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PRE 2010 DOCSCity of Fridley, Minn. N° 10106 BUILDING PERMIT Date: Feb. 19, 1969 Owner: Norman A. Dalberg Builder Amber Construction Address _ Address 5 941 Benjamin S t . N. E. r LOCATION OF BUILDING No. 6156 get S t ins on Blvd. _ _ Part of Lot Lot 4 _ Block 1 Addition or Sub -Division _ Cochran Addn. Corner Lot ---- Inside Lot __ X Setback 35 —_ Sideyard 6 t 11' Sewer mevation _-._ 921.49 - 92.9.90 924.49 - 923.90 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling- Front 26/35 Depth 42' Height 201 Sq. Ft. Cu. Ft Garage Front 24' Depth 24' Height 10' Sq. Ft. Cu. Ft. Type of Construction _Frame Fst. Cost _ $26,OOG _ To be Completed SEWER WYE 1. 88' North of Manhole 2. 136' North of Manhole WATER TAP LINE - 81 East of Property Line Must use 6" VCP in street R/W 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 a-etfbrth and in compliance wi pr ons of ordinances of the city of Fridley. r Ir— $100.00 Sewer Connection Charge In consideration of the payment of a fee of $ 47 .00 permit is hereby granted to Amber Const. Co. to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota 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. -4 1 G Official Building Muhich NOTICE: This permit roes not cover the construction, installation for wiring, piumbing, gm boating, sewer or water. Be wre to as the Building Inspector for separate permits for them items. O' APPLICATION FOR BUILDING PE4tMIT CITY OF FRIDLEY, MINNESOTA 7 a7 7. : iia ADDRESS LOCATION OF BUILDING NO. LOT BLOCK ADDITION OR SUBDIVISION COMNER LOT INSIDE LOT �� SETBACK �3 S— SIDEYARD b �� SEWER ELEVATION TOP OF FOOTING 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 A5Depth Height Square feet 7.2-- Cubic Feet 2 - Depth Depth Height Square feet 5 2� Cubic Feet f ; Type of Construction Estimated Cost To Be Completed /.�� Ar /9-e The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the. Department of Buildings, and hereby declares that all the facts and z,:.dresentations stated in this applicattion® axe true and correct. DATE —SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side. --" .3 /2-e` [ SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for pny addition to any existing structure or building, 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' Codes Type 1, 2, & 4 - $1.75 for each one thousand cubic feet, or fraction thereof, in such cubical cuntents. Type 3 & 5 - $1.50 for each one thousand cubic feet. For the purpose of computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout 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 height 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. NSSSD Connection Charges based on location - Area 1 or 2. City of Fridley - Application for Planmbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures y NO. RATE TOTAL Number Fixtures ....... .............. x $2.00 $ e Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. Z iri Z O .J C�j9 �U' d 0 Z O f F t N WATER HTR. GAS EIEC Base x $3.25 $ Electric Water Heater % $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................— x $2.00 $ -21 -2 t2 Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 7� 1st 2nd 3rd 4th _ • Future Connection Openings I a,oanecrea wua New Fixture, Old Openings Sewer Cesspool C PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... .............. x $2.00 $ e 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 8 $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................— x $2.00 $ -21 -2 t2 Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE A, 49 , co 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, Minn -� ' 1Pr 19W Owner Kind of Building r Used as '� To be completed about Estimated Cost, $ Old ew Building Permit No %0 4106 Permit No. Signe By— Business Phone No- ROUGH o ROUGH Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ...........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour 6.00 $ over 3 gal, per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL $ See Fee Schedule $ TOTAL FEE 6 Dept. of Bldgs. Phone 560-3450 I City of Fridley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Kind o: Used a: To be completed about Estimated Cost, $ Old—New. Building Permit No. 10 > 0 b Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No Trade Name CUnLm Size No Capacity Sq. Ft. ED- R BTU �� H.P. Total Connected Load�� r S� Kind of Fuel�G BURNER —Trade Name Size No Capacity. Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signe f AN AIR CONDITIONING Go DRIVE By Nll lIQ MAIM a nug11Y,ZIA 432 <z Business Phone No 11-2 PERMIT for power plants and Keating. Cool- ing, ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of ! Heating Plants %�t-Ct L) to be installed ltered—repaired MakeSize Oil fired—, Coal fired—, Gas fired ; Gas Authorization Remarks o Approved Final Inspection i 19_ Inspector Permit N° -4426 Fee $ /Z e Office of the Inspector of Buildings City of Fridley City of Fridley, Minn., Owner Location (e (e f S_t , �. 'd - Kind of Buildingc� How Occupied Work to be Commenced!" a,191� To be Completed ,19_ Estimated Cost, Old -New, Building Permit No. 0 Permission is hereby granted to to install--erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein nanzpd, and to the specifics ns set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings Original PermiltforPLUMBING FITTING 3�® N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for ttms!2-3 e lumbin In ector 560-3450 'vin number of this ermit., inspection shall be phoned in to the plumbing Inspector, giving p DESCRIPTION OF WORK Number, Rind and Locaiion of Fixtures City of Fridley ,19� Stories ; d 0 3 U z 7 s ..ems 4 M VJ F z 6 M Z tll m Y d 2i F- z= C O ❑ LL $ o S N O Z O¢ J C' LL U z h N d d U m z m E d❑ E J U U X 4, J m a d IL b d W e to Z d a U` K WATER HTR. GAS ELEC. Basement 1st 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings Permission is hereby granY- "- to do the plumbing and gas fitting in the building described i the statement hereto attac d, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Date Inspector. Final Inspection Date Inspector. 42 ' M -6-65-d Location 6l -5 6 /" Kind of Building Used as To be Completed , 19___ - Estimated Cost Old -New. Building Permit No.—I—V� l G f Inspector of Buildings. Application for Power Plants and Heating. Cooling. Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL l e rsd b' 7� $ See Fee Schedule TOTAL FEE $ Dept. of Bldga. Phone 560-3480 City of Fridley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Alin_?__ , 6 19� � Owner Kind of Building Used as To be completed about Cost, $ Permit No. Permit N DESCRIPTION OF WORK HEATING or POWER TS—Steam, Hot War, Warm A No Trade Name J Size Not Capacity Sq. Ft. E.D.R BTU H.P. Total Connected LoadKind of Fu BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) SUBURBAN AIR CONDITIGNiN Signe By WIN Cc►e9rA SS_ CQ�4P Business Phone No Original PERMIT for Power lants and Heating, Cool- ing, Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Heating Plants `-%2 to b installe ltered—repaired Make Oil fired ; Coal fired—, Gas fired—; Gas „, . Approved Final Inspection Date , 19_. Inspector Permit N° 4558 Fee $ Office of the Inspector of Buildings City of Fridley City of Fridley, Minn.— Owner inn. Owner r Location 6 LT) S & Kind of Building 41. e How Occupied Work to be Commenced ,19-4 To be Completed ,19 9 Estimated Cost, $ & ! ®° ft Old -New, Building Permit Permission is hereby granted io n` ' C-G"fA' �° - t 9 to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein na7e�'_- nd to the specificatio set forth in the approved application for this permit on file in the office of the Inspector of Buildings.,�, J� , Inspector of Buildings 42 2M11 -VV �I Air Conditioning Systems and Devices 7 7;RAIRTY WARM AIR: RATE TOTAL. Furnace Shell & Duct Work ....... $10.00 $ Replacement of Furnace ..... 6.00 4 Repairs & Alterations—up to $500.00 6,00 $ _ Repairs & Alterations each add. $500.00 3.00 CIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ... .. .. .$10.00 $_ each add. 60,000 BTU .................... 3.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations --up to $500.00 6.00 $ Repa &(�Al�terations ch add. $500.00 3.00 $�e O (TEAM or I;OT WA SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft, EDR Steam 3.00 Each add. 320 sq. ft. IDR Hot Water 3,00 $_ 'IL BURNER—to 3 gal, per hour 6,00 $ over 3 gal. per hour—,See Fee Schedule 6AS BURNER sup to M.000 BTU) &00 $ over 199,000 BTU See Fee Schedule *AS FITTING NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures a .76 $ Gas Range to 199, x$ 5.00 $ JR CONDITIO 0 e PAN- HEATING SYSTEM See Fee Schaduk FENTILATING SYSTEM ILLTERATIONS & REPAIRS TOTAL FEE $ -3a ROUGH FINAL. Dept. of BIdgL Phone 5W4UW L� `(]�.,, -,,,�',7 _..tea.... � / - � i City of Fridley: The undersigned hereby makes application for a permit for the work hereir specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, O Ig Z/ C):�of ✓�-''� �' �' Building Used To be completed about Estimated Cost, Old --New. Building Permit No. Permit No.-4AEL_ ON OF WORK HEATING or POWER team, Hot Water, Warns Air—No Trade Name Size No - Capacity Sq. Ft. E.D.R BTU " . Total Connected Load Kind of Pbel BURNER — Trade Name Size No CaPaci Sq. FIL ZM.R BTU HIP. (REMARKS -OYER) CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATIOiM AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE USIDENTIAL Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (Piping needed with MOP furnace) Gas Range RATE TOTAL $ 20.00 S $ 10.00 S S 10.00 $ Can Dryer S 10.00 $ LENNOX HS18261 Air Conditioning (all also $ 10.00 $ All Others/Repairs and Alterations 1t of Value of Appliance or Work $ COMERCIAL/INDUSTRIAL 1t of Value of Appliance or Work State Surcharge TOTAL *EE Reinspection roe ($15.00) Rough Inep. Date Final Insp. Date , Approval for Permit MINIMUM FEE FOR ANY HFATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE Effective Auq. 1. Igsl Job Address. 6156 Stfnson Blvd Department of Buildings, 6411 University Ave. N.E., rridley, NN 55432 City of rridley Tel. 0571-3150 The undersiqned hereby waked application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. r0dley. Minn. CANER C JENSEN KIND Or BUILDING frame :F USED AS dwelling S TO BE COMPLETED ABOUT =n recel t of ng mit —r — ESTIMATED COST $ 900.00 S .50 OLD - NEW BUILDING PERMIT MD. PERMIT NO. S S DESCRIPTION Or FURMACC/BURNER HEATING or POWER PLANTS, Stead. Not Nater. Wars Air- No. Trade Nave Oise No. Capacity Sq. Ft. CDR BTU NP Total Connected Load Kind of Fuel SUMER - Trade Name Sire No. Capacity Sq. rt. EDR STU fthmond 8 ISO dnJ.0 h: -� tri c� ��° ��.�. • BP 5182 WBroadway Company Signed By Attach stack verification fors with replacement furnace Imrmits/ Tel. No *Air Conditioners can not two• placed in %id.• yard without written pursission free adtotninq nrtgldvor. CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS$225.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On May 10, 1999 JOB ADDRESS 61549 till ntwn NO OWNER_��V TOTAL �rv� BUILDING USED AS ESTIMATED COST t� PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units_ Circle One (Steam) (HQtn�erj 7tarm Air $ Trade Name )( Size No.U-1 BTU HP EDR $ Z5, Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an $ 50 rulings of the Building Division, and hereby declares that all the facts'and representations stated in this application are'true and correct. HEATING 0IT.IV(Cz67rNf> Signed (41/312D�WDATE �( Approved By Rough -In Date Final Date �l CHESINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes K No ( ) 2. Is free from rust or deterioration YesK) 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 -,551 TOTAL BTU's ' D4 7. Has a liner been provided for water heater Yes() No ()A]/,4- 8. Has combustion air been provided for water heater Yes() No () 46 Remarks:Y �l ' M� C�3' �D , List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 F63) 572-3604 FAX: (763) 571-1287 ADDRESS : 6156 STINSON BLVD NE PIN : 133024440058 LEGAL DESC : COCHRANS ADD : LOT 4 BLOCK 1 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT O.: 2004-00188 DATE ISSUED: 02/10/2004 VALUATION $ 18,000.00 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 SECTION 310.9.1.2 OF THE 1997 UNIFORM BUILDING CODE WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS. BASEMENT FINISH IS APPLICANT A CONTRACTOR? 1 APPLICANT G R DANIELSON & SON CONSTRUCTION CO 15012 RAVEN ST NW ANDOVER, MN 55304 OWNER JENSEN CHARLENE R 6156 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 provisiong, of any other state or local law regulating cfnstr orormqt(ce of construptiop. Bldg BUILDING PERMIT FEE FIRE SURCHARGE STATE SURCHARGE, VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # 6488 � I - SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 293.25 18.00 9.00 5.00 325.25 NEW [ ] CITY OF FRIDLEY Effective 1/1/2004 ADDN [ ] 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 3,5.Kb BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name && Address: U�r L� Tel. # -103 y Contractor: ok a .451 9 MN LICENSE # a®- t A3 DDS Address: 5017— RAV _!5b_M-W, tA44Zn AAN, 5'30- Tel.# tp l X Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. :Z q I e GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: _ '� i �l , Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 2-® 4 b I # to12-m (dge ®s'9q-� 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. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ J TOTAL $ 3o�s •.2�" STIPULATIONS: BUILDING PERMIT FEE SCHEDULE The Chief Building Official 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 repair 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: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 -$500,001 to $1,000;000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate. 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. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only P, CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 k'AX: ( 763) 571-1L57 ADDRESS : 6156 STINSON BLVD NE PIN : 133024440058 LEGAL DESC : COCHRANS ADD : LOT 4 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT 1Y0.: 2 00235, DATE ISSN . R/19/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. BASEMENT FINISH; RELOCATE ELECTRIC PANEL; GFI AT GARAGE # INSPECTIONS 2 APPLICANT ERICKSON PLBG HEATING COOLING 147192 LANE NE BLAINE, MN 55449 - OWNER JENSEN, CHARLENE R 6156 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 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 STATE SURCHARGE, ELEC FLAT ELEC PERMIT FEE - MIN (RESI) TOTAL PAID WITH CHECK # 31679 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0.50 40.00 40.50 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 F63) 572-3604 FAX: (763) 571-1287 ADDRESS : 6156 STINSON BLVD NE PIN : 133024440058 LEGAL DESC : COCHRANS ADD : LOT 4 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00263 DATE ISSUED: 02/24/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A EXTEND TWO HEAT RUNS AT BASEMENT; ADD ONE HEAT RUN AT BASEMENT # A/C UNITS 0 VALUE OF APPL OR WORK # FURNACES 0 # GAS DRYERS # GAS RANGES 0 APPLICANT ERICKSON PLBG HTG & COOL INC 147192 LN NE BLAINE, MN 55449 - OWNER JENSEN, CHARLENE R 6156 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 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 regula�on4ruction or the performance of construction. _ _W 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 # 31696 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 425 0 25.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 25.50 CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 2002 6431 University Ave NE T Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES n JOB ADDRESS��c RATE SCHEDULE U" _ OWNER Residential Rate %D Furnace Shell and Duct Work, Burner - TOTAL BUILDING USED AS Also Replacement Furnace $ 30.00 $ _ (Side Vent - Fill Out Back) ESTIMATED COST PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESC�i IPTION OF FURNACE AND O8 BU,_NER Gas Range $10.00 $ o No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) ~ Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR "Air Conditioning • All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. I Jo of Value of A Iiance or Work pp " BTU HP EDR A :ommercial/Industrial 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein LL specified agreeing to do all work in strict accordance with the City Codes an State Surcharge S .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. v TOTAL FEE III DATE LL SI IMUM EE FOR AY HTING/COQbING/VENTICATION , HEATING CO-tEFRISIMION/AR CONDITIONING PERMIT IS $25.00 1.US THE 1.50 S?ATE SURCHARGE - -t Signed k f " Al --� TEL # v , FAX # REINSPECTION FEE $47.00/Hr Iry Conditioners can not be placed in a side yard without v�iAir Approved B Rough -In Date Final Date "�' 3 C) •ritten permission from adjoining property owner. FILL OUT BACJCSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNgCE LL FEB -26-2002 14:40 FROM CIT'r OF FRIDLE`r TO 7637834566 P.06i06 THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR'THE APPLICATION WILL BE RETURNED When , 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 an anrent codes and manufacturer spedfl harts including sizing, length, number of ebows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufactur+ees specifications This does include AGA -LAMA Category I Central Furnace Venting Tables for int assisted and natural draft appliances. Yes( ) No( ) Theis sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to • A will be sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When u+�Q n now UgMUng Uglaw the undersigned hereby verifies ttiat it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GANIA 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 #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 Toth Appliances Toth Btu Input Common Vent Type Vert Height Diameter inches Appy #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type v� i : HEATING CQ 9 %d, j �,, Q,�, Signed B7• �N i TOTAL P.06