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AF - 38018� /"� �'�1 City of Fridley, Mi.nn. BUILDING PERMIT Da�; Oct. 2, 1968 Owuer: Homedale Blders . B�� S ame Addresa 5217 Wayzata Blvd. �,g�s Same .�'�'� � 7 �o ��s� LOCATION OF BUILDING No. 74'4'�_ Street Concerto Curve _ p� of Lot Lot � __ Biock 2 Additlon or 5ub-Division ____Melody Manor 3rd Addn.. Coraer Lot � Inaide Lot X Setback 35 � .�_ Sideyard 10 � Sewer IIevation ____ $$� • 29 �����x 883 • 29 Tou of Footin.� DESCRIPTION OF BUILDING To be Used as: Dwelling �t ____46' �p� 24' f 28aHeight ....._ 20� �, F.t, 1152 �� 23, 040 Garage Front 16� Depth 24� ITetght 10� Sq. Ft 384' �, �, 3840 Type of Construction Frame ���$19, 000.00 _ To be Completed SEWER LOCATION - WATER LOCATION- 50' East of Manhole 60' East of Manhole In consideral3on oP the issuance to me of a germit to construct the building described above I agree to do the proposed work in accordance with the descrlpt3on abov �ae� forth and in compliance with a�l proviio of oidinances of the dty of Frldley. / f� �i �s �i� � $100.00 Sewer Connection Charge � � In consfderatton of the payment of a fee of $ 40. OA ��{t is hereby granted to �Omedale Bldess . to conatruct the building or adclition as described above. Thispe rmit ia granted upon the express condition that the pensfln to whom ft ie granted and hia agent�, employees and worlflnen, in all work done in, around and u�n said building, or anypa� thereof, sY►all conform in all respects to the orainaacee of Fridley� Minnesota regarding location, conatruct�on, alteratlon, maintenance, repair and moviag of buildinga wituin the dty ]imit� and thia permit may be revoked at any time upon violation of oE the provisions of said ordinanc�s. � � '% � � NOTICE: 'Ihb ps�it d� ae� eovsr fhs eomtrn�toa, 6ulaU�Hen fer �rtrtee, plambieg, pn 6uHoA, uw�r or wafsr. 8� am to as tha Bnildiu8 lasp�etoe for aparaM parmita fer �6a� it�na. .. . APP�ICATION FOR BUIIsDINC PERMIT � ITY OF FRIDL��C 9 MINIV�SOTA OWN�ti �� NAl� BUII�ER �,�,� A�DDRF�5S AUD�S .S�v� LCCAT�O�T OF B�II�II�TC % �1 � /' � �� r > . . . - - ' - -� ��'�/".f � �_,/__ _ . ._ I'�- -= ' � --- . . - - - - LO'T � BLOCK ,�, A�DITIOlV O�i. StTB�IVI�IO � �,�� �OR�'ER LGT I�I�IDE I,OT�S�'I'BAi:I� �-� SI�E'� / � °' S�ER ELE`�ATIOP� TOP OP �'OCTI?�� Apg�li�a.nt atitiach to thz� �'o�. T-��o �'e?�ti.�i �ates o�° S�vey oi Lot ar�. p�o�o�s�d. buzld�.r.:g lo�atio� cLra�. o�? �hes:: �cr°ti�°icat�� o 7F,S��R.IF'I' i ON C��' BL�II.��NG To Be ����. A� m ,/ Fro�t ��pth H�ight �� �quare ieet • ��,� � Cubzc FE�t :� �_ ��= -- � F�ont /�p De�th � � Height / � � "f Square beet � � `� �:ubi� Fe�t �' _ � '_ / ���� �� Type oi Construction ,��'��'s�l�. Est�.mated Cost /� � To Be Completed �ey—��� /.� � � � ��- The undersig:n.ed he�eby ma.k�s application for a permit iox �he �vo�k he�ei�. specii°i�d9 agxeeing to dc� all work ita �trict accoraance r�itih thP City o� Fridley Ordinarbce� a.nd rulit2g� oi th� Departnent oW�' Build�..g� 9 and hereby d.eclares that alI the �acts at�d rep�°e�er.tatioi�a �tat�d it� thi� application axe true z�:�.d co�reeta DATE %�� �—' C( i3 ��C?�TATIIRE ��i9��'" i�������0� (SehEdule o�° Fee Cost� car� be fouc�d on the Reve��e Side� .-.s� �_� � � � � '=J � � i � � ,. �� � _ � �-_ � / � � � BUII,DING PEftMIT FEE SCHED�I,E SECTION 2o The In�pector of Buildings �hall, �aefore issu�g per�it� for the esection of any building o� �truetur�, o?� for any addi�tion to a.�y existing �tructuz°e or build.i.ngy or f or ax�y �.lte�ation o_r rep�„ir� to any exiating building or st�uctu�e9 upon ap�Zi;;at�on th�refosF:, �er�uirE the pa,yu�ent by the �.ppli�ant for 8uch permit of f�es to the amo-u�t he�ei�� below �et io�°th and in the ma.,�ner he�ein provid�d to�wit: Uniio�m Buildir�. Codea Typ� 19 2, & 4-$1075 fbr each one thous�.z�d cubic feet, or fraction thereofe �.n sucr cubical c�nt�ntso Type 3 8e 5� $1050 for eaeh one thousatad eubie �eeto For the purpose oi computin.g iees ior buildi.ng permits9 the cubical contenta of any buil3ing or addition to a uniform height throughout by multiplying the ground area covered from a point six (6� inches below the floor lin.e of the basement or the cellar to the average height of the upper auriace o� to the average height o�° the roof �uriace of the ma.�.n gable of a pitehed roof o For repairs ox° alteration� to ax� existi.ng �tructu�e, the fee ah�,ll be at the �ate oi $3000 per each iive hundred dollars ($500a00) or fraction thereof in the cost of all p�oposed worko In no case sha11 the fee �ha�ged f°or any p�rmit as aet forth i,� Section 2 be lesa than $50000 NSSSD Connectiox�. 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O � : : : : � : : : : : : : : � : : : : 0 0 aa �a �a "�a �a k �a �a x � � � � '� � � � � � � w � �� � � � g $ � � ���.���� H w H H H �� � � � 0 a x � � y � tD 0 I 0 I m b� � D � � D � m � n _ m C r m w a � 4 � s b � a � � � a. p ~ � x ,' w � � Storl� 8 � w�r�ae � @ c�os�rs �� URINAtS � � enrti O � � e�si� � b � SINKS � wasH � ranrs DRINK. FOUNT. sHwRS. _ FLOOR DRA�NS GTCN � BASINS �uro wwsi�en GAS MPL GAS RANGE GAS i OPENINGS �� 8 M � � � ��� � � �. Z. � � � � � n �a� ���� ��pC po � p, re � o m �b� °� � �o � � ��o Q � �' �° � � �. Fpy � � y W � � b � �b � R7 O`° �W �p � �' o � p' o p � Q, o M ���w � ����. o���. ���� �� W� �, � � w ��o �a�" ... .. � � a. co< `„6 m � + � � � � � �4 � � �d r'� � � �ro a0 Rx % h°n i� _. M o � � m � �'� �J� � � � �\ r� � � � o' � � ` : ` � �, �o � � ' a � � � o � .�, � � � 'd � 0 m � � L�. � � �T c �' �f-_ HOUSE HEATING TEST RECORD ADDRESS_���� � � ,, APT. F-OOR CI S BUR /�'� OCCUPA�v�} OWNER ��_;s��t��� HEAT L-a55 DATE HTG. INST. ^-AS C0. METER BAD # SOLD BY INSTALLED BY � �-�� Electrical Work By Gaa Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. _ f,� GA5,-0�SIC�A��� �� . MAKE � �=`�" %� �=a �-�`�/� � � %" �°-"� ''�-��''.�r MAKE OF BURNER _ Modal � � �� �`.� '!� [,°° � �� Model Serial .� �+ ���� %���� �� � Max. BTU Rating — UNiT HTR. OTHER CONVERSION INPUT f� �^�� MAKE OF FURNACE Model CONTROLS Er THERMOSTAT a������'Heat Plug Vent Size Yalve f - °? KIND OF UNER 'k" + > � . ^�'SIZE�NONE Limit ��� �' ��� � Droft Hood Reguloror Limit Setting -�--�°`'�' Filters Size Number Fan Setting ��'S'� �'''/`�,`� Chimney Loeation Inslde `�°` Outside Pilot Type "" — Pilot Make ��=s- �. °<`' Pilot Modal � � � �- *� � Pilot Timing � ��-� - Chimney Construeiion Smoke Bomb Wiring +� �°° Draft � ��'" Test Tag L.W. Cut Off Do r Pressure Lighting Inst. �- Prossure �� � Pe�.c CO � �� � `� A ate�ted �' - - � /,; Input CFH �� c' P�e � "�.' A �� pany Testi�g ` ��s'' � . � _ - Staek Temp. _�,�_� Percent CO ��F��' Mame of Toster ' Form 235 � STATE OF MINNESOTA D<rARTMtNT OF NUMAN aERVICEB 444 LARAYETTE ROAD ST. rA�1L. MINN680TA ss101 � �8-86 Date Citv of Fridlev 2oning Authority 6431 Universitv AVe. N.E. Street Address Fridlev, MN 55432 City State Zip Code RE: ZONIATG NOTIFICATION OF APPLICATION FOR LICENSURE Subject: ,� Name of Day Care Home Applicant �� �D �(�o--r���-� Street Address � ����� City Sta e Zip Code ���'1�° ���ik� �C%-�" D6S-2722 (9-85) pz-oz�zz-oa /D —/� �� �� Type of License: Family Day Care _�_ Group Family Day Care Licensed Capacity ( � Phone No. � �� � �� `�U This is to inform you that we are in receipt licensure under Minnesota Rules, parts 9502.0300 Rule 2), Family Day Care and Group Family Day Care this license is subject to compliance with the Statutes, Sections 245.781 to 245.812 and 252.28, the Public Welfare Licensing Act and the rules of Services. of an application for to 9502.0445 (formerly Standards. Issuance of provisions of Minnesota subdivision 2� known as the Department of Human You should note that under Minnesota Statutes� Section 245.812, Subvision 3� a licensed day care facility serving 12 or fewer persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi-family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, Licensi g Worke � Street Address 30 days after receipt of this letter, we day care home to be in compliance with COMMUNITY HFALTH & SOCIAL SERVICES DEPARTMENT COUNTY OF ANOKA COURTHOUSE, FOURTH FLOOR Name o A ency Organization City State Zip Code AN E�UAL OPPORTUNITY EMPLOYER n z v (� O � w m � T m� �m �, v� D Z -� O oz Z < N IV �n � 1� � o -o � �a � o� v,• � H � O H � A � � 0 3 � � a� 0 �' � �• d QQ � � .o a o �� f�D � .� a o fD � � �� a � 0 c .+ � m z N 'o m � O Z � rn m � .p V 0 O \ 2 1 ��3 N � ? im� ��3 �"��RI oOm Dy�° r�i � Z y n � O Z _ �pm _ '�'� '� � Z \ �n � �o rnr 3� -� � < N m Z �� o°o Z � �' oa -° � o a ma ( � ' 0 c 00 � � v � f�D ---I m r � ?t � � d W v � N � f�D � W � � � � � � _ � Z � C� O 4 . b D '--I m w i N G� Q ti � o � 3 �� < �. o► � � a C °, � '� O1 � � fD 0 1 0 �- � � a m r -n c m � m S d � 69 (yq W � � � 0 -.�y� � �• � cc m � m � a � ° a m � �! 7�' 00 N. o m � aq N � �. fD � �, � a � (�0 � � �. a� a � �'�D�G r« � � � �; �n' _ �, � � O � � °' x' fl' �' a ' v ort, �• � �• lD � � � =�► d � n � fD GL n "'` � � 0 O c � � nr cu � N y n f�D � � � Q- � 3 c� nSi � r: O r* ? O..w 1 � r+ 1 � � � � � ? � 3 fD C7 tD n�i � � O y n 7C � � a S cn � Q. y f�D � �. � � O o " �� < `D p� N � c c� � -�+. N -0 N• ?� D lAD � O .. �C o C = H � r � � 0 z � D n � ... 69 c `� � � c� � -i� n�i Q. N z d c�D 2 � v� N� �D Z 0 m' 0 � D c� 0 a 0 ? 7� o� N N N N yI d N v m 1 � o�i D c uAi N N Q 7 O. � ���d � � -o. cn ce � �, m p�q � d cn or v� � < � c_So �� �� d �a,• >> •�r �' ,7 � � — C � � � j n � S rt � < ��W�o � `� A � � � V � 1 � � � d � � � fD � � t� tt► �► ro �• �-• �. cn o 0 0 0 � O O O O O "�'' �D if1 6A -� oo -a z �cdo — °- o rn � _O � � � �� p � d m ='• � C � � �� � � N _ o � (� � �. O � > > � fp fD .-nr ^ m � o- cn m r fV� � QI'rlZv � � �.-. 2 0 � dr� �t- � � v --n 01 "t � � � if! b9 � �o� rD- m � � D --1 m v n 0 � � r�,, W � � � m � � z O i �d' 6j . rv � � � c � 0 Z � C � m v �\8'zs n n wa ��r v� C O w3�•� Qi Z i� � 1 � � �� m m w<� = N � � Z m c° � r p m Z � < (!1 a � 'v z O �- � O W � v � � � �r `1.. � �v r �� �O rnZ �O � � � � Z o Z � � � D� � Z ON za v_z .� v o= Zm z -Di �Z � � -Ni � Rf � 3r0 N Z � C v "' Z <� �S NO z � m t� < N 0 7 L d � C Ct � r N O O � .� - . When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, Yes No () and is securely supported and firestopped where required. The venting system is plastic/PVC and meets all current codes and manufacturer Yes No specfications including sizing, length, number of elbows and termination. ( � �� The undersigned aiso 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 Yes �No (; assisted and natural draft appliances. The existing combustion air is sized and installed to meet the cuRe�t codes and manufacturers specifications. When required to install a new combustion air, it will be sized and installed to meet the cuRent codes and manufacturers specifications. Yes (� No ( Yes (�/S No ( ) When installing a new venting s sy tem, the undersigned hereby verifies that it is a listed assembly and meets the cuRent codes and manufacturer's specifications. T�� fan ass sted a d natu a dAaft appliancesentral Fumace Yes () No () Venting Tables for Is the common vent n� e�o ed f om the ommonv ent alnd ent dtly after an appliance has bee Yes (�No () separately as per current codes. A liance T e and SizelCommon Vent and Vent Connector Information ' ce #1 T e BTU Input 0'00 Fan Assisted or Nat � Applian YP BTU Input fJ, J'r�'/ Fan Assisted or Nat � Appliance #2 Type �����°%� � - Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances �_ Total Btu Input /��_ Common Vent Type Vent Height,i�= Diameter �_ inches Appliance #1 Vent Connector Height �ft Length = Diameter � in Type Appliance #2 Vent Connector Height �ft Length .,,,�_ft Diameter �in Type Appliance #3 Vent Connector Height = ft Length = Diameter in Type ALTERATIONS: Describe ¢ � G ��� HEATING CO: GU �cQ � 3- ZG -�/ Date : Signed By: Building PLUMBING Permit Ivo.: � Uc.�� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date xec'd: %-' - DATE YOUR E-MAIL ADDRESS SITE ADDRESS v THIS APPLICANT IS: ❑ OWNER [�ONTRACTOR PROPERTY NAME: � +e OWNER/ ADDRESS: V CITY STATE��IP S��Ca' TENANT PHONE: CONTRACTOR NAME: �T Ce i� � �I (.�fM�T��j. � TitPr'b"�� -' SUBMIT A COPY OF STATE LICENSE # J EXP DATE �( YOUR STATE ADDRESS: CITY �f�-��,, � STATE V�I t,�IP�D� LICENSE WITH PHONE ��- �-� �= �7C3-�,� FAX - E� -- APPLICATION PERNIIT TYPE `�SINGLE FAMILY � TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � �W ��PLACEMENT DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS Wf�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPI' WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVi� BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING _ BATHTUB GAS PIPING p✓� cr�rtrcE,vsE} SWIMMING POOL WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS) _ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION _ WATER METER OTHER ;�?'��.����"�E �?�t.�}���r�{��.' '�!� 'ER.F �'iS(i(i ;.„s s,: , ' 1>FkfiI1?I'['T' �E� �Q�t �'R'C.�J�C`� f.���'. �$� : Permit Fee $ Number of fixt�ures @$10.00 x$10.00 =$ Surchar e .50 Number of fixtures a�$15.00 __ x$15.00 =$ TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$ State Surchazge = $ .50 Tota1= $ , � THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the cas a work which re '� review and approval of plans. SIGNATURE OF APPLI ANT i� PRINT NAME��� l/ l�n DATE Z . n, _ , ' `�' . . �*��TC?�";� ,�E. A�`�.�, F ...Y'' .. - . . ��`�� t:7�1�� �C)R.,��*�?�N{ar E�}��;'i`1�ICt�il,,:d��II ..;. "., �"�r��!Ri�:`. ,� �''. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977