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PRE 2010 DOCS• City oFridley, f FMinn.0 BUILDING PERMIT N° 4096 Date: ............r�... ...._.._...��.....�....� �.... - Owner: ............ - ...._............ - ...... ...... ............... ... ........ .......................... Builder_.._._. - ....... ...... ......... Address......................... .._............... ............... ..._....__._.......... _.._.... Address N OF BUILDING No...%::f 7_6./Street ................... ._:....................------......... Part Af Lot ..... .............. _........... ......_...._......._...._......_.....� Lot ... ..-........... Block ..... _....... ................. Addition or Sub -Division .�sr.L� ..._.._..__..._..... Corner Lot .................................... Inside Lot ...................:............ Setback.............. Sideyard.......�....................................._........... ..... Sewer Elevation ............?,3-.,? .....9.'`'�................._.................._.. Foundation Elevation .....P . 6......................._............._.. DESCRIPTION OF BUILDING To be Used as: �� / % 0V .qtonst ..... Front 0........... Depth Height 7-....:. Sq. Ft. �Q. YP Cu. Ft. /1..,e......_.. ..... Front/e/;�e Depth 7..24V Height f � �.0..� Sq. Ft. .•�.��f�. Cu. Ft. �o..f..-0 Type on .......................................................... Est. Cost ...../.. �C.l To be Completed ................._................. f/ . ............... ...... In consideration of the issuance to me of a permit to construjft the building described above, I agree to do the proposed work in accordance with the description above set orth and compliance with provisions of ordinances of the city of Fridley. , - 11 Z19 O In consideration of the payment of a fee of $ ..?../7.... .., 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. �-- Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. fes.=iii City of Fridley Application for Piwnbing and Gas FMng PenWt �- Dept. of Bldgs Phone SII 4-7470 DESCRIPTION OF WORE tion �} Number, Kind and Location of Fixtures Loca in �y Number Fixtures ...................... x $1.50 $ O Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. 8OV Q� O� < 3 J !U' °d m O �U' z a z (�9 O . R ` N WATER HTR. GAS ELEG Base 0 NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ 'S Additional Fixtures .................... x .50 $ J x 2.00 $ 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ O Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ......Z x 2.00 $�0 New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ 'S Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS 8: ALTERATIONS—Refer to Code Description.............................................. . / /J TOTAL 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 correct. Fridley, Minn 7 Owner 19— Kind of Building l --P- , 19— Used as To be completed about —/a s— Estimated Cost, 0010.0 Old—New. Building Permit No 4 Sign - By Business Phone No, , J, AUG 18 1959 Rough 11 POST 1M-12-58 Application for Power Plants and Hearing. 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 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $� 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. IDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. IDR 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 $ 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 See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE Dept. of Bldgs. Phone SU 4-7470 S 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 correct. Fridley, Owner 195— Kind of Building Used as — To be completed about Estimated Cost, $ 195— Old—New. Building Permit No. �" S DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No '14Trade Name Size N Capacity � / "(2 �/. Ft. E.D.R BTU H.P. Total Connected Load 'C�/ 0-crt6 5�71-4Kind of el & .-I BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. REMARKS: 11 POST 1M-12-58 P✓i�� Application for Power Plants and Heating. Coding. Ventilation..Refrigerafion tind 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 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU .................. 2.00 $ Replacement of Furnace ............................. .§€.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 $ 5 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 See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL _ FIM ROUGH FINAL Dept. of Bldgs% Phone SSU, 4-7470 Lac Lacation SCJ (� �/ . it 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 correct. Owner Kind of Used as To be completed about � / — / *' 1 J / e),� Estimated Cost, $�aa — .r,�_ C� Old—New. Building Permit No. ✓ G / Permit No. 1. DESCRIPTION OF WORK HEATING or POWER PIJUM—Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Name . Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) % , - 1 Ir /s Bv i"V�D.42 2M 7-59 Business Phone No- tly P/Z 16>R • i � f�VYE�LL/�'/lr �S'B!o/ A . ozFV 79.0 MEE 7 F-ZEV 47 S 67A2irr&xV4 o SUBJECT PE T NO. City of Fridley 171.6 8 AT THE TOP OF THE TWINS BUILDING PERMIT r CIPTNOE � L'______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. t ` � ,'� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 5/26/83 JOB ADDRESS 5861 - 4th Street N.E. 1 LEGAL LOT NO. BLOCK TR ACT OR ADDITION SEE ATTACHED DESCR. 15 5 Bennett,- Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lillian Kruesel 5861 - 4th Street N.E. 571-3353 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. R & M Associates 3482 Auger, White Bear Lake 770-9322 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 ElNEW El ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO tTIPULATIONS Roof can be the 2nd layer but not 3rd. Install galvanized valleys. 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 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 1 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 $1,135 $.57 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $20.50 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $21.07 SIGNAT REOFCONTRACTORORAUTHORIZEDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT V BLOG It, 0A1 SIGNATURE OF OWNER IIF OWNER BUILOERI IDATEI CITY Of FRIDLEY Effective Aug. 1, 1981 APPLICATION F014 RESIDENTIAL BUILDING PERMITS (News Alterations, Additions. or Repairs) CWHER: 5 z1- ADDRESS: TEL 110: - 7/ - 3 3 BUILDER: _ �' /7°I ADDRESS: -3 TEL TEL N0: 770 ' 3 2.2— Construction Location - STREET po: s t STS: q Sit ij , ce 1b't •L Ms ADDITIONS Corner tot: Inside Lot: " Setback: Sideyards: Applieant attach to t):is fors two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CQNSTRUCTJON Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Ajbic Peet: type of Oarstruction:. c+ Lou 4- 0M Estimated Cost: lb be Cbr-pleted: hit. A Alt. 8 Proposed Driveway Width If Now Opening is Desired: $ ' i SEE RiVER►E SIDE OF SHEET The undersigned hereby makes application for a permit fer the tork herein specified, agreeing to ib ,all work ti, strict accordance with the City of Fridley Ordinances tnd rulings of the Delvixtment of Buildings, and hereby declares that all the facts and representAtiens stated in this application are true and correct. I U'%Tzt SIGNAzvME: Stipulations: 3 f, d -O Effective Aug. 1, 1981 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL ,� "" �7- / n Job Address 5V (a/ iroo %H �i`• �Ie� C1L�C( Furnace Shell and Duct Work, Burner (Also replacement furnace) $_20.00 $ .70 -co Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. #571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) $ 10.00 $ Fridley, Minn. 1 '192 All Others/Repairs and Alterations OWNER b&/19N 6Q1r6EL 1% of Value of Appliance or Work $ A666C KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS k_106 IL / I—M, 1% of Value of Appliance or Work $ Ta BE COMPLETED ABOUT �y j(ei®, Ko ESTIMATED COST �o�CJD •" State Surcharge $ .50 8 , i BUILDING PERMIT N0. PERMIT NO. �F2� TOTAL FEE sjiao OLD - NEW Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough insp. HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Date •2� . r9J //� //1� ,I� p Trade Name ta'jmo S� size No. ado—me ?x _ Final Insp. �o / Date Capacity sq. Ft. EDR HTDm� LLP Approval for Permit �� %�_, Total Connected Load Kind of Fuel �� ( %Vr/ 2) BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 Company !J PLUS $.50 STATE SURCHARGE Signed ey Attach &tack verification form with replacement furnace permits Tel. No. loft/ C -" • it tib itione—rs-ca mDt-i)e--placed---irr-side-yard-without en f SUBjECt City of Fridley Z2) AT THE TOP OF THE TWINS PERMIT 1572®_36®4 BUILDING `y COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE CITY HALL FRIDLEY 55432BER REv612-571-3450 DATE PAGE OF APPROVED BY r910415 10/26/98 � JOB ADDRESS 5861 4th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 5 1 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Junkert 202-3354 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Tabor & Sons Inc. 1805 P - 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 O ADDITION ❑ ALTERATION jjk REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof house and garage 16 SO tear -off 9 CHANGE OF USE FROM TO STIPULATIONS ITnderlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN BO 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 $1371 .69 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 OF CONSTRUCTION $45.75 Fire 1.37 ��PERFORMANCE PLAN CHECK FEE TOTAL F Licen 5.00 5 1 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI v LIGATED IS YOUR PERMIT BLDG NS WP oATt. S,GNATURE OF OWNEROF OWNERBUILDERI MATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: -5 � j � I i S r /v a Legal Description: '5""q /<- Owner Name & Address: i) /I k -k -C V Tel. # Contractor: / 4 cr MN LICENSE # Address: Tel. # �'7� 0 S0 z. 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 - Construction Type: ��1 ��, r g"c �(Oc j' Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 4( 2G -� 4 APPLICANT: Permit Fee $ Fire Surcharge $ State Surcharge $ L q SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ . STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side Tel. # .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] SUBJEtTIT City of Fridley 247 AT THE TOP OF THE TWINS BUILDING PERMIT r � • __�_��. COMMUNITY DEVELOPMENT DIV. 572-3C 04 RO. r PROTECTIVE INSPECTION SEC- T CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910415 10/12/01 JOB ADDRESS 5861 4 Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED OESCR. 15 5 I I Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim/Heather 3unkert 5861 4 Street NE 571-9292 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 0 ADDITION 0 ALTERATION P REPAIR 0 MOVE 0 REMOVE B DESCRIBE WORK Reside House 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. 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 1 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 $4,500 $2.25 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. @ $111.25 Fire SC $4.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTA EE $ 18.00 SIGNATURE OF CON TR TOR OR AUT art' 1 ATEe EN ROPE ALIDAT D HIS ISYOUR P IT X40, S,GNATu E OF OwNEApF 0 tE UiL ERI iDATEi BL -NSP r,ATE NEW ( J ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address �Vr Effective 1/1/2001 (763) 572-3604 Bldg Insp Legal Description: -�- ' Owner Name & Address: ► v1 � - e�C 1�v��s�r� Tel. # r71- Contractor. '�)e_\4p MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # 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. Construction Type: Le- i Estimated Cost: $ qsw' 00 Driveway Curb Cut Width Needed: �t. + 6,Ft = Ft x $ _ $ DATE: loh2kl APPLICANT: 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 (7631572-: _ Tel. # ': _5 7/-9x9.2 $ rl• 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 [ ] $ �!8• pr+ CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave 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 (Ne%v Furnace, Fireplace, Insert) Gas Range ;�, ®lo'l`l Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS SO 40 Z — 4 " S� V E Few Total Owner —sum -W. St° <T«,%Yi a i'tl dV $35.00 $ 3r -du Building Used Asju J �i.i $10.00 $ $10.00 $ Gas Dryer r, $10.00 $ -Air Conditioning - AllSizes �Q(,Iuck (.(Al')1rnoxV $25.00 s25-00 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 on work less than $500.00 Gpmmorcial/Industrial/Institutional 1.25% of'Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Commercial/Industrial/Instltutional ESTIMATED COST -00 PO PERMIT NO DESCRIPTION OF FURNACE AND BURNER 0 of Heating U ts�_ Circle One (Steam) (Hot Water) Warrn Air Trade Name. i1 rA � &DIONYh-G& Size No. BTU `7 S" 13 y HP EDR Fuel %ice & AC Total Connected Load Burner Trade Name BTU Size No. 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Slate Surcharge $ , 50 HEATING 00dfl�� ,l.Gfxf TOTAL FEE $/OO• SSU Signed ('LQ,�Gyia Tel q11o3-7J 7" 4��y REINSPECTION FEE $50.00/HOUR FAX # D2 — 0L/— a-10 R' Date-oS- *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 Approved by Rough -in Date Final Date ,5ree/_ y7 s /V4_ £0'd -H101 FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT*CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing 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. Yesl< 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 -LAMA Category 1 Central Furnace Venting Tables for fan Yes No( ) assisted and natural draft appliances. The existina combustion all is sized and installed to meet the current codes and manufacturer's specifications. Yes (�1, No( ) When required to lnstall a new combustion air, ii' will be sized and installed to meet the current codes and manufacturer's specifications. Yesk) No( ) When Installing a new venting system, the undersigned hereby verifies that R is a listed assembly and nests 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 Tye and SizelComrnon Vent and Vent Connector Information Appliance #1 Type_tmi BTU Input dim Fared or Nat — Appliance #2 Type BTU Input ®vv Fa? ted orlat, Appliance #3 Type BTU Input Fan Assisted o Total Appliances Z— Total Btu Input go Common Vent Type Vent Height I Diameter T- inches Appliance #1 Vent Connector Height ft Length ft EXameter 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: --65' - Building PLUMBING Permit No. Inspections RESIDENTIAL APPLICATION Received By: _ 763-572-3604 CITY OF FRIDLEY Date Rec'd: `c) -I DATE -1 fig D YOUR E-MAIL ADDRESS SITE AD &ESS 61 THIS APPLICANT IS: ❑ OWNER *ONTRACTOR PROPERTY NAME: r` OWNER/ ADDRESS: 5141 it% CITY / STATE sSy3Z TENANT/zIPi PHONE: CONTRACTOR NAME: STATE LICENSE # 543(o.5— EXP DATE SUBMIT A COPY OF YOUR STATE ADDRES : ►4'elal A e_ CITY /1l t STATEAgIP s f LICENSE WITH PHONI(WZ)!j2-/-4(Q3 FAX APPLICATION - PERMIT TYPE ,,/ Y<SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORK 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 labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR:PROJECTS WHERE LABOR EXCEEDS$300,FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPTW.IERE NOTED .•:FiCPIR£S: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINX/LAV _FLOOR DRAINS _ SHOWER _ WATER PIPING _ _ GAS PIPING (w&m cmucmm) SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB CLOTHES WASHER KITCHEN SINK^WATER CLOSET _ BACKFLOW PREV. ($15) _WATER _ _ _LAUNDRY TRAY HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER Permit Fee $ Number of fixtures @ $10.00 x $10.00 =M$� Surcharge .50 Number of fixtures @ $15.00 x $15:00 = $ TOTAL DUE $ Number of fixtures @ $35.00 I x$35.00—$ , oQ State Surcharge = $ .50 Total = $ SO 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 app ' tion 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 o I ork whit quires review and approval of plans. ff�o' SIGNATURE OF APPLIC PRINT NAME �/NSI DATE Z ltI !. y -5�b ,iH� $ I�, .4 I_:.41 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977