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AF - 44078� Cit of Fridle , Mi.n.n.� Y Y BUILDING PERMIT _ � �1 ��` Date: � �� ... ...................................�.......^....._................... ... ............................... Owner: Address N° 423'7 Builder .(/... ..!�i�'f.�,`�j i��-"�`► �-t+'�/� , � � rr. ................_...................................--�--............. . _. Address.. � � ......................................................_............_............................-- L CATION F BUILDING �J � No.��.Q._1... Street ._.-�f.� -- ...- _ ............... ..... ...... ........._/!.._.�............ Part„of t _...................--............._............. ..................--��------... • Lot ...._._.��t' .-- .............. Block .......:..---_��.......................... Addition or Sub-Division �!��E��. i��'�"'� ....... ... .........................................._..---�---...._..... _ f .k � i Carner Lot .- .__._. _._._.._...--.._ Inside Lot �..._.........__ ...... ....... Setback _�._........ Sideyard / a.. ._....�� ...� .. . • .................... ...... Sewer Elevation To be Used as: /�O,cvLGC G�..�...... Foundation Elevation DESCRIPTION OF BUILDING _ • �� .._. '7 ,Q' Front .:�°�.��Y Depth �'z.." � Height L..�...�`.Q Sq. Ft. �J_�._b Cu. Ft. P1�..�Y.....�� _..__...__........._......_ ..................._.. Front ..........._... ._._ Depth ......__.__... _ Height ..._. _.......__._. Sq. Ft. ... Cu. Ft. O"o Type of Construction ...f�-�c��„�......... Est. Cost_.�. �. ��;�..... � To be Completed ....._............_...... In consideration of the issuance to me of a permit to construct the building described abave, I agree to do the proposed work in accordance with the description above set and in compliance with all provisions of ordinances of the city of Fridley. � -.�'__ . . ._ :_....-. --...�i_�� ............................_...._...... ,- ._., � � —cp :. . � ; _, ... In consideration of the payment of a fee of �� ___........._., 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 an� provisions of said nrAinanePC_ , t��7 Building Inspector NOTICE: This permit does not cover fhe wnafruefion, inatallafion for wiring, plumbing, gas heatieg, sewer er wafer. Be sure fo se� the Building Inspector for separate permifs for fhese items. 4 y f : APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA : N<< , Owners Name ,�.��,� irs�� +�xT�,�Builder,. f SaZ /vl '� Address �b a �. .� N'G�=.� �e� d ,�v.� ,A.ddress s a � �- LOCATION OF BUILDING No. Street Paxt of Lot Lot Block �_ Addition or S�i.b.Div. i� 6r�-�-- ��o Corner Lot Inside Lot � Set Back �S Side-Yard %O -= ��' �� SEWER ELEVATION FOUNDATION ELEVATION � Appli;a.n� atta.ch to this form Certifica.te of Survey of Lot and proposed building loca.tion. . . . DESCRIPTION.O��BUILDING �. � . To be used as : �`h � � Q,.� � Front �" L � Depth .�' � j �,l ~ Height sP�lT ��v� ) Sq. Ft, , � .s'a �.. Cu. Ft. . � Front Depth �Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be completed The undersigned hereby ma.kes applica,tion for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this applica,tion axe true and correct. � DATE: � z z, / 5i S`% SIGNATURE ,� (A Schedule of Fee.costs can be found on the Reverse Side.) , • � � � � r� ��.- ,�. . / I 6,K � � o y City of Fridley � Ap�ication for Pliumbing anc� G�s Fitting Pere�it � Dept, of Bldgs. Fhone SU 4-7470 DESCRIPTION OF W�K �7 � �� Number. Sinc� aad Locatioa Fixtures Location J°" �� 4i I F � Z F_ N� Vt Y N} Z] s � 3u � aQO�'- m � 3� o� Base lst � 2nd � % �, 3rd 4th • Futurs Conaection Openiags '� New F ixture, Old Opesiiags � � vi c'^ _�n w w ? * ;t WATER HTR. � � Z U Z � N VI J IA � w u=i �o c�m a3 C�a.��n �p F N cAS ELEC. PARTIAL RATE SCHEDULE � Sewer �' cesspooi n PLUMBING FIBTURE RATES: NO. RATE T01`AL Number �xtures . . . . . . . . . . . . . . . . . . . . _.L! x $1.50 $ � � �o Future Fixture Opening ................ g 1.20 $� New FYxture Old Open3nS .............. x 1.00 $ Catch Basin ............................ x 5.25 � � Water Heater (Up to 20U,000 BT'U) . . . . . . � r x 2.00 $ � `"' New Ground Run Old Bldg. . . . . . . . . . . . . g 3.25 $ GA$ FITTING FEES: NO. AATE TOTAL ist 3 Fistures . . . . . . . . . . . . . . . . . . . . . . . . . . �_ s $1.50 � � ` 5 � Additional Fixtures . . . . . ....... .. .... . . x .50 $ Gas Range to 200,000 BTtT . ..... .... .. .. a$.00 � REPAIRS 8c ALTERATIONS—Rsfes to Cods Descript3on ................................................� TOTAL FEE � °�� City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares fihat all the facts and representations stated in this applicatian are true and correct. Fridley, ' � - � �-1 — 19 � S7 Owner . I 1�`.�-"-"-.�C� � `�� ,y 19 Kind of Buildin I � , 19— Used as � ""� To be completed about - � � � 's � 1 �" � ` Estimated Cost, � Old—]�'"ew" �.�Building Permit � Connectian Permit No. .:........j ............................................. MAY 2 1960 ��a"�� wa� �� -� � �� 3ewer M�' n�o�t - .,t-�..�!"`�" �' �� - �11 1M-&58 � �"'�-t.��r�,.C..�,,�� G�..E..,.�.,�,�,,.,,,,�c,_��.�..�...,� '. c.r1 �- .f � - �'�' > ��, APR��cation �or P�wer P�ants cwid He�ating. Cooting, �'entilntion. Refrigerafiio�n ond Air Canditioning Syste�ms and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . 5.00 $ Repairs & Alterations each add. $506.00 . . . . . . . . . . . . . . . 2.50 $ M$CH. WARM AIR Furnace Shell & Duct Work to 120,000 BTCT . . . . . . . . . . . . each add. 6U,000 BTLT . ....:................. Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . Repairs & Alterations each add. $50Q.00 . . . . . . . . . . . . . . 8.00 $ �. � Z.00 � 5.00 $ 5.00 $ 2.50 $ 3TEAM or HOT WATER $Y$TEM Fiarnace Shell & Lines—ta 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq, ft. EI1R Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $ Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $ OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTiJ) . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ 5. � GAS FITTING FEES: NO RATE TOTAL lst 3 Fixtures x$1.50 $ 1•50 Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU . . . . . . . . . . , x 2.00 $ AIR CONDITIONING � FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM � ALTERATIONS 8c REPAIRS TOTAL FEE $ �+. SO REMARK3: \\. Dept, oi Bldgs. Phone SU 4-7470 Locstion 52�1 Buchanen Street �^, �`',� v� s� w City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to da all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, �vrinn. February 25 , 1s560 owner Philip D. HiY'sch Co. 195_ Kind of Building Fr�,me 195_ Used as Re8id8riC8 To be completed about March 25, 1960 Estimated Cost, $ bSU.UU Old—New. Building Permit No. � � DESCRIPTiON OF WORK HEATING or POWER FI,ANTS—�Steam, Hot Water, Warm Air—No. Trade Name Westinghouse 5ize No. CT�' 12S Capacity Sq. Ft. E.D.R. 12„��_ BTiT g,p, Total Connected Load 65,150 Kind af Fuel GA8 BURNER — Trade Capacity. Size No. Sq. Ft. E.D.R. BTLT H.P. FRED VOGT & CO. Sign CONDITIONING By 6530 West St. Lovis Park. Mi '- 67 11 pOST t M-t 2-58 Business Phone No �eSp}a _j ; y�- , J �, i y a j �-" �. ._ -r : ��.�! .1 �c-� . . [7�Xf ��)9 ��1 ; .` / � � 1� ^ , . .. - � i .....,. 1 � 1 H�A7 LOSS CAL.CUL./�TIO�,S � _ . - Weatherstrips I'p.S.��.�.�. i��--- — �ons2reaccion No. _ — - �,aide � �-� — �i/indowi � Doora ReEcrencc j�ui. VJall Int. �sil �'eiling Roof F'loo -- ----- ---- - ------ -- _ _. �--- Yes—No , Yes—No J � i-=-= i - -- _ - — _ ----- ! -_ ' �'I.� �: s'� �oom ��,engt(n / t�idth f �#eight I� k�.j F' � 1 — -- ----- - - ----� ------�-� ---- -�-= � -,�! �.� Windows anci Doors—�rac�Cage and Area ; �1inc3��vs a �Vld[h Height ti�.�ot Lineai :t. Arefl � Wldth No. nt pnne o( pane � IlRh�e of crack �p. (t. �� No. nf pane ---�' �' -L �U � � G - - - - ��'t I� � � _ ' — 1---- -L -- -- " In5ltration �ass � j— � 1 Fap_wall � �t,-- l�iet txp. wall a Int. wall Ceilitig .7J- � /,� � �I , ` Floor Total Btu. sRec�uircd sq. #t. F.D.R. os sq. ins. i� A. I.eadcr area 1 f'S•�,�%-fi-!,)� rv Room ( I..ength; f/r'' Width /s Windcws and Doors--Gmeka$ �and Area� Width HeiKAt Yo. ot .�ueal fL Area Ne. o[ oana of nane If��ts ,! otarack �a ft. Infiitration Glass %cp. wall ,� IVet exp. wail � int. wall � l,eiiing Floor Total Btu.^ F�equired sq- r, � ., No. In6ltration Gta�s f:xp. wa�� st Net e�, wal! lnt. wail Culing Hloor � v Totai Bcu. J .�. .7 ,� j '�"a. �'" fls��.i` /�? . / F` Y'- ��/ � I—" � 1�jV jDIA�£APOLIS, M1NN. Insulation o How Applied In6ltxation `_______1 S: Ci]ans ,Z G � �x�. �vall �, � - - Net e:p. wall Int. avail Ceilin� p Floor c:' Tntal �tu. � Required xq. ft. E.D.R. or aq. ins. W.A. [.eader area � F�.I '� Room I Length / Width � i�indows and Doora—Crackage and Area Nldth HN`h[ No. of Llneal ft. Aro� No, o[ nsn• ot psn� ULhU ot crqrk nq_ ft. Infiier�stion / / �tas � Esp. �nll � . NeR ez�. tMall le�k. wa,ll Cei�ing .�:(, Floor Total �cu. Required sq. ft. E.D.R. or sq. ins. W.A. Leac3er area Fl.� Room I Length w�ath �4lindows and Dooro---Crackage and Area �Wldch Re1�ht No- o[ Lln�al tt. Aret No. o[ oan• ot oan� ltsnu o[ crnek �q. tt. Inhltrat;on �,lAns - Fsp. �aall _ "� �_ IVet �x�. �val1 1nR. �a18 ieiling f� I oo r ioeai �Ea�. E�e��.�i�� sq. ft. E.D.R. cr sa. ins. WA. L.eader arca �� „ s r L► Q 'L1 . .�..'�?`. �� .d-- �.� - '�. C�-' t�•us ..Mr�.> s . H�AT LQSS �AI.CUL�,;�AQ�lS I��PA�tiMEN"I' �F 3Ul�DINGS MINNERPOLIS. MII1N. _ _W-atheratri�s ^__ �� ' �uA� '�' (I i'onatruction No.^' �, Insulation � VVinc�ws � Donrs � Reference � Ont. Wall Int. WaIE Ceiling Roof Floor I Kind How Applied — _-- ---- — � � _ ' _— — -- i'es--No Yrs—NQ i 9_ II �. � i _ _ , � l.� f��,��, Room ( Length Q' ulidth }-�cight , { 1� .j , Room L.engti� Width Height� 6 � � --�--J�e=--"'=---_— - — --------i1----- � - I -��(�,L_ , Windows and Dours--�rackag� and Area I Windows and Doors---Cracicage and Area tl'i�]th He�R�� No. oC Llnr.e:f ft. Arra �� V.'idth HeiqRt No. o[ Lfeetl tt. Area � No. cf pane of pane ii�rhta c£ c-x��k �q. it. i No. �of oane of PAne It�ht• ot c ck p. t �/ _�' .1-_0 -- --- - r � - — �� y � . G . . , � s .�.3 J 1► ��, _.�_.l—_ � __ cotf Inhltration �4, �t�' � Glass Ezp. wa(I , ,p Net exp. wail Int. waEi iei�ing �° � y, Fioor �. Tochl B��. Required sq, ft. E.L�.FZ. or sq. ins. W.A. Ltac�cr area � E•l�--ftoom� Length f' Widtt� p=: Windows and I3oars�—Crarka�e xnd Arca —T— Wfdth Height No. oL [.Intal ft. Area No. ot pane oY pane I!`hts oT crac& p. (t. � ..�.. � � G I �'.1 % t� �_ � i�sf Infiltration Gta,s__ � �c' �p. W.�i �1 IVet tzp. vrail Int. wa!! �.eiiing � �/ r,3 Fluor �,V `P�ota1 &u. Requieed aq. ft. £.i).R. or st�. ins. �d.�l, �.,e�s�er area s' FI.� �� . Room ? Lsngs�a�/,,,,� Width ; Windows and Doors—�rac�Ca$e and Are� Width HclgTit No. ot Ltnmal ft. Ar�a NA. r,[ psne �f Dane 71db41 0� crack ta. ft. -- � � �� a .� G�e :c.. �-- p t __._�__��_�_.y �� oe l�nfilt�ation � ,� 1 � Glas� Exp. wal� / ,2—� _ 1Vet eup. w�11 tnt. wali - � Leiling 3,C� �"'� � F I�r ! � � Tocal Btu. —R�quircd �c�. ft. �.D,R. ar nq. an�, W.A, L�a�er ar-n [3� . H�;$hc ` I � e � . � �� ---sa-�--�-- .2� ,�. / � fa�_ j �� —�` �" L: �' 7 � + �� e�qi�e , �tu �� s � i.— ' " I I I caf. � In6ltration Cxlasa � v Exp. wall % � Ivet ezp. watl /,, f.� ,2� ` 3- ;�r. W�i�,��•,� G__2 s—.z� .. / Ceiiing Ffoor i Tetai Btu. Requircd sq. ft. E.D.R. or sq. ins. W.A. Leader area �1.; Room ; C.e�gth Width Windows and Doora—Cnciage and Area Wldth He1�ht No. ot Llneal It. Area No. ot pan• ot D►a� 1lrht• of crack p. ft. Infiltration _ �_ Gt�as ��. �$af Net exp, wat! Int. wal! Ceiling ' F1oor Total Btu, Required sq. fk. E.D.R. or aq. ins. W.A. i.eader area --F1.I �Rnom I l.ength VGidth �'indows snd Doert---Craekage snd Area Width Hefrht No. of Lln�al tt. Arra No. of px�e ot pan• II`6b of crnct p. [t. �_— � i Coef Infilt�ration Glass �ap. �ail Net exp. wali �nt. wali Cei)�ng Floor �Fotai Btu. ��rc�u+,ed �q. ft. E.D.R. or eq, ins. WA. �.eader area .� r r Height Heighc --- Btu , 1 CITY OF FRIDLEY INSPECTION DIV. 1•lo •�/ � 6431 University Ave NE � Fridley, MN 55432 572 — 3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On March 1, 199�j � PLUMBING FIXTURE RATES New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appiiance Water Heater —Electric Water Heater — Gas** Gas Range** NO. RAi"E Gas Dryer** _ Back Flow Preventer Required ()Yes () No Type _ $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.Q0 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS t.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL $ .50 JOB ADDRESS � Z� � � IJ�TT�'�lJ ��JP'/�� The undersigned hereby makes apK>(ication 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 application are true and correct. OLMON, MIKE 5201 BUCHANAN STREET NORTHEAST FRIDLEY, MN 55421 Owner (612) 571-1931 Building Used As 199� O V /��5� p Estimated Cost PERMIT NO. � w � i � n�A t PLUMBING COMPANY 1�1n't /l� � SIGNED BY TEL N0. ' ? � ��_' " : Approved By ` Rough—In Date Final Date�.�r �� S .G'1 MINIMUM FEE FO$ ANY PLUMBING/GAS PERMIT IS $�S� PLUS THE $.50 STATE SURCHARGE **COMBUS110N AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A, MINIMUM SIZE 9 SG� INCHES. � Oz z �� _ _ C[ZYOF FR[DLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 February 23, 2001 Mike Olmon 5201 Buchanan Street NE Fridley, MN 55421 Re: Final Inspection at 5201 Buchanan Street NE Contractqr: Norblom Plumbing Dear Mr. Olmon: A mechanical permit was issued on January 6, 1999 for the installation of a gas water heater at your property. According to Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be perFormed on the mechanical permit. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, your permit will expire and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. Sincerely, DAV NSEN Buil i g Inspector DJ/mh � . , �.. � SUBJECT � .. . � � i � P . City of Fridley 3 i 894 AT TNE TOP OF THE TWINS g� J � L D 1� 1 � P E R M I T r ; � ° RE IPT NO. � • COMMUNITY QEVEIOP�ENT OIV. A �' �I� �/ r � y '� PROTECTIVE INSPECTION SEC. ��3� �t N � j � . , � � �"'1 � CITY NALL FRIOLEr 55�32 NUMBEA � pEV DATE PAGE Of APVROVEO 8V �'""'�" �'' 612--571-3450 9t0-F15 6/12/O1 / / JOB ADORESS 5201 Buchanan Street NE - 1 IEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACMED DESCR. 9 2 Marian Hills SHEET 2 PROPERTY OWNER MAIL AODiiESS 21P PHONE Billie Pagliolo 5201 Buchanan Street NE J CON7RACTOR MAII ADORESS ZIP PHONE IICENSE NO Dave Wiger Construction 901 Rice Creek Ter, Fridley, MN 55432 763-572-8403 4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO. 8392 5 ENGtNEER MAII ADDRESS ZIP PHONE LICENSE NO 6 USE Of BUILDING ' Residential 7 CLASS OF WOFK O NEW O A�DITION 0 ALTERATION C� REPAIR p MOVE O REMOVE 8 DESCRIBE WORK Reroof House (21 Sq) Tear-off 9 CHANGE OF USE FROM TO STiPULATIONS Underlayment must comply with the State Building Code. tVPEOFCONST. OCCUPANC�GROUP OCCUPANCV�0A0 SEPARATE PERMITS ARE REOUIRED FOR EIECTR�CAL, PLUMBING, MEATING. VENTILATING OR Alii CONDITIONING TMIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITMIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENpED OR ABANDONEO fOFi A PER100 OF 120 DAVS A7 ANV TIME AFTER WORK IS COMMENCED. " NO� DWIG. UNITS OffSTREET PARKING I MEREBY CERTIFV THAT I MAVE REAO ANQ EXAMINEO THIS APPLICA710N 1 STA�LS GARAGES ANO KNOW THE SAME TO BE TF]UE ANO CORRECi. ALL PROVISIQNS Of LAWS VAlUAT10N SURTAX ANO OFOINANCES GOVERNING TMIS TYPE Of WORK WILL BE COMP�IED WITH WMETMER SPECIFIEO HEREIN OF NOT. TME GRANTING Of A VERMIT �2�147 $1.07 DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OFl CANCEL TME pEqMl?FEE SACCMARGE PROVISIONS OF ANV �HER STATE OR LOCA� LAW REGUTATING CON- STRU ON OR T PERFORMANCE OF CONSTRUCTION �H3 • LS, F�Ye SC �2. IS PLAN CHECK FE TOi FEE '" � � l°Z'� � Lice� S $5.00 91.47 $�GNOTUQEO�CO �QACTOpOp�UTHOQiZEOOGENT iD�rE� � EN ROPERI VALIOATE fH151$ V$�+��'IT / O��I S�GNOTUAEOFOWNEQ��FOWNERBUIIOERi Ip�TEI ..8� iN O� � � IlilE NEW [ ] ADDN [] ALTER .. [ ] Effective 1/1/2001 CITY OF FRIDLEY (763) 572-3604 Bidg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: � � � � � �� ' �¢'g'V'�'� Legal Description: S� tiG � �iq-� ►� �' Owner Name & Address: �l«f� h��l p L G Tei. # Contractor: �� 1.1 / C�� MN LICENSE # Address: �'� / � t e,� C/(�� %'��'it', Tel. # 7C�3 "-� � o� � �'�°3 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Wdth HgUGround Sq. Ft. ��DQ /� /�a �eS'F �� T � �/� 12 � a �l'� Construction Type: Estimated Cost: $ �/�� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ c 9_ � � DATE: � � 2 d� APPUCANT: �� Tel. # J� �� -��d 3 CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ �,�- �S�' Fee Schedule on Reverse Side $ � - /S� .001 of Permit Valuation (9/10th%) $ /, d� $.50/$1,000 Valuation $ $1150 per SAC Unit $ �-r. UC� $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 [ ] � %� `{`% � Q N O o� � i � � N n .Q 0 Y `� .j �v a ClTY OF FRIDLEY BtJILDING IAlSPECTION 0 8031 University A��e NE m Ftid:ey, M� 55432 � 763•572-3604 FAX 763-5T2-12E7 RATESCHEOULE Residential Fv�nace Shelt anQ O,rc� Work, 8urner d also Replacement Furr3ce Gas Piping (Nerv furnax, Fireplace, hiseR) GasRange Gas Dryer 'A.r CandAioning - AI Sizes � �� Effective 4/1/20D4 APPLICATION fOR POWER PLAIYfS AND FlEATING, COOLING. VENTiLATION REFRIGERATiON AND AIR CONDIT�ONING SYSTEMS AND DEViCES l I l ;OB A�OFtESS �i L�_ 1 ��LY;�y� 1 r1 � �`�li � To af : _� Owner :�.-:J�r{-"� i 7"� � r � � �-+'1 �� $ 35.00 $ 30.00 s-SS,V� euiding llsed ps � �(1'�5�,� � ESTIMATEp COS1 PERMIT NO `� �'�l' �l � �� /�" $10.00 $ $10.00 $25.Q0 Al1 ather Repairs o� Att�•a!�ort� (Jst on ?actc) 196 of Value ot Apptiance or Work JMin;n.�m Fee $15.00 tor 4esijential or 596 0/ cast of A Improv2meni tvniChaier is greater On work iess lha� :SOC.00 � � o Cqmmerciafllndustrial/Instilutionai ;. 1.25% orf Value cA Apptiance or Work (tist on Back� � N-�.�irnum FeE £35.J0 !cr Ccrn�reiCiaf/Indus:riz/��st�!utima! V r� N REI.VSPECTfON FEE 550.00/NOUR � � T i � J S:ate Sute�arge TOTAL FEE QESCRIPT{ON OF FUHfVACEAND BURtdER � -- � # of h'eating Units�_ CirGe One (Steam) (HOt Water) rWarm Aiiy c �rade Narne �' Size No. � �>'V`� bTU (�� HP ECR �� —!`4 G" iotal Connected LoaQ 1�� v� f�/�., , Burner Trace Name Si� �o. �� HP EDR The tmden.gned hareby makes application tor a permit for the w�:k hereln specitied agreeing t� do all work in strct acoordanoe wi(h the CityC�es $ and ��lings of the Bui!ding Oiris�on, and hereby �ectates lhat a!I the faCts and representations stated in this applica ion a�e t�ue and oorrect. � .50 HEATING fl0�� Y'�r/.�I G1 -- l�I � �� v / g(7CJ .5� g;grx;d_ �� Tel q-,� � S,�S � J 2 �iU(rl��) ' �L� ' 77� � aai� ��jl�li�� `Air Conditia7ers can �ol be �laceal in side yard without written approval frcm aayoining pr�perty owner • copy to Qry FILI O�T BACK SIDE fpR STACK YERIFICATiON OtY REPLACEM�NT FURNACE f '� �> Approved try Rau� in �ate Firal Dale David Kolb� L".I-i�•'�'GQA l�:Jy �1TY OF FRIDLEY 784-5902 �. oa,�pa FILL !N COMPl.ETELY FOR REPL4CEMENT FUEZ BURNING APPLIANCE PERMITS OMMON NENT VENT CONNEC7�R AND STION �IIR VERIFICATI When re 1 ci� an e�ci�tin fumace, the undersigned hereby verifies that the ventir�g has been examined and is fr+ee from rust, deterioration, obstructions. and i5 securely supported and fi�eslapped where required. Yes (� No () The ventir�g system is plaStiGPVC and meets all current mdes and manufaclurer spcnifiaations �ncluding slting, Iength, �umber ot etbowS and trrmination. Yes () No (�,�I The undersigned dlso verifies that tfte �placement unft is a listed assembly and meets the cument w��s a�d manufacturer's speciflcations. Thls does mclude AGA-GAMA Category I Central Furnace venling Tables far fan assisled and natural draR appliances. The eYistint� combush,_,_„oh Air �s Sized and installed to meet the current cades and manUfadurer's specifiCations. When requi�ed to instal! a new combusL'on a;r it will be sized anC installed to meef fhe current cades and manufacturers speci�qtions, Yes (� No ( ) Yes ( �j'/ No ( ) Yes ( ) No (� When insta�Ili�a a new ventina sv�t , the undersigned hereby verifies that it is a listed assemb{y and rneets the cument codes and manufacturers specificatlons 7his does include AGA-GAMA Catcgory I Central Fumace Venting Tables for fan assisted and r�atu�al draft app�;anCes. Yes () No (� is the common vpnt �md v�nt connectors sized artd installed wrrrctly acter an appliance has been removed frorr� the common vent and vented separately � pe,r current cedes. Yes (!/� No () A lanc 7 Com on Vent and Vent Connectq� Information ApptianCe #1 1'ype �•�'M(�C_. fl7U Input O'j^ F�n Assisted or Nat ��'1 Applfance �k2 Type �;,� ,M�1-,i 6'fU Input `-f� cr, ^„ Fan Asststed or Nat �_ Appliance #3 Type B7U Inp�t Fan Assisted or Nat Tota! Appliances 2 Tdal Blu Input o�_ � ��: u Common Vent Type ��'�k/� � � �►wu�� Vent Height _ 1 S, Oiameter � inches Appliance it1 Vent Conneetor HeigM 3 ft Length�i it Diameter in i 5•� � t,� I � APp�� i�2 Vent Connedor Helght �,ft Length �4 ft D'►ameter �in Type 5:��, I I Appliance #3 Vent Connector Neight ft Length ft Diameter in Type �' HEATING CO' � T ; Signed By; � •� /y��. �`"__ " Oate � /t�/1a TOTRl. P.Od p,4 ` CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 __ _ �._,____ � PE IRN� T NO.: 2004-019 �---__._.. . DATE ISSUED: 10/21/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5201 BUCHANAN ST NE PIN : 253024210053 LEGAL DESC : MARIAN HILLS : LOT 9 BLOCK 2 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION . NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL FURNACE (WARM AIR, TRANE, 80,000 BTUS) AND AN AIR CONDITIONER. # A/C UNITS 1 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 0 APPLICANT HEATING PERMIT MINIMUM FEE 0.00 OTSEGO HEATING & AIR CONDITIONING FURNACE SHELL/DUCT WORK 35.00 7829 PALMGREN AVE NE GAS RANGE FEE 0.00 OTSEGO, MN 55330- GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 OWNER TOTAL 60.50 LYN TORKILDSON 5201 BUCHANAN ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions f any other state or local law regulating construction or the p rformance of construction. Applicant Date Bldg Insp / D � � SEPARATE PERMITS QUI D FOR WORK OTHER THAN DESCRIBED ABOVE.