PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PENT N° 3055
Date: ........ .... ............. .
r � Q
Owner Builder
... . .... . .. . .... . . .
Address .. .. .............. .. �. ... Address ..... �� ............... v� .......... .
L TION OF BUILDING
No. c�. �P Street .../.�.. .. ...... . .................. Part of Lot .................
Lot .. ...... Block ... .... ...... Addition or Sub -Division .GAY...
Corner Lot ............ Inside Lot ............ Setback ..... Sideyard :r���J
DlESCRIPTION OF BUILDING
To be Use as:
Front ..�
, Depth �y.... Height.! ft Ft.� ® �Cu Ft. ........
�.�� .1 ............. Fro TTT.... Depth .. •Height�g. Sq. Ft. ...�1./Cu Ft... .
Type of Construction .. .... Est. CSL• A".tt iv....... To be Completed ... ..............
f f'// 7 '7 � A—V-A� W- r1-1- ?� -'� -, L/- 54 ?74- /�
—
�
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 set forth and in compliance with all provisions of
ordinances of the city of Fridley. �a,
In consideration of the payment of a fee of $........., permit is hereby granted to ..... .. .....
......................... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon ,said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. 1-n
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
AM • A --i ly.
. lk
9
53-81-S-915 51
City of Fridley
Applin fw rk" end G= r uln
Dept. of Bldgs. Phone MD -3980
DESCRIPTION OF WORK 6756 N. E. 7th. Street
Number. Kind and Location of Fixtures I'Oca"an
O I
En
r
d
in
;
C
O
V
< 3
<
tS! aa[
(<! V
/
•N
WATER HTR.
GAS
EIEC.
Base
Ist
I
st
ll
Ga
ill
I
2nd
3rd
4th
-Future connection Openings
+ Now Fixture. Old Openings
—
Connsetod with
Sewer ❑
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ........I ........ - x $2.00 $
Future Fixture Opening ........... x $1.50 $ _.
New Fixture Old Opening .....:.... x $1.50
Catch Basin .. x $3.25 $
Water Heater ;Up to 99,000 BTU). • .. x $3.00 $
New Ground Run Old Bldg...... x $3.25 $
Electric Water hater................. x $2.00 $
SAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ............ • • • x $2.00 $
Additional Fixtures .................. x $ .75 $
Gas Range to 199.000 BTU ............. x $5.00 $
City of Fridley:
The undersigned hereby makes application for a permit for the Rork herei
specified, agreeing to do all work in strict accordance with the Citi Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct
Fridley, Minn 8-9-74 18_
owner Joseph Mikre
Kind of Building Frame
Res.
Used as
To be completed about 8-16-74
Estimated Cost, $ 10.00
Old—Building Permit No. Permit No. > w
Signed
By ---•-
MINNEGAsee
Business Phone No
ROUGFI
REPAIRS A ALTERATIONS—Rotor to Code .50 State Surcharge
Install Gas Grill 5.00
Description ............................................. 3
TOTAL FEE ; 5.50
Class 'N :Surcharge .50
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 tAX: (763) 571-1287
PERMITO.: :2070—
DATE
ISSUED: 05/27/2004
ADDRESS :
6756 7TH ST NE
PLBG FIXTURES (NEW OPENINGS)
PIN :
143024240091
0.00
LEGAL DESC :
RICE CREEK TERRACE PLAT 4
:
LOT 3 BLOCK 5
GAS RANGE FEE
PERMIT TYPE :
PLUMBING
0.00
PROPERTY TYPE :
RESIDENTIAL
WATER HEATER - GAS
CONSTRUCTION TYPE :
ADDITION/ALTERATION
0.50
VALUATION :
$ 500.00
PAID WITH CHECK # 54576
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
# ELEC WATER HEATERS
0
VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS I
# GAS DRYERS
0
# GAS RANGES 0
# OF NEW FIXTURES
0
# WATER TRMT APPLIANCES 0
9 2 RTN1eyl
NORTHWOODS MECHANICAL
BOX 1085
FOREST LAKE, MN 55025-
(651) 2574951
OWNER
JACQUELINE LAVALLE
6756 7TH 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 atter 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
regijWkL&construction or the performance of construction.
j=�ci �"
,% , `Am
PLBG PERMIT MINIMUM FEE
0.00
PLBG FIXTURES (NEW OPENINGS)
0.00
PLBG FIXTURES (EXIST OPENINGS)
0.00
WATER TREATMENT APPLIANCE
0.00
WATER HEATER - ELEC
0.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
PLBG REPAIR/ALTERATIONS
0.00
WATER HEATER - GAS
35.00
STATE SURCHARGE, PLBG FLAT
0.50
TOTAL
35.50
PAID WITH CHECK # 54576
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT �. s,7
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
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 &75& " 1 3� A )
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.00
$15.00
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
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.
DATE: 17- 946cl , 20
OWNER
LT
,315-10L) BUILDING USED AS
ESTIMATED COST Q)Z-)-- PERMIT NO. CZ)Q4[ `C CJ'(0)
PLUMBING COMPANY A�)4d:2�_r YYZJ l22"
SIGNED BY TEL N0.
Approved By Rough -In Date Final Date
�� MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF CO:
s-3-5, 5 L) OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE
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
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 :
Building
BUILDING
Permit No.: I
Inspections
763 -572 -
RESIDENTIAL APPLICATION
Received B 6*
JTPd 5*WTI
CITY OF FRIDLEY
763-502-49774977 FAX
EFFECTIVE 7-1-2010
DATE 10-5—JO
YOUR E-MAIL ADDRESS � hAoLa
C(�111d�j�NC
�,C ih
SITE ADDRESS %1S(P
L
�I *rCC,N.E .
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: ag0.kie. L ',JP.U_C.
ADDRESS: CD i su q.1b '5Wt * 0.e. E. CITY
TATE MN ZIP 55132
TENANT
PHONE: 617. — 3$Z 319 3
CONTRACTOR
NAME:—VhW %Uu\t�etS� 1"e—
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # Z43% _
EXP DATE
AND CERTIFICATE OF
ADDRESS: (� \ %V4 WU�A-
+�
CITYT`%Me=
Q STATEAM ZIP 563'11
INSURANCE
PHONE 'I - - I 3 FAX
- 9y3
PROPERTY TYPE
`SINGLE FAMILY SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH OOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ W HOME CONSTRUCTION 13 ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: V4:11 E vl
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
22
13HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES ❑ HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
❑ Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
13 Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
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)
'1'U'1'ALJOB VALUA'11U1N uuuuYAf4uy lYrr.
Permit Fee $ __' See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $5.00
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $24 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ i'� 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 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 applicatior a ermit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case o wor 4h ch ggpjFe�review and_approval of pits.
SIGNATURE OF APPLICANT f PRINT NAME ( Ao W 1r11CG MW► 4 DATE \O
APPROVAL INSPECTOR SIGNATURE
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK