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PRE 2010 DOCSDate: Owner: Address - z i/- 0- City of Fridley, Minn. BUILDING PERMIT x® 4005 - Builder-------- ---------------... -._..._. . Address....................... _............. ......... _... _............... ___._.. _..._.._......__..._-_ . __ . L-OC'ATION OF BUILDING No... .. . 0 ........... Street .................. ....... -..... Part of Lot ............................ .......... ................................ Lot ........... ro2............. Block ....._..-................. _................. Addition or Sub -Division .. - ........._.... _.... ..._..�-�✓..._ i � `f � ... Corner Lot .................................... Inside Lot ....................................... Setback..................��....... Sideyard..lD.......... (�...../...............---..........._.._.._.. Sewer Elevation .................... .............. .............. _............................ ........................ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: pall N ................_......._........... Front T.�...-T .. Depth �r-�...- Heightf......-..Q.. Sq. Ft0�5...�..` Cu. Ft. z. o.o� - .............. _...................... _.............. Front ..... -................. t. Depth ................. _.. Height ��....._................. Sq. F....._...------...._.. Cu. Ft. ....._............. ... Type of Construction...................................................... Est. Co�.....7 �._a_..... To be Completed ....._---.........._............._. In consideration of the issuance to me of a permit to`co the/�l�ng bed above, I agree to do the proposed work in accordance with the description above et forth an t�( co// ance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $.6..o�� ,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 violationX an f tl rovisions of said ordinances. Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these items. City of Fridley, Minn. BUILDING PERMIT N? 5 5 4:2:) 61, Date: ..' Owner: Builderen W. ffifieEz. Address Address - TIO F. BUILDING No. Street _ _ Part of Lot Lot ___ _ Beek Addition or S4 on — ___ ' OF Comer Lot ....._��,e"'- Inside Lot whack Sideyar_ Sewer Elevation _ Fo�tion Elevation DESCRIPTION, OF BUILDING To as: lop - Front Depth Height Sq. Ft. �� Cu. F'tSOMIK+G1 From Depth ei t Sq. Ft. _ __ Cu. Ft. r Type of Construction Est._-�a' - 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 all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ %, 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 any of the provisions of said Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating,. sewer or water. Be an to we the Building inspector for separate permits for these henna 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Address J LOCATION OF BUILDING No. / Street L",! ��_ part of Lot Lot Block Addition or Subdivision Corner Lot i Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used ass �y Front Depth Height ® �" seq. Ft... . Cu. Ft. d � Front Depth H eight Sq. Ft. Cu. Ft. Type of Construction ---I Estimated Cost - To be The undersigned heredy 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. _ ;I j adule of Fee Costs can be found on thA Reveiae Side). CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1991 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS O D New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture 3 $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00.n.l V. W '1991 Sump/Receiving Tank $ 7.00 ,, II Water Treating Appliance $10.00 Owner S4 -C42 H E,.J 9 Itt4 Water Heater -Electric $ 7.00 Water Heater - Gas $10.00 Building Used As 91rs; Jr_t4 -AL b v4re I I i ja Gas Range $10.00 4 % Gas Dryer $10.00 Estimated Cost 10100 . - PERMIT NO. / � �� Back Flow Preventer Required ( )Yes () No Type $5.00 PLUMBING COMPANY 14 _:�t4G- Reinspection Fee $30.00 SIGNED BY TEL No.Az� -Z3z/ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance Approved By Rough -In Date Final Date 9 State Surcharge .50 „ MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT 18 $15.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE HOUSE HEATING TEST RECORD ����� ADDRESS �L ��®�� APT. L OR [SUBURB OCCUPANT OWNER_� � -0 4 HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY Electrical Work .By Gas Line B TYPE OF HEAT GA FA.: L"—_HW STEAM SPACE HTR. UNIT NTIL OTHER GAS DESIGN CONVERSION MAKE _+%'� `2 MAKE OF BURNER Model Model Serial Mo.. BTU Rating INPUT ��% ��� MAKE OF FURNACE CONTROLS THERMOSTAT Heat Plug Volvo- Limit alve Limit Limit Setting �9 Fan Setting Pilot Type Pilot Make Pilot Model Model �e'( Vent Size � KIND OF LINE t©v SIZE NONE Draft Hood `� Regulator Filters Size ' ee2>—Number Chimney Location In Outside Chimney Construction Smoke Bo r �— Wirin Pitot Timing ,���'� Draft �e�`` -4-1fTest 9 0,46 Tag e,'- L.W. Cut Off Door Pressure — Lighting Inst.y Ir /� Pressure Percent CO2 6 Date Tested Input CFH_ Percent 02 Company Testing Stock -it CO Name of Tester SUBJECT PER City of Fridley 3 AT THE TOP OF THE TWINS BUILDING PERM IK'2624 r o r � i -------COMMUNITY DEVELOPMENT DIV. j L �/j� A2S,5 � PROTECTIVE INSPECTION SEC. r � NUMBER REV DATE PAGE OF APPROVED BY 'e-4 � CITY HALL FRIDLEY 55432 L 612-571-3450 910-F15 6/15/98 Drive JOB ADDRESS 700 Overton Stxaet NE 1 LEGAL LOT -NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 6 Brookview Terrace 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Steve Hengen 700 Overton Street NE 572-9426 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Pat Boland Construction 3233 140 Ave, Andover, MN 55304 421-1344 20010173 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 Ij ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 32' x 16' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING Before digging call for all utility locations 454.0002 REQUIRED BY LACK 7 Ri 'r'E PERMITS REQUIRM . FOR WIRINGIA HEATING, PLUMBING AND 510 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 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 $45,000 $22.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 529.75 Fire SC $45.00 STRUCTIO HE PiERFOR CE OF CONSTRUCAION. LAN CHECK FEE TOTAL FEE L Li ense SC $5 00 $602.25 SIGN TURE OF NTRACTOR A AUTHORIZED AGEN I AEI WHEN PROP Y V LIDATED THIS IS YOUR PERMIT 04 91LDG INSP PATE S,GNATUREOFOWNER,IFOWNER BUILDER) IDATEI t NEVA/ ] Effective 1/1/98 ADDN CITY OF FRIDLEY ALTER ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2' BUILDING PERMIT APPLICATIONr ConstructionAddress: �� _ �� � � ��' Al Owner Nam Contractor: Address: � —.—Tel. # 617 —t1Z1 � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EVIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. :/2; GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: A/®m Estimated Cost: $ 4(5-w'm (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. = Ft x $ = $ DATE: �i� APPLICANT: Tel. CITY USE ONLY Permit Fee $qU Fee Schedule on Reverse Side C"ire Surcharge $, .001 of Permit Valuation (1/10th%) State Surcharge $ Y2, 5D $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ J—, $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 [ J TOTAL $ STIPULATIONS: Land Plenniny LQVSrrWyiny SoilsTe$tin9 C/vil fr Municipal "Iff eerin9 �o 370Mississ#iSt.N . Minrneo�o/s ?/, ENGINEERING,."'INC. Salml4--6066 Engineers Surveyors certificate ®f su,rve � o� ^ �N R14F_ 0 N T Iran i t it x/..33 J2/Ve a lro� I- - •- --- � i Groh - f 1 J`�-� 7%� I Loi n C�t L G, 55,00 ~�V tEW TERRACE �'-- � Di *T 10 M /hefvby'cerfi�y that/his is a firs and toured re?,wenfotian o/'o scrvey 4'#je bio eries ;'#x 46arr Aw.,ibsd /and,ond /"067 a/'a// tt ildinys , Nwrew, arch l ris�Alr wa mchimanfs , iCa y, fun or *7.m;d /mid. As surveyed by me Ilei-- d5f A•D tU2. ' SUB URBAAV .ENG/NEERING , INC. .r ; / /,��y,� Wil.) .% ; fnyC ineers Fig Surrerfo%s. r� CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1998 PLUMBING FIXTURE RATES: NO.RATE TOTAL New Fixtures / $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas** $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE JOBADDRESS oM4-� {J,;,e 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. — I y , 1998 Owner S� b_�t Building Used As 4 s w a / Estimated Cost Z ��• —v .PERMIT NO. PLUMBING COMPANY SIGNED BY .2 TEL N0. viz 7-Z3z� Approved By Rough -In Date Final Date fe $ .50 MINIMUM FEE F R ANY PLUMBING GAS PERMIT IS $20.00 $ 126 2 PLUS THE .50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. FA SUBJE& PERMI City of Fridley 31178 AT THE TOP OF THE TWINS BUILDING PERMI T r ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. - PROTECTIVE INSPECTION SEC. 4416f NUMDEN DEV DAT--] E PAGE OF APPNOVED BY CITY HALL FRIOLEV 55432 L 612-571-3450 910415 7/14/00 JOB ADDRESS 700 Overton Dr. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 6 Brookview Terrace 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Steve Hengen 700 Overton Drive 572-9426 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Pat Boland Construction 3233 - 140th Avenue Andover M 55304 421-1S44 20010173 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 CX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Construct 141 x 141 cedar deck 9 CHANGE OF USE FROM TO STIPULATIONS For stipulations, see attached plans. 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 I 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 $.92 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT $1,842.40 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISION NY OTHER STATE OR LOCAL LAW REGULATING CON• 66.20 Fire SC $1.84 STRUCTI OR E PERF NCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE Licens 5.00 $73 6 SIGNATURE OF N' TOP OR AUTN ED AG T (DATE, P OPER V (DATED TH IS Y UR PERMI BLD iNSP eoo gAtE S,GNATURE OF OWNEROF OWNER BURDERi iDATE, FA NEW [ l Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Ins ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Q BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: �J elf Tel. # — Contractor. _ ��� MN LICENSE# d1cQ173 Address: 3��� �` 10YTel. # 4:71-1-3W 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 / Z -;P �Sq. Ft OTHER: 4FA P464e-- AT' �� Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. = Ft x $ _ $ DATE:71'111op- APPLICANT: Tel. # 4T/ `77 7 Al G'W -7q9-3 (111V CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing In application Permit Fee $ Fee Schedule on Reverse Side Al Fire Surcharge y .001 of Permit Valuation (1/10th%) State Surcharge$ s $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge STIPULATIONS: $ $1100 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 [ ] MU'a=4 i' CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1; sse 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace 30.00 $ (Side Vent - Fill Out Back) Gas Piping i 1�2C ace- 10-) (t'!7 : as range 10. Gas Dryer $10.00 $ *Air Conditioning - All Sizes $ 25.00 $ All Others/Repairs $ Alterations (LISTBACK) Kcao 1 % of Value of Appliance or Work 0 $ Commercial/Industrial 1.25% of Value of Appliance or Work JOB ADDRESS d d %L'ar / Dr! ve, 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 rrect. _,1998 OWNER v/ C� 7�/S5 ��✓ BUILDIN ESTIMA DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Trade Name BTU Circle One (Steam) (Hot Water) (Warm Air) Size No. HP EDR $ Fuel Total Connected Load State Surcharge $ .50 Burner Trade Name TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr BTU Size No. HP EDR, HEATING COMP Signed By Tel No Y'7-'2- —9 0 *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE written permission from adjoining property owner. REPLACEMENT FURP �- g a Rough -In Date - -��, r , final Date STACK VERIFICATION ON Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHIlANEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 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 total BTU's connected . Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAX: (763) 571-1287 PERMIT.:200401176 DATE ISSUED: 07/28/2004 ADDRESS : 700 OVERTON DR NE PIN : 143024110130 LEGAL DESC : BROOKVIEW TERRACE 3RD ADD : LOT 12 BLOCK 6 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. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 400 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINDAUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 NORBLOM PLUMBING CO 2905 GARFIELD AVE S PLBG FIXTURES (EXIST OPENINGS) 0.00 MINNEAPOLIS, MN 55408-2173 WATER TREATMENT APPLIANCE 0.00 (612) 827-4033 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE GAS DRYER FEE STATE SURCHARGE, PLBG FLAT 0.00 0.00 0.50 OWNER HENGEN STEPHEN M & LAURA L 700 OVERTON DR NE TOTAL 35.50 FRIDLEY, MN 55432 PAID WITH CHECK # 28720 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 of any other state or local law regulating� 1cons� ction or the performance of constru .o } ADDlic�nt "cons Date / / Bldg SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 30ITY OF FRIDLEY INSPECTION DIV. AM University Ave NE 'ddley, 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 ;:i:{•':%: ,.` ..W:i:ii Urinalr :i.:•:Q:•:::':::.:i::::::i:? Shower i '.2•.:.�' :}:i:::ii: « Wash :^ - •::::::�ii.•_i:•i:::i:i:: TrayDrain Floor o. : i:•::..�:n... Aut Washer r •.i:::i.:.::'.:}iiri:::•:.:: Ga Range Water Heater Stoies ............... Gas Elec Basement[-*..*.-.-.*.*"*.*-...:,..,*,*,---...-..*"-.,..-' Floor Floor Floor Floor 4 3LUMBING FIXTURE RATES: Jew Fixtures )Id Opening, New Fixture 3eer Dispenser Now Off Basin NO. RATE TOTAL I atch Basin lain Water Leader lump/Receiving Tank Nater Treating Appliance Nater Heater -Electric Nater Heater - Gas** jas Range** Sas Dryer** 3ack 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 leinspection Fee $50.00/Hr 4LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE JOB ADDRESS_ aW &XW 200 OVtib v The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city odes and rulings of the Building Division, and hereby declares that all the fads and representations stated in this application are true and correct. HENGEN, STEPHEN 700 OVERTON DRIVE NORTHEAST .20 FRIDLEY, MN 55432 OWNER (763) 572-9426 BUILDING USED AS KSi d er1GZ_ ESTIMATED COST g6c) ov PERMIT NO.' LU PLUMBING COMPANY -NO (_ p ` 0yA UA/VL tQi SIGNED BY � TEL N0.1`f-12) $2%-e10,33 Approved By O Rough -In Date Final Date MINIMUM FEE FO ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ 35. SD OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A, "PROVIDE COMMON VENT INFO ON BACK SIDE 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 existina 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 Tctal 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 : 0 - Building $-®, BUILDING Permit No.: K4> Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Fire Surcharge CITY OF FRIDLEY Date Rec'd: DATE AUN I YO E-MAIL ADDRESS $5.00 (State Licensed Residential Contractors) SITE ADDRESS �0f fGp dieti $1450 per SAC Unit (Plans to MWCC for determination) THIS APPLICANT IS: ❑ OWNER Sk6ONTRACTOR / ft + 6 ft = ft x $20 = $ PROPERTY OWNER/ NAME: _Skue alit -a. jam. $450 Conservation Plan Review ADDRESS: 7U0 f CITY i5A t".c r STAT&L&'IPT��� TENANT Sewer Main Charge PHONE: 2C – 3-71– 76 6�3 Agreement necessary( ) Non Necessary( ) CONTRACTOR NAME: Make checks payable to: City of Fridley Attach Stipulations STATE LICENSE # L 1 EXP DATE 317,�Q SUBMIT A COPY OF _b O YOUR STATE LICENSE ADDRESS:P WITH APPLICATION PHONE jZ- FC -6- V(9J FAX J /--.e_ %� 3 - J g -;' PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISHt�ROOF ❑ DRAIN TILE ❑ DECK 'j SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW 0,ADDITION ❑ MAINTENANCE/REPAIR ODELING DESCRIBE WORK BEING DONE: fin L'c 14%r - 6-,, SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑,�7�j�OUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES MOUSE & GARAGE GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED G 3. List of structural members to be used PROPOSED HEIGHT: 1 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 $ OCCUPANCY _ TYPE Permit Fee $-®, See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ L t -,::P{ (.0005) times the total job valuation - Minimum $.50 Fire Surcharge $ M9 4ME4 .001 x Permit Valuation (1/10%) License Surcharge $ 'S45 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary( ) Non Necessary( ) Total Due $ Gk 6 Pro 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; that the work will be in accordance with the approved plan in the case of all work which require, review and approval of plans. 99,, ,, l�J� SIGNATURE OF APPLICANT /l/�CGh _ ! 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