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PRE 2010 DOCS53-84-S915-51 PLUR42ING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... .. .. ....... x $2.00 $ Future Fixture Opening ......... ...... x $1.50 $— New Fixture Old Opening ......... . x $1.50 $ Catch Basin ... ....... x $3.25 $— Water Heater (Up to 99,000 BTU) ...... x $3.00 New Ground Run Old Bldg. . .......... x $3.25 WATER HTR. Electric water Heater z $zoo U5 GAS FITTING FIM: NO. RATE TOTAL Int 3 Fixtures .......................... x $2.00 Additional Fixtures . .................. as � 9 U X 0 0 a F N GAS ELEC. Barn let 2nd 77- 3rd 4th Fniwe Connection openings Connected New P13ftn' old openingsSewe ❑I -- CMRW*l El PLUR42ING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... .. .. ....... x $2.00 $ Future Fixture Opening ......... ...... x $1.50 $— New Fixture Old Opening ......... . x $1.50 $ Catch Basin ... ....... x $3.25 $— Water Heater (Up to 99,000 BTU) ...... x $3.00 New Ground Run Old Bldg. . .......... x $3.25 $ Electric water Heater z $zoo $— GAS FITTING FIM: NO. RATE TOTAL Int 3 Fixtures .......................... x $2.00 Additional Fixtures . .................. x $ .75 Gas Range to 199,000 BTU .............. x $5.00 $--3-.00 Description................................................$ TOTAL FEE $---3-.-O-O City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Mm 4-27-70 19— Owner R Nielson Kind of Building frame Used as res To be completed about 5-2-70 Estimated Cost, $ 10,00 Old—New. Building Permit No. poxmit Mo. Sign:;; B Business Phone No ROUGH-� FINALI—jb - 3 0 '. ? (-) S3 3� Laity of Fridley, Minn. No 10 838 BUILDING PERMIT - Date: _ September 18, 1970 Owner: Ralph Kelsen guilder Inter City Builder Address _ _5876 Stinson Rlyd. N.E- Address 250.0 Milrr-ay Avenue X -E- _ LOCATION OF BUILDING No. 5 876 Street Stin s o l yd - -- Part of Lot Lot .__ 43 Block Addition or Sub -Division Auditors Kuh #92 Corner Lot _ Inside Lot _._. % Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Gaffe Front 22' Depth 24' Height 81 Sq. Ft. 528 Cu. Ft. 4224_ Front Depth height _ _ Sq. Ft. Cu. Ft. Type of Construction Frame Est. Cost ,£2 00 . _ To be Completed 10/20170 Provide hardsurfaced driveway. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth �F in compliance with all provisions of ordinances of the city of Fridley. A /J In consideration of the payment of a fee of $ 7 0.00 , permit is hereby granted to T n t er. Ci ty Builder to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: This permit does not cover the construction, installation for wiring, ping, gas beating, sewer or water. Be sure to we the Building inspector for separate permits for these hems. ..a - I'. r .. \lr . - 1 4 - As. APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NA14E : 11 9 L a2 ,d/ e G rS BUILDER : _ l�v;��e lei ADDRESS: e % ! L �P,f1y'� ADDREss • a D NO :. STREET: LOT: 4-2'3 BLOCK: ADDITION: A aJ 1T® re_l j !� f dy CORNER LOT: INSIDE LOT:_SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As ® Front • Depth • (- Height • V Square Feet:. g Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: /V e Estimated Cost: -$ 9V ® C-)�- To Be Completed: 0& r X0 — 7 0 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE:* _ ge- / � T 7� SIGNATURE: 'i_ (See Reverse Side For Additional Informs on.) i, BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average.+ height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. 'In no case shall the fee charged for any permit as set forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application, to allow for proper review of the proposed structure and of the construction site. A Certified Survey of the lot,.showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. CERTIFICATE.OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. . 7 I > HARVEY A. CARTWRIOHT ANOKA COUNTY SURVEYS HENNEPIN COUNTY SURVEYS MINNEAPOLIS SURVEY* 8410 SHADY OAK LANE N.E. SUNSET 6-0049 OWNER INDUSTRIAL 1UDICiA` BUSINESS - TOPOGRAPHICAL. CITY LOTS - PL'ATTIN�f` R61ph Nielson h OF C T IG OLSON J. E. HILL, C VILNING THEECORDS ENG NEER ESTABLISHED 1888 .LAND SURVEYORS C.. F. SANDHOFF CIVIL ENGINEER REGISTERED UNDER LAWS OF STATE OF MINNESOTA ESTABLISHED 1808, LICENSED BY ORDINANCE ;OF CITY OF MINNEAPOLIS JAMES NELSON 348 PLYMOUTH BUILDING LINCOLN 8'721 SURVEYOR ESTABLISHED 1922 uii(e�jVii•+ (Certificate METROPOLITAN LAND G SURVEYORS. ESTABLISHED 1051 7 6 Inv. 13511 599-51 a ,3,cl 7 .5 Z 94. (.Z'— _;j7 .Z' �-� I hereby-�certity that this is a true and correct plat oaf'a, a survey of the North 1/2 of Lot 43, Auditor's Subd v tion Number 92,, Anoka County, Minnesota subject to an easement for road ,;purposes .over the East 33 feet thereof as surveyed by me this 23rd day of March, 1955 A.D. SIGNED CARS HT AND 5 1-5-F 9 Stone l d (7;y t+°. -J O , "¢. ` --- -- — —33" -' 3w 7.5.5-' v I Note: This survey is for mortgage loan rurr_.oses only and is void for any other useI I hereby-�certity that this is a true and correct plat oaf'a, a survey of the North 1/2 of Lot 43, Auditor's Subd v tion Number 92,, Anoka County, Minnesota subject to an easement for road ,;purposes .over the East 33 feet thereof as surveyed by me this 23rd day of March, 1955 A.D. SIGNED CARS HT AND 5 N SUBJECT City of Fridley 12146 AT THE TOP OF THE TWINS or? BU IL DING P E R r CEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-560-3450 910-F15 5/29/73 JOB ADDRESS 5876 Stinson Boulevard 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 43 Aud. Sub. #'92 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ralph Nielsen 5876 Stinson Boulevard N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. Johnson Company 2513 Central Avenue N.E. 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 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside and Trim 9 CHANGE QF USE FROM TO STIPULATIONS PERMITS REQUIRED FOR WIRING, SEPERATE HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Alum. 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. 2,000 1.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 12.00 STRUCTION OR THE PERFO NCE OF CONSTRU N. PLAN CHECK FEE TOTALFEE 13.00 !� SIGNATURE OF CONTRACT RAUTHORIZEDAGENT (DATE) O WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG.INSP I DATE " SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) N p � IRN> I��.i dy , 1 , , n r - 1 ,y , ( b7i.m:. 'r3 Vi.t J�d4�6ri 1 - �.,� of p).j` , ,i i _:3 4 , M i _ -. .. n_ e :•I d"} i7 )dr Illi }i t APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: PH l V 1, 9 6. •S cs J BU ILDER : � I % � � a ,i 1., �(®yy as S c ,J Qa ADDRESS : %i f�1 so J ✓ J ADDRESS: �' `� a -j /L NO • . .5-4,7 & STREET: 'S r` ; ri s, ,( (3 I✓ LOT: BLOCK: ADDITION• CORNER LOT: INSIDE LOT:A SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As:, DESCRIPTION OF BUILDING Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: 1?0- s i ® L d' /P Estimated Cost: $ 6 ®® P To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. L/'��';(' '9 DATE : * SIGNATURE • --- (See Reverse Side For Additional Information.) A BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average.* height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be :less than $5.00. VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application, to allow for proper review of the proposed structure and of the construction site. A Certified Survey of the lot,.showing the location of the foundation, once it has been constructed, will be required before Proceedin& with the framing. CERTIFICATE..OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Odcupancy has been issued. CITY OF FRIDLEY PERMIT O.: 2004-00406 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 03/30/2004 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5876 STINSON BLVD NE PIN : 243024140030 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 92,000.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 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 A 19'X 12' LIVING AREA ADDITION AND A 36'X 24' GARAGE ADDITION STATE LICENSED CONTRACTOR 1 APPLICANT BRUNN REMODELING CO INC (4016) 2161 108 LANE NE BLAINE, MN 55449- (763) 780-0323 OWNER NIELSEN RALPH R & MAVIS R 5876 STINSON BLVD 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_�� 1$s acv DateZ9 f BUILDING PERMIT FEE 937.75 FIRE SURCHARGE 92.00 STATE SURCHARGE, VALUE 46.00 LICENSE SURCHARGE 5.00 TOTAL 1,080.75 PAID WITH CHECK # 5968 / L pa y -k` 156 / NEW [ ] Effective 1/1/2001 ADDN CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ®� Construction Address: 50-7b 5Ti ISS Q I4 bLy o. Legal Description ..MQF.M '�Z. o� L6 43 AUblTDCLS 5oisgIVI.so92- Owner Name & Address: JEER1 BETV RuLtS S',976 SIINSokl 6 diel. # 743 ' 9V6 -0UZ,Z, Contractory N N N 1) 0 ED"j6". f dr- MN LICENSE # 4of l - Address: 110 /06"" LA #49 $LI&I0I✓ . M fJ f i-44� Tel. # 7b 3 - 7 54003 Z-3 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Q LIVING AREA: Length Width t Height Sq. Ft GARAGE AREA: Length ---- width `, 4' Height®� Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: A 0 101�'l o IJ, Estimated Cost: $ Aq L p 00-6 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: ITL ::' APPLICANT: �PtfEVj i2t�r�p� Tel.# i�3`�' ®—®3z3 CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATLO.NS; Call (763) 572-3604 for Permit Fees if mailing In application $ 7 7S Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $ e, $.50/$1,000 Valuation $ �- 4! -- $1150 per SAC -Unit $ ��Irf $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 [ ] MNcheck COMPLIANCE REPORT Minnesota Enerqy Code MNcheck Software Version 3.0 COUNTY: Ramsey STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Single Family DATE: 3-30-2004 DATE OF PLANS: 3-29-2004 TITLE: Energy Calculations PROJECT INFORMATION: Gerry and Betty Hults COMPANY INFORMATION: Brunn Remodelinq Co., Inc. 2161 108th Lane NE Blaine MN, 55449 COMPLIANCE: PASSES Required UA = 48 Your Home = 41 15.0% Better Than Code Permit # Checked by/Date Area or Cavity Cont. Glazinq/Door Perimeter R -Value R -Value U -Value --------------------------------------------------------------------------- CEILINGS 168 44.0 0.0 WALLS: Wood Frame, 16" O.C. 215 19.0 4.0 GLAZING: Windows or Doors, Above Grade 25 0.350 DOORS 32 0.350 FLOORS: Over Unconditioned Space 168 35.0 0.0 HVAC EQUIPMENT: Furnace, 91.0 AFUE HVAC EQUIPMENT: Air Conditioner, 13.0 SEER --------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the buildinq plans, specifications, and other calculations submitted with the permit application. The proposed buildinq has been designed to meet the requirements of the Minnesota Energy Code. Builder/Designer s-�'�� ;d�� Date �q CGU CITY OF FRWLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 5876 STINSON BLVD NE PIN 243024140030 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT.: 2004-00905 DATE ISSUED: 06/15/2004 VALUATION : $ 2,000.00 NOTE: REPLACE TWO FIXTURES IN FIRST FLOOR BATHROOM. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES APPLICANT WALSH PLUMBING INC 97116 ST NE BLAINE, MN 55434 NIELSEN RALPH R & MAVIS R 5876 STINSON BLVD NE FRIDLEY, MN 55432 0 # GAS WATER HEATERS 0 # GAS RANGES 2 # WATER TRMT APPLIANCES 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 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 9f any other state or local law regulating construction or the p rformance of construction. Applicant 45114g7-W Date Bldg Insp6 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 REPAIWALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 11440 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 0 0 0.00 20.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 20.50 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE t Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE New Fixtures L 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 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL �U•d JOB ADD 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. OWNER BUILDING USED AS ESTIMAT D C T, PLUMBIN COID f SIGNED BY Approved By DATE: / , 20 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 ADDRESS : 5876 STINSON BLVD NE PIN : 243024140030 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-009151`' DATE ISSUED: 06/15/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # 0-100 AMP CIRCUITS 6 APPLICANT KING ELECTRIC PO BOX 296 CIRCLE PINES, MN 55014 NIELSEN RALPH R & MAVIS R 5876 STINSON BLVD NE FRIDLEY, MN 55432 ELEC AMP SERVICE FEE 30.00 ELEC CIRCUIT FEE (0-100 AMPS) 30.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 60.50 PAID WITH CHECK # 10791 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 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 construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 5876 STINSON BLVD NE PIN 243024140030 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE HEATING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION PERMIT N 2004-0091U_,' , DATE ISSUED: 06/15/2004 VALUATION : $ 1,500.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL GAS RANGE, GAS DRYER, AND EXTEND DUCT TO ADDITION. # A/C UNITS 0 VALUE OF APPL OR WORK # FURNACES 0 # GAS DRYERS # GAS RANGES 1 APPLICANT ELK MECHANICAL HVAC INC 6361 SUNFISH LAKE CT STE 100 RAMSEY, MN 55303 rel", R NIELSEN RALPH R & MAVIS R 5876 STINSON BLVD 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 f any other state or local law regulating construction or the dorm ce of construction. Applicant Date ; j Bldg HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS PIPING FEE GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 20636 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 1000 1 0.00 0.00 10.00 10.00 10.00 0.00 10.00 0.50 40.50 CITY 0F FRIDLEY BUILDING INSPECTION . 3a`� Effective 4/1/2004 6431. University Ave NE -, Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES _r1 5'0 N ?VLV 0 JOB ADDRESS rJ RATE SCHEDULE Fee Total _ J -1/3 E17` i'�L) 1_ Residential Owner Furnace Shell and Duct Work, Burner & �ts7 P also Replacement Furnace $35.00 $ Building Used As Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ �- vvj`� ESTIMATED COST � t,PERMIT NO Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. *Air Conditioning - AllSizes $25.00 $ BTU HP EDR Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater �D ®® /7Jd A) OdO The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ HEATING CO L )�5L -tJl /-A L 14 V,A L TOTAL FEE $ ' `� Sig ed Tel # REINSPECTION FEE $50.00/HOUR FAX # y Date 5 0 ¢ *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough4n Date Final Date -& 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 venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Building MECHANICAL Permit No.: O 051 Inspections RESIDENTIAL APPLICATION Received By: r 763-572-3604 CITY OF FRIDLEY n 763-502-4977 FAX EFFECTIVE 1-1-08 DATE .d YOUR E-MAIL ADDRESS SITE ADDRESS ��%� .oP-, m'� 61VJ THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME;ep�ii{ f td I :S OWNER/ ADDRESS: 5911 �4' !x`101 t�II�Q� CITY !'! • ,dl STATE_J"SAZIP�V TENANT PHONE: _A0 . �a�� to — CONTRACTOR COMPANY NAME: Flearth 8 Home Technol�l", Inc. NOTE: SEPARATE CITY CONTACT PERSON: LICENSES ARE STATE LICENSE # Ueenae 20512060 EXP DATE REQUIRED FOR GAS 2700 N. Fair~ AVO. CITY STATE ZIP ADDRESS: N aril AND HVAC. an ..w SUBMIT COPY OF BOND PHONE 6511633-2561 FAX ANDINSURANCE PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ® NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) OR Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: 4 ��"^� 9 � MODEL: �� '& r, ^ ' SIZE/BTU A 0,!�,73 MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEIBTU $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _A/C TO AIR EXCHANGEER $15 (WOOD) $35.00 _NEW GAS GRILL $10.00 _AIR _FIREPLACE BOILER $35.00 $35.00 _GAS UNIT HTR $10.00 _FURNACE CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10 00 TGAS PIPING $10 00 VENTILATOR $15.00 �z L „x - Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accord ce with the approved plan in the case of all work which requires review and approval of plans. �� PRINT NAME �Cd l� i S �yi f DATE % 2 v SIGNATURE OF APPLICANT d^ APPROVED BY DATE ffi City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMESL � � ry €, t�r "1asr -est 1. Combustion Air (See note below) s3,e6� a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations. Building I hereby apply BUILDING conformance Permit No.: &--, ., Inspections an application for a permit RESIDENTIAL APPLICATION Received By: 763-572-3604 PLICANT CITY OF FRIDLEY Dae Rec'd: 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE ZD // / c� YOU�R E" -MAIL ADDRESS i'h i /ie w e 5 u r P9 ✓�e 4 o e v v-1 SITE ADDRESS 6k14 e � L 5-,,- `/3 $�'.r5 v6-, PVT&,t r /" d Ie, THIS APPLICANT IS: ❑ OWNER CTOR PROPERTY OWNER/ Nom: ADDRESS: 10976 5.0, 5o✓, &,--1 Al—' CITY Fr < l � STATE//A/zip sV-'F- 32 TENANT PHONE: 7-13 `5D C rl1D CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # 01-5-5- 57-6 6 EXP DATE 3%3/ YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: lar V417` —CITY kW ,--- STATE&CZIP SnQ.P INSURANCE PHONE 76 3 — 6 --ell— 03 0:R.- FAX PROPERTY TYPE DINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH Ekt6tSF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION CN_T/ENANCE/REPAIR ❑REMODELING DESCRIBE WORK BEING DONE: *Ce- /`py j(i1� r5A,i ,e} %S" J ^ e ai 1'e4L 1 SIZE OF IMPROVEMENT C-1 ce LENGTH WIDTH HEIGHT SQ FT ROOFING D116USE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES [3 HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum 13 Trim 1. Site Plan/Survey showing the existing structures ❑ Other 13 Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S % (USING , S"- OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge THIS IS AN I hereby apply or a building permit and I a conformance th the ordinances and codes o permit but on an application for a permit approved pl in the case of all work whi SIGNATURE O PLICANT APPROVAL INSP See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined b neering Agreement ssary ( ) Non Necessary ( ) Make ecks Davable to: Citv of Fridlev Attach ICATION A PERMIT -NOT VALID UNTIL PROCESSED vle that the information above is complete and accurate; that the work will be in of Fridley and with the MM'W&Ota Construction Codes; that I understand this is not a rk is not to start wr0fpii�_e�k inn site; that the work will be i accti ce with the review and approvtPRINT 6 A_ DATE L I. Building MECHANICAL Permit NO.:��= Inspections RESIDENTIAL APPLICATION Re j pd B 763-572-3604 CITY OF FRIDLEY De QA 763-5024977 FAX EFFECTIvE 2.19-09 DATE O 4 YOUR E-MAIL ADDRESS SITE ADDRESS 7f'jai o n y o n,� THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: -1-r OWNER/ ADDRESS: 0e.. 1'1.f . CITY ,9" . _.I IP2 STATE WZIP�� S TENANT PHONE: CONTRACTOR COMPANY NAME: SUBMIT A COPY OF .. CONTACT PERSON: dba Fireside Hearth & Home License 20512060 YOUR STATE STATE LICENSE # EXP DATE 2700 w, FairviewAve. LICENSE WITH ADDRESS: CITY Roseville, MN 55113 STATE ZIP APPLICATION 6511633-2561 PHONE FAX PERMU TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: R NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK it n _, 4 a 0 &r s, F r!eP eye e- P ' e_ FEES ARE BASED ON $10.00 PER FIXTURE, ERCE 'T WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELS Equipment Installed MFG: 4 10 MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 LINER $10.00 DRYER $10.00 POOL HEATER $35.00 _CISIDVINEY _GAS DUCT WORK $10.00 J_GAS PIPING $10.00 VENTILATOR $15.00 Number of fixtures @$10.00 x$10.00=$ /a. Number of fixtures @ $15.00 x $15.00 = $ IS'. Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $° FEE $:15.50 Total = $t1ZlD THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. B SIGNATURE OF APPLICANT PRINT NAME elf* D rr,.s t� / DATE PLEASE NOTE: SEPARATE PERMITS ARE RE UIltED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977