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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: .. r:. I.�....... .............. r er .. .. ... ........... ..... ess�. j.. . . ...... , Builder............................................. Address............................................. LOCATION =OBUILDING Qt M447.91.. Street... .......... ....... ............. Part of Lot .... .. to.. Lot ........ Block .................. Addition or Sub -Division ... Corner Lot ............ Inside Lot ............ Setback .. .. Sideyard . ®2s .. .. . • DESCRIPTION OF BUILDING To Used as: .... .. Front .... Depth .� :. !� Height ..... �. Sq. Ft: Cu. Ft ........ ... ............... Front ........ Depth ...... Height ........ Sq. Ft. ........ Cm Ft. ........ Type of Construction ................... Est. Cost. ..... To be Completed ....... ..�..... ® ® ..� In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description aboveset and in compliance with all provisions of ordinances of the city of Fridley. 1 11 00 In consideration of the payment of a fee of permit is hereby granted t0102 - ......................... o ......... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. -A 4° . • Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES q/ JOB ADDRESSy , RATE SCHEDULE The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares Also Replacement Furnace $ 20.00 $ that all the facts and representations stated in this application are true and correct. —&'�� ,1991 Gas Piping (Needed with new furnace) $10.00 $ OWNER aw Gas Range $ 10.00 $ BUILDING USED AS Ctu) Gas Dryer $10.00 $ ESTIMATED COST CP (� PERMIT NO. Jf &2 I "Air Conditioning - All Sizes $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ IS• Commercial/industrial 1 % of Value of Appliance or Work $ State Surcharge $ .50_ TOTAL FEE $ `-' MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. 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. BTU HP EDR HEATING COM Signed BLAINE HTG, A/C & ELECT. INC. _ -- - 13562 CENTRAL AVE. N.E. Tel No. 127-0 L 6T Approved B Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( i 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 Remarks List Alterations`` Being Done: wtZA Yn HEATING COMPANY Signed By Date r• SUBJECT City ®i Fridley 2 7247 AT THE'TOP OF THE TWINS r BUILDING E R M I T 1COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 � NUMBERDATE REV PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/18/98 JOB ADDRESS 5781 W. Moore Lake Drive 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13 1 1 Donna 's Lakeview Manor SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Theodore Bra 633-8683 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 9k REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (18 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1501 .75 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. $51.25 Fire SC $1.50 PLAN CHECK FEE TOTAL FEE Zfl $53./0 SIGN URE OF CONTRACTOR OR AUTHORIZENT IOATEI N P PEV DATED IS YOUR PE IT BLD INSP 0PATE S.GNATUR OF II NER BUILDERI IOATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 41 BUILDING PERMIT APPLICATION �, I ConstructionAddress: %d�/ tic" %�%"��i�- Ate,o�— Legal Description: Owner Name & Address: Tel. # 6�5 . 3--�'6 Contractor: 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 EWPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: / alt U Construction Type: Driveway Curb Cut Width Needed: DATE: 9 - � o° �n° APPLICANT: Estimated Cost: $ 29e (Fee Schedule on Back) S CITY USE ONLY Tel. # e� _5f - Permit Fee $ ,-2 �_ Fee Schedule on Reverse Side Fire Surcharge $ % 9b .001 of Permit Valuation (1/10th%) State Surcharge $ %� $.50/$1,000 Valuation SAC Charge $ $1000 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 $ S S� STIPULATIONS: a . . FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 e (612) 571-3450 • FAX (612) 571-1287 BUILDING PERMIT APPLICANT: HOMEOWNER I understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. By signing this document, I attest to the fact that I am building or improving this house myself. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building on speculation or for resaje and that the house for which I am applying for this permit, located at - 2L / Dart- 6Z 4 , is the first residential structure I have built or improved in the past twenty four (24) months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund * in the event that any contractors I hire are unlicensed. nature of Homeowner Date Ucensed residential building contractors and remodelers are covered by the recovery fund. Ucensed residential roofers and manufactured home installers are not covered by the recovery fund but are required to hold a surety bond. To determine whether a particular contractor is required to be licensed, or to check on the licensing status of individual contractors, please call the Minnesota Department of Commerce, Enforcement Division, at (612) 296-2594, or toll-free at 1-800-657-3602. SU13JE& P City of Fridley - 31627 AT THE TOP OF THE TWINS BUILDING PERMIT i 0. COMMUNITY DEVELOPMENT DIV. �� r PROTECTIVE INSPECTION SEC. 1 � NUMBER REV DATEPAGE OF AVPROVEO SY = 1 ----I CITY HALL FRIDLEY 53432 612-571-3450 910-F15 1/22/01 JOB ADDRESS 5781 West Moore Lake Drive NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Pat Miller 5781 West Moore Lake Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Amain Homes Inc 7691 Central Ave NE, Fridley, MN 55432 612-685-9999 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20131003 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW 0 ADDITION [R ALTERATION ❑ REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK lst Floor Remodel; Construct a 27' x 12' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Call for footing inspection on deck before pouring cement. WAR1qjjq- Before diggi�� Call fOft all utiiity iOcati0ns 4 0002 y CA SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $5,000 $2.50 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 CH GE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $111.25 Fir SC $5. 00 STRUCTION OR THE ERFORM NCE OF CONSTRUCTION PLAN CHECK TOT FEE 7,%' ��_ Ot Lice e $5.00 $123.75 SIGNATURE FCO TRAPT& OR A1040RIZED AGENT IDATEI E PR P 10 E THIS IS Y��MIT _ 7XVA Bl .NSP MATE S,GNATURE OF OVVNERIIF OWNER BUILDER. IDATEI NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: g 0 . ��®did 1A,<!j- -�ll, Legal Description: Owner Name & Address: Contractor: LIVING AREA: 1 IL 4(8Ue Tel. # MN LICENSE # 6 / 3/ CO 3 Tel.# Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width 1-7 Hgt/Ground Sq. Ft. OTHER: Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft.GR�L(o + 6 Ft = Ft x $ _ $ DATE: I � � o - �' APPLICANT: GPV� Tel. #—(0 CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $f /I.- •2-4 ..' Fee Schedule on Reverse Side $ �o .001 of Permit Valuation (1/10th%) $ �v $.50/$1,000 Valuation $ $1150 per SAC Unit $E _ � $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 [ ] $3 b?S— | li 24 , Fae r�►�e . Jr 3d� w 0 Z.0 I n 6Vd &G Z.0actJ67,Fp/ GCJ 1�7ooe C/io_df 00- a Jan -12-01 08:26A FOUR STAR REALTY 780 5962 Joidl L cel for Your Deck Tha�fais 1/4°:1' os:45#0732 P.04 Iliastretjon losy iopiot options not inalehi. Mar TOTAL PAGE.08 snr � 4 �L •" V 7- A 31 2ud Greet Treated B Rijn Jolat Di0-1(Z" 2d Groin Treated 0 ladsor �s �. 218 Green Treoled 0 Run 01st s ' 288Gres Trailed E 1110-1/2' Jo'ut 2d grow Troatod F 1*90 Rim Joiat ' 2:8 Drug Troofad F 14'91 Joist � s" god Bran Treand 6 Z0, Rim Islet • o = e 28d g Grow Treated zoo Rim Islet — s 2a Broin Tmfwd Le4er- JoioN aro be on 160ae1n. e Joists to ba hums from tha (edeir with jeict 681ere, a- Joiefe It be toe-oalled to 6ei�no with 1-1/2" (ad) ddwsi:id malls. e IN 1071118 ib bo flu -41114 to joieh A fd2ire WA 3-112" 116dj so vaitd nes. $loelial end bridyims is not ebm, but way be required by roor iseai Code. Iliastretjon losy iopiot options not inalehi. Mar TOTAL PAGE.08 snr Jan -12-01 08:27A FOUR STAR REALTY 780 5962 Post in Beim DDinseasfoa Smart eaiga 19732 9' 9" 4'6' 6 b' ®- Denotu railing posts and Aro pl NW At A qu mu,mum post #paring. lllustntlon MAY depict options not inol96d. P_06 ...o. ero Jan -12-01 08:26A FOUR STAR REALTY 780 5962 19 8p12 P{am tfiup thm plan to QN MMIrto puretuaa,. Post ontallomr:59731 Boom imension Sheet g q" 4-6- 6. P.03 C � O! 41 011ie, 76 4 � O �6 ZwS OSS T��.� �e Denafos railing Pasfs and are placed at a 43` macimum post spicing. 111ustrotion may depict option, not ineluded. Lr Jan -12-01 08:25A FOUR STAR REALTY780 5962 P.02 POS19p #: 39732 o 1/12/2001 ' ' Take this sheet to the Building Materials desk to purchase your materials. You have selected a 1X x 27' deck 9' off the ground. - - Green Treated Framing Material Below is motion of the railing style and Horizontal Deckin options You have sslWad for your decd. 5/4" x 6" Stains Brown Treated Deck Boards 36" Spindle Railing 2" x 2" x 42" Stained Brown Treated Spindles 4" x 4" x 48" Stained Brown Treated Railing Posts Poured Footings 12" Tube 4' deep Gelvonired Square Head Screws 2" x 8" Joists 2" x 8" Beams 40 PSF deck load Illustration may dspiet o (See above Picture or chosee ra �1r�pm q A/ Jan -12-01_.08 27A FOUR STAR_ REALTY .� 780 5962 Buy Lo for You Dank Toaf M Sodsle VV: f Duip#-59732 „w P.05 MU1111WIPRIN A r 2-2d Orm Treaw B 716' 2 -he firma Truhl G IV60 2-1a firma Troma1 111"fratioo mq dopid options not iooiuded. CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 200( 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 5 `7'3 I . MDL -re U4 -c tilt, �cc, RATE SCHEDULE OWNER_ ? M► l Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace b•®® BUILDING USED AS We-1[rh k $ 30.00 $ ll (Side Vent - Fill Out Back) ESTIMATED COST PERMIT NO. /z Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) Warm Air) Gas Dryer $ 10.00 $ Trade Name cnrc�ea� Size No.-finb *Air Conditioning All �.� ®� BTU®„ HP EDR - Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU_ HP EDR erre 4&. MC- 39 / y-i/� Commercial/Industrial 1.25/0 of Value of Appliance or Work $ 5-0 0 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and 56-50 representations stated in this application are true and correct. TOTAL FEE $ DATE _ ®�-®� -®/ 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. H EAT I N G CO Ri 0.4,t 1,A4 LS,geti—Mag-Z Signed TEL # 763 '75y -2-t Approved B/4. Rough -In Date Final Date CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 763-572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2001 PLUMBING FIXTURE RATES: 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 () Nc Type NO. RATE 0 $ 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 $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance TOTAL JOB ADDRESS '� ' 1 J � "� v '-z State Surcharge $ .50 TOTAL FEE 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. n C;'?-/� - _,200i Owner Building Used As Estimated Cost PERMIT NO. PLUMBING SIGNED BY Approved By Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 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 installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date CITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON FACH FLOOR Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS011E O'�S 6WLA✓ 12— New. Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and reps ind correct. Catch Basin $ 7.00 MILLER, PAT Rain Water Leader $ 7.00 5781 MOORE LAKE DRIVE WEST �/� 20_Q1 Tank $ 7.00 FRIDSump/Receiving (763) 5 4 84 55432 (763)574-1841 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 Water Heater - Gas''" ^� $10.00 Building Used As Gas Range** $10.00 J Gas Dryer** $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLO PLUMBING COMPANY QP�li}�/✓��C' C'L Reinspection Fee $47.00/Hr SIGNED BYTEL N0. Z ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance • Approved By Rough -In Date Final Date State Surcharge $ .50 TOTAL FEE $20._550 MINIMUM FEE- FRI ANY PLUMBINGIGAS PERMIT IS $20.00 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting;system is plastic/PVC and meets all current codes and manufacturer specifications :including sizing, length, number of elbows and termination. Yes( No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 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 installina a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I. Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance�has been -removed from.the common vent and vented separately as;per.current codes. Yes( )No( Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector. Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: 9 SUBJECT r' City of Fridley3 855 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. DIV. COMMUNITY DEVELOPMENINSPECTION 572-3604 -3i7o PROTECTIVE INSPECTION SEC. NUMBER - REV DATE PAGE OF APPROVED BY E Z II CITY HALL FRIDLEY 55432 �'' 612-571-3450 910415 6/7/01 10B ADDRESS 5781 West Moore Lake Drive NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS 7,IP PHONE Patricia Miller 5781 West Moore Lake Dr NE 574-1841 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Amain Homes Inc 7691 Central Ave NE Fridley, MN 55432 780-5500 20131003 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 class of WORK ❑ NEW O ADDITION ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Basement alterations 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ' NO. DWLG. UNITS OFFSTREET PARKING 1 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 $30,000 $15.00 DOES NOT PRESUMETO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY O HER STATE OR LOCAL LAW REGULATING CON- TRUCTION OR T FORMANCE OF CONSTRUCTION $441.75 Fire SC $30.00 PIAN CHECK FEE TOTAL FEE License C $5.00 91.75 SIG NA TUAE'RACTQR OR AUTHORIZED AGENT [DATE) EN /P.ROPVK>4ALIDAT5gTHIS OF BL -NSP IS Y R PERMIT -I f)ATE S.GNATURE Of OWNER of OWNER BUILDER) IDATEI 9 i NEW [] ADDN [ J CITY OF FRIDLEY i ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 666 Construction Address: Legal Description: — 1 L Owner Name & Address: 1 i IL` C.IN La -cu -L- S,44� Tel. # Contractor: �-IAI�� QOM%9' C MN LICENSE # ;? 0l3 l D ®3 Address: a.)–,A+c No,, V c ()Lc,�Tel. # dig 0 Ste/ Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT 1� LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/G ound Sq. Ft. OTHER: 0117 Construction Type: Estimated Cost: $® Driveway Curb Cut Width Needed Ft. + 6 Ft = Ft $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application ��5 Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ 00 $.50/$1,000 Valuation $ $1150 per SAC Unit $ ,S , 00 $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 [ ] $ 4/ 9/, -yam -7— =4\0 33c> a-72-)(02 I -YI Pe//O&FA1 3/0, PO /0q P)'A� FMM h A ccw 1 l 4- iMr �?cviQ'� SFa/ �11� 7) Alt SEs/ ;QEQui�Ki JO[l COPY SHALL BE AVAILP.i")l F ON T} IILjnn T 2w z. Ni'S C2, C 1)4-6 a 1 qouo� q C., L)cq U� � �2S /rt1 r�// Every sleeping room shall have at least one window with a sill height of not more than 7 44" above the floor and Ilial! provide nut less than 5.7 sq. ft. of apEnril.,le 2rej vJth a min. height of 211" and a c.f 20". PLAN APPROVED SUBJECT To F1 —LVOtk('*Jl INSPECTIONELD BLD 1 SPE�TOft SAW? WALL, e- /3 M,- -90 Mi1j: A JO[l COPY SHALL BE AVAILP.i")l F ON T} IILjnn T 2w z. Ni'S C2, C 1)4-6 a 1 qouo� q C., L)cq U� � �2S /rt1 r�// Every sleeping room shall have at least one window with a sill height of not more than 7 44" above the floor and Ilial! provide nut less than 5.7 sq. ft. of apEnril.,le 2rej vJth a min. height of 211" and a c.f 20". PLAN APPROVED SUBJECT To F1 —LVOtk('*Jl INSPECTIONELD BLD 1 SPE�TOft SAW? WALL, e- /3 M,- -90 Mi1j: CITY OF FRIDLEY INSPECT iON DIV. 6431 University Ave NE Fridley, MN 55432 763-572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT KAAD&e w 1URIZO ng: MYTI IMPQ Tn RF W -R -TAI I r:n ON EACH FLOOR Effective On Jan 1, 2001 PLUMBING FIXTURE RATES: 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 NO. RATE TOTAL JOB ADDRESS Water Heater - Gas" _ Gas Range" _ Gas Dryer" _ Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 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 Estimated Cost PERMIT NO. (� ' , 20� t✓ $15.00 PLUMBING COMPANY C�� 1,/� )_A1 — Reinspection Fee $47.00/Hr SIGNED E ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved State Surcharge $ -50 MINIMUI TOTAL FEE$ ®s PLUS T � e TEL N0. �G' �� ✓ �� d�� Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE :• %i •.,.�: M-�:>�� Wash f`3}�'"°• •� Floor en::y < Auto. ;�a#��: %:. j� %ieYi :::/:i: Gas >> =: Water Heater Stones >r,Y.>.ir•: r•: f:�ose>< Urinal ;:'\A'�;�b,..;•.ir: :. ": Shower '#",..:.>.. S °fN! �:i�..,.v.::{�; r: Tra < Drain �`+�:>::. ..�5:•>'•i::i}ri?;i B�51nw Washer . :. : Range _ ..... Gas Elec ,. .Sfr.-r.::x :.+� :..✓ .;:.%: .i:'e,•l•} }};vy,E r.; h:i:::$ •: x:.; :i �:{:•:. :•: b:::.4.v::: Base >{•' ,.:.nv:::,.:::::::.. ..::.. wj$:v;:i>f,{t.•::: ::. ..:. .•:}N%:;4.•r::}}:• :j':..•.v: :.•;n. --•::.:.-..:.�::::::::•.:: :....>....:......:.. ....•rsiir.+v.•::.:.�. •:::n .: Floor +i.r:ems O:Lr :P�Sx Floor 2 ><: <:>N;;::::119 Floor3:i �.•f......... its:'•;';'%:i•:::•i':: .................. -<.::::}•.}:.}'.}i::.. .i.:.}:::::i:::..}: . .:: -.::.i:.: FooI r4 ........... PLUMBING FIXTURE RATES: 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 NO. RATE TOTAL JOB ADDRESS Water Heater - Gas" _ Gas Range" _ Gas Dryer" _ Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 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 Estimated Cost PERMIT NO. (� ' , 20� t✓ $15.00 PLUMBING COMPANY C�� 1,/� )_A1 — Reinspection Fee $47.00/Hr SIGNED E ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved State Surcharge $ -50 MINIMUI TOTAL FEE$ ®s PLUS T � e TEL N0. �G' �� ✓ �� d�� Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes( ) No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 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 manufacturers specifications. Yes ( ) No ( ) When required to Install a new combustion air, it will be sized and installed to meet the current codes and manufacturers specifications. Yes ( ) No ( ) When Installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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 Tyne and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances _ Total Btu Input Common Vent Type Vent Height _ Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date CITY.OF FRIDLEY INSPECTION DIViSION 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, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of. Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL. $ 30.00 $ $ 10.00 $ $ 10.00 $ $ 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. .50 •m mul id Effective On January 1, 2000 BUILDING USED AS RESIDENTIAL ESTIMATED COST �� PERMIT NO. 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 FIREPLACE --- Burner Tra-de Name G� Size No. BTU ;.3�— 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE &2/a -a/ HEATING CG -?ALLIED r^IRESIDE dba FIRESIDE CORNER Sign cam- TEL # Approved EW—— Rough -In Date Final 4-t'--.L-4W., COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has .been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required.. Yes( ) No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 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 installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category i Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( } Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By. Date : e CiiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 January 18, 02002 Pat Miller 5781 West Moore Lake Dr NE Fridley, MN 55432 Re: Final Inspection at 5781 West Moore Lake Dr NE Contractor: Fireside Comer Dear Pat Miller: A mechanical permit was issued on September 14, 2001 to install a gas fireplace at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days, and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for" and no further action will be taken. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/mh Aft, . l SUBJECT ERMIT NO. City of Fridley 32214 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. 16. COMMUNITY DEVELOPMENT CIV. PROTECTIVE INSPECTION SEC. �® I_ �®j f E � 1 NUMBER REv DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/4/01 10B ADDRESS 5781 West Moore Lake Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Patricia Miller 5781 West Moore Lake Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Amain Homes Inc 7691 Central Ave NE, Fridley, MN 55432 612-685-9999 20131003 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 O NEW ADDITION 0 ALTERATION 0 REPAIR O MOVE O REMOVE B DESCRIBE WORK Construct a 30' x 20' Addition to Dwelling S CHANGEOFUSEFROM TO STIPULATIONS See notations on plan.. WARNING BefoFe digging call for SEPARATE PERMITS all utility locations REQUIRE® FOR: ®R RE DIRE Q Y LAVA' HEATING PLUMBING AND SIGNS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING 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 @ $46,698 $23.35 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- $613.45 Fire SC $46.70 STRUCTION OR JPE PERF RMANCE OF CONSTRUCTION PLAN CHECK FEE TAL FEE /0"Y ®/ Licen SC $5 0 7 $688.50 SIGNA RE OFtONTRACTORORAUTHORIZEDAGENT iDATE, HE PR LY VALID TED THIS IS YOUR PER /TR)/ S-GNATURE OF OWNERoF OWNER BUILDER. IOATEj ' iEKOG INSP DATE Aft, . l NEW [) Effective 1/1/2001 ADDN CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 BUILDING PERMIT APPLICATION C Construction Address: ,�%� �) /A)� (c�'j'. a I 0 Legal Description: Lb —k l� `3c 1 U— I i Owner Name & Address:; R t° _ /a- /� c c.� Tel. # Contractor: L30A'A `�'� MN LICENSE # ®I l CXQ Address: �� 1 cap AJS (fl :4 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 E Sq. Ft. Q� GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: , baa •A' 77.83%;SSG 75. ora Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: 01 APPLICANT: Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ j .?�Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ ,73.35 $.50/$1,000 Valuation SAC Charge $ / $1150 per SAC Unit License Surcharge $ S.Oo $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 [ ] STIPULATIONS: CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS '5-gsF/ (sem f Cki 64--l- �.- 4?i RATE SCHEDULE �J OWNER Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of. Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL. BUILDING USED AS RESIDENTIAL $ / ESTIMATED COST 116Qc_2-N PERMIT NO. 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 FIREPLACE --- BurnerTra-de Name /06(- Size No. —&7)b $ BTU - a- 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. TOTAL FEE $ =i -w 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. DATE /- �)D -0 2— HEATING CO ALLIED FIRESIDE dba FIRESIDE CORNER Signed 44.V_CZ:_ TEL # _ 6a -/EL; 3SZi Approved By Rough -In Date Final Date COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance; the -undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required.. Yes( No( ) . The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 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 manufacturers specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 572.3604 RATE SCHEDULE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 117. of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $__t0. 0" $ 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. ru 4 Ap-� &5- '4/c $ .50 D L) 0,0 A:�- Effective On January 1, 2000 JOB ADDRESS ��1 L4� °�0�2G X,4 -k,:: bte. OWNER PA -F– BUILDING USED AS ESTIMATED COST PERMIT N0. �d DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water Warm Air Trade Name Size No. 67:N/-T)C,}en,,KZ, BTU VP OCO HP EDR Fuel A�4'7-�A-s' Total Connected Load Burner Trade Na BTU 29 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. VJPMOR "XCT R% INSATE 612142 AVEWE NIO. CRYSTAL. MN HEATING CO Signed Approved By 1!!!�— Rough -In Date TEL # Final Date COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 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 installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: CITY OF F RIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2002 PLUMBING FIXTURE RATES: 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" NO. RATE TOTAL JOB ADDRESS .5- � 5'/ �// f�,y,�}2� i94C __y__ Gas Range" _ Gas Dryer** Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type �lt $15.00 Reinspection Fee $47.00/Hr Afts Pi l A j& '/3� :2, d ALL OTHERS AND/OR REPAIR ND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge .50 TOTAL FEE $ 3® - 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. 2, �. �l , 204LZ Owner Building Used As Estimated Cost PERMIT NO. > PLUMBING COMPANY_ SIGNED BY®C TEL NO.N,,?— C � FAX# 763 `7 - Approved By Rough -In Date Final Date 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 COMMON VFNT, VENT CONN .TOR AND n0MR1 ISTION AIR VFRIFI CATION When _re ln_acing an _xictlna Iran , 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 nmb ustinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a npw cnmbiistien a*4 it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a new v _n ino system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central 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_ Appliance #2 Type _ Appliance #3 Type _ Total Appliances _ BTU Input BTU Input _ BTU Input Total Btu Input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat 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 : BuildingBUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By:763-572-3604 ki-70 Date '' uI CITY OF FRIDLEY : DATE o?U V �'A ( )8 YOUR E-MAIL ADDRESS 1�S0,.�d@ a e� e •Cow, SITE ADDRESS 5-7-'81 � ' m 66C " b(; THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY OWNER/ NAME: 3G. i TENANT ADDRESS:CITY STATE ZIP 11 PHONE:�I:�� — J� -1641 NAME: Renewal By Andersen CONTRACTOR SUBMIT A COPY OF STATE LICENSE # 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 r —STATE—ZIP— TATEZIPWITH WITHAPPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NO PROPERTY TYPE ❑ TWO FAMILY/NEW G 651-264-4.777 ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 1_ ;,,mgyp,Cp SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT So- Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING ❑ Vinyl ❑soft FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Aluminum ❑ Other ❑ Trim ADDITIONS. I. Rr POR(`i-iRS SUBMIT: Site PhWStnvey showing the existing structurt ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS tmujL, r Ora Amm nAzED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE TOTAL JOB VALUATION $ 1� 1 i �� ' U.B.0 FEE SCHEDULE)OUCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ 5.�q $ 5.00 See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: Citv of Fridlev Attac THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be i conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work whirequires view and approval of plans. II �\ C� SIGNATURE OF APPLICANT GLV PRINT NAME Q�'(+,4a _ NSCS �`� DA 5l) (� C$