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PRE 2010 DOCSCity of Fridley, Alinn. WELDING PERMIT N? (::56� Date: Zo- Owner: *NJ dohe Builder Address ORI O Cfl B 1 ING NO. street.... Part "Z7Z "A Lot Block Addition or Sub -Di vI&I Comer Lot"----- Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation ._-- DESCRIPTION OF BUILDING Used Front �i Depth Height Sq. Ft. A41 21K40,Cu. Ft J= P/7 6 Front Depth Height Sq. Ft. C:- Ft- SV4 Type of Consgetion EsiLCost--/ _\,1____e__�A_.to1eCompleted __ 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 $-- *S,7-, 'Amp- permit Is hereby granted to to construct the building or addition as' described above. This ranted upon the express condition that the person to whom it is granted and his agents, employees 1sn= is in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any 1!�W� ordinances. 'o5any of the provisions of said jjj�jer'fe 1 7 NOTICE: This permit does not cover the construction, Installation for whing, plumbing, gas heating, sower or water. Be sure to see the Building Inspector for separate permits for these items. 1 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLE$► MINNESOTA Owner's Name Builder Address Address LOCATION OF BUILDING No. Street Part of Lot Lot Block Addition or Subdivision, Corner Lot Inside Lot Setback_,___Side-Yard SMIER 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. Cu. Ft. FrontDepth 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 of Fridley ordinances and ruling of the Department of Build- ings, and hereby declares that all the facts an representations stated in this application are true and correci /� , /"-? , DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse SiA4- City of Fridley Application for Plumbing and Gas Pitting Peewit DepL of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location q� N NO. RATE T TaAL Number Fixtures ...................... x $1.50 $Z Future Fixture Opening ................ S tyo1O $ New Fixture Old Opening .............. pp� F -v! Catch Basin ............................ x 3.25 $ (9 ? `aa x 2.00 $ -Z , d 61 WATER HTR. x 3.25 $ GAS FITTING FEES: 3 ii 7 ® m Vl 3 F- LL Y) O� LL 0 U ` s' �qa. �qZ O R N GAS ELEG Base ! l 2— 1st 2nd 3rd 4th FutConnection Openings Connected withure I Sewer � New Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE T TaAL Number Fixtures ...................... x $1.50 $Z 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 $ -Z , d 61 New Ground Run Old Bldg. ............ x 3.25 $ 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 $ 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. Owner Kind of Used as Ta be cu,,,jj,u&.vu avvu6 Estimated Cost, $ Old—New. Building Permit No � � � Pe it N Signe By . Coil Business Phone No ROUGH Z FINAL ad 2M . M Application for Pourer Plants and Heating, Cooling, 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 ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 ............ 2.50 $ STEAM or HOT WATER SYSTEM / C� 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 $ 6 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 FEE $ Q 0 ROUGH FINAL Dept. of Bldgs. Phone SU 4-7470 C -A - 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 Used a: To be completed about Estimated Cost, $_ Permit No,� Permit No.—.>— or o._ OF WORK HEATING or POWE to , Hot Water, Warm Air—No Trade Name � Size No GCS Capacity Sq. Ft. E.D.Rg BTU e e H.P. Total Connected Loader Kind of Fue BURNER — Trade Capacity. (REMARKS -OVER) .QW 4E 2M Size No Sq. Ft. E.D.R I BTU H.P. Business Phone It 9. W. i ROM I ' . A Azo�;t 0�� HEAT LOSS CALCULATIONS DEPARTMENT OF BATUA DINGS / MINNEAPOLIS. MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows Doors Reference Out. Wall Int. Wall Ceiling I Roof I Floor Kind How. Applied Yes—No I Yes—No 19— R ml U--- I i ----.L V l:.i.L U -:—L. ® II ® Midi ---.L .0 L \YI AOL .7l uaio{.+ ii' � Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. .16 75, %• /� L) Width Height No. of Lineal ft. Area No. of papof pane lights of crack sq. ft. 3 If 1. ® E' A- Ar Coef. Btu Infiltration 10 lCoef.1 41a U Glass 161 z. 12 e Exp. wall Net exp. wall 1 is 6 Net exp, wall ®a/ Int. wall' Floor Ceiling Floor ��®® Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room ( Length /L Width 2,5- N Total Btu. 1 '19-96S Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 31, D FIA J' w.- � -r- Room .I Length 00- L Width ° t. Heiaht �. Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. riefgnt Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of papof pane lights of crack sq. ft. 3 If 1. ® E' A- Ar 3 SO /& B 3G a N ,* lCoef.1 Btu Infiltration 161 z. 12 e Glass Net exp. wall 1 is 6 Exp. wall ®a/ Net exp. wall Floor Int. wall Ceiling Anr Floor Total Btu. 1 '19-96S Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 31, D FIA J' w.- � -r- Room .I Length 00- L Width ° t. Heiaht �. Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. B d AJ Coef. Coef.1 Btu Infiltration ,* Il' ,Zs Glass z. 12 1/ Exp. wall Net exp. wall 1 is 171,6 Net exp. wall Ceiling Int. wall Floor Ceiling Floor Anr Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area /e Windows and Doors—Crackage and Area Width I Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. A 4, Coef. Coef. Btu Infiltration ,* 3g Glass. Exp. wall ? 1/ Exp. wall Net exp. wall / t LI 171,6 Net exp. wall Ceiling Int. wall Floor Ceiling Floor Anr Total Btu. I 2A Z ZE Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Quo e 1 RI_I /d..,9vmn...Renm I Lenath to Width / 51 Hehtht f Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration ,* Glass L Exp. wall Net exp. wall / t LI 171,6 Int. wall Ceiling Floor Total Btu. -- r.. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area it, g '1 F1.1 , L Room I Length 17,° Width to Height S; Windows and Width 1 No. of pane Infiltration Area x s. Btu /971 Glass Z Exp.. wall Net exp. wall 10 1/b, Int. wall Ceiling Floor Total Btu. �. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 40 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide WindowsI Doors Reference Out: Wall Int. Wall Ceiling � Roof Floor Kind How Applied Yes—No Yes—No 19— P FI -1 Rnnm I I.Pnath as w1rith I Z. .,-. R^nrn 11.Pn.th .4 Width ;7,• Height I - --I <- ' -y ------ 1 ---0-- f X;� Windows and Doors—Crackage and Area ---- Width Height No. of Lineal f . Area No. of pane of pane lights of crack sq.ft. 9W 71 P Coef.1 Btu Infiltration Coef. Btu Coef. Btu Infiltration :t> Net exp. wall y 46 Glass Ceiling a c Yi � ,s e p Exp. wall P ea Int. wall Net exp. wall r,: a A ;°. Int. wall, v Ceiling P,rn ,r ,F 6 4_ Floor... �k -15"Po Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I; F a fly F1.1 � a:_ Room I Length 14 Width .--T Height f Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration Coef. Btu Coef. Btu Infiltration :t> Net exp. wall y , Glass Ceiling a c Yi � ,s e p Exp. wall P ea Int. wall Net exp. wall r,: a A ;°. Int. wall Floor Ceiling P,rn ,r ,F 6 4_ Floori e Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F11 , a" Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration Coef. Btu Coef. "Btu Infiltration," Net exp. wall y , Glass Ceiling a c Yi I", Exp. wall P ea Int. wall Net exp. wall Ceiling Int. wall Floor Ceiling Floor Total Btu. 7 1. Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration Coef. Btu Glass y Exp. wall Net exp. wall y Int. wall Ceiling a c Floor 4., I", Total Btu." Required sq. ft. E.D.R. or sq. ins. W.A. Leader areati _ Roem I Length � �. Width. � - Heiuht , Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Coef. Btu Infiltration Exp. wall Glasse y Int. wall Exp. wall Floor Net exp. wall J = 6 1 St-, 12 . , Int. wall Ceiling Floor Total Btu. 7 ,� Required sq. ft. E.D.R. or sq. ins. W.A. Leader area .t F1.1 Room I Length Width Height rr Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of.pane lights of crack eq. ft. Coef. Btu Infiltration Glass -12 Exp. wall Net exp. wall;M. y Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area s 11 Required sq. ft. E.D.R. or sq. ins. W A. Leader area �.d a D•76 �U , s HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows Doors Reference Out. Wall Int. Wall Ceiling I Roof Floor Kind How Applied Yes—No ( Yes—No 19— A Fl 1 Room I Length Width i i- Height Ir II R-1 Room I Length J:Z L Width /2 Heiuht 7 iv L1 I AI-- ® .c. D___ I i _ aL A. L IFI: -].L . m T -1-:-L. b L Windows and Doors—Crackage and Area Width Height Noof Lineal ft. Area No. of pane of pane liggixtts of crack I sq. ft. Windows and oors—Crackage and Area Width Height No. of Lineal ft. Area No.. of pane of lights of crack sq. ft. pane JCoef.j Coef. Btu Infiltration 54 Coef. Btu Infiltration Glass /16, 4 S J - Glass Exp. wall Net exp. wall z 9710 Ceiling A-1. Exp. wall Net exp. wall Floor ® / ® Net exp. wall Int. wall /� 3P ,2 Int. wall Ceiling / Ceiling Floor Floor iv L1 I AI-- ® .c. D___ I i _ aL A. L IFI: -].L . m T -1-:-L. b L Windows and Doors—Crackage and Area Width Height Noof Lineal ft. Area No. of pane of pane liggixtts of crack I sq. ft. I' Coef. JCoef.j Coef. Btu Infiltration 54 // J9 17t4g Glass /16, 2'q ® OAra Exp. wall Net exp. wall z 9710 Ceiling A-1. /970 Net exp. wall Floor ® / ® 2006 Int. wall f 11,30 Floor Ceiling Floor Total 13tu. 1 i E 9 a Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 17.1 A/ I * 'i A9 R....... I t anatt. 11 ^ vu.A,.t. '01. E.te:,.t.t� Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. off2 pane of pane lights of crack sq. ft. d Coef. JCoef.j Btu Infiltration /® 39 // Glass e As /16, Exp. wall R ® OAra Int. wall Net exp. wall z 9710 Ceiling A-1. /970 Int. wall Floor Ceiling 5:9 f 11,30 Floor Total Btu. I 3y137- Required y13ti. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration 31 /® Glass L i LS / Exp. wall As S,) Net exp. wall / R ® OAra Int. wall Net exp. wall 07 Ceiling A-1. §0 141-0 Floor Total Btu. 1 1"0 41 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area m 1 h. o__ r 1 1 ---#.L .— UI.A"L .. -C Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane I lights of crack sq. ft. Coef. Coef. Btu Infiltration d S o 31 Glass Exp. wall Net exp. wall 7Y As S,) Exp. wall Ceiling 13711b Net exp. wall 07 1 96 // 70 Int. wall Ceiling 5:9 f Floor Total Btu. 1292,9 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area It,t 'A F1 I k. . _ _ R...,... I I .p..oth ® 7, Width i — Height 7 . Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration /,,® S o Glass ®� Exp. wall Net exp. wall 7Y ;�6 Int. wall Ceiling 13711b /37A Floor Total Btu. 3340 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 p• A-3 t Ut ! N @ d ¢ 4 4i WA ou A.-'6 p 'r,,✓ ��{ '�'�` Thr � �Y i. ej fi Jj MEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS y Weatherstrips A.S.H.V. . Construction No. Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind Yes—No Yes—No 19— );. ' Fl I r Room I Lenc,th Width j �- Height II FI I ._ Rnnm I Length o Total Btu.,i 3 41 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area L�. F1.1 , hA nib Room I Length y- Width i ' Height `•' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of Dane ofpane lights of crack sq. ft. i- Windows and Doors—Crackage and Area Coef. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. g Btu Infiltration` _ d lCoef.1 Btu Infiltration t Exp. wall I e:' 7C Glass,' Net exp. wall 6 I i o t' Exp. wall Total Btu.$^ Ceiling.,fi Net exp. wall Floor Int. wall A s;," Ceiling Floor r: Total Btu.,i 3 41 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area L�. F1.1 , hA nib Room I Length y- Width i ' Height `•' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of Dane ofpane lights of crack sq. ft. i- Coef. Btu Coef.1 Btu Infiltration` _ d Glass, �, x'� N fn ": t Exp. wall Int. wall Net exp. wall 6 I i o t' Int. wall Total Btu.$^ Ceiling.,fi Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Floor Y. 1.1000 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Coef. Btu Infiltration Y Btu Infiltration Glass S Exp. wall �, x'� N f t r Net exp. wall' Exp. wall Int. wall Net exp. wall Ceiling",. I i o Floor Total Btu.$^ Ceiling Required sq. ft. E.D.R. or sq. ins. W.A. Leader area MINNEAPOLIS. MINN. " Insulation How. Aoalied Width �. Height " Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Coef. Btu Infiltration .3 a s; Glass �, x'� N f t r r Exp. wall Net exp. wall 2 J) as I i o Int. wall Ceiling 4, 1 Floor Total Btu:'''"' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area R-1 —.-. Room I Length Width Height r Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pen. lights of crack sq. ft. Coef. Btu Infiltration`'`'"' s; Glass<' f t r r Exp. wall Net exp. wall 7 ,k- I i o Int. wall Ceiling Floor Total Btu. 4 Required sq. ft. E.D.R. or sq. iris. W.A. Leader area M 1 .` ' ` f' ::> R.,.,... I 1 .nnoth k 7, Width Height z --1 m B4 A%rl Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of.pane lights of crack sq. ft. Coef. Btu Infiltration Glass f t r k e-, U" Exp. wall Net exp. wall 7 ,k- I i o ; ° 'Ie' Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 'f,P .J. Date: Julz 7s 1965 Owner: Wm. Jensen Builder Charles E. Johanson Address 589 Rich Greek Terrace Adams 160 kartman Circle N° 813.1 36161 LOCATION OF BUILDING No. _ 589 Street Rice Creek Terrace part of Lot Lot - 7 _ Block Addition or Sub -Division _ Rice Creek Terrace Corner Lot Inside Lot Setback Sideyard Sewer Elevation _. Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Plat 7 Front Depth height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost — 1.0 .O—OQ•-0 _ To be Completed Storm damage repair In consideration of the issuance to me of a permit to construct buil g describedrtlh2 e I agree to do the proposed work in accordance with the description above set forcompliance pr ons of ordinances oP the city of Fridley. In consideration of the payment of a fee of$ 0.00 , permit is hereby granted to Chas. Johanson to construct the building or addition as described above. This permit is granted upon the eupresa 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 thereof, shall cenform in all respects to the ordinances of Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings within the city limits' permit may be revoked at any time upon violation of any of the Provisions of said ordinance. 1 UAM, Jensen Building inspector NOTICE: Uh ponce does not cover the construction, knWidion for whing, phunbieg, gas boding, sewer or water. Be erre to see the Budding hapector for separate peraft for these urine. AFPLICATION`FOR BUILDING PERMIT CITY OF lRIDLEX MINNESOTA ADDRESS LOCATION 'OF ' BUILDING` No. Street Part of Lot LOT .$LOCX �� ADDITION OR SUBDIVISION Corder Lot Inside LOT,r^ Setback side -;Yard SEWER ELEVATION ' FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be- used ad: DESCRIPTION OF' BUMDING • Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Pt Type of Construction . Estimated Cost /`® & 0 To be -completed__ 01 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 rulatngs'of;.the Department•of"Huildings,'and hereby declares that all the facts and representations stated in this application are true and correct. SIGNATURE` (Schedule of Fee Costs can be found on the Reverse 52-84-5915.51 City of Fridley Application for Plumbing and C%n Fitting Perndt Dept. of Bldgs. Phone 860-3450 DESCRIPTION OF WORK Location 589 Rice Creels Tera° . Number, Kind and Location of Fixtures 6i ��p x $2.00 $ �5y5�{ Future Fixture Opening ................ Y $ Z Z x $1.50 $ w ? • F • N WATER HTR. GAS ELEc Base New Ground Run Old Bldg. ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ 1st x $ .75 $ Imstj Gas Incinerator $ Gas Incinerator 1 5.00 REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ 2nd TOTAL FEE $ 5.00 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer El Cesspool El 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 a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ Gas Incinerator 1 5.00 REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ 5.00 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. 8-28-68 Fridley, Mnn 19_ Owner Will Jenson Kind of Building frame Used as res To be completed about 9-2-68 Estimated Cost, $ 10.00 Old—New. Building Permit No Permit NO.�� Si o By Business Phone o ROUGH FINAL CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer Rate TOTAL $ 20.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ *Air Conditioning - All Sizes $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ /a 0 Commercial/Industrial 1 % of Value of Appliance or Work $ State Surcharge $ .50_ TOTAL FEE $ 16-. � o MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 0 r e€ 69eggk 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this pplication are true and correct. OWNER CAe®r,6 &,9S BUILDING USED ASC- L G y ESTIMATED COST /202, l PERMIT NO. 111-3/ DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name AJe Size No. BTU HP EDR HEATING COMPANY�%�xc'/" ! Signed By G�� Tel No. S-4 07 Approved B f 9E Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON 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 Remarks List Alterations Being Done: � fin± GL A �,e jA 114 7792 HEATING COMPANY Signed By Date ��nn��SnnTATE OF UPJ Q � DEPARTMENT OF METRO WATERS, 1200 WARNER PHONE NO. 772-7910 March 11, 1992 David Blaska 589 Rice Creek Terrace Fridley, MN 55432 NATURAL RESOURCES RD., ST. PAUL, MN 55106 FILE NO. RE: LIMITED PERMIT 188-6232, TIRE WALL RETENTION, RICE CREEK, FRIDLEY, ANOKA COUNTY Dear Mr. Blaska: Enclosed is Limited Permit 188-6232 which authorizes you to retain an existing used tire wall along the bank of Rice Creek. If, at any time, the wall is removed or fails, it must be replaced with a more suitable erosion control method that is approved by the DNR. Your permit has been limited to take into consideration Minnesota Rules 6115.0211 Subp.5, Items A & D which are concerned with the tire wall's lack of consistency with existing land uses and its aesthetic intrusion upon the area. Please be sure to review all the special provisions, especially number 17 which states that you shall contact the Regional Hydrologist upon the failure of the tire wall or removal. Minnesota Statutes provide for an administrative hearing of you are aggrieved by the action taken on this permit. Be advised that to take advantage of this review process, you must file a hearing request and any required bond within 30 days. I have enclosed a copy of Streambank Erosion .Gaining a Greater Understandincr for future reference. This guide discusses how streambank erosion occurs, and several alternative stabilization procedures. Research has shown that tire retaining walls are not an effective means of protecting streambanks from erosion. If you have any questions about the terms and conditions of this permit please contact Area Hydrologist Tom Hovey at 772-7910. Sincerely, Gam- *'� J n Linc Stine Regional Hydrologist cc: USCOE Ron Anderson, St. Paul Waters Anoka CD B. Gilbertson, AFM City of Fridley Rice Creek File Rice Creek WSD George Jurgenson, C.O. AN EQUAL OPPORTUNITY EMPLOYER LIMITED P.A. Number NA -02733-04 (Rev.3/90) U04ESCYTA PROTECTED WATERS 88-6232 DEPARTMENT of NATURAE. REsouWES PERMIT DtVtSM oFWATM Pursuant to Minnesota Statutes, Chapter 105, and on the basis of statements and information contained in the permit application, letters, maps, and plans submitted by the applicant and others supporting data, all of which are made a part hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant named below to change the course, current or cross section of the following: Protected Water County Rice Creek Anoka Name of Applicant Telephone Number (include Area Code) David Blaska (612) 571-4435 Address (No. & Street, RFD, Box No., City, State, Zip Code) 589 Rice Creek Terrace, Fridley, MN 55432 Authorized to: Retain existing used tire wall along the bank of Pace Creek. The wall shall be replaced with a more suitable erosion control method approved by the DNR'upon, failure. Purpose of Permit: Expiration Date of Permit Bank Protection June 30, 1992 Pro ert De crib as: pNW o NE Section 14,. T30N, R24W County Anoka As Indicated: (S) As Indicated: (11) the ordinary high Does not apply water level This permit is granted subject to the following GENERAL and SPECIAL PROVISIONS: GENERAL PROVISIONS 1. This permit is permissive only and shall not release the permittee from any liability or obligation imposed by Minnesota Statutes, Federal Law or local ordinances relating thereto and shall remain in force subject to all conditions and limitations now or hereafter imposed by law. 2. This permit is not assignable except with the written consent of the Commissioner of Natural Resources. 3. The Regional Hydrologist shall be notified at least five days in advance of the commencement of the work authorized hereunder and shall be notified of its completion within five days thereafter. The Notice of Permit issued by the Commissioner shall be kept securely posted in a conspicuous place at the site of operations. 4. No change shall be made, without written permission previously obtained from the Commissioner of Natural Resources, in the dimensions, capacity or location of any items of work authorized hereunder. 5. The permittee shall grant access to the site at all reasonable times during and after construction to authorized representatives of the Commissioner of Natural Resources for inspection of the work authorized hereunder. 6. This Permit may be terminated by the Commissioner of Natural Resources at any time he deems it necessary for the conservation of water resources of the state, or in the interest of public health and welfare, or for violation of any of the provisions of this permit, unless otherwise provided in the Special Provisions. 7. Construction work authorized under this permit shall be completed on or before date specified above. Upon written request to the Commissioner by the Permittee, stating the reason therefore, an extension of time may be obtained. 8. The excavation of soil authorized herein shall not be construed to include the removal of organic matter (as indicated above) unless the area from which such organic matter Is removed, is impervious, or is sealed by the application of bentonite after excavation. 9. In all cases where the doing by the permittee of anything authorized by this permit shall involve the taking, using, or damaging of any property rights or interests of any other person or persons, or of any publicly owned lands or improvements thereon or interests therein, the permittee, before proceeding therewith, shall obtain the written consent of all persons, agencies, or authorities concerned, and shall acquire all property, rights and interests necessary therefore. 10. This permit is permissive only. No liability shall be imposed by the State of Minnesota or any of its officers, agents or employees, officially or personally, on account of the granting hereof or on account of any damage to any person or property resulting from any act or omission of the permittee or any of Its agents, employees, or contractors relating to any matter hereunder. This permit shall not be construed as estopping or limiting any legal claims or right of action of any person other than the state against the permittee, its agents,employees, or contractors, for any damage or injury resulting from any such act or omission, or as estopping or limiting any legal claim or right of action of the state against the permittee, its agents, employees, or contractors for violation of or failure to comply with the permit or applicable provisions of law. 11. No material excavated by authority of this permit nor material from any other source, except as specified herein, shall be placed on any portion of the bed of said waters which lies below (as indicated above). 12. Any extension of the surface of said waters resulting from work authorized by this permit shall become protected waters and left open and unobstructed for use by the public. 13. This permit does not obviate any requirement for federal assent from the U.S. Army Corps of Engineers, 1421 U.S. Post Office and Custom House, St. Paul, Minnesota 55101-9808. SPECIAL PROVISIONS 14. The permittee shall comply with all rules, regulations, requirements, or standards of the Minnesota Pollution Control Agency and other applicable federal, state, or local agencies. 15. Permittee shall ensure that the contractor has received and thoroughly understands all conditions of this permit. 16. Erosion control measures shall be adequately designed for the site characteristics. They may include staked haybales, diversion channels, sediment ponds, or sediment fences. They shall be installed prior to commencement and maintained throughout project. All exposed soil shall be restored (by seeding and mulching or sodding and staking) within 72 hours of completion of project. 17. The DNR, Division of Waters Regional Hydrologist shall .be notified in writing at 1200 Warner Road, St. Paul, Minnesota 55106, prior to removal or upon failure of existing wall. Failure of this project shall be described as any structural instability, a navigational hazard, a public nuisance, or a structure in the state of disrepair. c: Tim Fell, USCOE Anoka CD City of Fridley Ron Anderson, St. Bruce Gilbertson, Rice Creek file Rice Creek WSD George Jurgeuson, Paul Waters DNR Fisheries Conservation Officer Authorized SignatureP4 Title Date & 44tz� *-%-- John LirU Stine Regional Hydrologist tSTATE OF � GAJ DEPARTMENT OF NATURAL RESOURCES 1200 Warner Road., St. Paul, MN. 55106 PHONgPD/296-7523 FILE NO. DNR PROTECTED WATERS PERMIT APPLICATION NUMBER '5T — REQUEST FOR REVIEW AND COMMENTS DATE: Z To: P --TLE FROM: TOM HOVEY, HYDROLOGIST METRO REGION DIVISION OF WATERS WATERS AFFECTED: PROJECT SPONSOR: Z)A0,'d 48 /a,Sk,',f NATURE OF WORK: & 4.. a5 e r �L COMMENTS DUE BY: L-98 AN EQUAL OPPORTUNITY EMPLOYER tmDEPARTMENT OF 16 NA -02870-04 NM505T4% Rev. 4/81 NATURAL RESOURCES LOCAL UNIT OF GOVERNMENT COMMENTS PART s Section I (To .,be completed. by. applicant) Name of Applicant Address (Strreeet, RFD, Box No.,.City, State, Zip Code) Quarter Section(s) Section(s) Townships) Ranges) lCoOntylies) PROJECT LOCATION l � 4! , t /'/" , � t� A ® ' Project will affect: (name and number of fake, wetland,` or watercourse) 1`�flee RAC& -hereby submit •this application for permit to: (mark proper box)`' Signature of'Applicant Date O appropriate water work in protected waters X Section II(To be completed by local unit of government) The following.,local unit of government comments andiorrecommendations -are.submitied for consideration;bythe Department,of Natural Resources in"the disposition of the referenced .permit application. (YOUR RESPONSE MUST BE, SUBMITTED TO THE: DNR WITHIN 30 DAYS::) Water Appropriation .Permi€�Applications-are.to 'be sent to the Central Of - Ice, St:'Paul, and Protected Waters Permit Applications to.the DNR Regional Office. SEE REVERSE SIDE FOR CORRECT MAILING -ADDRESSES) Was theproposed project,fieid inspected: by this local unit of -government? ❑NO - AYES (if Yes, give viewer's name) Viewer's Name Title Authorized Signature Title Date Telephone No. (Area Code) c Name of responding. Soil and Water Conservation District, Watershed District, City or. County Address (of theabove named local unit of government) (DNR — Division of Waters addresses on back) REGION 1 C BEMIDJI Area) Regional Hydrologist DNR -Division of Waters 2115 Birchmont Beach -Road N.E. Bemidji, MN 56601 (Z18)._755739731 . Detroit Lakes Area. Area Hydrologist - w DNR -D -i -vision of -Waters --P.O. Box 923 Detroit Lakes, MN 56501 (2181-847-1579 - - Fergus Falls Area Area Hydrologist DNR-Qvision of Waters 1221 -Fir Avenue East Fergus Falls, MN 56537' (218)139-7576 'thiel River Falls 'Area Area.,Hydrologist DNR-Oi inion of Waters123'Main'Ave N;: Thief River Falls, MN 56701 (218) 681-7789 REGION 2 (&GRAND RAPIDS Regional Hydrologist Area) DNR -Division of Waters 1201 East Highway 2 Grand Rapids, MN 55744 (218) 327-4416 Duluth Area Area Hydrologist DNR -Division of Waters French River Hatchery 10029 North Shore Drive Duluth, MN 55804 ( 218) 723-4786 REGION 3 (&BRAINERD Area) Regional Hydrologist DNR -Division of Waters 424 Front St., Box 648 Brainerd, MN 56401 (218) 828-2605 Cambridge Area Area Hydrologist DNR -Division of Waters 915 South Highway 65 Cambridge, MN 55008 (612) 689-2832 St -Cloud Area Area Hydrologist DNR -Division of Waters 3725 12th St. North P.O. Box 370 St. Cloud, MN 56302 (612) 255-4278 REGION 4(&NEW ULM Area) Regional Hydrologist DNR -Division of Waters Box 756, Highway 15 South New Ulm, MN_ 56073 (507) 354-2196 Spicer Area Area -Hydrologist DNR -Division of Waters P.O. Box 457 232 Lake Ave. South Spicer, MN 56288 (612) 231-5435 Detroit Lakes AV � 3 Fergus Falls ■ 613F St. Cloud Cloud ■ REGION 4 Cont'd Mankato Area Area Hydrologist DNR -Division of WAters Nichols Office Center Suite 180, 410 Jackson St. Mankato, MN 56001 (507) 389.215.1 Marshall Area Area Hydrologist DNR -Division of Waters Box 111, 1400 E. Lyon Marshall, MN 56258; (507) 537-7258 L s Regional Office mom Regional Boundary ■ Area Office' -- Area Boundary REGION 5 Regional Hydrologist DNR -Division of Waters P.O. Box 6247 Rochester, MN 55903 (507) 285-7430 REGION 6 Regional Hydrologist DNR -Division -of Waters 1200..Warner Road St. Paul, MN 55106 (612) 296-7523 CENTRAL OFFICE DNR -Division of Waters 500 Lafayette Road DNR Building St. Paul, MN 55155-4032 (612) 296-4800 V. VII. X. XI, NA -02622-03 F,ev. 12/85 PERMIT APPLICATION VATURAL' EPARTMENT OF TO WORK IN PROTECTED WATERS OR WETLANDS [Eso_ 'Ga (INCLUDING DAM SAFETY) RESOURCES ► ► Please read instructions before attempting to complete this application. OFFICE USE ONLY. P.A. N0. n M SWCD Q C/C ❑ W.D. ❑USCOE Applicant's Name (Last, First, M.I.) Authorized Agent (if applicable) Telephone Number&areacode Address (Street, RFD, Box Number, City, State, Zip Code) LOCATION OF PROPOSED PROJECT (BE SURE TO INCLUDE SKETCH SHOWING HOW TO GET TO THE SITE) Government Lot(s) Quarter Sections) Sections) No. Township(s) No. Range(s) No. Lot, Block, Subdivision Fire No., BOX N0. or Project Address County Project will affect ❑ Lake. ❑Wetland or ❑Watercourse (name & number, if known TYPE OF WORK PROPOSED (CHbCK ONE) IV. TY OF PROJEC -' CHECK ONE) ❑ excavate ❑ repair ❑ shoreline ❑ shore -protection ❑ obstruction ❑ dam ❑ fill ❑ remove ❑ channel ❑ harbor ❑ bridge ❑ other ❑ drain ❑ abandon ❑ sand blanket ❑ permanent dock ❑ culvert (specify) ,E1 construct ❑ other (specify) ❑ install ❑ riprap ❑wharf ESTIMATED PROJECT COST $ A. LENGTH OF` SHORELINE AFFECTED (IN FEET): VOLUME OF MATERIAL FILLED OR EXCAVATED (IN CUBIC YARDS): BRIEF EXPLANATION OF PROJECT: (EXPLAIN WHAT PROJECT CONSISTS OF AND HOW WORK WILL BE DONE) PURPOSE OF PROJECT: (Explain why this project is need'ed') ENVIRONMENTAL IMPACT' (,y nticipated changes to the %nater and related land resources, including unavd dable;"but detrimental effects) ALTERNATIVES (Other alternatives to the action proposed) s.; I hereby make application pursuant to Minnesota Statutes Chapter 105.42 and all supporting rules for a permit to work in or affect the above named protected water(s) in accordance with all supporting maps, plans, and other information submitted with this application The information submitted and statements made concerning this application are true and correct to the best of my knowledge. STATE OF COUNTY OF " Subscribed and sworn to before me this day of 19a My commission expires`, % Signat I of Notary Signature of Owner or Authorized Agent Date Signature of Leasee," Date Distribution: w..' White: DNR WALTER J. MULC,AHY e, Blue: SWCD NOTARY PUBLIC H1111'ESOTA Green: Watershed District RAMSEY COUNTY �`GOldenrod: City or County My Commission Expires Oct. 07,19$U Pink: Army Corps of Engineers Canary: Applicant . . . . . . . . ..: • - - I 1 Q m 01 SUBJECT PERMI City ®f Fridley � 215001 AT THE TOP OF THE TWINS BUILDING PERMIT' RECEIPT COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 7 r NUMBER REV. DATE PAGE OF APPROVED BY � /"'1 � CITY HALL FRIDLEY 55432 �....A-If I.J 612-571-3450 910-F15 8/18/92 JOB ADDRESS 589 Rice Creek Terrace NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carole Blaska 589 Rice Creek Terrace NE 571-4435 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 8 DESCRIBE WORK Construct a 1514' x 141 Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. MING Before digging call for all utility locations 454.OUO2 REQUIREDBY 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 60 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 AN[,CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS` TYPE OF WORK WILL BE COMPLIED $4 847 $2.42 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r 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- $81.00 Fire SC $4.85. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $88.27 SI NATUREOFCONTRACTOR ORRAUTHORIZED AGENT (DATE HEN PROPERLY VALIDATED THIS IS YOUR PERMIT Q M - BLD iNSP nATE SIGNATUREOFOWNEROFOWNERBUILDERI ID TEI m 01 NEW [ ] Effective 3/1/92 ADDN (] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: Contractor: 46 nie-o Address: �9r,Yq Ki.CG LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # �%/- 4/ MN LICENSE # Tel. # 6-71-4q 35 - Attach 5 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length ' Lf " Width ILI Hgt/Ground Comer Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd Setback Driveway Curb Cut Width Needed: Ft. + b Ft = DATE: APPLICANT: Sq. Ft. Sq. Ft. Sq. Ft. AA�Lll Side Yard Setbacks Estimated Cost: $ 4 10 6 d ��;I'—. Ft x $ CITY USE ONLY (Cost on Back) Tel. # Permit Fee $ 0' ®. 0 Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ - $5.00 (State Licensed Residential Contractors) Driveway Escrow $ - > Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ TOTAL STIPULATIONS: 1 0 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On August 1, 1995 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 5'0 "i k- I C. t �! P— £ E K New Fixtures Old Opening, New Fbdure 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 , 4 $10.00 $10.00 $iS.00 e& 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. IAI16 ,1995 Building Used As Estimated Cost®d PERMIT NO.ILI PLUMBING COMPANY Reinspection Fee $42.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS t-6 1.5% of Value of Fixture or Appliances . Approves! By State Surcharge 50 TEL N0. Rough—!n Date Final Date TOTAL FEE $2�o 56 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALT. BE PROVIDED PER UMC SECTION 604(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. Wash Floor Auto, Gas Heater Stories, Urinalr r Y �..a :.:.' ` h ��° _Water Shower Tra Drain ;�.' Washer :._ : ,,, Range Gas Elec a Dagement Basement '. iyENE.nw (. Floor 1 r t i4.. Ft �',a i3°ii:,!i., ;,hKaiu:z Floor 4 a A MEN, ' ! _ PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 5'0 "i k- I C. t �! P— £ E K New Fixtures Old Opening, New Fbdure 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 , 4 $10.00 $10.00 $iS.00 e& 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. IAI16 ,1995 Building Used As Estimated Cost®d PERMIT NO.ILI PLUMBING COMPANY Reinspection Fee $42.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS t-6 1.5% of Value of Fixture or Appliances . Approves! By State Surcharge 50 TEL N0. Rough—!n Date Final Date TOTAL FEE $2�o 56 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALT. BE PROVIDED PER UMC SECTION 604(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. CITY OF FRIDLEY INSPECTION DIV. Effective On Janoary 1, 1 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES [ WA 9 -4 L103 Residential Furnace Shell and Duct Work, Bumer – 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 Rate $20.00 $10.00 $10.00 $10.00 $10.00 Co mmerelalAndus–trial 14 1% of Value of Appliance orWork State Surcharge TOTAL FEE JOB ADDRESS,� The undersigned hereby makes application for a permit for the work herein TOTAL 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 anc rect. Ob OWNER 57/- f-)q3S' BUILDING USED AS ESTIMATED COST PERMIT NO. Qg§CRIP3]QN OF FURNACE AND OR BURNER E MINI'M'UM FEE. FOR ANY HEATINGICOOLINGIVENTILATtON REVER19JE—RATION/AlIR CONDITIONING PERMIT IS, PLUS THE U0 STATE SqRCHARGE REINSPECTION FEE $30.00 *Air Con ditlonets can not be placed in a side yard without written permission Uom. adjoining property owner. No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMPANY Signed By Approved By Rough–in Date Tel No. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE f CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 LICENSE AGREEMENT The undersigned Carole Blaska , being the fee owners of certain property located in Fridley, Minnesota, at 589 Rice Creek Terrace , and legally described as: 14-30-24-12-0064 hereby grant to the City of Fridley, Minnesota, and that the City's employees, a license for the purpose of gaining access across the above-described property to a retaining wall and other structures adjacent to Rice Creek. This license is only for the purpose of allowing the aforementioned persons access for maintenance purposes. This license is intended to last ten (10) years from the date of its execution, and is not transferable or useable by any persons other than those designated herein. By accepting and using this license, licensee hereby agrees to repair any and all damage caused by the City or its employees while using this license on the above-described parcel. Signed: f Carole Blaska and sworn to efore me this 3' day of 1998. i'19 Public a ROBERTA S. EN h�Tt.; '( Pil(!LtC • V ANO:\A COt.; �nmrn. Exp. Ja SUBJECT O. City ®f Fridley r " 2 8487 AT THE TOP OF THE TWINS BUILDING PERMIT P R COMMUNITY DEVELOPMENT DIV. ______ PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 11/2198 JOB ADDRESS 589 Rice Creek Terrace 1 LEGAL LOT NO. I BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 2 I Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carole Blaska 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO David J. Wi er Constr. 901 Rice Creek T r NE -F-ridlgy 55432 572-8403 8392 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 O NEW 0 ADDITION 0 ALTERATION 6ax REPAIR 0 MOVE 0 REMOVE B DESCRIBE WORK Replace 2-2nd floor bedroom windows and 1 window in basement family room. 9 CHANGE OF USE FROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of house. 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 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 7ALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WQRK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1350 .67 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVIS NS DF ANY OTHER STATE OR LOCAL LAW REGULATING CON- FORMANCE OFeCONSTRUCTION TRU;y 45.75 Fire SC 11.35 PLAN CHECK FEE TOTAL FEE License SC As-nQj 1$52.77 SIGNATURE OF CONTRACTOR OR THORIZEO AGENT IDATEi WHEN�P'ROOPER ALIDATED THIS IS YOUR PERMIT BLOr. iNSP z TEAT E S-GNATURE OF OWNER dF OWNER BUiLDERi MATEi NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 A BUILDING PERMIT APPLICATION ConstructionAddress: 6-317 Rafe awx' 71'erx3exe-- Y Legal Description: Owner Name & Address:j �`�® �7 ��A $'1`� Tel. # Contractor: 09dQA A) (G'�� MN LICENSE # 6J Address: �d % 9/CR 7-FleeJAe F Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground Leis Rand w -Y '�- k1 � Driveway Curb Cut Width Needed: Ft. + 6 Ft = Sq. Ft. _ Sq. Ft. _ Sq. Ft. _ /!'IecR Estimated Cost: $ 666 4Cg/.0 n, ag ?s (Fee Scheduleon Back) Ft x $ = $ DATE: NO() o?, %APPLICANT: Tel. # .�7 07 - e -'l ® 3 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge $ 560 Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: $ �9 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] ►,, SUBJEtT P IT NO City of Fridley 2�f9i 7 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. . COMMUNITY DEVELOPMENT DIV. -% �� r PROTECTIVE INSPECTION SEC. / I CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910415 6/16/99 10B ADDRESS 589 Rice Creek Terrace 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 1 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carole Blaska 571-4435 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dave wiger 901 Rice Creek Terr. Fridley 55432 572-8403 8392 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 O NEW ❑ ADDITION ❑ ALTERATION :9( REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garaq6 24 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED 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 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 $2098 $1.05 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISjp,NS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. STRUT107 OR IHE PERFORMANCE OF CONSTRUCTION $83.25 Fire SC $2.10 PLAN CHECK FEET AL FEE L1cen 5 0 91.40 SIGNATURE OF CON ACTOR OR AUTHORIZED AGENT (DATE, HEN P BL G INSP - A ED THIS IS Y R+.�/�i C /�IAtE $,GNATURE OF OWNER,IF OWNER BUILDERI ibA TES NEWS ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: ("s e6 z -F Tel. # L5W Contractor: 041)F kjJ (5'A -R MN LICENSE # Address: e f Ce eAAFIr We#er Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: d F/ /jC %` m le - O 6C License Surcharge $ 00 I � sq Driveway Escrow $ Construction Type: Estimated Cost: $ d 98 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x Jv DATE: ( WmPPLICANT: Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ �, �� Fee Schedule on Reverse Side Fire Surcharge $ --2.10 .001 of Permit Valuation (1/10th%) State Surcharge $ S $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 00 $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 $ 91, �U STIPULATIONS: FA suBiEcr ` PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 311®2 NO. • COMMUNITY DEVELOPMENT DIV. __ r PROTECTIVE INSPECTION SEC. 1 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ' 612-571-3450 910-F15 6/26/00 JOB ADDRESS 589 Rice Creek Terrace 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carole Blaska 589 Rice Creek Terrace 571-4435 3 CONTRACTOR MAIL ADDRESS 55432 ZIP PHONE LICENSE NO Dave Wiger 901 Rice Creek Terrace, Fridley, MN 572-8403 8392 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 Cy! REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Window Change (Living Room) No structural changes. 9 CHANGE OF USE FROM 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. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ANCES GOVERNING I TYPE OF WORK WILL BE OPERMIDT $1,500.00 $.75 WITH WHETHER HER SPECIE ED HEREIN OR NOT. THE GRANTING OF AS DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE Fire SC PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $23.50 $ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION .50 PLAN CHECK FE TOTAL F E Licen S $5.00 $ 0.75 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATEi E v EN ROPLIDAT D JAIS IS Y�WR $E MIT s d •� BLD/ INS6" =/j GATE S,GNATUREOFOWNEROFOWNERSUiLDERI iDATEi FA Qefl®-?L NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 gc� BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Apdddress: ��KU� ffL,��S�/� Tel. # d-71— L.� �y417 ✓ Contractor: UMN LICENSE # Address: ®f /C ��4- Tel. # c2 ^ jy�/02 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: eJ11,) 0 ej </- / U/ A.) �! cS7`RzC C %LefA9 L O'A"J* 6ST Construction Type: Estimated Cost: $ 45W Driveway Curb Cut Width Needed: Ft. + 6 Ft = __Ft x $ $ DATE: to p,c O`er CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control APPLICANT: 0/91)t" W Tel. # Call (763) 572-3604 for Permit Fees if mailing in application $arta j `--'dee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $ $1100 per SAC Unit $P $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above Ell $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ ®- STIPULATIONS: 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 Effective On January 1, 2001 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 $ .50 $95, *Air Conditioners can not be placed in a side yard without /,_ , written permission from adjoining property owner. �. ,31 D � C" /V F( 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 iQ -//-ci HEATING CO Signed �r! TEL # Approved By " Rough -In Date Final Date BACK SIDE MUS7 rBE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBI ISTIOK AIR VERIFICATION JOB ADDRESS �- IZk '% �® OWNER Rate TOTAL BUILDING USED AS $ 30.00 $ d I ESTIMATED COST PERMIT NO. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name ;�,'o zv /feed 2// XL Size No. �5--CxD BTU _357e --t7 HP EDR $ 25.00 $ Fuel . Total Connected Load Burner Trade Name Size No. $ BTU HP EDR 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 $ .50 $95, *Air Conditioners can not be placed in a side yard without /,_ , written permission from adjoining property owner. �. ,31 D � C" /V F( 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 iQ -//-ci HEATING CO Signed �r! TEL # Approved By " Rough -In Date Final Date BACK SIDE MUS7 rBE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBI ISTIOK AIR VERIFICATION 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 () 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 installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central 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 Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input ` Appliance #2 Type BTU Input Appliance #3 Type BTU Input Total Appliances Total Btu Input Common Vent Type Vent Height Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 PERMIT N.: 2004-00476 DATE ISSUED: 04/12/2004 ADDRESS 589 RICE CREEK TER NE PIN 143024120064 LEGAL DESC RICE CREEK TERRACE PLAT 7 LOT 7 BLOCK 2 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A INSTALL ATTIC AIR CONDITIONER WITH DUCTWORK # A/C UNITS 0 VALUE OF APPL OR WORK # FURNACES 0 # GAS DRYERS # GAS RANGES 0 APPLICANT DEPENDABLE INDOOR AIR QUALITY INC 2619 COON RAPIDS BLV COON RAPIDS, MN 55433 (763) 757-5040 OWNER BLASKA CAROLE B 599 RICE CREEK TER NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Bldg HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 65808 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 8500 0 0.00 0.00 0.00 0.00 0.00 85.00 0.50 85.50 CI 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 �qo " gD7?0 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS -�q ~ hj'oe o Fee Total n� j� Owner �(,t(�' ` $10.00 $ $10.00 $ $10.00 $ a *Air Conditioning -All Sizes L$25.00 All Other Repairs or Alterations (List on Back) p 1% of Value of Appliance or Work 11�$u-01D Minimum Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater 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' *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City 0 Building Used - 3 ESTIMATED COST _ PERMIT NO ` DESCRIPTION OF FURNACE AND BURNER �_ # of Heating Units Circle One (Steam) (Hot Wate (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size 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. HEATING FAX #. 1{ Tel #70' ✓ �`�/ C 7/. 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 existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) 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 installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central 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 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 Appliance #2 Vent Connector Height ft Length ft Appliance #3 Vent Connector Height ft Length ft Diameter in Type Diameter in Type Signed By: Date: CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning -AII 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 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS Fee Total ��77 _ Owner ��-�t / B 3� $35.00 Building Used As_� $10.00 $ ESTIMATED COST PERMIT NO $10.00 $ $10.00 $ $25.00 $ 3" $— DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name{�la �v��nel uJl_ Size No. PS2Q� BTU HP EDR Fuel hr',- az„a Total Connected Load Burner Trade Name BTU HP Size No. EDR The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and repres ntations stated in this application are true and correct. State Surcharge $ HEATING 0_ci erg TOTAL FEE $ Signed .L fil r Tel # REINSPECTION FEE $50.00/HOUR FAX # Date Z&a(�� *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City 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 existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes Vr No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central 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 Type and Size/Common Vent and Vent Connector Information Appliance #1 Type (SO, 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) ,/�P �Q•P ,�O��D HEATING CO: CLI, ma4jazl-) Signed By: , Date