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PRE 2010 DOCSq'3v( City ®f Fridley, NUmn. N9 9843 BUILDING PERMIT Date: — July 25, 1968 Owner: — Glen Bruer Bider Rodney Billman, Inc. Address Address 151 Silver Lake Road New Brighton, Minnesota No. 1541 ` Street Lot — 20 __ Block LOCATION OF BUILDING Windemere Drive part0 f Lot ? Addition or Sub -Division Innsbruck 5th Corner Lot WX Inside Lot _ Setback — Sideyard Sewer Elevation982.82 _ 986.82 Ton of Footing To be Used as: Dwelling Front Front — Type of Construction Frame DESCRIPTION OF BUILDING 74' Depth 321/26' Height — Sq. Ft. 2257 Cu. Ft. Depth Height Sq. Ft. Cu. Ft. __. Est. Cost _128,A 0 __ To be Completed Nov. 1, 1968 SEWER LOCATION - 23' North of Manhole WATER LOCATION - 36.5' North of Manhole ( at Property) 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 forth in compliance with a& provisions of ordinances of the city of Fridley. pp e. $100.00 Sewer Connectidn Charge In consideration of the payment of a fee of $ 68.00 , permit is hereby granted to Rodney Billman, Inc. 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 bu41d4ngs within the city limits andel this permit may be revoked at any time upon violation of any of the provisions of Bald ordinances. Official Bufldh%xRffXffA1 NOTICE: TMs permit does not cover the co n, festaMon for wiring, phnabing, gas heating, sewer or wafer. Be sun to we the Building Impactor for separate permiu for them hems. APPLICATION FOR BUILDING PERA'!IT CITY OF FBIDLEY, 41k SQTA OWNER'S NAPS &&, BUILDER ADDRESS. LOCATION' 0 ' BDi.bIPZG '�2 NO. 16 > STREET LOT.. -: BLOCK .� ADDITION OR SUBDIVISION CORI-MR LOT ►f WSID/ELOT SETBACK�,�S.IDEY /'U .ter..:..-9L—TOP • �P �. ;.SJ .:l.. SEWER ELEVATION9,�L. TOF OF FOOTINd O �, Applicant attach .to this form Two 67;tificates ;of.'Survey of Lot and'propos-ed ,• building location drswn ops these' beiifti aces. DESCRIPTION 0.r tftU.1KG To Be Used As: FrontDepth. eightt__, Square feet `Cubic Feet Front Depth Height Square feet Cubic Feet Type of Construction ' /< Es'timat;ed • Costes To Be Completed 1 q6 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. DATE A/A, SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). .o� V '70 r Application for Power Plants and Heating, 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 $ I 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 $ 57 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 $ 5.00 $ AIR CONDITIONING 1 $ 1 FAN HEATING SYSTEM See Fee VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL 7- /g - 7 $ TOTJ FEE $ Location 1541 City of Fridley: The undersigned hereby makes application for a permit for the work hereir 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. i, Fridley, Minn 19 _ Owner �`� U t d-�-+ wn %CA*� Kind of Buildingl2 Used as To be completed about Estimated �,Z Cost, $ ®®� Old--(L�TevrfBuilding Permit No. Permit No_ �'*44440 04V HEATING or POWER PLANTS -Steam, Hot Wates Warm No i Trade N%=Size No � V 14. L Capacity Sq. Ft. E.D.R. 4) _ BTU//�� H.P. Total Connected Load . `� Kind of Fuel 1.7 Aw G&3- BURNER — Trade Name�� Size No Capacity Sq. Ft. E.D.R BTU H.P. 4E (REMARKS -OVER) PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: U RATE TOTAL SF d x $2.00 $_8 C oe G Future Fixture Opening u� 18-e G 2 Iflp < (�9<O • t N WATER NTR. GAS EIEC Base Water Heater (Up to 99,000 BTU) .. x $3.00 s--3, _66 New Ground Run Old Bldg. x $3.25 $ Electric Wates Heater s $200 $ GAS FITTING FEES: NO. RATE TOTAL. 1st 3 Fixtures ..... ..... .. - i 1st / Additional Fixtures .... .............. / $ Cas Range to 199,000 BTU .............. x $5.00 $ - 2nd ZAL 3rd 4th _ _ — ° Tubas Connection Openings, Connected With – NOW FiXtUre, Old Ope e I ❑ Cesspool❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $2.00 $_8 C oe G Future Fixture Opening x $1.50 $ New Fixture Old Opening x $1.50 $ Catch Basin .. x $3.25 $ Water Heater (Up to 99,000 BTU) .. x $3.00 s--3, _66 New Ground Run Old Bldg. x $3.25 $ Electric Wates Heater s $200 $ GAS FITTING FEES: NO. RATE TOTAL. 1st 3 Fixtures ..... ..... .. - i x $2.00 $ D - Additional Fixtures .... .............. x $ .75 $ Cas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Cods Description .................................. . J a TO'T'AL FEF 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. Fridley, Minn- 7- Z 19— Owner Kind of Building Used as To be completed about Estimated Cost, $ Old ew Building Permit No.—. / �`t� _Permit No. 3 Signed. By- - Business Phone No_ ROUGH FINAL C/J SUBJECT PER City of Fridley ® 180 AT THE TOP OF THE TWINS BUILDING PERMIT r RE COMMUNITY DEVELOPMENT DIV. <. PROTECTIVE INSPECTION I r SEC. c% 1 . i NUMBER REV. DATE PAGE OF APPROVED BY IL , CITY HALL FRIDLEY 55432 L"" 612-560-3450 910-F15 9/4/75 JOB ADDRESS 1541 Windemere Drive N.E. 1 LEGAL LOT NO. BLOCK TRA CT OR ADDITION SEE ATTACHED DESCR. 20. 2 Innsbruck 5th Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Norman Dufresne 1541 Windemere Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION KI ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish basement 9 CHANGE OF USE FROM TO STIPULATIONS REQUIRED FOR WIRING, SEPERATE PERMITS HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 R-1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,000.00 .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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $6.00 PLAN CHECK FEE TOTALFEE $6.50 SIGNATURE OF CONTRACTOR OR A RIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG. INSP OA IGNATURE OF OWNER IIF OWNER BUILDERI ID TEI C/J APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMITS CITY OF FRIDLEY, MINNESOTA Applicant attach to this form, Two Certificates of Survey of lot and proposed building location drawn on these Certificates To Be Used As: DESCRIPTION OF BUILDING Front: Depth: Square Feet; Cubic Feet: Front: Square Feet: Type of Construction: To Be Completed: "'L2 riJ:� Height: Depth: Height: Cubic Feet: Estimated Cost: 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. DATE ..®® IT/° SIGN TURE OWNER'S NAME:/V«<��r�ia�,J � BUILDER: i�7'7.-- ADDRESS : l �� ADDRESS': NO: STREET: zQ-t" .IAT: BLOCK: ADDITION: .CORNER LOT: l/ INSIDE LOT: SETBACK: SIDEYARD:- Applicant attach to this form, Two Certificates of Survey of lot and proposed building location drawn on these Certificates To Be Used As: DESCRIPTION OF BUILDING Front: Depth: Square Feet; Cubic Feet: Front: Square Feet: Type of Construction: To Be Completed: "'L2 riJ:� Height: Depth: Height: Cubic Feet: Estimated Cost: 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. DATE ..®® IT/° SIGN TURE SUBJECT City of Fridley 7�2)1 0 AT THE TOP OF THE TWINS BUILDING PERMIT r R PT-U _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. o-13 CITY HALL FRIDLEY 55432 NUMBER REV.DATE PAGE OF APPROVED BY I'J 612-571-3450 910415 8/23/93 JOB ADDRESS 1541 Windemere Drive NE 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Lot 20 2 Innsbruck 5th. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Lewis 1541 Windemere Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Marquis Inc 1556 McClung Dr Arden Hills MN 55112 631--2315 8439 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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install two windows. 9 CHANGE OF USE FROM TO STIPULATIONS See notations. on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN BO 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 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 $7 $a 50.. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT (�� PERMIT FEE SAC CHARGE DOES NOT PR SUME T IVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS A HE TATE OR LOCAL L REGULATING CON- $25 00. Fire SC $1.00 STRUCTIO TH P RFORM CE OF CONST ION. • PLAN CHECK FEE TOTAL FEE �J --7 License SC $5,00' $31450 SIG T EOFC ,RACTOR UTNORIZEDAGEN tOATE) WHEN P O RLY V ATED THIS IS YOUR PERMIT �BLDG INSP FATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) N [ ] Effective 5/26/93 ADDN [ ] CITY OF FRIDLEY �3 ALTER { ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: _(i54 ( W [ w11 1 AF -r- - Legal Description: Owner Name & Address: Tel. # ContraciSrz'x_� 2 I MN LICENSE # 6 0 E340 Address: (5 -';Co 0Af-C-Zu P'4 d-)a'Ll Tel. # (o 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. DEAX AREA: length Width Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: \aoC1 Approx. Completion Date: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Side Yard Setbacks E0if6i;d Cost: CCDCD, 0 (Cost on Back) Ft x $ = $ DATE: 7 [ APPLICANT: N Tel. #_ �-(�— Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ �. �' p .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ ` $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ Conservation Plan Review $450.00 Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary { ] Not Necessary [ ] TOTAL $ Za STIPULATIONS: (031 -Z3tS— T:Ar?AtLj rtwN. V�I nLSI� I.vvc('• i' A�otJ!.�� Biu-�ct� -A:12 . Lst:-- s� sr�r�� lid �c000 � f$Xtoo Vrfq4-9i1j "41111c, 1A n at Ji This Plan Must's-�(/ � Be Maintained And7 4. Accessible On Thsaark L. Pignateno`° S t,� Builder License `` Zr a�� <� AGSr aQjkUonstruction Site President No.0008439 U V'�'�` MARQUIS- ■ DESIGNER • BUILDER • CONTRACTOR 1556 McClung Dr. Phone and fax Arden Hills, MN 55112 631-2315 s 0 V VI I T VI- r rill LCT II1401-t .IIUN UIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Lnective un uanuary I, 1 YY3 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater -. Gas $10.00 Gas Range $10.00 Gas Dryer $10.00 Back Flow Preven.ter Required (*Yes ( ) No Type)A/ L I<11JS -$5.00 '--hod72-0,4 Reinspection Fee $30,00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge TOTAL FEE JOB ADDRESS I`�V iukwQ,,P 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. i .J✓c � I , 198b1 Owner Building Used As Estimated Cost PERMIT NO. PLUMBING COMPANY s� SIGNED BY TEL N0. 7 Approved BK Rough—In Date Final Date 22 $ .50 4'p MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 $ �`, - PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 1541 WINDEMERE DR NE PIN : 253024110067 LEGAL DESC : INNSBRUCK 5TH ADD : LOT 20 BLOCK 2 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,547.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (22 SQ) TEAR -OFF STATE LICENSED CONTRACTOR 1 APPLICANT MIDWEST ROOFING SIDING WINDOWS INC 313 JEFFERSON HWY CHAMPLIN, MN 55316- (763)427-9696 OWNER LEWIS GARY A & KAREN S 1541 WINDEMERE DR NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating co i ction o 'he erformance of construction. A ican Date Bldg PERMIT �O.: d004-00482 DATE ISSUED: 04/12/2004 BUILDING PERMIT FEE 83.25 FIRE SURCHARGE 2.55 STATE SURCHARGE, VALUE 1.27 LICENSE SURCHARGE 5.00 TOTAL 92.07 PAID WITH CHECK # 17616 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Cry "/ �v > /4- F Construction Address: I/V U V ��0��<� k . /-v Legal Description: Owner Name & Address: b6ir Ltw 5 Tel. # 763- 57-a ` J Contractor. i MN LICENSE # foo l U�-7-7 Address: Tel. # NI -L-116 " �QULI Attach to this application, a Certificate of Surrey 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: (I 'V Construction Type: �P o t ra1 Estimated Cost: $ - ` •1000 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: APPLICANT: T.1.9 Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL 1!i1V&1,&]41l)d►1A& Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $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 [ ] STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 N'AX: (76J) 571-1LZVI ADDRESS : 1541 WINDEMERE DR NE PIN : 253024110067 LEGAL DESC : INNSBRUCK 5TH ADD WATER TREATMENT APPLIANCE : LOT 20 BLOCK 2 PERMIT TYPE PLUMBING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION 5b PERMITO.: �2OO 16U8 DATE ISSUED: 09/15/2004 VALUATION : $ 400.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES # WATER TRMT APPLIANCES APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612)827-4033 OWNER LEWIS GARY A & KAREN S 1541 WINDEMERE DR NE FRIDLEY, MN 55421 0 # GAS WATER HEATERS 1 0 # GAS RANGES 0 0 VALUE (FOR MINIMUM CALC) 400 0 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regu . nstruction or the performance of construction. PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 29083 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. ;431 University Ave NE =ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR JOB ADDRESS_ 6an0AP_ ' ILfa O -W tl J.4 - .....:.:..:::::::::: ' v::; �•r':: Urinal ....::::........ .... Shower .•ryi{.•.:5,{ii::•: i:: :.:..•,.•.. •.:::.gin:: Wash Tray ' Floor .:..... � :.::..vim:.i:•iY Auto. o. .....,...:GaS AN �a Range Heater Stories . :.Water ••::f..tit Gas Elec Basemen and rulings of the Building Division, and hereby declares that all the fads 3low Off Basin $10.00 and representations stated in this annlication are tnie and cnrrprt match Basin $10.00 Floor 1 lain Water Leader $10.00 1541 WINDEMERE DRIVE NE 20 4PY Sump/Receiving Tank $10.00 FRIDLEY, MN 55421 Floor 2 $35.00 :.'•i::ti:Yii%i OWNER (763) 572-15&0 Nater Heater -Electric $35.00 :f. Nater Heater - Gas** � N Floor 3 3$. � 1 BUILDING USED AS wt� �S a 3as Range** $10.00 3as Dryer*` $10.00 Floor 4 ESTIMATED COST WO PERMIT NO. 3ack Flow Preventer Required( )Yes () No Type $15.00 1 `- PLUMBING C � ` OVA PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ 6an0AP_ ' ILfa O -W tl J.4 - Jew Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein )Id Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes 3eer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the fads 3low Off Basin $10.00 and representations stated in this annlication are tnie and cnrrprt match Basin $10.00 LEWIS, GARY p p lain Water Leader $10.00 1541 WINDEMERE DRIVE NE 20 4PY Sump/Receiving Tank $10.00 FRIDLEY, MN 55421 Nater Treating Appliance $35.00 OWNER (763) 572-15&0 Nater Heater -Electric $35.00 Nater Heater - Gas** � N $35.00 3$. � 1 BUILDING USED AS wt� �S a 3as Range** $10.00 3as Dryer*` $10.00 ESTIMATED COST WO PERMIT NO. 3ack Flow Preventer Required( )Yes () No Type $15.00 1 `- PLUMBING C � ` OVA COMPANY O UiW1 ADT reinspection Fee $50.00/Hr SIGNED BY TEL N0. N 12a 827- cl033 4LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ • 5a FEE �S o MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL $ OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE f FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes ( ) No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No. ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No( ) When required to Install a new combustion air, it will be sized and installed to meet the current codes and manufacture'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 :