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AF - 35171�(. C. �o�u�m a�d �ssociates, ��c. LANDSURYEYORS 10130 HlGHWAY 65 NORTHEA57 MINNEAPOLIS, MINNESOTA 55433 a,/� , � �� .� CERTIFICATE OF SURVEY: SAMl1EL TEMPLIN +1 � � W � � + = — �0-� — LLJ —�—� , � �N� O � � � � 1`e �" _ � ' ' � 43.T — � �-------- T ( � Telephone 7845480 SGALE = 1 �� = G'O� 3450-�80-57 --c� DEt�r�s i RaN 14 2 � —" I � 33. 9 � � �� • �� � � (�2 -`J-F I'�2 � N W� n' ' }, ( 4' H � ; l-S=F }� ; �1� C'°'s-_ � � %i -c�v t � �� � 22�. � 142 t — � �� � / - �C+",.'.:. UESC'r,It��i:�:i: :A: 4� Ji�C� 3, �i,^,£'trdLeY �dtU'£�15 ��at t, n!tW;;! Coun*_y, �'inr.e5Gt1. O N i �- �� ,,'�; r �r� � � cY� of F�.a�ey�, .�. . - 3 9� 6431 Unive�aity Ave. N. E., Mmnea.Aolis, Minn. 55432 BUILDING PERM[T . ��: April 28, 1972 p�; _ Sam xemplin g�� S,E. Templin Coastruction � 6184 Stinson Blvd. Ad� Same LOCATION OF BUILDING N� 6701 Street Ashton N.E, Part oF Lot Y.ot . �� .._. Bl 1 Addition. or Sub-DivIIsian Edgewater Gardens Plat 2 � .ot C�r�er Lot � Lot % Setback 35 � 8iaeyard 6' & 15' BeWe� Elevai3�sn. Foundation IIevatton DESCRIPTIOW OF BUILbING To be Used as: -E� eatry Souse �nt 24' �� 35' Height .� Fk �� .C�. Ft Att . Garage ��, r �� , � �St-ory F�ront 2A Depth 2� Sei�ht 10 Sq. Ft. cu. Ft. � ,� � ��� frame � � 19,675 .51 To � �p�,� Summer 72 Prflv3.de i�erification survey and Hard Surface Drive Letter on file that plat wi11 be filed SEWER LOCATION; 47� N. of Ma.nhole WATER LOCATION: 58' N. of Ma,nhole Ia c�nsiderai3on of the issuance to me of a permit to conetinict tbe g described above, I agree tp do $h8 propa�ed work in accordance with the d�cYpiton above set forth and com�ance with a� provisions � �ees of the d1Y og �Y• � � � Ia consideration of,.the paymeat of a fee of $ 44.00 ��t is herebY granted toS• E. Templin Construction Co. to construct the buil�ing or addition as described above. This �it is granted upon the ezpress condition that theperson to whom it is graated and hi� agentsy employees anc� worlunett, ia all Work done in, around and upon safd bwtlding, or any part thereo� shall conform in all respects •io the ordinanc�s oE F`ridley, 8dinnesota regarding location, conaixuction, alteration� mainten.aace, repair and nnoving of bwtld� �� dty limi#s and this �rmit maq be revoked at any time upon violatioa of aay oP the Prov3aions of �said c arence Beliele � NOTICE: Th& per�nh does aot wver the eoasfrue�ion, ia�aqafion for widne, plumbing, eae heaNng� aewer or weter. Be stms to ms tLs Buildiag laspeetoe for separa�e permhs for th� ifee�a. �' ., , � - , m� � � 4-� �.C. �OI�� A�D ��a��CI�T�� ��C. � LANDSU VEYORS .� 10130 CENTRAL AVE. N.E. (Hwy. 65) — BLAINE, MINNESOTA 55434 Telsphone • 784-5480 CERTIFICATE OF SURVEY:_SA�'lU�l.. TEMPLIN � l..,J ' � � .Q O �� O (/� \ \ � u .. »z.o .��_. �� . ��- � ' � •i ., ��� �� • .» �.. . 9 . . ` �g R . . . Sa. y ' �� . � , � 14Z.0 � � � �� _° �� o� � � . �i �� � �: }' T= J , , � . � I' , �� ay ' v\ , 1 �. SGALE 1=30' 33Z3 -q DENOiES IRON ��� - L� . 2 } � � � Q !�� . ;A � o � � � � J .. . �C � � LEGAL DESCRIPTION: � Lot 4, Block 1, Edgewater.Gardens Plat 2, Anoka County,;�Minnesota. g��•�� ��� �� t����1R� ��504 � � � ,r-� �. �.�— s��;��� � �� i . � I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OR THE BOUNDARIES OF THE ABOVE bESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN• CROACHMEN45, IF ANY, FROM OR ON SAID LAND. AS SURVE1fED BY MH TFIIS.....�%ti1.....DAY OF ............... Apri1...................A.D. 19.��......... • . N.C. HOIUM AND SOCI T S, INC. � � . , Y / i • _ ...................:.............. ......,��' � ..........»..........»............... � , � �' � Minnssota Rsqishotioe No. ......�.�.l:":.�... �T ` . , APPLICATION FOR RESIDENTIAL, ALTERATION, ow� � s ��a� ADDRESS : ���� OR AllDITION BUILDING P,ERMIT CITY OR FRIDLEY, MINNESOTA . x:�"i L�.v�.r� � S: No:. G � STREET: ���I���� � LOT: BLOCK• ADDITION:GG CORNER LOT: INSIDE LOT: `'� SETBACK �.�.�. �. �� IDEYARD• (O �''��� .� Applicant attach to this form �tao Certificates of Survey of Lot and propoaec� building location drawn on these Certificates. � - DESCRIPTION OF BUILDING To Be Used As : �.` Cj � � �Y ��� / 1 / Front: � Depth: �� Seight: � y x � y aw.�� ��-a R y Square Feet: ff O/ Cubic Feet: /,�/ri�1�- /T' ��+/7�'C i Front : �� Dep'th : ZZ- � Height : � � Square eet; Cubic Feet: Type of Constructio • Estimated Cost: $ � �r To Be Completed: .? i� ��`��' `-° ,�� �::p 5� C The undersigned hereby makes applicativn for a permit for the work hexein specified, agreeing to do all work in stiict accordance with the City of Fridley Ordinances and ruliugs of the Department of Buildinga, and hexeby declarea that all the facts and representations stated in this application are true and correct. DATE • � �"" �''' SIGNATLTRE : (See everae Side For Additional Information.) ) �; j �y�;�,��,�, �f:;.�..;1 —�_ � � �d ii� 9 ',�� °�` �', � �� �I -°� � � E� � `�� j-, i/ � �`,, (�' �--i ,, ti � T��T� � ���� + - ���, 0 � A � bf � �' �� , �-� � � `� °'� Ci' �j r�. p' � A � �.t � � � "r.� � �, �"' � '� t✓+�'' 1 � �_. '�'��_'" �. � � � G `� , eI ,. . . � � � �� � t � � �� � - � � � .d � BUILDING PERMIT FE�� SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building ox structures or fox any alteration or repairs to any �xi�ti�� buil�ding or structure, upon applicatian th�r�fore� req�ir� ��� ������ �� ��� applicant for such pexmit of fees to tfie �moa.a�� ���ei� b���� ��� �+��e��n �� �.a� the manner herein provided to-wit: 'UNIFORM BUILDING CODE t Type 1, 2& 4-$2 m 15 fo� eac� o�e tlnousax�d cutsic feet, or fraction thexeo£e ia� such cubical conicents, �rpe 3& 5�$1e�5 gor e�ch one tthous�xasl �ubi� £���t. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical content� of any building or addition, is determined by multiplying tlae ground are� covered from a point six (6) inches below the floor lin� of the basement o� �he cellar to ihe av�e���� heights of �hP �xpper sux£ace or to the average �ei�h� of the ��of �u���.�e �f �la�e x�in gab�.e o�' m� �itched ro�f. For repairs or alterati�ns to an exisging stxucicure, �he i�e shall be at the rate of $3.00 per each five hund�ed dolla�s ($500a00) or fraction thereof in the cost of all proposed work. Ia no case shall the fee charged for any permitbas set forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDAI'ION NOTE: Permits for construction will be issued a minimum of 24 hours fram the time of application, to allow for proper review of the proposed structure and of the construction site. A Certified Survey of the lot, showing the location of the foundation, once it ha�.been constructed, will be required before mroceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy sh�ll be made ten (10) days prior to the use or occupancy of aaay structure for which a building pennit has been issued; and said structure shall not tse used or accup�ed until a Certificate of Occupancy has been issued. a��� ..,..w .;y....,- ,-°•`,--=-P . _ -+.w;- __ _ °._,.�„+'°+" �t �""K,���,.�� 'l�f;`�ez".. ;� ��, . .# �5 �' '� � �! s .. b�����. j � " _ ' � � �, - 3` '� � ." � � µ �� �. . � �T '` rT� a' 's�- ... . . . , . _. _ . .. . .. . _ _ - '�` �S � �'g'�T"q� � � '�{ �'. . .. y ,f,�_ ,�� �._ I . . . . . � � � �. � I i - , . - . .. } . `. . . .. _ . . _ " � � y �� . T �-� �i i � , �° T � � , t � . , y .. � . . � . . � . ' - . . .. � .. . , � -, �. . . . , . ,.,.. , , �. . . . . � , . . . . . f r . �: � � . .. �+-. � - . . __ . . ' ' I . . . _. . . . . . . . ... .. . . . .. ,. , . . . . . . . ' . .' ' _ t . � . . - . I . . . .. .. . 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". . . , . . .. .. . . r �_.. _ � � � � � � � Q � � � 8 m � '� � �S � �' � � W Q e �" � � � "�' � r '" � � "� � � m � � � � � � � ����� A � �� ' � ,.. tid • O � M • 0 � • � n �o • �' O � � � �. = �so.� �� . � , a �• m • � �� ' m� �� : � ; : . � � °.° . : . . . : g : � . . . � • . . � � . . : . : . . : . . . . : . .. . . . . . ; : . . . : . : . . . . � ; o 0 . y : 11 M M M 11 N 11 X il i/ E• 8 � 8 �8 � 8 � $ � 8 � � � : � el► � p M M � \ �1 N � � � y . - �, � o � o e�� � � � � 0 D � � 7� —D�1 fi7 H � T v � m �� �� � � � z � � � � m � � � � � � $ 0 E � a � odn � � I� 0 " ■��► ' � ���1 . � ■�i1 � _ ■■�� • • ■■�� : : ���1 � �o °���� � M ~ � � � °' �. � � � .. � � � � � N � aae�rs wuws NTM � � :�� www T1tAK FOUwr. s�. Roa� awHs uTa+ a�w� �uro w� c� �wo�. � � GAS OVENINGS .. i • N � �� ��.� � �� �` � �� � �� � a� � o � �� �m�.� "� � � � �� ��m � �� � � �, m �a�� �.. ��� ��� � � � � .. 3A � "a � i� � �� � � �� � � � �. �� �m �� �. � � � � � � � - �. @ , City of Fridley pT �e Tov aR *� rw�a ------� GOMM1N11TY OEV[L.OrMENT OW, i MOT�C7rvR IMf�CT10�1 Ot�T, �•-.` � pT�l NALL FIIIO�Y N*R .1 N�'NO•�NO JOb Anclx@88� ��/ ner � Contractor A ,� a �Ici F � Z � � � ; n aoNVa •,�� � i ----- i •saai i •MNtva Im w BNISY9 � � li�11/7 i0 o sNrvaa aoo�� '� � ;��� ��s IO �p .1NflOd �� � HNIMO �� I��8AYN1 A " HSYM I BIIN�B •NIf1lY �uw � � � �, eo 0 w .� � �' I I � I � I � � � � I � _ � � � � � ,� � � A e� � . � �3 ►� , �.��T ---� .. PLUMBIiVf, PERP1IT APPLICATIt�iJ /�� s ��m a� �--0 � s . '/�,�''.Sn�� se Plumbing Fixture Rates: N0. RATE TOTAL Number Fixturea x $2.00 �_ Future Fixtures x $1.50 New Fixture-Old Open. x $1.50 Catch Basin x $3.25 Water Heater-99,000 BTU x $3.00 Ground Run Old Bldg. x$3.25 Elec. Water Heater x $2.00 Gae Fitting Fees: lst 3 Fixtures x $2.00 Additional Fixtures x $ .75 Gas Range-199,000 BTU x $5.00 R�irs � Alterations See �scription; Code I State Surcharge .50 1 � TOTAL FEE $ ✓�S� !The undereigned hereby makes application for a perniit for the work herain specified� agreeing to do all work iu strict accordance wi.th the City Ordiaances and rulin oi the Aepartn�nt of �uildinga, and hereby declare that ail'th� �acte and repxesentatione atated in thie application are true aad correct. � - '�-,� - 7'� 'Signatur n$te -- --, , - � /Z-/�- ��o .� � � � - P►- � Y G• N N 1�+ IC V P 4 W � � C n►� � m � n' �•- L n n n C n �,p -sf a a n n G m � r, �p p n v � t+ C� n r n 7r '� n � Z N F, h «� o �- io � �+ � O ►� •,,,� r O u� O S 60 �t n c..- � �o � �- �„� a c o � d r. ►� � � p ° �r n T_ � �' n o n «�- n � �t •"+7 r• o t s-o .�, � � � c'+ � o�.+ x o° °� ��c m rn e�s � n� r � a� c � � � R • � m•� R � � h7 C•7 � P� R O O +� „ ""' p �° • � � m r � W r � � .. z y ' • n Y �° °p . � �'7 aO _ r�r� —�-i �, -N C • p. 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ID 7 Ba52.I16 � O n O P� � ' ' r r- SiniC9 a o � � . a Wash .7Yays •�- � I • Drinkin9 � r � � • Fountai.ns n O S m 0 � a 2 n � �� �� �. � �m � O o y - ° � Z C H m O O � � � m 3� O H N '+9 � [y+J O � N ` � � C ;° sc � r ►�+ . iC-c t�i� H � � y m Z N• ° c� o � � ►i R � � ' o � y � _ � N - m � O y `J � '� � � � • � ,� _ � � � r"�j � ��_ ro � � _ ' . P • Z � m � ,., G) o Y i1) o � - ^ _ ' - -_ .. -. .� . . . D - _Shovers . 'Floor Drai. ICat�b ^�J �( � � t � Bess.ns p Autamatic � ( fi' � Washer r I - � .Gas -APpZ_ r� D --I � Hisc_ FiSct p L 1 � �ge T 0 � - �� . - � I � m rv 3 p1 R , C'j � I � � ^ r to ►t Z � K � n " r Z O . � D cn , p rr a+ m m r t�n o � Z ° p' o> ~K m � -i I n �n 't r m n b -- � o r�-a'-� v�° � a � r. r Oi � y fs n � a C� 1 R fT N �J A tn Tn K � r m t77 .n m a a o n. o►t cn r rn � re �e :n o � K m � �c o0 o r+� w m G (j� -i '7 �' 3 A. Y '� � n o ac � a O c F' r b O rT p m.0 � �D � �m ao' � p K O ''� � ���� � O ; � � � � � � m � .,� m o o m K .i .,, n ¢ �' ►- u x � et a c c r r O '- m aY� � '�' 'c .- n. .� m �„ � w R � L,' r'r �O v- O � . 3 tn Q a • � � � - ' m +a , �, m o c � n �s � �ao¢ - � � - r �' K ►�- a O� 'a � a rc m � 1% PI Q n a ' � !� `C m s"' R � 6. i ' W Y- M p n K O �a r?K 0 0� .. .* �► � n m ? � - _ y. . ' _ _ _ - se -�-ec p �- --- � I_ o R c, ""_. �r r � - �. a c. rr ►c ._ � � K K X � G V [� ? . q r O A O F+ (y ►[ •t m � � m R ^ - sue�ecr PERM City of Fridley 19 4 6� RT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ; � RECEIPT NO. � • COMMUNITY OEVELOPMENT DIV. ' LL ��'���� r � � PROTECTIVE INSPECTION SEC. 1 � i i••-. A��" ,•� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L �+` 612-571-3450 910-F15 5/11/88 / / JOB ADDRESS 6701 Ashton Avenue 1V.E. t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. �i 1 Fdgewater Gardens Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRES$ IIP PHONE Randall Ra.�ana.gh same 571-8996 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. � ' 4 ARCHITEGT OR DE81dNEFi MAIL ADDRESS ZIP • PHONE LICENSE NO. 5 EN(iINEER MAILADDRESS Z�P PHONE LICENSENO. 8 USE OF 6UILDINti ' �S1CZP.11'�ci�. 7 Cu►SSOFWORK � N� � ADDITION ❑ ALTERATION O REPAIR ❑ MOVE 0 REMOVE 8 DESCRIBE WORK Construction addition to a gara e. 300 e feet. 8 CHANOE OF USE FROM TO STIPULATIONS SEPARATE PEFiMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINti, HEATIN(i, �PE OF CONST. OCCUPANCY dROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONINQ. THIS PERMIT BECOMES WULL AND VOID IF WORK OR CONSTRUCTION 20NIN(i 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. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX ANO,ORDINANCES (iOVERNINCi THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEHMIT $4,300 $2.15 DOES NOT PRESUME TO GiVE AUTHORITY TO VIOLATE OR CANCEL TIiE pERMITFEE SACCHARt3E PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $%Z.00 PLAN CHECK FEE TOTA FEE 4.15 SiG T E�ACTO Oan�r�ORiZEDnGEN �DATE� yy PROPE LY ID T T I IS YOUR PERMIT � � st ��/ � ` S—� 2 r� 0 SIGNATUREOF OWNERI�F OWNE�7 BUILDERI IDA EI INSP nATE I�1 [ ] A�N [� AL7ER [ ] �nstruction Address r�; � Description City of FYidley R-1 Ai�ID R-2 Buildi.ng Permit Appl ication EEfec;tive 5/L88 �� Owner Na�ae & Adc3ress Gbntractor s Ad�ress: � s�/-�i`�,6 - Tel. � > Attach to this appl ication, a Certif icate o� &uvey af the lot, with the proposoed oonstruction dra�m on it to scale. �TIO�J � IMPROVII�J� LIVi11� AREA: Length Width Heic�t St�. Ft. �� Length ► �� Width � la � Height sq. Ft. "3 d� D�Cit 1�,: Lpngth wicith �gt/Groima 9q. It. •�4;��+; � Wrner Lot [ ] Type of Gonstruc,tion: Approx. Completi� Uate: J u��. � S.��� - siae Yara setbacks Estimated Cost: S - ���v Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: S � Width + 6' See Back Page n�: _�;��� �ia�: �N��� � T�.. � �'7� �`'i�6 � �v� c� osE a� Pe=mit Fiee S F�ee �chedu].e on Reverse Side Stat�e Surcharge S . A 5.50/51,000 Valuation SAC (hatge � 5550 per SAC Unit � Driveway Fscraw � Al� '7�" or At� '�° Above Park F�ee Sewer Main t1�ar • V• S.i'IPUI.A�I�: �, , ,�-- ���� � rlee Determit�ed by Engirrnering Agreement Neoessary [] Na� Neaessary I I , t�� �3�� �� � o �� �P���v 3�g a�►,v� � �� � =_�l �. �. ' �;�v 4 �+� ��:ix� � �e Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any �dition to any existing building or strt�ture, or for any alteration or `repair to any existing building or structure, upon application there�ore, require the payment by the applicant for such permit of fees to the amount herein belaw set forth and in the manner he�ein prawided to-wit: �TAL VALUE �� W TWO $501 t0 $2�000 � °'��� �, ,�°'1 � ' '!� �.� Y 4e. ,_ TiJ ��iiY���� `�r` �� �� �.� �7Mi W.�� � / S15 for first $500 pl� S2 for each additiona]. $100 or f raction thereof, to and including 52,000 52,001 to �25,p00 S45 for first �2,000 plus $9 for each additional fraction thereof, to and including 525,000 525, 001 to $50, 000 $252 for f irst 525, 000 plws $6.50 for eac,h adclitio�al fraction thereof, to aand including 550,000 550,001 to 5100,000 5100,Op1 to $500,000 5500,001 to 51,000,000 51,000,001 and up $1,000 or $1, 000 or 5414.50 for first 550,000 plus ��.50 for each �3itianal $1,000 or fraction thereof, to ancl includinq $100,000 5639.50 for first $100,000 plus 53.50 for each additi�al �1,000 or fracti� thereof, to and including S5p0,000 52039.50 for the first 5500,000 plus �3 for each additional 51,000 or fraction thereof, to and including 51,000,000 �3539.50 for the first 51,000,000 plus S2 for each additional �1,000 or fraction thereof ��VEfn4�jl DEP F�ST� (Concrete Curb Streets Only) Alternate "A": Remwa], and replavement o� c�rb and gutter a�ly - Driveway width plus 6 feet times 513.50. ��r�� "B": Reno�val and replaoement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times �15.75. ����!� ' = M • � • � a•���� � ; M •)�I Permits for construction will be issued a minimum of 24 hours f rom the time of application to allaw for proper review of the proposed structure and of the o�nstruction site. A Certificate of �rvey of the lot, shawing t,he location of t,he famdation once it has been a�nstrt�ted will be re+quired before grooeeding with the fraaning. �� < �� ADDRESS PIN LEGAL DESC PERNIIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF F.RIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: : 6701 ASHTON AVE NE : 153024140050 : EDGEWATER GARDENS PLAT 2 : LOT 4 BLOCK 1 : HEATING : RESIDENT7AL : ADDITION/ALTERATION 571-128? PERMIT O.: 2004-00726 '� � DATE ISSUED: 05/19/2004 VALUATION : $ 199.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A 5IDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A DRYER WITH 1/2" COPPER AND SHUT-0FF VALVE. # A/C U1�TITS 0 VALUE OF APPL OR WORK # GA8 DRYERS APPLICANT CENTERPOINT ENERGYMIINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- ;�1:'/�I �1:� JAMES MCGILLICUDDY 6701 ASHTON AVE NE FRIDLEY, NIN 55432 1 # GAS RANGES AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authoriud is not commenced witin 60 days or if conslruction 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 lmow the same to be true and correck 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 construction or the performance of construction. I: . _ , , ���-i�I ���- � • �� GAS RANGE FEE GAS DRYER FEE AIIt CONDITIONIlJG FEE HEATING REPAIItS/ALTERATIONS STATE SURCHARGE, MECH FLAT HEATING PERMIT MIIJIMUM FEE TOTAL PAID WITH CHECK # 1009041 SEPARA"1'� Y�xMrrs xr:c�uu�li rvx wuxx v i r�x � r�aN L���xus�L Acs� v�. 0 0 0.00 0.00 0.00 0.00 0.50 15.00 15.50 , '� � < a � � 0 � � � ° � � � � ° m � 0 o�i � � ma �o 0 m � 7 m � 0 � 0 n � � m Z � � n -i 0 Z -n m m � � 0 \ s 0 � � X � \ ,�°, 4' � � C� � � � \ � � � C� � �� � � � � �+ � o � � � fD � C m � � m �� � � c � � � � � � c � °� �� -a o � � � 3 0 � "• � �� .� � v�, a N � � N � �� � 3 � � o � °� � rn � � � m � � m � � o, m 3 Na � �, Ui -a O m � � � y � O � � o, o ai � � �,�� � o o = cn o° � v � U7 � °� � � � N � v � � 0 � 5 ma � �° � N v Q4 m � N -o v � oa m � C � � � � � �3 � � � � � � � ,cNi� o 0 0 � °o � °o � � � � � � � � � � CI� � � �y Im � d � � C�i� V � T j 3 N � � C. G � fD Z m 2 � � G) � � n � 8 °' � �, � � o �;�Q N C O � �� �� �. � �' � � N � N � � "� �'� � � � �� �; � m � a Q o ���� � � 7 y � "i� a� ° a � .� o °�* � �s � � c� � �"' � o � � � � � � � � 7 � W � � a m z � � _ -� v� m � o � W � � m �ca°* c� s z� � � m oa � � � � a o � �= o �� � � � � � � � � �. � 0 � _ a o m � r. � � � o ' � � � 3 � � � v 8 � m z 3 � z 0 w � N � � 0 � � � � � 'a v � � 3 � m � � a � ° v � � � � � � � w � � � � � � � �. _ � � Oa c �. �. �I � �, � �Q � N � � � .. `o 00 v v z � � � a �.c� � " � � N � � � � Z � � � � � a D N � 0 x Z �� m w � v, C � � � v � � � � � --I O Z � � � � � r � D rn -� �z °zo � z -v a� � m c� � � vz �� �a Z zv � _ �� mZ � �n z°o vz v� �' m r" � Z � � � � O � Z � N O .P FILL IN COMPLETELY FOR REP44CEMENT FUEL BURNING APPLIANCE PERMITS COMMOM VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When realacin� an e�cistina furrwace, the undersigned hereby ve 'rif'ies 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 s�cifications 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 cuRent codes and manufacturer's specifications. This does include AGA-GAMA Cat�ory I Central Fumace Venting Tables for fan assisted and natural draft appliances. The existins� combustion air is sized and installed to meet the current codes and manufacturer's specifications. When required to install a new combustion air. it will be sized and installed to meet the currer�t c�des and manufacturer's specfications. Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) When installin4 a new ventina svstem, the undersigned hereby verifies that it is a listec! assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () 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 currer�t c�des. No ( ) Yes ( ) IVo ( ) Appliance Tvpe and SizpJCommon 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 Tatal 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: (Describel HEATING CO: Signed By: Date : CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 _.� PERNIIT N : 200401971 DATE ISSUED: 5/2004 (763) 572-3604 FAX: 763 571-1287 ADDRESS : 6701 ASHTON AVE NE PIN : 153024140050 LEGAL DESC : EDGEWATER GARDENS PLAT 2 : LOT 4 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION . NOTE: AIIt CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRIITEN PERIVIISSION FROM ADJOIl�TIl�TG PROPERTY OWNER COARBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. 1NSTALL A FURNACE (WARM AIR, CARRIER, 70,000 BTUS) AND AN AIIt CONDITIONER # A/C iJNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 VALUE (FOR 11�IINIMUM CALC) 2000 APPLICANT HEATING PERMIT MINIMUM FEE 0.00 PRACTICAL SYSTEMS ` FURNACE SHELL/DUCT WORK 35.00 4342B SHADY OAK RD AIR CONDITIONING FEE 25.00 HOPKINS, MN 55343 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 60.50 PAID WITH CHECK # 1882 OWNER JAMES MCGILLICUDDY 6701 ASHTON AVE 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 work will be complied with whether specified herein or no� The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or locallaw regulating construction or the p formance construction. Applicant Date Bldg Insp SEPARATE PERMITS Q D FOR WORK OTI�R THAN DESCRIBED ABOVE. � O � F-; �� , Q,-r.,y�,,.� � a o a �: � a �-� Ci °� �D � o � � � m �' � ' O . �� r+ � � $ �a : a : g °' ,� � � m g� n y � � � � a �: , , o � z o �, %� � ,.� .:, � 'mG � � � � m � � 3 0 Z � --I C � ' �.,'. . m � � � ° N d � � • � e � m N � � � 0 z m m tts O � x C � 0 � m 3 � � {�- 3 °� � �' . C � � w. o ,-C�1 D . � �' a.. O � � � 3.0.. � o oi � � � N � . � oC. r• � Nf� � A � � � �� m � 3 �' � � 7 � — � �� � � rn � � � ? � o�v S � D N .�, ',tn � o < � � � � O � � • -+ � N � o � � � g � � � p N �rt�� °� o o � 1 � � O v °� � °, � � � a � � � ma � �ii � N v � -. o� �U�7 O � � H► iH t�A b�l fA d3 O . , .¢ � � � �v_� x o�a � B- Z � O .I �=�v� Nv° �y� �7CN.. (D �W w� tn� o �• 3 o�i c,�, v rnZa� �d ���� �`'�m �. U3f � v � a a c� c� m 2 � � � � �.:m � N � f�! � �� � � ��; � � �D oa ? N C O � �"rtu'� o� �s °'� °� 3 �S y 7��' y � �'� v_ � � �?�'� d �D � 7 N '* 7 a a � ���� ���� � ' �' � � o, � o $ •°+ m �`s � ci n m ���o ��� � ? ��� <D 7 � � � � � � a � z m m x v � � � � o � W � � � c� o, �, m = z� � O `° °° . � O � �' d 1 1 c� -� � � = o � � � 7 � � � � � °' s � � _ a o m N " � � d o ' � � � N d � � � � � � y O � � . W $. � � � � 3.� z_.�:�'�'. � � �_ � -n � .a '� � o ". � � � � $ � v ` N � W � � �. . _ . .. � u ,_ � � y. N w 0 � -n . �. +' w � . N 00 � � a � 3 z � cn � : . . . . . . + _ : . F s2it.� ,_ . . . � �. __ ..�........_ . _ . F, - F' � . � .,-�.�. � O O Ut. � � � '�:' .$:�. '��. .;��,n �, � �,. . n1.'D . � � � � O � � � :. "� z EO�, - ` � _ .:.:Z ,0 � _ �: ..,. .;_�. Z, "�G . ,.; a � m � ' � �., _ . �� �� tA: :,c: �:: O. , , Ci.>� 3 .°-'. � W � a � � ' v Z � ,� c:' ;..;, � v � �' m � � 8 � f . � : -:�, :o:�.a --i �::, Z Z _ ' _ ��; . :. �� ; �. :v _ �, _ � � (\ . �-.�;� :�' v `� � �" . "'� Z rn � � � � _ � . � �•. � n .- � �a :.o. z;o :� . ^ ' v Z v o - -- �__ _�:�:�` c � m m P � � �� . �� .- : •" . _-� r � , °z a�. � a �. �� � � s � c 0 7 < `n �' � �v Z �m C v � VI � m � Z � m m � NQ v � x �1� IiV ��MPI.EiLY FQ1Z ftE�'LACEME�iT �UEL �URNIN{� �PL6tvdCE PE iT� GOMl�9l� VENTe �NT CONNEGi'OR ��OM�USiit3�1 l�1R V��iC�T10N Utilten �s1 $r� �ua �trr�a, tl�e urssc�igned t��by �' t�s t� tt� v�e�in� has �n examined and is fr� frc�m et�sif, �terioration, obstntc�iorts, �nd is �trely supparted a�nd tirestop�d wher�e required. Yes� N� (} - - t' s - i,.:��.� : '' a - - s+ - �r���-��, �s - � Nt - -.rc,�t rc�� �� . h � ` r.� :; : :t' � - • _ • � . • : : I f -'- , ihe undens�gned atso verfies � tf� repiac�m�f c�t � a��emWy � t�B�S � t�uf'� t%� � Ff1�iU��kJ6�F�S S�t��10�iS. �3 � inctude ACA-GA�A► C�t�r�ry t Cet�trai �umace V�n#ing T�bies #nr fact ��s�I ar� r�attural tirarft �c�:s. .c)-t._�i�.. :... .r.�_:. t v':.:� _ ..Y C-a _ :a ;:s � • �.a 1� � a «��f O . r.« - �.�.:«_�._i, ti �1HR 18QUIC� t01�1S��� S�W C�lY1�iU'S�Oi1 d�P. t� �� S� ��i.S#�i t0 RI� � t�17'@t't# t�@S � fti�1l��'S S�t��[13. {vc, ( } Y� (7°� i�fio ( } Y�€`a ( } NO { j Y8S ( } �O � � When ir�staHir� a new v�n� svs�em. tk� unde�signed hereby verfies i� � �s a �sf�! assemi�ty �xi m+eeis � cum�nt � � m�t�ur�e�'s S}�q�. Ti�s ��lude ACAr�AA�A C�a�y i Cec�tca! Futr�� Y� t} Ve�ing Tabies for €an assiste.ct and natural �ft �ppliarx�s. = t• •, - - �;�.._ � ..�_ �� � f � -_ r� r�� �- '+►Xe:t - • i t�i '�=e r�, -�.�i:' ��. �� -� �t- 1:�-<-, - s'. �� s !� � •�. •: -, 1 �• t o�� ,:�:�:,.�� - - -._ - ,;_ .. «..:�. Yes ( ) No t � MO ( } 14ppli2�nce �1 Type l'lil �_ BTU lr�ut 'i �� 8 00 Fan Assisted or 1Vat � A}�iar� #2 Tj� BTU tr� ao Fan �is#� or P�lat A,p�pi[��c�e �'3 Tj�e BTl1 ��._ Fa� Assist� ar �4at �_ T� p���s _ Tdal Btu ir�t — Commort V�nt Type � � VenY f�igt�f �� ��� �r � � ft t3iameter f+'t TY� � �t+ee #4 \leat Co��or Het9ht � � ft �ameter e +� Ty� �ppliance #2 Ver�t Connector 1-�ight {� p�meter irt "f� �i� #3 Vent Cone�a' Heighi ____ f� t�� �� — HE�+�TING CC) J -'�•-_- � :. Kline Corp. DBA: Practical Systems 43426 Shady Oak Road Hopkins, MN 55343 952-933-1868 -_� - ,. -.__. \��I .; G' j ; /. � � .Y /i�.i7l:� _ , -