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PRE 2010 DOCSCity of Fridley, . WELDING PERMIT ® E93 Date: Owner: Builder — Ad Address LCATIO F BUILDING No. � Street - ,- ` PartPLO.... Lot _ _ Block Addition or Sub -Di Corner Lot _... Inside Lot _._,_ - � SQtback Sewer Elevation Fo tion Elevation DESCRIPTION OF BUILDING To U Front Depth / Height Sq. Ft. ca. F;/W Fron Depth Sq Ft. Cu. Ft. Type of Construction Fast. cosi _ To be Completed 77 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 $_c , 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 thus permit may be revoked at any time upon violation of any of the Provisions of said ordinances. , f ---- NOTICE: This permit does not cover the eonstrestion, installWan for wiring, phnahing, on hedh g, sewer or water. Be sire to no the Building Inspedor for s►parate permits for these hems. owner's Name Address APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ilder LOCATION OF BUILDING No. C �� Stree -�- 4 %6/Part of Lot� ' 9 Lotf Block Addition or Subdivisio Corner Lot Inside Lot setback Side -Yard SETTER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used asa DESCRIPTION OF BUILDING z� Der3th -"- sq. Ft. CU. Ft • FrontDepth Height sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completed, d The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE �� SIGNATURE �✓� �� (Schedule of Fee Costs can be found on th, everse side). nil . �. A. M r . , ► oil SUBJECT PER City of Fridley ® 18246 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEI O. � COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 i � CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/15/85 JOB ADDRESS 5685 Quincy Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 17 6 Donnay ' s Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Hoff 5685 Quincy Street N.E. 571-3762 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] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof welling 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the. 2nd layer but not the 3rd. Install ridged galvanized valleys where necessary, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Fiberglass. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ] ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT.: THE GRANTING OF A PERMIT $500 $.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTR CT N. $15.00 PLAN CHECK FEE TOTALFEE 01 ( / < $15.50 G NATURE OF CONTRACTOR OR AUTHORIZED A EN IDATEI1IIEN •v PROPERLY LIDATg E/D/A THIS IS YOUR PERMIT �� SIGNATURE OF OWNER I IF OWNER BUILDER) IDATEI LDG )NSP DATE` oil NEW [ ] City of Fridley ADDN. [ ] �R-1 AND R-2 i ALTER. [ ] Building Permit Application Construction Addre Legal Description: Effective 4/1/84 Owner Name & Address: -� d��� � � � N S� ` �Je-- Tel. # Contractor: SA�h� Tel. # Address: S 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 4_ Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yid. Setback Side Yard Setback Type of Construction: S��G 4giSS Estimated Cost: $ Approx. Completion Date: / Mbx)i`-W Proposed Driveway Width If New Opening Is Desired: Alt. A Alt B $ $ See Back Page for Explanation DATE: %D U-�'- APPLICANT: 2tz Tel. # CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $125 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] .. -'W SUBJECT City ®f Fridley 26129 AT THE TOP OF THE TWINS BUILDING E M I T ` RECEIPT'NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-57.1-3450 910415 6/2/98 JOB ADDRESS 5685 Quincy Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 6 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary/Carla Lessen 5685 Quincy Street NE 571-2950 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 Cj ALTERATION ❑ RE AIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install basement egress window 9 CHANGE OF USE FROM TO STIPULATIONS Window must comply with the State Egress Code. TYPE OF CONST. OC UPANCY 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 ST LLS 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 $500 $.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- $21.00 Fire SC $.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE I '011L FEE _C1e-$22.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN VALID T THIS IS YOUR PER OP SIGNATURE OF OWNER I IF OWNER BUILDERI IDATEI &%L G INSp GATE qEW [ ] Effective 1/1/98 ADDN CITY OF FRIDLEY '�LTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: - 5 L- 6 J 0, U t 5 �- Legal Description: Owner Name & Address: �'�c� �� (��r �C-, I _c, s 5 -e�, 65-('0 C;z uc t Tel. #y °j- -71 - 7,5 -CD Contractor: A— MN LICENSE # [- - �ZSp I cv,� -7S r G, Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF RYIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: L e n --r\+ s Construction Type: l,�cDc cQ oa Estimated Cost: $ 5-0 � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: (� `, ' CE- APPLICANT: ��'G � - , 2 Tel. # 5 % - j 1 j0 CITY USE ONLY Permit Fee $ Z i Fee Schedule on Reverse Side Fire Surcharge $ 5'6 .001 of Permit Valuation (1/10th%) State Surcharge $ S'y $.50/$1,000 Valuation SAC Charge $ $1000 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 $ ems► Z Z. STIPULATIONS: - SUBJECT_ - P City of Fridley 29818 AT THE TOP OF THE TWINS BUILDING PERMIT r RE O. COMMUNITY DEVELOPMENT DIV. r i PROTECTIVE INSPECTION SEC. 1 e � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/6/99 JOB ADDRESS 5685 Quincy Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 6 Donna T s Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Gary & Carla Lassen 571-2950 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 Rk REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage (24 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 CON T. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2098 $1.05 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $83.25 Fire SC $2.10 PLAN CHECK FEE TOTALFEE $86.40 SIG JRE OF CONTRACT Q UTNORIZED AGENT IDATEI H OPERLY VALIDATED THIS IS YOUR PERMIT 7459 '(O' SIGNATURE OF NEP SIF OW NER BUILOERI IDAT I BLDG INS TIATE d. NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: ._ Owner Name & Address: 9AR y s- j P–,A L S #�l se -p/ Tel. w;0,:m– Z -9-T® — I Contractor: _ ,A2.A MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT u Construction Type: AeAoW Ag sc Akp Q�– Estimated Cost: $ �9� Driveway Curb Cut Width Needed: DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT: Ft. + 6 Ft = Ft x $ _ $ Tel. # CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] w Abl®� cl_�.�" SUBJECT O. , City of Fridley 31643 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO i COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF AI5PAOVjOBi 612-571-3450 910415 2/6/01 JOB ADDRESS 5685 Quincy Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 6 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Lassen 5685 Quincy Street NE 763-571-2950 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 D ADDITION I ALTERATION O REPAIR 0 MOVE O REMOVE B DESCRIBE WORK Partial basement remodel 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. S EQAT PE ySR�dF®Ro HLUN#Ad LUIRIIl p Q SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $900 @ $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .45 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $35.70 Fire SC $.90 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL EE 7.05 iGNA TUBE OF CONCTOR OR AUTHORIZED AGENT PR PER ATE HIS IS Y UR PERMIT ppb fIDATE, PJ1 " lvl ^ d7 S,GNAT E F OWR,�F O14 N WNER8 1AR1 tDATEt BLDG P r)ATE Abl®� cl_�.�" NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: LA A Legal Description: Owner Name & Address: P--:;rr 14 fyLqa�L n Tel. #��- 5 7/ 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 `0 r -r Width Z-2) FT. Height -7 I=T Sq. Ft. -7 'i FT GARAGE AREA: Length WA Width Height Sq. Ft. DECK AREA: Length I„Width Hgt/Ground Sq. Ft. OTHER: AA /A Construction Type: RAS1= Al.lr /J -T KEMOD01. Estimated Cost: $ 90C)A Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. # '763- !�' 7 /- Z 9S -O &ARy "-Sre Al CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ � .001 of Permit Valuation (1/10th%) State Surcharge $ SO I $.50/$1,000 Valuation SAC Charge $ i'$1150 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 $ o ®a1 STIPULATIONS: I SUBJECT OERMIT N City of Fridley327 6I` AT THE TOP OF THE TWINS BUILDING PERMIT F R COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. PROTECTIVE '5997 ,•� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By L J\ 612-571-3450 910-F15 7/16/02 JOB ADDRESS 5685 Quincy St NE 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DescR. 17 6 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADORE$$ ZIP PHONE Gary Lassen, 5685 Quincy St, Fridley, MN 55432 763-571-2850 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Cities Home Improvement, 640 Mendelssohn Ave N, Golden Valley, MN 55427 20076414 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-591-0332 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK C)j NEW O ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Install new siding. 9 CHANGEOFUSEFROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code requires that a weather - resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions to this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in the application guidelines. Call for inspection of wrap before covering. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ` NO. OWLG. UNITS OFFSTREET PARKING 1 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 QE COMPLIED $61300.00 $3.15 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• 139.25 Fire SC $6.30 STR CTION OR THE PERFO �MAN�OFCONSTRUCTION PLAN CHECK FEE TOTAL F E X 6 0� License .00 1$15/.70 SIGNA TUREOF CONTRACTOR Op AUTrIOFtIZED AGENT IDATEI NOPE ALIDATED IS IS YOUR PERMIT g1B 19d INSP - r,A,E S-GNATURE OF OWNEROF OWNER BUILDERI IDATEI I NEW [ J CITY OF FRIDLEY Effective 1/1/2002 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: �6 6 J U v- o cy J 4-- /Ue Legal Description: Owner Name & Address: 4 r ,SS e h Tel. # 6-i 1-- 7XV Contractor. ; 0.s' ArnA_ MN LICENSE #rr �� 1 g Address:oLi� -c ,Ua 644vt 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/Ground Sq. Ft OTHER: �R Construction Type: , 71-06nA Estimated Cost: $ Q00 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x DATE: /r� c'-2— APPLICANT: Tel. #, 6,�- f -49'3 a:�?-_ Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 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 TOTAL Cqt1L M74t01NWA1 $ 9 . � .2 Fee Schedule on Reverse Side $ 6.30 .001 of Permit Valuation (1/10th%) $ 4L'�7' $.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 [ ] $ 1 -'53 V STIPULATIONS: 10 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAX: (763) 571-1287 ADDRESS : 5685 QUINCY ST NE PIN : 233024410019 LEGAL DESC : DONNAYS LAKEVIEW MANOR ADD : LOT 17 BLOCK 6 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION C PERMIT NO.: 2004-00007 DATE ISSUED: 01/02/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS 1 # 101+ AMP CIRCUITS APPLICANT BURNSVILLE HEATING & AIR COND LLC 12481 RHODE ISLAND A SAVAGE, MN 55378- (952)894-0005 OWNER LASSEN GARY L & CARLA R 5685 QUINCY ST 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. Applicant Date Bldg Insp ELEC CIRCUIT FEE (101+ AMPS) STATE SURCHARGE, ELEC FLAT ELEC PERMIT FEE - MAX (RESI) ELEC PERMIT FEE - MIN (RESI) TOTAL PAID WITH CHECK # 021768 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0.00 0.50 0.00 20.00 20.50 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAX: (763) 571-IZ51 ADDRESS : 5685 QUINCY ST NE PIN : 233024410019 LEGAL DESC : DONNAYS LAKEVIEW MANOR ADD : LOT 17 BLOCK 6 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PENT NO.: 2004-00025 DATE ISSUED: 01/09/2004 VALUATION 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 REPLACE FURNACE (WARM AIR, LENNOX, 70,000 BTU) AND AIR CONDITIONER # A/C UNITS 1 VALUE OF APPL OR WORK # FURNACES # GAS RANGES APPLICANT SEDGWICK HEATING & AIR COND LLC 8910 WENTWORTH AVE S MINNEAPOLIS, MN 55420-2853 (952)881-9000 LASSEN GARY L & CARLA R 5685 QUINCY ST NE FRIDLEY, MN 55432 1 # GAS DRYERS 0 ENTER VALUATION 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 constru tion or the performance of construction. Annlicagt� /I Date I Bldg Insp HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 069231 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 4760 0.00 30.00 0.00 0.00 25.00 0.00 0.50 55.50 CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, ,MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING -SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work,- Burner, - Also Replacement Furnace (Side Vent Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning.- All Sizes All Others/Repairs & Alterations (LIST ON BACK). .1% of Value of Appliance or Work Commercial/Industrial 1:25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $ 50 STATE SURCHARGE. REINSPECTION FEE $47.00/Hr *Air Conditioners can not be.: placed in a side yard without written permission from adjoining property owner. TOTAL $ �® G JOB Al OWNE Effective On January 1, 2002 BUILDING USED AS -p ESTIMATED COSTPERMIT NO. �� T DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Uni ' Circle One (Steam) (Ho >Water) farm Air Trade Name C�� Size N BTU m HP EDR Fuel_ Total Connected Load Burner Trade ame Size No. BTU' 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 an rulirigs of the Building Division, and hereby declares that all the facts and representations stated in, this application are true and correct. DATE -w r HEATING CC..ee-�i� rte®IIS C0 ��w 5010 Wentworth Ave. So. Signed FAX # '(952) 881-9000 Approved By i Rough -in Date Final Date. - FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JHE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE; RETURNED COMMON VFNT VENT CONNFCTOR AND C®MRt1STIC3N AIR VFRlFI .A`rIDN When Cpl -ing an Pxisiing-h raoca, the undersigned hereby verifies that the venting has-been extirdined _and- is free from rust, deterioration; obstructions, and is securely supported..and firestopped where required. "Yes O 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 exis ing nambUSJ112nair is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a neW cambustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes O No ( ) When installing a new t• _ntlrlg S , the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturefs 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 O No ( ) Appliance Tyra and SizaLCommou Vent and Yj&.d Connector Infn=a inn 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 13tu 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 HEATING CO: Signed By: Date: 2 - vo TH BE�L!OMUS(4BE FILLED IN WHEN REPLACING FOL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VENT. VENT CONNECTOR ANn COMBUSTION AIR VERIEIGATION When replacing aranee, the undersigned hereby verifies that the venting has-been examined.and is free from rust, deterioration; obstructions, and is securely supported,an'd 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. YesNo ( ) The. La iiS ing cambusMan air is sized and installed to meet the current codes and manufacturer's specifications. Yes { } No (4 When required to install a new combustion air,itwill be sized and installed to meet the current codes and manufacturer's specifications. Yes IN o ( ) When int Ming a new m _nting --ystem, 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 �l No ( ) Is the common vent and vent connectors sized and installed correctly after a i appliance has been removed from the common vent and vented separately as per current codes. Yes b�No ( ) Appliance Tvype and Size/C®mmnn Vent and Vent Connecter Inf®rmatinn { Appliance #1 Type kV ✓ ✓t a- c-9— BTU Input QCV Fan Assisted or Nat Appliance #2 Type I --r BTU Input 3-7 !S�-00 Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input O 0 Common Vent Type 0 Uk5-5 Vent Height Diameter inches Appliance #1 Vent Connector Heightft Length ft Diameter in Type C (&.s 5 %� Appliance #2 Vent Connector Height Aft Length 4-1 ft Diameter _ .1 in Type es -5 L Appliance #3 Vent Connector Height ft Length —ft Diameter in Type HEATING CO: r _ Signed By: Date : �I3 7-W , y Building PLUMBING ermit No.: -ao 5 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec' / DATE 5 -/ S -0 ^ YOUR E-MAIL ADDRESS 14 -ae,7 P ee�', -05 SITE ADDRESS PS Vl y 1 VC- THIS APPLICANT IS: OWER ❑CONTRACTOR PROPERTY NAME: OWNER/ ADDRESS: J' 49�' Gr �C .CITY�%/�i� /e, STATE IP `j2- TENANT PHONE(7&32 5 7/- Z` 5—U _ CONTRACTOR NAME: - STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRE CITY STATE ZIP LICENSE WITH p NE FAX APPLICATION PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW XREF CEM�TI //a DETAILED DESCRIPTION OF WORK e-� k' .C®Al PER MS 1613.665 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 should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor /00 x .05 = rz-vo FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) SINK/LAV FLOOR DRAINS _ WATER PIPING —BATH —SHOWER PIPING (vEED crirrrcEw) SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB —GAS _ CLOTHES WASHER KITCHEN SINK CLOSET _ BACKFLOW PREV. ($15) _ _ —WATER DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ze 1! Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ 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 applic tion 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 a ork whic equires review and approval of plans. 411KI 0 S e DATE ©5-- 5 SIGNATURE OF APPLICANT PRINT NAME T , V t� fry Vs City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977