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PRE 2010 DOCSit • � � moi' �® ..�'_,. Builder a ft N° 6929 ����� �=��0 TI OF BUILDING NO. Street ` ,� Part of Lot Lot --Block Addition or Sub -Divisions _ Inside Lot Setback r�`� ® Corner Lot Sideyard ._ . Sewer Elevation V21 6 1- 1 19 g Foilgvation DESCRIPTION TC(* U s/ Front -it Az� Depth . Height Z�G) Sq. Ft. Ca. Ft,4Z , 6 nt Depth Height Sq. Ft. Ca. Ft. Type of Construction_ Fast.' To be Completed In consideration of the issuance to me of a permit to cons building described above I agree to do the proposed work in accordance with the description abfo in compliance with a& provisions of ooverdinances of the city of Fridley. 7 , In consideration of the payment of a fee of $ J I permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. � /--I Building Inspector NOTICE: This permit doss not cover the construction, lastallstiee for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these fleas. e. 4 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME �� ✓��� P BUILDER ADDRESS � La ®� As3� 'ems v .�� � ADDRESS LOCATION OF BUILDING. No. j Street I- part of Lot Lot Block Addition or Subdivision Corner Lot_.A_Inside Lot Setback- Side -Yard SEWER ELEVATION �?,XS® ELEVATION �� �a 6 3 7-/ 14) Applicant attach to this form Two Certifies, es o Survev of Lot and proposed build- ing location drawn on these Certificates. To be used as: DESCRIPTION OF BUILDING Front zlz' Depth 17=G Height rte® Sq. Ft. i :p— Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction ,�� �, �, Estimated Cost r To be Completed 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. (Schedule of Fee Costs can be found on the Reverse Side). City of Fridley, Blinn. BUILDING PERMIT Dates 23 February 1967 Smith & Anderson 912 40th Ave. NE NQ 9142 Builder _Robyn Lemancik _._.— Address 8470 Eastwood Drive LOCATION OF BUILDING No. 4591 street __ 21-2 Street NE Part of Lot Lot _ 15 —__ Block 1 Addition or Sub -Division Rearaa,ngemgUt of BPL MOUTI34&l5, Corner Lot — x Inside Lot Setback --_ Sideyard X 9 -5 _& 17 5 Sewer Elevation 70' South of Manhole * — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Home Front 42.1011 _ Depth 24-.&...3p Height ._._..2Q Sq. Ft. _ Io83_ Cu. Ft. 21 ,56Q. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Est. Cost $14.002_____ _._ To be Completed 15 May 1967 *Sewer does not come to property line Water 51' South of Manhole; to property line Top of footing - 828.03 In consideration of the issuance to me of a permit to construct the building the proposed work in accordance with the description above set forth and in cc ordinances of the city of Fridley. _ I agree,,to do vrQvigcns of 22.00 g In consideration of the payment of a fee o 00.00 NSSSDpermit is hereby granted to Robyn Lemancik . to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: This pormh does not cover the construction, hictallafion for wiring, plumbing, gas heating, *ewer or wafer. Be sure to no the Building Inspector for separate permit* for them items. ' IJ BaLGERALD xi k VE -0 I S. COMPANY td r LAND SURVEYORS 1MOTSMUID ilat!= TAW'S OF STATE OF 2UXNMWrA XJCVXSED; SY Ok DWANCE Or CITT Or EA3'OUS 69 1.7, daho Ave. N. 1319922 Minneepoli*, Mune ota .55428 °iGT� TRAR� - 1€�i3t 4iL �'_C'VPAE'Ar—f AL -'. 70K6 GiR,APHIC+A.L f P, J..psr�i 1a 0.x G,t THAN'30 Y is Of rbe ero a ii`c to -,0" M2 v`e°k"S���� r:. �@E 'd .,$ t si` r6 CiT U�tSS _. pi.Aae .-Fr)'wtiss�'7 �. A -$$A adth 4: Apderson Invo to # IgR0 115-5' S ale V*m 30' /rt a • 4" 4�► ti aop 3 All Leat 15, B10ek i, 911 Ocks1-1 14,AND i>rPt;'IQr AL ® le) We hereby certify that this is a true and correct represents- oma';.,.•, o �'."' tion of a survey of the6aund0riss of ifw above described Signed land and the location 91 all buildings and vigible- encroach- LOT SURVEYS COMPANY ments, if any, from or isle said land. *A r_)q Surveyed by us this �ay �f �' 148 i Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ NECK. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ 9.00 each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water . 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ....................... 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ gi 06 GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH . FINAL See Fee Schedule TOTAL FEE $ X- i4'0s3 14,s® Dept. of Bldgs. Phone SU 4-7470 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 co Fridley, Minn r—! 1S Owner Kind of Building i Used as To be completed about Estimated Cost, $ �'� S 6' Q® Old ew Building Permit No. 2Z ! � Permit No.�& DESCRIPTION OF WORK HEATING or POWEA PLANTS—Steam, Hot Water, arm Air No N I Trade Name ,^--^� Size -- Capacity Sq. Ft. E.D.R o r BTU H.P h� Total Connected Load �c Bind of Fu BURNER — Trade Name Size Capacity Sq. Ft. E.D.R BTU H.P Signe By G iC .40 42 Business Phone No- 1001 Xpnlnmar $ Minneapolis 16, Minn. (REMARKS -OVER) U. 54611 D-36 z � HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTION Weatherstrips - A.S.H.V.E. Construction No. Guide WindowsDoors Reference Out. Wall Int. Wall Ceiling Roof Floor Yes—No I '-Ye—s--No " es—No 1'9_ / m I ®, d f?- I r ---.L .? 1r AerA.L . -7tf-:-L. 4� Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. G Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall 1 o e' Int. wall P Ceiling 450Q 9�, Floor S -b 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 ®vim Room l Lenath 1!:P Width 0 Heiirht Windows and Doors—Crackage and Area Width Height No. ofLineal ft. Area No. of pane of pane lights ofcrack sq. ft. G Coef. Btu Infiltration Coef. Btu Infiltration e' Exp. wall 1r P Glass 450Q 9�, Z ® S -b Exp. wall Z ®jC 91co- Floor Net exp. wall Int. wall Floor Int. wall Ceiling Ceiling Floor Floor Total Btu. 3 3 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 ;rl -7- Room I Lenseth <0" Width C-- Heiaht Windows and Doors—Crackage an Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Coef.1 Glass e' Exp. wall 1r -671 Net exp. wall 450Q 9�, Int. wall Ceiling 91co- Floor total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and I X= H No. of vane of MINNEAPOLIS. MINN. Insulation Kind How Applied Room I Length 041f Width /0 ors—Crackage and Area ht No. of Lineal ft. Area Coef.l Btu Infiltration z:z 13Y ir TQ Glass i & zo ZOO Exp. wall% Z Net exp. wall Int. wall Ceiling jr j o Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area i Fl.l /d9 Room I Lenath j& WidthZZ Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Coef.1 Btu Infiltration Glass Glass -671 5;`3 r— ®`0 Exp. wall Net exp. wall Int. wall Net exp. wall Si® Int. wall Floor Ceiling Floor Total Btu. 12 j 0K Required sq. ft. E.D.R. or sq. ins. W.A. Leader area D--_ s r ---.L s' WI -b -L A01 ue:..L: - Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration 1-� Glass ®w Exp. wall � d„® Net exp. wall Int. wall Ceiling 0 Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area D-56 z 041W IS HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTION MINNEAPOLIS. MINK. Weatherstrips A•S.H.V.E, Construction No. Insulation Guide Windows ' Doors Reference Out. Wall Int. Wall Ceiling RoofFloor Kind How Applied lies—No I -'es- No 19_ Room l Lenath dem Width /.;;,Height c;p, II > FU Room I Length -2 Width 1 ?Heiaht � Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 37— 75 Z — Z r Z 2� V Coef. Btu Infiltration 3 Glass ® ®p Exp. wall, Net exp. wall Z Int. wall 9'® Ceiling Glass Exp. wall Z Floor d S77 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area A FI.I 2,4y Rn rn I i -nth / 2 W..dth og �V i-i—ht S;-** V Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No, of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq, ft®. — Z r Z 2� V Coef. Btu Coef. Btu Coef. Btu Infiltration Z Net exp. wall 9'® . Glass Exp. wall Z Ceiling Int. wall Floor ®® jL Net exp. wall 9 Int. wall Ceiling Floor / Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length r, Width /ieight Windows and Doors--Crackage and Area Width Height No. of Lineal Yt. Area No. of Dane of pane Ilghte of crack eq. ft. Btu Infiltration Glass Exp. wall .Z Net exp. wall Int. wall Ceiling Floor / Z Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No, of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. .3 Coef. Btu Coef. Btu Infiltration Z IR g z - Glass Exp. wall Net exp. wall 9'® Net exp. wall Ceiling Int. wall Floor Ceiling Floor _...___ vil -/z-,b Total Bfu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FV Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No, of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area i City of Fridley, Minn.. BUH DING PERMIT Owner: Donald Ko-pecky Builder Same Address - 4591-2-15: Street N.T- Address Same N° 10340 No. _4.591= Street 2�1.: Street N=F,,.,, _ Part of Lot Lot Block 1 Addition or Sub -Division _P1 outh Addition(Rearrange 13,14,15) Corner Lot _X __ ___ _ Inside Lot Sewer Elevation Setback —... Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: G"age Front 28 Depth -24 Height 10 Sq. Ft. - 672-- Cu. Ft. _ 6720 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction — Frame Est. Cost 2 000.00 _.. To be Completed _ _ 12 2 Paved Driveway In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work m accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. A, A , ,,, In consideration of the payment of a fee of $ 0.0)_ __, permit is hereby granted to Q ald Ko-oecky to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and. moving of buildings within the city limits and this permit may be revoked at any time upon violatio y of the provisions of said ordinanc e& r NOTICE: This permit does not cover the Construction, installation for whing, plumbing, gas heating, sower or water. Be some to no the Building Inspectorfor soperaM permits for these Items, APPLICATION FOR.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAMEr _ BUILDER ADDR.ESS ADDRESS NO. STREET!! LOCATION OF BUILDING LOT BLOCK ADDITION OR SUBDIVIS CORNER LOT INSIDE LOT SETBACK SIDEYARD SEWER ELE`iATION TOP OF FOOTING Applioaut 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: Front Depth S2 % Height Square feet Z®L. Cubic Feet "7 ? Front Depth Height Square feet Cubic Feet Type of Construction T _ Estimated Cost ca ®m To Be Completedf' -- y 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 SIGNATURE (Schedule of Fee Costs can be fouyid on the Reverse Side.) ,�.'I v� 0 r- eL • - - Yom--- -- — _ , �-�++ . `-. ,f ..a` ` P' - Lot ' Z5, Block Is ND 15 f PT We hereby certify that tfris is a true andcorrect representa- 4 tion of a survey of the boundaries of the above described land and the location of all buildings and visible encroach• ments, if any, from orrc-•yi said land. ,' Surveyed by us this L,7 Iyday of a&-r—a-Y1461 i f ca Signed /3 - •�.�.�-�:r� �-, �..�'';,�'�'�A-•' , LOT SURVEYS COMPANY • 1?EGISTEFED UNDER LAWS OF ST.9T£. LICENSED BY ORDINANCE pf' �:•..zq•-,�� of GPTY of xi.KNERP GEES - , � V017 tdahe, A%t N. N • 'n,��� � NIT � J 1911)Ii••i1P},;`:�• '1ian W oa 1 11244 .. J t S�4.Ft '1 SSlid oa. - . D -j , 5C 301 A' ,�.'I v� 0 r- eL • - - Yom--- -- — _ , �-�++ . `-. ,f ..a` ` P' - Lot ' Z5, Block Is ND 15 f PT We hereby certify that tfris is a true andcorrect representa- 4 tion of a survey of the boundaries of the above described land and the location of all buildings and visible encroach• ments, if any, from orrc-•yi said land. ,' Surveyed by us this L,7 Iyday of a&-r—a-Y1461 i f ca Signed /3 - •�.�.�-�:r� �-, �..�'';,�'�'�A-•' , LOT SURVEYS COMPANY �° , � N • 'n,��� � NIT � J f - .. J t ,�.'I v� 0 r- eL • - - Yom--- -- — _ , �-�++ . `-. ,f ..a` ` P' - Lot ' Z5, Block Is ND 15 f PT We hereby certify that tfris is a true andcorrect representa- 4 tion of a survey of the boundaries of the above described land and the location of all buildings and visible encroach• ments, if any, from orrc-•yi said land. ,' Surveyed by us this L,7 Iyday of a&-r—a-Y1461 i f ca Signed /3 - •�.�.�-�:r� �-, �..�'';,�'�'�A-•' , LOT SURVEYS COMPANY City of Fridley Dept. of Bldgs. Phone M-3450 DESCRIPTION. OF WORK Number, Kind and Location of Fixtures V 13 a o Z H 8 c 3 u$ ► a WATER HTR. 7G.SFLEC. Base 1st 2nd 3rd 4th • Futuro Coasaeclios Openings i Fixture, Old Openings Connected with SevC]Now Cesspool ❑ PARTIAL. RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................. x $2.00 $ 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 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water heater............ �e a $2.00 $ SAS FITTING FEES: NO. RATE TOTAL 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 Citi Qzdinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct' Owner Kind of Building Used as To be completed abs}�t Estimated Cost, Old—New. Building Permit No. Permit No. R, Signed - � 3 By Business PhonetNo ROUGH 1st 3 Fixtures x $2.00 Additional Fixtures ................. x $ .75 $ Gas Range to 199,000 BTV ... ,........... x $5.00 $ REPAIRS & ALTERATIONS—Beier to Code .50 State Surcharge Description .............................................$ _ TOTAL FEE $ �� SUBJECT ""i City of Fridley ip AT THE TOP OF THE TWINS g U I -L D I N G PERMIT r CEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 11/17/75 JOB ADDRESS 4591 - 21� Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1S 1 Re -arrangement of 13,14,15, Plymouth SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Donald Kopecky 4591 - 211 Street N.E. .560- 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW E� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 28' x 20' Addition to garage 9 CHANGE OF USE FROM TO STIPULATIONS RNOING.:n SEPERATE PERMITS REQUIRED fOR WIRING, Before digging call 10071L ,;,, HEATING, PLUMBING AND SIGNS. ELECTRIC - GAS TELEPHONE - REQUIRED BY LAW 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 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 'HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,144 2.07 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. $10.50 PLAN CHECK FEE TOTAL FEE $12.57 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG )NSP DATE SIGATURE OF OWNER (IF OWNER ILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: �) BUILDER: ADDRESS: 147 ' , ADDRESS: NO: Ll �%/ STREET: ' LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYM: Applicant attach -o this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: 1W ,-4 DO Front: Depth: —Height: r Square Feet: _ S -L 0 Cubic Feet: SW 0 .Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: r0 A Estimated Cost: _$_____ To :,Be Completed: AA Q a P,., fi, 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, 0 DATE: _ JI �'% % SIGNATURE (See Reverse Side For Additional Information.) I --- r T�' sa SUBJECT PE City of Fridley 2 ®3 5 9 AT THE TOP OF THE TWINS PERMIT( BUILDING r � • __ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/15/90 JOB ADDRESS 4591 - 2� Street N,H, 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 2 1 Rearrangement of $.1, 13,14,15, Plymouth SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry/Nancy Hofschulte 4591 - 211 Street N.E. 572-0939 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 O NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 6 DESCRIBE WORK Construct a, 10 x 6e Deck. Addition 9 CHANGEOFUSEFROM TO STIPULATIONS See notationp�on plan, .. VIAgn Before digging CaO! f0f all utilitywi 2 RIE a10 n ByLAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 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 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 $150 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $600 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- $17 DO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION, PAN CHECK FEE TOTAL FEE $17,50 G ATUREOFCON'R T RAUTHORIZEDAGENT (DATE) WHEN PROPERLY V IDATED THIS IS YOUR PERMIT S / S BLDG INS P w SiGNATU OFOW ERIIF OWNER BUILDER) (DAT I NEW [ ] Effective 1/1/90 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: _S 1 2°�� S7' -J2/hOff Y Legal Description: owner Name &Address : 6ARR e t FiM Ldr' #-ia� c=sc / y� s Tel . #S-72-0739 Contractor: W. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LTM G AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length /4'2-`'r Width r He t/Ground ' Sq. Ft. S Y anEERt: Corner Lot [gyp] Inside Lo C ] Ftp. d Setback ®• is Yard Setbacks Type of Construction: -�A?rM w o a A Estimated Cost: a Approx. completion Date: _� G S i G Proposed Driveway Width If New opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: SIS_ hO APPLICANT Tel. # Permit Fee $ n.w State Surcharge $ SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ $ ' SU STIPUTATIONS: CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] W o o o or 'o o c p a pz m c. z A �? z m z O o Y p -o O m a, a ''- O a o O p z A? n c c G S p p zn N`, 0 0 v TL m C ^ na �o m �o z �O �. �. m G7 o fi o 0 0 X, R 5. m a c V ® v 3 < • m m m> b .A - - - - - - -t C � A �N, T `Q ITI N Cv N e �aO 7� m 10 �1 �..� �p II II II II II, II I m Vt yvp 1 n ` I N X X X X X X N Nj 110 Zp z 75; ) tr;sv II II II �°` II II I II � oI C r) `�.. 'L 0 r3 • v; 4� � +r e � „ ��SI of 'O C 4 m X � � z N I II II It It III II II -31 DO CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE m PLUMBING FIXTURE RATES: NO. RATE a New Fixtures a 7.00 - U Old Opening, New Fixture x m $ Water $ 5.00 - S � $ 7.00 - $ Catch Basin S 7.00 - $ Rain Water Leader $ �; a sump/Receiving Tank Heater y +� M u d W .+ y C. •� $ m C -•+ N .Y C N .0 •+ m u 'a M d M N �C C N ++ d n. ! S IK ►. 10.00 - $ Gas Dryer O a O u 0 Back Flow Preventer Required ( ) Yes H No IA ;i +1 ow° S o w a� M N N N N N M .0 0 1 og ai 1A a u440'8<s° 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) - New Fixture, old opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures S 7.00 - $ Old Opening, New Fixture $ 4.00 - $ Beer Dispenser $ 5.00 - S Blow Off Basin $ 7.00 - $ Catch Basin S 7.00 - $ Rain Water Leader $ 7.00 - $ sump/Receiving Tank $ 7.00 s $ Water Treating Appliance $ 10.00 $ Water Heater - Electric $ 7.00 m $ Water Heater - Gas $ 10.00 S Gas Range $ 10.00 - $ Gas Dryer $ 10.00 = $ Back Flow Preventer Required ( ) Yes ( ) No Type S 5.00 - $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance REINSPECTION FEE $30.00 State Surcharge TOTAL FEE L:ffective Date January 1, 1991 Job Address ��-5 / - (/ -S1 Building Inspection Div. 6431 University Ave NE Tel. No. 572-3604 Fridley MN 55432 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 Depdrtment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. /, 1991 OWNER KIND OF BUILDING r USED ASL -e TO BE COMPLETED ABOUT �y ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By 24 L- Tel. No. kOUGH INSP. Date FINAL INSP. Date APPROVAL FOR PEP -MIT MINIMUM FEE FOR ANY PLUM141 VGAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT PE_RM4T-NO:--,_„ City ®f Fridley WRECKING 2 4 AT THE TOP OF THE TWINS PERMIT 213 r ', R O _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r _ , CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �'' 612-=571-3450 910-F15 5/8/92 JOB ADDRESS 4591 -^ 21� Street. NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 1 SHEET Rearan ement of Plymouth` 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry Hofschulte.. 4591 - 21 Street.NE 572-•0939 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 O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Remove 16' x 2W Storage Auildin 9 CHANGEOFUSEFROM TO STIPULATIONS Clean site Q;ff all construction.dehris, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 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 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 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- $15800 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15,0,0 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) HED) R;/,LY AL �AT THIS IS _YOUR jP/cEY{R�MIT�/J�1 01 LDG )NSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI [ J Moving [] Wrecking C;I'I'Y OF FRIDLEY NOVI ]G OR 1=3UM APPLICATICK Job Address: q,, ? � Legal Description: �A owner & Address: R (r' rel. # 5-72--r-)9� j Contractor: Tel. # Address: State License # Living Area: length Garage Area: Length Other: Length A,- i Width Width Height Sq. Ft. Cu. Ft. Width Height Sq. Ft. Cu. Ft. 2-{0 Height Sq. Ft. Cu. Ft. Estimated Cost of Wrecking/Moving Approx. Om pletion Date75 RoViAvylk • :i • ■ ■�4■ City Water/Sewer Mpls. Gas Cacpany Northern States Power Northwestern Bell Tel Co. 571-3450 [ ] 372-4720 [ ] 566-9120 [ ] 293-0665/293-1319 [ ] Water Bill Paid: Yes [ ] Amount To Be Collected [$ ] Initials Moving Route: FEES Moving: Principle Building into Fridley . . . . $ 80.00 Accessory Building into Fridley . . . . $ 20.00 Minim= Fee: $15.00 Through, within or out of City . . . . $ 15.00 Wrecking: For each 1,000 cubic feet or fraction .$ 1.25 For structures which would be impractical to cube, the fee shall be based on the total cost of wrecking at the rate of $6.00 for each $500.00 or fraction. The undersigned hereby makes application for a permit to wrecVmove the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Building Department, and the State Code which requires any water well on the property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application are true and co Signature PEST FEE: . rf SUBJECT City of Fridley 3=0 2 AT THE TOP OF THE TWINS BUILDING PERMIT i • COMMUNITY DEVELOPMENT DIV. e PROTECTIVE INSPECTION SEC. r 1 . � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 8j16/99 JOB ADDRESS 4591 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 15 I 1 lRearrangement of Plymouth B1. 13 14 15 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry Hoffschulte 572-0939 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Milton Johnson Co. .525 LowjX Ave 5418 781-9,548 20RS 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 Q ALTERATION ,. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 32 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 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 2797 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 PERFORM NCE OF CONSTRUCTION 83,25 Fire S 2.80 % PLAN CHECK FEE TOTAL F f� Lice $5.,00/ 9 45 SIGNATURE OF CQNfRACTQR OR AUTHORIZED AGENT IDATEI HE 0FPR9F 0 VALIDAT IS IS 000,11 B IpgP gAtE SIGNATURE OF OWNER 'IF OWNER BUILDER, IDATEI rf N li 1V (X J • • Effective 1/l/97 ADIIN [ I ' CITY OF FRIDLEY ALTER ( ) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 r-���` BUILDING PERMIT APPLICATION V f D ConstructionAddress: 4591 2 1/2 Street N.E. Legal Description: Owner Name & Address• Larry Hoffschulte Same As Above Tel. # 572-0939 Contractor: Milton Uohnson Company MhTLICENSE# 2083 Address: 525 Lowry Avenue N.E., Mpls, 55418 Tel.# .781-9548 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCREPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Tear off and re -roof' c� -29 7 Construction Type: house and garage Estimated Cost: $ .(Fee Schedule on Back) Driveway Curb Cut .Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT:7 81�-954.8 Tel. # CITY USE ONLY Permit Fee $ J Fee Schedule on Reverse Side ire Surcharge $ �_� (� .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge$5.00 (State Licensed Residential Contractors) driveway Escrow $ Alt. "A" or Alt. "B" Above ?rosion Control $ 4450.00 Conservation Plan Review 'ark Fee $ Fee Determined by Engineering ewer Main Chargc $ Agreement Necessary [ ] Not Necessary TOTAL $ a%� _ SUBJECTPE City of Fridley 30214 AT THE TOP OF THE TWINS BUILDING PERMIT r 16 COMMUNITY DEVELOPMENT DIV. _ f PROTECTIVE INSPECTION SEC. e NUMBEN REV DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 53432 612-571-3450 910415 9/14/99 JOB ADDRESS 4591 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 lRearrangement of Plymouth Bl. 13,14,15 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry Hofschulte 572-0939 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Norling Exteriors Inc. 341 79th Way Fridley MN 55432 784-8936 20098700 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 R§X REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reside house and garage 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering 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 SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $8000 $4.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARG PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW Fire STRUCTION OR THE PERFORMANCE OF ONST CTION $153.25 C $8.00 PLAN CHECK FEE TOTAL?F. E IE.Licens C 5.0 $ 7 5 SIGNATURE O% CONTRACTOR OR AUTHORIZED AGENT IDATE. 0100fN P OP ALIDAT 0 S IS RPEMIT S.GNATURE OF OWNER aF OWNER BUILDER, IDATEI BLDG NSP IPQ 1 0 NEW [ ]� Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION J Construction Address: Legal Description: n i Owner Name &Address:Tel. # Contractor: �� MN LICENSE #� Address: / el. # - 3C Attach to this Ipplication, a Certificate of -Survey of the lot, with the proposed construction drawn on-itAo scale. DESCRIPTION OF BIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: / 6 n Construction Type: Estimated Cost: $ Drivewav Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ /6_ 3 c�S ^ Fee Schedule on Reverse Side Fire Surcharge $ :8.00 .001 of Permit Valuation (1/10th%) State Surcharge $ C-) $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ (DO $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 $ /moo I �oS STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE 1 Fridley,'MN 55432 572-3604 1� 1 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTAL I Fn ON FACH PI OOP 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 TOTAL 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 $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge JOB ADDRESS_ 1TE i -s dt>ci�,3i✓ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the fluilding Division, and hereby declares that all the facts and representations stated in this -application are true and correct. HOFSCHULTE, LAWRENCE 45912 1/2 STREET NORTHEAST FRIDLEY, MN 55432 Owner (763) 572-0939 Building Used As T)S-61p;;:RF Cz 11 123 12001 � J Estimated Cost PERMIT NO. dL36 PLUMBING COMPANY t /6rke)L )L4 PL0n1:M)& (-1 SIGNED BY,� • TEL NO.$ Approved By Rough -In Date Final Date w TOTAL FEE $M. 550 PLUS THE S.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6A. COMMON VENT INFO ON BACK SIDE WO 10� 0 011-l" PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas"* NO. RATE TOTAL 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 $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge JOB ADDRESS_ 1TE i -s dt>ci�,3i✓ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the fluilding Division, and hereby declares that all the facts and representations stated in this -application are true and correct. HOFSCHULTE, LAWRENCE 45912 1/2 STREET NORTHEAST FRIDLEY, MN 55432 Owner (763) 572-0939 Building Used As T)S-61p;;:RF Cz 11 123 12001 � J Estimated Cost PERMIT NO. dL36 PLUMBING COMPANY t /6rke)L )L4 PL0n1:M)& (-1 SIGNED BY,� • TEL NO.$ Approved By Rough -In Date Final Date w TOTAL FEE $M. 550 PLUS THE S.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6A. 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 BTU Input Fan Assisted or Nat venting has been examined and is free from rust, deterioration, obstructions, BTU Input Fan Assisted or Nat and is securely supported and firestopped where required. Yes () No ( ) The venting;. system is plastic/PVC and meets all current codes and manufacturer Total Btu Input 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 -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-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 ( ) ARPliance 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 : I UiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 March 7, 2003 Mr. Lawrence Hofschulte 45912 1 /2 Street NE Fridley, MN 55421 Re: Final Inspection at 45912 1/2 Street NE Contractor: Norblom Plumbing Co Dear Mr. Hofschulte: A plumbing permit was issued on November 30, 2001 to install a water heater at your address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the, Codes. We will keep your permit open for another 30 days and if we do not hear from yu within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/mh