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PRE 2010 DOCSBUILDING Village of Fri Date`".".`. . ... . . • Owner ..., rr..- ........ Address ...................................... i N° 2397 Builde... ..�;................................... i Address ::............ LOCATION OF BUILDING No. Street ... . ........ . ..... ... Part of Lot . ..... ........... . Lot ..:...:��.� .+".'.'. Block ... ......... Addition or Sub -Division . hfift Corner Lot ....... .... Inside Lot . f::........ Setback Sideyard %a ................. DESCRIPTION OF BUILDING ToA�;o - ..« . Front ... Depth .�y." .. He! ts...... Ft.. Cu. Ft........ . Y, u. _ Sq. ...... .. ..... Height ......... Sq. Ft...... Cu. Ft........ . ... To be Completed Type of Construct3 : ............ Est. Cost ................. ................... 4 �K. In conaideratio of the issuance to me of a: permit to .construct the building described above, I agree to do the proposed work accordance with the description above set forth and in compliance with all provisions of ordinances of the age of Fridley. ,.... + ... .......66.4.6... 0-0 . ...�.A " 14* payment of a fee of $........ , permil is hereby granted to 66:66 ................. to construct the building or addition as described above. TlWpermit is granted upon the •express conditi n that the person to whom it is granted and his agents, employees and workmen, in all work done in, around an 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 ivith- the village and this permit may be revoked at any time upon violation of any of the provisions of said V. . 'JIM—F, '.':.M. ; ..... Building Inspector NOTICE: This perm)does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. �il .7 City of Fridley, Minn. BUR DING PERMIT N® 3336 cry Date: ........................................ e �r Owner ..L ....: `',�% ': Builder Address�...:`:. ....� .�. �.:: Address ...G. �� LOCATION OF BUILDING No�,4. Ir .. Street � . :'E"` ......... Part of Lot ................................ Lot ............ Block .................. Addition or Sub -Division ....................................... Corner Lot ............ Inside Lot ....,..... Setback ............ Sideyard ........................... DESCRIPTION OF BUILDING To,be Used as: �' � ..�... Depth ........ Height . .. ... Sq. F't �.?..: Cu. Ft Front � � ®�� � , .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft ........ Type of Construction ..................miltCast.. ..` ........... To be Completed ................... i (f Z 3.5_ 7 6 jrfn�erad tion of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in con}pHance with all provisions of ordinances of the city of Fridley. , , u ?�°.......�. :�.. ............ In consideration of the payment of a fee o ' $...�r�.. -permit is hereby granted to ................... ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it Is granted and his agents, employees and workmen, in all work done In, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ``, .Y � Building Inspector 'A4. NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. 0 Date: June S, 1965 City of Fridley, Minn. BUILDING PERMIT Owner: _Ray=d Gullickson Builder Address 5645 5th Street N. Be Address Same LOCATION OF BUILDING No. 5648 street 5th Street N. E. Part of Lot _ Lot 1 & of 2Block _ 3 Addition or Sub -Division Hamiltons Corner Lot — Inside Lot Setback __ _ Sideyard Sewer Elevation To be Used as: Type of Construction Foundation Elevation DESCRIPTION OF BUILDING N? 7777 Front Depth Height Sq. Ft Cu. Ft Front Depth Height Sq. Ft Cu. Ft Est. Cost 01, 800• 00 To be Completed 0 Storm damage repair • 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 afl provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ID,= , permit is hereby granted toRa=cmd 9,13 3 kson 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 regardi,gg location, construction, alteration, maintenance, repair and moving of buildings wiorthi n� city limit uns permit may be revoked at any time upon violation of any of the Provisions of said Allen Jensen Building Inspector NOTICE: Tbb perm@ don mot sown the eoastrudlen, Mshpa = for wM h& pbmbtme, Bn baths, sewer or water. Be sun to no the BWMh* bnpester for separNo pwmha for thea home. 777 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA t OWNER'S NAME MMDER DD / i ADDRESS LOCATION OF BUILDING No. Street Part of Lot r LOT d' �TJLO CK _3 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 OF BUILDING Front ` Depth height Sq. Ft. Cu. Ft. Front Dept Height Sq. Ft._ Cu. Ft. Type of Construction C n Estimated Cost ��® 1 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. DATE_YI4 S SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). SUBJECT PE T NO. City of Fridley WRECKLNG . NO 16 3 81 AT THE TOP OF THE TWINS PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ,.' 612-571-3450 910-F15 9/11/81 10B ADDRESS 5648 - 5th. Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 11 A 2 3 Haini.lton's. Addn. to Mechanicsville SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Raymond Gullickson 5648 - 5th_ Street N.E. 574-9468 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 ❑ REPAIR ❑ MOVE ❑� REMOVE 8 DESCRIBE WORK Wreck.16' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Area to be cleaned of all debris.. 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 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 NONE WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $15.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT .�� ?—//— R I� o g f( 8 SIGNAT EOF OWNER IIF OWNER BUILDERI (DAT EI BLDG INSP DATE Effective Aug. 1, 1981 City of Fridley iLr•dEGT Permit No. AT THE TOP OI THE TWINS r L WRECKING PERMIT APPLICATION Receipt No. t L-------- COMMUNITY DEVELOPO4XT OIV, L I! FROTECTIVE NdECTOR OAT, CITY HALL FMOLET 994U 09-600'3"0 MYLsi]L REV. DATE ►AYE OP A►PROV 0 By Job Address -7/4 v -7/4lyt Legal Lot No. Block No. Tract or Addition Desc. ,� �d �1Z / 6 .,S Property OwnerAddress Phone /V S 7V - s" 6 Contractor �- Address Phone Description Front Depth Height Sq. Ft. Cu. of Bldg. /11C/1-;2.-.;2-���-j() _Ft. No. of Dwelling Units Taxes Paid Tax Receipt No. o9 <,,9 6- XK i I Estimated Cost of Wrecking To Be Completed Utilities to be Notified and date Services Disconnected Npls. Gas Co. N.S.P. Northwestern Bell Tel. Co. Engr. Dept. Cust. Bus. Of c. ` Bus. Of c. 372-4850 330-5540 I' 332-4112 lJ Date Dat4 Date Wrecking Fees: $1.25 for each 1000 cubic feet or fraction For structures which would be impractical to cube, the fee shall be based on the total cost of wrecking such structure at the rate of $6.00 for each $500.00 or fraction. MINIM M FEE: $15.00 No State surcharge on Wrecking Permits. Approved By Water & Sewer Department: All Bills Are Paid Services Are Disconnected The undersigned hereby makes application for a permit to wreck the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Department of Buildings, and hereby declares that all facts and representations stated in this application are true and correct. ContiYactor 00 Date r We the property owners on the South side 57th Avenue who border the right-of-way between 4th and 5th Streets, do hereby declare our intent to have 176 feet of this right-of-way blacktopped by a private contractor. We the undersigned, will be responsible for the financing of this improvement as per agreement between us. We will also be responsible for the maintenance of this portion of the right-of-way and it is agreed that this alley will not be posted as a private drive. We the undersigned, do reserve the right to solicit an appropriate portion of the cost for this improvement to the property owners along this right-of- way who make major improvements (such as garage, shed, parking area, etc.) or constant usage of this alley due to our improve- ments. 5"G L/ Signed: 1. Date 2. � � �LZf Z 5639- 7- 3. gel 5. S—li P �� S T Ij!�- SUBJECT PERMIT City of Fridley N 16 3 8 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T I RE EIPT NO. •COMMUNITY DEVELOPMENT DIV. ------- r I PROTECTIVE INSPECTION SEC. ".-I CITY HALL FRIDLEY 55432 I.J NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/11/81 JOB ADDRESS 5648 - 5th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1, A 2 3 Hamilton's Addn. to � NechmiCavillLHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Raymond Gullickson 5648 -- Bk 5th -Street N.E. 574-9468 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 ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 24" x 3W Detached Gara e 9 CHANGE OF USE FROM TO STIPULATIONS Locate garage 3 feet north of fence and 25 feet south_ of north property line. Provide a hard surface driveway. SEPERATE PERMITS REQUIREI FOR WtRt r. HEATING, PLUMBING AND SIGNL WARNING Before digging call local utilities TELEPHONE - ELECTRIC - CAS Etc. 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 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 SURTA�Xr AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $61804 $3.40. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $62.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALLE190 $ - SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT SL BLDG INSP OA SIGNA RE OF OWNER IIF OWNER BUILDERI MATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: ADDRESS:��� TEL NO: BUILDER: Sjel 172,g:- ADDRESS: TEL NO: Construction Location STRIMT NO:.5 6 `/1? STREET: T f Af LOT: , A, �✓�^ aC 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 C0'F7R 1!4 F0 G e9RS6EFront: Depth: -30 Height: cS Squane. Feet: Cubic Feet: 7Z0V Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Ls -am F es' Estimated Cost: $ t47 JO L%� Zb Be Cbmpleted: 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. 1 y DATE: ,1 _ r 0 ! SIMATUrz: Stipulations: I i�N2.�breR► koc.� , 'U C) Soap. cis A.) a. Pew YAND APPRAISAL CARD I GARAGE - CARPORTS vnQrwrF, JDITION EFFECTIVE AGE YEAR BUILT /S ATTACHED DIT. CLASS BASM'T YEAR BUILT FRONT CLASS SIDE BACK NO. STORIES FOUNDATION FLOOR OPEN SCREENED GLAZED Lh BY BY EXTERIOR FOUNDATION FLOOR �9" 1 2 3 ROOF EXTERIOR INTERIOR ROOF O.H. DOORS 1/ t$ C P• w INTERIOR ELECTRICITY 3 BREEZEWAY YARD IMPROVEMENTS YEAR BUILT CLASS DRIVEWAY FOUNDATION FLOOR I .;4 EXTERIOR ROOF INTERIOR DIMENSIONS RESIDENCE , X = BASEMENT X FINISH = BREEZEWAY X = X X = X = t"Ai X = 5'a X = ! - X _ x = PORCHES X = X - - X = X = X = X = x = x = X = BUILT INS NO. 19 19 19 b 19 v 34 //0 use, (o a S RANGE -OVEN p HOOD -FAN v n DISHWASHER GARBAGE DISP. - FIREPLACES 3 •FIXTURE BATH 2 - FIXTURE BATH CERAMIC TILE VANITY CARPET - YARDV A> ­4 /C INTERCOM ERE AIR CONDITIONER 6 WALKOUT `� ,� `� �»� ��� i .f> . . 4t, „y 4 � y S Karl • `� �p,#>"@"'S* 1 ". ^� � � $ � � r � � Y� � .F o-�, T �r l •p''." � �Ty�p �} Aa it � � � g j � i�? �$ �� �� � +d� i s 4 � � �fl, � it r. 5 �n,Zs3,, 9.w r SUBJECTNO. ° City of Fridley 2 3 5 AT THE TOP OF THE TWINS BUILDING PERMIT - RECEIPT NO. Ir • _____ COMMUNITY DEVELOPMENT DIV. r I � PROTECTIVE INSPECTION SEC. �© NUMBER REV DATE PAGE OF APPROVED By ' ---n CITY HALL FRIDLEY 55432 "•' 612-571-3450 910-F15 7/24/95 JOB ADDRESS 5648 5 Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1, Pt 2 3 Hamilton's Addn to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ashwood 5648 5 Street NE 571-4210 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO D & D Home Improvement Inc 7401 Central Ave NE, Fridley MN 55432 784-7543 4840 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 Q ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 30' x 9' Deck and Ramp 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,200 $1.10 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 RR THE PE RFO CE OF CONSTRUCTION $54.00 Fire SC $2.20 PLAN CHECK FEE TOTAL FEE License SC $5.00 62.30 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN A_LIDDAATED THIS IS YOUR PER�,M/IIT �PAOPERL f G�/F�.� 26/ --r 0, BLO -NSP TEf SIGNATURE OF OWNERoF OWNER BUILDERI IDATEI NEW )) Effective 8/l/95 ADDN (j CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2®� Building Permit Application Construction Address: _ 5-7h S -- — -- - - Legal Description: — Owner Name & Address: Dh Woo Tel. #-6 - Contractor: D & D Home Improvement, Inc _ MN LICENSE # 4840 Address: 7401 Central Ave NE, Fridley, MN 55432 Tel. # 784-7543 _ 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 Tom® Width �_ Hgt/Ground 91 Sq. Ft. 3'70X OTHER: - Corner Lot p4 Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: T -P ea 1-(+Mbe� ---- Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = t x $ _ $ DATE: �% ���` � APPLICANT: Tel. #�_ CITY USE ONLY Permit Fee $ 5 �'/. Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ ! /® $.50/$1,000 Valuation SAC Charge $ C1 $850 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 $ 30 STIPULATIONS: D & D HOME IMPROVEMENT INC. 7401 Central Avenue N.E. Phone 784-7543 Fridley, MN 55432 IVE M .4, cA� Cross SectiaAS Deck �.. a VerAfticgi CIf 'rmofirA)Ari gPacIw� ' x8 TAteb Totsts f o,c.• — t'-,*cb yxy Posts ya' deev $'' Nand U4n Nome, smp"v" Ilr 9184 95 3 gid) al5� AGREEMENT ,owner of the property located at �� ,�7� •c��i �� ✓� have no objection to the City allowing the construction of a/an�� to be 1 ocated at 57 without the required certificate of survey that the City ordinarily requires for all new construction. —Signature ate Witness T �o �p JJ>%�IU�'WA� 4 SUBJECT PE NO. City of Fridley 26916 AT THE TOP OF THE TWINS BUILDING PERMIT -RtCVTT_ NO. COMMUNITY DEVELOPMENT DIV. ,l/ PROTECTIVE INSPECTION SEC. Cl �� / r 1 NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 �j 612-571-3450 910415 7/30/98 JOB ADDRESS 5648 5th St NE 1 LEGAL LOT NO.BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 & 1 2 1 Hamiltons SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert and Joan Ashwood 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 Ek REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK -Reroof ha3:ear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment f LLE1:l7rym1Errt must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIREO 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 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 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 1584 .79 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. $51.25 Fire SC $1.58 PLAN CHECK FEE TOTAL FEE 53. SIGNATURE OF CONTRACTOR OR AUTHORIZED ENT IDATEI OPER V (DATED TH IS YOUR PERMIT BLOG [NSP y r�ATE Si ATURE OF OWNEIR OF OWNER BUILDER( [DAT I NEW [ ] Effective 1/1/98 ADDN [ ] ALTER [ J CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION X ConstructionAddress: Legal Description: >' Owner Name & Address: Tel. # Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE-AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: __ 'F Construction Type: Estimated Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ .DATE: -7- 3 6 — `j g APPLICANT:M1 Tel. # s 7 ) Y Q) CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ S `' .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 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 $ STIPULATIONS: CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES � RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 $ 36 - 00 (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ *Air Conditioning - All Sizes $ 25.00 $,QO 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 $ .50 TOTAL FEE $5® MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE S.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in -a side yard without written permission from adjoining property owner. 1. JOB AD OWN BUILDING USED AS6PSIQL4 C -f—, ESTIMATED COST 6 G� ective On January 1, 2000 PERMIT NO. 7Y/ LD DESCRIPTION OF FURNACE AND OR BURNER No. of Heating UnitsCircle One (Steam) (Hot Wat;r) (Warm Air Trade Name Size No. BTU 6nn HP EDR Fuel Total Connected Load_ Burner Trade N BTU HP Size No EDR 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. BLAINE HTG. A/C & ELECT TE,-- —`^f 13562 CENTRAL AVE. �l E. HEATING NOKA, MN 55304 0 Signed L # iv Approved By Rough -In Date Final Date.. 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 wh,ece required. Yes O No(,) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ),No( The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance TvDe 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 SEP -19-00 TUE 11:16 AM DREYER,ROBERT 7554937 P.04 � r ' R ! 1000 Sq Jobb 7eme Enti rt. idesll!a,a t1A/7 Rlf1r1 Priuloul mlified by RCCA to ]Hoot all 1quiremems of Mtaumi J Form c MNUFUF .4. rU14ut. RItiA'1'-J: 3.0.14-- W12070 - - 1 X=QOrRDDm Cntizo Y.OLsc ramtslcr standard 2 8tnv=gFat'tpoaedWeH 1'>4.r, Ft, 194.0 Ft Ft Ft 9 Room l0imeiiono. Pt C . C 1 25.0 x 36.0 Pt >< Ft. x Ft 4 Cc!*%Ft CDadltOption 8.0 1 d R.0 best/cool TYPE OF CST Him Area Btuh Arca Bruh Area Btth Area WA E UN)$ RE NO. HI CiS Langth RS CIS Length Ht8 C13 L -S h Ht8 CiS LmlgLh HIS C18 S drams r 12D 7.2 2.1 992 *«*+ a«. 992 ns. cert agar •r*r waw* arwr BYPOSed b 14B 13.0 2.9 260 roar o00 26C rr.s gar u*a ...• .r.. .•.. 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DO saw «iii 1628 ar► y *rrr 20 Cf14Air Regtlired acct 19382 wra 1036 1036 ++**++* 1D36 1036 *tor rrrr Priuloul mlified by RCCA to ]Hoot all 1quiremems of Mtaumi J Form CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR New Fixtures --:,.•.•.:. • -.-.-.---------= r'- -----'--- :f.1.QYIxx:r;i: Uri Shower TraStories nal 3 .: : Floor Drain - Auto.sh Washer , Water HeaterWa Gas ..:..":<,. Gas Elect and rulings of the Building Division, and hereby declares that all the facts :>. Basement a ment and representations stated in this application are true and correct. Catch Basin $ 7.00 -112 Z 1 �CX� Rain Water Leader $ 7.00 Floor 1 $ 7.00 ASHWOOD, ROBERT Water Treating Appliance $10.00 Owner 5648 5TH STREET NORTHEAST Water Heater -Electric $ 7.00 floor 2 Water Heater - Gas"' _ $10.00 (763) 571-4210_ Building User i!'�e5 i o%in Gas Range`* $10.00 Gas Dryer*' Floor 3 11n os Estimated Cost "� PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 n PLUMBING COMPANY — Lj(9 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ SAOC,_ &!b 0QJ/ 15L 13�LOJ 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 -112 Z 1 �CX� Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 ASHWOOD, ROBERT Water Treating Appliance $10.00 Owner 5648 5TH STREET NORTHEAST Water Heater -Electric $ 7.00 FRIDLEY, MN 55432 Water Heater - Gas"' _ $10.00 (763) 571-4210_ Building User i!'�e5 i o%in Gas Range`* $10.00 Gas Dryer*' $10.00 11n os Estimated Cost "� PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 n PLUMBING COMPANY — Lj(9 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS -1.5% of Value of Fixture or Appliance State Surcharge $ 50 TOTAL FEE $ 20.50 SIGNED BY Approved Final Date 0 "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 -SQ INCHES. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5648 5 ST NE PIN : 233024310030 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMI71�NO.:2004-01952 DATE ISSUED: 10/22/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL DRYER WITH FLEX CONNECTOR AND DRIP TEE. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 144 APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER ASHWOOD ROBERT J & JOAN M 5648 5TH ST NE FRIDLEY, MN 55432 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 wort 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 consp;or the performance of construction. HEATING PERMIT MINIMUM FEE 15.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 PAID WITH CHECK # 1020338 TPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. -CITY OF FRIDLEY BUILDING INSPECTION f 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *}Air Conditioning -AII Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater R o 6 1. 3 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS - 70 I� t Fee Total Owner T,7d,01 $35.00 $ Building Used As ���✓��tij A71 , $10.00 $ ESTIMATED COST r `'- 60 PERMIT NO "� �® $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $25.00 $ BTU HP EDR Fuel Total Connected Load Com mercia flndustriaVInstitutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE $ Burner Trade Name Size No. BTU HP EDR 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. /% _ $ c HEATING CO $ I �'J� Signed_ Tel # 1,410"�l `SIf REINSPECTION FEE $50.00/HOUR FAX # lD�� ,"�7J Date l`�� / ✓y7 *Air Conditioners can not be placed in side yard without written approval��%//� from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No The existing combustion air is sized and installed to meet the current codes BTU Input and manufacturer's specifications. Yes ( ) No( ) When required to install a new combustion air, it will be sized and installed Fan Assisted or Nat to meet the current codes and manufacturer's specifications. Yes ( ) No( ) When installing a new venting system, the undersigned hereby verifies that Total Appliances it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Vent Height Venting Tables for fan assisted and natural draft appliances. Yes ( ) No( ) Is the common vent and vent connectors sized and installed correctly after ft Diameter in Type an appliance has been removed from the common vent and vented ft Length 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 : vl t 1 VI 1 7\I►JLL I ►►VJr Lv I ►V►i Lit v. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT curK011vo V1 gar► ►, cove. PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 54� A18 'S�' / 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 NN�� Rain Water Leader $ 7.00 200,22 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 Building Used As .ta�JC2� Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost .� PERMIT NO. /3. l Back Flow Prevventer Required NYes O No Type.e-t'rG0' 7ra5 $15.00 J`r0a PLUMBING COMPANY Reinspection Fee $47.00/Hr SIGNED TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX # - 7429 - % -074/4 1.5% of Value of Fixture or Appliance Approved By Roug4-In Date Final Date State Surcharge .50 va S � MINIMUM FEE F R ANY PLUMBINGIGAS PERMIT IS $20.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHA BE P OVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 1 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wash j;,,',.; Floor > Auto. Gas '? .Water Heater { „r Stories Urinal :'< `' Shower <::f Tra A ry Drain v•.:k Washer i?:;:%F> Ran e Basement ;;'-4•i:Fjv;':;:<e//:; 'r,•...P?n f• of �+;';' {. f..; .1 f � ''{:$;+$'. , h,`{:•:' :%'i:{;':%:,+.$;i'' ��:�. Fi?.✓f i:i ✓ p...�''f/,;i:.r .,•:v� . a ;r:,:,✓.•;{ FL; K•:: o•``'•. '•.Y•'M'•:vy?,•; •}• •••,• '{ .• .f ;; h. i$'?: v? :. : 'v:'E'"°"' �YtY�a.✓�: `''.,, ,{ri:y +kt{5' .•.•.•F.. '�r��� ?,+.w.;';`•y':•° %a:4'Jri••'4•hP {yi .+•`:'`.1t3:+ ti �a.� .,e,::+f✓ ?::►.•?ii f� iR ;,1,v ;, ..q; Floor 1 $? nh ?'.;•.%'✓i Y f$ :r7`• '%:h'' $?$ •r..:>.i .:.a•.,; $< :? :F x:'.. f, ft :: 5s: f.,{ Floor 2 •;f:;+ :✓::?. •;"• �$:3'��% C'� ��ww++ "?'•: ;,F,;+ v: +$:iv {QA's ff$$.{ ff. n✓.•v✓/r•S;i;•`•%'::, n:{ijr,;.;• •:$•'••7�v:%'.��;:,':; ;{q,,;,;,,,;: ✓ ;^`<;•. ::�✓ �, ✓ •:�.'`+,,• ;•'$r.?A3••s"n: cY, // in ,`'•y{y;'•il,•; s $r:F. ,,�r;JA 1.0 • • +:4 •� ,...{.?'3.,,}.;.;.v''•eitiv}a,••v �>:..,.;,r,.#'?,;.;?; '?I�.?i,,1{{OS,<'•Ltir .$�', ;y:'SV'•:�.1,+$ :`f.,v.? .r ,4!,. ..., ; ivr r'O;:?xx::i/✓.•$ : `�� {••` :$ y ✓:.,k.: >,.. •. v'+>.%'�An }+;F ':'•?e;:�.•:.• `.•?�.. p,.;. $� y'`?`:;• :�:+.;:::`$%%$':%y;:••`a•: q; .,:: iy}R}r';.�{.�. `;F'r�vik{S' F} {i�;`, Floor �:��.• 3Floor �r�xw: <,=.�z:;::•$:, �. y:.:.;;:;,,,,�A , • � }" 4$<?s• $ ' S ,.. : s�:�.: �:,.. �F;;✓' : ;� 4:;;✓a`', '✓ f`%:)�R" /:f :• %% �'✓> l ?•3,e7x: :p�,r,"`;;, • ;:� . i;? ::F;;,$xfi%.'$,✓f,S,. ri:�;:x•,''•';::5:; ;5? {• ¢ :%r%••y` �;g?%{; 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 54� A18 'S�' / 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 NN�� Rain Water Leader $ 7.00 200,22 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 Building Used As .ta�JC2� Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost .� PERMIT NO. /3. l Back Flow Prevventer Required NYes O No Type.e-t'rG0' 7ra5 $15.00 J`r0a PLUMBING COMPANY Reinspection Fee $47.00/Hr SIGNED TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX # - 7429 - % -074/4 1.5% of Value of Fixture or Appliance Approved By Roug4-In Date Final Date State Surcharge .50 va S � MINIMUM FEE F R ANY PLUMBINGIGAS PERMIT IS $20.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHA BE P OVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 1 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2002 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** NO. RATE TOTAL JOB ADDRESS s6q U 5-H, S�— fir= Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 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 �'Z'l 206 Z_ $ 7.00 (�� $10.00 Owner 6; "� d1 el( $ 7.00 $10.00 Building Used As $10.00 $10.00 Estimated Cost PERMIT NO. $15.00 PLUMBING COMPANY `:"l,214t PZ&L Reinspection Fee $47.00/Hr ` Uveli' SIGNED BY L/2 �G� � G� TEL N0. %�^•VGC1 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX # 3 s O 1.5% of Value of Fixture or Appliance Approved ByqFO Rough-In Date Final Da e �� State Surcharge .50 MINIMUM FEANYPLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $_eL0.3;) 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 COMMON VENT, VFNT CONNECTOR AND COMM IRTION AIR VERIFICATION When ranl� acinn 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 px-mine cem6 is inn air is sized and installed to meet the current codes and manufacturer's specifications. When required to install a now enmhughnn air, it will be sized and installed to meet the current codes and manufacturer's specifications. When jpstag a naw venting cv�stem, 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. 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( ) Yes( ) No( ) Yes( ) No( ) Yes( )No( ) 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: