PRE 2010 DOCSCity of Fridley, Minn
BUILDING PERMIT
Date: ------.. .... -....-._.._....�_ .--------------------
Owner:
Address
N° 4257
Builder--
Address........_............._----------..._...-.....----.................._.._......._...-.._.._...---....._.......__....
�y %
LOCATION OF BUILDING
No. ..g r .. Street . -(elL %' ...._................. 14d=. ............ ......... Part of Lot ........................... ........ ......................................
_.._
Lot....._. ...................... Block ..... .;..................................... Addition or Sub -Division ............ ............... ................. -....... ........... ............................. -... -_...... -.....
� 91
Corner Lot ................... .......... Inside Lot ..... %�........................... Setback .......' � "® y 4.......... Sideyard ...!_... 0..._..0...._........---..... ...................
Sewer Elevation ...... ............. _............. _............. ...................................................... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
.� .. Front .. __� '' �' 1 ! �®
.............._.....----------%..��. � Depth ...... f Height ..........� Sq. Ft... _.......... ® Cu. Ft.
....f �Ls .. Front .r �� .. Depth ...._...._......._.. Height 7WSq. Ft . ' ..........1 Cu. Ft...............0..,%
Type of Constm on ........................... ..............._........._.... Est. C—C To be Completed ..................................................
In consideration of the issuance to me of a permit to construct the b ' g described above, I agree to do
the proposed work in accordance with the description above set compliance with all provisions of
ordinances of the city of Fridley.
... -..........--- - ..... ........_ + _....__...__..._-._..._.. ..._....__._.........
CO
In consideration of the payment of a fee 4P' $vr_'—.., 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
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
SUBJECT
O.
City of Fridley
2773 6
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
; � PROTECTIVE INSPECTION SEC.
��
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
I ` CITY HALL FRIDLEY 55432
IL""__
. , I'J 612-571-3450
910-F15
q/ 11/98
JOB ADDRESS 820 66th Ave NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
2
1 Meadowlands
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Glenn & Mar beth Yama uetti Same571-9532
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Owner 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 YJ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house & garage 24S 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 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
$2056.00
$1.03
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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.
PLAN CHECK FEF,,
TOTAL FEE
e
$77.84
N TURE OF CONTRACTOR OR AUTHO 1 ED AGENT ID71;
R
ERLY
ATED T IS YOUR PERMIT
I BLD UA.
r.
—,✓
OA TE
SIGNATURE OF OW ROF OWNER LDERI 1 TEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Y'ConstructionAddress:
Legal Description:
41) N,4�-' r
Owner Name & Address: �e tA �, M�/ ��A-�vi.prGM t ip Tel.
Zd #
—
Contractor: a Ix ,,& & . uu 14=5 MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
Effective 1/1/98
"10
LIVING AREA:
Length
Width
Height
Sq. Ft.
GARAGE AREA:
Length
Width
Height
Sq. Ft.
,DECK AREA:
Length
Width
`Te
Hgt/Ground
4-
Sq. Ft. r
OTHER:
$
Alt. "A" or Alt. "B" Above
acs
2 q
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
Construction Type:
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
Estimated Cost: $
�� S
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft =
Ft x $
_ $
4jLTel.
DATE: -C)IJbIj T
APPLICANT:
# 5 -7 1-12 S-3 2
CITY USE ONLY
Permit Fee
$ %
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 163
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$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:
� � i
y
SUBJECT
P
City of Fridley
33397
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.��
COMMUNITY DEVELOPMENT DIV.
/
� ;
r PROTECTIVE INSPECTION SEC.
L7L
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
"'1 CITY HALL FRIDLEY 55432
IL"""R,
j 763-571-3450
910415
3/27/03
10B ADDRESS
820 66 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
2
1 Meadowlands SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Eileen Dale 820 66 Avenue NE 763-502-1690
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO:
RMA Home Services Inc 3200 Cobb Galleria Pkwy STE 200, Atlanta, GA 30339 20268257
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
763-542-8826
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Cj REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace one window within existing opening
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
PeTmit Inspection Cards
Will Be Mailed
To Homeowner To Post
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
]
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
$1.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,000
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.
Fire SC $2.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$69.25
PLAN CHECK FEE
TOTAL FEE
Licen a SC $5.00 1
$77.25
SIGNATURE Of CONTRACTOR OR AUTHORIZED AGENT ,DATE,
W EN PROPERLY VALIDATED THIS IS Y UR PER IT
_
0-3
DG ,NSP GATE
S.GNATURE OF ON/NERdt OWNER BUILDER, (DATE,
y
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF "IDLEY
ALTER [ l SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: `b o3 0 - Lo U` " k.5 -k.
Legal Description:
Owner Name & Address: L +1-e fe rlo —1--)01-R_ . I
Contractor:. RMA HOME SERVICES INC.
' Home Depot Installed Sales
Address: 3200 Cobb Galleria Pkwy., Ste. #200
Atlanta, GA 30339
A 763-542-8826 urvey°af the
1c BC -20268257
in -it to scale.
DESCRNMON C1F1IiW-[PR()V MWT _ .
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Tel. #, i4
MN LICENSE # -
Length
Length
Length
Driveway Curb Cut Width Needed:
Width }
Width
Width
Height
Height
Hgt/Ground
. It .
Tel. #
Sq. Ft.
Sq. Ft
Sq. Ft.
Cm'
_
�
Estimated Cost: $ Q '
Ft. + 6 Ft = Ft x $
DATE-,�� •m�1,1.03APPLICANT:,4 Tel. #'?S:g•
M9
CITY USE ONLY
as
Permit Fee $ Fee Schedule oniReverse Side
Fire Surcharge $ C>) .001 of Permit Valuation (1/10th%)
State Surcharge $ /' $.50/$1,000 Valuation
SAC Charge $ $1050 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL $
STIPULATIONS:`Orq -3
Alt. "A" or Alt."B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
'PITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004
1431 University Ave NE
'ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
763) 572-3604, FAX (763) 571-1287
MARK NUMRFR nF FDM IRFS Tn RF INATAI 1 Fn ntu Gera Gi nno
'LUMBING FIXTURE RATES:
Jew Fixtures
Ad Opening, New Fixture
leer Dispenser
llow Off Basin
NO. RATE TOTAL JOB ADDRESS 6annV�.2 -0-5, IYW IlL1V_
,atch Basin
Iain Water Leader
)ump/Receiving Tank
Vater Treating Appliance
Vater Heater -Electric
Vater Heater - Gas**
Sas Range**
las Dryer**
lack Flow Preventer Required ( )Yes () No
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.00
Type $15.00
teinspection Fee $50.00/Hr
+LL 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 aoolication are true and correct.
DALE, EILEEN
820 66TH AVENUE NORTHEAST , 2046
FRIDLEY, MN 55432
OWNER (763) 502-1690
BUILDING USED AS_ I�.e,Sl d evtc-�
ESTIMATED COST W 0 00 PERMIT NO.
PLUMBING COMPANY NO (_�P` ow� U vA IQT
SIGNED BY TEL N0. (G17)927 -c/033
Approved By �1 Rough -In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
$ �S OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE
30MBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE
IRMO=
'LUMBING FIXTURE RATES:
Jew Fixtures
Ad Opening, New Fixture
leer Dispenser
llow Off Basin
NO. RATE TOTAL JOB ADDRESS 6annV�.2 -0-5, IYW IlL1V_
,atch Basin
Iain Water Leader
)ump/Receiving Tank
Vater Treating Appliance
Vater Heater -Electric
Vater Heater - Gas**
Sas Range**
las Dryer**
lack Flow Preventer Required ( )Yes () No
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.00
Type $15.00
teinspection Fee $50.00/Hr
+LL 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 aoolication are true and correct.
DALE, EILEEN
820 66TH AVENUE NORTHEAST , 2046
FRIDLEY, MN 55432
OWNER (763) 502-1690
BUILDING USED AS_ I�.e,Sl d evtc-�
ESTIMATED COST W 0 00 PERMIT NO.
PLUMBING COMPANY NO (_�P` ow� U vA IQT
SIGNED BY TEL N0. (G17)927 -c/033
Approved By �1 Rough -In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
$ �S OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE
30MBUSTION 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
G
Building
$35.50.
Number of fixtures ;@ $15.00 :'
PLUMBING
Permit No.:�t�
Inspections
FLOOR DRAINS
RESIDENTIAL APPLICATION
Received By:
763-572-3604
_ GAS PIPING (NEED CITY LIC)
_ SWIMMING POOL
CITY OF FRIDLEY
Date Rec'd:
763-502--49'77\ FAX
WATER CLOSET
_ BACKFLOW PREV. ($15)
_CLOTHES
_ DISHWASHER
_ LAUNDRY TRAY
WATER HEATER ($35)
` , FOR IRRIGATION
EFFECTIVE 2-19-09
a Z%'
DATE o�
YOUR E-MAIL ADDRESS
SITE ADDRESS 940
(a lQ
THIS APPLICANT IS:
❑ OWNER
/EONTRACTOR
PROPERTY
NAME: C
-e(/1
OWNER/
ADDRESS: 9.30Ave-
C CnT I
STATE IP _4553
TENANT
PHONE: -7 kko S '-'
5 -DA- 1 6 '%
CONTRACTOR
NAME: 1 f' Y ice(
®V &'aL pI'6-,
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE #
LO l L L%S- 017-7 EXP DATE
LICENSE, BOND AND
STATE BOND #
EXP DATE
CERTIFICATE OF
ADDRESS: �o�
/,,A
/!'L�1 ✓] .5' CITY 6
y�I
STATE 1► �P ZIP�W
INSURANCE
PHONE °1. �P 3
–59A - Le�? �O FAX 'I (o3- 5U
PERMIT TYPE
SINGLE FAMILY
❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW
❑ REPLACEMENT
I DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
Number of fixtures ;@ $15.00 :'
is $15.00 = $
Number of fixtures @ $35.00
_ BATH SINK/LAV
FLOOR DRAINS
_ SHOWER
_ WATER PIPING
_ GAS PIPING (NEED CITY LIC)
_ SWIMMING POOL
_ WATER SOFTNER ($35)
—BATHTUB
WASHER
_KITCHEN SINK
WATER CLOSET
_ BACKFLOW PREV. ($15)
_CLOTHES
_ DISHWASHER
_ LAUNDRY TRAY
WATER HEATER ($35)
` , FOR IRRIGATION
WATER METER
X OTHER
Number of fixtures @ $10.00
x$10.00=$
Number of fixtures ;@ $15.00 :'
is $15.00 = $
Number of fixtures @ $35.00
x,$35,.00, = $
State Surcharge
(MINIMUM $35.S0
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 plication fora a it and work is not to start without a permit on site; that the work will be in accordance
with the approved pl in th case of all which requires review and approval of plans. �q
SIGNATURE OF APP CANT PRINT NAME DATE ZC) v
PLEASE NOTE: S TE PERMITS ARE REOUIRED FOR BUILDING. ELECTRICAL .AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977