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PRE 2010 DOCSs C 1 I Date:J_ _ my 23? 1968 Owner: Charles Johanson Builder Address 160 Hartman Circle Address Same Same LOCATION OF BUILDING No. 454 Street _ Rice Creek Blvd. part of Lot — Lot — 10 -_ Block 2 Addition or Sub -Division _ Holiday Sideyard _ 20'/ 15' Corner Lot — Inside Lot — X Setback 35' 3S;'12 - N9 9839 Hills, 2nd Addn. Sewer Elevation 843.05 . 846.00 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 50' Depth 261611 Height 20' Sq Ft, 1350 Cu. Ft. 27,900 Garage Front 20' Depth 24' Height 12' Sq. Ft, 480 Cu. Ft. 5760 Type of Construction Frame Est. Cost _ _ $27, 000 _ To be Completed SEWER LOCATION - 16.5' North of Manhole WATER LOCATION - ' North of Manhole 26.5' In consideration of the issuance to me of a permit to construct the building bed above I agree to do the proposed work in accordance with the description above se o and in e o pli ce with ail provisions of ordinances of the city of Fridley. Sewer Connecti6iX Charge In consideration of the payment of a fee of $---4-9-2-0—, permit is hereby granted to— Charles Johanson 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 of the provisions of said ordinances. arence Be is e NOTICE: This permit does not cover the construction, Install>tion for wiring, Plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for thus Menu. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY. MINNESOTA q 11111111 11 "!! 11, OWER'S NAME F)c F ➢nhanI . BUILDER Charles.. Johansw 160 'Hartman C'srcle _i;_0RaF5ia_nCirc e ADDRESS RUT) ELWIQXKW _ADDRESS _q,_L5432 LOCATION OF BUILDING C NO. STREET PART OF LOT LOT. _/ _OBLOCK Z ADDITION OR SUBDIVISMI %a. C014NER LOT 1.1 SIDE LOT SETBACK 35-- SIDE -YARD M -Z> SEWR BLEVATION FOUNDATION ELEVATION Applicant attach to this fozn. Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION UP BUILDING To Be. Used Ad: Front $1-0 Depth 2° `� Height_ -,7 - D -7 Sq. Ft. 3b -D Cu. Ft. .2 00 f Front Depth .. 2=_V Height Sq. Ft. '7�`7e —Cu. Type of Construction____7 �� ._Estimated Cost "le, To Be Completed ov, 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. RE .SIGNATU DATE o. (Schedule of Fee Costs can be found on the Reverse Side).' it I * .1 44-9 el 0 Ar>. 3° - City of Fridley Application for Plumbing and Cans Fitting Permit Dept. of Bldgs. Phone 860-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location S 36 pp 3if �� w 3i ccO CLL C O� OJLLo QFQ V3 u�qd (94 uda (9Sa �' udn UO F N WATER HTR. GAS ELEC. Base 1st / 2nd 3rd 4th _ • Future Connection Openings New Fixture, Old Openings I Connected with Sewer � cesspool E] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $2.00 $—./S r�` Future Fixture Opening ................ x $1.50 $— New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... I x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ City of Fridley: The undersigned hereby makes application for a permit for the work 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 e7— 0 190 Owner 1 L- E - -s c/o /'USS Oka Kind of Building -�' N A--hn ', Used as 'tL'j C'L t- / 14J To be completed about Estimated Cost, $ Old—New. Building Permit No, �J Permit No. Signerdw By Business Phone No_ 71 ROUGH FINAL Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldga. CP%hone 660-3450 GRAVITY WARM AIR: RATE TOTAL Location- � / a Furnace Shell & Duct Work ........................... $10.00 Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ 690,00 each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ..................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 6.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 200 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM it ALTERATIONS & REPAIRS TOTAL FEE $ 5 ROUGH FINAL 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 -arynd correct. Fridley, Minn `7 , 19 Owner Kind of Building _ jn c Used as 4/-dV' To be completed about Estimated Cost, $ C9 OW—New. Building Permit No. q33 Permit No.��/ DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name � �S�i't-� Size NodO C t - 117 Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load /► sQ —Kind & 1 ✓ 6®® - BURNER — Trade Name G4 Size No , � 00 Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) i Original PERMIT for Power Rants and Heating. Cool- ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of-_ /' Heating Plants to betal ltered—repaired Make Oil fired—,- Coal jwed ; Gas fired %' ; Gas Authorization Noti _ Remarks Approved Final Inspection Date , 19._ Inspector Peru __ 4597 Fee $ Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. , 19� Owner Location 46-' Kind of Building�� _ How Occupied Work to be Commenced—, 19 To be Completed / 119_ Estimated Cost, $ / v ' ,y Old -New, Building Permit No. `/'f32 Permission is hereby granted io „' t11'1& -A -t -a A' ® ® to install--erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set forth in the approved application for this permit on file in the office of the Inspector of Buildings. p _- o `v * , -Inspector of Ruildinas a z 2M 1147 V Application for Power Plants and Healing. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water ............... .. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTI) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...... x$ 2.00 $ g w o Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL !�" 7 $ See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone 560-3450 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. Owner Kind of Fridley, Minn % — 49 ! 19 20 e Used as To be completed about Estimated Cost, $ jj Old—New. Building Permit No. Permit No. ",, x`006 DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No Trade Name Size No A r A ,.?K tic) Capacity Sq. Ft. E.D.R BTU A.P. Total Connected Load Kind of Fuel-® BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signed `IJLP By- CQjb.4P Business Phone No-- (REMARKS-OVER) o- Original PERMIT for Power Plants and Heating. Cool. ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No.of �r Heating Plants (711h) d&� &—_ to b i talied tiered—repaired Make l y �/L a-)- - - Size 46 �6 - 366 0 ; Oil fired ; Coal fired ; Gas fared / ; Gas Authorization No. Remarks Approved Final Inspection Date , 19_ , Inspector �_ 3_� Permit N° - 4809 Fee $ - Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. Q , 19v� Owner Location�'`�•�` Kind of Building N �A&Ms_l How Occupied Work to be Commenced—,19— To ommenced ,19_ To be Completed ,19_ Estimated Cost, $ /WD -0t) Old -New, Building Permit No. Permission is hereby granted to �Aket . 71 VIA 4 1 .d.hk f ) 'f LA L/ to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specs ations sgt forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings az 2M 1I -V V J City of Fridley Applisalion for ftmbing md Sm RMWI Pemd! Dept. of Bldgs. Phone 960-3490 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING 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 Heater :Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............... 2 x $2.00 $ 2.00 Additional Fixtures .................. x $ .95 $ Gas Range to 199,000 BTU... x $5.00 $ install (2) gas liter 6.00 REPAIRS & ALTERATIONS—Refer to Code I.eeasoia 154 Rice Creek Blvd. City of Fridley: 52-84-915.51 The .undersigned hereby makes application for a permit for they ®soak herei specified, agreeing to do all work in strict accordance with the City Ordinance and Wiling of the Department of Buildings, and hereby declares that &A the fact and representations stated in this application are true and correct Fridley, Minn Sept. 21, 1971 � l9, Owner Charles Johanson Kind of Building frame Used as -residence To be completed about - Sept. 24, 1971 Estimated Cost, $ 20.00 O1dX-New. Building Permit No op.. -,747— Si ed. By hN��R1° Business Phone No ROUGH Description ............................................... $ TOTAL FEE $_ 8.00 Mass 'A' Surcharge .50% 17� ::::mss=NEeNsa::■ ............... PARTIAL RATE SCHEDULE PLUMBING 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 Heater :Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............... 2 x $2.00 $ 2.00 Additional Fixtures .................. x $ .95 $ Gas Range to 199,000 BTU... x $5.00 $ install (2) gas liter 6.00 REPAIRS & ALTERATIONS—Refer to Code I.eeasoia 154 Rice Creek Blvd. City of Fridley: 52-84-915.51 The .undersigned hereby makes application for a permit for they ®soak herei specified, agreeing to do all work in strict accordance with the City Ordinance and Wiling of the Department of Buildings, and hereby declares that &A the fact and representations stated in this application are true and correct Fridley, Minn Sept. 21, 1971 � l9, Owner Charles Johanson Kind of Building frame Used as -residence To be completed about - Sept. 24, 1971 Estimated Cost, $ 20.00 O1dX-New. Building Permit No op.. -,747— Si ed. By hN��R1° Business Phone No ROUGH Description ............................................... $ TOTAL FEE $_ 8.00 Mass 'A' Surcharge .50% 17� SUBJECT P IT NO. City of Fridley (21804 AT THE TOP OF THE TWINS BUILDING PERMIT rr ______ COMMUNITY DEVELOPMENT DIV. 1 r PROTECTIVE INSPECTION SEC. (1j o NUMBER REV. DATE PAGE OF APPROVED BY i --5 CITY HALL FRIDLEY 55432 %'j 612-571-3450 1910-F15 4/22/93 JOB ADDRESS 454 Rice Creek Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 2 1 Holiday Hilla 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Michell Michurski 454 Rice Creek Blvd NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Richard Hastings Contr. 6331 Riverview Terr NE Fridley 5749966 4051 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 �7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof; Dwelling C25 S ares) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd, 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 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 $� $,68 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT ,350. 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- $33.00 Fire $C $1.35 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $40,03 SIGNATURE OF CONTRACTOR OR VJTHORIZED AGENT ( ATE) WHE ERLY V LID ED THIS IS YOUR PERMIT �%1 �—! SIGNATURE OF OWNER of OWNER BUILDERI (DAM BLDG INSP DATE NEW ADDN CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 1/1/93 Construction Address: L M "-- A f ?, S- k 'I ics ciz-ej�ZK bLup, - M�C�e� -- 1 V -5-y x � Legal Description: Owner Name & Address: AA;C-4eCL AA�Ctl kkSkl Tel. # Contractor: c A A:zS MN LICENSE # 4f Address: 633) RtL7L-AUJ&C-0 Psf�' Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length OTHER: DESCRIPTION OF IMPROVEMENT Width Width Width Comer Lot [ ] Inside Lot Ft. Yd Setback Type of Construction: Approx. t-ompicuun ijaw: D � Driveway Curb Cut Width Needed: Height Height Hgt/pround Sq. Ft. Sq. Ft. Sq. Ft. Side Yard Setbacks Estimated Cost: $ (Cost on Back) Ft. + 6 Ft = Ft x $ = $ DATE: fz�Z" 73 APPLICANT: Tel. # -S-;;q— �7 � 6 Permit Fee Fire Surcharge State Surcharge SAC Charge $ 3.3.00 $ $ License Surcharge $ C) Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: s03 ----�L CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.501$1,000 Valuation $750 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary' t j Not Necessary SUBJECT City ®f Fridley 21986' AT THE TOP OF THE TWINS BUILDING MIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMBER REV.DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/20/93 JOB ADDRESS 454 Rice Creek Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 2 Holiday Hills 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mitchell Michurski 454 Rice Creek Blvd NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Ideal Construction Inc. 12621 Tyler Cir, Blaine MN 55434 757-3101 4240 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 �D ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE 8 DESCRIBE WORK Construct a 12' x 37k Deck; Remove old Deck; Replace 11 windows and 3 doors 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. WARNING G Before digging call for all utility locations 454-0002 . REQUIRED BY LAW 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 NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 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 $30,000 $15.00 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- $284.50 Fire 5C $30.00 TRUCTION OR THE PER RMANCE F CONSTRUCTION. PLAN CHECK FEE TOTALFEE O raj License SC $5.00 $3.34.50 SIGNATURE OF CONTRACTOR OR Ard-THO-RIZO AGENT (DAT) WHEN (DATED THIS IS YOUR PERMIT MPRLZYV SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI BLD IIVSP SATE NEW [ j ADDN [ j CITY OF FRUM" ALTER [ j SINGLE FAMILY AND DUPLEILES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: 11 ,jq Lo4 Effective 5126/93 Owner Name & Address: /1/1; f h`L i C A 14r pkv Yel. # 571 :5. 7 Contractor: ,Jci eat f �t �i®� etc °� °11 NLICENSE # Address: P- QrcJe_ o l ! c� n °� Tel. # 9 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 P Width Hgt/Gr and Sq. Ft. OTHER: �� L ��o �c e�� " h06 A— Cornea Lot [ j inside Lot [ j Ft. Yd Setback Side Yard Setbacks Type of Construction: k� i a jo w 51 a ®� � Estimated Cost. $, 39 n d - Approx. Completion Date: V euaQe"' k (Cost on Back) Driveway Curb Cut Widffi Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: _ r ! - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL L 1 I U3� l.►�IL I � $ Fee Schedule on Reverse Side $ P .001 of Permit Valuation (1/10th%) $ /-5-,00 $.50!$1,0 Valuation $ $750 per SAC Unit $ 5, 60 $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ Conservation Plan Review $450.00 $ Fee Determined by Engineering $ Agreement Necessary [ j Not Necessary [ $� STIPULATIONS: f CITY OF FRIDLEY INSPECTION DN. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Effective On August 1, 1995 7 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONr)ITInNING ..RYRTFM.R ANn nF:VIC:FS Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) 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 TOTAL ��,,�11 $ 30.00 $_IL $10.00 $ $10.00 $ JOB ADDRESS 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. OWNER ,A1/ y BUILDING USED AS ESTIMATED COST _ 26P0 r PERMIT NO. O CC DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Z Ai r lc Size No. BTU HP _ EDR Fuel Total Connected Load State Surcharge $.50 Burner Trade Name Size No. BTU HP EDR TOTAL FEES s?) ,�HEATING COMPANY Sharp MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION Heating and Air Conditioning REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed 4854 Central Aye. N - Ere No. PLUS THE $.50 STATE SURCHARGE eign7s, 1,719 a:)4xl (612) 5.72-0459 REINSPECTION FEE $42.00/Hr f ,. � Approved By Rough—In Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE 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's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes () No ( ) Yes () No ( ) 3ITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO RF INt4TAI I Fn ON FArN P OOP Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: 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** NO. RATE TOTAL JOB ADDRESS _',4jNF t', &401✓ I_ 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 FEE $za-550 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. MICHURSKI, MITCHELL %�� 454 RICE CREEK BOULEVARD N.E. // 20 02- FRIDLEY, MN 55432 (763)571-5275 Owner _ Building Used As��1��RY C oe Estimated Cost PERMIT NO.92 PLUMBING COMPANY LO NICat Al SIGNED BY TEL N0. Zr �' ' O Approved By Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE R !. rCR • R' � .. t '.�F . Lam® PLUMBING FIXTURE RATES: 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** NO. RATE TOTAL JOB ADDRESS _',4jNF t', &401✓ I_ 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 FEE $za-550 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. MICHURSKI, MITCHELL %�� 454 RICE CREEK BOULEVARD N.E. // 20 02- FRIDLEY, MN 55432 (763)571-5275 Owner _ Building Used As��1��RY C oe Estimated Cost PERMIT NO.92 PLUMBING COMPANY LO NICat Al SIGNED BY TEL N0. Zr �' ' O Approved By Rough -In Date Final Date 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 BTU Input venting has been examined and is free from rust, deterioration, obstructions, Appliance#2 Type and is securely supported and firestopped where required. Yes () No ( ) The venting: system is plastic/PVC and meets all current codes and manufacturer BTU Input specifications .including sizing, length, number of elbows and termination. Yes O No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does Vent Height include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance 1 Vent Connector Height assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes ft Length and manufacturer's specifications. Yes( ) No( ) When required to install a new combustion air, it will be sized and installed ft Diameter in Type 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 ( ) Appliance Tvae 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 HEATING CO: _ Signed By: Date : CITY OF FRIDLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 " (763) 572-3604 RATE SCHEDULE DIViSION APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 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. Effective On January 1, 2002 JOB ADDRESS 0.2Z R: " Cf--ee / OWNER �Z - zelre-� TOTAL BUILDING USED AS gvj%e ESTIMATED COST ;26PERMIT NOl 5 ! l DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name #sem % fl Size No: BTU HP EDR $ Fuel /+✓ Total Connected Load Burner Trade Name 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE /-�2- HEATING CO Signed /� Z-� /4,'6, TEL # 65-1- g;33--e_�4 i FAX # Y Approved By Rough -In Date Final Date SUBJECT PE City of Fridley 33367 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. •COMMUNITY DEVELOPMENT DIV. fr ��e�_ r � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 763-571-3450 910415 3/13/03 JOB ADDRESS 454 Rice Creek Blvd NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 2 1 Holiday Hills 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim/Sue Kozarek 454 Rice Creek Blvd 763-572-2141 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Wellington Windows 3938 Meadowbrook Rd St Louis Park, MN 55426 952-933-6300 a 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 ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Replace patio door 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. SEPARATE PERMS PL 1' I REQUIREDTING n � WIRING 911 88 MUMPLUMBINd AND SIGIIS To Homeowner TO Post 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 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 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 $2,255 $1.12 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. $83.25 Fire SC $2.25 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE City is nse 86.62 SIGNATURE OFCONrAACTOAORAUTHORIZED AGENT iDATEi HE PROWL)(" THIS IS40UR ERMIT/ I. BL G -NSR q lE S-GNATURE OF OWNEROF OWNER BUiLDERi tDATE, NEW [ ] ADDN [J ALTER [ i gl`t'63 Construction Address: Legal Description: Owner Name & A Contractor. CITY OF FRIDLEY Effective 1/1/2002 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION H Yom j 5Ve O e- K Tel.# -763 - 7-d -?lW MN LICENSE # E 1=21&� o Tel. # �t6�'4o �l Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF UMPROVEMENT LIVING AREA: Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: f'zce (We r?ewf o Construction Type: Rc4&D Estimated Cost: $ �a5rf- Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ DATE: APPLICANT:Qvt �/1 Tel. # Call (763) 572-3604 for Permit Fees if mailing application or Fax to 763LS714287 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 CITY USE ONLY - $ �5 Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th% $ `. /a $.50/$1,000 Valuation $ $1200 per SAC Unit $ C) $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 [ ] �a TOTAL $ 0 k:>. STIPULATIONS: s Building BUILDING Permit No.: &q Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRID D 7 DATE ' BL,EY YOUR E-MAIL ADDRESS K LI CA t '%✓', (!9 LJ �� °�� Cc " SITE ADDRESS �S (cam CX_'C Fr– '6t ei/✓ THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: �J 1 y+ fi .I� cr eo/e- TENANT ADDRESS: CITY STATE—ZIP— TATE_ZIPPHONE:7&3_.S'7Z"- PHONE:-7&3–.6'7Z– 'Z/L( i CONTRACTOR NAME: GUI: 5T1 1 y or oe STATE LICENSE # f/O� �? EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY S`T'''` STATE~ WITH APPLICATION PHONE ( �� Y! o FAX PROPERTY TYPE GLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES _ PERMIT TYPE ❑ ADDITION ❑ G GE/SHED ❑ WINDOWS ❑ BASEMENT FINISH OOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ ❑ ADDITION ANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DO SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING2 � 11HOUSE ONLY NUMBER OF SQUARES �/ OUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. 3. Proposed floor plan 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. 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 & I TYPE OF WINDOW TO BE INSTALLED 4 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 $ J5 OCCUPANCY TYPE Permit Fee $ L) See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 7 .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ ,��`} $5.00 (State Licensed Residential Contractors) SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $1675 per SAC Unit (Plans to MWCC for determination) $ e7 ft+6 ft= ftx$21=$ $ D $450 Conservation Plan Review $ Fee Determined by Engineering $ ent necessary ( ) Non Necessary ( ) $ �hecks payable to: City of Fridley Attach THIS IS AN I hereby apply for a building permit and I conformance with the ordinan an permit but only an applicati for a p plan in the case of all work hich r ' es re, SIGNATURE OF APPLICANT A PERMIT -NOT VALID UNTIL PROCESSED Kat the information above is complete and accurate; that the work will be in ridley and with the Minnesota Construction Codes; that I understand this is not a to start without a permit; that the k will be in accordan a with a approved val of plans. PRINT NAME 1N� DATE D 1 Building Inspections 763-572-3604 DATE -----T4 SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOt-MAIL ® 0,5�. COMPANY NAME.' CONTACTPERs 410 WET EES ^fiA1A1 � %, MN 55408 STATE LICENSE # PHONE FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY 11 TOWNHOUSE TYPE OF WORK: 13NEW LACEMENT 13ALTERA7I0wREMODEL DETAILED DESCRIPTION OF WORK Permit PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cast up to $. 0.00,,wlii6 ever is greater, fox the e. improvement, installation or replapemenf of a residential, fixture, excluding *efiXtures...('�' should reflct onlythe cost of labor) ?s...... . i . Labor cost under $300 = $15.00. Labor cost between $300 to $S00 = cost oflabor X .OS - .FEBS $ASID ON $10.00 PER FIXIWE .EXCEPT WHERE NOTED. Fes: PK. TAL FOR PROJECTS WHERE LABOR EXCEEDS SS • NUMBER OF EACH BELOW) MODEL: S12TATU EquipmentlnsWiled MFG a MFG. MOSi7 {BTCJ mom- MFG: MODEL: SIMSTU A� FIREPLACE (GAS) $15.00 GAS RA14GMVEN $10.00 TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NES' GAS GRILL $10.00 BOILER $35.00 _FURNACE $35.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $1000 GAS PIPING $10.00 VENTII,ATOR $15.00 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = :b Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 $_ TOTALDUE $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge Total THIS IS AN APPLICATION FOR A PERhIIT-NOT VALID UNTIL PROCESS® I hereby apply for a budding permit and I aclmowledge that the information above is complete and accurate; that the work will be iE conformance with the ordinances andcodes of City of Fridley and with the Nfinnesota Construction Codes; that I understand this i� not a permit but only an on for a work is not to start widlout a permit; that the work wdl be in accordance with the approved plan in the of 'ch view and approval of % ( - -" - - - - - , /l. - SIGNATURE OF City of Fridleg Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-672-3604 FAX: 763-502-4977 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMESIADDITIONS EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTIi4Q°I 0M.E6 1. Combustion Air (See note belot) a. tJil. or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or PropanoUGC Chapter 3 with MN Amendments 2. Makeup Air (See note below) & IMC Chapter 5 with MN Amendments 3. Venting a_ Gas appliances 1FGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new consfruction IMC 1346.0312 5. Ventilation a. Per MN EneW Code 7670 or 7672 6. Duct Design Per IMC 1346.0603:2 a. ACCAManual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations Building PLUMBENG Permit No.: Inspections SIDENTLA-L APPLICATION Received By: 763-572-3604 CITY" OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 1-1-08 DATE_�� YOUR E-MAIL ADDRESS SITE ADDRESS e_ (�A! ,0_ 64— d3k THIS APPLICANT IS: ❑ OWNER -MSS ITR.ACTOR PROPERTY NAME: 1r; /C - ADDRESS: _- Qg�e ezW ITY ®p . STATE zip OWNER/ TENANT PHONE: = —- 7'7 mt/$� CONTRACTOR NAME: c P - ��/ C --- STATE LICENSE ®G �� EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE . PHONE %�'�2 "—�� FAX PERMIT TYPE FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: ❑ NEWS DETAILED DESCRIPTION OF WORK PER MS 16B.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 x .05 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINK/LAV DRAINS SHOWER _ WATER PIPING _ _FLOOR _ BATHTUB PIPING (NEED CITY LIC) SWIMMING POOL —WATER SOFTNER ($35) _ —GAS _ CLOTHES WASHER KITCHEN SINK —WATER CLOSET _ BACKFLOW PREV. ($15) _ _ DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION — WATER METERe/ Z� _OTHER Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 (MINIMUM $15.50) (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 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 all w _ which requires review and approval of plans. 0- Q� Q �® SIGNATURE OF APPLICANT PRINT NAME vc DATE APPROVED BY DATE 1011 IN City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977