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PRE 2010 DOCSCity of Fridley SUBJECT P N0. 13464 AT THE TOP OF THE TWINS BUILDING PERMIT • r CI COMMUNITY DEVELOPMENT DIV. t✓ I PROTECTIVE INSPECTION SEC.IL y NUMBER REV. DATE PAGE OF APPROVED BY 1 �'•-1 CITY HALL FRIDLEY 55432 L"•- �.J 612-560-3450. 910-F15 4/19/76 JOB ADDRESS 1417 West Danube Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, 12 1 Innsbruck North 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Domestic Development Inc. 201 West BurnSIdille Crosstown, Burnsville 55337 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 ® O B" a a Co a 35' x 441 Dwelling and a 26' x 25' Garage ACCURACY OF ri%IULt:T DOES UTILITY LOCATIONS T UARANTEE THE DIVISION REGARDING CURB mEVA:p 9 CH F M ATI®Ie! PUrP®SES ONLY AN: b USING AT DRIVEWAY OPENINGS. IT SHOULD VERIFY i STIPULATIONS Provide a hard surface driveway. Provide X sod in the front and side yards. Provide a verifying survey before capping. Provide truss design. SEWER LOCATION: (Approx. 10' Deep) 2' west of manhole (Inv. 960.48) WYE ELEV: 960.47 TOP OF FOOTING: 963.75 Minimum e WATER LOCATION: Approx. 3' east of sewer service "VISIOII SAIFEI Y CH`i IRnL aC ;;r , DO NOT PLANT OR SEpEFFATE PERMITS REQUIRED FOR WIRING, TH1,1T?4 NTHIS AREA Wii i-JC'UT A4'• PROVAL OF THE CITY OF i=RIDLEY. HEATING; PLUMBING AND SIGNS). SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 1540 +650 32,620 + 650 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 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. $ 41,900 $20.95 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- $60.35 $350.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ra 1 0� �f �9 �A v PLAN CHECK FEE TOTAL FEE `? 6 $431.30 SGNATUREOF ONTR CTORORAUTHORIZEDAGENT (DATE) - WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT .. ""'" BLDG INSP R ECd - /fes DATE SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) F� P 4 205-76 SURVEY FOR: DOMESTIC DEVELOPMENT, INC. 2234 272/26 , HARRY S. JOHNSON COMPANIES, INC. U 8330- 220ST. W., LAKEVILLE, MINNESOTA 55044 PHONE (612) 469-4481 III $urveyor's Certificate cA� �J /70. G / vS ILI, NN .o no �E —IMPORTANT— NOTIFY THE FRIDLEY ENGR. DIVISION REGARDING CURB I ?MQVAL AND REPLACEMENT 'AT DRIVEWAY OPENINGS, f G TWE CITY OF FRIDLEY DOES NOT GUARANTEE THE ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS. THIS DATA IS POR. INFORMATION PUCPOSES ONLY AND PERSONS USING IT SHOULD VERIFY THE INFORMATION _ 4 '. H = "ITE NOTES * Existing elevations are shown hereon * Proposed garage floor elevation 9G• 2 4! * Proposed front house entry eleva- tion i * Proposed rear house entry eleva- tion �0 ARID 000r@ digging call local utilities TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BYLAW 5C.La /,&7C/ = /ron - fiona/r�e�j� I hereby certify that this is a true and correct re- presentation of a survey of the boundaries of: Lot 12, Block 1, INNSBRUCK NORTH 2ND ADDITION, accord- ing to the recorded plat thereof, Anoka County,Minnesou and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. It also shows the location of a proposed building. As surveyed by me this 13th day of April, 1976. Ai,drry S. Johnson Land Surveyor Minn. Reg. No. 5065 4 IVIS O\mc�� o4s *A -aS\ �sk\oN A-0 VPNY :vvo 1 10 APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: __ BUILDER: Domestic Development, Inc. 201 W. Burnsville Crosstown, ADDRESS:— ADDRESS: Burnsville, MN 55337 NO:. 1417 STREET: Danube Road LOT: 12 BLOCK: 1 ADDITION: INNSBRUCK NORTH 2ND ADDN. CORNER IAT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Tao Certificates of Survey of Lot and proposed building location drawn on these Certificates. _r DESCRIPTION OF BUILDING To Be Used As: :! Depth : �y ® Height : d / Square Feet: _124 Cubic Feet: Front :<1 Depth. Height: / 0 Square Feet;` 10`4 _ Cubic Feet: 40 Type of CGnstruction: Estimated Cost: $ 5762-'LZ50 To Be Coiupl=,ted: The undersigned hereby makes application for a.permitc fox the.work herein specified, agreeing to do all work in stti.ct accordance with the . City of Fridley ordinances and xuli.ngs of the Department of Buildings, and hereby declares that all t'tie facts and representations sta-, d in this application are true and correct, DATE: / SIGNATURE (See Reverse Si.d(- 1'ox Additional Inforni~�tion, 4. 40, 30- 2,0, 02,0, 9 t® Ed! a, M__ .-V - + 1 - - 1 - -- - - --- - --J 770 alp XI c -77— ti7 1 i i I 1 � P cy— 1 J % II / I' ; i I _ — W 8F do UO a 00,14 205-76 SURVEY FOR: DOMESTIC DEVELOPMENT, INC. 2234 272/26 `kV HARRY S. JOHNSON COMPANIES, INC. ' 8330- 220ST. W., LAKEVILLE, MINNESOTA 55044 PHONE (612) 469-4481 I $urveyo s Certificate L M a .41 .f 7,0 • ,1G J S / O �otr CW J \\ oa ,Ile 3 p0 , NOTES * Existing elevations are shown hereon * Proposed garage floor elevation 996.2 * Proposed front house entry eleva- tion * Proposed rear house entry eleva- tion 5Cc7LG / //!ch = 3,0 /ell O evenv%.s /ron I hereby certify that this is a true and correct re- presentation of a survey of the boundaries of: Lot 12, Block 1, INNSBRUCK NORTH 2ND ADDITION, accord- ing to the recorded plat thereof, Anoka County,Minnesoti �y A.% and of the location of all buildings, if any, thereon, and All visible encroachments, if any, from or on said land. It also shows the location of a proposed building. As surveyed by me this 13th day of April, 1976. al;_/� Aijrry S. Johnson Land Surveyor Minn. Reg. No. 5065 46eu G. Mark Nagel 1916 W. JBth at. Bloomington, Mn. 55431 Phone B84-1187 CITY OFt OWNER iGME511c pts, ADDRESS - ®DJ J LEGAL DESCRIPTION OF PROPERTrt LOT BLOCK z SITE ADDRESS PLAN xvxBER 3_ loci ADDITIOz D!"'� EXTERIOR EMLOPE' AVERAGE "U" CONPUTATION 1 LINEAL FEET OF EXPOSER WALL TOTAL SQ. FB'. OF EXPOSED MALL 190 A'L TOTAL SQ. FT. Old' GLASS 0 90% 079 XFG • N 'D E R s 0 TYPE C S hT CFX LEAKAGE . Z S TESTED BY SrATr- 4PPRov R D DATE TOTAL SQ. FT. OF DOORS S1 TYPE / l(HC}. MFT® L — PF -6 s r, TYPE OF INSULATION IN WALLS C&14SS '3 11-t "' 'PRICK wR0 VALUE h TYPE OF INSULATION IN CEI LG. F C a SS /e "'" THICK "R" VALUE Z I - -7 o TYPE OF INSULATION:IN FLOORS "R" VALUE AVERAGE "U"' VALUE OF EXPOSED WALLS ABOVE TIRADE e / NINIXUD OF .17 FOR ONE AND TWO FAXILB DWELLINGS YINIAUM OF .22 FOR ALL OTHER BUILDINGS e Zt7C LAW OFFICES OF o JANIES C. TARBOX W-972 FIRST NAT•L BANK BUILDING ST. PAUL, MINNESOTA 55101 TZLEraoNZ 227-8321 May 17, 1976 Village Clerk Village of.Fridley City Hall & Courthouse Fridley, Minnesota In re: Lot 12, Block 10 Innsbruck North 2nd Addition Anoka County, Minnesota Dear Sir: Have any building permits been issued concerning the above property? If so, will you please note the name and address of the person to whom they were issued. I enclose self -enclosed, stamped return envelope. Yours very truly, James C. Tarbox JCTks Enclosure Building Permit #13,464 for Lot 12, Block 1, Innsbruck North 2nd Addition (1417 West Danube Road N.E.) was issued April 19, 1976 to Domestic Development Inc., 201 West Burnsville Crosstown, Burnsville, Mn. 55337 Tel. #894-4040, signed by Mr. Frank Kleckner. If you need any further information, aG. fre contact me at 571-3450. AV T -6 -AL LARK Community Development Adm. Appik-a-b Pcww ri-?�z ov-1 CeCZ-1 Vc9nis'Hirzilocn, d ,km Ici V a - bt.4,:�q Air and Dond= PARTIAL RATE SCHUMULE GRA V I r I WARM AM RAVZ TOTAL 1417 west Danube ramire Sell & D�ici Work 610.00 r Rep!zemcnt of rurn3re 6.00 City of Ridley: Pepairs & A"crat;ons— up to S500,00 6 r)o $ The - undersigned hereby makes application fo7r a permit for the, work 14'er. 0- r specified agrc-eing to dc all work in strict accordance with the City 'Ordt. -P. - A ce-- Repairs & Alterations each add. $500.00 3 Vj and niling of the Depaitment of Buildings, and hereby declares that arl'tbe facu and mon.-spniations stated in this application are true and correct. DaML WARM AM rridley. Mian May 18, 19 LEI:- F%Lraace Shcll & Deed Work to 120,M BTU -SIO OD 10.00 ezch am. to'M BTU 3.V) aOwner Domestic Development RepUce-nent of Furnace 6.00 $ Kind of Building Frame Repairs & Alterations --up to $500.00 6.00 S_ Duelling • Repairs & Alterations each add. S504.00 3.00 Used as. To be completed about August 18,, 1976 STEAM ax HOT WATM SYSTEM Furnace Shell & Lines --to 400 sq. ft FZR Stemn SM00 5 Estimated Cost; $ 2,100.00 Furnace Sheri& Un.—to 640 sq ft. EDR Hot Water 1000 Old Building Permit No. Permit No. 60 413 Each add :00 3q. 1`1 EDR Stearn '300 $ -140w. Each add. 320 sq. ft EDR Hot Water 3.00 DWICIRLM027 OF WORM OIL ZUENZE—to 3 gal. per hour 6.00 S. HEATING or POWM MANTS-Stewn, Not Amer, Warm lir—No over 3 gal. per hour --See Iree Schedule 5-00 Trade NameI-IennoX Size G12Q3-110 GAS BURNTE (up to 151M.000 BTU) 6.00 over 199.000 = S** Fee eckedule Capacity—_-- Sq. rt. F-D.R 110POOO —BTU GAS FITTING rErs: WO RATE TOTAL _X.P Ist 3 nxtures %S zoo S 00 Total Connected Lead. 110_q378 Kind of ysle, Natural Gas Additional Flirtures x .75 $--. BURNER — Trade Na Iennox Size No_212Q3-110 Gas Range to M.MO State Surcharge .50 Catiad —'sq. lit.rj) R 3.10, 000 — I=— EMIL AM - M—AD M 0 X Ir G1 $-_ Fans 2 bath plus venting kitchen hood TAN F-71=2ING SYST= F" ScLedalo VENTMATMG SYSTEN VL20.00 ALTMATMNS & RMOMIM TvrAL 37.50 -a Kleve Heating & Air'Conditioning ROUGH '.941-4211- 1 Elsa5�_ 13075 Pioneer Trail Eden Prairie, Minnesota 55343 E—AT LM'� UUA1,LWf'ONS, ALIm c F ]BUILDMIS Constmaica No. aswation D,"rs I Refe CD" iiOut, WAH lint. WAH C.,—e3ins fi xT K&A ic Height and t)c.,r*—Cr,%c itid Tre7a W"Ws &W t k Ogg 4 PC &►t40 M AS*% Q, au vV cruv A Exv. waN P, vv 43VP6 Whk Raw - =_ or sq. in-Ij W -A, Le&&r a Ad4 , W� a 00' W a Of or Ama liwbka trw 77 —1—Frt —j— JI ion LT - - - - - - ------ I VIA UP' Wa ft. MR., or s,J. i-lft. am Rft*i Arco X919 I � R,, E -DR w *q. ir,-., Exp, w49 IRL wag Flwt 7-7t` ciAl AT[: ! 'AR`I'Ii M Or IIUILDIRCS Canatrxtcta. No. tm'�iart tclsfe Ce Glut. Wali lot. WSI Cedes' fTFkmr Kied Now ApO'., ,- - L.en�t W rlth Height �] �1.� Length _ WitlitjE I•Ieiaht !VnEt$a� t�ckar► sad i�eree '•""' tlridlb si�rlt ids. at Aaaat dt. A:na *(oafs* kt tciwD tkrbt�s a! oraeffi sq'it, q l!?iilfEft C40. MINI Exp.�ypyy�y l�fYtl sg .OYRn, ew wod a�w.amutr NA IWA I" WWA ctaiar, - Fkew es+ a —J racka ant Area and o. of t_enl ft. Ac•s� [�+�s !IK2rark tiq !t. C"f. A Btu 41i"s .A, I.eaeice Careen Wiser A"me a. terteo� at. rt. 4 YnM1 . i� .A. LAader •ntt aid Area Wt �. +rAr. IW.t4. mar' arstE TOW mak. � ._.. RootimA EMS. ft. fiJC R t r EiQ. s".A. Zara► or artea In l IAMAI vim i•iekht WtEtodu+ore & csacksgs godAt�cti t llaEAt to tt "sm, -. fiN ;Ks. vt wa W ri titrtat. att:�ci� q. tt. '•""' .ate... -"° I@i�ti'fltlRtE1 MINI Exp.�ypyy�y l�fYtl sg .OYRn, ew wod a�w.amutr I" WWA ctaiar, - Fkew es+ a —J T' �.� �.. I Req#imml sq. ft. I;.DJL w sq. im VA....... -J: r a wEr pV'SikAn &11'dI ESC &ad Am -- tet 0. ;.ti74R Ti:- r .Arsa yip tt as En few er atilt L.4 FMI .tea...«,. wev tt ow wA UL waw Floor Total ..,.. �. t s e•+ `/ ti'•�I.O .,..,.... l�ap't. of Elder. P'tioze .`•.=�•a"•.:x7 ... .. • r f I � _ DESCRIP'�IO:i OT WOM. `/ I' G�/ H)ULkiDLo V :iC^Sar, v�.t Lr.d T ^cr_ien o! EstiIT3L2d CASt, $ x I c..s tree. t'IX*rU4n- RATES: 140. P.ATV TOTAL iv r{ S! U I U a (U I e LA'� ed ice! �rs^.bea Fixtures . > .......... ... I/�zl�j $ I iI • = x 51.ENBusin,,= •Sig - 7�,1 i/ISI/ I•I/ Hm' Phone No ew F ixtu!! e Oi! Opf inn.... • :.. • . X Si.50 r Ca:ch Basin ....... 0 .......... , . - x $3.25 3 . S;'atcr Heater 'U'p to 93.000 B T UI .... ----L-- x S300 5 - • 1 I I S ; .New ...... • e . a ; 2.0y S S— --- rnxx- , (f� - 3 i ^ 7 - aAS r T : TNG c-^t:S: "10. Fin T:: TOTAL. %t 3 Fixsur es .................. ®._ x 52.03 v yy .-•�--•--'� X V• .75 S -- cl t s`•iav : Ir: -.:•5. Old t;Tls ::.:�s Ccc.:pcol Q City of Fridley'. The undersib-nee, hereby mikes a;)PUc3'i0n for a per=iit fcr thr -c:= herta specified, a. eeing. to do ail Nvc:k in Stact acccz'da :cc w::h the Cid and r 'ing of the U -.':pa tr.^cnt of Builc nU, and he: eby declz: e-, Lha, ail the foci • and representations stated in Lh.s ap;.'.ica°,'.--'n are t:'.:e a.rd car c -e- dey, 3fi OwnerC,- Kind of Build:. ^.z Wc)6 i tsA Used as �c,�J�e L ° Ai c' To be completed abut v L.. PARTIAL RATE S�`H"DU! EstiIT3L2d CASt, $ O.d�� t'IX*rU4n- RATES: 140. P.ATV TOTAL e LA'� ed �rs^.bea Fixtures . > .......... ... — x S2.G�. $ • = x 51.ENBusin,,= •Sig - F`uture F:xtu:e Opening ....... • • • Phone No ew F ixtu!! e Oi! Opf inn.... • :.. • . X Si.50 Ca:ch Basin ....... 0 .......... , . - x $3.25 3 . S;'atcr Heater 'U'p to 93.000 B T UI .... ----L-- x S300 5 - • G: o_..^.d Run Old Bldg.... :.. o . x :3.25 S .. . .New ...... • e . a ; 2.0y S S— --- rnxx- , (f� - 3 i ^ 7 - aAS r T : TNG c-^t:S: "10. Fin T:: TOTAL. %t 3 Fixsur es .................. ®._ x 52.03 v tlGera:L.�.B♦ F:x:•ti es • • s • • . s s.. . s . e s .-•�--•--'� X V• .75 S -- - • . . '�•--- Gu ?.s. -.be to 25.3.E B a v ......... ®..:._-,�--•- _ . .50 State Burchca ge .G L:ER •.'.®foz So Coda J p � E August 31, 1976 6431 UNIVERSITY AVENUE I.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Domestic Development Inc 201 West Burnsville Crosstown Burnsville, Mn. 55337 Re: Final Inspection at 1417 West Danube Road N.E. Dear Sirs: A final inspection was made of the above address on August 30, 1976 and the following items were noted that must be completed before the construction can be finaled out; 1. Post address on front of house. 2. Provide a verifying survey. 3. Provide handrail on lowest set of stairs. 4. Provide joist hangers on outside of deck joist. 5. Provide joist hangers on joist over sub -basement stairwell. 6. Complete firewall in garage. 7. Provide door closer on door between house and garage. 8. Repair same door where hole has been bored. 9. Provide sod in the front and side yards. Items 1 through 8 will be expected to be complete by September 15, 1976 and item 9 will be expected to be complete by October 15, 1976. Please call us if any problems arise that will prevent you from completing these items by those dates. Sincerely, 3OWTIC. , BARREL G.'CLARK v cfamunity Development Adm. nti 14" 1llG_TyTU 0 ' N2 43270_j .� jI- ! t. Building Job Report ADDRESS C ,�� Ci l� L( ) . J� } �i / a �.•� / OWNER BUILDER DATE .y_ / _ X711 PppERMITp NO. DESCRIPTION e—Q (n /) (j SLC — INSPECTION RECORD DATE REPORT U}n�r[� QQ��ra1 n�� I1� �,rr�rcG 6� i OWNER — REP. INSPECTOR a �, SUBJECT P City of Fridley 2 2 0 8 0� AT THE TOP OF THE TWINS BUILDING PERMIT O COMMUNITY DEVELOPMENT DIV. 1-3r PROTECTIVE INSPECTION SEC. t NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/26/93 JOB ADDRESS 1417 West Danube Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 1 Innsbruck. North 2nd Addn SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Mike Holly 1417 West Danube Road NE 574-0058 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Accord home Builders. 1273 Bucher Ave, Shoreview MN 55126 785-7009 1492 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW �] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct a 161 x 12' Deck. 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan, Provide smoke detectors as per UBC -1210 adjacent to all sleeping areas and in basement, WARNING Before digging call for all Utility locations 454-0002 REQUIRED BY MVV TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. 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 $2 000 $1,00. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT I PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $45..00. Fire SC $2.00. TRUCTION OR THE PErORYANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.0Q $53,00 WHVROPWLY VALIDATED THIS IS YOU PER IT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI DATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI FotYr:rS sysp � NEW [ I Effective 5126/93 ADDN ( I CITY OF FRIDLEY , 3 ALTER (J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �F Building Permit Application Construction Address: f'i t Legal Description: kck v %ry. -i.. '1®rvv% P6``� Aga: -4,- Owner Name & Address: M ; &- No \\_1 Tel. # 5qjr- ®®5 V Contractor: RcwcR�, %cus MN LICENSE # Address:�2'13 V3w-kcr Ave.. 56;r.4rc.,0 6161 9-e1J-6 Tel. # rj%5--7009 Attach to this application, a Certificate of Survey of the " lot, with the proposed construction drawn on it to scale. DESCRIPTION OF B&PROVEMENT LIVING AREA: Length Width GARAGE AREA: Length Width DECK AREA: Length l Width OTHER: Corner Lot [ I Inside Lot [ I Ft. Yd Setback Type of Construction: I er-44c-A- % C e.da r Approx. Completion Date: I Height Sq. Ft. _ Height Sq. Ft. Q A Hgt/Ground Sq. Ft. Side Yard Setbacks �6r Estimated Cost: $ r� (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: .3 -'13 APPLICANT: 7 � �'�'— Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge $ TOTAL $ �� Fee Schedule on Reverse Side .001 of Permit Valuation (1110th%) $.501$1,000 Valuation— $750 per SAC Unit f $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. `"B" Above Conservation Plan Review $450.00 Fee Determined by Engineering Agreement Necessary ( I Not Necessary [ 1 STIPULATIONS: 205-76 SURVEY FOR: DOMESTIC DEVELOPMENT, INC. 2234 272/26 ,. HARRY S. JOHNSON COMPANIES, INC. ' 8330 - 220ST. W., LAKEVILLE, MINNESOTA 55044 PHONE (612) 469-4481 $urveyor')s Certificate 101" s. �J \ZO/ e 1„'k 0 �0 THI CITY OF FRIDLEY DOES NOT GUARANTEE- THE ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS. THIS DATA IS FOR INFORMATION PURPOSES ONLY AND PERSONS USING IT SHOULD VERIFY THE INFORMATION C"N '. H = `'ITE NOTES * Existing elevations are shown hereon * Proposed garage floor elevation 9G• 2 * Proposed front house entry eleva- tion i * Proposed rear house entry eleva- ted tion WARNING kfore dlooing call local utilities TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAVs/ . 29 3 p:7 83 �Qp Q C/eno/c-.s �ro� fiOna/r��J Ll/c�'f �ar�v�e .—IMPORTANT -- NOTIFY THE FRIDLEY ENGR. DIVISION REGARDING CURB R9MOVAL AND REPLACEMENT 'AT DRIVEWAY OPENINGS, I hereby certify that this is a true and correct re- presentatitin of a survey of the boundaries of: Lot 12, Block 1, INNSBRUCK NORTH 2ND ADDITION, accord- ing to the recorded plat thereof, Anoka County,Minnesot and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. It also shows the location of a proposed building. As surveyed by me this 13th day of April, 1976. rry S. Johnson Land Surveyor Minn. Reg. No. 5065 a CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On March 1, 1996 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 L/(% Water Heater — Gas** / $10.00(9 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $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 JOB ADDRESS //6� 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. '�_' , 1996 Owner Building Used As Estimated Cost PERMIT NO. PLUMBING COMPANY C411a ,'�7 SIGNED BY /1 ` TEL N0. A V Approved By /i (,u Rough—In Date Final Date S $20.00 TOTAL FEE t�i� PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. M SUBJECT PERM City of Fridley 2 AT THE TOP OF THE TWINS BUILDING PERMIT Ir � RECEIPT NO. • -------COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 � NUMBER REV DATE PAGE OF APPROVED By /---1 CITY HALL FRIDLEY 55432 b12-571-3450 910-F15 9/10/96 JOB ADDRESS 1417 West Danube Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 1 1 1 Innsbruck North 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mike Holly 1417 West Danube Road 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Lambert Construction 12741 Jefferson St NE, Blaine, MN 55434 754-5648 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20061962 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (30 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlaymeut 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 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 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 $2,475 $1.24 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 Fire SC $2.47 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TAL FEE Licen§4 SC 5P.00 y j $83.46 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI PRO e!fhLj5G INSP E Y VALIDAJEJO THIS IS Y URR PERMIT SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI M NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application diId7 !JeS1- hAN�►�f' N;�6 ConstructionAddress: Legal Description: k c7- /,q Lc Owner Name & Address: go Z l- y / y! 7 t,) . b A v c e z Tel. # Contractor: 9 �Ie -r Cv.y 5"T MN LICENSE # 2 ®®6 1 1 � Address: 12?z/I 5T N£ 6t.A ►A19 Tel. # 759--5'4q3 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: K02 F O F F 3®. S A U AJ2 1 X &J, -;a Comer Lot { J Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks $ ::,2.41'7 Type of Construction: State Surcharge Estimated Cost: $ r�2 �1 m c)(::) Approx. Completion Date: STIPULATIONS: ' (Cost oAack) Driveway Curb Cut Width Needed:' '` : Ft. + 6 Ft = Ft x $ _ $ DATE: g.- Z o - 9,C APPLICANT: �, � Tel. # CITY USE. ONLY Permit Fee $ `% V. 75 Fee Schedule on Reverse Side Fire Surcharge $ ::,2.41'7 .001 of Permit Valuation (1/10th%) State Surcharge $ %, $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $� C' ' $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: CID FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 June 1, 1999 Mike Holly 1417 W. Danube Road Fridley, MN 55432 Re: Final plumbing inspection at 1417 W. Danube Road Contractor: Mr. Rooter of Anoka Cty. Dear Mr. Holly: A plumbing permit was issued on June 8, 1998 for the property located at 1417 W. Danube Road for a new water softener. According to Section 30.5(a) of the 1991 Uniform Plumbing Code a final inspection shall be performed on plumbing systems. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (612) 572-3603. Sincerely, Barry Riesch Building Inspector 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 EACH FLOOR r _ r . Effective On January 1. 1997 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Su p/�ee ' ' Tank Water Treating Appliance JFIfll< Water Heater — lectric Water Heater — Gas** NO. RATE TOTAL 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 $10.00 $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 $CLLO 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 andrepresentations stated in this application are true and correct. 1998 Owner Z: ��/ � &1( ®®� f Building Used As��pu ®®� Estimated Cost PERMIT NO. �- PLUMBING COMPANY ,VAO 72Se 01E 14WA -V SIGNED BY TEL N0. !;W—�/�� Approved By Rough—In Date Final Date MINIMUM FEE IOR ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. CITY OF FRIDLEY INSPECTION DIVISION ) I 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 Rate TOTAL Furnace Shell and Duct Work, Burner — Also Replacement Furnace $ 30.00�— (Side Vent —.-Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $ 10,00 Gas Range $10.00 $ Gas Dryer' $10.00 $ *Air Conditioning == All Sizes $ 25.00. $ All Others/Repairs4 Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appllance or Work State Surcharge TOTAL FEE Effective On January 1, 1998 JOB ADDRESS 1 L —: - D U Q 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_(� �01S j �1C� ESTIMATED COSTPERMIT NO. ✓AC'S DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Un' s , Circle One (Steam) (Hot Water) rrn Aires Trade Name LWM\-- Size No. _a BTU 000 HP EDR $ Fuel K 6 , Total Connected Load MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY__ Signed By Tel No. '0 4 Approved By Rough—In Date Final Date 17 3—_<2< FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE ' CEMKNEY AND STACK VERIFICATION : The undersigned hereby verifies that the existing chihmey or, stack: 1. Has been carefully examined Yes O No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater' Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No { ) Remarks: List ALTERATIONS Being Done: 01 SUBJECT AlTffffNO. City of Fridley 31833 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC.®� �� q6 {,7J, �,--vD�� U r 1 NUMBER REV DATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 � 612-571-3450 P10415 5/18/01 10B ADDRESS 1417 West Danube Road NE i LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 1 Innsbruck North 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Mike Holly 1417 West Danube Rd NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sela Roofing & Remodeling Inc 4100 Excelsior Blvd, St Louis Park, MN 55416 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 612-823-8046 1050 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 0 ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (24 Sq) 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 REOUIRED 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 @ $2,454 $1.23 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• $83 25 Fire SC $2.45 R CTION R THE PERFO MANCE OF CONSTRUCTION PLAN CHECK FEE TAL FEE 1'(29 Jejet� LICE'W SC $5 0 $81.93 IGNA URE OF CON • TOR OR AUTHORIZED AGENTIDATEI W E N P P RLY VAL,1,19ATED THIS IS YOUR PERMIT .000 s SIGNATURE OF OWNER SIF OWNER BUILDER. IDAT( BLDG wSP - gATE 01 NEW [] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction AddrE Legal Description: Owner Name & Ad Effective 1/1/=01 (763) Contractor: SELA RGIGIelNG & SE CInELINC. RIC MN LICENSE # U S U Address: 4100 EXCELSIOR BLVD. Tel. # r (Z �6 ZS - $y ST. LOUR5 IJAHK, MN 554 16 Attach tIRRW%� ation, 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: o L - l614 `6 Fr— Construction Type: V -Q- cab 'rlZ'0� Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: APPLICANT: x2 Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ 633 - Fee Schedule on Reverse Side Fire Surcharge $ � . c� .001 of Permit Valuation (1/10th%) State Surcharge $ 1, ;�3 $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ �, 0o $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 $ A STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-12217 PERMIT NO.: 2004-02095 DATE ISSUED: 11/17/2004 ADDRESS : 1417 W DANUBE RD NE PIN : 243024430043 LEGAL DESC : INNSBRUCK NORTH 2ND ADD : LOT 12 BLOCK I PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ACCESSORY BLDG VALUATION : $ 400.00 APPLICANT HEATING PERMIT FEE, COMM 35.00 STATE SURCHARGE, OTHER 0.50 NORBLOM PLUMBING CO 2905 GARFIELD AVE S TOTAL 35.50 MINNEAPOLIS, MN 55408-2173 PAID WITH CHECK # 29380 (612) 827-4033 OWNER HOLLY MICHAEL A & MARY E 1417 W DANUBE RD NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating oonstruction or the performance of construction. Applicant Date Bldg Insp Date, SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. EffeetiveApri 1, 2004 6431 UrMNsity Ave NE >=ridby, MN 5543'z APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR a > . . Urinal _ Shower Wash Floor Auto = Gas Hea9w T Drain Washer Range Gas Elec NIFIDNZ . C E-- Fbor 3 M Floor 4 - - PLUMBING F CTURE RATES NO. RATE - TOTAL JOB ADDRESS t 1--7 QL1A1U,)2,ii New Fbdures $10.00 The Undersigned hereby Makes appfication for a permit for the work herein Old Opening, New Fixture $1040 spedlied agreeing to do all wo* in strict accordance wM the city codes Beer Dispenser $1000 and rulings of the Building Division, and hereby declares dial all the fads Blow Off Basin $10.00 and representations stated in M application are true and om ect Catch Basin Rain Water Leader $10.00 $10.00 D/ Ito z mplReceiving Tank $1000 iter Treating Appliance $35.00 J rHeater -Elec c $35.00 der Heater - Gas" _ $33.00 BUILDING USED AS ST e nG� z Range"' $10.00 C30 o a Dryer' $10.01) ESIIMATFD COST q6 � PERW NO. Mick Flow PmvenW RegWred ( )Yes ( ) No TYPe $16.00 PLUMBING COMPANY NO f-U OVA inspection Fee $54.o0lFir S1G1ED BY TF1 NO ( WZ) 927— 4ry33 L OTHERS ANDIOR REPAIRS AND ALTERATIONS --d-:'-25% of Vakm of Fixture or Appliance C=> _ C=:> State Surcharge AWmved By Rough.-In Dade Final Date = . � TOTAL FEE AIIINIMIJ11II FEE FOR ANY PLUMBlItiGMGAS PERMIT IS $15.00 or 5% OF COST o OF THE IMPROVEMENT MICHEVER M GREATER PLUS THE SURCiHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-,A. "PROVIDE COMMON VENT INFO ON BACK SIDE CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning -All Sizes All Other Repairs or Alterations (List on Back) 1516 of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 APPLICA ; FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIG TION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ $10.00 $ JOB ADDRESS Owner Building Used As ESTIMATED COST $10.00 $ DESCRIPTION OF FURNACE AND BURNE $10.00 $ # of Heating Units _ Circle One (Steam) (Hot Water) (Warm Air) C Trade Name Size No. $25.00 $J ` BTU HP EDR Fuel Total Connected Load Commercial/Industrial/institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/industrial/institutiorial State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR Burner Trade Name BTU HP Size No. 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. [) *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEIIT FURNACE Approved by Rough -in Date Final Date 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, 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 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 I tAi)lii€W a newyehting syjt2m, 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 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 min Type Appliance #3 Vent Connector Height ft Length ft Diameter ::in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date a