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AF - 47163� .� Date . .. . .../`�' � � .�Own .. . ....... ✓ Address �P. . /. �./ . . . � � BUILDING PERMIT LJ .�- Village of Fridley, Minn. N� 2 9�� . ./.�.��........ 7. . ......... ... Builder .............1C.�... .. ................. r TJ�`�� ..... ...... .�... A dress ......................................... � LO�ATION OF BUILDI G / � No. . .(�? . � � . . . . . . Street . . . . . . . . . . . �. . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . Loi . .�.` : . .. . . .. . Block . . . /. .. . . . . . . . . . Ad ition or Sub-Division �, . . . . . . . . . ,. /��!��:�!. , , , , , ` p �A� l� �' � l��L�.Q�Y Corner Lot . . . .. . . . . . . . Inside Lot . . �. .. . . . Setback ,;1. .�, . . . . Sideyard .� �.` . . . s.�--�,� DES�RIPTION OF' BUILDING To , be Used as: �1 c� 5� �� i • • • • . • . . . . . . . . . Front . .�`. � ," Depth°�.! . a�FIeight . �.t. i �Z�?�/ . . . . . .. . �4. . Front .°.�.�. . . . Depth .°7.d'. . Height . .. . .. .. . . . �•'s ype of Construction . . . . . . . . . . . . . . Est Cost . . . �. � .� � �. , . . . , . . sQ. � t. �� cu. r t. . . . . . . . . , Sq. Ft. �: � . Cu. Ft. . . . . . . . . To be Completed ................... ��X / n � � . �� ' ,� ,�� ,�,�,w�.�� ` j ��G� ��"�L Tn consideration af the issuance to me of a perrnit to construct the buiiding described above, I agree to do tlie proposed work in accordance with the description above set forth and in compiiance with all provisions of 6rdinances of the village of Fridley. _ / 7 `� . ..C... � In consideration of the payment of a fee of $. lF�.`.-�permit is hereby granted to .y��`� . �.o� .. to construct the building or ad dition as described above. This permit i5 g ed upon the express condition that the person to whom it is granted and his agents, employees and worl�nen, all work done in, around ar►d 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 with- in the village limits and this permit may be revoked at any time upon violation oF any of the provisions of said ordinances, r �1 _ � NOTICE: Inspector This permit does not cover the construction, installation or atteratian for wirirr�piumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. �t � City of Fridley ` r' A'cation for Pfum in •• . PP� b g and Gas F�tt�ng Pe�rnr�t DepL of Bldgs. Photte SU 4-7470 DESCRIPTION OF WORB / �� Number, Kind and Locafioa of Fixtures Location (O � � WATER HTR, Gi .0 � � � VI Y F- K Z = N W W Z i � 'r,�„ ��n i x u, Z '� x} z z � o u zv� OF s � v1 c� u� a f/� I; � � <� � Z � 4y i Q I � O� U m < 3 U' <`U` �a' (`'! O R N GAS ELEC. � m f In �i 1- � LL N LL O Base lst 2nd 3rd 4th • FuYure Coanection Openings * New Fixture, Old Openings PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up ta 200,000 BTtT) . . . . . . New Ground Run Old Bldg . . . . . . . . . . . . . 3ewer Cesspool NO. RATE TOTAL — x $1.50 $ — x 1.20 $ — x lA0 $ — x 3.25 $ — x 2.00 $ — x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU . . . . . . . . . . . . . . x 2.00 ¢ REPAIRS 8c ALTERATIONS—Refer !o Code I}escription ................................................$ �Q, y (��l2a�G�e-�--% TOTAL FEE $ � �`d City of Fridley: d 0 9� � �� ti The undersigned hereby makes application for a permit far 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 ali the facts and representations stated in this application are true and correct. Fridley, Minn f�'- �- S' , 19�_% Owner �►3��dd _ , 19— � Kind of Bui ding , 19— Used as To be completed about Estimated Cost, Old—New. Building Permit 11 POST 1 M-12-58 SUBJECT I c�ty of Fridley �� . �, �- AT THE TOP OF THE TW�NS g U I L D I N G P E R M I T f ; � RECEIPT NO. � ` ___�_ COMMUfJITV DEVELOPMENT DIV. j r � V � PROTECTIVE INSPECTtON SEC. �� /„ � � �J l(/ ' � ��L � CITY HALL FRIDIE� 55432 NUM9ER :�EV DATE PAGE OF APPROVED BY �""�"� ,�' 612-571-3450 9�0-F15 8/20/96 � � J08 ADDRESS 6959 Hickory Circle NE 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 1 Ostman's Third Addition SHEET 2 PROPERTV OWNER MAIL ADORESS ZIP PHONE John Koshuba 6959 Hickor Circle NE 3 CONTRACTOR MAIL ADORESS ZIP PHONE UCENSE NO Hendricks Roofin Co 252I Jones Pl W Blo min - d ARCHITECT OR DESIGNER MAIL ADDiiESS ZIP PHONE LICENSE NO. 2003227b 5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION O REPAIR D MOVE ❑ FiEMOVE X 8 DESCRIBE WORK Reroof House & Gara e 27 S Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OP CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE FiEQUIRED POF ELECTRICAL, PLUMBING, HEATINC�, VENTILATING OR AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VO�D IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCEO WITHIN 60 OAYS. 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 { HEREBY CERTIFY THAT I HAVE READ AND EXAMIIJED THIS APPLICATION 1 STA�LS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX aND ORDiNnNCES GOVERNING 7HIS TYPE OF WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �Z�ZZ% 1.11 DOES NOT PRESUME TO G1VE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHAFGE PROVISIONS OF ANV OTHER STATE OR LOCAL LAW FEGULATING CON- STRUCTION OR THE PERfORMANCE OF CONSTRUCTION. �%�F. %S Fire SC L.23 PLAN CHECK fEE Al FEE License S 5. 83.09 SIGNATU�7EOFCON�RACTOA0�7AUTMOA�ZEDAGENT IDATEi AO V IO 0 THIS IS YOUF PERMIT . � - 6 SiGNATUF�E OF OWNEN ��F OWNER BU�LDERI iDATE� ''1p5 OFTE N�w tl ADDN (j ALTER �`�]'' Construction Address: � Legal Description: Owner Name & Address: Contractor: �� Address: �* �$,�� CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ��-/ � / � li � T^� 1—� I� �<� � ( (� r L� ,, Effective 8/ 1 /95 �. _ . __ �"37��0 ? � � Tel. # MN LICENSE # Z� �.3 ZL%-� Tel. # - � � plication, 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: �rt �B a � `f � D ti � �U�S� ,�'11f12 ��ii2j} Cs�_ Comer Lot [] Ins� Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construcri7n: {t- �Q�� Estimated Cost: $ c� oi o2. 7� �� Approx. Completion Date: � Z.� I-�(p 'ef�6� (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: � - APPLICANT: �� EST Tel. # - � — t�'1'O Pe�t Fee Fire 5urcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: BLOOMIN . (612� U 4 O� �� . ,�( �-( /�2�/�'��= $ ,-_ �� '�:.-��Fe� Seh�a��on �ev�rs� c;de , � � $ �., �3 .001 of Permit Valuation (1/lOth%) $ � � � � $.50/$1,000 Valuation $ $850 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 [ ] 7� $- CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOUNG, VENTILATION, 572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND D�VICES JOE3 ADDfZESS l0 l J�� RATE SCHEDULE Residentiat � . Furnace She#I. �nd Duct Work, Burner • Aiso Repl�cement Furnace ; (Side Vent • Fill Out f3aek) Gas Piping (Needed with new furnac�, but t replace ent) Rate TOTAL $ 30.00 $ $ lO.Ofl $ Gas Range (,T� $ 10.00 Gas Dryer $ 10.00 "Air Conditioning • All Sizes , � $ 25.00 All Others/Repairs � Alterations (LIST ON BACK) lqo of Value of Appliance or Work Commercial/Industrial 1.25qo of Value of Appliance or Work State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION gEFRIGERATION/AIR CONDITIONING PERMIT IS 525.00 PLUS THE 5.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. . '� _ , _ :_ UWNE BUILDING USED Effective On May 10, 1999 � � �-f�.. �� .1 ✓ ESTIMATED COST � PERMIT N0._ ��%��- ,�" DESCRIPTION OF FURNACE AND OR BURNE� $— No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. C3TU HP EDR $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $_ 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 $. .50 rulings of the Building Divisiori, and hereby declares that all the facts'and representations stated in this application are'true and correct. $ �� HEATING CO �� y�.- ►2i � Signed t�-tOri�� DATE l d S✓ q- Approved B Rough•In Date Final Date r�l� CITf OF FRIOLEY INSPECTION DIV. ,� ��-7�� Eifec[ive On January 1, 1990 643f University Ave NE �% � � Fridley, MN 55432 APPLICATION FCZR P1_iJMBING AND GA� FITTlNG PERMl7 572- 3604 :. . , _. , ... .� _-a , , ...: . v ... .s. —.. -. :r.:..._,. . g.nr . . � . _ . � ' ,. .�.i} . ',. _ .. � _ �vt . • .. � . ,a �� . . �� . .. ",. , .,� �_•; i. _ 'i _t.�. _ __. �. ; � . : - ., _ (� �t �" 9 �/; c, �Co ,� 7�; 2G t ro 1V rr./ �/ �y y �o �i?I t'�o 5 F,� �� A �£ 5 �oo `� 1��.5 ��.��vv _ � ,;.�, ,a. ;. . . . ,� � �_'., _ �,�diDEDP�Rt1M� Sr�,;,.';ivjQai�� , , ;,<�BLF6-AAA;NiM� v' I�i. ,��Gl�.�;t-'�;5. SuB�ECT - I NV� - c�ty of Fridley 313 41 . AT THE TOP OF THE TWINS g U I L D I N� P E R M I T ; � RECEIPT NO. � • COMMUNITV DEVELOPMENT DIY. �� r � ~ � PFIOTECTIVE INSPECTION SEC. 1 . � � � �'•'1 � CIFY MALL FRIDLE� SSIJ2 NUMBEA nEV O�TE P�GE Or •4vnOVEO Br �.'_.�; '•� 612-571-3450 9t0-F15 8/24/00 � / JOB AOORESS 6959 Hickory Circle NE t IEGAL �OT NO. BLOCK TpACT OR ADDITION SEE ATTACNEO oesca. 23 1 Ostman's Third Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ 21P PHONE John Koshuba 6959 Hickory Circle NE 763-571-9233 3 CONTRACTOF MAIL ADORESS ZIP PHONE UCENSE NO Aage Construction 6518 Cambridge St, St Louic Park, MN 55426 612-928-9399 e AiiCNITECT OA DESIGNEFi MAIL AODRE5S 21P PMONE UCENSE NO. 5 ENGINEER MAIL ADORESS 21P PHONE IICENSE NO Residential 7 CIASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION {�7 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace side entrance steps on house 9 CHANGE OF USE FROM TO STiPULATIONS Steps must comply with the State Building Code for rise, run, and platform size. Railing, if required by code, must be provided. SEPARA7E PERMITS AFE REOUIRED fOR ELECTRICAL, PLUMBING. NEATING, TYPE OF CO VENTILATING OR AIR CONOITIONING. THIS PERMIT BECOMES NUIL ANO VOID If WORK Oii CONSTRUCTION 20NING AUTMOR12E0 IS NOT COMMENCED V�1ITHIN 60 DAYS, OR IF CONSTqUCTIpN OR WORK IS SUSPENOEO OR ABANDONEO fOR A PER100 OF 12Q OAYS AT ANV TIME AfTEF WORK IS COMMENCEO. NO OWLG. I HEREBY CERTIFV TMAT I MAVE REAO ANO EXAMINEO iM1S APP�ICATION 1 AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS Of �AWS VALUATION AND OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMP�IED WITH WHETMEq SPECIfIE� MERE�N OR NOT. THE GRANTtNG OF A PERMIT �2sOOO OOES NOT PRE$UME TO GIVE AUTMORI7V TO VIOIATE OR CANCEL THE pEqMl7 FEE PROVISIONS Of ANY OTHER STA7E OR LOCAL LAW REGUTATING CON- STRUCTiON OR HE PERFORMANCE OF CON UCTION $.69 . ZS �� _�� P�ANCMEC �� Cit SiGN4tUAE OF CON'AACTOQ Op • TMQ IZEO �GENT IDAiE� H �� OWNEA BU�IDERi iDATE� OCCUPANCYGROUP OCCUPANCVLOAO SQ. fT CU fT. OFfSTFEET PARKING STALLS GARAGES SURTAX r �1 •�0 SAC CNARGE F re SC $2.00 T TA� FEE e $72.25 VAL�A ED TMIS IS Y�UFl PEiiMI ALIG-2�-2E��1H �18�� r=RC1M CITY LF FRIDLE�( TCi b12915i519 P.E�!04 N�1N � � ADDN () C17Y QF FFiiDL�Y E�tive 1/1/2000 ALTER [ j SINGL�� FAMILY AND DUpI,EXES R-7 AND R-2 �r63j 572�3604 Bldg tnsp BU1LDlNO PERMITAPPLtGATIC�N fi �R�� j � � � ConstrUCtion Ad�ress: t C, ��C ►'' �,t r'C I Q� ,3i3 / �e8al D�sca�iption: _ _ , Qwner Name & Addre�s: J�h r1 11vSh U q� _ ,_ Te� ��3— 5-j �— Q' Z33 Cottfractor: _ Gl� .O 1't��' C'� U�1 MN LIC�NSE � iV Address: (0� I g rn 61� r' St • , La �1 �s � R� r 1 /�1 VlJ T�. �(D l 2`� �--�I G� 5 � l�� ' Attach to thts appl�cabon, a Cc�ificate of Survey of the �ot, with the proposed canabvction drawn on it to s�ale. LMNG AR�A: GARAGE AREA; D�CK AREA; OTFlER: DE8CRIPTION pF IMFROVEMENT Lsngth ,._.^„ V�dth . Netght Sq. Ft �_ Len9#► �� Vlridth a� Hefght �� Sq. ��, �, .� � t ��'� f '�► , r� Constructian Type: , Es�mated Cost: � � Deivreway Curb Cut Width Needed: Ft + g�tA Ft x �oa��• � Z! 0� APPI.MCAAIT: /�, C !1 � N Y - Perrnit Fee Fir� Surcharge Sfate Surcharge SAC Charge Liaense Surcharge Drn+eway �scrow Erosion Contrul Park Fee $ewer IVlain Charge 70TAI. STIPUiATIONS: Cail (763) 572-3604 for Pem�it Fees if re�a;ling tn appGcati4n Ts�. � g�z y3 � • �Fec Schedule on Rever�e Side $ -.�1� dD _, .OQ1 af'Permit Valuati0rl {1/10th%� � � $.v4/�1,p00 Valuation � $1100 per SAC Unit �— �_$5.Ot] (State Licens�d Residentia! Conirac#ors} �..�_,�,�Alt. "A" ar AR. "�" Rbove $ $45Q.00 Canservaibr� Plan Review � ,_Fee Determined by Engineering �_. Agreement Ne�ssary [] Not Nec�ssary j] � �� o�s� ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 S"lL-36U4 r�aa�: : 6959 HICKORY CIR NE : 153024110025 : OSTMANS 3RD ADD : LOT 23 BLOCK 1 : PLUMBING : RESIDENTIAL : ADDITION/ALTERATION S"/1-llif7 PERMIT O.: 2004-01195 ,,. DATE ISSUED: 07/28/2004 � VALUATION : $ 2,200.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL 4 NEW FIXTURES WITH OLD OPENINGS. # ELEC WATER HEA.TERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES # WATER TRMT APPLIANCES APPLICANT ALPHA MECHANICAL INC 15167 FILLMORE ST NE HAM LAKE, MN 55304 OWNER KOSHUBA JOHN S 6959 HICKORY CIR NE FRIDLEY, MN 55432 4 # GAS WATER HEATERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 0 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 worl� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law r con truction or the performance of cons ction. nnlicant Date � ) Bldg PLBG PERMIT MI1�iIMUM FEE PLBG FIXTURES (NEW OPENI1�iGS) PLBG FIXTURES (EXIST OPENII�TGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 6625 SEPARATE PERMITS R�OUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 2200 0.00 0.00 40.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 40.50 CiTY OF FRIDLEY INSPECTION DIV. 6431�University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT� `7"�� MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures Old Opening, New Fixture � Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank � Water Treating Appliance Water Heater -Electric Water Heater - Gas'* Gas Range"" Gas Dryer'* Back Flow Preventer Required ()Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 � JOB ADDRESS__ (.� �G�Q jrl G K�%e � G�, ��l �l C The undersigned hereby makes application for a permit for the work herein specified agreeing to do ail 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. DATE: � � �/ `� , 20� OWNER ��Pi /� �O ��/�) �d BUILDING USED AS f I�� ESTIMATED COST �v � PERMIT NO. �� L ' ��! � %� ` PLUMBING COMPANY � T" 0'i" /"� �G' y'� N� Reinspection Fee $50.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS ��, �J ) 1.25% of Value of Fixture or Appliance G�� State Surcharge TOTAL FEE $ .50 $,�-�.� Approved By i� Rough-In Date TEL NO.�G�' �3� G�l � � Final Date OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN 5300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. *•PROVIDE COMMON VENT INFO ON BACK SIDE i FILL IN COMPLETELY FOR REPLACEMENT FUEL BUF�NING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUS'TION AIR VERIFICATION When replacin� an existin� furnace, the undersigned hereby verifiesi that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. � . The venting system is plastic/PVC and meets all cu�rent codes and m�nufacturer s�ecifications including sizing, length, number of elbows and terminatidn. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This dbes include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. The existin� combustion air is sized and installed to meet the currenf codes arid manufacturer's specifications. 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 ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) When installin�.a new ventin� svstem, the undersigned hereby verif�es that it is a listed assembly and meets the cu�ent codes and manufacturer's� specifications. This does include AGA-GAMA Category I Central Furn�ce Venting Tables for fan assisted and natural draft appliances. : Yes () Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. No ( ) No ( ) Yes ( ) No ( ) Appliance Tvae and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Tdal Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describel HEATING CO: Signed By: Date : ADDRESS PIN LEGAL DESC CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 ,"/1-36U4 r �: : 6959 HICKORY CIR NE : 153024110025 : OSTMANS 3RD ADD : LOT 23 BLOCK 1 ,�/1-llif / PERMIT NO.: 2004-01226 ;��J � �� DATE ISSUED: 07/30/2004 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION . NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. THREE CIRCUITS FOR BASEMENT AND 2ND FLOOR BATHROOMS. # INSPECTIONS 2 APPLICANT KY-DAN ELECTRIC 24655 ESSEX AVE FARMINGTON, MN 55024 OWNER KOSHUBA JOHN S 6959 HICKORY CIR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp. ELEC PERMIT FEE - MIN (RESI) STATE SURCHARGE, ELEC FLAT TOTAL PAID WITH CHECK # 5593 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED At3UV�. 40.00 0.50 40.50 sue�ecr IT NO. City of Fridley 2 5 4 9 4 AT THE TOP OF THE TWINS g U i L D I N G P E R f ; ` RECEIPT NO. � ; y � COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. ��f qG� � � / �•---�; �'��;•, CITY HALL FRIDLE� 55�32 NUMBEi� REV DATE PAGE OF AVVpOVED BY 612-571-3450 9t0-Ft5 9/12/97 / / J08 ADORESS 6959 Hickor Circle NE t LEGAL LOT NO. BLOCK TFACT OR ADDITION SEE ATTACHED DESCR. 23 1 Ostman's Third Addition SNEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PNONE John Koshuba 6959 Hickory Circle NE 571-9233 3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO. m 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE IICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION � ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct approximately 20 linial feet of 4' plus height of retaining wall 9 CHANGE OF USE FROM TO STIPULATIONS Construct to comply with Heid Engineering report. w�H�� Before Qigging c�3�1 � foi� `� � �fl �tNiiy locations. 4�a=Q002 REQU�REQ_ BY LAIN � . TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PIUMBING, HEATING, VENTILATING OR AIF CONOITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. fT. AUTHOFI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONEO FOR A PERI00 OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKtNG I HEREBY CERTIFV THAT I HAVE iiEAD AND EXAMINED THIS APPLICATION 1 STA�LS GAflAGES AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED �2�000 �L.00 WITH WHETHER SPECIFIED MEREIN Ofi NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOiiITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• 62.25 Fire SC �L.00 STRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. � PLAN CNECK FEE TO L FEE $65.25 S�GNATUAEOFCON'RACTOAOAAUTHOR�ZEDAGENT IDATEi E pp Y VALI T D THIS iS VOUR PERMIT .,s_._. 4 r r S�GNATUAE OF OWNEA ��f OWNER BU40ER� ID��E1 B G INS q�TE N E�V ADDN ALTER [1 [1 [1 ' CITY OF ERIDL�:I' S[NGLE FAiYIILY AND DUPLE�ES R-1 A.ND R-2 BUILDING PERMIT APPLICATION Effecti��e lll/97 �5�9 � � � ConstzuetionAddress: �g `� t` � J � � � l � � � < f � � � � Legal Description: _ ��/� 2� � f� C rC � � � ,,y�� ,� S � i' � ��A Owner Name & Address: J� j,� „� J�� s�u- �� Tel. # S-1 (� Z 3� Contractor: , MN LICENSE # Address LI't�ING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the iot, with the proposed constiuction drawn on it to scale. DESCRIPTION OF IMPROVEA'IE\�'T I-ength Width �ng� W'idth �n W' th � 2�x _ �a �ti � _ Height _ Height Hgt/Ground d� �/ `� Tel. # Sq. Ft. Sq. Ft. Sq. Ft. _ _ � �� ,� (� �� Construction Type: �; G, �� o� o,( � o�- ��ated Cost: $ , (Fee Schedule on Back) Driveway C�rb Cut .Width Needed: Ft. + 6 Ft = Ft x$ � _$ DATE:f �' 1�� APPLICANT: Tel. #�� l °I 'Z 3'3 �'ermit Fee Fire Surcharge �tate Surcharge SAC Charge �icense Surcharge ,�riveway Escrow �rosion Control Yark Fee Sewer Main Charge TOTAL i'1'[PULA'!'[(�i��S: CITY USE ONLY �� - � Fee Schedule on Reverse Side $ � U C� .00.1 of Permit Valuation (1llUth%) $ /. UO $.50/$1,000 Valuation � $950 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ �$450.00 Conservation Pian Review $ Fee Determined by Engineering $ Agreement Necessary [ ) Not Necessary [ ] � ��- �� c �.A IQ 1.�1C�TH I IV� I��ITfiQ M([�.4J D�S L 10�' �QR �L{�K �ONhIE��'IDN_ r�rrr� r �� +rrrr �15TAI.L fitiR10, P tAGE � AU�TJQPdA�, OCiUFi.�s�$. �u�� a r�u,c�sr. s��,w� aac�c�,u. �MP�+40T RLLT� TOP � LN� y � � �.�. � � � � ��11 �� i � � �A{NAQ61��iC � T41 FT BE�III�D M9r � /��I�IA � R �� ti t _-�• ti � t � � �� i' .i�: 1 YIIOIY�NOYA r M i�i�f Y ` '. � AA[�ftlD �3T OR � �� d FT L�NG � ti__ _^.. 1 1 � �� T � 11 _ ^ � � � � � V 6" l�lN!!�IlJ�I �R�0.1tillA.A�fl �l.��'� 8�l�E di4 SDIL TE6T8 �I�A�ABLE �4SSU�tE D � : � ° A1VD �OIL WT = 120 PCF B�tC�F�.f. IN �ir� 1.1F�'S At+lik Gt7MPi�OT TQ 9��r. $TA�4R4 FF�C�'t'QA 4,�1�+l93' 7q 1 i � � � � �� o ._._.. .. .. ..w..�.. ��aiaQ�t� Anc�ar Di�oha � 0 �� } �� i �ti V � i � � � � � � O ��m w' � � � � �� Z � � � � rn �� , w� m �� r O � � 4 � � � V � � � � � � �r � � N � j �� i � m w � �� c� � � � � i 1 I 0 � � �r� J j �, r u= � +a : , � �� ^ � � � �� 1 � � r �� ,� + � � ' � r� � �'' � � r r + + � � � r � � a� � � ' -n � � � _ - � ' i2 � w w �.�' �� I a r ;` �i . . .� �' .' i �` i ,� � �� r � � �j�� . � � � � J►! � � �mQ a�2 r � 8 F� � � 0 � � o� �� rii �T � ' �� G Z � � �� ADDRESS PIN LEGAL DESC PERMIT TYPE CITY OF FRIDLEY PERMIT N�: 2004-01573 6431 UNIVERSITY AVENUE NE — --- _�_ FRIDLEY, MN 55432 DATE ISSUED: 09/09/2004 T63) 572-3604 FAX: (763) 571-1287 : 6959 HICKORY CIR NE : 153024110025 e e e PROPERTY TYPE . CONSTRUCTION TYPE . OSTMANS 3RD ADD LOT 23 BLOCK 1 BUILDING RESIDENTIAL ADDITION/ALTERATION 0 VALUATION : $ 12,000.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. TWO BATHROOM REMODEL PER PLAN. STATE LICENSED CONTRACTOR 1 APPLICANT DREAMMAKER BATH & KITCHEN 20204058 6801 WAYZATA BLVD ST LOUIS PARK, MN 55426- OWNER KOSHUBA JOHN S 6959 HICKORY CIR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor: will be complied with whether speci d herein or not. The granting of a perm't does n re e to give authority to violate or c�c��r o o� y other state or l0 1 reeulatin� ti x t ormance of co „ Bldg Date BUILDING PERMIT FEE PLAN CHECK FEE FIRE SURCHARGE � STATESURCHARGE,VALUE LICENSE SURCHARGE TOTAL � SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 209.25 136.01 12.00 6.00 5.00 368.26 JUL-23-2004 06:04 AM DREAMMAKEP 9524179083 P.02 --....___�.. �.. � (0_(.��5 / r•-• p�TY OF FRID�E�( Eff�cdve 4hl'2004 rvCw l) 6431 Unlv�rei�Y Ave IyE, F►idley, MN b5�432 Cr�l 57�3804 BIdQ tnap ADDN I � S1NGL� ��IL.Y AND DUPt.�XE� tt-1 AND R-2 (783� 679-1287► Fax AL1'ER I � BU{LD1NG PERh�IT APPLICATION ��`�� '�'7� !„qr-,Gi r-�-�r v �rn,l l'�.��r_�.-P� - Construction Pvdaress: �M �1�� — �ner Name & Addr� Co�ctor: � MN Tel. � � In� • � l - �� ;NSE # �Q -�% - � ;re�, # � � ca�on a Ge�Rlflc.�t� o�f SurveY oT tt� �"'� ( p�t��t to thi� �p�i , bt� with th� proposed construction drawm on d to scale. DESC�TiON qF 1�APROVEMEM' �� nn�rca.,��►: �sn�tt� �..._,�� --�---- He�M .._._. Sq. Ft. GARAGE AltEA: L�ngth - — yvkiih � �9� __..— 3q. Ft. - - - C3�CK ARFA Ler�th _ Wldth ,,,,�,,,,,��,,, HgllGr�ound . 8q, Ft ` - OTHER: � II�/ � 1 :. . :: r�� l i`�ic�iti•i��1�-,:�.j=yr��.��.��,— — ° �'IV'dWay CUrb C.ti1t NNid:h IVe�ded: „�.,. Ft t e Ft = Ft :K � m$ .-...._........._ ' 0� � T�.��s��1�qR�i DATE � 2 • I4PPLIC . C�11(76316T�04 tor Permit Fdes If n��ling b1 appll�tlo�. F�z ba T63�71 12Q7 �f uoi�g crgdk cAR! ��d vre wip call ycu tor ca�d numbar. CITY U8E OIdLY - Permit F� Pl�n Review Fite Sutct'+�r�e S�te Surr�ar+�� SAC Chst'ge Lioenee Surch�rge Curb Cut Escrow Erosion Control Park Fee Sewar Main Charg� ic�m $ �q� �� % 1� ; ol $ ��---°�? - � � a� � ,� ., .�� Cj � � - � s S � S?•� Fee Sched�ule on Rs�vers� Sid� 659�6 of P�rmlt Fee .00� af Permit Valuatlon (1�10th°/o) �.�0/$1,OOI� Valuatlon g1360 pe� �AC Un� �5,00 (S#�at�e licettsed Residenti�l Contractor�) Af'. �,A" or E11t. �'G7n I"�u�� $�50.00 Cc�n$�rvatlon Plan Revlew Fee Detemnined by Engineerb�g Agroem�nP, Necessary ( ] Not Necx�s�ry ( ? � r • ...,: r. • :F. JUL-23-2004 06:05 AM DREAMMAKEP v � • ` - L � �� • "� .«,. t : - .� , - �, � - � �� _ ., w : � - r 1�� , J � � " '� � �'�.� � �, -� �,� � �� . 9524 �79083 � v � � � � J � ` r 7 � � � . � ^� �, , , � -- �.l•� __ ..__..__ iz � � � � v� � � � � � � � � � m � � � � Cb ¢. �� '' � V � � ' � �. � � , � � � P.04 i� �• ' � 1 �M �� rn � �o --� � JUL-23-2004 06:06 AM DREAMMAKEP �. 95241 T908o P. 05 � � . .:.-{ ................�.....,.....r ... . . ..._...............' ... ...... ......._.,.. .,. ,... ............_. .............. .... .,.. ....,.........._..,....._... �._............... � ..,. . + , ' .. . ..... _:r;.f��.. .._. ... .. .. _ .... .. . _ . j • � ... ..... ... . . . .... ... . . ,. y �� . -- • .. ._. . . � . .... . .... . . . .. ..... �. ... ._. ... e i � i � • i i.. : r . .. ... ` f.'. ,..--''�f � _....... ... �, ' � i :J : i : �_ � i • ..� ._ . ..._...... . .,._. . .. � • � ..� ,, . • � : t • x ;�� 1 .• r� • � »............_....... ............._...,i : 1�4�"�'A�+l� .. ,�.. �,. . i ��y ` � 'SI' .�.... � 1 : • �Q� � • . j , t ' i � '�1�.'�.�.4; � � . N� UNU'1dC�.J � CP'�ti�� ' � ' � CA�1 N l� � � � , � :` . , ......... ._ ... .. . .... ... :...� :: � � 1� ,- .... :;. � QU �-- � `�' � `_'_._' � :WV ' ' t � p �� Q^ �D f ; � :, � i U��. . _jyi�l,lQ�`�..., . .. . � �=�.,��US .. �. � . .,,� �� ...�.. ' �MIO Qs , � � / ; :.�.. ILE t ��► �, � , � �=� � � • ''"� '' 'firll � � � W I Y� c�.d. � . ` ' . . �.. .. ... _ .._. .. ' � �� • \ .; ' �: _ . ��1,--- - " j _.. . .... ._.� �'' .........,.. r plan 6�p�clftat� Apprmn� � � �� A� "� !/� )1. �'7 tr�et.#s - . �. l. �,.v '`.Ji: k:� :Y :1'l.��a....' ......:.... .........: �w�Nrui�TM:!!!�! . . , �et�rw.: 1��1 S{ , �,. 4 � 1 �� ' � �' �`� . .` ��.. ��.1�+:+��}A �;� 1..��' � �� w. .. ✓. �I,�Y�:{� .i �� .Y� �� P -- rn�N.... � � ;''t, :; .. :� :��.. w. i � .i: i � � 1 � :'�: ` , . i . f :,: , ` . ;.. � �:. ; ; ;. ...._ .�: .. .... � .... � � ; � .. . , �...�. .�. . . - , `��i �- � � . ..�. .. , :,�� . .. . .. . . ,. ................��...,.................... ................_.............�...... ... ........ .......: . . . ..... ... �...... .. . .... .,..,., . .... .......... . ...... . ... . , , . . .. . ... .. ... _...... .. . .. • on� N�Iblti Bt�^q1 �[0 .�_..., .�-s/ ?FU� ie A(► Oridenal d�N�11 and i�1Ylt tat bc Daliellcd: 6/23��' fY�OCt10Vq1QO�ObOOjOb�tO�Hd ��:o�oc�r....�a rolaa.eaorcopl.eunlew.appue.eleree►m. r�imoa:ensnoo4 sdiwanene so nc joe o�aidon�. bean �Id or job oMar plseod. ..-•..•— �� -�s��f �ITY OF �RIDLEY BUILDING Ii�SPECTION v 9 i431 University Ave ME 9 ?ridley, MN 55432 L 7635723604 FAX 763-571-1287 -� 9 D n RATE SCH�DULE ` Residential Furnace Shell and Duct Work, Si�rner & also Replacement Furnace Gas Piping (Netiv Furnace, Fireplace, lnsert) � Gas Range Gas Dryer �o� � ��o.��- Effective 4/1/2004 APPLICATlON FOR POINER PLANTS AND HEATiNG, COOUNG� VENTlLAT10N REFRIGERATI0�1 AND AlR CONDITIONING SYSl"EMS AND DEVICES F� LS�! $35.00 $ $10.00 $ $10.00 $ $10.00 $ *Ai Cflnditioning-All Siz�s $25.00 $�C7� �rr ��r ��?� ia 63 0� V rz� c o /YI 8 z�F3o�- f411 Other Repairs or AiteYations (List on Back) ��'�' ` rn�� 1% of Value of Appliance or Work �1 �1'�p°� �$ l30 . C�U a Nlinimum Fee $15.00 for ReSidential or 596 of Cost of �� `� ��c A;,� Y improvement whichever is greater on work Ie�ss than $300.00 S��e � � � Cornmercial/Industria�/Institutional } 1.2596 of Value of Appliance or Work (List on Back) � Minimum Fee $35.00 for Commerciaijindusiriaijinstiiutiona� � Y � State Surcharge TOTAL FEE $ � $ .50 � $ 155 ,� v ; REINSPECTION FEE $50.00/HOUR �*Air Conditioners can not be. placed in side yard wtthout ►vritten approval N from adjoining property ovmer - oopy to City ti N . � FILL 4UT BACK SiDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE ¢ JOB ADORESS 1�� 1`F iC��C-oc-t� C- i ��C� ��J owner � �, .r� �o5h� � c� Building Used l�s � ES �d e hc � ESTfMATED COST / CP �� `��ERMi7 Pi0 QESCRIPTION! OF FURNACE AND BURNER it of Heating Units Circle One (Steam) (Hot Water) (Warm Airj Trade Name Size No. BTU HP EDR Fuel _ _ Totaf Connected Laad Bumer Trade Name Size No. BTU HP EDR The under5igned hereby makes application fo� a permit for the work herein specified agreeing to do a11 work in strict aocordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts � at?� represent�tions stated in this appiication are tn�e and correct. CENTERPOINT ENERGY HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed �� Tel i� 763-757-6202 FAX tl� Date I Z- 1 L-6S Approved by Rough-in Date Final Date zo•d �alal FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTI�'JN AIR VERlF1CATtON When re�lacins� an existinq furnace, the undersigned hereby verifies tf�at the venting has been examined and is free from n.ist, deterioration, obstructi<�ns, and is securely supported and firestopped where �equired. Yes (� No () The venting system is plastic/PVC and meets ail current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (� No O The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specif+cations. This doHs include AGA-GAMA Category I Central Furnace Verrting Tables for fan assisted and natural draft app(iances. The existinq combustion air is s�zed and installed to meet the current codes and manufacturer's specifications. When required to install a new cembustian airiit will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( � No ( ) Yes ( � No ( ) Yes � ) No ( ) When installinq a new ventina_svstem, the undersigned hereby verifies that it is a listed assembly and meets the current vodes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assist�i and natural draft appfiances. Yes (� Is the comman vent and vent connectors sized and installed cflrrectly after an appliance has been removed from the common vent and vented separately as per current cades. No ( ) Yes � ) No ( ) Appliance Tvpe and Size/Common Vent and Vent Cunnector Information Appliance #1 Type BTU lnput Fan f�lssisted or Nat Appliance #Z Type BTU Input Fan �ssisted or Nat � Appliance #3 Type BTU lnput Fan �lssisted or Nat Total Appliances Tdal Btu Input _______ Common Vent Type Vent Height � Diameter inches App(iance #1 Vent Connector Height ft Length ft Diameter• in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS• (Des�ribe) CENTERPOINT ENERGY HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 _ -' ' Z _ � Z-.csS- Signed By: Date : ?R/�Gl ' rl 'C GIJ.9lSL Ol J.31Q 1�I� �0 J,l d a WO?J -I S? :'[ T b00Z-LZ-�db „ . , CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 (763) 572-3604 FAX: (7631571-1287 ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE REPRINTED ON 1/12/2006 : 6959 HICKORY CIR NE : 153024110025 : OSTMANS 3RD ADD • LOT 23 BLOCK i : HEATING . TIAL : X ALTERATION PERMIT NO.: 2006-00052 DATE ISSUED: OU05/2006 NOTE: INSTALL VERMONT CASTING WINTERWARM WOOD INSERT IN BASEMENT FIREPLACE AND VENTING APPLICANT WOODLAND STOVES & FIREPLACES 1203 WASHINGTON AVENUE SOUTH MINNEAPOLIS, MN 55415 (612) 338-6606 OWNER KOSHUBA JOHN S 6959 HICKORY CIR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. The granting of a permit does not presume to give authoriry to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date STATE SURCHARGE, MECH FLAT FIREPLACE INSERT TOTAL PAID WITH CHECK # 29741 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0.50 35.00 35.50 Ff�:O,�'� :Cit•y uf Frid.ley _ ` . �3uilding Inspections 763-��z-3�a:� pA1 �. SiTE ADI�RESS � TFi1S APPLICATfT IS: pROP�RTY OWNER/ TENANT coNTxp►cTOx � �� l NAME;,� ADDR ESS:_ PHON�=_ COMPANY „F3�j�� FA;; �10. : 76357112�7 7� `. � �- CHANICAL �ia-"�.�OC�s�- � ��G' �' Dec. 19 21705 11:57AM P2 _�� ENTxA� APPLICA'TION CITY OF �'RYD�EY E-MAIL AI>ARESS SL3BM[T A COPY OF CONTAC'! PERSON: „�, ---"—"—` STt�7T LiCENSE # ,�„�.— ��+j' �+4TE �- YOiJR STA7�E �^ � K�� `' LIC�NSE WIT�-I ,,vD�;s:_,� 901 � T744i�14L.�--�- crrY..�� qPp�.ICATION PHONE -_–�— � F� PERMIT TYPE TYPE O� WORK: I �NEw DETAILED llESCRIPTION OF FAN[IL'Y 0 TW O FAMII.Y p REI'LACFM�N'f ❑ 'i'OWM-IOUSF G1,aLTBRATION/REMOD�I.. Pezmit No,:� Reccived F3y: .._._ Date Rec'd: w ' A' AT��P� PER MS 168.665 the pex-rnit f�e is a minimurn of $15.04 or 5% oT tl�e to �e r��P s° (�0 Ohould�xeflect onl�y the;cos rof laboc ) improvement, uistallation or reptacement of a residentia! fixture, excluding LaUor cost under $300 =$15.00. Labor co5t between $300 to $500 = cost of labor ^ x.05= FOR FROJECI'S WHL�RE LABOR fi7CCE�llS 5500, F�ES ART BA.S�D �N $10.U0 p�R �1XTUIZC, EXCE�'T WI3ERE NOTEA. ITX'CURES: ([NDICAT� T�TAL NUMBEEt OF F..4CH ��LOW) MOUEL: ��—.. SIZEf67'U Equipment InstflUcd MFG: �— MpDEI.: _.�._-- Si�� "~�" MFO: ^ _ SJZEJSTU , MFO: MObF.L' �— GAS RANG�Jt�VEN S10.00 A1C S25.U0 IREFLAC� (GAS) $IS,OQ ��y GAS l3KILL 510.40 �Allt TO AIR EXCHANCriER $ l5 FIREPLACE (WOOD) 535.00 C� �T };� s1D.00 �DOILER $35.00 �FL7ItNACE 5�35,0o pOOL H�AT$R 535.00 �CI-I[MNEY LINER SI0.0o pAS DRYLR 51�.00 '—�-�qT(j„qTOK 515.00 oAS NIPING S10.oU w�. .�: , ir�. '. � "' w �. ' . ,. . �t:1� �DUCT WOitF: T10.00 __ — ' .�,'�if'4�y . �.�il��' p�%G15�� VF(i�K'^.!11% t1'�, � �A RY'IN Q ' . ' �.:� . . _ _ _ _ Pernut Fee $�Qb ._ Number of i'ixtures (a; �10.00 x$l0A � SUrcharge � 50 Number of fixtures (a3 $15.00 x$15.00 =�_ ,��Tn� �� $ �� Number of fixtures Q $25.00 � x $25.00 � �� NumUer of 6xtures @$35.00 x 535.00 �$� State Surclla�rge = $�—S.Q Total � $,� T�IS IS AN APPI-ICATION POR A PERMIT-N4'1' VALIA UNTI!- PROC�SSBD I hereby apply for a building �ernnit and I acknowledge that the information above is comiplete and accuarate; tk�ac the work will be in conformance with the ordinances and codes �f d�e Ciry of �ridley and with the T�4innesota Cv»struction Codes; that I undorstand i'his is not a permit but only an application for a permit and work is not to Stari without a�crmit; that the work will be in accordance with thc approved plan in the case of w ich requires review and flpproval of p1�y,s.� �� 51C3NATURE UP APYL1CANi' _ ! V. PRINT NAMF l/ / QS DAT�„ �' .1 � O _ . __. . w,w�. p. � Cxty of Frid[cy Building Ia�speetions Aepartment 6431 Universiiy Avenue NE, Fz'i.dley, MN 55�32 763-572-360� , FA.X: 763-502-4�77 3U11C�lrig _nspections 763-572-3604 �ATE / �ITE ADDRESS � i HIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS ❑ OWNER STATE LtCENSE PHONE 6`�Z-79y-ZZr3 0 §INGLE FAMILY/NEW CONSTRt3CTIt ❑ TWO FAMILY/NEW CONSTRUCTION PERMIT TYPE I ��A�ION ❑ GARA O BASEIv�NT FINISH 0 ROOF ❑ DECK J�'SIDIN TYPE OF WORK: � ��' ❑ ►�xT�artCEntEP.�nt DESCRIBE WORK BEING DONE: OF IIvIPROVEMENT NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEtGHT: SID G ❑ Vinyl ❑ Aluminum� _ _ � � ❑ Other �� WINDOWS IN EXISTfNG OPENINGS ONo OR FOR NEW OPENING DESCRIBE SIZE OF OPENING CHANGES Bc A,� TYPE OF WINDOW TO BE INSTALLED d' 1� Permit N Received B Date Rec'd: � //� � L�iTY / �/ ✓< < / STA' � pti. EXP DA7'E O �iI_ �� CITY ./� F,�x'7�T^��z-v� 7 SIZE STORIES 'SHED .�`WINDOWS ❑ DRAIN TILE ❑ OTHER ❑ HOUSE 8c GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE osot�c � Tcim ❑ Fascia LACATION OF WINDOWS WmTH _ _ HEIGHT A�l�l�'!"LIR .�J � �� Ft �ASEIvIENT REMODELING SUBIvIIT: 1. Existing Floor Plan 2. Proposcd floor plan 3. List of snuctural members to be used FOR NEW CONSTRUCTION INCLUDIIJG DECKS, ADDITIONS. & PORCHES SUBMIT: t. Site PlanlSurvey showing the existing strucwres and proposed project. 2. Two sets of construaion pians 3. Energy Calculations ALL FEES ARE BASED ON VALUATIOIV, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION 3PT OP.� U.B.0 FEE OCCUPANECY TYPE Permit Fee Plan Review Fire Surchazge Surcharge License Surchazge SAC Charge Curb Cut Escrow Emsion Control Park Fee Sewer Main Charge Total Due $ � 7 S' $ — $ ��, _ vc� $ fs� oa $ �"_ at� $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS [S 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 ordinance d codes of the City of Fridley and with the Minnesota Construcrion Codes; that I understand this is not a permit but only an application r a ermit 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 work whi h;e i�s reyleV(r and appro�tl of plans. 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