Loading...
PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT IIT. Cj'72 Date: ....._ _ _... _.�..___.__..................... ...... Owner:��Builder ....._......._....._............_..... ys� q Address ....� .._. ...... m ..._ Address ........ _...--•- K.. LOCATION BUILDING No.... .. ...... Street ....._ �" _: � �! ._...._..... Part ofr-Lot a.......... Lot .............W1...•..__........ Block -•... ........ .....------------- Addition or Sub-Division� .._ _:..._ _ .....:_ Y.. .1 -MI- I' Corner Lot .................................... Inside Lot ............ " •""_--------- Setback ........... _........ Sideyard --i _ .............................. Sewer Elevation ... ....................... ...................... .............. ........ ............................ Foundation Elevation DESCRIPTION OF BUILDING To Used ash, .... Front "? .. Depth ...:. Height -.._.. Sq. Ft. , Cu. Ft. .T,�./_. �ivo . .�....... Fro ..... Depth eighti Sq. Ft. _ Cu. Ft...._._�'` Type Construction:...: _....... Est. Cos& ..........•.......... To be Completed .............. .... ...................... - - CAUTION THIS PERMIT G()Ej NOT.. . ION OF ANYA� BUILDING FAL; I ��IOI!®MS� �NtA�tTS AND 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. o In consideration of the payment of a fee of $420-7 permit is hereby granted to.......................................................... _.___...____..._._.._..._._........ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time, ups Rlation tai any of the provisions of said ordinances. . , r+" I Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING PERMIT . CITY OF FRIDLEY, MIldNF�S0 A Owners Name Builder Address LOCATION OF BUILDING 'Z-7 �&_ I Le) - No. Street 'L�Part of Lot Lot Block ,� Addition or Sub.Div, 3 L 6 d�� Corner Lot Inside Lot_L:::—Set Back Side -Yard Z/1,,��, SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot_and proposed building location. DESCRIPTION OF BUILDING To b used a • Fron Depth �� � Height_+,+,, Sq. Ft. `�- Cu. Ft. Front Depth _ Heightt,,, Sq. Ft. Cu. Ft.,rl Type of Construction ' �% Estimated Cost To be completed The undersigned hereby makes application for a permit for the work.herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares tat all the facts and representa- tions ;q_tated in this application are true and cor ect. At (I Sche66le of Fee costs can be found on the Reverse Side.) :0 ^- - 57e P S— City of Fridley, NUmn. N? 7904 BURDING PERMT Date: June 16, 1965 owner: Mary Herzgk Builder 0 •R • Anderberg Co. Address 831 Bice Creek Terrace Address 29213 Oakland Aire. LOCATION OF BUILDING No. 831 Street Rice Creek `herr. Part of rAt Lot 6 Block 1 Addition or Sub -Division Btookyiew Terr. 3rd Add,. Corner Lot _ Inside Lot Setback Sideyard Sewer Mevation Foundation Mevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Ca. Ft. Front Depth Freight Sq. Ft. Cu. Ft. Type of Construction Est. Cost _3 0.•00 Tobe Completed In consideration of the issuance to me of a permit to construct ding described above I agree tc do the proposed work in accordance with the description above and compliance with ail provisions of ordinaaoes of the city of Fridley. � _ In consideration of the payment of a fee of $ 10.00 permit is hereby granted t = erg CO. to construct the 'building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regardinglocation, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any fi3me upon violation of any of the provisions of said ordinances. Allen Jensen Building fpr NOTICE: Sh psm b door not em m the eomcdw, lmite� for wbin& pWmbbv8• Bsu b"A& "Ww er water. Be sure to we the Buiidhm iaspnmr for t pauft pwmih for these hems. b APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA'" OWNER'S NAME , U&17 k BttTLDER 0 . R. Anderbera CC) .,. ADDRESS 331 Rice Creek Terrace ADDRESS 2923 Oakland Ave. LOCATION OF BUILDING No. 331 Street Rice Creek Terra8art of Lot LOT BLOCR ADDITION OR SUBDIVISION,=�C Imo. Corner. Lot -Inside LOT 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 as; DESCRIPTION OF BUILDING Front Depth, Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. - Cu. Ft. Type of Construction geroof & misc. repairs Estimated Cost 3,500.00 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 6-15-65 (Schedule of Fee Costs can be found on the Reverse Side). 109 SUBJECT PeMlft NO. City of Fridley 1712 3 AT THE TOP OF THE TWINS BUILDING P E R M IKit 1 r � . R O. • COMMUNITY DEVELOPMENT DIV. 1 r PROTECTIVE INSPECTION SEC. 9` 3 7f 1 , NUMBER REV. DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/9/83 JOB ADDRESS .831 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6 1 Brookview Terrace 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joseph Beverage 831 Rice Creek Terrace N.E. 571-2935 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 X 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Cedar VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES 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 $3000 $1.50 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- $38.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $40.00 SIGNATURE OFCONTTRACTgO/RR OR AUTHORIZED AGENT 1DATEI WHEN PROPERLY nIDATED TH�ISO IS YOUR PERMIT Z p 4:t2 LOG WSP f DA SIG ATU E OF OWNERIIF OWNER BUILDERI IDATEI CITY OF FRIDLEY Effective Aug, If 1991 APPLICATION F014 RESIDENTM BUILDVIG PEMITS (New. Alterations. Additions. or Repairs) OWUER: k'a UV M A*t-- R ►%L 4 , x ADDRESS: T'3 c -Z I W4 .e c Ar�c:-, BUI LDER : 5�--• ADDRESS: TEL NO: 5 -7 / —'?-93S- TEL NO: Construction location • STR= NO: 3 l STrd=: r c -'-s 0�� !c % c LOT: sI.000: �� ADDITION: l� %W o Ic v 1 C --c- j T,7!�r 3 ,z 0 Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this foam two Certificates of Survey of tot and proposed building location drawn on certificates to scale. DESCRIPTIOR OF CONSTRUCTION 21 D= Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Peet: A Type of Cbrstructim:Air/ Estimated Cost: : Z,`'®u--30oca Tb Be Cbr-pleted: _ �® A it. A Al t. 8 proposed DrivOWAY Width If New Opening Is Desired: SEI: PZVER: E SIDi OF SHEET Tire undersigned here makes a lication for • b5' '' PP permit icz the %jork herein specified, agreeing to do ,all work ii, strict accordance with the City of Fridley Ordinances and rulia:ys of the Delxlxbncnt of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. 6tipulations: 10 SUBJECT PEN0. PERMIT City ®f Fridley 00 4 31 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV.y v PROTECTIVE INSPECTION SEC. / A CITY HALL FRIDLEY 55432 NUMBER REYDATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/24/90 JOB ADDRESS 831 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 1 BrOokview Terrace 3rd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joe Beverage 831 Rice. Creek.Terrace.N.E, xxx 571--2935 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Mark Nord Masonry 3868 Jackson Street N.E,, Columbia Heights 55421 788-7928 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 �J ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct new concrete front step 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $300 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE ln\ $15.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY V LIDATED THIS IS YOUR PE IT '7M " O of B DG INSF DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI 10 NEW [ J Effective 1/1/90 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: % /�. �, lie -e' Legal Description: I � ea,�e�/G Owner Name & Address: o./4025 �e.� �� ��/ /�� ���� Tel. Contractor:Z- Tel. Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVIIG AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ke A,) Corner Lot [ ] Inside Lot [KJ Ft. Yd Setback Side Yard Setbacks Type of Construction: 111f 4-5 faLA�� Estimated Cost: $ .3 c Approx. Completion Date: jj 5 Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: - APPLICANT: Tel. # --;W 7 f X Permit Fee $ `J/ -c // e2 State Surcharge $ SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Marge $ STIPUTATIONS: CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Ul New Fistures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ WdLer S . Blow Off Basin $ 5.00 $ ' $ 5.00 $ % a W $ Hydraulic valve Heater $ 5.00 $ Sump or Receiving Tank C $ water Treating Appliance $ 7.00 � $ 5.00 $ oSf $ 10.00 $ Gas Dryer M M0 $ Back Flow Preventer Ihquared. . . Yes ( ) No C oi O U.N N cL UN cn C7 Go a v a State Surcharge $ .50 Re�napection Fee $ ow u TOTAL FEE 5 % S,7) 'as lec w 0 lot 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) - Now PLature, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fistures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Bain Water Leader $ 5.00 $ Hydraulic valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ water Treating Appliance $ 7.00 $ not water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Ihquared. . . Yes ( ) No ( ) Type S 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance 5 State Surcharge $ .50 Re�napection Fee $ (515.00) TOTAL FEE 5 % S,7) Effective Hay 1, 1990 Job Address J I 1 C�� ��� �� A/c-- Department /c Department of Buildings City of Fridley Tel. 1571-34SO 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. I G( C)C.i . ig % u OWNER o Ly G KIND OF BUILDING qq USED AS 1 cI �cW C TO BE COMPLETED ABOUT c�/=z�/� t ,J A J ESTIMATED COST ��i 7a��®� OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP.—�� Date APPROVAL FOR PERMIT !11N1M04 FUE FOR ANY PLUMBIN PERMIT IS $15.00 PLUS THE 6.50 ST4TE SURCHARG ;ITY OF FRIDLEY INSPECTION flfViStON Effective On January 1, 2000 5431 University Ave NE -ridley, MN 55432 APPLICATION FOR POWER PLANTS AND IDEATING, COOLING, VENTILATION, 763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYS'T'EMS AND DEVICES JOB ADDRESS gni_ __Q1j r- D Q ��1 WE SCHEDULE I—,- .n - - _ 3esidential 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 Dryor *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1.% of Value of Appliance or Work commercial/Industrial 1.25®70 of Value of Appliance or Work Rate State TOTAL BUILDING USED AS $ 30.00 $_ ESTIMATED COSTQA PERMIT NO. $10.(94 � I7ESCRIPiDON OF FURNACE AN0 OR U NEI1 $ 10.00 No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ A,0.00 $e Trade Name_' _.. _ Size Pio. nap BTU HP _ EDR_ $ 25.00 $ Fuel — _-- oad Total Connected Load--- State Surcharge TOTAL_ FEE 4 NIMUM FEE FOR ANY H.D:ATINGI/COOLING/VENTID.ATION IE 199RRAAYION/IdELCONDITIQU ING MNIT IS $25.00 - LU STHE 5.550 STATE SURCHAIRGE !E.INSPECTION FEE $47.00/Hr Air Conditioners can not be placed in a side yard without mitten permission from adjoining property owner. Burner Trade Name_ _ Size No. $ BTU--- HP E.DR, $ 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 1_ .50 rulings of the Building Division, and hereby declares that all the facts and $� representations stated in this application are true and correct. DATE HEATIN ' 4— Signed TEL # 42) '�]n Approved By Rough-ln Date Final Da ?0'd `4d10i COMMON VENT, VENT CONNECTOR AND COMIiM!2N APB VERIFICATION When replacing an existing f4rrance 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 plasWPVC and meets all current codes and manufacturer spec Mentions 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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes { ) No( ) The ex_19fl t, a ccrnbc_stion air is sized and installed to meet the current codes and manufacturer's specifications. Yes No ( ) When required to install as neva cornbuVion air, I: will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No { ) When installing a new venting M stern, 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 i me and Size/Cornmon Vent and Vent Conmetor Information Appliance #1 Type _ �_ BTU Input t=an Assisted or Nat Appliance #2 Type ETU 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 02 Vent Connector Height ft Length ft Diameter. jn Type Appliance #3 Vent Connector H1eight ft1L\enngthh ft-�Diam�eter �- inn Type( Ai_TE f TIONS• (Describe) ' 1 _ I I HEATING Signed By: eo/zo I d 5;09868L 01 A3 -la l ?jd -j0 UI:) W02ld 8S : ZT 0002--ZZ-nON CITYOF ! `RIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Resi en Furnace Shell and Duct Work. Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of value of Appliance or Work Minimum Fee $15.00 for Residential or 55/6 of cost of improvement whichever is greater f` cc, !�;_ Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES r�merciai/in ustrial/institutional :L25% of Value of Appliance or Work (List on Back) Minimum Fie $.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 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 Approved Rough4n Date Final Date Ow I JOB ADDRESS Fee Total ' Owner 3 ::tte�DfA76'- $35.00 Building Used As $10.00 $ ESTIMATED COST PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10,00 $ # of Heating Units__, Circle One (Steam) (Hot Water) W m Air Trade Name Size No. $25.00 $ BTU HP EDR Fuel Total Connected Load $ Sumer Trade Name Size No BTU HP EDR r�merciai/in ustrial/institutional :L25% of Value of Appliance or Work (List on Back) Minimum Fie $.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 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 Approved Rough4n Date Final Date Ow I 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 odes 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 1 Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes No ( ) The existinsa combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes No ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No { When installina a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (} No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes ( No { ) Appliance Type and SizelCommon Vent and Vent Connector Information Appliance #1 T A -)-A P aC -t BTU Inp man Assisted o Nat pp Type � �-.— Appliance #2 Type BTU Input I=an Assisted or a Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances. Total Btu Input to Common Vent Type C2 'I Vent Height ��� -Diameter inches Appliance #1 Vent Connector Height C --ft Length --�Lft Diameter �in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: Signed By: Date: - Building BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY nate Recd: / DATE L i YOUR E-MAIL ADDRESS SITE ADDRESS131 r-0 THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: P ADDRESS: q31 di — Aff'E TY 'FP—I L4�n4 STATE ✓ TENANT PHONE:�"J d-2 CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX FAMILY SIZE X� Pa si PROPERTY TYPESINGLE E3 TWO FAMILY/NEW CONSTRUCTION STORIES — PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER r„ ❑ SWIIvIMIIJG POOL lY TYPE OF WORK:)KMAINTEN ❑ NEW ❑ ADDITION l ANCE/REPAIR IJREMODELING DESCRIBE WORK BEING DONE: a c-7- 0 dV w ope 9 - SIZE OF IMPROVEMENT LENGTH .7 0' WIDTH '�fo HEIGHTSq. Ft. ROOFING ❑ HOUSE ONLY .._ NUMBER OF SQUARES -2-� �330USE & GARAGE BASEMENT ING SUBMIT: 1. Existing Floor Plan GARAGES [3 ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT: ❑ DETACHED GARAGE �j 3. List of structural members to be used SIDING ❑ Vinyl f _ � ✓w Soffit �IWLe,6 FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim [�� 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING T 97 .B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ c OCCUPANCY TYPE Permit Fee L Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due , See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks Pavable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. t SIGNATURE OF APPLICANT a�e PRINT NAME 0544A ���� A"1E l Z Building BUILDING Permit No.: Inspections.. RESIDENTIAL APPLICATION. Received By: 763-572-3604 CITY OF FRIDLEY Date AUG M. 763-502-4977 FAX EFFECTIVE 1.1-08 DATE 2 9 YOUR E-MAIL ADDRESS SITE ADDRESS .3 Ak. '-n '• THIS APPLICANT IS: O OWNER CONTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: N CITY STA1'F�ZIP� PHON"?' ' CONTRACTOR NAME: ADDRESS: STA z>P�l SUBMIT A COPY OF PHONE I — (p FA7{ YOUR STATE LICENSE STATE LICENSE # EXP DATE ®I D PROPERTY TYPE SINGLE FAMILY Si O TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE 0 ADDITION 0 GARAGEISHED ZVINDOWS D BASEMENT FINISH 0 ROOF 0 DRAIN TILE O DECK D SIDING D OTHER O SWIMMING POOL TYPE OF WORK: D NEW HOME CONSTRUCTION 0 ADDITION XMdAIVTENANCF/REPAIR 0 REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING 0 HOUSE ONLY NUMBER OF SQUARES 17 HOUSE & GARAGE BASEMMT REMOD G SUBMIT: GARAGES PROPOSED SIZE: D ATTACHED GARAGE 1. . 2. Existing Floor Plan Proposed floor plan PROPOSED HEIGHT: 0 DETACHED GARAGE 3. List of structural members to be used SSIIDING FOR NEW CONSTRUCTION INCLUDING DECKS, D Vinyl DSofflt ADDTTIONS & POICIIES SUBMIT. 0 Aluminum 0 Trim I. Site PlawSurvey showing the existing structures D Other O Fascia and proposed pmjwt. 4JiND(iwS 2. Two sets of construction plans IN EXISTING OPENINGS Aties DNo F OWS 3. Energy Calculation OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS TOTAL JOB VALL Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge etc, ne�rw -Ll v—vAliVl\, JAUUULIAky IN W 1OF LABOR AND MATMAi S: rnuv e % C/g /t1G THE 1997 UBC FEE SCHEDULE) $ f , "v See Back Page for Fee Schedule $ 65% of Building Permit Fee $ / . 56 .001 times the total job valuation _ $ . I .0005 x Permit Valuation Mmimmn $SO $ -$5.00 (State Licensed Residential Contractors) $ $1825 per SAC Unit (Plans to MWCC for determination) $ ft+6 ft= ttx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ r,1d.. Agreement necessary ( ) Non Necessary ( ) to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the Wormation above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; his is not a permit but only an applicatio for a permit and work is not to start without a permit on site; that the work w� be in ac7npg�a all work which review and 791, fplan.SIGNATURE OF APPLICANT RINT NAME`DATE'S t Lac APPROV$D BY DATE