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PRE 2010 DOCSP CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996 6431 University Ave NE )) Fridley, MN 55432 ° APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR W:..: r Wash t1.k�. r• low.'A Gs Water S for es ,. r Heater f Urinal 1�..... Sho wer frtk. Tra Y C11tl� Drain <� .I.. E�..:;:.. Washer .:::.::::::.�::.: ......... p�?:r:::;•, Range �>< Gas 'Elee Basement < mt n Floor or 1 Floor 2 Floor3 r Floo r4 r PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS3 New Fixtures $ 7.00 The undersigned hereby makes application for a perm it.for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work In strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 ! _ �• Sump/Receiving Tank $ 7.00 Water Treating Appliance Owner Water Heater —Electric ONO Water Heater — Gas** $10.00 Building Used As Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost PERMIT NO. /33" 0 Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Q-�.�JC� Reinspection Fee $42.00/Hr SIGNED @YAF��L N0. 7& 3 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS fig: 1.5% ofValue of Fixture or Appliance State Surcharge $ .50 Approved By Rough—In Date Final Date $ �Q,0 MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. SUBJECT PE MIT NO City of Fridley 1 31776" (� � 6 AT THE TOP OF THE TWINS T BUILDING PERMIT r RECEIPT NO. _____ COMMUNITY DEVELOPMENT DIV. i V � PROTECTIVE INSPECTION SEC. 672�� F = � CITY HALL FRIOLEY 55132 NUMBER REV GATE PAGE OF APPROVED BY 612-571-3450 910415 4/27/01 JOB ADDRESS 5431 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 24,25 1' 1 Hamilton's Addition to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Irene & David Vasecka 763-572-0645 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 8 USE OF BUILDING Residential 7 CLASS OF WORK NEW O ADDITION ❑ ALTERATION O REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 60' x 27' Foundation for Manufactured Home; Construct a 24' x 24' Garage; Construct a 0 x 2 Porch onto House 9 CHANGE OF USE FROM TO STIPULATIONS See notations on print. Provide a hard surface driveway. Provide sod in the front and side yards. Provide city with copy of verifying survey before setting home on foundation. Paid Park Fee of $750.00 SEWER & WATER LOCATIONS: SEE CITY ENGINEERING DEPARTMENT WARNING SEPARATE PERMITS Before digging cath for all ` REQUIRED EOR: 454®®oitions PLUMBNd Ain s Gills REQUIRE® BY LAW 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 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX Fire SC AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $ 153,722 $76.86 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 153.72 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STAT OR LOCAL LAW REGULATING CON. STRUCTION THE $1? 296 .15 $1,150.00 OR PE FORMA OF CONSTRUCTION PLAN CHECK FE TOTAL E --- SIGNArURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEs EN PROP ALIDAT D IS IS VQWA PERMIITT/J � V • f BL -NSP - f�A F( S,GNATURE OF ON/NER,IF OWNER BUILDERI IDATEI NEW ADDN An AR [I Construction Address: Legal Description: _ Owner Name & Addre. Contractor. �% Z2�� CITY OF FRIDLEY Effective 1/1/2001 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5" 2_3604 Bldg Insp BUILDING PERMIT APPLICATION Y �4#17 5/ -- I v I et. *F; MN LICENSE # _ T„2�/4e1. # � : rz U Attach to application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESC P N OF IMPROVEMENT �4� /yX/ LIVING AREA: Length 46 Width Height Sq. Ft. �% J 7 % 63 GARAGE AREA: Length Width HeightSq, Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Tyam' ' s® PL Estimated Cost: $�� 7a� a �t� rem Driveway Curb Cut Width Needed: Ft + 6 Fp/ �T t x $ $ DATE: APPLICANT: CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing � application in pp Tel. # Permit Fee $ o? /6- Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $-/-Z,4Z(2-, & `-O $1150 per SAC Unit License Surcharge $ = $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. 'B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ `7SPjQ 00 Fee Determined by Engineering Sewer Main Charge $ --E'}— Agreement Necessa ry[ ] Not Necessary [ ] TOTAL $,3—L': —L—/-3 STIPULATIONS: ITY OF FRIDLEY INSPECI iUN DIV. 431 University Ave NE Adley, MN 55432 '63-572-3604 MARK Urinal` Shower Basement Floor 1 Floor 2 Floor 3 Floor 4 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wash T.a., Washer PLUMBING FIXTURE RATES: NO. PLUMBING RATE TOTAL $ 7.00 Z • "Z> New Fixtures 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 JOB ADDRESS 3 Effective On Jan 1, 2001 y41 R �365.3 Heater Elec 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. Owner via_ Building Used As Estimated Cost t SDD PERMIT NO. PLUMBING COMPA �y SIGNED BY TEL N0. Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By State Surcharge MINIMUM TOTAL FEE $ '�� S� MUS—Tig COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. Rough -In Date Final 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 CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2001 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 ADDRESS6Y 3 /-- q JA�� RATE SCHEDULE Residential Rate Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 but not replacement) Gas Range $ 10.00 Gas Dryer $ 10.00 *Air Conditioning - All Sizes $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work 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. OWNE TOTAL BUILD ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) arm Air $ Trade Name 14t i C_ Size No. BTUOfo ,00 HP EDR $ Fuel_T914T- � p L 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 ail work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE S�— �i — 0 HEATING CO n& 1, 5 90-41 IUB 6 Signed /% TEL # 3Zo -972 - q7 -7c Approved By f Jnd!� Dough -In Date Final BACK SIDE MUST UE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION ,IDS 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 manufacturers 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 CO: Signed By: Date : NEW I l Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572.3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION qq 571 Construction Address: Legal Description: Owner Name & Address: fl 1 AC 0, e�' a..�. Tel. # �t . Contractor: MN LICENSE # 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: Construction Type: Estimated Cost: $ 11 e Driveway Curb Cut Width Needed: � rt. + 6 Ft = Ft x $ v�s"a = $ DATE. % APPLICANT: - Tel. # w CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1150 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 [ ] SUBJECT City of Fridley(f33190 AT THE TOP OF THE TWINS BUILDING PERMIT r REC N COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � � NUMBER REV DATE PAGE OF APPROVED BV CITY HALL FRIDLEY 55432 L J ` 763-571-3450 910415 10/21/02 JOB ADDRESS 5431 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 24,25 11 Hamilton's Addn to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dave/Irene Vasecka 5431 4 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO 3-D Builders & Restoration 542 37 Ave NE, Npls, MN 55421 612-802-8337 20233912 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW [j ADDITION O ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct a 22' x 14' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Mtn WARNINING llefO digging SII fog all utility locations 454.0002 IFOUIRED BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PEFIMIT 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 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $3,105 $1.55 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOS NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $97.25 Fire SC $3.11 IO O E PERFORMANC�OF CONSTRUCTION �� PLAN CHECK FEE iicen SC $5.,/0 TOTAL FEE $106.91 fP��R�oS SI ATUR OF CONTRACTOR OR AUTHORIZED AGENT 46ATE, H N PR LY VALID ED THIS IS YOUR P RMIT 7 OA SIGNATURE OF OWNER,IF OWNER BUiLDERi iDATE, NEW [) CITY OF FRIDLEY Effective 1/1/2002 ADDN (J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER (J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �"� � Legal Description: Owner Name & Address: Contractor.. 5- -D c- oyyk-s - c g- Tel. # MN LICENSE #�� 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 `cam Width ` i Hgt/Grounde-'N4 " Sq. Ft OTHER: fV'v'% i vlq�� Construction Type: e '�� rj:5&56�timated Cost: $ Driveway Curb Cut Width Needed: FL + 6 Ft = Ft x $ _ $ edam DATE: IkC�PPLICANT:V7—��Tel. # Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ Cl 9, 51 Fee Schedule on Reverse Side Fire Surcharge $ '3, // .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1200 per SAC Unit License Surcharge $ $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: CIlYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 December 20, 2002 Irene & David Vasecka 54314 Street NE Fridley, MN 55421 Re: Final Inspection at 54314 Street NE, Fridley Dear Irene & David Vasecka: A final reinspection was conducted on December 20, 2002 for the completion of the manufactured home foundation, garage, porch and deck at the above address. The inspection noted that the construction was completed according to the approved plan and occupancy of the building is approved. If you have any questions concerning this matter, please feel free to contact me at 763-572-3603. Sincerely, DJ/mh To whom it may concern; Please extend the building permit issued to- 5431 Street N E. by (6) six weeks due to unforeseen reason. Some of which are: Death of listed homeowner (Irene Vasecka) Resale of home to daughter Storms throughout last summer (helping other family members with downed trees etc.) Car accident. Motorcycle accident I am hopeful that you will grant our request as the work will be completed in that time frame. Thank you Helen Pratt Robert Pratt Samantha Freese Adam Freese (Cie ql�� 74 NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION c5• — 17 --0S Construction Address: 6LA I tib S+ Legal Description: Owner Name & Address: -TWLI- L)LsecJ<o- 5^mg,) AAm Trej--1,e— Tel. # 4G3-- Contractor: k)me, MN LICENSE # 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: LengthZ� Width 04 Height + Sq. Ft. Ll GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: &4'm (n 12 x i e> _ ztro Construction Type: N)CLO `Cun'tOACA Estimated Cost: $ 11,400® Jogcr-s S®r Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: 6- I:�-®�; APPLICANT:6-7 Tel. # 4G?-5°7(-�� roa- 44o —660 y 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 CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 [ ] TOTAL $ � IW STIPULATIONS: 80 standard studs 1 french door double hinged 2 satndard doors 1 egress window 1 set of block for egress window carpet 12 can lights 16 24 power outlets 3 34 back boxes 5 dimer 120 �- switches s 1 standard switch 25 outlet covers 2 double outlet box 1 single outlet box 1 mini blind 2 door handle 2000 ft of romex 3 base board heaters 2 thermostats closet orginazation system 94 ceiling tile 10- 2x4x10 treated 4 2x10x8 treated big roll of polly 10 2x4x10 regular 41 bats of insulation lots of drywall .� lots of mud lots of drywall screws 2inch paint primer wall trim window and door trim LtJ6tJ�bW OUJer kA j l ncl\ rnor\ 28 - 2x2 ceilling pannels 22 - 2x6 wall studs 2 - 2x6x 10 standard 2 - 2x6x10 pressure treated 30 - 2x4 wall studs 2 - 2x4x12 standard 2 - 2x4x12 pressure treated 9 bats of insulation 5 GFI outlets 1 sealed fan with light (shower) 1 Standard Fan 2 wall mount lights 1 vanity light for 6 foot vanity large Mirror for bathroom _ 1 Stool 1 comer shower 1 set of faucets for tub 1 tub drain 1 shower faucet set 1 shower head 1 - 6 foot vanity with double sink 1 - 3 foot door 1 comer storage cabinet 1 heater for tub 2- sink faucets 2 sink drains and traps 2 standard light/ fan switches 2 dimable light switches 12-2 gauge romex 4 light switch covers 5 GFI outlet covers 1 Gallon of primer 1 Gallon of mildew proof paint 70 - 1x1 foot tile Tile glue Tile Grout my.ma �Y �P AM a � _ ()Lt -4e -,r u)c�-i I 1101ii1rui rumm j ME LO Comer Jacuzzi Tub ()Lt -4e -,r u)c�-i I CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 _ MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 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** Gag. Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. x, DATE: 20 ��. � � .S �C OWNER BUILDING USED c ESTIMATED COST C C� PERMIT NO. PLUMBING COMPANY SIGNED BY C - L TEL NO Approved By $ .50 Rough -In Date Final Date �] MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ / OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE Building Inspections 7.63-572-3604 SITE ADDRESS - = THIS APPLICANT IS: PROPERTY OWNER/ TENANT MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY 2 o c 6 YOUR E-MAIL ADDRESS A OWNER DCONTRACTOR ADDRESS: 5—t - 5 CITY- -279 ITY,-279 CONTRACTOR I COMPANY SUBMIT A COPY OF YOUR STATE LICENSE WrM APPLICATION PERMIT TYPE TYPE OF WORK: CONTACT PERSON: 19 EXP DATE Permit No. • Received By: Date Rec' STATE LICENSE CITY STATE-ZIP- ADDRESS: TATEZIPADDRESS: PHONE FAX SINGLE FAMILY O TWO FAMILY 0 TOWNHOUSE J� NEW 0 REPLACEMENT ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK C� 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 fixtures. ('Phis should reflect only the cost of labor ) improvement, installation or replacement of a residential fixture, excluding the Number of fixtures @ $10.00 x $10.00 = $ Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor 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: SIZE/BTU Equipment Installed MFG: MFG: MODEL: SIZEBTU MFG: MODEL: (GAS) $15.00 SIZE/BTU GAS RANGE/OVEN $10.00 A/C $25.00 _FIREPLACE TO AIR EXCHANGEER $15 _ (WOOD) $35.00 NEW GAS GRILL .0.00 GAS UNIT HER $100.FIREPLACE 00 _AIR $35.00 _FURNACE $35.00 _POOL HEATER $35.00 _BOILER CHIMNEY LINER $10.00 _GAS DRYER $10.00 GAS PIPING $10.00 _ VENTII,ATOR $1500 -- DUCT WORK $10.00 ��%'�'_{ ev pip. $ Number of fixtures @ $10.00 x $10.00 = $ Permit Fee $ Number of fixtures @ $15.00 x $15.00 = $ Surcharge TOTAL DUE .50 Number of fixtures @ $25.00 x $25.00 = $ $35.00 = $ Number of fixtures @ $35.00 x 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 ork which requires review and approval of plan SIGNATURE OF APPLICANT PRIM NAME ftyaQ 4 &ALDATE 9 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 propanoUGC 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 FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER P2 jI--tz�-- understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at ,�5/,3/ - ' 5,K -__A ) , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and 1 understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date 9- Z/-06