT;SETBACK; SIDEYARD:.. Afflicimt- at"ch to, d%U f4m=_Vo Certificates of SurvgX of Lot and proposed bujIdUg 14mation dr4wn *a tbase Certificates, VESCRIPTION OF BUILDING To Be Used Am,. � L �- f-) 0, Square Feet;Cubic Foeti, L -yrout., Depth; Height; Square Feet; Cubic Feet t Tyfa of Constructions Q'?IGtimate4 Cost: $ To Be "toted; The undwpisnP4 hereby aces application for. a permit for the work herein peal gfladl, agreeing to do all work in stftct accordance with the City of Mdlvw OrdUumces and TutSW 0 the Department of Buildings, GAd hereby doolarep dwX all the I -acts and representations stated ja this appItcation age true =4 correct, SIGNATURE: (Oft Revorve Side For Wtuonal info tion.) 0 'i '� d-rr `e.� fie'"� n{ re �'s. �.ao wiso$:.`.,:a �..twrt:•.1as kra 1 cr ig :. r d�. ys t>' W /� t r, � k"' !i � �✓ fZi/ 6875 /b�hncl 14 4,1E. I � V 8// V �C/ - Ls� /°,Yv s '.1 A N1< �JIr�.SCN'Vit/1nJ Soils 7esl;n, *� q f C . Crvr/ Fr Alimrupal SUN-! �' 6"OGn r.. En Q in ee � t` -,; SUI' V�YOP-5 .JJ Oznr-ca ge. a r'+ L�ara •i ./.• I• i' Z� . 1; I zz�! V /hereby cerlr�u M,7rzfhrs is afrue and arrecl mpresenfalion of)a !wo"I" LI q,✓4he boundir/es ��O%fie ob,,,r d--cr�kd risible �,:crCvclrmtnlS , rr'c�^� . -:.37' nr !+T 5-vc/ iorrci. As surveyed 1W me fh15 ? - A.U. 0461 rl�: rRl�'�I I , INC. C.rrpid�crs £ Sur er/crs � � _ _City of Fridley SUBJECT MI AT THE TOP OF THE TWINS BUILDING PERMIT .14048 L COMMUNITY DEVELOPMENT DIV. vk?w� r 1 PROTECTIVE INSPECTION SEC. 1 i i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 812-560-3450 910-F15 5/4/77 JOB ADDRESS 5840 - 4th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4, 4 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Larson 5840 - 4th Street N.E. 571-4778 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same I 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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 28' x 26' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Release signed by neighbor for okay for no survey . WA6 REQUIRED FOR WIRING $etre digging call local w1i"O's g RA'C'E PERMITS }'QEPNONE -ELECTRIC - GAA S Etc. )HEATING, PLUMBING AND SIGNS. REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 7280 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 1-1 728 ANY AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 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. $5,387 $2.69 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 $29.12 NONE OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $31.81 SIG .F TUREOFCONTRACTOROR UTHORIZEDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT 2� BLDG INSP DATE SIGNATURE OF OWNEWdF OWNER BUILDER) (DATE) rl CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWfdER:�A�c� %� BUILDER: ade2 �f Address: !to Address: Tel. No.: z1-77� No.:Street:K )y LOT: y 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 these Certificates. DESCRIPTION OF BUILDING To Be Used As: 6 E. Front: Depth: a6 Height: Square Feet:? '1 Cubic Feet: r? Zy s Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: ��y�/`%� Estimated Cost: $�j��.2� To Be Completed: 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. See reverse side for additional information. DATE: cy - SIGNATURE: Stipulations: s z,G 01 C AGREEMENT owner of the property located at F J'o - �/ �' Ste_, have no objection to the City allowing the construction of a c -4e to be located at - ;�� r) ' without the required certificate of survey that the City ordinarily requires for all new construction. Witness r� J. DEBORAH A. LENTSCH Fr NOTARY PUBLIC - MINNESOTA WASHMGTON COUNTY MY Commission Exp. Aug. 25, 1983 1V1WV1A�NV1, ii ,,�, -�' e, 4"" Signature L / /VA �oor � �.�,s _ lel., • Ss5�33 Address ,5-,/5.A -7 Date SUBJECT PERMIT NO. City of Fridley 2 0 3 9 9 AT THE TOP OF THE TWINS BUILDING PERMIT i? RECEIPT N COMMUNITY DEVELOPMENT DIV. 1 ~ PROTECTIVE INSPECTION SEC. r 1 � 1 I NUMBER REV, DATE PAGE OF APPROVED BY ; CITY HALL FRIDLEY 55432 J4 612-571-3450 910-F15 6/1/9.0 JOB ADDRESS 5842 - 4th.Street N, E, 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 4 Bennett Palmer Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Karen Besch 5840 - 2 4th. Street N.E. 572-2265 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. 8 USE OF BUILDING Double B.unga,low 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION JJ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install egress window tn basement bedroom 9 CHANGE OF USE FROM TO STIPULATIONS Window must meet State Egress Requirements TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 2 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5OQ $� 5O WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15,00 STRUCTION 9WTHE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE � ��- (`•�j � /� $15,50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI NHEN PROPER Y V IDATED T IS IS YOUR PERMIT BLDG INSP JQA4 SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI NEW [ ] ADS [ ] AL'I'T [ ] nn Construction Address: C� legal Description: R-1 AND R-2 Building Permit Application (� 7 /0 Effective 1/1/90 ®�v owner Name & Address: c.U— , X c , del.:R Contractor: S � © a Tel. # �- Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DE4C'RIP CK OF LTVDG AREA: length Width Height Sq. Ft. GARACM AREA: Length Width Height Sq. Ft. DECK AREA: length Width OHgt/Ground sq. Ft. OTHER: �� : <-�ef___- n -0./)--? ." hiv,ss� t . _ _' _ A9-c�' Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: Approx. Completion Date: Proposed Driveway Width If New opening Is Desired: Ft. $ $ See Back Page // Wid + 6' DATE: l� _ � O APPLICANT: Tel. # S%� ` Permit Fee $ %S - D C) State Surcharge $ e,_p SAC C uirge $ Driveway Escrow $ Park Fee $ Sewer Main Ciarge $ STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary L ] Not Necessary L ] D_?_65 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1, 1991 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATIOA AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Rete TOTAL Furnace Shell and Duct Work, Burner - Aisoa Replacement Furnace $ 20.00 $ aD, 6D Gas Piping (NBeded with new furnace) $ 10.00 $ Gas Range Gas Dryer "Air Conditioning - All Sizes $10.00 $ $ 10.00 $ $10.00 $1.a. All Others/Repairs & Alterations (LIST ON BACK) I% of Value of Appliance or Work $ Commercial/Industrial I % of Value of Appliance or Work $ State Surcharge $ .50_ TOTAL FEE $ • �� MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 6_R Yn '&�' S-' AVE 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Md rC -1 <R(o ,1991L OWNER%Z BUILDING USED AS r1f51G�C � I ESTIMATED COST 660 .7Co PERMIT NO. / M// DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units_ Circle One (Steam) (Hot Water�arm Trade Name Lfe)nn ), Size No. BTU _ HP_ EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING Signed B COM NY Mcg /&ag By No. � _ c;2 Approved By C Rough -In Date Final Date jq - 2-- � Z FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION i The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes 0 No ( ) 2. Is free from rust or deterioration Yes {%� No ( ) 3. Has no foreign objects lodged within Yes (Xj No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes) No ( ) 6. Has total heating BTU's of All other BTU's 35 OLD TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type N0. RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL S Yes ( ) No ( ) _ $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance Reinspection Fee $ State Surcharge ($15.00) TOTAL FEE Effective Date May 1, 1988 Job Address 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. � lg OWNER KIND OF USED AS TO BE COMPLETED ABOUT ESTIMATED COST �j(�c OLD - NEW BUILDING PERMIT NO. PERMIT NO. ( // ::ompany { Z C ,"I L J 0 LL�c Signed By ! kb -'C.` Tel. No. S�S ROUGH INSP. Date C FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE m ae. N ro u x d Water w C o a ds m .ci ro m u W w Heater w a� -4 b m c W F •a 3 M m 6 W w w a N 0 vet •.i .0 C� u •.[i i �. u W g m 4 14 10H O o ca to W m U o as 31ec 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (") a New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type N0. RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL S Yes ( ) No ( ) _ $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance Reinspection Fee $ State Surcharge ($15.00) TOTAL FEE Effective Date May 1, 1988 Job Address 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. � lg OWNER KIND OF USED AS TO BE COMPLETED ABOUT ESTIMATED COST �j(�c OLD - NEW BUILDING PERMIT NO. PERMIT NO. ( // ::ompany { Z C ,"I L J 0 LL�c Signed By ! kb -'C.` Tel. No. S�S ROUGH INSP. Date C FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE City of Fridley SUBJECT PE2 2/'6- 3 9 AT THE TOP OF THE TWINS ? BUILDING PERMIT RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. -238-7 3 �y vx NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 J`Ik"'J 612-571-3450 910-F15 6/27/94 JOB ADDRESS 5840 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 4 1 Bennett Palmer Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Karen Besch 5840 4 Street NE 572-2265 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 Duplex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE % 8 DESCRIBE WORK Install two egress windows in lower level 9 CHANGE OF USE FROM TO STIPULATIONS Install windows per State Building Code. Provide smoke detectors adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 2 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $700 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $19.00 Fire SC STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. .70 PLAN CHECK FEE TOTAL FEE 20.20 SIG E OF CONTRACTOR OR AUT IZED AGEN IDAATEI EN LY VALIDATED THIS IS YOUR PERMIT C% d 7'EPIC BLDG INSP r1ATE GNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW i I Effective 1/1 94" ADDN i CITY OF FRIDLEY ALTER (j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: — _a-�4c� ��_ — S� � � ��� _ _ L Legal Description: QV_ Owner Name &. Address: ez fV S tel. #— Contractor: �j V F MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: '11 C:)a c�t tit�nbcA_� s Driveway Escrow Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Erosion Control Type of Construction: $450.00 Conservation Plan Review Estimated Cost: $ h pU . c9y Approx. Completion Date: Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] (Cost on -Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft — Ft x $ _ $ DATE: r! CIAPPLICANT: Tel. # CITY USE ONLY Permit Fee $ / 9, Fee Schedule on Reverse Side Fire Surcharge $ - °%L7 .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $800 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 $ C� STIPULATIONS: 1 � °•-� Y R 19 � CITY OF FRIDLEY INSPECTION DIV, Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 58gD � � �t. NE RATE SCHEDIJLE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $�,� representations stated in this application are true and correct. !L ,19gy Gas Piping (Needed with new furnace) $10.00 $ OWNER K�'e� Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $10.00 $ ESTIMATED COST APQ0- DC) PERMIT NO. / *Air Conditioning — All Sizes $10,00 $ ®® DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK 1% of Value of Appliance or Work $ No. of Heating Units 1 Circle One (Steam) (Hot Water (Warm Air !' Trade Name ef'N°o u Size No. Commercial/industrial BTU HP EDR 1% of Value of Appliance or Work $ Fuel ( l-0— Total Connected Load State Surcharge $ .50 TOTAL FEE $ Z MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 t�& _01111Z�- R.50 STATE SURCHARGE REINSPECTION FEE 00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY eatr Signed By f 1� �.0 r 1 Tel No. `'t C—`f Approved By Rough—In Date Final Date M01_9 J FILL OUT BACK SIDE FOR STACK VERIFICATION ON �n REPLACEMENT FURNACE q W I CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes No ( j 2. Is free from rust or deterioration Yes ( No ( ) 3. Has no foreign objects lodged within Yes (A No ( j 4. Is securely supported Yes No ( ) S. Meets all current Code requirements for size and total BTU's connected Yes No ( ) 6. Has total heating BTU's of All other BTU's 41) 000 TOTAL BTU's mc) Remarksk,d- fwuvv--., 4 ad nn /V Q) List Alterations Being Done: HEATING COMPANY ftk,) e Signed ByOa/dsrn Date 1 C1 l q q CITY OF FRIDLEY 114SPECTION DIV. Effective On March 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS, AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES V RATE SCHEDULE JOB ADDRESS SiScl z Y I I .e � /t�- /- The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - Also Replacement Furnace �U. iI rulings of the Building Division, and hereby declares that all the facts and $ 30.00 $ representations stated in this application are true and correct, (Side Vent - FIII Out Back) Gas Piping (Needed with new furnace) $ 10.00 $_10, 00. ,1 996 OWNER�iaorc Coy-�4Jkv� N Gas Range $ 10.00 $ —�- BUILDING USED AS . Gas Dryer $ 10.00 $� .LJ ESTIMATED COST9� eO a, DD PERMIT *Air Conditioning - All Sizes $ 25.00 $ NO. All Others/Repairs & Alterations (LIST ON BACK) • DESCRIPTION 0_F _FURNACE AND OR BURNER 1%, of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) arm Air Commercial/Industrial Trade Name_ 'u-4. f` Size No. BTU 441 Poo HP EDR 1.25% of Value of Appliance or Work $ Fuel /I2 Total Connected Load State Surcharge .50 Burner Trade Name Size No. 'TOTAL FEE $ D. �� . BTU _ HP EDR' , HEATING COMPANY _P 1I4 �IT,c MINIMG �N� REFRIGERATION/AIR CO(�DITIONING�_ERMIT IS 25.OQ Signed By Tel No. 7-,2d? f PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By 14 Rough -In Date Final Date��% 'Air Conditioners can not be placed in a side yard without FILL OUT FLACK SIDE OR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE B Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHIMNEY 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 ( ) 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'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 Yes () No ( ) 8. Has combustion air been provided for water heater Yes( No (" ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIV. 6481 University Ave NE Fridley, MN 55432 572-3604 PLUMBING FIXTURE RATES: New Fixtures APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wash Floor �> Auto. i` Shower we ...::::::::.:..:...:.. D Trayrk. ::Washer Effective On March 1, 1996 Gas (Vt( Water Heater Range7tt < Gas I 'Elec NO. RATE TOTAL JOB ADDRESS_) SS s?,(-/ '` .0', �- '1'� Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas** Gas Range** 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 $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge The undersigned hereby makes application for a permit.forthe work herein LSU 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. /D 50 Owner Hd e,G&i e Building Used As F -e Estimated Cost 000 ©v ,A 0 be ;r 1996 � v A, i D PERMIT NO. O 7— PLUMBING COMPANY �`'(•o� ��cr�.d, hu l�pe,1( �o , SIGNED BY17QQ �� TEL NO. CO%^02 7( Approved By Rough—In Date Final Date $ �' MINIMUM FEE FOR A NY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE r PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 So INCHES. SUBJECT City of Fridley =46 AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT. � • __ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC r ; I NUMBER REV DATE PAGE OF APPROVED BY i /"'1 CITY HALL FRIDLEY 55432 A' 1.j 612-571-3450 910-F15 10/14/96 JOB ADDRESS 5842-5840 4 Street NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 4 Bennett Palmer Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Karen Besch (5842 Unit that needs fire repair) 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Advance Companies 6400 Central Ave NE, Fridley, MN 55432 572-2000 4423 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Duplex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR X ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Repair fire damage 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors as per 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 SQ. 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 2 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 @ $22.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $45,000 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- $529.75 Fire $45.00 STR�1r ION OR THE PERFORM CONSTRUCTION .7 \i 'L`// l d , Y PLAN CHECK FEE License SC $5.00 TOTAL FEE $602.25 SIGNATU OF CO 'RAC Aur ED AGENT (D EI WHEN PROPERLY LIDATED THIS IS YOUR PERMIT BLD INSP DATE SIGNATURE OF OWNER I IF OWNER BUILDER)--- WATEI NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application *—V? ConstructionAddress: 5-4?y2- 57" A145- Legal Description: ��11 Owner Name & Address: �i9QL:'�% i.7L�SC�-f Tel. # Contractor: 1J)dJWCL: COLI P,44 le� MN LICENSE # Address: &e -/Co nt A4 AC A)a- Tel. # S 72 Z 6a'O 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: Corner Lot [ J Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: F � �j¢� Estimated Cost: $ y Approx. Completion Date: IR5 yAys (Cost on Back) Driveway Curb Cut Width Needed: _ DATE: APPLICANT: Permit Fee $ Fire Surcharge $ �–Is, ez State Surcharge $ 29-150 SAC Charge $ License Surcharge $ ,-Ab Driveway Escrow $ Erosion Control $ 'ark Fee $ Sewer Main Charge $ TOTAL $ 6Z�451' STIPULATIONS: Ft. + 6 Ft = Ft x $ CITY USE ONLY Fee Schedule on Reverse Side Tel. # r 641 3� o .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 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 RATE SCHEDULE Residential Effective On January 1, 1997 APPLICATION FOR POWER -PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING -SYSTEMS AND DEVICES JOB ADDRESS 5— 02 Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range *Air Conditioning — All Sizes iv do All Others/Repairs & Aiteratii 1 % or Work Commercial/Industrial 1.25% of Value of Appliance or Work ON BACK) The undersigned hereby makes application for a permit for the work herein Rate TOTAL 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 $ 30.00 $ representations stated in this application are true and correct. to vim- ,1997 $10.00 $ OWNER.�GP�/1� $10.00 $ BUILDING USED AS $10.00 $ ESTIMATED COST PERMIT NO. J � $ 25.00 DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load State Surcharge $ , 50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE $ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING COMPANY .40�je_ z9iKZ Signed BTel No. Approved By Rough—In Date Final Date FILL OUT BACK SIDE FOR TACK VERIFICATION ON P J REPLACEMENT FURNACE V CEUAE4EY 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 O No ( ) —3. Has no foreign objects lodged within Yes O No 4. Is securely supported Yes O No ( ) 5. Meets all current Code requirements for size and total 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 Yes () No ( ) 8. Has combustion air been provided for water heater Yes O No ( ) 7 Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: 6ITY OF FRIDLEY INSPEC'► iON DIV. 5431 University Ave NE Fridley, MN 55432 763-572-3604 MARK Urinal Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE APPLICATION FOR PLUMBING AND GAS FITTING PERMIT OF TOTAL Wash New Factures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas" $10.00 Gas Range" $10.00 Gas Dryer" $10.00 Back Flow Preventer Required ( )Yes ONo Type S $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2001 Gas ;.. Water Heater Rnnnp : _., . Gas lElec JOB ADDRESS 5 O --/a Z� 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. --)//0/0/ .. 20_ Owner Building Used As Estimated Cost L-5 - 6 0 PERMIT NO. / 9CZ PLUMBING COMPANY SIGNED BY TEL N0. Approved By A Rough -In Date Final Date A7'l 2'0 State Surcharge $ .50 ��jj�� MINIMUM � R ANY PLUMBING/GAS PERMIT IS TOTAL FEE C-21- FEE THE $.50 STATE SURCHARGE 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 ( ) 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 manufacturers specifications. Yes () No When installina 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 CITY OF FRIDLEY PERMIT NO.: 2004-01504 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/01/2004 572-36U4 YAX: (763) 571-1257 ADDRESS : 5840 4 ST NE PIN : 233024240020 LEGAL DESC : BENNETT-PALMER ADD : LOT 4 BLOCK 4 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : DUPLEXES CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH. # INSPECTIONS 1 APPLICANT HUNT ELECTRIC CORPORATION 2300 TERRITORIAL RD ST PAUL, MN 55114- 1111AIRI p1;7 BESCH KAREN 5188 HELENA RD N OAKDALE, MN 55128 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 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 117431 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.