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PRE 2010 DOCSCity of Fridley, Minn. BUELDING PERMIT N® 3130 Date: ...../ ........ 8 Owner / .: -...� Builder ..... ........ ................. Address././ ®•,f `. ............. Address ............................................. LOCATION OF BUILDING No. ....if. Street .................... Part of Lot .................. ........... Lot ..... Block ... ..... tion or Sub -Division ...... . ........ Corner Lot ............ Inside Lot ............ Setback �I Sideyard ........................... O'puset-i lull a"Womm To be Used as: ,per Front . �. Depth � Height �.... Sq. Ft. . !.. �� Cu. Ft. Fro t Depth ... Height .... .. Sq. Ft. ........ Cu. Ft. ...... Type of Construction ;t. :. Est. Cost.. /� ®�.� To be Completed ... f� ....... .... . In consideration of the issuance to me of a permit to construct the building desribed a v , I agree to do the proposed work in accordance with the description above set fo d in plignqall provision of ordinances of the city of Fridley. . . ......... .l..... I/ 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ...... r .. ....... 3tTspector 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, City of Fridley AppllcaOm for PhodAng and G�n Fh#Wq Form* Dept. of Bldgs. Phone 3$0-3450 DESCRIPTION OF WORK Number. Kind and Location of Fi)ftres Ill 119,11 IlI 1 it 1 l o i f. I§ 12 150 32 i 5 i� i i� i l s! Base 1st 53-84-S915.51 Leeaffen 6110 -9i4 Rainbow Drive NE. WATER HU. City of Fridley: eo P N GA5 ELEc. The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ovftnance and ruling of the Department of Buildings, and hereby declares that aR the fact and representations stated in this application are true and correct. Fridley, Minn June 15g 1972 Owner Donald Hemmer - Kind of Building frame Bawer❑ Used as residence Cesspool F-1 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ............ x $1.50 $-- New -New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.26 $ Water Heater (Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. : $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............... _ 2 x $2.00 ; 2.00 Additional Fixtures .................. x $ .?b $ Gas Range to 199.000 BTU.......... x $6.00 $ install (1) gas grill & (1.� lite 6.00 REPAIRS A ALTERATIONS—Refer to Coda Description .............. . ............................... f TOTAL FEE $ 8.00 To be completed about June TO, 1972 Estimated Cost, $ 20.00 OldXNew. Building Permit No. Permit No. .1 Signed. By ROUGH a Z_ gaSs ®A-- surcharge ..500 Business Phone No MIN CITY OF FRIDLEY APPLICATION FOR PWMBI'NG AND GAa" FITTING PERMIT / 9 Job Address<�� ice✓ �/! PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES. NO. RATE TOTAL R -..ber Fixtures x $3.00 Future Fixture Opening x K m Yew Fixture, Old Opening Water m c M a+ m P4 o m $ a E+ c .Ci —a rs m w $ �� N a re k a GL w Nater So.tener x Heater $ New Ground Bun Old Building X, $5.00 $ Electric Water Heater x $5.00 $ 1p+ r. C E at 4 • x u $ Additional Fixtures ss $1.00 $ Gas Rznge .to 199,000 BTU x $M 00 $ . O First $100.00 �N .$S.CO $ each add. $100.00 or faaction $2.00 $ W 43°q! C ra 4 4 0 n O .i .iap.� t�1. o m N m d o as lec N U D r. F� to 3 Q A 0 ru U M 3 1st 2nd 9 3rd �Z} Future Connection Opening Connected with Sewer ( New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES. NO. RATE TOTAL R -..ber Fixtures x $3.00 Future Fixture Opening x $2.00 Yew Fixture, Old Opening x $2.00 $ Cash Basin x $5.00 $ Water heater - to 99,000 BTU X � $5.00 $ �� 10,000 B11U to 199,000 BTU x $10.00 $' Nater So.tener x $7.00 $ New Ground Bun Old Building X, $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: Ist 3 fixtures x $3.00 $ Additional Fixtures ss $1.00 $ Gas Rznge .to 199,000 BTU x $M 00 $ . REPAIRS `v ALTERATIONS First $100.00 .$S.CO $ each add. $100.00 or faaction $2.00 $ State Surcharge $ .50 ' TOTAL FEE $�7 �✓ RFINSPEC:TIOS MZ tslo.003 � • 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 roprouontations stated in this application arc true and corrc;ct O' IER XSND C USED AS Fridley, I+.n. - 19-0� TO BE COMPLETED ABOUT��_1 ESTIN.ATED COST Qp OLD - NEW BUILDDIO FERMIT NO. PMMIT AO. Comp.:ny .L Signed By Tel. NO. 4- �� l i �Iirt �L2u ROUGH INSP * Date sDyate FINAL INSP. Date APPROVAL FOR PEMMT 2YINIMUM FEE FOR ANY PLUM..SING PERMIT IS $7.50 PLUS $.50 STFJ'$ S'JR~^r"MR :. City of Fridley SUBJECT - 1-70 AT THE TOP OF THE TWINS BUILDING PERMIT _ r R E COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE OF APPROVED BY L 612-571-3450 910-F15 6/20/83 PAGE JOB ADDRESS 6110 Rainbow Drive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 3 Sylvan Hills SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Shirley Dammer 6110 Rainbow Drive N.E. 571-1759 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. R & M Assoc. 3482 Auger White Bear Lake 770-9322 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 Install escape window and metal soffits 9 CHANGEOFUSEFROM TO STIPULATIONS 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 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 $1,300 $.65 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- $22.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE _ �"— �� ,� $22.65 GNAT RE FC NTRAAC OR OR AUTHORIZED AGENT (DATE' i WHEN PROPERLY LIDATED THIS IS YOUR PERMIT s SIGNATURE OF OWNER OF OWNER BUILDER) (DATF&y - �-- BLDG INSP 4AT CITY OF FRIDLEY Effective Aug. 1, 1981 APPLIC11TIM FOR RESIDENTIAL BUILDING PEW-111TS (New, Alterations, Additions, or Repairs) OWNER: �!? /e^J-e-�4 ��m BUILDER: ADDRESS:.I1le, ALI 21- ADDRESS: 6/Y2 - _m TEL N0: �'%`® /7 TEL 120: 7 7,0 Construction Location STRICT NO: STREET: , / LOT: *7 BLOCK: ADDITION : i u Vii- dz � aa —s Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CON'STPUCTION Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: r,�r Rb Be Wnpleted: Estimated Cost: 3 Alt. A Alt. B Proposed Driveway Uidth If New Opening Is Desired: $ $ SEE p.EVF.RSE SIDE OF SHEET . RSie undersigned hereby makes application for a permit for the %.nrk herein specified, agreeing to do,all work in strict accordance with the City of Fridley Ordinances and rulings of the Delkzrtyncnt of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: � " �- � SIGNATUI•c: Stipulations: ON SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 22565 iqjECIEIPT _ _ COMMUNITY DEVELOPMENT DIV. �0 / r e � PROTECTIVE INSPECTION SEC. (� NUMBER REV DATE PAGE OF APPROVED v CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/26/94 JOB ADDRESS 6110 Rainbow Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 1 Sylvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirley Dommer 6110 Rainbow Drive 571-1759 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. First Choice Exteriors 2405 Annapolis Ln N #240, Plymouth 55441 553-1918 4266 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 ❑X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling and replace window (not bedroom) 9 CHANGE OF USE FROM TO STIPULATIONS Inform homeowners to provide smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. 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 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 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 $9,600 $4.80 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- $117.00 Fire SC $9.60 STRUCTION O THEPE RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $136.40 �,� SIGNATURE OF CONTR CTOR OR AUTHORIZED AGENT (DATE)EN E Y Y ATED THIS IS YOUR PERMIT BLDG )NSP ryAT SIGN ATURE OF OWNER OF OWNER BUILDER) IDATEI ON NEW f( ADDN CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES.R-1 AND R-2 Building Permit Application Construction Address: _� /lQ_ �0 Lo & Legal Description: /Owner Name & Address ntractor: I" ddress: ,? q D S' Address s�,rl� CtAo! G� �k h� I, /J a 40 N Effective 1/ 1 /94 Tel.# tS�7l"I%J� MN LICENSE # 14J 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ) Ft. Yd Setback Side Yard Setbacks Type of Construction: tL l w cw Estimated Cost: $ 9(o eV Approx. Completion Date: 6, — P® — 9 (Cost on Back) Driveway Curb. Cut Width Needed: Ft. + 6 Ft Ft x $ _ $ DATE: �� J� `% APPLICANT: �� Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY $ 10-M Fee Schedule on Reverse Side $ . 60 .001 of Permit Valuation (1 / 10th %) $ $.50/$1,000 Valuation $ $$00 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 [ $ 13 bpi STIPULATIONS: ' a n, .*�' ... SUBJECT PE City of Fridley 27668 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. A n d � , i�s� !y <,�1{ NUMBER REV DATE PAGE OF APPROVED BY ,.� CITY HALL. FRIDLEY 5032 L J` 612-571-3450 910-F15 9/10/98 JOB ADDRESS 6110 Rainbow Dr 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 3 1 S lvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirle Dommer Same571-1759 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO New Haven Construction 42166-9225 20077950 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residence 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage 22S Tear—off 9 CHANGE OF USE FROM TO STIPULATIONS vxxx-kxvMNtM Underlayment must comply with the State Building Code. 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 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 $1,885.00 $.94 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLAITA.PR CANCEL THE PERMIT FEE SAC CHARGE PROVISI S OF ANY. OTHER STATE OR L AL LA GULATING CON- $ 59.50 Fire SC $1.88 STRU ON OR THE PERFO ANCE OF STR T PLAN CHECK FEE TOTA EE se SC 5.0 $67.32 V-64NATURE OF CON TOR OR AUTHORIZED AGENT IDATEI EN rROP 81.IN.- VALIDA HIS IS UR PERMIT,,.-.,,,,, r r DATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI Sep 09 98 06:22a Kerri 566-7183 poi 41 [ ] Effective 1/1/98 ADD14 [ ] CITY OF FRIDLEY ALZER [ ] SINGLE FAME]LY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: Tel. # Contractor: ,4 !may,, C s MN LICENSE # aQ a 7 7 9SG Address: 93 v -!g A`L "' `� �, Tel. # -.5y G .I- 2 -2- ., LIVING AREA: GARAGE -AREA: DECK AREA: Attach to;ihis application, a Certificate of Survey of the lot, with the proposed conmedon drawn on it to scale. Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type: ° Ff- - Pt o if Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. # CITE' USE QM Permit Fee $ CJ �� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ S-60 $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 [ I Not Necessary [ 1 TOTAL $ (®2,3� STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV.�� Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Zee_ to Wash ::<-: F or :..��:<:::>:: >:..... �+�...... t ........ Gas • � : Water Heater .:;:::::.< < Urinal :: ho r ones # S we >' Tray ...'' ' Drain ::::,:,:::<.. Y fI,,..::.... Washer p Range :.: :<: as Elec Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESSL"- &2 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 re true and correct. Catch Basin $10.00 Rain Water Leader $10.00 DATE: 20 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER P4 1p� Water Heater -Electric $35.00 Water Heater - Gas`* $35.00 BUILDING USED AS Gas Range'' $10.00 Gas Dryer" $10.00 ESTIMATED COST PERMIT NO. Back Flow Preventer Required ( )Yes () No r� Type $15.00 PLUMBING COMPANY c�yG C i r Reinspection Fee $50.00/Hr SIGNED BY TEL N0. 0 s2' * ALL OTHERS AND/OR REPAIRS AND ALTERATIONS ' 1.25% of Value of Fixture or Appliance f a Approved By - Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE FO A Y PLUMBING/GAS PERMIT IS 15.00 or 5% OF COST TOTAL FEE OF THE IMPROVEM WHICHEVER IS GREATER ON WORK LESS THAN $300 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( ) i The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and terminatidn. 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 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 Furnice V6nting 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 : 3uilding $ BUILDING Plan Review Permit No.: " �� i inspections Fire Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY License Surcharge Date Rec'd: D ?ATE :; - YOUR E-MAIL ADDRESS $ /- ;ITE ADDRESS 9;1)1 or - $ Erosion Control $ HIS APPLICANT IS: ❑ OWNER CONTRACTOR $ PROPERTY OWNER/ NAME: tS.'f- ab 6 re U $ ADDRESS: I® !'t/ P CITY STATIIP TENANT n g , r)— PHONE: S f CONTRACTOR NAMESUB; r STATE LICENSE # 204 �C/7 EXP DA ®® OPY OF YOUR ATE LICENSE ST ADDRESS: //AApt LA -) CITY e" STAT104aIP�,�F —�j-- WITH APPLICATION PHONE 'r FAX PROPERTY TYPE INOG FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/AIEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISHROOF ❑ DRAIN TILE ❑ DECK ( ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:-Pe.1'4 &&,) SIZE OF IMPROVEMENT 2 LENGTH S'® WIDTH 2 HEIGHT S . Ft.4 ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES MOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS, & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 7 9 --OCCUPANCY TYPE Permit Fee $ Plan Review $ Fire Surcharge $ Surcharge $ J_ g License Surcharge $ g-00 SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ n g , r)— See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) 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 permit I ac ledge that the information above is complete and accurate; that the work will be in conformance with the ordinances an es of a ity of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for it d ork is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work es r v' w roval of plans. _� / / e' r) /I L91 � SIGNATURE OF APPLIC PRINT NAME �E/ �Gi" l DATE (� Building MECHANICAL Permit NO.: O —Wlocgq Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 Dat .J UL `� 2 20 CITY OF FRIDLEY 763-502-497/7 FAX EFFECTIVE 2-19-09 DATE f Z-/ ®� YOUR E-MAIL ADDRESS•/ eQ��-�®✓1 �4 9✓nc - c m✓"% SITE ADDRESS K116 12-A J'. 6w lop, THIS APPLICANT IS: ❑ OWNER ViCONTRACTOR PROPERTY NAME: L ✓4 A A'J�+� OWNER/ �S ADDRESS:_ 61/0 I&J'Ad" CITY A-J�� J STATEMA/ lP n Z TENANT PHONE: ) 6 3 - S) /- /') S" i CONTRACTOR COMPANY NAME: Ac-L—e A -N 4 ' .4/ SUBMIT A COPY OF CONTACT PERSON: _ 3 -,V /-& ,,/" ► STATE LICENSE # EXP DATE YOUR STATE LICENSE WITH ADDRESS:_ 3/4(V 4r4w 5k x1t CITY S Lm /-,ILL AJC STATEM4.-'ZIP S-s-sF7Z APPLICATION PHONE % 6 7,� CJ - P' `� FAX _;>ci PERMIT TYPE 9QSINGLE FAMILY 11 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW (REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK�g�?l�,t�FEES ARE ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: S2t"V c."O SIZE/BTU Coe 00 L) MFG: (A/ "/C/, MODEL: X -f-4pA-r SIZE/BTU R 4e -t MFG: MODEL: SIZE/BTU _A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 _ AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 FURNACE $35.00 UNIT HTR $10.00 _GAS _CHIMNEY LINER $10.00 _GAS DRYER $10.00 HEATER $35.00 _POOL _DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 tTn q ka - �.. $ 'kms h »r -a,4 s` �`��gt;.:.. ': '� •�iri .f �f ? { b s3 � r 4. ''� ' 2" E Z ,;-F � �.,4 � .. "�' 6 E ^'.' its � ,.,�.�""`•3wa.� $ 5, rtt 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 code of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for . permit and ork 's not to start without a permit; that the work will be in accordance with the val of plans. approved plan in the case of all work is quir ev' and=NAME SIGNATURE OF APPLICANT �� O`/ ` f Z Z �0 DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977