Loading...
PRE 2010 DOCSCity ®f Fridley, Minn.. No 10048 BUILDING PERMIT Date: Dec. 4, 1968 Owner: Wallace Marcus Builder AMber CgAstruction Address Address 5 941 Benjamin. S t . N. E. LOCATION OF BUILDING No. 6172. Street Stinson Blvd. — part of Lot Lot 3 Block 1 Addition or Sub -Division _ Cochran Addition Corner Lot _ Inside Lot _ x Setback 35' _ _ Sideyard 5 ' & 10' Sewer Elevation ____ 920.52 21 _ 924.52 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front _._. 40' Depth 24' Height —20 Sq. Ft. 964 Cu. Ft 19280 Garage Front 2'z Depth 241 Leight 10' Sq. Ft. 528 Cu. Ft. 5 280 Type of Construction _ _ Frame Est. Cost ,_,,,_ ,21.900 _ To be Completed SEWER LOCATION - 163' South of Manho&e 187' North of Manhole WATER LOCATION - To Be Tapped Top of Footing to be 8" higher than the house to the North 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 orth and in 7!:li Zt,h provisions of ordinances of the city of Fridley. - $100.00 ewer Connection Charge In consideration of the payment of a fee of $ 41.00 . 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 andmoving of buildings within the city limits andel this permit may be revoked at any time upon violation of any of the peons of said ordinances. Clarence Belisle NOTICE: Tbts permit does sof cover the construction, insis Mon for wiring, plumbing, gn heating, sewer or water. Be sore to see the Building inspector for separate permits for these Items. I APPLICATION FOR BUILDING PEMT CITY OF FRIDLLY, MINNESOTA ADDRESS AmREss er 17' if LOCATION OF BUILDING Uj No 5' 7" 24 V,& LOT 3 - BLOCK ADDITION OR SUBDIVISION foci q A COMM LOT IN :IDE LOT BA' X, SETBA- 35- SIMARD SLWER ELEVATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed build location drawn on these Certificates. DESCRIPTION OF BUILDING To BPUsed As: Front Y 0 Pepth Height square feet Cubic Feet Front -1-- Depth Height ;-7-7 Square feet Cubic Feet Type of Construction Estimated Cost oeo To Be Completed 6 -7 -C -9 The undersigned hereby makes application for alerml-t':io'r the wo, 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 i%:ij.)resentations stated in this application are true and correct. DATE 2 9-/&" SIGNATURE 6 - (Schedule of Fee Costs can be foubd on the Reverse Side'.) W BUILDING PEEKIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or fon any 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 applieant'for such permit of fees to he amount herein below set forth and in the manner herein provided towit. Uniform Building Codes Type 1, 2, & 4 - $1.75 for each one thousand cubic feet, or fraction thereof, in such cubical contents. 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.repaire or alterations to an existing structure, �00.00) he fee shall be at the rate of $3.00 per each five hundred dollars ($ or fraction thereof in the cost..of all proposed work. In no case shall the fee charged for any permit as se forth in Section 2 be lees than $5.00. NSSSD Connection Charges based on location - Area 1 or 2. City of Fridley 1119 1111 If 111,11,11 fill 111 Ilg Ig 1*1 11 :1 N 1� R MMMMOMMMME IMM MEMNON IN� �%NERMUZZ OEM w PLUMBING 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 ... I ............ .. x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. . ... .... x $3.25 $ Electric Water Heater x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ....... .................. x $2.00 $ Additional Fixtures . .................. —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FM $ City of Fridley: ,41 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_ Owner Kind of Building Used as To be completed about Estimated Cost, Old—New. Building Permit No. poxmit N6. ` C� ) Signe By Business Phone ROUGH FINAL 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 $ NECK. 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 ®0 GAS BURNER (up to 199,000 BTU) 5.00 $ 61 over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ a 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 $� Dept. of Bldgs. Phone 560-3450 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 `jam Kind of Used as To be completed about Estimated Cost, $ Old; ew. uiiding Permit No. Permit No. " 6&5 HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No -41 Trade Nam Size No Capacity Sq. Ft. E.D.R BTU— — H.P. Total Connected Load Kind of Fuel. BURNER — Trade Name Size No Capacity. (REMARKS—OVER) Sq. Ft. E.D.R BTU H.P. Signe By 8419�ifTEit DRIVE MINRLMILIS, MINNESOTA 55 Business Phone No City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures bei Z Y Z Z 1w <3 !2 Z f F S N WATER HTR. GAS EIEC y3o2 wo c�1 ,a9,. Base / X 1st 2nd 3rd _ 4th • Future Connection Openings Connected with New Fixture, Old Openings I Sewer Cesspool El PLUMBING 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 s $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ...... ................... _ x $2.00 $ ®<a 0 E) Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Dept. of Ridge. ��Phone 560-3450 Loeat" 41 f e��l.n_�-z SZd L_ 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, Minny` „ 19k7 Owner Kind of Buildings Used as To be completed about Estimated Cost, $ /.:?- Old ew. uilding Permit No — L04 ®�D Permit No. %g2-6 Signe®+�` By Business Phone ROUGH FINAL-3-- Gas INAL,, -- Description ................................................$ TOTAL FEE 160 42 ,: No. Make PERMIT for Power Plants and Heating, Cool. ing, ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK Oil fired—,— Coal fired—, Gas Remarks Approved by Plants to b installe ltered—repaired Size ; ✓ ; Gas Authorization IL— Final Inspection Date , 19_ Inspector Permit N° 4383 Fee $ Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. V , 19-�l Owner L2� AXA [ -= Location 1-7 Q Kind of Building` e How Occupied Work to be Commenced ` ,19-LOJ To be Completed 1 ,19-M Estimated Cost, $ Old -New, Building Permit No. %® Permission is hereby granted to '"'�"`��' &-��, d�o 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 named, and to the spep fications set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings .QjRNW42 2M 11$7 V N? 4826 Original Permit for PLUMBING N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., I Fee �C DESCRIPTION OF WORK Number, Kind and Location of Fixtures City of Fridley- ,19 Stories W U FQ W O -I 3 U Q ? V r0Z Ilk 0 m }. m Q m N Z Y tll Q U = m rZz 3 N Y 7 K O ❑ LL w N C z 0 LL❑ T z ti¢ U QI z a Q❑ C -1 m S IL 04 a a O Q O nzO Q C7 a WATER HTR. GAS ELEC. Basement gat / a 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for d` Openings Permission is hereby granted A.Uh 4 to do the plumbing and gas fitting in the building described in the statement heretoshed, upon the express condition that the person to whom this permit is granted, and his agents,tployees 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 Inspector. 42 tsa-6-65-v Owner Location Kind of Building Used as To be Completed— Estimated ompleted Estimated Cost - '--6 Old -New. Building Permit No.__Z a, v Vt Date Inspector of Buildings. N? 4888 Original PermitFITTING N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for permit inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., Fee $ DESCREPTION OF WOKS Number, Sind and Location of Fixtures City of Fridley stories E W r o 3 U 4 Z 7 F m O m !- m m Q m x Z W m Y F: m a Z Q C a 0 3 N O IL W 0 x N K m 0 -1 t, 0 S m 7 Q Q U m Z rc ❑ .1 m K E It m a Q d G Q O m z Q Q G E WATER HTR. GAS ELEC. Basement 1st 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings Permission is hereby granted�to do the plumbing and gas fitting in the building described in the Ytatement hereto attached, 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 Inspector. 42 iM–a-ss-v Kind of Building Used as— To s To be Completed ,19— .estimated Cost Old -New. Building Permit No. Inspector of Buildings. 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 Effective On May 10, 1999 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 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. $ 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 CO Signed /Z,-1` DATE- LIZ �5 Approved By Rough -In Date Final Date 3'.2t-01 L FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS �� �'__o OWNER Rate TOTAL BUILDING USED AS��: $ 30.00 $ ESTIMATED COST - PERMIT NO. $.10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ $ 10.00 $ No. of Heating Units Circle,One (Steam) (Hot Water) (Warm Air) Trade Name e s sem/ v$j, No. BTU o-3 HP R $ 25.00 $ Fuel - Total Connected Load Burner Trade Name Size No. $ BTU HP EDR State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 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. $ 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 CO Signed /Z,-1` DATE- LIZ �5 Approved By Rough -In Date Final Date 3'.2t-01 L FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHRMY AND STACK 3MRM, CATrON No ( ) The undersigned hereby verifies that the existing chimney°or stack: No 1. Has been carefully examined Yes(.) No (` ) 2. Is free from rust or deterioration.:. Yes ( ) No (' 3. Has no foreign objects lodged, within Yes O No ( ) 4. Is securely supported . ; - Yes O No ( ) 5. Meets all current Code requirements-for:size and total BTU's connected Yes O No ( ) 6 Has total heating BTU's of _ All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater S. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes () No ( ) Yes No SEPARATE PERMITS REQUIRED FOR WORK OAR THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT'NO.: 2004-002. 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 02/118/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6172 STINSON BLVD NE PIN : 133024440057 LEGAL DESC COCHRANS ADD LOT 3 BLOCK 1 PERMIT TYPE BUILDING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 3,256.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF FLAT ROOF 400 SF ADDITION (.045 MIL. EPDM) IS APPLICANT A CONTRACTOR? 1 APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 97.25 3.26 HEIDERSCHEID BROS CONSTRUCTION INC 1532 164 LANE STATE SURCHARGE, VALUE 1.63 HAM LAKE, MN 55304- LICENSE SURCHARGE 5.00 (763) 862-0616 TOTAL 107.14 PAID WITH CHECK # 15400 OWNER BOYUM SUZANNE R & ERIC J 6172 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 notesume to ive authority to violate or cancel e p o 'sio f any er state or local law regula ' cti the o ce of co ction. Applican Dat 110 Bldg Inst Da SEPARATE PERMITS REQUIRED FOR WORK OAR THAN DESCRIBED ABOVE. 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 BUILDING PERMIT APPLICATION Construction Address: / % - S/ / vt ,Sam 9 Lvd Fri ell, Legal Description: Owner Name & Address: c, t., v✓l Tel. # 7c,3 61_3 3 Contractor: 14,etded 5cAPccP MN LICENSE# ae3®C-,®3Sr5' Address: /5-3,P �� �'L`' L..7 Aa -•yr Zo-IC e- , Tel. # L3 e4. a " G- C 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. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: OTHER: Length L DU s" Hgt/Ground Sq. Ft. ;40v;-- - ra cpted—rd Construction Type: Estimated Cost: $ I Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: -1-1 � -b `i APPLICANT: LTel. -® 74 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 P; 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 [ ] TOTAL $ 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 CITY OF FRIDLEY PERMIT .: 20 4-0054' 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 04/21/2004. (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6172 STINSON BLVD NE PIN : 133024440057 LEGAL DESC : COCHRANS ADD : LOT 3 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION 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 INSTALL A FURNACE (WARM AIR, LENNOX, 90,000 BTUS) AND AN AIR CONDITIONER # A/C UNITS 1 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 35.00 GOLDEN VALLEY HEATING & AIR 5182 W BROADWAY GAS RANGE FEE 0.00 CRYSTAL, MN 55429-3591 GAS DRYER FEE 0.00 (763) 535-2000 AIR CONDITIONING FEE 25.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 5237 0.50 60.50 OWNER BOYUM SUZANNE R & ERIC J 6172 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 y other state or local law regulating construction or the pe on an of constructio . Applicant Date Bldg Insp LD SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. - CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell a t Work, Burner & also R cement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning-Al:I:S�ize� All Other Repairs or Alterations (List on Back) i%o of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Commercial/Industrial/Institutional Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES/ JOB ADDRESS Fee Total -I- VU4' Owner $35.00 $ 3�j0� Building Used As19��el A $10.00 $ ESTIMATED COST ®D���/ PERMIT NO 6�007 Wim` 7 $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units ! Circle One (Steam) (Hot Water)arm Air Trade Name .� Size No�(9 $25.00 $ U� BTU ?0Z HP EDR Fuel Total Connected Load $ Burner Trade Name Size No. BTU HP EDR 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE �y REINSPECTION FEE $50.00/HOUR �(� •� *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Divisifbm gy wsr IUgl4acts and representations stated in F Aa� C AifA r( t& AIR HEATING CO 5152 !NEST BROADWAY eRYSTAI�i MN 66420 703.535.2000 Signe ,/� TJJel #If I Date Approved by k Rough -in Date Final Date 1 4 6 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. Ye 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 comm n vent and vented separately as per current codes. e* Yes /No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type Ff;' BTU Input Fan A2 sisj d at Appliance #2 Type BTU Inputffiss r at Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input 0/ 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 :I �`/J 51- ROUSE HEATING TEST RECORD ADDRESS 17150 9 a U /" APT. FLOOR CITY OCCUPANT Ab�-jU77 OWNER HEAT LOSS DATE HTG. IN SOLD BY INSTALLED BY Electrical Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. GAS MODEL SERIAL INPUT THERMO,S,TAT. VALVE rTonnq LIMIT LIMIT SETTING FAN SETTING _ PILOT TYPE PILOT MAKE , PILOT MODEL PILOT TIMING _ L.W. CUT OFF HEAT PLUG PRESSURE 1%9 A(Xj PERCENT CO2 INPUT CFH PERCENT 02 STACK TEMP. t PERCENT CO FORM 235 CONVERSION OF BURNER SUBURB Y OTHER MAX. BTU RATING MAKE OF FURNACE MODEL VENT SIZE KIND OF LINER SIZE NONE DRAFT HOOD REGULATOR FILTERS SIZE NUMBER CHIMNEY LOCATION INSIDE OTSIDE CHIMNEY CONSTRUCTION _-n SMOKE BOMB WIRING &V DRAFT TEST TAG DOOR PRESSURE rs DATE TESTED 9 0 dviay COMPANY TESTING (SIV NAME OF TESTER CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 YAX: (763) 571-1287 ADDRESS : 6172 STINSON BLVD NE PIN : 133024440057 LEGAL DESC : COCHRANS ADD : LOT 3 BLOCK 1 PERMIT TYPE ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION PERMIT NO.: 2004-00546 401 1�� DATE ISSUED: 04/21/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE AND AIR CONDITIONER # INSPECTIONS APPLICANT GOLDEN VALLEY HEATING & AIR 5182 W BROADWAY CRYSTAL, MN 55429-3591 (763) 535-2000 OWNER BOYUM SUZANNE R & ERIC J 6172 STINSON BLVD NE FRIDLEY, MN 55432 1 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 wort 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 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 5237 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 Dat d �l Z CITY OF FRIDLEY DATE 1 IS ® 1 ADDRESS SITE ADDRESS IMM7 THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY NAME: rt% - OWNER/ ADDRES : P CITY STATE ZIP�� TENANT PHO - 331 q CONTRACTOR NAME: STATE LICENSE # / /" EXP DATE / ADDRESS: 0 � P -e- CITY 57f-,� � STATE ZIP 'O® SUBMIT A COPY OF YOUR STATE LICENSE WITH PHON</ 5®j qe _570 -® FAX .37 APPLICATION PERMIT TYPE INGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE 0 NEW LACEMENT TYPE OF WORK. DETAI E DESCRIPTION F W RK �° C= / W 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 re4qct only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 405-0-0 FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL ER OF EACH BELOW) A BATH SINK/LAV DRAINS SHOWER —WATER PIPING _FLOOR _ BATHTUB _ GAS PIPING ovmw cuymc©vm)_ SWIMMING POOL —WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK Q �, f.,*r WATER CLOSET _ BACKFLOW PREY. ($15) _ _ _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER PERMIT FEE PRO 9:101k W5,00, „1 ER1tiIi I Fj�VOR P, 5 C? ER. X500 Permit Fee $ oy Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ _ State Surcharge = $ .50 Total = $ 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 i not to start without a permit; that the work will be in aodmqith the approved plan in the case of rk w evi and approval of pl SIGNATURE OF APPLICANT PRINT NAME A) DATE1 EASSSC} E: E TJ ,P1 Ra W kEQU1RELi 3R BUIL ?11 1 " 1LICAL! AND mgcgA City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, NN 55432 763-572-3604 FAX: 763-502-4977 Y A Building $ BUILDING Plan Review Permit No.: _00V Inspections Fire Surcharge RESIDENTIAL APPLICATION Received By:, ak 763-572-3604 CITY OF FRIDLEY Dat 763-502-4977 FAX $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ EFFECTIVE 1-1-08 Erosion Control $ DATE -7 �' YOUR E-MAIL ADDRESS $ SITE ADDRESS 4P/-7.2S� rr1SOn /9411( $ Agreement necessary ( ) Non Necessary ( ) Total Due s THIS APPLICANT IS: ❑ OWNER W-ONTRACTOR PROPERTY OWNER/ NAME: /-3DWIn ADDRESS: � CITY C -Ile Y STATE TENANT PHONE: NAME: LZ��1F'ec C'r�'►Sfrvc i�c�� ADDRESS 9 04 �- CITY STATEr^AGIP Ssii-{ CONTRACTOR SUBMIT A COPY OF PHONE -4-' 9 — 3 t 3 o FAX YOUR STATE LICENSE STATE LICENSE # ";�.S'4-7,;?-- C,2 o EXP DATE PROPERTY TYPE gSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 7:ec-�- 112erocxP SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT Z 7.333 ROOFING11OUSE ONLY NUMBER OF SQUARES / HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 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 & PORCHES SUBMIT: ❑ Vinyl []Soffit 1. Site Plan/Survey showing the existing structures 1. ❑ Aluminum ❑Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ ztZDeJB 3 OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharged .0005 x Permit Valuation Minimum $.50 License Surcharge $ 0 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due s Make checks payable to: City of Fridley Attach Stipulations 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT'S-- PRINT NAME DATE APPROVED BY DATE Page 2 - Building Residential Application 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 FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1" $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69:25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1' $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1' $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1St $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1' $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1St $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. 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 City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 ten.,._ " _ ._/_.w3p Building $ BUILDING Permit No.: Inspections $ RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Date Rec'd: � 763-502-4977 FAX $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ EFFECTIVE 1-1-08 $5.00 (State Licensed Residential Contractors) DATE f // /-8 YOUR E-MAIL ADDRESS SITE ADDRESS 6O/72 S7`iriS'yi/ 1312-1 Al2 Curb Cut Escrow THIS APPLICANT IS: ❑ OWNER XONTRACTOR PROPERTY OWNER/ NAME: ��F///%✓/ $ ADDRESS: to l7� �75h m/vim CITY r STATE /WZIP TENANT $ PHONE: ?/? 3 J SO6- 6X03 Fee Determined by Engineering Sewer Main Charge NAME: v� CONTRACTOR ADDRESS: `7'70 CITY S,"'• STATE Ar.dLIP SUBMIT A COPY OF PHONE /6S1) L�00 - 3/30 FAX YOUR STATE LICENSE STATE LICENSE # ;;116Scf7d-tiO EXP DATE sh/A9 PROPERTY TYPE 'SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK V:$IDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION 1"INTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT 3 a LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ 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 [offit ADDITIONS & PORCHES SUBMIT: 'm 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ T and proposed project. 13 Other 0 cia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ 350a OCCUPANCY TYPE Permit Fee $ <— See Back Page for Fee Schedule Plan Review $ 3, Sz-) 65% of Building Permit Fee Fire Surcharge $ 4, S® .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 11-14? % _Iq� Make checks payable to: City of'Fridley Attach Stipulations 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires re iew andappy val of plans. SIGNATURE OF APPLICA-N.T-1 _ �'� PRINT NAME /" �" DATE 08 Page 2 - Building Residential Application 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 FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1" $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for 1St $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1' $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1" $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1St $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1" $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the I' $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. 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 City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 m •11 V C PROJECT: 6027 VwrmAvenue TS/ Services,LLC c m Screened in Deck MN 66a BMN�Na Fridle MN Y, (672) 217 -INS (I" srnucrUm_Cnm: WMDs7U iLA (888) USM35 WAM www-telengirt�ers com rn mv,