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PRE 2010 DOCSCity of Fridley, Minn. N° 8452 BUILDING PERMIT • Date: $pptemht-r 14, 1965 Owner: Erick Erickson Builder Owner Address 457. - 57th Place N.F.. Address r1 L_J n LOCATION OF BUILDING No. 451 Street 57th Place NiE_ Part of Lot Lot ? _ Block 4 Addition or Sub -Division City View Additicm Corner Lot _ Inside Lot X Setback Sideyard X Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front 14 Depth 221 Height Sq. Ft Cu. Ft. Front Depth freight Sq. Ft Cu. Ft Type of Construction Fame Est. cost 45.DA...00__ _ To be Completed Storm Damage 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 ill provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 4_00 , permit is hereby granted toErick Erickson to construct the building or addition as described above. This permit is granted upas 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 regardinglocation, construction, alteration, maintenance, repair and moving of buildings within the city llamits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: rob pom* dos rot saver tho dorshudlor, festaMer for wirb & phmbire, en heating, sewer or water. Be are to no the Bulbdn9 hupeetor for separate permW for these hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ep OWNER'S NAME ��s r �` — BUILDER e ADDRESS ADDRESS LOCATION OF BUILDING Street Part of Lot LOT BLOCK ADDITION OR SUBDIVISION Corner of inside L ' ` Setback, Side -Yard SEWER ELEVATION FOUNDATION ELEVATI01j Applicant attach to this.form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING ate, 0 To be used as: —�� Front Depth, --9- Height, Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost tj 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. DATF -' _ .f01 � r SIGNATURE �� o W, (Schedule of Fee Costs can be found on the Reverse Side). 0 0 I I M SUBJECT P City of Fridley17 5 51 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEIPT NO. `L ....... COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. -'-'1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY %.J 612-571-3450 910-F15 6/13/84 JOB ADDRESS 451 - 57th Place N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 4 City View Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Dennis Kolflat 451 - 57th Place N.E. 571-5357 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 g ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 8' Deck 9 CHANGEOFUSEFROM TO STIPULATIONS 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 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $650 $.50 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 STRUCTION 0 THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $3.75 $19.25 SI NATO EOF CONiRACTORO THORI D ENT (DATE) _ WHEN PROPERLY LIDATED THIS IS YOUR PERMIT / �- BLDG INSP 0AT SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI I I M R. M O Z a► i d Co T - a z z O Z a► i d NEW ADDN. [ ] [ ] City of Fridley FR -1 AND R-2 ALTER. [ ] Building Permit Application Construction Address Legal Description: Owner Name & Address: S2a' P/" /ii- r. �_— Z/,te� Effective 4/1/84 1-,4 A7 5�1.-W4 Tel. # $ 7�'S 3s� Contractor: '_V0_ f- Tel. # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: I%% Corner Lot [ ] 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 % �i ` Width Hgt/Ground 2,f Sq. Ft. SU Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: Lk -P10 Approx. Completion Date: % -Z- --fy Estimated Cost: $ Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: - � APPLICANT: .C�.>'S � % Tel. # 5- 7/- S 3S-7 CITY USE ONLY Permit Fee $ Ma Fee Schedule on Reverse Side Plan Check $ 02 25% of Building Permit Fee State Surcharge $ _9-70 $.50/$1,000 Valuation SAC Charge $ MM_- $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ K1; J Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: SUBJECT P City of Fridley 2135 AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. _ PROTECTIVE INSPECTION SEC. �(P CITY HALL FRIDLEY 55432 NUMBER REV GATE PAGE Of APPROVED BY 612-571-3450 910415 5/27/92 10B ADDRESS 451 -- 57th Place NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 4 City View Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Hargreaves. 451 - 57th Place NE 571-5163 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc. 7401 Central Ave NE 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 ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (9 Squares) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $477 $,50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 Fire SC $.48 STRUCTIOW10—h THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $20.98 G a R DF 'RA OR OR AUTHORIZED AGENT IDATEI HEN P V (DATED THIS IS YOUR PERMIT 7PERL - �y _ BLDG INSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW '[ ] Effective 3/1/32 ADDN [ J CrfY OF FRIDLEY ALTER[ ] SINGLE. FAMII.Y AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: &, Z4! � Tel. # 7�-SLlo_ Contractor: D & D Home Improvement, Inc. MN LICENSE # 4840 Address: 7401 Central Avenue N.E., Fridley, MN 55432 Tel. # 784-7543 Attach to this application, a Certificate of Survey of the lot, with the pry construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: Length Length Length DESCRIPTION OF IMPROVEMENT Width Width Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ J Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: �-- i�--//�-�� Estimated Cost: $ Approx. Completion Date: ,�c/A� 0Se- (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE:APPLICANT: Tel. # -�4 7� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge $ DD $ ,q $ —6 $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: [*j-W=1MAW@jz Fee Schedule on Reverse Side .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above. Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT Ap DEVELOPMENT DIV.V----- _COMMUNITY r PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE Of APPROVED BY 1r---1 - CITY HALL FRIDLEY 55432 L----11� "'' 612-571-3450 910415 10/2/98 JOB ADDRESS 451 57th Place NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 8 4 Cit View Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Tabor & Sons Inc. 1805 Polk St NE M789-1902 2001424R 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 )a REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house& ar. (12 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 1028 $.51 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 $37.50 Fire SC $1.03 PLAN CHECK FEE TOTAL FEE -Licensp-SC 44.0 SIGNATURE OF CONTRACTOR OR IrliTHORIZED AGENT IOATEI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT 41-1 BLAG -NSPf r S,GN4TUBE OF 0WNER SIF OWNER BURDERI IOATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress:57 Legal Description: �! ,jg le - Owner Owner Name & Address: Tel. # Contractor: < So V MN LICENSE # Address: `j/ vp Tel. # 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: CITY Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: /Z Ss�� er., Construction Type: �� a� ✓ �� A�«„'� Estimated Estimated Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: /�,,2 ",9 9 APPLICANT: �`� Tel. #7V—/, -&z - 7 /az- Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL 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 [ ] y CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1998 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 6151 $20 /L! E, RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Fumace Shell and Duct Work, Bumer - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Fumace $ 30.00 $ o, vo representations stated in this application are true and correct. (Side Vent M' Fill Out Back) /0 a q 1998 Gas Piping (Needed with new furnace) $10.00 $ /&, V v OWNER Tiu �/Iti, tivl� - Gas Range ` $10.00 $ BUILDING USED AS c� Gas Dryer $10.00 $ ESTIMATED COST_____ PERMIT N0. 12-714110 *Air Conditioning- All Sizes $ 25.00. $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs°$ Alterations (LIST ON BACK) 1°k of Value of Appliance or Work $ _ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Trade Name_ Size No. iso Commercial/Industrial BTU L10cvc7 HP EDR 1.250/° of Value of-Appliance or Work $ Fuel Total Connected Load State Surcharge X50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE X101 sza 6ZA"ARD HEATING A0 A!R C0NDM01gW8 CD. 410 VVES r LAKE STREET HEATING COMPANY AWNWOUS, MN MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By Tel No. PLUS THE $.50 STATE SURCHARGE Ir. Z,� REINSPECTION FEE $42.00/Hr Approved By Rough-In Date Final Date (tk *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STA VERIFICATION ON 1011 j/Q/ written permission from adjoining property owner. REPLACEMENT FURNACE Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CEWNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack:' 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater! Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: suejEtr PERM I1 bin City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT("290 5 3 r E r.v _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. i --_-� ��"' �•� CITY HALL FRIOLEV 55432 612-571-3450 NUMBER 910-F15 REV DATE 3/23/99 PAGE OF APPROVED BY JOB ADDRESS 451 57 Place NE 1 LEGALLOT DESCR. NO. 8 BLOCK 4 TRACT OR ADDITION 1 City View Addition SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sally Guzek 451 57 Place NE 574-0485 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Master Remodeliniz Inc 32 10 Ave S. Hopkins.MN 55343 932-9311 20012916 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 O NEW 0 ADDITION 0 ALTERATION X REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Reside House 9 CHANGEOFUSEFROM TO STIPULATIONS Call for building wrap inspection before covering. SEPARATE PERMITS ARE REOUIREO 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 AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION ZONING SO. FT CU FT 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 STALLS GARAGES AND KNOW THE SAME T BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDI NCES G FINING THIS TYPE OF WORK WILL BE COMPLIED WITH WH T ER SPE IED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $5,200 SURTAX $2.60 DOES N/ T P ESU TO GIVE T ORITY TO VIOLATE OR CANCEL THE PROW S OF THE R LOCAL LAW REGULATING CON. STRU o P o F CO CTION PERMIT FEE $112.25 SAC CH GE Fie SC $5.20 PLAN CHECK FEE TOT/L FEE Li SC 15 0 $125.05 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATE, HENMRVL IS I OUR�f�MI 71rSIGNATURE OFOWNEAi�FOWNER BU4DER, iDATEi rBLD i TATE NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 i ?j BUILDING PERMIT APPLICATION ConstructionAddress: �lr� S 7RG IVC-- 1X 1 1-'L !f Y J Legal Description: Owner Name & Address: 54 L G Y Gu 24F, 5#MF,*5 A4Vc-- Tel. #mw� KOM Contracto��,■��,.,_,� 0 �T� MN LICENSE # a a 0 1� 914 Address 55343 N„ftach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF MIPROVEMENT Tel. # 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: ��- �• Estimated Cost: $ .� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 3/;2 -3 hq APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 5, , .001 of Permit Valuation (1/10th%) State Surcharge $ 9,(00 $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ J`J� ® 0' $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: U I Y Of I KIULL- 1 IN"I'I k. i ION IrIV (3431 University Ave N(: F iidley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT L-Ilective Un Jan i, 2UO2 PLUMBING FIXTURE RATES: NO. RATE TOTAL IVINMK NUMttltK Ur FIX I URES 1-0 BE INSTALLED ON EACH FLOOR The undersigned hereby makes application for a permit for the work herein Water ]Closet Bath specified agreeing to do all work in strict accordance with the city codes Wash Drink. Floor Catch Auto. Gas Gas Mlsc. Water Heater Stories Urinal Tub Shower Sink Tray Fount. Drain 18asin Washer Appl. Range Fitt K. _;: Gas Elec Basement _d 7 SumplReceiving Tank _ $ 7,00 Water Treating Appliance $10.00 Ownerz.. Floor 1 Water Heater Electric $ 7,00 Water Heater - Gas" _L $10.00 Building Used As� Floor 2 $10.00 Gas Dryer" $10.00 /._. Estimated Cost PERMIT NO_ Back Flow Preventer Required ( )Yes () No Floor 3 Type $15.00 PLUMBING COMPANY Reinspection Fee $47.00/HrNO_q. Floor 4 �... Sit ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX* 1.5%" of Value of Fixture or Appliance �•� :::::.�.:. nom:: :.::•::. x.:: •.•: }:bie::: :•:::... PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS �S%—,`j % p[,,, A,)& 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 Budding Division, and hereby declares that all the fads Blow Off Basin $ 7,00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ .7,00 _d 7 SumplReceiving Tank _ $ 7,00 Water Treating Appliance $10.00 Ownerz.. Water Heater Electric $ 7,00 Water Heater - Gas" _L $10.00 Building Used As� Gas Range" $10.00 Gas Dryer" $10.00 /._. Estimated Cost PERMIT NO_ Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Reinspection Fee $47.00/HrNO_q. SIGNED BY TEL (%'y"7-- ' Sit ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX* 1.5%" of Value of Fixture or Appliance �•� Approved By Rough -In Date Final Dale " : =• State Surcharge .50 MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT, IS $20:00,? TOTAL FEE THE $.50 STATE SURCHARGE `COMBUSTION AIR SHALL BE PROVIDED PER UMC _PLUS SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE ,"'. k - is .ash t q�1 > THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED t COMMON-VENT. VENT CQNNF[`TQR Amn CQMR1 IATIAN AIR VFRIR CAT1QN - .r. -. When ra In acing an exi�o oranna, 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 plasticlPVC 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 existingcnmh ustinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a npw cnmhustinn air it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a naw ytanfingsue-tam, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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( ) Applianna Type and SizpK:nmmon !ant and lent rnnnactor Informatinn Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height _ Diameter inches D 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 CITY OF FRIDLEY PERMIT NO.: 2004-00164 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 02/05/2004 572-3604 FAX: (763)571-1287 ADDRESS : 451 57TH PL NE PIN : 233024240083 LEGAL DESC : CITY VIEW : LOT 8 BLOCK 4 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A INSTALL GAS WATER HEATER # GAS WATER HEATERS APPLICANT NORT 4WOODS MECHANICAL BOX 1085 FOREST LAKE, MN 55025- (651)2574951 1w ' CLARKE,DEREK 451 57TH PLACE NE FRIDLEY, MN 55432 1 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 re ons ction or the performance of construction. A licant Date PLBG PERMIT MINIMUM FEE 20.00 STATE SURCHARGE, PLBG FLAT 0.50 WATER HEATER - GAS 0.00 TOTAL 20.50 PAID WITH CHECK # 6085 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building PLUMBING Permit No. Inspections RESIDENTIAL APPLICATION Received By: - 763-572-3604 CITY OF FRIDLEY bate Rec'd: �- 1 LJ / 1-1- to G 1 c. r ke e K4 m• Co wL DATE YOUR E-MAIL ADDRESS -11 SITE ADDRESS Li S �� PIACLs r Fe ((i L C THIS APPLICANT IS: WNER OCONTRACTOR PROPERTY NAME:is C k C& -42 K C ADDRESS: `( S' ( S 7 T h pG CITY ( D L CL -7 TATElM ^V ZIP S3 zf 3Z TENANT PHONE: ?& 3 - SSG CONTRACTOR NAME: Efi F ' oo /2--X STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE—ZIP- TATEZIPLICENSE LICENSEWITH PHONE FAX APPLICATION PERMIT TYPE *SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW P, REPLACEMENT DETAILED DESCRIPTION OF WORK 12C -?1'Z,14 c, --L LZA Z vL PER MS 16B.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. (Thisshould_ reflect only the cost of labor) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = FOR;1'ROJECTS WHERE LABOR EXCEEDS—$500,—FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPTWBERENOTED...FIXT-UMSs,.(1NDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS SHOWER _ WATER PIPING _ _FLOOR _ GAS PIPING mw crirucEm) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _ _ _ _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER V/� L ✓L`� W000 Io .. ..;r. IN k. g __'0011,111 AN ?Ys` 2s �' a Permit Fee $ `' Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $_ 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 requi es review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977