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AF - 43270� SUBJECT � P � City of Fridley _- 17 6 6 4 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r � � � � . ' COMMUiJITY DEVELOPMENT DIV. ' j L'--��-, . r � � PROTECTIVE INSPECTION SEG � � � � , � � � ��1 � CITY HALL FRIDLEY 55432 N�UMBER REV. DATE PAGE �OF � A P VED BV �----�: ,.� 612-571-3450 9�0-F15 8/20/84 / / JOB ADDRESS 1341 H Creek Park Lane N.E. 1 LEGAL LOT NO. B�OCK TRACT OR ADDITION SEE ATTACHED DESCR. % �V. Al1C�. .� b. #1� �LO't 2� B�.00k 1� Hidden wOOC�S% SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gambrel 3 CONTRACTOR MAIL ADDRESS Z�P PHONE 1�CENSE NO. Garjac Inc. 481 - 206th Avenue N.E., Cedar, MN 55011 434-7096 4 AFCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING R@S1C3@I1't].dl 7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a 54' x 33' Dwelling and a 28' x 22= Garage SE�ERAtE PERMfTS REQUIRED �OR WIRING 9 CHANGE QF USE FROM O � � � STIPULATIONS Proyide a hard surface driveway. Provide sod in the front and side yards. Provide City with_copy of verifying survey before capping. Plat must be recorded prior to Certificate of Occupancy or property is sold. Park Fee of $1500.00' Paid. Water & Sewer Location: Not Available. iNARNING Before digging caft loca! utilities .� �irr o� ��rotEY oots tro� Gu,��,�rm� �r�� tEIEPHON� •�tECiRIC • GAS Ete. ,.�� ,►�,r.� oF uTitm► tocAtioNS �r�o �Gk-,:�7�.- ��t��11��D 8Y �.AW !: Y'"� ��. !`; fGP. INFOkti�ATION PURPO�ES ONl1' r�.�;� r:=°::WS'^.: E►SING li SIIOULD VEWFY TFtE WfOR/NATiG�*: �"�W SM� SITk TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIiiEO FOR ELECTRICAI., PLUMBING, HEATING, VENTILATING OR AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED 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 OFFSTAEET 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 ��-00�800 �SO.�iO 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- S U TION R THE PERFORMANCE CONSTRUCTION. �`43S.r'J� $425.�� PLAN CHECK FEE TOTAL FEE �.�8.88 �1� ��.9.88 SIGNATUREOFCON� ACTORORAUTHORI DAGENT IDATE) WHEN PROPERL V ATED HIS IS VOUFI PERMIT F i�` L� SiGNATUAE OF O�NNEA iIF OWNER BU�LDERI IDATEI BLDG INSP � TE NEW [ ADDN. [ I pLTER. � � City of Fridley �R-1 AAD R-2 . Building Permit Applieation Effective �/1/84 Construction Address: � 3. y ea.�� ,+z L r�^.'t�. ;� Lega1 Deaeription:� � i�eu� � S� r � �oZ ( �`, �S� W� .� �/� M � /c'(' L ' _ Tel . # �.Dwner Name 6 Address : �� R S �'�/Q� �C, /�v G + • Tel . # y3 �� ` �� Contractor: '> Addresa• LIVIHG AREA: GARAGE AREA: DECS I1REA : OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction draWn on it to scale. DESCRIPTIOA OF IMPROYEMENT Length `�� liidth 33 Height g, Sq. Ft. � 9`S � Length vZ� g Nidth aa,_� Height __�___ Sq. Ft. �� Length Width Hgt/Ground Sq. Ft. ._._ Corner Lot [] Inside Lot � Ft. Yd. Setback Side Yard Setback __ Type of Construetion• %� F Estimated Cost: # '� . /� � 1 Q�, g� Approx. Completion Date: "� Alt. A Alt B Proposed Drive�aay Width If NeK Opening Is Desired: See Back Page for Explanation DATE: � � IN ��`( APPLICANT: � Tel. # Permit Fee Plan Check State Surcharge SAC Charge Park Fee SeWer Nain Charge TOTAL STIPULATIONS: Pc�" �Mus, Sc►c,,,� ......—�-- CITY IISE OKLY � �� 1 O g. 8�S � S'a. �(U s � Z � .n� a .�'SbO.Ot� � �� ZS °I�� Fee Schedule on Reverse Side 25x of Building Permit Fee $.50/�1,000 Yaluation �u25 per SAC Unit ' Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 3�, R�.cc�.ro t:�► QrZ.� i�. '� � C� 2'�. Gr.�P�`'ut �" BiJII.DIAG P$Rl�IIT FEE SCHBDIILB The Chief Building Official ahall� before issuiag permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing Duilding or structure, upon application therefore, require the payment by the applieant for such permit of fees to the amount herein beloW set forth and in the manner herein provided to-Wit: ?otal oaluation =1.00 to =500.00 �501.00 to a2,000.00 �2,001.00 to a25,000.00 Feea ' ; �10.00 (Minimum Fee is a15.00) � =10.00 for the first �500 plus �1.50 for each additional �100 or fraction thereof, to and ineluding t2,000. �32•50 for the first �2,000 plus a6.00 for each additional �1,000 or fraetion thereof, to and ineluding a25,000. �25�001.00 to a50�000.00 �170.50 for the first �25,000 plus �4.50 for each additional a1,000 or fractioa thereof, to and including �50,000. a50,001.00 to �100,000.00 a283•00 for the first #50,000 plus �3.00 for eaeh additional �1,000 or fraction thereof, to and including #100,000. �100,001.00 and up �� B� '' i �v. ..�-�--z J � c / 4 'L / °� �-Z �433•00 for the first �100,000 plus �2.50 for eaeh additional ;1,000 or Praction thereof. DRIVEfiAY DEPRgSSION ESCRW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - DriveWay width plus 6 feet times �13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach With 6 inch depth - Drivexay �idth plus 6 feet times a15.75 VBRIFICATIOp OF FOIIIVDATIOA Permits for construction Will be issued a minimum of 2�1 hours from the time of application to a11oW for proper revieW of the proposed structure and of the construction site. A Certificate of Survey of tbe lot, shoWing the location of the foundation once it has been aonstructed Will be required before proceeding with the framing. I Oo, ��► �A�4.M+� wc .r �,�-� ' 433.d �f 3 v s'f I�sZ. _ i �,35�. z.� �ou ,e•�— t.�P, 3y K�Y 1�i3� � I�C 2.� Z.'� J � 4e.y� 7�{�l�{Z.?b � 3� S� . �i�s = ►a� X �z �t3 � �� Z . y� GA�.�cc zZx a�7 G3� ��I.Cz � ?332,2Z. !'ao � �� .�b C1TY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PEHMIT n � m q u • x d Water � a� � � n E: G a � � m o w p�', �' � Heater � o .� $ a ''� uxi -� y o g u�� u� m�g u�, u, x usi u � a� r� v�i � o w ai w u� a°' 3 c 3 � c� o s lec � � � ( ( i.t % � 1 ' � 2nd 3rd 4 th (It) � Putura Connection Openinq Comected with Sewer (�) � New Pixture, Old Opaning water RATE SCHEDULE PLUMBING FIXTURE RATES: N.v ri: tu:•� �uture lixtura• Old Op�nioq, N�w ti:tur• B��r Dispens�r Blow Ofi 8a�in Catch 6asin Rain Mat�r Lsadar Nydraulic Valv• Su�p or Racairing Taok Mat�r Tr��tinq Appliancs Hot M�t�r 8�ater Ga� R�nq• Ga• Dryer NQ. 8 � �_ RATE s s.00 S 3.50 S 1. 50 S 4.00 g 5. 00 g 5.00 5 5.00 S 5.00 S 5.00 S 7.00 S 5. o0 g 10.00 g 10.00 ALL OTNERS 1WD/OR REP1i1IRS ]1ND ALTERIITIONS l• ot Valu• of lixtur• or Appliance Win� Stata Sorcharge p.ccson r« _��_ (S1S.00) TOTAL PEE TOTAL s �d_oo S /D. Sv S S 5 S S S 5 S s S7�o S S 5 5 . 50 S S�° •0() :�.;�,!�� tc[e�tive wuy. �, i7oa �ob Address / �� ' f" � %��;� �� Department of Buildings City of Fridley Tel. M571-3450 The undersigned hereby makes application for a pertlt for the work herein specified agreeing to do all work in strLct a�c.o�daRCq with the City Codes and rulings of the Departaent of Buildings, and h�eby daclares that all the facts and representations stated in thls applic�tiau� ara true and correct Fridley. Mn. ( , 19�� ONNER � �� D'7 � KIND OP USED AS TO BE COl�LET'ED ABOt1T ESTIM7ITED OOST OLD HUIL NG PERMIT NO Ooapeny 6.�. sr- S ;� lC K rr C f/� Sfgned By � G9-�--- Tel. ��% "�� _( C' PERMIT NO. ��Z7 ROUGH INSP. nate FINAL INSP, j �! I � ' � � oace APPItUVJ1L FOR PERMIT �[ � . NINIMUM FEE F'OR ANY PLUMBING PERMIT TS =10.00 PLUS THE $.50 STATE SURCHARGE � CITY OF FRIOLEY F.f[ective Auq, 1, 1961 APPLICATION FOR POWER PLANTS AND HEATING, COOIlNG, VENTILATION, REfRIGERATION AND AIR CONDlTIONING SYSTEMS AND QEVICES �. RATE SCHEDULE lESIDBI�iTIl1L �-� Purnace Shell aod Duct Work, 8urner l�l�o r�pl�ca�nt turn�ce) Cas Pipinq (ptpinq n�edrd vith nw� lurnace) Gas Pange Ga• Dryer • Air Conditioninq (ell •ises) RATE S 20.00 S 10.00 S 10.00 S 10. 00 S 10.00 All Others/Repair� end Alterations lt of Value of Appliance or Nork COM!lERCIAL/ INflUSTRIAL lt oi Valua oi Applianca or Nork State Surcharge, �•F'�. _� Rein�pection !ea (515.00) aouyn Ie.p. Date Pinsl In�p. — �G � � Ote Approval ior P�rwit �` �� MINIMUM FEE FOR ANY HEATING PEAMIT IS S1G.00 PWS 5.50 STA1'E SURCIf)1NGE To�r�r. S !�� S �i _� �3 �1 � ,F�`C� �'/a�� /" .^1 1- � Job Address "tX_ ,�� —'-`- i �� Departs�ent of Buildlnqs 6�)1 Univerafty Iw�. N.B., FTidl�y, !pl 55��2 City of Fridley Tel. N571-3�50 s '!'he underelqned hereby n�akeA appllc�tlon ior � peiwtt tor tM wrk h�r�1n apecifted aqreeinq to do all wrk io etrlct �ccordanc� Mlth tM City Ood�• s and rulinqa of the Departaent ot Butldlnqs, and heraDy d�clar�• that •11 th� facts and representstio�s •tated ln this applicatlon •r• tru� �nd cocr�ct• S s S $ .SO S �:�, S� ;. .y G' Att�ch stack veriflcation tocs with replsce�ent Cur�ace pecwits •A1[ Conditioners can not be plsced in sid�• yard without wsltt�n pi•tsisaion fra� a�ljolning roiqhbor. Prid �ey. Mlnn. , 19� a�+wea (�^ r ��C� ��i�`��"�(`'I.LC�l('�J� _ KINO OF 8t1ILDING SY �� e�� i V��ti� ��'t '"' �� _ useo ws �\ Y 1�,��/ ``�� Y�11� ��i �ro ee eoMrc�reo nearr ESTIMIITED C06T OLD - NE11 BUILDING PEPMIT !p. PENMIT N0. �( J� � oescrurrioa oF ro�►+�►ce/suaNea HEI►TING or POMEN PLINTS. St�Yi. Not M�t�r, Nan Air- No. �C� r' �`, Traae Na�e L ^ �i'�,�i� _= sis� !b. Capactty � Sq. Pt. EOR !7V ��_� NP �_ 7bta1 Connected ivad `_ 1� l'��! Kind ot lu�l 4� �� BUPNER - Trade Na�e Size No. Gpacity Sq. Rt. EDR 91V MP SUBUaBA� 9�c�� R oaiv�� CO. Coa+pany � , 7�C"�S4'Ji � - Siqned BY L/ f ! • .�a� - °1I�/ Tel . No. F� �-� —�O � l�`�-� ,..... � � � �� • � � - , tt�acc�.. ,w,. t. t�.i C� � �j� M*LJ[At10N i0R POMER PLANTS AND HEATING• COOLING, VENTI U710N, REFRIGERATION AND A�R fANDITtONII� SYSTEMS ANO �ViCES �� lLSIDEI►?UL r� MLl and Duct Mork, Surner 1�►l�o r�pl.cwnt turn�c+) C�s Plpinq �plpinq w��A� �ith � lurwc�l W• tlange � G�• Dsp�r MTE 9'O?AL S 20.00 S S 10.00 S S 10.00 S S 10.00 S � Air Conditioninq tsll siu�) S 10.00 All Otht=�/eePair� ae�d 1►lter�tion� 21 ot V�lue ot Appli�nce or Mork COMtLRCIAL,rINDtf'STR IJ1L 1� o! Y�lus ot Applisnca or lbrk 6�ate Surcharge TO?]1L !ZE R�in�p�ctia� �N t 515.00 ) Rouqh insp. D�te tinal In�p. C''�� 1Z— �ata, � 1►pprov�l tor t�r�it � MINIMUM PEE �OR ANY HPJITING PERMIT IS 510.00 PLUS S.SO STATE SURCNI►RCE S 10.00 S_� S S .S� S 1�T� A S AttaM •t�cA ve�lflc�tion Eon viN sepl�c�nt turnace pe�lts •Ait tbedltioncrn c�e net M• pl�ced ie +�.f�• rard viUwut �citbn p�•eslw/ow ��a� �dp�s/nq �eiqNwr. � 1341 Creek Park Lane N.E. Job Address Oepart�ent of suildlnqs 6411 univer�/tr A��. M.L., rriai.r� 1!1 SS��2 Clty of F[/dley Tel. •571-)�50 � 7?w undrrelqeed hereby �ah�� appllc�tfon [or � p�e*it tor tM wrk Mr�ln s�+ectlled �qreelnq to do •!l wrk tn •trict •ccord�ne� vith tM Citr Qod�� and �ul�nqe ot th� Dep�ruent o[ suildlnq�, �nd her�b1r Mcl�r�• th�t •il th� t�ct� •nd repre�enu t1on� •tated /n thi� �ppllc�tlon se� tsv� and oorr�ct. rrlelor. Klm,July 25, 1986 1�_ . wat� Robert Gambrel f rame ICINO Or �UIIaIMG �� u residential ro s� co�i.crco �sarr GSTIMi1TED L'06T 1�'��•�� Oi� - NQI �UILDING ►LIMIT ID. KIMIT N0. �/.�•_-�-� OrSCRIRICN OF fU1NAGL/�UIML1l MGTING or POME11 /MIrlS. StN�. Mot IMt�[• Ibe� Aie- Mo. �� sia. �. c.P.eicr sa. rc. ew� siv �_ Mr �� Klnd ot Twl �UINER - TM.ae N..e sts. Mo. Capacity S9. �t. LDR �'N �,_ N� .�_ co.N.�rn De endable H ,�� r 519ned sy ; 1��a1�''°"'=��--1�� T��, �, 757-5040 sue�ecT PE City of Fridley 1928 AT THE TOP OF THE TWINS g U i L D I N G P E R M I T r � � RE � • COMMUNITY DEVELOPMENT DIV. q� � � �' / � r � � PROTECTIVE INSPECTION SEC. p�� 1 . l � l.-_- �;�"'1,•j CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV i �� 612-571-3450 9�0-F15 11/19/87 / / JOB ADDRESS 1341 Creek Park Lane N.E. LOT NO. BLOCK TRACT OR ADDITION 1 LEGAL SEE ATTACHED DESCR. 2 1 H].13C12ri WOOCIS. SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Robert Gambrel 1341 Creek Park LaneN.E. 572-0070 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING Residentia 1 7 CLASS OF WORK O NEW ❑ ADDITION C� ALTERATION � REPAIR ❑ MOVE O REMOVE 8 OESCRIBE WORK Finish basement x�$ CPartial) 9 CHANGEQFUSEFROM TO STIPU�ATIONS See notations on plan SEPARAT E PERMITS WIRONG� yEATlN�� P REQUIRED FO LtIMB�N� �N p S'G NS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL ANO VOID IF WORK OFi CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION 1 STAILS 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 $S �OOO S2 • 5O DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEI THE pEFMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. $SO. SO PLAN CHECK FEE TOTAL FEE $53.00 Si AT RE FCO TFACT Oanu7 ORIZEDAGENT IDATEI WHEN PROPERLY V I ATED THIS IS YOUR PERMIT � � [�"') . g �s / ' SiGNATURE OF OW R�IF OWNER BU�L Ei:� DA E G P � A7 NEw L ] City of Fridley Effective �/1/86 ADDN. [ ] �R-1 AND R-2 � p,I,TER. L l Building Permit Application Construction Address: �� N� Cre�� -� ��'��y �SY3 z Legal Description: L-o� � �°� � � �� d �`''� �� `' � S Owner Name & Address: ��b��% J, Gaw. ��e � Tel. � S7Z-oo7a Contractor • 5 e � � Tej� . # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to seale. DESCRIPTION OF IMPROYEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: DECH AREA: OTHER: Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. ��5��--- -��,s� r � �;� � � -- Corner Lot (] Inside Lot [] Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ sDoO Approx. Completion Date: /"'�� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: � $ See Back Page for Explanation `% Tel . � S%Z -UU7� DATE: /( ` � �_...� APPLICANT: CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �Sv $ .�� a. 5� $ � $ `�. $ �� -_ . - ��, .� ?� _ _ __ _ __ _. . � �_ � ��`.�`� .� Fee Schedule on Reverse Side 25� of Building Permit Fee �.50/$1,000 Valuation � 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] �o �o 0 4— �x � 3�.� � ��a � � � � V � Q � .� C .(� 3 . V , �.... - _ _ � �t. 3 7 ±� .. R1 � \MA / tl A� � � /r A � ^�" h vi � i� � � , � � � � i � I � 1 1 l 1 � 1 I � � � i , `_ � i � � � � � � I i i I ! � ; � � i t � ! � � ' �-------_____ ._ ._. �__-._.._.. __._.__ __ > { � trr ,. ; � x _.. � ` c . , o � � `.}, :� R M .- � L V ` \ i �' i � � �i 4 •( V� � - � �. • = .�� - � j � -� � �� -- ., t� � ^ . __ ._�-- -- -------- � � 't`�__��+K � �� CtTY OF FRIDLEY Effective May 1, 1990 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCNEDULE QESIDBI�TIAL ' Furnace Shell and Duct Work, BurneT (�►lso r�placuent furnacel Gas Piping (pipinq n�aded vith new furnace) Gaa Range • Gae Dryer RAT E TO'PAL $ 20.00 $ 10.00 $ 10.00 S la.DO • Air Conditioning (all si�zee) S 10.00 All Othera/Repaira and Alterations 1• of Value of Appliance or Work CO!lMERCIAL/INDUSTRIAL lt of Value o! Appliance or Work State Surchazge TOT]►L !EE Reinapection Fee (S15.00) Rough Insp. Date Final Insp. � `<�"" ` � Date Approval for Permit 0 $ $ $ s _� S S s S .50 S �5 C� U S t 5 Sd A��FI; ,�4�� Min�m�aa�o #� a_R�326 700 W. Linden Avenue P. 0. Box 1165 Minneapolis, MN 5544�J-1 � �5 MINIMUM FEE FOR ANY HEATING PERMIT IS s15.00 PLUS S.50 STATE SURCHARGE •Air Conditioners can not be plared in �:ide yard without written pernis�ion fcan ad�oin►��9 rwr�qldx,r. Job Address �� -�- � � � -�- �- �` �� De�artment of Buildinqs, 6431 University Ave. N.E., Frtdley, MN 55432 City of Fridley Tel. M571-3a50 ' The underslgned hereby makes application for a pettit for the work hereln specified aqreeing to do all work in strict accordance vlth the City Cades and rulings of the Department of Buildinqa, and hereby declares that all ths facts and cepreaentationa stated in thia application ars true and eorract. Fridley, Minn. �'— � % . 1�� OWNER ��—�\-�� (�.Q �" �. KIND OF BUILDING � � USED AS �'� .�� c \�'� L' 7`O BE COMPLETED ABOUT �-- c� �`� / . ESTIMATED COST � (`) (`� - V` U OLD - NEM BUILDING PEPMIT Iq. PEPMIT ti0. �` lC_)�` ? DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLAN15, Steam, Hot Flater, Macs Atr- No. Trade Naae Capacity 'lbtal Connected Load Sq. Ft. EDR slze �+o. gq'U HP Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Coopany S eq/�y� � - � , 9/, l��• el. No. NIIINRf��bA�A Fill out Dack side for stack verification on replacanent furnaces SuB�EtT City of Fridley AT THE TOP OF TME TWINS g � I L D I N G P E R M I T i � � � � � COMMUNITV DEVELOPMENT DIV. � LV �'.�� r � � PROTEC7IVE INSPECTION SEC. � � ' �"'� � CITY HAII Ffi101E� SSIJ2 NUMBER �'""'�" �'' 612-571-3450 9t0-F�5 J08 ADDRESS 1341 Creek Park Lane NE 1 IEGAL �OT NO. BLOCK TRACT OR AOOITION OESCR. 2 1 Hidden Woods 2 PFOPERTV OWNER MAIL ADORESS Ken Luke � CON7RACTOR MAIL ADORESS Pennington Construction �c 4347 Central � AHCHITECT OR DESIGNER MAIL AODRESS 5 ENGINEER MA�L ADORESS 6 USE Of BUIl01NG Residential 7 CI.ASS OF WORK 8 DESCRIBE WORK 9 CHANGE OF USE FROM STIPULATIONS REV OATE 7/22/99 ZIP IIP v�GE OF � � �_°°� PNONE 1 7RS PNONE PHONE 29922 RE EIPT NO. ��..J ! / �nnNOvEO Br SEE ATTACMEO SMEET LICENSE NO i9 2(11 fi9 �ICENSE NO. LICENSE NO O NEW O ADDITION ❑ ALTERATION XX REPAIR O MOVE O REMOVE TO Underlayment must comply with the State Building Code. TYPEOFCONST. OCCUPANCVGROUP OCCUPANCvLOAD SEPARATE PERMITS ARE REOUIRED FOR EIECTR{CAL. PLUMBING, NEATING. VENTILATING OR AIR CONOITIONING TMIS PERMIT BECOMES NULI AND VOID if WORK OR CONS7RUCTION zpNING SO. FT CU FT AUTHOR12ED IS NOT COMMENCEO WITHIN 60 DAVS. OF IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONEO FOfi A PERIOD OF t20 DAYS AT ANV TIME AFTER WORK IS COMMENCED. N0 OWLG. UNITS OffSTREET PARKING I HEiiEBY CEi;TIfV THAT 1 HAVE READ ANO EXAMINED THIS APP�ICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL Pf10VIS10NS OF LAWS VALUATION SURTAI( ANO OFDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIEO WiTH WHE7HEA SPECIFiEO HERE�N OR NOT. THE GRANtING OF A pERMIT 4457 DOES NOT PRESUME TO GIVE A TMORITY TO VIOLATE Oii CANCEL THE pEqM1T fEE PROVIS NS OF ANY OTMER S A E OR LOCAI lAW REGULATING CON- STRUCTI 9/ OF TME PEFj�jORM N OF CONSTiiUC710N �--� ,�ill1. ZS � NAiUAE Oj'4qN'AACT�1 Qp • NEA Ni ,o•re, iD�T6 �RG SC FEE V VAI.10 THIS I UR E1a IT � / � r�cTE NEW ` ADDN ALTER r� [l [] ConstructionAddre; Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1 / 1 /99 1'� �0 _ � � �U 1� Owner Name & Address: �� -p Tel. # .� �� 0�' Contractor: � � MN LICENSE # .�DI 6�.3 �l � Address: � c �n�,-� � �e, ./%/� Tel. # �i�'�-S/� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. �OTHER: �� ` � ,�;,,, e �, ��— �_..'-- Construction Type: � �� O Estimated Cost: $%3�%� 4 ,� I��-�'Q�r�c.�p � (Fee Schedule on Back) �-` Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �� --� APPLICANT: �,q � � � �„� �,� � � e,n Tel. # _ Permit Fee Fire Surchazge State Surcharge SAC Charge License Surchazge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � Il/ �s- $ � ��o $ �- $ � S-Ud CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1050 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 [ ] $ �� CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FtTT1NG PERMIT � >, � q � � � � Nater A O O� C YI q tll y �- M C-•� y N V u -i F m F�,af( ro m��0y N pa, �'' Heater ►p� 01 M i.' A ,�C�( t C C � ~8 U�•a O t � U � d �J .�r N A � •�i �0 1+ O t r-+ O,0 7 16 �q N N�o � v► U 5 oD � �n Z � u. w a u ao 4 3 t� i� u O .as lec � lat 2nd 3rd a� (R) � Puture Connection Opening Co�uiected with Sewer (�) � Nev Fixtur�, Old Openinq Mater RATE SCNEDULE PLUMBING FIXTURE RATES: N0. Ne� ti:tur�• �'�' �uture �lxture• Old Op�ning, N�r li:ture Hasr Di�panser 91ov Oft Ba�in Cstch Basin Rain Matei Leader Hydraulic Valve Su�p or Recaivtnq Tank Mat�r Treatinq Appli�nca Hot Mater tle�ter Gae Ranqe Gas Dryer J1LL OTHERS AND/OR REPAIRS AND AI.TERATIONS 1� ot velue of Pixture or Appltance Reinspection Pee S (SI5.00) RATE S 5.00 g 3.50 S 1. 50 S 4.00 S 5. 00 S 5.00 5 5.00 S 5.00 S 5.00 $ 7.00 $ 5.00 g 10.00 S 10. 00 Statc Surcharge TOTpL PEE TOTAL S,Z . / O S S S S S S S 5 5 S S S Sav. a" S s50 S�Q�� tttective Auq. 1, l��nl Job Address ,� ��ji�e K O,L Ln � - Department of Buildings City of Fridley Tel. 1{571-3450 The undersiqned hereby makes application for a parmit for the work herein specified agreeing to do all work in strict aceordance wlth the City Codes and rulinys of the Departmen[ of euildinqs, and hereby declaree that all the facts and representations stated in this application are true and rnrrect Fridley. Mn. _ � a �-�_, 19� ONN£R ��(!)'�„ ��,�� KIND OP BUILDING � f,4 m� usEn As �(.cJ P( �: n�r TO BE COMPLETED A80UT � II.�I � — ESTIMATEP C0.ST ��Q� OLD - N61d BUILDING PERMIT NO. p�FrfIT NO. _�`� '/ �(Q --�._..�— Canpany ! i C /7� � �/I / f� .4 � (! !i siqned 8y a ' rel. No. � � �� ROUGH INSP. Date FINAL INSP. -=+^ �(J �O � Date APPROVAL FOR PERMIT � �9ININUM FF:E FOR ANY PLUME3ING PERMIT IS 510.00 PLUS THE S.50 ST.4'ft SURCNAkGE: CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3504 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shelt and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - Al! Sizes t;''. . , t Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND.AIR CONDITIONING SYSTEMS AND DEVICES F�e Total $35.00 $ .�. $10.00 $ /D.o 0 $10.00 $ $10.00 $ $25.00 $ �� All Other Repairs or Alterations (List on Back) � 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of improvement whichever is greater, on work less than $500.00 Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR • $ JOB ADDRESS�3�` �/� �'��h�` �-� Owner /7 eivwe'�`t � U(�.Q Building Used ESTIMATED COST �7�� PERMIT NO t DESCRIPTION OF FURNACE AND BURNER # of Heating Units____�__ Circle One (Steam) (Hot Water) ( a14V rm A� Trade Name,�3�'�"'7� Size No.�rs,vu„�c;� � . BTU �,Odd HP EDR Fuel /1% I¢�� Total Connected Load Burner Trade Name Size No. BTU H P EDR The undersigned hereby makes appiication 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. $ .50 $�.a� *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City HEATING Sign � C Tel #,7�3 °-%�f -G/�i , FAX #�3 -7�y �fGl�! Date 1�-Z7 -�✓S . I FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough-in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION , When replacinA an existinq furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes (j,� No () The venting system is plastic/PVC and meets ali current codes and manufacturer specifications 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 current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. The existinq combustion air is sized and installed to meet the current codes and manufacturers specifications. Yes(� No( ) Yes (I� No ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( No () When installinq a new ventinq system, 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 Furnace Ventmg Tables for fan assisted and natural draft appliances. Yes (1,� 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 ( No ( ) Appliance Type and Size/Common Vent and Vent Connector In#ormation Appliance #1 Type P U�C BTU lnput �� Appliance #2 Type BTU Input Appliance #3 Type BTU Input Total Appliances Tdal Btu Input , Common Vent Type G��-�� Vent Height a'�5 Fan Assisted or Nat �° �g ��'� �. 5 Fan Assisted or Nat Fan Assisted or Nat Diameter �_ inches Appliance #1 Vent Connector Height �ft Length �� ft Diameter �— in Type P vG Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type �l�'F � /4�l7o.v� � 4CS�-+�'� HEATING Signed B'y: �. � 11 �.5, �-- S.Sy,� �-- �;��i��_�!n�_� 1��,��,�1'�}i�� , - -, l'�.l'�1�ll�t��(� 1� . ,,�I UI_�.`�"'�� L ��'I'I_I(':��1��O� ,� �� .�, ��-C��f��' I; _. . _ 1 ;, �� - � �� , �,_�-°� ; �-��,��-� � (�11�� OI� I i �Z�L�1� � � � ��.�< i � DATE ��I '° �� b YOUR �MAIL ADDRESS S[TE ADDRESS 1'3 4 I �/1 E� K ��L K L� THIS APPLICANT IS: ❑ QWNER �3CCONTRACTOR PROPERTY NAME: K E�/ t�, �� ,,/ OWNEW p1�DRESS. 1 3 y I �. 2� E/c aR /G �ITY F�2, � i� L� y STATE"`"' ZIP `�SS<3 .�, TENANT �7 6 3- S� i-�� 9� PHONE: CONTRACTOR ��: Terry Overacker Plbg Inc SUBMIT A COPY OF STA'tE LiCENSE # � y 4 P M 1628 County Hwy 10 YOUR STATE a.DDxESS: Spring Lake Park, MN 55432 � z� LICENSE WITH pHONE (763) 572-8880 APPLICATIQN PERMIT TYPE � SINGLE FAMILY t] TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � ��`'� ��CEAg'NT DETAILBD DESCRIPTION OF WORK ,/�,LQ-C-�-e.� �/ o�� ''� ��'�''�"�' �� PER MS 16B.665 the permit fee is a minimam of $15.00 or 5% of the tota! 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 $500 = cost of labor x.OS = FOR PROIECTS WHERE LA$OR �XCEEDS 5500, FBES ARE BASED ON SS0.00 PER PIXTURE, EXCEPT WHERE NOTED. FIXTiJRES: (TNDICATE TOTAL 11t3MBER OF EACH BE}..OV� BATH SINK/l.AV FLOOR DRAINS SHOWER _ WATER PiPtNG BATHTUB GAS PTPING (NEenCns'uc�s�j SWIMMING POOL _ WA7'ER SOF7NEK (S35) � CLOTIiES WASHER � KITCFiEN S1TIK WATER CLOSET � BACKFIAW PREV. (SIS} � DISHWASHER LAUNDRY TRAY �WATER HEATER (S35) ' FOR IRRIGATION WATER hfETEIt _ OTHER ��`��'� ��, .��T�:��,� a Y y�''��'^�}:'�� r.,,. `�� r� ��"' � f� *�� `�_ �� . �`< Permit Fee $ 3� . � Number of fixiures @$10.00 x$1U.0(l –$ Surchar e .50 Number of fixtures @$1�.Q0 x$lS.UU =$ TOTAL DUE $ S,,S'�} Number of fixtures @$35.00 x$35.00 =$ — State Surcharge – $ .SO ' Total = $ THIS IS AN APPLTCATION FOR A PERMIT NOT VALID UNfIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accvrate; 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 on}y an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved pian in the case of all work which requires review and approval of plans. SIGNATtTRE OF APPLICANT � _ PRITTT NAME �A C K r G_ �C � d n.�� DATE ! d// d/� G r:....... �., ,.,.6 .. � , ..... � � .,��1�� !��'�'��'. �.� �'?. � . . . ,� .. . _ : ..� ��' ,. °�!�.`.-`� ��'� �t ��% �r � p � .. �, City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley,�MN 55432 763-572-3604 �AX: 763-502-4977 � Building Inspections 763-572-3604 763-502-4977 FAX DATE 3 � � SITE ADDRESS %3 `� / THIS APPLICANT IS: �oop� BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-08 Permit No.: Received By: ��--�- s - �.- �, ► . � . . . �1� 1 111 YOUR E-MAIL ADDRESS /M/� lSE GA�i'��7�Y (� �MGA�57 • NET C R EC/� /�rsR.� Ls►-..� � ❑ OWNER .OfCONTRACTOR PROPERTY OWNER/ NpME. �p7NLE�� L�� TENANT p,DDRESS:/�i�/ �'�F�K ��R�'�- L^� CITY �I ��-�'`1 PHONE: %( �i "" 5 7 �'� ��% GI 8 - — -- � — -,_� ..-- - — .._.�a.,. �. ATE�'%�'✓ZIP SS¢3 Z J CONTRACTOR ADDRESS: �36 � C'REEK PA'�k-- G� CITYF'e�OC-C�I STA'I'E�`'��✓ZiP SS43 Z SUBMITACOPYOF PHONE %63 ��/��77ZC-�b�-L�'-7g7�3 —S�/ - 87��3- YOUR STA,TE LICENSE STATE LICENSE #�� Sv 4I S U!� EXP DATE 3 3� ��°$ PROPERTY TYPE PERMIT TYPE TYPE OF WORK: �TSINGLE FAMILYMEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAG ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING � SWIMM 0 i�IEW EIOME CONSTRUCTION ❑ MAINTENANCE/REPAIR STORIES / NG POOL ❑ ADDITION �REMODELING O DRAIN TILE I�OTHER DESCRIBE WORK BEING DONE: k�TGNGN ��`'1//JEL � C/�/�/E75 � FLGbR/�/G— , 1��/�'% i a'�`'/w�u— c77F flR fTAPR(1VFTvTFNT LENGTH �3 � WIDTH � 3 HEIGHT � SQ �T ��'q ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROP05ED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXiSTING OPENINGS ❑Yes ❑No OR POR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPR nF WINDOW TO BE INSTALLED ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE BASEMENT REMODEL[NG SUBMIT: I. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTTON INCLUDING DECKS, ADDIT[ONS & PORCHES SUBMIT: ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Trim and proposed project. ❑ Fascia 2. Two seu of construction plans 3. Energy Calculations LOCATION OF WINDOWS NUMBER OF ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: � (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ %5U . OJ OCCUPANCY TYPE Permit Fee $ � See Back Page for Fee Schedule Plan Review $ � j ti� 65% of Building Permit Fee Fire Surcharge $ ,-i S .001 times the total job valuation Surcharge $ ,� .0005 x Permit Valuation Minimum $.50 License Surcharge $ S��,CJ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft= ft x$21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary () Non Necessary () Total Due $ (+ (�.,, Make checks payable to: City of Fridley Attach 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 the Minnesota Con truction Codes; that 1 understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work wi 1 be in accordanc w� the a r d plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPk ANT _ PRiNTNAME t%D�./ l��/�-�-��°s DATE 3�� I�8 APPROVED BY � �.f',� v �( ��'s�'2��C DATE � �� ,. � / t4: M yP . �� i:� � A i f.t g,��` .. , � -._�'� = S �..ti�. � ,k; `'' � .. - . . � � . ' ._ ' �l' ',,.� Y�;:�T ��: "'' � W4 i . r . . ! � • . '. f . �. .. f 1-: �_'w.�. � _ � � .. .... . . ..... ..�..: �' �. _ • �- . _ ' . . ,�; : ..^; ,� ',"�� ..,,� � k i �l� � 1 - x � �,.,. re� + � .,t ' -* � .. : . _ , , _. „: ..'• �. t . . T _ ' . . . , � ,. „ . ; : „ , . .: : _ , : � «," ... _ .. �._..___ . .. . ,. , ; e . :i b � i ' ' . -. . : .. - - " .. • . . � . � -. .. .. . ` .: . ... ,' . A . ... � '..'.�. _ ... .y. � .:� •...., � . .. ... - .r . � ,. : ...... ;r::.°.r„ M �--.wlc� .. i_ . , � � . - ' '-1, K.. hita'h „�i,; � ..u: �. . . �.� � �q_, v?''� y': ,,'�.� - 3 � . • --. . . ... . .. ... ,. . .. . :� "' .. >, .:.. : �' � �'• - .... ... : _ . ... '.. � . .-. ' �:.. .i...`, ::�.. � . . -.T.. ..., -,_.� � � ' ' - . . ( . . ' , . .. 4 ��.. 2� � � a�va�w�a FOR CODE OMPL{P,NCE . .� ��:: � REMOVE a' G-X�57i�/!r- I X��Fi 7 5 i.�/ .�c i Tc. �Fc�./ , I X • /NS i.N-!�_ s'2 X �'f - �r}G�� c"� A� 5 �/E� �� _ � FILL Lci/ 7N �� /�/t�j�n//�-I,L. '%d �//FTGIf rc'X/5T/ ^fCs" L / O . � fZ �i'Z OR�fi.efA-t��. �.v W�1'[.c�'„ �!v .4GF5 5 E �F'G7�e,� cA-� : A-i✓r� f�Bv�-i.5�.✓G . � N ,� �• • �Cyw�.�u� REVgi.� ' ! ' , � � NE�� . �.. , . . ` i ��-o�� jQ�, S��'J l�► ��' � c�a s Wh� �J �. _ �s�". - � �� 5 �G,c,:7 "'1��- -- -- — �. � , c : ., � cn � 'M � � ��i �= -��,b . ` Vr��.. 1 `�zc.�v�s ! IU �V ► �a� `f l� h o�s� � � � . � � ; .. � �"a.- L � . . : . � 4 �" _ ! � A�.,�° .. . . . , . .� . , � i� ,, : - . � """�"','?� ' �• . :�� r - � � .i r . •6 _. .�,.�i _. ^ ^ _. - . ,,�a,�� -z� � f� .,.,a . , : �" -( _ �; , �,. �� g» , � " �e aaa��"a�Hc��',ffiwsxw: �3' �� 4 s:.'$ � �-� '� ."�!� S '� � �.±:.. �e :.�.� �: ..E � .�i��l'�'s+�*;�`t4a4.,.;°-F".e..� r . :C�1R�W "�x�'�'a c... . ....�.1,. . � _� •" �`�9 . . .�. . , : .�_ -._.—•- . _.. .. ... , _... .. .. . ... . . _. ., _ _, . . _ , . . , � <.i. . . �. . � � � �. . � . � . . .. � �. . . . .. . . . - . . . . . . � " ` ' . `: 5 ?- . r ". � . , � .. , . � Building PLUMBING permit rTo� — Inspections RESIDENTIAL APPLICATION Received By: � -1 , 763-572-3604 CITY OF FRIDLEY �R�� 763-502-4977 FAX EFFECTIVE i-a-o8 DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY NqME: A e„� �� OWNER/ pDDRESS:�� v� L-e.. �C �c.r IL CITY �C' i -� STATE�IP ��3 Z TENANT PHONE: CONTRACTOR NAME: �j 2.r�G� i� P� vh� �� A f �! SUBMIT A COPY OF STATE LICENSE # G I�� -� 1� EXP DATE I%� 3 l- 0 a YOUR STATE `/ � LICENSE, BOND AND STATE BOND # C� �-1 CJ C� �-I 75 6 EX DATE l Z' 3/- O�i CERTIFICATE OF pDDRESS: S E� O� 3� I /� � C CITY L�^^� 1�r ,��j C- ____STATE►M+'�Z[P SS�a INSURANCE pHONE 7 G 3�� 3 g- 1-I 7 0 3 F.ax PERMIT TYPE J`��'LE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW ��PLACEMENT DETAILED DESCRIPTION OF WORK � o � c i�,�- �� V 0.�^ ��E �• 1��^ �-'� � u C-`' 6 t '''^ � 4� I O`A C� C9 �'� 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 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FE� $15.50. BATH SINK/LAV FLOOR DRAINS SHOWER _ WATER PIPiNG T BATHTUB GAS PIPING (NEED CITY LIC) SWIMivIING POOL _ WATER SOFTNER ($35) CLOTHES WASHER � KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS) � DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRR[GATION ` WATER METER _ OTHER � � � Y, - Permit Fee $ Number of fixtures @$ I 0.00 x$10.00 =$ Surchar e .50 Number of f xtures @$15.00 x$15.00 =$ TOTAL DUE $ OR Number of fixtures @$35.00 x$35.00 =$ State Su�charge = $ .50 (MINIMUM $1 S.SO) (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is comptete and accurate; that the work wiii 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 on site; that the work will be in accordance with the approv� plan in the ca,se o�-a#1 work whic requires review and approval of plans. � f -7 Q� SIGNATUREOFAPPLICANT '� PRINTNAME 1(V�,�C Z. ' l� �c� DAi'E 3' � I� 0 u APPROVED BY � r ` f DATE �� ^�'.' � ,k,� � � ,.��s�5,��'�.. .�. , , ..,: . .,... . ._ .. . . . . . . .. �—• � City of Fridley Building Inspectio�s Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3644 FAX: 763-502-4977 Building Inspections 7. 63-572-3604 SIT'E ADDRESS �;,, 7�RS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION f- MECHA.NICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS � "fuNER �ONTR.ACTOR CITY s � r • . � � . _ Permit No.; Received By: ��_ Date�: APR 1.1 2 08 ATE��,ZIP COMPANY NAME: COMACT PERSON: STATE LICENSE # EXP DATE ent'�RFCC•II/l�� ,� � ��'° �ou1 C�- (� �_—CITY - - STATE�IP,� PHONE PERNIIT TYPE "° °�GLE FAMILY ❑ TWO FAMILY TYPE OF WORK: � ��"� � �PLACEMENT )ETAILED DESCRIPTION OF WORK �� b(1, �-1 FAX "/,/Q � - �i ��{ ' L I ❑ TOWNHOUSE al .'rERATION/REMODEL PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, 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 WHERE LABOR EXCEEDS $5�, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERENOTED. FIXTURES: iWDICATE TOTAL NUMBER OF EACH BELOV� MODEL: SIZEBTU EquipmentInstalled . i"ffG� SiZE/BTU �G: MODEL: MFG: MODEL: StZE/BTU A/C $25.00 _FIREPLACE (GAS) $15.00 GAS i2ANGEJOVEN $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GWLL 510.00 BOILER $35.00 FURNACE $35.00 ,_GAS UIdIT HTR 510.00 CHIMNEY LINER $10.00 _GAS DRYER S10.00 POOL HEATER 535.00 DUC'T WORK $10.00 _,GAS PIPMG $]0.00 _VENTILATOR S15.00 ,. �, .... . . __ -: r'� � . _ _ ___._. _---- -_-_ _.,.�... _ _. _va....c�;.ci. ' _-. . . � .. . �. � , �. . . '. aaK^ ns':".a � �a+ uc�'.x+ ,.•�r.-:r:c . . ..,.,,: .... � .. ...... .. .. .... _ . .. , ......: ... „3?G. : .. .. ..,..� . . ...,. �. -.... . . . :.,:.,. �...... .. . . , i. ,. S_. ., ,:. �'� Permit Fee $_a� —' Number of fixtures @$10.00 x$10.0 = Surcharge $ .50 Number of fixtures @ $I5.00 x $15.00 = $ TOTAL DUE $�_•.��.2 Number of fixtures (a3 $25.00 x$25.00 =$ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ 50 Tota1= $�o�� THIS I5 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 applica ' for a pertnit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all rk whic e uires review and a prot�al of plans. PRiNT NAME DATE Z Q 3�� SIGNATURE OF APPLIC / City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 Fax• 7�'�-5(1�-4977