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PRE 2010 DOCSCity of Fridley, No 9795 BURDING PERMIT Owner: _Dr. W. Lawton Builder ____ Rod y Billman.. Inc. Address 1450 Trollhagen Dr. Address 151 Si lyer T.a.kP Roar1- 10 , No. 1 5QO Street W -i nd eme3ze Drive . — —_ Part of Lot Lot 6 Block ______1 Addition or Sub -Division _ ]:nn9"h*miGk 5th @_d_cL+j.en Corner Lot —_ Inside Lot — X.__ r..._.._ Setback _` 3 52 --- Sideyard ._..6 Sewer Elevation 980.58 — Foundation Elevation 983.58 • �' To be Used as: Dwelling Front _ 70' Depth 301 Height 201 Sq. Ft. 152 Ca. Ft. _-3 ZOO Garage Fro t X41 Depth 261 Height _ _ 121 Sq. Ft. 624 Cu. f 7488 game 028, 00 Type of Construction _ Est. Cost 3__-_ _ __ To be Completed SEWER LOCATION - 501 East of Manhole WATER LOCATION - 601 East of Manhole In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above set �Orth and in compliance with 21 provisions of ordinances of the city of Fridley. /0 J &,I,., X In consideration of the payment of a fee of $ 57.00 , permit is hereby granted to Rodney Bi.11man, Inc. to construct the building or addition as described above. This permit is granted upon the express conditio:d that the person to whom it is granted and his agents, employees and workmen, in all work. done in, aroundEd Fridley, Minnesrithin the dtyts and thins permit may be revoked at any time upon violation of any oY the provisions oY ssaaid ordinances Building Of ficial Br eher NOTICE: This permit does not cover the construction, installation for wiring, Plumbing, on heating, rower or water. Be ams to no the Building inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF `FRIDLEY . MINNESOTA... ADDRESS— . _ -_ ,_ —I ARE t4 LOOA f416rBUILDING r �� NO.'S LOT , BLOCK :ADDITION OR _ SIiBDIVISION � J _ CORPdER-LOT ' INSIDE LOT�SETBACR G SIDEYARD l✓ Q� 7� SEWER ELEVATION TOP OF FOOTING 4 plicant, attach, to this form Two- Cartifigates of.'Survey.-of - Lot' and proposed building loogtioa drawn on.the sQ. Certificates. DESCRIPTION OF BUILDING To Be Used As: Frpnt t' Square feet /'` . Cubic Feet�� Front____j k. Depth - Height° l Square feet LZ `� Cubic Feet Tape of Construction Z��ze Estimated Cost To Be Completed, �'Z/ / 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 represea ations stated in this application are true and correct. a DATE-- / SIGNATURE �` _ _ (Schedule of Fee Costs can be fou d the Reverse Side. s 7 49 /4/' 0.,.4 City of Fridley Application for Plumbing and G= sitting Permit Dept. of Ridge. Phone 860-3450 l� DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location 41 NO. RATE TOTAL 6, Number Fixtures .............. x $2.00 $ "� Future Fixture Opening e8 $ O x $1.50 (9 09 0 z �UO • P • N WATER HTR. GAS ELEG Base : $ Electric Water Heater a $2.00 $. GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ -2 G Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 1st 2- 2nd 3rd 4th • Future Connection Openings New Fixture, Old OpeningsSewer I Connected with El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 6, Number Fixtures .............. x $2.00 $ "� Future Fixture Opening x $1.60 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... .................. .. x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $. GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ -2 G Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE City of Fridley: The undersigned hereby .makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct, -- a ��/ Fridley, Minn- — `� 19^ Owner 61 —a (2 Kind of Building -�•�- Used as To be completed about in 5;g -'k- 57 ` F Estimated Cost, $ Q >/ Old�v�. Building Permit No / Permit No.- Signed o.Signe By Business Phone ROUGH FINAL 0 �l u Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ... .................. 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ................. ...... 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ ?° Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING 371%0 FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS e ROUGH FINAL ' See Fee Schedule TOTAL FEE $ Location City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn "IT 19 Owner Kind of Building )r - Used as To be completed about Estimated Cost, $ Z Old—New. Building Permit No. � Permit No. 1 7/ DESCRIPTION OF WORK HEATING or POWER PLANTS --.Steam, Hot Water, Warm Air—No 1 Trade Namev �+ Size No. � &Q �� Capacity. Sq. Ft. E.D.R. A ® BTU H.P. Total Connected Load -7-1;0 3 �� Kind of Fuel BURNER — Trade Namet—w. Size No Capacity Sq. Ft. E.D.R BTU H.P. 4E (REMARKS -OVER) Business Phone 1 A SUBJECT PE IT NO. City of Fridley 15753 AT THE TOP OF THE TWINS BUILDING PERMIT P R EIPT NO. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. � = I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY .___.dl.° '•j 612-571-3450 910-F15 5/29/80 JOB ADDRESS 1500 Windemere Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 3 1 Innsbruck 5th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE R. Johnson 1500 Windemere Drive N.E. 574-1219 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. I,. Gudmunsen Construction 1410 Coon Rapids Boulevard 757-3557 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 [I❑X � NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 221 x 12' Porch and a 21' x 12' Deck 9 CHANGE OF USE FROM TO STIPULATIONS Porch can not be converted to year around living area without a variance approval. WAcp Be fae dimming call 1%81 t,tiiiti, SL"PERATLE PERA&TSTELEPHONE - ELECTRIC. W Etc. HEATING. pLDM8,IVG r tviil�FD p� 8t REQUIRED 8Y L Atit1/ �D SIGN& 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 $g, 500 $4.75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE LAW REGULATING PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE&OR LOCAL CON- $57.00 NONE TRUCTION HE PERFORM OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE nV 2 j° $14.25 $76.00 SIGNATu OFC NTRACT RORAUTHORIZEDAGENT (DAT WHEN pPROPERLY VAL ESD T�HI§ is YOUR -P RMIT BLDG )NSP SATE SIGNATURE OF OWNER tIF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions*, or Repairs) OWNER: Is A,l.�'ScSIJ ADDRESS: TEL NO: '57_2y -1 Z,; BUILDER: L oJrn vpas e.,J (?oa�S ADDRESS: el— /0 TEL NO: 2L 7� Construction Location • STREET NO: _L C)CD STREET: j ct e LOT: 4)-' BLOCK: ADDITION: fig 96 1) Q, /� _ 1:5:4 Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: x27, f Depth: I i Height: (> Qr Square. Feet: 2— Cubic Feet: 06` y� Front:` Depth: Height: __ai Square - Feet: % 7 Cubic Feet: CPOType of Construction: �� AV-m Estimated Cost: s- 0 Tb Be Completed: go C/A ®e � `7 Alt. A Alt. B Proposed Driveway.Width if New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET.. The undersigned hereby makes application for a permit for the work -'herein specified, agreeing to do all work in strict accordance with the.City of Fridley Ordinances and rulings of the.Department of Buildings, and hereby declares that ll the facts and representations stated in this application argue and corr.�5`� DATE: X5/2 : / JO SIGNATURE: Stipulations: V/ QAAJ N kq^ P IT C Tr Goa U Caw urco K vao � AGREEMENT _,'owner of the property located at % O e/ � � -1'� ,. have no objection to the City allowing the construction of ato be located at 1�CO �Wk,V uy , �&e_ without the required certificate of survey that the City ordinarily requires for all new construction. ' Address Ra, - 2 � n, ") Date Witness SUBJECT PE ITN City of Fridley 2 0 5 8 7 AT THE TOP OF THE TWINS BUILDING PERMIT r R PT NO. _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. a 32� c_..,�/� NUMBER REV. DATE PAGE Of APPROVED BV CITY HALL FRIDLEY 55432 j 612-571-3450 910-F15 9/24/90 JOB ADDRESS 1500W.indemere Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 3 Innsbruck 5th_ Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Johnson 1500 W'i.ndemere Drive N.E. 574-1219 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Walker Roofing Company 2701 - 36th Avenue South, Mels.., MN 55406 729-2325 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Cgl REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (34 Squares) 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be 2nd layer but not 3rd, On all new roofs or tear -offs and replacement roofs, State Code requires that 2 la*aers of 15 Ib. felt, mopped together, be installed to a point 24 inches up from exterior wall line, or the use of other approved underlayment membrane. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING S0. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 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 $1 r 70.0 $.85 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $39.0.0 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE Fire SC $1.70 $4155 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEIW HIS IS YOUR PERMIT ;ENPROPPUALAT BLDSP �A TE SIGNATURE OF OWNER IIF OWNER BUILDER$ IDATEI NEW [ ] Effective 8/16/90 ADDN [ ] R-1 AND R-2 L7// C? / qv ALTER [ ] yAd1ding Permit Application Address: / Construction A : d6—t 6 1�l/ , ��► � �t Y, / 10 e f= w Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Ki LIMG AREA: le4-gth Width height Sq. Ft. GARAGE AREA: length Width Height Sq. Ft. DECK AREA: length Width Hgt/Groand Sq. Ft. Off: Corner IAt [ ] Inside Int [iol Setba Side Yard Setbacks Type of Construction: cco— Estimated Cost: $ ' Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: Ft. $ $ jp Width + 6' See Back Page DATE: �/� / 7 APPLICIN1': Tel. # MY USE CNLY 3 9, 00 Permit Fee $ i. Fee Schedule on Reverse Side Fine Surcharge $ /•70001 x Permit Valuation (1/10th �) State Surcharge $ �.�� ' 4-0t.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] Tam $ _ L� S'I'IPUTATIONS : I 0 �• fI 11 - y 4 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES (� l O � ' 07 JOB ADDRESS l� RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and so Replacement Furnace $ 20.00 $A, PJ l') representations stated in this application are true and correct. Side Vent -Fill Out Back 1? ,- . 1994 Gas Piping (Needed with new furnace) $10.00 $ OWNER Gas Range $ 10.00 $ o BUILDING USED AS Gas Dryer $ 10.00 $ �� ESTIMATED COST_ /�l� `_"�. PERMIT NO.____ *Air Conditioning - All Sizes $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST N BACK) 1% of Value of Appliance or Work$ al I 0 Commercial/industrial 1 % of Value of Appliance or Work State Surcharge TOTAL FEE 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. 2 No. of Heating Units_____ Circle One (Steam) (Hot Water) NiEiir Trade Name T Size No.f Z16 M o 7 S� BTU 7 5 0 u c) HP EDA _ Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR P)HEATING COMPANY Signed By Tel No. ,5-,3 7-e5-191 Approved B f Rough -in Date Final Date104 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CHIMNEY AND STACK. YERIFICATI� The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes {A 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 4/,J/� C' 7. Has a liner been provided for water heater Yes QC No ( } 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: HEATING CO: Signed By: Date: SUBJECT P NO. ` City of Fridley 2 3 8 7 AT THE TOP OF THE TWINS BUILDING PERMIT (_RECEIRT-O. Ir? � • ______ COMMUNITY DEVELOPMENT DIV. r I L PROTECTIVE INSPECTION SEC B 1 � f NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 11/9/95 JOB ADDRESS 1500 Windemere Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 3 1 INnsbruck 5 Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Sela Roofing 4100 Excelsior Blvd St Louis Park MN 5823-8046 1050 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 tX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Counterflash dhimney; replace bath damper vent 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 $600 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $.50 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- Fire SCC STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $23.75 $.60 PLAN CHECK FEE TOTALFEE License SC $5.OQ $29.85 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERL ALID TED THIS IS YOUR PERMIT Ap eld BLDG NSP d )ATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) NEW [ ] Effective 8/l/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application WV3/0 Construction Address: 6Vt& 9 Alt �" /V , 4� Legal Description: Owner Name & Address: /5-00 CA�pe Tel. Contractor: 3C --'C'4 /o ap/,rd� _ MN LICENSE # Address:VZOD �%XG�S/Oif &-1,10 5 /6 Tel. # 2-3dd S16 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: C ,Z Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $b _ Approx. Completion Date: � f f (Cost on Back) Drivewayb t Width Needed: Ft. 6 Ft — - _ $ DATE: 1 5 APPLICANT: Tel. # CITY USE ONLY Permit Fee $ 3. %4 Fee Schedule on Reverse Side Fire Surcharge $ �0 .001 of Permit Valuation (1 / 10th %) State Surcharge g $ �� $.50/$1,000 Valuation SAC Charge $ _ $850 per SAC Unit J License Surcharge $ C" (f $5.00 (State Licensed Residential Contractors) �,►y�� 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: CITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURF.R TO RF IN.RTAI I Fn ON FArH P nnR Effective On Jan 1, 2000 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" NO. RATE TOTAL JOB ADDRESS fA4NE- 4', 6LAOIEe__ --I— 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 $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge 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 aDDlication are true and correct. JOHNSON, FREDRICK 7/11 20 1500 WINDEMERE DRIVE N.E. FRIDLEY, MN 55421 ..Owner— (763) 574-1219 Building Used As��I��JU Estimated Cost PERMIT NO. ) -.3 PLUMBING COMPANY PLO 4j C L SIGNED BY TEL N0.41049740:;:� Approved By Rough -in Date Final Date .50 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. lv15 4:0;csmul z vm;j 1017, 11: 1 cT "Z COMMON VENT INFO ON BACK SIDE ® SR ® z s� ,F Yiiit i� ® re M -Off 0 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" NO. RATE TOTAL JOB ADDRESS fA4NE- 4', 6LAOIEe__ --I— 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 $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge 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 aDDlication are true and correct. JOHNSON, FREDRICK 7/11 20 1500 WINDEMERE DRIVE N.E. FRIDLEY, MN 55421 ..Owner— (763) 574-1219 Building Used As��I��JU Estimated Cost PERMIT NO. ) -.3 PLUMBING COMPANY PLO 4j C L SIGNED BY TEL N0.41049740:;:� Approved By Rough -in Date Final Date .50 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. lv15 4:0;csmul z vm;j 1017, 11: 1 cT "Z 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 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 -LAMA 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 -LAMA 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