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PRE 2010 DOCSAPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: BUILDER:chard Miller Homes ADDRESS: ADDRESS: 1700 Silver Lake Road New Brighton, Minn NO:. 6200' STREET: Stinson Blvd iLOT: 2 BLOCK: 2 ADDITION: Cochran's CORNER LOT: XX INSIDE LOT:SETBACK: 35+ SIDEYARD: 10' $ 22' � 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 Dwe 1 14g Front : 42 Depth: d 24 Height • '19" r Square Feet: 1008 Cubic Feet: X91 a Garage Front: 20 Depth: 22 Height: 10, Square Feet; 440 Cubic Feet: 4400 , A Type of Construction: Frame Estimated Cost: $ 27,000 To Be Completed: May 31, 1971 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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: Feb 17, 1971' SIGNATURE: (See Reverse Side For Additional Information.) 16 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 for less than $5.00. e -- VERIFICATION OF FOUNDATI NOTE: Permits for construction will be issued a m i df'v24 time of application, to allow for proper review othee 0 osL- of the construction site. A Certified Survey of the lot,,showing the 1 has been constructed, will be required befor CERTIFICATE. OF OCCUPAN Y Application for a Certificate of Occupancy shall b made to(gtyeetmer s ri ) Y P to the use or occupancy of any structure for whichila buildi has b issued; and said structure shall not be used or oc upied un ifica of Occupancy has been issued. it wCity of Fridley, Mim.BURDING PERMIT Date: _ February 19, 1971 Owner: Richard Miller X Fomes Builder 1cand Miller Homes Address 1700 Silver Lake Road Address LOCATION OF BUILDING No. 6200 _ Street Stinson Boulevard part of Lot Lot 2_ _ ____ Block 2 Addition or Sub -Division . Cochran' a Addit;Loa Corner Lot — x Inside Lot _ _ Setback 35' _ _ Sideyard 10, Sr 22' Sir Elevation — _ 918-37 _ ---921 37 Wye Ton of Footing DESCRIPTION OF BUILDING To be Used as: D-wel11ng Front 49- f Depth 9-4_' Height _ 201— Sq. Ft. - 1008 Cu. Ft. 20.169° Garage Front 20' Depth ---221 22' Height _ 10' Sq. Ft. _ 4401 Cu. Ft. 4.400 ° Type of Construction Frame Est. cost _ $2.7_,QQ_Q__.._ To be Completed Mey 37 971 SEWER LOCATION: 110 ' North of Manhole INV. Elev. of Manhole: 919.27 WATER LOCATION: 99' North of Manhole Provide Hard surface driveway. Verify location of foundation with survey before framing. 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 and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 46.00 permit is hereby granted to Richard Miller Homes 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 thus permit may be revoked at any time upon violation of any of the provisions of said ordinances. (—)Ry�� CE BELIS NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heafing, sewer or water. Be sure to we the Building hupeetor for separate permits for there hamm s J. PLUR42ING FIXTURE RATES: NO. RATE TOTAL Number Fixtures S x $200 Future Fixture Opening oa� x $1.50 $_. • 0 d New Fixture Old Opening x $1.50 $ Catch Basin .. x $3,25 W Water Heater (Up to 99,000 BTU) / x $3.00 e WATER HTR. x $3,26 $ Electric Water Beater = $2.00 $. GAS FITTING FEES: NO. RATE TOTAL let 3 Fixtures ......... .... ......... x $2.00 $ ? . V d Additional Fixtures ..... .............. x $ .75 $ Gas Range to 195,000 BTU .............. x $5.00 $ Base lot 2nd __44 3rd — 4th _ ° Puture Connection Openings 1 Connected wish e New Fid, Old Openings err ❑ Cesspool P ❑ PLUR42ING FIXTURE RATES: NO. RATE TOTAL Number Fixtures S x $200 Future Fixture Opening oa� x $1.50 $_. • 0 d New Fixture Old Opening x $1.50 $ Catch Basin .. x $3,25 $ Water Heater (Up to 99,000 BTU) / x $3.00 $ ay New Ground Run Old Bldg. x $3,26 $ Electric Water Beater = $2.00 $. GAS FITTING FEES: NO. RATE TOTAL let 3 Fixtures ......... .... ......... x $2.00 $ ? . V d Additional Fixtures ..... .............. x $ .75 $ Gas Range to 195,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description .... ............................. .............$ TOTAL FEE _ _00 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, Itillinn 1�A e 19 Owner / go i ff Kind of Building Used as rc� ®® To be completed about Estimated Cost, $ 04&—New. Building Permit No.— . __Permit No.a Signed.41 �r By_ o Business Phone No ROUGI FINAL j `.� ^ ?�/ WWI- jo Application for Power Plants and Heating, Cooling. Ventilation. Refrigeration and ' Air Conditioning Systems and ®eAces PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470 °GRAVITY WARM AIR: RATE TOTAL :, uV ace Shell & Duct Work .......................... 8.00 $ Rj�placement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU ....................... h Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. e. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... . Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... Each add. 200 sq. ft. EDR Steam ...................... Each add. 320 sq. ft. EDR Hot Water .................. OIL BURNER—to 3 gal. per hour ....................... . over 3 gal. per hour—See Fee Schedule 8.00 $8.00 &41 2.00 $ 5.00 $ 5.00 $ 2.50 $ 8.00 $ 8.00 $ 2.50 $ 2.50 $ 5.00 $ GAS BURNER (up to 400,000 BTL) ....................... 5.00 $ 5.00 GAS FITTING FEES: 1st 3 Fixtures 1 Additional Fixtures ................. Gas Range to 200,000 BTU . ;AIR CONDITIONING FAN HEATING SYSTEM t VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL IV NO RATE TOTAL _ x $1.50 $1.50 _ x .50 $ _ x 2.00 $ $ S F Schedul Location 6200 Stinson Blvd. N.E. City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Alin. April 7, 1971 , 19 — Owner Richard Miller Homes Kind of Building Frame Used as Residential To be completed about 5/1/71 Estimated Cost, $ 550.00 Old—New. Building Permit No Permit N DESCRIPTION OF WORK HEATING or POWER PLANTS—,Steam, Hot Water, Warm Air—No 1 cp Trade Nam. westinghouse Size No EGOH 110 ® MOW s 000 Sq. Ft. E.D.R BTU H.P Total Connected Load 60x660 Kind of Fuer Gas ee ee e TOTAL FEE $L4.50 ® 6 BURNER — Trade Name Westinghouse Size NoFGUB®1.10 Capacity $I 0 000 Sq. r, E.D.R BTU H.P HEAT LOSS ATTACHED jgn� (REMARKS—OVER) Signe B 5 -b167 St. Louis Pork, M.nne 55426 Business Phone No Windows and Doors®Crackage and Area Btu Ate. `OAT No. of tights Lineal ft. of crack °"' Weath@YStri� Aa.�.El' •�• Guide, �n08raleti��a ; lip D s i ilndows ` Doors Rehrenee, Out. Wad Int. wa11 f eilieaa °. t i iii®. 2j, � ,Raiosel Eengh' ;,,,._ Width Height Windows and Doors®Crackage and Area Btu Ate. Width Height of pane of pane No. of tights Lineal ft. of crack Area e®. ft. _ _k y Coeff. Btu' 'Infiltration Infiltration ,,'AG;.'. ,, Ca1as� ! a Exp. wall J 9 0 it-0 Net enp. wall f6t enp, wall Floor Int. wall Int. wall' 42 Ceiling —4t- e, 1 Ceding 1 �^ Floor Total Btu. Required sq. ft. E°D.R. or sq. ibis. W.�. Ialder:lgYe� Required sq. $t.. E.D.R. or sq. ins. VA, Leader area F1.1 Width ,,O - Leight Windows and m-crackage and Area Btu No. Width or pane height Aro. of .iter pane liahBo Lleq_a ft. off crack Are9 e4. fel. _ _k y Coef. Btu �In�ltYation Infiltration ,,'AG;.'. ,, ice- w ,a Glass Eup. gall .3 c) ' J 9 0 it-0 Net enp. wall Net ems. wall Floor Int. wall Int. wan 42 Ceiling —4t- e, 1 Ceiling% 1 �^ Floor - - Required sq. ft. E°D.R. or sq. ibis. W.�. Ialder:lgYe� °Total $tu. Required sq. fft. ErM.P- gr sq..im. W.A. header area Floor` m— I Lel Windows and Doors3—Cracl Width H - 064t °. No. of no. of pane of pane lights i Infiltration GDago Eup. waEll .2- ;k Net eap. wall � . , I D1 � • i /l Width /'r� . Height �? g and Area heal ft. Area of crack no rt. It�:E nt. wa t° p Floor' Total Btu`. r� �equir¢d sq lft. m. ar,aq. ins. W.A. Deader area F1.1 Room .I Length Width Windows and doors--Craclsage and Area p WiW�� 9o. of Lineal tt. Area Aro. of ;:lighto of crtack an. ft. �E ei � e , a orref. Btu A' 7 alai ft,, ®f crack " Area, e®. ft Area sq. it _ _k y Coeff. Btu Infiltration Gly F.mp. gall Net eup. wall Io wall i` Ceiling 7 �' t ° 9 Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Fader area f �oi9ff Floor €find. klo4tr Applied RanI��ath ,,�' W�dtDt .'A;) .Hew Windows and l?o®r Yackase € nd Area ` a Aro. Width of pane Height of pane No. Of. lights " alai ft,, ®f crack " Area, e®. ft Area sq. it _ _k y C�e�° l�tt9 r Infiltration Caef. Infiltration ,,'AG;.'. Glassy ice- w ,a Glass 3 V it-0 Net enp. wall Exp. wall Floor Int. wall Net eup° wall~i 42 Ceiling —4t- e, 1 .; Int. wall Floor Total Btu. : ,q Required sq. ft. E°D.R. or sq. ibis. W.�. Ialder:lgYe� Floor` Total Btu. ` 7 Required sq. ft. E.D.R. or sq. ins. VA. Leader a'rea' F1.1 /,I , � :gym I Lealgth ,� ,:. - Width- / Height Windows and boors—°-Crackage and reg �i - s �yy No. Width of pane Height of pens go. of ' Lineal ft - lighto : of crack Area sq. it y C�e�° l�tt9 r Infiltration Infiltration ,,'AG;.'. Glassy Ems. wall Enp. wall a 3 0' . <, Net enp. wall Floor Int. wall 34�� �4 Ceiling —4t- e, 1 / Floor Total Btu. : ,q Required sq. ft. E°D.R. or sq. ibis. W.�. Ialder:lgYe� Windows and Doors- Crachage, Qnd. a �F. e fi' No. Width of pane Height No. of of pane lights- Lineal ft. of drank Area. 934. ft.. y C�e�° l�tt9 r Infiltration Glass Ems. wall 7 7 E Net exp. wall 0' . 7 Ra Int. wall Ceiling Floor 34�� Total Btu.. Required sq. ft. E.D.R. or sq. ins VIA,.- Lt6 ams , n.l l fft I l..enath ` Width,,,' Hei*t"� Windows and Door&—Crackffi9e and Area. ` Width Height No. of Lineal et, Area Aro. of pane of Dans lights " of crack. ca. ft.' r .. tf - C�eff. liter �, Infiltration Glass ani. wall�c__ Net exp. wall Int. wall Ceiling Floor—A, a. ;+� 7--5 Total Btu. Ez Required sq. ft. E.D.R. or sq: -ins. W A° Iaade `area PI SUBJECT 9 . PETJ7 City of Fridley - 61 AT THE TOP OF THE TWINS BUILDING PERMIT � R IPT NO. �L -----_ COMMUNITY DEVELOPMENT DIV, 1 PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j, 612-571-3450 910-F15 4/17/84 JOB ADDRESS 6200 Stinson Boulevard N.E. 1 LEGAL LOT NO.BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Cochran' S Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mr. Barts 6200 Stinson Boulevard N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Merchants Maintenance, P.O. Box 33335, Coon Rapids, MN 780-1555 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE x 8 DESCRIBE WORK Construct a 14'.x 16' Enclosed Deck 9 CHANGE OF USE FROM TO STTPULATIONS Ift WARMNU Bit°m digging call local EPERR 'E PERMITS REQUIRED FOR WIRING, utiii#ie: TELEPHONE - ELECTRIC - GAS Etc, HEATING, PLUMBING AND SIGNS. REQUIRED BY LAS" TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 224 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2'600 $1.30 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 ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $38.50 None CTION OR THE PERFORMANCE OF CONSTRUCTION. e PLAN CHECK FEE TOTALFEE 1 4t_ `SIGNATURE $ 9.63 $49.43 OF CONTRACT O AUTHORIZ GENT (DATE) M WHEN PROPERLYVILI DATED THIS IS YOUR P RMIT BLDG INSP r)ATPF SIGNATURE OF OWNER OF OWNER BUILDERI (DATE) PI NEW [ l City of Fridley Effective 4/1/84 ADDN. �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Legal Description: A4 % -4- Xt%5 6AC(-;-� Tel. # - Property �Qt�rnerjAadr: Contractor:��'�'�� Tel. # Address: �� Ae� ,j 5Isq/3-S - 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: Length Width _ Hgt/Ground Sq. Ft. OTHER: Corner Lot [ 7 Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: 1�� Estimated Cost: $ Approx. Completion Date: `ev - 7 `?A44 4 I1.0Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: �7 S5` APPLICANT• J" "e= Tel. Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY ------------ Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 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 Valuation Fees $1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $29000.00 $10.00 for the first $500 plus $1:50 for each additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $1.50 for each additional $1,000 or fraction thereof, to and including $50,000. $50,001.00 to $100,000.00 $283.00 for the first $50,000 Plus. $3.00 for each additional $1,000 or fraction thereof, to and including $100,000. $100,001.00 and up $433.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof. DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75 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 the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. t L Land planning 8" t'r (Amt 6873 Highway No.65 N.E. Land Surveying • • Minneapolis, Soils Testing %t�tllP,Q�lll�� %2C. Minn. 55432 Civil Engineering Telephone 784-6066 Municipal Engineering Engineers & Surveyors Area Code 612 Mortgage Loan Survey for R%CHAT20 MILLC-2l-10MCS CoZaU • Y-Qinate- � U low- � I I Were r"r'.--.Jr@d Kiri. . 6A 1 wer ' t� ij 14.5 - I I ti" �bq N X02 No Aumt'j V7-- til.C. Scale:"`�'= 30� LoTI, BLocvr2 GOCHQA�,,W"S 0\7 ow �NO1GA ouwTy This is a true and correct representation of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is made only in connection with a mortgage loon now being placed on the property and no liability is assumed except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is understood and agreed np monuments have been placed for the purpose of establishing lot lines or boundary corners. Dated this 25 day of Fe6rAanjA. D. 193-. SUBURBAN ENGINEERING, INC. E."ginef s jjr Su a ors by + w till a I J ifs Sill, Al I 41 I It I J ifs Sill, Al I 41 S CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING COMPANY _ MAHppppp(EAnNG AND AIRc��TIONIN GO. � ----e EI ®US,MvN 5 Signed By 512.04-�el No. ApprovedRough—in Date Final Date Z-4) FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS �, 2 c Q �� q RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 representations stated in this application are true and correct. (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ s,� , tJr,? OWNER Gas Range $ 10.00 $ V BUILDING USED AS Gas Dryer $ 10.00 $ ESTIMATED COST PERMIT NO. *Air Conditioning — All Sizes $ 10.00 $ DESCRIP'jION QF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Val, ue of Appliance or Work $ No. of Heating UnRs_L_,_ Circle One (Steam) (Hot Water (Warm Air) __ Trade Name ', Size No.CZ,- Commercial/industrial BTU Qk, coo HP EDR 1 % of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge .50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE ' P �j MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING COMPANY _ MAHppppp(EAnNG AND AIRc��TIONIN GO. � ----e EI ®US,MvN 5 Signed By 512.04-�el No. ApprovedRough—in Date Final Date Z-4) FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: NF1 through #8 required when using a side vent furnace. CHIMNEY AND STACK. VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes (} No ( } 4. Is securely supported Yes () No ( ) S. Meets all current Code requirements for size and total BTU's connected Yes () No 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( } 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: HEATING CO: Signed By: Date: b LI RESIDENTIAL LOAD CALCULATION Purchaser JcA► 0rJon Sales Rep Date Addie s s Running walls below grade: L—° x (Ft wall Ht)= Sq Ft gross wall below grade 5q Ft windows and wall below jSq Ft gross wall Running walls above grade: � �y x �� (Ft wall Ht)=,��� above arade(lst floor) (1st Floor) Running walls above grade: (2nd Floor) X ems- ( Ft wall Ht) = ISq Ft gross wall Sq Ft gross wall otal gross Sq Ft Sq Ft windows and doors above grade WNet wall above Windows & Doors Sq Ft x HTM = `l srxy BTUH Inf. (w&d x 1.3) Sq Ft x HTM = BTUH Net wall below grade `:, { Sq Ft x HTM = BTUH Net wall above grade" Sq Ft x HTM =BTUH Exposed Ceiling `;li- ISq Ft x HTM = BTUH Exposed Floor+ Sq Ft x HTM =BTUH _ IKE' BTU TOTAL Windows & Doors', Ceilings & Floors ���r. �D 410 W. LAKE ST. MINNEAPOLIS, MN 55408-2998 612/824-2656HEATING AND AIR CONDITIONING CO 'Serving Tho 7Wn Cities Since 1930" ORSAT TEST RECORD ADDRESS i 1' OCCUPANT(/ --- DATE HTG. INST.,/d - 7- INSTALLED BY GAS LINE BY �- TYPE OF HEAT: GA FA HW STEAM_ 1072 PAY�N E AVE. ST. PAUL, MN 55101-3892 612/772-2449 CITY OWNER�.� SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE �y MAKE Of MODEL 670 Q Qko A-,�� �t MODEL, SERIAL Lf �: 2 6 e2 7 MAX. BTU RATING INPUT " 61zo 11 MAKE OF FURN CONTROLS MOD CONVERSION THERMOSTAT HEAT PLUG VENT SIZE VALVE KIND OF LINER SIZEe NONE LIMITDRAFT HOOD REGULATOR LIMIT SETTING.c ��` CHIMNEY CONSTRUCTION" FAN SETTING/c DRAFT=� TEST TAG,a�� PILOT TYPE S LIGHTING INST. PILOT MAKE City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PERMIT NO. 23742 f _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 612-571-3450 C NUMBER 910-F15 REV DATE PAGE OF AP JOB ADDRESS 6200 STINSON BLVD 1 LEGAL DESCR. LOT NO. 2 BLOCK Z TRACT OR ADDITION COCHRAN' S ADDITION SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS JEAN OLSON 6200 STINSON BLVD FRIDLEY MN 55432 ZIP PHONE 572-3410 3 CONTRACTOR MAIL ADDRESS ILTON JOHNSON CO 525 LOWRY AVE NE MPLS 55418 ZIP PHONE LICENSE NO. 781-9548 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RESIDENTIAL 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK REROOF - 2nd LAYER 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1440.00 • 72 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE F C -�-�y ICENSE SC 5.00 55.66 SIGNATURE OF CONTRACTO OR'AWTHORIZED AGENT IDATEI WHEN PAOPER -I� , BL G INSP VALI ATED THIS IS YOO/�UR PERMIT /'d'�✓ 0 MATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW' Effective 8/l/95 A6DN CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 6200 Stinson Blvd. N.E. Legal Description: Owner Name & Address: Jean Olson Tel. # 571-3410 Contractor: Milton Johnso Company MN LICENSE # 2083 Address.525 Lowry Ave. N.E. Tel. # 781-9548 — Attach to this application, a Certificate of Survey of the Oc& 75U -P11 lot, with the proposed construction drawn on it to scale. P_ DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 11 i Side Yard Seth Comer Lot Inside Type of Congructio Tear -off (house & rear porch) Estimated Cost: 4 sq. Approx. Completion 11/6/9/9 5 ei +_ -n I W._� W Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: 9/26/95 APPLICANT: Tel. #. CITY USE ONLY Permit Fee —__Fee Schedule on Reverse Side Fire Surcharge of Permit Valuation (1/10th%) State Surcharge $.50/$1,000 Valuation SAC Charge $850 per SAC Unit License Surcharge $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary Nat Necessary y_f4_­ .......... TOTAL L4 STIPULATI0 781-9548 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 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,00 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. 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 the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. SUB�ECi City of Fridley` 28679 5��BTpF THE TWINS BUILDING PERMiT NO. • _ _ COMMUNITY DEVELOPMENT DIV.® INSPECTION SEC r PROTECTIVE i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 11/30/98 JOB ADDRESS 6200 Stinson Boulevard 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Cochran'_s Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jean Olson971-3410 3 CONTRACTOR MAIL ADDRESS 933-6300 ZIP PHONE LICENSE NO Wellington Window & Door Qo- 393R Mendowbrook Ed- qt Tnijiq Pk 9549f; 352()n 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING 7 CLASS OF WORK O NEW O ADDITION O ALTERATION 7cJc REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Window replacement 9 CHANGEOFUSEFROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of house. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5344 $2.67 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $112.25 Fire SC $5.35 PLAN CHECK FEE TOTAL FE 1-111 $120. 7 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IRATE. E�'e MOPELDATED T I IS YOlIT S-GNATURE OF OWNER.If OWNER BUILDER. (DATE, BL 00 AD OA1E NEW ADDN [ ] CITY OF FRIDLEY Effective 1/1/97 ALTER [ ] SINGLE FAMILY AND DUPLEXF�S R-1 AND R-2 �. BUILDING PERMIT APPLICATION ConstructionAddress: d: Legal Description.- Owner escription:Owner Name & Address:e�� Q 5 Tel. # Contractor: MN LICENSE # Address:��� Tel. # 3- a Attach to this application, a Certificate of Survey of the o2 LP 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 S Ft. DECK AREA: q' Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: J Estimated. Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft:x $ — $ DATE: J 1 z y• g g APPLICANT: Tel. CITY USE ONLY e Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charg e TOTAL Fee Schedule on Reverse Side $ S 5,5- 001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $950 per SAC Unit L!�=- $5,00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ .$450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary ry [ ] Not Necessary [ ] STIPULATIONS: �� AP BUILDING PERMIT FEE SCHEDULE' 'I'lte Chief Building Official sliall, before issuing permits for the erection of any building or structure, or for any 4iddition 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 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $1()0,000 $100,001 to $500,000 Y $887.25 for first $100,000 plus $5.00 for each additional $1,000'or fraction thereof to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000;000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each. additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. 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 the proposed structure and of the construction site. A Certificate of Survey cif the lot, showing the location of the foundation mice it has it has been construe :_-d wi ! hL rccluircd hefore hnrcecdIng with the framin«. SUBJE61' PE O. City of Fridley 0370 AT THE TOP OF THE TWINS BUILDING PERMIT � RE EIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE 63 NUMBER- REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 J` 612-571-3450 910-F15 10/8/99 JOB ADDRESS 6200 Stinson Blvd 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 I Cochran's Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jean Olson 0 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Wellingaton Window & Door Co 8 - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential T CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 7i® REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the house. Permit Inspection cards W ill Be Mailed To Homeowner To Post SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED I WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2000 $1.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $69.25 SC $2.00 PLAN CHECK FEE TOT EE Lice a $5.00 $,,11.25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN ROP ALIDA THIS IS/YOUR Kq'o / ` SIGNATURE OF OWNERoF OWNER BUILDERI IDATEI BL iQINSP MATE NEW [ l Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address:C� Legal Description: Owner Name & Address: L04v\ (� � � Tel. # Contractor: Address: MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length DESCRIPTION OF 11NIPROVEMENT -7 1-3VCO Tel. # q3 3- d � 3 Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. OTHER: Construction Type: tjo U") R P (a,/e/-?a'-/Estimated Cost: $ 1 � Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 14v 01 -7APPLICANT:�_ e Tel. # � CITY USE ONLY Permit Fee $�'2 Fire Surcharge $'�, 0 0 - State State Surcharge $ /,()0 SAC Charge $ License Surcharge $ j _C► Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ r� STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] 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 DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $23.25. 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 the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. CITY OF FRIDLEY INSPEC-I iUN DIV. 6431 University Ave NE Fridley, MN 55432 763-572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On Jan 1, 2001 PLUMBING FIXTURE RATES: NO. RATE New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range" Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 TOTAL JOB ADDRESS (0-;t66 6L Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance c2L State Surcharge $ .50 TOTAL FEE $a —,Sc 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. 20d 5 Owner Building Used As a S Estimated Cost SbO, PERMIT NO. PLUMBING SIGNED Approved By ,a.- , h/ 1� TEL NO. -2 22 S Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Stories .- ••�}:, <` .ii}.:::::f-�iti2:.4:;: a:.::.: <:> I fit:: Urina : . �.:;:�::: i.{.. ,:: Shower ia:x......:<«: :..0 .::: <:%r :. ,.r:. :r.>.:..• < Wash .. Y:� jf%i• ri {::R.h••r% - .Gl.+:: a,:., Tray :<>:: <:>.:.:::: �3�?tiE:;::.:};}: :Floor .h:•v:C: E}:::C:Yi•r:-.v: .. ii Drain - Auto.is::;:.::.: `�i��. .:d C.; :i:::4:::iF:•:i:i:•:•:'• ORMWasher t :.:.: Gas :•ils `::?sh•`:. <}:.,; r:: Ran a`:=::.. = Water Heater <'`> ry.-?:.:?•; .;...k[..`:...:Y'M:: ::: Gas Elec :::ii.•.`:%<:`::. :... ....... • • qtr •}}}} .... :'?i : �;, ':':ipl.•pJ' Basemen lFoor ...:.::.}>...«.:::::::: ...4: .:..........:.:.:... I1 }x'ror. ..... ..ir.. ..v.,. of ::;:::-:p:::'•: - Floor 2 Vr< : LE r;ca Floor 3 Effl 00 FI r 4 : PLUMBING FIXTURE RATES: NO. RATE New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range" Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 TOTAL JOB ADDRESS (0-;t66 6L Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance c2L State Surcharge $ .50 TOTAL FEE $a —,Sc 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. 20d 5 Owner Building Used As a S Estimated Cost SbO, PERMIT NO. PLUMBING SIGNED Approved By ,a.- , h/ 1� TEL NO. -2 22 S Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes ( ) No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No ( ) When installina 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 : 643: University Ave NE Fridley, MN 55432 (763)572-3604 -7p3-611-/A APPLICATION FOR PLU SING AND GAS FITTING PERMIT MARK NUMBER OF FIX 0 em, W,6�5 M/9-/ 41 -614tf r' D PLUMBING FIXTURE;FATI= New Fixtures Old Opening, New Fixture Beer Dispenser slow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating.,4ppiiance Wat,--f Heater-Electrid . Watar Heater - Gas** NO. RATE TOTAL JOB i DRESS ,7V-'' $ 7.00 The undersigned hely mak" apprcadon For a peimft for thetwo, 6Telh $ 4,00 specified agreeing to do all work in strict: sc co --d. rice with1t,-,e city code- $ 5.00 and r lings of the Building Divisbon, arrf heroteft-et ail the $ 7.00 and representations stated in thts appl lion are true and cofr ct $ 7.00 $ 7.00 Gas Range" Gas Drye-r— B:ect': Flog Preventer Required( )Yes ( )N01 T1�f� Reinspection Fee $47.00IHr. $ 7.00 $10.110 $ 7.1`0 $10.00 $10.00 $1©.x)0 $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1,5% of Value of Fixture or Appliance State Surcharge TOTAL FEE Owner J /liOA/ Building Used As Estimated Cost 7J�� lJ PERMIT W). PLUMBING COMPANY �� r�.��.- ✓ o✓ �- � - � �,' T�' ®® FAX # 07 Approved By Rouyfi-In Data Final Date � 50 $ �Cr- MINIMUM MINIMUM FETE FOR ANY PL l'. M31INGfOsA.S P=MIT IS 520,00 S, PLUS THE +.50 STATE SURCHARGE CONIBUSTION AIR SHALL BE PROVIDED PER UPMC 3EC:TION 504(A) AND TABLE 6-A. COMMON VENT rNFO ON 3A0K Sia