PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn. N° 2417
Date....................
ilder
Owner..............................
Address .! ..4 W .�.`V .... Address ...................................
q LOCATION OF BUILDING
No.':'.. Street. -4 0 ......... Part of Lot .......................
Lot ... ..... Block .. ........... Addition Sub -Division. .`�.:%
Corner Lot ....... l .... Inside Lot ............i S yar ..1,00.416W,* r -r. ........ .
To be Used as:
OF BUILDING
�... Front /AW .. Depth Ah Height %�t � ... Sq. Ft......... Cu. Ft........ .
...................�. Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft. ........
i
Type of Constructio' 4 st. Copt q. - 00..p c ....... To be Completed Ao*tP t ! ... .
In consideratit 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 4age of Fridley.
ideration;'of the payment of a fee of $47446, 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 andjupon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota x} garding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits ',nd this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. JJ i9 .00-N ,
/?W ..... Building Inspector
NOTICE: it
it
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
91
su6iEtT
P T NO.
City of Fridley
2 9 312
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
RECEIPT NO.
`u ...... COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC
a
fQ
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
4/27/99
JOB ADDRESS 213,215,217,,2-19 53 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION Carlson' s
SEE ATTACHED
DESCR.
33
6
1 Summit Manor North Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Two Hands LTD 4601 Excelsior Blvd, St Louis Park, MN 55416
920-5393 20095303
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
4-Plex
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION DA REPAIR
O MOVE O REMOVE
8 DESCRIBE WORK
Reroof Building (30 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
4 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
$2,571
$1.29
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC ARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
`P
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
T TA FEE
27
ce e LiSC//00
83.61
SIGNA RE OF CONTRACTOR RAUTHO ED AGENT ATE,
HEN R ALIJ T
THIS IS Y R PERMI
I
i
_
S-GNATURE OF OWNEROF OWNER BUiLDERI iDATE�
BL iNS
(�A fEIF
91
NEW [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
-Heltcri
Owner Name & Address:�� (TI D, 11. al l 53rd AVP_ N. E iegc�<-, Tel. #
Contractor: —T—LOO floLnc W. MN LICENSE # 0 001 S 303
Address: Wool �y Slow- e2j%jA , S .I �ar M� i�bTel. # �� -5. 13
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:
Construction Type: —Q r p Estimated Cost: $
(Fee Schedule on Bac )
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT:
Permit Fee $ W, , '%J5
Fire Surcharge
$ eq- 5 7
State Surcharge
$ �)
SAC Charge
$
License Surcharge
$® C� ,
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $
STIPULATIONS:
Tel. #
CITY USE ONLY
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 [ ]
suBJEtTRMIT
NO.
City of Fridley
ri 31471
AT THE TOP OF THE TWINS
BUILDING
PERMIT
�
RECEIPT NO.
`v ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
O
r PROTECTIVE
1 . �
1 CITY HALL FRIDLEY 55432
REv
DATE
;GE OF
APPROVED BY
612-571-3450
rNUER
10-FIS
10/12/00
/
JOB ADDRESS 215-219 53 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
33
6
Carlson° s
Summit Manor North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Helen Bigos 215-219 53 Avenue NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
2 Hands LTD 4601 Excelsior Blvd, St Louis Park, MN 55416 612-920-5393
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
4 Plex
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION CR REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install fascia
9 CHANGE OF USE FROM
TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
$2,500 $1.25
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•
S UCTION OR THE PERFORMANCE OF CONSTRUCTION
$83 25 File SC $2.50
PLAN CHECK FEE TO L FEE
Lb-1) A - 0
Licen C $ $92.00
SIGNATURE OFC N7 TOROR AUTHORIZED AGENT (DATE.
E P O WjKY VAL A-D THIS IS YOUR PERMIT
V ! 40
S-GNATURE OF OWNEROF OWNER BUILDER. IDATE.
,G I�Sm- nATE
NEW I l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 r�5
BUILDING PERMIT APPLICATION�1
Construction Address:
-21S
Legal Description:
Owner Name & Address: 4-j_� � , ,� Tel. # ld -
Contractorl' Ute, ,Q CACP MN LICENSE #
Address: L4 60 i '?- Xn n1.A!n �Q Tel. # W2- %;a 0 -5-
3'9s7�
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:
Construction Ty /—�`�',��} Estimated Cost: $_
Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft x $ _ $
DATE: b a - C7 APPLICANT: Tel. #(n1,, 9 a b -539 3
CITY USE ONLY - Call (763) 572-3604 for Permit Fees If mailing In application
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge $ ® .001 of Permit Valuation (1/10th%)
State Surcharge $ , 6 o`t 5 $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$-_$l 100 per SAC Unit
$_ J b 6 $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
Park Fee $
$450.00 Conservation Plan Review
Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ qo� 00
STIPULATIONS:
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
571-36U4 VAX: (763) 571-1257
ADDRESS : 213 53 AVE NE
PIN : 233024330085
LEGAL DESC : CARLSONS SUMMIT MAN NO ADD
LOT 33 BLOCK 6
PERMIT TYPE PLUMBING
PROPERTY TYPE MULTI DWELL
CONSTRUCTION TYPE ADDITION/ALTERATION
PERMIT1(0 2004-01914
DATE ISSUED: 10/18/2004 '
VALUATION
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A GAS WATER
HEATER
# BACK FLOW PREVENTERS 0 # CATCH BASINS 0
# ELEC WATER HEATERS
# GAS WATER HEATERS
# RAIN WATER LEADERS
APPLICANT
BOILER SERVICES INC
10327 FLANDERS ST NE
BLAINE, MN 55449-
BIGOS BEN B & HELENA
11641 CEDAR PASS
MINNETONKA, MN 55305
0 # NEW FIXTURES (EXIST OPENINGS)
1 # OF NEW FIXTURES
0 VALUE (FOR MINIMUM CALC)
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
regulpiage(kmtruption or the performance of construction.
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (EXIST OPENINGS)
CATCH BASIN
RAIN WATER LEADER
WATER HEATER - ELEC
WATER HEATER - GAS
BACK FLOW PREVENTER
STATE SURCHARGE, PLBG FLAT
PLBG PERMIT MINIMUM FEE
TOTAL
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.50
0.00
35.50
CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT R 5 2 8
(763) 572-3604, FAX (763) 571-1287
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
JOB ADDRESS / 77-1/(: �=- /Y -C
New Fixtures
$10.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$10.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$10.00
and representations stated in this application are true and correct.
Catch Basin
$10.00
f
Rain Water Leader
$10.00
DATE: 20_
y
Sump/Receiving Tank
$10.00
Water Treating Appliance
$35.00
OWNER S Z ij c5 6 E jG %-
Water Heater -Electric
$35.00
_
�/
Water Heater - Gas**
$35.00 0
BUILDING USED AS
Gas Range'"
$10.00
/� )
COST PERMIT NO.
Gas Dryer"*
$10.00
ESTIMATED
Back Flow Preventer Required( )Yes
( ) No
.
EA
Type
$15.00
PLUMBING COMPANY S—i 2 % %/ d F.S
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
Approved By Rough -In Date Final Date
State Surcharge $5 0
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 of
TOTAL FEE $ Z�CJ OF THE IMPROVEM NT WHICHEVER IS GR ER ON WORK LE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.71/6�It�OVID�COMMOVE
9 's- t_JI
W ['F_,
'i
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
BTU Input Fan Assisted or Nat
venting has been examined and is free from rust, deterioration, obstructions,
BTU Input Fan Assisted or Nat
and is securely supported and firestopped where required.
Yes () No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
Total Btu Input
specifications including sizing, length, number of elbows and terminatidn.
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 Fumice
Venting Tables for fan assisted and natural draft appliances.
Yes () NO( )
16 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 :
PEMO TYPE
TYPE OF WORK
PHONE B�
u INsii
O TOWI
O NEW
FIXTURES; (QRJICATS TOTAL NUMB;VTORY
CH
FF.,EB BAMED 04610 PER FIXTURE)RAINS
NOTED
_ CLOTM WASH
01S WASHER
FOUNTAIN
TRAP
,�_ORINKHG
_FAUCET ..•.—am
.FLAMMABLEWASTE
YTRAY
TANK
FAX •,; cel 1-" / _ A
NULTIFAWLY
u COM MIST AUNDUSTRIAL
REPLACEI iBNT
... jtPZ VALVPJ (1115)
BACKFLOW PREV.
ROOF DRAINS
.SHOWER
_,SLOP SINK
To POOL
O SWWNINO POOL
O Cum
U A.TJREMODEL
URINAL
WATER HEATER ($3S)
� WATER METER
WATER PWING
WATER SOFTENER ($38)
WATER CLOSET
Minimum: $35-00
$.50 on petm)fa 196q than $1,000
Make Checks Payable to: City of Fridley
THIS A-PLICATWNFORA PMWFr-NOTVAL1UUNWILrR�JVl '
1 hereby apply for a ptumbin0 penult and I that as wamgm ebovq a COV02 and amraw, that the www vAl be in mdfomni M VA ft
rnd wm and lodes of ft Ctty of Ftktley va Bre oftneaala cmtmc*m Cadeei that l IUldaretend V ke rat a pemrtt but only an gWreappUmW Por a•
pamft end work b ru I Io dart without a pe that th Wwk wM be kn eamrdenoe with the approved pW In 00 ease of 01 Wolk whloh reA� ieviowr arld
apprmel of plem i (7-1
61
NAME OF APPUCAW DA i
gam -nm of: APPUCANT
a -t UNIV6RSiTY AIVENUE.K FRID "- UN f
�i33).�rz-�eoa
permit Fee
Plan Review
Stjmhar(ie.-----
Total Due
5
a
FAX •,; cel 1-" / _ A
NULTIFAWLY
u COM MIST AUNDUSTRIAL
REPLACEI iBNT
... jtPZ VALVPJ (1115)
BACKFLOW PREV.
ROOF DRAINS
.SHOWER
_,SLOP SINK
To POOL
O SWWNINO POOL
O Cum
U A.TJREMODEL
URINAL
WATER HEATER ($3S)
� WATER METER
WATER PWING
WATER SOFTENER ($38)
WATER CLOSET
Minimum: $35-00
$.50 on petm)fa 196q than $1,000
Make Checks Payable to: City of Fridley
THIS A-PLICATWNFORA PMWFr-NOTVAL1UUNWILrR�JVl '
1 hereby apply for a ptumbin0 penult and I that as wamgm ebovq a COV02 and amraw, that the www vAl be in mdfomni M VA ft
rnd wm and lodes of ft Ctty of Ftktley va Bre oftneaala cmtmc*m Cadeei that l IUldaretend V ke rat a pemrtt but only an gWreappUmW Por a•
pamft end work b ru I Io dart without a pe that th Wwk wM be kn eamrdenoe with the approved pW In 00 ease of 01 Wolk whloh reA� ieviowr arld
apprmel of plem i (7-1
61
NAME OF APPUCAW DA i
gam -nm of: APPUCANT
a -t UNIV6RSiTY AIVENUE.K FRID "- UN f
�i33).�rz-�eoa