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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N1° 2244 .... ..:...�.� ........ Date � e R Owner .. ...... .. Builder.....................I'...................... .AIP ?4 . = Address Address ........... ..... LOCATION OF BUILDING No. ..... !:. .. Street ..... 7 7 .............................. Fart of Lot Lot ......... .. Block ... ........... Addition or Sub -Division ... . ..... ............ Corner Lot ............. Inside Lot .... SetbackoOIO! Sideyard ....�I....... ........... DESCRIPTION OF BUILDING To be Used as: d. �y j .. ... Front .. Depth .07 A. Height Sq. Ft..... �i ... Cu. Ft........ . ont ........ Depth .....eight ......... Sq. Ft......'... Cu. Ft, ........ Type of Constructio ... Est. Cost ..... To be Complete .....ii ... .... . a Inconsideration of the issuance to me of a permit to construct the building described the proposed work in accordance with the description above set forth and in compliance ordinances of the village of Fridley. re, I agree to do all provisions of ........... A . In consideration of the payment of a fee of $:tea . , permit is hereby granted to ... .' .... ....................... to construct the building or, addition' as described above. This pe rm is granted upon the express condition that the person to whom it is g%anted• and his "agents, employees and Workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of tie provisions of said ordinances. A -- ..(, .....t„!f✓:`: uilding Inspector s NOTICE: This permit does not cover the construction, installation or alteration for wiring, sewer or water. 'Be sure to see the Building Inspector for separate permits for these l gas heating, 97 —8h 41$O51 PARTIAL RATE SCHEDULE PLUN)91NG FIXTURE RATES; N0. RATE we Neter Fixtuso$ " $1.00 $�^ Future !'!.•dura Opening 4r $2,00 $ water I $2.00 A x $5,00 b a -4 V1 $5..00 $ M 41 ,; $10,00 �� $ Water Softener HQator III J ' New Grour,d•tain Old Building .G �Hn $ N X b QN ,(GJ C U N .( lot 1 fixtures _ x 51.00 $ JJditLana l rixturan 0 0 u' a �+ a x $10.00 '•�c .•1 2�Q A Q w Jq VapI IA roNp O ns leC G7 V`�1 Ia. U (G sa( .2w l7 f i s c onn et, ran re j 2 1 )rt (R) - Future Connection Opening Connoctad with Sewar 1•) - )low Fixture, Old Opening Wator PARTIAL RATE SCHEDULE PLUN)91NG FIXTURE RATES; N0. RATE TOTAL Neter Fixtuso$ .....-._-x $1.00 $�^ Future !'!.•dura Opening >1 $2,00 $ Kcw Fixture, Old Opening x $2.00 Catch Basin x $5,00 $ t.Witar Hoater - to 99,000 BTU x $5..00 $ 100;C00 BTU to 199,000 BTU x $10,00 �� $ Water Softener __- x $7,90 `� ' New Grour,d•tain Old Building x $5,00 $ Electric water Heater - x $5.00 $ .CAS FITTING FEES; ' lot 1 fixtures _ x 51.00 $ JJditLana l rixturan __- x $1.00 :Cs$ Rsnge to 199,000 BTU x $10.00 $ �� REPAIRS S A I L;SUN TI ONO rirst :100.00 each add. $100.00 or fraction State Surcharge TOTAL FEE $2.00 $ .50 10.50 Job Addreea Department of Uuildinga City of Fridley I Tal, §571-1450 The undersigned hereby make$ application for a permit for the war specified agruaing-to do all work in strict accordance with the Cl and rulings of the Department of Buildings, and hereby declare$ th the faota and rapracantation$ $toted in this application Ara true 11-16-77 Fridley, Mr1, , OWNER JAMES BERGLAND ' KIND OF BUILDING frame - USED AS res. TO BE C014PLETED ABOUT 11-2 '-77 ESTIMATED COST OLD - fUl BUILDING PERMIT NO. �'Ffy1IT 110. �� G • Company _ _ M1Nkc9,GASC0 Signed By Tal. No. ROUGIi INSP. Date FIN1}I. INSP. Data ' APPROVAL FOR PERMIT MIIIIMUM FEE FOR ANY PLUMBING PERMIT I9 37.50 560-3450 ' City ANOKA COUNTY 6431 UNIVERSITY AVENUE NE September 18, 1978 FRIDLEY, MINNESOTA 55421 Mr. J. G. Berglund 1670 - 77th Avenue N.E. Fridley, MN 55432 Re: Change of House Numbers Dear Mr. Berglund: It has been necessary for this office to change the address of your house FROM 1670 - 77th Avenue N.E. TO 1670 Osborne. Read N.E. LEGAL DESCRIPTION Lot 2, Block 1, Spring Lake Park Lakeside Addn. We have notified the Post Office Department, Minneapolis Gas Company, Northern States Power Company; Northwestern Bell Telephone Company and various departments in City hall of this change. Sincerely, Qj-aL- DARREL G. CLARK Community Development Adm. DGC/mh 560.3450 CitCy ® rtalle ANOKA COUNTY 6431 UNIVERSITY AVENUE NE September 18, 1978 FRIDLEY, MINNESOTA 55432 Minneapolis Post Office Department Superintendent of Delivery 1st & Marquette Avenue Minneapolis, Minnesota 55402 Re: Change of Address City of Fridley Gentlemen: We are listing the following change of address in the City of Fridley; Nom: Mr. & Mrs. J. G. Berglund FROM: 1670 - 77th Avenue N.E., Fridley, MN 55432 TO: 1670 - Osborne Road N.E., Fridley, MN 55432 LEGAL DESCRIPTION: Lot 2, Block 1, Spring Lake Park Lakeside We have notified the occupant of this change and we would appreciate it very much if you would change your records accordingly. Sincerely, I DARREL G. CLARK Community Development Adm. DGC/mh CC: City Water Billing Dept. City Assessing Department Minneapolis Gas Company - Brooklyn Park Office Northern States Power Company Northwestern Bell Telephone City Voters Registration Homeowner R SUBJECT PE City of Fridley 4 Q 5 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. Ir COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ®7S/ 1 1 � ; � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 4/17/96 JOB ADDRESS 1670 Osborne Road NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Spring Lake Park Lakeside SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Williams/Hill 1670 Osborne Rd NE 780-9449 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 ❑ ADDITION ❑ ALTERATION Q REPAIR ❑ MOVE ❑ REMOVE R 8 DESCRIBE WORK Reside House with Vinyl Siding 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 @ 1' 000 $ .50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W 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- $ 34.75 Fire SC $1.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE OTAL FEE ' $36.25 3NATUR OF CONT C 0 O THORIZED AGENT 0 TEI PRO LY VVIED THIS IS V UR PERM- WILRI r � ATURE OF OW NE ATEI DG INSP GATE R NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: Legal Description: Owner Name & Address: Contracts Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Effective 3/1/96 �� Cel. # 7Lb - ENSE # Tel. # %f 6 — 5?A19 - Length Width Height Sq. Ft. -� Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed:+ 6 Ft = Ft x = $ DATE: / 7 . APPLICAN : Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $`�. �%� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ $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 $� a S STIPULATIONS: SUBJECT City of Fridley 25083 AT THE TOP OF THE TWINS BUILDING PERMIT f 1 � �•, LV ------ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r � i NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/21/97 JOB ADDRESS 1670 Osborne Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Spring Lake Park Lakeside SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shawn Hill 1670 Osborne Road NE 780-9449 3 CONJRACTOR 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 ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct a 16' x 28' Deck 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. WARNING Before digging call for all utility locations 454-0002 REQUIRED BY LAW 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 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 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 ��jj 973 $1.99 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3, 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- $87.25 Fire SC. $3.97 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $93.21 S tATUREOFCON-R TOR R UTHORIZEDAGENT IDATEIW-�-HEN PROPE Y,VALI/fQATED THIS IS YOUR PERMIT 1,- `ry0 `a% L�// " fB OG INSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) NEW [ ] Effective l/l/97 ADDN ( ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: I V C)s(r M Legal Description: Owner Name & Address:��A�UJ l / (. 7�'/, /I tTel. # Contractor: MN LICENSE # Address: Tel. # 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/Grounk5 �,Sq. Ft. Y S 7 OTHER: Construction Type: �� Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: FL + 6 Ft = Ft x $ _ $ DATE: -7 C APPLICANT! 44 Tel. #�C! Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: a� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 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 [ ] 7 SUBJECT I NO. City of Fridley 30462 AT THE TOP OF THE TWINS BUILDING PERMIT i L -Reettiniquuo' COMMUNITY DEVELOPMENT DIV. - ------ � � PROTECTIVE INSPECTION SEC. r 1 � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 l J` 612-571-3450 910-F15 11/1/99 % JOB ADDRESS 1670 Osborne Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 1 Spring Lake Park - Lakeside SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shawn Hill 780-9449 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO AMEK Construction Inc. 140 W 98th St #103 Bloomington 55420 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 ?YX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (17 S 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 SQ. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN BG 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 $1486 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $.74 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- $54.00 STRUCTION OR THOF CONSTRUCTION Fire SC $1.49 e/ PLAN CHECK FEE oll TO L FEE 1 Licens C $5.00 61.23 GNAT E F CON' ACTOR OR AUTHORQED AGENT (DATE, N P OP ALID D THIS IS Y UR PER / QQQ S,GNATURE OF OWNER,,F OWNER BUILDER, ,DATE, BLD ,NsP DATE 7 NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FANULY AND DUPLEXES R-1 AND R-2 �(p BUILDING PERMIT APPLICATION Construction Address: -70 C5 ne Legal Description: Owner Name & Address: U"n �i c G� Tel. # Contractor: -49 MN LICENSE # Address: woL(/� 7 g��- �`� - J� i �� G� Tel. # 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 _ GARAGE AREA: Length Width _ DECK AREA: Length �?. OTHER: I Construction Type: ,� P (a+ e Tag - Driveway Curb Cut Width Needed: 1p Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. a R-� 44stimated Cost: $;�� 1'1U 6 Ft. + 6 Ft = Ft x $ M1 DATE: l (� APPLICANT: �!� �G;;A Tel. TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ 5V Fee Schedule on Reverse Side Fire Surcharge $ /. �� 9 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ • d 0 $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 STIPULATIONS: l f� 70 U� 'q dxf A-.)/V 97i� /f LoA/A ON RSL Tl� GfIZ�/`1L Ir- AWi- f. / W t WtAt,, ZA0127i L Aar fes. � iii r•�s �/� �® � ll� �L � rs✓� � Co �g� r�-!� 6- wPt4-1 T � � A, STS f7e- t pk /" Building BUILDING Permit No.: — 13� Inspections Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-304 Fire Surcharge CITY OF FRIDLEY Date Rec'd: 10 -if- -Q 1®' , ' D� YOUR E-MAIL ADDRESS Gt%�C�S / �q�. Cdr DATE SITE ADDRESS �� d /� VxMc,�� " Curb Cut Escrow THIS APPLICANT IS: OWNER ❑CONTRACTOR $ $450 Conservation Plan Review PROPERTY OWNER/ NAME: ! Sewer Main Charge TENANT ADDRESS: 1(0 --lb OSo&)"i- Wz- CITY (Zl�l pCP>l STATES IP r75e45 Z PHONE: ( 51 its i 2S CONTRACTOR NAME: 'q q- - STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE ASINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOFg DRAB TILE ❑ DECK [3 SIDING OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ADDITION ❑ MAINTENANCEIREPAIRODELING DESCRIBE WORK BEING DONE: INSt�' n- , �-rgp(11 DOwNS7it�.S 'a TWO euf�rrJ W�-5. �,F wtuV SIZE OF IMPROVEMENT LENGTH C e WIDTH HEIGHT Sq. Ft. OO OF NG NUMBER OF SQUARES ❑ HOUSE ONLY ❑ 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: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ❑ Vinyl ❑Soffit ADDITIONS & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I . 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 & 1 TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ♦ TTTT / T G'. ALL FEES ARE BASED ON VALUATION, INCL.UDIN(: Tnli UUP 1 UV J ROUX tu"J ir"ki r ac�J 0' (USINr' THF 1997 U.B.0 FEE SCHEDULE) TOTAL_ JOB VALUATIONS -79'D. q2 OCCUPANCY TYPE Permit Fee $ 3` z. toy See Back Page for Fee Schedule Plan Review $ i , ;z 65% of Building Permit Fee Fire Surcharge $-1-2 .001 times the total job valuation Surcharge $ 44S .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 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 $ 09 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 pei conformance with the ordu ces s permit but only an applicat n for plan in the case of all work hich : SIGNATURE OF APPLICANT and I acknowledge that the information above is complete and accurate; that the work will be in codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a ermit and work is not to start without a permit; that the work will be in accordance with the approved tires review and approval of plans. Iq I/ PRINT NAME P- �Il- W S DATE ly - / & - 0 6 Building PLUMBING Permit No.: - t Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Reed: /Date DATE t O - D �pn YOUR E-MAIL ADDRESS � qo&*A) wis- p_ �OD(ge'!4 tt oz). LUQ "� L SITE ADDRESS 16-76 D S QO P� 0 N, T -XbAiq A 5',q3 L THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY NAME: ? OWNE� n ADDRESS: _ J Lo 7 d 6 5 90 P Ni- 9b 1J1J42___ CITY (tel �L �l.2i STATE�ZIP� 2 TENANT PHONE: & 51 20 g B 8 �5- S CONTRACTOR NAME: S CLP STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH PHONE FAX APPLICATION PERMIT TYPE X.4INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: NEW ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK W S'O,L P -M- G{gow 1(3 611`52-MilV7 +t4 ALL / / EtjrAIL5 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.shouldreflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FO"ROJECTS WHERE LABOR EXCEEDS -S500, FEES ARE BASED ON $10.00 PER FIXTURE,EXCEPTVi'3 REAOTED.:<RI {TARES .. INDICATE TOTAL NEER OF EACH BELOW) d SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATH —BATHTUB —GAS PIPING (nm cn-rumNm) SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _ _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER 11 d _ .,: _. _ .. ._ . �.� _ .. ,. w10, " . �� PSA: Permit Fee $ Number of fixtures @ $10.00 —� x $10.00 = $ 5, 6_ c3U Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ 50, 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 mid codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only permit and work is not to start without a permit; that the work will be in accordance with the aallk approved plan in the ch requires review and approval of plans.//�� /-SIGNATURE OF APPLICPRINT NAME. f"tNp P -W W Z5� DATE ' 010 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 z %D k/,4(//q > r aUC �2A1, 2 C, +j 6A C) /"l�. .y ttOil-c,G y 6 , �"Og&j w &gwlt )670 05� CITY OF FRIDLEY BUILDING INSPECTION S Effective 4/1/2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES J JOB ADDRESS 1&'70 a5&I-fie RATE SCHEDULE Fee Total T Residential Owner Lea -14 PG(XIAII SO l/1 Furnace Shell and Duct Work, Burner & v/ also Replacement Furnace $35.00 $ 7 Sdo Building Used As S efl. GL./ Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST PERMIT NO Fireplace insert $15.00 $ Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units % Circle One (Steam) (Hot Water)o.�(Wa�rmAir) Trade Name igyyl2X ► C a h � a"40L Size N *Air Conditioning - All Sizes $25.00 $ S BTU (Std YVI HP EDR 92 7a Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater on work less than $500.00 The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ 0.50 (if permit fee is over $1,000 multiply by .0005) TOTAL FEE $60"�-o *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 HEATING CO [?-- + 14 )E(!� � IL Signed Tel # q/Z FAX # SC e- Date �� 6 Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina 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 installina 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