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PRE 2010 DOCSSUBJECT PER City of Fridley ® 133 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. iy_______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION r � � SEC. 1 . � CITY- HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 1/29/76 JOB ADDRESS 5790 West Moore Lake Drive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 4 Donn.ay's Lakeview Manor Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Henry F. Adamski 5790 West Moore Lake Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. M. E. Steman 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 Ek REPAIR ❑ MOVE ❑ REMOVE DESCRIBE WORK Install drain tile 9 CHANGE OF USE FROM TO STIPULATIONS 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. $1,050 .52 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- $9.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $9.52 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) PERLY VALIDATED THIS IS YOUR PERMIT � s laz _ BLDG. WSp DATE IGNATUR F OWNER IIF OWNER BUILDER) (DATE) - APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA r �% OWNER'S NAM: BUILDER: �4 ADDRESS • g�7 91177 ADDRESS%- NO:. STREET: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and propose.'. building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front: .Depth: Square Feet: Cubic Feet: Height: Front: Depth: Height: Square Feet; �%� Cubic Feet: Type of Construction: PA4;vlEstimated Cost: $ AOS_�) - �J J To Be Completed: 4 �?? b / �( The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. ^r �t DATE:_/% �-� Z 7 SIGNATURE: (See Reverse Side For Additional Information.) :l; 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 1977 mski re Lake Drive N.E. _____..j, ..... 55432 Re. Drain Tile at 5790 West Moore Lake Drive N.E. Dear Mr. Adamskio TELEPHONE ( 612)571-3450 Please be advised that our records indicate that you obtained a permit to install a- drain tile system in your basement and that an inspection was made and the piping system was approved. Apparently you have experienced dampness in the lower course of blocks in your .foundation walls. Subsequently we made an inspection on August 30, 1977 to try to determine the probable cause. During our -inspection we cycled your sump pump and noted that it does not pump the sump down low enough to drop the water level below the bottom of the inlet pipes and also that after shut down, the discharge pipe water flows back into the sump leaving the water level substantially above the two inlet inverts. This causes the drain pipe system to continuously be filled with water, thereby causing the dampness you are experiencing. There are a few alternatives or a combination of things that should be done. First, if the floats on the present pump can be adjusted s.o.that the pump starts sooner and lowers the level of water in the sump lower (below the bottom of the two inlets). In addition to this, there should be a back water valve installed to restrict the flow -of water back into the sump from the discharge line. If this can not be done, then a different type of pump (submersible type) should be installed. It too would need a back water valve or a deeper sump could be used with the present pump if the floats can not be.readjusted. I have talked to your contractor, Mr. M. E. Steman, and he agrees with our conclusion, however, he apparently feels he is not responsible for your problem since he was asked by you to use your old pump. He did state that he would be willing to sell you a new pump and was confident that it would solve your problem. Mr. Henry Adamski September 1, 1977 Page 2 If you have any questions in regard to this matter, please feel free to contact me at 571-3450. Sincerely, e. DARREL G. CLARK Community Development Adm. IGC/mh CC: Mr. M. E. Steman 9920 - 36th Place North Plymouth, Mn. 55441 hi SUBJECT - PE NO. City of Fridley ®14438 AT THE TOP OF THE TWINS BUILDINGr PERM � CEIPT NO. __ COMMUNITY DEVELOPMENT DIV. -------- 1 PROTECTIVE INSPECTION SEC. 1 � NUMBER REV. DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 L J� 612-560-3450 910-F15 10/24/77 JOB ADDRESS 5790 West Moore Lake Drive 1 LEGAL LOT NO. BLOCK. TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE HenryF. Adamski 5790 West Moore Lake Drive NE Fridley, MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re-> oofing 9 CHANGE OF USE FROM TO STIPULATIONS 1. At the time of the 3rd re -roofing, the first two layers must be removed. 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 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 $800.00 5O 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- $7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $8.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) , WHEN. PROPERLY VALID TED THIS IS YOUR PERMIT Cf l ��1 ti Q_'1 ko SIGNATU OFOWNERIIFO NE BUILDERI IDfkT BLDG. INSP -DATE hi CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PEWTS (NEw, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: C G BUILDER: Address: )9to f -/-� z- Address:. Tel. No.. No. 1 Z LOT: CORNER LOT: Street: BLOCK: ADDITION: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: rc—roo"r Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: To Be Completed: Estimated Cost: $ 800.60 Alt. A Alt. B Proposed Driveway Wid 'h If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. See reverse side for additional information. DATE: C7� SIGNATURE: Stipulations: rmi1 !qv -ox CITY OF FRIDLEY INSPECTION DIVISION Effective On May 10, 1999 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS lam - RATE SCHEDULE OWNER I iA ► VAI 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 Rats TOTAL $ 30.00 $ Z D $ 10.00 $- $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 BUILDING USED AS CLLAALU W, ESTIMATED COST "D0Q -n PEIJIITNO, zz /4 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units—L Circle One (Steam) (Hot Water ar ir) Trade Name V- til Cuy- + Size No. Ly 0"j 0 BTU ate , V D --Q' HP EDR Fuel Fel - -r . Total Ccnnected Load 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are'true and correct. W c EyNkY�n— Tn�LC) BL�iNE H-ro. Aic & ELECT. ,�,c. HEATING CO 1356a CENTRAL AVE. N.E. omlvru% MW 55M Signed R-/1 DATE Approved By Rough•In Date Final Date d-0-C)o F1 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes 'IVN) No ( ) 2. Is free from rust or deterioration Yes `ii 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 6 Has total heating BTU's of All other BTU's o TOTAL BTU's 11J u D Too Yes (A,, No ( ) 7. Has a liner been provided for water heater Yes (Y) No ( ) 8. Has combustion air been provided for water heater Yes (q No ( ) Remarks: List ALTERATIONS Being Done: N G a.. G 1 1 It 11--1 1 A &. f f l `3 CLC t vv -\-t y $- S vpol �,i - _M- V�� y n BLAINE HTG. A/C $ ELECT. Ji - 13562 CENTRAL AVE. N.C. HEATING CO: ANOKA, WIN 55309 Signed By: Date: ��j , 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 Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 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 representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 "—f� . 206CO Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner_ Water Heater -Electric $ 7.00 Water Heater - Gas** _L $10.00 Building Used As Gas Range** $10.00 i �� 217 � ? Gas Dryer'""'' $10.00 Estimated Cost � PERMIT NO. l e Back Flow Preventer Required ( )Yes () No . �- Type $15.00 PLUMBING COMPANY=. Reinspection Fee $47.00/Hr SIGNED ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance TEL N0. 6/Z 54Z I -elsT Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE R ANY PLUMBING/GAS PERMIT IS TOTAL FEE $ PLUS ,THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 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 Fu rA Ar P- BTU Input &a MO Fan Assisted or Nat Appliance #2 Type WA.,Tgg- W717 -e— BTU Input &oO 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 1j €�`� A✓ % rUs Arc. L� 1-� Com. 00-0 HEATING CO: 151 SUBJE& City of Fridley 30653 AT THE TOP OF THE TWINS BUILDING PERMIT sy .......COMMUNITY DEVELOPMENT DIV. SEC r PROTECTIVE INSPECTION ,,J CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED By 612-571-3450 910-F15 2/4/00 JOB ADDRESS 5790 West Moore Lake Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 1 Donnays Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tammy Resch 5790 West Moore Lake Drive NE 572-3734 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Moneywise Homes 2518 Hillsboro Ave N, Golden Valley, MN 55427 546-2327 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20179738 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION 47 REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS 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 $10'680 $5.34 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 NY OTHER STAT R LOCAL LAW ULATING CON. $195.25 Fir SC $10.68 E PERFOR E OF CONSTRU N %SIOXHATURE PLAN CHECK FEE TOTA FEE y ®� Licens $5.0 $216.27 C TRACTOR OR AUTHORIZEDAGENT EI OPER ALIDAT O HIS IS UR P MITQQ�� A —1qu S-GNATURE OF OWNERJF OWNER BUILDER, (DATE, 2KENP BLD INSo :Az BATE as//// 666666.....��ffffff 151 Construction Address: 0 Legal Description: Owner Name & Address: 1 o-w`vv%-e.se-� Tel. #�i -�"�a - 3�3gi Contractor: ®vt� 5 e LICENSE # -7 Address: / t.4 6o r, ® Ave d , Neo /e o' Tel. #- Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: I , I - g (,ce vd Estimated Cost: $ lb L J O , & a Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ 31 DATE: ® ® APPLICANT: Tel. CITY USE ONLY Permit Fee $ '96 ,:a2 ' ^ Fee Schedule on Reverse Side Fire Surcharge $ %, � o .001 of Permit Valuation (1/10th%) State Surcharge $_S V $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 40® $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 $ �/'4, d 2 STIPULATIONS: E CITY OF FRIDLEY INSPECTION DIViSION 3 1 3P 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 I , JOB ADDRESS % d 111 Ot� 1.-9 - RATE SCHEDULE OWNER Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS Also Replacement Furnace $ 30.00 (Side Vent -Fill Out Back) ESTIMATED COST l a� " PERMIT NO. 7 �� Gas Piping (Needed with new furnace, $ 10.00 $ 4 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 Size No. ZV l� BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ 1 l� 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 Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 representations stated in this application are true and correct. TOTAL FEE DATE �1 BLAINE HTQ. A/C ELECT.; IINC. MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO 13562 CENTRAL AVE. WE. REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # 2 REINSPECTION FEE$47,.00/Hr�� Air Conditioners can not be placed in a side yard without Approved By Rough -in Date Final Date I written permission from .adjoining property owner. FILL OUT BACK IDE F STACK VERIFICATION ON REPLACEMENT FURNACE 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. Ye . No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ) "' The undersigned also verifies That the replacement unit is a listed assembly and meets the current codesand manufacturer's specifications. This does include AGA-GAMA Category ]:Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes No( ) The existina combustions -air is sized and installed to meet the current codes and manufacturer's specifications. Yes o ( ) When required to install a new combustion air,,d will be sized and installed To meet the current codes and manufacturer's specifications. Yes No ( ) When installina a new ventina 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. s 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 No0 ( ) 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 : 3uilding BUILDING Plan Review Permit No.: inspections RESIDENTIAL APPLICATION Surcharge Received By: 763-572-3604CITY OF FRIDLEY SAC Charge Date Rec'd: )ATE ® YOUR 4 -MAIL ADDRESS $ ;ITE ADD S e—% 9'0 Not) see /L J/ r . $ i HIS APPLICANT IS: OWNER ❑CONTRACTOR $ PROPERTY OWNER/ $ - Total Due TENANT ADDRESS: ® F STA _,.ff 3-43 PHONE: °1 L I - �J �� - i n4 M_yy_ 12 57106 CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE TN E FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: PNEW ❑ ADDITION ❑ MAWTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: LA 144 e Aid; Li® ®t t°&-1' 6e,&-rn�e SIZE OF IMPROVEMENT 4WyyV LENGTH ZIV ® WIDTH 00 L -I` HEIGHT /% ®6 ' Sq. Ft. -'I ROOFING 0 HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2• Existing Floor Plan Proposed floor plan PROPOSED SIZE: 13DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT:/ P SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, %Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I . Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOC�!�TION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE S12E OF v/1l® f e OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 jg.�bC FEE SCHEDULE) TOTAL JOB VALUATION $ ®0, 0190, OCCUPANCY TYPE Permit Fee See $ 1 �? . '�L < Plan Review $ Fire Surcharge $ 1 �� Surcharge $ 5-0c) License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ - Total Due $ 2'l _ Oso 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 savable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicati n for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work hich requir s re iew and approval of plans. p SIGNATURE OF APPLIC PRINT NAME�� q,� 9+ VW DATE 9' FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I� M—y understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for specific ex ion fr m the licensing requirements. As the owner of the property at i6kPIL , Fridley, am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 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, 1 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. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Na Date 5790 6desV Z40 rr t4 ee - ----------- 135 CA CA fb "I otr 40 CJ - CA (P 03 4c) Qh CA cj) CA J50 Zoo lot,.'1? .3¢ qd _496- k p !1 ' e. S• S � ,.>, .� >i 7 \-1 �[•� Joe � _.s t¢I t A-9 55 i7 o2 tom. y/ � r• 4 b4. J �D • • b •OQ'y'e�. fJSGn L� 8 T to N. AC!S3B T•:e I's .moo. ca /3$ PI w tu .'ss � r3s 1 C tis a — f r /S A� Z4 t7 l ...: 1 /me of //X South ! e/ sec f nn 23 ? shite 0� lQ?_ � J