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AF - 46065Vi.11age of Fridley, Minn. BUILDING PERMIT `�°• 14 0 9 _ �_: ��' Date .�.�:4h:•:. �,-.. �..... .. ... : � �'' /�` �,,�'' t;. �" �'�` �' Owner . :. , . ... Builder .:::�`�,q�r�';.�'��3. ""` `;�.. �� -� Address . . . . . . . . . . . . . Address . . . .�,� ..� . .'T. . . � . .: . r�i�.�t � . . . . . � _ .s�� - . . . . . . . . _ . . . .: a- ... _ ' . � � �J ' - . �. � �: -. ... LOCAT O OF BUILDING �/� No. � ..ls�� . Street . . . .q�� . . . . Aart of Lot .� ��`.�.i�� ,��:.C� Lot ` .. °`: .' s . . Block . ....�. ........ Addition or Sub-Divisiun .... � . '?�:r.-: .. � .f:-:..� .......r � � ' Corner Lot . . . . . . . . . . . Inside Lot � Setback . . � . � Sideyard . . . .�� . � . �i! . . . I�ESCRIPT[ON OF BUILDING To be Used as: : `` , • ��iV:�: � i � "l� . . Froni . . . . .�. Depfli :� : ':'. , � Height .!`a . .�. . Sq. Ft. . . . . . . . . . . . . . ' � Cu. Ft . . ... ... . Front . . Depth ...... Height ..... Sq. Ft. .... . Cu. Ft ....... �, Type of Construction ��k.. . r:� .�. . . Es�. Cost . .. , . .. .... ... . To be Completed . ... . . .. . .� : � ,� �� e� ' + �j"" �•'r�',� . � 1�.�` yrr'�` ' "�'r _ - _ `, � . � � _ ,� � �.�� °� �-. _ _- - . __r_ . � _ --��--��`� , ; In considergtion of the issuanee to me of a prermit to construct the building described above, I agree to do ��;,� tihe progosed work in aecqrdance with the descripllon above t. or�h d in liance�h all ravisions o��%'" o�dinances of the vi7lage of �Fridley. ` �,f� P' -� t . . "� y =,r �. � � >'%' �'1: �„a" YtP r ��(" �,r°�rt�`Z''�°� �_—,.,+..c . . � � �. �� .�..., `...... �. . ........� ............. . . � . . . . . . .- � c'r� �. � . . . - - t ��,.. . . , ' .� ia consideration of the payment of a fee of $. ,��.•.�: ....�, nermit is hereby granted to ..'. ..:: l+ ....'.. :..'. :'"."� .. �� .... .... , to'construct the building or addition as described above. This permit is Sran'ted.ul�on the, express condition that the person to whom it fs granted and his agents, employees and worlmaen, in all work done iny around and upoa said building, or any part th�eof, shall conform in all respects to the ordinanc�s of Fridley,.:Minnesota regarding location, construction, alteration, maintenance� reAair and moving of buildings with- �n the vi�lage ]imits and this permit ma,y be revoked at any time upon violation of any of the provisions oP se3d ordinanccs. `�` f' r! � �b� i f ,, � ' . .. ...'S� ,. . . �� .... .. ... . .. ..`�:> `:'��.. . Bi1�1d�IIg ?aSpeCtOT _ _ _ _ _ s' Nor�cE: `. � This permit does not cover the con�truction, installatiom-or atteration for wPri��_piumbtng, gas heatirtg, I sewer or water. Be sure t� S" � Building Inspecto� for`separate permtts fy��p; items. q; �:: r � i � _ ,f, . . � � . : ` _ ' Y ' : r . . . : . �� : . ,.,-.� , . :_� . . - _ � �_' _'.' -, - , �.. . . . _-..:.� -_,.._. _ _. _. ___,:._" --_ _ '_ _ .__"_ . . _ 'IC _ . _. . . . y ��'Oo C � �; �p ° o��yb 3 �o�� ' � � �. � ~ 6 � C � `�J �' � �o' y °��. �'�A'b � � �� , �. � � ��,� �•Q �o�:�� b�� o��' �,�0a� Q '� . ��.��i M � �� ° b �° � Q�� '�:o � �, o � �� ' � �� C � � �•b � �o ��a �0�� ! �� . �. � � o � �• ,��o ��. �0 �Q� A ��A � � � '�' � n. M� � � � �� O �. � r. �pb � � �o�� a. � �� b�A'� y � � v�i O � � �� A �, � b��O ��•� � �� , � � �. �. �, ��,�� y�� •�' � �' � a x o z � b � � A � � � � � �. � � �' � � � � � � I � � � � �' a � � � � � � n � � r � 'ti �, � O 0 � � � � 0 � � � c0 O � � R. � � x � � � � � s � 0 0 n � a� � � . � a � �. o � � � � � � � � � � � � y ' O Z r � , � � � � � m � A � � � � � � Q� O "1 � 'I'� e Q. _. � � � � ;� i�i • 7p � � � � � �: -�. a Q o t� � � � � O � 70 e� �� 3 � , �, � Q � a e� � �. � e� � a. A� � _ y � � �. � ' � � O ^ — . � W � � � � � �O ,� � o� oo- � "�.! w � � SuBJECT � , City of Fridley 3 � � ,� AT TNE TOP OF TME TWINS � � I L D I N G P E R M I T r ; � RECEIPT NO. � ' COMMUNITY DEVEIOPMENT OIV. � ,„ � ry r � v � PROTECTIVE INSPECTION SEC. r� � 1 . � � _ �"'1 � CITY MALL FRIOLE� SS�J2 NUM�EF REV D�TE v�GE Oc �6ppOVEO Br ��"'� � �'' 612-57�-3a50 s�aF�S 10/4/00 / / JOB ADDRESS 1328 Hillcrest Drive NE 1 LEGAL LOT NO. BIOCK TRACT Oii ADDITION SEE ATTACMEO oesca. 25 3 Moore Lake Hills SFIEET 2 PROPEiiTY OWNER MAIL AODRES$ 21P PHONE Keith Brutlag 1328 Hillcrest Drive NE 763-572-0894 3 CONTRACTOR MAIL ADDRESS 21P PNONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAI ADDRESS ZIP PNONE IICENSE NO. 5 ENGINEER MAII ADDRESS 21P PHONE LICENSE NO B USE OF BUILDINO Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION �] REPAIR ❑ MOVE O REMOVE B DESCRIBE WORK Reroof House & Garage (25 Sq) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPEOFCONST OCCUPANCYGROUP OCCUPANCVLOAD SEPARA7E PERMITS ARE REQUIRED POii EIECTRICAL. PLUMBING, MEATING, VENTILATING OR AIR CONOITIONING TMIS PERMIT BECOMES NUIL AND VOID IF WORK Op CONSTRUCTION IONING SQ. fT CU fT. AUTHORIZED IS NOT COMMENCED V�1ITHIN 80 DAYS. OR IF CONSTRUCTION OR WOFK IS SUSPENOEO OR ABANDONEO FOii A PERIOD OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING 1 MEFiEBY CERTIfY THAT I MAVE READ ANO EXAMINED TMIS APPLICATION 1 STA�LS GARAGES ANO KNOW TME SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING TMIS TYPE OF WORK WI�L BE COMP�IED WITM WMETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �L,557 �1.28 OOES NOT PfiESUME TO GIVE AUTMORITY TO VIOLA7E OR CANCEL TME pEqMIT FEE SAC CMARGE PROVISIONS Of ANY OTMEF STA7E OR IOCAL LAW REGUTATING CON- STRUCTION OFi THE PERFORMANCE OF CONSTRUC710N �iB3 . ZS Fire SC �Z . SC) PLAN CMEC EE TOTALFEE $87.09 �GNATUpEOFCON ACTOpONAUTMOA�2EDOGENt IDATE� N PR.OP VA 7E MIS IS ](�UN P IT / �� S�C�iNATUqE O� O N Aiii OWNfpB EA� iD�TE� p(� iNSp r�oTE NEW [] ADDN [] ALTER [ ] Effective 1/1/2000 CITY OF FRIDLEY (763) 572�604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDiNG PERMIT APPLICATION Construction Address: � � � � /��; `�� .PS � � r Legal Description: Owner Name 8� Address: � ��TZ, �i v�- l c�� Tel. #-�' �� S�-Z t� �`t �( Contractor: � U� h� v- MN LICENSE # Address: Tel. # LNING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft Length _�_ Width Hgt/Ground Sq. Ft �5'.�� Construction Type: Estimated Cost: $ �SS � �� Driveway Curb Cut Width Needed: Ft. +.6 Ft = Ft x$ _$ DATE: /U%� �d v APPLICANT: , Tel. # �" Z- —0 � �1 � CITY USE ONLY - Call (763) 572-3604 for Permit Fees ff mailing in application Permit Fee $ c�.�. �� Fee Schedule on Reverse Side Fire Surcharge $ o�-�� .001 of Permit Valuation (1/10th%) State Surcharge $ /,ag $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control $ $1100 per SAC Unit $ $5.00 (State Licensed Residential Contra�tors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [] Not Necessary [] TOTAL STIPULATIONS: ►� �% .� _.. BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing pemuts 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 building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,OOlto $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,�1 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $SO,Oi?0 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $1Q0,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $5(K1,0� $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete G�rb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $23.25. VERIFICATION OF FOUNDATION Pemnits for construction will be issued a minimum of 24 hours from the time.of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Onlv r � D m .' �` Z � O N a Q m m � � n � �' = O N. � Z N � A �7'7 -�. c� m � � � o � � o � O � � �' � 2 �� Oq n fD � � O � � �' � y `c Q- O � � � � a � i-rt S 0 c .� 0 D --i m � d� �. . � _ � � _ rn � Z � C� 0 �� U � � o � C1 D � r � m � � m � 3 � ov �D n �' O `�o 3 p� � < 01 �, � � a C O � � = d' � A m O G O � � � �` � � � �� o �.. � � N � a � � � � � n � fD � fp� � a �o a� Ol �. N y ? � � �. y W �, (D _. � a � av �- � � o � � o. ov Q � � vo� <' � � .� 3 N�—p� � tn O � T• � � o N 'n� Q- y 'C rt?1 �. �D _ � � =± � � n � N Q n �' � A p O c � � d �D � � -� 7 y � � � � � � � A N � :+ O �+- � O-., � � � � � fD =�� ,n.t S lD S CD C�i �D c �'� o N o 'c � Q s m � a �' m � _. � D F�+ � �O °, s < fD � N \ fD (�p °a , c, D '� � N u>� D c�o � O _r � o 3 N � 1"" � -� 0 Z � D c� v D "� n 0 a � � D N N N N � fll N v � � � G� D�'Ie�D C1 N N C N � �� °-• � �D fD = m Qq m � tn � S �z��c� � � � � � � Q . � � � � � .-r Q � a = C � � � � � � � � � � � � � W � O � � n � � ~` v v � � � � N � f� _ N � � � � � � N �--� �-+ r (N C77 O O O O °o °o o° o° °o °� m EA {� bA 69 Eff 4i► k" --i c,� o . ^a ` �` � � � �� C � � m --I � d � Z � � 2 � N N m Z O v � -*� ao -i z �p C °> a °- o co �, Z = d � �, � N N = �, 04 � � � �y , �.. o _° � c� � �n � fD O � > > � fp fD ,-n+ ^ fD � � � N o m � �R m z v � � O � 2 0 � � � �-r � �c fD � � v � 3 :,>� .� rn Cn � D � m 0 C7 O � � � m � � Z � � \ ��. � _ � � N Ca 2 rn � C r f*1 c � v m z � �ii c � m o �. cDn � a � r�.� �- " � � � �4 � � �i dd'.�, (�� N O. W � F-+ � � C O F �z`m � � `� v � � N � z � � �� Z � mrn C7 � � Z � C � a � � z � 1"' °rnrt -ai � o �� z a �'�1 .n I�J ao . -1 � �' p o .� Z � Z � v� a� � �� vz �v o= �- Z m W Z -�1 D � Z � � rA N n � m� � 30 �, N Z �, v < v �" � �� < -� n � � N � � Z � � Oy � � � � � � ( � (� � �� O � -°r. � � � � � � � � CHIMNEY AND STAC� ��+'YCATiON The undersigned hereby verifies that the existing chimney or stack: 1. Has been cazefully examined Yes (� No () 2. Is free from rust or deterioration Yes (1� No () 3. . Has no foreign objects lodged within Yes (a� No () 4. Is securely supported Yes (� No () 5. Meets all current Code requirements for size and totai BTU's connected Yes (�No () 6 Has total heating BTU's of �% �iC'>.� \ � ir f��'� .�< ��S'� �� Lc �,�9 �- t, , � , , �� 6.� � � � � � � ��`t- l ��t-�_ o��i �- All other_�TU' �- - ��+ �� -- � '" � �!/ TOTAL BTU's �� Q �'�-� 7. Has a liner been provided for water heater Yes () No (� 8. Has combustion air been provided for water heater Yes (�j No () Remarks: List ALTERATIONS Bein'g Done: HEATING CO: Signed By: Date: ��co _��, �°�� R � _ CITYOF FIZ[DLEY FRIDLEY MUNICIPAL CENTER • 6431 UTIIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 February 1, 2002 Rev. Keith Brutlag 1328 Hillcrest Dr NE Fridley, MN 55432 Re: Final Inspection at 1328 Hillcrest Drive NE Contractor: Airco Hea.ting & Air Condirioning Dear Rev. Brutlag: A mechanical permit was issued on January 3, 2001 to install a furance and air conditioner at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of tYus date, no inspection has been called for. The permit fee that was paid covers the inspection to ma.ke sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for" and no further action will be taken. To set up the inspection or to have any questions answered, please contact the Building Inspecrion Division at (763) 572-3604. Sincerely, DJ/mh � � C� ON � � 0o m -�-I C � � z aW m �� <� �m "n � D z �O oz Z < �* D .-I-rr -t � o 'D � a c�o � �' 7 N � fA. "'� O y � n � � O = � o a, � a� O �•-° �• c� 00 " � �� . � �' r�- y � Q o fD � � � a . � S O C .,- D � � 0 < m Q W � 0 C Oq � � v � � T � d 0 � � 4 � d � � m Z N � rn � � z 'T'1 m rn t� � v 0 0 � _ -. CT�iZ H�3 = m C 3 ��rn oorn yy�'1 °� m�Z O� Z v _ -_� -�-� DOZ �zcli m�0 �o m �Z 3� --1 � < Nm Z � � O O Z Cn 2 ov m � Q' Z � � c� O -� m r � � . � � � . \ � � , ) � � o N � o � � � d nGi � � c O � D _, � � e�' _ n m 0 0 � o � � � � � � c m -� m � � o> N Ef1 �fl � � �i o � � D �' m � � � � �,• F p, �'1 \ � � �-�H-i a � m � � j n � m � u � a ho p.�p � ''} � N j � � �. y W �, fD C � O. � �� o � a� Q � �•oo� <� � � � �� • � N � �, � �, a �'a�� . � � ,�y- =i' � � � � :+�o° =�a� � � d � � � m � N � � a�� . '+ o °+�-., 1 � 0 1 � � 1 fD — �" �-i. 'i' S (D �" fD C7 � � � O y O � �, a � m a � m � _. D � _ � 0 O ? C � 1 p� N � fD f�D � O � D �. -� N v_ ft� u�' a � � A fD � �, o .� �o � N � r � 0 z W D C� v D � C� O � Q. O � � Oq D � N � N � � N N � � N� -, � � N � N� �. s� � . � N � � � 69 b9 cJi O O O E� � � �° C � � m � � a N Z N N 2 � � N� m z 0 m 0 � • • . � c � � p m � — C Q ' � o Z = � � � . � � m � Oq � � 2 O � <? � � n� � n � o p > > � Cp m .�+ ^ � Q. v� m r N' °' � rnz� Q p �o� _ 0 � D) '-r fD w1i � � v L7 D�� p� y C t/1 N � 7 Q- � � � C� fD -d�(nN � .�+ � � � � oi Q�G� m 7 �p r' m � o � �,��+n. � n' = C o � � � � � c � � � � � � � o � � n � �� v � v W � � � � -. {�q {fl �--� G� O O � O O '* m �6�9 b9 -� �' a �, r �e a � m N � _ m v c r m � C �� D � � � z m � � C Ci C� N � d "� D � I� t ! � rn � � z O � � � G � � � -� V 'i'I 01 (7 W Q W � � �� C � W �C'�l a,z� � 0 N � � �� m W�� N m Z z� rn �° m -i � z v � � a � .� z �o � �� O rn Z �O � � O� Z � Z� v� a� �z ON za vz �v o= �- Z m � Z -�i D �Z � � -� c� � m0 N � z Z� .� v m w °z N�� I � N � O z � �� J > � n � �` � � � � �- ,� < � � O � � � , d �\ � 0� C d `G � N 0 0 � COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacins� an existins� furance, 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 () No () The venting system is plastic/PVC and meets all 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 manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fara assisted and natural draft appliances. The existina combustion air is sized and installed to meet the current codes and manufacturer's specifications. When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturers specifications. Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) When installing a new venting system� the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No () Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No () Appliance Tvpe and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input ` Fan Assisted or Nat Applfance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total 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• (Describe) HEATING CO: Signed By: - Date : � a� m � c � � � D t° r � 'n m m t� i.i � .) I� o D �� a O �' rn d � _ m o� z „O c � `D m o � DD v � �_°-, Cn °1 D �v � � rn � O z � � m � � -� m 0 � � m � � v 0 0 _ � -1 °�' °y' v°', `2 � � c c�i eni °D � � m �� n� n� o� 3� ci � °' � � -,i v � m m m .o �- � p -n `° � � i==i��aoOV,-° �� c`°u .tD°',. � e�i � n y. �� . c � � ,. m m - m, � � � � m � * � -, � <, � �. � N < ' m �° � c�i ., Z � D Q- � � n� � v -I � � � N � �°-. � � � * � � � � � � c � � m n .�. � .. N .� Z O I I I�I I I I I I I I I � � � �,� � � � � � � � � C71 O O O�I p V�I �l �I CJI 1� �1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 D �1 fn � � � � r < � m � a v 0° z W � � � � � O � � D � � 0 C f� � 3 v � m � � m � r o? Z O v •,� � 6 v � � � �. � 1'" O �t`' �1" m � 3 .�.. c� a ci 0 M � � �V � m � 3 -� 0 W a 3 � c N � n � 3 �D I� � � � w 0 u'� r �v=� '��0 w Z m � � � � � � N � "� G m z 0 � _ � -� � � � � � � � �o O I� � a � C =+e � �D n � � �• c�D .. �p � � W o o: � � N _v, o U! "+ O �, > > � � � o. � s � m � fD o � � fl. m � � � � N � � °: m a� � � o d °- m N N � r C W z � � c � m � m u� z O � m -i O D r � W � — � � THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED [`ph"Il�nl` t�t�T� I�I�T C�I`f� GTOR AI`D .nMBIISTInR AIR VFRIFIGATI(�N When � �n acin�an _Yic in0,f �� ncP, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstru�tions, and is securely supported and firestopped where required. Yes ( 1 No () The venting system is plastic/PVC and meets all currenB codes and manufacturer speafications including sizing, length, number of elbows and termination. Yes ( 1 No () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does indude AGA-GAMA Category I Central Fumace Venting Tables for fan assis`eeai arnd na�ur�l draft �pptiances. �1e PY�G�rl�eme��en air is sized and installed to meet the current codes and manufacturer's specifications. Whgt1 required to �n�� a n_w _emb �ctien air� it will be sized and installed to meet the cur�ent codes and manufacturers specifications. �@n jp�j�jp� a n_w ventin,e � m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft applianc�s. 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 ( ) Yes( ) No( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes( )No( ) ! � � . � M— •o' . � • ' • 1! 11 • � — � . / � ' � • � � ' M • � • �11 . / • � AppGance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Applianc-�#3 ��e - - — - BTUIn�t__ Fan A�istesi�t �Lat Total Appliances Toi�l 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 _ 1 � •► �r r.:- HEATING CO: Signed By: Date : a' , CITY OF FRIDLEY 6431 UNIVER5ITY AVENUE NE FRIDLEY, MN 55432 57Z-36U4 l+�AX: (763) 571-1Z87 PERMIT NO.: 2004-02174 DATE ISSUED: 11/29/2004 ADDRESS : 1328 HII,LCREST DR NE PIN : 243024120046 LEGAL DESC : MOORE LAKE HII.,LS : LOT 25 BLOCK 3 PERMIT TYPE : BUII.,DING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RESIDING VALUATION : $ 3,500.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTII.,ITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317 OF TI� 2000 INT'ERNATIONAL RESIDENTIAL CODE. APPLICANT TERRY CULBERTSON CONSTRUCTION 18520 YAKIMA ST ANOKA, MN 55303 (763)735-8264 OWNER BRUTLAG KEITH W& DOROTHY A 1328 HII..LCREST DR NW 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 cerrify that I have read and examined this applicarion and l�ow the same to be ttue and correct. All provisions of laws and ordinances goveming this type of wor� 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 regu�t`mg construction or the performance of construction. Bldg BUII.,DING PERMIT FEE FIRE SURCHARGE STATESURCHARGE,VALUE TOTAL PAID WITH CHECK # VISA SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. 97.25 3.50 1.75 102.50 .� NEW [J ADDN [ ) /�LTER � Construction Address: GITY OF F-flIDLL-Y 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION trrecuve 4i�r�uug (763) 572-3604 Bldg Insp (763) 571-1287 Fax �� r- �� Legal Description: Owner Name & Address: I�e; � �i rr.u°�' l29 Tel. #%�,3 -S �� -��5� l Contractor. i2rrN �.,lbe�-�s�n �on��-r r_ �,'bn MN LICENSE# �Dy�O�� l Address: ��D Y�akima St ��v-�s I o�� 1� 55 3� �7'el. #� 1� -� 3_S -�a 6 e/ LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the bt, with the proposed construction drawn on it to scale. � DESCRIPTION OF IMPROVEMENT ' Length Width Height Sq. Ft Length Width Length �dth Height Sq. Ft Hgt/Ground Sq. Ft Construction Type: �� i� ��4 Estimated Cost: $ �a�DO r � C� Driveway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x$ _$ DATE: l% D e APPLICANT: e L�,, ��, Tel. #� l� - �3�-�a 6,�/ Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL e $ �, ` � $ $�e� —�- � � �`I5 $ .$ $ $ $ $ $ Q�• C/ CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ J Not Necessary [] STIPULATIONS: BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing pemnits for the erection of any building or structure, or for a�� addition to any existing building or structure, or for any alteration or repair to any existing b�ilding or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $5� $501 to $2,�0 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,�0 FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 a $69.25 for first $2,000 plus $14.00 for each additional $1,0� or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $SO,OQO plus $7.00 for each addidonal $1,000 or fracdon thereof, to and including $100,000 $993.75 for first $1�,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $5(10,a}0 $500,001 to $1,000,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fracdon thereof, to and including $1,�0,000 $1,OQ0,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annuallY determined rate Pernuts for construction will be issued a muiimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv �uiiciin, �nspe�tions 763-�72-360�- 7b� -��?-�-97? F�..i DA1'L �/ I I' D `7 A SI1'LADDRESS ��%o �l (�I THIS APPLICANT iS: ❑ OWNER Y'I2�PER'1'Y OWivEYt/ TENANT CONTItACTOR SUBMIT A COPY OF YouR sTa� LICE,ISE, BOND AND CERTIF'ICATE OF INSURANCL PERNIIT TYPE �� 1"�T � �� ,��r��'�'�� ,�'�'�.% �� '�� crrv� �_�-r�s YOURE-MAIL aDDRESS � �. ADDRLSS: � _/�ig t-7� ((w(�T (,✓ �l(,( PHONE: �'IQ�� S�'Z � ��q�-{ STATE LIC�ISE # STATE BOND � _ _ ADDRESS: $�'J �� {°e� Sf �{� #� ( CITY 4 , PHONE 'L4'�'�J~� � ZI %� F.1X� j� SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: I � �' DETAILID DESCRIPTION OF WORK �]REPLACEMENT i� Permit N Rec�ived Bv: �a��dn�9 Sur � E.`CP DATE � ,�,.,��.•.�� . G;CP DAT� `"" STATE �i�I ZII' ,r � ��i . 7_�i nS� e PER MS 16B.665 the permit fee is a mini.n� of $15.00 or 5% of the total cost np to 5500.00, whichever is greater, for the improvement„ installation or replacement of a residential fixture, excluding the fixtures. (This should reflect oniy the cost of labor ) Labor cost under $300 =$15.00. Lai�or cost berween $300 ta $500 = cost of labor x.OS = plus SO surcharge OR FOR PROJECTS yVF�RE LABOR EXCEIDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WII�RE NOTED. FDLTCTRES: (IlVDICATE TOTAL NUMBER OF EACH BELOV�. MINIMUM FEE $ I5.50. SATH SIIVK2AV ' _FLOORDRAINS SFiOWER WATERPTPING BATiiTUB GAS PIPING (NEED QTY LIC) SWIbIMING POOL WATERSOFTNER ($3� _ CLOTF�S WASHER _ KTTCF�N SINK WATEA CLOSET BACKFLOW PREV. ($1� _ DISHWASF�R _ LAUNDRY ZRAY � 3WATER HEATER ($3� FaR IRRIGATION WATER METER • OTHER Permit Fee TOTAL fMINIMLJM $15.5 $ Number offixtures @ $10.00 x $10.00 = $ .50 Number of fixtures @$15.00 x S 15.00 =$ $ OR Number of fixtures @$35.00 6 x$35.00 =$'�� State Surcharge = $ .50 � (MINIMLJM �15.50) Totaf = � S• �"a THIS IS AN r�.PPLICATION FOR A PERMIT-NOT VALID UNTiL PROCESSED [ hereby apply for a plumbing perrnit and I acicnowledge that the information above is complete and accurate; that the worlc 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 anplication for a permit and work is not to start without a permit on site; that the lvork tivill be in accordance �.vith the atiproved lan in the case of a.11 �.vorlc !vhich requires review and a{�proval of plans. 5IGi1ATTJP�L f�F : L.�NT %�%�o"� (,iE2� °RINT ;�IAML, /�f � v!� l�(sL`71�'Q/V DATL �' II � �I'PROVL-D f3v ��Tr: ` � 13 �3 pr�L �E'�I�:�SE?:1.H�T'�:'E2IvtI7"S �R� R�UUIIZETJ �OR B.l1TI�DING:.�i.ii"� 'R1C:aL..ai�D i.-IEC�ni�:iC.`�L. �,vORIti t�''$?� �3R � ' 'C�18�� 7111Q1:1� jh1S[��'�UILS �'��1F'+:.:*�11�31t ;=�� i :tlive:sit�,� .�.��enue �E. =r:dle�r. .':�ii•l =_--- .";�.=- --=_: �,(is . . . . _. ,;� -. �)=--°"