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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Owner ............:.......................... Builder Address ...................................... Address N® 3341 LOCATI OF BUILDING No. .4.70-9a . Street ... Y ... .... ... Part of Lot ............. . ..... . .... Lot ... / ... Block ........... Addition or Sub -Division .a.. ,.. . ... fs:dee:-� .. ... Corner Lot ............ Inside Lot ..X ...... Setback .31i.1 ..ard .... /-'r ..... . DESCRIPTION OF BUILDING To be Used as: B ... >..... Front ®�P Depth g;k� ®"eight ../9 sq. Ft. /® :� Cu. Ft. /.`l Q /. ... Front T.4P- d®Depth .:11.- � "'Height ..AFT"P /Sq. Ft. AR.P. Cu, Ft. P99(0:0 Type of truction ................... lkt. Cost/ .�P / .o.0 ....... To be Completed ................... In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of nrAinannna of 4Hn Atu of PHAlav In consideration of the payment of a fee of $W. 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. . .. Building Inspector 1 - ..P NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. pp[►f MGASCO 53 -8b -s-915.51 City Of Fridloy • Applicaalarn for Plumbing and Gas RNin-7-1 Permat - Dept. of Bldca. Phone 560.3450 DESCRIPTIO.; O: V011 -A4 Locz6770 Plaza Curve N. E. Number. Kind ¢nd Locr-tion of Fixtures Futuro Coaaecti.^,a Oponings •w Eowor 0 Xow Fixturo. Old Openings - Ce"Pool 0 PARTIAL ROTE SCHEDULE .UMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening.......... x $1.50 Catch Basin . . . .. . . . . . . . . . . . . .. . x $3.25 wATra HTR. Water Beater fUp to 99.000 BTU) • • • • � $ New Ground Run Old Bldg.......:. x $.3.25 S Electric W&tar Hector .............. a $2.00 $ AS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......... * . • • • • • • N GAS ILEC x $ .75 $ Gas Range to 199.000 BTU ........... S a N ► G7 � •3 � . �# st 1 ian 3 _ i i Futuro Coaaecti.^,a Oponings •w Eowor 0 Xow Fixturo. Old Openings - Ce"Pool 0 PARTIAL ROTE SCHEDULE .UMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening.......... x $1.50 Catch Basin . . . .. . . . . . . . . . . . . .. . x $3.25 $ Water Beater fUp to 99.000 BTU) • • • • x $2.00 $ New Ground Run Old Bldg.......:. x $.3.25 S Electric W&tar Hector .............. a $2.00 $ AS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......... * . • • • • • • x $2.00 $ . Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ........... 1 x 55.00 $ 5.00 City of Fridley: The undersigned hereby makes application for a permit for the- wort herei specified, agreeing to do all work In strict accordance with the City Ordinance And ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct' Fridley, Minn 4-24-75 19 Owner Lloyd W. Opsetta Kind.of Building 4rame Used as Res. To be completed about 5-1-75 - Estimated Cost, $ 10.00 Old Building Permit No. Permit No. Signe. By MINNEGASCO _. Business Phone No ROUGH FINAL ,,/- //'° % .EPAIRS & ALTERATIONS—Rofor to Code .50 State Surcharge Descriptioa • ....................... 1.... . ..........� 7WAL FM $ 5.50. -V S-urcharge .500 E Aprrcemn far' 6 Cud N.CaNtnj cc.-Xng, venrkfta. MCS � -.%a M cad MY CaLCfisM'mniluba&.e� o PARTIAL RATE SCHEDULE GRAVITY WARM AIR: F%umacr Shelf & Duct Work Replacement of F urnare Repairs & Alterations --up to $500.00 Repairs & Alterations each add. 4500.00 CM W AM Flarnace Shell & Duct Worts to 130,000 BTU toch add. 60,000 BTU Replacement of Furnace Repairs & Alterations --up to x.00 Repairs & Alterations each add. 4300.00 RATE TOTAL $10.00 8 6.00 s.- 600 600 S 3 OU $ ..S1000 $ 3.U0 8� 6.00 1 6.00 S 3.00 $ Pim.ace Shell & Lines—to 400 sq. ft FMR Steam $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $, Each add 200 sq. ft. EDR Steam 3.011 $ Each add. 320 sq. ft EDR Hot Water 3.00 $ OIL BUFFER—to 3 gal. per hour 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) 6.00 4 - di vM 199,000 MT See Fe® fthedule GAS FITTING F1 M. NO RATE TOTAL 1st 3 nxtures as 200 S Additional Fixtures x .95 Gas Range to IMI.M0 :$ 5.0D $ State Surcharge .50 ISCM Fee zcbzdah TOTAL. M$ c'� D*pt. of B1.4m 1horw City of Mdley: The undersigned hereby makes application for a permit for the work here(r specified agreeing to do all Fork in strict accordance with the City Ordinsmeev and niting of the Depai tment of Buildings, and hereby declares that all the fatu and repr,?cPntatiuns stated in this application are true and correct. F`rid)ey, Minn- ��'" ®� 17 - Owner _ Kind of Building Used ae To he completed about Estimated Cost, $ — I Q d / Ol New. Building Permit No. ___ __ Permit No.�(i3�, HEATING o WER. PLANTS—S' Hot Wa Warm Air No / Trade btam�� ` Faize .,Pi capacity—__.— Sq. Ft E.13.11 & BTU 1P Total Connected lead__."kR3� of �✓ BURNER — Trade Name Size N� (Mamaas—ev¢M) SUBJECT PER O. City of Fridley N A146 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT N0. 11 maCOMMUNITY DEVELOPMENT DIV. r I PROTECTIVE INSPECTION SEC. ��'•1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 18-19-75 JOB ADDRESS 6770 PLAZA CURVE N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 3 RICE CREEK PLAZA SOUTH ADDITION SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE LLOYD OPSETH 6770 PLAZA CURVE N.E. FRIDLEY MINNESOTA 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. DENE.SEN COMPANY, INC., 2836 COLFAX AVENUE R017TH, MPT—s- 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RESIDENCE 7 CLASS OF WORK ❑ NEW XE:k ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK CONSTRUCT PORCH 15 x 10 ENCLOSED BUT NOT HEATED PATIO UNI 9 CHANGE OF USE FROM TO STIPULATIONS PROVIDE FROST FOOTING SEPERATE PERMITS REQUIRED FOR WIRING1 ` HEATING, PLUMBING AND SIGNS.Waft AKIMIN6. Before digging call local utilities TELEPHONE - ELECTRIC - GAS Etc. 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 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 R-1 150 1,500 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 $3,600 $1.80 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROAI IONS OF ANY OTHER sygrE OR LOCAL LAW REGULATING CON.- STCONSTRUCTION. $21.60 =THEFOROF PLAN CHECK FEE TOTAL FEE flQ_ /9"/— 23.40 SIGNATUREOj7TRACTOR7HORIZED AGENT (DATE) WHEN PROPERL ALIDATED T' IS IS YOUR PERMIT 8-19-75 SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) BLDG INSP DATE -APPLICATION FOR RESI•DENTIAL., .ALTL'It�1TI0N, OR ADDITION•BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA • OWNER'S NAriE : BUILDERAe ADDRESS: ADDRESS N0 STREET: . . LOT: % SBLOCK : ADDITION.: CORNER LOT: INSIDE LOT: SETBACK: SIDLYARD: Two Certificates -)f Survey -of -16t and.proposed Applicant attach to this foxr� buildinC7 location c- awn on these Certificates. DESCRIPTION OF BUILDING To Be Mir Front: /�� Depth: •/® Height: / lNe"Soc , %v,r Square Feet: /Z Cubic . Feet : Front: Depth: ' Height: Square Feet; Cubic Feet: Type.of Construction: Estimated Cost: Z To Be Completed: %-s The undersigned hereby makes application fora permit for the work herein specif ied� 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 representations stated in this application are true and correct. DATE: v 7� SIGNATURE: .(See reverse Side For Additional Info t n.)" 7 �� a3,�. -� 1.76- ' . •�a vac ��.av �® ®� MINDEn FANG ENGINEERS AND SUPZVEYGRS LkNO SUGiVEY1N0 50tL5 TESTING CIVIL d+. MUNICIAAL ENGINEERING LANO RC,ANWINC G418-SG"rw AVENUE N. ^31j f MINNEAPOLIS 2?, MILAN. KE 7- 3G3T vil'ol I (took A lit off Isirve-4f rj �. ✓ r -7 .� I ,l 4 WE HERE5Y CERTIFY THAT TH15 15 A TRUE AND CORRECT REPR.E5ENTATI0N OF X SURVEY of THE. BOUMOPAIE.S OF THE LAND NBOVE DESCRIBED AND OF THE LOCATIOtJ OF ALL BUILDINGS, IF WY; WERE44, AAiD ALL VIS15LE ENCROACAMENTS,, IF ANY, FROM OR ON SAID LAND. MINDER ENGINEERING CO.,INC. t 1�.. DATED TN15 ' r DhYOr �` ��" �'� A.O.1��-t , ENGINEERS At1[a SVStvEYORS ®R 63-%-8790C1 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures $ 5.00 m $ 3.50 m $ 1.50 Beer Dispenser $ u' Blow off Basin $ m Catch Basin Water 5.00 Rain Water Leader $ 5.00 Hydraulic Valve $ 5.00 Sump or Receiving Tank $ 5.00 Water Treating Appliance $ W w $ 5.00 Heater H o Gas Dryer_ $ 10.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 4j 1% of Value of Fixture or Appliance k m Reinspection Fee $ m m TOTAL FEE m +� a W W g 19 u V 0 v D to y 3 w ra 0 1 1st d er 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer M = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures $ 5.00 Future Fixtures $ 3.50 Old Opening, New Fixture $ 1.50 Beer Dispenser $ 4.00 Blow off Basin $ 5.00 Catch Basin $ 5.00 Rain Water Leader $ 5.00 Hydraulic Valve $ 5.00 Sump or Receiving Tank $ 5.00 Water Treating Appliance $ 7.00 Hot Water Heater $ 5.00 Gas Range $ 10.00 Gas Dryer_ $ 10.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance State Surcharge Reinspection Fee $ ($15.00) TOTAL FEE TOTAL $ .50 s 10.50 Effective Aug. 1, 1981 Job Address 6770 Plaza Curve 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. 9-11-81 , 19 OWNER SIELAFF KIND OF BUILDING f rame USED AS TO BE COMPLETED ABOUT res. 9-18-81 ESTIMATED COST 50.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Compan fin-° Signed By Tel. No. ROUGH INSP. Date FINAL INSP. �—t U Date APPROVAL FOR PERMIT . h,A MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE SUBJECT PERMIT NO. City of Fridley2 210 0 AT THE TOP OF THE TWINS ? BUILDING PERMIT r 41ECEW4-NC1-- � • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. � I NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 �""ilk" 612-571-3450 910-F15 9/10/93 JOB ADDRESS 6770 Plaza Curve NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 15 3 Rice Creek. Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brad Sielaff 6770 Plaza Curve NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Adolphson Construction 16 66� Way NE, Fridley 55432 572-2659 6261 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 I� REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (21 Squares) Tear--off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply faith._ the State Building Code. Provide adequate attic ventilation. Provide smoke detectors per UBC 222 1210 adjacent to all sleeping areas and in.basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,550 $1.27 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $ 54.00 Fire SC $2.55 STRUCTIO R THE PERFORMA CE OF ONSTRUCTION. PLAN CHECK FEE TOTAL FEE !' License SC $5.00. $62.82 SIGNATURE OF CbikeFrACTURO HORIZED AGENT IDATEI i nH ,R ERl ALIDATED THIS IS YOUR %PERMIT JNSr DATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 5/26/93 ADDN [ ] CITY OF FRIDLEY31 [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 % 0ALTER Building Permit Application Address: 6770 e Zt/ � Construction '* Legal Description: Owner Name & Address:®� ®- Tel. # Contractor: C MN LICENSE # coo 426 / Address: C 4!�a' co - Tel. # S ;7Z-ZCor 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: C94 -6C' &.e -- m z / S` Corner Lot [ ] Inside Lot [ ] Ft. Yd k Side Yard Setbacks Type of Construction: Estimated Cost: $ `� Approx. Completion Date: 60 14 0,/ (Cost on Back) Driveway Curb Cut W`10th Needed: Ft. + 6 Ft = x = $ DATE: 151, Z/0ZCz5&PL1CANT: Tei. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control CITY USE OMM $ 54 OCA Fee Schedule on Reverse Side $ ,2-S�;.001 of Permit Valuation (1/10th%) $ / 29 $.50/$1,000 Valuation $ $750 per SAC Unit $ 'r oo $ Park Fee $ Sewer Main Charge TOTAL $ $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Conservation Plan Review $450.00 Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ) STIPULATIONS: sue,iEtr P N City of Fridley 27 X79 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L J` 612-571-3450 91 415 9/21/98 JOB ADDRESS 6770 Plaza Curve NE 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 15 3 1 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kathy Campbell 572-0887 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Progressive Building Systems 23120 Garrison Rd Corcoran 55340 498-7241 20104340 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 j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Rfxgx Reroof house & garage (23SQ) 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 OCCUPANCYLOAD 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 $1,971.00 $.98 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- $62.25 Fire SC $1.97 STRUCLPA OR THE P FORMANCE OF CONSTRUCTION PLAN CHECKFEE TO L FEE Licens SC $5. ,/ $70.20 1 ',,NATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATE, E PROP VALI T THIS 1 R PERMIT B G NSF' pArE S.GNATURE OF OWNER Ort OWNER BUILDER, ,DATE, 61=11A ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAA1ILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 'g, Legal Description: T, Effective 1/1/98 Owner Name & Address: '� Tel. # ' .I—;;t;2 -r-V8 ? Contractor: ��.-� MN LICENSE #,�, Address: ZOO j:5' Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF BIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length��/ Width Hgt/Ground Sq. Ft. OTHER: $ c23, -�z Construction Type: Estimated Cost: $z (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 9' P / -i 9 Permit Fee APPLICANT:Tel. # Fire Surcharge $ 1 State ,Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ ®- r, ?0 . STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] CITY OF FRIDLEY PERMIT 04-00939 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 06/21/2004 572-36U4 FA2L: (763) 571-1287 ADDRESS 6770 PLAZA CRV NE PIN : 143024230038 LEGAL DESC RICE CREEK PLAZA SOUTH ADD LOT 15 BLOCK 3 PERMIT TYPE PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 720.00 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 # WATER TRMT APPLIANCES 0 APPLICANT TIMS QUALITY PLUMBING INC 523 CENTRAL AVE OSSEO, MN 55369- (763) 571-0454 OWNER CAMPBELL KATHRYN A 6770 PLAZA CRV 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 wort 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 re latin traction or the performance of construction. Applicant & Dates Bldg Ins' PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 WATER HEATER - GAS 35.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 8882 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 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: NO. RATE TOTAL JOB ADD New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin Rain Water Leader $10.00 $10.00 1 �/ DATE: �� "T , 20 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER Z ' Water Heater -Electric $35.00C�1f Water Heater - Gas** $35.00 BUILDING USED AS�� Gas Range** Dryer** $10.00 $10.00 ESTIMATED COST / </JU ` PERMIT NO: k02 lyGas Back Flow Preventer Required ( )Yes () No - Type $15.00 PLUMBING COMPANY, A r® Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE SIGNED BY Approved By Rough -In Date TEL N0. 3 ,5N_6'WT Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ 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 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 Fumace 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 :