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PRE 2010 DOCS01 SUBJECT #E City of Fridley 33325 AT THE TOP OF THE TWINS BUILDING PERMIT 1 , AftEffirOO. � rr COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 � NUMBER REV DATE PAGE OF APPROVED BY _ CITY HALL FRIDLEY 55432 763-571-3450 910-F15 1/22/03 JOB ADDRESS 6464 Van Buren Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4,5 4 1 Florence Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Osborne Builders Inc 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Osborne Builders Inc 5869 Hackmann Ave NE, Fridley, MN 55432 763-502-6765 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20332034 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK NEW O ADDITION 0 ALTERATION O REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Construct a 44' x 25' Dwelling; a_22' x 22' Garage; and a 10' x 10' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide City with a copy of a VXXXXXXX verifying survey before capping. Provide sod in the front and side yards. Provide a hard surface driveway. Paid park fee of $750.00. SEWER & water locations: See City Engineering Department SEPARATE PERMITS WARNINEG" RE IED FOR: Befor® digging call for VNIRI HEATING all agility locations � 00� PLU8pPIt� AND SIRS 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 SQ. 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX Fire SC AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $54.79 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $109,576 $109.58 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS & ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANC OF CONSTRUCTION PLAN CHECK EE L ens SC $5.00 TOTALFEE $2,494.12 + PF ^� `_ S-GNAruRE OF CONTRACTOR OR AUTHORIZED AGENT (DATErW EN PROPERLY VALIDATED THIS IS YO R PERM yr 1 /, G IOAtE S,GNATURE OF OWNEROF OWNER BUILDERI iOATEi 01 NEW CITY OF FRIDLEY Effective 1/1/2003 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: Legal Description: ®� 5 Owner Name & Address: Contractor: n5. oe,4 z Arlrlr=cc•1r_k4 f kelckw, ref e_ All Tel. #P,2^a)0 MN LICENSE # .✓ 41-515 yj��el. # )43 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT J LIVING AREA: Length L( Width Height Sq. Ft. 7, GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: ALe_1SX__1_ Estimated Cost: $ / q 6 00,�— Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ • IP APPLICANT: DATE. 1/ (� Tel. # 142)� 9/ 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. CITY USE ONLY - Permit Fee $ 0 �0 0 Fee Schedule on Reverse Side Fire Surcharge $ / 5 .001 of Permit Valuation (1/10th%) State Surcharge $ 64 '79 $.50/$1,000 Valuation SAC Charge $ 0 a?S. ®O $1275 per SAC Unit License Surcharge $ 6,0 $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ _750. Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS TOTAL $ '� . i /JeA.) p y /' e ui-j-(s 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 ' 11 11 � ' 111 111 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 $1,000,001 and up $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 $17.00. 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 NEW ADDN [ ] ALTER [ ] Construction Address: { I cnal nimcrrintinn• L C7 i CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION (�q �q Ilia �3a,.) S4 - e Hlqk 0`10 9"00 Effective 1/1/2003 (763) 572-3604 Bldg Insp (763) 571-1287 Fax IN -HI -®IIS Owner Name & Address: .) Tel. # A, Contractor: DS Aen eMN LICENSE# Address: mac' 7 -4/e /ti / l-; le -1 A ltl-521%dfel. # )4, --5-0,2 1 qq,D Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT 0 LIVING AREA: Length L( Width j "Height Sq. Ft. GARAGE AREA: Length 2 Width °C '^ Height Sq. Ft. �/C3 f DECK AREA: Length i Width Hgt/Ground Sq. Ft. /00 OTHER: pi' ' G�rt1 ` is Il /C� '//�,, 7�• 7q Construction Type: Estimated Cost: $ V 00 �1— Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ c�In p d9 DATE: ''�� ^ APPLICANT: Tel. # 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. CITY USE ONLY - Permit Fee $ /0 Fee Schedule on Reverse Side Fire Surcharge $ / .001 of Permit Valuation. (1/10th%) State Surcharge $ -79 $.50/$1,000 Valuation SAC Charge $ / aZ ? S • 00 $1275 per SAC Unit License Surcharge $ 5.00 $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review -560 ark Fee $ '4-7 . jOFee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ TOTAL $ '�11 LKIr I STIPULATIONS* L1 ��- �� ,�ce� City of Fridley 6431 University Ave. NE Fridley, MN 554324383 763-571-3450 08 -Jan -03 Special Assessment Search And Statement of Charges TO: On all that tract or parcel of land lying and being in Anoka County, Minnesota described as follows to wit: Parcel No: 14-30-24-41-0118 Lot: 4-5, Block: 4, FLORENCE PARK ADD LEVIED SPECIAL ASSESSMENTS This is to certify that I have examined the records in the office of the Clerk, City of Fridley, Anoka County, Minnesota, and for such search, certify that the following special assessments appear unpaid with respect to the above described tract or parcel of land: Term Certified Initial Interest Remaining Current Current Proiect Number Proiect Description Type (Yrs) Date Amount Rate Balance Principal Interest 9100-0000-00 OOREG SA(Water/Sewer 5120 15 12/31/1960 $380.57 5.00% $0.00 $0.00 $0.00 4000-0049-00 00 SS 4400 20 09/25/1962 $100.05 6.00% $0.00 $0.00 $0.00 6000-1975-00 OO ST 6400 10 04/19/1976 $1,150.52 7.50% $0.00 $0.00 $0.00 Amount Certified to Anoka County Auditor for Current Year Taxes Is: $0.00 PENDING SPECIAL ASSESSMENTS For the purposes of this document, the City of Fridley has determined that an assessment is considered pending after the City Council passes a resolution ordering the improvement, the approval of plans and the advertising for bids. This is prior to the City Council adopting the final assessment roll. If you seek further information, you should do so upon your own independent inquiry. Any amount given as to pending assessments is informational only and may or may not be the amount ultimately assessed. Term Initial Interest Estimated Proiect Number Proiect Description (Yrs) Year Rate Pending Amt. NONE MISCELLANEOUS FEES Description Status Date Fee Amt. NONE UTILITY CHARGES You shall be responsible to verify the status of any outstanding utility charges. To check utility charges ( water and sewer) contact Fridley Utility Billing Department at 763-572-3529. The records referred to above are public and may be inspected by anyone during regular business hours. The search of these records was made by the undersigned as a public service on request. The undersigned certifies that the above indicated searches were made and are believed to be accurate, however, the undersigned or the City of Fridley does not insure the accuracy of the above statements and does not assume liability for errors and/or omissions. The above figures are good through November 15, 20 Date Prepared: Wednesday, January 08, 2003 By Page 1 of 1 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2003 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures l� 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 () Nc Type $ 7.00 'N, 06) The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $7.00 .2003 $7.00 $10.0.00 Owner 6o' Cis born ul $ 7.00 $10.00 10,®0 Building Used As h r< Lous $10.00 $10.00 Estimated Cost PERMIT NO. $15.00 PLUMBING COMPANY N 0('J S ?>rO&"1 0 c) Reinspection Fee $47.00/Hr SIGNED BY. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By State Surcharge .50 MINIMUM TOTAL FEE $ Lam% _0 PLUS THE TEL N0. Z6 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 THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED CnMMAN VENT. VFNT CONNECTOR AND CAMgI ISTI )N AIR VFRIFICATInN When re In acing 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 .emhus Inn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to Install a new _nmh s inn air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When ins affi g 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 #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 HEATING CO: Signed By: Date all NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 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: (6 W Uk ,-, Lty-e_C4 .5+e { Legal. Description: Owner Name & Ac Contractor: Ad 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: Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: //-$ Ft x $ DATE: �t 5—U APPLICANT: el.# 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 R TOTAL $ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 PERNUT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition t6 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 ' 11 11 � ' 111 111 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 $1,000,001 and up $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 $17.00. 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 1W C17YOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 July 22, 2003 Osbome Builders Inc 5869 Hackmann Ave NE Fridley, MN 55432 RE: Final Inspection at 6464 Van Buren Street NE, Fridley, MN Dear Sirs: A final inspection was conducted on July 22, 2003, for the completion of the dwelling at the above address. The inspection noted the following items that need to be completed before the permit can be finaled: 1. Complete final grading and provide sod in the front and side yards. 2. Provide the City with a copy of the verifying survey. We will expect the above items to be completed on or before August 30, 2003, and a reinspection called for. The dwelling is approved for occupancy. If you have any questions concerning this matter, please feel free to contact me at 763-572- 3603. Inspector DJ/Is CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 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 1.255o' of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE 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. Effective January 1, 2003 JOB ADDRESS�L� OWNER TOTAL BUILDING USED AS .�r✓el� ��,`�v ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units_ Circle One (Steam) (Hot Water) arm Air $ Trade Name Size No. GUclPo 2� BTU ;raonev HP EDR $ Fuel Total Connected Load Burner Trade Name Size No._ $ BTU HP ED $ 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 $ 1 5 a representations stated in this application are true and correct. DATE JIi�a3 HEATING CO Z_� Signed FAX # vz� Approved By _ Rough -In Date Final Date /� THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When rant" me an eYietina 1i 'ranee, the undersigned hereby verifies that the BTU Input BTU Input venting has been examined and is free from rust, deterioration, obstructions, Yes i No ( ( ) and is securely supported and firestopped where required. _ Fan Assisted or Nat The venting system is plastictPVC and meets all current codes and manufacturer Yes (► No( ) specifications including sizing, length, number of elbows and termination. Common Vent Type The undersigned also verifies that the replacement unit is a listed assembly Diameter inches and meets the current codes and manufacturer's specifications. This does _ ft Length include AGA-GAMA Category I Central Furnace Venting Tables for fan Yes () No( ) assisted and natural draft appliances. ft Diameter ft Diameter Type N The axinfing rnmho intien air is sized and installed to meet the current codes Yes () No ( ) and manufacturer's specifications. When required to'--`-" a now cnmw ictinn air_ it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When iostalWinane�gSy`M, 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 Yes No Venting Tables for fan assisted and natural draft appliances. () ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented Yes( )No( ) separately as per current codes. Appliance #1 Type BTU Input BTU Input Fan Assisted or Nat Fan Assisted or Nat Appliance #2 Type 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_,_____ in Type Appliance #2 Vent Connector Height ft Length Length ft Diameter ft Diameter Type N Appliance #3 Vent Connector Height - _in HEATING CO: Signed By: Date : CfiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 September 22, 2003 Osborne Builders 5869 Hackmann Ave NE Fridley, MN 55432 Re: Final Inspection at 6464 Van Buren Street NE, Fridley, MN Dear Sirs: A final inspection was conducted on September 22, 2003 of the new house construction at the above noted address. The inspection noted that the construction has been completed in accordance with the approved plans. The structure is approved for occupancy. Ifyou have any questions on this matter, please feel free to contact me at 763-572-3603. Sincerely, DJ/mh CITY OF FRIDLEY PERMI O.: 2004-01260 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE I /2004 , (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6464 VAN BUREN ST NE PIN : T000052 LEGAL DESC : FLORENCE PARK ADD : LOT 4 BLOCK 4 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A WATER SOFTENER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 300 # WATER TRMT APPLIANCES 1 APPLICANT PLBG PERMIT MIMMUM FEE 0.00 SHILOAH WATER CO PLBG FIXTURES (NEW OPENINGS) 0.00 7319 166 AVE NW PLBG FIXTURES (EXIST OPENINGS) 0.00 RAMSEY, MN 55303- WATER TREATMENT APPLIANCE 35.00 (763) 753-9244 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE 0.00 OWNER GAS DRYER FEE 0.00 HUGO DZHIC PLBG REPAIWALTERATIONS 0.00 6464 VAN BUREN ST NE STATE SURCHARGE, PLBG FLAT 0.50 FRIDLEY, MN 55432 TOTAL 35.50 PAID WITH CHECK # 9995 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 any other state or local law regula ' g cons c n or the performance of construction. Applicant t .i Date t Bldg Ins p Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE ` Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wash Floor �> Auto. :. •:.�`::::::>:� �i:.....-- :�.�7.::::>:::::::::: G8S .:: Water Heater Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: Urinal I'll i1Shower NO. RATE TOTAL New Fixtures $10.00 Old Opening, New Fixture $10.00 Beer Dispenser $10.00 Blow Off Basin $10.00 Catch Basin $10.00 Rain Water Leader $10.00 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 Water Heater -Electric $35.00 Water Heater - Gas** $35.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Drain JOB ADD 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. 1-1 DATE:L6 20=� OWNER BUILDING USED ESTIMATED COST PERMIT NO. PLUMBING Reinspection Fee $50.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance �6� State Surcharge TOTAL FEE TEL N0. 2(sa�� Approved By MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT: VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina 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. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and terminatidn. 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 Fumoce Venting Tables for fan assisted and natural draft appliances. Yes () No( ) I� 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 : i CITY OF FRIDLEY PERMIT NO.: 200402247 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/07/2004 572-3bU4 F -AX: (7b3) 571-12117 REPRINTED ON 12/8/2004 ADDRESS : 6464 VAN BUREN ST NE PIN : T000052 LEGAL DESC : FLORENCE PARK ADD : LOT 4 BLOCK 4 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 1,700.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. APPLICANT HUGO DZHIC 6464 VAN BUREN ST NE FRIDLEY, MN 55432 OWNER HUGO DZHIC 6464 VAN BUREN ST 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 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 BUILDING PERMIT FEE 60.10 PLAN CHECK FEE 39.07 FIRE SURCHARGE 1.70 STATE SURCHARGE, VALUE 0.85 TOTAL 101.72 PAID WITH CHECK # 2189 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. FJ NEW O CITY OF FRIDLEY ' tuecuve 4! ii/-uu4 ,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: 644 VAN �)�, Izoxj 5X434 Legal Description: Owner Name & Address: %� S� � � Tet. #M2 67Z 13 42 Contractor. 5E L ye:r MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT It Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type: SCJ 1 r J� �� Estimated Cost: $ I a° Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: APPLICANT: Tel. # 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. CITY USE ONLY - Permit Fee $ hr Fee Schedule on Reverse Side Plan Review 65% of Permit Fee Fire Surcharge $ �_ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1350 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Curb Cut 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: qW 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 $501 to $2,000 $23.50 for first $500 plus $3.05 for each additional $10 or fraction thereof, to and including $2,000 $2,001 to $25,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,00 $25,001 to $50,000 $391.25 for first $25,00 plus $10.10 for each additional $1,00 or fraction thereof, to and including $50,000 $50,01 to $10,00 $643.75 for first $50,00 plus $7.0 for each additional $1,00 or fraction thereof, to and including $10,000 $10,01 to $500,00 $993.75 for first $10,00 plus $5.60 for each additional $1,00 or fraction thereof, to and including $50,000 $50,01 to $1,000,00 $3,233.75 for the first $50,00 plus $4.75 for each additional $1,00 or fraction thereof, to and including $1,00,00 $1,00,001 and up $5,608.75 for the first $1,00,000 plus $3.15 for each additional $1,00 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 P7 z 10 Cm O 0,10 a CITY OF FRIDLEY PERMIT NO.: 2004-02271 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/13/2004 572-3604 FAX: (763) 571-1287 ADDRESS 6464 VAN BUREN ST NE PIN T000052 LEGAL DESC FLORENCE PARK ADD LOT 4 BLOCK 4 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS 1 APPLICANT HUGO DZHIC 6464 VAN BUREN ST NE FRIDLEY, MN 55432 OWNER HUGO DZHIC 6464 VAN BUREN ST NE FRIDLEY, MN 55432 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 ELECTRIC FORM FEE 1.00 TOTAL 21.50 PAID WITH CHECK # 2195 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 SEPARATE PERMITS REQUIRED FOR WORK 01-HFK THAN DESCK113hi) ALSUVII. Building BUILDING Permit No.:et,�4S "-moi Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: -DO DATE 1-5 YOUR�EJMAIL ADDRESS SIADDRESS I'r J TE N � %. /V ?137 5643M THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: S 0 3Z/ / G TENANT ADDRESS: CITY STATE—ZIP PHO CONTRACTOR NAME: OW tv STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE ❑ SINGLE 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: ANEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: I I SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2• Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING 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. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ I,580. �4+6 OCCUPANCY TYPE Permit Fee $ ® See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ b 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; that the work will be in accordance with the approved plan in the case of all work wY140 requires revie and approval of plans. %� j /� /� SIGNATURE OF APPLICANT � 3 Z/ L PRINTNAME �/ U50 3 Z7 #1 y DATE U ' O� 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 n $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for l' $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 1" $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 1s` $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 Y2,� CX '01, Building Inspections 763-572=3604 DATE IT 6' .1 - -- 4- SITE ADDRESS 6464 THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR F- MAIL ADDRESS Al OWNER ❑CONTRACTOR NAME•//C� ZJ s�I a - ADDRESS: N n) /80 z / % ` CITY PHONE: 63 571 3 NAME: STATE LICENSE # EXP DATE ADDRESS: CITY STATE ZIP Permit No.: 1000 Received By: Date Rec'd: TFIAZIP. PHONE PQ SINGLE FAMILY/Ni ❑ TWO FAMILY/NEW ❑ ADDITION BASEMENT FINISH DECE �v ! o";CR FAX ❑ ROOF ❑ DRAIN TILE ❑ SIDING ❑ OTHER ❑ SWIMMING POOL AIR ❑ ADDITION DESCRIBE WORK BEING DONE: qq SIZE OF IMPROVEMENT LENGTH / vc WIDTH / G f HEIGHT Sq. Ft. NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 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 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ -7 OCCUPANCY TYPE Permit Fee $ 97 25' See Back Page for Fee Schedule Plan Review $ (,i ',3 0 65% of Building Permit Fee Fire Surcharge $ 3 ® q, (-") .001 times the total job valuation Surcharge $ o a , �� .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ 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: City of Fridle Attach Stipulations THIS IS AN APPLICAT16N FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building perr d I a edge 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; that the work will be in accordance with the approved plan in the case of all work which T'quires review anapproval of plans.1 SN PRINT NAME DATE IGNATURE OF APPLICAS^ � " -� 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 l' $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