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AF - 35630CITY OF FRIDLEY INSPECTION DIV. 643"1 University Ave NE -. Fridley, MN 55432 572-36Q4 :: � � / �' ' Effective On January 1,199�( APPUCATtC?N FOR PUWER PLANT3 AND HEATING� COOUNCC�ii, VENTIiATION, RE�RlGERA710N AN� AtR CONDITIONlNG SYSTEMS AND DEVtCES !�r �_ . JOB ADDRESS �� Residentiai Fumace Shell and Duct Work, Bumer — Aiso Replacement Furnace (Side Vent — Fiit Out Back) Gas Piping (Needed wi#� new fumace) Gas Range Gas Dryer *Air Canditioning — Ali Sizes Alf Uthers/Repairs & Alterations (UST ON BACl� 1°�6 of Value of Appiiance or Work Commercial/i rtdustrial 1% of Value of Appiiance or Work Rate T�7AL $ 20.00 $10.00 $10.� $10.00 $10.00 State Surcharge TOTAL FEE $ �� $ �� $ $ $ �� ;� The undersigned hereby makes applicatian for a perm'rt for the work h�ein spea'rfied agree�ng tv do aA wwk in s#rict acco�dance with the City Codes ar�d �ulings of the Building Division, ar�d her+�by dec�ares that all the tact� and representations st�ted in this appiication a rue a��rrect. \ �� - 19"�' BUILDtNG USEO AS � �� ESiIMAIED COST � PERMlTNO. � ; 1 •�, • : ► _ ;► � �.: : ► : $ No. of Heating Units Circie One (Steam) {Hot Water) arm Air) Trade Plame � Size Na t�rf �j BTU HP EDR $�i v` o Fue! _ Totai Connected toad_ -� �� a. �o MINIMUM FEE FOR ANY HEATING/CQO�INGNENTlLAT{ON REFR{GERA'[tON/A{R GONDiTlOtdtNG PERMI'� IS Si5 00 PLU8 THE �.50 STATE SU�tCHARGE REWSPECTtON FEE $30.00 *Air Conditioners can not be piaced in a side y�rd without written permission trom adjoining property owner. Bwrnet Trade Name Size ido, BTU HP EDR HEATtNG COMPANY U �� Si ned B � Tel No. `12d S� 9 Apprcved B Raugh—fn Date Finaf Date FILL OU7' BACK SIDE FOR STACK VERl�lCATlQN 4N REPLACEMENT FI�NACE .i NOTE: ��1 through �E8 required when using a side vent furnace. � � Cj��Y .,d�TD STACK ,y,�.�jFICATION The undersigned hereby va ifies that the existing chimney or stack: 1. Has been carefully examined Yes�� No () 2. Is free from n�st or deteri�adon 3. Has no foreign objects lodged within 4. Is securely supported S. Meets all cinrent Code reqttirem�nts for size and totai BTU's cc�nneeted 6 Has t�otal heating BTU's vf All other BTCT's T4TAL BTU's YesONaO Yes()No(} YesONoO YesO.No(} T. I�iaas a liner been provi�d far water heate� Yes () No () 8. Has combus�tion air been provided for wate�r heater Yes {)' No O �= Remarks:� � � � .-, . . _ 1 . .. c t� 1 l� � L��,��.4�� . � HEATING CO: Signed By: Date: HOUSE H�ATING TEST RECORD ADDRESS �� APT. FLOOR CITY SUBURB OL�UPRNT OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY E(ectrical Work By a Gos Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE G�- � MAKE OF BURNER Mode l Model Sxiol Max. BTU Rating INPUT �� MAKE OF FURNACE Model ONTROL S �� THERMOSTAT� � Heat u Ya�t Siza V.Iv. —S� � KIND OF LINER l �IZE NONf Limit Draft Hood Regularor Limit �+t�� 0 Filters Size X�� Nu er Fan Setting Chimney Loeation Inside Outside Pilot Type �% -�- - Chimney Construction ,� Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting inst. Prossure Peresnt CO2 Date Tested �� Input CFH —Peresnt OZ Company Testing Staek Temp s Pereent CO Name of Tester Form 235 Ann�ss PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 s�z-36o4 r��: : 6300 ABLE ST NE : 143024410103 : FLORENCE PARK ADD : LOT 15 BLOCK 6 : BUILDING : RESIDENTIAL : ADDITION/ALTERATION s�l-iz�� :.�.J, . . _ �.----�- �� PERMI�N O.: 2004-00972 e, ' `�-----_.._,___�_.. _.. .. ,, DATE ISSUED: 06/22/2004 VALUATION : $ 28,170.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 iNTERNATIONAL RESIDENTIAL CODE. REMOVE EXISTING ATTACHED GARAGE; MOVE ROOF LINE AND INCLOSE. CONSTRUCT A 22' X 7' LIVING AREA ADDITION AND A 32' X 24' DETACHED GARAGE. APPLICANT OSTWALD DAVID M& STEPHANIE A 6300 ABLE ST NE FRIDLEY, MN 55432 OWNER OSTWALD DAVID M& STEPHANIE A 6300 ABLE ST 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 wor� 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 co�truction or,theApe�ormance pf constructiop. � BUILDING PERMIT FEE PLAN CHECK FEE FIRE SURCHARGE STATESURCHARGE,VALUE TOTAL PAID WITH CHECK # 8032 Bldg Insp Da li� " � � SEPARATE PERMITS REOUIRED �OR W()RK OTHER THAN DESCRIBED ABOVE. 431.65 280.57 28.17 14.08 754.47 NEW ADDN ALTER �� CITY OF FRIDLEY Effective 4/1/2004 �� 6431 University Ave NE, Fridiey, MN 55432 (763) 572-3604 Bid Insp � �� SINGLE FAMILY AND DUPLEXES R-1 ANDR� �� (763) 571-1287 , x \„ �fj BUILDING PERMIT APPL1CAT10N �, ` h'� � , 1 �� ,�` ��..� gY -�d Construction Address: �o � ��'-- �' � - Legal Description: �� ' /S �%� � � ,�/or�'r«- ,,��C � � Owner Name & Address: ,�I tC� �1 � ��c��l�,� Tel. # � -3��_ Contractor: MN UCENSE # Address: Tel. # LNING AREA: GARAGE AREA: DECK AREA: QTHER: Attach to this application, a Certificate of Survey of the bt, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT 1� . G,t,1 ! �� f � �q . �� Length a�_ Width _,�_ Height Sq. Ft. �S ��j� Length 3� Width o?'y Height�,��— Sq. Ft. �ilo i� 1� Length Width HgUGround Sq. Ft. L/A._.n r �✓_.1 srlc Pil�i"'J^(n+6fIN� .�'G/'.i.G�. %1'YJI.� /�l^�� ^i T��/�'�� "'�/f�/� �a.a� , nG�,.,1 �r, t.� wcy �`.+n.0 iC - 3h , n3/.�' \ Construction Type: ;r�"�+F�✓ ��5�%�t _ Estimated Cost: $ �� 1�� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ •G- 7� v� APPLICANT: ��!%� Tel. #�� 3-�3y- X►'S`v �ATE. � Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $�.`� ( , C� 5 $ a-8�0 • 5-1 $ �, , 1% $ jy .[��i $ .$ $ $ $ $ �� $ � Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation , $1350 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 [ ] � . . . STIPULATIONS: �u �� BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,9Q1 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 - for first $2, 000 plus $14.00 for each additional $1 yU00 or fraction thereof, to and including $25,000 $391.25 for fust $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each addidonal $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the fust $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width'plus 6 feet, times the annually determined rate Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv �. �X�< � r'.,;,� �r' �.r'�`�Y:�''� �"�