PRE 2010 DOCS1J
•
City of Fridley, Minn.
BUILDING PERMIT N® 3567
Date: ... .... !..... ...........................
Owner ....................................... Builder .. .... .
Address ...................................... Address .............................................
LOCATIONOFBUILDING
No. Street ...�'�.. �!Q(e! .h;!/.!5 ,........... Part of Lot ............ .....................
Lot ..,g ...... Block ...,( ............. Addition or Sub -Division .. .. 4'C'C1 1IU4......... .
i '.
Corner Lot ............ Inside Lot .. ........ Setback 3.;X7.. -.V'.'. .Sideyard . A/.. P .................
DESCRIPTION OF BUILDING
To be Used as: i
Front f®.— /d&pth �:('.. ��� Height ./.. Q.` A "® Sq. Ft. MAP? Cu. Fte. pl
............... Y.... Front ........Depth ........ Height ...�... Sq. Ft. ........ Cu, Ft. ........
Type of Construction ................... hist. Cot/.?, (! � ....... To be Completed ...................
r-od' i'i�iltls�
In consideration 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 setand forth oompHan with provisions of
ordinances of the city of Fridley.
,%(... .......... ............. .....
In consideration of the payment of a fee of $. Wil......, 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. I
... �.., Building Inspector
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.
OCit3' oFridley, F , Minn. ,
BUILDING PERMIT N® 4 4 4 5
Date: .. - .- -•-l--`'�••--------------••----•----.....
Owner: i � f%..... ............... Builder1.4 ov
- -
Address �A - '_ - (�/�. ..... .•-.,
y Address -.............- - - _............................ _.._....
Q L TI BUILDING
No.f..�?.... Street . �� .................�.............r..................................... Part of Lot ......
Lot...................................... Block ..... ........ ....................................... Addition or Sub -Division ....................................
Corner Lot .................................. Inside Lot ..................................... Setback ............................................. Sideyard
Sewer Elevation ................................... .............. .................................... .................. Foundation Elevation ...........
DESCRIPTION OF BUILDING
oTb sed....._.. -- r-----.... Front l..._..t ..._.. Depth .. .. _.. Height ./ .._ ... Sq. Ft. S...YVI Cu. Ft jf��0
............................................................ Front ..... -................. Depth ...................._.. Height .. _.._............. Sq. Ft _- Cu. Ft..---_......_.........
Type of Construction _ �!��[,12._.. Est. Cosi .....,11 ... ..._. 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. r, n A J/ 4-/
In consideration of the payment of a fee of $.7. ._....."..-'........, perfiit 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. _--� 1 .4
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.
APPLICATION FOR BUILDING PERMIT
CITY OF'PRIDLEY, MINNESOTA
OwnersName' h C� /`]� C�c_. (, d l/TBuilder S Ce: d� �> �V
Address! `
t►
LOCATION OF BUILDING
No. Street Part of Lot
Lot Block Addition or Sub.Div.
Corner Lot Inside Lot Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
C' Depth I Height
Sq. Ft. .3 y Cu. Ft.
Front % Depth Height
Sq. Ft. .(;u. Ft.
Type of Construction Estimated Cost
To be -completed
The undersigned hereby makes application fora permit'for the work.1erein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and correct.
DATE SIGNATURE 5"o r G
(A Schedule of Fee costs can be found on the Reverse Side.) 04-0r�
City of Fridley, Minn.
BUILDING PERMIT
r
Date: J=e_ 17,E 1965
Thomas U Cobb
Builder Thomas L. Cobb
Address 5908 6th St. N&E. Address 59056th St. N.E.
LOCATION OF BUILDING
,;�S�s 3
N° '7929
No. 5908 Street 6th St. N,,B. — Part of Lot
Lot 2 –Block 1 Addition or Sub -Division Bennett Palmer Addition
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 Fast. Cost 90= _ _ To be Completed
• Repair Storm Damage
1�1
In consideration of the issuance to me of a permit to construct the building described above I agree to do
theproposed work in accordance with the description above set fo and in ce with ill provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 10.� permit is hereby granted to Thomas Le Cobb
to construct the building or addition as described above. This permit is granted upon
thn�j
s condition thatdoround and uponinnesota regarding ion, ooy ctialat any time upon vio a13on off any of tmhoe prgovisionaeaid
wl
ordinaixs�. city limits and ttiia
Alen Jensen Building LuPector
NOTICE:
fhb peemt doss net comer the comtrucftoe, hutaih»ton for vArIM ph mbing, ga headn& aver or water. Be wrs to we
da BuHdim hmpeetar ter aparafe permits for thea Nems.
y
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDI11TCy,
=MIMA Street f Part of Lot
R ADDITION OR SUBDIVISION <
z
LOT . .VI
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 Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Costes
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.
`f
DATE�_�' SIGNATURE
(Schedule of Fee Costs can be Bout} on the Reverse g- a).
G
97-8)•-116051 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Job Address 5908 6 STREET NE
Department of Buildings
City of Fridley
Tel. NS71-3450
The undersigned hereby makes application lora permit for the work hei
specified agreeing -to do all work in strict accordance with the City Coy
and rulings of the Department of Buildings, and hereby declares that al.
the facts and representations stated in this application are true and ct
Fridley, Mn. 6''16-77 , 19_•
OWNER MICKEY LEXCEN '
KIND OF BUILDING frame
USED AS res.
6-23-77 '
'PO 8E COMPLETED A80UT ��-�•__
.PARTIAL RATE SCHEDULE ESTIMATED COST 10.00
PLUMBING FIXTURE RATES: NO. RATE TOTAL oLD -NEW BUILDING PERMIT N0. IT NO.
Nu --bar Fixtures x $3.00
Future Fixture Opening • -1 $3.00 $ Company •
0
Now Fixture, Old Opening __ x $2.00 S _-
Signed By*
Catch Basin, -X $5.00 $ __- ,
t Nater Heater - to 99,000 BTU, x $5.00 $ Tel. No. .
100;000 BTU to 199,000 BTU x $10.00 $
Water Softener x $7. Q0 S
New Ground Run Old Building � x $5.00 $ ROUGH INSP. .
Date ,
Electric Water Heater -,_� x $5.00 $ ,
GAS FITTING FEES: ,' FINhL INSP. /0 -96
Date
lst 3 fixtures x $3.00 $
Additional Fixtures x $1.00 $
$ •APPROVAL FOR PERMIT
x $10.00
.Gas Range to 199,000 BTU �.,
REPAIRS $ ALTERATIONS '
First $100.00 $5.00
each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.,50
State Surcharge, $ .50
TOTAL FEE $ 8.00 ..
rT!N5PTCP!0M FEE
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(R) - Future Connection Opening
Connected with Sewer
(•) - 11aw Fixture, Old Opening
Water
Job Address 5908 6 STREET NE
Department of Buildings
City of Fridley
Tel. NS71-3450
The undersigned hereby makes application lora permit for the work hei
specified agreeing -to do all work in strict accordance with the City Coy
and rulings of the Department of Buildings, and hereby declares that al.
the facts and representations stated in this application are true and ct
Fridley, Mn. 6''16-77 , 19_•
OWNER MICKEY LEXCEN '
KIND OF BUILDING frame
USED AS res.
6-23-77 '
'PO 8E COMPLETED A80UT ��-�•__
.PARTIAL RATE SCHEDULE ESTIMATED COST 10.00
PLUMBING FIXTURE RATES: NO. RATE TOTAL oLD -NEW BUILDING PERMIT N0. IT NO.
Nu --bar Fixtures x $3.00
Future Fixture Opening • -1 $3.00 $ Company •
0
Now Fixture, Old Opening __ x $2.00 S _-
Signed By*
Catch Basin, -X $5.00 $ __- ,
t Nater Heater - to 99,000 BTU, x $5.00 $ Tel. No. .
100;000 BTU to 199,000 BTU x $10.00 $
Water Softener x $7. Q0 S
New Ground Run Old Building � x $5.00 $ ROUGH INSP. .
Date ,
Electric Water Heater -,_� x $5.00 $ ,
GAS FITTING FEES: ,' FINhL INSP. /0 -96
Date
lst 3 fixtures x $3.00 $
Additional Fixtures x $1.00 $
$ •APPROVAL FOR PERMIT
x $10.00
.Gas Range to 199,000 BTU �.,
REPAIRS $ ALTERATIONS '
First $100.00 $5.00
each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.,50
State Surcharge, $ .50
TOTAL FEE $ 8.00 ..
rT!N5PTCP!0M FEE
011
SUBJECT
City of Fridley
dE,
28342:
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
.
�
a: _____ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
j PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/21/98
JOB ADDRESS
5908 6th Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
1 Bennett Palmer
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mary Lexcen
571-3239
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Premium Roofing 6680 Lucia -Ln -
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 O ADDITION O ALTERATION QK REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage 22 s Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
1 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
1885
.94
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
$59.50
Fire SC 1 .88
PLAN CHECK FEE
TOTAL E
SIGNATURE OF CON TRACTOR OR AUTHORIZED AGE NT iOATE.
N P OP R LIDATE T ISIS YOUR PERMITi
S.GNA TUBE OF OWNER iIF OWNER BUILDER, tOATE,
BLD INS"
r�AtE
011
NEW [ ] Effective '1/1/98
ADDN [ J CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ->170 $
Legal Description: TF�`( cVFlr-t &4evr-
Owner Name &Address:le4�1(c fx/ Tel. #,'7/-3d, 32'
Contractor: �iP�/1�/�r� /�co�i MN LICENSE # go -
Address: Tel. # S7/-3723
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: �i S � � 4'�"
Construction Type:)t00,1t�-JtIC, Estimated Cost: $ z/yO�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: /0 -d4 g1 r APPLICANT: Tel. #-521-371-3
Permit Fee
$ -j % -ro
Fire Surcharge
$ 4
State Surcharge
$
SAC Charge
$
License Surcharge
$, ce3
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ �-7 5z
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 DIViSION�
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
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
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.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.
Effective On May 10, 1999
jOB ADDRESS 6110 LP 4-h I
OWNER
TOTAL
BUILDING USED AS_
$ ;�b. U0
ESTIMATED COST �'�Di� • U PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_1 Circle One (Steam) (Hot Water) arm )
$ Trade Name Yi.,Gi, E Size No.3? C) 7
BTU_ HP EDR
$ Fuel Total Connected Load
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 an
$ .50 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.,; .
13562 CENTRAL AVE. N.��
HEATING ANOKA, r?N 55°04
Signed LATE
`I r�
Approved By/Rough-in Date Final Date
I
Remarks:
List ALTERATIONS Being Done:
BLAINE HTG. A,C ELECT., ING
HEATING CO: i356A2 OKA, SAL FA ;f r"IV.E.
Signed By:
Date: -AjGj
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 Qj No ( )
y
5.
Meets all current Code requirements for size
and total BTU's connected
Yes No ( )
6
Has total heating BTU's of LR (4 U
All other BTU's
TOTAL BTU's LQ U-19 ( 9 b
7.
Has a liner been provided for water heater
Yes (V4 No
8.
Has combustion air been provided for water heater
Yes f4 No ( )
Remarks:
List ALTERATIONS Being Done:
BLAINE HTG. A,C ELECT., ING
HEATING CO: i356A2 OKA, SAL FA ;f r"IV.E.
Signed By:
Date: -AjGj
HEATING
SIP41NEANDCONDITIONNGAIR ELECTRIC1C.
HOUSE HEATING TEST RECORD
ADDRESS_] eJ ® 97 C. TA -3-f AIN�— APT.
OCCUPANT M -+R :� lt-Br,CG ell OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY
Electrical Work By
TYPE OF HEAT GA FA
Pl&&.,tlr
FLOOR CITY SLMURB
INSTALLED BY _ C �n one, 14 mac, Fr' -4
Gas Line Bya.wlate,
HW STEAM_ SPACE HTR. — UNIT HTR._ OTHER
GAS DESIGN CONVERSION
MAKE _�!� Cla t MAKE OF BURNER
Model 3 433 iCOL f/ 0 ;2A1 %O Model
Serial Max. BTU Rating
INPUT (yam ` &Vy MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT
Heat Plug
Vont Size
Valve C. A ip-e. Ay4e
a 3
KIND OF LINER
SIZE NONE
Limit S 4Cm e®
Draft Hood
Regulator
Limit Setting L A ® a
Filters Size
Number
Fan Setting
Chimney Location Inside
Outside
Pilot Type /4,o k :5
P4 f4ce-
Chimney Construction
Pilot Make 3,9q&,2 I'
Pilot Model 7 / `%
Smoke Bomb
Wiring
Pilot Timing 4 egg
Draft
Test Tag
L W. Cut Off II
Door Pressure
Lighting Inst.
Pressure w,'
Percent CO,
Date Tested
Input CFH
Percent O.
Company Testing 6 1
Stack Temp. S�
Percent CO
Name of Tester /I w -gel? e
ee 14 -;1" L. 0 2160,
Form 235
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763) 571-1287
PERMIT .: 200400465
DATE ISSUED: 04/08/2004 '
ADDRESS
: 5908 6TH ST NE
PIN
: 233024240002
LEGAL DESC
: BENNETT-PALMER ADD
# NEW FIXTURES (EXIST OPENINGS)
: LOT 2 BLOCK 1
PERMIT TYPE
: PLUMBING
PROPERTY TYPE
RESIDENTIAL
CONSTRUCTION TYPE
ADDITION/ALTERATION
VALUATION
$ 400.00
NOTE: COMBUSTION AIR
SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A
INSTALL GAS WATER HEATER
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (EXIST OPENINGS)
0.00
0.00
# ELEC WATER HEATERS
0
VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS)
0
# GAS WATER HEATERS 1
# GAS DRYERS
0
# GAS RANGES 0
# OF NEW FIXTURES
0
# WATER TRMT APPLIANCES 0
APPLICANT
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (EXIST OPENINGS)
0.00
0.00
NORBLOM PLUMBING CO
2905 GARFIELD AVE S
WATER TREATMENT APPLIANCE
0.00
NIINNEAPOLIS, MN 55408-2173
WATER HEATER - ELEC
0.00
(612) 827-4033
WATER HEATER - GAS
35.00
GAS RANGE FEE
0.00
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
0.00
0.00
0.50
OWNER
LEXCEN ALLEN M & MARY L
5908 6TH ST NE
TOTAL
35.50
FRIDLEY, MN 55432
PAID WITH CHECK # 28069
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating co traction or the performance of construction.
Applicant Date
t
Bldg Insp D
QCDADA qM DUD AdTTQ DLYITTTDCTI C/1D RTl1DV nrrLTCD TLTAAT T1CQPDTR1PTI AUMIPi
:ITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004
431 University Ave NE
ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
763) 572-3604, FAX (763) 571-1287
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
'LUMBING FIXTURE RATES: NO.
�..:.?:i..f:g.
UnnaI
Shower
..............-.-.-.-
:»...»...>...:..::.:>.:.:>.;.:.:.Wa
sh
Tra
..:=��...::.�
F oor
DrainRange
dAuto. .:�:,.:......
.:
Gas
-�
Water Heater
a
..#..,e.�..t...�:.::.�.:.:.>.
and representations stated in this application are true and correct.
Gas ElecSto
Basement
><`
;ump/Receiving Tank
$10.00
FRIDLEY, MN 55432
Nater Treating Appliance
$35.00
OVA (763) 571-3239
Nater Heater -Electric
$35.00
I
T10 -or,
BUILDING USED AS �SI � erne
Sas Range'
3as Dryer"
$10.00
$10.00
ESTIMATED COST �6 oto PERMIT No. ! • ��;�(��
3ack Flow Preventer Required ( )Yes ( ) No
n 1 t
Type
$15.00
PLUMBING COMPANY j V O C Ok � cants IpTJlo�
Floor 2
0
Flo r 3
Floor 4
'LUMBING FIXTURE RATES: NO.
RATE TOTAL
JOB ADDRESS_ o S o'LJ A AAi
dew Fixtures
$10.00
The undersigned hereby makes application for a permit for the work herein
)Id Opening, New Fixture
$10.00
specified agreeing to do all worts in strict accordance with the city codes
3eer Dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the facts
31ow Off Basin
$10.00
and representations stated in this application are true and correct.
,atch Basin
lain Water Leader
$10.00
$10.00
LEXCEN, MICKEY/MARY
5908 6TH STREET NORTHEAST 3/ 20 01
;ump/Receiving Tank
$10.00
FRIDLEY, MN 55432
Nater Treating Appliance
$35.00
OVA (763) 571-3239
Nater Heater -Electric
$35.00
Nater Heater - Gas'
$35.00
BUILDING USED AS �SI � erne
Sas Range'
3as Dryer"
$10.00
$10.00
ESTIMATED COST �6 oto PERMIT No. ! • ��;�(��
3ack Flow Preventer Required ( )Yes ( ) No
n 1 t
Type
$15.00
PLUMBING COMPANY j V O C Ok � cants IpTJlo�
ieinspection Fee $50.00/Hr SIGNED BY
5�4-
%LL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
Approved By
State Surcharge $ 6b
MINIMUM FEE FOR ANY I
TOTAL FEE $ 3S SD OF THE IMPROVEMENT WF
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
TEL N0. (&2)827- 0,3j
Final Date ! al
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes ( ) No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes ( ) No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No( )
When Installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes ( ) No( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes ( ) No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date
NEW [ 1 CITY OF FRIDLEY
ADEN [ j 6431 University Ave NE, Fridley, MN 55432
ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Ai
51
LIVING AREA:
GARAGE AREA.
DECK AREA:
OTHER:
eq, fh
.F
Tel.
Effective 4/1/2004
(763) 672-3601 Bldg Insp
(763) 571-1287 Fax
rl
MN LICENSE # LCr' �w 1' i T
#
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.
Construction Type: a��' a �: ���' "�� Estimated Cost: $ 2
Driveway Curb Cut Width Needed: Ft.* 6 Ft = Ft x $ = $
DATE: — i G S APPLICANT:n:r.rTei.
Call (763) 672.3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
20/eo'd
$ 83 • Z- Fee Schedule on Reverse Side
$ -- 65% of Permit Fee
$ x_25 .001 of Permit Valuation (1/10th%)
$ i• I''l $.50/$1,000 Valuation
$ $1350 per SAC Unit
$ 5 $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 { j
$ 91-6,17 STIPULATIONS:
3IQ I dd d0 Ai D VS : E T VOW -LO -03a
Building
MECHANICAL
Permit NO.: ' " 11 In
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604p�y
CITY OF FRIDLEYR
'
�
DATE (� �1YOUR 1-MAADDRESS
SITE ADDRESS • 1�Vj
G
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME:
OWNER/
TENANT
ADDRESS: CITY STATE ZI
PHONE:
CONTRACTOR
COMPANY NAME:
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
LICENSE WITH
STATE LICENSE # EXP JATE {�j
11D!5; Ur iv
ADDRESS: CITY L / STATF�ZIP
APPLICATION
PHONE FAX �� .
PERMIT TYPE
y°(INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
' JANEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILhED DESCRIPTION OF WORK �-
'v 1)CX ] 6-tA ��
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor)
Labor co t and 300 = e o 00 = c labor
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) 0(_ �ih LIH' � 9
��� ��� -Ie
Equipment Installed MFG: MODEL. I V�1, 1 � ,✓z-` SIZ TUr�
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
YA/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
_DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00
PERMIT FEE PROJECTS FOR UNDER$500
PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50
Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of pi ) l� •�� I
✓t %
SIGNATURE OF APPLICAN - PRINT NAME ( DATE tI/
PLEASE NOTE: SEP TE PERMITS REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
i