PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date:
owner:
Address
Address
LOCATIM OF BUILDING
No.ixeet —` r it Part of Lot
GO
Block Addition or Sub-Dividon
Corner Lot _ ___ Inside Lot Setback to Sideyarjea
Sewer Elevation ____ Foundation Elevation
DESCRIPTION OF BUILDING
X
V
Front Depth „ ,pl"�- Height Sq. Ft. Z Cu.
Depth Height _ Sq. Ft. Cu. Ft.
Type of Construct! Est. C-kt To 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.
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 h% 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
withiaa� city limits and this permit may be revoked at any upon viol�Lie�,of any of the provisions of said
w
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 hems.
Application for power Plants and Heating. Cooling. Ventilation. Refrigeration and
Air Conditioning Systems and Devices 'U'vo AS ����,�io -� n7sr- /V,
AP
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470
GRAVITY WARM AIR: HATE TOTAL Location 4��5� dr.01,/
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
Repairs & Alterations—up 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. 00,000 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. IDR Hot Water ...
8.00 $
Each add. 200 sq. ft. IDR Steam ......................
2.50 $
Each add. 320 sq. ft. IDA 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:
1st 3 Fixtures ......................
Additional Fixtures
Gas Range to 200,000 BTU ...........
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
NO RATE 7,d-
- x $1.50 $
_ x .50 $
x 2.00 $
See Fee Schedule
TOTAL FEE $ Z-520
Owner
i f i W
Kind of _• //"
Used as
AU, GT1 s
19
To be completed about
�O
Estimated Cost, $
01 e!T! Building Permit No. `S Permit No.
DESCRIPTION OF WORK
HEATING or PO PLANIt-Steam, Hot Water, Warm Air—No—
Trade Name Size Nom_ /y
Capacity S Ft. E R BTU—/ H.P.
�os,�. z ,
Total Connected Loa " 0 " Kind of Fuer
BURNER —Trade Name Size
Capacity Sq. Ft. E.D.$% - ° BTU H.P.
/) GEO. SED ICK HTG. & AIR-COND. CO
1001 Xenia AV. S.
Minneapolis 16, Minn.
Signe
By
.QW
42 7M Business Phoneo
(REMARKS -OVER)
r
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures
x
$3.00
N
x
$2.00
>4
m
$2.00
b
x
o
Water Heater - to 99,000 BTU
x
m
100,000 BTU to 199,000 BTU
Water
$10.00
Water Softener
x
$7.00
New Ground Run Old Building
x
�
0 a
N
q
GAS FITTING FEES:
4J
S+
p,
w
x
$3,00
Heater
N
4J
Gas Range to 199,000 BTU
x
$10.00
REPAIRS $ ALTERATIONS
b
N
N
b
W
$2.00
State Surcharge
TOTAL FEE
$4v
N
C.'
.[
"a
'
m
11
4J W
1) N
to
N
M
-r4
3
0
Q w
O
En
O
w
U M
3
U
U
.c
O
as
lec
cin
U
P7
1
1st
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures
x
$3.00
Future Fixture Opening
x
$2.00
New Fixture, Old Opening
x
$2.00
Catch Basin
x
$5.00
Water Heater - to 99,000 BTU
x
$5.00
100,000 BTU to 199,000 BTU
x
$10.00
Water Softener
x
$7.00
New Ground Run Old Building
x
$5.00
Electric Water Heater
x
$5.00
GAS FITTING FEES:
lst 3 fixtures
x
$3,00
Additional Fixtures
x
$1.00
Gas Range to 199,000 BTU
x
$10.00
REPAIRS $ ALTERATIONS
First $100.00
$5.0Q
each add. $100.00 or fraction
$2.00
State Surcharge
TOTAL FEE
/ REINSPECTION FEE
($10.00)
Job Address J
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 a1Jpplica`tioGnj are true and
/ccorrect
Fridley, Mn./ v d U / f , 19 /
OWNER /✓ �� l / T /L--)
KIND OF BUILDING 0,
USED AS --p L' F I
TO BE COMPLETED ABOUT 7 l�J U U �� J l / 1®
ESTIMATED COST
CLI) - NEW BUILDING PERMIT NO. PERMIT NO. VJ h.J
Company L PLO G
Signed By
Tel. No.
S
$ ,50
UGH INSP.
Date
NAL INSP.
Date ^�
'PROVAL FOR PERMIT %!
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
SUBJECT
City of Fridley
2 3 6 27
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
Ir
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC
3® p% I
NUMBER
REV
DATE
PAGE OF
APPROVED By
1 CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/11/95
/ /
JOB ADDRESS 5924 4 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
I
1
Holly Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Rajal Zajac 5926 4 Street NE
586-9771
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION J7 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (24 Sq) 2nd Layer
9 CHANGE OF USE FROM
TO
STIPULATIONS
Roofing can be the 2nd layer
but not the
3rd.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED 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
1
1 STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,440
$.72
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
ATING CON-
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW RE711
STRUCTION OR THE PERFORM CE OF CON CTION
$48.00
1.44 Fire SC
/95
PLAN CK FEE
TOTALFEE
`
50.16
SIGNATURE OF CONTRACTOR AUTHORIZE GEN IDATEI
vr HE
w
B G SP
LY LIDATED
THIS IS YOUR PERMI
DATE
9S,GNATURE
_
OF OWNERIIF OWNER BUILDERI (DATE)
NEW (] Effective 8/1/95
ADDN [ ] CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: .59 z -fl-I 5 -1' Q e 5 q G
Legal Description: U [e-
Owner Name & Address: Tkq S"+ k Tel. #
Contractor: _ MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
"- ) — . � c11
Comer Lot [ ] Inside Lot [ ]
Type of Construction:
Approx. Completion Date:
4 J Q � 0 6v - /, y
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $ L1 q0 _
Driveway Curb Cut Width Needed:
DATE: APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
(Cost on Back)
Ft. + 6 Ft = Ft x $ _ $
Tel. #
CITY USE ONLY
4 1
$ , Fee Schedule on Reverse Side
$ /- L�� .001 of Permit Valuation (1/10th%)
$ , 2Z $.50/$1,000 Valuation
$ $850 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 [ ]
Ile—
TOTAL $
STIPULATIONS: .
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
Effective On March 1, 1996
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
JOB ADDRESS ft 79,(,3� 4
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 $ C''). Ci 0. representations stated in this application are true and correct.
$ 10.00 $ ,1996
OWNER
$ 10.00 $
BUILDING USED AS
$ 10.00 $ / /
ESTIMATED COST���,j , G�> PERMIT N0. 437
$ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNE8
$ No, of Heating Units, Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No,
BTU 7:_'), HP EDR
$ FueVulc& _ C Total Connected Load
State Surcharge .50 Burner Trade Name
TOTAL FEE L�_)
MINIMUM FEE FOR ANY HEtiTINVG/CUOUWLgNENilLATION
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.
BTU
HP
Size No.
EDR
HEATING COMPANYSULID, ,v
Signed By Tel NO.°QL __4 -, '\—J_
Approved By Rough—In Date Final Date
FILL OUT BACK SIDE F R STACK VERIFICATION ON
REPLACEMENT FURN CE
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
�=i
CEWKNEY 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:
�=i
SUBJECT
MIT
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
29259
h.REC
`� -------COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
L 612-571-3450
910415
4/20/99
10B ADDRESS 5924-5926 4 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
1
Holly Terrace SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Rafat & Theresa Zajac 11641 Washington St NE, Blaine, MN 55434 862-3395
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Woelfel Bldg Construction 390 Derrynane, LeCenter MN 56057 507-357-6207 6711
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Duplex
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION Lj REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof Structure (20 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,714
@
$.86
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
$56.75
Fire SC $1.71
PLAN CHECK FEE
TOTAL FEE
�1^ '^ I 00�
YI°6
T
License SC $5.00
$64.32
SiGNA EOrTOII OR AUT"ORIzEdAcENT IOATE,
WHEN PROPS Y VALIDATED THIS IS YOUR PERMIT
444
S,G ATUREO 0WNEA0F OWNERBUIER. iOATE.
•* _
BLot NSP BATE
NEW [ ] CITY OF FRIDLEY
ADDN [ ]
ALT [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 9.
Legal Description:
Owner Name & Address:
a
Contractor: Ddnn2
_<� t
la j(U (" M55N
's �_Jttach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Effective 1/1/99 rr��
Tel. # O Co Q --i3-33-5
TENSE 0!—*—
)Tel. # En
Co a 6 9
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground� Sq. Ft:
v
Estimated Cost:
Construction Type:
$
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
Cr
DATE.
IZO (9' APPLICANT^ Tel. # _ 3 3 9S
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC -'Charge`
License Surcharge
Driveway Escrow
Erosion Control
Park Fee.,
Sewer Main Charge
'7 l
$ 61
TOTAL
STIPULATIONS:
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
RATE SCHEDULE
I�113`ep
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,:
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace $ 30.00 $
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00 $
Gas Dryer $10.00 $ 6
*Air Conditioning — All Sizes $ 25.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work $
Commercial/industrial
1.25% of Value of Appliance or Work $
State Surcharge
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.
Effective On August 1, 1995
JOB ADDRESS 7 /' 11�( t, I le -L
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 a%d corfect.
OWNER �h s�Gy�®ter% /G�/�t/�/ moi✓
BUILDING USED AS //GcJ F-- /ZwrZ
ESTIMATED COST! PERMIT NO.
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
Burner Trade Name Size No.
BTU HP
EDR
HEATING COMPANY`�/
Signed By Tel No.
4 (1/1f �. (,off
Approved By Rough—In Date Final Dat5Y
FILL OUT BACK SIDE FOk STACK VERIFICATION ON
REPLACEMENT FURNACE
Remark/s:/
�i ,s
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
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 ()
No ( )
Remark/s:/
�i ,s
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIV. �.0\ Effective On Jan 1, 2001
6430. University Ave NE L � o
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
763-572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO. RA`i E TOTAL JOB ADDRESS -1'9 R G 4 J_r 71 E-1
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
Rain Water Leader $ 7.00 / o _'20a/
Sump/Receiving Tank $ 7.00
Water Treating Appliance $10.00 owner S I� A of NS 0 fV tjy Al S ® AJ
Water Heater -Electric $ 7.00
Water Heater - Gas*" $10.00 �— Building Used As %�€S
Gas Range*" $10.00 ew%
Gas Dryer** $10.00 Estimated Cost -T®o. PERMIT NO.
Back Flow Preventer Required ( )Yes () No )
Type $15.00 PLUMBING COMPA Y ilAl-S® moi
Reinspection Fee $47.00/Hr SIGNED B TEL N0. 769- �*_63 - C,;? _'�4
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 4—( �-
1.5% of Value of Fixture or Appliance err.
Approved By Rough -In Date Final Dat i
State Surcharge $ .50
MINIMUM FEE FQR ANY PLUMBINGIGAS PERMIT IS $20.00
TOTAL FEE $•PLUS THE S.50 4TATE 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 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:
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
February 11, 2002
Shannon Munson
5926 4" Street NE
Fridley, MN 55432
Re: Final Inspections at 5924 4" Street NE and 5926 4"' Street NE
Contractors: Reliant Energy-Minnegasco-Blaine Heating
R. A. Johnson & Son
Dear Ms. Munson:
A mechanical permit was issued on December 13, 2000, to install a gas dryer at 5924 4"' Street,
and a plumbing permit was issued on April 6, 2001, to install a water heater at 5926 4"' Street.
According to both the 1991 Uniform Mechanical Code and Section 4715.2800 of the State
Plumbing Code, a final inspection shall be conducted on the work authorized by these permits. As
of this date, no final inspections have been called for.
The permit fees that were paid cover 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
CI -I Y OF I-HIULLI INSI�Lk. 1 ION UIV,
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTI IRFS Tn RF inicTAI i cn nm CAl,u ri
L-Iteclive On Jan 1, 2UO2
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas"
Gas Range"
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
Reinspection Fee $47.00/Hr
$ 7.00 The undersigned hereby makes application for a permit for the work herein
$ 4.00 specified agreeing to do all work in strict accordance with the city codes
$ 5.00 and rulings of the Building Division, and hereby declares that all the facts
$ 7.00 and representations stated in this application are true and correct.
$ 7.00
$ 7.00
Z7 ,20_n -_-3
$ 7.00
$10.00 Owner nn e�yl Z)5 lYj1
$ 7.00
$10.00 Building Used As
$10.00
$10.00 Estimated Cost PERMIT NO. / l --
$15.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
.50
PLUMBING COMPANY
SIGNED BY C TEL N0.
FAX#
Approved By Rough -In Date Final Date '
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL, BE RETURNED
When r nlarinQ an axictinn f uranna, 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 rnmhuetion air is sized and installed to meet the current codes
and manufacturers specifications.
Yes () No ( )
When required to install a new nomhuctinn air it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes () No ( )
When installing a new vpnting slestpm, 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,
Applianr^ Tyne and Size/Comman-Vant Size/Common-Van
Yes( )No( )
and Vent onn rtor Informatinn
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter
inches
Appliance #1 Vent Connector Height ft Length ft Diameter
in Type
Appliance #2 Vent Connector Height ft Length ft Diameter
in Type
Appliance #3 Vent Connector Height ft Length ft Diameter
in Type
HEATING CO:
Signed By:
Date :
3uilding BUILDING Permit No.: �`
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'dc�
)ATE 5 1 9 t o it YOUR E-MAIL ADDRESS
,ITE ADDRESS C --)90W - Ef � C9 �S4 A/�Aj �i�L4 Z2 --
'HIS APPLICANT IS: ❑ OWNER AONTRACTOR
PROPERTY OWNER/
NAME: 5h C nno <l
Mr J•n !h 0 J
$ 65% of Building Permit Fee
ADDRESS:g� aL1 !J
St,
CITYF t C� (C to STATE�GIP�aZ
TENANT
License Surcharge
PHONE: iia - 5-'l l — ca
-15 $
$ $1550 per SAC Unit (Plans to MWCC for determination)
CONTRACTOR
Nom:
o (7, C-9,
$ $450 Conservation Plan Review
STATE LICENSE # ;305LY9
7
3 J DATE 3131 1 Ol,z
i` 't Sys CITY &M!L (' "< r. STATEM &kIP CLi30
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: 1,2 00 --A" nc
I r�F'—PVW�a
WITH APPLICATION
PHONE -
FAX
1(v� $
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION
SIZE
OF APPLICANT
O FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION
❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH
❑ ROOF
❑ DRAIN TILE
❑ DECK
❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW
❑ ADDITION
❑ MAINTENANCE/REPAIR
❑ REMODELING
DESCRIBE WORK BEING DONE: Roo f
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT L1100 Sq. Ft.
ROOFING
NUMBER OF SQUARES_
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT: _
SIDING
❑ Vinyl
❑ Aluminum
5wOther
& GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS, & PORCHES SUBMIT:
I . Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No 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 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ` ,4L4t E A- OCCUPANCY TYPE
Permit Fee
$ $ a �' See Back Page for Fee Schedule
Plan Review
$ 65% of Building Permit Fee
Fire Surcharge
$ .001 times the total job valuation
Surcharge
$ I 40 .0005 x Permit Valuation Minimum $.50
License Surcharge
$ c7ll $5.00 (State Licensed Residential Contractors)
SAC Charge
$ $1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$ ft + 6 ft = ft x $20 = $
Erosion Control
$ $450 Conservation Plan Review
Park Fee
$ Fee Determined by Engineering
Sewer Main Charge
$ Agreement necessary ( ) Non Necessary ( )
Total Due
$ 1 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 aclmowledge 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.
OF APPLICANT
�SIGNATURE PRINTNAME -EKGC9 fie e\b eA P (L-- DATE 9 �O�
Building MECHANICAL Permit No.- r
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FIZIDLEY
763-502-4977 FAX EFFECTIVE 1-1-2010
DATE 5- 49- / D YOUR E-MAIL ADDRESS
SITE ADDRESS 6' aq AP" S4- NE FF a /,a/—,
THIS APPLICANT IS: ❑ OWNER XCONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNUT TYPE
TYPE OF WORK:
t L Sk-
PHONE:] d3- 5-7(- 61,97
COMPANY NAME: ft t v L- O k,Lt ►-
CONTACT PERSON: C k r< J le � p
�� Oft STATE M N ZIP SS q A
STATE LICENSE # EXP DATE
ADDRESS: 4 0 T "t t+- �, S� N$ CITY g:1 /1(t STATE MU ZIP
PHONE J " 7,r(+ d �j S FAX
❑ SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK:- I)5A A (I At 4D-- C o v-. & c- E ( 4s,^
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALL'S PER MANUAL J 2006 ASffitAE HANDBOOK.
Equipment Installed MFG: av v � MODEL: 1110 0i I- D l $ SIZE/BTU 1- 1l3, 10
MFG:
MODEL:
SIZEIBTU
MFG:
MODEL:
SIZE/BTU
A/C $25.00
FIREPLACE (GAS) $15.00
_GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $15
FIREPLACE (WOOD) $35.00
NEW GAS GRILL $10.00
$35.00
$35.00
_GAS UNIT HTR $10.00
_BOILER
LINER $10.00
_FURNACE
_GAS DRYER $10.00
POOL HEATER $35.00
_CHIMNEY
DUCT WORK $10.00
_GAS PIPING $10.00
_VENTILATOR $15.00
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 (17�..eL�a{Jw,�� _ PRINT NAME—(!1' 1' am D4TE S' 9 1 ` /
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977