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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N4 C528 Address Address AL LOCATION DING No. p A j0A A Part, Lo Lot Block ddition or Sub -Di vision Corner Lot . Inside Lot — Setback ,,. , � Sideyard -J - Sewer Elevation .— Foundation Elevation DESCRIPTION OF BUILDING To Used • ti Front Depth . Height I& Sq. Ft. &77 Cu. Ft toWe� SFr t Depth tSq. Ft. Cu. Ft. Type of Constructioqm�._. _ Fast, fyo–W++Q 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 all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $-'-r 7 , permit is hereby granted to 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 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, maintenance, re and moving of buildings within the city limits and this permit may be revoked at any time upon violatig f any of the provisions of said ordinances. _ _ Building Inspector NOTICE This permit does not cover the construction, installation for wiring, plumbing, gas heating, Sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA N �%� /,. der 1 r��✓�o Owners Name Address LOCATION OF No. / Street P t o Lot Lot Block z tion or u sion Corner Lot Inside Lot Setback 3 0,S Side -Yard_ _ SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be ued as: r Type of To be Completed DESCRIPTION OF BUILDING I DeDth '-)� - - Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. ted Cost The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that 1 the fact dAre eesentgV stated in this plic ion are true and correct. DATE -� SIGNATURE (A Schedule of Fee Costs can be found on the Reverse Side.) Application for Power Plants and Heating, Coding. Ventilation..Rehiigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 S. 0 each add. 60,000 BTU ....................... 2.00 $ _ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 ....... :...... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTL) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ s Q ROUGH FINAL Dept. of Bldgs. Phone SU. �50= City of Fridley: The undersigned hereby mak>es ation for a permit for the work herein specified, agreeing to do all worstrict ordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Q�\ � Fridley, 112��� �- � / , 19 — Owner) - Kind of Building Used as To be completed about u Estimated Cost, $ 1 O]d�New. Building Permit No. �permit No. S DESCRIPTION OF WORK :/0 HEATIN r POWER steam, Hot WaWarm NNoo- Trade Nam Size No, Cr- `0 G Capacity. Sq. Ft. E.D.R lffG G H.P. Total Connected Load Kind of Fuer BURNER — Trade Name Size No Capaci I Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) .6' Ek. 42 2M 7-$9 01j City of Fridley VIV Application for Plumbing and Gas Fitting Permit DepL of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK 2 t,// �j2 e (/ 12 y Z)R /yE Number, Kind and Location of Fixtures Location y 4l NO. RATE TOTAL Number Fixtures ...................... d x $1.50 a m Z u°i x w Z • F • N WATER HTR. GAS ELEC. Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x O $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ --rel Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ Base 1st / 2nd _ 3rd _ 4th Future Connection Openings Connected with Sewer � New Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... d x $1.50 $�"v Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ --rel Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Ss� G'y Description ................................................$ TOTAL FEE $ SO City of Fridley: The undersigned hereby makes application for a permit for the work herein specified; agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fddley, nflnn J U L 17 1961 19_ Owner C% SSF - �i� / e << a o A/ Kind of Building Used as D W. / To be completed about Estimated Cost, $ Old—New. Building Permit No fO v Permit No. LONDON PLUMPING CO. Signed By�Lwrs./� �^ Business Phone No ROUC3H'' FINAL a a 2M 7-59 • 'Y5-dv� City of Fridley, Minn. N? 7673 BUILDING PERMIT Date: June 2, 1965 owner: Jack Hlo richt Builder P. D. Q. Claim Service Address ZWXX 241Mercur7 Drive N. E. Address 6305 Pry ant Ave. So. LOCATION OF BUILDING No. 2+1 Street Mur== Dr va K- E- Part of Lot Lot _ Block �' Addition or Sub -Division _ Sylvan Hills, Plat rt+. Corner Lot — Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation To be Used as: DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Front Depth Height Sq. Ft. Type of Construction Est. Cost 86,36.20 To be Completed Storm Damage Repair 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 t forth and is pliance with a'll ovisions of ordinances of the city of Fridley. In consideration of the payment of a fee of it 10,90 , permit is hereby granted to Service 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 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 reg location, construction, alteration, maintenance, repair and moving of buildings within city limits and permit may be revoked at any time upon violation of any of the provisions of said o Allen Jensen Building Inspector NOTICE: Thb permit does cot cover the eondrucHon, leddl = for wkleg, plumbiag, gee heating, awer or water. Be sure to we #6 BaHdiag lespaxor for apue a pernft for thea Nems. V APPLICATION FOR B ING.PERMIT CITY OF FRIDLTYy IdNNESOTA J OWNER'S NAME BUILDER D ADDRESS /� c ADDIt2SS LOCATION OF BLUDING No, Street part of Lot,. Lot Block Addition' or Subdivision Corner Lot Inside Lot_,,.$etVatk Side Yard SEWER ELEVATIQN FOUNDATION EUVATION Applicant attach to thie form, Two Certificates of. Survey of Lot and proposed build- ing location drawn on these Cettificates. To be used as: DESCRIPTION OF BUILDING front Depth Height Sad. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost 4,, 3 i- 2- O _10 -.be -Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work ift strict 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. JSchedule of Fee Costs can be found on the Reverse Side). 4W 4t 4 5 41 City of Fridley, Minn..`' N° 10071 BUILDING PERMIT Date: December 27, 1968 Owner: Jack Hobright Builder McCall & Ompany AddrQ88 _ . 24 X Xercury prime Address 1618 Wast Lake St, M i nnaa.nnI J-8 LOCATION OF BUILDING No. 2_ Street , Mey-e-nv �r I?riva Part of Lot Lot _ _ 8 _ Block Addition or Sub -Division Sylvan Hills Plat 4 Corner Lot —_ Inside Lot --- Setback —_ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Repairs for fire Front _ _ Depth Height Sq. Ft. cu. Ft. House Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Fast. Cost -$3,000 _ __ 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 aJl provisions of ordinances of the city of Fridley. _ In consideration of the payment of a fee of $_ 18 - 00 ---, permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and. moving of buildings within the city limits and this permit may be revoked at any time upon violation of the provisions of said ordinances. NOTICE: 'lids permit don not cover the construction, hufaWon for wiring, plumbing, gas hosting, sower or water. Be sore to as the Boiiding inspector for separate permits for thea home. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, KMNESOTA OWM Is NAME s ®L� 1� % l'i BUILDER /" 1, C /-7,1-,(- J (2 C+ , ADDRESS 7'-/ / - )-j F A a u /3 V n &.t � t ADDRESS ) L / q J=,s t- d - o K r, LOCATION OF BUILDING NO. STREET 1I s c, cl? o lig LOT BLOCK ADDITION OR SUBDIVISION COR'K'ER LOT INSIDE LOT SETBACK SEWER ELEVATION TOP OF FOOTING SIDEYARD Applioant attach to this form Two Certificates of Survey of Lot. and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: 1-7.t /$ S lq /'- T 1- A l-;�-tj r7 - Front Front Depth Height Square feet Cubic Feet Front Depth Height Square feet Cubic Feet 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 rulings of the Department of Buildings, and hereby declares that all the facts and i,,:.Aesentations stated in this application are true and correct.Z DATE1 �' �7'_ SIGNAL. (Schedule of Fee Costs can be found on the Reverse Side.) SUBJECT City of Fridley 33 � 2 = AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. I fr C)rl r PROTECTIVE INSPECTION SEC. 5q i r NUMBER REV DATE PAGE OF APPROVED 8Y CITY HALL FRIDLEY 55432 763-571-3450 910415 10/l/02 JOB ADDRESS 241 Mercury Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 Sylvan Hills flat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Greg Carlson 241 Mercury Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contr 6331 Riverview. Ter NE, Fridley, MN 55432 574-9966 d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 4031 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE ❑ REMOVE B DESCRIBE WORK Reroof House & tuck -under garage (16 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 1 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 $1,715 $.86 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- $63.15 Fire SC. $1.72 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION . PLAN CHECK F E TML FEE L e C 0 $ 70.73 I SIGNATURE OFCON TRACTOR OR AU ORIZEO AGENT I ATEI HE PRO /—K— Y VALIDA ED THIS II' $�,Uw�� �" S,GNATUAE OF OWNEROWNER BUILDERi DATE, GIF BL INSP DAtE NEW [ ] CITY OF FRIDLEY Effective 1/12002 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: Tel. # Contractor. MN LICENSE # -A) 5 Address: 633 / Tel. # S % �/-5;p,1, e!�' 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. FL GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hg Ground Sq. Ft. OTHER: f e. =:Ag - � t Construction Type cAWd-i-o-r Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE:/ ®L APPLICANT. Tel. # S 7 � Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763471-1287 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 1ftf&r&14I101,'WM 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'Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ � STIPULATIONS: ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 241 MERCURY DR NE 143024320024 SYLVAN HILLS PLAT 4 LOT 8 BLOCK 1 ELECTRICAL RESIDENTIAL ADDITION/ALTERATION PERMIT NO.: 2004-00705 'xO9� DATE ISSUED: 05/13/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE AIR CONDITIONER. # INSPECTIONS 1 APPLICANT SUBURBAN ELECTRIC 109814 ST HANOVER, MN 55341 OWNER CARLSON GREG, GLEN & ANGELA 217 69TH AVE NE FRIDLEY, MN 55432 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 3800 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 construction or the performance of construction. Applicant Date Bldg Insp. Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT N 2004-00708 6431 UNIVERSITY AVENUE NE - FRIDLEY, MN 55432 DATE ISSUED: 05/13/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 241 MERCURY DR NE PIN : 143024320024 LEGAL DESC : SYLVAN HILLS PLAT 4 : LOT 8 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 3,033.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL AN AIR CONDITIONER (LENNOX 2 TON) # A/C UNITS I # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 APPLICANT HEATING PERMIT MINIMUM FEE 0.00 SEDGWICK HEATING & AIR COND LLC FURNACE SHELL/DUCT WORK 0.00 8910 WENTWORTH AVE S GAS RANGE FEE 0.00 MINNEAPOLIS, MN 55420-2853 GAS DRYER FEE 0.00 (952) 881-9000 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 25.50 OWNER PAID WITH CHECK # 069968 CARLSON GREG, GLEN & ANGELA 217 69TH AVE 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 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 construction or the performance of construction. Applic Date Bldg Insp 1 Dat J l SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. b, �'WaJ?7 CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning -All SizesQ> 1, l ?l (-J_,1zPn) AH Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Mi'Qimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ $10.00 $ $10.00 $ $10.00 $ $25.00 $—d-504 Commercial/industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR Wa JOB ADDRESS Owner_ / Building Used As�/�z C ESTIMATED CO PERMIT PERMIT NO t2kC / ` ��1 DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size No. 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 $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $� HEATING CO $ J,S.66 *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Tel #&gJ-474�y46�� ✓ / / ,V --W FAX # V Date Approved by Rough -in Date Final Date�a7 / D 15�-1 11 1 OITY OF FRIDLEY BUILDING INSPECTION 6431 Univ&sity Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct ,Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) -1% of Value of Appliance or Work Minimum Fee $15:00 for Residential or 5% of cost of Improvement whichever is greater n Effective 4/1/2004 APPLICATION FOR POWER PLANTS -AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS Z� ' ` ►C'� �Y ee Total /) Owner Ca 0 yn ��'✓ i S d'� $35.00 $ D5 O® Building Used As Cots `-&P'r C-Q� $10:00 $ ESTIMATED COST 3 © PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units__L_ Circle One (Steam) (Hot Water) ( armAir Trade Name �-VlO uvl Size No. Leto , ac c*> $25.00 $ BTU 000 HP EDR Fuel r1 Total Connected Load 3b S t- I Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR $ Burner Trade Name BTU Size No. 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 $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ y HEATING CO $ 50Sign Tel # 9S2'4 l" 000 FAX # Date *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date 14 FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMfTS .6 COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR 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 (j(f 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 k) 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 FL., rte- BTU Input r N Appliance #2 Type H— BTU Input Fan Assisted or tab Appliance #3 Type BTU Input Fan Assisted or at Total Appliances Total Btu Input Common Vent Type C11055 (S Vent Height Diameter S inches Appliance #1 Vent Connector Heighta-�Lft Length �� ft Diameter in Type C -I mss Appliance #2 Vent Connector Height _� ft Length � ft Diameter in Type �L Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date From: 7635020227 Page: 1/4 Date: 12/3112008 8:56:06 AM Building COTAL JOB VALUATION BUILDING SiN TXIJE 1997 UBC FEF: SCHEDULE) Permit NO.: Inspections OCCUPANCY TYPE RESIDENTIAL APPLICATION $ Received By: 763-572-3604 $ 65% of Building .Permit Fcc Firc Surcharge $ .001 times the total job valuation 763-5024977 FAX CITY OF FRIDLEY (.. I a .0005 x Permit Valuation Minimum $50 n Date $ _ T $5.00 (State Licensed Residential Contractors) CFFECTNE I.1.08 $ $1825 per SAC Unit (Plans to MWCC for determination) DAT11 ' G? _ . YOUR EMAIL ADDRESS b yn ihers rm / SITE ADDRESS !f-I'y Lei% 1)'r e e $450 Conservation Plan Review THiS APPLICANT IS: ni�i 0 OWNER WC:ONTItACTOR Fee Determined by Engineering PROPERTY OWNER/ NAME: Agreement noccssary ( ) Non Necessary ( ) TENANT ADDRESS; 62 ATV3 14&1P L-? S &7 Make checks payttble tot City of Fridley Attach PHONE; NAME: w ,J MAZ ADDRESS;CITY f.,TATFfiP,�S�/3 SUBMIT A COPY OF PHONE r 7 ' FAX -- �� YOUR STATE LICENSE L STATti LICENSE EXP #�7,_5_ � T)ATi; _GO ,3� - / el PROPERTY TYPE 13 SINGLE FAMJLY/NEW CONSTRUCTION SIZE O TWO FAMILY/NEW CONSTRUCTION STORrr.S PERMIT TYPE 4 ADDITION O GARAGE/SHED O WINDOWS 13 BASEMENT FiNiSH Q ROOT• © DRAIN TILE 0 DECK ❑ SIDING 19 OT R I 13SWIMMING POOL TYPE OF WORK: 0 NEW HOME: CONSTRUCTION 0 ADDITION I)eMAINTENANCEMEPAJR CI REMODELING .DESCRIBE WORK BEINGDONE; (J � Q L� gc P GU SIZE OF IMPROVEMENT LENGTH WIDTH H IGHT SQ F!' A0_0JEEN.G ❑ HOUSE ONLY NUMBER OF SQUARES O HOUSE & GARAGE BASEMENT REMOREI XQA JAWT: Q AT TAC'HED GARAGE 1, 2. Existing Floor Pian Proposed floor plan PROPOSED SiZE; © DETACHED GARAGE 3. List afstnrctural members Lobe used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, O vinyl CiSoffit ADDITIONS. & PORCHES 5.UA 1Z. ❑ Aluminum O Trim I. Site Pian/Survey Showing the existing structures O Other 13 Fascia and proposed project WINDOWS 2. Two sets of cotisintclion plans iN EXISTiNEXISTiNG OPENINGS ❑Yes ONo LOCATION OF WINDOWS 3. Energy Calculatlons OR FOR NEW OPENINGS-DESCRIDE SIZE OF OPENING CHANGE.$ &- TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS AUL rn.n.0 Arta: 15A WS;) 4JIN VALUATION, INCLUDING TAE CO, OF LABOR AND ii?ATFRIAL.S: COTAL JOB VALUATION SiN TXIJE 1997 UBC FEF: SCHEDULE) OCCUPANCY TYPE Permit Fee $ ®l S See Back Page for Fee Schedule Plan Review $ 65% of Building .Permit Fcc Firc Surcharge $ .001 times the total job valuation Surcharge $ (.. I a .0005 x Permit Valuation Minimum $50 License Surehargc $ _ T $5.00 (State Licensed Residential Contractors) SAC, Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 61 =_ ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement noccssary ( ) Non Necessary ( ) Total Due $ S &7 Make checks payttble tot City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I herebyp apply fat a building permit and I acknowledge that the information ahvve Is complete and atcuratc; that the work will be in conformance with the ordinances and codes of the Clty of tridley and- with the Minnesot Construction Codes; that I understand this, Is fiat a permit but only an application for a permit ind work is not to start without a permit on Rita; that lh ortt will be itt accord nc h t proved plan i ca�c ofall work which requires roview and approval of plane. v SIC=NATL?,E OF AP ICANT RINT NAME • ra , 1 ��1TAW7�A r, IM Ron Miller ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND LIMITS OF YOUR POLICY. �G "-7/ iN CIuC�1 WixSoAV% 64 E I r./j 41A il?UST 460 �uo� UsF ��e��� e� u�r lowdItf R. Miller Construction, Inc 7671 Central Ave Suite 101 Fridley, MN 55432 763-571-3514 Lic. #6354 12/31/2008 Estimate: CARLSON_GREG Claim Number: 23L306208 Insurcd: CARLSON, GREG Policy Number: 93ED67170 Property: 241 MERCURY DIt Type of Loss: Fire FRLULEY, MN 55432-4906 Deductible: $500.00 Home: (952) 835-40211 Price List: MNMN7F8D 1 Restoration/Service/Remodel F = Factored In, D = Do Not Apply Date of Loss: 12/22/2008 Date Inspected: I2/29/2008 Summary for Dwelling Line Item Total Material Sales Taxn 6.500 /n x 601.20 2,364.32 Subtotal 39.08 General Contractor Overhead @ 10.00/0 x 2,403.40 2,403.40 General Contractor.proft @a 10.0% x 2,403.40 240.34 240.34 Replacement Cost Value (Including General Contractor Overhead and Profit) Less Deductible 2,884.08 (500.00) Net Payment $2,384.08 Ron Miller ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND LIMITS OF YOUR POLICY. �G "-7/ iN CIuC�1 WixSoAV% 64 E I r./j 41A il?UST 460 �uo� UsF ��e��� e� u�r lowdItf CARLSON. GREG Attic 1,050,00 SF Walls 1,040.00 Sr Floor 320.00 Sr Long Wall .R. Miller Construction, Inc CARLSON_GREC 1,040.00 SF Ceiling 208,00 SF Short Wall 12131/208 LxWxH 40' x 26, x s' 2,096.00 SF Walls & Ceiling 132.00 LF Moor Perimeter 132.00 LF Ceil Peri AESCRIPTION motor QUANTITY UNIT COST RCV I. R&R Blown -in insulation . 16" depth . R44 1.040.00 SF 2.08 2,163.20 2. R&R Baffle vent 40.00 LF 1.32 52.80 Totals; Attic 2,216.00 Line Item Subtotals: CARLSON_GREG 2,216.00 Adjustments for Base Service Charges Insulation Installer Adjustment 148.32 Total Adjustments for Base Service Charges: LINr,- ITEM. TOTALS: 148.32 CARLSON_ GRED; 2,,164.32 Grand Total Areas; 1,056.00 SIF Walls 1,00-00 SF Floor 320.00 SF Long Wall CARLSON—GREG 1.040.00 SF Ceiling 208.00 SF Short Wall 2,096.00 SF Wails and Ceiling 132.00 LF Floor Perimeter 132.00 LF Ceil, Perimeter Page- 2 Building $ BUILDING Permit No. Inspeekions 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY nate o JAS 763-502-4977 FAX $ $5.00 (State Licensed Residential Contractors) SAC Charge $ EFFECTIVE I-1-09 Curb Cut Escrow DATE C YOUR E-MAIL ADDRESS iM r I ev^ 04), ).S'- tD Q (.e.? e.5 t-, /'I eI SITE ADDRESS ,;k4 I M & CCU CY OP. EP 1—�_a3=-K :3.q' THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: e.-(` t -=q 14-.5_/` (�S TENANT ADDRESS: 9D® / CITY JJ� I`CLI try STATE/(; ZIP Agreement necessary ( ) Non Necessary ( ) PHONE:S�vZ — S CONTRACTOR NAMEZ mt`I 1`ey— SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # _ TE EXP DA "' - '-6 3 AND CERTIFICATE OF _ ADDRESS: / 71 ��fmj Ce �t zi �fJ CITY STATE GIP INSURANCE PHONE _� —� ar% FAX PROPERTY TYPE SINGLE FAMILYINEW CONSTRUCTION SIZE R� TWO FAMILYINEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ADDITION ❑ MAINTENANCE/REPAIR REMOD1EL� IN�G1 DESCRIBE WORK BEING DONE: &(hD VC $— f °C Q(( N d� �j� bj �t I`c F'I = /4 est !� �Cs 1°!11 �S ra-petz SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 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: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 02 C) 95;1— OCCUPANCY TYPE Permit Fee $ `� _ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ o .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$. Erosion Control $ $450 Conservation Plan Review Park Fee - $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ (p-�, GCj Make checks payable to: City of Fridley Attach Stipulations 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 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 work w ich re,,,vi yes review and approval of plans. SIGNATURE OF APPLICANT / ___ PRINT NAME al C Aj ` / g�f DATE '� Ci