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PRE 2010 DOCSDate••• •a•• Owner .. Address ........ BUILDING PERMIT Village of Fridley, Minn. N° 2551 Builder.......................... Address ......................................... OCATION OF BUILDING No. Street cm -o .............. Part' of Lot ................ ..... . Lot ..... �� . Block ... , .... Addition or Sub- Division .. , . so ... . I dF Corner Lot .......11i.... Inside Lot .6e ....... Setback .ZC ....... Sidevard ---.c -_---.-- DESCRIPTION OF BUILDING To be Used as; ;X A^ ,.-. . I. Front ! Depth : Height . ... Sq. Ft.. ... Cu. Ft. ........ ...................11. Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft........ . Type of Construction ,.. Est. Cost ..� ...... To be Completed .................... L, -.s � A 0 In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work �h accordance with the description above set forth and in compliance with all provisions of ordinances of the v 1 age of I'ridley. in consideration of thea " p yment of a fee of $..�$ ,permit is hereby granted to .... r • . .... to construct the buildin or addition as described above. This perrmt i5 granted u n the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around anc 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 village limitslll and this permit `riiay be revoked at any time upon violation of any of the provisions of said ordinances. .....ta"x... Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. ;.Be sure to see the Building Inspector for separate permits for these Items. Ij 0 City of Fridley, NUmn.. BUILDING PERMIT N9 (:5:6::3:0 Date::"r...�w ... .�,,,. Owner: Builder Address —. _ Address —_--- - - ---- L04TN � BUILDING IO � �.... P f Lot lorSb-DiisoLot Bock M ....• ._. _. n. Corner Lot . .— inside Lot _ Setback ' _ _ Sideyard Sewer Elevation _ ____ — Foundation Elevation ESCRIPTION OF BUILDING To , Vsed nt ti" Depth Height Sq. Ft. 99/Cu. F ro Depth eight' Sq. Ft. Cu. Ft. Type of Construction Est 0 AA.,.�.- T be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $T _ ., 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, Nnnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any ti'mee upon "viola. f any of the provisions of said ordinances. NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, ;sewer or water. Be sure to we the Building Inspector for separate permits for these items, 4 APPLICATION FOR BUILDING PERKIT CITY OF FRIDLEY, KINNESOTA �z Owner's Nam Builder Address Address LOCATIo OF BUILDING No. !/ ✓� -Street Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard SEVER ELEVA'T'ION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING Sq. Ft. Cu. Ft. Fron __ Depth Height Sq. Ft. Cu. Ft. 10 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 ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct. (Schedule of.Fee Costs can be found on the Reverse Side). BUILDING PERMIT FEE SCHEDULE Section 2. The Inspector of Buildings shall, before issuing any permit for the erection of any building or structure, or for any addition to any existing 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 wits 2.1. For any such permit for the erection of any fire -proof building, other than a garage, warehouse; factory or grain elevator, or for the erection or any fire -proof_ addition, for similar occupancy, to any existing building shall be at the rate -of $1.90 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 build- ing 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 bon -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 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 con- tents 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 as set forth in Section 2 be less W • $4.00. 13a Vii._ City of Fridley, Mm. W? 8461 BURDING PERMIT Date: September 161 1965 Peterson -Ode - Builder to. Add rens 2l - . . . e 0 No. 115 Street Ventura __ Part of Lot Lot - 2 _ Block _ 5 Addition or Sub -Division .Sunmi't Manor 'North. Corner Lot Inside Lot Setback Sideyard Sewer Elevation ___ _... Foundation Elevation To be Used as: Dwelling Front 3 2' _ Depth _ 2w4_1 _ Leight 14' Sq. Ft. 76.8_ cu. Ft Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Fr9= Est. cost $13, To be completed Storm Damage Repairs In consideration of the issuance to me of a permit to co et the building described above I agree to do the proposed work in accordance with the description above 4t rth and in complianc with ;J1 provisions of ordinances of the city of Fridley. "n -0a, gj�. In consideration of the payment of a fee of $_].Z Q0 , permit is hereby granted to Deco $3 -Ars. Inc. the express to construct the building or addition as described above. This permit is granted upon 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 location, construction, alteration, maintenance, repair and moving of buil�ngs within the city 138nits and permit may be revoked at any time upon violation of any of the Provisions of said ordinaz NOTICE This permit dons not raver the construcilm, hntaWon for wiring, plumbing, gas heating, sewer or water. Be wre to we the Bolhihig hupector for sopmft pwmft for thea® Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME y BUILDER 1 _ ADDRESS+ - ADDRESS LOCATION OF BUILDING NO, _ STREET PART OF LOT . LOT BLOCK ADDITION OR SUBDIVISIZ/.Ls�.'r � U CORNER LOT INSIDE LOT SETBACK SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION Applicant a building to To be used rt t form Two Certificates awn on ese Certificate , I'l '00, of Survey of Lot and proposed Front- Depth % Height Sq. Ft. �Cu. Ft. Front Dept T Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cosh 0, 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. �p� � 0Ove l '�"''°� A DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). b - 4 BUILDING PERMIT FEE SCHEDULE SECTION 2, The Inspector of Buildings shall, before issuing any permit for the erection of,any building or structure, or for any addition to any existing building or structure, or for any alterations or``repairs to any existing building or strueture,.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: 2.1. For any such permit for the erection -of any fire -proof building, other than a 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 $1.40 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..existirig building shall be at the rate of $1.25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis. Buildiug-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 -fire -proof addition, -.for similar occupancy, to any existing building or for each such building or addition - ninety cents ($4..90) for each brie thousand cubic feet or fraction thereof, in the cubical contents thereof with the 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 ($510,00) or fraction thereof in the cost of all proposed work. 2.6. In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. _STORM REPAIR DAMAGE FEES; Residential; Estim ted Cost of work up to $500.00 - $5.00 Estimated Cost of work -...-W over '5'0.00 - $10.00 Commercial; Estimated 't of work up to $500.00 - $10, Estimated - it of work over $500.00 - $20.. SUBJECT PER City of Fridley 15164 AT THE TOP OF THE TWINS BUILDINGr PERMIT S � CEIPT N0. • COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. i , NUMBER REV. DATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 �•----� ' ,'j 612-560-3450 910-F15 5/l/79 T / JOB ADDRESS 115 Ventura Avenue N. E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 5 Carlson's Summit Manor North SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Harvey Baungartner 115 Ventura Avenue N.E. 560-7933 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK .Construct a 12' x 20' Addition to House 9 CHANGE OF USE FROM TO STIPULATIONS WARNING SEPERATE PERMITS REQUIRED FOR Before digging call local utilities HEATING, PLUMBING AND SIGNS. TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW 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 60 DAYS, OR IF CONSTRUCTION ,. 240 1920 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. $3,500 $1.75 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- $21.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 5.25 $28.00 SIGNATURE OF CONTRACTOR ORAUTHORIZ DAGENT (DATRIr WHEN PROPERLY BLDG. INSP VALIDATED THIS IS YOUR PERMIT DATE SIGNATURE OF OWNER (IF OWNER BUILDER! (DATE) , e CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PENMITS (NEW, ALTERATIONS, ADDITIONS,' OR REPAIRS) OWNER: ...1711jeLag � ;06,0. BUILDER: Address: ��� t���V g�- . Address: Tel. No.:O- No.: Street: LOT: BLOCK- ADDITION: CtMLSvAJ S tninc i 61 fq/uw—' CORNER LOT: INSIDE LOT: �_ SETBACK.: SIDEYARDS: iUU2�� 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: A4jp k)- Front: �`% Depth: .� t� %T Height: Square Feet: 2 Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: 000 cc "1"-.s'i F�00 Estimated Cost: To Be Completed: Alt. A Alt. B Pa:dposed Driveway Width if New Opening Is Desired $ $ . (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional information. DATE: Y— L 2 g SIGNATURE: J Stipulations: S' -(�- K G.06 0� 9 0�1 aL a�. BUILDING PER141T 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: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet. pLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $15075 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $17.85 11 !M9041100110 !1 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 $7.50 plus $.50 state surcharge. MERI KATION 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 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. ! 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. M prl ®-"CIVIn OUDIO K1nG Out &MM E■*hWCft 7101 France Ave. So. Edina, MN (612) 920-4272 SERVICE PERFORMANCE REPORT Customer Name Make Amplifier Model # Serial # 1. THD at Rated Power Watts L % • R % 2. Frequency Response 20Hz 20KHz 20Hz 20KHz 3. Separation db 4. Signal/ Noise Phono db db Tuner 1. Dial Calibration 90MHz 106MHz 2. IHF Sensitivity uV 3. THD at 400Hz Mono Stereo 4. Separation db 1. Wow -Flutter 2. Tape Speed 3. Signal/ Noise 4. Speed 5. Fast Rewind Time Comments Tape Deck Technician Date %WRMS Hz ± db Sec. �y AN �r X i tod n m Z 1 par � I ® 'I � 1 P I I RN allDlO Kino Cmilin Sound Erg11ef9 7101 France Ave. So. Edina, MN (612) 920-4272 SERVICE PERFORMANCE REPORT Customer Name Make Amplifier Model # Serial #. 1. THD at Rated Power Watts I-% R % 2. Frequency Response 20Hz 20KHz 20Hz 20KHz 3. Separation db 4. Signal/ Noise Phono db db Tuner 1. Dial Calibration 90MHz 106MHz 2. IHF Sensitivity uV 3. THD at 400Hz Mono Stereo 4. Separation db Tape Deck 1. Wow -Flutter %WRMS 2. Tape Speed Hz ± 3. Signal /Noise db 4. Speed % ± 5. Fast Rewind Time Sec. Comments Technician Date SUBJECT PERMIT NO. City of Fridley 16 0.4 9 AT THE TOP OF THE TWINS BUILDING PERMIT: r RECEIPT NO. � • _____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE `/ NUMBER REV. DATE PAGE OF APPROVED BY "1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 1/7/81 JOB ADDRESS 115 Ventura Ave. N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 5 Carlson's Summit North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harvey H. Baumgartner 115 Ventura Ave. N.E. Fridley 55432 560-7933 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 E;k ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install a Fuego V built in fireplace. 9 CHANGE QF USE FROM TO STIPULATIONS Fuego V by El Fuego I.C.B..O. 3319 1. Must be 30" from the sidewall 2. Provide combustion air for the existing furnace. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Metal 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 R-1 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 $600.00 $.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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $8.00 SIG TUREOFCONT ACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VA IDATED THIS IS YOUR PERMIT l SIGNATURE 0 W ER IIF OWNER B DERI IDATEI BLDG INSP r;jfTE CITY OF FRIDLEY APPLICATIm FOR RESIDE iNTIAL BUILDING PERMITS (New, Alterations, Additions,. or Repairs) OWNER: 11 AV6Y 1143,4U W4 /z.• ADDRESS: V�Ae774-4g-4 Av6, TEL N0: 560 -? l3 BUILDER: ADDRESS: TEL NO: AlConstruction Location STRUlT NO: STREET: LOT: BLOCK: ADDITION: Corner Lot: Xnsiae 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 -Feet.- Cubic Feet: type of Construction: ��¢C c s �daN �ii(0�T d"1 ,4 6®�� e' c Estimated Cost: $ � ®® p � To Be Completed: 1 7 Alt. A Alt. B Proposed Driveway width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET The undersigned hereby makes application for a permit for the S;pork 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 represen Unions stated in this application are true and correct. DATE: SIGNATURE: Stipulations; �i�OM • �� ' r � ell 0 VIP i 13U11_1)1NG 11EfZ141T f=t?ty SCIIEJ) UI_F' 51.::'.t'IOM 2. 'Th6 In%;pcctor of 1316.1dirnJ : shall, before i.t;sui.ng pennits for the erection of ally buil.(Ung or or for any `addi.tiom to ally c!r.i.cti.irrl tiilcling or :,tzucturr_, 6r for any or repairs to -any exi..t:incJ 1ntiJ.di.n<J or st):ucture, ujwn arvli.c:at.i.on thcr..:for.e, requ-i.re Mie payment by the applicant. for such permit of fees to tlse amount herein below set forth and in the manner herein p ovidad to -wit; NEW C'OI4S`I'1;[JCTIO14: Single Family llorne:; and Garacles: ;'.4.00/1.r 000 cubic feet. ' V1.171ii C1II C1;: 25 percent:.of building permit fee. DRIVEWAY DEPMSSIOl•1: (Concrete Curb Streets Only) Alternate R: Removal and rreplacerrcent of concrete curb and gutter only; Driveway width plus 6 feet x` Alternate 13: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet.x $17.85 ,DDITIONAL INFORMATION For the purpose of computing fees for building permits,. the cubical contents of any building or addition, is detc+rmi.ned 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 •rQ rase shaa..l ..the fee charged for any permit as set forth ix; Section .2 bc_ ICss • - than $7.50 plus $.50 state surcharge. ' VERT F I CATI OiRi OF FQU.ND11T I ON NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application to a1l.ow for proper review of the proposed structure and of the construction site. l 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. . J�TIFIG�T�OF OCCUPANCY 1►ppli.cation 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 :hall not be used or occupied until a Certificate of Occupancy has been issued. i - SUBJECT P IT NO. City of Fridley 26908 AT THE TOP OF THE TWINS BUILDING PERMIT r `-REM—PT-NO. _ _ COMMUNITY DEVELOPMENT DIV. I LV ��� PROTECTIVE INSPECTION SEC. III � NUMBER REV DATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/30/98 JOB ADDRESS 115 Ventura Ave 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 5 1 Summit Manor No SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Chris Flemin ;C & Sons PO Box 9047 St Paul 59109 961-1277 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20129655 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 00 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (22 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Buidling Code. 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 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1834 $.92 DOES NOT PRESUME TO GIVE AUTHORITYT VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR L AL LAW REGULATING CON- STRUCTION OR THE ERFOR NCE OF STRUCTIO $59.50 Fire SC $1.83 PLAN CHECK FEE TOTAZ,7�!5 7` -"f 1)�TRE Lic $5.00 $6 OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN OPER;DATED T/ S YOUR PERMIT BLDQr INSP - �..c FATE SIGNATURE OF OWNER i IF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 0 brg . ConstructionAddress: ! V �� / C '� �Z.f , %� , Legal Description: Owner Name & Address: Tel. # � Contractor: t L ��%i l.� �����« C � �°��' MN LICENSE # XAddress: PO © f6 -r '�w C"j, .S /eg Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: x OTHER: DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. e go-S' ga-V 9,5 C J'-- --Ce&'r (D X Construction Type: Estimated Cost: $ 1 G)33� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE:_ Tel. # TOTAL $ L r), �-�— STIPULATIONS: r CITY USE ONLY Permit Fee $ �9. �d Fee Schedule on Reverse Side Fire Surcharge $ ?:)3 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ L 0 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ L r), �-�— STIPULATIONS: r BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE FEES $1 to $500 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B":. Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. SUBJEeT PER - City of Fridley ?-, 2878 9 5U44 THE TWINS IT Ir 4.57NO. BUILDING PERMIT C • COMMUNITY DEVELOPMENT DIV. LV _ -__ " INSPECTION SEC r PROTECTIVE . CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 12/31/98 JOB ADDRESS 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 5 Summit Manor No. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harvey Baumgartner 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO North Central Bldrs. Inc. 7401 42nd Ave N New Hoe 55427 533-16168 3763 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 3a REPAIR O MOVE ❑ REMOVE B DESCRIBE WORK Reside damaged siding, trim & fascia 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING 1 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 $6992 $3.50 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 OR THE PERFORMANCE OF CONSTRUCTION $124.75 Fire SC $6.99 PLAN CHECK FEE TOT EE Lice $5.0 $ t,410.24 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE, EN Of VALID TE HIS IS YOUR P RMIT S,GNATURE OF OWNER,IF OWNER BUILOERI IDATEI BLPA INSP r)AT NIEW ' [ ] Effective 1 / 1 /98 ADDNCITY OF FRIDLEY [ ALTER4 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION s ConstructionAddress: J15-[� /--Rid y lni� �� ��� ¢ Legal Description: Owner Name & Address: Tel. # Contractor: ,,//�A �,�� MN LICENSE Address: ®%C2! — �REN 0, s� 5,5'el. # 5,33 -616 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: Z 60/—A)G ,, 7RM _ Construction Type: ��� � Estimated Cost: $�, 229. (Fee Schedule on Back) Driveway Curb Cut Width Needed: DATE: APPLICANT: Permit Fee $ 1014,75- 75 Fire Surcharge $ 6. State Surcharge $ 3 SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Ft. + 6 Ft = Ft x $ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $ $1000 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE FEES $1 to $500 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCIROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. 1, CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON FACH FI nnR Effective On January 1, 1999 PO�,TfY® PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader NO. RATE TOTAL JOB ADDRESS HG.e Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $16.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ do. 5 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Building Used As h0l&U ku� Estimated Cost�QQ • PERMIT NO. PLUMBING COMPANY McGuire & Sons 605 - 12th Ave So. SIGNED BY Approved By Rough—In Date Final Date PLUS THE $.50 STATE SURCHARGE "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. IS $20.00 U11 SUBJF& P MIT NO. City of Fridley 3 210 3 AT THE TOP OF THE TWINS BUILDING PERMIT t COMMUNITY DEVELOPMENT DIV.®� R EIPT NO. r ! � PROTECTIVE INSPECTION SEC. NUMBER REY DATE PAGE OF APPROVED BY , CITY HALL FRIDLEY 55432 L 612-571-3450 910-F15 8/28/01 JOB ADDRESS 115 Ventura Ave I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED OESCR. 2 5 Summit Manor N SHEET 2 PROPERTY OWNER MAIL ADDRESS 41 ZIP PHONE Harvey Baumgartner, 115 Ventura Ave, Fridley, MN 554V 763-572-9606 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Harvey Baumgartner 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 NEW O ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Deck 9 CHANGE OF USE FROM TO STIPULATIONS REQUIRED FOR: HEATING See notations on plans. laps. ?W BIN6 A Before dogging call for all utility locations 454.0002 MQUIRED BY LAW 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 $1,656.00 $.82 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- $60.10 Fire C $1.65 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTA E 11-1 W. 5 7 SIGNATURE NTRACTOR OR AUTHORIZED AGENT IDATEI EN ROPE VyALIO TE HIS IS OUR PERWr 41LERI > d.✓r S�GNAT RE O� OwNERIv O ER IDATEI INSP ' gAiE U11 NEW I ] Effective 1/1/2001 ADDN (] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: %%`� VC --iv T6gd4A XV6- Legal Description: Owner Name & Address: 414R3A,4m Tel. # 763 - t ?�P_ 9 % &6 Contractor: 574m4z- MN LICENSE # Address: S' MIc- Tel. # s'A4MC- 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 4Q F7, Width /a P7- Hgt/Ground 6-a Sq. Ft. OTHER: Construction Type: Estimated Cost: $ A Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 9- 13 ^ ® % APPLICANT: Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ &0i /0 Fee Schedule on Reverse Side -- $ , fo5 .001 of Permit Valuation (1/10th%) $ ®, $.50/$1,000 Valuation $ $1150 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 [ ] $-- 6j 1 161 BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $23.25. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses 0nly The Home Depot #2802, 5650 MAIN ST, NE, FRIDLEY, MN 55432, (763 Mon Aug 13 12:06:41 2001 File saved as: f:\dn\decks\8130AA09.DEK Deck Dimensions for Deck 1 12' ' 'so/& = /�o/�6X�� Joist Spacing = 16 in. o.c. m The Home Depot #2802, 5650 MAIN ST, NE, FRIDLEY, MN 55432, Mon Aug 13 12:06:41 2001 The materials in this deck will cost $1369.23 File saved as: f:\dn\decks\8130AA09.DER 3D View C 6 6 - ,;;�rw A y '�Co 16A S 072Ar 14Ev4 (763 �„ 6;A MC -c The Home Depot #2802, 5650 MAIN ST, NE, FRIDLEY, MN 55432, (763 Mon Aug 13 12:06:41 2001 File saved.as: f:\dn\decks\8130AA09.DEK Deck Layout Olt �:::2' 1E -4P 45 T. J of .cam �h MIA -1011X1 ;4 MA CITY OF FRIDLEY INSPECTION D1ViSION 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 OWNER_/ 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 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $10.00 $ $ 10.0fl $ 10.00 $ $ 25.00 $ State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLI G/ ILATION REFRI ERATION/AIR CONDITIONING PERMIT IS $25.00 PLU5 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 On January 1, 2000 BUILDING USED ESTIMATED COST ,5 PERMIT N0. Le! ° DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Piot Water) (Warm Air) Trade Name L Size No• BTU 1;Zs HP EDR Fuel 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 representations stated in this application are true and correct. DATE HEATING CO S �� Signed TEL ## Approved By Rough -In Date Final Date COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( } The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category l 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 manufacture'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 1 Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No { ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: 6Ar-e--s Signed By: Date: