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PRE 2010 DOCS/ SUBJECT PERMIT NO. City of Fridley ® A538 AT THE TOP OF THE TWINS BUILDING PERMIT Ir? 1 0 -RECEIPT NO. ' Lu ------ COMMUNITY DEVELOPMENT DIV. P?9%3 PROTECTIVE INSPECTION SEC. 1 L� /---1 CITY HALL FRIDLEY 55432 ` I L---- ''J NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 12/30/77 JOB ADDRESS 1412 West Danube Road N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 17 1 Innsbruck North 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harstad-Todd Construction 2200 Silver Lake Road, New Brighton 636-3751 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 Elj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 381.x 40' Dwelling and a 32' x 24' Garage` SEPERATE PERMITS 9 CHANGE OF USE FROM HEATING, FTEUM13ING AND SIGNS. STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. A recognized soils testing agency must certify the excavation and compaction tests at 2 foot intervals of 'fill in writing. Verify proposed lot drainage with the City Engineering Dept. Minimum front yard setback is 38.25 feet. Provide truss design. SEWER WYE: 65' East of Manhole (Manhole Inv. Elev: 958.83) WYE'ELEV',959.32 MINIMUM: HOUSE ELEVATION: 962.32 INNING WATER LOCATION: 31 East of Sewer Service Before digging cal! Iml utiliti TELEPHONE - ELECTRIC - GAS E` THE am OF MOM IW NOT GUARANTEE TIaC ACCURACY Ole MM LOCATIONS AND ELEVATIO -'.R ' ) '?,Y L AN .5 DATA IS FOR INFORMATION PURPOSES ONiLY i.l, 1 ?SONS USING ' 'SIIOULD VERIFY THE INFORMATIO,-� ON THE SITE TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. - Wood Frame 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 R-1 1328+768 34,240 Total 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. $48,255 $$24.13 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $136.96 $375.00 STRUCTION THE PERFOR ANCE CONSTRUCTION, PLAN CHECK FEE TOTAL FEE "c 77 $34.24 $570.33 WHEN PR PERLYTED THIS IS YOUR PERMIT SIGNATURE OFC NTRACTORORAUTHORIZEDAGENT (DATE) I 1I -'�V BLDG INSP - DATE SIGNATURE OF OWNER (IF OWNER BUILDER) - IDATEI • CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NE=W, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: Address: No.: / q I P- Street: t) 13UILDEII: [4 54H © WD Address: cab 4j ✓ ,/y �� l� Tel. No.: 60 3 6o 3 7 571 �z V, L I I LOT: % BLOCK: I ADDITION: 1 w 4� y b y u e dC , �?yi AAJj 1 61A CORNER LOT: INSIDE LOT: X SETBACK: 3.t -)i .t ` SIDEYARDS: 17 / * IIf 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: is Front: Depth: Height: Square Feet: % Cubic Feet: 17,64 �ZY Z Front: 3,117— Depth: A `/ Height: Z Square Feet: Cubic Feet: %61'Af) Type of Construction: I,ti'^0 c c )'v 2 ` Estimated Cost: $ ToI ®2 `✓ ' To Be Completed: 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 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 dditional informatio DATE: �P—® pe - c � 7 SIGNATURE:"'� - -�G �/- JAI �/ rip xsr of p� OWNER SITE ADDRESS ,EXTERIOR 'ENVELOPE AVERAqE11V UTAt ION I �- %, 3,2 M, H. i Mv, r_LrV. = °75 W, 53 W &P�� - -- q 6.,32 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS PITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures x $3.00 Future Fixture Opening x m New Fixture, Old Opening Water . $2.00 a� x $5.00 Water Heater - to 99,000 BTU �- x H-H� 100,000 BTU to 199,000 BTU m a m41 ►+ W W x $5.00 Heater �,m $5.00 e w u a1 w v a14 O W O 4 m O O g ,ij .W J y m m iw U14 m y S o w N w U wi° 3 U 0 as lec lst 1 t 1 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures x $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x . $2.00 Catch Basin x $5.00 Water Heater - to 99,000 BTU �- x $5.00 100,000 BTU to 199,000 BTU r. $10.00 Water Softener x $7.00 New Ground Run Old Building x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: lst 3 fixtures x • $3.00 Additional Fixtures x $1.00 Gas Range to 199,001 B -TU x $10.00 REPAIRS $ ALTERATIONS TOTAL $ S S First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE REINSPECTION FEE ($10.00) Job Address `' =s r�ive-i/,3 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. OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. ROUGH INSP. Company Signed E Tel. No. Date FINAL INSP. e-1 ` ;'�' Date APPROVAL FOR PERMIT �g MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $•50 STATE SU1tMMyGE Gi iY OF FRIDLEY MINIMUM FEF. FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Job Address / f WES DAA1W F Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Department Repairs & Alterations -up to $500.00 of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley dle y Tel. #571-i450 MECHANICAL WAIM AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ _ specified agreeing to do all work in strict accordance with the city Codes each add. 50,000 BTU 4.00 $, C) and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct. Repairs & Alterations -up to $500.00 7.00 4.00 $ $ 199? Repairs & Alterations each add. $500.00 Fridley, Minn. STEA.'.1 OR HOT EATER SYSTE.%i: 1/ OWNER Co HrT Railer & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING each addr.. 50,000 BTU 4.00 $ °� q t L ILCZ Boiler only up to 100,000 BTU 7.00 $ USED AS each addn. 50,000 BTU 6.00 $ OIL TO BE COMPLETER ABOUT, KI BURNER- to 3 gal. per hour $10.00 $` /Poo each add. 3 gal. per hour 10.00 $ ESTIMATED COST GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ ,(3 l OLD - NEW BUILDING PERMIT NO. PERMIT NO. (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ DESCRIPTION OF FURNACE/BURNER Additional Fixtures x Gas Range to 199,000 BTU X $ 1.00 $10.00, $ $ HEATING or POWER PLANTS, Steam,.Hot Water Warm Air No. AIR CONDITIONINGmrade Hama N140 Size No. �® FAN HEATING SYSTi `1S Se® Fee Schedule VENTILATING SYSTEMS $ V �� ALTERATIONS REPAIRS � Capacity' sq. Ft. EDR _BTU HP State Surcharge $ $ .50 Total Connected Load 7 Kind of Fuel &r &4S TOTAL FEE $• --® BURNER - Trade Name 'p`T Size No. ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date ($10.00) FINAL INSP. Company Date Signed By APPROVAL FOR PERMI ' Tel. No. MINIMUM FEF. FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE _71d - 7klDo, HEAT LOSS ULCULATIONS DEPARTMENT OF INSPECTION Weatherstrips GuideConstruction No. Windows Doors Reference Out.W&H Int. Wall Ceiling Roof Floor Kind Y­eS__N_0 1 19— 1 1 11 Fl. &�:L Room Length" Width ,, Height F1.1 ChRoomI Lei Windows and Doom-Crackage and a Windows and Doom-Crael I otal t5tu. I Required sq. it. E.D.R. or sq. ins. W.A. Leader area F1.1 4%t Roo7mLength Width Height Windows and Doors. -trackage and Area 104 t.6 Height I Llrn.0%1�11. Are. I of . I lights lit U @a. ft. 1-14/1 4e'o lmpi"Z I MY. Lm Glass r 4,61 ff a 0 Exp. wall Net exp. wall Int. wall Ceiling 9 9ww9 U20 1 99", Total Btu. Required sq. it. E.D.R. or sq. ins. W.A. Leader area F1.1 Arr1l;4loom I Lenff th /< CZ 77H—ekht _ Windows and Doom-Crackage iaidArea lCoef.1 Btu Width HeightNo. Of Lineal ft. Area No. of pans of pan" lights of crack MR. it. IF mo H611" Glass CoAl Btu Infiltration AT Infiltration Net exp. wall Int. WAR Glass 4 Clogs Up. wall -31-11 all .1 Total Btu. Net exp. wall b Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Int. wall Net exp. wall a Ceilingj® 4 lot. wall Floor I otal t5tu. I Required sq. it. E.D.R. or sq. ins. W.A. Leader area F1.1 4%t Roo7mLength Width Height Windows and Doors. -trackage and Area 104 t.6 Height I Llrn.0%1�11. Are. I of . I lights lit U @a. ft. 1-14/1 4e'o lmpi"Z I MY. Lm Glass r 4,61 ff a 0 Exp. wall Net exp. wall Int. wall Ceiling 9 9ww9 U20 1 99", Total Btu. Required sq. it. E.D.R. or sq. ins. W.A. Leader area F1.1 Arr1l;4loom I Lenff th /< CZ 77H—ekht _ Windows and Doom-Crackage iaidArea lCoef.1 Btu widthKe_-Ke-Ight No. ogoal It. Anb No. Owe Of1*06 Oltbtoof.. it no. ft tee H611" Glass coef. Btu Infiltration Net exp. wall Int. WAR 05 U1, 4 Clogs Y0 Total Btu. Esp. wall b Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Exp. wall Net exp. wall a Height 4 lot. wall Ceiling Int. wall Ceiling Floor V/11 Floor Total Btu. L�_7(1 Required sq. ft. E.D.R. or sq. ins. W.A. tender area ,13L -4p MMEAMUS. MM., Insulation How Applied Width Height and Area out ft. Crack IFt Wiodows aid Soom-Crackage a Area lCoef.1 Btu Infiltration 9 Die H611" Glass Exp. wall Coef. Btu Net exp. wall Int. WAR 3 0 4 Ceiling Floor Y0 Total Btu. Exp. wall b Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Exp. wall J C1 I 7A_&-:*'iP UR.. — 11 ....It. 19 VV;Jth Pq Height Wiodows aid Soom-Crackage a Area Width Height No. of Lineal ft. Area No. of vane of pane lights of track SQ, ft. -97- 9 Die 2— Coef. Coef. Btu Infiltration 3 0 4 Glass Glass Exp. wall Exp. wall Net exp. wall -7 Net exp. wall Ceiling Int. wall Ceiling Floor Floor Aa J7 1 6 7/ Total Btu. 1 dy— Re"ired sq. ft. E.D.R. or sq. ilia. W.A. Leader area J 911 h .1 AP JWh AmMomm I I ffinath Id- Width // Heizht Windows and Doom trackage and Area Width H a I a bt - RRo_.Ot Lineal ft. Area No. of pans of past lights of crack Coef. Btu Infiltration 3 0 4 Glass Exp. wall Net exp. wall -7 Int. wall Ceiling Floor Total btu. Required sq. ft. E.D.R. at sq. ins. VA. Leader area or tyss . MEAT LOSSICALCUATIONS .DEPARTMENT OF INSPECTION MOMEAPOUS. ME& Weatherstrips _ • Guide Construction No. Insulation Windows Doors Reference Out. Wap Int. Wall Ceiling Roof Floor Kind How Applied Ye� a—f�— ems— 0 19® �b"" F1.1 NI , Room Length Width Height Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Wtdeh HNght No. o Llneal [t. Area Wldth Helgbt No. of L/nul tt. Area No. of pane of cane lig to of crack ae. ft. lee. et Wena of nano light- of crack_ art. Ar; 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 Fl.l Room I Length Width Windows and Doors--Crackage and Area Width Height No. of Lineal it. Area No. of pans of pane lights 1 of crack m. ft. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. iHs. WA. Leader area F1.1 Room I Length Width Windows and Doo's--Crackage and Area Width Hoigbt No. of Llneal ft. Area No. of pane of pada lights of crack eq• ft. C Infiltration Glass Exp. wall Net exp. wap Int. wall Ceiling Floor Total Btu. Required sq. ft. MR. or sq. ins. WA. Leader area Btu Btu Coef. Btu InfiltrationS' Glass ST j Exp. wall. 0", V4 Net exp. wall' Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. ' f Room Length 6 Width Height Windows and Doors—Crackage aid Area wldtb Hol.h, No. o —Ll­aeal•fL Ana Not or pane of Pone lights of crack p. ft. Coef. Btu Infiltration g T", 0 k k !r Glass Exp. wall; Net exp. wall Int. wall , e „ Ceiling Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area F1.1 Room I Len W' Height Windows and Doors--Crackage aid Area Width 11tolght No. of peal ft. Ana No. of pane of pane Ugbto of amok sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall lot. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA: Leader area 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 Fl.l Room I Length Width Windows and Doors--Crackage and Area Width Height No. of Lineal it. Area No. of pans of pane lights 1 of crack m. ft. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. iHs. WA. Leader area F1.1 Room I Length Width Windows and Doo's--Crackage and Area Width Hoigbt No. of Llneal ft. Area No. of pane of pada lights of crack eq• ft. C Infiltration Glass Exp. wall Net exp. wap Int. wall Ceiling Floor Total Btu. Required sq. ft. MR. or sq. ins. WA. Leader area Btu Btu t 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)S71-3450 Mr. Bob Todd Harstad-Todd Construction 2200 Silver Lake Road New Brighton, MN 55112 Re: Final Inspection at 1412 West Danube Road N.E. Dear Mr. Todd: A final inspection was made on April 28, 1978 of the above address and the following items were noted which must be completed before the structure can be finaled out; 1. Regrade rear yard to alleviate water problems by June 15, 1978. 2. Install smoke detector in lower level by May 16, 1978. 3. Install handrail to basement level by May 1¢, 1978. 4. Install one step between house and garage by June 15, 1978. 5. Provide sod in the front and side yards by October 10, 1978. 6. Provide a hard surface driveway by October 10, 1978. We will expect the above items to be completed by the scheduled dates when reinspections will be made to determine compliance. If you have any questions on these items, please contact me at 571-3450. Sincerely, RON HOLDEN Building Inspector RH/mh 17- 111111111111111PPii 2191 SILVER LAKE RD. & NEW BRIGHTON, MINNESOTA 55112 ® PHONE 636.3751 December 5, 1976 Mr. Ron Holden Inspection Department City of Fridley 6431 University Ave. N.E. Fridley, MN 55+32 RE: 1+12 West Danube Dear Ron: 1. Attached is verifying survey. 2. The deck is completed. 3. The door closure will be on the fire door and house numbers installed by December 15, as per your request. Yours very truly, HARSTAD-TODD CONSTRUCTION CO. Robert s. Todd RST/lint cc enc, 4� .oa..o sas iom s s 'f'�MIT NO. SUBJECT PE city of Fridley `" m 5053 AT THE TOP OF THE TWINS BUILDING PERMIT f R-ECiFFI N O . ` ______ COMMUNITY DEVELOPMENT DIV. L r I PROTECTIVE INSPECTION SEC NUMBER REV DATE PAGE OF APPROVED By iCITY HALL FRIDLEY 55432 j 612-571-3450 910-F15 5/12/97 JOB ADDRESS 1412 West Danube Road NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 17 1 Innsbruck North 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Huisinga 1412 West Danube Road NE 571-0172 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Midwest Siding & Roofing 18979 Gladstone Blvd, Maple Grove MN 55311 20010277 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 416-4804 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j1 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (29) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 $2,392 $1.20 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- $74.75 W Fire .SC $2.39 STRUCT NOR THE PERFO MANCE OFC STRUCTIQN / PLAN CHECK FEE TOTAL FEE /`� LaA I E License SC $5.00 $83.34 `�­­:�T SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERL ALID TED THIS IS YOUR PERMIT BLDG )NSP ad lorTE SIGNATURE OF OWNER nF OWNER BUILDER) (DATE) 'f'�MIT NO. NEW I ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER ( ) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 14 t D-- Lo Legal Description: Owner Name & Address: 1r Ina uintrym Tel. # Contractor: MN LICENSE # Address: -M �jc Tel. # Lig b LA Attach to this application, a Certificate of Survey of th§' h 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: Lengh Width Hgt/Ground Sq. Ft. OTHER: r Construction Type: �,QW Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: S`(a— APPLICANT: i Tel. # LLQ -`'t ED L/ CITY USE ONLY Permit Fee s $ ' ' Fee Schedule on Reverse Side Fire Surcharge $ c .001 of Permit Valuation (1/10th%) State Surcharge $ ,, ,2 C $.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: l 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, P+k (®6-�'7 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS I L4 I �- ! �a r���� R�• RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) 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 of rulings of the Building Division, and hereby declares that all the facts and $ 30.00 $ 3y• representations stated in this application are true and correct. / 2 -- ) t .1997 $10.00 $ I R� OWNER ��„.�. � Aci 5e -,,g&- S`7(.- a l ? 2. Gas Range $10.00 Gas Dryer $10.00 *Air Conditioning - All Sizes $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value Applianceofor Work 00 ,r CI.'-ae-1, Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge Gq� $ .50 TOTAL FEE s�° MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/1 -Ir *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. BUILDING USED AS , vee ESTIMATED COST 31 C- 9 �' PERMIT NO. rc DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water)(Warm Air Trade Name Xd rk Size No. BTU -i? -O, v -&V HP EDR Fuel ,tl" �.s Total Connected Load Burner Trade Name Some— Size No. BTU—IR-o, arm HP EDR HEATING COMPANY /��T�n� ad W 4J&- 4/1 - Signed Tel No. Z 7 - Z 3 Zf Approved By Rough -In Date Final Date FILL OUT BACK SIDE FO STACK VERIFICATION ON REPLACEMENT FURNACE TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: . List ALTERATIONS Beina Done: HEATING CO: Signed By: Date: Yes () CHIlVINEY AND STACK VERIFICATION ( ) The undersigned hereby verifies that the _existing chimney or stack: No 1. . Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported . Yes ( ) No ( ) 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 8. Has combustion air been provided for water heater Remarks: . List ALTERATIONS Beina Done: HEATING CO: Signed By: Date: Yes () No ( ) Yes () No ( ) Building PLUMBING Permit NO.: Q0 M50A-Q) InspectionsRESIDENTLAL APPLICATION Received By: U 763-572-3604 CITY OF FREDLEY D 1" _2D1 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE I 0`Z—W `® SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT 0 OWNER E-MAIL ADDRESS 2 CONTRACTOR NAME: 6�',ff�a iL ;✓Gal SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: q' �' CITY STATEZIP INSURANCE _ BACKFLOW PREV. ($15) _ _ TRAY PHONE � FAX PERMIT TYPE INGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE 11 TYPE OF WORK: I ❑ NEW #EPLACEMENT 11 DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. WATERPIPING _BATHSINK/LAV BATHTUB _FLOORDRAINS GAS PIPING (NEED CITY LIC) _SHOWER SWIMIW NG POOL —WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15) _ _ TRAY TWATER HEATER ($35) FOR IRRIGATION —DISHWASHER _LAUNDRY WATER METER OTHER THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in thethe&Xr z all work which requires review, and approval of plans. SIGNATURE OF APPLICANT (Aft A PRINTNAME iii/ S041- DATE ,®✓ c'� APPROVAT. TNRPRC rnRR WMATTTRF City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977