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PRE 2010 DOCSCity ®£ Fridley, BURDING PERMIT N® 6911 Date: ' rV 9 Owner: Builder Address Address TION OF %NG No. Stree of Lot Lot _ __ _ Block a Addition or Sub -Division Corner Lot — Inside Lot _ _ `® Setback Sideyard LJ Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To Used to Front � Depth „ e� Height Sq. Ft. Cu. Ft. �B'�� .. Front _iDepth � Height � Sq. Ft. d P Ca. Ft..�e�ro Type of ction Est. �—`�Ro be Completed In consideration of the issuance to me of a permit to construct Abe buil ' g described a e, I to do the proposed work in accordance with the description above set . and in pliance � all ov9sions of ordinances of the city of Fridley. // 17 In consideration of the payment of a fee of $ _ = J , 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. done in, around and upon said building, or any thereof, shall cx�nform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any time urn violation of any of the provisions of said ordinances. Building Inspector NOTICE Ob perp* does not cover the sonstrustioo, hoteMon for wiring, plumbing, an heating, sewer or vaster. Be sure to We the Budldh* Inspector for soperate permdta for these dens. City of Fridley Application for Plumbing and Gas Fittting Permit Dept. of Bldgs. Phone SII 4-1 DESCRIPTION OF WORK I� Number, Kind and Location of Fixtures Location 47 NO. RATE Yl X unj C Z Z O w x w Z • F • N WATER HTR. GAS ELEC. New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ o�O 3.25 $ a� d qq 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 Base Gas Range to 200,000 BTU .............. x 2.00 $ t B 1st 2nd 3rd 4th ° Future Connection Openings Connected with New Fixture, Old Openings Sewer Cesspool PLUMBING FIXTURE RATES: NO. RATE TOTAL /0110 d Number Fixtures ...................... ty x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... d x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE 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 co ect. Fridley, Minn_ 0�-3' 19 &-/ Kind of BtiAding a Used as To be completed about .�`�v' - Estimated Cost, $ ®C ✓✓ Old—New. Building Permit No Permit N� Signed By 1Z - _ Business Phone No. k; 7— %/,z ®-v- ROUGH FINAL d2 97-84-879001 CITY OF FRIDLEY APPLICATION FOR PW MBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric water Heater x $3.00 $ x $2.00 $ x $2.00 $ x $5.00 $ x $5.00 w x Water o ami $7.00 $ m $5.00 $ a ro yon Q u, M w a w Im State Surcharge. Heater $ .50 TOTAL FCE $ 8.00 N REINSPECTION FEE +1 [ 4 G N C G C K q ; .14 0 x U' 0 -J 0 En v0 ii V a q ai N 3 4 w va S U W a 3 C74 t� O as 'lec 1st J LU 2nd 3rd 4 th (R) o Future Connection Opening Connected with Sewer (�) A New Fixture, Old Opening Wates PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric water Heater x $3.00 $ x $2.00 $ x $2.00 $ x $5.00 $ x $5.00 $ x $10.00 $ x $7.00 $ x $5.00 $ x $5.00 $ Job Address 1505 Trpll•agen Dors Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facL•a and representations stated in this application aro true and correct Fridley, Mn. 7-12-79 , 19 OWNER KIND OF BUILDING ftaM8 USED AS res TO BE COMPLETED ABOUT 7-19-79 ESTIMATED COST 40.00 OLD - NEW BUILDING PERMIT NO. PEPJ4IT NO. A} / `Q Company Signed By I+ItINNFf�A�(`A ROUGH INSP. Date Tel. No. GAS FITTING FEES: FINAL INSP. 1st 3 fixtures x $3.00 $ Date Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ APPROVAL FOR PERMIT01�Lj— REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE State Surcharge. $ .50 TOTAL FCE $ 8.00 REINSPECTION FEE +1 (51n.onI CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK K11 IMRFR OF FIXTI IRFS TO RF INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 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 l3aper Back Flow Pf6venfer 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 0� $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS I% of Value of Fixture or Appliance _ State Surcharge $ .50 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Estimated Cost PLUMBING COMPANY. SIGNED BY Approved By Rough -In Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $- PLUS THE $.50 STATE SURCHARGE Water:; Closet Urinal Bath: Tub Shower Wash Drink. Floor Catch Auto. Sink: Tray Fount, Drain Basin Washer Gas Appl.; Gas Mise'' ` Water Heater Range Fixt.. <: Gas Elec Stories Basemen Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 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 l3aper Back Flow Pf6venfer 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 0� $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS I% of Value of Fixture or Appliance _ State Surcharge $ .50 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Estimated Cost PLUMBING COMPANY. SIGNED BY Approved By Rough -In Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $- PLUS THE $.50 STATE SURCHARGE 1 SUBJECT P , City ®f Fridley 215 5 4 AT THE TOP OF THE TWINS BUILDING PERMIT r o _ COMMUNITY DEVELOPMENT DIV. rr r PROTECTIVE INSPECTION SEC. "1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 9/17/g2 JOB ADDRESS 1505 Trollhagen Drive NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 2 Innsbruck 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Don Kirchner 1505 Trollhagen Drive NE 574-0555 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Sawhorse Construction 4740 42nd Ave N, Robbinsdale, MN 55422 533.0352 2382 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 Construct a 14' x 12'.Addi-tion; a 20' x 20" Deck.; remove existing deck 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. Add smoke detectors. unless already installed. WAR Before cG all ligging call fog "till ry locations R nrr% ��454-0002R 1� By LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $11,644 $5.82 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $135.00 Fire SC $11.64 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE A 2- License SC $5.00 $157.46 SIGURE OF CONTRACTOR OR AUTHORIZED AGENT I IDAT'1 W EN PROP LY VL ]D TED THIS IS YOUR PERMIT DG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEi 1 NEW [ ] Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: J 57C> 5 T- Ll, 1-(A 4611J Legal Description: Lci '7; A-L'�CL -.2, ,�i��.5��'��`(�' ��-'a') m/0, Owner Name & Address: -Ro /< C 2 e, 14 Tel. # Contractor: �5'4c'j 14V MN LICENSE # Z -3 Address: 147 q 0 Lf �L- e A ge_ IJ �/ ��s � Tel. # 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 8 Width Hgt/Ground :24" Sq. Ft. OTHER: � !t) 0 Z.e, Corner Lot [ ] Inside Lot Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ f Approx. Completion Date: hJ o v /5t-" `d J. w144 — Driveway Curb Cut Width Needed: (Cost on Back) Ft. + b Ft = Ft x $ = $ DATE: C / q 2- APPLICANT: 1 Tel. # -2 -� IT _ USE ONLY Permit Fee $/ �,d''�� Fee Schedule on Reverse Side Fire Surcharge $ 11,61 .001 of Permit Valuation (1/10th%) State Surcharge $—_ 7 $.501$1,000 Valuation SAC Charge $ -- ---- $700 per SAC Unit License Surcharge $ .:9' 040 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ +' Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary ( ] TOTAL $ , P6 0 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 FEES $1 to $500 $15 (Minimum Fee is $15 plus surcharge) $501 to $2,000 $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3539.50 for the first $1,000,000 plus $2 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. e |jo� iIko/:,rk] m� ----------''--'----------- ' ---- — -------- ---'--------------------- --'--' I 7 GEORGE E. HOPKINS Registered Land Surveyor and Civil Engineer Phone SO. 1-8856 10701 Nicollet Avenue South Minneapolis 20, Minn. PLAT OF SURVEY Scale 1 inch 40 feet mor=TY of Rodney W. Billman 3000 — 36th. Ave. N.E. Minneapolis 18, Minn* oeserlbed' as 7, Block 2 �' Ibimak Znd IMitiou "-' deno}e5 iron monumi This surrey vas made and certificate drawn for the parpose of showing the . boundarisei of the lot and the easement of record. There are no encroachments. Building stakes .were not not by the surveyor. CERTIFICATE OF SURVEY that on D®c� 19--5-9_ I surveyed the property 'described above and that the above plat is a correct SUBJECT PERMIT NO. City of Fridley 21588 AT THE TOP OF THE TWINS BUILDING PERMIT ' i COMMUNITY DEVELOPMENT DIV. -R-E4DEPPT`N O. _ � e_ �/ PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15F 10/2/92 JOB ADDRESS 1505 Trollhagen Dr NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 Innsbruck 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kirchner 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Fireside Corner 2700 N Fairview, Roseville MN 55113 633-2561 1068 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 O REPAIR ❑ MOVE ❑ REMOVE S DESCRIBE WORK Install gas «Corner`s fireplace 9 CHANGEOFUSEFROM TO 1109. STIPULATIONS Separate. Gas. Permit necessary for gas line, Specifications of testing agency to be followed` TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $900 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 Fire SC $.90 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $21.40 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WH P E Y V L ATED THIS IS YOUR PERMIT � C/� / y r ' "5 BLD N P GATE SIGNATURE OF OWNER (I DOWNER BUILDER] IDATEI NEW I 1 ADDN ALTE I H Effective 3/1/92 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 nnilAina Permit Annlication Construction Address: ► _ a ��—�' L= °` Legal Description: Owner Name & Address: e t�R Tc}. # -- MN LICENSE # I � Contractor: AddrssC -=�... _ __� a (\� �� t-' �' a �J�Tel. # e _ 0 1 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 ARRA: Length _ Width Height Sq. Ft. DECK AREA: Length i� Width Hgt/Ground Sq. Ft. OTHI-R: ��? r X-14-3E1� Corner Lot [ J ' Insid& . t Ft. Yd Setback _ Side Yard Setbacks Type of Construction: Estimated Cost: $ quo.- Approx. Completion Date: I CIPSI (Cost .an Back) Driveway Curb Cut Width Needed: --Ft, + b Ft = Ft x $ $ DATE. 1 A1'NLICAN–� �, �b��-% Tel. #" CITY USE ONLY Permit Fee $_ JL Fee Schedule on Reverse Side Fire Surcharge $ _'i&1 .001 of Permit Valuation (1/10th%).•-:. State Surcharge $T $.50/$1,000 Valuation SAC Charge _– $ $700 per SAC Unit License Surcharge $� �'�d $5.(X) (State Licensed Residential Contractors) Driveway Escrow $ - Alt. "A" or Alt. "13" Above Park Fee $„ . _ o Fee Determined by Rnginceritig Sewer Main Charge $ - _ _ Agreement Necessary ( I Not Necessary [ ) TOTAL,; STI131 lLAT1ONS. CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, T 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 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 $ 30.00 representations stated'in this application are true and correct. (Side Vent — Fill Out Back) ,1995 Gas Piping (Needed with new furnace) $10.00 $ 7`i ' ® 5 OWNER, /�� Gas Range $10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ ESTIMATED COST ��C� PERMIT NO.� *Air Conditioning — All Sizes $ 25.00 $ pgSCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Waterl)arm Air Trade Name Size No. Commercial/Industrial BTU_7, VO HP EDR 1.25% of Value of Appliance or Work $ Fuel eglff Total Connected Load State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY Signed By Approved By' LLE Rough—In Date Final Date FILL OUT BACK SIDE // FOR STACK VERIFICATION ON REPLACEMENT FURNACE 1;4 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done. - HEATING CO: Signed By: Date: Yes () No ( ) Yes () No ( ) i 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 ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done. - HEATING CO: Signed By: Date: Yes () No ( ) Yes () No ( ) i HEATING TEST SUMMARY ADDRESS CITY, SUBURB OR TWP. OCCUPANT bM 4`U'5 Rev- OWNER DATE HEATING INSTALLED -TS INSTALLED BY -5ex/j2 TYPE OF HEATING GA. FA HW STEAM UNIT HTR. MAKE MODEL 6,P9Q� ®675-J SERIAL 5026 006-34 INPUT 1Sx o®0 THERMOSTAT llo6Le ' HEAT ANTICAPATOR SETTING GAS VALVE —w _ LIMIT /�' SETTING a,� oa FAN SETTING i=::,K& ON �X.00 OFF PILOT TYPE -SlWk- Pt"t- IGNITION MAKE MODEL 0-776-R&D--zllMING 1 �� GAS PRESS. •9" PERCENT CO2 6 a 02 CO CFH INPUTS STACK TEMP / 7 -of VENT SIZE 2 DRAFT FILTER SIZE 16M CHIMNEY LOCATION IN. - C T. CHIMNEY CONSTRUCTION WIRING TEST TAG INSTALLED LIGHTING INST. DATE TESTED 3-95 . TEEING COMPANY _SUBURB HTG. & A/C NAME OF TESTER CITY OF FRIOEY INSPECTION DIV, Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE 45�lr - 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 $ 30.00 $ representations stated in this application are true and correct. (Side Vent — Fill Out Back.)% l ,1996 Gas Piping (Needed with new furnace) S10.00 $ OWNER All, 1 Gas Range $10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ ESTIMATED COST PERMIT NO. "Air Conditioning — All Sizes $25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs $ Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) I Trade Name Size No. Commercial/Industrial P BTU HP EDR 1.26% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge S .50 Burner Trade Name Size No, BTU HP EDR TOTAL FEE S-6�_ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE S.50 STATE SURCHARGE REINSPECTION FEE 542.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING COMPANY Signed By Tel No.�/CG�� Approved ByRough—in Date Final Date <Ltl FILL OUT BACK SIDE R STACK VERIFICATION ON REPLACEMENT FURNACE 3uilding $ BUILDING See Back Page for Fee Schedule Permit No.:00 =nspections RESIDENTIAL APPLICATION ucharge Received By: 763-572-3604 (.0005) times the total job valuation — Minimum $.50 CITY OF FRIDLEY $ , , AY 0 A10 )ATE 3 /10 YOUR E-MAIL ADDRESS ITE ADDRESS t4 C S -T,^D l! 4 0 /I S I V E 5 , 00 $5.00 (State Licensed Residential Contractors) %C Charge $ 'HIS APPLICANT IS: ❑ OWNER -B+CONTRACTOR irb Cut Escrow 'ROPERTY OWNER/ NAME: Chif� %c A n 0 ft + 6 ft = ft x $20 = $ TENANT /� ADDRESS: ��7 0 5A r0 [ %) (� Q (/� GTTY % /-el TATE ZIP 6 L( a 1 $450 Conservation Plan Review PHONE:_ L t 3 t• S 3 �l 3 $ Pella Windows & Doors CONTRACTORNAME:_ 15300- 25th Avenue N.- Suite 100 C( S A � y S . G n t( -7 SUBMIT A COPY OF STATE LIC Plymouth, MN 55447 Make checks payable to: City of Fridley Attach Stipulations YOUR STATE LICENSE ADDRESS: 763/ 745-1400 CITY STATE ZIP WITH APPLICATION PHONE PROPERTY TYPE -USINGLE T.lcense# 20165884 ❑ TWO FA _ .'ORMS PERMIT TYPE QADDTTION ❑ GARAGE/SHEDWIND OWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION t544AINTENANCE/REPAIR ❑ REMODELING JJ ,ESCRIBE WORK BEING DONE: A �Io Woo r i (/0 w r t 1A lklr 1,o,* b e / 1%4-4 truntt,S IZE OF IMPROVEMENT LENGTH WIDTH HEIGHT . Ft OOFING ❑ HOUSE ONLY UTTER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: -RAGES ❑ ATTACHED GARAGE I. 2. Existing Floor Plan Proposed floor plan tOPOSED SIZE: El DETACHED GARAGE 3. List of structural members to be used ZOPOSED HEIGHT: :DING FOR NEW CONSTRUCTION INCLUDING DECKS, Vinyl ❑Soffit ADDITIONS & PORCHES SUBMIT: Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures Other ❑ Fascia and proposed project 2. Two sets of construction plans INDOWS EXISTING OPENINGS '1SYes ❑No LOCATION OF WINDOWS CI U + 4 J100�''1 3. Energy Calculations 2 FOR NEW OPENINGS -DESCRIBE SIZE OF ,ENING CHANGES & : PE OF WINDOW TO BE INSTALLED PA 3+p+dt t'u�UER OF WINDOWS l pD ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ $ 1 s G OCCUPANCY TYPE ,rmit Fee $ 14 '7 . 5 See Back Page for Fee Schedule an Review $ 65% of Building Permit Fee ucharge $ It 31 (.0005) times the total job valuation — Minimum $.50 re Surcharge $ 00.7 a/ ,001 x Permit Valuation (1/10%) cense Surcharge $ 5 , 00 $5.00 (State Licensed Residential Contractors) %C Charge $ $1450 per SAC Unit (Plans to MWCC for determination) irb Cut Escrow $ ft + 6 ft = ft x $20 = $ osion Control $ $450 Conservation Plan Review rk Fee $ Fee Determined by Engineering ;wer Main Charge $ Agreement necessary ( ) Non Necessary ( ) ,tal Due $ l 'g 5. e1 I Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED iereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a rmit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved m in the case of all work which requires review pid. approval of plans. NATURE OF APPLICANT �� PRINT NAME 7 S c h P n DATE �� 1 y BEFORE Width=112.5" Height=47" 47" 30" 52.5" 30" • Job 789MREWOH / Kirchner AFTER Width=112.5" Height=53" 112.5" 30" 52.5" 30" �u-� ` _il�ie�C