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PRE 2010 DOCSSUBJECT'S P MIT NO. City of Fridley ® 13211 AT THE TOP OF THE TWINS PERM I T r BUILDING CEIPT NO. COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 9/16175 JOB ADDRESS 6230 Rice Creek Drive. N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 ] Rice Creek Estates 2nd Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Briar Homes Inc. 8535 Central Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE �O 8 DESCRIBE WORK Construct a 26' x 40' Dwelling and a 24' x 26' Garage 9 CHANGEOFUSEFROM TO STIPULATIONS provide a hard surface driveway. Provide a verifying survey before capping. (Provide sod in the front and side yards) SE'PERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 R-1 1151 +624 23,620+ 6240 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, WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $37,250 18.63 TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE F ANY OTHER STATE OR LOCAL LAW REGULATING CON- aDPRESUME TH ER RMANCE OF CONSTRUCTION. $55.24 $325.00 17/ PLAN CHECK FEE TOTAL FEE �y S $398.87 4rNATURE OF CONTRACTOR OR AUTHORIZED AGENT ID E) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT !)�!U—tC( -0o --j-0(` i BLDG INSP D TE •� SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI • o APPLICATION FOR RESIDENTIAL, ALTERATION, `+ OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'SV��BUILDER:1g� ADDRESS�� _,oADDRESS:. NO:. �eZ'.�CJ STREET: r LOT: BLOCK: I ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD %a__V0 Applicant attacl to this form Trio Certificates of Survey of Lot and proposed building location drawn on these Certificates. _ DESCRIPTION OF BUILDING e Used As: Front: ��m Depth: �4 0 Height: 2t Square Feet:Z-k) Cubic Feet: 74, Front: °�l'�� Depth:_ Height Square Feet;(')ti Cubic Feet: 0. Type of Construction: �Estimated Cost: $ To Be Completed: e� The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work iri stzict accordance with the City of Fridley ordinances -and rulings of the Department of Buildings, and hereby -declares that'all the facts and represent stated in this application are true and correct. DATE: ` I kA `-'< SIG (See Reverse.Side For. Additional Information.) 1pInowi®ry City of Fridley 1 Appliccafla a for Plumbing c.. d Gas Fil$i'mj Peru s .e.�..,e..- .....,_.�--.. _._. Dept. of Bldoa. Phone 560.3450 .. DESCRIPTION OF WOrR LocIIYl� • ��� � ��'G e �� � �!� �� / � � � ��� Number, Kind and Loeelfon of Fixtures City of Fridley: ii i ~ � < _ ~ x 3 = i � rt �, � .� • Z O S � z UN oK •. � � � Cr1 7 < pw s 7 e / • M wATEA MTR. GaS ELtG Base l 2nd 3rd 4th Furize• ConsoCt s•L Cj>0nIri7%wuue'n•w.a w..w __ Sever�- + Xnvy Fixt-aro. Old Op-snmIgs Ccc Pool p PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE �TOpTAL� � Number. Fixtures • . • • . • • .... e . e . e .�..�{ iii. x $2,00. $. Future Fixture Opening ............. New Fixture Old Opening... • • e • . • e x $1.50 $ Catch Basin. x $3.25 $ Water Heater '.Up to 99,000 BTU).... x$3.08 $ J , New .Ground Run Old Bldg... . •.. x $.3.25 $ EldctAc Water Heater ............. 0 a $2.00 $ .*AS FITTING FEES: HO. RATE TOTAL lit Fixtures •••••. •..... •.e••e x 32.00 , m Add tonal Fixtures ............... x $ .75 $ Gas Range to 199,000 BTU .......... x $5.00 $ The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the Cita 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 195" Owners Z'-19 Kind of Building Used as e To be completed about /✓ e Iz Estimated Cost, $ 2 2 ! Old New 13uiidirg Permit No. Permit No. Signe By Business Phune No�— ROUGH FINAL R.El;AIRS k ALTERATIONS -Refer to. Code .50 State Surcharge Description ............... i .................. • ... . T OTAL FP'.E �s..�Rn, 4,x.a, 1° ,.,..Ar G^^ r•• R�„A..+?':.nRi.,#"R A,,,S, R;'7...^..$req w. •.',.P.-a,.�,.9,t•n �s �'�9'&e�$�'a✓'7i D�ev"�i �`at+L6�rw N t"i.-e �ba.db �I9.�: w.O t4•^�,4 �e3�+i,a•�p �4u L�aa L:+�iss li.'uO LA@ L,rYI:L�4r6 �tod�k�iiie �i� Zeys .,�n .".gid DQ �: ez': iia b a�C' uC 1vsrox6a e�+ "� ter 4'Ss �.irL PARTIAL RATE SCHEDULE GRA v I r I VARM AIR: RATE TOTAL Furnace Shell & Duct Work $10.00 $ Replaerment of Fumare 6.00 P.rpat-c & Altcrat:ors-up to $500.00 600 $ Repairs & Alterations each add. S500.00 3 OU $ =CkL WARM AIR Furnace Shell & Duct Work to I34,OW BTU ezch add. 60.000 BTU Replacement of Furnace Repairs & Atte-ations--up to $504.00 Repairs & Alterations each add. $500.00 .310 00 $ a, 0 V �r 3.W S 6.00 $ 6.00 $� 3.00 STEAM or HOT NATER SYSTEX Fsrr:ace Shell & Lines-- to 400 sq. tt F.DR Steam $10.00 $ Furnace Shall & Line -_•to 630 sq: it. EDR Hot Water 1000 $. Each add 200 N. ft. EPR Steam inn $ Each add. 320 sq. ft EDR Hot Water 3.00 $ OIL BURNEP.-to 3 gal_ per hour 6.00 $ over 3 Bal. per hour -See Fee Schedule GAS BtMA h'ER (up to 199,000 BTU) 5.00 � ®ao over 190.000 BTU Sae Fae Schmdule GAS FITTING F e:e.3. NO RATE TOTAL I st 3 Fixtures %S 200 $ Additional Fixtures x .yg-- Gas Rare to 193.W0 AB 6.00 $ AIR COLD1T 0111ING, TAX X71ATING T2T'a 4 1r q'?:NTnJ.TMG S'ST XLTZRATTONS & Rr'"PAUM ROUGH TEAL_/ - / . - % % State Surcharge .50 1309 roe 1 ;Xla YOT11E. P'= $ ;Zof 15� Dept. of Bldgm. Phom MD -VM �C! C lz, C-1 E - City 1E - City of Twdley: The undersigned hereby makes application for a permit for the work berelr specified agreeing to do all work in strict accordance with the City Ordin4ntet and ruling of the Depat tment of Buildings, and hereby declares that all tho fcAds and representatiuns stated in this application are true and con•ect. Fridley, Minn 7' owner Kind of Building Used as To be completed about �+ Estimated Cast; $r Old --New. Building Permit No. -_ ___ _ P.rmit No. vcla"Ox OF WORZ HEATING or POWER PLANTS --,Steam, Rot Watei, arra No Trade Name P Size No / Capacity Sq. FL E D.R BTU Total Connected Lid Riad of FLel 6*145- BURNER - Trade Name__ Size No Capacity Sq. FL E.D R MM - mr t..aacs-oaaal �.. SUBJECT P City of Fridley PAT THETOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. , • COMMUNITY DEVELOPMENT D PROTECTIVE INSPECTION SEC.. r � � NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 1•' 612-571-3450 910-F15 11/18/96 JOB ADDRESS 6230 Rice Creek Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Rice Creek Estates 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Denn s Forstrom 6230 Rice Creek Drive NE 3 CONTRACTORI MAIL ADDRESS ZIP PHONE LICENSE NO. West rn Remodelers 2520 W Lar, enteur, St Paul, MN 55113 645-1411 N/A 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WO 7K ❑ NEW ❑ ADDITION ❑ ALTERATION p REPAIR 11�� ❑ MOVE ❑ REMOVE 8 DESCRIBE WO K Resi4e House 9 CHANGE OF UI E FROM TO STIPULATION$ TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERM TS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING 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 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,000 @ $2.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHERS OR LOCAL LAW REGULATING CON- TRUCTION OR PERFORM NC OF CONSTRUCTION $99.75 Fire SC $5.00 THE PLAN CHECK FEE TOTALFEE License SC $. 0 I $107.25 SIGNAT E &CONTRA ORORAUTHO?VZEDAGE T IDATEs WHEN PAOPER VALIDATED THIS IS YOUR PERMIT SIGNATURE O OWNER SIF OWNER BUILDERi (DATE) BLD iNSP MATE NEW j ] Effective 3/1/96 ADDN L ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: a-'� O CR Legal Description: Owner Name & Address: Tel. # Contractor: V� �� — MN LICENSE # tv Address -& VJ �, l�(� �U 1 , l) 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: I:engtfi Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 9 Z� Z- lJ Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ SO 0 O Approx. Completion Date:Al (Cosa on. Back) Driveway Curb Cut Width Needed: t. + 6 Ft = t x $ - $ DATE: APPLICANT: Tel. # 6- `/ J Y/l CITY USE ONLY Permit Fee $ �' , 7 Fee Schedule on Reverse Side ' Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ 2 $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: 01 SUBJECT City of Fridley 1 AT THE TOP OF THE TWINS BUILDING PERM, T r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC I � � NUMBER --TREV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/27/97 JoB ADDRESS 6230 Rice Creek Drive NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 1 Rice Creek Estates 2nd Addition SHEET 2 PROPERTY OWNgR MAIL ADDRESS ZIP PHONE Dennis Forstrom 6230 Rice Creek Drive NE 574-0042 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW C. ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10' x 12' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 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 1 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 $1,056 @ $.53 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 F ANY OTHER STATE OR LOCAL LAW REGULATING CON- $37.50 Fire SC $1.06 THE PER ORMANCE OF CONSTRUCTION ST TI 0& � ��� PLAN CHECK FEE TO AL FEE $39.09 6 TjUE CTOR OR AUTHORIZED AGENT tDATEi HE PPO rf VALIDAjj1D THIS IS YOUR PERMIT &iG �FCON' -B DG INSP DATE A- SIGNATURE OF OW NER OF OWNER BUILDERI (DATE) 01 NEW [ ADDN [ ] CITY OF FRIDLEY ALTER [ ) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 0'W.� II�b- IA v Legal Description: Owner Name & Address: Contractor: Effective 1/1/97 gp�asaa� Tel. # 6ill-Of, ejZ MN LICENSE # Address: o f?t&— Tel.# Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width — 1,V,' Hgt/Ground Sq. Ft. /gyp OTHER: %/GSC Construction Type: &-gwn �ela; Estimated Cost: $ �')C) (Fee Schedule on Back Driveway Curb Cut Width Needed: Ft. 6 Ft = —Ft.x $ _ $ DATE: APPLICANT: Tel. #V2 CITY USE ONLY Permit Fee $--����® Fee Schedule on Reverse Side Fire Surcharge $ /. U(� .001 of Permit Valuation (1/10th%) . State Surcharge $ 11-3 $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $� STIPULATIONS: SUBJECT' City ®i Fridley 2 33 6 9 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. C71 /S r J0 NUMBER REV DATE 8/14/97 PAGE OF APPROVED BY CITY HALL FRIOLEY 55432 L.._.�' '•� 612-571-3450 910-F15 JOB ADDRESS 6230 Rice Creek Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Rice Creek Estates 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dennis Forstrom 6230 Rice Creek Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Richard Hastings Contr 6331 Riverview Ter NE, Fridley MN 55432 574-9966 4051 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] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (24 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd but not the 3rd layer. 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 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 $1 503 $.75 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- $ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE License C $5. TOTA FEE $58.50 SIGNATURE OF CONTRACTOR OR THORIZEDAGENT 1 ATE) , EN ROP VALIDAW BLD )NSP THIS IS YmJR P RUNT BATE SIGNATURE OF OWNEROF OWNER BUILDER) IDATEi NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: Tei. # Effective 1/l/97 L Contractor: P tiAz!� : c 5 MN LICENSE #moi 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: Construction Type: t p -e, - Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: q ? APPLICANT:. Tel. # �` tt _VW CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ i, �� .001 of Permit Valuation (1/10th%) State Surcharge $ %S $.50/$1,000 Valuation SAC Charge $ $950 per. SAC Unit License Surcharge $ s, C $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: y K. / SUBJECT P City ®f Fridley 31300 AT THE TOP OF THE TWINS BUILDING PERMIT r � R EIPT NO. r •COMMUNITY DEVELOPMENT DIY. 6u ___ - f PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED Br CITY HALL FRIDLEY 55432 '•, 612-571-3450 910-F15 8/11/0.0 JOB ADDRESS 6230 Rice Creek Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. I 1 Rice Creek Estates 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dennis Forstrom 6230 Rice Creek Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings 6331 Riverview Terrace NE Fridley, HN 55432 574-9966 4051 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION CN REPAIR O MOVE O REMOVE B DESCRIBE WORK Tear Off and Reroof House and Garage 24 sq 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,098.00 $1.05 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $83.25 Fire S $2.10 PLAN CHECK FEE TOTAL EE A'�IN4.-EUT. �101.A�CTO. Licens C ° 5. 0 1.40 210 AGENT I ATEI NRO R LIDA D HIS IS YOUR PER IT �+ ' _ S.GNATURE OF OWNERoF OWNER BUILDERI IDATEI IL INSP pat K. / NEW [ J Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 I BUILDING PERMIT APPLICATION D �Pz Construction Address: 2 3 c �' (� 0 Legal Description: Owner Name & Address: Z) o,,�4- Tel. # Contractor. z 1 "k7Li7 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: S Construction Type: 71�FA-k ® FF '+- K F& o®F Estimated Cost: $ `� ()99 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: 9/11 160 APPLICANT: , r Tel. CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ ��� Fee Schedule on Reverse Side Fire Surcharge $ 0 .001 of Permit Valuation (1/10th%) State Surcharge $ /10s— $.50/$1,000 Valuation SAC Charge $_$I 100 per SAC Unit License Surcharge $ S 00 $5.00 (State Licensed Residential Contractors) Driveway Escrow Erosion Control Park Fee Sewer Main Charge STIPULATIONS: "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Ellectiv� January 200 CITY OF FR' INSPECTION DIViSION 6431 Univer..- _, Ave NE Fridley; -MN 55432 APPLICATION FOR GOWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 JOB ADDRESS RATE SCHEDULE �` OWNER ,n X11 � I n r-rr (C� Residential Rate Furnace Shell and Duet Work, Burner - Also Replacement Furnace $ 30.00 (Side Vent Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 but not replacement) Gas Range $ 10.00 Gas Dryer $ 10.00 *Air Conditioning- All Sizes $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATINGICOOLING/VENTILATION REFRi ERATIQN/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $ 50 STATE SURCHARG9 REINSPECTION FEE $.47.00/Hr *Air Conditioners can not be -placed in a side yard.without written permission from adjoining property owner. TOTAL s3EP_'�'D i BUILDING USED ESTIMATED COST PERMIT NO. � 1® DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units._._ Circle One (Steam) (Hot Water) Qli Trade Name 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE Final Date d D y FiLLOUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When , the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, Yes No and is securely supported and firestopped where required. The venting system is plasticlPVC 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 Fumace Venting Tables for fan Yes)K) No ( ) assisted and natural draft appliances. The is sized and installed to meet the current codes Yes (> No and manufacturers specifications. When required to fri.qj�+r[ w� GnmeL;��� i ; itwill be sized and installed YesX-Na ( } to meet the current codes and manufacturers specifications. When ins-ft"Ing a rmw yam ng SIMM, 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 Yes (4 -'No. ( } Venting Tables Lfor fan assisted and natural draft appliances. is the common vent and vent connectors sized and installed correctly after an appliance has been removed from tie common vent and vented yes( )No( } separately as per current codes. Anallanna I-aI=a and S[ze/Gnmmnnvant and Hent Cnnnadar [oformatinn Appliance #7 Type �ar� c��c� _. BTU Input 0D, too© Fan Assisted or Nat Appliance #2 Type v �!-c� ��- BTU Input D, no g Fan Assisted or Nat �____� _... Appliance #3 Type BTU Input _______ Fan Assisted or Nat Total Appliances _-_�____„ Total Btu Inputbtu o 11 Common Vent Type GN V -V- W -4-T Vent Height 2-2 Diameter ��_._ inches ' . ir:N Appliance #1 Vent Connector Height � ft Length L-11 ft Diameter n Type Diameter �' in Type Appliance #2 Vent Connector Height �ft Length Appliance #3 Vent Connector Height ft Length _ft Diameter _ in Type_,_,_.. Al RATIONS ijlo„seIbel IN r t A A ..— A _ --,n CO: Signed By: ,�� I�