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PRE 2010 DOCSVillage of Fridley, Minn. BUILDING PERM" N°11 Office of INSPECTOR OF BUMI)INGS Owner_ e I'l Aro < Architect Builder 1 Fridley, Minn., . ®` 18. LOCATION OF BUILDING Addition WSub-Division Of DESCRIPTION OF BUILDING Front -94-416 Depth A- Height Stories Mannerof Construction 1 w• To be used as "'' To be complete Estimated Cost` Permit is hereby,glianted to 4fiZ&.a-,s to,,r��.r�p the buildings' 1. ::�.,� i,_ • described in the above statement. This permit is granted Upon the express condition that therson to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upo said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Uhm, regarding the 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. —Jnspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings ldangs of. Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and ,contained in the above permit are true as therein stated." Subscribed and sworn to before me at Frii day of A.D. 19 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1, 1991 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 Gas Piping (Needed with new furnace) Gas Range Gas Dryer Rate TOTAL $ 20.00 $ $10.00 $— $10.00 $10.00 $ $10.00 $ 'Air Conditioning - All Sizes $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work . ' 145. CD$ Commerc laUlndustrial 1 % of Value of Appliance or Work $ State Surcharge $ .50 TOTAL FEE $ L 5.6b MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS ''1°� _ �o�ih W—da A) E7 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. g Zq --q q ,1991 OWNER QOrON -T2oUlC� BUILDING USED AS ESTIMATED COST �� PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Bumer Trade Name Size No. BTU HP EDR HEATING COMPANY Signed Approved By BLAINE HTG, A/C & E=H;T. INC 13562 CENTRAL AVE. N.E. Rough -In Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 ( ) 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 Remarks List Alterations Being Done: HEATING COMPANY Signed By Date SUBJECT 'P N. City of Fridley 297�B AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMOER REV DATE PAGE OF APPROVE' BY I CITY HALL FRIDLEY 55432 ' 612-571-3450 910-F15 6/28/99 JOB ADDRESS 49 62nd Way NE 1 LEGALLOT NO. Pt. 14 BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5, Pt.16 18 Fri dl ey Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Jezkovick 571-3766 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO D L Builders 1166 14th Ave SE Mpls MN 55414 378-0950 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 ®C REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroo.f house (14 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State BuildingCode. 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 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 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 1224 .61 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- TRUCTION OR THE PERFORMANCE OF CONSTRUCTION 47.90 Fire SC 1.22 PLAN CHECK FEE TOTAL FEE License SC $5.00 $54.73 SIG AruRE F CONTRACTOR OR AUTHORIZED AGENT 100E, WHEN PROPERLYNALIO TED THIS IS YOUR PERMIT BLO INSP r DATE S,GNATURE OF OINNEROf OWNER BUILDERI IDATEI r ►. NEW[- j Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 A BUILDING PERMIT APPLICATION � � ebb Construction Address: Legal Description: Owner Name & Address: 1r 'TG2-4b1j�Y- 6 &&JAI Tel. #'S-21-37(p& Contractor: L • , li s MN LICENSE # Z M q (o711 Address: (1 to lr I q4—"- ►AI SC A&V, SS u I L( Tel. # I s7n-095 a a - 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 S Wid Hgt/Ground Sq. Ft. OTHER: Construction Type: Iavk-L da/ lzezx Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: %'�S•�`l APPLICANT: Tel. #CdIZ !-/5 a CITY USE ONLY Permit Fee $ L, Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ %, $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 06 $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 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 t'AX: (763) 571-1287 PERMIT NO.: 2004-02038 DATE ISSUED: 11/05/2004 ADDRESS : 49 62 WAY NE PIN : 153024440018 LEGAL DESC : UNAVAILABLE : LOT 0 BLOCK 0 PARCEL 0 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE. # INSPECTIONS I APPLICANT RTS ELECTRIC 8720 257 AVE NW ZINR ERMAN, MN 55398 (763)856-6010 OWNER MISSY PEDERSON 49 62 WAY 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 construction or the performance of construction. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 11581 SEPARA"1'E PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRMLEY R 5 6 7E&n O.: 2004-020 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/26/2004 (763) 571-36U4 FAX: (763) 571-IZ87 ADDRESS : 49 62 WAY NE PIN : 153024440018 LEGAL DESC : UNAVAILABLE : LOT 0 BLOCK 0 PARCEL 0 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION 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 A FURNACE (WARM AIR, YORK, 60,000 BTUS) AND GAS PIPING FOR A RANGE, DRYER, WATER HEATER, AND FURNACE. VALUE OF APPL OR WORK 3300 # FURNACES 1 # GAS DRYERS 1 # GAS RANGES 1 VALUE (FOR MINIMUM CALC) APPLICANT KEVIN'S HEATING & COOLING INC 6474 20 AVE S HUGO, MN 55038 MISSY PEDERSON 49 62 WAY NE FRIDLEY, MN 55432 3300 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 regulating cons ction or the performance of construction. .App Date HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 10.00 GAS DRYER FEE 10.00 HEATING REPAIRS/ALTERATIONS 20.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 75.50 PAID WITH CHECK # 2635 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY -OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE f;Idley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Zia JOB ADDRESS Fee Total $35.00 $10.00 $10.00 $10.00 *A;. ^--A 44--_i.�+FSi�es $2&.% di`dr ea��i �v�ue All Other Repairs or Alterations (List on Back) 10/6 of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE $ Building Used As l/Q !21 e- $ lo• ESTIMATED COST 3-3c v ° p a PERMIT NO C; -JQ $ 0.0' DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water (WaDAir Trade Name o Size No. $ /C), BTU U v6 D HP EDR Fuel munal a S Total Connected Load $ Burner Trade Name Size No. BTU oyo 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 REINSPECTION FEE $50.00/HOUR *Air Conditioners can not be placed in side yard without written approva from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE and representations ssstated in this application are true and correct. HEATING CO Ae! C 'l YA�f� Signed Tel # Y,11T FAX *--6S Date /0 / � .�0 T Approved by Rough -in Date Final Date .1104 ! 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 o 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 W 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 Pa iv ff u iv BTU Input d vole Fan Assisted o Na Appliance #2 Type BTU Input Fan Assisted or at Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances 4 Total Btu Input d U Common Vent Type L► � Vent Heighty 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 I ft Length ftft Diameterin Type /1 Al TFRATKINS- (Describe) e 0,--/'7/'*0 , f— tole) � C.-, f'- -t.- !r HEATING CO: Signed By: Date : LA-�oy CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 (763) 572-3604 FAX: (763) 571-1287 PERMIT NO.: 2004-02330 DATE ISSUED: 12/27/2004 ADDRESS 49 62 WAY NE PIN 153024440018 LEGAL DESC UNAVAILABLE LOT 0 BLOCK 0 PARCEL 0 PERMIT TYPE PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A PH 763-572-8880 # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES # OF NEW FIXTURES 3 VALUE (FOR MINIMUM CALC) # WATER TRMT APPLIANCES 0 APPLICANT TERRY OVERACKER 1630 CITY RD 10 SPRING LAKE PARK, MN 55432 (763)572-8880 OWNER MISSY PEDERSON 49 62 WAY 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 construction or the performance of constcti Annlicant_ — Date T t , Bldg Insp PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 7529 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 0 2410 0.00 30.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 30.50 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NI IMRFR ni: FIXTI IRFR T() RF INRTOI I Fn nN Genu CI nnQ ki RATE �<:: •.{... »Wash ;�f;Floor: $10.00 Auto.: : °``Stories Gas '' `:; Water Heater .,r.:x:ci?.: Urinal?:: Shower Beer Dispenser Tra I Drain r,..`�_ '{< Washer:>: Blow Off Basin xkYGas and representations stated in this application are true and correct. Catch Basin .•�<: . Rain Water Leader $10.00 Ran a '. Elec BasemeV. Sump/Receiving Tank :: .::'°ai:r Water Treating Appliance $35.00 OWNER -e e S -6 ,0j 1:h} $35.00 :;.i}'(•;L;•'.;Floor Water Heater - Gas`* $35.00 ' BUILDING USED AS OC,,� c,� e ..� 1 A - i?:{'• $10.00 � �_ Gas Dryer** $10.00 2:.<...;`,,p•'y'°'°'r,:k'•fi::.: Back Flow Preventer Required ( )Yes () No q:::S:Floor l Type $15.00 PLUMBING COMPAN Reinspection Fee $50.00/Hr SIGNED BY TEL NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance 3' ,,:MZ'•�yb , J.y,sr,".;i:j.�e..':..r..:'+.?.•.;{.rfr.. y},":• Ur•'i[";'Floor Approved By Rough -In Date Final Date :>:,<.:•:..�� �'''a %.�, 4 ;:ar:..,Y :. 'S+•.G: `•, �,:::. �lr�,.,.. :: .Floor :�� :. TOTAL FEE s -3-0--s' OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 :,,s:..:.s :;:::• :,.<:<.:.c...< �:;:;>.� : PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS &o9'.4-/ YW 4ff New Fixtures $10.00 d' 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 . Rain Water Leader $10.00 DATE: f.�� �- 200 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER -e e S -6 ,0j Water Heater -Electric $35.00 Water Heater - Gas`* $35.00 ' BUILDING USED AS OC,,� c,� e ..� 1 A - Gas Range** $10.00 � �_ Gas Dryer** $10.00 ESTIMATED COST � �/� PERMIT NO.-. Back Flow Preventer Required ( )Yes () No l Type $15.00 PLUMBING COMPAN Reinspection Fee $50.00/Hr SIGNED BY TEL NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge$ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 60A OF COST TOTAL FEE s -3-0--s' OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "'PROVIDE COMMON VENT INFO ON BACK SIDE I 05/03/2005 14:24 9529265960 TO IS 60 P,0142 PPR -14-2M4 5.5102 FROM CITY OF FR I DLEY C-f}tadUv� 4/1/2004 NEW r ] CITY CW FRIDLEY MN 664 X31 ; swo Imp ADDN ] 8431 univanRy Ave NL. F:mi*, o Ra t? ) 63 w-1-420 Fax AMILY AND ALTER I a g1 BIJILDDIN13 PERMIT APPLICATION NORTHWEST EXTERIORS PAGE 02 Cmnmctlon Addroa•: Legal Dwriptiarl:sem. MT•t. # b"� ► - �b�q _._----- Omw Nome & gym- _ MN LIGMSE - Addn➢es; Wjcattort, a Certtflcate of e+svey of the at, With tlq proposed =Mtruction dm wn On it tO Scale. RESCCR1PInON OF IMPre0VWENT fwlviN0,AR6A: Length, Width ._.� HOW Sq. Ft Haipht _________ Sq. FL.-..•-.�--- tiAFtAOt: ARS Length ,!._.� Width Hgt/Caround �.,,�. Sq• PL DflCKAFtEA: Length_____, h O'17�R: Cmtatruction Typo: � � A' W n C� O W Esamated Coat: $ - Drtveway Curb Cut Width Needed:._ Yt, 4 ® Ft ,,.fit x $ a $ DATE: APPLICAW: Tole_-�5�� - �3 for Permit 6T PermitFe•sm K mal{ME in appliWeam I�tx do X71-1 R using credfl: CaH card and vre wHl �afl (�) you for card number. CRY USE ONLY - Permit Foe Plant Review Fire Surcharge Stage Surcharge SAC Chmp Cuda Cut Escrow F..roslon Control Perk Fee Sewer Main Charge Fee Schedule on Reaerm® Side 65% of Permit Fee .001 of Permit Valuation (1/10th°1/c) $.30!$1,000 valuation Sim per SAC Unit 15.00 (State Uceneed Residential COrftiftm) Alt. "A" or AIt, "B" Above $450,00 Comrvafion Plan Review Fee DOWMfl >ed by Engineering Agreemern Necaasmry j ] Not NeceNor i' -1 TOTAL $ I �}`TGI-53 8-6�64-1S-s4 xP 6S�oia v �� From: City of Fridley To: 6516531743 Page: 516 Date: 5/15/2007 2:19:23 PM Building MECHANICAL Permit No.: -/o 77 Inspections RESIDENTIAL APPLICATION Received By. 763-572-3604 CITY OF FRIDLEY Date R EM M10 1,C DATE A YOUR E-MAIL DRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER )<ONTRACTOR PROPERTY NAME: o + ip ADDRESS: 10 /4' CITY e 3TATE �sf� TENANT nn PHONE: .S 7 t —.Z ye.2A 1 IQ CONTRACTOR COMPANY NAME d •S rI raaC�� C CONTACT PERSON: SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE �/d1a LICENSE WITH ADDRESS: y�l CITY tt _STATFSIP� C� (i C��i�� APPLICATION �� , PHONE (/Sl S� " ! O ` ©t%.Zr% FAX /OJ 4(—r PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: YNEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK W s PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, 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 cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS 5500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) p Equipment Installed MFG: Q 6t MODEL: P,S ABb SIZEBTU C> © D MFG: MODEL: SIZEBTU MFG: MODEL: SIZE/BTU A/C $25.00 (GAS) $15.00 _GAS RANGEIOVEN $10.00 _FIREPLACE TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL 510.00 _AIR $35.00 $35.00 _GAS UNIT HTR$10.00 _BOILER _FURNACE IM LINER $10.00 DRYER $10.00 _POOL HEATER $35.00 _CHNEY _GAS DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 R :: } F. ..:::........................................................................... ......:....:P Permit Fee $ S 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 (a), $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 re uires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME.�1P(%! OLOF DATE ..............•...:.::......:......:......::::.......:::....:..;......:...........:........:.::.......:........... :.EP:ARiTE >RE .:::.: 1:I*(3R.$I 11Ci<:>I$I1L<77IW>`>3< :::::::::,.alr's:,........................:..........x.................................r�........� ... .XQ City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 2007 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Fridley MN 55432 a NE RECD MAY 17 2001 Mechanical Permit# Residential Application City of Fridley See Back Side For Required Information Date -5-110 -0-+ Site Address: 4CI !'Doi � The applicant is: cirlce one Owner or Property Owner. in jgg? - c+- C r LVA1.610n Address: P City: e4 ct I e.AA State: M rl zip: 51��-?L/32-- Phone: o Cell. Fax: Contractor Informa ion Company Name: t in Ajic,- ee Tier Contact Person: Addres : / U Ili City: 0 State: Mf) zip: 2-553® Phone: 3 - -17d- Cell: Fax: 90-3 -L ,>9 Email: r MN Bond# & Exp Date Type of Work circle one): New Re lacement Alteration/Remodel Detailed Description of work: T - Equipment Installed: MFG: ` rh0r-% Model: SSX IL401 FS Size/BTU: 14 See MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 Air to Air exchanger $15.00 _Furnace $35.00 Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ 0 Minimum fee $15 or 5% of cost of improvement Surcharge Total Due $ 0.50 whichever is greater + surcharge 0?5- SU— Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical 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 case of all work which requires review and approval of plans. Signature of Applicant: Dater` ,40`0 Approval Inspector Signature: Date: Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005