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PRE 2010 DOCS---------- Village of Fridley, Minn. BUILDING PERNM 6iH Office of INSPECTOR OF BUILDINGS owner .Architect Builder— Fridley, minn- LOCATION OF BUIMING No. —Part of Lot, Block. Addition or Sub -Division DESCRIPTION OF BUILDING ]Front Depth Height Storles_-_:'— Manner of Construction— To be used as To be complet Estimated Cost Permit to hereby granted iv, °' "'�! o the building described in the above statement. This permit is granted upon the express condition that the person to whom It is granted, and his agents, employees and workmen, in all the ' work done In, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of 3?6&4,� Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city 1&�Its, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. jnspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work In accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duty sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, Minnesota, this i day Of D. 19-4- City ®f Fridley, Minn. BUILDING PERMIT N® 3096 Date:�� ✓"' ........................ ......... Owner Builder ...... /............ Address ..i.® .. .... Address ...... ,/..�� .. LOCATION r%= BUILDING No. 'In ... Stree ...... t ....... Part of Lot ............................... Lot ............ Block .................. Addition or Sub -Division ....................................... Corner Lot ............ Inside Lot ....6 ... Setback ��... Sideyard ... .. .................. V DESCRIPTION OF BUILDING To be Used, as: .. Front DepthHeight ........ Sq. Ft. Cu. Ft. ........ ............... Front . Y .. Depth l' �.� ®Height Sq. Ft. � OLL Ft. ........ Type of Construction ................... Est. Cost... C3.`-o.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 above set orth and in compliant with all provisions of ordinances of the city of Fridley. ".-W '-ZA0" Onew .............A . In consideration of the payment of a fe of $. , pe t is hereby granted to'�? 4✓65 ....... . ............ to construct the buAWmg or addi ' 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. W'.241 - : 0 ��.:� . W NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plum g, gas heating, sewer or water. Be sure to see the Building Inspector ?pr separate permits for these Items N" PORC lNe `eah 4 CtA) How s C. octL FFR "A c City of Fridley Application for Plumbing and Gas Porn53-84-S 915.51 bias F'itti'ng Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORE Number, Kind and Location of Fixtures Location 310 Osborne Rd. V) < x $1.50 ` � x $1.50 ? VI 3 1- C LL x $3.00 QZ LL O �Z 3 u m< O 3 J t� °d (9 (� U' Z a t� O • F • N WATER HTR. GAS ELEC. Base 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer � Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................. New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg. ............ Electric Water Heater _ GAS FITTING FEES: 1st 3 Fixtures ...... .................. Additional Fixtures ................... Gas Range to 199,000 BTU ............. x $2.00 $ x $1.50 $ x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ a $2.00 $ NO. RATE TOTAL 1 x $2.00 $ 2.00 x$.75 $ x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description . irastali (1)..gas _lite....................$_3.00 TOTAL FEE $ 5.00 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, w. Nov. C 1970 , 19_ Owner Arnold Hohnson Kind of Building frame Used as residence To be completed about Nov. 11 s 1970 Estimated Cost, $ 10.00 Old XNew. Building Permit No Permit No. 6�� `I7 ROUGH FINAL ,)- - 9- G ` 71 d2 S' By:'` , Business Phone N OU 6AS (,Q,, y✓ SUBJECT PERMIT O. City of Fridley 15.9.4 6 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T _ rp CEIPT � • COMMUNITY DEVELOPMENT DIV. __ INSPECTION SEC. r PROTECTIVE 11411 1 � = CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/30/80 JOB ADDRESS 340 Osborne Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Parcel 1580 1 Nl� of Section 11 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dorothy Johnson 340 Osborne Road N.E. 784-6755 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd but not 3rd roof. Install ridged galvanzied valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt 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 $1,290 $.64 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 $9.64 NAT URE OFCONTRAC A HO�RIZ�EDAGGEENT WHEN PROPERLY-,VALIDATED THIS IS YOUR PERMIT 3(DATE) BLDG INSP rATE SIGNATURE OF OVOERI WN RBUILDERI (DATE) y✓ CITY OF FRIDLEY APPLICA* Im FOR RESIDENTlAL BUILDIING PERMITS (New, Alterations, Additions, or Repairs) Ot�t�ER: lg ®AJ BUILDER: ADDRESS: at) at) ADDRESS: TEL NO: 7,e Li (O TEL 140: Construction Location ' STRMT No: �U STREET: ��( ) d1 LOT: . C3i 1c,CeJ[ BLOCK: ADDITION: Corner Lot: Insiae Lot: Setback,: Sideyards: Applicant attach to this form tcao Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION W Front: Depth: height: Square. Feet_ Cubic Feet: Front: Depth: Height: _ Square -Feet: Cubic feet: Type of Construction; Estimated Cost: $ To $e Qbrapleted: C:;� uj—o—� Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . Mie 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 iti this application are true anAl correct. D..TE: 3 0 S IGNATU IE : Stipulations: ,� 17(y r:z ective Aug. 1, iyai CITY OF FRIDLEY 63-8),416051 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures - Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ 10.50 Job Address 3L0 Osborne Road Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 8-16-81 , 19 OWNER ,TOMSON KIND OF BUILDING frame USED AS res. 1' TO BE COMPLETED ABOUT ' -24-81 ESTIMATED COST 50.00 OLD - NEW BUILDING PERMIT NO. !7T o 9 /�Company NCGASG0 Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE m m Water m 01 e H C .ci � .0p, w Heater ii �3 s� x Bm x a u m 14 g m m o vii v ] y 3 a w° N w an 3 c� s lec 1st ran e 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures - Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ 10.50 Job Address 3L0 Osborne Road Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 8-16-81 , 19 OWNER ,TOMSON KIND OF BUILDING frame USED AS res. 1' TO BE COMPLETED ABOUT ' -24-81 ESTIMATED COST 50.00 OLD - NEW BUILDING PERMIT NO. !7T o 9 /�Company NCGASG0 Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE ' r 64J 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 JOB ADDRESS_ J qo ®s 6 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer "Air Conditioning - All Sizes Rate TOTAL $20.00 $� i $ 10.00 $ $ 10.00 $ $ 10.00 $ V J $ 10.00 $to All Others/Repairs & Alterations (LIST ON BACK 1 % of Value of Appliance or Work Commercial/industrial 1 % of Value of Appliance or Work 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Y117 ,199,- OWNER BUILDING USED AS ESTIMATED COST 100 PERMIT N0. 113 ' DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units its� Circle One (Steam) (Hot Water) Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load - $ .50 $ 3 ® P,, - MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY ROYALTON HEATING &COOLING 4126 8M AMU' Signed B BROOKLYN PARK, MQ 55443 HUNE s t! Approved B Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION 0 REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes No ( ) 2. Is free from rust or deterioration Yes ( o ( ) 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6. Has total heating BTU's of All other BTU's L/b do 0 TOTAL BTU's ®� Remarks List Alterations. Being Done: HEATING COMPANY Signed By Date ROYALTON HEATING & COOLING 4120 - WH AVENUE N. BROOKLYN PARK, NIN 55443 Yes ( ) No ( �� Yes ( No ( ) Yes ( No ( ) HEAT LOSS CALCULATIONS --- ROBERTS-HAMILTON COMPANY --- MINNEAPOLIS, MINNESOTA Weatherstrips A.S.H.V.E Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof I Floor Kind How Applied Yes -No I Yes -No 1 19 TV anuvwa auu 1JVVla - No. Width Height of pane of pane L.lat ma No. of lights G allu tilGa I Lineal ft. Area. of crack sq.ft. (� 1 �,`�,� aN 5$ i Z.6, 1 .G 1 t I eA I W to 1 1 -73.1 Ud 4. Coef.1 Btu Infiltration Glass Exp, wall Net exp. wall Int. wall Ceil. or floor Total Btu. Required sq.ft. E.D.R. or sq. ins. W.A. Leader area uluvwa anu a.Pvvla - %,daGKa G allu tura No. Width I Height I No. of I Lineal ft. Area of pane of pane lights of crack sq.ft. Infiltration io f0 / Glass Exp. wall Net exp. wall Int, wall Ceil. air Um Total Btu. Required sq.ft. E.D.R. or sq. ins. W.A. Leader area 111Uv W J allu ULKA J - l.1 Qt:Ka G ang t11Ga No. IWidth I Height I No. of I Lineal ft. Area. of pane of pane lights of crack sq.ft. Infiltration _ Glass Exp. wall _ Net exp. wall Int. wall _ Cell. or floor Total Btu. _ 11 1 V f l' I leer I K -7 E.D.R. or so. ins. W.A. Leader area illuuwa a11u L/uula - V1aVAa G allu A1Ga No. IWidth I Height I No. ofI Lineal ft. Area. of pane of pane lights of crack I sq.ft. Infiltration Glass Exp. wall _ Net exp. wall Int. wall Ceil. or floor Total Btu. Required sq.ft. E.D.R. or sq. ins. W.A. Leader a Fl. Room I Length Width Heijtht F7.I Room ILenZh Width Windows and Doors - Cracka a and Area Windc ws and Doors - Cracka a and Area No. Width Height No. of Lineal ft. Area. No. Width Height No. of Lineal ft. Area. of pane of pane lights of crack sq.ft. of pane of pane lights of crack sq.ft. Coef. Btu Infiltration Infiltration Glass Glass Exp. wall Exp. wall Net exp. wall Net exp. wall Int. -wall Int. wall Ceil. or floor t Ceil. or floor total413tu. Total Btu. Required sq.ft. E.D.R. or sq. ins. W.A. Leader area Required sq.ft. E.D.R. or sq. ins. W.A. Leader area, I Btu Coef.I Btu Coef.I Btu SUBJECT City ®f Fridley P96 5 0 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. � `L ______ COMMUNITY DEVELOPMENT DIV. SEC j r PROTECTIVE INSPECTION 0.'x'1 �CITY HALL FRIDLEY 55432 �'� NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 6/8/99 JOB ADDRESS 340 Osborne Road I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Par. 2580 Section 11 - N 1/2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dorothy Johnson 784-6755 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 OX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof (23 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO 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 1 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 $2010 $1.01 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 PLAN CHECK FEEaVALIDAT L F, 7iGNATUBE OF CON'R pR Rau ORiZEOAGENT iDAATEEN R S Is UR MIT �Q/L-( SL [NSA DAfE S,GNATURE OWNER] NER BUILOERI DATE, s NE*[ l Effective 5/10/99 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION u Xconstruction Address: ,344) Osborne Legal Description: Owner Name & Address: re Contractor: . f - -/ I Address: Tel. # (6 Z-12 2E Y- 6 7ss MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length OTHER: Re R6100 Construction Type: Driveway Curb Cut Width Needed: DESCRIPTION OF EMPROVEMENT Width Height Sq. Ft. Width Height Sq. Ft. Widjh ti— Hgt/Ground Sq. Ft. ,Estimated. .. Ft. + 6 Ft = Ft x $ ma DATE: /9 APPLICANT: La& Tel. #-(6 /a) 7,'L%67.SS Permit Fee $ C "� Fire Surcharge $ State Surcharge $ 1 a ( SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ 66, I STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NLIMRFR ()F FIXTI IRFS Tr) RF WRTAI I Pr) nM Gnru 9'1 nnQ 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** NO. RATE —j -- Gas Range** _ Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS _',MX1F te, aEZOIE�?_ 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 remesentatinm Qt=tom+ in fhc- are true and correct. JOHNSON,DOROTHY 340 OSBORNE ROAD NORTHEAST FRIDLEY, MN 55432 20 ®�. (763)784-6755 Building Used As '�E-6 t1x:7m cz 00 Estimated Cost 0_�_ PERMIT NO. PLUMBING COMPANY ®Iz�1�Jt L()/►?�d�� SIGNED BY TEL NO.��Z"S�T Approved By Rough -In Date Final Date q-0,2- $ _50 MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS S20 00 $za-_550 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 7w 0* • •�Emm IMMM _- 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 —j -- Gas Range** _ Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS _',MX1F te, aEZOIE�?_ 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 remesentatinm Qt=tom+ in fhc- are true and correct. JOHNSON,DOROTHY 340 OSBORNE ROAD NORTHEAST FRIDLEY, MN 55432 20 ®�. (763)784-6755 Building Used As '�E-6 t1x:7m cz 00 Estimated Cost 0_�_ PERMIT NO. PLUMBING COMPANY ®Iz�1�Jt L()/►?�d�� SIGNED BY TEL NO.��Z"S�T Approved By Rough -In Date Final Date q-0,2- $ _50 MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS S20 00 $za-_550 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 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 Cb: f Signed By: Date. Building BUILDING Plan Review PermitNomaltA Inspections Fire Surcharge RESIDENTIAL APPLICATION Received B340 763-572-3604 $ CITY OF FRIDLEYL License Surcharge $ 763-502-4977 FAX SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = R x $21 = $ EFFECTIVE 1-1-08 $ $450 Conservation Plan Review DATE YOUR E-MAIL ADDRESS -Fi % �e� a" ' ca4 SITE ADDRESS ®!l Total Due $9 THIS APPLICANT IS: ❑ OWNER 91CONTRACTOR PROPERTY OWNER/ NAME: 2�a ADDRESS: -/ ® CITY STATE/?aaZ-ZIP TENANT PHONE -,(2t03) NAME: 4or t - CONTRACTOR `j ADDRESS: 4i1 f ' Q SCJ �-o CITY t�04 60J.6 STATE;, --7 4ZIP 75,E SUBMIT A COPY OF PHONE _ ae FAX( YOUR STATE LICENSE ® �� EXP DATE STATE LICENSE # PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED MwmDows ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR FREMODELING DESCRIBE WORK BEING DONE: ��' O Q� i €+ua 5AJ,,-tA 5 �'L\ r- ! SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING OUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES 13 HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum 0 Trim and proposed project. ❑ Other ❑ Fascia Z. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS E)Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS-13ESCRIBE SIZE OF Psf ba1�� OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED L NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ 00 OCCUPANCY TYPE Permit Fee See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = R x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $9 Make checks payable to: City of Fridley Attach Stipulations 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 gnly an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the a proved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME L? n o� ,w� Z- DATE APPROVED BY DATE