PRE 2010 DOCSIII
Village of Fridley, Minn.
BUHMING PERM"
N? 764
Office of INSPECTOR OF BU"INGS
4,11
Fridley Minn.,
Builder
II
LOCA#ON OF BUILDING
, -e
NO. Street —Part of Lot
Lot Block— Addition or Sub -Division
DESCRIPTION OF BUILDING
Front L -n'--- Depth',-*
Heipt --, Stories �'2 I `- manner of Constxuctio Zr
To be used as, Estimated Co
To be completed at
the building -
upon the express c
the work done in,
nances of Fridley,
within the city lin
ordinances.
k -" -
described In the above statement. This permit to granted
tion that the person to whom it is granted, and his agents, employees and workmen, in all
and and upon said building, or any part thereof, shall conform In all respects to the ordi-
m., regarding the construction, alteration, maintenance, repair and moving of buildings
and this permit may be revoked at any time upon violation of any of the provisions of said
AGREEMENT AND SWORN STATEMENT
of Buildings.
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, 11 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
11 " R
true as therein st�ated. ' d'`
1 13 ,,
h
Subscribed and sworn to before me at Fridley, Minnesota this
day of A.D. 19 :2
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SUBJECT
PER
City of Fridley
0789
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
COMMUNITY DEVELOPMENT DIV.
~ PROTECTIVE INSPECTION SEC.
d
r ,
/
CITY HALL FRIDLEY 55432
NUMBER
REV
GATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
I
4/29/91
JOB ADDRESS 542 - 66th Avenue NE
1 LEGA LLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
Rice Creek Terrace Plat
2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Viktorin Stutz 542 —66th Avenue NE
571-5623
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.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (18 Squares)
9 CHANGEOFUSEFROM TO
STIPULATIONS
Roof can be. 2nd layer but not 3rd.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED 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 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
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
$g.36
$.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-
$25,00
Fire SC $.94
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
26,44
OF CONTRACTOR OR AUTHORIZED AG T (DATE)
WHEN PROPERL
V
T IS IS YOUR PERMIT
TURE
SP
MATE
SIGNATURE OF OWNER IIF VNER BUILDERI IDATEI
NEW [ ]
ADM [ ]
ALTER [ ]
Cmistructi on A uesss: � Ll 2,
R-1 AMID R-2
Building Permit Application
Effective 2,/1/91
�1 7�,
Legal Description:
Owner Name & Address: �` i lK!F02; �� �TTz `� = G� fi �l1 WW1.
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed oonstn3ation drawn on it to scale.
LivnG Amm: length Width Height Sq. Ft.
GMLVZ AMM: length Width Height Sq. Ft.
BEEK AREA: length Width Hgt/Gro u d Sq. Ft.
Corner Lot [ ] Inside T { ] Ft. Yd Setback Side Yard Setbacks
Type of construction: Estimated Cost: $ `j
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
idth + 6' See Back Page
APPL'
ICiDAE: Tel. # 5) 1_'
Permit Fee $ c ' � -00
Fire Surcdfarge $ • g-1
State Slirrharge
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer main Charge $
CITY =M COZY
Fee Schedule du a on Reverse Side
.001 x Permit Valuation (1/10th $)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Eng+ *+tiring
Agreement Necessary [ ] Not Necessary [ ]
J
BUB�ECT
Cg of Fridley
THE TWINS
BUILDING
PERMIT
28383
57
�Q/, 1
-7141
1 ,
• ------, COMMUNITY DEVELOPMENT DIV.
V
INSPECTION SEC.
r 1 � PROTECTIVE
/
1 G 1
1 �
L
i CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/22/98
JOB ADDRESS
542 66th Avenue NE
T LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
Rice Creek Terrace Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Sheryl White
571-3991
3 CONTRACTOR MAIL ADDRESS 425-4737
ZIP PHONE LICENSE NO
Twin City Exteriors Co.I55369-4093
2939
e 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
0 NEW 0 ADDITION 0 ALTERATION IRx REPAIR 0 MOVE 0 REMOVE
B DESCRIBE WORK
Reside
9 CHANGEOFUSEFROM TO
STIPULATIONS
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REOUIREO 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
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
5000
$2.50
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
$99.75
Fire S 5.00
PLAN CHECK FEE
TOTAL F
Licens
.00
112
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iOATEr
PRO ER YOUR PERMIT
'Oeo�T
�TEDT
SIGNATURE OFOWNERaFOWNER BUROEA1 iDATEj
SLOG 19
nAtE
NEW I' ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
5�d-ZIJ4
Legal Description:
Owner Name & Address: 5> yL
Contractor: 4) In 17 -
Address:
T -Address: ger /) -,7,di</,1,0 V IaJ
M
Ap-
Effective 1/1/97
Tel. # .-'7/--. ---3 9 9l
MN LICENSE #-�?'�
Tel. #6X Y -Y:7.
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWROVEMENT
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 $ _ $
1111111111111111111111111 1111 111 1�1 y/�/.��/: Vii►:"
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ 9%, Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$ . —,j�pQ
$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 [ ]
as'
TOTAL
$ I
STIPULATIONS:
CITY
OF FRIDLEY PERMIT N .:
2004-01966
6431 UNIVERSITY AVENUE NE
,
FRIDLEY, MN 55432 DATE ISSUE
04
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 542 66 AVE NE
PIN : 143024130005
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. INSTALL A GAS WATER
HEATER.
# 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
VALUE (FOR MINIMUM CALC)
200
# WATER TRMT APPLIANCES 0
APPLICANT
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
0.00
0.00
H P PIPEWORKS
3670 DODD RD STE 100
PLBG FIXTURES (EXIST OPENINGS)
0.00
EAGAN, MN 55123-
WATER TREATMENT APPLIANCE
0.00
(651) 365-1340
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
35.00
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
0.00
0.00
0.00
OWNER
DAVID WAHLGREEN
542 66TH AVE NE
STATE SURCHARGE, PLBG FLAT
0.50
FRIDLEY, MN 55432
TOTAL
35.50
PAID WITH CHECK # 10031
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 work
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 q
f any o r state or local law
regulating construction or the p orm of construction.
Applicant Date
00,
Bldg Insp D@�
SEPARA E PERMITS RE FOR WORK OTHER THAN DESCRIBED ABOVE.
JITY. OI✓ F"RIOL.EY INSPECTION DIV
431 University Ave NE
Adley, MN 55432
763) 572-3604, FAX (763) 571-1267
n
Eife iive.April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT '+4'3.
6AAr?It All IKAR1=R ng: GIYTI IPPA Trl RF INSTAI I Fr! ON FAM FI i7OR 1,9
ILUMBING FIXTURE RATES: NO, RATE TOTAL JOB ADDRESS
lew Fixtures
The undersigned hereby makes application for a permit for the worts herein
washWaterHeater
$10.00
Floor
Auto.
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rii
Sories
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Show
Tray
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?x>ro
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Drain
:ain Water Leader
�rRan a
:'>
a:2'i-v-y..r1:
Gas ElecWasherUrinal
ao.a,3
xv.iiCi:0�rPi>_:?O_i"N
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ESTIMATED COST PERMIT NO
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Floor 1
m %LL OTHERS ANDIOR REPAIRS AND ALTERATIONS
` 4 1 25% of Value of Fixture or Appliance
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ILUMBING FIXTURE RATES: NO, RATE TOTAL JOB ADDRESS
lew Fixtures
$10.00
The undersigned hereby makes application for a permit for the worts herein
)Id Opening, New Fixture
$10.00
specified agreeing to do all work in strict accordance with the city Modes
leer dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the facts
clow Off Basin
$10.00
and representations stated in this application are true and correct.
:atch Basin
$10.00
$10.00
DATE: 200. l /
:ain Water Leader
.2 _
A lump/Receiving Tank
$10.00
Vater Treating Appliance
$35.00
OWNER ci t a A
Vater Heater -Electric
LL
$35.00
O Vater Heater - Gas'* ��
$35.00 .ba
BUILD ING USED AS
aasRange*`
$10.00
u Sas Dryer**
$10.00
ESTIMATED COST PERMIT NO
lack Flow Preventer Required ( )Yes () No/
I n
X E � i��(.�8�(����4
Type
$15.00
PLUMBING COMPANY
teinspection Fee $50.001Hr
SIGNED BY TEL N - 5 — �
m %LL OTHERS ANDIOR REPAIRS AND ALTERATIONS
` 4 1 25% of Value of Fixture or Appliance
v Approved By Rough -In Date Final D e
NState Surcharge $ .50
MINIMUM FEE F R ANY PLIiMBINGtGAS PERMIT IS 15.00 or S% OF COST
J TOTAL FEE OF THE IMiPROV MENT WHICHEVER IS GREATER ON WORK LESS THAN 300
� JOMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE $-A. "PROVIDE COMMON VENT INFO ON BACK StDE
JUL-27-2004 10:50 CITY OF FRIDLEY P.03iO3
i
FILL IN COMPLETELY FOR REPLACEMENT FUEL BUtkNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
1Nhen rbalacing 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 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 dbes
include �GA-LAMA 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 mahufacturer'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 i6stalling a new venting s stern, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's'1
specifications. This does include AGA -LAMA Category I Central Furnace
draft appliances.
Yes) No( )
Venting Tables for fan assisted and natural
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 V) No ( )
Appliance Type and Sizo/Common Vent and Vent Connector Information
Appliance #1 Type:& at Q u r _ 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 l Total Btu Input
Common Vent Type Vent Height Diameter
inches
Appliance
#1 Vent Connector Height _ft Length ft Diameter in
Type
Appliance 92 Vent Connector Height ft Length ft Diameter _in
Type
Appliance #3 Vent Connector Height ft Length ft Diameter in
Type
ALTEW—IONS: Describe
HEATING CO:
Signed By: Date
TOTAL P.03