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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® s o 0:8:) Date:"` ears Owner: Builder Address Address WCATI OF�V ILDING 104 No. �� Streeter �� Part QfLot Lot Block Addition or Sub- �±! Corner Lot _ Inside Lot (back Sideyard Sewer Elevation _ Podation Elevation DESCRIPTION OF 'BUILDING. To be sed a8: � } • �- ,� Depth Height —a140 Sq. Ft cu. Ft40 t Depth Height Sq. Ft cu. Ft Type of ConstructionbklAdftFst To be completed In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above set forth and in ,compliance with 21 provisions of ordinances of the city of Fridley. w.. In consideration of the payment of a fee of permit is hereby granted to thto construct the building or addition as described above. This permit is granted up= express condition that the person to whom it is granted.astd 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 of Fridley, Minnesota regarding location, construction, alteration, snaiatenaace, repair and moving of buil�ngs within the city ];snits and this permit may be revoked at any upon violation of any of the provisions of said ordinances.. r it r"i NOTICE: TW p0emh den not corer the cmutructiee, hwhliatien for wMkm, pivmbtag, yu hen8ng, ewer or wdnr. Bn sun se sen the WNW& Iuspeftr for separate peewits for then hems. J. _. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name� ggLA Builder o549,9 p4zat_. Address � to � ���� 40tQ Address Zoe - F;2 qo,• ��� : 6- 9g'. LOCATION OF BUILDING ,e . No. 0/ -0 Street -4 Part of Lot 06a4-0 6T Lot. Block Addition or Subdivision Corner Lot Inside Lot y Setback Side -Yard - SEWER ide-YardSEWER ELEVATION FOUNDATION ELEVATION ° Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING t ff. sq. Ft. �i -CU. Ft. :3 1 2 r_ Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost 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 Ordinances and ruling of the Department of Build- ings, 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). w � h Y a • M � '0001. AL I 71 PERMIT for Power Plants and Heating, Cool. ing, Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of % Heating Plants to be installed—altered—repaired Make / Oil fired ; Coal fired fired V ; Gas Authorization No. Remarks Approved Final Inspection Date , 19_ Inspector #�Y/17 Permit AT° 4832 Fee $� �y Office of the Inspector of Buildings City of Fridley City of Fridley, Minn., ©ee —?/ , 19-2-0 Owner Co -IJ.UkdUL� Location 610.,-2c) Kind of Buildin-�� How Occupied Work to be Commenced—, 19— To be Completed A ,192-o Estimated Cost, $ �ccd n Old -New, Building Permit No Permission is hereby granted to to install—erect—use the material and devices described in the above statement. This permit is granted upon t express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set fo h in the approved application for this permit on file in the office of the Inspector of Buildings. / 1,1 '�/� 3 Inspector of Buildings 2M 11 -sr v 0 97-84 1116051 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT •PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL hu -.bar Fixtures x $3.00 u Future Fixture Opening x fl $ water bo $2.00 $ Catch Basin. x $5.00 $ Water Heater - to 99,000 BTU, x $5.00 $ 100;000 BTU to 199,000 BTU 04. 5 Water Softener __ Heater $7.90 V . x C N Electric Water Heater �_ x $5.00 $ .`5 9 A R ci a9 a� $3.00 $ Additional Fixtures �� J �° w e " W4A $10.00 '12'b x �a 8 2 ' x i3 $8.00 o as • leo $2.00 $ State Surcharge_ w $ _50 H x aw to w IS t tad 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) o New Fixture, Old Opening Water •PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL hu -.bar Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ Now Fixture, Old Opening x $2.00 $ Catch Basin. x $5.00 $ Water Heater - to 99,000 BTU, x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener __ x $7.90 $ New Ground' Run Old Building ^_ x $5.00 $ Electric Water Heater �_ x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x $3.00 $ Additional Fixtures �� x $1.00 $ .Gas Range to 199,000 BTU � x $10.00 $ REPAIRS 6 ALTERATIONS ' First $100.00 $8.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge_ $ _50 TOTAL FEE $ 8__00 3iE MSPECTION FEE Job Address i� 6620 LUCIA LANE NE Department of Buildings City of Fridley Tel. 0571-3450 The undersigned hereby makes application lora permit for the work her specified agreeing -to do all work in strict accordance with the City Cot and rulings of the Department of Buildings, and hereby declares that ala the facts and representations stated in this application are true and tx 6-23-77 Fridley, M.'1. , 19� OWNER EUGENE SCHILZ KIND OF BUILDING frr me USED AS reS S. TO BE COMPLETED ABOUT , 0-29-77 ESTIMATED COST 10.00 OLD - NEW BUILDING PERMIT N0. PF_lillIT N0. Compo . MINPAIGNSMASCO Signed By Tel, No. ROUGH INSP, Date FINAL INSP. 16 7 Date APPROVAL FOR PERMIT .1V!� MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 Glass "A" Surcharge .50( ' SUBJECT PERMIT NO. City of Fridley_ 187 '-J AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT NO. LL ______ COMMUNITY DEVELOPMENT DIV. r i PROTECTIVE INSPECTION SEC. ���/ 1 � ` CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 11/7/86 JOB ADDRESS 6620 Lucia Lane N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6D A,ud. Sub. #21 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ricky Throndson 6620 Lucia Lane N.E. 571-4971 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. AMRE 3700 -Annapolis Lane, M ls. 55441 553-0020 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 ❑ ADDITION ❑ ALTERATION Ek REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 ISTALLS 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $10,000 $5.00 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- STR CT ON OR THE PERFORMA E OF N $80.50 7 CHECKFEE TOTAL FEE -0STRUCTION. $85.50 SIGN RE OFCONi A TO ORAU7HOR12EDAGENT (DATE) WHEN PROPERLY ALIDATED THIS IS YOUR PE IT 1119t - BLDG )NSP SAT SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW LAY City of Fridley Effective 4/1/86 ADDN. L ] �R-1 AND R-2 ALTER. L ] Building Permit Application Construction Address: Legal Description Owner Name & Address: Contractor Address Tel. # eJ 9 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: Corner Lot [ ] Inside Lot [ ] Ft.Yd. Setback Side Yard Setback Type of Construction: . . ®on.-�eej° ` Estimated Cost: $ ®�� �2-- /� /,so,— Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: �� //7— �i � APPLICANT: Tel. # CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 25$ of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] City of Fridley SUBJECT W 18 6 5 8 AT THE TOP OF THE TWINS BUILDING PERMIT Ir CEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 = � CITY HALL FRIDLEY 55432 j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/8/86 JOB ADDRESS 6620 Lucia Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6D Aud. Sub. #21 SHEET I 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ricky Throndson 6620 Lucia Lane N.E. 571-4977 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW C ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a Second Accessory Building (24' x 24' ) 9 CHANGE OF USE FROM TO STIPULATIONS Special Use Permit approved 10/6/86 for Second Accessory Building. Close up openings between house and garage or provide rated assemblies. Provide a, hard surface driveway. Remove tires and debris from side yard. Move boat to side/rear yard or store in garage. Garage materials, siding and roofing to match existing house. 1A�tg� SEPARq�-E PERMITS WIRING, � Before di Ing NSA TIN;' FOR __ call local utilities tEL PLUMBING D A -ELECTRIC. �N� SI�aN GAS Etc. REQUIRED By LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. 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 ISTALLS 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7,067 $3.53 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $68.50 PLAN CHECK FEE TOTALFEE $72.03 SIGNATOR ON TRACTOR ORAUTH 12EDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT ^§LDG INSP ® DA fE SiGNATU RE WN RIIF OWNER BUILDER) (DATE) NEW [ ] City of Fridley Effective 4/1/8( ADDN . FR -1 AND R-2 i ALTER. [ 7 Building Permit Application Construction Address: � o Z c) /w- L.S-c- e�4 Legal Description: /-Q-/- 6L Lstj'i ' Owner Name & Address: �' + Y/'/0GWd) `' d �'� o ���� �"J Tel. # Contractor: Si Tel. 4 Address: 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: Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback __ Side Ya rSetback Type of Construction: Ne -&A Estimated Cost: $ j4L2-L—�'� Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: / 0A AK— Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: 0 C LOWS UP ori P" w i -e C.,)ork j z kPI APPLICANT: 44-;7xTel. # f l CITY USE ONLY $, So Fee Schedule on Reverse Side $ ---- 25$ of Building Permit Fee $ �, 3 $.50/$1,000 Valuation $ $475 per SAC Unit $ ee Deter -mined by Engineering Ar"ment Necessary [ ] Not Necessary [ ] A-.$ x t44 ae- ki . L6M& CINOF FRIDLEY CIVIC CENTUR • 0331 UNIVERSITY AVE. N.E. FRIDLEY. MINNESOTA 55132 • PHONE 1612) 571-3450 Ricky Throndson CITY COUNCIL October 7, 1986 6620 Lucia Lane N.E. Fridley; M 55432 ACTION TAKEN NOTICE On October 6, 1986 , the Fridley City Council officially approved your request for a special use permit, SP #86-12, to allow a second accessory building on Lot 6D, Auditor's Subdivision No. 21, the same being 6620 Lucia Lane N.E. with the following stipulations: 1. Provide a hard surface driveway with construction of garage. �2. Remove tires and debris from side yard. \3. Move boat to side/rear yard or store in garage. `4. Garage materials, siding and roofing to match existing house. If you have any questions regarding the above action, please call the Planning Department at 571-3450. Sincere , James L. Robinson Planning Coordinator JLR/dm Please review the noted stipulations, sign the statement below and return one copy to the City of Fridley Planning Department. by October 21, 1986, Concur wi action taken za a �lJl.StP.�c�# 886-12 L OWIOL P N Nub 3 r xipv STATE OF MINNESOTA COUNTY OF ANOKA CITY OF FRIDLEY In the Matter of a Special Use Permit, SP #86-12 74+655 CITY COUNCIL PROCEEDINGS SPECIAL USE PERMIT The above entitled matter came before the City Council of the City of Fridley and was heard on the 6 day of October , 19-96—, on a petition for a special use permit pursuant to the City of Fridley's Zoning Ordinance, for the following described property: To allow a second accessory building on Lot 6D, Auditor's Subdivision No. 21, the same being 6620 Lucia Lane N.E. IT IS ORDERED that a special use permit be granted as upon the following conditions or reasons: See Council minutes of October 6, 1986, with 4 stipulations. STATE OF MINNESOTA COUNTY OF ANOKA ) CITY OF FRIDLEY OFFICE OF THE CITY CLERK I, Shirley A. Haapala, City Clerk for the City of Fridley with and in for said City of Fridley, do hereby certify that I have compared the foregoing copy and Order granting a special use permit with the original record thereof preserved in my office, and have found the same to be a correct and true transcript of the whole thereof. IN TESTIMONY WHEREOF, I have hereunto subscribed my hand at the City of Fri d eMinnesota, in the County of Anoka on the 9-r%,C day of 19_x. DRAFTED BY: City of Fridley 6431 University Avenue N.E. Fridley, MN 55432 SHTPiiM A. HA PALA, CITY 6LERK i `yam• ...y �,r"\`y ��' n Mr. Flora, Public Works Director, stated the Council, in 1984, approved a variance for property at 420 67th Avenue to reduce the side yard setback frau 10 feet to 7 feet to allow an addition to this home. He stated the petitioner didn't complete this contruction and is now requesting the Council re -approve this three foot variance in order to construct a three -season porch behind the garage. Mr. Flora stated the adjoining property owner has submitted a letter that he has no objection to the variance. NDTION by Councilman Goodspeed to re -approve the variance to reduce the side yard setback frau 10 feet to 7 feet for the property at 420 67th Avenue to allow construction of a three -season porch. Seconded by Councilman Fitzpatrick. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. .� \ u ; 1 �.. � . 4�� _:_�1.,1 �. _�. �u ...7 • � � rya is : . A. CONSIDERATION OF A SPECIAL USE IEPT, SP 086-122, 70 ALLI�W A _SF'COM ACCESSORY BUILDING, GENERALLY LOCATED ON TAT 6D, AUDIME'S SUBDIVISION NO 21, THE SAME BEING 6620 LUCIA LANE N.E., BY RICKY THRONDSON• Mr. Flora, Public Works Director, stated this is a request for a special use permit to allow a second accessory building at 6620 Lucia Lane. He stated the property is zoned R-1 and is in a predominately residential area. He stated the petitioner proposes to construct a new garage approximatey 526 square feet to provide extra storage for vehicles, as well as a boat and trailer. Mr. Flora stated the Planning Commission recommended approval of this Oecial use permit with four stipulations, which he outlined. J ' NOTION by Councilman Schneider to concur with the recommendation of the Planning Commission and grant special use permit, SP #86-12, with the following stipulations: (1) A hard surface driveway be provided with �l construction of the garage; (2) Tires and debris be removed from the side (� yard; (3) Boat be moved to the side/rear yard or stored inside garage; and (4) Garage materials, siding and roofing are to match existing house. Seconded by Councilman Fitzpatrick. Upon a voice vote, all voting aye, / rJh Mayor Nee declared the motion carried unanimously. Mr. Flora, Public Works Director, stated this is a request for a special use permit for property located on the corner of Commerce Circle South and Commerce Circle East to allow offices not associated with a principal use. He stated the property is zoned M-1 and the building constructed on the site is 21,040 square feet with 50 parking spaces provided. He stated one-half of the building would be used for offices and the other half for warehouse -9- NEE 2— •:�a� ��� _ i •:_ + Jit _s-y� 1 IRI* �M .:_ 3.0- Mr. Flora, Public Works Director, stated this is a request for a special use permit for property located on the corner of Commerce Circle South and Commerce Circle East to allow offices not associated with a principal use. He stated the property is zoned M-1 and the building constructed on the site is 21,040 square feet with 50 parking spaces provided. He stated one-half of the building would be used for offices and the other half for warehouse -9- 746455 Numerical V Grantor Grantee--"" %corded�— Checked — Margin_ Tr, Ind OFFICE OF COUNTY RECORIIER STATE OF MINNESOTA, COUNTY OF ANOU I hereby certify that the within instrm- Gj ment was filed in this office for record � FEB on the rED 1 3 i.gp7 M ^ d was duly recorded [WN CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 Q. October 51 1987 Ricky Throndson 6620 Lucia Lane Fridley, MJ 55432 RE: Special Use Permit, SP #86-12 Dear W. Throndson: I recently inspected your property at 6620 Lucia Lane, to determine compliance with the above referenced land use permit. 7his inspection revealed failure to comply with one of the four (4) stipulations of this permit. (See enclosed.) The specific stipulation in question is that of hard surfacing the driveway. This was to be completed along with the garage. At this time, the City of Fridley is requesting that you obtain a contract for service, to hard surface the driveway by October 21, 1987. You may still have time to contract for services along with the City. To find out more about this possibility you may speak with Jon Thompson at 571-3450, or you may contact the contractor yourself. You will want to speak with "Smitty" of Diversified Paving at 421-4120. I will be contacting you within the next week to further discuss the above. Sincerely, Lisa Campbell Code Enforcement LCAM C-;87-502 r . I G7YOF FRIDLEY C1%'IC CIi1T1 k UNIVERSITY AVE. N.E. FRIDLEY. MINNESOTA 5W2 -PHONE (612)471.34.50 Ricky Throndson 6620 Lucia Lane N.E. Fridley; KZ' 55432 On October 6, 1986 CITY COUNCIL ACTION TAKEN NOTICE October 7, 1986 , the Fridley City Council officially approved your request for a special use permit, SP a86-12, to allow a second accessory buildina on Lot 6D, Auditor's Subdivision No. 21, the same being 6620 Lucia Lane N. 1:. with the following stipulations: 1. Provide a hard surface driveway with construction of garage. `2. Remove tires and debris from side yard. ,•3. Move boat to side/rear yard or store in garage. 14. Garage materials, siding and roofing to match eyisting house. if you have any questions regarding the above action, please call the Planning Department at 571-3450. Sincerel , r James L. Robinson Planning Coordinator JLR/dm Please review the noted stipulations, sign the statement below and return one copy to the City of Fridley Planning Department. by October 21, 1986, Concur wid action taken CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective Date May 1, 1988 Job Address e6Kv X U (f ) �F Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. If,-,> 19-OD10 4L1 OWNER ; o!�!� J KIND OF USED AS TO BE COMPLETED ABOUT RATE SCHEDULE ESTIMATED COST 0 NO. RATE Water »mi ro /oLD - BUILDING PERMIT NO. H "4 u $ 5.00 C m m a w $ Company Heater o U C N o) Beer Dispenser $ 4.00 $ Signed By S 8 x b $ 5.00 $ M Lk N $ 5.00 $ m v 5 cq a`� m S O a w q m w u c� y ro 4 3 itl t7 $ 5.00 tj Date s Elec $ 7.00 $ Hot Water Heater 5.00 FINAL INSP. $ Sr Date Gas Range o $ Gas Dryer $ 10.00 $ APPROVAL FOR PERMIT Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 1st d ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE Reinspection Fee $ 2nd $ .50 ($15.00) TOTAL FEE$�'D 3rd 4th (R) a Future Connection Opening Connected with Sewer (*) a New Fixture, Old Opening Water Effective Date May 1, 1988 Job Address e6Kv X U (f ) �F Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. If,-,> 19-OD10 4L1 OWNER ; o!�!� J KIND OF USED AS TO BE COMPLETED ABOUT RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL /oLD - BUILDING PERMIT NO. PERMIT NO. New Fixtures $ 5.00 Future Fixtures $ 3.50 $ Company Old opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Signed By Blow Off Basin $ 5.00 $ Tel. No. Lk Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic ValveROUGH S 5.00 $ INSP. Sump or Receiving Tank $ 5.00 $ Date Water Treating Appliance $ 7.00 $ Hot Water Heater 5.00 FINAL INSP. $ Sr Date Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ APPROVAL FOR PERMIT Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 S ` ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE$�'D E:ferr've Date May ' 19BE CITY OF FRIDLEY PLICATION FOR POWER PLANTS AND HEATING, ;.OLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYS aMS AND DEVICES COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work State Surcharge r J> Reinspection Fee ($15.00) Rough Insp. Date c Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00' PLUS $.50 STATE SURCHARGE $ $ .50 Job Address Department of Building% 6431 University Ave. N.E.► Fridley, MN 55432 City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance d� the Cres ity Codes and rulings of the Department of Buildings, and hereby this application are true and correct. facts and representations stated in 19 Fridley, Minn. OWNER e! RIND OF BUILDING USED AS p TO BE COMPLETED ABOUT ESTIMATED COST ./ OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm A��e �®® ��� J')Lel OBB� Size No. 4� Trade Name---.-s-� �— HP Capacity Sq. Ft. EDR BTU �j Total Connected Load -ZA Ot`9!� Kind of Fuel BURNER - Trade Name Capacity Sq. Ft. EDR BTU HP Company Signed By Tel. No. Size No. *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces �- TOTAL �SI� � Furnace Shell and Duct Wfumac, $ 20.00 Burner (Also replacement Gas Piping $ 10.00 $ (piping needed with new furnace) $ 10.00 $ — Gas Range $ 10.00 $ Gas Dryer * Air Conditioning (all sizes) $-10.00 $ All Others/Repairs and Alterations $ 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work State Surcharge r J> Reinspection Fee ($15.00) Rough Insp. Date c Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00' PLUS $.50 STATE SURCHARGE $ $ .50 Job Address Department of Building% 6431 University Ave. N.E.► Fridley, MN 55432 City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance d� the Cres ity Codes and rulings of the Department of Buildings, and hereby this application are true and correct. facts and representations stated in 19 Fridley, Minn. OWNER e! RIND OF BUILDING USED AS p TO BE COMPLETED ABOUT ESTIMATED COST ./ OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm A��e �®® ��� J')Lel OBB� Size No. 4� Trade Name---.-s-� �— HP Capacity Sq. Ft. EDR BTU �j Total Connected Load -ZA Ot`9!� Kind of Fuel BURNER - Trade Name Capacity Sq. Ft. EDR BTU HP Company Signed By Tel. No. Size No. *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or sUckl 1. Has been carefully examined Yes (.) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and Yes ( ) No ( ) total BTU connected 6. Has Total heating BTU's of All other BTU's TnTAI CC Remarks Cjy `cam 2 L�fl{' �� ✓ /��-� �J Company Signed E Da to A A 13 HERRI K & NEWMAN PA. q ATTORNEYS AT LAW Virgil C. Herrick David P. Newman James D. Hoeft Gregg V. Herrick Lisa Campbell Code Enforcement City of Fridley 6431 University Avenue Fridley, Minnesota 55432 RE: Ricky Throndson Dear Ms. Campbell: December 14, 1987 I am writing in response to your inquiry of December 1, 1987. For your benefit I would suggest to you that this situation is similar to the one which the City recently encountered regarding the Apache Trailer Sales site. Yes it is permissible for the City to cite the property owner for his failure to comply with the terms of the Special Use Permit. In fact, it is my understanding that on occasion the City has done this in the past. Additionally, the City does have the right to revoke the Special Use Permit in the event that the property owner fails to comply with the stipulations contained within the permit. In order for this to occur there must first be a public hearing of which the property owner is given reaso- nable notice and at which the property owner will have an oppor- tunity to present any relevant information or testimony which he might desire. After hearing all of the testimony the City Council could then take the steps prerequisite to revoking the Special Use Permit. If after the Council has taken action to revoke the Special Use Permit and the Use continues, then the City would have the option to go into Court to seek an order of the Court authorizing the City to remove the illegal structure. I hope that this letter provides you.with the information you have requested. If in fact it is the staffs desire to recommend revocation of the Special Use Permit then I would suggest that you work closing with our office in making sure that all the pro- cedural and due process requirements are met. incerel� yours, David DPN:jeb cc: Jock Robertson Suite 205, 6401 University Avenue N.E., Fridley, Minnesota 55432, 612-571-3850 City of Fridley SUBJECT P 18688 THE TOP OF THE TWINS _ Irp,AT BUILDING PERMIT CEIPT NO. COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. ' NUMBER REV DATE PAGE OF APPROVED BY "'1 CITY HALL FRIDLEY 55432 0' ��� 612-571-3450 910-F15 10/8/86 JOB ADDRESS 6620 Lucia Lane N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6D And. Sub. #21 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ricky Throndson 6620 Lucia Lane N.E. 571-4977 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE 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 5j ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a Second Accessory Building (24' x 241) 9 CHANGE OF USE FROM TO STIPULATION Special Use Permit approved 10/6/86 for Second Accessory Building. lose up openings between house gp4 g age or provide rated assemblies. rovide a hard surface driveway.' ove tiresd debris from side yard. Move boat to side/rear yard or store in garage. age materials, siding and roofing to match existing house. SEPARATE j''�'j'jiAv� WIRING _ TS �E►a,_ Before di ��. , HEATING, digging FOR call local utilities , FLUp..�"_D ���NG ELECTRIC. AND SjG S �SFtc, REQUIRED BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 'HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7,067 $3.53 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $68.50 PLAN CHECK FEE TOTALFEE $72.03 SIGNATU�NTRACTOR OR AUTI+ IZED AGENT IDATEI WHEN PROPERLY V LIDATED THIS IS YOUR PERMIT �'N B CG �r+SD rA p SIGNATURE ROF OWNER BU4DERi iDATE) SUBJECT P City of Fridley 2 3 0 0 6 AT THE TOP OF THE TWINS BUILDING P E R M I T RECEe Ir? ' ' COMMUNITY DEVELOPMENT DIV. _ v PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/14/94 JOB ADDRESS 6620 Lucia Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6D Auditor's Sub. #21 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rick Throndson 6620 Lucia Lane NE, Fridley 55432 571-4971 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential' 7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Change rear entrance; new stairs to basement 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 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 $.75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,500 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- $35.00 Fire SC $1.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $37.25 NATURE OF NTRACTOR OR HORIZED AGENT IDATEI HEN PROPERLY V LIDATED THIS IS Y/OUR PERMIT r - BLDG I SP f ®` OATE NATURE OF NER NER BUILDER) IDATE NEW [ ] Effective 1/1/94 ADDN [ ] CITY OF FRIDLEY ALTER 14 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress:� Legal Description: Owner Name & Address:Zeek // e ,o S 6W6 bt&A bo Tel. # Contractor: MN LICENSE # Addr , 41 .. Tel. # . Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: rCAK Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Apmox. Completion Date: Moor 36 7 L (Cost on Back) Dri7a=t Width Nested: Ft. + 6 Ft = Ft x $ = $DA� APPLICANT: L ' Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 3� Fee. Schedule on Reverse Side $ k ..001 of Permit Valuation (1/10th%) $ f $.50/$1,000 Valuation $ $800 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Newry [ ] QL2 00 SUBJECT PERMIT NO, City of Fridley('27 684 AT THE TOP OF THE TWINS BUILDING PERMIT x"9/11 Ir � • _ COMMUNITY DEVELOPMENT DIV. ------PROTECTIVE PROTECTIVE INSPECTION SEC. r � � NUMBER REV DATE PAGE OF APPROVED BY � '—'1;,j CITY HALL FRIDLEY 55432 IL ---- 612-571-3450 910-F15 A 9/10/98 10B ADDRESS 6620 Lucia Ln 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6D Auditor's Subdivision #21 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE LuAnn Throndson Same 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Bob & Sons Roofing 4553 Xerxes Ave S Minneapolis - 4 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 fjl REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (18SQ) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 $1,542.00 $.77 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- $51.25 Fre SC $1.54 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. e PLAN CHECK FEE TOTA EE q^��' Lic SC $5 0 $58.56 SIGNATURE OF CONTRACTOR OR AUTRtRIZED AGENT IDATEI EN R P VALID THIS I R P,E$IQ IT 81. INSP fflBATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI 00 NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: CoG p` o Lin n r_ t o Ln Legal Description: Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: MN LICENSE #a 0:510 � S .`5 2110 Tel. # 9 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Length Driveway Curb Cut Width Needed: DATE: q — I ®" APPLICANT: Width Height Sq. Ft. Width Height Sq. Ft. Wid H round Sq. Ft. Ft. + 6 Ft = -0ir'-Z- Estimated Cost: $ (Fee Schedule on Back) Ft x $ = $ Tel. # . STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ /,S5 .001 of Permit Valuation (1/10th%) State Surcharge $ .27 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ y $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 'S-8 S� . STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 571-36U4 1+'AX: (763)571-1287 PERMIT NO.: 2004-02237 DATE ISSUED: 12/02/2004 ADDRESS : 6620 LUCIA IN NE PIN : 133024240031 LEGAL DESC : AUD SUB NO 021 (2ND REV) : LOT 6D BLOCK PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) # WATER TRMT APPLIANCES 0 APPLICANT H P PIPEWORKS 3670 DODD RD STE 100 EAGAN, MN 55123- (651) 365-1340 ,@.d IS THRONDSON LUANN 6620 LUCIA IN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions yf any Or state or local law regulating constructiop, or therform ce of construction. Applicant Date / / Bldg mum PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIWALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 10466 SEPARATE PERMITS MQMRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 1 0 200 0.00 0.00 0.00 0.00 0.00 35.00 0.00 0.00 0.00 0.50 35.50 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR 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** NO. RATE TOTAL JOB ADDRESS l06U LCIS I Gl LA - N Iv Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge 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. DATE: I I A q - ®�'' 20 OWNER -T &Db4 �j 0 1f1 %-00 BUILDING USED AS �PiCil��lC� ESTIMATED COST PERMIT NO. PLUMBING COMPANY W PI NW®(Y-S - 300 bodi FC.t ECL MLA 651)15 SIGNED BY 0 W) TEL N0. Approved By Rough -In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST ~, TOTAL FEE $ LI OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMB0STION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE 3�J Gj() FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTIONAIR VERIFICATION When replacing an existing furnace, 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 existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No( When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When installing a new venting 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 Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances 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 :