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PRE 2010 DOCSArchitect-' ' Builder x � � Front To be used as--!j- Permit i Permit is hereby granted to a, # r e . 9, the building—, a p� fir, described in the above statement. This permit is granted upon: the express co dataion that the Pon to whom it is granted, and his agents, employees and workmen, in all the work done my nd and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley;14nin., regarding the construction, 'alteration, maintenance, repair and moving of buildings within the city]amit , and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. I, � � � il � >"�� � �4 Inspector of Buildings. AGREEMENT AND SWORN STATEMENT In considLrIjon of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permitI I hereby agree to do the proposed work in accordance with the description above set forth d according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby�tateand say that the facts stated by me and conained in the ab ve permit are true as therein stited. s f x r� Subscrilped and sworn to before me at Fridley, Minnesotc,,'`thss u A.D.y 1 h �. day a r$-ri }D9'e) i Village of Fridley, Minn. BUILDING PERMIT N? 912 Office of INSPECTOR OF BURDINGS ii Owner Architect Builder Fridley, Minn_ 19 LOCATION OF BUILDING Street NO. e —Part of Lot Lot Block.Additionor Sub -Division DESCRIPTION OF BUILDING Depth Height- Stories 6r -Manner of Construction To be used as -4 !!24". To be completed- Estimated Cost (7 Permit is hereby granted tc,. an the building- described In the above statement. This permit i s granted upon the express condition that the person to whom It is granted, and his agents, employees and workmen, In all the work done in, around and upon said building, or any part thereof, shall conform In all respects to the ordi- nances of Fridley, Xinn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. of Buildings. 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 and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby jstate and say that the facts stated by me. and -contained in the above permit are true as therein stated. J Subscribed and sworn to before me at Fridley, day of 4elt A.D. 19 Minnesota, this City of Fridley, Minn. BUILDING PERMIT N? 3688 Date: ....... ....... Owner....................................... Builder �.. .... ..... � .. .... Address...................................... Address ........................... ................. �j LOCATION OF BUILDING No. . C.�.y .. Street .... ..,.. Part of Lot ............................... Lot ............ Block .................. Addition or Sub -Division ....................................... Corner Lot ............ Inside Lot ............ Setback ............ Sideyard .........1... .. , DESCRIF}TION OF BUILDING To be Used as: .................... Front ....... Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Front ........ Depth ....... Height ...... Sq. Ft. ........ Cu. Ft. ........ Type of Construction ................... list. Cost.. �®f� . Comp ................... . ......... To be Completed ...... In consideration of the issuance to me of a permit to construct the building degribed 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. .. .......... P enE.— 1-13 In consideration of the payment of a fee of $/9....... permit is hereby granted to .................:. ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. .... ..... .. .. Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, Olumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. —a f I M- � a "� -ik t�' 1 3 6 P' •� t e r R. h ° r•�_ 9 r yy K .� -1 .. yyy�p� LT y)� ((.1]`■ _{�y'�/p"�yf�p ., 2 � N±Li �G `4_t -.sy f "1 4 /" yqy � y - ♦ f j� MI�1�'�Yi •�/1R � 'r��l�} .i �T✓rv�' ��.� ��`�! *k S � �_ 4 T1I 1�ta�'nl dire � be t X V� rah �� �at+k �sr' aeent �e�arr and V����-��� �h�i,r � � K • �e 6� Ohl$ t�'ta6ti�irf �witiab �� �oi� r�� ►�'k �n;��i� t1�t��,�o� tbe� � �� �- `. 1 #€ laid r�. ir+it�d` rays albpo t ia at.t'�sati�<�, � smay► � F. Il ` ` "1 s 7 a i r �� s� '+ ,� i � s,t- s- � - ri+ r �.. ✓- F r€ r -. .r,�'S` '"� a �p ;; x s�'' S m�• y c� rl,�� -a'->! moi. ..a � +,. tt ,r ,� �. s i F x 4 { _ � $^ �,�"Jy � 'd 3^. ���. moi" �q Y" �: �„�• f - i T :t -&.e � t City of Fridley, BUHDING PERMIT®� 1�T. '7393 Date: -� 0 Owner: el Builder ,,,,,Y�-14� 16 t Address Address — � L TION OP 1 ING No. Street art Of Lot Lot _ __ Block Addition or Sub -Division ._ _ Corner Lot _ Inside Lot _ _ Setback -- Sideyard Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING be Used f F, t Depth Height Sq. Ft. Cu. n nt Depth _ _ s He ght _ Sq. Ft. Cu. Ft. Type of Co coon Est. To 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 afl provisions of ordinances of the city of Fridley. ,I In consideration of the payment of a fee of $ ® , permit is hereby granted to thto construct the building or addition as described above. This permit is granted upon e express condition that the person to whom it is granted sari his agents, employees and workmen, in. all work. $ane in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of F hin the dty limits and this permit may be revoked at any tune upon violation of nay of the provisions of said inances. Building Inspector NOTICE: TMs permit dos not emr the construction, hutelWon for wbb& plumbing, gn hadb& sewer or wrier. Be su to we the Building ins wMr for separate permhs for these item. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAMEBUILDER ADDRESS, , A �� ADDRESS LOCATION OF..EUILDING No.Street �°�,^ F/ .... - --Part :of Lot Lot.. Block. Addition or Subdivision Corner Lot Inside Lot Setback Side Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant at.tach.to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates.. DESCRIPTION OF BUILDING To be used as: Front Depth Height Sq. Ft.. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completedi The undersigned hereby makes application,for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings ofthe Department of Buildings, ano.hereby.declaras .that all the facts and representatious stated in this application are true -and correct. DATE e / / i SiCNATMV- f'9�' A ®�r rte_ _.� '�^1 %•-� eO� �'�i jSchedule of Fee Costs can be found on the Reverse Side). w - - BUILDING PERMIT FEE SCHEDULE Section 2. The Inspector of Buildings shall, before issuing any permit for the erection of any building.or structure, orfor;_any addition to any exist- ing building or structure, or for any alterations or repairs to any existing building or structure, upon application therefor, 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: 2.1. For any such permit for the erection of any_fire-proof building, -other than a garages warehouse, factory or grain elevator'; or for the erection of any fire -proof addition, for similar occupancy, to any existing building shall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical contents. 2.2. For any such permit for the erection of any fire -proof garage, warehouse, - factory or grain elevator, or for the erection of any fire -proof -addition,' for similar occupancy, to any existing building shall be at the rate of $1.25 for each.one thousand cubic feet, classified_ as "fireproof" by Section 502 of the Minneapolis Building Code, HOUSES 2.3. For any such permit for the erection of any non -fireproof building other than a garage, warehouse, factory or grain elevator,,or any non -fireproof addition, for similar occupancy, to any existing building - permit $1.00 for each one thousand cubic feet. GARAGES 2.4. For any such permit for the erection of any non -fireproof garage, warehouse, factory or grain elevator, or for the erection of any non -fireproof' addition, -for --similar occupancy, to any existing building or for each such building or addition - ninety cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $4.00.. - For the purpose of computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout by multiplying the ground area covered from a point six (6) inches below the floor line of.the basement or cellar to the average height of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. 2.5. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction thereof in the cost of all proposed work. 2.6 . In no case shall the fee -,charged for _any permit, .a# set forth in Section 2 be less. than -0.00. -- City of Fridley AT THE TOP OF THE TWINS SUBJECT PERMIT PERM[ ITY, 12169 r 1 `L ------COMMUNITY DEVELOPMENT DIV. j PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 612-560-3450 BUILDING RE /! NUMBER 910-F15 REV- DATE 6/7/73 PAGE OF APPROVED BY JOB ADDRESS 7501 Van Buren Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED - DESCR. 8, 9 3 Shaffer's Sub. #1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Alvin Schramm 7501 Van Buren Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install 28' Diameter Swimming Pool 9 CHANGE OF USE FROM TO STIPULATIONS See Health Inspector's memo dated June 6, 1973 and having 9 stipulations. tJ(f$ED FOR .TE PF 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ZONING R-1 SO. FT. CU. FT. ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS GARAGES 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 VALUATION $1, 000. 00 SURTAX .50 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 THE PERFOR ANCE OF CONSTRUCTION. /-/ $6.00 PLAN CHECK FEE TOTAL FEE T5i3GNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY V ATED THIS IS YOUR PERMIT BLDG. INSP �� DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) 01� Swimming Pool Stipulations Mr. Alvin Schramm 7501 Van Buren.Street Plan Reviews 1 Pool should have two inlets basing -it on a requirement of one inlet for every 400 square feet of pool aree•or one inlet per 12,000 gallons of pool capacity. 2 Pool must turnover at least every 12 hours- Using the filter surface area and figuring a filtration rate of 2 gallons per square foot, I figure roughly a turnover every 8 hours which i8 good - 3 Yard.or step area must be fenced with &.self closing and a self latching gate . ! 4 1 assume you will have some deck area either elevated at pool edge or at bottom of step area Some deck area is needed to clean feet of dirt and grass before entering pool . S -A back siphonage device must be provided on water line to outside spigot if a garden hose is used to fill pool F 6 Electrical wiring must be approved by the Electrical Inspector.' $ No diving board . 8 Provide a teat kit.and safety equipment 9 Provide steps from pool PLANS APPROVED JUNE 6, 1973 HARVEY J. MPHEE HEALTH INSPECTOR APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ADDRESS: ADDRESS: NO:. 6-6 1 STREET: LOT'-- fBLOCK: CORNER LOT: IN 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; Front: a8 rDepth: Height; Square Feet: Cubic Feet: —Front: — Depth: Height: Square Feet; Cubic Feet: �( Type of Construction Estimated Cost; $ To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct, j DATE: 1� / % SIGNATURE: (See everse Side For Additional Information.) n 0 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 an7 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 pewit as set forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDATION NOTE., 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 Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. BUSINESS NAME: aa-s-� -';U lip, 90-0e :!IVAIZ TEL. # ADDRESS: 7 J'Q I &E TYPE OF BUS. On this date, the health authority made an investigation of the subject facility. The deficiencies noted at this time and the necessary corrective measures are given below. If you have any questions concerning this matter, please feel free to call on us at our offices (City Hall, 6431 University Avenue N.E., Fridley) Telephone No. 560-3450, Ex. 41. Received by; 0 ACS M F Potwar PM S � © va ' nor 4F = Air fly !i«3 Srsxnis =d Do GRAVITY WARM AIP: I°ce Shell & Duct Work Replacement of nrnare Repai-c & Alterat.ons--up to $500.00 Repairs & Alterations each add. $500.00 Accm VAM AM 7%ama,ce Shell & Duet Worts to 130,000 BTU each add. 60,000 BTU Replacement of F%irnace Repairs & Alterations—up to $500.00 Repairs & Alterations each add. 5500.00 RATE TOTAL $10.00 6.00 600 S 300 E ..31000 $ 3.0() $ 6.00 S74 6.00 $ 3.00 E 1.1 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 Ordia cev and ruling of the Depai tmrnt of 13uildings, and hereby declares that an the fad and reprrcontatiuns stated in this application are true and correct. Fridley. Kind of Building Used as , A STEAM as HOT WATER $Yffiii To be completed about /,�� Furnace Shell & Lines -to 400 sq. ft F.DR Steam $10.00 S Estimated Cost; S —_ ra Furnace Shell & Line --to 640 sq. ft. EDR Not Water 1000 S. Ol New. Building Permit No. Permit Each add 300 sq. R. EPR Steam .4.rx) E — - — Each add. 320 sq. ft EDR Hot Water 3.00 °"i�iOA OF WOR.Z OIL ZURN cR—to 3 gal per hour 6.OD S over 3 gal. per hour—See Fee Schedule HEATING or WZR PLANTS ---Ste ',Tot Water A9r No GAS :42IR (up to 199,000 BTU) &00 $ / Trade Name oar 199.000 BTU See Fee Schoduls Capacity---. Sq. FL ED-& X GAS FUTING FEES. NO RATE TOTAL _ 19�E= BTU mp 1st 3 Fixtures x3 200 S Total Connected Iwd j� of Fuel Additional B4atures x •75 $— BURNER -- Trade Nam Size � Gas Range to lS9.WO 2$ 5.00 E f State Surcharge .50 8 Fee ackirldwo TOTALri Capaci f, Ft, iE.1D R BTU _ SUBJECT PER City of Fridley 13'720 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC.�� 1 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 8-25-76 JOB ADDRESS 7501 Van Buren Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8,9 3 Shaeffers SHEET -F-PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ed Schultz 7501 Van Buren Street NE.. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Tri Co 7555 Van Buren Street N.E. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. SAME 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING residential 7 CLASS OF WORK ❑ NEW Cj,. ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE nn 8 DESCRIBE WORK9-araqp t X 25, addition 9 CHANGE QF USE FROM TO STIPULATIONS ` SfPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood frame VENTILATING OR AIR CONDITIONING. 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 400 A.0-0— ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS 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 $Z,SOO 1.48 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION16.00 OR THE PERFORMANCE OF CONSTRUCTION: PLAN CHECK FEE TOTALFEE &1-1-f a 17.48 V GNATURE OF CONTRACTOR OR AUTHORIZE GENT (DATE) 00PEN PROPE2LY VAID EDT IS YOUR PERMIT BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL ALTERATION, ADDITION, OR REPAIR BUILDING PERMIT J r OWNER'S NAME •�� BUILDER: l C( ADDRESS:— 2 C) A' 114 ADDRESS: ' S` r t14111 NO:. STREET: LOT: BLOCK: /d c, �� ADDITION: .S" � CORNER LOT: INSIDE LOT: SETBACK:&4t ,-_ SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be,7jsed As: C A'r4 ? 4 Front: Square Feet: < Height Depth: � "'Id ~ Cubic Feet:` Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost:J D To Be Completed: /f2- The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stxict 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: t SIGNATURE: (See Reverse Side For Additional Information.) �o v Ark - )e , SOA I � t% BUILDING PERMIT TEE SCI11 RULE 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: IgEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1000 cubic feet PLAN CHECK: 25 percent of building permit fee. 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 forth in Section 2 be less than $°x.50. VERIFICATION OF FOUNDATION NOTE: 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 Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. « TRI—CO. BU.ILOERS, INC. 7561 VAN BUREN N.E. FRIDLEY, MINNESOTA 55432 PHONE (612) 633-2727 Lo evcI-, -e SUBJECT PERM City of Fridley �9_ AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r 1 � COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r 1 PROTECTIVE 1 i � 1 1 -"--1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �.___1l•' �•� 612-571-3450 910-F15 3/8/83 JOB ADDRESS 7501 Van Buren Street N. E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 8,9 3 Shaffer's Sub. #1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ed Schultz 7501 Van Buren Street N.E. 786-9202 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Charles Aspenson Const. 6370 Starlite Boulevard N.E. 574-9706 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 C. ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 12' x 30' Addition to Rear of Structure 9 CHANGE QF USE FROM TO STIPULATIONS B p+� AIT PERMITS QUIR �e���� i -o 1 � i GLEi H 011'4 E^ EL fl"a RC °° G AS Et L. HIC-ATING. PLUMBING AND SIGNS, REQUIRED BY LA TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $14,250 $7.13 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $110.50 NONE STRUCTION Cffl THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE �a�7 $ 27. 45x26 SIGNATURE OF CONTRACTOR OR AUTHOR) IDAGENT IDATEI " WHE OPE LY V L AT IS IS YOUR PERMIT BLDG INSP 0ATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIC14 FOR RESIDENTIAL BUILDING PERMITS (New. Alterations, Additions, or Repairs) OWNER: ED & JUDY SCHULTZ ADDRESS: 7501 VAN BUREN TEL 90. F86-9202 - _ BUILDER: CHARLES A§PENSON ADDRESS: 6370 STAREITE BLVD. TEL NO: 574-9706 Construction Location STR=T NO: 7501 STREET: VAN BUREN 3+0T: Qj BLOCK: ADDITION: _ �l � ,e !� -a z Corner Lot: x Inside Lot: , Setback: _ 9oe, Sideyards: -30' Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION �b Front: %C ` Depth: 3y' Height: Square Feets Cubic Feet: Front: Square Feet.- ADDITION eet: Depth: Height: Cubic Feet: ADDITION eN , IV Zype of Construction: Estimated Cost: S Zb Be Oumpleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: S S SEE MERSE SIDE OF SHEET The undersi ned here makes application for • 3 by pp permit for the work -herein specified, agreeing to do,all work in strict accordance with the City of Fridley Ordinances and rulings of the Deik"irtment of Buildings, and hereby declares that all the facts and representations stated In this application are true and correct. D,%TL: MARCH 1 1983 SIGNATUlE: Stipulations: PAS Re. Ha BUILDING PERMIT FEE SCHEDULE 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 Ln the manner herein provided to -wit: . L TOTAL VALUATION FEES $1.00 to $500.00 $10.00 Xinimum Fee $15.00 plus surcharge $SOl to $2,000 $10.00 for the first $500 plus $1.50 for each additional $100 -or fraction thereof, to and including $2,000 $2.001 to $25,000 $32.50 for the first $2,000 plus $6.00 for each additional $2,000 or fraction thereof, to and Including $25,000 $25,001 to $50,000 $170.50 for the first $2S1,000 plus $4.S0 for each additional $1,000 or fraction thereof, to and including $508000 $50, 001 to $100, 000 $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 and up $443.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof PLAN CHECK: 25 percent of building permit fee DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only Alternate "A": Removeal and replacement of curb and gutter only , Driveway width plus 6 feet x $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 x $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. ft,aro%w ` 3c c Ie 3l feyoo"_ i4, 20)y dA I 2®v& COW r .on' A e MW s 01- sueIECT PE T NO. City of Fridley Q 7099 AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT � • bL------ COMMUNITY DEVELOPMENT DIV. f � � PROTECTIVE INSPECTION SEC. 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 8/17/83 JOB ADDRESS 7501 Van Buren Street N- E- 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 8,9 3 Shaffer's Sub. #1 SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Edward Schultz 7501 Van Buren Street N.E. 786-9202 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Concord Builders 4538 Lyndale Avenue North 588-9401 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 91 x 9." peck 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS 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 $450 $.50 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $15.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) N, WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT w SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) I BLDG INSP I OAJE 01- Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: ` Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Fent: Cubic Feet: _ 14 Type of Construction: Lj000 s Estimated Cost: Rb Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE TEVERSE SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the work herein specified, agreeing to do ,all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representitions stated in this application are true and correct. r DATE: � `-� SIGNATURE: Stimulations: CITY OF FRIDLCY Effective Aug. 1, 1981 ' APPLICATION FOR RESIDENTIAL BUILDING PER141TS (New, Alterations, Additions, or Repairs) OtJNER: � c BUILDER: ADDRESS: 7� ��1����a��=�� _�� �r� ADDRESS: TEL n0: TEL NO: ��Ds( Construction Location STRMT NO: 7�l STREET: 1� LOT: BLOCK: 13 ADDITION: I `S Corner Lot: Insi¢ie Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: ` Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Fent: Cubic Feet: _ 14 Type of Construction: Lj000 s Estimated Cost: Rb Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE TEVERSE SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the work herein specified, agreeing to do ,all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representitions stated in this application are true and correct. r DATE: � `-� SIGNATURE: Stimulations: 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 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: Total Valuation $1.00 to $500.00 kgs $10.00 (Minimum $15.00) $501 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $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 to $50,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $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 and up $433.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof Plan Check: 25 percent of building permit fee. 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 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. PITY SF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 §431 Uff versily Aire NE Fridley. MN NW2 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 52-3�0 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS d%�� l C� Biel? e of ST Al. e RATE SCHEDULE The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares Also Replacement Furnace $ 20.00 $ LC that all the facts and representations stated in thisplication are �CILLfZ� / � true and correct. '1991 Gas Piping (Needed with new furnace) $ 10.00 $ OWNER ��W r-4 SG--�i u / / Gas Range $10.00 $ BUILDING USED AS Sc �611,j Gas Dryer $ 10.00 $ ESTIMATED COST /V00, PERMIT NO. /0190 "Air Conditioning - All Sizes $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs &Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units i Circle One (Steam) (Hot Water) (Warm Air Trade Name Alklz� Size No. Commercial/industrial BTU_ ?S- o e> HP EDR 1 % of Value of Appliance or Work $ Fuel_ M477 //_%i Total Connected Load � ® � State Surcharge .50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE $ 1�_ HEATING C MPANY (',, 7,—, r, MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION / REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By ( Tel No. S--7/- 3159 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Approved By Rough -In Date Final Date "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND OTACK 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 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6. -Has total heating BTU's of -%J, ® o All other BTU's yo cy C -- TOTAL TOTAL BTU's I/ � , 67 () J Remarks 9 List Alterations Being Done: HEATING COMPANY&J C/o1n X8 Signed By Date Yes (a. -T No ( ) Yes " No ( ) Yes ( -�-r No ( ) Yes (1--r No ( ) CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997 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 The undersigned hereby makes application for a permit forthe 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 or�ect. (Side Vent - Fill Out Back) 1997 Gas Piping (Needed with new furnace) $10.00 $ OWNER. � � �,� ®I q®x Gas Range $10.00 $ BUILDING USED AS__e Gas Dryer $10.00 $ ESTIMATED COST PERMIT NO. � All *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) Trade Name Size No. Commercial/Industrial BTU HP EDR 1.25% of Value of Appliance or Wor $ Fuel Total Connected Load State Surcharge $ 50 Burner Trade Name Size No. ��t� BTU HP EDR . TOTAL FEE ---- Dimnond Power Mech., 1ne. �. HEATING COMPANY 8375 Sunset Rd. Rp ring a MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION" - Lake P 4 SW92 REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By �'x-� Tel No. 9V- ?/ PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved ByRough-In Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE R STACK VERIFICATION ON 3�b written permission from adjoining property owner. REPLACEMENT FURN CE Remarks: . List ALTERATIONS &emn Done: HEATING CO: Signed By: Date: CEUPANEY 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 ( ) i S. Meets all current Code reTAreements for size I 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 ( ) S. Has combustion air been provided for water heater Yes () No ( ) Remarks: . List ALTERATIONS &emn Done: HEATING CO: Signed By: Date: PURCHASE ORDER PURCHASED BY jo -/ 99- 4?3 U THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY F 56793 THIS NUMBER MUST APPEAR ON ALL CORRESPONDENCE SENT TO US SUPPLIER ADD ESS CITY OF C® FRI D LEY PHONE N0. AVE. N.E. FRID �� FRIDLEYEY, MN 55432-4384 CONTACT 612-571-3450 PRINTED ONRECYCLEDPAPER . L ,� � PAYMENT VOUCHER BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW STATED ITEMS. DATE RE PAYMENT AUT ED BY - & ACCOUNT QTY. UNIT PLEASE ENTER OUR ORDER FOR THE FOLLOWING UNIT PRICE AMOUNT 1 A.0 a 0-26901 t- NDI &IAAJ Al t®l -.3 - lic. cl?r O Ifil-6a:0-.3 a-6 S-0 r 6000 o x-60 ' lot—.6600-3W-1309 'Sa 0 TOTAL cZl6 THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION, OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE. WHITE, VENDOR - YELLOW, PURCHASING - PINK, ACCOUNTING - GOLDEN ROD, DEPT. HD. SUBJECT RM7�O1 City ®f Fridley 2 AT THE TOP OF THE TWINS BUILDING PERM a ` RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �� o �� NUMBER REV DATE PAGE OF APPROVED BY _ I I CITY HALL FRIDLEY 55432 612-571-3450 910-F15 1.7/16/98 JOB ADDRESS 7501 Van Buren St 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8.9 3 Shaffer'su i n #1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Edward Schultz 786-9202 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Twin City Exteriors Co 9060 Zachary Ln N #108 Maple Grove MN 55369 425-4737 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Repair storm damage 9 CHANGE OF USE FROM TO STIPULATIONS1',� TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 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 I 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 $500 .50 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 SC $.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $21.00 PLAN CHECK FEE TOTAL FEE License SC $5.00 4 $27.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY V I ATED THIS IS YOUR PERMIT BLOG I SP 6;-e - - GATE _ SIGNATURE OF OWNERdF OWNERBUILDER) IDATEI r. NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAI ILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: �� %�1L% Legal Description: Owner Name & Address: ��,,[� �LZ J T y, Tel. # Contractor: 11,01A) C t 7-y i�:X HiQ to AAS -n MN LICENSE #��� Address: l4 6a e-?&Hpf 2Yl r� fj f1� R ,� PaE %' 5yW Tel. # '`eta X 4737 _ Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT 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: EP t ated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # a CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. A or Alt. B Above 0 Erosion Control $ •$450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary . g g [ J Not Necessary j ] TOTAL $ STIPULATIONS: w � r SUBJECT NO. City of Fridley 304 AT THE TOP OF THE TWINS BUILDING PERMIT RE COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. PROTECTIVE 1 NUMBER REV DATE PAGE OF APPROVED BY =� 11-11 CITY HALL FRIDLEY 55432 �'� 612-571-3450 910415 10/26/99 10B ADDRESS 7501 Van Buren Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8, 9 3 Shaffer's Subdivision #1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Judy Schultz 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Advance Alum. Supply Inc. 7701 Main St NE Fridley 55432 571-3440 7983 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION O ALTERATION SK REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside and partial trim 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. Permit Inspection cards Will Be Mailed TWO 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 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 $4000 $2.00 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $97.25 FireC $4.00 PLAN CHECK FEE TOTAL License 5.00 $1 .25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATEr N OPE ALIDAT IS IS YOUR P R/MMIT _ WQ C! .NSo RAI S-GNATURE OF OWNEROF OWNER BUILDER. iDATE, $ 612 571 2260 ADVANCE ALUMINUM 01 1 IJ.1t L , DN [ J ffective 1/1/98 AL CITY OF FRIDLE:Y I l SINGLE FANDLY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION -otructionAddress: .eg d De*cription: — �wj ter Nkme & Address: 170,0 >e Tel. # fon tor: A a MN LICENSE # idd ss: 7- - Tel. f1/�- 3 D Attach to this application, a Certificate of Survey of the lot, with the proposed constriction drawn on it to scale. DATE. — -�. APPLICANT: Tel. # S/--• 7yyd CTTX USE ONLY Perr4it I DESCRIPTION OF IMPROVEMENT G *REA: Length Width Height Sq. Ft.; GE AREA: Length Width �— Height Sq. Ft. SEA' Length Width Hgt/Ground Sq. Ft.' $ $1000 per SAC Unit License urcbar a g tionType: $5.00 (State Licensed Residential Contractors) )rivdwa Estunated Cost: + Curb Cut Width Needed: Ft. + 6 Ft - (Fee Schedule on Back) Ft $ $ $450.00 Conservation Plan Review 'ark Pe x . _ $ DATE. — -�. APPLICANT: Tel. # S/--• 7yyd CTTX USE ONLY Perr4it I -"ee $ OS Fee Schedule on Reverse Side Fire ISu barge $ , 10 .001 of Permit Valuation (1/10th%) State) Su rcharge $. Cj $.50/$1,000 Valua tion SA CC ge $ $1000 per SAC Unit License urcbar a g ~' $ � • ® ® $5.00 (State Licensed Residential Contractors) )rivdwa 1 Esorow $ Alt. A or Alt. B Above ?rosi4n ontrol $ $450.00 Conservation Plan Review 'ark Pe $ Fee Determined by Engineering ewer Main Charge $ Agreement Necessary [ J Not Necessary [ J TOTIL $ 106, aS- . TIONS: MnAj SUBJECT �. City of Fridley y 31995 AT THE TOP OF THE TWINS BUILDING P E R M I T r 0 LL ______ COMMUNITY DEVELOPMENT DIV. - PROTECTIVE INSPECTION SEC. 572-3604 /,`p'`J f � / NUMBERREV DATE PAGE OF APPROVED BY "'� CITY HALL FRIDLEY 55432 l 612-571-3450 910-Ft5 7/16/01 JOB ADDRESS 7501 Van Buren Street NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8,9 3 1 Shaffer's Subdivision #1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Judy Schultz 7501 Van Buren Street NE 763-786-9201 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Windows America of YM 7928 University Ave NE, Fridley, MN 55432 763-786-8115 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20248265 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Two vinyl retrofit window replacements and patio door 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. hrinit Inspection Cords Will 0e Mailed nUMBoWnef To T011Post SEPARATE PERMITS ARE REOUIRED 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 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 $1.29 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,578 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- $83.25. Fire SC $2.58 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE T TAL FEE Licen C $5. $92.12 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE, HE PR VA D ED THIS IS YOUR PPEERMJIITTT (� ✓V S.GNATURE OF OWNER OF OWNER BUILD.ER1 IDATEI BL G INS 04 WR --24-2009 15:34 FROM CITY OF Fit t DL.EY TO 7868125 P.02/03 ADON Cffy OF FIUDLEY (7) Ip ALTER [} SO4GLE FAMILY AND DUPLEXES N°1 AND R-2 BL4LDING PERMIT APPUCAnON i i'J R A. Length li'4 h n - GARAGEAREA:rm Height_ Sq. Ft DECK AREA: Length Width HgVGmuftd_ Sq. Ft :*; COn � ' � :? �,� L re{ r w.W'� - Esbma Cos: $ �5`1�00 revLaeemewfs ge s�fdddar� DrivewaY Curb Cut Width Needed: —FL + 6 Ft ---Pt x s Permit - I State Surcharge Z. $.50/$1,000 ! !- CITY`OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 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 JOB ADDRESS 1501 VAN 15URE-4 6T N E RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent r 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°70 of Value"of Appliance or Work Commercial/ Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. OWNER IA,PY 5CRLtLT*-7 TOTAL BUILDING USED AS �.Iv(DEn1C ESTIMATED COST -0495• PERMIT NO. �50 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units l Circle One (Steam) (Hot Water) ( arm $ Trade Name )AN lTzc)L-- Size No., 6 KT BTU HP EDR $ Fuel NIAtT. CaA Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ 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 $ 30. Z50representations stated in this application are true and correct. DATE 17— • 10. 0 Z HEATING CO HOME CNEK,6V C 6 t TEIz Signed b TEL # 143 4710 Mb FAX # 76p, 41& Q Approved By Rough -In Date Final Date THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT�VENT CONN CTOR AND CI AIR VFRIECATlON When I " ting ftpnrfl, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and frrestopped 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 f() No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes No ( ) The existing-Qmhnstron air is sized and installed to meet the current codes and manufacturers specifications. Yes V) No ( ) When required to install a npw comb jetion airrit will be sized and installed to meet the current codes and manufacturer's specifications. Yes (/) No ( ) When installing a new venting,yyc m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( I 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. Apnlianc Typand Rize/Common Yes V) No( ) - Vant and V _nt rnnnactor Information Appliance #1 Type FwRNACE BTU Input `75,000 an Assis e r Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances _ I Total Btu Input S odo 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: HOMC Signed By: Date: RIGHT -J LOAD AND EQUIPMENT SUMMARY Entire House Home Energy Center 15200 25th Avenue North, Plymouth, MN 55447 Phone: 763.476.1990 Fax: 763.476.1143 a For: Schultz 7501 Van Buren St NE, Fridley, MN Notes: WA Des<rpgln, I,nfolrma 'ro.n Weather: Minneapolis -St. Paul, MN, US Winter Design Conditions Summer Design Conditions Outside db -22 OF Outside db 91 OF Inside db 70 OF Design TD 92 OF Inside db Design TD 75 16 OF OF Btuh Daily range M 0 Rate/swing multiplier Relative humidity 50 % Heating temp rise Moisture difference 29 gr/Ib Heating Summary Building heat loss Ventilation air Ventilation air loss Design heat load Infiltration Sensible Cooling Equipment Load Sizing 47643 Btuh Structure 0 cfm Ventilation 0 Btuh Design temperature swing 47643 Btuh Use mfg. data 200 0 Rate/swing multiplier Summary 0 Total sens. equip. load Method Simplified Construction quality Average Fireplaces 0 z6g He 1490 Coolin Area ft Efficiency 0 Volume (ft') 11968 0 Air changes/hour 1.0. 0.5 Equiv. AVF (cfm) 200 0 Heating Equipment Summary 0 Make Heating temp rise 0 Trade Total cooling 0 0 Btuh 0 Btuh 3.0 OF n 0.96 0 Btuh Latent Cooling Equipment Load Sizing Internal gains 0 Btuh Ventilation 0 Btuh Infiltration 0 Btuh Total latent equip. load 0 Btuh Total equipment load 0 Btuh Make Trade Cooling Equipment Summary Efficiency 80.0 AFUE Efficiency 0.0 EER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temp rise 0 OF Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat Load sensible heat ratio 0 % Printout certified by ACCA to meet all requirements of Manual J 7th Ed. 1 VVrjCj 1t5.0$ C Right-Sufte Residential TM 5.0.28 RBR20001 2002 -Dec -10 09:35:41 AM C:1Wrightsoft HVAC\2002VWBaslcl_oad.rsr Page 1 RIGHT -J WORKSHEET Entire House Home Energy Center 15200 25th Avenue North, Plymouth, MN 55447 Phone: 763.476.1990 Fax: 763.476.1143 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wr�gF7tso FC Right-Sufte ResidentialTm 5.0.28 RSR20001 2002 -Dec -10 09:35:41 C:\Wrightsoft HVAC\2002\AABasicLoad.rsr Page 1 MANUAL J: 7th Ed. 1 I Name of room Entire House Schultz 1 21 Length of exposed wall 156.0 ft 156.0 ft I I 1 3 Room dimensions 34.0 x 44.0 ft 4 Ceiings Condit. Option 8.0 ftheaticool d 8.0 ft heat only TYPE OF CST HTM Area Load (Btuh) Area Load (Btuh) Area Area EXPOSURE NO. Htg I Clg (ftp Htg Clg (ftp Htg I Clg Htg Clg Htg Clg 5 Gross a 12C 8.3 1.8 1248 **** * ** 1246 Exposed b 1 0.0 1 0.0 0 **** 1 0 1 1 walls and c 0.01 0.01 01 **** *" 0 partitions Id 1 0.0I 0.0 01 *`*` I **" 1 01 e 0.0 0.0 0 - **** o **** ***` f 0.0 0.0 0 **`* `** 0 8 Windows and a 2A 43.7 - 158 6905 **** 158 6905 glass doors b 0.0 ** 0 0 **" I Heating c 1 1 0.01 ** 0I 0 **** 1 0 01 - I I dl 1 0.01 ~ O I 01 **** 1 0I 0 *`** e 0.0 ** 0 0 **** 0 0 f 0.0 ** 0 0 *"` 0 0 7 Windows and North 0.0 0 *""* 0 0 *`** 0 glass doors NE/NW 0.0 0 **" 0 0 **** 0 Cooling E/W I 0.0 1321 `**` 01 1321 **** 1 01SEIS 0 1 South I 0.01 26 *•**0.0 01 261 **** 01 Horz 0.0 0 *** 01 0 *`** 0 8 Other doorsa 1 OF 29.4 6.3 42 1236 0 42 1236 0 1 b 0.0 0.0 0 0 0 0 0 01 Icl 1 0.01 0.0 01 0 01 0 0 0 9 Net la 12C 8.3 1.8 10481 86771 01 1048 8677 0 1 1 I exposed lb 1 0.010.01 01 01 01 0 0 l 01 1 I I I I I and c 0.01 0.01 01 01 o 1 0 0 1 i I pwalls artitions 1 d 0.0 0.0 01 0 0 0 0 0 I I el 0.01 0.01 01 01 01 0 01 01 I I I I I f 0.01 0.0 01 01 01 0 01 0 10 Ceilings a 16D 4.9 2.1 1496 7294 0 1496 7294 0 I I I b 1 0.01 0.01 0 0 0 0 01 01 I I I I OI 01 01 1 1 1 1 1 d 1 0.01 0.01 OI 01 0 I I e 0.0I 0.01 01 01 01 01 01 01 I I I I I f 0.0 0.01 01 01 01 01 0 0 11 Floors Is 21A 2.2 0.0 1496 33031 0 14961 3303 0 (Note: room lb 1 0.0 0.01 0c 0 01 0 01 0 01 I 1 I I perimeter 1 0.0.0 0.0 01 is d lel 0.0I 01 0 01 0 001I I for slab O.OI 0.01 01 01 OI of 01 1 1 1 1 floors) fj 0.01 0.0 01 01 0 0 01 01 1 12 Infiltration a 101 7.6 200 20226 0 200 20226 01 1 13 Subtotal loss=6+8„+11+12 **** 1 476431 47643 * I I Less external heating I `*** I 01 **`* 1 I 0 "**` 1 ILess transfer I **** I 01 `** 1 `*`* 0 *'*` 14 Duct loss 0 **** 0°/ 0 15 Total loss = 13+14 *'** 47643 **** "** 47643 16 Int. gains: People @ 3000 **** 0 0 **** 0 Appl. @ 1200 0 *" 0 0 **°` 0 `*** 1171 Subtot RSH gain=7+8..+12+16 1 **** "" 1 0 **** 1 `*" 01 "" 1 ex cooling 1 ,,,, i 1 0 "**' 1 " I 01 * *. 1tra. I ' ..Y. 1 1 Leesss s srnal fer *"` °/d . **** .... I °/d **** 1 1 1181 Duct gain 1 0°id 1 OI 0°/d I 01 1 1191 Total RSH gain=(17+18)*PLF 1 1.00 1 "" 1 01 1.00I IIi * 01 1201 Air required (cfm) I .... I 01 01 *`*�* . I0 i O I Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wr�gF7tso FC Right-Sufte ResidentialTm 5.0.28 RSR20001 2002 -Dec -10 09:35:41 C:\Wrightsoft HVAC\2002\AABasicLoad.rsr Page 1 HOUSE HEATING TEST RECORD ADDRESS 7501 VAN &ZEN 51 96 APT. FLOOR CITY re, I'D LEY OCCUPANT OWNER 5CHL{ 1 -TZ HEAT LOSS DATE HTG. INST. SOLD BY HOME ENERGY CENTER INSTALLED BY HOME ENERGY CENTER Electrical Work By HARRISON ELECTRIC Gas Line By TYPE OF HEAT GA FA X HW STEAM SPACE HTR. UNIT HTR. OTHER I Model. Serial . INPUT. THERMOSTAT Valve Limit Limit Setting _ Fan Setting _ Pilot Type Pilot Make Pilot Model Pilot Timing _ L.W. Cut Off _ Pressure _ Input CFH _ Stack Temp._ Form 235 v Z Heat Plug Percent CO2 Percent 02_ Percent CO. MAKE OF BURNER _ Model Max. BTU Rating _ MAKE OF FURNACE Model Vent Size KIND OF LINER_ Draft Hood Filters Size _ Chimney Location Chimney Construction Smoke Bomb Draft Door Pressure_ Date Tested_ Company Testing Name of Tester_ SIZE NONE Regulator Number Inside Outside Wiring Test Tag Lighting Inst. Building PL BSG Permit No.: q `C"q Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY a 763-502-4977 FAX EFFECTIVE 2-19-09 DATE i 111 11 % YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: ADDRESS: vxmbk&r-_1__CITY P4�� STAT"ZIPJFE'y OWNER/ TENANT PHONE:-'0- -q 7, r CONTRACTOR NAME: ILVI& 61-I14 r1"d1MbjA4 STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: 92AP ( CITYjIC STATE�ZIP INSURANCE PHONE e-�� �g� FAX �U� PERMIT TYPESINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW PEPLACEMENT DETAILED DESCRIPTION OF WORK 'd �(Arm PY( _ fIG1(/ L hfA'if� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. BATH SINK/LAV DRAINS _ WATERPIPING _ _FLOOR —SHOWER _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL —WATER SOFTNER ($35) —BATHTUB CLOTHES WASHER KITCHEN SINKWATER CLOSET _ BACKFLOW PREV. ($I5) _ _ —DISHWASHER _ _ LAUNDRY TRAY ,WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER ursja f � >itt Ic 7.� €3 a t ,r.l �' {t,'i:;,•�y�}, 'btu � € ;::: 'i fi i d'y�"t �r �+, r.� �.':� 3 fps; ' N�'1s'. -} a �J ev,� �'- 3.. ., �.x�t�t%-.. 2 �. '., � i { i nC �'ni. �' kal; �ry� R �..; h moi,: �i 'moi � .SY"Y" °t�fi •! � 3 i. �' :� �5 i;3=�.,, } )$ f '9{> .:'z X � � d� � .,� <rc �' � $f 3'. 3 �" ' 4 `^ � ,� q ,� .��'k t• � J� ' 'a;:,. 1. 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THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT i�� -(� PRINT NAME �,/DATEVi6/`0 /V I?I;l<�15E �7 �EPRAT'EPE�� ARE':ff:��UIREi�:�'(�R ��[.iiLD1N�; F,�,E�'IRICAL: AND iCF�ANIC YJORI� t�', City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977