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PRE 2010 DOCSBUILDING PERMIT N.0 2486 j Village of Fridley, Minn. Date •:3 •'" ,$r . .. . . Owner a.. Bullder asp .................... Address. .+.. .... Address ......................................... .I LOCATION OF BUILDING No. i� ...... Street Part of Lot ............... ..... . Lot ..../.Y. ....... Block . ............ Addition or Sub -Division .. , . Corner Lot ....... Inside Lot ... .. Setback - Sideyard lee AW.............. . �I DESCRIPTIONS OF BUILDING To be Used as: ... Front... Depth : ..: Height , :r;.: , . Sq Ft. f . Cu. Ft. ....... ... Front ,�... Depth . :... Height ......... Sq. Ft. .. Cu. Ft........ . Type of Construction)c, . Est. Cos4,%t ... To be Completed In consideration the proposed work in i f the issuance to me of a permit to construct the building described above, I agree to do accordance with the description above set forth and in compliance with all provisions of ordinances of the vilT ge of Fridley. .... ..... ... ... .................. In cos e:�ation pis . the payment of a fee of $.. kC. , permit is hereby granted ... f to construct the buildin addition as described above to . ,car .. This 't anted upon the express condition that the person to whom it is granted and his agents, employees and wor In, work done in, around and, pon said building, or any part thereof, shall conform in all respects to the, ordinances of Fridley, Minnesota ic garding location, construction, alteration, maintenance, repair and moving of buildings with- in the village 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 d es not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. B sure to see the Building inspector for separate permits for these items. SUBJECT P City of Fridley 21459 AT THE TOP OF THE TWINS BUILDING PERMIT f CEI T NO. I COMMUNITY DEVELOPMENT DIV. _ PROTECTIVE INSPECTION SEC. CITY, HALL FRIDLEV 55432 NUMBER REV. GATEPAGE OF APPROVED BY 612-571-3450 910-F15 7/27/92 :] JOB ADDRESS 6321 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 4 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Evangeline Sundberg 6321 Washington St NE 571-9724 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Grundman Construction 5627 Lannon Ave Albertville MN 55301 497-223S4125 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 j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Rerooi IiQuse & Garage (22. Squares) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS -� Underlayment must cc ply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1r166 $.58 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE NY OTHER STATE OR LOCAL LAW REGULATING CON- $ 29.00 Fire SC $1.17, E PERFORM E OF CONSTRUCTION.III PLAN CHECK FEE TOTAL FEE MSAGNATURtf'OF License SC $5.00 $35.75 CONTR-A*W6RORAUTHORIZEDAGENT (DATE) HE PRO RLY V LI TED THIS 11 YOUR PERMIT -2 „ BL.OG-)NSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] ADDN [ ] ALTER [ ] Construction Address: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application S E Effective 3/1192 Owner Name & Address: zze1 Qek&e -19ez a Tel. #-5-y-�7zy Ij Contractor: �'t !164.4 �, 604 S MN LICENSE # 000 y/z Address: (e'Z 'p7 La o o--.., --Ar2 f- .-, f - l b e dll f A 5�->®' Tel. # �/97- 2- " "� 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: T6 de �.�� rQ' 5 C r .1 Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: lear o iM R `-00"� Estimated Cost: $ Approx. Completion Date: 77 (cost on Back) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ _ $ DATE: 7a- ; 9 Z APPLICANT: Tel. # W7- z Z 3 E - CITY USE ONLY Permit Fee $ 9. " Fee Schedule on Reverse Side Fire Surcharge $ / 1'7 .001 of Permit Valuation (1/10th%) State Surcharge $ ��' $.501$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ -5-,00 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ ,3S -,'7S - IN SUBJECT City of Fridley 24843 AT THE TOP OF THE TWINS BUILDING PERMIT R O. Ir? � ` COMMUNITY DEVELOPMENT DIV. b ______PROTECTIVE r 1 INSPECTION SEC. 7/ I =/---{ CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY j 612-571-3450 910-F15 12/31/96 JOB ADDRESS 6321 Washington Street HE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DescR. 13 4 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Pap en 6321 Washington Street NE 571-5061 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Steinbach Construction 2347 Gaston Ave White Bear Lake MN 55110 2636 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 429-2887 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE R 8 DESCRIBE WORK Alter 1st floor living area; remove and repair front entry wall 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,000 $3.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION O ERFORMAN CONSTRUCTION. $112.25 Fire SC 6.00 CHECK FEE OTAL FEE �PLAN �'70�License C $ .00 A $126.25 SIGNATURE OF NTRACTOR qORIZED AGENT f (DAT r, PR P RLY VALI ATE D THIS IS YOUR PERMIT R SiGNATURE OF OWNER OF OWNER BUILDERI IDATEI G INS gA7E IN NEW [ ] Effective 3/1/96 / ADDN [ ] CITY OF FRIDLEY' a ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ^ l�yL� Building Permit Application ConstructionAddress: (a '62- [ W A a Legal Description: Owner Name & Address: -Tc MJ� Tel. #7l� (� Contractor: (.,�,� �- MN LICENSE #a Address: °�Z ��k"V ` Tel. # W&CIt `to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF MWROVEMENT LIVING AREA: Length Width --fes.... Height-�-r----- Sq. Ft. 7-1:94' ?- .._ GARAGE AREA: Length _ Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: A& A-irL Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ o ,c) Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: ��'/� ``� APPLICANT: Tel. # h"I" CITY USE ONLY Permit Fee $ I- �� Fee Schedule on Reverse Side Fire Surcharge $---L -CQ .001 of Permit Valuation (1/10th%) State Surcharge $ 3. 00 $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ , C`' 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 [ J TOTAL $ o?S STIPULATIONS: R M 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 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) 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 State Surcharge TOTAL FEE .50 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from.adjoining property owner. Burner Trade Name BTU HEATING COMPANY Signed By M Size No. EDR . Tel No. Approved By Rough—In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS 3)d W w g E 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 $ 30.00 $ representations stated in this application are true and c31997 $10.00 OWNER $10.00 $ BUILDING USED AS $10.00 $ _ .ESTIMATED COST �� '" PERMIT NO. $ 25.00 $. DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load State Surcharge TOTAL FEE .50 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from.adjoining property owner. Burner Trade Name BTU HEATING COMPANY Signed By M Size No. EDR . Tel No. Approved By Rough—In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CEUMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 2. Has been carefully examined .. Yes O No ( ) 2. Is free from rust or deterioration Yes O No ( ) 3. Has no foreign objects lodged within Yes O No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other, BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) $ Has combustion air been provided for water heater Yes (,) No ( ) Remarks: M SUBJECT city of Fridley �, 73;354 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIP `y ___._ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. g7�g Cd NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910-F15 3/4/03 JOB ADDRESS 6321 Washington Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 4 1 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim/Tonya Pappen 6321 Washington Street NE 763-571-5016 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Lampert Exteriors 1852 Como AVe, St Paul, MN 55108 651-695-3680 20103953 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 0. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows within existing openings 9 CHANGE OF USE FROM 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. J WN InSPeCts"On Cards .11I B e M all To 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 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 @@ $2.71 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT $5,428 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- $125.25 Fire SC $5.43 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE Ticense SC $5.00 1 $138.39 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WH PROPERLY VALIDATED THIS IS YO R PERIT 8L0 INIP QA TE SIGNATURE OF OWNER-6 OWNER BUILDER- IDATEI M FEB -20-2003 09:30 FROM CITY OF FRIDLEY TO 6512870145 P.02/05 NEW (] CITY OF FRIDLEY Effective 1/1/2003 ADON (] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address: 6-521 C Legal Description: Owner Name & Address: Contractor. Vk-o Tel.# %43 5 7/_50%% MN LICENSE # ,2D® 3�S,� Tei. # ��'/ �`% Y-_ Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT WING AREA: Length Width Height,,,,_ Sq. Ft. GARAGE AREA: Length �. _ Width Height �— Sq. Ft_ DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: A � Estimated Cost: $ T � (yc� _5/eeS` Driveway Curb Cut Width Needed: Ft. * 6 Ft = Ft x $ = $ "W'OW�— APPLICANT: —.14 Cali (763) 573-3604 for Permit Fees if mailing in applications Fax to 763-5714287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge Ucense Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ 1%A 57 l3S-37 A I Fee Schedule on Reverse Side 0.4 of Perrnit atuai9o*+ ;1/1 h%N $.50/$1,000 Valuation $1275 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ 01 SUBJECT PERMIT N�-=--.._ City of Fridley ' 33988 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO.'� COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r �Q NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55032 763-571-3450 910 -FIS 10/22/03 / / JOB ADDRESS 6321 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 4 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim & Tonya Poppen 6321 Washington Street NE 763-571-5016 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same d 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 l ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Basement Finish 9 CHANGEOFUSEFROM TO STIPULATIONS - See notations on plan. SEPARATE Pffik REQUIRED FOR. - oWISING, WIRING, HEATING® 'PLUMBING AND SIGNS 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 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 $7,000 $3'50 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 $149.75 6!r.yATUtRE OFC TRACTOR OR AUTHORIZED AGENT (DATE, WH PROPERLY VALIDATED THIS IS YOU PERMIT S. ATURE FO E jWNER BUILDER, ,DATE, BL G NSA BATE, b 01 NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: _ Legal Description: Owner Name & Address: Contractor. 4 - Effective 1/1/2003 (763) 572-3604 Bldg Insp (763) 5714 287 Fax t0 Tel. # MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Te: yp 1--1rnSVN Estimated Cost: $ � boo • C 0 �SsC�� Driveway Curb Cut Width Needed:F . + 6 Ft = Ft x $ =$ DATE: (- t APPLICAN Tel. # 13 Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ x.00 $ '--3 5 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] I----- -- ---- --------- I I I I 6 I I I i I I 11'7 I I I I Laundry I I . I I I I I I I i UP I R _ 1I �£QV i ��`t 7:p(u nn,b Family Rim Mr -6) I s I r 22'5 I �l Irv£ b�4t I I--------s------ -------------------- rh LIVING ARE 12 s \� V- - - - - - - - - - - - - - - - - - - n ------------------ G 'A 00 _ �� 'A� 1019 % OR CODE _ �c�gSffS *I,'`I JLANCE C9 %11 BLD !ns r ` x�f W l �d �r�tC-Qv W Q S� v Closet N R cf- !n Closet M 5'9 N 5'9 m lei oi 13'11 d ` Closet !" iS 11063 I u4c 1SJ%.kbc_ " j S 4'6 SOD .5. L N �\S\\ � \riga tytukt\ (tA �r, - r t j 115 VI b .$ 6F i-InILJi :_ 1 w46PEG i ION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMRFR OF FIXTURES TO BE INSTALLED ON EACH FLOOR ✓Ii Jail 1, LUUJ PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS (-� 311 ��Sh 12&�n S'-- t�) New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** Back Flow Preventer Required { )Yes () No Type $ 7.00 2Jd cc> The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $7.00 / e �ILI ,20p_� $ 7.00 $10.00 Owner f!_':6M $ 7.00 $10.00 Building Used As $10.00 $10.00 CSC Estimated Cost �n�� a PERMIT NO. $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE PLUMBII` SIGNED Approve( $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 $21-S-0 PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMQN VFNT- MFNT CONNECTOR AND CnMRI ISTION AIR VFRIFICATION Whenns, Imp an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The rxIcXng nnmhi actinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new rnmhnntinn airy it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When ins ailing a new v _n ing nyst _m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type Al T RATInNS- (Decnrihe) HEATING CO: Signed By: Date : CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes II 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 $ 10.00 $ 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. JOB Al Ai rl�'1►r�1 Effective January i, LUuj BUILDING USED AS ESTIMATED COST ?'61.t!D0) PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load Burner Trade Name Size No. $000 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 10 -N J e3 HEAT Si FAX # r i Approved By Rough -In Date TEL# -7 �3 -cj��'i�U� Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED CQNNFCTQR AND QMRIIRTK]N AIR VFRIFICATit N rnMM f)N NT <r=NT When Mpl- ; an x;stin0 ua=, the undersigned hereby verifies that the BTU Input venting has been examined and is free from rust, deterioration, obstructions, Appliance #3 Type and is securely supported and firestopped where required. Yes (1 No ( ) The venting system is plastictPVC and meets all current codes and manufacturer Total Btu Input specifications including sizing, length, number of elbows and termination. Yes( No( ) The undersigned also verifies that the replacement unit is a listed assembly Diameter inches and meets the current codes and manufacturer's specifications. This does ft Length include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance #2 Vent Connector Height assisted and natural draft appliances. Yes( No ( ) The ati- nn r-nm6 isjInn air is sized and installed to meet the current codes ft Length and manufacturer's specifications. Yes( No ( ) When required to Intek 11 a new camhiietinn airs it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When; jpctaffinn a new venting system, the undersigned hereby verifies that it is'a fisted assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: Signed By: Date: .'-rGn� 3capp C, r-� (ol i ck)&Al ns1 S -71 -soles -PCi,1C — Vvk I -C— oI �, ,S K�� c b, cad L-'-`` ---� R, a P®� 4 do i �n a� �tst � +0 iz-t C, S T�1 r dq,-�),tv's icha,, PI,eG.�, s J 4 IDOLS (kt4, . . /i 4ibnesota DEPARTMENT OF ADMINISTRATION August 2, 2005 Tanva Poonin 6321 Washinaton St. Fridlev MN 55432 RE: Inclined Wheelchair Lift - Elevator ID#-10404PT04-07R Residence: Poppin, Tanya Residence 6321 Washinqton St. Fridley 55432 Dear Sir/Madam: Minnesota Statutes Chapter 16B provides that the Department of Labor and Industry, Building Codes and Standards Division, Elevator Safety Section, inspect and approve elevators and manlifts (endless belt lifts) before they can be legally used in Minnesota. An Inspector from the Elevator Safety Section recently inspected your residence and determined it meets requirements of the Minnesota Elevator Safety Code. NOTE: Compliance with Minnesota Rules and the ANSI/ASME A17.1, Safety Code for Elevators and Escalators does not necessarily assure compliance with the Americans With Disabilities Act of 1990. Sincerely, BUILDING CODES AND STANDARDS Mark A. Jonson State Elevator Inspector mai/rkr (CE -2) c: Julkowski, Ronald, BO, City of Fridlev Ability Solutions ElFormMR Building Codes and Standards, 408 Metro Square Bldg., 121 7th Place E, St. Paul, MN 55101-2181 P: 651.296.46391 F: 651.297.19731 TTY: 651.627.3529 and ask for 296.9929 www.buildingcodes.admin.state.mn.us Building BUILDING Permit No.:Q(Cx�S Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ Nom; = �•,�®�� Plan Review $ TENANT La ? L 0 LU A fu%f �—D CITY�� License Surcharge ADDRESS: L-1 >(-� $ Curb Cut Escrow PHONE: % .- 71 P $ CONTRACTOR NAME; MNIN CITY W Sewer Main Charge C. SUBMIT A COPY OF STATE LICENSE # XP DATE YOUR STATE LICENSE ADDRESS: �Dt�Y1tLLAi� PB MN �? CITY STATE ZIP WITH APPLICATION PHONE PROPERTY TYPE INGLE FAMILY/NEW SIZE ❑ TWO FAMILY/NEW CO STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH M -ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT NUMBER OF SQUARES Z GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE Soffit ❑ Trim j(Fascia WIDTH HEIGHT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes 13No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ — 1� F OCCUPANCY TYPE Permit Fee $ • Q!5; - SPlan Plan Review $ Surcharge $ Fire Surcharge $ License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ See Back Page for Fee Schedule jots, 65% of Building Permit Fee ) 0 (.0005) times the total job valuation - Minimum $.50 t/� /A .001 x Permit Valuation (1/10%) �9jd� 1 $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determinat n X ft+6ft= ftx$20=$ � $450 Conservation Plan Review U�� j�IP Fee Determined by Engineering 1 / Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and code of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application fo e t and w rk is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whi a and approval of plans. � SIGNATURE OF APPLICANT PRINT NAME �`�'' "'� UW /DATE Z Z Page 2 - Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE FEES .... „ " , . , : • .-,. . . $1 to $500 $23.50 (Minimum Fees $23 5iq bs sur°ch&ge) �n9 $501 to $2,000 $23,50 For?'13360" "'It"'$�i0 I-' iii additional $100 or fraction, to and . including $2,000`,,�k:� ' WE" 74 $2,001 to $25,000 $69.25 for I- $Z,00,0;01t $ A;" ft,�ach additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1s` $25,000 plus. $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1- $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1' $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1' $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1' $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, N!N 55432 763-572-3604 Fax: 763-502-4977 City of Fridley 6431 University Ave NE Fridley MN 55432 (763) 572-3604 or Fax (763) 502-4977 RECD J U L 1.12007 a�00i -CSWZV Water and Sewer Permit Application ❑ New Connection ❑Utility Line Repair/Relocation ❑ Existing IRWater and Sewer Connection Date: A6 -% Job Address: /o 320 UJOS b l ,, 5� N 6U rn �1t� Name of Applicant (Plumber): f �o d , Name of Property Owner: FC m \,z- K us n% r Existing Structure Permit # Permit Type: Sewer Fee: Water Fee: Meter Fee: Repair Fee: Relocation: State Surcharge: -90 SAC Charge: Special Assessment Fee: Applicant Inspector Total: $ 1/0. 0 Water Meter Repair — Weeke d & Holidays $125/hour Water Connections Permit $50 Sewer Connections Permit $50 Inspection Fee for Watee'werjAne Repair $40 Special Assessments See Finance Cost of Water Meter See Utility Billing SAC Charge $1675 State Surcharge 50 Water Tap See