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PRE 2010 DOCSCity of Fridley, Minn. r` BUILDING PERMIT N° /A 4833 `- Date: Owner: mss......_: Builder _. . ......... .... _...... _..._..____..__.__._._..... __ ___....W_ ------- _.._.... __---- e Address _..... _00_ . , Address ....... ........ .... .._._...---._...___.._...._.__......_........ _ .... _----------- _....... _._.... LOCATI N OF BUIPING �......No..14 ...Street Par t o t ............. _ ?s __.. Lot ......... Block .......... ..........._......._....... Addition or Sub aDivisiogr"i'�"�. !....-= Corner Lot ._ ........................ Inside Lot ...... . ......... Setback .---. # ........ _........ Sideyard ....._ , ...... .......... . SewerElevation............................................................. ............... _.......... _........ Foundation Elevation ........ .......................................... _......... _................... DESCRIPTION OF BUILDING To be)Used as f We Cu. Ft, ;�.+.....i�J: Front-+" -.. Depth ..... Height _.. Sq. Ft.ad ....._.. Depth ..... _ ght ......_.. Sq. Ft. Cu. Ft ... ..... ..:_: :....�...-----...----- Front _ �. of Construction .... :' e. Est. Cos .. .. �o be Completed ................ j 4 j� c� In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of.. ..:.:'""'" permit is hereby granted to. .... _............. �._____.......__:_._..._:..__..._..._.: to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be, revoked at any time upon violation of-V#ny of the provisions of said ordinances. yr uilding .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 Net Builder_ Address.] " ddress �;� % t�✓:�.°.s �'�`�r, LOCATION OF BUILDING No.Str""est' _ -Part of'Lat Lot _' Block . 3 Addition or Sub. Div. i'te,� ��sic,�A�?A Corner Lot Inside Lot .1t 1 y Set Back _..3..� Applicant"&tt&ch to this form Certificate of Survey of Let.and proposed buildingloe tion. DESCRIPTION OF BUILDIN To be used as e � Front _ Depth._Height _. Sq. Ft. `� Cu. Ft. i Front Depth 'eight �- Sq. Ft. ..'.^ Cu: Ft. . Type of Construction i -l4• .� Estimated Cost To be `completed A4y.► I /9(.-o The undersi6ied:hereby makes application -for a permit for the work herein spdcified, 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 representations stated in this application are true and correct.. Date Signature (A Schedule of Fee Costs can be found on th .Reverse Side) Application for Power Plants and Heeling, Coding, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... .................. 2.00 $ _ Replacement of Furnace ............................. P.00 $ Repairs & Alterations—up to $500.00 5.00 $ Repairs & Alterations each add. $500.00 .......:....... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL ROUGH FINAL Dept. of Bldgs. Phone SII. 4-7470 n Location ofvL2 J ( /C' City of Fridley: 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 representations stated in this application are true and correct. Fr' ey, �� 19 Owner Kind of Bding /X � n Used as To be completed about Estimated Cost, $ '!b O —Ne Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POAVER PLANTS—,Steam, Hot �Wa , Warm No Trade Nam 6 p- - Q due- Size No Capacity Sq. Ft. E.D.R- BTU H.P. Total Connected Load `�� `rG Kind. of Fuel BURNER — Trade Name Size No Capacity. (REMARKS—OVER) Sq. Ft. E.D.R BTU H.P. RAY N. WELTER H EATI N G CO. 4637 CHICAGO AVE. Sign ed—M i N N E tt8 i ; ioltfdi �� By 7 42 2M 7-59 Business Phone No �✓ '� City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK �_ Number. Kind and Location of Fixtures Locatio N NO. RATE TOTAL Number Fixtures ...................... Z Future Fixture Opening ................ i`�'" YZ� x 1.00 $ �paZ_ �TF3-ZNu Water Heater (Up to 200,000 BTU) ...... ,a w u Z •R • WATER HTR. x $1.50 $ �- 5 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. '� Z Fp'�z' Z a 90 N GAS ELEC. 02 Base 1st % f 2nd _ 3rd 4th • Future Connection Openings Connected withI Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... C(gS�J x $1.50 $ Future Fixture Opening ................ '= x 1.20 $ ' New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................Z x $1.50 $ �- 5 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE City of Fridley: 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 reby declares that all the facts and representations stated in this application true d correct. A Owner 6c.� Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit ROUGH FINAL .QMW42 2M 7-59 k SUBJECT P - City of Fridley --` 28564 AT 0 THE TWINS BUILDING PERMIT O COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 7�- 61 PROTECTIVE 1 ; � CITY HALL FRIDLEY 55432 '•j NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 11/12198 IDB ADDRESS 267 Rice creek Boulevard 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 15 3 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Virginia Evens 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Peak Roofing 11506 S. Oakvale Minnetonka 5530 938-8150 20045301 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 O MOVE ❑ REMOVE 8 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 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 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 2056 $1.03 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CMA E PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. STRUCTION OR PERFORMANCE OF CONSTRUCTION 74..75 Fir SC 2.06 �T/HHEE� G PLAN CHECK FEE TOT FEE L c .84 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI 04EN JWTHIS IS rQkJ PE V S-GNATURE OF OWNER,IF OWNER BUILOERI IDATEI INSP r'ArE NEW 4 ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ; ®`' '_ � /. Legal Description: Owner Name & Address:, �; �, e CITY USE ONLY Tel. # Contractor: �_�� �� �.' Fire Surcharge MN LICENSE # Address: //S 0 State Surcharge $ A o3 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT �2c0ys730 / 539- 9f s -o LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/ round Sq. Ft. OTHER: ( nC`7 59 �� U,/ d U S � Construction Type: ��e ®� iL��ti Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: �' � &- C— Tel. # % ? fls CD TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ Sr Fee Schedule on Reverse Side Fire Surcharge $ Oto .001 of Permit Valuation (1/10th%) State Surcharge $ A o3 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ Sr ®D $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 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: NO. RATE New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range" Gas Dryer" Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL 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 Pluilding Division, and hereby declares that all the facts and representations stated in this application are true and correct. EVENS, VIRGINIA 267 RICE CREEK BOULEVARD N.E. '2003 FRIDLEY, MN 55432 C� 3 Owner (763) 574-9593 3 �J �l �f.7 Building Used As _ �`e6k:Qg;�N Com. � Estimated Cost PERMIT NO. A B -/S PLUMBING COMPANY ®i��L� LU% AjCr C�} SIGNED BYTE N0. Z - O Approved By Rough -In Date Final Date--®� .50 MINIMUM rtC MIS ANT I'L.tJINISIN141t iAb I,tKMI1 15 520 TOTAL FEE $20.550 PLUS THE 5.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Stories ..........................Unna ......................Shower 5....-----.......Tra Wash F tttt-<: =<:::: Floor :>•::::> Auto. Drain Washer .->::>::::>::>::: .. .::..:::;:;: Gas :��:«::::::: Water Hea ter Rana Gas Elec BasementI ><> :l.- vv.• .nv.:..•:...: y:: Floor 1 I F o0 r2 Floor 3 .. ... Floor 4 PLUMBING FIXTURE RATES: NO. RATE New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range" Gas Dryer" Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL 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 Pluilding Division, and hereby declares that all the facts and representations stated in this application are true and correct. EVENS, VIRGINIA 267 RICE CREEK BOULEVARD N.E. '2003 FRIDLEY, MN 55432 C� 3 Owner (763) 574-9593 3 �J �l �f.7 Building Used As _ �`e6k:Qg;�N Com. � Estimated Cost PERMIT NO. A B -/S PLUMBING COMPANY ®i��L� LU% AjCr C�} SIGNED BYTE N0. Z - O Approved By Rough -In Date Final Date--®� .50 MINIMUM rtC MIS ANT I'L.tJINISIN141t iAb I,tKMI1 15 520 TOTAL FEE $20.550 PLUS THE 5.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 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 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 installina 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 ( Appllance 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: Date Signed By: CIlYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 June 8, 2004 Ms. Virginia Evens 267 Rice Creek Blvd NE Fridley, MN 55432 Re: Final Inspection at 267 Rice Creek Blvd NE, Fridley Contractor: Norblom Plumbing Dear Ms. Evens: A plumbing permit was issued on May 1, 2003 to install a water heater at your address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/mh Building BUILDING Permit No.. Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY Date Rec'd: C` DATE A �f / ��� YOUR -MAIL ADDRESS SITE ADDRESS 426l 2 4/ a L f tit° rk B11"', THIS APPLICANT IS: ❑ OWNER 'CONTRACTOR PROPERTY OWNER/ NAME: VIraw ADDRESS:(/,,&2 `� f6?tey lam_ %�� /� e64@Vl-Y STATE ZIP, e7,/,3 TENANT PHONE: ��l �j - 5-7V 1 J CONTRACTOR NAME: STATE LICEN A SUBMIT A COPY OF YOUR STATE LICENSE ADD S: CITY STATE ZIP WITH APPLICATION IP golnUaWAX ' PROPERTY TYPE ❑ SINGLE FAMILYNEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH PROOF 0 DRAIN TILE ❑ DECK ❑ SIDING O OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE-- �� re? SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES J3eHOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT: ❑ DETACHED GARAGE 3. List of structural members to be used 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. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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 $ C)C) OCCUPANCY TYPE Permit Fee $o See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due H .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+68= ffx$21=$ $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 and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances anodes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for Hermit is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which 'uire vie d pproval of plans. > �j SIGNATURE OF APPLICANT �' PRINT NAME.P. DATE / ��%