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PRE 2010 DOCSCity of Fridley, Mim. BUILDING PERMIT N? E691 Date: Owner: '..� Builder°_ Address _ _ _. Address --- ---- �-- - — LO ;A TION OF U WING No. !_ Street _VW_ _ Part of t u Lot ---Block ddition or Sub -Division Corner Lot __ _ __ _ Inside Lot _ _ ___ Setback s.Z _ _ _ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T ;'be Use : I f + " Front Depth Height 0 Sq. Ft.:, Cu. Ft. 4V Front Depth SeHelpt ...:._..Sq. Ft. Cu. Ft Type of Construction _ Est Cost .___ 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 all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of It +r ' —,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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances.. Building Inspector t 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 PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address Addressvf LOCATION OF BUILDING No.`_ S gl- Street W� of Lot Lot Block Addition or Subdivision�G l. Corner Lot Inside Lot V__ Setback 3T„side-Yard SMIER.ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: -0 . -JX- 4 Front Depth height sq. Ft. Cu. Ft. Frontepth Height- sq. eight Sq. Ft. CU. Ft. 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 -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 fireproof 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 fireproof garage, warehouse, factory or grain elevator, or for the erection of any sire -- 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 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 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. 2e5. 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 r `;1 $4.00. t� Application for Darer Plants and'Heating. 'ng, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIRo RATE TO-- Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Aiteratians--up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ..... . .................. 2.00 $ Replacement of Furnace ............................. .§.00 $ Repairs & Alterations—up to $500.00 ................ 5.00 $ Repairs & Alterations each add. $500.00 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq: ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ..................... x $1.50 $— Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM See Fee Schedule vENTYLATING SYSTEM �-� ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL Dept. of Bldgs. Phone SU, 4-7470 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Kind of Building-�'�"✓� Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. — Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, ��No e � /e�-� Trade Name �' � Size No - W 4 Capacity Sq. Ft. E.D.R 10V 0-1&0 BTU H.P. Total Connected Load '5-7 f S- Kind of Fuel BURNER — Trade Name Size Capacity Sq. Ft. E.D.R BTU H.P. SigIIed a By C*KZpF..142 2M 7-59 Business Phone No- ` 4,-, 2-11 (REMARKS—OVER) HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDI MINNEAPOLIS, MILAN. eatherstrips A.S.H.V.E. Construction No. Insulation Guide indo I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied Yes o Yes—No 19— Width Height No. of Lineal ft. Area No. of pan of p ne lights of cr k sq. ft. -7- Net exp. wall F1.1 Room I Length 'Width /,.,?-",Height &VO FLL4Room I Length J Width Windows aAd Width No. of pane 14-11— Doors—Crackage and Area Height No. of Lineal f , Area of pan lights of crack sq. ft. •® /A!5 Glass Windows and Doors—Crackage and Area Width Height No. oYLineal fkL Area No. of pane of pane lights of cr sq. ft. +mak �.a> Exp. wall f i Coef. Btu Infiltration Int. wall Infiltration Glass 0 Glass Floor Exp. wall 0O Exp, wall '' Net exp. wall t0 14W Net exp. wall Int. wall Int. wall Ceiling Ceiling Floor Floor Total Btu. Total Btu. Required . ft. 9. 15.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. Room -1 Length �Width /® HeightFl,� Room Length // Width Wi dows Doors—Crackag and Area Windows and Doors—Crackage and Area Widthvj Height I No. of Lineal ft. Area Width Height No. o! Lineal ft. Area No. of pane of pane light. of crack sq.$ft. JCoef.j Btu Infiltration Glass Exp. wall Net exp. wall ® % Int. wall Ceiling /® Floor Total Btu. Requir D.R. or sq. ins. W.A. Leader area R.r 17'r, Room I Lenath / Width //I I-Ieiaht / Win ows and Doors—Crackage and Area / Width Height No. of Lineal ft. Area No. of pan of p ne lights of cr k sq. ft. -7- Net exp. wall Coef.1 Btu Infiltration Infiltration Icg 1 /1 Glass 11-W Lri-v MOW Exp. wall f Net exp. wall Int. wall C el ili ng 0 Floor 0O Floor Total Btu. ft. E.D.R. or sq. ins. W.A. Leader areawxg?z M M7 Height I% - Btu Glass / Exp. wall / Net exp. wall Int. wall Btu Infiltration Ceiling / /ii Io2 le Floor 5& Total Btu. f Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. Room I Length�� Widtly� -- Heigh Windows and Doors—Crackage and Area Width Height No: of Lineal ft. Area No. of pane off pane Iiia is of cr ck eq. ft. / pl + 1 Coef. Btu Infiltration / %f� Glass Exp. wall --- f Net exp. wall Int. wall Ceiling Floor 0O Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area D•56 7VOW9 r HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A.S.H.V.E, Construction No. Guide Windows Doors Reference Out. Wall Int. Wall Ceiling I Roof I Floc Yes --N — 0 19_ Fl. Room I Length Width Height Fl. Windows and Doors—Crackage and Area Width Height No. oP Lineal ft, Area No. of pane of pane 1lghts of crack eq. ft. Btu Infiltration / Glass d �V Exp. wall Net exp. wall Coef. Btu Int. wall Ceiling Coef. Floor �® Total Btu. OIL Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.I IYI Room I Length , ® Width ' Heigh Windows and Doors—Crackage and Area I /� tlz Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. d �V Exp. wall Net exp. wall Coef. Btu Infiltration Glass Coef. Exp. wall �® Net exp. wall -�- Int. wall Ceiling /® Floor Total Btu. Requir t .D . or sq. ins. W.A. Leader area Room I Length ®` Width �' Height o indows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pan lights of cr k sq. ft. /01 1p Btu Infiltration I /� tlz Glass d �V Exp. wall Net exp. wall / A(0 // z® Int. wall Ceiling Coef. Floor Total Btu. �® Required sq. ft. E.D.R. or sq. ins. W.A. Leader area i MINNEAPOLIS, MAVN. Insulation Kind How. Applied Rnem I Length �3 'Width Ji7' Heiah ' Win ows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. ag !.I Infiltration '9Glass Coef. Btu InfiltrationIZ/ Net exp. wall Int. wall Ceiling Floor Exp. wall ®' Net exp. wall /%(� Int, wall Ceiling Floor �o® Total Btu. Ye 7 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. iris. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of Wane ot.nane liehte I of crack I eq. ft. I I I I I I Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES:RATE TOTAL Number Fixtures ......................• x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ c d New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... � x $1.50 $ / , 5 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $I� Dept. of Bldgs. Phone SII 4-7470 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 Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Winn 19 d'- -2— Owner C", Kind of Building Used as To be completed about C" eC� Estimated Cost, $ Z ® 4:v d:�5 Old New Building Permit No Z Permit No. Signed- Business igne Business Phone No ROUGH FINAL �U' 10 z z • R u N WATER HTR. GAS ELEC G� O Base 1st 2nd 3rd l4E 4th • Future Coaaectioa Openings Coanected with Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES:RATE TOTAL Number Fixtures ......................• x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ c d New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... � x $1.50 $ / , 5 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $I� Dept. of Bldgs. Phone SII 4-7470 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 Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Winn 19 d'- -2— Owner C", Kind of Building Used as To be completed about C" eC� Estimated Cost, $ Z ® 4:v d:�5 Old New Building Permit No Z Permit No. Signed- Business igne Business Phone No ROUGH FINAL Effective Date May 1, 1988 i CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT e o m Water Job Address �/3 LV ji"lv � p, W � Heater Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are/ true and correct Fridley, Mn. G 19 OWNER KIND C USED AS 7V— — 11 J TO BE COMPLETED ABOUT RATE SCHEDULE m 9 PLUMBING FIXTURE RATES: NO. �t TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. New Fixtures $ 5.00 $ r Future Fixtures "$ 3.50 $ Company Old Opening, New Fixture $ 1.50 $ Signed By Beer Dispenser $ 4.00 sroa ✓r Tel. No. 9- 9<6e- Blow Off Basin $ 5.00 $ .. cd $ 5.00 $ m Rain Water Leader 4J 3 P Bg ROUGH INSP. Hydraulic Valve $ 5.00 $ N m omi $ 5.00 $ •.�i Water Treating Appliance x ,sb, R FINAL INSP. Hot Water Heater v ••oi [5 x Date u $ 10.00 10.00 v APPROVAL FOR PERMIT Gas Dryer $ $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ 43 1% of Value of Fixture or Appliance $ 49 fd v 54 oo ani 9 State Surcharge Reinspection Fee $ E�C S a w ni $ u omo 99 o s lec 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are/ true and correct Fridley, Mn. G 19 OWNER KIND C USED AS 7V— — 11 J TO BE COMPLETED ABOUT RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. New Fixtures $ 5.00 $ r Future Fixtures "$ 3.50 $ Company Old Opening, New Fixture $ 1.50 $ Signed By Beer Dispenser $ 4.00 $ ✓r Tel. No. 9- 9<6e- Blow Off Basin $ 5.00 $ .. Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ ROUGH INSP. Hydraulic Valve $ 5.00 $ Date Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ FINAL INSP. Hot Water Heater $ 5.00 $ Date Gas Range $ 10.00 10.00 $ APPROVAL FOR PERMIT Gas Dryer $ $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 9 State Surcharge Reinspection Fee $ E�C $ .50 ($15.00) TOTAL FEE $ CITY OF FRIDLEY INSPECTION DN. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner — Aiso Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — Ali Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/industrial 1% of Value of Appliance or Work Effective On January 1, 1993 JOB ADDRESS The undersigned hereby makes application for a permit for the work herein Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and $ 20.00 $ representations stated in this application are true and correct. $10.00 $ OWNER__ i:%�1-• - $10,00 $ . BUILDING USED AS $ 10.00 $ $10.00 ESTIMATED COST PERMIT NO. $�� DES RIPTI N OF FURN&QE AND OR BURNER $ No, of Heating Units j Circle One (Steam) (Hot Wat arm Air) Trade Name �P.Oz Size No. — BTU 6V0 HP EDR $ Fuel Cal -5 Total Connected Load State Surcharge $ 50 TOTAL FEE `(' MINIMUM FEE FOR ANY HEATING/COOLINGiVENTiLATION `! REFRIGERATIONIAIR CONDITIONING PERMIT IS 115.00 PLUS THE S.vO STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed In a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY V Approved Ba_ Rough—In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 10 ON,, , CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( ) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( j 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( i No ( ) S. Meets all current Code requirements for size and total BTU's connected Yes ( j No { ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done• HEATING COMPANY Signed By Date 0 SUBJECT PERMIT NO.�� City of Fridley 26543 \' AT THE TOP OF THE TWINS BUILDING PERMI f , ' o t COMMUNITY DEVELOPMENT DIV. I v PROTECTIVE INSPECTION SEC. �®TJ r NUMBER REV DATEPAGE OF APPROVED BY CITY HALL FRIDLEY 55432 l 612-571-3450 910-F15 7-10-98 JOB ADDRESS 5813 Washington St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 11 1 Lyndale Builders 7th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP 574HOrf37 Brian Ackerman 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Minnesota Rusco, Inc, 9901 Smftana Dr, Minne tonka, 55343, 935-9669, 2173 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 O ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Cover soffit/fascia &window trim -install garage door, storm door, replacement windows any egress requirements are being met. 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectores in all sleeping rooms and all levels of the dwelling. 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 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$5$362 $2.68 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- Fire Sc $5.36 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $112.25 PLAN CHECK FEE TO L FEE Licens $5• 125.29 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEIP OP A IDA THIS I UR PER I 1AA BLD INSP BATE S)GNATURE OF OWNER OF OWNER BUILDER) IDATEI 0 SEP -19-1996 14.2 lvtw ! 1 ADDN [ AL'T'ER ConstructionAddress: Legal Description: Owner Name & Address: Contract Address: CITY OF FR I DLE`r" CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application M 612 571 1287 P-01/02 Effective 3/1./96 Tel. # ENSE# a/73 Tel. # —95'a— 71t &1) LIVING AREA: GARAGE AREA.- DECK REA:DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRHMON OF DII"R.OVEMENT Length Ungth ]Lente Width height Width Height Width uorrr3r.,�,.,a Sq. Ft Sq. Ft. Sq. Ft. - - - _y4tyy 1 a– — ®2o GHQ P p �i )"'-� Pg I s- r-F6U/'r'PArre-C7- &Lr t-- Q�e' Conner Lot [ j Inside Lot [ j Ft. yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ " 3 p Approx. Completion Date:- (Cost on ,Bach) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x = $ DATE: APPLICANT: Tel. # TOTAL $ '11ATIONS: a49 CITY USE any 'eimit Fee $ ��.�,5� Fee Schedule on Reverse Side =ire Surcharge$_� ;� .001 Of Permit Valuation (1/10th%) ,tate Surcharge $ ? (' $.50/$1,000 Valuation ,AC Charge $ $900 per SAC Unit 1cense Surcharge $OW W-` SSD $5.00 (State Licensed Residential Contractors) lriveway Escrow $� Alt. "A" or Alt. "B" Above zosion Control $ $450.00 Conservation Pian Review "ark Fee $ Fee Determined by Engineering ewer Main Charge $ Agreement Necessary { ] Not Necessary { ] TOTAL $ '11ATIONS: a49 'SEP -19-1995 14:23 CITY OF FPIPLEY 612 571 1281 P.02/02 BLUDI ATG 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 stricture, 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 iucludiag $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 tip $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRJWWA3P 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. - TOTAL P.02 SUBJECT N City of Fridley28335 AT THE TOP OF THE TWINS BUILDING PERMIT R � COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 76, r PROTECTIVE 70 i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY j L 612-571-3450 910415 10/20/98 JOB ADDRESS 5813 Washington Street NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 11 1 Lyndale Builders 7th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brian Ackerman 571-1137 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Master Remodeling Inc. 32 10th Ave S Hopkins 55343 932-9311 20012916 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 ❑ ADDITION ❑ ALTERATION 2 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (20 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building 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 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 $1714 $.86 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 56.75 F e SC $1.71 PLAN CHECK FEET AL FEE Lice C 0 64.32 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGE NT (DATE- _ EN PR BL G INS Y VAL - D THIS IS YOUR PERMI W 0/ �O AP � MATE SIGNATURE OF OWNER OF OWNER SUILOERI IOATEI NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY 0 ALTER [ ] SINGLE FANCY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �J ConstructionAddress: �� /� (i✓!�5#-f r✓X 171 •% 57- lV Z5 -- Legal Description: Owner Name & Address: �� 1 7'�% iC ��i3 �'✓ Tel. # Contractor: Address: MN LICENSE # Attach to this application, a Certificate of Survey of lot, with the proposed construction drawn on it to s e. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground 57W-//37 a, INC- Now- 991. L M 2M9916 meq. Ft. Sq. Ftp! Sq. Ft. OTHER: 191V 206 Construction Type: Za- ® ��o6�5 e4ro7 Estimated Cost: $ P 04. (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE; /0 � APPLICANT: �� Tel. # / STIPULATIONS: CITY USE ONLY Permit Fee $ %r;), 6- 9S' Fee Schedule on Reverse Side Fire Surcharge $ �� % O .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 Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: BUILDING PERMIT FEE SCHEDULE The Chief Building Oficial 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 ftj $25,001 to $50,000 $50,001 to $100,000 i $21 (Minimum Fee is $21 plus surcharge) , $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $251,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for fist $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $1Q0- $100,001 to $500,000 $887.25 for, fast. $100,000 plus $5.00 fol: each additional $1,000 or fraction thereof, -to -and including $500,000 $500,001 to $1,000,000 V $2887 25 for the first $500, b� • 000 plus $4 25 for each addxhonal on,thereof; to and000 me iuduig"' e $1,;000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each. additional $1,000 or fraction thereof,; z DRIVEWAY DEPRE$SIOMESCROW (Concrete Curb Streets' Only) Alternate "A": Removal and replacement of curb and gutter only Driveway- width plus b 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. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT nnAMV au innQco nc CIVTI IDCC Tn RG IAICTDI I Pn nAl F=Ar.P P nnFt Reinspection Fee $50.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By State Surcharge $ .50 TOTAL FEE $ 15"5D COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. Rough -In Date TEL NO. 741"✓ 2y//&7 Final Date "PROVIDE COMMON VENT INFO ON BACK SIDE Urinal ''I�i#:_ Shower tib` Tra �?!I'li<�> or Draln f �I��::;::::: ash er ». ': as Ran Beer Dispenser Vater Heater ':` `...... Gas Elec :<< Basement---------------- and representations stated in this application are true and correct. Catch Basin Rain Water Leader $10.00 $10.00 DATE: �'�% �- l , 20 O S' Sump/Receiving Tank $10.00 2 6o�`/��, hrl'a rJ wbavrz Water Treating Appliance $35.00 OWNER '' Water Heater -Electric $35.00 Floor 1 Water Heater - Gas** $35.00 BUILDING USED AS Gas Range" $10.00 Gas Dryer" $10.00 ESTIMATED COST O`�� PERMIT NO. Back Flow Preventer Required ( )Yes () No Type to For 2 o PLUMBING COMPANY Floor 3 Floor 4 o Reinspection Fee $50.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By State Surcharge $ .50 TOTAL FEE $ 15"5D COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. Rough -In Date TEL NO. 741"✓ 2y//&7 Final Date "PROVIDE COMMON VENT INFO ON BACK SIDE 5-F13 6 I'R?2 f691 ✓" PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS '51 iPef 01 New Fixtures r $10.00 /0'0@ The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin Rain Water Leader $10.00 $10.00 DATE: �'�% �- l , 20 O S' Sump/Receiving Tank $10.00 2 6o�`/��, hrl'a rJ wbavrz Water Treating Appliance $35.00 OWNER '' Water Heater -Electric $35.00 Water Heater - Gas** $35.00 BUILDING USED AS Gas Range" $10.00 Gas Dryer" $10.00 ESTIMATED COST O`�� PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Reinspection Fee $50.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By State Surcharge $ .50 TOTAL FEE $ 15"5D COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. Rough -In Date TEL NO. 741"✓ 2y//&7 Final Date "PROVIDE COMMON VENT INFO ON BACK SIDE t FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstrudtions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and terminatidn. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) T�e existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's; specifications. This does include AGA-GAMA Category I Central Fumoce Vinting 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date :