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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMITS® 4'718 . _R _ � Date: Ze Owner::Builder.................. _.............. _.._. ... __.......... _...... _ ....... _._..._.._...... _......... Address ... �..r. '" e !� 1 �,r:.�* Address ._ ..:. .,1................. _.............. LOCATION,LOCATIOWOR BUILDING No. ...... .+. Street _.....f .:;. �.._ _.+......... P Lot ...................._......_..._.._.._....- ........_......_i._.._..... Lot ......... ................. Block ....._..: .-.3.. ............ Addition or Sub -Division At F ... Corner Lot ................................. Inside Lot ... ^'"............ Setback S-- ------------ - Sideyard ..... �+� ... 0- .............. I................... Sewer Elevation ......------------- _......---•---.....-.--••----------- ............. ........................ ..... Foundation Elevation 'DESCRIPTION OF BUILDING To Used s: n ,p r�+v Depth .. " .,:: Height . - Sq. Ft. Cu. Ft..t._.C� . _..... .... Front ,�^ 400 Front ...: Depth .... Height q• i+ . Cu. Ft. /,�.... S Ft.. Type o Construction �.r'`ae'�...... Est. st ... .......... To be Completed .._ ..............._.........._.................... CA �� THIS mw 2()Es NoT.' ION Oic ANY f',,; AnnTryry",V COVENANTS- ANO . UVI�I���vl I�LJIf�It,r1I©: . 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 $.e .............. , 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 ordinances. Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name�� Builder„,,' Address WK S 3 F-' 4 �,r Address B CVION OF, BUIL G r No. 6 63 Street Part of Lnt LotBlock Addition or Sub.Div. 4.:� Corner Lot.Inside Lot4-�Set Back aSide-Yard G SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING Front Depth �_ � & ! Height Sq'. Ft. IV,�,.�-_, Cu. Ft. Front Depth Height Sq. Ft... Cu. Ft. Type of Construction" Estimated Cost'�� To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing'to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and correct. DATE 41-:71 SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.)�� CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Job Address 6G Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ 4b.00 Department of Buildings„ 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. 4571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. * Air Conditioning (all sizes) $ 10.00 $Vb.00 Fridley, Minn. 19�% All Others/Repairs and Alterations OWNER� C \� InancQ 1% of Value of Appliance or Work $ KIND OF BUILDING F_- COMMERCIAL/INDUSTRIAL USED AS 1% of Value of Appliance or Work $ TO BE COMPLETED ABOUT ESTIMATED COST 3, /M State Surcharge $ .50 OLD - NEW BUILDING PERMIT NO. PERMIT NO. TOTAL FEE $ ), Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Final Insp. Trade Name (>r Size No. 15%1_�) xC CAC) Date Approval for Permit Capacity Sq. Ft. EDR BTU 203,004L) HP , Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity d,��a ^OSq. Ft. EDR BTU '3b,b C) HP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 Company COE, PLUS $.50 STATE SURCHARGE Signed y Tel. No. *Air Conditioners can not be placed in side yard without written permission fram adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIMNEY 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 connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company Signed By Da to R SuBjECT P City of Fridley 33401 AT THE TOP OF THE TWINS BUILDING PERMIT f o COMMUNITY DEVELOPMENT DIV. 1 LV r � PROTECTIVE INSPECTION SEC. � 1 r NUMBER REV DAT PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910 -Fl 5 4;1/03 JOB ADDRESS 5163 Rainer Pass NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 3 1 Innsbruck 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Linda Zdon 5163 Rainer Pass NE 763-572-8301 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 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION j] REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (32 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must meet 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 SQ. 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 $3,705 $1.85 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- $97.25 Fire SC $3.70 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE $102.80 SIGN URE OF CONTRACTOR ORAuTHORiZEDAGENT tOATE� W PROPERLY VALIDATED THIS IS Y UR PERMIT 1 S. ATURE OF OWNER dF O E U4DERi iDATE, p iNSo 41, T - R NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: t 42)6-[ rte r ?aSS Legal Description: Owner Name & Address: LI r, da, '-,d.-0-n Tel. #-7(;5 - 5��1—�3�/ Contractor. '7-0 ( �- MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 3 SC6, r � ^� Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: till D3 APPLICANT: ��+%'� Tel. #26-3-S 7.2 - 36/ Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ '-Z� $ d $ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater ®V � v 0 3 1F® Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES ))' Poss JOB ADDRESS f (03 " ajOlel Fee Total Owner �r cyia $35.00 $� C� $10.00 $� Building Used As ESTIMATED COST PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of HeatingMWTW_N_ Circle One (Steam) (Hot Water) Ai C Trade Name Size No. $25.00 $ BTU .7a� i U HP EDR Fuel Total Connected Load Commercial/Industrial/institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR Burner Trade Name BTU HP Size No. 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 $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $?(J'SK) *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City Tel #&S 2el-96 7/ FAX # f- 2® t- Date 34 0' FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existina 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 manufacturers 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 manufacturers specifications. Yes No When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturers 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. YesIN 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:2tL>CQ Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat 7 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 Signed By: From: 651 688 2743 Page: 111 Date: 6!212009 8:13:17 AM Building BrU.IL.DING Permit No.: (� '4Fl6I Inspections RESIDENTIAL APPLICATION Recei ;q 763-572-3644 JUN CITY OF FRIDLE`1� Date Rec' °' 763-502-4977 FAX EFFECTIVE 1-1-09 DATE.� +� / / YOUR E-MAIL ADDRESS G,�✓Cr� /�a r[� Rfr tit /r -Cyr s'�'L.. SITE ADDRESS /6.� /� �,{ p /s��! _ THIS APPLICANT 1S: O OWNER itCONTRACTORF PROPERTY OWNER/ NAME: Z"'7ela TENANT ADDRESS:,St76 STATE/if4JLIP PHONE: CONTRACTOR NAME: SUBMIT A COPY YOUR STATE LICENSE ATE LICENSE # ? F- ,�6'e �'Y'M!5 EXP DATE AND CERTIFICATE OF ,� ADDRESS:_ �e 9 I �r'�O/JEEOil.0 c'� ,// � Crry ��f rj `�+�- STATE/;7" INSURANCE PHONE g ! ` ey�� - y�' FAX S -r -,O ff- PROPERTY TYPE pWSINGLE FAMILYINEW CONSTRUCTION SIZE Q TWO FAWLY/NEW CONSTRUCTION STORIES PERMIT TYPE 17 ADDITION 13 GARAGE/SHED WINDOWS to u,�w,•,r,a - /-�c/Sfr.+Z E3 BASEMENT FINISH ❑ ROOF ❑ DRAIN'FILE E3 DECK O SIDING ❑ OTHER ❑ SWIIvfMTNG POOL TYPE OF WORK: O NEW HOME CONSTRUCTION ❑ ADDITION 0 MAINTENANCE/REPAIR AULEMODEI.ING DESCRIBE WORK BEING DONE: re.+'109!�" -;4w-T SIZE OF 1MPROVBLIENT LENGTH WIDTH HEIGHT S9 Fr ❑ HOUSE ONLY NUMBER OF SQUARES E3 HOUSE &GARAGE RASEMENT jt MODELING I MIT• GARAGIE$ 1. ❑ ATTACHED GARAGE 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: E3 DETACHED GARAGE 1 3. List of sMu;Wal members to be used PROPOSED HEIGFIT: SMIiNG FOR NEW CONSTRUCTION INCLUDING DECKS, E3 Vinyl ❑Soffit ADDS_ & PORCHES SUBMIT: O Almninum p Trim 1, Site Plan/Survey showing the Misting structures ❑ Other 0 Fascia and proposed project nab--n-Q-W—S I Two sets of construction plans 3. IN EXISTING OPENINGS Oftes []No LOCATION OF WINDOWS Energy Calculations OR FOR NEW OPENINGS-10ESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS .+..,. IV �M10.3,« nv.zz" WIN vnLUA>! LUN, 1AULUDING T ift C:CWF OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S /.s' �.?1) OCCUPANCY TYPE Permit Fee $kkg a,a S See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum S.50 License Surcharge $ d $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = it x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( } Total Due $ , Make checks payable to: City of Fridley Attach Stimulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and l 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 on site; that the work will be in accordance with the approved plan in the case of)aPvvDrk whilequires review and approval of plans. // SIGNATURE OF APPLICANT 'tZLL PRINT NAME 4AA&7_ -�04z 'Z�- DATE PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMRTNC;_ HI Rt"_ M FrAT . ANn mpr wAvit-AT Wnrzu 111