The URL can be used to link to this page

PRE 2010 DOCSR # BUILDING PERMIT Village of Fridley, Minn. N° 2195 Date ....... ....... Owner Address......................................... Builder........ ... ........................ Address......................................... LOCATION OF BUILDING No.. , • ' • Street ... "100 ................ ..... Part of Lot ....................... Lot ... 7 ..... Block.......... Addition or Sub -Division .. .� Corner Lot ............. Inside Lot Setback 1. Sideyard .. ................ DESCRIPTION OF BUILDING To be Used as: L eNin . � . tteignz fr sq. �.LI U. 'u. P't• Front Depth ........ Height ....... ........ Sq. Ft. Cu. Ft. ........ Type of Construction ... Est. Cost 4a0i V of....... To be Com leted .. ......... 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 and in compliance with all provisions of ordinances of the village of Fridley. In consideration of the payment of a fee of $. perms is hereby granted to 4)# . ... to construct the buildin?Vlaa dition as described above. Th:Wtt isVMd upon "e 4 on that the person to whom it is granted and his agents, employees and workmen, in all work done in, Jound and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. I ,o- s.. — Building Inspector NOTICE: IV This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. i t. ARVID L.UAK&L-JN th 3UN ING. 3200 FRANCE AVE. S®. 3rd. STREET N. E. ' Bo.6d 75 75 75 85 All------ I IA., In „eClA. r-71 N07. Z -N LAJ 40,4 11547- M 27 25 26 _74— 28 E g 7b P-4 4 23 22 mss_ 2 -ja t at , 21 I NEN. 004 ip, ffifo- -ANE Zia$ 4 16 -on 15 17 18 7. iz — J , 367 .r -7712 —j �UtilifieQ 13 10 "'-'-rO 4 75 411i 19 L -i L63 5017 CLEARVIEW STREET 879.01 City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location 5056 NE, 3 Street PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... .............. x $2.00 $ m N Z Y 'T Z eC 3� o� 8Z i �O S W < �� W �� 3 0p 61 F N WATER HTR. GAS EIEC Base $ Electric Water Heater a $2,00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ....................... .. x $2.00 $ 2. 00 Additional Fixtures .................... x $ .75 $ 1st o *ter o wt 2nd 3rd 4th ° Future Connection Openings New Fixture, Old Openings Connected with I Sewer 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 a $2,00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ....................... .. x $2.00 $ 2. 00 Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do 411 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 JUN 6 1968 19 Owner 00 Kind of Building Fraw Used as Residence To be completed about JUN 111968 Estimated Cost, $ 10-00 9Old-XNew. Building Permit No Permit No. O Signe MINNEAPOLIS GAS O. Business Phone No ROUGH FINAL Description ................................................$ TOTAL FEE $ 42 2.00 01 SUBJECT ERM City of Fridley 18778 AT THE TOP OF THE TWINS BUILDING PERMIT RE w____ COMMUNITY DEVELOPMENT DIV. z r PROTECTIVE INSPECTION SEC.73 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 1/13/87 JOB ADDRESS 5056 - 3rd Street N.E. 1 LEGAL LOT NO.BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 27 5 Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dick/Vickie Johnson 5056 - 3rd Street N.E. 572-8743 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ,q,ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE ,Y 8 DESCRIBE WORK Reroof Dwelling 9 CHANGEOFUSEFROM TO STIPULATIONS Roof can be 2nd layer but not the. 3rd, Install ridged galvanized valleys if necessary. 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 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 ] 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 $400 $.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. $15.00 PLAN CHECK FEE TOTALFEE $15.50 SVTURE OF CONRACTO OR AUTHORIZED AGENT (DATE) WHEN PROPERLY LIDATED THIS IS YOUR ERMIT�j BLDG INSP qpT SIGNATOR OF O NERI F OWNER BUILDERI (DATE) 01 NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Legal Description: _0+ �(oCk `7 SU Im04 1=--M267 Owner Name &Address: t fate-7®v�� Tel. 5 -7Z -T743 Contractor: Tel. # Address: -- LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. )('(2 v bob 0O(l5e - Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: � 500 �D Estimated Cost: $ 4CX�• Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: APPLICANT: Tel. 0 51 x-5743 CITY USE ONLY STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] /1 Permit Fee $ Plan Check $ State Surcharge $' SAC Charge $ Park Fee $ Sewer Main Charge $ TOTAL $ STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 L I IT) ?-X\ Effective On January 1, 1999 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO RE INSTAI I Fn ON FAr.W GI nno 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 Preventer Required ( )Yes () No Type $15.00 0 JOB ADDRESS The undersigned hereby makes application for a perm it 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. W19 1999 Owner) X11 \ 'Nk ," 1 Building Used As�i Estimated Cost �'`�^ PERMIT NO. PLUMBING COMPANY► " `C " �C - J m� Reinspection Fee $42.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE Approved By $ .50 TEL N0, 1 Ql _q ll l `0;�� Rough—In Date Final Date MINIMUM FEE FO ANY PLUMBIC $ PLUS THE $.50 STATE SURCHARGE "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. 00 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 r63) 572-3604 FAX: (763) 571-1287 ADDRESS : 5056 3 ST NE PIN : 263024230105 LEGAL DESC : CARLSONS SUMMIT MAN SO ADD : LOT 27 BLOCK 5 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 400.00 PE N. 2200400983 DATE ISSUED: 06/24/2004 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. REPLACE ONE WINDOW WITHIN EXISTING OPENING. REPLACE VALLEY FLASHING; EXTEND EAVE 6 INCHES. APPLICANT JOSHUA & SARAH, DRULEY 5056 3RD ST NE FRIDLEY, MN 55421 CUR•AI 017 JOSHUA & SARAH, DRULEY 5056 3RD ST 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 wort 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 construction or the performance of construction. Bldg Insp� BUILDING PERMIT FEE PLAN CHECK FEE FIRE SURCHARGE STATE SURCHARGE, VALUE TOTAL SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 23.50 15.28 0.40 0.50 39.68 NEW [ ] CITY OF FRIDLEY ` ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Effective 4/1/2004 (763) 572-3604 Bldg Insp (763) 571-1287Fax v Owner Name & Address: ID q)-S-61jSTel. # Contractor. Hoei-e c—kes-�) MN LICENSE# Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LMNG AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft Length Width Construction Type: ZeP 4.�-1 �% k ��y Hgt/Ground So. Ft Cost: $ "C-� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ = $, ?At DATE: 6 f -V 42C6 L/ APPLICANT: abs r �Y� Tel. # 7 �6 3 - -SO a- 6.737 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 CITY USE ONLY - $ ';?3 50 Fee Schedule on Reverse Side $ 65% of Permit Fee $ 4 4A0 .001 of Permit Valuation (1/10th%) $ 5® $.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: --------------- 1 ROT � P \ coq c�-4trce ��R i E �?6 r'o•& red bac e n y o fke ro-t 6Zr O.� c.� & JO � r A e -e -del -i CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 r'AX: ADDRESS 5056 3 ST NE PIN 263024230105 LEGAL DESC CARLSONS SUMMIT MAN SO ADD LOT 27 BLOCK 5 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION 571-1287 PE NO. 2004-01450 DATE ISSUED: 09/07/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL VENTING FOR BATH EXHAUST. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 30 APPLICANT JOSHUA & SARAH, DRULEY 5056 3RD ST NE FRIDLEY, MN 55421 OWNER JOSHUA & SARAH, DRULEY 5056 3RD ST 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 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 regulating conAruction or the performance of construction. AnvHeant . Date i I Bldg HEATING PERMIT MINIMUM FEE 15.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 6431 UniVersityAve NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater 44 J47gi Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ $10.00 $ $10.00 $ $10.00 $ $25.00 $ Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR JOB ADDRESS �—b S 3(-d S t- N �� Owner --1®'L L'CCL Building Used As )�� ESTIMATED COST�� PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU M Size No. EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ HEATING $ S� Signed_ *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE FAX # Date Approved b Tel # �51- 'C765 - tough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina 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 existina 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 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) (�Descyribe) � HEATING CO: Signed By: Date : tS4..'! °{ a \Jvj 0 VI Effective January 1, 2003 CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS YQ 5 -Ca 3 r�° �J FAX (763) 571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. OWNER`�\A\��i .�F. TOTAL'3�-00 BUILDING USED ASS�Sis��Mi ESTIMATED COST R %,�W COSTPERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heat' Units_ Circle One (Steam) (Hot Water) arm )Ir $ Trade Name - Size No. 4ONV 4 BTU A L�Q kJ HP EDR $_ Fuel J).:h Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATN►M & Iwo = •� HEATING CO ISM County Rd 61 WOM MN 55369-92.31 Signed 1763i428't�L # l FAX # Approved By Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED nnmmnN <FNT VENT nnNNFr-Tnc ANn rnMBIISTION AIR VERIFI _ATION When ranla ina an exietin0 fitrannn, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supporter nd restopped where required. Ye�i No ( ) The venting system is specifications includin The undersigned also and meets the current include AGA-GAMA C assisted and natural d The exisfinnSnmh and manufacturer's and meets all current codes and manufacturer ith. number of elbows and termination. Yes No ( ) Rat the replacement unit is a listed assembly manufacturer's specifications. This does ICentral Furnace Venting Tables for fan and installed to meet the current codes When required to inetall a new cnmhigctinn airy it will be sized and installed to meet the current codes and manufacturer's specifications. Y No ( ) Yes No ( ) Yes No( ) When jpgtaljpn a new venting sy ttam_, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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. Yel*) No ( ) Air nli nce Dyne and S67a1Cnmmnn Vent and Vent r'nnnector Information Appliance #1 Type BTU Input Fan Assisted o—._. Appliance #2 Type BTU Input _ Fan Assisted or Nat Appliance #3 Type BTU Input _ Fan Assisted or Nat Total Appliances ___L_ Total Btu Input Common Vent Type 3�' r r CjXp9 Vent Height IS--' Diameter 3 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 HEA Signed By: X \--. Date: Building MECHANICAL Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY Permit No.: Received By: Date Rec'd: DATE I YOUR E-MAIL ADDRESS 1 V `'� � �%� C SITE ADDRESS S� � � � rc THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: r. F --L ADDRESS: <V Sh t d 5-4 _CITY '� STATE ZIP PHONE: % y ; - 5 - 6 7 31 COMPANY NAME: CONTACT PERSON: STATE LICENSE # EXP DATE CITY STATE ZIP ADDRESS:, PHONE IFINGLE FAMMI FAMILY ❑ TWO FALY ❑ NEW rEPLACEMENT DETAILED DESCRIPTION OF WORK FAX ❑ TOWNHOUSE ❑ ALTERAnON/REMODEL a ce PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the ) improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor10 Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor � 0 x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) MODEL: MFG: SIZE/BTU Equipment Installed MODEL: SIZE/BT MEC,; MODEL: (GAS) $15.00 SIZE/BTU _GAS RANGE/OVEN $10.00 A/C $25.00 _FIREPL.ACE —AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 IRE NEW GAS GRILL $10.00 UNIT HTR $10.00 _ _BOILER _FURNACE $35.00 LINER $10.00 GAS DRYER $10.00 _GAS POOL HEATER $35.00 �VEILATOR $15. 00 _CHIMNEY DUCT WORK $10.00 GAS PIPING $10-00 .. 44i 113-tyi':.. � a!=...�ili'�.�1\.+`W,..r .v✓Yi/�RxTY.✓ ..°b.. -.s: .._ .w.a .i..., S .«.... _.. ... _..... _ Permit Fee $ Number of fixtures @ $10.00 x $10.00 = Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ 0 Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ 50 Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. / \ r SIGNATURE OF APPLICANT � � —_PRINT NAME Jc u� DI U. DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMESADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEWIEXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or PropaneUGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) & IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations Building $ BUILDING $ Permit No. Inspections RESIDENTIAL APPLICATION $ Received By: --O- 763-572-3604. Park Fee $ Sewer Main Charge DREM40V 1T2007 Total Due $ CITY OF FRIDLEY J—G tL� L DATE I( YOURggE-.^,MAIL ADDRESS S e,,PC It ! i (DA C- C3AIL SITE ADDRESS �� !- t OlJ G� THIS APPLICANT IS: WNER ❑CONTRACTOR PROPERTY OWNER/ NAME: („L CL� TENANT ADDRESS:_S-0S—Tv fir& S r- &V(-7 CITY r �D STATE" S� r PHONE: 7 6 % .? 7 CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBNUT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPEINGLE FAMILY/NEW CONSTRUCTION SIZE C3TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT 'TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH°ROOF ❑ DRAIN TILE ❑ DECK �] SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEIN6 DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING NUMBER OF SQUARES IS ❑ HOUSE ONLY `OUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ „LL OCCUPANCY TYPE Permit Fee $ k-2 Plan Review $ Surcharge $ License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ See Back Page for Fee Schedule 65% of Building Permit Fee .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for deterinination) ft+6ft= 8x$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I. understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires rev and approval of plans. 0 SIGNATURE OF APPLICANT G ,2 i�%7 INTNAME-�v�cece G� �f �d (,eATE It Building Permit Fee BUILDING Permit No. Inspections $ RESIDENTIAL APPLICATION Received By: 763-572-3604 763-502FAX CITY OF FRIDLEY Date RtCt o, , Do 4 -4977 .0005 x Permit Valuation Minimum $.50 License Surcharge . $5.00 (State Licensed Residential Contractors) SAC Charge EFFECTIVE 8-19-09 $2000 per SAC Unit (Plans to MWCC for determination) �y / / � I - DATE _I I 17 1 i col YOUR E-MAIL ADDRESS GS I&0. rf�i� e" (`Y. fi�Z ✓ ee. C o !'A SITE ADDRESS SM SE6 r CL 54 , V C 4 THIS APPLICANT IS: (OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: a5 % ttC'. TENANT ADDRESS: CITY STATE ZIP Fee Determined by Engineering PHONE: CONTRACTOR NAME: SUBMIT A COPY OF —$ $ YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE i71 SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING OTHER ❑ SWIMMING POOL TYPE OF WORK: 0 NEW HOME CONSTRUCTION ❑ ADDITION ❑ REMODELING MAINTENANCE/REPAIRrr'' -- DESCRIBE WORK BEING DONE: f� I a e -e r e>41P—d ec Ste- SIZE OF IMPROVEMENT LENGTH f WIDTH HEIGHT % `' S FT ROOFING ❑ HOUSE 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: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum 1. Site Plan/Survey showing the existing structures ❑ Other .11II'Trim ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ , 5 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 $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge Agreement necessary ( ) Non Necessary ( ) Total Due —$ $ _ Make checks Davable to: Citv of Fridlev Attach Stiaulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work high requires review and approval of plans. '' d I c� SIGNATURE OF APPLICANT Z� PRINT NAME ✓� 4cfc A4 > u ATE 11111 +OD 7 19