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PRE 2010 DOCSa City of Fridley i tlNECT Permit No. s TP1s i AT THE TOP OF T!V'IN$ PLUMBING PERMIT APPLICATIOid d tu-------- COIJMVNITY OEYELOPUENT DIV, i PROT�C,TtVtY Sz3 CYFG"1 N.ZPY, CCTV WALL Pr(atDLV DCS$ DAYS PAOE w &FI ROVED By 0#2-O00-3450 -t1gA 02115/73 1 1 800 Job Address 0- rk e_ ON e. eNke S! \14 E "1 "i-1 OCaner Address Phone Qv� r,e.rS -- Contractor Address Phone Kind of Building Use We -1\ "\* V\ Completion DateEstimated Cost I PlumbingFixture Rates: NO. RATE TOTAL F JI z I J Number Fixtures x $2.00 D 3 ° 4 I Future Fixtures x $1.50 3DSYDlI ! I I •� New Fixture -Old Open. x $1.50 ,ddtll U I I O Catch Basin x $3.25 I Water Heater -99,000 BTU x $3.00 Ground Run Old Bldg. / x �•a.S 1yI Saar I 1 .$3,25 'MNItlaI I j f � I Elec. Water Heater x $2.00 ,, sNlsHe K�G ff I I I Gas Fitting Fees: �O C SNltlaa Cp a0O1:1I 0 lst 3 Fixtures x $2,00 ,0i saa1hol+sl ;Z ° I I I Additional Fixtures X $ .75 � � — •1Nnod s,Nlaa ( I I Gas Range -199, 000 BTU x $5.00 �; sAtla1 NStlM I ' ' I O I Repairs & Alterations �q A I See S>INisf I Description: Code I I a, 6NISV9I G State Surcharge s50 I I G9 MI _ TOTAL FEE $ -3• 7S I + ( a The undersigned hereby makes application for a permit ! slrN,anl I I ; for the work herein specified, agreeing to do all work 913S013 2 in strict accordance with the City Ordinances and ruling j--- a91VM� ! I of. the Department of Buildings, and hereby declare that --- all the facts and representations stated in this application are true and correct. f � A N coI i -Signature Date ; /-t� // - �( - �� CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY itiAR..Ni AIR: Farnace Shell & Duct Work Replacenent of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARN! AIR: RATE TOTAL $12.00 $ 7.00 $ 7.00 $ 4.00 $ Furnace Shell & Duct Work to 100,000 BTU $12.00 $ each ado. 50,000 BTU 4.00 $ Reziace.:.ent of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ STl a}. OR HOT WATER SYS701: Boiler &Lines up to 100,000 BTU $12.00 $ ea=h addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU �Q �x�p $$10.00 AIR CONDITIONING - - $ FAN HEATING SYSTEMS See Fee Sc edule $ VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS_ , S $ State Surcharge $ .50 ,�z� U %60.00 VakLx, TOTAL FEE $ Z ®D I � �.0a & . �,, . sw4b 4 y.00 ROUG:i INSP. REINSPECTION FEE Date (.$10.00) FnZAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 Jon Address Department of Buildings City of Fridley Tel. #571-3450 E 7-7-F JT• A� 67, The undersigned hereby makes application for a permit for the work herein sp=_cified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. �4A,6 1�_, 19� OWNER�'�'—`,eY If r $�lfi/�/�✓� L • �h /PL/FNC � KIND OF BUILDING 9IA4_Q� USED AS TO BE COMPLETED ABOUT 7 `( �ry 7 ESTIMATED COST *00, OLD - EW BUILDING PERMIT NO. PEPUMIT NO. ll/ DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Waim Air- No. Trade Name Capacity Total Connected Load BURNER - Trade Name Size No. Sq. Ft. EDR _ BTU HP Capacity Sq. Ft. EDR Kind of Fuel r Uff Size No. BTU HP • Tel. No. City of Fridley SUBJECT PERMIT 13581 AT THE TOP OF THE TWINS PERMIT BUILDING REC COMMUNITY DEVELOPMENT DIV. � - r � � PROTECTIVE INSPECTION SEC. 1 . � NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-560-3450 910-F15 6/9/76 JOB ADDRESS 604 Lafayette Street N.E. 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 42-45 I D Riverview Heights SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Jerry Laplante 604 Lafayette Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENS :,NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 11 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 26' x 16' Addition to dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Provide City with.copy of truss design. Support existing wall foundation at 1:1 ratio - minimum 450 angle. PERMITS REQUIREn fOR W'R'NG, SEPERATE. HEATING, PLUMBING AND SIGNS, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED, $5,000 $2.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $22.69 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE -, 1 $25.19 OFC0 TRACTOROR TH RI T ATE) HEN ROPE LY LIDATED THIS IS YOURPERMft A Z "S1.NATV&LOF OWN RII OWN R D RI ID T 1 BLDG iNSP D TE L APPLICATION FOR RL`SIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S . NAME : j 4ft R x 4A%'L /�l l U %�' BUILDER : A %y%OE ADDRESS:' k Aj?,ET TT. MF ADDRESS : S♦9rYJ,�' NO:. 6 O STREET: 1, 6 F A %/Z%TE S TA 1 E LOT: W MAI 45 BLOCK: L2 ADDITION: 78'4-/3Sx CORNER LOT: INSIDE LOT: SETBACK: SIDE -YARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: 770 Front: pZ /Depth: A height: Square Feet: ( Cubic Feet: • �z 0 Front: Depth: Square Feet; Cubic Feet: Height: Type of Construction: 4jd0,0 AN/F Estimated Cost: —$ ,S, DOC7 . cc To Be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with.the City of Fridley Ordinances and rulings 'of the Department: of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: G SIGNATURE: (See Reverse Side For Additional Informa ion.) t��j'j, o v cad - 4 �T�,[�'f 14 -Tl d,� ` zSU R 4 ,?2. o -v s�'' F� �. 0 T%,.,, G..c.) Q"L. -YgcLN0RT/ o•J 4-7'�� b `BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs 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: UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose :.f computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the averages height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, .the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDATION NOTE: Permits 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 Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. z SCO UA jr Ld < 4 LwJ aLU C6 CL 40 Q 0. Us a k T- C-6 u %A s UA IC p Q ► Y vr- 1-K1ULtY 1NbrtU 11VN U+v. 8431 University Ave NE Fridley, MN 55432 572-3804 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR ttrectrve un %amuary 1, Aman PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 6 0 q 6 A FRY &T' ` S7 '(f� New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated In this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 ' , 1998 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner �� A PAW T a - Water Heater -Electric $ 7.00 Water Heater - Gas** _L $10.00 r o -° ° Building Used As µ o ^^ F Gas Range" $10.00 ;L-50- PERMIT NO. � Gas Dryer** $10.00 Estimated Cost Back Flow Preventer Required ( )Yes O No Type $15.00 PLUMBING COMPANY 2.AIr- Edi 6 6> Reinspection Fee $42.00/Hr SIGNED BY � 21._- TEL No.'S7� ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By A Rough -In Date Final Date,��=-°�-/�� State Surcharge $ .50 MINIMUM FEE FOA ANY PLUMBINGIGAS PERMIT IS $20.00 TOTAL FEE $ .40 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE G -A. MINIMUM SIZE 9 80 INCHES. City of Fridley su6jEtT C32751 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEI v ....... COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. } �� r PROTECTIVE �J1 NUMBER REV DATE PAGE OF APPROVED Br CITY HALL FRIDLEY 55432 612-571-3450 910415 7/03/02 JOB ADDRESS 604 Lafayette St NE I LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 42, 43 D Riverview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry LaPlante, 604 Lafayette St, Fridley, MN 55432 763-784-1217 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings, 6331 Riverview Terrace Fridley—. 763-974-9966 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE - ❑ REMOVE x 8 DESCRIBE WORK Re-roof XXXXXX (tear-off) - 16 sq. 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING. VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,715.00 $.86 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE Licens .00 V.73 -1/3 SIGNATURE OF CONTRACTOR OR AUT40RIZED AGENTIII) ATE I E PRO VALID,ATP6 THIS IS YOUR PERMIT S,GNATURE OF OVVNEAoF OWNER SUILDER1 iDATE, Bh&G -NSP OfQAtE NEW [ ] CITY OF FRIDLEY Effective 1/1/2002 ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 5722604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: D 7 Fe `/z��,6- Legal Description: Owner Name & Address: JW k i�- I,6 PLAv7`E Tel. # -)SY - d Z e Contractor. '�L <- 4A ZD MN LICENSE # YR6 % Address: 6,331 Z v<= P- (2 o Lzi L- TF- R-' Tet. # 67 q--7 F4t Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft _ GARAGE AREA: Length Width Height Sq. Ft _ DECK AREA: Length Width Hgt/Ground Sq. Ft _ OTHER: S� • - - - - - _ % 74571t! Construction Type: %�� Off i-Z,091ry F 1405 ` yp Estimated Cost: $ , Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ = $ DATE: APPLICANT: �Tel. # Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $ e0l /S� $ /• 7z $ •� $ d/ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by'Engineenng Agreement Necessary [ J Not Necessary [ J TOTAL $ %• %3 STIPULATIONS: _ , � vi i 1%iULIZY IN6F-L:k. 1 lUi'v �; a. 6431 University Ave NE Fridley, MN 55432 (763)572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT C 00 f- cop- f �a 0 -b MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR s-UCctive uli Jaia ;, Zuu21 I Au PLUMBING FIXTURE RATES: 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** f►1• Gas Dryer** Back Flow Preventer Required ( )Yes () No Type Reinspection Fee $47.00/Hr RATE $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance tj Lvo Y't A4� Surcharge TOTAL FEE TOTAL JOBADDRESS(4T LAfA7*IT AU JUS T01c4,y COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 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 and representations stated in this application are true and correct. 6 2-2�2 3 ,=2- Owner J SP LIi PIA I Building Used As Estimated Cost 02,a-2 PERMIT NO. PLUMBING COMP"Y SIGNED BY L N0.%G3 :56 If - c?6 (I Z9 FAX # 4L Approved By Rough -in Date Final Date •�—`�l/ 50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VENT, VENT CONNFCTOR ANn COMBUSTION AIR VFRIFICATION When raI� acing n t%xls+Ing gran -p, 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 manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The axoetrngremhiictien air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to inctau a new immhngfign airy it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When instaifulg a now v _nting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace 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 #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 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 HEATING CO: Signed By: Date : CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $�•� $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ 60 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.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. S .50 w JOB ADDRESS 60q h 14 OWNER LA P/)QP4 ` BUILDING USED AS 211p) e.9 �A-rv", Effective On January 1, 2002 d ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BUIiE's' �+ CJ No. of Heatin Units / Circle One (Steam) (Hot o . Warm A*) Trade Name Size No. k). BTU _%0 kU HP EDR`' Fuel tea+. 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE HEATING CO County t Signed 18550 Us* Gramm,# Sam 5 . 2,13 FAX # (763) 42&3677 Approved Bye_ Rough -In Date L�A Final Date �� THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VENT, VENT CONNFCTOR AND COMMIRTIM AIR V RIFI CATION When re In aeon® an existing 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 Furnace Venting Tables for fan assisted and natural draft appliances. Yes >1 No( ) The existing combustion air is sized and installed to meet the current codes and manufacturers specifications. Yes �k No( ) When required to install a new t-nmhi ,Mien aer.it will be sized and installed to meet the current codes and manufacturers specifications. YeW No( ) When ins alling a new venting, 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 Furnace 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 Type and Sime/Gammen Vent and Van enn actor Informs ion Appliance #1 Type BTU Input Assiste r Appliance #2 Type 0 BTU Input Fan Assisted o . a Appliance #3 Type BTU Input Fan Assisted or at b-- Total Appliances -— Total Btu Input Common Vent Type Vent Height 17 Diameter 'inches Fr Appliance #1 Vent Connector Height ft Length ft Diameter in,, ype Appliance #2 Vent Connector Height ft Length ft Diameter in -ype . Appliance #3 Vent Connector Height ft Length ft Diameter in ;Type y 11471NO & COOLING TWO INC 1140;li -416y Rtr 81 1855 GrOft MN 55369-9231 HEATING CO: (763) a 5-367-7 Signed By: Date Building PLUMBING Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-1-08 DATE 6/2 E / L V YOUR E-MAIL ADDRESS SITE ADDRESS (, C f L A FA1 0' T` S I - THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF INSURANCE PERMIT TYPE TYPE OF WORK: 0 OWNER I-ONTRACTOR Permit No.X6 Zf'dU 9� Received By: NAME: iL /L L q Pe .✓ ; G S Y3 . ADDRESS: 6 cy L 4 /+ N T r CITY / �6 �� L• _STAT Z1 L PHONE: 3 -)f y ' -7 NAME: — EXP DATE STATE LICENSE #— Terry Overacker Plumbing, Inc. EXP DATE STATE BOND it 502 E Main Street — STATE ZIP ADDRESS: Anoka, MN 55303 PHONE 0 SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE CI NEW REPLACEMENT DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the luos50 surchof labor ge Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.000 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. WATER PIPING _ BATH SINK/LAV _FLOOR DRAINS —'SHOWER HOWER — POOL _ WATER SOFTNER ($35) _BATHTUB —GAS PIPING (NEED CITY LIC) —WATER CLOSET _ BACKFLOW PREY. ($15) _CLOTHES WASHER _ KITCHEN SINK WATER HEATER ($35) FOR IRRIGATION —DISHWASHER _LAUNDRY TRAY WATER METER —OTHER _ Permit Fee $ 35- d Number of fixtures @ $10.00 x $10.00 = @ $15.00 x $15.00 = Surcharge .50 Number of fixtures $ TOTAL DUE $ 6� OR Number of fixtures @ $35.00 x $35.00 = $ 50 State Surcharge = $__50 (MINIMUM $15.50) (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and 1 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 application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. VSIGNATURE OF APPLICANT �^ PRINT NAME ,14 c /L , K' v , 1 G DATE Z 0 V 00 DATE APPROVED BY City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building BUILDING PermitNo. V1 Inspections RESIDENTIAL APPLICATION Received By:0 763-572-3604 CITY OF FRIDLEY DWReSEP 0 2 2006 763-502-4977 FAX EFFECTIVE 1-1-08 DATE zdrDff YOUR E-MAIL ADDRESS SITE AD RESS O THIS APPLICANT IS: ❑ OWNERCT/OR PROPERTY OWNER/ NAME: (- L CITY�r�'G� STA ZIPI S �3 � TENANTADDRESS: PHONE: NAME: STA �ZII'�� CONTRACTOR ADDRESS: ::%-v di iyf Awl CITY GI SUBMIT A COPY OF PHONE �/ �%�O r ��/r% FAX YOUR STATE LICENSE STATE LICENSE # Z %yam✓ EXP DATE PROPERTY TYPE GLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED INDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION NTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: /We e w gr— SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS UKes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED/Zi NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION S c/' 40:6 `t OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule $ 65% of Building Permit Fee $ go .001 times the total job valuation $ tj,-](' .0005 x Permit Valuation Minimum $.50 $ ism $5.00 (State Licensed Residential Contractors) $ $1825 per SAC Unit (Plans to MWCC for determination) $ ft+6 ft= ftx$21 =$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ ) , , °� Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesot nstructio o ,that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in ac d i h ved plan in the case of all work which requires review and approyal of plans. SIGNATURE OF APPLICAN PRINT NAMFG11� �/'c.9��i1 14� APPROVED BY DATE I 604 Lafayette st ne Galvanized T&C X Steel ❑ Plastic ❑ Tile ❑ Other --i--- --- -- ------ T WELLHEAD COMPLETION W EI ge i { rahouse Outside: El Well House El At Grade Inside: El Basement Offset 16 mile ❑ P@less Adapter/Unit ❑ Buried ❑ Well Pit -- ❑ Burled - n Won Pit S — Q eeu,l MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring Sealing WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes, Chapter 1031 ° * ff�I ) H 317292 WELL OR BORING LOCATION County Name ANOKA ❑ Other PROPERTY OWNER'S NAME/COMPANY NAME Township Name FRIDLEY Township Na 30 Range No. 1 24' Section No. 03 I Fraction (sm. - Ig.) FftNWA NW/, Date Sealed Thursday, October 10, 2013 Date Well or Boring Constructed 1943 GPS LOCATION - decimal degrees (to four decimal places) Latitude Longitude Depth Before Sealing 102 ft. Original Depth CM no reCOrd It. AQUIFER(S) X Single Aquifer ❑ Multiaquifer STATIC WATER LEVEL Measured Estimated Date Measured October 10, 2013 21 fL below ❑above land surface Numerical Street Address or Fire Number and City of Well or Boring Location 604 LAFAYETTE STREET NE, FRIDLEY, 555432 WELLBORING X Water -Supply Well ❑ Monit. Well ❑ Env. Bore Hole E] Other Show exact location of well or boring Sketch map of well or boring in section grid with "X" location, showing property N lines, roads, and buildings. CASING TYPE(S) in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown I 604 Lafayette st ne Galvanized T&C X Steel ❑ Plastic ❑ Tile ❑ Other --i--- --- -- ------ T WELLHEAD COMPLETION W EI ge i { rahouse Outside: El Well House El At Grade Inside: El Basement Offset 16 mile ❑ P@less Adapter/Unit ❑ Buried ❑ Well Pit -- ❑ Burled - n Won Pit S — Q eeu,l - [Other IN RASEMENT 1 Mile ❑ Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) LAPLANTE JERRY R. STA Diameter Depth Set in oversize hole? Annular space initially grouted? 2 in. from 6 to 102 ft. ❑ Yes X No ❑ Yes ❑ No ❑ Unknown Property owner's mailing address If different than well location address indicated above 604 LAFAYETTE STREET NE in. from to� ft. ❑ Yes E]No ElYes ❑ No ElUnknown FRIDLEY, MN 55432 in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE S o mE Screen from 102 to ft. Open Hole from to ft. Well s mailing address If different than property owner's address indicated above SAME OBSTRUCTIONS RodsfDrop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction Type of Obstructions (Describe) Removed 54'X 125" Drop Pipe & Jet Packer.... Obstructions removed? Its Yes El No Describe GEOLOGICAL MATERIAL COLOR HARDNESS OnFROM FORMATION TO PUMP Tyle Deep Well Jet Pump & 20 Gallon Tank... If not known, indicate estimated formation log from nearby well or boring. GEOLOGY FROM: 831 iO EAST RIV ER ROAD Removed Not Present [I Other Sand 0 20 1 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: X No Annular Space Exists E] Annular Space Grouted with Tremie Pipe E] Casing Perforation/Removal clay20 80 in. from to ft. ❑ Perforated ❑ Removed Hardpan I 80 100 in. from to ft. El Perforated ❑Removed Gravel 100 130 Type of Perforator Shale 130 150 VARIANCE Was a variance granted from the MDH for this well? ❑ Yes ❑ No TN# Sandrock 150 1755 Well =3•x175' GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., one bag of bentonite - 50 Ibs.) Grouting Material Neat Cement from 6 to 6.5 ft 0.0815 9Rg bags Open Hole = ?? Envlroplug from 6.5 to 102 ft 15.5665 bags Static Water = 48' �g from to ft. 0 �araSR$ bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑ Yes 19 No How many? REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING Well Located East Side Of Basement. LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The Information contained in this report is true to the best of my knowledge. Well Depth Measured From Grade Level Myron L. Malenke I Malenke Water (763) 493.3650 1426 A M.D.H. Inspector Was Not On Site During Well Sealing Licensee Business Name License or Registration No. Received Well Sealing Notification From M.D.H ' _ M. L. Malenke - 347 A October 10, 2013 03 30 24 22 0094 Ce d! Repr ntativ ignature Certified Rep. No. Date Malenke Sr Jesse Malenke Jr HT LOCAL COPY 2 Name me of Person Sealing Well or Baring HE -01434-14 IC# 140-0423 5/13R