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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° .3 0 "N 0� Date: ......_____.__.._._......_..__.._.._. _. _ ___.._..._. _ ._. Owner: Y"Builder Address ...'t- Address LOC ION OF BUILDING ff� No. -77)-. k_.... Street _.�`_'����'f.. __ ..a.._ ..,_a..�:__.._...._............_...__.... Part o4 Lot Lot ..... ....................... --....... Block - ... .............. -............. .................. Addition or Sub -Division ....._.................. Corner Lot ------ ............................. Inside Lot ....._......._....--------- ------ `Setback ............. ............. .............. Sideyard ...I Sewer Elevation....._............._.............__..........._............._............._......._...._......_ Foundation Elevation _............... __.......................................... DESCRIPTION OF BUILDING �y -1O ....... f:`;... ...... Front J.... -.. Depth ....cC.... Height ...CJ......-- Sq. Ft ..� ,�.... �... Cu. Ft. �...._. _......._.............. Front ..... _................. Depth ................ .. Height .. Sq. Ft....................... Cu. Ft......................... Type of Construction ........ Est. ..."'.".'....... To be Completed ..... ........ _... ........................ ....... 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 city of Fridley. In consideration of the payment of a fee of $.�....._:"'..��..... permit is hereby granted to................... _...._......._. to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. r�4� Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or wafer. Be sure to see the Building Inspector for separate permits for these Hems. • a�ed APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY$ MINNESOTA Owners Name ,jpd IjQ,1� L. I JA- l Q N a&61VI7 Builder E L- 0 Ag D'A UR 1 Address J-1 4 r 3 -A M. E Address 14 Q 7h ® Q1 N S M A _ LOCATION OF BUILDING No. Street s `Id /�y �,—art of Lot Lot .�� Block Addition or Sub.Div. . Corner Lot Inside Lot ,: Set Back Side -Yard ._ SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: C 1Q IQ fl.4 Front ,. % Depth jj Height- � Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Fts Type of Construction Estimated Cost 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and correct. DATE o� — SIGNATURE e*.X W''' , Ar)e (A Schedule of Fee costs can be found on the Reverse Side.) p L- rt AKVIU L.UAKL5UN th ?SUN INC. 3200 FRANCE AVE. SO. 3rd. STREET CLEARVIEW STREET N. E. ' w I herl-Ilr CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT RATE SCHEDULE y PLUMBING FIXTURE RATES: NO. b RATE TOTAL New Fix tures 0 5.00 $ Future Fixtures Water 3.50 $ Old Opening, New Fixture- $ 1.50 $ Beer Dispenser $ 4.00 V14 pR', W $ 5.00 Heater Catch Basin W $ 5.00 $ WR $ $ Hydraulic'Valve RC 5.00 $ N $4 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater pH U X $ . $ 10.00 $ Gas Dryer �b yJ`g $ Back Flow Preventer Required. NS�oLw�i ( m $ ALL OTH1:!?S AND/OR REPAIRS AND ALTERATIONS Uaoot 1% of Value of Fixture or Appliance $2 yCO) W umv 3 Reinspection Fee $ o , Fle TOTAL FEE 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) s New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fix tures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture- $ 1.50 $ Beer Dispenser $ 4.00 S Blow off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic'Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater t $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) TYPe $ 5.00 $ ALL OTH1:!?S AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $2 State Surcharge $ .50 Reinspection Fee $ , ($15.00) TOTAL FEE Job Address Department of Build City of Fridley Tel. #571-3450 Effective Date May 1, 1988 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. OWNER c c,, ( r L IL KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By 2905 GARFIELD AVENUE MINN- ESOTA v� Tel. No. &V-433 - 8274311 ROUGH INSP. Date FINAL INSP. / / - ) ` — P 62 Date APPROVAL FOR PERMIT MINIMUS'! FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 41&jda- CITY OF FRIDLEY INSPECTION DIV. C ,?jb �� Effective On August 1, 1995 6431 University Ave NE O Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, -,� A (� 6n �- 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owier. Signed 8910 WENTWORTH AVE. SO. .VNEAR00&�P@', 55420.2853 Approved By Rough -In Date _ Final Da 7"26a; FILL OUT BACK SIDE R STACK VERIFICATION ON REPLACEMENT FJRNACE JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declams that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are true t.nd correct. (Side Vent -- Fill Out Back) �-�_� �h ,1995 Gas Piping (Needed with new furnace) $10.00 $ OWNER �a� � �� rfc . 5-72 -T-709 Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer 1 $ 10.00 $ ESTIMATED COST ®� PERMIT NO. /�` 13 *Air Conditiizes��^ $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commerciallindustrial BTU HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Loud State Sumharge $.50 Burner Trada Name Size Na. BTU HP EDR TOTAL FEE el, $ _ V. i HEATING COMPANY ur®Tiwr. e ®iP MNI)ITIMINr, rn MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owier. Signed 8910 WENTWORTH AVE. SO. .VNEAR00&�P@', 55420.2853 Approved By Rough -In Date _ Final Da 7"26a; FILL OUT BACK SIDE R STACK VERIFICATION ON REPLACEMENT FJRNACE SUBJECT IT City of Fridley 217760 AT THE TOP OF THE TWINS BUILDING PERMIT r RE-EI-PT NO. _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. Uy NUMBER REV DATE 9/14/98 PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 JOB ADDRESS 5068 3rd St NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 26 5 Carlson's Summit Manor South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carrick Same 572-8709 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Viking Home Improvement Co 4832 2j St NE Minneapolis - 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 J] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house, garage & shed (20SQ) Tear-off; Fascia 9 CHANGE OF USE FROM TO STIPULATIONS Reroof-Underlayment must comply with the State Building Code. Fascia-Install soffit ventilation to meet the State Building Code. 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 1 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 $2,994.00 $1.50 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 ST TE OR LOCAL LAW REGULATING CON- $74.75 Fire SC $2.99 STRUCTION OR THE PERFOR E OF CON RUCTION PLAN CHECK FEE TOTAL E p G?IJ0 '< Licen $5 $84.24 SIGNAT RE OF C -,RAC OR OR AUTHORIZED AG NT MATE- EN RO VALIDAT IS IS PE$� :IL20G -NSP � BATE SIGNATURE OF OWNER I IF OWNER BUILDER- IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2k0b BUILDING PERMIT APPLICATION AA ConstructionAddress: Legal Description: Owner Name & Address: u L LlL. Tel. # 5 -7 Z —-%0 �J Contractor: vLlkilyeryl dl © MN LICENSE2- Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: e, rf}�j/rs2 Construction Type: ��% �o�- F,E� Estimated Cost: $ 2 U® Yr T (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: - - rAPPLICANT� Tel. # Jr%a 1AP?10 CITY USE ONLY Permit Fee $ �`�- 7� Fee Schedule on Reverse Side Fire Surcharge $ 9Cj' .001 of Permit Valuation (1/10th%) State Surcharge $ /-570 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 00 $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 STIPULATIONS: City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit O' • �D Residential Application City of Fridley See Back Side For Required Information DateSite Address: The applicant is: (Cirlce one) Owner ontrac Property Owner. 6,04 WiDf Address: City: State: Zip: Phone: Cell: Fax: Contractor Information Company Name: Contact Person: Address: 1✓% City: da State: IIAJ Zip: Phone: Cell: Fax: Email: MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel lkla;21�)_ Detailed Description of work: Equipment Installed: MFG: Model: Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 _A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 _Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 _Duct Work $10.00 _Gas Range/Oven $10.00 Permit Fee $ ' (Total from above -Minimum fee $35.00) Surcharge $, Total Due 0.50 Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical 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 case of all work which requires review and approval of plans. Signature of Applicant: Date: ell Approval Inspector Signature: z..- Dater 7.0 Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. 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 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit # �- Residential Application City of Fridley See Back Side For Required Information Date_`C� Site Address: G The applicant is: (cirice one) Ownerontract r Property Owner: Address: City:State: Zip:K�'✓ Phone: Cell: ax: Contractor Information Company Name: Contact Persgn: Address: City:4'klr State: Nk' Zip: Phone: -5110 Cell: Fax: Email: MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel , Detailed Description of work: Equipment Installed: MFG: Model: Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 _Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $-ef (Total from above -Minimum fee $35.00) Surcharge $ 0.50 Total Due $ _�35•56- Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical 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 case of all work which requires review and approval of plans. Signature of Applicant: Date: Approval Inspector Signature: o,,F1 1N - Date: U Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. TMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances TFGC 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