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AF - 47570i u . City of Fridley, Minn. BUILDING PERMIT Date: __May 241_�1967.___._.._._..___.._.._...._......__..__.._. N° � :'�' `i � -� 9 2'7 � �r, Rob���DeGardner Builder . _..__.__ _��._._____. _..__.__.._.obe�t.._De-ga��.��..�...._--.--.._�..____._.� Address ...__.....�A�A17th Ave.__North_. _ 2010 17th Ave, ftorth _. __.._------_._ Address �__....�_..._.__..._______._.._...__R._. i _ LOCATION OF BUILDING No. _..__557_.._._.._ Street .__...�anesYi��,e____.__.....____....._............_...._._--- Part of Lot _._..._...__.__._.. � 20-21_-22..._ Block _._. E._._..---._.._._.._.___. Addition or Sub-Division .....�I.:Y..��Yi.�.�LH,�3ght8._---• � � Corner Lot _.___..........._.__.. Inside Lot _-�----_.._..__----._ Setback ._._.._35 .5_._._._ siaeyard __._: 15___ .� Sewer Elevatian __....$4�_.$.4..._.._.._._.._.._._____._.___------_ 1��� ...._---.�.4.R,.$.4 Top of Footing DESCRIPTION OF BUILDING To be Used as: � Dwe 11 ing .._._...... Front � Q.'____ DePth .�..�'__.._. Height .._.....1,�_'. Sq. Ft. ..3.�2.�._.. Cu. FL _.1Z,.�90 _._.._.._..______......_..._.�.__ Front ___.___� Depth ________. Height _.._.._......_ Sq. F� _.._ Gtit. I+'t. Type of Construction _. Frame _._...._.�__.. Est Cost _._._..$11,5_00.__------- To be Completed ._._.. SEWER LOCATION 3' East of l�anhole WATER LOCATION 12' East of Sewer In consideration of the issuance to me of a permit to construct the building described abave, I agree to do th� proposed work in accordance with the description above set � and in compliance with all ProvYsiona o! ordixianoes of the city of Fridley. , ° C��� �_..._�5..���-.:2ea��'3��'�✓ $100.00 NSSSD In ca�sideratfon of the payment of a fee of $._ 26 ._00 ����t is hereby granted to_ Robert DeGardner to constxuct the buflding or addition as descxibed above. Thispermi t is granted upoa the �express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances o� Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buil� within the city limits and this permit may be revoked a t ax�y time upon violation of any of the provTisio�s of sa�d ordinances. CLARENCE BELISLE B�� � NOTICE: This p�nntt dws no1 eover th� eonshueNoe, in�hllallen fs� wirin�, plumbing. �u hufin�, aw�r er wNa. d� mn fe sN f6� Bvildiag Insp�eMe for s�paraN p�rmils for fh�a iMms. � � > APFLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER�S NAME O UILDER ADDRESS � O � 0 !'j � �J'% � ADDRESS � � LOCATION OF BUILDING � ,. - - : �� N0. � `� � STREET ",� � � �. % `f' S U � ,�� �. � * PART OF LOT ` ��� LOT�p 2/ ���J BLOCK �_ ADDITION OR SUBDIVISTON � CORNER LOT INSIDE LOT SETBACK a�,S' SIDE-YARD /� SEWER ELEVATION TOP OF FOOTING Applicant attach to this form two certificates of survey of lot and proposed building location drawn on these two certificates. DESCRIPTION OF BUILDING To be Used as : / ��,-eiQ�,�....� -- Front �a Depth '3�,% Height �� Sq. Ft. � L �/ Cu. Ft. �� i G�-'� T- - Front Depth Height Sq. Ft. Cu. Ft. Type of Construction � _ Estimated Cost '����'`�d-rJ To Be Completed The undersigned hereby makes application for.a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Qrdinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE � SIGNATURE _ (Schedule of Fee Costs can be found on the Reverse Side). � ,,� �, � d / � � �. � cl � S / a d ` � i � .� � . � ,,\ . , , . � - ., � � � s. Application for Power Plants and HeaNng. Cooling, Ventilation� Refrigerotion and Air Condi�oning Systems and Devices ' PARTIAL RATE SCHEDULE GAAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ...........................$10.00 � iteplacement of Fumace . . . . . . . . . .. .. . . . . .. . .. . . .. . . . 6.00 � Repairs & Alterations—up to $500.(?0 . . . . . . . . . . . . . . . . . . 6.00 $ Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . . . 3.00 $ MECH. WARM AIR � Furnace Shell & Duct Work to 120,OOQ BTIT . . . . . . . . . . . . $10.00 $ each add. 6U,000 BTU . . ........... ... . . .. .. . 3.00 � Replacement of �xrnace . . . ... . . . .. .. . .. . . . . . .. . . ... . 6.00 $ Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . 6.00 $ Repairs & Alterations each add. $500.OQ . . . . . . .. . . . . . . 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......$10.00 $ Furnace Shell & Line--to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 3.00 $ Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 3.00 $ OIL BUR1vER—to 3 gal, per hour . . . . . . . . . . . . . . . . . . . . . . . 6.00 $ over 3 gal. per hour—See Fee Schedule � GAS BURNER tup to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . b.00 $ over 199,000 BTLT See Fee Schedule —f GAS FITTING FEES: NO RATE T�L lst 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .7b $ Gas Range to 199,000 . . . . . . . . , x$ 5.00 $ AIR COMDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS 8t REPAiRS ROUC3H FINAL ; See Fee Schedule �-�3cs ' TOTAL FEE s�L,�. Dept. of Bldgs. Phone 560-3450 1 , �� �,� � City of �Yidley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City Ordinance: and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are t�e and correct. Fridley, • I/.I1�.�A���,��►=5�'Tl✓i7'//.%�IL . � . '�r Used as � To be completed about Estimated Cost, $ -s�':s� � . r� "l�i�J �'' � l Old ew 'lding Permit No. Pezmit No. � f� 19�.%'�' DESCRIPTION OF WORK � HEATING or PO R PLANTS—Steatn, Hot Water,�S�L3�y-Ads� No. Trade i�iame_ �iE��i���. Size No �%r�� .j Capacity Sq. Ft. E.D.R. BTiJ H,p. / ��' r Total Connected Loa ` Kind ot Fue BURNEft — Trade Nam ' Size No- ������ Capacity Sq. Ft. E.D.R �� � BTLJ H.P. �o4E RAY I�. WELTER HEATING CC]. Signe � 63'TL"HTC.,�G . By ltINdEAPOLIS 7. MINNE�OTO Business Phone No• ��� �O G � (REMARKS—OVER) ,• �s� � . 53-8l, -s-915.51 � � .�iifi'� G'� �3'lG�3}/ I . ' � ?���i���-.�j'.#ii� �LZ� ��12YTwii � � +4,a K���..��'J � �)1i� �43:i ii ' • ne�. of sia�. phon. �.sasa ... . . � DESCRIP7t0:i O: V10iZ:: � � 557 N. F. Jamesville Street Nu��xr. Y.i�.3 nnd Locr2ien of Fixh:ros . i'Ot��"� . .- L I: = � . J? j� � ? �S � 3 Ba�e Ist 2 r.3 3:d � � p WAT(� MiR. �' .� t v T O • i' � " ' � $ z �u 3 0 � U z i��:.�-��� �'i� �< 7� 7< 7 r N.c�s n�c. v, _; . {o � _ � ,. o ;v < 3 �u u � ju �i � {::� L � � t� i r • Funiz• Goa.:o:.t:ca Opoa:nr.s ; 3{�w Fi:ch:zti. O:d O�oair.r,s PARTIAL RAT� S�N�DULE I ' ���a�r � Cc«Pool ❑ 7LIIMBING FIXTL'RE RATES: NO. RATE T07AL . Nurr.ber F:xtures . . . . . . . . . . . . . . . . _.____._... x S2.G0 S ' F1�ture Flxture n�,cning . . ... . . . . ... x 51.50 S -.- ;�ew Fixiure OId Operur.g.... .:.... x 51.50 i--- Cstc� Basin . . . . . . . . . . . . . . . . . . . . x 53.25 S �4a:er Fiea;er '4'p to 99,000 BTU3.. .. x 53.G0 5 • tiew Crcund Run Old B:dg. ....•..:. _r_____._ x 5,3.25 S E,:�Ctz'FC i'�a:o2 Fisatat. . . . . : . . . • . . . . _ �2.CJ S ."i1S FITTI�IG FEES: NO. RnTE TO?AL ist 3 Fixtuzes • • • • • • • • • ••• • : • • • • x S2.G0 ; Ad�'itional F:xtures. .. . . . ... . . . ... x S .75 j Gas RanTe to 1�A.000 BTtT ..... ...... 1' x S5.00 6. 5.00 0 City of �'Y�idley: , . Thc undersi�ned hereby rra�es apalication for a permit fcz thc aoz3c he:ei specifi�d, a.;ree:rg to do a:l �ti•crk ia s:r'c: acco:dar.,e k:::s the C:� C`:-ci:.:::a and ruling of the I?epar:meni ef Builc�'n�s, and he: �by declzres L�at aII Lhe f:ei and rearese:liations statc�i in ihis ap�Lca:+uc are trlr :.nd correct lo-i-75 29� Fridley, D'.ian • Owner �cha.el G. Moki�ta ___ ' Klnd of Buildir.g Fr3me • Used as Res. ' _ To be completed about l�rl-75 ---- 'Estimated Cost. S 10,00 __ _ �o4�'ew. Bui:diag Pesmit ro � P•r 't No. �z'�� , Sigrs��!� � . gy � • -- Susinrss Phvae : io ROJGIi � � PINAI. � 1. - �- � - 7 S � • p.EPAiR3 �r ALTERATIOXS—A•i.r so Cod. .50 State 5urcharge . Descri�tion . . . . . . . . . . .. . . . . . . . ... . . . ... . ... . ... . ... . .��--- • ' ' � ' . . TOTAL FEE ; 5• 5� �!Class "�A�' .�urcharg� .5Q¢ . . . � . . . , . City of Fridley, Mi.nn.. 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PE��MIT Date: _.._..N.Qx.embe��9..�...l.s_Zl_ Owner: ....._Rodne_y__Sandmon �--..__.__..__.._..__._:_..�. . Builder Same . Address _.__5.57._�Js�.��it:1,�..1..���S��.t_.�.,.E - _.___.. Address ��` LOCATION OF BUILDING No. _..._.557___._____.._. S�.�t __�Janesville Street N.E. _ p� of Lot Lot .2.����-�.�.2.__.Block __.._..:._.._...__E.._._ .................... Addition or Sub-Division .�..._Riverview Heights Corner Lot ...___.__....._:._.._.__ Inside Lot _.__X _.._ ___ Setback __ ...Y_.._... Sideyard Sewer Elevation ...-----_...-------------------__.__.---•---.��•--.._....�_ Foundation IIevation .; •-----•---- " DESCRIPTION OF BUILbING To be Used as: �a$e.-W._._-----•--------•- Front _._22.� _. Depth _2Fi � .._. Height _.._.lII.�_... Sq. F� � Cu. Ft �.5Z.�0.� .____LL.----•---•----•-----•------ Front � DePth � Heipht ._ __ Sq. F't � Ct1. 1� t. Type of Construction ___Frame..�� ��, �t �,�2505.00.--�_ To be Completed 1�Y_� 1972 Set slab elevation to drain to existing driveway. Provide a hard surface drive. In consideration of the issuance to me of a permit to construct the building desc;ribed above, I agree 'tQ clv the proposed work in accordance with the description above set orth and in mpliance with all pro�visions ot Ordinances of the city of Fridiey. 1.25 State urcharge In consideration of the payment of a fce of $�._ 11.00 �� ��� is hereby granted to Rndnp� SmnAman ...�___._.._..__.._..._.._....._...._._._._._._._� to construct the building or addition as described above. This permit is granted upon, the express condition that the person to whom it is granted and his agents, employees and worlunen, ia alt Work done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinaace8 oi Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of builtiiri� tyithin the city limits and this pernut may be revoked at any time upon violation of any of the provisions of said o�rdinances. ` j�l�.bGl�.� r �i Buildin8 � HANK MUHICH ♦ J NOTICE: Tfiis permit does not cover the eonafruefion, insfalla�ion for wiring, plumbeng, gas heafing, ssw�r or waNr. 6� sun to sN the Building Inspector fo� separafa psrmits fo� ihese items. s-- ` 1 --. , . APpLICATION FOR RESIDENTIAL, ALTERATION, OR AllDITiON BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER � S NAMI; : Gs c� � ��dI1� /U BUILDER : `.S ADDRE$ S S �� 7 _..��.c. S� N,�: �, ADDRES S� � t�i0 : . �� � STREET : LO�: .Za1 zl. � Z BLOCK: ADDITION: �� CORNER LOT: INSIDE LOT:�,_SEIBACK: SIDEYARD: ApplicanC a�tach to this form Two Certificatea of Surve of �,ot and pzopoaed bu�.lding locatiox� dxawri cm these Cextificates. ti 7�m P�SCRIPTION OF BUILDING To Be Used As: s /.`�S 7-8- � °° 4� � k ° � ZO /o ��'Zva �Q�-e,c.�� Fs'�t : Z .Z Depth : Z � Height : /I'� / T Square Feet: �%2 Cubic Feet: �%� j � Z i ,3 f' Fxonts Depth; Height: u� ,� � Squaxe Feet; Cubic Feet: f!�� T�►pe of Coastruction: �/��,�,,.,,,�d� ` Estimated Cost: $��c'° o0 2� � 3 G ��---- ���7`� ' �, °ZS�oS.3� To Be Completed� �'I� ,Z2, � .�. �25z � �� 1fie unde�sigaed hereby makes applicati�n for a�ermit for the work herein epeciiied, agreeing to do a11 Mo�ck in sttict �ccosdaace wi.th tba Cl,ty of �+'aci,dley Oxdiaance� and zvliqga of the Department of Buildings, and heraby decl�;res that all tba facta and representations stated iu thia application are true aad correct. naT$ : ��, /� �g �, f sicru►�a�a: � , (Sea Revsr�e Side For Additianal Iaformation.i S`" � S��� ��� � 6 �/ /� / :� l��^ y� •'ty� � / .�" .� s� .J... ! . �.����,.� �°��; ,. �� �_ / �� �� � 7-� ��;.� � f�:� � - � ��. a N�Ja� r'> �` ti /� �"i? C�' �`-' � l V� � : ,,•.-�;F-�,-.�,._,..�.. _ �...... ,���?�?��4-�t,. �'%7�: �a ,�C,/ � _ C> � y / � / n/ , p r�j��wa �_,,�'� 4 sue�etT P�MiT" l�."'�. . City of Fridley 3 0419. AT THE TOP OF TME TWINS g � I L D I N G P E R M I T � -" � f ; � RECEIPT NO. � ; y__ COMMUNITY OEVELOPMENT DIV. f � � PROTEC7IVE INSPECTION SEC. �� 7� i � , � � �"'1 � CITY NAIL FRIOIE� SS�32 NUMBEP pEV D�TE P�GE Oi �nvnOVEO Bv �'""�" �'' 612-571-3450 9t0-Ft5 10/19/99 / / JOB ADDRESS 557 Janesville Street NE 1 LEGAL �OT NO. BLOCK TRACT OR Ap01710N SEE ATTACMEO DESCR. 20,21,.22 E Riverview Hei hts SNEET 2 PROPERTY OWNER MAIL AODR�S$ Z�P FMONE Steve � Liz Hamre 786-0530 3 CONTRACTOR MAIL AODRESS ZIP PMCNE UCENSE NO a ARCHITECT OR OESIGNER MAIL AODFiESS IIP PMONE LICENSE NO. 5 ENGINEER MAIL ADDiiESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WOFK O NEW � ADDITION O ALTERATION ❑ REPAIR p MOVE O REMOVE 8 DESCRIBE WORK Construct a 12' x 18' sh 9 CHANGE Of USE FROM TO STIPULATIONS See stipulations on plan. TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE REOUIREO FOFi EIECTRtCAL, PIUMBING, NEATING. VENTILATING OR AIR CONOITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU fT. AUTHORIZED IS NOT COMMENCEO V�IITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR A@ANOONED FOR A PERIOD OF 120 DAVS A7 ANV TIME AfTER WORK IS COMMENCEO. NO DWLG. UNITS O�fSTREE7 PARKING 1 HEREBY CERTIFV THAT I HAVE READ ANO EXAMIN�O THIS APPIICATION STA�LS GARAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SUR7A% AND ORDINANCES GOVERNING TNIS 7YPE OF WpRK WILL 8E COMPUED WITM WHETMER SPEC�fIE� MEREIN OR NOT. TME GRANTING Of A PERMIT �ZSOU �.. ZS DOES NOT PiiESUME TO GIVE AUTMORITY TO VIOIATE Oii CANCEI THE pEqMIT FEE SAC CNARGE PROVISIONS OF ANV OTMER STA7E OR IOCAL LAW REGULATtNG CON• STqUCTION OA THE PERFOFMANCE Of CONSTRUCTION �83. 25 Fire SC 2. rJ� PLAN CNECK fEE TOiAL FEE Si ♦TyFEO�CON"P�(TOAOp�UT O�ZEO�GEht �o�tE, EH R P ALIOA MIS IOSYOUp PEpMIT / � ��� �GN4T q p pWNEA� O�N F il Epi �DAfE� � � Bl �HSo � qatE NEW [ ] . ADDN [ ] ALTER [ ) Construction Addre; Legal Description: �1� Effective 5/10/99 � � CITY OF FRIDLEY SINGLE FAN�.Y AND DUPLEXES R-1 AND R-2 BUII,DING PERMIT APPLICATION �i� � � ,� „n� .�1�. Owner Name & Address: Contractor: Address: MN LICENSE # . . Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DE.SCRIPTION OF IlVIPROVEMENT Tel. # : �� ., .. ; '���r� LNING AREA: Length Width Height Sq. Ft. �:ARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. ' OTI�R: `o� X �� •N�1�Q� Construction Type: �Q�Qi Estimated Cost: $ ca�, S�e �� Driveway Curb..Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ - DATE: $� 9� APPLICANT: �iyi� Tel. # 2,�,�-�U,$'.�v Pernut Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ .3. � �Fee Schedule on Reverse Side $ . s� .001 of Permit Valuation (1/lOth%) $ $.50/$1,000 Valuation $ $1050 per SAC Unit $ $5.00 (State Licensed Fesidential Contractors) -:-� . . $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering � $_ _ Agreement Necessary [ ] Not Necessary [ ] r � ° � . , � + . , y:�.� u �. i j ` 1 � A � � r t ,..� 'f rk' � 1 1 � � �� � S � _ ` � , �"�\' 1 R� � f t., y . � i: { f� � i- 4{ r�'^ t � .`�� . 1 ly� F� .� �h. J:t 4 � i :F � . . _v? � �.i �` '.µ+4 1 /t �♦ '1 ri�: � � r i � I j ' ' �. t �,. '_ 1 4 �, yi ' �,� � i. k l k4 la -,.# � ..�' L . � ' � � 2 r 'e it i ,�i . � ,. � �; � fY� � ' �- � � � , � �; � s1 -� � �"� ' r � ��� � �4,,, ��,,��`�� , � ��, i '�. ; �� ,+�T � t� % 'i �:,k , i J. _ .�."��+ .''�r` t -i t �".. ,,,1 �' �� 4ais • �"'�. � > � .. ` ; X '. r t, � '�-.� � � � � ��a. �F �'�� ��.• r ,a'��.�u�j %i";. i . � t Y � w � > , � �� s,y� �f ) �Y � . +. '� J�a *::� 1 � -.'-� +s i .5 ; s- � � '`� � : r / ze• �,' � - + " +l' ,i t .n 1, :' � r`l � ya t r,�� ';+�� _ y „^'�'hd�."` �'{,,,;�;,,y � =:,� i" 4-. ; i r'%``-..:..� '� ��: Y ti, �t � j „ L�. _�'� �.�:� j� {- .r{ rn-�r, W�� ri ,� . a �� , i it ,,.: � . 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Ft . . � . . . . . �..,? . � 3Zk � � 7 l � 1 `\ .y }'? � w , , , YBA�n t ..r..�: ..�.,:-r � �.! ��,:.:.,.. �' i � r, K>-�k�. '-� ,iytr i.-�j . ..�a -C 'i ' -o. »,�, f , ' , � � , , . . , . � . r � j 4 j Q M 1 . �A4��t-:'fi�'.x+i:.i:1��4 ;�..�,�pr..r?�,.;r, ,. ., .. --- .. . �. . . . . . --- �� , ;ITY OF FRIDLEY INSPECTION DIV. 431 University Ave NE 'ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 D� ' 6� Q a p' Effective Apri11, 2004 -f b APPLICATION FOR PLUAABING AND GAS FfTTtNG PERM{T MARK NUMSER OF FIXTURES TO BE INSTALLED ON EACH FLOOR 'LUMBING FIXTURE RATES: �ew Fixtures )Id Opening, New Fixture 9eer Dispenser 31ow Off Basin NO. RATE TOTAL JOB ADDRESS_ �t�nnn:¢. • a.S o'W Y1�n� ;atch Basin iain Water Leader �ump/Receiving Tank Vater Treating Appliance Vater Heater -Electric Vate� Heater - Gas'* 1 �as Range** 3as Dryer`: 3ack Flow Preventer Required OYes O No TYpe $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.Q0 $10.00 $10:00 $15.00 � teinspection Fee $50.00/Hr '�LL OTHERS AND/OR REPAIRS AND ALTERATIONS � 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE 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 and rulings of the Building Division, and hereby declares that all the facts atld 1'ep�eSentations stated in this annlicatien are tn�g a�d COffeCt. HAMRE, UZ 557 JANESVILLE STR�ET N.�.. FRIDLEY, MN 55432 OWNER ��63) 786-0530 � BUILDlNG USED AS �S! �+e.✓1� ESTIMATED COST �f%'O � PERMITNO. " ! 20 � S PLUMBING COMPANY O��` 0'v►� r SIGNED BY • TEL N0. ii�o12�1�Z%-5�033 .� Approved By $ •� Rough-In Date Final Date -------------- - -- - --- ----- - -------•--•----- -----... .— ------. .. _ . $�S � OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. �OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. '"�PROVIDE COMMON VENT INFO ON BACK SIDE Building Inspections 763-�72-3604 JAT� " 1 >� I — �I!'E .4DDRESS 7 T';-ilS APPLICANT IS: PROPERTY �,�� OWNER/ �DRE; TENA.�'T pHONE: 0 MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY 0 E-MAIL ADDRESS CI Pennit No.: Received By: CONTR4CTOR COMPa.1�Y N�: ' CONTACT PERSON: O�LI-����— Anderson Heating and Air-Conditiomng sLa�.ur .4 coP�• oF N/p 4341 Central Ave N.E. �'OUR STATE STATE LICENSE � LICENSE �'tTH ,qDDRESS: '�' u .�PPLIC.ATION pH�� �7���_�/_ �S// _ C��. Ilt$, Mn SS421 a'��.. 1 PERNIIT TYPE I�MGLE FAMILY ❑ TWO FAMILY D TOWNHOUSE TYPE OF WORK: � �W ��PLACEMENT DETAILED DESCRIPTION OF WORK � ❑ ALTERATION/REMODEL A _STATE ZIP PER MS 16B.665 the permit fee is e�entlof a[re� den5 o fixture� xcluding the fixtue so �TOO.Ohould�reflect ongy the cos�trof labor ) improvement, installauon or replac Labor cost under $300 =�1 �.00. Labor cost between $300 to $500 = cost of labor x.05= rOR PROJECTS �`}-IERE 1-4BOR E7:CEEDS SS , FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT �'�'HERE NOTED. FIXTURES: (INDICATE TOTAL '�ti'�3ER Of EACH BELO�� MOD X� SIZEBTU�?�� Equipment Installcd 1"�G 5��� �� MODE g�E/gTU �_ �� MODEL: �._ FIREPLACE (GAS) $I5.00 _GAS R.ANGE/OVEN $10.00 �`�`�� �`� �� FIREPLACE (WOOD) $35.00 _T�iEW GAS GRtLL $10.00 _P1R TO AIR E?�CH.4NGEER $15 • �FURNACE $35.00 _GAS UNtT HTR $10.00 BOILER 535.00 POOL HEATER 535.00 CHIT�L'�'E�' LINER $]0.00 GAS DRYER $10.00 —�N7'ILATOR 515.00 DUCT WORK �10.00 GAS PIPING $10.00 — _ . .. • _ — ,,.,, ., ... �.. k� ���t.., �..,� ��:�,.:.,,,�n,;�r�,�����nuF:p�in�rTS:QV�R`�50 �I3' FEE PRO' , , :- . , .. ..;. ., , :..„ tr.w., ,..w -.... ,. , . ._ ... _ ._ . Permit Fee $ .Q� Number of fixtures @$10.00 x$10.00 =$ Surcharge � . 0 Number of fixtures @$15.00 x$15.00 =$ TOTAL DLJE � Number of fixtures @$25.00 x$25.00 =� Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Mir►nesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and appro��al of plans. � SIGNATURE OF APPLICAM C G�i`Z��� �----PRINT NAMEC ��i TT e/� ��L `'�I L/J DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �� REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC „ � �IE1RV HOMESIADDITIONS EXISTlMG HOME ❑ MAKE-UP AlR REQUIRED FOR NEW/EXISTING HOMES ' 1. Combustion Air (See note below) . a. Oil or solid fuel IMC Chapter 7 with MN Asnendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amen�nents • 2, 1vlake-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venti.ng a. Gas appliances IFCrC Chapter 5 with MN Amendments b. Fuel other than gas TMC Chapter 8 with MN A.mendments REQUIRED FOR NEW HOMES 4. Heai loss & cooli.ng load per room a, Required on new construction IMC 1346.0312 5. Ventilation . a Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be .used for combustion and make up air: calculations � Building � BUILDING Perrnit No.: ��- �'i Inspections RESIDENTIAL APPLICATION d B�-�- 763-572-3604 �� �' `� 763-502-4977 FAX CITY OF FRIDLEY vate xec'd: J ��-� EFFECTIVE 1-1-2010 DATE �' ���� V ^ YOUR E.-MAIL ADD SS '� �� �_ t� V� 1 �� �-ini'✓' f.� C f C� ✓� {'�1 I1 � %� SITEADDRESS SS 1 Gc��1QSlf1 � L )1'i1�Q�C�� THIS APPL[CANT IS: ❑ OWNER �ONTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: �S\ 7 �� Vt ��G S CITY � STATE,�IP S SN�� PHONE: 7�0 3— 7� tO '� C� � O CONTRACTOR NAME: i, S � e.- SUBMIT A COPY OF STATE LICENSE #% b�D � O � 0 EXP DATE ��/�—� Z- YOUR STATE LICENSE � _ AND CERTIFICATE OF ADDRESS: �i ?�'/? S�.-�y,q /J�iw-�n CITY� n�[�.ar- STATE/�3P ��30 INSURANCE pHONE ' FAX � 6 - %�v ' PROPERTY TYPE `�SINGLE FAMILY/NEW CONSTRUCTlON SIZE ❑ TWO FAMILY/NEW CONSTRUC7ION STORIES PERMIT TYPE ❑ ADDITION O GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FIMSH �tOOF ❑ DRAIN TILE ❑ DECK d'SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDiTIOAI �MAINTENANCEJREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: J�. ✓'b t! SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING �1 HOUSE ONLY BASEMENT REMODELING SC�MIT• NUMBER OF SQUARES 2 I� �HOUSE & GARAGE 1, Existing Floor Plan GARAGES ❑ TTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: �'bETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl �Soffit ADDI1'IONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1• Site Plan/Survey showing the existing structurcs ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS OYes ONo LOCATIOrf OF W[NDOWS FOR W[NDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACNRE S7'iCKER ON WINDOW. OPEIIING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES AKE BASED UN VALUA"1'1V1V, iNCLUlliNG "1'HL�' CU,"1" VF LAISVK A1vL MA1LKiAw: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ _ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due $ �?� �� See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ ' 4� $5.00 (State Licensed Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ (a J, r Make checks uavable to: Citv of Fridley Attach THIS IS ,4N APPL�CATION 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 applicatio r a permit and work is not to start without a permit on site; that the work will be in accordance with the appmved plan in the case of I ork which equ' es review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME `� �� �'a Z� k DATE f��� T % D