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PRE 2010 DOCSVillage of Fridley, Minn. BiTI MING FERMW Office of INSPECTOR OF BUILDINGS Fridley, Minn.,° , 19141 LOCATION OF BUILDING Street"'' ."�- '�'> Q Part of Lot Block Addition or Sub -Division DESCRIPTION OF BUILDING Front -1' Depths "4 height f Stories 0""t Manner of Construction To be used ar3`x p 8 +" 'r» To be Com leted ; Estimated Cost Permit is hereby the building 61 upon the express c the work done in, nances of Fridley, within the city lin ordinances. S sm described in the above statement. This permit is granted icon that the person to whom it is granted, and his agents, employees and woikmen, in all and and upon said building, or any part thereof, shall conform in all respects to the ordi- m., regarding the construction, alteration, maintenance, repair and moving of buildings and this permit may be revoked at any time upon violation of any of the provisions of said in_snector of Buildings. ,, z — 71 AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector', of Buildings of Fridley of the above permit! I hereby agree to do the proposed work in accordance with the description above set forth aid according to the provisions of the ordinances of Fridley, and, being first duly sworn, I herebystate and say that the facts stated by me and contained in the above permit are true as therein ted. day of sworn to before me at Fridley, +c ::--A.D.10- City of Fridley, Mm. BUILDING PERMIT - P Date:0jr-'I �/' Owner: N° 5387 Builder -- Address ,,rr LOCATION OE ; ,,UILDING X0- -/ 4;1/ - Street Y s, _ _Part of Lot Lot _ ___r___.__ Block _ _ Addition or Su i}rsion Corner Lot ....._ Inside Lot � � —back fi � ideyard Sewer Elevation - _ __ . _ _ F dation Elevation -- -- To be. Usodas• bar 'Front DESCRIPTION OF BUILDING r_ Depth , Height Sq. Ft.f > Cu. F"'. /. Fro Depth _ . Height ;V45 ... Sq. Ft.. Cu. Ft. ,-, . Type of Construction Est. obstTo be Completed 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 $-F=..,._..—, permit is hereby granted to 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 clone 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, re . and moving of buildings within the city limits and this permit may be revoked at any time upon viola tipn a a of the provisions of said ordinances. -r - o /' Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to we the Building Inspector for separate permits for these items. 4 HOUSE -HEATING TEST,_ RECORD ADDRESS La APT. FLOOR CITY SU RB %o"f OCCUPANT" 01,e C-aA2 OWNER sa HEAT LOSSD TE HTG. INET. SOLD BY �,/j�t�� �'� 2f INSTALLED BY � � Electrical Work By Gas Line By - TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER MAKE Model Serial INPU G S DESIGN CONVERSION �/ MAKE OF BURNER Model Max. BTU Rating MAKE OF FURNACE Pilot Model Model OT Vent Size KIND OF LINE SIZE 12 NONE Draft Hood Regulator Filters Size xA I Number Chimney Location Ins0utside Chimney Construction tt p/ @� Smoke Pilot Timing 7 S� d5� e ® Draft L.W. Cut Off Pressure :3 g` Percent CO2 a Input CFH Percent O Stack Temp. Percent CO'* Form 235 Door Bomb Wiring 0/," —moo .Test Tag 6 -®Le ::., Pressure Ir / Lighting Inst. a-�P.�d'r���� Date Tested Company Testing Name of Tester CONTROLS THERMOSTAT Heat Plug +,a VC, I,,. Limit W [ Limit Setting Fan Setting ZI 10 Pilot Type Pilot Make S Pilot Model Model OT Vent Size KIND OF LINE SIZE 12 NONE Draft Hood Regulator Filters Size xA I Number Chimney Location Ins0utside Chimney Construction tt p/ @� Smoke Pilot Timing 7 S� d5� e ® Draft L.W. Cut Off Pressure :3 g` Percent CO2 a Input CFH Percent O Stack Temp. Percent CO'* Form 235 Door Bomb Wiring 0/," —moo .Test Tag 6 -®Le ::., Pressure Ir / Lighting Inst. a-�P.�d'r���� Date Tested Company Testing Name of Tester CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 r Residential APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fiat . ~ Shell and Duct Work, Burner - 1' .. ement Furnace Gas Fit; ;cJ (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repalrs.& Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1% of Value of Appliance or Work Rate $ 20.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 State Surcharge TOTAL FEE Effective On January 1, 1993 •: ADDRto ESS The undersigned hereby makes application for a permit for the work herein TOTAL 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 s 00 representations stated in this application are true and correct. ,1993 $i I?—C BUILDING USED AS�� Q ESTIMATED COST 4 /(�5(� PERMIT NO. ! l QESCR)PTfION OF FURNACE AND OR BURNER $ No, of Heating Units ` Circle One (Steam) (HotWater) arm Air) Trade Name �f'I-►Y1n.kP�' Size No. D 00 Q0 R -toe BTU HP EDR $ Fuel— Gap, Total Connected Load 50 Burner Trade Name Size No. BTU HP EDR $ 0 MINIMUM FETE 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. DRENDAM INDOOR AIR QUALITY, INC, HEATING COMPANY_ 2619 COON RAPHL18. fit: ►i EVARD COON RAMS. MN 554? 3:J Signed By Tel No. :15:1 - 5h L4 n Approved B4E Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: I. Has been carefully examined Yes�c (/ � No ( ) 2.. Is free from rust or deterioration Yes {) No ( ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes (°y'-) No ( ) 5. Meets all current Code requirements for size and total BTU's connectedy Yes ( ) No ( ) 6. Has total heating BTU's or All other BTU's TOTAL BTU's j. Oct J1 Remarks List Alterations Being Done- N 01 SUB.IEtT City of Fridley 2 9 71 AT THE TOP OF THE TWINS BUILDING PERMIT � `y ------COMMUNITY DEVELOPMENT DIV. RECEIPT NO. 13R 4 r � PROTECTIVE INSPECTION SEC. � NUM9ER REV DATE PAGE OF APPROVED By i CITY HALL FRIDLEY 55432 it.... � �'' 612-571-3450 910 -FIS 7/14/99 JOB ADDRESS 6131 Sunrise Drive NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Betty Robertson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings 6331 Riverview Ter,574-9966 4051 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 O NEW O ADDITION O ALTERATION V REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof house and garage 21 S Tear-off CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 $1835 92 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION 66.20 Fire A $1.84 PLAN CHECK FEE TOTAL q9 Li, S-GNATURE OF CON'RACTOROOAUTHORiZED AGENT iDATEi MEN PRO LI A E I$ IS Y UR PE I 1 S-GNATURE OF ON/NERnF OWNER BUILDER. ,DATE1 11R, 04.iNSP TATE 01 .. . NEW[ l Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FA ULY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 6/3/ Legal Description: Owner Name & Address: R g rr, /Zp Int t7 S 0 Al Tel. # Contractor: ,, Ck A &-D )4k' Ic - 6 "'5 -S MN LICENSE # D 5 Address: � ) a, U � 1 (97 L-) T- tc Tel. # �' � �9 �� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: $ $1050 per SAC Unit License Surcharge Construction Type: ` a F F -4-tC tF20 o F Estimated Cost: $ Alt. "A" or Alt. "B" Above Erosion Control Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: - l Ydl 2 APPLICANT: e Tel. # S? T- P fa TOTAL STIPULATIONS: $ 2.5. 9� CITY USE ONLY Permit Fee $ �. �U Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $—.1 $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ Lj '! ,O $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 [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ 2.5. 9� 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. Building BUILDING Permit Fee Permit No.: Inspections Plan Review RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Surcharge Date R 763-502-4977 FAX License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ EFFECTIVE 1-1-2010 Curb Curt Escrow $ DATE II % YOUR E-MAIL ADDRESS a Gl fZ �WS W- { U -CQ 01 SITE ADDRESS t 3 [ 1.t.11rlU Di N 6 - $ THIS APPLICANT IS: ❑ OWNER CONTRACTOR $ PROPERTY OWNER/ NAME: p $ TENANT ADDRESS: IDA I Zw && S e 1/ f • ME CITY k JA W,4A STATWPZz _6 PHONE: �(p�J-i)'%�p` CONTRACTOR NA M:TI1®,i inflow Store Home IlilpfoVePl° ez.—�.3 SUBMIT A COPY STATE LICENSE # 2 31 -/ �jZ EXP DATE %Z YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: Z� Z �( &ftft�.�n e,* I 1!5 CITY + . STATF 4ml ` SS!# R INSURANCE PHONE 2 • FAX PROPERTY TYPE DAINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED INDOWS ❑ BASEMENT FINISH ❑ ROOF DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION I 1A MAINTENANCEMEPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:( JYL ,6,r jpruo SIZE OF IMPROVEMENT J 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: . SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, El Vinyl psojT ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS )!QYes []No LATION OF WINDOWS A FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF �'�J Mew -t epC, M MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & s IN TYPE OF WINDOW TO BE INSTALLED UJA NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 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 Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Curt Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due. $ Make checks payable to: Ci of Fridle 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 p permit on site; that the work will be in accordance with the approved plan in the case ofryall �work which requires review and approval of plans. r SIGNATURE OF APPLICANT J jUt Ait� , � PRINT NAME ( eem I. sa n DATE S Y 1O PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK I