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PRE 2010 DOCSCITY OF FRIDLEY INSPECTION DIV. Effective On January 1,199k" 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 1A-7�3 Z)Ay-- CA, RATE SCHEDULE :. The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and furnace Shell and Duct Work, Sumer - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ Z.®.ec representations stated In this application are true and correct. (Side Vent - Fill Out Back) - -7 -,"Gas Piping (Needed with new furnace) $10.00 '►Q X�� Civ , z Z \�,ca� .car- e V �At- iMt✓� Gas Range $10.00 6 $ BUILDING USED AS ) \40_ v v\. Gas Dryer A $10.00 $ ESTIMATED COST o`D PERMIT NO. *Air Conditioning - All Sizes 1�0 10.00 $ \ `� P® -O RES„ CRIP_I70N OF FURNACE, AND OR BURNED All Others/Repairs & Alterations (UST ON BACK) 1% of Value of Appliance or Work $ No. of Heating UnJts_ _�_ _ Circle One (Steam) (1lot Water) arm Air Trade Name R� �o ry Size No. \ 2 S Commerclal/Irdustrial BTU � ,Lot7 HP EDR 130-F 1% of Value of Appliance or Work $ Fuel 6AS Total Connected Load State Surcharge ?Q Sumer Trade Name Size No. BTU HP EDR TOTAL FEE $� -,, MINIMUM FEE FOR ANY HEATINGICOOLJNG/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $1590 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. HEATING COMPANY -E \-AK > Vd\t,C'Ab0sQ d /--'Ac-- Signed By Q=i � kTel No. App roved44d— Rou 9h -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CBMM AND STACK VEJU ;ICATION The undersigned hereby verifies that the existu►g chmmey or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( } 3. Has no foreign objects lodged within Yes () No ( } 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes { } No ( } 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( } 8. Has combustion air been provided for water heater Yes () No ( } Remarks: HEATING CO: Signed By: Date: City of Fridley SuBJECT 2 3 1 4 AT THE TOP OF THE TWINS BUILDING PERMIT r I NO. ______ v COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC e'er -1 CITY HALL FRIDLEY 55432 NUMBER REV112/20/94 ATE PAGE OF APPROVED BY 612-571-3450 910-F15 JOB ADDRESS 1478 Ro al.0ak Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 1 Totino Grace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Imperial Homes Inc. 4196 Lexington Ave N Shoreview MN 55126 483-5518 -i—CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 20014230 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 FINGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 0 REPAIR ❑ MOVE ❑ REMOVE x B DESCRIBE WORK Construct a 54' x 34' Dwellin • a 32' x 26' Garage; and a 26' x 12' Patio 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. Provide sod in ' the front and side yards. Provide a verifying survey before capping. Pay Park Fee of $1,500.00 Sewer & Water Locations: See attached sketch.VV- A h�..g. � Before digging Call for all utility locations 454-0002 SEPARATE PERMITS REQUIRED FOR REQUIRED Y LA S� WIRING, HEATING, THEUC IFFFt1DLbAS VOT GUARANTEE THE, ACCURACY OF UTILITY LOCATIONS INNS l- ND ELEVATIONS. THIS DATA IS. FOR INFOFNIATION PURPMES ONLY, THIS INFO AND PPERSO((��Npp��S y(�Jpp.ySIING SEPARATE PERMITS ARE REQUIRED FOR Ei"1 p1CAt. F�t�JMBt49, H �TI 6, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS FcRM1T 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 I STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX Fire SC AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $101.69 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $203,388 $203.39 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- $1,003.50 $800.00 NCE OF CONSTRUCTION. STRUCTIO R THE PER7.1-10M PLAN CHECK FEE TOTAL FEE ` License SC 15.00 $2,113.58 + PF HEN PROPERLY LIDATED THIS IS YOUR PERMIT sl NATUREOF NTR C OROR nHORIZEDAGENT ATEI s iw s" 4 BLDG NSP P 2- DATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI� 01 NEW [) Effective 1/1/94 ADDN [ ] CITY OF FRIDLEY5�Y-3 ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Y7Q COnSttUdiOnAddr=: x x xx ROYAL OA K Cou2T 2i o LE--( MN Legal Description: d o r l B Ll- 1 -t"o T i M6 G 2z, C -E A u o K A C ouN ru M►J nc,,�� Owner Name 8c Address: Tel..# Clontractor: =M Pt✓R� AL• loM4 into. MN LICENSE # 2001 230 Address: 1419 to LEX in14ToN AVE W. 5 HOf-tV1Eu1 MM 55-12 & Tel. Z.) - - Attach to this application, a Certificate of Survey of the 453- SS l 8 lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length S `1 Width 3 y Height 9 Sq. Ft. 2 718 GARAGE AREA: Length 3 Z Width Z & Height 1 / Sq. Ft. 83o r�1A-r 10 AREA: Length 2(- Width 12- Hgt/Ground o Sq. Ft. 3 /7- OTHER: zOTHER: w�Q Corner Lot M Inside Lot [) Ft. Yd Setback 35 '- 6,' Side Yard Setbacks Z3. S AND Type of Construction: Rnic eyc6 NEW Estimated Cost: $ 0 b o Pcul Lar Approx. Completion Date:g - / s - (Cost on Back) �,A 4P 'C'dv y Driveway Curb Cut Width Needed: Ft. 6 Ft t x $ — $ DATE: 12-- APPLICANT: Tel. # USE ONLY 795; $Ael �j�'/® 22 kdy/y,9'1 Y-0 Permit Fee $ /a ®��`Sv Fee Schedule on Reverse Side /G gf, t i Y�. 41317, 76. Fire Surcharge $ � ..001 of Permit Valuation (1/10th%) ,2034 9,8f 2;'o State Surcharge $ %��, �"� $.501$1;000 Valuation 2431 34 SAC Charge $ 9-6 0, f $8W per SAC Unit License Surcharge $_ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ 1 S,Do . oy Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ 3 0J, TOTAL $ 3,o<3 STIPULATIONS: —----.-- �Z C;1SRT1F;1C;;ATff= C?F vURVF='"r For: Imperial Hom-es 25 N00°01'10"Eo gni•`' •9 127.86 38.61 '• 9 Ln 0--- 955.6 o - 95g. 10 i —_ 0 c %k9C,6 •. Gey! 32.3 ; W 1> a 2 oor 1i II as Proposed o a' I" -1 00 V . Nouse I uoC 1 .v � • H57 Garage Drive j-- - S 35.54 to N1> 26.7 PQS6, 10 127.98 ' 35.87 1 N00001'10"E a o i ARTHUR STRMST N3. FOR w ONLY PSR ONLY PROPOSED aEVA WOWS' a DENOTES 11 FOOT OFFSET. TOP OF BLOCK 957.9 Garvge DENOTES PROPOSED aEVA 170NS. GARAGE FLOOR = 957.5 r- DENOTES DIP—MWN OF DRAINAGC. LODY£Sr (ZOOfi -- S52.5 Oiag.: 88.0 x 44.3 = 98.52 Lot 1. Block 1, Totino Grace, Anoka County, Minnesota 'Scale i" =,C! O Denotes Iron Mon. I Book: XXX Page: XXX .lob No 94626HS Owg.by BG Disk2� We hereby certify that this is a true and corrcct ropresentation of a. mum d sON$ INC a survey of the boundaries of the above described land" and of the LAND SURY94rORS location of all buildings, if any, thereon. and all visible encroachments, bl" LEXINGTON 4tYM NO. if any, from or on said land. E. G�.aR i C. GiRC.x P{Nn, MvaWT4 Dated this TAI -of C, 1994 BY Minnesota Lic. , No. 9� 6"14-3625 1'E1.. 'T8b-5�5b TOTAL F.01 1� t ,wi � I 08 56 -91 41, Sid in A -3-19 �► 21.0 11.7 956 v LLJ all0 �yb 22.0 -.. C14 oa 0 y 54.0 \65 \� \°110 10 QD IN ......._� \._. �... C e �5b W c r 1510 X510 M, gS00 I OWNER I MPazI A.L 4omeS I roc. • CONTRACTOR Sar,nr AS ADDRESS 41gto I.EXINtA7ot-4A.vE. SNd�E.VtEW ADDRESS PHONE t b PHONE JOB ADDRESS x*cacx rl_ayAL 0&V_ eou'l' LoT + 11LtL l TOT100 4rzpL� ,tao� a�acN Determine working square footage of each of the following: 1. -TOTAL EXPOSED WALL AREA 2?, SQ. FT. X • II = Z5 3 2. TOTAL ROOF/CEILING AREA 1901 SQ. FT. X 1 417. 3. BUILDING PERIMETER (not including garage) I$4- Lin. Ft. TOTAL EXPOSED WALL AREA. (Walkout basements or 2 story homes, figure from floor line to bottom of uppermost ceiling joists. On split entries, figure from top of blocks to uppermost ceiling joists): Z-,"0?::, SQ.FT. a. Total wall window area ........................... 4a!2 SQ.FT. b. Total door area .................................. SQ.FT. c. Total sliding glass door area ..................... SQ.FT. d. Total fireplace wall area (If exposed) ........... Who, SQ.FT. e. Total wall framing area (Average 100) ............. 'L30 SQ.FT. f. Total net wall area ........................... IZ-9l SQ.FT. g. Total rim joist area' ............................. 2.77 SQ.FT. Total exposed concrete foundation wall area ...... I12-SQ.FT. h. Total foundation window area ...................... NIA, SQ.FT. i. Total net foundation area above grade ............ 172- SQ.FT. DETERMINE "U" VALUE OF EACH WALL SEGMENT a. 4L5' X Ifun 30 = I11 6:— b. Sp X fluff Z�j = ZZ.4- c. X fluff ,40 = N/P d X fluff .14 e. 2,3o X nun 08�', = Z0•Z4 f- I"�yf . X fluff g. 2-72 ,.L X nU" •040 h. N /A, X null • 4- = WIN. I-72– X nun -09 = is .4h 4. TOTAL ......................................... = Z51 - If total of #4 is the same or less than #1, you have met the intent of SBC 6006 (C) 1. Z51 .53 Ls3, �3 -_ ":.'c'.ti�T.."C•>ot. �••t�, ;;:i.: �.; �'^..•;+s.:- r..�;sxy�.�1'•�'x g,.:v>..��rY"'„m•�"�",',C'.`«.°a- 9So01 Total Exposed Roof/Ceiling area = ...................... 1901 SQ.FT. j. Total skylight area .... ........ ... ..'...... -- SQ.FT. k. Total roof/ceiling framing area (10%) ........ A0 SQ.FT. 1. Total new insulated roof/ceiling area ........ 1-11'7 SQ.FT. j• X n U n k. 190 X nun X fluff oz -a _ 3'1•'1? 5. TOTAL ...... ................. ........... Q-1.14 If..total of # 5 is the same or less than'#2, you have met the intent .of SBC 6006 (c) 1. 47-, 14 < 4q. SS ALTERNATE BUILDING ENVELOPE DESIGN To utilize the total building envelope system, the values established by the sums of items #4 and #5, shall not be greater than the sums of items #1 and #2. 1. 153 . + 2. 5'ga = �. 9 l 4. ZS(, 5�, + 5. 1611 zcq -G•-? <. 30 2. 11 OCi j 9. Minnesota Pollution Control Agency October 17, 1994 The Honorable William Nee Mayor, City of Fridley 6431 University Avenue NE Fridley, Minnesota 55432-4383 Dear Mayor Nee: Enclosed is a copy of Permit.Number 19369 for the construction and operation of a sanitary sewer extension system to be located in Fridley, Minnesota. Please carefully review the permit including any Special Conditions, General Conditions (No. 1-20) and information relative to plans and the permit application. Please let us know if you have any questions regarding these documents. If you do have questions, you may contact me at the address listed below or call me at (612) 296-7762. If you like, you may also use our toll free number, which is 1-800-657-3864. Sincerely, Donald K. Perwien, P.E., Staff Engineer Compliance Unit 1 Municipal Section Water Quality Division DKP:jmg Enclosures: Sewer Extension Permit cc: City Council c/o William Burns, Manager Charles W. Plowe, Charles W. Plowe Consulting Engineer Metropolitan Council -Wastewater Services, c/o Don Bluhm Metropolitan Council -Technical Services, c/o Marcel Jouseau 520 Lafayette Rd. N.; St. Paul, MN 55155-4194; (612) 296-6300 (voice); (612) 282-5332 (TTY) Regional Offices: Duluth • Brainerd.- Detroit -Lakes • Marshall • Rochester Equal Opportunity Employer • Printed on recycled paper containing at least 10% fibers from paper recycled by consumers. rt s� a ----------------- d3 % yS Minnesota Pollution Control Agency 1LJ b PERMIT FOR THE CONSTRUCTION AMID OPERATION OF A DISPOSAL SYSTEM CITY OF FRIDLEY Anoka County Pursuant to authorization by the Minnesota Pollution Control Agency (MPCA), and in accordance with the provisions of Minn. Stat. chs. 115 and 116, plans are approved and a permit is hereby granted to the above -referenced Permittee for the construction and operation of a sanitary sewer extension in Fridley, Minnesota. The facilities will consist of 440 linear feet of 8 -inch sanitary sewer pipe. The facilities are further described in MPCA approved standard specifications and plans designated as: "Totino Grace Addition" received September 20, 1994, prepared by Charles W. Plowe Consulting Engineer for the city of Fridley. It is the Permittee's responsibility to assure compliance with any special conditions and the general conditions that are required by this permit. This includes taking all necessary measures needed to comply, including, but not limited to, the notification of contractors or others who may be carrying out this work. PERMIT NUMBER: 19369 DATED: October 17, 1994 aurie H. Martinson cting Supervisor, Compliance Unit 1 Municipal Section Water Quality Division 520 Lafayette Rd. N.; St. Paul, MN 55155-4194; (612) 296-6300 (voice); (612) 282-5332 (TTY) Regional Offices: Duluth - Brainerd.- Detroit .Lakes - Marshall - Rochester Equal Opportunity Employer • Printed on recycled paper containing at least 10% fibers from paper recycled by consumers. MINNESOTA POLLUTION CONTROL AGENCY GENERAL CONDITIONS FRSANITARY SE R E TENSION PERMITS GENERAL CONDITIONS: 1) Material, labor and equipment for temporary erosion control measures and the acceptable maintenance thereof shall be provided during the life of the project, to effectively prevent water pollution through the use of berms, dikes, dams, sediment basins, fiber mats, netting, gravel, mulches, grasses, slope drains, and other erosion control devices or methods. Surface cover materials shall be anchored to reasonably prevent their entering waters of the State by erosion or rising water levels. - 2) Temporary pollution control measures shall be included for all construction activity associated with the project where such work is necessary, for example borrow pit operations, haul roads, equipment storage, and plant or waste disposal sites. 3) The temporary pollution control provisions contained herein shall be coordinated with any permanent erosion features to the extent practical to assure economical, effective, and continuous erosion control throughout the construction and post -construction period. 4) The surface area of erodible earth material exposed by clearing and grubbing, excavation, borrow and fill operations shall be minimized and immediate permanent or temporary control measures shall. be taken to prevent contamination of adjacent streams and other water -courses, lakes, ponds, and areas of water impoundment. Cut slopes shall be stabilized by methods such as seeding and mulching as the excavation proceeds to the extent considered practicable. Slopes shall be graded properly to minimize erosion. 5) The Appl-icant will be required to incorporate all permanent erosion control features into the project at the earliest practicable time. Provisions should be made for continual checking and maintenance of all control measures, particularly during periods of rainfall, to ensure maximum effectiveness. Temporary pollution control measures will be used to correct conditions that develop during construction that were not foreseen during the design state; that are needed temporarily to control erosion that develops during normal construction practices, but are not associated with the permanent control features on the project. 6) The Applicant will control the area of excavation, borrow and embankment operations commensurate with his progress with finish grading, mulching, seeding, and other such permanent erosion control measures. Should seasonal limitations make such coordination unrealistic, temporary erosion control measures shall be taken to the extent feasible. 7) Oil and other liquid substances capable of polluting water of the State will be stored in accordance with the requirements of MPCA Miscellaneous Water Quality Rules Chapter 7100.0010 - 7100.0090 (formerly Minnesota Code of Agency Rules 6 MCAR 4.8004) (formerly WPC -4). -2- 8) Stream Bank Stabilization shall be utilized if it is needed to prevent erosion, and shall be constructed of materials which will not pollute waters of the State. 9) If an effluent will result from the project the Contractor shall submit to the MPCA plans, for approval, to provide for the following: a) Water from dewatering operations including effluents from construction activities shall only be discharged when the effluent complies with the applicable water quality and effluent standards. Dewatering shall be performed using well points where feasible and practical, all other dewatering shall be performed so as not to result in increased turbidity in the receiving water. This may require the use of desilting ponds to reduce suspended solids. When the MPCA requires, permits must be obtained. b) A Disposal System Permit shall be.obtained by the Contractor from the MPCA prior to any hydraulic dredging or tunneling, or other activity including an effluent whisch•may contain potential pollutants. 10) This permit shall not release the permittee from any liability or obligation imposed by Minnesota or Federal statutes or local ordinances and shall remain in force subject to all conditions and limitations now or hereafter imposed by law. The permit shall be permissive only and shall not be construed as stopping or limiting any claims against the permittee for damage or injury to persons or property, or any.waters of the state resulting from any acts, operations or omissions of the permittee, its agents, contractors or assigns for damage to state property, or for any violation of the terms or conditions of this permit. 11) No assignment of this permit shall be effective until it is executed in writing and signed by the parties thereto and thereafter approved by the Agency. 12) No major alterations or additions to the disposal system shall be made without the written consent of the Agency. 13) The use of the disposal system shall be limited to the treatment and/or disposal of the sewage, industrial waste, other waste materials or substances described in the plans and/or permit application and.associated material filed with the Agency. 14) The Agency may modify, suspend, or revoke in whole or in part, this permit after giving notice and providing an opportunity for a public hearing or by taking direct enforcement action, or any just cause including failure: (a) to comply with the terms stated herein, or (b) to comply with Agency water quality regulations and standards presently in force. Nothing herein shall prohibit the Agency from exercising its emergency powers. -3- 15) The permittee acknowledges that nothing contained herein shall prevent the future adoption by the Agency or its predecessors of any pollution control regulations, standards, orders or statutes more stringent than those now in existence or prevent the enforcement and application of such regulations, standards, orders or statutes to the permittee. 16) The Agency, its officers, employees and agents review and comment upon engineering reports and construction plans and specifications regarding this permit solely for the limited purpose of determining whether such report, plans and specifications will enable the facilities subject thereto to reasonably comply with the regulations and criteria of the Agency.' 17.) This permit has not been reviewed by the U. S. Environmental Protection Agency and is not issued pursuant to Section 402 of the Federal Water Pollution Control Act Amendments of 1972. 18) The plans for the project have been approved with the reservations stated on the attached sheet entitled "Information Relative to Review of Plans and Permit Application." 19) The permittee shall comply with all rules, regulations and requirements of the Minnesota Environmental Quality Board prior to construction of the proposed project. This permit is not effective until the permittee completes all applicable environmental review (Environmental Impacts Statement or Environmental Assessment Worksheet) which may be required for the project. 20) This permit authorizes the Holder to perform the activities described herein under the conditions set forth. In issuing this permit, the state/agency assumes no, responsibility for any damage to persons, property or the environment caused by the activities of the Holder in the conduct of its actions, including those activities authorized, directed or undertaken pursuant to this permit. To the extent the state/agency may have any liability for the activities of its employees, that liability is explicitly limited to that provided in the Torts Claims Act, Minnesota Statute § 3.736. MINNESOTA POLLUTION CONTROL AGENCY Water Quality Division INFORMATION RELATIVE TO REVIEW OF PLANS,AND PERMIT APPLICATIONS June 1, 1992 The review of plans and specifications for sewage, industrial waste or other waste disposal systems and application for permits is made in accordance with the authority conferred by law (see MS, Section 115.07). Approval of plans and permits is based upon the assumption that the information provided by the applicant is correct and that all necessary legal requirements have been or will be satisfied. Plans for sewage, industrial waste or other waste disposal systems are examined with regard to the design features which apply to operation and maintenance of the treatment works or sewer system, the degree of treatment to be provided, the effectiveness and reliability of'the system or methods employed, and compliance with applicable standards systems. The bulletin entitled Recommended Standards for Wastewater Facilities, 1990 Edition, and supplements thereto, as well as other information are used in examination of the design, operation and maintenance aspects of the proposed system. Sewer plans are recommended for approval on the basis that the system is to collect only domestic sewage and such industrial or other waste as may have been provided for in the design. Foundation or footing drains to collect ground water and roof drains or other surface water conduits should not be connected to the sanitary sewer system. Adequate field supervision and inspection by a qualified representative -of the owner should be provided at all times during construction to assure that the project is constructed in compliance with the approved plans and specifications. The Agency assumes no responsibility for the integrity of structures or physical features, or for the reliability, durability or efficiency of specific items of propriety equipment or material. All applicable federal, state and local laws, regulations or ordinances must be followed in the design, location and construction of proposed sewer systems or treatment works. The Agency reserves the right to withdraw its approval of plans if construction is not undertaken within a reasonable period after issuance of the permit. Parks Streets Maintenance TO: John Palacio, City Building Inspector PW94-330 FROM: Scott Erickson, Assistant Public Works Director DATE: October 7, 1994 SUBJECT: Grading, Drainage, Utility and Street Plan Review of Totino Grace Addition 1. Address all previous comments from plan review dated June 15, 1994. 2. A storm pond agreement is required. 3. Note on page 4 of the Special Provisions to the General Conditions, item No. 1 b, that dust control and sweeping is required on a daily basis. 4. Under the General Conditions, item No. 14.9 - Identification, note the City of Fridley to be held harmless also. 5. Page 1 of the Standard Utility Specs, item 2.1.2 should read Neenah No. R -1733- A. 6. Provide copies of the approvals from the MPCA, MWCC, and Rice Creek Watershed District. 7. Concrete curb and gutter shall be B-6-18. 8. Provide soil boring information for the street design. 9. Provide an Engineers estimate for the project. 10. Re -align the watermain in the cul-de-sac area with maximum of 45o bends. All bends shall be blocked with'/ CY concrete blocking material. 11. Redesign the valving layout and connection on Arthur Street as noted on the plans. October 7, 1994 Page 2 12. The street patch on Arthur Street shall be 3 in. of asphalt (2341) on 6 in. of Class 5 base or match existing, whichever is greater. 13. Note pipe class and size on all utility lines. 14. Install grated rip -rap and filter blanket on storm discharge. 15. Provide a revised grading plan on next submittal. 16. Show erosion control on the plan. 17. Show locations of proposed sewer lines for the lots off of Matterhorn Drive. 18. The pending assessments for the two lots off of Matterhorn Drive are currently being reviewed. SE:cz cc: Michele McPherson Charles Plowe September 22, 1994 ;l 1� Metropolitan Waste Control Commission Mears Park Centre, 230 East Fifth Street, St. Paul, Minnesota 55101-1633 A Service of the Metropolitan Council 612 222-8423 Mr. John Flora Public Works Director City of Fridley 6431 University Avenue, NE Fridley, MN 55432 RE: Totino Grace Addition Dear Mr. Flora: The Metropolitan Council -Wastewater Services has reviewed your application for a sanitary sewer extension for Totino Grace Addition. This project is in accord with your comprehensive sewer plan (CSP) and consistent with the Metropolitan Urban Service Area. We will file this project as part of your CSP and inform the Minnesota Pollution Control Agency that we have no objection to the installation of these facilities. rely, onald S. Bluhm Manager, Municipal Services DSB:JET:bw 9-21-94a.csp cc: Marcel Jouseau, Metropolitan Council Don Perwien, MPCA Equal Opportunity/Affirmative Action Employer .., A � G -r Ce-, Minnesota Pollution Control Agen4iz cy 520 Lafayette Road North, St. Paul, Minnesota 55155-4194 APPLICATION FOR PERMIT FOR SANITARY SEWER EXTENSIONS AND/OR CHANGES FOR MPCA USE ONLY I. Date II. File No. Instructions: 1. Submit one completed application with one set of plans and specifications for each sanitary sewer extension and/or change. 2. ALL portions of this application MUST be completed and signed if the sewer extension and/or change is to be considered. 3. An application fee is required under Minnesota Statutes section 116.07, subd. 4d (1990) and Minnesota Rules chapter 7002 (Permit Fee Rules). The fee is $240.00 per permit application and must be submitted with the application. Please make your check payable to the Minnesota Pollution Control Agency. III. CITY: FRIDLEY IV. ENGINEER, FIRM: COUNTY: ANOKA CHARLES W. PLOWE, CHARLES W.PLOWE CONSULTING ENG. ADDRESS: 9180 LEXINGTON AVE. NE, CIRCLE PINES, MN 55014 V. SEWAGE TREATMENT PLANT, Name: PIGS EYE DATE: 9/9/94 PHONE: 785-1043 Is the proposed sewer project in accord with the City of District Comprehensive Sewer Plan? X (Yes) (No) VI. Title of Plans and Specs: Totino Grace Addition Developer/Owner Name: Royal Oaks Realty Address: Lexington Ave. N. City: _Shoreview. MN 55126 Phone: 483-5518 VII. DESIGN OF GRAVITY SANITARY SEWER: Total Length of Pipe: VIII.DESIGN OF PUMP STATION(S), Pump Capacity (gpm)' Total Dynamic Head (ft) Length of Forcemain (ft) Forcemain Diameter (in) Forcemain Material Friction Factor (C) 440 feet Pipe Diameter(s): 8 inches No. of Pumps: 0 STATION 41 STATTON i!? PUMP #1 PUMP #2 PUMP #1 PUMP #2 IX. ESTIMATED FLOW INCREASE: Initial: •0025 MGD Project: .0025 MGD Ultimate: .0025 MGD Basis for estimate: 7 homes X 3.5 can/home X.100 jzal/cap =_0._0025 MGD The project flow should represent the design daily average flow from the completed project as proposed in this application. The ultimate flow should represent the design daily average flow from the proposed development and any areas that will ultimately be served by the proposed sewer extension. PO -00139-07 1993 X. ESTIMATED BODS INCREASE: Initial: 4.41 #/day Project: 4.41 #/day Ultimate: 4.41 #/day Basis for estimate: 7 homes X 3.5 cap/home X .18 lbs/cap = 4.41 #/day XI. NATURE OF AREA TO BE SERVED BY THE PROPOSED SEWER EXTENSION: (a) Residential: Number of New Homes: 7 Number of Existing Homes: (b) Commercial/Industrial (Describe): 0 (c) Other (Describe) 0 XII. Will the proposed sewer project be designed and constructed as described in Standard Utilities Specifications prepared by the City Engineers Association of Minnesota? Yes XIII.DETERMINATION AS TO THE NEED FOR AN Er,IRONMENTAL ASSESSMENT WORKSHEET: (Minnesota Environmental Quality Board Regulation) Please check as appropriate: Yes No Is the ultimate flow increase 500,000 gallons per day (gpd) or more and is the project service area within a city served either by the Metropolitan Waste Control Commission (MWCC) or the Western Lake Superior Sanitary Sewer District System (WLSSD)? X Is the ultimate flow increase 500,000 gpd or more and is the project service area within a city with a population of 20,000 or more not served by either MWCC or WLSSD? X Is the ultimate flow increase 100,000 gpd or more and is the project service area within a city not served by MWCC or WLSSD with a population less than 20,000 but at least 10,000? X Is the ultimate flow increase 50,000 gpd or more and is the project service area within an incorporated city not served by MWCC or WLSSD with a population less than 10,000? X Is the ultimate flow increase 50,000 gpd or more and is the project service area in an unincorporated sewered area? X If a yes answer was appropriate for any of the above conditions, then the preparation of an EAW is mandatory. Do you anticipate that a draft Environmental Assessment Worksheet (EAW) will be prepared by the city or county? NO Approximate date of completion of EAW NO SEWER CONSTRUCTION FOR THE REFERENCED EXTENSION MAY BE UNDERTAKEN UNTIL YOU ARE IN RECEIPT OF THE REQUIRED PERMITS) ISSUED BY THIS AGENCY AND AS DEFINED BY LAW UNDER MINNESOTA STATE STATUTE 115.07, SUBDIVISION 3. Signed: 41 5�? Reg. No. hf2a -7 (Engineer) Printed: Charles W. P1owe Signed: orized City Representative) Printed: 4: =� r' -I Title: r RICE CREEK WATERSHED DISTRICT SUITE 132 ARDEN PLAZA 3585 LEMNGTON AVENUE NORTH ARDEN HILLS, MINNESOTA 55126 RCWD PERMIT -NO. 94106 ccs City of Fridley MOIItgOIDery WStBpII Iaepeatcr Eklia RM File PERMIT APPLICATION NO. 94106. Keith Eibexi steiner, President Rued to. Biltmore Construction, Inc., 4196 Lexington Ave. N., Shoreview, MN 55126 Location: Southwest quadrant of Gardena Avenue and Arthur Street, Fridley. Purpose: Land Development and Final Site Drainage Plans for construction of a single•fam>7y residential development to be known as Totino Grace Addition, 4± acres. At their meeting on October 12, 1994, the Board of Managers of the Rice Creek Watershed District reviewed your permit application, and the recommendation of the District Engineer based upon the following exhibits: L Permit Application, dated June 6, 1994, received June 7, 1994. 2. Preliminary Drainage and Utility Plan prepared by Charles W. Plowe, Consulting Engineer, dated May 26, 1994, received June 7, 1994. 3. Preliminary Grading Plan prepared by E. G Bud and Sons, Inc., dated May 26, 1994, received. June 7,' 1994. 4 Preliminary pla preps by E. G. Had and Sons, Inc., dated May 26, 1994,. received June 24, 1994. 5. Calculations for 1- and 100 -year stormwater runoff and ponding volumes prepared by Cbarles W. Plowe, Consulting Engineer, dated May 24, 1994, received June 7, 1994. 6. Certification of Wetland Conservation Act compliance by the City of Fridley, dated September 27, 1994, received September 28, 1994 7. Cash surety in the amount of $2,000, received September 28, 1994. They found the project as planned to be in accordance with the Rules & Regulations and Guidelines of the District and therefore approved the permit as requested, with the following additional STIPULATION; The Board of Managers will require that the fill limieasement boundary be clearly marked in the field prior to commencing grading. These fill limits shall remain posted until such time that the District Inspector bas approved the return of the permittee's cash surety at the completion of the project. It is the responsibility of the Permittee to provide all measures necessary to contain sediment on the site during constriction. This may require the use of erosion control measures not outlined on the erosion control plea. If this requirement is not met, the Permittee may be ordered to provide additional erosion control measures if deemed necessary by the District Inspector. It is also the responsibility of the property owner to provide necessary maintenance to assure that the stormwater management systems approved as part of this Permit will continue to function as originally designed. Continued on reverse---- RCWD PERMIT NO. 94106, continued: Page 2 NOTE FOR PROVIDERS OF A CASH SURETY. Failure to implement and maintain the sediment. erasion control and cover establishment measures outlined m the permit exhibits may result m forfeiture of your cash surety. If such measures are satisfactorily Provided, the cash surety will- be returned with interest after permanent vegetative cover has been established. Please notify .,dire District Office m writing when permanent vegetative cover has been established and a final inspec° will be made. Two (2) inspections of the project site are included with this Permit, one after erosion cont - :sures are in place and one after project completion, and revegetation, and will be conducte:, assure comPlisace with all agreements, terms, and stipulations of this Permit. Failure to camp" : ;pith the foregoing may result in remission of the Permit, and is. in violation of Chapter 112.89 MSA, a misdemeanor Any additional inspection, requested or required, will be billed at $25/visit. This document is not transferable, and is valid for one (1) year ager the date of issuance. No construction is authorized beyond the e3q&atioa date. If Permittee requires more time to complete construction, a renewal. of the Permit will be nary. Please contact RCWD at 483-0634 when the project is about to commence so an inspector, may view the work in progress. By acceptance of this Permit, Permittee has consented to the foregoing. The enclosed Owner's Certification form must be completed and forwarded within tea.. (10) days of project completion. --- -- -v--Y 12, J"'M is Form C Revised 1/91 Engineering Sewer Water (Parkstr Seets Maintenance TO: John Palacio, Chief Building Inspector PW94-343 FROM: Scott Erickson, Assistant Public Works Director DATE: October 19, 1994 SUBJECT: Grading and Drainage Review of Totino Grade Addition 1. Note locations of sewer services for the lots on Matterhorn Drive. The sewerl- water services should be "gophered" under the street to limit the damage to the existing street surface. 2. The 32 -inch wide street should be face-to-face. 3. Clearly show watermain valving configuration on the plan. 4. All material testing shall be performed at the developer's expense and as requested by the City. 5. Provide soil borings. 6. Provide copies of MPCA, MWCC, and the Health Department approvals. 7. A Storm Pond Agreement will need to be executed before a building permit is issued. 8. Revise erosion control as noted on the plan. 9. Address all previous comments. SE:cz cc: Charles Plowe Michele McPherson . ter Engineering Sewer Water Parks Streets Maintenance TO: John Palacio, Chief Building Inspector PW94-343 FROM: Scott Erickson, Assistant Public Works Director DATE: October 19, 1994 SUBJECT: Grading and Drainage Review of Totino Grade Addition 1. Note locations of sewer services for the lots on Matterhorn Drive. The sewed' water services should be "gophered" under the street to limit the damage to the existing street surface. 2. The 32 -inch wide street should be face-to-face. 3. Clearly show watermain valving configuration on the plan. 4. All material testing shall be performed at the developer's expense and as requested by the City. 5. Provide soil borings. 6. Provide copies of MPCA, MWCC, and the Health Department approvals. 7. A Storm Pond Agreement will need to be executed before a building permit is issued. 8. Revise erosion control as noted on the plan. 9. Address all previous comments. SE:cz cc: Charles Plowe Michele McPherson Erig ineering Sewer Water Parks Streets Maintenance TO: John Palacio, City Building Inspector PW94-330 FROM: Scott Erickson, Assistant Public Works Director DATE: October 7, 1994 SUBJECT: Grading, Drainage, Utility and Street Plan Review of Totino Grace Addition 1. Address all previous comments from plan review dated June 15, 1994. 2. A storm pond agreement is required. 3. Note on page 4 of the Special Provisions to the General Conditions, item No. 1 b, that dust control and sweeping is required on a daily basis. 4. Under the General Conditions, item No. 14.9 - Identification, note the City of Fridley to be held harmless also. 5. Page 1 of the Standard Utility Specs, item 2.1.2 should read Neenah No. R -1733- A. 6. Provide copies of the approvals from the MPCA, MWCC, and Rice Creek Watershed District. 7. Concrete curb and gutter shall be B-6-18. 8. Provide soil boring information for the street design. 9. Provide an Engineers estimate for the project. 10. Re -align the watermain in the cul-de-sac area with maximum of 45o bends. All bends shall be blocked with'/ CY concrete blocking material. 11. Redesign the valving layout and connection on Arthur Street as noted on the plans. [i s October 7, 1994 Page 2 12. The street patch on Arthur Street shall be 3 in. of asphalt (2341) on 6 in. of Class 5 base or match existing, whichever is greater. 13. Note pipe class and size on all utility lines. 14. Install grated rip -rap and filter blanket on storm discharge. 15. Provide a revised grading plan on next submittal. 16. Show erosion control on the plan. 17. Show locations of proposed sewer lines for the lots off of Matterhorn Drive. 18. The pending assessments for the two lots off of Matterhorn Drive are currently being reviewed. SE:cz cc: Michele McPherson Charles Plowe CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On August 1, 1995 APPLICATION FOR PLUMBING AND CAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR WWt Wash fi$� Floors Auto, 3 4 Gash y Wat®r Heater NWIP Stories Cil , Urinal; Shower h Tra Drain - , � Washer 5; Ran e Basement , . y , Fluor 1 u I. ri ek-g q h. } Floor 2 tt Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures Old Opening, New fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water treader 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 $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE i cro 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. t Building Used As 5-17- 9 Estimated Cost PLUMBING COMP SIGNED BY r Approved ByA PERMIT NO. At / s:i�zjv e�. —,�� -? TEL N0. �� G ��` Rough—In Data Final Date mn�+rwrvrtr 1 0..L.. fyi1 AI. 7 1`i.V➢riL7fitl1�/ $ ✓ PLUS THE $.SO STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. v..i i r ur rnivLrzi w4orC411uIV Ulv. 6431 University Ave NE Fridley, MN 55432 572-3604 tnecuve un uanuary 1, 1uvj APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO RE INSTA1 I F:n ON TACH FI OOR PLUMBING FIXTURE RATES: NO. RATE. TOTAL New Fixtures j $ 7.00 Old Opening, New Fixture $ 4.00 ::fie h Urinal owe r sh Wash ra T Floor I F Dra(n �:::�:::::• � �h Auto :�'� WasherStories Gas mangeS Rain Water Leader :Water Heater $ 7.00 s ElecT t` Basement amen Water Heater —Electric i Water Heater — Gas $10.00 /1.:!L) Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No Floor 1 Type •$5.00 Floor 2 F loor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE. TOTAL New Fixtures j $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin 17.00 Catch Basin $ 7.00 Rain Water Leader $.7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric .$7.00 Water Heater — Gas $10.00 /1.:!L) Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No Type •$5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge $ .50 JOB ADDRESS q &JAI -Nk, C(lLt,r+ 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. 199 Owner >K-iA—WZ� Building Used As % Estimated CostPERMIT NO. PLUMBING COMPANY SIGNED BY TEL N0. ��I 'td ApprovedRough—In Date Final DateZad �� MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT) TOTAL FEE PLUS THE $.5o STATE SURCHARGE SuB.,ECT PE City of Fridley 231 AT THE TOP OF THE TWINS BUILDING PERMIT Ir � ' RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. _ r ; L PROTECTIVE INSPECTION SEC. �� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 JOB ADDRESS 1478 Royal Oak Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Totino Grace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Imperial Homes 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Fireside Corner 2700 N Fairview Ave, Roseville MN 55113 638-3304 1068 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 B DESCRIBE WORK Install gas fireplace (Model 6000DV) 9 CHANGE OF USE FROM TO STIPULATIONS Install per manufacturer's specifications. SEPARATE PERMIT'S REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 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 $1,100 $.55 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- Fire SC $1.10 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $27.00 PLAN CHECK FEE TOTAL FEE License SC $5.00 $33.65 WHEN PROP LY VALIDATED THIS IS YOUR PERMIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI DG INSP D.TE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI CITY OF FPIDLEY 'NEW ADDN [ j ALTER [ ) Construction Address: ` k4 Legal Description: Owner Narne & Address: TEL: 612-571-1287 V Feb 16,94 17:14 No.016 P.02/i CITY OF FRIDLE;Y. ' SINGCE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Contractor: FIRESIDE CORNER MN LICENSE # zfuv Address: AOSEVILLE. MN 5 5113 Tel, # Effective 111194 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 Su. Ft. GARAGE., AREA: Length 1e� Width. Height,® Sq. Ft. DECK AREA: Iength Width _ Hgt/Ground. Ft. OTHER: V5 T LQ 25 Corner Lot { j Inside Lot,[ 1 Ft. Yd Setback Side Yard Setb cks Type of Construction: J2h r', Estimated Cost: $ n M- _ Approx. Completion Date: (Cost on Back) Driveway qurb Cut Width Needed: + 6 Ft - Ft x $ = $ DATE: '` 1 q APPLICANT: Tel. Pemit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY. USE ONLY $ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1110th%) $ $.501$1,000 Valuation $ $800 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 f Not Necessary I j SUBJECT T ..� City of Fridley 2 3 9 4 3 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. Ir ' ' COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC r � � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 1/8/96 JOB ADDRESS 1478 Ro al Oak Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 1 1 Totino Grace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Craig/Mona Valenty 1478 Royal Oak Court HE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Imperial Homes Inc. 4196 Lexington - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20014230 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 6 DESCRIBE WORK Finish basement 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. 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 1STALLS 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 $15,700 $7.85 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 ANY OTHER STATE R LOCAL LAW REGULATING CON- V'SON- $237.25 Fire S�,' ��15.70 ST UCTIO O THE PERFORMANC 0 CONSTRUCTION PLAN CHECK FEE TOTALFEE ��/ it 9L, License SC $5.00 $265.80 SA_ NATURE OFCONTR CTOR R uTH IZED AGENT (DATE) x a "• WHEN PROPE s BDG INS' Y VA DATED THIS IS YOUR PER//MIT PATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] Effective 8/l/95 ADDN (] CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2�� Building Permit Application Construction Address: I`i7 ROYAL OAK COURT — Legal Description: LOT 9 K I ToT i N O� � 12Qc.E ,®dD Owner Name & Address: CIZAi(� t MONA VA LES!?Y Tel. # A4 Contractor: 2 M'P E Z I A L. 40 M E j I NC-. _ MN LICENSE # 200 Address: `�/ 9� LEX/dgTou Ai/r 61//6"kl Tei. # V83 -S'S"/8 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 '5Width 3 Z Height 8 O Sq. Ft. %a 56 s f. GARAGE AREA: Length Width Height Sq. Ft. ]DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: — Comer Lot P4 Inside Lot [ ] Ft. Yd Setback 3 Side Yard Setbacks 6Xi57'iNt'/ Type of Construction: R fS t ,0EN7/.6 L • Estimates Cost: $ f /.� 7od = Approx. Completion Date: ocE,6 -Ao {- Driveway Curb Cut Width Needed: 111Ft. (Cost on b Ft = Back) Ft x $ _ $ DATE: / z 7-'7/7 r APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ c,2 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $850 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 [ ] CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES \7 JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are true and correct. (Side Vent — Fill Out Back) Fey e '1960 - Gas Piping (Needed with new furnace) $10.00 $ �c)i-� OWNER Gas Range $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ ESTIMATED COST PERMIT N0. IC2i60 *Air Conditioning — All Sizes $ 25.00 $ 12ESCRIETIQN OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK 1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industria@ BTU HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge .50 TOTAL FEE 251-0 `K-) �vv MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name BTU HP Size No. EDR HEATING COMPANY Signed By-��'��--- � Tel No. 3_2T -';- Approved By Rough—in Date Final Date Z G� 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 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes () No ( ) Yes () No ( ) C.INOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 March 22, 1996 Mr. Richard Riemersma Imperial Homes Inc. 4196 Lexington Ave Shoreview, MN 55126 Re: Final Reinspection at 1478 Royal: Oak Court NE, Fridley Dear Mr. Riemersma: A final reinspection was conducted on March 21, 1996 of the above address and the structure was approved as constructed. Occupancy of the structure is approved. If you have any questions on this matter, please feel free to contact me at 571-3450. Sincerely, 1�0: A4,;Iz BARRY W. RIESCH Building Inspector BWR/mh 10/30/01 TUE 16:32 FAX 651 224 1742 TO: STEVE WILLEMS COMPANY: ALBERS SHEET METAL FAX NUMBER: 651/224-1742 DATE: 10/20/01 NUMBER OF PAGES FOLLOWING: 0 ALBERS SHEET METAL —FROM; JOHN O'CONNOR &T- BOSSAIRE REMARKS: Energy Recovery Cell (ERC) The Air to Air Energy Recovery Unit shall be supplied with a Patented flat plate cross flow Energy Recovery Cell that has a continuous formed transfer surface made from 0.0085 inch thick -1100 aluminurnDAft- Formed714 plate separators. The entire transfer surface shall be visible for thorough inspection. The cell construction shall consist of folded edge seamVerma-Boss"" sealed corners, aluminum structural corners, and 16 gauge end plates These design features allow the ERC to withstand 10 inches of differential pressure All efficiencies are derived from the ASHRAE 84-1991 standard. The energy recovery cell is designed to withstand temperatures to 240° F. With Regards John O'Connor FAX OONFIDENTIAUTY (VOTE The information contained in this facsimile message is legally privileged and confidential information intended only for the use of the individual or entity named above. If the reader of th' nessage is not the intended recipient, you are hereby notified that any dissemination, distribution or copy of this telecopy Is strictly prohir 'nu have received this teiecopy in error, please immediately notify us by telephone and return the original m 't the address below via the United States Postal Service. Thank You. PHONE# BOSSAIRE 0 FAX# 6121378-0049 �h� 2901 FOURTH STREET SE 612/378-2604 w" 4NEAPOLIS, MINNESOTA 55414 0,(�y X03 do off' 0�J 'ITY OF FRIDLEY INSPEC•1 iUN DIV. 431 University Ave NE 'ridley, MN 55432 -63-572-3604 Urinal Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR .....= Wash )' Floor Auto. -w;�;. :...F,:;,�: �•��:.�.:.::.:.:... Washer NO. RATE TOTAL New Factures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range" Gas Dryer" Back Flow Preventer Required ( )Yes () No Type $ 7.00 l �� $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Effective On Jan 1, 2001 Water Heater. Gas IElec 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. le) LG3 ' 12001 I✓tre�.t� �' f%OUia t/ Owner e Building Used e_5 Lc(ft i 4-- V':5Kj&r5 00 e v � Estimated Cost P 3 700 PERMIT NO. ��/ / ! - PLUMBING COMPANY TEL N0. Rough -In Date Final Date /L-5 Reinspection Fee $47.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved B State Surcharge $ 50 MINIMUM TOTAL FEE $ �� PL.US TH COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the 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 Installinu 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) HEATING CO: Signed By: Date: MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION IEFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 FLUS THE $.50 STATE SURCHARGE ?EINSPECTION FEE $47.00/Hr Air Conditioners can not be placed in a side yard without rritten permission from adjoining property owner. HEATING CO�i�,,Z �/��%�°%� 411 I FRMI��Frol n-/ Rough -In Date Final Date CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective On January i, 2001 n 9 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND 763.572.3604 HEATING, COOLING, VENTILATION, 9 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SC}IEDULIE - OWNER119A101 IC4- A)A Residential Rate TOTAL Furnace Shell and Duct Work, Burner BUILDING USED AS=Sd� o Also Replacement Furnace $ 30.00 (Side Vent - FiII Out Back) $ ESTIMATED COST !J�® PERMIT N0. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) $ 10.04 Gas Range $ AESCRIPTION OF FURNACE AND OR BURNER _ Gas Dryer $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. `Air Conditioning All Sizes $ 25.00 $ BTU HP EDR Fuel Total Connected Load All Others/Repai rs & Alterations (LISW ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Ji ^-ommercial/Industrial 1.25% of Value of Appliance Work ' or $ The undersigned hereby makes application for a permit for the work herein i State Surcharge $ .50 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 7s representations stated in this application are true and correct. TOTAL FEE DATE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION IEFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 FLUS THE $.50 STATE SURCHARGE ?EINSPECTION FEE $47.00/Hr Air Conditioners can not be placed in a side yard without rritten permission from adjoining property owner. HEATING CO�i�,,Z �/��%�°%� 411 I FRMI��Frol n-/ Rough -In Date Final Date u 1 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 1 Central Furnace Venting Tables for fan assisted and natural draft appliances. The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. 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 ( Yes( ) No( 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 ( ) AmIlance 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 A! OF .+... ;: HEATING • Signed- SO/20'd zbLTVEZZS9 Ol A3-1QId=i d0 AIIO WOdd ZO:SZ Z00Z-Sti-100 CITY OF FRIDLEY PERMI NO.: 2004-01861 L 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/12/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 1478 ROYAL OAK CT NE PIN : 243024130004 LEGAL DESC : TOTINO GRACE ADD : LOT 1 BLOCK 1 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 12,810.24 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CONSTRUCT AN OPEN PORCH WITH WINDOWS 12'X 24' WITH A STORAGE BASE THAT IS UNFINISHED. STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE 223.25 IMPERIAL SIDING & REMODELING PLAN CHECK FEE 145.11 140 HUDSON AVE N FIRE SURCHARGE 12.81 BIG LAKE, MN 55309 STATE SURCHARGE, VALUE 6.41 LICENSE SURCHARGE 5.00 TOTAL 392.58 PAID WITH CHECK # 9158 OWNER VALENTY CRAIG T & MONA C 1478 ROYAL OAK CT 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 y othe state or local law regulating construction or the pe ormanc of construction. Applicant Date ef Bldg hrispjee_L&Lj� SEPARATE PERMITS mQ D FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY51M3-Effe'1l'v94/1/2004 ADON [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION p I L OA COLi9 Construction Address:. _ _ `� � � o y� T Legal Description: LOT i3LL?C-R. Td T I dpi® P -a( -t /vv Owner Name & Address: Ci2Aic, 't PAONA 41_6)fY Tel. # 65) Contractor. :L m PES i b Ir Htmec IN(- - MN LICENSE # -X001 42 30 Address: 10 0 0 cT�/ ?0Ao E w EST S Id -m E V I EW PIP Tel. # GS 1 q J 0 1 � 017- �!�IZ6 . Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT U p6w P69CN AREA*` ,Q- Length 17- Width Height Sq. Ft. Z �' ror i d 1 ' f AkEA:j �l►Length Width 7-'1 Height 0 Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: lt- Iv5r X _j 4.qag) ff,_.4r,,L Estimated Cost: $ = f�� C.,� Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft x $ —=$ DATE: OCT I u 7-t"H APPLICANT: R I c FI /J R o H. 12 I C rn QeS ri A Tel. # GSI - _4 H � - 1!; 1) Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side $ i Z_ ` , 1 65% of Permit Fee $ .001 of Permit Valuation (1/10th%) $ f�� • ( $.50/$1,000 Valuation $ $1350 per SAC Unit .$ ,�j , (9 $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 [ J $ STIPULATIONS: �ri�icare o� su�v�� l For: Imperial Homes B� - r... - [ �� .� �/ Nfl0°01'10"E 127.98 ate•' N00001'10"E ARTHUR STQMMT N X500 a� {� FOR U I fi � izx 1 `R,ONLY asrD aEVA770)VS 0 DEMOTES 17 FOOT OFFSEr. OF 84OX 957.9 Garage DENOTES PROPOSED Et.EWA 7701VS. AGE F4000R = 957.5 r�- ,DZWOMS DIREC710N OF DRAINAQ� LDKC- r /ZOOR 9.,cc^.5 Diag.: 88.0 x 4.4.3= 98.52 Lot 1. Elio-ck 1, Totino Grace, Anoka County, Minnesota ale 1"� �►�� 0 Denotes iron Mon. Book: XXX Pa e: XXX .fob No. _94626HS Dwg.tay SO Disk29 : hereby cartify that this is a true and oorroct representation of M. Co, MUD 4 SON$, INC survey of the boundaries of the above described land' and of the LANG SWRYW•ORg :otion of oil buildings, if any, thereon, end all visible encroachments, 9180 LSD04TON AVU. NO, any, from or on sold land. E.�'• t:1R= PIMM, MNN TA 8 .ma! b"14-6215 Tai.. °t&&-SrPD6 ted this /�T day of �. 1994 Y Minnesota Lic. No. ` TOTRL P.01 MINNESOTA DEPARTMENT OF AGRICULTURE rk FROM THE FARM TO YOUR FAMILY tl Anoka. County December 3, 2004 iVtlr. Craig Va1en 147$ Roayl Oak Lane dFridley, MN 55432 RE: Mona's Cakes Dear Mr.Valenty: This office has completed a preliminary plan review for Mona's Cakes the located at 1478 Royal Oak Lane in Fridley, Minnesota. The plan review was conducted as required by Minnesota Statute Chapter 28A and the Minnesota Food Code Chapter 4626. The Minnesota food code is the primary governing document for this review and may be found on line at www.leg.state.mn.us/leg/statutes.asp by requesting Minnesota Rule Chapter 4626. All appropriate permits from the local authorities shall be applied for and issued prior to starting any work on the site. Failure to comply with this may result in a delay or this office not issuing your retail Food Handlers license until the proper permits are issued. Our inspector will verify that the permits have been obtained. The Minnesota Department of Agriculture grants preliminary plan approval to the plans for this proposed food establishment. Upon this agency certifying that all items in this review have been addressed, final plan approval will be granted. This preliminary plan approval is based upon the pans s—ubm--iffe-d to trus office. Any deviation from the OpLoved plans and % ecifications must have prior approval from this agency_ Preliminary approval of the plans and specifications does not constitute endorsement or acceptance of the completed establishment. Periodic on-site inspections may be made during construction. A final inspection of the completed establishment, with equipment installed, must be conducted to determine if it complies with the requirements of the Minnesota Food Code. Contact Food Inspector Dave Seipel at 651429-8598 to arrange for a final inspection prior to stocking any food products. An anticipated completion opening date of Demcember 15, 2004 was indicated on the application form and you are listed as the contact for this project at 763-574- 0313. General Comments This review was for an addition to an existing bakery. No HACCP plan was submitted with this plan and none was review. Nothing shown in the plans indicated that a HACCP plan was necessary. No menu or equipment list was submitted with the plans. Licensing of your firm is dependent upon proper installation of an approved water supply, plumbing and waste system. Our inspector will review your approval letters from the appropriate authorities to insure these 90 West Plato Boulevard • St. Paul, MN 55107-2094 • 651-297-2200 • 1-800-967-ACRI • www.mda.state.mn.us An Equal Opportunity Employer • TTY: 651/297-5353/1-800-627-3529 • Mr. Valenty December 3, 2004 Page 2 requirements are met. Pursuant to MS 31.175 a license shall not be issued or renewed without approved plumbing, water and waste systems. (4626.0980, 4626.1030) (5-101.11, 5-401.11) Also our inspector will review approvals from building and fire officials before granting final approval. Please provide copies of approvals for review at the final inspection. Minnesota requires that all equipment be Certified to the National Sanitation Foundation Standards for clean ability, durability and performance. New or used equipment not meeting these standards are prohibited. Any equipment installed that does not meet these standards may be ordered removed. All equipment as submitted met NSF standards. The room finishes consisting of tile flooring, FRP walls and. vinyl coated ceiling tile are acceptable. The installation of the convection oven will require a class II hood system. Our inspector will verify this during the final inspection. It is our understanding that your firm currently has the necessary sinks for operation. The following listed items will be verified by our inspector at the final plan review inspection. Please address each item listed below. Equipment Food equipment shall meet the applicable National Sanitation Foundation (NSF) International food service standards. The equipment shall be determined by NSF International or an American National Standards Institute (ANSI) 234.1 accredited independent entity, including Underwriters Laboratory or the Edison Testing Laboratory, to be equivalent to the NSF International Standard. The use of equipment, that does not meet the NSF standards, prohibited. Bakery equipment must comply with the Bakery Industry Sanitation Standards Committee (BISSC). (4626.0505)(4- 201.11) Custom fabricated or modified equipment must be constructed by a contractor listed by NSF International. The name and address of the fabricator for custom fabricated equipment must be identified. (4626.0505)(4- 201.11) All service counters and other millwork surfaces shall be protected with stainless steel, plastic laminate, or equivalent, covering all exposed wood. In areas where food equipment involves heat or moisture, or where food comes in contact with the surface, a stainless steel finish or approved equivalent material is required. Solid surfaces for food contact, such Corian or Gibraltor° shall be constructed by a fabricator listed by an approved third -party testing agency. They are required to be installed on six-inch legs or a solid base. All areas of the custom fabricated counters shall meet the requirements of NSF International Standard No. 35. All hard grain decor wood (e.g. oak) shall be properly sealed with a polyurethane or varnish -like material. (4626.0505)(4-201.11) Used equipment meeting NSF International, NAMA, or BISSC standards, specified at the time of installation is permitted if it: met the NSF International, NAMA, or BISSC standards, in effect at the time it was manufactured, remains in good repair, is capable of being maintained in a sanitary condition, and is approved by the regulatory authority. Your inspector will evaluate any used equipment to determine if it is acceptable. (4626.0505) (4-201.11) Mr. Valenty December 3, 2004 Page 3 Provide multi -use equipment, utensils, and food storage containers than are smooth, easily cleanable, and resistant to pitting, chipping, or scratching. All food equipment in a retail food store must be designed as to be easily cleanable, durable and be adequate for its intended use. Household utensils or equipment is prohibited. The use of commercial equipment not meeting the NSF standards must be evaluated and approved prior to installation. (4626.0505)(4-201.11) Retail shelving and refrigeration and freezer display cases shall be designed and constructed to be durable and to retain their characteristic qualities under normal use. (4626.0505)(4-201.11) Provide sufficient refrigeration to hold all readily perishable food products at 41°F or less. Provide sufficient ventilation (e.g. louvers, etc.) for the compressor unit to evacuate any buildup of heat at the underside of the cold pans in and about the compressor area. (4626.0675.) (4-301.11) If an ice machine or bulk water unit is to be installed, the waste drain must be properly plumbed and divert to an indirect waste (air break) floor drain. *(4626.1045 A.) (5-201.11) Food Protection Provide a food thermometer for checking the internal temperatures of potentially hazardous foods. Thermometers must be provided in all coolers, freezers, and hot holding units where potentially hazardous food is stored, and must be located in an area that is representative of the true air temperature. (4626.0705)(4-302.12) The internal temperature of potentially hazardous food must be maintained at 41'F or below, or 140°F or above, except during preparation. *(4626.0395(3-501.16) All freezer units shall hold food frozen. (4626.0370)(3-501.11) Food on display must be protected from potential contamination from coughs, sneezes and improper handling by installing properly constructed food shields, the use of packaged food items or other effective means of protection. (4626.0320)(3-306.11) Provide tongs, ladles, spatulas, scoops, single -service papers, etc., to avoid unnecessary manual handling of dispensed food items. (4626.0330 A.) or * (4626.0330 B.) (3-306.13) Utensils must be stored in an appropriate manner between uses. (4626.0275) (3-304.12) Installations Seal (caulk) all annular openings around pipes and other conduits, where they pass through walls and floors. Seal all junctures between the wall surface and the edges of attached equipment with approved caulk/sealing compound. (4626.1395 A. (1) (6-202.15) If conduit pipes are provided for beverage lines they must extend at least three to four inches above the finished floor elevation at both ends. The annular opening between the beverage lines and the conduit pipe must be sealed with a hard material and provide a cleanable finish. (4626.1395 A. (1))(6-202.15) All doors to the outside of the establishment must be self-closing and vermin proof. (4626.1395 A. (3.))(6-202.15) Mr. Valenty December 3, 2004 Page 4 Lighting Provide at least 10 -foot candles (110 LUX) of light intensity, at a distance of 30 inches from the floor, in the walk-in refrigeration units, dry food storage areas, and during periods of cleaning. Provide at least 20 -foot candles (220 LUX) of light intensity, at a distance of 30 inches from the floor, for areas where food is provided for consumer self-service, including buffets and salad bars, or where fresh produce or packaged foods are sold or offered for consumption, inside equipment including reach -in and under counter refrigerators, in utensil storage areas, in areas behind a bar used for ware washing, and in toilet rooms. (4626.1470)(6-303.11) Provide at least 50 -foot candles (540 LUX) of light intensity for areas where food employees are working with utensils and equipment where safety is a factor and areas used for ware washing. (4626.1470)(6-303.11) Install effective shielding or shatter -resistant bulbs for all light fixtures over exposed food storage, food preparation, food display facilities, clean equipment, utensils and linens, and unwrapped single -service or single -use articles. (4626.1375) (6-303.11) Plumbing At least one toilet facility and not fewer than the number required by law shall be provided. *(4626.1075)(5-203.110) These facilities must be conveniently located and accessible to employees at all times.* (4626.1095)(5-204.11) Toilet rooms must be provided with adequate ventilation, hand cleanser, single -use towels or hand drying devices, tissue paper and waste paper receptacles. Toilet rooms shall have at least one covered waste receptacle for sanitary napkins, paper towels or diapers. (4626.1260)(5-501.17) Plumbing plans must be submitted to the Minnesota Department of Health, Engineering Unit, or delegated authority for review and approval prior to installation. All plumbing must be installed according to the Minnesota Plumbing Code, including current amendments. *(4626.1045) (5-202.11) Equipment connected to the potable water supply shall be protected from back -siphonage. Equipment with submerged inlet lines (dish machine, garbage disposal, steam table, urinal, etc.) shall be equipped with an approved backflow preventor, this includes all threaded hose bib connections. *(4626.1085) (5-203.14) If a post -mix beverage system is provided, an approved pressure-type, back-flow preventor upstream from the control valve on the carbonator (water line to the carbonator) is required. (Toilets shall be equipped with an anti -siphonage ball cock assembly. The water line serving a dipper well shall be permanently installed with an air gap on the water line entering the fixture. * (4626.1055) (5-202.13) Please contact a licensed plumber or refer to the Minnesota plumbing code. Install a hot water heater in accordance with NSF Standard #5. (4626.0505) (4-201.11) It must be of adequate size and recovery rate to provide hot water to all taps during.peak water usage. Lack of hot water will require the installation of additional hot water capacity. (4626.1025) (5-101.13) If a grease interceptor or grease trap is required by the city building official, it shall be mounted flush with the floor in an accessible location for maintenance. The Iid shall be water -tight and securely fastened in place. Under no circum- stances shall a grease removal device be installed above the floor. (4626.1195)(5-402.13) Mr. Valenty December 3, 2004 Page 5 General Labeling Provide complete labeling information is provided on all prepackaged food products offered for sale at self-service. The labeling of these prepackaged food products must include, but is not limited to: 1) The name of the product; 2) Name, address and zip code of manufacturer, packer or distributor; 3) Complete listing of ingredients in the order of predominance by weight. 4) Net weight. Provide open quality assurance dates on all prepackaged foods with a shelf life of 90 days or less. (4626.0435)(6-602.11) Sinks Install hand washing sinks in all food preparation, food dispensing, toilet rooms and utensil washing areas. Generally this is within 20 feet as a person walks. 'x(4626.1095) (5-204.11)Provide hand cleanser, single -use towels, and a fingernail brush at the hand -wash sink located in the food preparation, and ware washing areas. Install a NSF three compartment, utensil -washing sink (4626.0680) (4-301.12) with integral drain boards, rack or tables, (4626.0685) (4-301.13) for the proper cleaning and sanitizing of all multi -use equipment and utensils. The size of the sink compartment must be large enough to accommodate the largest utensil/equipment, which is to be cleaned and sanitized. Provide and use an appropriate chemical test kit to determine the strength of the sanitizing agent in the final rinse water of the three -compartment sink. ( 4626.0715) (4-302.14) Install a separate food preparation sink if raw food will be cut or combined with other ingredients, or otherwise processed. (4626.0780) Install at least one service sink or curbed unit with a floor drain for disposal of mop water and similar liquid waste. (4626.1080)(5-203.13) Provide hooks or hang-up brackets at the utility sink for storage of mops and brooms. Utensil washing and hand washing sinks are designed approved and restricted to their respective use and may only be used for food preparation. Storage Provide adequate shelving covering the food operation to ensure that food products, utensils or single -service articles are stored at least six inches off the floor. (4626.0730 A.) Food storage shelving used in walk-in refrigerators must be in conformance with NSF standard #2. Chrome or zinc -plated shelving without an approved factory applied hard - baked protective coating is not approved for this purpose. (4626.0505 B) Retail shelving shall be designed and constructed to be durable and to retain their characteristic qualities under normal use conditions. (4626.0505A.) Provide an area for storage of employee's personal belongings that is separate from food, clean equipment, and single service supplies. (4626.1560) Provide an approved area for storage of chemicals, which is separate from food, food equipment, .and single service articles. (4626.1600) Mr. Valenty December 3, 2004 Page 6 Room Finishes The floors, floor coverings, walls, wall coverings, and ceiling surfaces shall be designed, constructed, and installed so they are: a) smooth, durable and easily cleanable where food operations are conducted; b) nonabsorbent, for food preparation areas, walk-in refrigerators, ware washing areas, toilet rooms, janitorial areas, laundry areas, interior garbage, refuse storage rooms, and areas subject to flushing or spray -cleaning methods, or other areas subject to moisture. (4626.1325) Concrete, sealed or unsealed, is prohibited: a) where food product packages, containers, or cases in those areas are opened. b) Under equipment in food preparation and service areas including under service cases. c) in walk-in refrigerators or freezers, ware washing areas, toilet rooms, mobile food establishment servicing areas, hand wash areas, janitorial, laundry areas, interior garbage and refuse storage rooms, areas subject to flushing or spray -cleaning methods and areas subject to moisture. (4626.1335 D.) Sealed concrete is permitted: in areas used exclusively for refuse storage. The floor beneath the display shelving units, display refrigeration units, and display freezer units located in the consumer shopping areas if readily movable, must be designed so that it is smooth and easily cleanable, and the floor beneath these units are maintained in a clean and sanitary condition. (4626.1335 D.) Unsealed concrete is permitted: Outside garbage and refuse containers, including compactors stored on a smooth and nonabsorbent surface. (4626.1230) Vinyl flooring is prohibited: in a walk-in cooler or freezer. (4626.1335 C.) Floor and wall _junctures: Shall be coved and closed to no larger than one millimeter (1132 inch) when cleaning methods other than water flushing are used for cleaning floors. At the floor wall juncture where the fiberglass panel meets the floor an acceptable base coving such as stainless, quarry or other pre -approved materials must be installed. (4626.1345A.) Where water flushing is used caving shall be sealed. (4626.13458.) Glued rubber coving may not be acceptable on fiberglass panels, as it may not bond to the fiberglass material. Floor surfaces: Shall in the food preparation, food storage, and utensil washing areas be constructed of smooth, durable, nonabsorbent, easily cleanable materials, which resist the wear, and abuse to which they are subjected. The walls and ceiling in the food preparation, utensil washing and toilet room areas shall be smooth, non-absorbent, and easily cleanable. (4626.1335A) Ceilings: Perforated or fissured drop lay -in ceiling panels are prohibited in food preparation, food service, and utensil washing or toilet room areas. (4626.1360B.) Ventilation All heating appliances which generate either excessive heat, vapors, condensation, greases, odors or fumes, must be properly situated beneath a mechanical exhaust canopy. The canopy and hood construction must meet the applicable standards of the NSF. (4626.0505) In addition, the requirements of the 2004 Uniform Mechanical Code and the 2004 amended Minnesota Building Code covering commercial kitchen ventilation systems must be met. Additionally vent less frying systems requiring alternative methods shall meet standards EPA 202, NFPA 96, UL 197 and have local building approval. (4626.1380) (4626.1475). N W Valenty December 3, 2004 Page 7 Miscellaneous In accordance with the Minnesota Clean Indoor Air Act, this establishment shall be posted as NO SMOKING ALLOWED. Post signs at all public entrances. This facility may not be constructed, remodeled or converted, except in accordance with the plans and specifications as approved by this department. Please contact me for approval of any proposed changes or additions. (4626.1720) Thank you for your cooperation in addressing the items outlined in this letter. I shall remain available for consultation and review of your facility's construction progress. Should you encounter any problems though the course of your construction or equipment installation activities, please call me at 651-297-1072. Sincerely, Ji Roe er Foo Standards Compliance Officer Dairy and Food Inspection Division JR:1jm C: Dave Seipel, Food Inspector Lorna Girard, Supervisor City Building Offidial SUBJECT City of Fridley 25 519 AT THE TOP OF THE TWINS BUILDING PERM 'Te_Rrmr_r-I P 1 1 • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. z1'711?A r 1 . I NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 ' 612•-571-3450 910-F15 9!18/97 JOB ADDRESS 1478 Royal Oak Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Totino Grace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Craig/Mona Valenty 1478 Royal Oak Court NF, 483-5518 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Imperial Homes Inc 4196 Lexington Ave, ghnre,xiew MN 59112 483-5518 20014210 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 C:k ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct retaining wall at entry 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Core fill and rebar - pin onto existing footings. SEPARATE PERMITS ARE REQUIRED 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 1 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 $2,800 $1.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NO R SUME TO GIVE AUTHORIT>Z VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVI NS F ANY OTHER STATE LO AL LAW REGULATING CON- STRU TION R E PERFOR Fire SC Z.8O =VOFC�CTION. PLAN CHECK FEE TOTALFEE SE-407 0 97 License SC $5.00 $83.95 SI NATURE OF CONTRACTOR OR AUT ORI DAGENT IDATEI WHEN PROPERLY LIDATED THIS IS YOUR PERMIT BL !NSP DATE SIGNATURE OF OWNERIIF OWNER BUILT IDATEI NEW ( J Effective 1/1/97 ADDN ( ) CITY OF FRIDLEY ALTER ( ] SINGLE FAMILY AND DUPLEXES R-1. AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: R-0 M LL ®A Y Legal Description: 6 LK Owner Name & Address: Cg-& Kq M ONA VA Tel. # '416-3 - S 5 1 y Contractor: -- Mf EYZ 1b L Es l ti C.. MN LICENSE # �- o O 1 9)-30 Address: `1 i9 (y LEX 1)'JCrTQN R-ue S N'ORZ SEW MN- Tel. # 433 LIVING AREA: GARAGE AREA: DECK AREA: OTHE . ----- 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 Sq. Ft. Length Width Height Sq. Ft. Length Width H_WGround Sq. Ft. l: -T,4 Inl t tjc, WALL. AT F- YJ7i Construction Type: gks IG- GAIL (:r,1Mj Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut.Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: I EP 16 97 APPLICANT: R )LN 21E m Dazs M A Tel. # 70l = 9 S-)- ( vet., CITY USE ONLY Permit Fee $ 7.5 Fee Schedule on Reverse Side Fire Surcharge $ ,$D .001 of Permit Valuation (1/10th%) State Surcharge $t ,0 $.501$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge- $ --S-700 $5.00 (State Licensed Residential Contractors) ')riveway Escrow $ Alt. "A" or Alt. "B" Above .drosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary j ] Not Necessary [ ] TOTAL STIPULATIONS: CITY OF FRIDLEY PERMIT NO.: 2004-01974 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/25/2004 572-36U4 FAX: ( 763) 571-125.1 ADDRESS : 1478 ROYAL OAK CT NE PIN : 243024130004 LEGAL DESC : TOTINO GRACE ADD LOT 1 BLOCK 1 PERMIT TYPE ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS 2 APPLICANT PRIZM ELECTRIC 6361 SUNFISH LAKE CT RAMSEY, MN 55303 XT./ON- __. VALENTY CRAIG T & MONA C 1478 ROYAL OAK CT 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. Applicant Date Bldg hasp Date ELEC PERMIT FEE - MIN (RESI) 40.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 40.50 PAID WITH CHECK # 8149 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY. MN 55432 572-3604 FAX: (763) 571-1287 PERMIT NO.: 2004-02130 DATE ISSUED: 11/18/2004 ADDRESS 1478 ROYAL OAK CT NE PIN 243024130004 LEGAL DESC TOTINO GRACE ADD LOT 1 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) # WATER TRMT APPLIANCES 0 APPLICANT SCHULITIES PLUMBING INC 1521 94TH LANE ME BLAINE, MN 55434 (763) 7864007 OWNER VALENTY CRAIG T & MONA C 1478 ROYAL OAK CT 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 atter 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 worl 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 co"ction. ADDlic t P Date 'i PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 28189 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. N 0 0 0 1500 25.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 25.50 CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 Rain Water Leader $10.00 DATE: ,f/�f� Z� '2 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 Water Heater -Gas** $35.00 BUILDING USED AS Gas Range** $10.00 Gas Dryer $10.00 ESTIMATED COST �� PERMIT NO. Back Flow Preventer Required ( )Yes () No - Type $15.00 PLUMBING COMPANY ? Reinspection Fee $50.00/Hr SIGNED BY TEL/N0.7 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance i Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $ OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE G " 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 BTU Input Fan Assisted or Nat venting has been examined and is free from rust, deterioration, obstructions, BTU Input Fan Assisted or Nat and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and rn inufacturer Total Btu Input specifications including sizing, length, number of elbows and terminatian. 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 ( } T�e 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 Fumice V6nting Tables for fan assisted and natural draft appliances. Yes () No ( ) I� 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) HEATING CO: Signed By: Date: