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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N? 3771 Date: ..........................(........... Owner ....................................... Builder a 44.�.... .................. Address ...................................... Address ..................... ...................... LO/CATION OF BUILDING No. �if .1. .'_� ... Street ..,! ..A .. ..... Part pt Lot ....:............... . Lot ... 4 ...... Block .... /............ on or Division � . .. .. . .. 15. Corner Lot ............ Inside Lot .. ....... Setback a...... Sideyard 9........l:o:............. DESCRIPTION OF BUILDING To �e Used ... < -a _ / f �1��� Front .�Depth .I : .` ® Height .top: ®. Sq. Ft.�� Cu. Ft ® !�. .. e aZ...... Front rl� . ® Depth s4 :�® Height Al . a-0.' Sq. Ft. Cu,. Ft. Type of Construction ................... F.st. Cost.. 1.�. To be Completed ........ . In consideration of the issuance to me of a permit to construct the building desribed 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. K .................................................... In consideration of the payment of a fee, of $..,I ...... 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. A NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. Applicatoon for Power Plants and Keating. Cooling.. Ventilation. Refrigeration and J Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470 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 Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $T Each add. 200 sq. ft. IDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS PIPINGr (Up to 3 Fixtures) .......................... 1.50 $ (Add 50c each over 3) AIR CONDITIONING $ / FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS REMARKS: $ TOTAL FEE $ '� City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Wnn °`� 195 Owner '/ "4, 195— Kind of Building 195— Used as /& &`"' To be completed about Estimated Cost, $ �� Old New. uildng Permit No. -,-3.271 DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm .Air—NaAL--A . Trade Name Size No �✓� -/k Capacity Sq. Ft. E D.R BTU " J--' H.P. f Total Connected Load—���-�� Kind of Fuc BURNER — Trade Name_ Size No - Cap city o Capacity Sq. Ft. E.D.R BTU H.P. sign By idFECTION HE�T1NC COMPANY, IMC. aQHO-11 POST 1M-8-58 BusineA 6i'i9L#o 0 MINNES01A D-56 !K-- 7 s" HEAT,; -LOS, ALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A.S.H.V.E, Construction No. Guide Windows Doors Reference Out, Wall Int. Wall Ceiling Roof Floor Yes—No Yes-- 0 19_ Room l Lengt Width 17 Height II FLI indows a d Doors--Crackage and Area Doors--Crackage and Area Required s 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 pan of pane lights of crack sq. ft. v ry q Width Coef. Coef. Btu Infiltration ,�� 1 D Glass Glass .0 Exp. wall, Exp. wall 6211 Int. wall Net exp. wall Net exp. wall S-5'/01 Int. wall Int. wall /S Z,f --n Ceiling Ceiling Floor Floor dS I ota! Btu. 1/0 Zz Required sq. ft. E.D.R. or sq. ins. W.A. Le er area I F1.1 ��/� Room I Lengt ,§�- Width & Height W ndows a Doors--Crackage and Area Required s 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 pan of pane lights of crack sq. ft. 34 ry q Width Coef. Btu Coef. Btu Infiltration 1 1440 G� Glass Net exp. wall Exp. wall 6211 Int. wall Net exp. wall S-5'/01 Int. wall /S Z,f --n Ceiling Net exp. wall Floor dS I otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area J Fl.1 ;Pi=!:: Room I Lennth l Width -7-0 Heiaht Windows and Doors—Crackage and Area 11 Required s Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. d CJS ry q Width Coef. Btu Infiltration WO Coef.1 Btu Infiltration G� Exp. wall Net exp. wall �Z? Glass Int. wall Ceiling Exp. wall /S Z,f --n Net exp. wall ,s T�� Int. wall Ceiling Floor D �. Total Btu. . ft. E.D.R. or sq. ins. W.A. Leader area Insulation Kind How Applied Ronm I Lenstlt -1 Width C ® Heiaht Windows and Doors—Crackage and Area 11 Required s Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. f d . Room I Length /,? Width Height Windows and Doors—Crackage and Area Width Coef. Btu Infiltration WO & 0 Glass G� Exp. wall Net exp. wall �Z? Int. wall Ceiling Floor /S Z,f --n Total Btu. 11 Required s .D.R. 'or sq. ins. W.A. Leader area F1.1 . Room I Length /,? Width Height Windows and Doors—Crackage and Area Width HeightNo. of Lineal ft. Area No. of pan. of pangp. light. o! crack .Q. ft. Infiltration Glass S Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Len Width Windows and Doors—Crackage and Area Width Relght No. of Lineal ft. Area No. of pa9qne ofBpane 1 ig99ht. of crack .Q. ft. 4D 0 6-0 r) Coef. Btu Infiltration l_ 0 '0 Glass a e�...� Exp. wall �, 6 Net exp. wall j Int. wall Ceiling Floor / J74 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area HEATI< WSS7,CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—NoYes—No 19_ FQ 73'241 Room I Length—&I Width Height II Fl.l Room I Length Width Height Windows and Doors—Crackage a d Area Width Height No. of Lineal ft. Area Ivo, 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. Z Coef.1 Btu Coef. Btu Infiltration Exp. wall GlassCz Net exp. wall Exp. wall d;P , Ceiling Net exp. wall Floor 42 Int.: wall Ceiling Floor /0 b otal titu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.) Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal Et. Area No. of pane of pane lights of crack ,.ft Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area Ivo, of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. 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 Glass Exp, wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.) 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. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 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. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area SUBJECT PEji. City of Fridley ®- IfRECE AT THE TOP OF THE TWINS gUILDING ERMIT r COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 ( i 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/14 83 JOB ADDRESS 173 Rivers Edge Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 1 1 Rivexsedge Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dolores R. Christenson 173 Rivers Edge Way N.E. 571-3914 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 Construct a 7' x 22 . Garacre Addition* 9 CHANGE OF USE FROM TO SMPULATIONS Seestipulations, listed on Oct. 14, 1983 letter. Variance approved Oct. 11, 1983 with thesestipulations:. Provide a hard surface driveway.WA �P �':'3 t, Before' digging caii icy; + utiwiPs TELEPHONE- ELECTRIC SEPERATE PEf MITS REQUIRED FOR WIRIK REQUIRED BY LAW HEATING, t LUIVIBING AND SIGNS. 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 S0. 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,650 $.83 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THEPERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE AOR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $ 1$.00 PLAN CHECK FEE TOTALFEE 18.83 NATURE OF CO AUTHD RED AGENT (DATE) - 'WH PROPS Y A I HIS IS YOUR PERMIT ,BLDG INS P l� DATE SIGNATURE OF OWNERIIF OWNER BUILDER) (DATE) OWNER ADDRE TEL 0 CITY OF FRIDLEY APPLICATIM FOR RESIDENTIAL BUILDING PLM -MTS (New, Alterations, Additions, or Repairs) BUI LDER : ADDRESS: TEL 110: Effective Aug. 1,° 1981 / Construction Location STRICT NO: ! STREET: A- et' e LOT: BLOCK: ADDITION: Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF C011STRUCTI011 rout: Depth: 2 �- Height: Square Feet: Ade Cubic Feet: Front: Depth: Height: Square Feet: Lf�Qo�� Type of Construction: 7b Be Cbmpleted: Cubic Feet: Estimated Cost: $ /6 - Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE FEVER -T:, SIDE OF SHEET Mie undersigned hereby males applicaticn for a permit fcr the %:ork 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 represenn atiens stated in this application are true and correct., A Stipulations: 9JJ-411� 101 TY CITY OF FRIDLEY 6431 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55432 TELEPHONE ( 812)571-3450 October 14, 1983 Ms. Delores Christensen 173 Rivers Edge Way N.E. Fridley, MN 55432 Side Yard Variance for Garage Addition Dear Ms. Christensen: Please be advised that on October 11, 1983, the Board of Appeals approved your request for a 3 foot variance; a reduction of the required 5 foot side yard to 2 feet for an attached garage. The variance Was approved With the following stipulations: 1. The west wall of the garage must be a fire wall and have no openings. 2. There is to be no outside storage along the west wall of the garage. 3. There is to be little or no overhang on the west side of the garage. 4. Provide a barrier along the west side of the driveway that is acceptable to this neighbor. In regard to item #4, the barrier, I have enclosed the portion of the City Code that states the specifications for such an installation. We hope that this information will be helpful in your deliberation over the agreement with Mr. & Mrs. Griebenow. Once a written agreement has been reached, please submit a copy to us in order that we can issue the building permit. If you have any questions on this matter, please feel free to call on me at 571-3450. Sincerely, C7 DARREL G. CLARK Chief Building Official DGC/mh ENC: 1 CC: Mr. Griebenow 1 4 General Provisions 205.046 REQUIRED YARD AND OPEN SPACE Required Yard 1. The following shall not be considered an encroachment on yard and J And Open Space setback requirements: r A. Yard lights and name plate signs in the residential distria provided such lights and signs are three (3) feet or more from all -I t lines and meet size requirements under the chapter of the City Code entitled "Signs". Lights for illuminating parking and loading areas or yards for safety and security purposes may be provided where necessary, provided that not more than three (3) foot candles of light intensity is present at the property line. B. On the primary structure, chimneys, flues, belt courses, sills, pilasters, lintels, ornamental features, cornices, eaves, bays, gutters and other similar projections are permitted, provided that they do not extend more than two (2) feet into the required yard and (3) in no instance in the residential districts, any nearer than three feet from the lot line. C. Unenclosed porches, canopies and steps to building entrances may extend not more than ten (10) feet into any required front or rear yard setback, provided they do not extend nearer than five (5) feet to any lot line. D. On existing structures, vestibules may extend not more than five (5) feet into the required yards provided they are only one (1) story and do not exceed fifty (50) square feet. E. Open work fire balconies and fire escapes may extend not more than one and one-half (1-1/2) feet into the required yard. F. A fence bordering side and rear lot lines shall be no more than seven (7) feet in height in any residential district or eight (8) feet in height in any other district. 0. A fence, wall or any natural hedge or closely planted vegetation that forms a barrier shall not exceed four (A) feet in height within the limits of the front yard in all residential districts. A. A fence, wall or any natural hedge or closely planted vegetation that forms a barrier shall not exceed a height of thirty (30) inches if within ten (10) feet of a driveway access for a distance of 10 feet in each direction from the intersection of the property line and street right of way line in all residential districts. I. On corner lots, no planting or structures shall impede vision between a height of thirty (30) inches and seven (7) feet above the curb line in the vision safety zone. ` J. In no case shall a fence or similar barrier impede vision or cause a hazardous condition to exist. 2. Access across the boulevard is restricted to driveways and sidewalks. 3. Easements *for sidewalks shall be permitted at a minimum width of five (5) feet unless included with a bicycle way trail, at which time the easement will be a minimum fifteen (15) feet in width. ID t..and Surveying Land Planning Gvd Engineering Environmental Engineering Geotechntcs Condominiums Scale - Denotes "nMonsnern set O Denotes Iron Monument bund . 5-rQFrtir CU as Certificat, Proper -f y�0 CD L For Dee ChrlsIwSOn c LO/ E' 1&i/ock /, Rl;lz-R EDGE A701ra 67v�r�y, Sfl wide uf�::.1j� f o=�.i�oq. etGcs��x�/ MA�� moi' v PN Wiv�� qe W6py (fog r/y 6// Way) We hereby certify that this is a true and correct representation of a survey of the boundaries of the land described above and of the location of all buildings thereon. and all, visible encroachments. if any. from or on said land, that this survey was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. As surveyed by me this 4M day of Oe obr/' .19 6IR . / p.o box I osseo m,nnesota 55369 c 1612,425-2181 cons Ong /j �� -� ,� ��_ �• erx,�neers a,.� o. /p/g ore o- %O-S-B� sec.ea a L . P CSI Vef $Ifle(j ..r No 1S 4 7' 9 �m ft X26.09�. .- 6'V9 Pw 4r inc E7 BARRIER AGREEMENT Per the October 11, 1983, meeting of the Appeals Commission of the city of Fridley, the following barrier between the proposed garage and driveway at 173 Riveredge Way and 169 Riveredge Way has been agreed to as one of the stipulations of granting the varience to Chapter 205 of the Fridley City Code to reduce the required side yard setback from 5 feet to 2 feet. Barrier Is Landscaped Traffic Barrier Placements Landscaped sufficiently to stop all pedestrian traffic between the north west corner of the garage of 173 Riveredge Way and the south east corner of the fence surrounding the back yard at 169 Riveredge Way. Barrier IIs Hedge of Alpine Currant Placements On property at 173 Riveredge Way center line 1 foot to 2 feet from west property line extending from 10 feet north of the street right of way line northward to the south wall of the garage at 173 Riveredge Way. Maximum Spacing of Plants Not to exceed 24 inches center to center. M4intanences To be trimmed suffient times during the season allowing for even growth of six inche per year up to a final height of the maximum allowed by code. Plantings ~f ` To take place on or before November 15, 1983. Approveds pprove s1.:e -' Delores Christenson harlene driebenow 173 Riveredge Way 169 Riveredge Way FridIOY Fridley CIVIC CENTER • 6431 UNIVERSITY AVE. N.E.. FRIDLEY, MINNESOTA 55432 • PHONE (812) 571-3450 September 14, 1984 Ms. Dolores R. Christenson 173 Rivers Edge Way N.E. Fridley, MN 55432 Re: Construction of Pedestrian Barrier at 173 Rivers Edge Way N.E. Dear Ms. Christenson: An inspection was conducted on September 12, 1984 to check for the completion of the pedestrian barrier that was agreed to be completed on or before November 15, 1983 (see enclosed agreement). This inspection noted that the barrier has not been completed. We will expect you to construct this barrier on or before October 15, 1984 when a reinspection will again be conducted to determine compliance. If you have any questions on this item, please feel free to contact me at 571-3450. Sincerely, DA LARK Chief Building Official DGC/mh ENC: 1 CC: Ms. Sharlene Griebenow 169 Rivers Edge Way N.E. rJ SuBjECT PERMIT NO. City of Fridley 9 AT THE TOP OF THE TWINS BUILDING PERMIT r CEIPT N • COMMUNITY DEVELOPMENT DIV. LL ------ PROTECTIVE INSPECTION SEC. I✓ � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/3/96 JOB ADDRESS 173 River Edge ay NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 6 1 River Ede Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brian Pence 173 River Ede Way NE 586-.0961 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Tabor & Sons Inc 3716 St Francis Blvd Anoka MN 789-1902 20014248 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Reroof front of house 10 S Tear -off 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ R6MOVE X 8 DESCRIBE WORK Reroof front of house 10 SO Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES 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 $800 $•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- $29.25 Fire SC $.80 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 5.--3 A � License SC $5.00 $35.55 SIGNATURE OF CO TRACTOR OR AUTHORIZED AGENT IDATEI fWHEN PROPERLY ^DATED THIS IS YOURPERMIT� BLDG NSP DATE SIGNATURE OF OWNEROF OWNER BUILDER^ IDATEI rJ NEW [ ] ADDN [ ] - CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: Legal Description: Effective 3/1/96 Owner Name & Address: -, / �y ,, 0 Tel. # 4 Contractor: MN LICENSE # 2oa/ Lia y P Address:_� 2 /C Tel. # t7 R 9 - / go I Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width HgtJGround Sq. Ft. OTHER: fl2 - G` 17FF_S Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft.. + 6 Ft = Ft. x $ = $ DATE: -,3 9` APPLICANT: , �- y� Tel. # 9,R s� L CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) _� State Surcharge $ c� $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ S_ C70 $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 [ ] S TOTAL $ STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 5 _®0(�/LJ "2 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** NO. RATE TOTAL Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE JOB ADDRESS The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: , 20 OWNER i BUILDING USED AS °t ` ESTIMATED COST PERMIT PLUMBING COMPANY H.P. PIPIEWORKS 3570 DODD ROAD SIGNED BY GAN, MN 551L N0. Approved By Rough -In Date Final Date $ OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE 2 - 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 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) Iam1�ollexeo l Signed By: Date :