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AF - 47594CIN OF FRlOIEY INSPECTION DIV. 6431 University Ave NE _ fridfey, MN b5432 572-3604 .: . � APRUCATION fOR POWER PLANTS AND HEATlNG� C40t1NC.,, VE1�TIi.NT{ON, REFRIGERA7IQN AND AIR CONDITtt3NiNG SYSTEMS AND DEVtCES Residential Fumace Sheft and Duct Work, Bumer — Atso Repfacement Fc+mace (Slde Vent — Fifi Out 6ackj Gas Pipi�g (Needed with new furnaoe) Gas Range Gas Dryer R/t� 6�-�� *Air Conditioning — Ali Sizes Alt (}thers/Repairs & Atterations (LlST �N BACK) 1% of Value af Appiiance or Wark Commercial/industrial 1�0 of Vafue of Appliance or Wcrk Rate TOTAL $ 20.00 $ $1 Q.t?0 $ $10.00 $ $ 10.00 $ .� $10.04 $ State Surcharge Tor�t. FE� Effeotive �n Jant�ary i,1993 JOB ADDRESS fp �l ,,��5 � �G� �,j� - /UG �; 7he undersigned hereby makes applicatian far a permit far the work herein � specifled agreeing to do ail work in s#rict acco�dance with the City Cades ar�d rulings af the Buitding Division, and hereby cieclares that ali the facts and representatians stat+�d in this apptication are true and correct. ,...'�G�,L.� �........1-�.� C)WNER _ _ _ i ' � BUILDING USED AS /;,��,��, ,��,� T � 1 tr^ t. ��,;' ESTtMATED CAS? . PERMlT NO. � /c"�_ � .. ♦ , f � � � ■ . . k � �11 .! _ 1 l . _ 1 $ No. of Heating Uc�its Cirole Orse (Steam} (Hot W�ter) (Wa�cn Air) Trade Name Size No. BTU HP EDR $ Fuei Tota1 Connected Laad �....._..._.� $L�. �IN�YlUM FEE FOR' ANY HEATlNG(C40LtNGNENTILATI�N REFRiGERATIO�N/A�� C,�O�DlTIO�lNG �ERMtT IS 5�5.00 PtU3 THE t.50 STATE 3U�HARQE REINSPECTION FEE $30.00 *Afr Gond�ioners can not be piaced in a side yard without writter� permtssion iram adjoining praperty ov�me�. �,_ � ,� � � Burner 7rade Nams Size No, BTU HP EDR HEATINGCOMPANY �� 0� S(�1.C.� Signed 6y ipi Na / �, Approved Rough—in Date Final Date CP - FtLL OUi BACK StQE �OR STACK VERI�ICA714N ON REPLACEMENT FI�NACE � _ CtTY OF FR[DLEY FRIDLEY MUN[C[PAL CENTER • 6431 UNIVERSITY AVE. N.E. FR[DLEY, MN 55�32 •(612) 571-3450 • FAX (bl2) 57l-!?87 December 1, 1999 PW99-146 Ms. Donna Glasow 621 Janesville 5treet NE Fridley MN 55432 ' Subject: Riverview Heights Improvement Projecf Dear Ms. Glasow: The City of Fridley has :completed the Riverview Heights Improvement project. As part of that project, you agreed to have your driveway paved by the Citycontra.ctor: Per the agreement, you were to have escrowed fimds for this work with the City. In order to expedite construction, we did not hold you to tha.t part of the agreement. Please remit payment of $381.71 to the City of Fridley by January 31, 2000 to cover the cost of your driveway installation. After this date, a 5% administrative charge will be added to the cost and the total charges will be placed on the tax roles to be assessed against yoiu property at 7% interest for 5 yeazs. If you have any questions, you may call me at (612) 572-355 L Sincerely, Jon H. Haukaas Assistant Public Works Director JHH:cz DRlVEWAY PAYMENT OPTIONS Piease mark an "X" next to the option which indicates your method of payment. Also, please oomplete the informatfon at the bottom of the page. � 1. I hereby agree to have the City pave my driveway �and � assess the cost against my property. I understand that the cost wiN be assessed at 7% interest over five years with s 5°� adminlstratirre charge. . � � 3. t hereby agree to have the City pave my driveway and wili escrow funds with the Ci#yr to cover #he cosf of c�r►structing :. my d�veway by Juiy 30, 1999. i also agree to sign a� agreement with the City regarding pavement of the dr�veway. 4. i do not wish to participa#e in the paving project. _ Name: _ �� '�. � a. ti R v�l � Addcess: �� _ an rL. s l� ,1 � e � c� c��e� rV� l�I � Signature(s}: Date: ' ?� d � � 1 ��.� � ' �' � 2 g �.b d s� �? �( � .33 � g l .'7/ �l X y SuB�ECi . City of Fridley 310 6 7 AT THE TOP OF THE TWINS g � I L D i N G P E R M i T r ; ;, RECEIPT NO. � ' CQMMUNI�Y OEVELOPMENT OIV. ' j V �"'� , ��KJ r � � PROTECTIVE INSPECTION SEC. � � � , �'-'1 � C17Y MALL FRIOIE� SS�32 NUMBER REV OaTE PAGE Oi �VnNOVEO Br �""�" �'� 6 i 2-571-3450 910-F15 6/ 19100 / / �oe Aooaess 621 Jaynesville Street t LEGAL �OT N0. BLOCK TfiACT OR ApD1710N SEE ATTACHED oesca. 5,6,7 P Riverview Heights sNEer 2 PROPER7Y OWNER MAI� AOORESS 21P PMONE Donna Glasow 621 Jaynesville Street 780-8081 3 CONTqACTOR MAII ADDRESS 21P PNONE LICENSE NO New Haven Construction 4208 83rd Avenue No. Brooklyn Pk, MN 55443 566-5225 � • ARCNITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO. 20077950 5 ENGINEER MAtL ADDRESS ZIP PHONE IICENSE NO B USE OF BUILOING Residential 7 ClA5S Of WORK ❑ NEW 0 AODITION ❑ ALTERATION �7 REPAIR O MOVE O REMOVE B OESCRIBE WORK Reroof - Tear Off 7 2/3 Squares 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED FOR ELEC7RICAl, PLUMBING, MEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCY LOAD VENTVLATING OR AIR GONOITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION 20NING S0. fT CU FT AUTHORIZEO IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTRUCTtON OR WORK IS SUSP�NOEO QR ABANDONED FOfi A PERIOD Of /20 DAYS AT ANY 71ME AfTER WpRK IS COMMENCED. NO DWIG. UNITS OfFSTREET PARKING I HEREBV CERTIfV THAT 1 HAYE READ ANO EXAMINEO TMIS APPLICATION 1 STAIIS GAiiAGES ANO KNOW TNE SAME TO BE TRUE ANO CORFiECT. AI,L PqOVISIONS Of �AWS VALUATION SUR7AX ANO ORDINANCES GOVERNING 7HIS 7YPE Of WORK Wll� 8E COMPL�ED WITH WHE7M�R SPECIFIEO MEAEIN Ofi NOT. TME GRANTING Of A PERMIT $699.00 ��Fg �..SO OOES NOT PRESUME TO GIVE AUTMORITV TO VfOLATE OR CANCEI ?HE pEqMl7 f EE SAC CNA E PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON- S�RUCTION OR THE PERfORMANCE OF CONSTRUCTION �Z9.6O Fl 2 SC .%O PIAN CHECK F TOiA EE Li s SC 5 0 ,�35.80 S�GN TUAE O� CON7 , p �U Op� D �GENT t04TE� � —�� EN P P AUOA D �S �S Y Ui: P � � � 5� �OWaEp OW QBw EA� iD��E� BlO �NSP �+��E NEW ADDN A��TE'R � �� [l tj Construction Address �..�L ( - CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1t2Q00 (763) 572�604 Bidg Insp �� , , Legal Description: Owner Name & Address: �i�.n � �,. (1-, 1 R� a� Tel. #'�S1D ��d �S l Contractor: � � - MN LICENSE #�� 7 g�v Adtlress: �l c> � '�� 1�� P /l%� � �,lt�tZr, c��-- Tei. # -�Co� "?�'Z�� s ` ... � , - - GARAGE AREA: DECK AREA: OTHER: Attach to this appiication, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height S . t. �. � Length Width Height Sq. FL Length Width HgtlGround Sq. Ft. /� f n ,,1 f. Construction Type: ec�� c�l— l�.e_�cx� . Estimated Cost: � l� Q7 Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x$ _$ DA7E: � � C7'� APPLfCANT: Tel. #�-Sl2.Z�J • CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in appiication Permit Fee $��i ��? Fee Schedule on Reverse Side Fire Surcharge $ •"�0 .001 of Permit Valuation (1/10th%) State Surcharge $ � � `�' $.50/$'I,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ .�C� $1100 per SAC Unit $ �"; o �� $5.00 {State Licensed Residential Contra�tors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ �� v � CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 PERMIT .: 2004-01127 ' ; _.-% DATE ISS : 0'i/16/2004 . (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 621 JANESVILLE ST NE PIN : 033024230118 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 2,000.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. REWORK WASTE AND VENT FOR KITCHEN, FULL BATH AND LAUNDRY. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 2000 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 2000 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE 0.00 BARNES PLUMBING CO INC PLBG FIXTURES (NEW OPENINGS) 0.00 3923 WSHINGTON AVE N I PLBG FIXTURES (EXIST OPE1�iINGS) 0.00 MINNEAPOLIS, MN 55412- WATER TREATMENT APPLIANCE 0.00 " WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE 0.00 OWNER GAS DRYER FEE 0.00 GLASOW DONNA J PLBG REPAIR/ALTERATIONS 25.00 621 JANESVILLE ST NE STATE SURCHARGE, PLBG FLAT 0.50 FRIDLEY, MN 55432 TOTAL 25.50 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 constru ion or the performance of construction. Applic Date , Bldg Insp � � � Date� � � SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. C��F FRIDLEY INSPECTION DIV. ` 84�fi University A�ve NE m N Fridfey, MP� 55432 m (763} 572-3604, FAX (783) 571-1287 � � �� Effec�ive A�rii 1, 20U4 APPLICATI�N FOR PI�UMBlNG ANU GAS FITTING PERMiT .. �- , � , � ;�iF;;i`""�-�-.��ii:il�� m � m N lf1 N.. - ----- � l0 ALI�ED ON �ACH FLOOR PlUMg1NG FIX7URE R�1TES: NO. RATE TOTAL � ° New Fi�clures °� �Id Op�ing, Nevl Fixture � Z 9eer Disgenser � 3low Off Besin �air� Basn . �ain tNater Leader � 3urnp/Receiving Tank A Na:er Treating Afipliance � Nater Hea��r-Eteatric � Nater Neater - Gas"" �, � �ras Range"' � u 3as Dryer" � � 3ack �iow Prev�rber Required ( )Yes ( ) NQ N� TYpE ..._ � � m a a� m � � m N � � � � � m $Q4 00 $1Q:00 $'( O.QO $10.00 $9 O.OD $10 00 $?0.00 $35.00 $35d0 �35.00 $10.00 S10.o0 $15.00 o �eitispsction Fee $50.OQ1Hr `�' �Li. �YHERS AtiGIG1R REP/�tRS RND ALiERAY�ONS � 1259�0 of Value oi Fixiure or A�phanoe dS. flo J08 ADp�ESS ��r I �.q.tr-L.Q„�, �� . The undersigned hereby makes application for a pem}! iar tf� v�rork harein spe;.ified agreeing to do all wa�k in stricl ace;ordance vn7h the cily cfldes and �ulings of the Buadir� Div�ion, and hereby dectares thatatl the fact� and �epresentatians stated in t�is application are true �nd correcf. DATE: _ ��.�/ / 5' , 2Q�____ o�►�� J� o ��.a. �r�� BUILplNG USED AS ��° � � ��+��- ES7fMAT�D COS7 �G�Dt?� RERMIT i�t4, <�f,�C��l `�'/ 1��7 '��1�h �� 1°D�t.e.�e��b r L+o . � �v�.�, PU�161NGCdMPRNY �� 1 .�j.� � f f ssyr Z. S�Gr��o a� ` r�c. t�o. 10l —! / 7 2 �5� �„ .SO �� v� BY Rough-tn Dats Fi�ral Dele � S�fe Surcharge $ � MINIMUM FEE �OR AI�Y PLUMBiNO/GAS FERMIT IS $15 00 or 6% OF C05T .-+ TOTAL FEE $ S. � OF THE lMPROVEMEN7 WF�ICNEVEA fS (#REATER ON WORK LE�S 7HAK $300 1 ��C�itBUSTION AIR SHALI, 6E PROVtDED PER U1VIC SECTION 5U4(A) AIVD TRBLE 6-A � � ��! �� . �� '"'PROVtD� COMMON VENT lNFO ON 9ACK SIDE � JUL-15-2004 09�1I FRO� CITY OF FRIDLEY TO 6125�91064 P.�2�02� i FILL IN COMIP�E1'�LY FOR REPLACEMIENT FUEL BUt�N1NG APPLIANCE PERMITS ��: 1Nhen re»lacins� a e�cistinca furnace the undersigned hereby veri�es that the venting has been exa�ined and is free from rust, qetetioration, obstructions, and is securafy support�d ahd firOStoppad wh�re required. The verrting syste�m is�plasticlPl/C and meets aJl current codes and m�nufacturer s�ecifications inclucting s'rzing, IeRgth, number of elbows and t�erminatidn. Th� undersigned also;verifies that the raplaoement unit �s o li9ted assetnbfy aric! meets #he current! oodes and manufacturer's specifi�:ations. This d'bes Enclude AGA GAMA Categary 1 Central Furnace Ventin$ Tables for fan assisted and natural draft appf+ances. • Tk�e exlstinq combustion air is sized arid instal�d to meet the current c�des and manufacturer's specifications, i 1Nhen requir�ed to i' 1 � b ir it wifl be sized a�d in�talied to meet the cu�r�ent codes and mar►ufa�cturer`s speafications. � i When installin,g a n�c�iv ventinq svstem, the undersigned hereby verifles that it is a listed assembly and meee�tss the current cades and manufackure�s; specificatians. T'his cEoes incl�de AGA-GAMA Category I Gentrai Fum�ce Venting Tables for fan! assisted and natural drafi appliances. � ; , !s the Common vent and vent connectors sized and installed correc�iy after an �ppiiance has been removed from the common vent a�d vented separate(y as per current cades. Yes ( ) No { ) Yes � � Np ( ) Yes( ) Na{ ) Yes ( ) No ( ) Yes { j No ( ) Yes ( ) No ( ) Yes ( ) No ( } Appliance #� Ty�e � BTU lnput Fan Assisted or Nat � Appliance #2 Type BTU Input Fan Assisted or Naf � Appliance �i Type 8TU Input Fan �0.ssisted or Nat Tofial Applia�ces ' Tctal Btu Input � Comrnan Vent Type � Vent Helght piameter inches Appliance #t Vent C�onnector Hei�hg ft Length � Diame;ter,,,�,�„_m Type Appliance #� Vent Connector Height ft length ft Diameter �(n Type Appiienoe #3 Vent Cannector H�fgh$ ft Length _,,,.,,, ft Dia+�netec „_„_,jn Ty� HEAi"ING CO: � � .�. • - Signad By: � , � s Date ?�� ! � 1�„ -- . . i —r Z0 3�Jdd �S'ld S�N21aS b90't6Z5Z Z9 TOTAL P.02 8b:80 b00Z/5i/L0