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AF - 43478SUBJEC7 City of Fridley 16 0 4 6 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T� r ' ' R , � �� 7. � �L ____. COMMUNITY OEVELOPMENT DIV. � r � � PROTECTIVE INSPECTION SEC. � � /'��1 � CITY HALL FRIDLEv 55432 NUMBER REV. DATE PAGE OF APPROVEO BV � ----�: `.� 612-571-3450 910-F15 1/14/81 � � JOB ADDRESS 7613 Brigadoon Place N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. H �. B�.OIN�AY'CJ Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Garjac Inc. 7635 Arthur Street N.E. 784-3579 3 CONTRAGTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. ".�".,� �s�� f �'� F�t�t�u f34ES N � 5 ENGINEER MAIL ADDRESS ��~"' � �' TtLiTt� (,�)�ti�';�;�5 A�P�HO ��`�AT'��,.SE NO. r��s �ArA �s Fa7 ��;�c��-.r�,a�ao,v V P /` 6 USE OF BUIIDING �'T S�'�oULD YERlf�f iHF tNFORMqTlpl�i Residential � TH� �r�• �i 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 41' x 24' Dwellin and a 24' x 24' Garage 9 CHANGE QF USE FROM TO STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards. Provide City wi.th.copy of verifying survey. SEWER LOCATION: (Approx. 6' Deep In Street) 65` N. af M.H. (Inv. 893.94) WYE ELEV: 894.20 TOP OF FOOTING: Fxpose service prior to establishing elev. WATER IACATION: Approx. 10' N. of Sewer Service DRIVEWAY DEPRESSION CJ�ST: N/A - e�isting depression as per developer M��i�� r�, j,TC� �;.:��c.+��'ri.° �"�`F� `�':r�'t��. Before digg�n� c�li fc �a! u}��f��^s S�PER�`�� 3 ; . TELEFF4G"+!�-�6:��"�r;.:4:—;�f�.��:c, H�AT�fdG PLt�t��1�3�s*;(� F��l� ��i�i`�S. . , R�i..'� �� : n' c.- �!. :�! o�� V�* 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 SQ. FT. CU. FT. AUTHOFIZED 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 1 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 $4S� 883 522.95 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR E PERFORMANCE OF �CONSTR CTION. $`�.09.04 $425.00 PLAN CHECK FEE TOTAL FEE 27.26 584.25 S�GNnr OFCONTRACT POA �7HOaiZEO EN7 iDnTE� �R�ERLY VALIDATED THIS IS YOUR PERMIT ` \/�I � � �.!__I-- SiGNA7URE OF OWNERIIF OWNER BUILDER� IDATEI BLDG iNSP � T . " . � C�t�rt�CR: _ 11DDF',FSS : TEL �0: CSTY �f= FftIUt_CY !{('PLICr'1'rlii;d f=Clft f:I:;T[)f-i�i�iIfli_ I3UILUI��G ('i�f�'rT'I"S (idGi•r, 1�1 i:cr;�t.-icr�s, f,cl�Jii:it�a�s, ar f?c�Pairs) �� UILDE:R: . ��,��. �l�'� ��. 11UDRCSS: �7�� /f./.�T(��/!� ST �G' � 7EL tJQ: '% � `�--',7.�'''� �' � Cons�Lruction Locat �on ' . s�rn_..��r rio : 7�i1 'S sa:�r�f:T: ,g /at I 9,g n c� � r� �� c.o , Lo��: � sLOac : �_____ �nnz�rzo�a : ��C a a �� ..e � /; .c� (..�TP� Corner Lot: Insicle Lot: �- � SefibacY.: 3.� Sideyards: /�� L � . Ap�licant attach to this form L-wo Certiticates af Survey of lot and proposed builc3ing location dracan on certificates to scale. DESCRIPTIOid 0� COfdSTP.UCTIOfd r ; « / � I'ront: -� � ` Depth: y`�, Iieight: 8 Squa�e. Fee�_ _ ��;.�� Qz17ic .Feet: _ � � Front: Drpth: Heigl�t: � , Squai:e� Feet: G�bic reet: . �`ype of Co_,struction : � � ��"� �= -� 7.b $e Cbr,�ple�ed: /7� � 1 <- j �� .. ��s� Estimated Cost: $ `.'�'C►�r*. Alt. A Alt. B Proposed Drivec•iay Svidth Tf New Opening Is Des�i.red: $' $ . , S�E R�VERS�: SIDE OF SHEET. �.ile ur,dersianed he�:eby n�a};es applicaticn for a perm�t fcr the �;nrk he.rein specified, agr.eeinq to do ,a11 work in strict accordance �•�ith the Ci:;y of_ P'ridley Ordinanccs and xulings of i.ile Dep��rtment of Bui.a.dings, and hex.eby c�eclares that all the f:acts and represen t�.�t�.ci�s stated ;ii thi5 an�lication re true and correc . � , � I- s- �� n��r: SzGrtn�vr� : ::: t::i�,u Ic1 S:.10115 : P��' a� 232 � �= l09.0� p.� Zs�� . .��.Z6 Tx ,q�. � � Zz.�' yS y�Z�.�a � ��. _ .�8�i, �' � � �� - a--� . � �aj� . �� ; r� �w� � � x a�/= 4B�/ �C G.23 � �G r3 ��000.� = �,130. 3':► 'Q� x 8 = ?$�2 G,. , Q# ' c�PQc�e l.�cvUt. 2 ti � 4'�. L lnog + (,x �'? = t o t _ i� �-u � 31.ot- '.�i,W3Z.to � /L : h3 �3 20 c�.. � ;:C��R- : z ��ri�1= s�� '' S.2S � 5.33 __?�.__ � (,O y �f x �•$1 = $',3t/ �Zy X/G r y��$3 �t, a�.Z3z� +I = �n9.o�I 2s�� , zG P•�. s;r; y�4 �t,� 2Z ,�i�' TJ� 59c- l.�,��. oa � . ��►Z, n Goyo a, �- __..�. �� 3Z 0 �.��Y�n�� G� > �i �oi�� -�� -�� / cl k� - �'/j� .' �,�' � � �� , ' �� , � J 7 . � � ' .�� - s� �' �� Q .� � � �:�r,� � .�;;% ?� �'�,-c� �. � �`n �4�% , O� � �J�� 0�� r�.�l o o fi � ��ti'S'r7�21�1J ��°J �� ,� �_ � _._ ---�. �Ol�'� �, �/�,�„� l �.�DO�_ � ��i.o� �� l � � � � 3�� Q � - _ , � � °� .��/' � �, � ✓. ,� ��- ��,� "�� , ��`�� ' � � � � � C -- ��s` �� - x�� C �✓r � � ,, ; S��^��y��s �'e��i�`��t� COMSTC?CK & DAVIS, iNC. Consulting Engineers and 'Las�d u�ttrveyoa�s 1446 County Road J, Niinrseapolis, MN 55432, (bi2) 784-934b SURVEY FOR: B & G Investments 961 Hillwind Road ;��,� �" ~ ,�k��,��,:` . Fridley, P�Iinnesota 55432 �� '4�I� r� �,r ;.�;; ��h e i.�, i� r i r ��` t �;:,� � .. . � . . . . . �t �: � i i (';.yfZ� _'�. i`r:,;,rt• �'�'� �r rC.f �f�?i!y t�� t ;"� ' S t�♦ ...J �,'�S.T. �, �iRcv�#� � � i�:.. . . W., �S � , 'i D"!'' �� C"t �, ` t,l ? e �.�,,� i 'ii:t'` r °'�k7 ��. � ��{ , a x `�,a f,+ < i i" �_ _ F•��=' ,t+ �X' �� .:t�t.,�.�1'v t 1 �� .- �'-� �..e'� � . . . . 1�, :�t tar�. .�,,�y3( ti f r. ' � "i.:> � `'= , . E ... �_ 'i,.� i-�.. 'f �,� . � � , 2.5 � S 89° O1' 09'� E- 137.63' � ;"r, �� •"f� ► , �� 3 � m ' 3 . (� al�o , c�. O � �o� � �u � � . o - O T �h� $ -'t . ; �, o �� ,;,t o� -�, o �� o � �' _ c.� 'ib� �a o�+�ua��i,,r � � Q � � � � � � � S f19° Of' 09" E-- >37. 61 ' z�' � .�-. ., , -. , , ; . c�t DESCRIPTION Lot 8, Block l, Blomberg Estates, City of Fridley, Anoka County, Minnesota. SCALE: l�� _ 40 p �enotes 1/2" cliameter iron pine monument set and capped No. 10832. 0 I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the �aws vf the State of Minnesota. � _�"'�' � O�3Z NOV . 1% . :L4HCJ �FZ%8 ' e��, g .r Reg. No. ' . Date Job No. Book, Na .� �� ,.��Y^ CUN5t)tv IA� . : : �� lL.�1C1lTItil�i '* � � , . .: I �� _ PIANN]N� � 'Y`'ht:''.rtc� tWt�l11t7'Mf:N't' �. �' , ._ : �;? CI ��••, . . 'Mltit�ii:SQTA � r�_ • Thi� :.u� ,•ic;�<,nt i: c.r��•i�i�•c3 t.�, � ;,��licar�t in r..c�m�autirx� �F.X'i�RTOR FtJVELOPE '�f AVt:H,1�i: "��'• tAC9'OR 1►J1'C:I�►tn7�I;�r:. .:;f •�nari�n is re-juircd so the BUII.U:NG ` UF•.3 'lAl. ,.:,r. ci�•t:c�rt��r��. t.i. �•. �c �� ,��nr;�,lv w1t1t t;�e I::�F'.,.��Y COP�S�:2'Ji,TION �.i . S, DE5Tr;7 C?'.I1"l:i.:A uI tF!c: S:ATC Is. . �,: (=�ect�Un E�OUO) . IY ls the AE>PLICANT'8 respc�nsibilit.;r L-_� accur3t��ly cc: ,:�.r..3; reflect the proper �ESIGtJ CRITERIII " in thc F,lai,s; s;�i,r,i�. frr.�ucL s�� ,•,� , l.f n�cdcd ta ,up[x�rt ttie "R" d�t�d "(1" factors uscci; ai,�i to a�s�rc conc: ��. per aE�provrd plar►s. J08 IACAT I ON : __ . _ O`iNER/CONT i2ACTOR : �iDi�tESS : _ .. .. ..---� PtiONE : �►. Determine the Total Exposed Wu:i nr�.a a� followso 1. Tbtal wall windaw area _,,�!�.:5( ? 2. Zbta2 door area ��, �' 3. Total slidinq glass door az,��:, �/o 4. 7bta1 fireplace wall area , yct 5. .'ibtal wall framing area (ave� a��c l�t) � i,�( ,,,_ • 6. 'lbtal riat wa�ll area above fl,�orlav�raqe 90�) //By 8'. ' 7. Tota�l rim joi,art �rea � ; : _ Subbotal e Zbtal exposed w�lt: area above ilods f l..�R .,_ 8. Tbtal loundatfoh xinQow area ..._.,�T. �„ _. g. Zbta1 net foundation area abave gra�4 �,�_� Subtoti►lz Tbtal exposscl ioundstipt asN r'-�."f �: GR�ND TOTAL EXPOSED N11LL 11IiEA �?y.3 _ 8. llultiply Che GR�i+lD TOTJ4L EXPEE?�ED W11LL 71Mi1 X.17 � It� I� j��,,;► . C. Determine the Z�c�tal Exposad FAOf/C�ili�g 11�ea �%l,lo�ts a ; .�� 10. ' Total skylight area ,.�...,.�., ' 11. Total roof/ceilinq fraomiriq area t10t) ,,,�,t/_,'�' „� 12. 1bta1 net insulated mof/ceilirg ar�a � 39 _ GRAND TOTAL EXPOSED Ri00f'f CSII.ING ��Fi1 �/ ��I ,_ `'.,w ,, . D. Multiply the GW�ND T(3TAL EXp'06�D ROO!'/CEILING► llft�lil X' .G�3 • ItN II "y�'��„�, �. s . : � .� �� ,�...�� . �� , �. w' .�_ . . _ � �::: ..�. :: _ . - � - nM, Yc�.P1Y pr.'!be . �►rca iMi � . �� .. . ,�.. M �, , � ., .., �:h �e�q�l�t ti-h)' arld � ��„ . '� pE•r.F�rmit�s the �� ` � , . � �,.; �. ` ; �. � � , .;� j,,, ,.,•,. w ._ , .: :� ,23.�.•.-_ A� ' � �� _� i� . . � , � . � _��.��_ -- " -' �� . „. , � � �_ - _., _Ss.-�--- - • "a ' • - --..'Y15'� �-- - - � ,.. .. � , ,�� _ � ��-ai--- f , . �_.-- -- __._ ____-.�2 = _..��5----_._ •r "�i" - a. ____�---- _ __�5�2 '.� � �,. ,� -- , � ' ' -- �1-- ---- .�.-. • ��L------ _ �_�r _ 6 . � // Sy_ � _ _ :< ' r _ • � _ _ -�.-�---- . � . _____ 1_ � � „ � �. � _ __.,_ � 2. _c�_______- :'` —� ,�U�� S� _ .v � t' 9 • �--�s'L--- � �` . ITF•M III '��• , AUll 1-� :'UR T.�TAL ��ALL S6GtdF.NTS ' a � e the "U" v��lue of each segment (10-12) ard multiply by �e area as F. Deterr�in ' follows: X N v �. 0 " ..,._.. :..,.---- 10. __,__=---_—' s _._.rL�i1�----- X ��UN J�„ _ . 11. iiS , � ,�� "n . �% 12. �o � `� X _'r'� � ITEM IV �;�-,.. AUD 20-12 FOR 'POTAL ROO�'/CEIL�NG SEGM�1'rS' Ve �e� �e intent �, 7f Item IZI is the same as, or less th+� Item I. Yau � � of State Building C�de G006 (c) 2• H. If I tem iv is the same as, or less thaa Itam I2.� Y'� �av� �t the intent of State Buildinq Code 6006 (c) l. —� . *r 7. ? � �ql 'e + Ite� II i. Add I tem I ____------ - � + Itea� IV • � R� / : , a2-�1�— . J. Add item Iii •n L•,. }, K. If the sum of I tems III And ri are less thsn it�s I snd II � Yo+u� have s�t the intent of the Code for total emrelopm m7ts�� 1ie undersiqned, as applicant for a buildi�J P8 s�nit�. Rereby aif irms the abcve infc+,matiot� h1� b��n ;�repa��d and submitted by �i�,eif or un�r Ais direction, � � aGknowl� 3cic�s th�� inforn+ation to be corrects�� rt ofathe h�l �9bPe�it iu rc�yy wi th rec(u irc�d plans in Pi� � resents tlte it�formatio►i ' . al�t� licat ion . ' W1TE+ BY : ��—_. --' � • . . . �i (1�: �! . A; � �i � c: a � � L .-1 �J � � � :t G ':� 4- r. s, c; ,'��' U � f � ''= i _::d ti _� ; i �-" i i ' .; _, � I CITY OF FRIDLEY � A?PLICATIQN FOR �UlNBING P+HD uAS FITTING PFa�rr I ;� .a +� . I _ e �s .,�� r+ •xi � y C: � " � n H a �n ro� w �" — i ..a X N,' �' � a�i � a�i N N UI r� � N 3 0"��+ N$ U� �3 � � G f- I � 1� I (�) _^,:t1=e Co:.nectio:� Ope^ir,g I Connected wi (•} = t:�x Fix=ure, Old O�eaing PAP,TIAL RATE SCNEDULE ?L'J�3ItiG FIXTURE RATES: rTO. RATE ....=rer Fi�t::res S x S3.Q0 c^s:..se c:xt..se Coer.:r.q � x $2.00 ;;e•.• : ix.::re, Cld Opening x S2. 00 � �C3"..C:: $3SI:1 X $5.00 :;ater -eatur - to 99.000 BTO � x $5.00 :��,OG� c:J to 199.000 STU x$10.00 tia:e= So=te.^.er x $7.00 ::e�.+ Grou.-.d va OId &u?Iding x SS.bO �iectric S+ater Y.eater x 55.00 w� ,r,.�S FZTTI\G FEES: lst 3 f:xtu:es � x 53,00 7,3di.:oaa2 Fix tures x S1.00 G.ss F�:-.qe `0 199, 000 ETU x 510.0� ' �:.�Ai �S $ ALTEr2aTI0\S r^i_sL S10J.G0 SS.OQ eac: acd. 5100.00 or fract3on 52.00 State Surcharqe TOTAL FEE d taater Job Address �� 3 �J f� �G "�i� O�' � �� Heater s+ Dep�rtrseat of Euildings N x City of Fridley � p as lec Tel. #571-3450 _ rThe undersi.gned hereby nakes apolication for a ge^nit for the wrk 2:er�a speeif.ied agreeing to do all work in stri�t accosc'ance with tie City Co�es and rulings of tho Depart:.ent of Buildir.gs, and hereby declares t:at all ttie facl•s a�id reprosentationa stated in this npplicatior nre true aad ccsroCt �l � � � Fridley, Mn. o� "�� , 19�/ Sewer Wates TOTAL $ /� , Q� $ �+ • OC� $ s S �-�s� $ S S $ S -O� S ` S $ S $ .50 s 3r:Sa RrS2v�PE.;.Z0:1 c£E ("J0.^?1 + OAI.IER �� G�'� �J n" ( ICIND OF SUTI,DING %IL �' � £ USED AS �� S TO BE COMPLETED ABOUT � " %�o - � � ESTIMATED COST �� D OLD - NEW BUILDING PER�CIT NO. YER:dIT Ir'O. ��'S'�� Co:npany W �3 � �c .� /�l � � !•1 SiqnEd By ' �= ere�� Tel. . �g� --//�'� It0',;;�iI INSP. , Date FINAL INSP. �' "� � V � Date APPROVAL FOR PER.'�IT _��'� - 24TNIMUM FEE FOR ANY PLUN.BING PER"".IT IS 57.50 pj,V$ 5.50 STATE SU�r'tGF. � � Y � �� CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLFN�, VENTILATION, REFRIGFRATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WAR�I AIR: Furnace Shell & Duct Work ''Replacement of Furnace Repairs & Alterations-up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARht AIR: ^urnace She21 & Duct Work to 100,QOQ BTU each add. 50,000 BTU * P.ep.lacement of Furnace - to 100, 000 BT[] Repairs & Alterations-up to $500.00 P.epairs & Alterations each add. $500.00 STT.�tif OR HOT WATER SYSTEM: � Soiler & Lines up to 100,000 BTU each ad3n. 50,000 BTU Boiler only t;p t.o 100,000 BTU each addn. 50,000 BTU ��IL BURNEF.- to 3 gal. per hour each �dd. 3 qal. per hour GAS BURNER- Erom 100,000 BTU to 199,999 BTU (over 199,Q99 BTt; see Fee Schedule) ��:AS FIT!'ii'v,G Ni:cS: let 3 Fixtures Additional Fixtures Gas Ranqe to '199,000 BTU AIR CO:JDITIONING FAN HEATIVG SYSTEMS See Fee 5chedule VENTILATING SYSTEbf5 - ALTcic�'�TI ONS $ REPAI RS , RA'TE TOTAL Job Address $].2.00 $ 7.00 $ 7.00 $ D��partment of Buildings, 643I L�nivers' y Ave. N.E., Fridley, MN 55432 4.00 $ C:_ty of Fridlep T<�1. #571-3450 .+� � $12. 0� S �v� • � 4.00 $ 7.00 $ 'I.00 $ 4.00 $ $7.2.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 $ ].0. 00 $ $:L0.00 $�(J. $ x s s.00 s 3 x $ 1.00 $ x $.L0.00 $ • State Surcharge TOTAL FEE Rf�UGH INSP. Date FINAI. INSP. �_�I� Date �E'Y20VAL FOR PERMIT �"_:�.tL_ REINSPECTION FEE (.$10.00) S $ $ $ $� !✓' MINIMUM FEE FOR ANY Y.EATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack veri£icati,on form ��e a:.dcrG�.gn�d ��zeby ;,,ak�� applicatic ; for a��s_:it fo� the work herein . specified aqreeing to do all wark in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that aIl the facts and representations stated in this application are f.rue and coriect. ,,.�.- 1 � Fr.i�2�y, Minn. ,�^q _ . 19�/ / 1 04'NER K:iND OF USED AS TO BE COMPLETED ABOUT ESTIMATED COST OI,D NEW BUILDING ERMIT NO. PERMIT NO. �f DESCRIPTION OF FURNACE/BUkNER HEATING or POWER P NTS, Ste2m, Hot Water, Warm Air- No, �� Trade Name Size No. -1.�--F--+L-�--s�� ,�. c Capacity Sq. Ft. EDR BT[�_y %� �n pHP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Compa �.�c� �L�f� ,, Siqned By � �'� I'-� Y �J . ,. . - '►e1.. No. �'•s' J � r' �M��F�Sky,F,q � � l.�s, � �� _ � � sue�ecT PE City of Fridiey o 19 8 6 4 AT THE TOP OF THE TWINS g U 1 L D I N G P E R M I T r ; � RECEIPT NO. � `y �_�� COMMUNITY OEVELOPMENT OW. _ r � � PROTECTIVE INSPECTlON SEC. � � /� �J � � � � i , � /"�1 � CITY HALL FRIDLEv SS432 NUMBER FEV. DATf PAGE OF APPROYED BY �..___1l.' '•� 612-571-3450 9i 0-F15 5��89 / / JOB ADDRESS �613 Brigadoon Place N.E. 1 LEGAL L07 NO. BIOCK TRACT OR ADDITION SEE A7TACHED DESCR. $ 1 Blomberg ES�.t2S SHEET 2 PAOPERTY OWNER MAI� ADDRESS ZIP PHONE Tom/5ue Anderson 7613 Brigadoan Place N,E. 780-5083 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Kramer Construction 2501 South Heights Drive, Coon Rapids, MDi 55433 757-5183 4 ARCHITECT OR DESIGNEFi MAIL ADDRESS ZIP PHONE UCENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION �] REPAIR � MOVE O REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE QF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THlS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHOR�2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT ANY 71ME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CEfiTfFY THAT I HAVE FtEAO AND EXAMINED THIS APPLICQTION �- STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WI7H WNETHER SPECIFIEO HEREIN OR NOT. 7HE GRANTING OF A PERMIT $4, 250 $2 .13 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $%Z.00 p AN CHECK FEE TOTAL FEE $74.13 S�GNATUFlE OF CONTRACTOA OA P.UTHORIZED AGENT iDnrEi '�� HEN PROPER�Y V ATED TH S IS YOUR PERMIT SIGNATURE OF OWNER UF OWNEF BUILDERi IDATEi BLOG iNSP � ��✓�E � �� [ l �� o�r�stru�tion Adaress: � C, 1�1 AND R-2 �� t �� Effective 5/1/88 / ,,� ♦� � Legal Description: VY�liGi iKi1��G � !'�.RiLG7.7: / (� U'''t t ` )1A_`f. Y 1 lk ('�Y,( 4 (�I/� iCl• � � (Jl/ y�� "� ��1. Wr. � � �\�/� � ` � i� \l�. �� 1.�� \ C� al _ 1Cl • � � �✓ 1 J � � � . f!� � t�� t u V. U �A e Attach to this applicatiar�, a G'�x�tificate of Survey of the lo�t, with the prq�osed oo�.structi� drawn on it to scale. LNII�IG AREA: L�ength CsARK� ARF��: I�.,r�gth DECR ARE�: Ierigth OT�R: R � � l� �1L +�T ��, �� y�{1'�)��'MY��\�� Width Width Width Helght Sq. Ft. Heic�t Sq. Ft. Hgt/Gro�u�d Sq. Ft. Cornex Lpt [] Inside Int [] Ft. Yd Setbac�c Side Yard Setbacks Zj�pe of Construction: �� ,� Q Estimated (bst: $ y d`_��. "'� , Approx . Oo��letion Date : "� % l � %' �C `� Proposed Driveway Width If New Openiryg Is Desired: Ft. $ $ �: �� f � Width + 6' See Back Page r APPLSCArft': ��c�s n �.� �r- c c� c.�. � � T�1. # � a � ` `J � l� Permit Fee $ `7 �?. D O State Surci�arge $ � . / ✓ SAC Q�arge $ Driveway Fscrow $ Park Fee $ sewoer r�taain Q�arge $ To►rp,i., $ `7' /, �..� � ��. UC� sriPVr�,TTa�s : � _ _. _ --.— X .%�� CTTY OSE �II,Y Fee Schedule aai Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee DeteYa�ined bY F�gineering A�ent NeoessaYY [] Not Neoessaxy L] � CITY OF FRlDLEY INSPECTION DIV. Efiective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Water � Bath Wash Drink. Floor Catch Auto. Gas Gas Misc. Water Heater Stories Closet Urinal Tub Shower Sink Tray Fount. Drain Basin Washer Appl. Range Fixt. Gas Elec easemen � ✓ Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. AATE TOTAL JOB ADDR New Fixtures Old Opening, New Fixture Beer Dispenser Blow Otf Basin Catch Basln Rain Water Leader _ SumpJReceiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas _,.�._ Gas Range Gas Dryer __ Back Flow Preventer Required ()Yes () No Ty� -- $ 7.00 $ 4.00 S 5.00 � 7.00 $ 7.00 s �.00 $ 7.00 510.00 $ 7.00 �10.00 �10.00 510.00 �5.00 Reinspection Fee �30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1�/o of Value oi Fixture or Appliance _ State Surcharge TOTAL FEE r �� The undersigned hereby makes application for a pe�mit for the work herein specified ag�eeing 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 application are true and correct. �� • . .,. Estimated Cost �� . PERMIT NO. ��%� � � PLUMBING COMPANY�m�`�J 1�;a,� /1('�` �� r �LL.�L�,O.�L � SIC�NED 8 TEL NQ. � � � l�'-�3 Approved By �` ` Rough- n Date Final Date .50 MIIJIMUM FEE FOR ANY PLU�ABING/GAS PERMIT IS 515.00 a I�O PLUS THE �.50 STATE SURCI tARGE ' - SuB�ELT . � ' City of Fridley AT THE TOP OF THE TWINS g U I L D i N G P E R M I T r � . � � � • COMMUNITY DEVELOPMENT DIV. � ; V �'�� , . . r � � PFiOTECTIVE INSPECTION SEC. 1 � � � � �"'1 � CITY HAIL FFIOLE� SSIJ2 NUMBE9 �""�'� �'' 612-571-3450 9t0-F15 �oe nooaess 7613 Bri adoon Pl t IEGAI �OT NO. BLOCK TfiACT OR AODITION oescR. g 1 Blom e E 1 2 PROPERTY OWNER MAIL AOORESS Tom Anderson 3 CON7RACTOR MAILADDRESS Nutzmann Bros Const 736 tsr Ave NW NPw 4 ARCHITECT OR DESIGNEF MAI� AOORESS 5 ENGINEER MAtI ADDRESS 6 USE OF BUILOING Residential REV I O�TE ZIP P�GE O: � � PMONE —2 PHONE PMONE PERMI l0� 28595 'REf:E1PLA19� � �� PPROVED BY see �Tr�cNeo SMEET LICENSE NO G 5'� LICENSE NO. IICENSE NO 7 CLASS OF WORK O NEW O ADDITION O ALTEAATION 6�X REPAIR O MOVE O REMOVE B DESCRIBE WORK 9 CHANGE OF USE FROM STIPULATIONS Underlayment must comply with¢ the State Building Code. TYPE OF CONST. SEPARATE PEfiMITS ARE FEOUIRED FOR ELECTRICAL, PLUMBING, NEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULI ANO VOID IF WORK OF CONSTRUCTION ZONING AUTMORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OI+ WOFtK IS SUSPENDED OF ABANOONEO FOR A PERI00 Of 120 OAYS AT � ANV TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS I MEREBY CERTIfV THAT I MAVE READ AND EXAMINEO THIS APPLICATION AND KNOW TME SAME TO BE TRUE AND CORRECi. ALL PROVISIONS Of LAWS VA�UATION AND ORDINANCES GOVERNING THtS TVPE OF WOAK WILL BE COMPUEO WITH WMETMER SPECIFIEO HEREIN OR NOT. TME GRANT�NG OF A PERMIT �ZZ�F2. DOES NOT PFESUME TO GtVE AUTMORITV TO VIOLATE OR CANCEL THE pEqMITfEE PROVISIONS OF ANV OTMER STATE OR LOCAL LAW REGUTATI CON- $TRUCTION O TME PERFO MANCE Of CONSTRUCTION �7�F.7S er-�—" '^' PLAN CHECKfEE �''�, -- ��/ Lice S�GNATUQEOF ON'AACTOQOQ�UTNOAiZEO�GENT IDATEi N P SiGN4TUAE O� OWNEQ�� OwHEQ Bu�IDEQ� IDAiE� � � INSP ' OCCUPANCYGROUP OCCUPANCY�OAD SQ.FT CU FT OFFSTFEET PARKiNG STA��S GARAGES SURTAX �1.�7 SAC CM E Fi C $2.14 TOi L F E �5 $ .96 D T MIS IS vOU PE IT . .� C qere . NEW ADDN ALTER �� 1 [� �� ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �� E, 1b�ON Effective 1/1/98 ,�� G� ;1�� '\ Owner Name & Address: o�+•.. ��.GY�r �5�+'��. - Tel. # �S(Q- �'r,�Q3 Contractor: /(%,,►�.w►�,�„„ /�,r�,s o�+�'- MN LICENSE # �oy�yf,� Address:'%,�G j =r /�ve„ %V•UV Tel. # 6'�� -C)/o�Fi Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Length Length DESCRIPTION OF IMPROVEMENT Width Height W idth Height W idth Hgt/Ground Sc�. Ft. Sq. Ft. Sq. Ft. Construction Type: e�c KQ� Estimated Cost: $ �� (Fee Schedule on Back) �/�,f� GU Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ � DATE: � rG�� APPLICANT: � Tel. # �%'�'t7j�k CTTY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ y. s $ $ ,� �� $ $ �� $ $ $ $ $ �7 Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1000 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 [ ] sue�ecT PERM City of Fridiey 3 0 9 9 0 AT THE TOP OF TME TWINS g U I L D I N G P E R M I T f ; � RECEIPT NO. � • COMMUNITY DEVEIOPMENT DIV. ��`,�� `ti: ----- � r � •� Pq07ECTIVE INSPECTION SEC. � � , � � �"'� � CITY HALL FRIOIE� SSIJ2 NUMBEfi pEV O�TE pAGE Oi �PPROVED er �""'�" �'� 612-571-3450 9to-Ft5 5/30/00 / / JOB ADDRESS 7613 Brigadoon Place NE 1 LEGAI �OT NO. BLOCK TRACT OR AODITION SEE ATtACHEO DESCR. $ 1 Blomberg Estates sHeET 2 PROPERTY OWNER MA�I ADORESS ZIP PMQNE Tom/Sue Anderson 7613 Brigadoon Place NE 763-780-5083 3 CONTRACTOR MAIL ADDRESS ZIP PHOkE LICENSE NO Wellington Windows 3938 Meadowbrook Rd, St Louis Park, MN 55426 933-6300 t AHCMITECT OR DESiGNER MAIL ADOFESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZtP PHQNf IICENSE NO fi USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDtTIOF1 ❑ ALTERATION � REPAIA ❑ MOYE O REMOVE B OESCRIBE WOfiK Replacement Windows 9 CHANGEOFUSEfROM TO STIPULATIONS Proviae 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. Overpaid $5.00. Please apply to next permit. P�!'t�t� ��;��+�� 5 TQ �� W��:��pa ��'� n�Q�� TYPE Of CONST. OCCUPANCV GROUP OCCUPANCV LOA� SEPARA7E PEAMITS AqE REQU�REO fOF ELECTRfCAL, PIUMBING, MEA7ING. YEN7ILATING OR AIR CONDITIOkING. � THIS PERMIT BECOMES NUII AND VOID IF WORK OR CONSTRUCTION IONING SO. fT CU fT. AUTMORIZED IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONEO FOp A PERIOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWIG. UNITS OFfSTREET PARKtNG I HEREBY CEfi71fY THAT 1 HAVE REAO AtJD EXAMlNED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of �AWS yp�UAT10N SURTAX AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �2'809 �1.40 WITM WHETMER SPECIFIED MEREIN Ofi NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL TNE pEqMIT fEE SAC CMAfiGE PROVISiONS OF ANY OTHER STATE OR LOCA� LAW fiEGULAitNG CON- SrRUCT�ON Oi7 TME PERFOpMANCE OF CONSTRUC710N �83.2.5 Fire .SC �Z.�F� PLAN CNEGK FEE TO L FEE Licen C "Ci ' $87.46 SiGNATUREOFCON'F�CTOQOA�UTHOAIZED�GENT iO4iEi E P O '� VAL ED THIS i5 V Ufl PER I� , — 3 lS � �—S�GNnivaEOFOwNEQ��OWNEFBU�iDEN� � �O�TE� OG �ti5 ��<<E NEW [ ) ADDN [ ] ALTER [ ] Construcdon Address: Legal Description: ��._�� -3 �� Effective 5/ 10/99 rn tJtc� ; U�� , CITY OF FRIDLEY SI�i 1GLE FAivIII,Y Ai�1D DUPLEXES R-i arrD R-Z ��31 Un .'u�� BUILDING PERMIT APPLICATION �(i�� V�C _.i�� p �� s+�.� a : a �� P � �-,*� � � � - Owner Name & Addr ss: � J"'1 c' U2 � D/� Tel. # d- S�% S� � Contractor: W'u�� !1 C3y� �/(%: n w� MN LICENSE #� IA � Address: a � I�tl �(� � � �vu� �� . I"+ Tel. # �� `- �Cjtj ; Attach to this application, a Certificate of Survey of the s�� lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF I1��ROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. � Constru.ction Type: � L� W,� Estimated Cost: $ �� "D Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ . DATE: J r, .-�CV� APPLICAI�IT: � Tel. # ��J `C�� CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge � �'3.as $ �. � ( $ I. �O Fee Schedule on Reverse Side .001 of Pernut Valuation (1/lOth%) $.50/$1,000 Valuation O50 per SAC Unit License Surchar $ �, : e" 5.00 (State Licensed Residential Contractors) Driveway Escro $ Alt. " or Alt. "B" Above Erosion Control $ $450. Conservation Plan Review Fark Fee $ Fee D temuned by Engineeri.ng Setver Main Charge $ Agree ent Necessary [] Not Necessary [ J �� ` � �p 1.�'` � .. TOTAL $.-1�� C� C� C Q.J F�` STIPLtLATIONS:�'`��1//,� cJ��i�'� �� /�� i�� JC�� . �r ��.� �"Z ��— �l��-�� i��"��1/�`�Gi.,�,f�s— �� a � ��- ��. G� ' ; G. ' ' � SUBJECi - " . City of Fridley AT THE TOP OF THE TWINS � u I L D I� V P E R M I T � � .� i • COMMUNITY OEVEIOPMENT O�V. � �y .-__- , r � � PR07ECTIVE INSPECTION SEC. � , � � �"'1 � CITY MALI FRIOLE� SSIJ2 NuMBEP pE� �"""�"� �'� 612-571-345Q 9�0-F15 108 ADDRESS 7613 Brigadoon Place NE t LEGAL �OT NO. BLOCK THACT OF ADOITION oesca. 8 1 Blomberg Estates 2 PROPER7Y OWNER MAIL AOORESS Tom Anderson 7613 Brigadoon Place NE 3 CON7RACTOR MAII ADORESS All Ways Decks 310 Wexford Hgts Dr, New Brighon, 1 ARCHITECT OR DESIGNER MAIL AODRESS 5 ENGINEER MAII ADORESS O�TE P�GE O: 6/25/02 / / �32726 RECEI� 3�� 1PPROVEO 8Y SEE ATTACHEO SHEET ZIP PHONE LICENSE NO �2 651-636-6051 ZiP PHONE LICENSE NO. 20003805 ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS Of WOpK ❑ NEW C� ADDITION ❑ ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct a 14' x 12' Deck 9 CHANGE Of USE FROM STIPULATIONS See notations on plan. wARNING Before dig9ing c�i� for a�� ufi�ity locations 454D002 �E�vr��o BY ��w SEPARATE PERMITS ARE REOUIREO FOR ELECTHICAL, PLUMBING, HEATING, � VENTI�ATING OR Alq CONDITIONING THIS PERMIT BECOMES NUII AND VOIO tF WORK OR CONSTRUCTION 20NING AUTHORIZED IS NOT COMMENCEO WITMIN 60 DAYS. Oii IF CONSTRUC710N Ofi WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 OAVS A7 " A V T ' N IME AFTER WOFK IS COMMENCED. NO DWLG. UNIT I MEREBY CEf;TIfV THA7 1 HAVE READ ANO EXAMIN�O THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE ANO CORRECi. ALL PROVIS10N5 Of LAWS VALUATION ANO ORDINANC EfiNING THIS TVPE Of WOpK WILI BE COMPUED WITH WMET SPECI ED MER NOT. THE GRANTING OF A PERMIT �1,932 DOES N PRESUME O AUTH ITY TO VIOLATE OA CANCEL THE pEpMITfEE�� PROV ONS OF AN T ST OR Al LAW REGULATING CON- R CTIpN OF7 TH CE C NS CTION �G9. ZS � f� PLL1C2 CI],,5�2 � f` � S�GNATypfE O� CON'aACTO�UTNOQI2ED eGEN1 N4�UAE O� OWNEA iiF OWNEA BUiLDERi IDA �D�iEi y / .� SEPARATE PERMiTS REQUIRED FOR: PLUMBIN� AND SN6�IIS SO.FT S STA��S C $5�0 o�� CU FT. OFFSTREET PARKING GARAGES SUFiTA% $.97 SAC CHARGE Fire SC $1.93 TOTALFEE �77.15 IA MIS IS VOUR PERMIT � -�s =i LOAD Z rvEw f l ADDN [J ALTER [ j CtTY OF FRIDIEY Effective 1/1/2002 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �(01.3 �r � �ia �� Legal Description: Owner Name 8 Address: � �^ ��f� °� loi3 ..�r+; � � .. �� Tel. # � � 3- 7 �a �'� s3 Contractor. �` ��,� 0�-� MN LICENSE #�� 0 3�� Address: 3;� �c��-� �4 �� Tel.# ��/-(� 3�-b� � ��.� ��'�� s��a ach o is application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LNING AREA: Length Width Height Sq. Fk GARAGE AREA: Length Width Height DECK AREA: OTHER: Length i � Width / � HgUGround Sq. Ft � Sq. Fk 1� Construction Type: ��-�-�- � 2-�` �� Estimated Cost: $�.-;�7 �� /� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: Co � �II \� �_ o� APPLICANT: �- Tel. #��/- b 3� - b� I Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $ r � � / . %3 $ ,�� $ $ .`� .4C� $ $ $ $ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 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 [ ] TOTAL $ � �• �� STIPULATfONS: 74 �CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective January 1, 2003 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning • All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25°Jo of Value of Appliance or Work Rate TOTAL $ 30.00 $ �� $ 10.00 $ $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REfRIGERATION/AIR CONDITIONING PERMIT IS 525.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. , JOB ADDRESS �� OWN ER ��r a��d�-n s o� BUILDING USED AS f�.�.��-.✓ , ESTIMATED COST �.3fY� � PERMIT N0. �Sr� / DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units_�_ Circle One (Steam) (Hot Water) Warm Air $ Trade Name.��„�y Size NaGGovl�'--2¢�--a��► BTU 70, ,� Qe� HP EDR $ Fuel � /��9- Total Connected Load $ $ $ .50 � 30 �o Burner Trade Nam BTU I:I, Size No ED 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE `�j' - l6- �3 H EATI NG CO ��_�� /�- �/L Signed �� C�� TEL # -- �d FAX # 7� 3� Z�C'� - �fG Q' � i Approved By Rough-In Date Final Date � �� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPUCATION WILL BE RETURNED •��i•► I ► I ► •►► •: S►� •�i: •► ! : : ! •► When m la�_in_� an eYietin� f�rance, the undersigned her y verifies that the venting has been examined and is free from rust, dete ' ation, obstructions, and is securely supported and firestopped'where uired. ��?r ""_ _�, �,�y,�� Yes ( 1 No O r��_�J The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows anci termination. Yes () No () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Th� �YeG in� r_emh �c4ien air �s siz�d and in�talled te meet the current codes and manufacturer's specifications. Wh9n ('equl�d to �netall a new _emb ��t;en a�r� it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( �lo ( ) Yes (�No ( ) Yes (r,)'No ( ) When jpS�lljQa a new ventin,�yy�±pm, 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 Fumace 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 (� () ��. .� .- .�. - .��.� -� .�. -� .�.- . . ..��. .� Appliance #1 Type BTU Input 2� � o� Fan Assisted or Nat � Appliance #2 Type BTU Input yoF,o, �� Fan Assisted or Nat nr�- 7 Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type � C�S P� Vent Height 's �� Diameter inches Appliance #1 Vent Connector Height ,Lft Length �_ft Diameter S�� in TypeL�� Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type __ HEATING Signed By: f� ��..�- �SY3� Date : . S � l4 —a3 �,� 2b-�� 1 12 � 50 FROM C I T'Y CF r R I�LE`( � 0 514B607 P.� 1%'�2 Yl C�JRiu = 1n1a �.u�.�.+� y � �. �scimated Cost $ CITY �F FRIDLEY (763) 572-3604 lteceipt � R- 3, C�MMERCIAL & INDUSTRIAL ,r� C�, �� 0 BVILDING PERMIT APPLICATION O� Cons truction Addxess �� Ce-��'�A\ t`U�-�Ue- �U'--�— zoning Legal '(`�� SO vti C��r; A 5� � S�(1�r�U�c� Tel� c�G 3� S 14- a533 Owner & Address �"OYl \ C � CONT:2ACTOR & ADD'RESS S`ncC�ouqh o��S�rvc�� '� Tel+ (763) �J�� `i19 � �,`� 3 � Fqi rv i � �3 Av e � , 5� - � A �� , '(`(�'(l �S 11 _ Architec� �i � � _ Reg.# F..*�gineer Reg.� � �� oF woRx [] New c�� r k � � �'O Coi�y OFC. A�EA: Yir:SE A'•c_-^..A: OTF�'rR ARE.a BUILDING CONSTRUCTION /N��- [� Addition � 1�lteration -Describe i �C�.-��AneOVS Cn� e�dAr �1'f� 4S a��h r�"Zt Length ier_gth � Length _ �' � SCo e. i<1 For'�'nA�i Oh �-o be FOr c�A rd�a b� ��n2c, Width� Height �, Sq. Ft. Widt?z Yieight Sq. Ft. Width F�eight Sq. Ft. APPLIGANT �\ 1 Z�� "'" e.�j�� e.?el # � w'S 1`� 1� I � DaLe �� 1� O� VAT,UATION Sg. Ft. x$ Cost/Sq. Ft. _`7aluation $ ) '� (�(��''� 5q. Ft. x� Cost/Sq. Ft. = z7aluation S �_$ t�.O �`-'�� Scr, Ft. x$ _ Cost/Sq. Ft. = Valuation $ ) TOTAL �1ALUE �'�"�� --_'4 �- Building Use � Constsuction Type_��-�S Occupancy Group Air CondiZioning �Yes []No Fire ProteCtlon Provi3ed � Y2s []No Perfonn�nce Bond Amount $��A See Reverse for Sche ule Received i]Yes []No Pernlit Fee $__a7�� J plan Check $ ""' C� - Fire surcharge 5 _� •�d State Surcharge $�,�r..,�'Z SPC Charge $ ��– Erosion Control $ Park Fee S Spec. Assessments $ DriveWay Escrow $ TOTAL $ �� PERMIT FSES See Fee ScheduZe on Reverse Side Irt Excess of Prepaid Aawunt - See Reverse Side , 001 x Perntit Valuation (1/lOth �S) $.50/$1,00o Valuation (SEe Sched. for > $1 Mi7.lion) $1150 oer SAC Unit (Plans to MWCC for determination) $450.�0 Conservation Plan Review Fee Determined By �ngit�eering Agreement Necessa:-y [J Not Necessary [] feet x $15.50/Eoot ATTACH 5TIPIIL IONS -� ��r�-L-�ut��.��=��in�z"' .� 1�,�_°�y1�1"'�oG� 7'a ��f�'� T ��iY� ��-�j%'"�"d�� . ��/i1�T.s ��'l��llf��'�' �_ �tf�/�� u�1/�iiv� ��y'y� �"L��(�� . CITY OF FRiDi.EY INSPECTION DIV. 8439 Unive�sity Ave N� Fridtey, MN 55432 {T63} 572-3604, FAX (763) 571-9287 �� `_ �,� Effective April 1, 2004 APPLICATION FOR PLU�ABiNG AND GAS FITTiNG PERMlT PLUMBING FIXTURE RATES: NO. RATE TOTqL J08 New FiXtu�es - Old O�ening, New Fi�dure 8eer Dispenser B�ow Off Basin Catch Basin Rain Water I.eader SumplReceiving Tank Water Tr�eating App�ance Water Heater -Electric � Water Heater - Gas"` �_ Gas Range" . Gas Dryer" Back Flow Preventer Required ()Yes () No Type $10.00 $10.00 $10.00 S 10.00 $10.00 $10,00 $10.00 $35.Op $35.00 $3�.00 $10.00 $10.00 $15.00 Reinspection Fee a50,00/Flr � ALL OTHERS AND/OR REPAIRS AiVD AITERATtONS 1.259�0 of Val�e of F'ixture or A�pliance State Surcha�ge rora� FeE 3 The undersigned hereby makes app�cation for a permit for the work herein specified agreeing to do all wo�k in strict accerdance with the city codes and rulings of the Building Oivision, and hereby declares that all the facts and representations stated 'm this applicatian are true and correc� DATE: , 3 20 oS OWWER eSG�g � ,•.e-� n 3S. o o Bu��OrNC3 usED As _ rY.l,�1n !/� r�c�i ESTIMAI'ED COST `�tp �19 PERMIT NO. $ .SO $ 3S. s� PLUMBiNG COMPANY (�—(,�_,�/�� , �� yn� �l�m �j�� SIt31�0 BY � 7EL N0. 7�0�'%SS (p S�(�' Approved By RouQh-In Date Fina) Date �N�dUM FEE FOR ANY PiUN�It�JGAS PERMIT IS !�� n o� �o� OF CQ, T OF TH� 11APR4VEIIf�NT WHICHEVER GREqTER AN wp K�E33 TWeN � QD COMBUSTION AIR SHAI,L BE PROVIOED PER UMC SECTION SO4(A� AND TABLE 6-A. '"pROWDE COMMaN v�N� ��FO ON SA K cme � � � � � � � � .. .. CITY � FRIDLEY . , c� FfLI !N CO�V1p1,ETELY FpR R�P�p��ENT FUEL BUJ�NING ARP�IANCE pER�IT$ ww.�___' _ _ . iNhen ►eDidcit� an existina tumace. the undersigned hereby verifies that the ver►ting has bee�t examined and is free from rust, deterioration, obstnuu;tions, at�d is securety supported and firesto n ; pped where requir�ed. TI� venting system is plastic/pVG � m�ts all current codes and mainufacturer s�e�fcations incleuling sizing. Ieng�h, number of e{bows aRd terminatidn. The undersigned atso ver�es that the and meets the curre�t codes and rr�a�a�u ernS nt �it is a listed asseinbly include AGA GqMq CategBry i Centrat Fumaae V��t�'m�i�� for�fa�� assisted and naturai draft appliances. T� e sti corr�busteQn air � S¢ed arxi msta(!ed ta �t the currenf oodes and manufacturers spec�cations, UVhen I•equit+ed to ir��H a ttew combustiort att it will be sizecl and inStalled to meet the curr�rtt �s and manufacxur�er's s�c�tions. � �� a W� � stem, the undersigned hereby verifies that it �s a listed assemt�y a� meets the cur�nt c�des and manufacturer's; spec�cations. This does include AGA-GANIq Cafegory I Centrai Fum�ce Venting Tabfes for fan assisted and r�atu�� draft apptiances. �s the �ommon vent and vent connectors sized and instaited corrediy �fter an �pliatice has been removed from the �ommon veM and vented se�aratelY as per current codes. AnnlianGe Tvoe and SizdCommo� Vent and Vent Co cctor � Yes i ) No ( ) Yes {y� No ( ) Yes ( } No ( ) Yes ( ) No ( ) Yes ( ) � � � Yes() No() Yes �Jf Wc ( ) A�� T� BTU Input F�n Assisted or Nat Ap�� T� BTU lnput Fan Assisted or Nat �� ApplianCe 4K3 Type BTU input Fan Assisted or Nat "� Total Appliances `,_ Tatal Btv lnput ----- Common Vent Type _ Verit Height �� p�meter i�s Appliance #1 Vent Connector Height _,ft Length ft�ameter in Tyge �_ Appl'�ance #2 Vent Connec#or Height �t Ler�gth ft Diameter in Type Appliance #3 Vent ConneCtor Height ft Length tt Diameter in Ty� ALTERATlONS; [Describe HEATiNG CO: Signed By: � : TOTAL P.03